%0 Journal Article %A Marina Tolou-Shams %A Johanna B. Folk %A Evan D. Holloway %A Catalina M. Ordorica %A Emily F. Dauria %A Kathleen Kemp %A Brandon D. L. Marshall %T Psychiatric and Substance-Related Problems Predict Recidivism for First-Time Justice-Involved Youth %D 2023 %R 10.29158/JAAPL.220028-21 %J Journal of the American Academy of Psychiatry and the Law Online %P JAAPL.220028-21 %X Justice-involved youth with clinically significant co-occurring psychiatric and substance-related problems are at increased risk for recidivism. Less is known about how psychiatric symptoms (i.e., internalizing and externalizing) and substance-related problems (i.e., alcohol and cannabis) interact to predict recidivism, especially at first court contact. Among 361 first-time justice-involved youth aged 12 to 18, we used nested multivariate negative binomial regression models to examine the association between psychiatric symptoms, substance-related problems and 24-month recidivism while accounting for demographic and legal covariates. Clinically significant externalizing symptoms and alcohol-related problems predicted recidivism. Moderation analyses revealed that alcohol-related problems drove recidivism for youth without clinically significant psychiatric symptoms and externalizing symptoms predicted recidivism, regardless of alcohol-related problems. After accounting for other predictors, Latinx, Black non-Latinx, and multiracial non-Latinx youth were more likely to recidivate at follow-up than White non-Latinx youth. Systematic screening, referral, and linkage to treatment for psychiatric and substance-related problems are needed to reduce recidivism risk among first-time justice-involved youth. Differences in recidivism rates by race/ethnicity not attributable to behavioral health needs suggest it is imperative to concurrently deploy large-scale structural interventions designed to combat systemic racial bias and overrepresentation of ethnoracial minoritized youth within the juvenile justice system. %U https://jaapl.org/content/jaapl/early/2023/01/16/JAAPL.220028-21.full.pdf