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
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
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.