Transcript Alcohol Drug Scale - University of Massachusetts Medical School

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 School
Supported by William T. Grant Foundation
Law and Psychiatry Program
Prevalence of MH Disorder in JJ
(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 Project
1994
Identified the need, developed the prototype
1996
Field testing, norms, initial validation
1998
Preparation for release
2000-8
Released to JJ agencies, developed technical support
office, National Youth Screening Assistance Project
2002-5
Developed national norms and MAYSIWARE
2003-5
Evaluation of impact of MH screening on MH services
in JJ programs
2006-8
Technical Assistance for MacArthur Foundation’s
“Models for Change” Initiative
Used Statewide in Probation, Detention or Corrections
In 38 States
NH
WA
MT
ME
VT
ND
MN
OR
MA
NY
WI
ID
SD
WY
MI
NE
RI
PA
IA
CT
OH
NV
UT
CA
IL
NJ
DC
IN
CO
WV
VA
KS
MO
NC
TN
AZ
OK
NM
SC
AR
GA
MS
TX
AL
LA
AK
FL
HI
DE
KY
MD
Purpose/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?
MAYSI-2 Use & Norm Study Donors
NH
WA
MT
ME
VT
ND
MN
OR
MA
ID
NY
WI
SD
WY
MI
RI
PA
IA
NE
CT
OH
NV
UT
CA
IL
NJ
DC
IN
CO
WV
DE
VA
KS
MO
KY
NC
MD
TN
AZ
OK
NM
AR
SC
GA
MS
TX
AL
LA
AK
FL
HI
= Statewide MAYSI-2 User
= Norm study donor
Method
• 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 (N = 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
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
Illinois
Final Sample (N = 70,423)
• Gender:
Boys - 78%
• Age (years):
12-14 - 29%
• Ethnicity/Race:
Black- 33%
Hispanic - 24%
Asian – 1%
Girls - 22%
15-17 - 71%
White - 39%
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%
Within 24 hrs
- 32%
=/> 48 hrs - 12%
MAYSI-2 Data

Gathered Item Responses and Scale Scores
ALCOHOL / DRUG USE
ANGRY-IRRITABLE
DEPRESSED-ANXIOUS
SOMATIC COMPLAINTS
SUICIDE IDEATION
THOUGHT DISTURBANCE (boys)
TRAUMATIC EXPERIENCES
8 items
9 items
9 items
6 items
5 items
5 items
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 Question
• Are the national norms for each scale
comparable to the original Massachusetts
norms?
Massachusetts vs National Sample
% Above Caution Cut-Off
50
45
40
35
30
25
20
15
10
5
0
MA
Alc/Drug
Anger
Dep-Anx
Somatic
Suicide
Thought
(boys)
Massachusetts vs National Sample
% Above Caution Cut-Off
50
45
40
35
30
25
20
MA
National
15
10
5
0
Alc/Drug
Anger
Dep-Anx
Somatic
Suicide
Thought
(boys)
Massachusetts vs National Sample
% above Warning Cut-Off
50
45
40
35
30
25
20
15
10
5
0
MA
Alc/Drug
Anger
Dep-Anx
Somatic
Suicide
Thought
(boys)
Massachusetts vs National Sample
% above Warning Cut-Off
50
45
40
35
30
25
20
15
10
5
0
MA
National
Alc/Drug
Anger
Dep-Anx
Somatic
Suicide
Thought
(boys)
Findings
Massachusetts
>
% youth above cutoffs
• Alcohol/Drug Scale
• Angry/Irritable Scale
National
% youth above cutoffs
Officially, decreased warning cutoff on Alc/Drug
Scale from 7 to 6
What Methods of Analysis Could
Be Used to Answer The
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



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.)
Cochran-Mantel-Haenszel (CMH)
Calculated Odds Ratios
ORs weighted for
reliability
General Linear Modeling
Produce Avg OR across all sites for each effect (Gender, etc)
I2 - Test Homogeneity of ORs
If Yes
Consistent Effect
If No
Explain w/interactions?
Overall Gender Differences (Main Effects)
% Above “Clinical” Cut Off
40
35
BOYS
30
25
20
15
10
5
0
Alc/Drug
Anger
Dep-Anx Somatic
Suicide
Thought
Overall Gender Differences (Main Effects)
% Above “Clinical” Cut Off
50
45
40
35
30
25
20
15
10
5
0
BOYS
GIRLS
Alc/Drug
Anger
Dep-Anx Somatic
Suicide
Thought
Are Gender Differences Consistent
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
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)
% Above “Clinical” Cut-Off
50
45
40
35
30
25
20
15
10
5
0
15 to 17
Alc/Drug
Anger
Dep-Anx Somatic
Suicide Thought
(boys)
Overall Age Differences (Main Effects)
% Above “Clinical” Cut-Off
50
45
40
35
30
25
20
15
10
5
0
12 to 14
15 to 17
Alc/Drug
Anger
Dep-Anx Somatic
Suicide Thought
(boys)
Are Age Differences Consistent
Across 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 = 1.2
Younger youths > older youths
When Do Age Differences Vary
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)
% Above “Clinical” Cut-Off
40
35
Black
30
25
Hispanic
20
15
White
10
5
0
Alcohol-Drug
Angry-irritable
Overall Race Differences (Main Effects)
% Above “Clinical” Cut-Off
50
45
Asian
40
35
Black
30
25
20
Hispanic
White
15
AK Native
10
5
0
Alcohol-Drug
Angry-irritable
Overall Race Differences (Main Effects)
% Above “Clinical” Cut-Off
50
45
Black
40
35
30
Hispanic
25
20
White
15
10
5
0
Depressed-Anxious
Somatic
Overall Race Differences (Main Effects)
% Above “Clinical” Cut-Off
50
45
Asian
40
35
Black
30
Hispanic
25
20
White
15
AK Native
10
5
0
Depressed-Anxious
Somatic
Overall Race Differences (Main Effects)
% Above “Clinical” Cut-Off
50
45
40
Black
35
30
Hispanic
25
20
White
15
10
5
0
Suicide Ideation
Thought Disorder (boys)
Overall Race Differences (Main Effects)
% Above “Clinical” Cut-Off
50
45
40
Asian
35
Black
30
Hispanic
25
20
White
15
AK Native
10
5
0
Suicide Ideation
Thought Disorder (boys)
Are Racial Differences Consistent
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 Vary
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
(% 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 Gate
% Above “Clinical” Cut-Off
50
45
40
35
30
25
20
15
10
5
0
Probation
Detention
Corrections
Alc/Drug
Anger
Dep-Anx Somatic
Suicide
Thought
(boys)
Differences by Region
% Above “Clinical” Cut-Off
50
45
40
35
30
25
20
15
10
5
0
Northeast
West
Midwest
South
Alcohol-Drug
Angry-Irritable
DepressedAnxious
Differences by Region
% Above “Clinical” Cut-Off
50
Northeast
45
West
40
Midwest
35
South
30
25
20
15
10
5
0
Somatic
Suicide
Thought (boys)
Advantages to the Meta-analytic
Approach 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
Conclusions
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
Conclusions
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 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)