SaVI colloquium 01 November 2013

Investigating TBI prevalence rates in adolescent young offenders in Cape Town

Pieter E ErasmusUniversity of Cape TownPsychology department

p.erasmus@live.com

SaVI colloquium 01 November 2013

Introduction

TBI serious health concern worldwide, cost to society great

associated with various externalizing and internalizing difficulties that increase risk for offending the lawspecific subgroups of the population more vulnerable to sustaining TBI and effects of TBI (especially male young offenders, LAMIC)

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SaVI colloquium 01 November 2013

Defining TBI

TBI= blunt or penetrating blow, shearing and tearing of axons.

Assessment: GCS, LOC or PTA

Dose response relationship

Impact of TBI varies greatly

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SaVI colloquium 01 November 2013

More on TBI

Measurement of TBI varies in researchFor example: Williams et al., 2010 n uses CHAT to establish TBI in young offenders mostly use length of LOC, some use feeling D&C and rarely PTA. Major causes of TBI = MVA, falls and interpersonal violence

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SaVI colloquium 01 November 2013

TBI and young offenders

Adolescence high risk period for TBI and delinquency

Farrer et al., 2013- Meta analysis reports 30% TBI rate in young offenders in HIC.However, limited information available on young offenders and TBI in LAMIC.

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SaVI colloquium 01 November 2013

Situation in South Africa

316 per 100 000 TBI (Nell & Brown,1993)

Badul (2012), 50% prevalence rate of TBI in 44 young offenders.

Uncertainty: Is this a function of the general population in South Africa or exclusive to young offenders?

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SaVI colloquium 01 November 2013

Aims

1 - expand on Badul’s sample of young offenders and compare to sample of non-offenders

2 - investigate the association of TBI with LOC and various emotional and behavioural measures

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SaVI colloquium 01 November 2013

Hypotheses

#1: The high prevalence rates of TBI in young offender population is not reflected in the broader non-offender population of Western Cape samples.

#2: TBI with LOC for young offenders associated with significantly higher rates of:

substance use, mood problems, difficulties with social relationships, and behaviour measures

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SaVI colloquium 01 November 2013

Participants (1)Investigating prevalence rates:

117 Young offenders from institution 27 non-offenders from school from same area as young offender institution

Investigating behavioural and emotional difficulties in young offenders with TBI

Group 1: Participants that have reported a TBI that included LOC (n=40)Group 2: Participants that have not reported a TBI that included LOC (n=77)

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SaVI colloquium 01 November 2013

Participants (2)

Inclusion criteria mixed race males, aged 13-17 years matched on age, sex, race, language and are from low socio-economic backgrounds

Exclusion criteria severe intellectual disability, mental disorders, diagnosed Attention Hyperactivity Disorder (ADHD), and medical conditions such as stroke, epilepsy or diabetes (Williams et al., 2010)

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SaVI colloquium 01 November 2013

Measures

The Comprehensive Health Assessment Tool (CHAT). Alcohol Use Disorders Identification Test (AUDIT). Beck Depression Inventory (BDI-II). Maudsley Addiction Profile (MAP). Reactive-Proactive Aggression Questionnaire (RPQ). The Inventory of Callous-Unemotional Traits youth version (ICU). Child Behaviour Checklist (CBCL).

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SaVI colloquium 01 November 2013

Procedure

Purposive and snowball sampling used for young offenders and non-offender samples.

For offenders- continue process…For non offenders- getting in…

Keep things ethical- beneficence, autonomy, confidentiality, approval

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SaVI colloquium 01 November 2013

Data Analysis

Used SPSS.

Prevalence rates from frequencies for young offenders and non offenders

ANOVA for between group comparisons for young offenders only.

significance level .05

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SaVI colloquium 01 November 2013

Results (1)

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Young offenders

Non-offenders

No TBI 58 (50%) 17 (63%)

TBI (D&C + LOC) 59 (50%) 10 (37%)

SaVI colloquium 01 November 2013

Results (2)

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Young offenders

Non-offenders

No TBI 77 (66%) 23 (85%)

TBI only LOC 40 (34%) 4 (15%)

SaVI colloquium 01 November 2013

Results (3)

Between group comparisonsYoung offenders that reported a TBI with LOC significantly higher scores for externalizing and internalizing difficulties.

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SaVI colloquium 01 November 2013

Results (3)

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TBI LOC No TBI F p r

Depressive symptoms

M=31, SD=12

M=26, SD=12

3.80 .03 .17

Reactive and Proactive aggression

M=23, SD=10

M=17, SD=10

4.75 .02 .26

Substance use

M=1.9, SD=1.1

M=1.43, SD=1.1

4.36 .02 .22

Criminal activity

M=1.08, SD=.9

M=.66, SD=.8

6.61 .005 .22

Socialising problems

M=2.15, SD=.9

M=1.61, SD=.8

6.47 .005 .28

Psychological health problems

M=11, SD=6

M=9, SD=6

4.33 .04 .20

SaVI colloquium 01 November 2013

Discussion (1)

The prevalence rates of TBI are higher for young offenders than non offenders, hypothesis one confirmed

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SaVI colloquium 01 November 2013

Discussion (2)

How do these prevalence rates compare to international findings?

Williams et al., 2010- 65% D&C + LOC, 46% LOCHux et al., 1998, 50% D&C + LOCPerron & Howard, 2008, 18% LOCFarrer et al., 2013. 30% LOCMy study 50% D&C + LOC, 40% LOC

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SaVI colloquium 01 November 2013

Discussion (3)

Young offenders reporting a TBI with LOC had significantly higher emotional and behavioural problems than participants that did not report TBI with LOC. Hypothesis two confirmed.

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SaVI colloquium 01 November 2013

LimitationsSelf report measure of TBI, reverse causation, most international research uses this style of researching TBI

Only sampled from one institution and one high school, assists in keeping participants matched, makes generalisability low

Small sample size for non offenders and low response rates from parents (50%).

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SaVI colloquium 01 November 2013

RecommendationsCorroborate with parents and verify using medical records

Increase sample sizes for non-offenders

Send out parent letters or arrange information sessions for all non-offender’s parents to potentially increase response rate

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SaVI colloquium 01 November 2013

Significance of study

Research on prevalence rates of TBI in LAMICAccess to large pools of offenders and non-offendersSignificant associations between TBI and emotional and behavioural difficulties that may lead to negative outcomes (e.g., crime)Assist in early identification of adolescent TBI before age of maturity reached

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SaVI colloquium 01 November 2013

Acknowledgements

Supervisor Leigh SchrieffCo-investigator Ju-Reyn OckhuizenStatistics Collin Tredoux

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