Milagros Bravo - Academia.edu (original) (raw)

Papers by Milagros Bravo

Research paper thumbnail of The Psychometric Properties of a Shortened Version of the Spanish Adolescent Dissociative Experiences Scale

Journal of Trauma & Dissociation, 2004

The aim of this study was to examine the psychometric properties of a Spanish translation of an e... more The aim of this study was to examine the psychometric properties of a Spanish translation of an eight-item version of the Adolescent Dissociative Experiences Scale (ADES-8). The eight items were selected to assess pathological forms of dissociative experiences. The scale was administered to a representative sample of 459 medically indigent adolescents, ages 11 to 17, who received mental health services in Puerto Rico. Results indicated that the ADES-8 demonstrated satisfactory internal consistency and test-retest reliability. As expected, most adolescents evidenced very low scores, with nearly half (46%) scoring zero. The scale showed expected patterns of convergent validity with variables that are hypothesized to be related to dissociative disorders, such as psychiatric impairment, comorbidity, and abusive experiences. Logistic regression analyses suggested that a cutoff score of three on the ADES-8 was the best screening rule for identifying persons with higher values on the convergent validity variables. The findings provide support for the clinical and research promise of the ADES-8 as a screening instrument for dissociative disorders in referred youths.

Research paper thumbnail of The adaptation and testing of diagnostic and outcome measures for cross-cultural research

International Review of Psychiatry, 1994

Research paper thumbnail of Symptom Scales of the Diagnostic Interview Schedule: Factor Results in Hispanic and Anglo Samples

Psychological Assessment, 1989

The Diagnostic Interview Schedule (DIS) was designed for use in large-sample surveys of mental he... more The Diagnostic Interview Schedule (DIS) was designed for use in large-sample surveys of mental health to produce categorical diagnoses according to criteria such as those found in the third edition of the Diagnostic and Statistical Manual of Mental Disorders, based on structured information about lifetime symptoms provided to nonclinician interviewers. Using symptom data from a probability sample of community residents

Research paper thumbnail of Prevalence and victimization correlates of pathological dissociation in a community sample of youths

Journal of Traumatic Stress, 2006

This study explored the relationships among a variety of victimization experiences and dissociati... more This study explored the relationships among a variety of victimization experiences and dissociative symptoms in a community probabilistic household sample (n = 891) of youths (11–17 years old) in Puerto Rico. To measure dissociative symptoms, the authors selected eight items from the Adolescent Dissociative Experiences Scale (Armstrong, Putnam, Carlson, Liber, & Smith, 1997) that are indicative of pathological forms of dissociation. Victimization factors associated with dissociation were investigated with bivariate logistic regression followed by multiple logistic regression. The results indicated that 44 (4.9%) youths experienced pathological dissociative symptoms. Forty-three (98%) of those youths experienced victimization. Logistic regression analyses indicated that the risk of pathological dissociation was significant among those participants who reported severe forms of physical abuse and those who were exposed to violence.

Research paper thumbnail of SEX DIFFERENCES AND DEPRESSION IN PUERTO RICO

Psychology of Women Quarterly, 1987

Sex differences in rates of depressive disorders and depressive symptomatology, as measured by th... more Sex differences in rates of depressive disorders and depressive symptomatology, as measured by the Diagnostic Interview Schedule, are examined for an island-wide probability sample of Puerto Rico. Consistent with previous research, depression is significantly more prevalent in Puerto Rican women than men. Risk factors associated with depressive symptomatology are examined from a sex-role perspective. The results of multiple regression analyses show that even after demographic, health and marital and employment status variables are controlled, women continue to be at higher risk of depressive symptomatology than men. These results are interpreted within a cultural and sex-role perspective.

Research paper thumbnail of Natural Disaster and Risk of Psychiatric Disorders in Puerto Rican Children

Journal of Abnormal Child Psychology, 2011

We examined the persistence of psychiatric disorders at approximately 18 and 30 months after a hu... more We examined the persistence of psychiatric disorders at approximately 18 and 30 months after a hurricane among a random sample of the child and adolescent population (4–17 years) of Puerto Rico. Data were obtained from caretaker-child dyads (N = 1,886) through in person interviews with primary caretakers (all children) and youth (11–17 years) using the Diagnostic Interview Schedule for Children IV in Spanish. Logistic regressions, controlling for sociodemographic variables, were used to study the relation between disaster exposure and internalizing, externalizing, or any disorder. Children’s disaster-related distress manifested as internalizing disorders, rather than as externalizing disorders at 18 months post-disaster. At 30 months, there was no longer a significant difference in rates of disorder between hurricane-exposed and non-exposed youth. Results were similar across age ranges. Rates of specific internalizing disorders between exposed and unexposed children are provided. Research and clinical implications are discussed.

Research paper thumbnail of The Spanish translation and cultural adaptation of the Diagnostic Interview Schedule for Children (DISC) in Puerto Rico

Culture Medicine and Psychiatry, 1993

This article illustrates a comprehensive cross-cultural adaptation model used to translate into S... more This article illustrates a comprehensive cross-cultural adaptation model used to translate into Spanish and to culturally adapt the Diagnostic Interview Schedule for Children (DISC). The process strived to identify similar phenomena to those identified by the original English version in a dissimilar context. To attain cross-cultural equaivalency five important dimensions were addressed: semantic, technical, content, criterion and conceptual. To meet this challenge various steps were taken, including bilingual committee, back-translation, reliability and validity testing. The result is an instrument which could be used, not only in Puerto Rico, but also in other Spanishspeaking child and adolescent populations after appropriate cultural adaptations.

Research paper thumbnail of Methodological Aspects of Disaster Mental Health Research

International Journal of Mental Health, 1990

ABSTRACT

Research paper thumbnail of Dimensions of attention deficit hyperactivity disorder: Findings from teacher and parent reports in a community sample

Journal of Clinical Child and Adolescent Psychology, 1995

APA PsycNET Our Apologies! - The following features are not available with your current Browser c... more APA PsycNET Our Apologies! - The following features are not available with your current Browser configuration. - alerts user that their session is about to expire - display, print, save, export, and email selected records - get My ...

Research paper thumbnail of Mental health status among Puerto Ricans, Mexican Americans, and Non-Hispanic whites

American Journal of Community Psychology, 1992

Research paper thumbnail of Test-Retest Reliability of the Spanish Version of the Diagnostic Interview Schedule for Children (DISC-IV

Journal of Abnormal Child Psychology, 2001

The test-retest reliability of the Spanish Diagnostic Interview Schedule for Children (DISC-IV) i... more The test-retest reliability of the Spanish Diagnostic Interview Schedule for Children (DISC-IV) is presented. This version was developed in Puerto Rico in consultation with an international bilingual committee, sponsored by NIMH. The sample (N = 146) consisted of children recruited from outpatient mental health clinics and a drug residential treatment facility. Two different pairs of nonclinicians administered the DISC twice to the parent and child respondents. Results indicated fair to moderate agreement for parent reports on most diagnoses. Relatively similar agreement levels were observed for last month and last year time frames. Surprisingly, the inclusion of impairment as a criterion for diagnosis did not substantially change the pattern of results for specific disorders. Parents were more reliable when reporting on diagnoses of younger (4–10) than older children. Children 11–17 years old were reliable informants on disruptive and substance abuse/dependence disorders, but unreliable for anxiety and depressive disorders. Hence, parents were more reliable when reporting about anxiety and depressive disorders whereas children were more reliable than their parents when reporting about disruptive and substance disorders.

Research paper thumbnail of Examining minor and major depression in adolescents

Journal of Child Psychology and Psychiatry, 2005

Background: Research has shown that a large proportion of adolescents with symptoms of depressio... more Background: Research has shown that a large proportion of adolescents with symptoms of depression and substantial distress or impairment fail to meet the diagnostic criteria for a major depressive disorder (MDD). However, many of these undiagnosed adolescents may meet criteria for a residual category of the Diagnostic and Statistical Manual of Mental Disorders-Fourth Edition-Text Revised (DSM-IV-TR), Depressive Disorder Not Otherwise Specified. Minor Depression (mDEP), an example of one of these categories, allows the inclusion of sub-threshold cases that fall below the diagnostic criteria of the five symptoms required for MDD. Minor depression in adolescence is important because it is significantly related to MDD in adulthood. The present study examines a number of risk factors, functional impairment, comorbidity and service utilization patterns associated with depression in community adolescents who met the DSM-IV criteria for mDEP and compares their profile to adolescents who met the criteria for MDD.Method: Puerto Rican adolescents 11 to 17 years old were selected from an island-wide probability household sample of children ranging in age from 4 to 17. The Diagnostic Interview Schedule in Spanish (DISC IV), together with a structured protocol of risks and protective factors, and service utilization questionnaires were administered to primary caretakers and their children.Results: Our findings indicate that youngsters with mDEP had significant impairment and used more mental health services than those with major depression. In addition, adolescents with mDEP had similar outcomes when compared to those meeting full criteria for MDD in terms of psychosocial correlates and comorbidity.Conclusions: The results, although not definitive, suggest a need for further research in order to determine the validity of the present DSM IV diagnostic criteria for mDEP in adolescents.

Research paper thumbnail of Psychometric properties of parents and children as informants in child psychiatry epidemiology with the Spanish diagnostic interview schedule for children (DISC.2

Journal of Abnormal Child Psychology, 1994

Parent and child reports were examined to study how epidemiological researchers can best use the ... more Parent and child reports were examined to study how epidemiological researchers can best use the information provided to describe childhood psychopathology. As part of a multisite methodologic study of mental disorders in children, a probability sample (N=248) of children aged 9 to 17 years from the San Juan metropolitan area was selected. This sample was enriched with 74 clinic cases. Both parents and children were administered the DISC.2. Results showed that prevalence estimates were influenced by the informant. The clinicians' diagnosis is more concordant with children's reports of depression and with parents' reports of disruptive disorders. Parents and children provided unique information when interviewed with a structured psychiatric interview about child psychopathology. Their unique perspectives contributed to the observed discordance that emerged when DISC parent and DISC child results are compared. Combining the two perspectives with a simple “OR” rule at the symptom level did not seem to capture the unique perspectives.

Research paper thumbnail of Gender disparities in mental health service use of Puerto Rican children and adolescents: Gender disparities in mental health service use

Journal of Child Psychology and Psychiatry, 2006

Background: Differences in service utilization indicating that boys use more mental health servi... more Background: Differences in service utilization indicating that boys use more mental health services than girls were analyzed to see if they could be explained by known correlates of service use. These correlates were arranged into individual (severe emotional disturbance, level of impairment and externalizing disorders), family (parental education, psychopathology and parental concern) and school factors (difficulties with school work). The objectives were to understand and identify the factors accounting for gender differences in mental health service utilization in order to develop alternatives to promote equity in service delivery.Methods: A representative sample of 1,896 children 4 to 17 years of age and their primary caretakers were interviewed for this study. Reports of service use were obtained using the Service Assessment for Children and Adolescents. Logistic regression was used to assess the relationship between gender and service use, adjusting for known correlates.Results: Our results showed that, except for impairment, other individual, family and school factors did not explain gender differences in service utilization. Males with impairment were 2.87 times more likely to receive services than impaired females (p ≤ .01), and this result continued to hold true for impaired undiagnosed boys compared to impaired diagnoses-free girls (p ≤ .001).Conclusions: Our findings showed a service disparity between impaired boys and girls who did not meet criteria for a DSM IV diagnosis, but no observed differences in service use between boys and girls who met criteria for severe emotional disturbance (SED). Continued investigations are necessary to analyze, assess and understand the different circumstances that bring boys and girls into treatment, followed by the development of appropriate intervention programs at the school and community levels.

Research paper thumbnail of Mental health status among Puerto Ricans, Mexican Americans, and Non-Hispanic whites

American Journal of Community Psychology, 1992

Compared mental health characteristics of island Puerto Ricans to three groups from the Los Angel... more Compared mental health characteristics of island Puerto Ricans to three groups from the Los Angeles Epidemiologic Catchment Area Study: Mexican American immigrants, U.S.-born Mexican Americans, and Non-Hispanic whites. The Diagnostic Interview Schedule was used to obtain both diagnostic and symptom scale information about affective disorders, alcohol abuse/dependence, somatization, phobic disorder, and psychotic disorder. Mexican American immigrants had the fewest mental health problems of all groups. Puerto Ricans had more somatization disorder, but less affective and alcohol disorders than U.S-born Mexican Americans or non-Hispanic whites. Results are considered in the light of selection factors, relative disadvantage of groups and methodological problems.

Research paper thumbnail of Stimulant and Psychosocial Treatment of ADHD in Latino/Hispanic Children

Journal of The American Academy of Child and Adolescent Psychiatry, 2003

Research paper thumbnail of The psychological sequelae of disaster stress prospectively and retrospectively evaluated

American Journal of Community Psychology, 1990

Research paper thumbnail of Methodological Challenges in Assessing Children's Mental Health Services Utilization

Mental Health Services Research, 2002

This paper describes the reliability and validity of the service assessment for children and adol... more This paper describes the reliability and validity of the service assessment for children and adolescents (SACA) for use among Spanish-speaking respondents. The test-retest reliability of the instrument was assessed in a randomly selected clinical sample of 146 Puerto Rican children and adolescents aged 4–17. Both parents and children were administered the SACA twice by independent interviewers over an average 12-day follow-up period. The accuracy of parental and youth self-reports was assessed by comparing these reports to information obtained from medical records. The results showed that parents and children (aged 11–17) were able to report with fair to moderate reliability any last year use of mental health services, any outpatient mental health services, and school services. Residential and hospitalization services were reported by both informants with substantial test-retest reliability. Slight or no test-retest reliability was obtained for parent and child on the use of the specific type of mental health professionals, as well as parental reports of several treatment modalities. Substantial sensitivity of the SACA was obtained when comparing medical records to parental and child reports to lifetime use of any service and outpatient mental health service. Moderate sensitivity was obtained for last year use of mental health services for both parent and child informants.

Research paper thumbnail of The DSM-IV Rates of Child and Adolescent Disorders in Puerto Rico

Few prevalence studies in which DSM-IV criteria were used in children in representative community... more 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. 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. 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. 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.

Research paper thumbnail of Effect of family role on response to disaster

Journal of Traumatic Stress, 1993

This study hypothesized that family role (marital and parental status) would moderate the effect ... more This study hypothesized that family role (marital and parental status) would moderate the effect of disaster exposure on the mental health of victims. The study included St. Louis residents exposed to floods and dioxin, as well as Puerto Rican respondents exposed to floods and mudslides. In St. Louis, worst outcomes were found for single and married parents exposed to disaster, substantially exceeding the symptomatology of all unexposed respondents except non-victim single parents. In Puerto Rico, victims without families had higher levels of alcohol abuse symptoms than did any other subgroup. Perceived emotional support was found to be an important moderator of disaster's effect on psychiatric distress in this site, generally overriding the effect of family role. Single parents in both sites who were exposed to disaster had substantially reduced levels of emotional support available to them, as compared to unexposed single parents, suggesting that single parents are at particularly high risk for losing access to emotional support following a disaster. This study suggests that both single and married parents constitute important high-risk victim groups. The findings also suggest that those perceiving they lack adequate emotional support, regardless of family role, may be in special need of services.

Research paper thumbnail of The Psychometric Properties of a Shortened Version of the Spanish Adolescent Dissociative Experiences Scale

Journal of Trauma & Dissociation, 2004

The aim of this study was to examine the psychometric properties of a Spanish translation of an e... more The aim of this study was to examine the psychometric properties of a Spanish translation of an eight-item version of the Adolescent Dissociative Experiences Scale (ADES-8). The eight items were selected to assess pathological forms of dissociative experiences. The scale was administered to a representative sample of 459 medically indigent adolescents, ages 11 to 17, who received mental health services in Puerto Rico. Results indicated that the ADES-8 demonstrated satisfactory internal consistency and test-retest reliability. As expected, most adolescents evidenced very low scores, with nearly half (46%) scoring zero. The scale showed expected patterns of convergent validity with variables that are hypothesized to be related to dissociative disorders, such as psychiatric impairment, comorbidity, and abusive experiences. Logistic regression analyses suggested that a cutoff score of three on the ADES-8 was the best screening rule for identifying persons with higher values on the convergent validity variables. The findings provide support for the clinical and research promise of the ADES-8 as a screening instrument for dissociative disorders in referred youths.

Research paper thumbnail of The adaptation and testing of diagnostic and outcome measures for cross-cultural research

International Review of Psychiatry, 1994

Research paper thumbnail of Symptom Scales of the Diagnostic Interview Schedule: Factor Results in Hispanic and Anglo Samples

Psychological Assessment, 1989

The Diagnostic Interview Schedule (DIS) was designed for use in large-sample surveys of mental he... more The Diagnostic Interview Schedule (DIS) was designed for use in large-sample surveys of mental health to produce categorical diagnoses according to criteria such as those found in the third edition of the Diagnostic and Statistical Manual of Mental Disorders, based on structured information about lifetime symptoms provided to nonclinician interviewers. Using symptom data from a probability sample of community residents

Research paper thumbnail of Prevalence and victimization correlates of pathological dissociation in a community sample of youths

Journal of Traumatic Stress, 2006

This study explored the relationships among a variety of victimization experiences and dissociati... more This study explored the relationships among a variety of victimization experiences and dissociative symptoms in a community probabilistic household sample (n = 891) of youths (11–17 years old) in Puerto Rico. To measure dissociative symptoms, the authors selected eight items from the Adolescent Dissociative Experiences Scale (Armstrong, Putnam, Carlson, Liber, & Smith, 1997) that are indicative of pathological forms of dissociation. Victimization factors associated with dissociation were investigated with bivariate logistic regression followed by multiple logistic regression. The results indicated that 44 (4.9%) youths experienced pathological dissociative symptoms. Forty-three (98%) of those youths experienced victimization. Logistic regression analyses indicated that the risk of pathological dissociation was significant among those participants who reported severe forms of physical abuse and those who were exposed to violence.

Research paper thumbnail of SEX DIFFERENCES AND DEPRESSION IN PUERTO RICO

Psychology of Women Quarterly, 1987

Sex differences in rates of depressive disorders and depressive symptomatology, as measured by th... more Sex differences in rates of depressive disorders and depressive symptomatology, as measured by the Diagnostic Interview Schedule, are examined for an island-wide probability sample of Puerto Rico. Consistent with previous research, depression is significantly more prevalent in Puerto Rican women than men. Risk factors associated with depressive symptomatology are examined from a sex-role perspective. The results of multiple regression analyses show that even after demographic, health and marital and employment status variables are controlled, women continue to be at higher risk of depressive symptomatology than men. These results are interpreted within a cultural and sex-role perspective.

Research paper thumbnail of Natural Disaster and Risk of Psychiatric Disorders in Puerto Rican Children

Journal of Abnormal Child Psychology, 2011

We examined the persistence of psychiatric disorders at approximately 18 and 30 months after a hu... more We examined the persistence of psychiatric disorders at approximately 18 and 30 months after a hurricane among a random sample of the child and adolescent population (4–17 years) of Puerto Rico. Data were obtained from caretaker-child dyads (N = 1,886) through in person interviews with primary caretakers (all children) and youth (11–17 years) using the Diagnostic Interview Schedule for Children IV in Spanish. Logistic regressions, controlling for sociodemographic variables, were used to study the relation between disaster exposure and internalizing, externalizing, or any disorder. Children’s disaster-related distress manifested as internalizing disorders, rather than as externalizing disorders at 18 months post-disaster. At 30 months, there was no longer a significant difference in rates of disorder between hurricane-exposed and non-exposed youth. Results were similar across age ranges. Rates of specific internalizing disorders between exposed and unexposed children are provided. Research and clinical implications are discussed.

Research paper thumbnail of The Spanish translation and cultural adaptation of the Diagnostic Interview Schedule for Children (DISC) in Puerto Rico

Culture Medicine and Psychiatry, 1993

This article illustrates a comprehensive cross-cultural adaptation model used to translate into S... more This article illustrates a comprehensive cross-cultural adaptation model used to translate into Spanish and to culturally adapt the Diagnostic Interview Schedule for Children (DISC). The process strived to identify similar phenomena to those identified by the original English version in a dissimilar context. To attain cross-cultural equaivalency five important dimensions were addressed: semantic, technical, content, criterion and conceptual. To meet this challenge various steps were taken, including bilingual committee, back-translation, reliability and validity testing. The result is an instrument which could be used, not only in Puerto Rico, but also in other Spanishspeaking child and adolescent populations after appropriate cultural adaptations.

Research paper thumbnail of Methodological Aspects of Disaster Mental Health Research

International Journal of Mental Health, 1990

ABSTRACT

Research paper thumbnail of Dimensions of attention deficit hyperactivity disorder: Findings from teacher and parent reports in a community sample

Journal of Clinical Child and Adolescent Psychology, 1995

APA PsycNET Our Apologies! - The following features are not available with your current Browser c... more APA PsycNET Our Apologies! - The following features are not available with your current Browser configuration. - alerts user that their session is about to expire - display, print, save, export, and email selected records - get My ...

Research paper thumbnail of Mental health status among Puerto Ricans, Mexican Americans, and Non-Hispanic whites

American Journal of Community Psychology, 1992

Research paper thumbnail of Test-Retest Reliability of the Spanish Version of the Diagnostic Interview Schedule for Children (DISC-IV

Journal of Abnormal Child Psychology, 2001

The test-retest reliability of the Spanish Diagnostic Interview Schedule for Children (DISC-IV) i... more The test-retest reliability of the Spanish Diagnostic Interview Schedule for Children (DISC-IV) is presented. This version was developed in Puerto Rico in consultation with an international bilingual committee, sponsored by NIMH. The sample (N = 146) consisted of children recruited from outpatient mental health clinics and a drug residential treatment facility. Two different pairs of nonclinicians administered the DISC twice to the parent and child respondents. Results indicated fair to moderate agreement for parent reports on most diagnoses. Relatively similar agreement levels were observed for last month and last year time frames. Surprisingly, the inclusion of impairment as a criterion for diagnosis did not substantially change the pattern of results for specific disorders. Parents were more reliable when reporting on diagnoses of younger (4–10) than older children. Children 11–17 years old were reliable informants on disruptive and substance abuse/dependence disorders, but unreliable for anxiety and depressive disorders. Hence, parents were more reliable when reporting about anxiety and depressive disorders whereas children were more reliable than their parents when reporting about disruptive and substance disorders.

Research paper thumbnail of Examining minor and major depression in adolescents

Journal of Child Psychology and Psychiatry, 2005

Background: Research has shown that a large proportion of adolescents with symptoms of depressio... more Background: Research has shown that a large proportion of adolescents with symptoms of depression and substantial distress or impairment fail to meet the diagnostic criteria for a major depressive disorder (MDD). However, many of these undiagnosed adolescents may meet criteria for a residual category of the Diagnostic and Statistical Manual of Mental Disorders-Fourth Edition-Text Revised (DSM-IV-TR), Depressive Disorder Not Otherwise Specified. Minor Depression (mDEP), an example of one of these categories, allows the inclusion of sub-threshold cases that fall below the diagnostic criteria of the five symptoms required for MDD. Minor depression in adolescence is important because it is significantly related to MDD in adulthood. The present study examines a number of risk factors, functional impairment, comorbidity and service utilization patterns associated with depression in community adolescents who met the DSM-IV criteria for mDEP and compares their profile to adolescents who met the criteria for MDD.Method: Puerto Rican adolescents 11 to 17 years old were selected from an island-wide probability household sample of children ranging in age from 4 to 17. The Diagnostic Interview Schedule in Spanish (DISC IV), together with a structured protocol of risks and protective factors, and service utilization questionnaires were administered to primary caretakers and their children.Results: Our findings indicate that youngsters with mDEP had significant impairment and used more mental health services than those with major depression. In addition, adolescents with mDEP had similar outcomes when compared to those meeting full criteria for MDD in terms of psychosocial correlates and comorbidity.Conclusions: The results, although not definitive, suggest a need for further research in order to determine the validity of the present DSM IV diagnostic criteria for mDEP in adolescents.

Research paper thumbnail of Psychometric properties of parents and children as informants in child psychiatry epidemiology with the Spanish diagnostic interview schedule for children (DISC.2

Journal of Abnormal Child Psychology, 1994

Parent and child reports were examined to study how epidemiological researchers can best use the ... more Parent and child reports were examined to study how epidemiological researchers can best use the information provided to describe childhood psychopathology. As part of a multisite methodologic study of mental disorders in children, a probability sample (N=248) of children aged 9 to 17 years from the San Juan metropolitan area was selected. This sample was enriched with 74 clinic cases. Both parents and children were administered the DISC.2. Results showed that prevalence estimates were influenced by the informant. The clinicians' diagnosis is more concordant with children's reports of depression and with parents' reports of disruptive disorders. Parents and children provided unique information when interviewed with a structured psychiatric interview about child psychopathology. Their unique perspectives contributed to the observed discordance that emerged when DISC parent and DISC child results are compared. Combining the two perspectives with a simple “OR” rule at the symptom level did not seem to capture the unique perspectives.

Research paper thumbnail of Gender disparities in mental health service use of Puerto Rican children and adolescents: Gender disparities in mental health service use

Journal of Child Psychology and Psychiatry, 2006

Background: Differences in service utilization indicating that boys use more mental health servi... more Background: Differences in service utilization indicating that boys use more mental health services than girls were analyzed to see if they could be explained by known correlates of service use. These correlates were arranged into individual (severe emotional disturbance, level of impairment and externalizing disorders), family (parental education, psychopathology and parental concern) and school factors (difficulties with school work). The objectives were to understand and identify the factors accounting for gender differences in mental health service utilization in order to develop alternatives to promote equity in service delivery.Methods: A representative sample of 1,896 children 4 to 17 years of age and their primary caretakers were interviewed for this study. Reports of service use were obtained using the Service Assessment for Children and Adolescents. Logistic regression was used to assess the relationship between gender and service use, adjusting for known correlates.Results: Our results showed that, except for impairment, other individual, family and school factors did not explain gender differences in service utilization. Males with impairment were 2.87 times more likely to receive services than impaired females (p ≤ .01), and this result continued to hold true for impaired undiagnosed boys compared to impaired diagnoses-free girls (p ≤ .001).Conclusions: Our findings showed a service disparity between impaired boys and girls who did not meet criteria for a DSM IV diagnosis, but no observed differences in service use between boys and girls who met criteria for severe emotional disturbance (SED). Continued investigations are necessary to analyze, assess and understand the different circumstances that bring boys and girls into treatment, followed by the development of appropriate intervention programs at the school and community levels.

Research paper thumbnail of Mental health status among Puerto Ricans, Mexican Americans, and Non-Hispanic whites

American Journal of Community Psychology, 1992

Compared mental health characteristics of island Puerto Ricans to three groups from the Los Angel... more Compared mental health characteristics of island Puerto Ricans to three groups from the Los Angeles Epidemiologic Catchment Area Study: Mexican American immigrants, U.S.-born Mexican Americans, and Non-Hispanic whites. The Diagnostic Interview Schedule was used to obtain both diagnostic and symptom scale information about affective disorders, alcohol abuse/dependence, somatization, phobic disorder, and psychotic disorder. Mexican American immigrants had the fewest mental health problems of all groups. Puerto Ricans had more somatization disorder, but less affective and alcohol disorders than U.S-born Mexican Americans or non-Hispanic whites. Results are considered in the light of selection factors, relative disadvantage of groups and methodological problems.

Research paper thumbnail of Stimulant and Psychosocial Treatment of ADHD in Latino/Hispanic Children

Journal of The American Academy of Child and Adolescent Psychiatry, 2003

Research paper thumbnail of The psychological sequelae of disaster stress prospectively and retrospectively evaluated

American Journal of Community Psychology, 1990

Research paper thumbnail of Methodological Challenges in Assessing Children's Mental Health Services Utilization

Mental Health Services Research, 2002

This paper describes the reliability and validity of the service assessment for children and adol... more This paper describes the reliability and validity of the service assessment for children and adolescents (SACA) for use among Spanish-speaking respondents. The test-retest reliability of the instrument was assessed in a randomly selected clinical sample of 146 Puerto Rican children and adolescents aged 4–17. Both parents and children were administered the SACA twice by independent interviewers over an average 12-day follow-up period. The accuracy of parental and youth self-reports was assessed by comparing these reports to information obtained from medical records. The results showed that parents and children (aged 11–17) were able to report with fair to moderate reliability any last year use of mental health services, any outpatient mental health services, and school services. Residential and hospitalization services were reported by both informants with substantial test-retest reliability. Slight or no test-retest reliability was obtained for parent and child on the use of the specific type of mental health professionals, as well as parental reports of several treatment modalities. Substantial sensitivity of the SACA was obtained when comparing medical records to parental and child reports to lifetime use of any service and outpatient mental health service. Moderate sensitivity was obtained for last year use of mental health services for both parent and child informants.

Research paper thumbnail of The DSM-IV Rates of Child and Adolescent Disorders in Puerto Rico

Few prevalence studies in which DSM-IV criteria were used in children in representative community... more 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. 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. 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. 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.

Research paper thumbnail of Effect of family role on response to disaster

Journal of Traumatic Stress, 1993

This study hypothesized that family role (marital and parental status) would moderate the effect ... more This study hypothesized that family role (marital and parental status) would moderate the effect of disaster exposure on the mental health of victims. The study included St. Louis residents exposed to floods and dioxin, as well as Puerto Rican respondents exposed to floods and mudslides. In St. Louis, worst outcomes were found for single and married parents exposed to disaster, substantially exceeding the symptomatology of all unexposed respondents except non-victim single parents. In Puerto Rico, victims without families had higher levels of alcohol abuse symptoms than did any other subgroup. Perceived emotional support was found to be an important moderator of disaster's effect on psychiatric distress in this site, generally overriding the effect of family role. Single parents in both sites who were exposed to disaster had substantially reduced levels of emotional support available to them, as compared to unexposed single parents, suggesting that single parents are at particularly high risk for losing access to emotional support following a disaster. This study suggests that both single and married parents constitute important high-risk victim groups. The findings also suggest that those perceiving they lack adequate emotional support, regardless of family role, may be in special need of services.