May Yeh

Prevalence of Psychiatric Disorders in Youths Across Five Sectors of Care

OBJECTIVE To examine the prevalence of psychiatric disorders among youths from the following five public sectors of care: alcohol and drug services (AD), child welfare (CW), juvenile justice (JJ), mental health (MH), and public school services for youths with serious emotional disturbance (SED) in San Diego, California. METHOD The Diagnostic Interview Schedule for Children was administered between October 1997 and January 1999 for 1,618 randomly selected youths aged 6-18 years who were active in at least one of the five sectors. RESULTS Fifty-four percent of the participants met criteria for at least one study disorder. Attention-deficit/hyperactivity disorder (ADHD) and disruptive behavior disorders (50%) were much more common than anxiety (10%) or mood (7%) disorders. Youths who were active in the MH and SED sectors were more likely than those not in these sectors to meet criteria for a disorder; youths in the CW sector were least likely. CONCLUSIONS Rates of psychiatric disorders, specifically ADHD and disruptive behavior disorders, are extremely high for youths in public sectors of care. Rates are generally higher in sectors designed to serve youths with psychiatric needs, but the prevalence of disorders was also high in sectors not specifically designed for this need (e.g., CW and JJ).

The acculturation gap-distress hypothesis among high-risk mexican american families

The authors tested the acculturation gap-distress hypothesis by examining whether parent-adolescent acculturation gaps were associated with greater conflict and youth conduct problems among 260 high-risk Mexican American families. The authors operationalized acculturation gaps in 2 ways: parent-youth mismatches in acculturation style, and parent-youth discrepancies in acculturation toward both mainstream and heritage cultures. Acculturation gaps were common, but results of hierarchical regression analyses indicated that parent-youth discrepancies in acculturation toward mainstream and heritage cultures were not related to increased conflict or youth conduct problems. Conduct problems were no higher in families in which the adolescent was more aligned with mainstream culture than the parent. Unexpectedly, the authors found more youth conduct problems in families in which the youth was more aligned with traditional culture than the parent. The results call into question the assumption that the more rapid acculturation of adolescents to American culture inevitably leads to distress in minority families.

Racial/ethnic differences in parental endorsement of barriers to mental health services for youth.

The present study investigated parental endorsement of barriers to care in a racially/ethnically diverse, at-risk sample of youth with mental health needs by testing the following hypotheses: (1) African American, Asian/Pacific Islander American, and Latino youth would have higher levels of unmet need compared to Non-Hispanic Whites (NHWs); (2) Parents of ethnic minority youth would report a greater number of barriers to mental health services for their children than would parents of NHWs; (3) The pattern of greater barrier endorsement by parents of ethnic minorities compared to parents of NHWs would persist across different barrier types; (4) Barrier endorsement would be related to unmet need for mental health services. As hypothesized, ethnic minority youth had higher levels of unmet need as compared to NHWs. However, despite this finding, parents of ethnic minority youth reported fewer barriers than did parents of NHWs, and this pattern generally persisted across barrier types. Furthermore, barrier endorsement was unrelated to unmet need. Post hoc analyses suggest the influence of cultural factors upon barrier endorsement, indicating the importance of taking such influences into account in future research on barriers to care.

Parental Beliefs About the Causes of Child Problems: Exploring Racial/Ethnic Patterns

OBJECTIVE To examine racial/ethnic patterns of parental beliefs about etiological explanations for youth problems. METHOD The parents of 1338 youths with identified mental health problems were asked about their beliefs about the causes for their childrens problems from a questionnaire with 11 etiological categories. RESULTS Parents of African American, Asian/Pacific Islander American, and Latino youths were generally less likely than parents of non-Hispanic whites to endorse etiologies consistent with biopsychosocial beliefs about mental illness. Some racial/ethnic differences were evident for sociological causes, but none existed for spiritual or nature disharmony etiologies. Analyses controlling for factors including child symptomatology produced fewer significant racial/ethnic differences but a similar pattern of results. CONCLUSIONS Racial/ethnic differences in parental beliefs about the causes of child problems exist in an at-risk sample, and implications for the help-seeking, utilization, and effectiveness of biopsychosocially oriented mental health services for diverse populations are discussed.

The Relation Between Violence Exposure and Conduct Problems Among Adolescents: A Prospective Study

This study tested the hypothesis that exposure to community violence, intimate partner violence, and child maltreatment independently contribute to the prediction of conduct problems over a 2-year period. Participants were a subsample of youth ages 12 to 17 years (N = 423) from the Patterns of Care study, which drew a stratified random sample of high-risk youth receiving services from public service sectors. Exposure to community violence significantly predicted conduct disorder and externalizing problems 2 years later when potential confounds were controlled. Child maltreatment predicted conduct disorder but not externalizing symptoms. Exposure to intimate partner violence was not related to either outcome. Exposure to community violence contributed to the development of conduct disorder and externalizing symptoms, even when exposure to child maltreatment or intimate partner violence was controlled. Results are discussed in terms of implications for treatment and prevention of youth conduct problems.

Parent-Child Interaction Therapy for Mexican Americans: A Randomized Clinical Trial.

This study compared the effectiveness of a culturally modified version of Parent–Child Interaction Therapy (PCIT), called Guiando a Niños Activos (GANA), to the effectiveness of standard PCIT and Treatment as Usual (TAU) for young Mexican Amerian children with behavior problems. Fifty-eight Mexican Amerian families whose 3- to 7-year-old child had a clinically significant behavior problems were randomly assigned to GANA, standard PCIT, or TAU. All three treatment approaches produced significant pre–post improvement in conduct problems across a wide variety of parent-report measures. GANA produced results that were significantly superior to TAU across a wide variety of both parent report and observational indices; however, GANA and PCIT did not differ significantly from one another. PCIT was superior to TAU on two of the parent report indices and almost all of the observational indices. There were no significant differences between the three groups on treatment dropout, and families were more satisfied with both GANA and PCIT than with TAU.

Why Bother with Beliefs? Examining Relationships between Race/Ethnicity, Parental Beliefs about Causes of Child Problems, and Mental Health Service Use.

In this study, the authors examined the role of parental beliefs about the causes of child problems in predicting later mental health service use in a large, diverse population of at-risk youths. Study hypotheses were that parental beliefs consistent with biopsychosocial causes would be associated with later mental health service use; sociological, spiritual, or nature disharmony etiologies would be negatively associated with service use; and beliefs would partially mediate the relationship between race/ethnicity and service use. Of the 5 biopsychosocial beliefs, 2 were positively related to later mental health service use. Unexpectedly, of the 6 parental beliefs related to sociological, spiritual, or nature disharmony etiologies, only 1 was negatively associated with later service use patterns. Parental endorsement of etiologies relating to physical causes, relational issues, trauma, and prejudice was found to partially mediate the relationship between race/ethnicity and service use for Asian/Pacific Islander American and Latino youths. ((c) 2005 APA, all rights reserved).

Referral sources, diagnoses, and service types of youth in public outpatient mental health care: A focus on ethnic minorities

Racial/ethnic variations in clinical and service delivery characteristics among youth in public outpatient mental health services were examined using data from San Diego County mental health service programs for fiscal year 1996 to 1997 (N=3,962). Differences in referral sources, primary diagnoses, and service types were investigated for three racial/ethnic groups (African Americans, Asian/Pacific Islander Americans, and Latinos) compared to non-Hispanic whites. Controlling for age, gender, functional impairment, and prior service use, significant differences by race/ethnicity were found for all three variables studied. Possible explanations for these variations and future directions for research are discussed.

Race/Ethnicity and Inter-Informant Agreement in Assessing Adolescent Psychopathology.

The authors examined the influence of race/ethnicity on patterns of ratings of adolescent psychopathology completed by adolescents, parents, and teachers in a sample of 600 adolescents. Robust racial/ethnic differences in behavior problems emerged with parent and teacher reports, but not with adolescent self-reports. Discrepancy scores revealed that minority parents reported fewer behavior problems than did youth. Such findings have important implications for treatment seeking, as parents are often the initiators of service use for youth. Compared to other informants, teachers reported fewer internalizing problems among minority adolescents in general, fewer externalizing problems in Asian/Pacific Islanders,and more externalizing problems for African Americans. These findings are consistent with a number of explanations, including cultural differences in adult distress thresholds, racial/ ethnic bias among teachers, and cultural differences in symptom expression.

Racial and Ethnic Variations in Mental Health Care Utilization Among Children in Foster Care

Although children placed in foster care have an elevated need for mental health services, little is known about the extent to which their needs are met and the factors associated with their utilization of such services. In this study we examined racial and ethnic differences in caregiver-reported mental health service utilization rates among a sample of 659 youth ages 2-17 years in foster care. Results indicate that White American youth were significantly more likely to receive services compared to African American and Latino youth, even when the effects of possible confounding variables were controlled. Possible explanations and implications for racial and ethnic disparities in service utilization are discussed.