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December 1988, Vol 45, No. 12 >
Article | December 1988

Estimnates of the Prevalence of Childhood Maladjustment in a Community Survey in Puerto Rico: Title and subTitle BreakThe Use of Combined Measures

Hector R. Bird, MD; Glorisa Canino, PhD; Maritza Rubio-Stipec, MA; Madelyn S. Gould, PhD; Julio Ribera, PhD; Myrna Sesman, PhD; Michel Woodbury, MD; Sara Huertas-Goldman, MD; Annette Pagan, MD; Arturo Sanchez-Lacay, MD; Margarita Moscoso, MA
[+] Author Affiliations

Accepted for publication Nov 25, 1987.

Reprint requests to Department of Psychiatry, Division of Child Psychiatry, Columbia University College of Physicians and Surgeons, 722 W 168th St, New York, NY 10032 (Dr Bird).


Arch Gen Psychiatry. 1988;45(12):1120-1126. doi:10.1001/archpsyc.1988.01800360068010
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References
Comments

• A two-stage epidemiologic survey was carried out on a probability sample of the population aged 4 through 16 years in Puerto Rico. The survey used the Child Behavior Checklist as a screening instrument, and prevalence rates were estimated on the basis of clinical diagnoses and other measures provided by child psychiatrists during the second stage. Maladjustment was operationally defined through the use of combined measures, including DSM-III diagnosis and a scale of functional impairment. Data were provided on the demographic correlates of maladjustment and on the comorbidity of DSM-III diagnostic domains. The prevalence rates obtained vis-a-vis the availability of mental health services on the island reflected a major public health problem.

REFERENCES

1 +
Canino G, Bird H, Shrout P, Rubio-Stipec M, Bravo M, Martinez R, Sesman M, Guevara L:  Prevalence of specific psychiatric disorders in Puerto Rico . Arch Gen Psychiatry 1987;;44:727-735.
2 +
Robins LN, Helzer JE, Weisman MM, Orvaschel H, Gruenberg E, Burke JD, Regier DA:  Lifetime prevalence of specific psychiatric disorders in three sites . Arch Gen Psychiatry 1984;;41:949-958.
3 +
Meyers JK, Weisman MM, Tischler GL, Holzer CE, Leaf PJ, Orvaschel H, Anthony JC, Boyd JH, Burke JD, Kramer M, Stoltzman R:  Six-month prevalence of psychiatric disorders in three communities . Arch Gen Psychiatry 1984;;41:959-970.
4 +
US Bureau of the Census: General Population Characteristics of Puerto Rico, US Dept Commerce, publication PC 80-1-B53, May 1983.
5 +
Garcia C, Rosello J: Puerto Rico ante el abuso del alcohol . RĂ­o Piedras, Universidad de Puerto Rico, 1976;.
6 +
Robles R, Martinez R, Moscoso M:  Predictors of adolescent drug behavior: The case of Puerto Rico . Youth Soc 1980;;2:415-430.
7 +
Langner T, Gersten J, Green E, Eisenberg J, Herson J, McCarthy E:  Treatment of psychological disorders among urban children . J Consult Clin Psychol 1974;;42:170-179.
8 +
Gould MS, Wunsch-Hitzig R, Dohrenwend BP:  Estimating the prevalence of childhood psychopathology: A critical review . J Am Acad Child Adolesc Psychiatry 1981;;20:462-476.
9 +
Links PS:  Community surveys of the prevalence of childhood psychiatric disorders: A review . Child Dev 1983;;54:531-548.
10 +
Verhulst FC, Akerhuis GW, Althaus M:  Mental health in Dutch children: I. A cross-cultural comparison . Acta Psychiatr Scand Suppl (No. (323) ) 1985;;72:1-108.
11 +
Verhulst FC, Bergen GF, Sanders-Woudstra JA:  Mental health in Dutch children: II. The prevalence of psychiatric disorder relationship between measures . Acta Psychiatr Scand Suppl ( (No. 324) ) 1985;;72:1-44.
12 +
Boyle MH, Offord DR, Hofmann HG, Catlin GP, Byles JA, Cadman DT, Crawford DT, Links PS, Rae-Grant NI, Szatmari P:  Ontario child health study . Arch Gen Psychiatry 1987;;44:826-831, 832-836.
13 +
Achenbach TM, Edelbrock CS:  Behavioral problems and competencies reported by parents of normal and disturbed children aged 4 through 16 . Monogr Soc Res Child Dev 1981;;46(Serial No. 188):1-82.
14 +
Garmezy N:  Never mind the psychologists: Is it good for the children? Clin Psychologist 1978;;31:3.
15 +
Shaffer D, Gould MS, Brasic J, Ambrosini P, Bird HR, Aluwahlia S:  A Children's Global Assessment Scale (CGAS) . Arch Gen Psychiatry 1983;;40:1228-1231.
16 +
Rutter M, Shaffer D:  DSM-III, a step forward or back in terms of the classification of child psychiatric disorders . J Am Acad Child Adolesc Psychiatry 1980;;19:371-394.
17 +
Bird H, Canino G, Gould MS, Ribera J, Rubio-Stipec M, Woodbury M, Huertas SE, Sesman M:  The use of the Child Behavior Checklist as a screening instrument for epidemiologic research: Results of a pilot study . J Am Acad Child Adolesc Psychiatry 1987;;26:207-213.
18 +
Canino G, Bird H, Rubio-Stipec M, Woodbury M, Ribera JC, Huertas SE, Sesman M:  Reliability of child diagnosis in a Hispanic sample . J Am Acad Child Adolesc Psychiatry 1987;;26:560-565.
19 +
Kish L:  A procedure for objective respondent selection within the household . J Am Stat Assoc 1949;;44:380-387.
20 +
Kish L: Survey Sampling . New York, John Wiley & Sons Inc, 1965;.
21 +
Endicott J, Spitzer R, Fleiss J:  The Global Assessment Scale: A procedure of measuring overall severity of psychiatric disturbance . Arch Gen Psychiatry 1976;;33:766-771.
22 +
Bird H, Canino G, Rubio-Stipec M, Ribera J:  Further measures of the psychometric properties of the Children's Global Assessment Scale (CGAS) . Arch Gen Psychiatry 1987;;44:821-824.
23 +
Hidroglou MA, Fuller WA, Heckman RD: Super Carp Survey Sections Statistical Laboratory , ed 6. Ames, Iowa, Iowa State University Press, 1975;.
24 +
Achenbach TM, Edelbrock CS: Manual for the Child Behavior Checklist and Revised Child Behavior Profile . Burlington, Vt, University of Vermont, 1983;.
25 +
Montenegro HA: Salud mental del escolar: Estandardizacion del inventario de probelmas conductales y destrezas sociales de T. Achenbach en ninos de 6-11 anos . Santiago, Chile, 1983;.
26 +
Davie R, Butler H, Goldstein H: From Birth to 7: The Second Report of the National Child Development Study (1958) Cohort . London, Longman Group Ltd, 1972;.
27 +
Rutter M, Yule B, Quinton D, Rowlands 0, Yule W, Berger M:  Attainment and adjustment in two geographical areas: III. Some factors accounting for area differences . Br J Psychiatry 1974;;125:520-533.
28 +
Robins LN:  Follow-up studies , in Quay HC, Werry JS (eds): Psychopathological Disorders of Childhood , ed 2. New York, John Wiley & Sons Inc, 1979;, pp 483-515.
29 +
Richman N, Stevenson J, Graham PJ: Pre-school to School: A Behavior Study . Orlando, Fla, Academic Press Inc, 1982;.
30 +
Costello EJ, Richardean B:  Epidemiology and child diagnosis , in Last CG, Hersen M (eds): Handbook of Child Psychiatric Diagnosis . New York, John Wiley & Sons Inc, in press.
31 +
Anderson JC, Williams S, McGee R, Silva PA:  DSM-III disorders in preadolescent children . Arch Gen Psychiatry 1987;;44:69-76.
32 +
American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders , ed 3. Washington, DC, American Psychiatric Association, 1987;.
33 +
Estadisticas vitales del departmento de salud: Informe anual 1986. San Juan, Puerto Rico, 1986.

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1 +
Canino G, Bird H, Shrout P, Rubio-Stipec M, Bravo M, Martinez R, Sesman M, Guevara L:  Prevalence of specific psychiatric disorders in Puerto Rico . Arch Gen Psychiatry 1987;;44:727-735.
2 +
Robins LN, Helzer JE, Weisman MM, Orvaschel H, Gruenberg E, Burke JD, Regier DA:  Lifetime prevalence of specific psychiatric disorders in three sites . Arch Gen Psychiatry 1984;;41:949-958.
3 +
Meyers JK, Weisman MM, Tischler GL, Holzer CE, Leaf PJ, Orvaschel H, Anthony JC, Boyd JH, Burke JD, Kramer M, Stoltzman R:  Six-month prevalence of psychiatric disorders in three communities . Arch Gen Psychiatry 1984;;41:959-970.
4 +
US Bureau of the Census: General Population Characteristics of Puerto Rico, US Dept Commerce, publication PC 80-1-B53, May 1983.
5 +
Garcia C, Rosello J: Puerto Rico ante el abuso del alcohol . RĂ­o Piedras, Universidad de Puerto Rico, 1976;.
6 +
Robles R, Martinez R, Moscoso M:  Predictors of adolescent drug behavior: The case of Puerto Rico . Youth Soc 1980;;2:415-430.
7 +
Langner T, Gersten J, Green E, Eisenberg J, Herson J, McCarthy E:  Treatment of psychological disorders among urban children . J Consult Clin Psychol 1974;;42:170-179.
8 +
Gould MS, Wunsch-Hitzig R, Dohrenwend BP:  Estimating the prevalence of childhood psychopathology: A critical review . J Am Acad Child Adolesc Psychiatry 1981;;20:462-476.
9 +
Links PS:  Community surveys of the prevalence of childhood psychiatric disorders: A review . Child Dev 1983;;54:531-548.
10 +
Verhulst FC, Akerhuis GW, Althaus M:  Mental health in Dutch children: I. A cross-cultural comparison . Acta Psychiatr Scand Suppl (No. (323) ) 1985;;72:1-108.
11 +
Verhulst FC, Bergen GF, Sanders-Woudstra JA:  Mental health in Dutch children: II. The prevalence of psychiatric disorder relationship between measures . Acta Psychiatr Scand Suppl ( (No. 324) ) 1985;;72:1-44.
12 +
Boyle MH, Offord DR, Hofmann HG, Catlin GP, Byles JA, Cadman DT, Crawford DT, Links PS, Rae-Grant NI, Szatmari P:  Ontario child health study . Arch Gen Psychiatry 1987;;44:826-831, 832-836.
13 +
Achenbach TM, Edelbrock CS:  Behavioral problems and competencies reported by parents of normal and disturbed children aged 4 through 16 . Monogr Soc Res Child Dev 1981;;46(Serial No. 188):1-82.
14 +
Garmezy N:  Never mind the psychologists: Is it good for the children? Clin Psychologist 1978;;31:3.
15 +
Shaffer D, Gould MS, Brasic J, Ambrosini P, Bird HR, Aluwahlia S:  A Children's Global Assessment Scale (CGAS) . Arch Gen Psychiatry 1983;;40:1228-1231.
16 +
Rutter M, Shaffer D:  DSM-III, a step forward or back in terms of the classification of child psychiatric disorders . J Am Acad Child Adolesc Psychiatry 1980;;19:371-394.
17 +
Bird H, Canino G, Gould MS, Ribera J, Rubio-Stipec M, Woodbury M, Huertas SE, Sesman M:  The use of the Child Behavior Checklist as a screening instrument for epidemiologic research: Results of a pilot study . J Am Acad Child Adolesc Psychiatry 1987;;26:207-213.
18 +
Canino G, Bird H, Rubio-Stipec M, Woodbury M, Ribera JC, Huertas SE, Sesman M:  Reliability of child diagnosis in a Hispanic sample . J Am Acad Child Adolesc Psychiatry 1987;;26:560-565.
19 +
Kish L:  A procedure for objective respondent selection within the household . J Am Stat Assoc 1949;;44:380-387.
20 +
Kish L: Survey Sampling . New York, John Wiley & Sons Inc, 1965;.
21 +
Endicott J, Spitzer R, Fleiss J:  The Global Assessment Scale: A procedure of measuring overall severity of psychiatric disturbance . Arch Gen Psychiatry 1976;;33:766-771.
22 +
Bird H, Canino G, Rubio-Stipec M, Ribera J:  Further measures of the psychometric properties of the Children's Global Assessment Scale (CGAS) . Arch Gen Psychiatry 1987;;44:821-824.
23 +
Hidroglou MA, Fuller WA, Heckman RD: Super Carp Survey Sections Statistical Laboratory , ed 6. Ames, Iowa, Iowa State University Press, 1975;.
24 +
Achenbach TM, Edelbrock CS: Manual for the Child Behavior Checklist and Revised Child Behavior Profile . Burlington, Vt, University of Vermont, 1983;.
25 +
Montenegro HA: Salud mental del escolar: Estandardizacion del inventario de probelmas conductales y destrezas sociales de T. Achenbach en ninos de 6-11 anos . Santiago, Chile, 1983;.
26 +
Davie R, Butler H, Goldstein H: From Birth to 7: The Second Report of the National Child Development Study (1958) Cohort . London, Longman Group Ltd, 1972;.
27 +
Rutter M, Yule B, Quinton D, Rowlands 0, Yule W, Berger M:  Attainment and adjustment in two geographical areas: III. Some factors accounting for area differences . Br J Psychiatry 1974;;125:520-533.
28 +
Robins LN:  Follow-up studies , in Quay HC, Werry JS (eds): Psychopathological Disorders of Childhood , ed 2. New York, John Wiley & Sons Inc, 1979;, pp 483-515.
29 +
Richman N, Stevenson J, Graham PJ: Pre-school to School: A Behavior Study . Orlando, Fla, Academic Press Inc, 1982;.
30 +
Costello EJ, Richardean B:  Epidemiology and child diagnosis , in Last CG, Hersen M (eds): Handbook of Child Psychiatric Diagnosis . New York, John Wiley & Sons Inc, in press.
31 +
Anderson JC, Williams S, McGee R, Silva PA:  DSM-III disorders in preadolescent children . Arch Gen Psychiatry 1987;;44:69-76.
32 +
American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders , ed 3. Washington, DC, American Psychiatric Association, 1987;.
33 +
Estadisticas vitales del departmento de salud: Informe anual 1986. San Juan, Puerto Rico, 1986.

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