Mental disorders and criminal re-referrals in juveniles who sexually offended

Sexual offending behavior of juveniles is often a reason for public concern. It is estimated that minors commit about 20% of all rapes and 30-50% of all child molestations [1]. A recent nationwide U.S. study of sex offender police records, demonstrated that 26% of all sex offenders in general and 36% of all sex offenders with juvenile victims were minors [2]. Although several studies have reported on the association of mental disorders and juvenile delinquency [3]-[5], only a limited number of studies have addressed the prevalence of mental disorders in juveniles who sexually offended (JSOs) (e.g., [6],[7]). Even though these studies reported high prevalence rates of internalizing disorders as well as externalizing disorders, they did not allow for firm conclusions because of methodological shortcomings (e.g., limited number of JSOs, variety of sexual offenses). Furthermore, although previous research in juvenile offender populations found a positive relationship between mental disorders, especially externalizing disorders, and reoffending[8]-[10], the Galli et al. [6] and Kavoussi et al. [7] studies did not address recidivism. Examining mental disorders in JSOs in relation to reoffending may contribute to the issue to what extent psychiatric care should be offered to this specific subgroup.

Furthermore, JSOs constitute a heterogeneous group. Previous research reported differences in mental health problems between subgroups of JSOs. While in rapists, for example, externalizing problems are more common [11], offenders with a preference for (prepubescent) child victims are more likely to show internalizing problems [11],[12], and were more often sexually abused themselves [13]. In addition, based on a retrospective analysis of justice files, Bijleveld and Hendriks [14] reported that group sex offenders had lower scores on the personality characteristics neuroticism, impulsivity and sensation seeking and higher scores on sociability as compared to solo sex offenders. Additionally, the subgroup of JSOs victimizing children in particular showed poorly developed social skills [15]-[18]. Although there has been much research on the mental health problems in various subgroups of JSOs, research on mental disorders is limited. Therefore, it may carry relevance to compare mental disorders in subgroups of JSOs, especially in subgroups based on age of victim preference [19],[20], as well as on the number of offenders taking part in the sex offense (solo or group offenders) [17].

Sexual recidivism rates in JSOs were repeatedly found to be relatively low. A recent review and meta-analysis showed that only 7% of JSOs reoffended sexually [21]. This was in line with a review of Fortune and Lambie [22] reporting on average 10% reoffending in JSOs (ranging from 0% to 42%). However, the same studies revealed that JSOs are generally more likely to reoffend non-sexually (e.g., burglary, theft, robbery). Caldwell [21], for example, found a general re-offense rate of 43%. Although mental disorders have shown to be related to juvenile reoffending in general [8]-[10], the aforementioned studies regarding JSOs did not address the relationship between mental disorders and sexual reoffending. As it has been shown that juvenile offenders in mental treatment diversion were significantly less often rearrested within one year than juvenile offenders of a full waitlist comparison group [23], treating mental disorders is hypothesized to reduce re-referrals.

The overall aim of this study was to examine the prevalence of mental disorders in JSOs and to assess its relationship with repeated sexual offending behavior. More specifically, the prevalence of mental disorders will be studied in the group of JSOs, as well as in specific subgroups. In line with previous research, a distinction will be made between JSOs with child victims, solo JSOs with adolescent/adult victims, and group JSOs with adolescent/adult victims [18],[24],[25]. It is hypothesized that, whereas JSOs with child victims will demonstrate the most internalizing disorders, group JSOs with adolescent/adult victims will show the most externalizing disorders. In addition, the relation between mental disorders and re-referrals in JSOs will be examined. This knowledge will inform us to what extent psychiatric care should be given to (subgroups of) JSOs in order to reduce (re-referrals for) sexual offending behavior.