title: The DSM-IV rates of child and adolescent disorders in Puerto Rico: prevalence, correlates, service use, and the effects of impairment.
abstract: 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.
authors.affiliation: Behavioral Sciences Research Institute, Medical Sciences Campus, University of Puerto Rico, PO Box 365067, Río Piedras, San Juan, Puerto Rico 00936-5067. gcanino@rcm.upr.edu
authors.forename: Glorisa
authors.initials: G
authors.lastname: Canino
authors.forename: Patrick E
authors.initials: PE
authors.lastname: Shrout
authors.forename: Maritza
authors.initials: M
authors.lastname: Rubio-Stipec
authors.forename: Hector R
authors.initials: HR
authors.lastname: Bird
authors.forename: Milagros
authors.initials: M
authors.lastname: Bravo
authors.forename: Rafael
authors.initials: R
authors.lastname: Ramirez
authors.forename: Ligia
authors.initials: L
authors.lastname: Chavez
authors.forename: Margarita
authors.initials: M
authors.lastname: Alegria
authors.forename: José J
authors.initials: JJ
authors.lastname: Bauermeister
authors.forename: Ann
authors.initials: A
authors.lastname: Hohmann
authors.forename: Julio
authors.initials: J
authors.lastname: Ribera
authors.forename: Pedro
authors.initials: P
authors.lastname: Garcia
authors.forename: Alfonso
authors.initials: A
authors.lastname: Martinez-Taboas
mesh_terms: D000293:Adolescent; D001289:Attention Deficit Disorder with Hyperactivity / Q000175:diagnosis / Q000453:epidemiology / Q000523:psychology; D019958:Attention Deficit and Disruptive Behavior Disorders / Q000175:diagnosis / Q000453:epidemiology / Q000523:psychology; D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D003865:Major Depressive Disorder / Q000175:diagnosis / Q000453:epidemiology / Q000523:psychology; D039721:Diagnostic and Statistical Manual of Mental Disorders; D005260:Female; D006630:Hispanic or Latino / Q000523:psychology* / Q000706:statistics & numerical data; D006801:Humans; D015994:Incidence; D008297:Male; D001523:Mental Disorders / Q000175:diagnosis / Q000453:epidemiology* / Q000523:psychology; D008605:Mental Health Services / Q000706:statistics & numerical data; D010552:Personality Assessment; D010698:Phobic Disorders / Q000175:diagnosis / Q000453:epidemiology / Q000523:psychology; D011647:Puerto Rico / Q000208:ethnology; D012494:Sampling Studies