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This study aimed to identify key transitional pathways in the criminal justice system from adolescence to adulthood and the risk factors associated with the escalation of criminal justice involvement over time. We retrospectively linked offending records from 1994 to 2022 and mental health records from 2001 to 2022 for a cohort of 1556 adolescents identified through four health surveys in New South Wales, Australia. Transition probabilities were calculated using the Aalen-Johansen method, and the hazards of transition-specific covariates were estimated. The median age of adolescent entry was 15 years. The cohort was predominantly male (87.5%) and non-Indigenous (65.6%). Among incarcerated adolescents, 76.8% transitioned to adult incarceration. Transition probabilities were the highest among those aged 10–13 years. Among those with mental disorders, psychosis was associated with transitions to adolescent and adult incarceration. Other risk factors for future incarceration include being male, Indigenous, socio-economically disadvantaged, having a history of adolescent incarceration, and being diagnosed with substance use and behavioural disorders. Younger adolescents have higher transition probabilities to more intense criminal justice involvement. Legislative and policy reforms are needed to delay the onset of adolescent criminal justice involvement and ensure age-appropriate rehabilitative strategies to reduce recidivism. • Multi-state modelling can be used to assess criminal justice transitions from adolescence to adulthood. • Younger adolescents have higher probabilities of further incarceration after entry into the criminal justice system. • Adolescent incarceration is associated with adult incarceration and has a leveling effect regardless of age at entry. • Mental disorders increase the risk of incarceration during adolescence and adulthood. [ABSTRACT FROM AUTHOR]

Introduction: Considerable evidence supports an association between poor impulse control (impulsivity) and violent crime. Furthermore, impulsivity and aggression has been associated with reduced levels of serotonergic activity in the brain. Selective serotonin reuptake inhibitors (SSRIs) are a class of anti-depressants that aim to regulate brain serotonin concentrations. Several small studies in psychiatric populations have administered SSRIs to impulsive--aggressive individuals, resulting in reduced impulsivity, anger, aggression and depression. However, no clinical trial has been undertaken in a criminal justice population. This protocol describes the design and implementation of the first systematic study of the potential benefits of SSRIs in impulsive---violent offenders who are at high risk of reoffending., Methods and Analysis: A randomised, double-blinded, multicentre trial to test the clinical efficacy of an SSRI, sertraline hydrochloride, compared with placebo on recidivism and behavioural measures (including impulsivity, anger, aggression, depression and self-reported offending) over 12 months. 460 participants with histories of violence and screening positive for impulsivity are recruited at several local courts and correctional service offices in New South Wales, Australia., Ethics and Dissemination: Results will be submitted for publication in a peer-reviewed journal. Possible implications of the effectiveness of this pharmacological intervention include economic benefits of reducing prison costs and societal benefits of improving safety. This study has received ethical approval from the University of New South Wales, Aboriginal Health & Medical Research Council, Corrective Services NSW and the NSW Justice Health and Forensic Mental Health Network., Trial Registration Number: ACTRN12613000442707., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Objective: To estimate the overall and cause specific mortality of Aboriginal offenders in New South Wales (NSW), Australia., Methods: The study cohort consisted of all Aboriginal men and women aged 18 years and older who had experienced full-time imprisonment in NSW between 1 January 1988 and 31 December 2002. Their data were linked probabilistically to the Australian National Death Index to obtain information on death. Standardised mortality ratios were calculated for all causes of death and adjusted for age, sex, and calendar year., Results: The cohort comprised 7,980 men and 1,373 women with 75,801 person years of observation. During a median follow-up period of 8.3 years, 485 men and 73 women died, giving an overall mortality rate of 733 and 755 deaths per 100,000 person-years. The risk of death in men was 4.8 (95% CI: 4.4-5.3) times and among women 12.6 (95% CI: 10.0-15.8) times that of the NSW residents, with a markedly elevated risk for almost all conditions. The leading cause of death was cardiovascular disease in men (112 deaths, 23%) and mental and behavioural disorders (17 deaths, 23%) in women. The risk of death was greatest following release from prison., Conclusions and Implications: High mortality rates for cardiovascular disease, a preventable and treatable condition, were seen among Aboriginal offenders. Prison has an important role to play in screening marginalised populations for a range of health conditions. This is particularly true for Indigenous offenders., (© 2012 The Authors. ANZJPH © 2012 Public Health Association of Australia.)