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Prevalence, Correlates, Service Use, and the Effects of Impairment

Glorisa Canino, PhD; Patrick E. Shrout, PhD; Maritza Rubio-Stipec, ScD; Hector R. Bird, MD; Milagros Bravo, PhD; Rafael Ramírez, PhD; Ligia Chavez, PhD; Margarita Alegría, PhD; José J. Bauermeister, PhD; Ann Hohmann, PhD; Julio Ribera, PhD; Pedro García, MA; Alfonso Martínez-Taboas, PhD

Arch Gen Psychiatry. 2004;61:85-93.

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.

From the Behavioral Sciences Research Institute, (Drs Canino, Rubio-Stipec, Bravo, Ramírez, Chavez, Alegría, Bauermeister, Ribera, and Martínez-Taboas and Mr García), and the Departments of Pediatrics (Dr Canino) and Psychology (Dr Bauermeister), University of Puerto Rico, Río Piedras; the Department of Psychology, New York University, New York (Dr Shrout); the American Psychiatry Institute for Research and Education, Washington, DC (Dr Rubio-Stipec); the Department of Psychiatry, College of Physicians and Surgeons of Columbia University/New York State Psychiatric Institute, New York (Dr Bird); the Department of Psychiatry, Harvard University and Cambridge Health Alliance, Center for Multicultural Research, Cambridge, Mass (Dr Alegría); the National Institute of Mental Health, Bethesda, Md (Dr Hohmann); the Department of Psychology, San Juan Veterans Administration Hospital, (Dr Ribera), and the Department of Psychology, Carlos Albizu University, (Dr Martínez-Taboas), San Juan, Puerto Rico.

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