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

被引:307
作者
Canino, G
Shrout, PE
Rubio-Stipec, M
Bird, HR
Bravo, M
Ramírez, R
Chavez, L
Alegria, M
Bauermeister, JJ
Hohmann, A
Ribera, J
García, P
Martínez-Taboas, A
机构
[1] Carlos Albizu Univ, Dept Psychol, San Juan, PR USA
[2] San Juan Vet Adm Hosp, Dept Psychol, San Juan, PR USA
[3] NIMH, Bethesda, MD 20892 USA
[4] Cambridge Hlth Alliance, Ctr Multicultural Res, Cambridge, MA USA
[5] Harvard Univ, Dept Psychiat, Cambridge, MA 02138 USA
[6] Columbia Univ Coll Phys & Surg, New York State Psychiat Inst, Dept Psychiat, New York, NY 10032 USA
[7] Amer Psychiat Inst Res & Educ, Washington, DC USA
[8] NYU, Dept Psychol, New York, NY 10003 USA
[9] Univ Puerto Rico, Dept Psychol, Rio Piedras, PR 00931 USA
[10] Univ Puerto Rico, Dept Pediat, Rio Piedras, PR 00931 USA
[11] Behav Sci Res Inst, San Juan, PR 00936 USA
关键词
D O I
10.1001/archpsyc.61.1.85
中图分类号
R749 [精神病学];
学科分类号
100205 ;
摘要
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 I 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-IWDISC-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.
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页码:85 / 93
页数:9
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