Ligia Chavez

Test-retest reliability of the Spanish version of the Diagnostic Interview Schedule for Children (DISC-IV).

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.

The Spanish Translation and Cultural Adaptation of Five Mental Health Outcome Measures

In this paper we report on the process of translating five mental health outcome measures into Spanish and adapting them to Latino culture. The instruments considered are the World Health Organization-Disability Assessment Scale, the Burden Assessment Scale, the Family Burden Scale, Lehmans Quality of Life Interview and the Continuity of Care in Mental Health Services Interview. A systematic process of translation and adaptation of the instruments was followed with the goal of achieving cultural equivalence between the English and Spanish versions of the instruments in five dimensions: semantic, content, technical, construct, and criterion equivalence. In this paper we present data about the semantic, content, and technical equivalence. Various steps were taken to achieve equivalence in these dimensions, including the use of a bilingual committee, a multi-national bilingual committee, back-translation, and focus groups with mental health patients and their relatives.

Stimulant and Psychosocial Treatment of ADHD in Latino/Hispanic Children

OBJECTIVE To examine to what extent Latino/Hispanic children with and without attention-deficit/hyperactivity disorder (ADHD) are receiving treatment and to identify variables that predict treatment with stimulant medication. METHOD Primary caretakers of a probability household sample (N = 1,897) of Puerto Rican children aged 4-17 years were administered structured interviews (response rate: 90.1%) from 1999-2000 to ascertain psychiatric disorders and types of services received. RESULTS Only 7.0% of children with ADHD received stimulant medication during the last year; moreover, only 3.6% had actually continued this treatment at the time of the interview. One fourth or less of those with ADHD received school-based services or psychosocial treatment. The male-female ratio in stimulant medication use was 10 to 1. In addition, only 0.2% of those with no psychiatric diagnosis received this treatment. ADHD and ADHD-not otherwise specified, impairment, and being male significantly predicted stimulant treatment. CONCLUSIONS Children with ADHD in this Latino/Hispanic population are not receiving the most efficacious treatments based on scientific findings and relevant clinical consensus. This population is undertreated rather than overtreated.

Methodological Challenges in Assessing Children's Mental Health Services Utilization

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.

Ethnic Differences in Perceived Impairment and Need for Care

Latino children in the U.S. have high rates of unmet need for mental health services, perhaps due to biased perceptions of impairment and need for care by parents and providers. We tested this argument using an experimental vignette design. Vignettes described children with problems that varied on severity (mild vs. serious), nature of the problem (internalizing vs. externalizing), as well as gender and ethnicity (Latino vs. Anglo). Raters were Latino and Anglo parents (N = 185) and providers (N = 189). Vignettes with Latino names were viewed as more impaired by both parents and providers, and this effect was significantly stronger in Latino vignettes with less severe problems. Severity and Latino features of vignettes also interacted with judgments of need for service. At higher severity, vignettes with Anglo names were judged to need service more than vignettes with Latino names, despite the same judged levels of impairment. Results are discussed in the light of the unmet need for Latinos.

Lessons from the use of vignettes in the study of mental health service disparities.

OBJECTIVE To examine the development, feasibility, and use of a vignette approach as an important tool in health services disparities research. DATA SOURCE Interviews with vignette developers and qualitative data from a novel mental health services disparities study that used vignettes in two samples: (1) predominantly low-income parents of children attending mental health specialty care who were Latino or non-Latino White and (2) Latino and non-Latino mental health clinicians who treat children in their practice. STUDY DESIGN We conduct a content analysis of qualitative data from patients and providers in the Ethnic Differences Study to explore the feasibility of vignette methodology in health services disparities research, and we identify lessons learned that may guide future vignette development. PRINCIPAL FINDINGS Vignettes provide a valuable approach that is acceptable to participants, elicits important insight on participant experience and services, and sheds light on factors that can help optimize study design for exploring health disparities questions. CONCLUSIONS Researchers, clinicians, and others should consider a set of factors that help determine when a vignette approach is warranted in research, training, or for other uses, including how best to address identified weaknesses.

Short-Term Persistence of DSM-IV ADHD Diagnoses: Influence of Context, Age, and Gender

OBJECTIVE Little is known about the effect of social context and gender on persistence of attention-deficit/hyperactivity disorder (ADHD) in children of early and middle school years. The study compared persistence of DSM-IV ADHD and ADHD not otherwise specified (NOS) over 2 years in two groups of Puerto Rican children. METHOD A three-wave study obtained data on Puerto Rican children 5 through 13 years of age at baseline. Samples were drawn in the South Bronx in New York (n = 1,138) and two metropolitan areas in Puerto Rico (n = 1,353). The Diagnostic Interview Schedule for Children Version IV was used to diagnose ADHD and ADHD-NOS. RESULTS ADHD or ADHD-NOS diagnosis at wave 1 strongly predicted disorder at waves 2 and 3. ADHD had a significantly stronger predictive effect than ADHD-NOS consistently across site and gender. There was a significant interaction with baseline age. For those younger at baseline, the strength of the prediction of ADHD-NOS was relatively weak; for older children, the presence of ADHD-NOS at baseline predicted risk of subsequent ADHD or ADHD-NOS. CONCLUSIONS Persistence of ADHD in children of similar ethnicity does not manifest differently across context and gender. Results suggest that age-specific symptom criteria and modification of age-of-onset criteria should be considered for the diagnosis.

ADHD Treatment Patterns of Youth Served in Public Sectors in San Diego and Puerto Rico

This article investigates geographic variation in stimulant medication use by youth with attention-deficit/hyperactivity disorder (ADHD) served by public mental health and/or drug and alcohol programs in San Diego (n = 790) during 1997—1998 and in Puerto Rico ( n = 726) during 1998.Youth were stratified into four groups: (a) ADHD, (b) ADHD—not otherwise specified (ADHD-NOS), (c) other DSM-IV diagnoses, (d) no diagnosis. Reported rates of stimulant use were as follows: ADHD, 32.9% (Puerto Rico) and 38.8% (San Diego), and ADHD-NOS, 20.2% (Puerto Rico) and 17.8% (San Diego).Youth in San Diego were more likely to use other psychotropics and to have experienced residential or inpatient care compared with youth in Puerto Rico. A regression model indicated that predictors of stimulant use at both sites included ADHD, ADHD-NOS, male gender, and younger age. Despite sociodemographic and cultural differences, both settings demonstrated similar patterns of stimulant use, suggesting these medications are not over-used in public sectors.

HIV testing in clinical and community settings for an international sample of Latino immigrants and nonimmigrants.

Latino/as in the United States and Spain make up a disproportionate percentage of cases of HIV infection, and often are diagnosed later than their non-Latino/a counterparts. Understanding the factors that affect HIV testing in different contexts is critical to best promote HIV testing, which is considered essential to both prevention and early treatment. This study explored differences in HIV testing rates among Latino/a participants in an international study designed to examine behavioral health screening for Latino/a populations. We collected data on testing rates and results from 407 Latino/as—both first generation immigrants and those of Latino/a descent—in the United States (Boston) and Spain (Madrid and Barcelona), through interviews conducted in community clinics and agencies. Using multivariate logit models, we evaluated predictors of screening and positive testing, adjusting for sex, age, and clinic type. HIV testing rates were highest in Boston, followed by Barcelona and Madrid (82%, 69%, and 59%, respectively, p < .0001). In multivariate regression models, Barcelona and Madrid patients were significantly less likely to have received testing than Boston patients. Significant positive predictors of HIV testing were: education level higher than high school, HIV concerns, infrequent condom use, other risk behaviors, reports of discrimination, and higher benzodiazepine consumption. Significant differences in HIV testing found in this study help to illuminate best practices for engaging patients in testing across sites. Los latino/as representan, tanto en Estados Unidos como en España, un porcentaje desproporcionado de los casos de infección por el VIH y, a menudo son diagnosticados más tarde que sus homólogos no latino/as. Conocer los factores que influyen en la realización de la prueba del VIH en diferentes contextos resulta fundamental para la promoción de dicha prueba, lo que se considera esencial tanto para la prevención como para el tratamiento precoz. Este estudio internacional explora las diferencias en las tasas de realización de la prueba de VIH entre participantes latino/as y que fue diseñada para examinar el estado de salud mental de los imigrantes latino/as. Para ello, se han recopilado datos sobre las pruebas del VIH y sus resultados en 407 latino/as - tanto inmigrantes como de ascendencia latina- en los Estados Unidos (Boston) y España (Madrid y Barcelona). La información fue recogida en entrevistas realizadas en clínicas y agencias comunitarias. Se evaluaron los factores que predicen hacerse la prueba de VIH y de tener resultados positivos en la misma, ajustando por género, edad y el sitio de reclutamiento del paciente, y empleando para ello un modelo de regresión logística multivariado. La tasa más alta de realización de la prueba de VIH fue la de la población de Boston, seguida por Barcelona y Madrid (82%, 69%, y 59%, respectivamente, p < .0001). Según los modelos de regresión multivariada, la probabilidad de que los pacientes de Barcelona y Madrid se hicieran la prueba fue significativamente menor que la de Boston. Entre los predictores positivos para realizarse la prueba estaban un grado de escolarización superior a la secundaria, el grado de preocupación por el VIH, el uso infrecuente del condón, el informar experiencias de discriminación y el uso elevado de benzodiacepinas. Las diferencias significativas entre las tasas de realización de la prueba del VIH entre las tres ciudades sugieren la necesidad de gestionar mejores prácticas para atraer a los pacientes hacia la realización temprana de la prueba.

Measurement Invariance of the Adolescent Quality of Life-Mental Health Scale (AQOL-MHS) across Gender, Age and Treatment Context

The Adolescent Quality of Life-Mental Health Scale (AQOL-MHS) was designed to measure quality of life in clinical samples of Latino adolescents aged 12–18 years, but has also been used in community samples. The original measure included three factors: Emotional Regulation (ER), Self-Concept (SC) and Social Context (SoC). The goals of this study are to replicate the factor structure using confirmatory factor analysis (CFA), shorten the instrument and test the degree of measurement invariance across gender, age, and type of sample. Participants for the analyses (N = 354) came from two populations in the San Juan Metropolitan Area: (1) adolescents from randomly selected households, using a multi-stage probability sampling design (n = 295), and (2) adolescents receiving treatment at mental health clinics (n = 59). We first carried out a conceptual item analysis for item reduction purposes and then assessed dimensional, configural, metric and scalar invariance for each factor using the Mplus software system. The original 3-factor structure was replicated with comparable model fit in each treatment context. Metric invariance was attained for all three scales across groups. Either full or partial scalar invariance was also observed with DIF in a total of 6 items. Invariance testing supports the use of the abridged 21 item version of the AQOL-MHS to compare diverse individuals with little bias using observed scores, but for refined estimates the ideal scoring will be from a latent variable model.