Psychiatric Emergency Presentations in Detained Adolescents: A Comparison With Community-Living Adolescents

Adolescents involved in the juvenile justice system have high rates of psychiatric disorder and social vulnerability. Those in custodial or semi-custodial detention may be particularly vulnerable to psychiatric emergencies, but the clinical factors associated with these crises remain insufficiently understood.

To characterise the sociodemographic and clinical profiles of detained adolescents attending a psychiatric emergency service and compare them with those of community-living adolescents.

In this retrospective cross-sectional study, we reviewed the medical records of all patients presenting to a public child and adolescent psychiatry emergency service in Brazil over 1 year. Detained adolescents aged 12-17 years were compared with community-living adolescents regarding sociodemographic characteristics, psychiatric diagnoses and presenting complaints.

Of 1206 adolescents, 160 (13%) were detained. Compared with community-living adolescents, detained adolescents were more likely to be male (86%: 53%), older (mean [SD] 15.9 [1.1]: 14.9 [1.6] years) and to identify as Black (13%: 8%). Stress-related/adjustment disorders (30%:10%), conduct disorder (27%:10%) and substance use disorders (26%:20%), were more frequent among detained adolescents, whereas depression was less frequent (26%:35%). Emergency consultations involving detained adolescents were more likely to include insomnia (43%: 19%) and suicide attempts (26%: 18%), whereas behavioural presentations such as agitation, aggressiveness, irritability, disobedience and attention difficulties were comparatively less frequent.

Emergency psychiatric presentations among detained adolescents were more strongly associated with stress-related disorders, suicidal behaviour, sleep disturbance and substance-related problems than with behavioural disturbance alone. These findings have implications for emergency psychiatric assessment within juvenile justice settings.