1. Self-harm and early mortality in justice-involved young people: a global systematic review
Rohan Borschmann – Murdoch Childrens Research Institute
Australasian Juvenile Justice Administrators (AJJA):
2nd Australasian Youth Justice Conference
Brisbane; 13 September 2016

2. Justice-involved youth in Australia
>65% of deaths in young people are due to preventable, behaviourally-driven causes => gen pop.
Youth Justice System (YJS) => vulnerable +++
In 2013 on any given day, 6,300 young Australians were under YJS supervision (1/420 young people)
Disproportionately male (83%) and from disadvantaged or remote locations (Indigenous youth x 17)

3. Health and social problems in justice-involved youth: what does the (limited) evidence tell us?
Population is characterised by complex health and social problems:
Self-harm, injecting drug use, mental ill-health, physical and oral health problems, externalising behaviours, HIV/AIDS risk behaviours and STIs
Many of these are risk factors for early mortality (*self-harm)
Despite this => very little is known about the mortality outcomes for the growing number of marginalised young people who come into contact with the YJS ever year (few rigorous studies to date)

4. Synthesising the evidence
To inform targeted prevention strategies, it is necessary to first understand the epidemiology of mortality in specific high-risk groups (within this already high-risk cohort)
On that basis: “Self-harm and early mortality in justice-involved young people: A global systematic review”

5. + terms relating to rates/risk & protective factors:
Search strategy
Search terms relating to the population and outcome
terms relating to rates/risk & protective factors:
Population terms ((e.g., (prison* or offend* or detain* or inmate*) and (juvenile* or adolescent or youth* or boy* or girl*))
AND
Outcomes terms (e.g., self-harm, self-mutilat* or cutting or suicid* or mortalit* or death* or early mortality)
Incidence and risk and protective factor terms (e.g., incidenc* or crude or rate* or epidemiolog* or protect* or risk*)

6. Inclusion & exclusion criteria
To be included in the current review, each study had to satisfy the following criteria:
The study had to report at least one of the following in a sample of young people (aged <25 years) with current/prior contact with the YJS:
1.) Rates of mortality (all cause); or
2.) Risk factor/s for mortality; or
3.)  Protective factor/s for mortality

7. Inclusion & exclusion criteria
Existing systematic reviews/meta-analyses were eligible for inclusion
Excluded: Narrative reviews, commentaries, purely qualitative studies book chapters, conference papers or proceedings, dissertations, magazine/newspaper articles, pamphlets, lectures and web pages
Medline, PUBMED, PsycINFO, Embase, Global Health, CINCH, Applied Social Sciences Index and Abstracts (ASSIA) and SciELO Citation Index

8. Findings

9. Findings
Scope too big for one review!

10. Findings
Scope too big for one review!

11. Findings
As such, we split it into two reviews:

12. Findings As such, we split it into two reviews:
1.) Self-harm in the YJS (prevalence/risk & protective factors)
and
2.) Early mortality in the YJS (prevalence/risk & protective factors)

13. Progress to date Literature searched Full text of articles screened
Eligible papers identified
Data extraction complete
Preliminary data only presented this morning

14. Risk factors (32/44 studies):
Results: Self-harm
44 studies – only 12 prospective cohorts; N=45–27,000
USA (18), Australia (12), UK (4), Japan (3), Sweden, Iran, Austria, Spain, Turkey, Russia, Taiwan (1)
Detention centres, justice registry data, youth probation databases
Risk factors (32/44 studies):
Demographic / temperament: Female, LGBT, homelessness, impulsive, ↓self- esteem, ↓coping skills, bad temper, anger management
Family-based: Family drug/alcohol abuse, social worker involvement, family suicide attempts, parental mental health problems, not living with a relative
Behavioural: High-risk sexual behaviour (females), other risk-taking behaviour

15. Protective factors (2 / 44 studies):
Risk factors (cont.):
Health: ADHD, personality disorder, depression/anxiety, past suicide attempt, substance use disorder, physical health problems
Social: Exposure to delinquency, exposure to attempted suicide, school expulsion
Criminogenic: Violent offence(s)
Victimisation: Sexual abuse (childhood or adolescent), dating violence, bullied in custody (9x more likely to have suicide attempt), childhood victimisation/trauma
Protective factors (2 / 44 studies):
Temperament: Good coping skills, positive beliefs

16. Risk factors (11/15 studies):
Results: Mortality
15 studies – only 4 prospective cohorts; N= ,000
USA (10), Australia (3), Canada (1), Germany (1)
Detention centres, justice registry data, youth probation databases
Risk factors (11/15 studies):
Demographic / temperament: Male, African American (US studies), impulsive, aggressive behaviour
Family-based: Low parental education, parental mental health problems, evidence of caregiver neglect

17. Protective factors (3/15 studies):
Risk factors (cont.):
Health: Evidence of cognitive deficit, mental health problems, substance use problems, injecting drug use, past suicide attempt(s)
Social: Exposure to violence, gang membership (>10x hazard of homicide)
Criminogenic: Greater involvement with YJS, early involvement with YJS, drug-related offences
Justice system: Use of restraints and being locked into sleeping cells increased rate of suicide attempts
Protective factors (3/15 studies):
1) Positive attitude; 2) ‘Partnered / completed school / working or training / stable housing; 3) Screening within 24hrs of reception: ↓suicide attempts

18. Many risk factors. Some are modifiable:
Summary of findings
Many risk factors. Some are modifiable:
Substance use, gang membership, drug dealing, early detention, early screening upon reception
…others are not:
Gender, ethnicity, parental education / mental health

19. What has not been evaluated/reported?
Communication impairments / verbal ability / comprehension & expression (x 0)
75% => language skills and literacy below national average
Cognitive impairment / disability (x 1)
Support received on transition into the community (x 0)
For each of these => strong narrative about policy and practice responses
Missed opportunities for screening & intervention?
What support should be provided to young people?
The dire consequences of custody for most

20. Current research
: Prof. Stuart Kinner (Griffith Uni.); NHMRC funding
“Deaths in young people involved in the youth justice system: Towards evidence-based prevention” (QLD-based study)
Data linkage to examine mortality outcomes of all young people who had contact with the youth justice system from 1 July 1993 to 30 June 2014
N~50,000; 622,000 person-years of observation; approx. 2, ,500 deaths.

21. Aims of current study:
To rigorously and comprehensively examine long-term mortality outcomes in this group of vulnerable young people.
To document the incidence, timing, causes, context and risk factors for preventable death in young people who have had contact with the YJS .
Inform targeted prevention and policy reform by identifying key psychosocial risk factors, health morbidities, precipitating factors and health/social service contacts in those who have died.

22. Contact: rohan.borschmann@mcri.edu.au
Thank you!
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