MAYSIs Across the Nation: What do 70,000 Delinquents Tell Us About Youths’ Mental Health Symptoms?...

MAYSIs Across the Nation: What do 70,000 Delinquents Tell Us About Youths’ Mental Health

Symptoms?

Gina Vincent, Ph.D., Thomas Grisso, Ph.D.,

Anna Terry, B.A., & Steve Banks, Ph.D.

University of Massachusetts Medical SchoolSupported by William T. Grant Foundation

Law and Psychiatry Program

Prevalence of MH Disorder in JJ Prevalence of MH Disorder in JJ (Teplin, 2002; Wasserman, 2002)(Teplin, 2002; Wasserman, 2002)

• Based on current studies conducted at a few JJ facilities, it seems

• 65% of JJ adolescents meet DSM criteria for at least one disorder (vs. 20% in general population)

• Rates of disorders vary by • Gender (higher for girls) • Race (highest for Whites and lowest for

Blacks)

History of the MAYSI ProjectHistory of the MAYSI Project

Identified the need, developed the prototype

Field testing, norms, initial validation

Preparation for release

Released to JJ agencies, developed technical support office, National Youth Screening Assistance Project

Developed national norms and MAYSIWARE

Evaluation of impact of MH screening on MH services in JJ programs

Technical Assistance for MacArthur Foundation’s “Models for Change” Initiative

1994

1996

1998

2000-8

2002-5

2003-5

2006-8

Used Statewide in Probation, Detention or Corrections In 38 States

AK

AL

ARAZ

CA CO

CT

DC

DE

FL

GA

HI

IA

ID

IL IN

KSKY

LA

MA

MD

ME

MI

MN

MO

MS

MT

NC

ND

NE

NH

NJ

NM

NV

NY

OH

OK

OR

PA

RI

SC

SD

TN

TX

UT

VA

VT

WA

WI

WV

WY

Purpose/Research QuestionsPurpose/Research Questions

• Develop national norms for the MAYSI-2• Are there differences between gender, age, and

racial groups in the reporting of psychological disturbance (as measured by the Massachusetts Youth Screening Instrument-2; MAYSI-2) among youth in the Juvenile Justice (JJ) System?

• Are these differences consistent (reliable, generalizable) across JJ systems nationwide?

AK

AL

ARAZ

CACO

CT

DC

DE

FL

GA

HI

IA

ID

IL IN

KS

KY

LA

MA

MD

ME

MI

MN

MO

MS

MT

NC

ND

NE

NH

NJ

NM

NV

NY

OH

OK

OR

PA

RI

SC

SD

TN

TX

UT

VA

VT

WA

WI

WV

WY

MAYSI-2 Use & Norm Study DonorsMAYSI-2 Use & Norm Study Donors

= Statewide MAYSI-2 User = Norm study donor

MethodMethod

• We gathered archival MAYSI-2 records and demographic information from 283 JJ facilities located in 19 states

• Started With 155,835 youths

• Removed cases that were:

1) duplicates,

2) outside of the age range, or

3) from any community or treatment facility

Final Sample (Final Sample (NN = 70,423) = 70,423)State % n State % n

Alaska 1.7 781 Missouri 3.6 1674

California 15.7 7293 Montana 0.6 297

Colorado 1.5 679 New Jersey 0.5 247

Georgia 11.6 5367 Ohio 6.5 3022

Iowa 1.5 687 Pennsylvania 29.6 13,718

Illinois 1 339 South Carol. 6.3 2912

Louisiana 5.4 2491 Texas 30.8 21,792

Mass 3.4 1586 Virginia 3.7 1711

Michigan 5.3 2007 Washington 6.0 2962

Minnesota 2.3 1050

Final Sample (Final Sample (NN = 70,423) = 70,423)

• Gender: Boys - 78% Girls - 22%• Age (years):12-14 - 29% 15-17 - 71%• Ethnicity/Race:

Black- 33% Hispanic - 24% White - 39%

Asian – 1% AK Native/Amer Indian - >1%• Legal Status: Pre-adj - 77% Post-adj - 23%

• Time of MAYSI-2 Administration (hrs after intake):

First few hours - 56% =/> 48 hrs - 12%

Within 24 hrs - 32%

MAYSI-2 DataMAYSI-2 Data Gathered Item Responses and Scale Scores

ALCOHOL / DRUG USE 8 itemsANGRY-IRRITABLE 9 itemsDEPRESSED-ANXIOUS 9 itemsSOMATIC COMPLAINTS 6 itemsSUICIDE IDEATION 5 itemsTHOUGHT DISTURBANCE (boys) 5 items

TRAUMATIC EXPERIENCES 5 items

• Caution Cutoffs: Most generalizable. Based on “clinically significant” scores from corresponding MACI and YSR scales of youth in the general population.

• Warning Cutoffs: Least generalizable. Compares juveniles to other juvenile offenders to identify the top 10% of the distribution of Massachusetts scores.

Research QuestionResearch Question

• Are the national norms for each scale comparable to the original Massachusetts norms?

Massachusetts vs National SampleMassachusetts vs National Sample % Above Caution Cut-Off% Above Caution Cut-Off

0

5

10

15

20

25

30

35

40

45

50

Alc/Drug Anger Dep-Anx Somatic Suicide Thought(boys)

MA

Massachusetts vs National SampleMassachusetts vs National Sample % Above Caution Cut-Off% Above Caution Cut-Off

0

5

10

15

20

25

30

35

40

45

50


MA

National

Massachusetts vs National SampleMassachusetts vs National Sample% above Warning Cut-Off% above Warning Cut-Off

0

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10

15

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25

30

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45

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MA

Massachusetts vs National SampleMassachusetts vs National Sample% above Warning Cut-Off% above Warning Cut-Off

0

5

10

15

20

25

30

35

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50


MANational

FindingsFindings

Massachusetts > National % youth above cutoffs % youth above cutoffs

• Alcohol/Drug Scale• Angry/Irritable Scale

Officially, decreased warning cutoff on Alc/Drug Scale from 7 to 6

What Methods of Analysis Could What Methods of Analysis Could Be Used to Answer The Be Used to Answer The Following Questions?Following Questions?

• What are the differences between gender, age, and race groups in the reporting of clinically significant levels of symptoms?

• Where differences exist, were these differences consistent (homogenous) across all sites and across all possible interactions?

Meta-analytic Procedures Meta-analytic Procedures Unit of Analysis – Site (JJ Facility) Separate Analyses for Each MAYSI-2 Clinical

Scale - TRAUMATIC EXPERIENCES not included Examined Odds of Scoring > Caution Cut-offs

Past research was done to determine clinically significant levels of disturbance.

Variables for Testing Interactions/Controls Gender Age Group (12-14, 15-17) Race (White, Black, Hispanic) Legal Status (pre vs. post-adjudication) Time of MAYSI-2 Administration

Meta-analytic Procedures (cont.)Meta-analytic Procedures (cont.)

Cochran-Mantel-Haenszel (CMH)

Calculated Odds Ratios

ORs weighted for reliability

General Linear ModelingProduce Avg OR across all sites for each effect (Gender, etc)

I2 - Test Homogeneity of ORs

If No

Explain w/interactions?

If Yes

Consistent Effect

Overall Gender Differences (Main Effects) Overall Gender Differences (Main Effects)

% Above “Clinical” Cut Off% Above “Clinical” Cut Off

0

5

10

15

20

25

30

35

40

Alc/Drug Anger Dep-Anx Somatic Suicide Thought

BOYS

Overall Gender Differences (Main Effects) Overall Gender Differences (Main Effects)

% Above “Clinical” Cut Off% Above “Clinical” Cut Off

05

101520253035404550

Alc/Drug Anger Dep-Anx Somatic Suicide Thought

BOYS

GIRLS

Are Gender Differences Consistent Are Gender Differences Consistent Across Sites & Demographics?Across Sites & Demographics?

• Mostly – girls at most all sites, on average, are more likely than boys to report clinically significant levels of symptoms on most MAYSI-2 scales

• Large Effects:• Suicide Ideation OR = 2.4

• Medium Effects:• Angry-Irritable OR = 1.8• Depressed-Anxious OR = 1.95 – 2.14• Somatic Complaints OR = 1.8

When do Gender Differences Vary When do Gender Differences Vary Across Youths?Across Youths?

• Alcohol-Drug Scale – gender interacts w/age consistently across sites

• 12-14 year olds – girls > boys (OR=1.6)

• 15-17 year olds – no gender difference

Overall Age Differences (Main Effects)Overall Age Differences (Main Effects)

% Above “Clinical” Cut-Off% Above “Clinical” Cut-Off

05

101520253035404550


15 to 17

Overall Age Differences (Main Effects)Overall Age Differences (Main Effects)


05

101520253035404550


12 to 14

15 to 17

Are Age Differences Consistent Are Age Differences Consistent Across Sites & DemographicsAcross Sites & Demographics

• Mostly – at most all sites, there were no differences or only small differences between younger and older youths in reporting clinically significant levels of symptoms on most MAYSI-2 scales.

• Small Effects• Angry-Irritable OR = 1.3• Thought Disturbance OR = 1.2Younger youths > older youths

When Do Age Differences VaryWhen Do Age Differences VaryAcross Youths?Across Youths?

• Alcohol-Drug Scale

Older youths > Younger youths OR = 1.7

• No appreciable age differences among girls

• No appreciable differences among youths in custody post-adjudication

Overall Race Differences (Main Effects) Overall Race Differences (Main Effects) % Above “Clinical” Cut-Off% Above “Clinical” Cut-Off

0

5

10

15

20

25

30

35

40

Alcohol-Drug Angry-irritable

Black

Hispanic

White

Overall Race Differences (Main Effects) Overall Race Differences (Main Effects) % Above “Clinical” Cut-Off% Above “Clinical” Cut-Off

0

5

10

15

20

25

30

35

40

45

50

Alcohol-Drug Angry-irritable

Asian

Black

Hispanic

White

AK Native

Overall Race Differences (Main Effects) Overall Race Differences (Main Effects)


0

5

10

15

20

25

30

35

40

45

50

Depressed-Anxious Somatic

Black

Hispanic

White



0

5

10

15

20

25

30

35

40

45

50

Depressed-Anxious Somatic

Asian

Black

Hispanic

White

AK Native



0

5

10

15

20

25

30

35

40

45

50

Suicide Ideation Thought Disorder (boys)

Black

Hispanic

White



0

5

10

15

20

25

30

35

40

45

50

Suicide Ideation Thought Disorder (boys)

Asian

Black

Hispanic

White

AK Native

Are Racial Differences Consistent Are Racial Differences Consistent Across Sites & Demographics?Across Sites & Demographics?

• No. Whites, on average, were more likely to report clinically significant levels of symptoms than Blacks or Hispanics, but

• Results generally were not consistent across sites, and

• The Meta-analysis was unable to determine the source of the variability in most cases

When Do Racial Differences VaryWhen Do Racial Differences VaryAcross Youths?Across Youths?

• Alcohol Drug Scale

• Whites > Blacks OR = 2.3 Large ES

• Hispanics > Blacks OR = 1.7 Medium ES• Variability in the magnitude of the odds ratios

between Whites & Blacks:

• Age (larger for older youths)

• Gate (larger for pre-adjudicated youths)

• State

Site-Level Variables Site-Level Variables (% of cases)(% of cases)

• Gate: Probation - 36% Pretrial Detention - 42%

Corrections (post-adjudicated) - 22%

• Density: Urban - 78% Rural - 22%• Region: West - 17% Midwest - 44%

South - 17% Northeast - 22%

Test Administration• Staff:Non-professional - 70% Professional - 30%• Setting: Individual - 87% Group - 13%• Method: Voice CD - 28% Self-administer - 64%

Staff Administer - 8%

Differences by GateDifferences by Gate% Above “Clinical” Cut-Off% Above “Clinical” Cut-Off

05

101520253035404550


Probation

Detention

Corrections

Differences by RegionDifferences by Region% Above “Clinical” Cut-Off% Above “Clinical” Cut-Off

05

101520253035404550

Alcohol-Drug Angry-Irritable Depressed-Anxious

Northeast

West

Midwest

South

Differences by RegionDifferences by Region% Above “Clinical” Cut-Off% Above “Clinical” Cut-Off

0

5

10

15

20

25

30

35

40

45

50

Somatic Suicide Thought (boys)

Northeast

West

Midwest

South

Advantages to the Meta-analytic Advantages to the Meta-analytic Approach for Norming TestsApproach for Norming Tests

• Provides the strength and consistency of “prevalence rate” differences across settings and youth characteristics (gender, race, etc.)

• Provides confidence in the generalizability of these findings across the population of interest

ConclusionsConclusions

1. % of youths scoring above cut-off not substantially different between Massachusetts and National norms

2. Girls in JJ much more likely than boys to report clinically significant symptoms – generalizes across JJ sites

ConclusionsConclusions

3. Wide variability in racial differences:

• White youths most likely to report problem levels of alcohol or drug use, but the disparity varies across the US

• White youths, on average, are consistently more likely than black youths to report suicide ideation

Future ApplicationsFuture Applications

• Translating the results to improve juvenile justice programs’ understanding of mental health needs of girls and ethnic minority youths • Published a revision of MAYSI-2 manual for mental

health screening in juvenile justice

• Studying whether race differences are “true” differences or measurement bias…

Study in progress: Item Response Theory and Psychological Disturbance in Young Offenders (NIMH) (PI: Gina Vincent)

MAYSIs Across the Nation: What do 70,000 Delinquents Tell Us About Youths’ Mental Health Symptoms?...

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