The DSM-IV rates of child and adolescent disorders in Puerto Rico: prevalence, correlates, service use, and the effects of impairment.

BACKGROUND Few prevalence studies in which DSM-IV criteria were used in children in representative community samples have been reported. We present prevalence data for the child and adolescent population of Puerto Rico and examine the relation of DSM-IV diagnoses to global impairment, demographic correlates, and service use in an island-wide representative sample. METHODS We sampled 1886 child-caretaker dyads in Puerto Rico by using a multistage sampling design. Children were aged 4 to 17 years. Response rate was 90.1%. Face-to-face interviews of children and their primary caretakers were performed by trained laypersons who administered the Diagnostic Interview Schedule for Children, version IV (DISC-IV) in Spanish. Global impairment was measured by using the Children's Global Assessment Scale scored by the interviewer of the parent. Reports of service use were obtained by using the Service Assessment for Children and Adolescents. RESULTS Although 19.8% of the sample met DSM-IV criteria without considering impairment, 16.4% of the population had 1 or more of the DSM-IV disorders when a measure of impairment specific to each diagnosis was considered. The overall prevalence was further reduced to 6.9% when a measure of global impairment was added to that definition. The most prevalent disorders were attention-deficit/hyperactivity disorder (8.0%) and oppositional defiant disorder (5.5%). Children in urban settings had higher rates than those in rural regions. Older age was related to higher rates of major depression and social phobia, and younger age was related to higher rates of attention-deficit/hyperactivity disorder. Both overall rates and rates of specific DSM-IV/DISC-IV disorders were related to service use. Children with impairment without diagnosis were more likely to use school services, whereas children with impairment with diagnosis were more likely to use the specialty mental health sector. Of those with both a diagnosis and global impairment, only half received services from any source. CONCLUSIONS Because we used the DISC-IV to apply DSM-IV criteria, the study yielded prevalence rates that are generally comparable with those found in previous surveys. The inclusion of diagnosis-specific impairment criteria reduced rates slightly. When global impairment criteria were imposed, the rates were reduced by approximately half.

[1]  T. Mcguire,et al.  Managed Care and Systems Cost-Effectiveness: Treatment for Depression , 2005, Medical care.

[2]  A. Erkanli,et al.  Psychiatric disorder, impairment, and service use in rural African American and white youth. , 2002, Archives of general psychiatry.

[3]  G. Canino,et al.  Methodological Challenges in Assessing Children's Mental Health Services Utilization , 2002, Mental health services research.

[4]  R. Spitzer,et al.  Lowered estimates--but of what? , 2002, Archives of general psychiatry.

[5]  D. Regier,et al.  Revised prevalence estimates of mental disorders in the United States: using a clinical significance criterion to reconcile 2 surveys' estimates. , 2002, Archives of general psychiatry.

[6]  G. Canino,et al.  Prevalence and Correlates of Antisocial Behaviors Among Three Ethnic Groups , 2001, Journal of abnormal child psychology.

[7]  E. Costello,et al.  Poverty, race/ethnicity, and psychiatric disorder: a study of rural children. , 2001, American journal of public health.

[8]  A. Pickles,et al.  Child psychiatric symptoms and psychosocial impairment: relationship and prognostic significance , 2001, British Journal of Psychiatry.

[9]  G. Canino,et al.  Prevalence and correlates of substance use disorders among older adolescents in Puerto Rico and the United States: a cross-cultural comparison. , 2001, Drug and alcohol dependence.

[10]  G. Norquist,et al.  Reliability of the services assessment for children and adolescents. , 2001, Psychiatric services.

[11]  R. Tremblay,et al.  Prevalence of psychiatric diagnoses and the role of perceived impairment: findings from an adolescent community sample. , 2001, Journal of child psychology and psychiatry, and allied disciplines.

[12]  E. Costello,et al.  The depressed child and adolescent: The epidemiology of depression in children and adolescents , 2001 .

[13]  P. Shrout,et al.  Test-Retest Reliability of the Spanish Version of the Diagnostic Interview Schedule for Children (DISC-IV) , 2001, Journal of abnormal child psychology.

[14]  H. Koplewicz,et al.  Diagnostic Assessment in Child and Adolescent Psychopathology , 2000 .

[15]  C. Berthiaume,et al.  Correlates of Mental Disorders in the Quebec General Population of 6 to 14-Year Olds , 2000, Journal of abnormal child psychology.

[16]  D. Shaffer,et al.  NIMH Diagnostic Interview Schedule for Children Version IV (NIMH DISC-IV): description, differences from previous versions, and reliability of some common diagnoses. , 2000, Journal of the American Academy of Child and Adolescent Psychiatry.

[17]  G. Canino,et al.  Parent and child contributions to diagnosis of mental disorder: are both informants always necessary? , 1999, Journal of the American Academy of Child and Adolescent Psychiatry.

[18]  R. Spitzer,et al.  DSM-IV diagnostic criterion for clinical significance: does it help solve the false positives problem? , 1999, The American journal of psychiatry.

[19]  A. Erkanli,et al.  Impaired but undiagnosed. , 1999, Journal of the American Academy of Child and Adolescent Psychiatry.

[20]  C. Hoven,et al.  A comparison of federal definitions of severe mental illness among children and adolescents in four communities. , 1998, Psychiatric services.

[21]  A. Rosenblatt,et al.  Prevalence of psychopathology among children and adolescents. , 1998, The American journal of psychiatry.

[22]  V. Mcloyd,et al.  Socioeconomic disadvantage and child development. , 1998, The American psychologist.

[23]  Phil A. Silva,et al.  Development of depression from preadolescence to young adulthood: emerging gender differences in a 10-year longitudinal study. , 1998, Journal of abnormal psychology.

[24]  Gail M. Williams,et al.  The Relationship between Low Family Income and Psychological Disturbance in Young Children: An Australian Longitudinal Study , 1997, The Australian and New Zealand journal of psychiatry.

[25]  A. Erkanli,et al.  Psychiatric disorders among American Indian and white youth in Appalachia: the Great Smoky Mountains Study. , 1997, American journal of public health.

[26]  G. Duncan,et al.  The effects of poverty on children. , 1997, The Future of children.

[27]  G. Canino,et al.  GLOBAL MEASURES OF IMPAIRMENT FOR EPIDEMIOLOGIC AND CLINICAL USE WITH CHILDREN AND ADOLESCENTS , 1996 .

[28]  A. Erkanli,et al.  The Great Smoky Mountains Study of Youth. Goals, design, methods, and the prevalence of DSM-III-R disorders. , 1996, Archives of general psychiatry.

[29]  D. Offord,et al.  What if we could eliminate child poverty? The theoretical effect on child psychosocial morbidity. , 1996, Social psychiatry and psychiatric epidemiology.

[30]  L. Colbert The Depressed Child and Adolescent: Developmental and Clinical Perspectives , 1996 .

[31]  M Davies,et al.  The NIMH Diagnostic Interview Schedule for Children Version 2.3 (DISC-2.3): description, acceptability, prevalence rates, and performance in the MECA Study. Methods for the Epidemiology of Child and Adolescent Mental Disorders Study. , 1996, Journal of the American Academy of Child and Adolescent Psychiatry.

[32]  J. Wakefield DSM-IV: Are We Making Diagnostic Progress? , 1996 .

[33]  E. Costello,et al.  A test–retest reliability study of child-reported psychiatric symptoms and diagnoses using the Child and Adolescent Psychiatric Assessment (CAPA-C) , 1995, Psychological Medicine.

[34]  E. Simonoff,et al.  The Child and Adolescent Psychiatric Assessment (CAPA). , 1995, Psychological medicine.

[35]  R. Spitzer Dsm-IV Casebook: A Learning Companion to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition , 1994 .

[36]  M. Schwab-Stone,et al.  Reliability of diagnostic reporting for children aged 6-11 years: a test-retest study of the Diagnostic Interview Schedule for Children-Revised. , 1994, The American journal of psychiatry.

[37]  R. Kessler,et al.  Lifetime and 12-month prevalence of DSM-III-R psychiatric disorders in the United States. Results from the National Comorbidity Survey. , 1994, Archives of general psychiatry.

[38]  Jacob Cohen,et al.  An epidemiological study of disorders in late childhood and adolescence--I. Age- and gender-specific prevalence. , 1993, Journal of child psychology and psychiatry, and allied disciplines.

[39]  G. Zahner,et al.  Rural-urban child psychopathology in a Northeastern U.S. state: 1986-1989. , 1993, Journal of the American Academy of Child and Adolescent Psychiatry.

[40]  P. Shrout,et al.  Drug abuse and illicit drug use in Puerto Rico. , 1993, American journal of public health.

[41]  G. Canino,et al.  Impairment in the epidemiological measurement of childhood psychopathology in the community. , 1990, Journal of the American Academy of Child and Adolescent Psychiatry.

[42]  G. Canino,et al.  Epidemiological comparisons of Puerto Rican and U.S. mainland children: parent, teacher, and self-reports. , 1990, Journal of the American Academy of Child and Adolescent Psychiatry.

[43]  G. Canino,et al.  Risk factors for maladjustment in Puerto Rican children. , 1989, Journal of the American Academy of Child and Adolescent Psychiatry.

[44]  L. Miles,et al.  2000 , 2000, RDH.

[45]  G. Canino,et al.  Estimates of the prevalence of childhood maladjustment in a community survey in Puerto Rico. The use of combined measures. , 1988, Archives of general psychiatry.

[46]  G. Canino,et al.  Further measures of the psychometric properties of the Children's Global Assessment Scale. , 1987, Archives of general psychiatry.

[47]  P. Shrout,et al.  The prevalence of specific psychiatric disorders in Puerto Rico. , 1987, Archives of general psychiatry.

[48]  M M Weissman,et al.  Lifetime prevalence of specific psychiatric disorders in three sites. , 1984, Archives of general psychiatry.

[49]  F. Earls The epidemiology of depression in children and adolescents. , 1984, Pediatric annals.

[50]  Americal Psychiatric Press Diagnostic and Statistical Manual of Mental Disorders, Third Edition , 1980 .

[51]  H. Wiegand,et al.  Kish, L.: Survey Sampling. John Wiley & Sons, Inc., New York, London 1965, IX + 643 S., 31 Abb., 56 Tab., Preis 83 s. , 1968 .