Self-reported neighborhood stressors and sleep quality among Puerto Rican young adults

OBJECTIVE

To examine the association between changes in self-reported neighborhood stressors and sleep quality and determine whether this varied by sociocultural context among Puerto Rican young adults.

METHODS

Data come from the Boricua Youth Study Health Assessment, a sample of Puerto Rican young adults from San Juan, Puerto Rico, and South Bronx, New York (n = 818; mean age=22.9years). Sleep quality was assessed using the Pittsburgh Sleep Quality Index (PSQI). Neighborhood social stressors (disorder, social cohesion, and safety) were parent-reported in childhood and self-reported in young adulthood and categorized into: low in childhood/young adulthood (reference group), high in childhood/low in young adulthood, low in childhood/high in young adulthood, and high in childhood/young adulthood. Sociocultural context was based on participant residence during childhood (San Juan vs. South Bronx).

RESULTS

Adjusting for sociodemographic factors, living with high neighborhood stressors in both childhood and young adulthood (prevalence ratios=1.30, 95% CI: 1.01, 1.66) was associated with overall poor sleep (PSQI score >5). Among PSQI components, living with high neighborhood stressors in young adulthood only or in both time periods was associated with worse subjective sleep quality and daytime dysfunction. Additionally, there were various associations between the neighborhood stressor measures and PSQI components. Results did not differ by sociocultural context.

CONCLUSION

Findings suggest that living with high levels of neighborhood stressors during childhood and young adulthood may have a cumulative adverse impact on sleep quality in young adulthood.

Sociocultural Risk and Resilience in the Context of Adverse Childhood Experiences

Importance

Knowledge about childhood resilience factors relevant in circumstances of marginalization and high numbers of adverse childhood experiences (ACEs) can improve interventions.

Objective

To identify sociocultural resilience factors in childhood that are associated with better young adult mental health in the context of ACEs.

Design, Setting, and Participants

This cohort study examined 4 waves of data from the Boricua Youth Study, which included Puerto Rican children from the South Bronx, New York, and San Juan, Puerto Rico. Participants were aged 5 to 17 years at waves 1 through 3 (2000-2003) and aged 15 to 29 years at wave 4 (2013-2017). Linear and logistic regression models tested the associations of 7 childhood resilience factors and their interaction with ACEs on young adult mental health outcomes. Data were analyzed from June 2021 to October 2023.

Main Outcomes and Measures

Perceived stress, major depressive disorder and/or generalized anxiety disorder (MDD/GAD), and substance use disorder (SUD) in young adulthood.

Results

Among a total 2004 participants, the mean (SD) age at wave 4 was 22.4 (2.9) years; 1024 participants (51.1%) were female, and 980 (48.9%) were male. Positive parent-child relationships and nonparental adult support during childhood were associated with both lower perceived stress (β = -0.14; SE = 0.02; P < .001; β = -0.08; SE = 0.03; P = .003, respectively) and lower odds of MDD/GAD (adjusted odds ratio [aOR], 0.84; 95% CI, 0.73 to 0.97; aOR = 0.81; 95% CI, 0.69 to 0.95, respectively) in young adulthood. Maternal warmth reported during childhood was also associated with lower young adult perceived stress (β = -0.11; SE = 0.02; P < .001). None of the resilience factors were associated with SUD. The resilience factors familism, friendships, and family religiosity were not associated with any of the mental health outcomes. ACEs were associated with poorer mental health outcomes; however, none of the resilience factors exhibited interactions consistent with being protective for ACEs. Unexpectedly, higher family religiosity was associated with more perceived stress in the presence of higher ACEs.

Conclusions and Relevance

The results of this study suggest that promoting positive relationships with adults during childhood may reduce later young adulthood stress and MDD/GAD. However, there is still a need to identify sociocultural childhood protective factors for ACEs. Caution should be taken in assuming what resilience factors are relevant for a given group, as higher family religiosity (one postulated resilience factor) was unexpectedly associated with a stronger, rather than a weaker, association between ACEs and perceived stress in young adulthood.

Adverse Childhood Experiences and Sleep Disturbances Among Puerto Rican Young Adults

Importance

Sleep quality is a known marker of overall health. Studies suggest that adverse childhood experiences (ACEs) are associated with sleep disturbances among children and adults.

Objective

To examine the association of retrospective and prospective ACEs with sleep quality among a cohort of Puerto Rican young adults from 2 sociocultural contexts.

Design, Setting, and Participants

This prospective cohort study used data from the Boricua Youth Study (BYS), a population-based study representing Puerto Rican children from the South Bronx, New York, and Puerto Rico conducted from August 2000 to August 2003. Participants who were 5 to 9 years of age at enrollment in the BYS and who participated in wave 4 of the BYS took part in the Health Assessment (HA) when they were 18 to 29 years of age, from April 2013 to August 2017. Of the eligible 982 participants, 813 (82.8%) participated in the HA. Statistical analysis was conducted from January 2023 to January 2024.

Exposures

Prospective ACEs measured from parent and youth responses and retrospective ACEs measured among young adults using questions from the validated ACE questionnaire from the original ACEs study conducted by Kaiser Permanente and the Centers for Disease Control and Prevention and published in 1998. Analysis included 8 overlapping items from both questionnaires.

Outcomes

Sleep quality was assessed in the HA with the Pittsburgh Sleep Quality Index. The summary score included 7 components of the Pittsburgh Sleep Quality Index. The hypothesis was formulated after data collection. Sleep quality information was gathered at the same time as retrospective ACEs in the HA.

Results

Of the 813 participants, 438 (53.9%) lived in Puerto Rico as children, 411 (50.6%) identified as female, and the mean (SE) age of participants was 22.9 (0.07) years. After adjusting for sociodemographic factors, retrospective ACEs had a significant association with worse sleep outcomes (β [SE] = 0.29 [0.07]; 95% CI, 0.15-0.44; P < .001). Prospective ACEs did not have a significant association with sleep quality, after adjusting for sociodemographic factors (β [SE] = 0.05 [0.10]; 95% CI, -0.14 to 0.24; P = .59).

Conclusions and Relevance

This study suggests that there is a significant association between retrospective ACEs and sleep quality among Puerto Rican young adults, after adjusting for sociodemographic factors. Prospective ACEs were not significantly associated with sleep disturbances, after adjusting for sociodemographic factors. Addressing ACEs reported in young adulthood may help reduce sleep disorders.

Does Context and Adversity Shape Sexual Behavior in Youth? Findings from Two Representative Samples of Puerto Rican Youth

Sexual risk behaviors often co-occur. Understanding the heterogeneity in patterns of sexual behavior among youth and how context of majority and minoritized status may be related to these behaviors can inform targeted STIs/HIV interventions. Data are from the Boricua Youth Study, a longitudinal study of two probability samples of Puerto Rican youth recruited in the South Bronx (SBx) and the metropolitan area in Puerto Rico (PR). We identified patterns of sexual behaviors among young adults (ages 15-24) with sexual experience (N = 1,203) using latent class analysis. Analyses examined context differences and the prospective relationship between adverse childhood experiences (ACEs) (childhood maltreatment/violence, family/parental dysfunction) and patterns of sexual behaviors (age at first sex, number of sex partners, sex with a high-risk partner, condom use, sex while intoxicated, oral sex, anal sex). We identified five classes of sexual behaviors: (1) currently inactive (16.51%); (2) single partner, low activity (13.49%); (3) single partner, inconsistent condom use (32.19%); (4) single partner, sex without a condom (27.65%); and (5) multirisk (10.16%). Young adults from the SBx (minoritized context), those who identified as male, and those with higher child maltreatment/violence ACEs were more likely to be in the multi-risk class relative to the single partner, inconsistent condom use class. Those from the SBx were also more likely to be in the single partner, sex without condom class, relative to the single partner, inconsistent condom use class. Differences in young adults' patterns of sexual behaviors between the two contexts, one representing the minoritized context (SBx) contrasted to the majority context (PR), were not explained by ACEs. Findings highlight the heterogeneity in the patterns of sexual behaviors among Puerto Rican young adults as well as how such patterns vary based on sociocultural contexts. Exposure to child maltreatment/violence ACEs was related to the riskier patterns; however, they did not explain why riskier patterns of sexual behaviors were found in the SBx compared to PR. Results underscore the need for tailored interventions and more in-depth examination of differences across contexts.

Association of Childhood Adversities With Suicide Ideation and Attempts in Puerto Rican Young Adults

Importance

Racial/ethnic and sex disparities in suicide ideation and attempts are well established, with higher risk of suicide ideation and attempt among US racial/ethnic minority school-aged youths (than their White peers) and girls and women (than boys and men). The suicide-related risk of racial/ethnic minority young adults, especially young women, may be strongly influenced by adverse childhood experiences, known early determinants of suicide ideation and attempts.

Objectives

To assess lifetime and past-year prevalence estimates of suicide ideation and suicide attempt and to examine sex differences in the role of adverse childhood experiences as a prospective risk factor for Puerto Rican young adults from 2 sociocultural contexts.

Design, Setting, and Participants

Data in this longitudinal cohort study are from 4 waves of the Boricua Youth Study, a population-based cohort study of Puerto Rican children from San Juan and Caguas, Puerto Rico, and the South Bronx, New York, 5 to 17 years of age (N = 2491; waves 1-3: 2000-2004) and 15 to 29 years of age (wave 4: 2013-2017). Data analysis was performed from February 26, 2019, to October 16, 2020.

Exposures

Adverse childhood experiences were assessed by interview in childhood and early adolescence (waves 1-3) and included child maltreatment (physical, sexual, and emotional abuse and neglect), exposure to violence, parental loss (separation, divorce, and death), and parental maladjustment (mental health problems, substance or alcohol abuse, intimate partner violence, and incarceration).

Main Outcomes and Measures

Lifetime and past-year suicide ideation and attempt were assessed in young adulthood (wave 4) using the World Health Organization Composite International Diagnostic Interview.

Results

Among 2004 Puerto Rican young adults (80.4% of the original cohort; mean [SD] age, 22.9 [2.8] years; 1019 [50.8%] male), young women compared with young men had a higher prevalence of lifetime suicide attempt (9.5% vs 3.6%) and lifetime suicide ideation (16.4% vs 11.5%), whereas past-year suicide ideation (4.4% vs 2.4%) was not statistically different. Logistic regression models, adjusting for demographics and lifetime psychiatric disorders, found that young women but not young men with more adverse childhood experiences had higher odds of suicide ideation (lifetime; odds ratio [OR], 2.44; 95% CI, 1.54-3.87; past year: OR, 2.56; 95% CI, 1.18-5.55). More adverse childhood experiences were also prospectively associated with lifetime suicide attempt (OR, 1.16; 95% CI, 1.04-1.29), irrespective of sex.

Conclusions and Relevance

The findings of this cohort study suggest that, among Puerto Rican young adults from 2 different sociocultural contexts, adverse childhood experiences were relevant to understanding suicide attempt and suicide ideation, the latter specifically among young women. The prevention of cumulative adverse childhood experiences could reduce later risk of suicide attempts and, among young women, for suicide ideation.

Development, Psychopathology, and Ethnicity II: Psychiatric Disorders Among Young Adults

OBJECTIVE

To estimate the prevalence of psychiatric disorders and their continuity since childhood among young adults from the same ethnic group living in 2 low-income contexts.

METHOD

Young adults (N = 2,004; ages 15-29) were followed (82.8% retention) as part of the Boricua Youth Study, a study of Puerto Rican youths recruited at ages 5-13 in the South Bronx (SBx), New York, and Puerto Rico (PR). We estimated prevalence (lifetime; past year) of major depressive (MDD), mania, hypomania, generalized anxiety (GAD), tobacco dependence, and any other substance use disorders (SUD).

RESULTS

The prevalence of every disorder was higher among young women from the SBx compared with those from PR (eg, 9.2% versus 4.1% past-year SUD; 14% versus 6.8% for MDD/GAD). Among SBx young men, tobacco dependence and illicit SUD were elevated. Across both contexts, men had higher adjusted odds of illicit SUD than women, while women had higher GAD than men. MDD did not differ by gender. Young adulthood disorders (except for alcohol use disorder and GAD) followed childhood disorders. For example, childhood externalizing disorders preceded both MDD (young men and women) and illicit SUD (young women only).

CONCLUSION

Young women raised in a context where adversities like ethnic discrimination concentrate are at high risk for psychiatric disorders. In certain high-poverty contexts, young men may present with MDD as often as women. Interventions to prevent psychiatric disorders may need to address gender-specific processes and childhood disorders. However, SUD prevention among young men may need to address other factors.

Developmental Psychopathology and Ethnicity I: The Young Adulthood Assessment of the Boricua Youth Study

OBJECTIVE

Developmental psychopathology processes pertinent to underserved ethnically diverse youths may not always coincide with those relevant to youths from nondisadvantaged groups. This article reports on the young adulthood assessment (fourth wave; April 2013 to August 2017) of the Boricua Youth Study, which includes 2 population-based samples of children of Puerto Rican background (N = 2,491) aged 5-13 years (recruited in 2000), in the South Bronx, New York, and San Juan, Puerto Rico.

METHOD

Study procedures included intensive participant tracking and in-person interviews of young adults and, when possible, their parents. Study participation rates, measures, and weights are described.

RESULTS

At Boricua Youth Study wave 4 (on average 11.3 years since last wave of participation), we reassessed 2,004 young adults (mean age = 22.9 years, range = 15-29 years; 51% women; retention rate adjusted for ineligibility = 82.7%) and available parents (n = 1,180). Nonparticipation was due to inability to locate/contact participants (8.6%); refusal (4.7%); and ineligible status (2.8%) owing to cognitive impairment, incarceration, or death. Among participants originally from Puerto Rico, 91% stayed in Puerto Rico during young adulthood. Of participants from the South Bronx, 52.4% remained in the area (85.8% within 100 miles). Most study measures had good internal consistency (Cronbach α ≥ .70).

CONCLUSION

Our results support the viability of retaining a population-based cohort of children from the same ethnic group across 2 contexts during a life stage when individuals are likely to move. Longitudinal samples that are generalizable to underserved populations can elucidate developmental processes of relevance for curtailing the risk of psychopathology in disadvantaged contexts.

Developmental Trends in Sexual Attraction Among Puerto Rican Early Adolescents in Two Contexts

Sexual attraction (SA), the earliest stage of sexual orientation, is scarcely studied. This prospective study examined, over 3 years, prevalence, changes in SA, and the role of context, among 946 Puerto Rican youth, aged 11-13 years at initial assessment in the South Bronx (SBx), New York City, and Puerto Rico (PR). Overall, 98.1% of boys and 95.3% of girls reported opposite-sex only SA at some point, whereas 13.8% of girls and 12.0% of boys reported any-same SA. Opposite-sex only SA increased over time, whereas other SAs decreased except for any same-sex SA among SBx girls. Girls in the SBx and younger youth in PR reported more any same-sex SA. Context and culture may play a role in the developmental trajectories of adolescents' SA.

Combined effects of multiple risk factors on asthma in school-aged children

BACKGROUND

Little is known about synergistic effects of several risk factors on asthma. We developed a risk score in Puerto Rican children, and then used this score to estimate the combined effects of multiple risk factors on asthma at school age in Puerto Rican and Swedish children.

METHODS

Case-control study in 609 Puerto Rican children (aged 6-14 years) and longitudinal birth cohort study of 2290 Swedish children followed up to age 12 years (The Children, Allergy, Milieu, Stockholm, Epidemiological Survey [BAMSE] Study). In both cohorts, there was data on parental asthma, sex, obesity, allergic rhinitis, and early-life second-hand smoke (SHS); data on diet and (in children ≥9 years) lifetime exposure to gun violence were also available in the Puerto Rico study. Asthma was defined as physician-diagnosed asthma and ≥1 episode of wheeze in the previous year.

RESULTS

In a multivariable analysis in Puerto Rican children, male sex, parental asthma, allergic rhinitis, early-life SHS, an unhealthy diet and (in children ≥9 years) gun violence were each significantly associated with asthma. We next created a risk score using these variables (range, 0 to 5-6 in Puerto Rico and 0 to 4 in BAMSE). Compared with Puerto Rican children without any risk factors (i.e. a score of 0), Puerto Rican children with 2, 3, and at least 4 risk factors had 3.6 times (95% CI = 1.4-9.2), 10.4 times (95% CI = 4.0-27.0), and 21.6 times (95% CI = 7.2-64.9) significantly higher odds of asthma, respectively. In BAMSE, the presence of 2, 3, and at least 4 risk factors was significantly associated with 4.1 times (95% CI = 2.3-7.4), 6.3 times (95% CI = 3.0-13.3), and 17.2 times (95% CI = 4.1-73.2) increased odds of asthma at age 12 years.

CONCLUSIONS

Our findings emphasize the multifactorial etiology of asthma, and suggest that concurrent eradication or reduction of several modifiable risk factors may better prevent or reduce the burden of childhood asthma.

Cockroach allergen exposure and plasma cytokines among children in a tropical environment

BACKGROUND

Little is known about the effects of socioeconomic status or cockroach allergen on immune responses in school-age children, particularly in tropical environments.

OBJECTIVE

To examine whether cockroach allergen and/or socioeconomic status is associated with plasma cytokine levels in Puerto Rican children.

METHODS

This was a cross-sectional study of 532 children (6-14 years old) with (n = 272) and without (n = 260) asthma in San Juan (Puerto Rico). House dust allergens (cockroach [Bla g 2], dust mite [Der p 1], cat dander [Fel d 1], dog dander [Can f 1], and mouse urinary protein [Mus m 1]) were quantified using monoclonal antibody arrays. A panel of 14 cytokines (interleukin [IL]-1β, IL-4, IL-6, IL-10, IL-17A, IL-17F, IL-21, IL-22, IL-23, IL-25, IL-31, IL-33, interferon-γ, and tumor necrosis factor-α) was measured in plasma samples. Low household income was defined as less than $15,000 per year (below the median income for Puerto Rico in 2008-2009). Linear regression was used for the analysis of cockroach allergen and plasma cytokines.

RESULTS

In a multivariable analysis adjusting for low income and other allergen levels, cockroach allergen was significantly associated with decreased IL-17A and with increased levels of 8 cytokines (IL-4, IL-10, IL-17F, IL-21, IL-25, IL-31, interferon-γ, and tumor necrosis factor-α). After stratifying this analysis by cockroach allergy (ie, having a cockroach positive immunoglobulin E reaction), our findings remained largely unchanged for children sensitized to cockroach but became weaker and statistically nonsignificant for non-sensitized children.

CONCLUSION

Cockroach allergen has broad effects on adaptive immune responses in school-age children in a tropical environment, particularly in those sensitized to cockroach.

Family Structure, Transitions and Psychiatric Disorders Among Puerto Rican Children

This paper examines whether family structure and its transitions are associated with internalizing and externalizing psychiatric disorders among Puerto Rican-origin children. It uses longitudinal data (three waves) from the Boricua Youth Study, which includes probability samples of children in the South Bronx (New York) and San Juan (Puerto Rico) (n = 2,142). We also examine factors which may explain how family structure and transitions may be related to child psychiatric disorders. Our results show that for both internalizing and externalizing disorders there were no significant differences between children of cohabiting (biological or step) parents or of single parents compared to children of married biological parents. In Puerto Rico only, transitioning once from a two-parent family to a single-parent family was related to child internalizing disorders. Family transitions were not associated with externalizing disorders at either site. Context may be an important factor shaping the risk that family dissolution is followed by an internalizing disorder among children.

A Quantitative Analysis of Ataque de Nervios in Puerto Rico

The authors present a quantitative analysis and assessment of the symptoms of ataque de nervios. A sample of 121 individuals living in Puerto Rico provided qualitative and structured data on ataques de nervios and psychiatric correlates. A total of 77 participants reported having an ataque de nervios during their lifetimes. Their reports of symptoms associated with the ataque-episode were analyzed using factor analysis. Two dimensions emerged from the analysis, representing respectively internalizing and externalizing experiences. Results sustained the heterogeneity of ataque de nervios with a marked anxiety component. The authors discuss results in the context of classification and understanding of ataques de nervios and a model for studying cultural variance among cultural syndromes.

Sex Differences and Depression in Puerto Rico

Sex differences in rates of depressive disorders and depressive symptomatology, as measured by the Diagnostic Interview Schedule, are examined for an island-wide probability sample of Puerto Rico. Consistent with previous research, depression is significantly more prevalent in Puerto Rican women than men. Risk factors associated with depressive symptomatology are examined from a sex-role perspective. The results of multiple regression analyses show that even after demographic, health and marital and employment status variables are controlled, women continue to be at higher risk of depressive symptomatology than men. These results are interpreted within a cultural and sex-role perspective.

Rethinking funding priorities in mental health research

Mental health research funding priorities in high-income countries must balance longer-term investment in identifying neurobiological mechanisms of disease with shorter-term funding of novel prevention and treatment strategies to alleviate the current burden of mental illness. Prioritising one area of science over others risks reduced returns on the entire scientific portfolio.

The longitudinal relationship between parental reports of asthma and anxiety and depression symptoms among two groups of Puerto Rican youth

OBJECTIVES

This study aims to examine the relationship between parental reports of child asthma and levels and slopes of anxiety and depression symptoms among two contrasting groups of Puerto Rican youth, and to determine whether asthma is a special risk above and beyond parents' reports of other youths' medical conditions.

METHODS

Two probability samples of youth in San Juan and Caguas, Puerto Rico (n=673) and in the south Bronx, New York (n=598), and their caretakers were interviewed in three yearly assessments. Parental reports of their children's asthma during each assessment were used to indicate whether youth had intermittent (PR=34%, NY=23%) or persistent (PR=7%, NY=16%) asthma. Youths' depression and anxiety symptoms were assessed using self reports to the DISC-IV. Information on youths' medical comorbidity was gathered through parental reports.

RESULTS

Multilevel analyses adjusting for comorbid medical conditions indicated that parental reports of youths' intermittent and persistent asthma were related to higher levels, but similar slopes, of anxiety and depression among youth in New York. In Puerto Rico, youth with persistent asthma experienced less improvement in anxiety over time than youth without asthma, but no other associations were found.

CONCLUSION

Having asthma, based on parental reports, represents a risk factor for Puerto Rican youths' internalizing symptoms, even after adjusting for comorbid medical conditions. This risk is more pronounced among youth living in New York, which highlights the importance of considering the social context in which youth develop and minority status when examining associations between physical health risk factors and mental health.

Asthma outcomes: symptoms

BACKGROUND

Respiratory symptoms are commonly used to assess the impact of patient-centered interventions.

OBJECTIVE

At the request of National Institutes of Health (NIH) institutes and other federal agencies, an expert group was convened to propose which measurements of asthma symptoms should be used as a standardized measure in future clinical research studies.

METHODS

Asthma symptom instruments were classified as daily diaries (prospectively recording symptoms between research visits) or retrospective questionnaires (completed at research visits). We conducted a systematic search in PubMed and a search for articles that cited key studies describing development of instruments. We classified outcome instruments as either core (required in future studies), supplemental (used according to study aims and standardized), or emerging (requiring validation and standardization). This work was discussed at an NIH-organized workshop in March 2010 and finalized in September 2011.

RESULTS

Four instruments (3 daily diaries, 1 for adults and 2 for children; and 1 retrospective questionnaire for adults) were identified. Minimal clinically important differences have not been established for these instruments, and validation studies were only conducted in a limited number of patient populations. Validity of existing instruments may not be generalizable across racial-ethnic or other subgroups.

CONCLUSIONS

An evaluation of symptoms should be a core asthma outcome measure in clinical research. However, available instruments have limitations that preclude selection of a core instrument. The working group participants propose validation studies in diverse populations, comparisons of diaries versus retrospective questionnaires, and evaluations of symptom assessment alone versus composite scores of asthma control.

Trauma, posttraumatic stress symptoms, and alcohol-use initiation in children

OBJECTIVE

This study examined initiation of alcohol use among adolescents, in relation to their earlier traumatic experiences and symptoms of posttraumatic stress disorder (PTSD).

METHOD

Data were from a longitudinal study of children of Puerto Rican background living in New York City's South Bronx and in San Juan, Puerto Rico. The subsample (n = 1,119; 51.7% male) of those who were 10-13 years old and alcohol naive at baseline was used in the analyses.

RESULTS

Alcohol-use initiation within 2 years after baseline was significantly more common among children reporting both trauma exposure and 5 or more of a maximum of 17 PTSD symptoms at baseline (adjusted odds ratio = 1.84, p < .05) than among those without trauma exposure, even when potentially shared correlates were controlled for. Children with trauma exposure but with fewer than five PTSD symptoms, however, did not differ significantly from those without trauma exposure, with regard to later alcohol use.

CONCLUSIONS

PTSD symptoms in children 10-13 years old may be associated with early onset of alcohol use. It is important to identify and treat PTSD-related symptoms in pre-adolescent children.

Violence, abuse, and asthma in Puerto Rican children

RATIONALE

Puerto Ricans have the highest prevalence of and morbidity from asthma of all ethnic groups in the United States. One potential contributor to the high burden of asthma in Puerto Rican children is exposure to stress and violence.

OBJECTIVES

To examine whether exposure to stress and violence is associated with an increased risk of asthma among Puerto Rican children.

METHODS

This study was a population-based probability sample of children in the San Juan and Caguas metropolitan areas in Puerto Rico. Information was collected in a household survey of 1,213 children and their primary caretakers.

MEASUREMENTS AND MAIN RESULTS

The prevalence of lifetime physician-diagnosed asthma was 39.6%. In the year before the survey, 14% of children had witnessed an act of violence, 7% had been victims of violence, and 6% had been victims of physical or sexual abuse. Although stressful life events and exposure to neighborhood violence were not associated with asthma, a history of physical or sexual abuse was associated with approximately twice the odds of current asthma (odd ratio [OR], 2.52; 95% confidence interval [CI], 1.27-5.00), health care use for asthma (OR, 1.95; 95% CI, 0.96-3.96), and medication use for asthma (OR, 2.35; 95% CI, 1.05-5.26).

CONCLUSIONS

Physical or sexual abuse is associated with high asthma morbidity among Puerto Rican children. To our knowledge, this is the first report of an association between childhood abuse and asthma. Our findings highlight the importance of screening for asthma among victims of childhood abuse, and to be aware of the possibility of physical or sexual abuse among children with asthma.

Area of residence, birthplace, and asthma in Puerto Rican children

RATIONALE

Puerto Ricans have the highest prevalence of asthma among all ethnic groups in the United States. There have been no studies that directly compare the burden of asthma between Puerto Ricans living in Puerto Rico and those living in the mainland United States.

OBJECTIVE

To examine the relation between birthplace, area of residence, and asthma in Puerto Rican children.

METHODS

Multistage population-based probability sample of children in the San Juan and Caguas metropolitan areas in Puerto Rico and in the Bronx, NY. Information was collected in a household survey of 2,491 children and their primary caretakers.

RESULTS

The overall prevalence of asthma among Puerto Rican children in this study was very high (38.6%). Although children from Puerto Rico had higher socioeconomic status and lower rates of premature birth and prenatal smoke exposure, the prevalence of lifetime asthma was higher in Puerto Rican children living in Puerto Rico than in Puerto Rican children living in the South Bronx (41.3% vs 35.3%, p = 0.01). In multivariable analysis, residence in Puerto Rico was associated with increased odds of lifetime asthma (odds ratio [OR], 1.27; 95% confidence interval [CI], 1.03 to 1.57) and lifetime hospitalization for asthma (OR, 1.47; 95% CI, 1.04-2.07).

CONCLUSIONS

Puerto Rican children in Puerto Rico had a higher risk of asthma than Puerto Rican children in the South Bronx, highlighting the need for further examination of the roles of migration, acculturation, and environmental and psychosocial factors on the development of asthma in this high-risk population.

Childhood depressive symptoms and early onset of alcohol use

OBJECTIVES

Few studies have assessed the relationship between depressive symptoms and early onset of alcohol use in children and early adolescents. We aimed to determine whether depressive symptoms in children are associated with subsequent initiation of alcohol use and, if so, whether this association is merely a result of demographic, parental, and/or individual risk factors shared by depression and alcohol use or independent of these shared risk factors.

METHODS

Analyses were based on a subsample of 10- to 13-year-old children (N = 1119) from the Boricua Youth Study, a longitudinal study of psychopathology among Puerto Rican children and early adolescents. Children in the study were assessed over 3 waves between 2000 and 2004. In-person structured interviews were conducted with both parents and children.

RESULTS

Depressive symptoms and alcohol use shared some significant risk and protective factors, such as parental psychopathology, parenting, child exposure to violence, and antisocial behaviors. After controlling for these factors, the association between depressive symptoms and alcohol use was reduced, but childhood depressive symptoms were still positively associated with subsequent alcohol use initiation. Children with medium or high levels of depressive symptoms were more than twice as likely to use alcohol as those with <2 depressive symptoms.

CONCLUSIONS

The finding of the current study that early life depressive symptoms may lead to earlier onset of alcohol use indicates the importance of identifying and treating depressive symptoms in preadolescent children. It also demonstrates the importance of examining shared risk and protective factors for understanding the relationship between depressive symptoms and alcohol use.

A study of disruptive behavior disorders in Puerto Rican youth: I. Background, design, and survey methods

OBJECTIVE

This is the first of two related articles on a study carried out between 2000 and 2003 designed to assess the prevalence, associated comorbidities, and correlates of disruptive behavior disorders in two populations of Puerto Rican children: one in the Standard Metropolitan Areas of San Juan and Caguas in Puerto Rico, and the other in the south Bronx in New York City.

METHOD

This article provides the study's background, design, and methodology. Probability samples of children ages 5 to 13 years were drawn at the two sites (n = 2,491). Subjects and their primary caretakers were interviewed using the Diagnostic Interview Schedule for Children-IV and a wide array of risk factor measures. The samples were weighted to correct for differences in the probability of selection resulting from sample design and to adjust for differences from the 2000 U.S. Census in the age/gender distribution.

RESULTS

The samples are representative of the populations of Puerto Rican children in the south Bronx and in the Standard Metropolitan Areas in Puerto Rico. Of the 2,940 children identified as eligible for the study, 2,491 participated for an overall compliance rate of 85%.

CONCLUSIONS

The study results, to be described in an accompanying report, are generalizable to the two target populations.

A study of disruptive behavior disorders in Puerto Rican youth: II. Baseline prevalence, comorbidity, and correlates in two sites

OBJECTIVE

This is the second of two associated articles. The prevalence, correlates, and comorbidities of disruptive behavior disorders (DBDs) in two populations are reported.

METHOD

Probability community samples of Puerto Rican boys and girls ages 5-13 years in San Juan, and the south Bronx in New York City are included (n = 2,491). The Diagnostic Interview Schedule for Children-IV and measures of correlates were employed to look at the association between DBDs and potential correlates, taking comorbidity into account. Data presented in this report were collected primarily between 2002 and 2003 but spanned a 3-year period from August 2000 to August 2003.

RESULTS

There were no significant age or site differences among males in rates of DBDs, but rates among females increased with age in the south Bronx and decreased with age in Puerto Rico. The salient comorbidity of DBDs was with attention-deficit/hyperactivity disorder. Multiple regression showed lack of parental warmth and approval, poor peer relationships, and parental report of aggressive behavior during the toddler years to be the most significant correlates of DBDs in this population.

CONCLUSIONS

Cultural factors, such as level of acculturation, were not associated with DBDs. The results suggest that clinical and preventive efforts need to emphasize interpersonal factors such as parent-child relationships and peer interactions.

The Brief Impairment Scale (BIS): a multidimensional scale of functional impairment for children and adolescents

OBJECTIVE

This article provides the results of the psychometric testing of the Brief Impairment Scale (BIS). The BIS is a 23-item instrument that evaluates three domains of functioning: interpersonal relations, school/work functioning, and self-care/self-fulfillment. It capitalizes on the strengths of existing global measures while addressing some of their limitations.

METHOD

Cross-sectional parent respondent data from one clinical (N = 757) and two community samples (N = 1,888 and 1,132) of children ranging in age from 4 to 17 years is employed to test the reliability and validity of the BIS. Receiver operating characteristic analyses are employed to assess useful cutoff scores on the scale.

RESULTS

The total scale's internal consistency ranged from 0.81 to 0.88 and from 0.56 to 0.81 on the three subscales. Test-retest reliability for individual items ranged from fair to substantial in all but six items. The BIS has high convergent and concurrent validity. Receiver operator characteristic analyses suggest possible thresholds for different uses.

CONCLUSIONS

The BIS is psychometrically sound, useful in assessments and as an outcome measure in clinical practice and research. Its advantages over other global impairment instruments are that it is respondent based, short in administration time, and multidimensional.

Prevalence and correlates of antisocial behaviors among three ethnic groups

Using data from the MECA Study, this report examines the prevalence of Conduct Disorder (CD), Oppositional Defiant Disorder (ODD), and various levels of antisocial behavior and their correlates among three ethnic groups: Hispanics, subdivided into Island Puerto Ricans and Mainland Hispanics; African Americans; and Mainland Non-Hispanic, Non-African Americans. Correlates considered include stressful life events, birth defects, low birth weight, learning difficulties, teen mothers, family environment, marital adjustment, social competence, parental monitoring, and family relationships. Logistic regression was used to determine the association of outcomes with individual correlates and of interaction terms with ethnicity. Differences between adjusted rates and observed rates of disorders and levels of antisocial behaviors are compared to estimate the extent to which each correlate explains the group differences in rates. Island Puerto Ricans had a lower prevalence of CD, ODD, and various levels of antisocial behavior than mainland Hispanics, African Americans, and non-Hispanic Whites. The lower prevalence appears to be associated with differences in the extent to which a number of these correlates are found on the island, the most salient being better family relations between the target children and their parents and siblings.

Prevalence of suicide ideation and suicide attempts in nine countries

BACKGROUND

There are few cross-national comparisons of the rates of suicide ideation and attempts across diverse countries. Nine independently conducted epidemiological surveys using similar diagnostic assessment and criteria provided an opportunity to obtain that data.

METHODS

Suicide ideation and attempts were assessed on the Diagnostic Interview Schedule in over 40000 subjects drawn from the United States, Canada, Puerto Rico, France, West Germany, Lebanon, Taiwan, Korea and New Zealand.

RESULTS

The lifetime prevalence rates/100 for suicide ideation ranged from 2.09 (Beirut) to 18.51 (Christchurch, New Zealand). Lifetime prevalence rates/100 for suicide attempts ranged from 0.72 (Beirut) to 5.93 (Puerto Rico). Females as compared to males had only marginally higher rates of suicidal ideation in most countries, reaching a two-fold increase in Taiwan. Females as compared to males had more consistently higher rates for suicide attempts, reaching a two- to three-fold increase in most countries. Suicide ideation and attempts in most countries were associated with being currently divorced/separated as compared to currently married.

CONCLUSIONS

While the rates of suicide ideation varied widely by country, the rates of suicide attempts were more consistent across most countries. The variations were only partly explained by variation in rates of psychiatric disorders, divorce or separation among countries and are probably due to cultural features that we do not, as yet, understand.

The comorbidity of alcoholism with anxiety and depressive disorders in four geographic communities

The comorbidity of alcoholism with anxiety and depressive disorders was examined in four epidemiologic investigations from diverse geographic sites. Despite variability in lifetime prevalence rates for these disorders, there was strong cross-site consistency in the magnitude and specific patterns of comorbidity. Individuals with alcohol abuse or dependence generally experienced a twofold to threefold increased risk of anxiety and depressive disorders. Phobic conditions typically preceded the onset of alcoholism, but no systematic pattern was observed for panic or depressive disorders. Considerable heterogeneity was also observed concerning the impact of comorbid conditions on symptoms of the index disorder. While the presence of comorbid anxiety or depressive disorders was consistently associated with moderate increases in the symptoms of alcohol abuse or dependence, alcoholism was associated with large increases in the number of depressive symptoms and little or no increase in phobic symptoms. The findings are discussed in terms of the self-medication hypothesis and the etiologic heterogeneity of these forms of comorbidity in the general population.

What happens to depressed men? Application of the Stirling County criteria

In a recent issue of the Harvard Review of Psychiatry, results from the Stirling County Study showed that the prevalence and incidence rates of depression were similar in men and women when "gender-fair" criteria were used and help-seeking was not required. We attempted to replicate these findings by applying the criteria for depression from the Stirling County Study to two national and six international epidemiologic surveys conducted in the 1980s and 1990s. Depression was defined as dysphoric mood and disturbances of sleep, appetite, and energy, with at least a mild degree of impairment. The rates of depression were computed using this algorithm with data from the US Epidemiologic Catchment Area Study, conducted in the 1980s, the US National Comorbidity Survey, conducted in the 1990s, and independent community surveys from Canada, Puerto Rico, France, Taiwan, Korea, and New Zealand. For the US studies, these rates were recalculated after persons seeking treatment were removed from the analyses, where such data were available. Using Stirling County Study criteria, the lifetime prevalence rate of depression remains approximately twice as high in women as in men cross-nationally, except in Puerto Rico. Excluding help-seeking as a criterion and controlling for birth cohort do not change the findings. The Stirling County findings on absence of a sex difference in rates of depression using "gender-fair" criteria may be due to methodological variance in the collection of data, sample size, or the social and/or genetic uniqueness of the Atlantic Canadian community.

The cross-national epidemiology of panic disorder

BACKGROUND

Epidemiological data on panic disorder from community studies from 10 countries around the world are presented to determine the consistency of findings across diverse cultures.

METHOD

Data from independently conducted community surveys from 10 countries (the United States, Canada, Puerto Rico, France, West Germany, Italy, Lebanon, Taiwan, Korea, and New Zealand), using the Diagnostic Interview Schedule and DSM-III criteria and including over 40,000 subjects, were analyzed with appropriate standardization for age and sex differences among subjects from different countries.

RESULTS

The lifetime prevalence rates for panic disorder ranged from 1.4 per 100 in Edmonton, Alberta, to 2.9 per 100 in Florence, Italy, with the exception of that in Taiwan, 0.4 per 100, where rates for most psychiatric disorders are low. Mean age at first onset was usually in early to middle adulthood. The rates were higher in female than male subjects in all countries. Panic disorder was associated with an increased risk of agoraphobia and major depression in all countries.

CONCLUSIONS

Panic disorder is relatively consistent, with a few exceptions, in rates and patterns across different countries. It is unclear why the rates of panic and other psychiatric disorders are lower in Taiwan.

Cross-national epidemiology of major depression and bipolar disorder

OBJECTIVE

To estimate the rates and patterns of major depression and bipolar disorder based on cross-national epidemiologic surveys.

DESIGN AND SETTING

Population-based epidemiologic studies using similar methods from 10 countries: the United States, Canada, Puerto Rico, France, West Germany, Italy, Lebanon, Taiwan, Korea, and New Zealand.

PARTICIPANTS

Approximately 38000 community subjects.

OUTCOME MEASURES

Rates, demographics, and age at onset of major depression and bipolar disorder. Symptom profiles, comorbidity, and marital status with major depression.

RESULTS

The lifetime rates for major depression vary widely across countries, ranging from 1.5 cases per 100 adults in the sample in Taiwan to 19.0 cases per 100 adults in Beirut. The annual rates ranged from 0.8 cases per 100 adults in Taiwan to 5.8 cases per 100 adults in New Zealand. The mean age at onset shows less variation (range, 24.8-34.8 years). In every country, the rates of major depression were higher for women than men. By contrast, the lifetime rates of bipolar disorder are more consistent across countries (0.3/100 in Taiwan to 1.5/100 in New Zealand); the sex ratios are nearly equal; and the age at first onset is earlier (average, 6 years) than the onset of major depression. Insomnia and loss of energy occurred in most persons with major depression at each site. Persons with major depression were also at increased risk for comorbidity with substance abuse and anxiety disorders at all sites. Persons who were separated or divorced had significantly higher rates of major depression than married persons in most of the countries, and the risk was somewhat greater for divorced or separated men than women in most countries.

CONCLUSIONS

There are striking similarities across countries in patterns of major depression and of bipolar disorder. The differences in rates for major depression across countries suggest that cultural differences or different risk factors affect the expression of the disorder.

The cross-national epidemiology of social phobia: a preliminary report

We present a preliminary report on cross-national rates, age at onset, comorbidity, suicide attempts and symptom profiles of social phobia. These data are based on epidemiologic community surveys using similar methods from the United States, Canada, Puerto Rico and Korea. The lifetime rate of social phobia (cases per 100 persons) varies by country, from 2.6 in the United States to 0.5 in Korea. Rates are higher in females than in males in all countries. The age of onset for any phobia is mid-teens to early twenties, and social phobia usually has its first onset before other psychiatric disorders. Only a third or fewer cases of social phobia are uncomplicated by another psychiatric disorder. The presence of social phobia increases the risk of suicide attempts in persons with any other psychiatric disorder. Symptom profiles vary by country. Our data indicate consistent patterns but different cultural expressions of social phobia in the countries studied. The early age of onset of social phobia followed subsequently by another psychiatric disorder raises the possibility that early treatment of social phobia could prevent the onset of other psychiatric disorders.

Psychometric properties of parents and children as informants in child psychiatry epidemiology with the Spanish Diagnostic Interview Schedule for Children (DISC.2)

Parent and child reports were examined to study how epidemiological researchers can best use the information provided to describe childhood psychopathology. As part of a multisite methodologic study of mental disorders in children, a probability sample (N = 248) of children aged 9 to 17 years from the San Juan metropolitan area was selected. This sample was enriched with 74 clinic cases. Both parents and children were administered the DISC.2. Results showed that prevalence estimates were influenced by the informant. The clinicians' diagnosis is more concordant with children's reports of depression and with parents' reports of disruptive disorders. Parents and children provided unique information when interviewed with a structured psychiatric interview about child psychopathology. Their unique perspectives contributed to the observed discordance that emerged when DISC parent and DISC child results are compared. Combining the two perspectives with a simple "OR" rule at the symptom level did not seem to capture the unique perspectives.

The cross national epidemiology of obsessive compulsive disorder. The Cross National Collaborative Group

Data on the epidemiology of psychiatric disorders from different parts of the world using similar methods and diagnostic criteria have previously not been available. This article presents data on lifetime and annual prevalence rates, age at onset, symptom profiles, and comorbidity of obsessive compulsive disorder (OCD), using DSM-III criteria, from community surveys in seven countries: the United States, Canada, Puerto Rico, Germany, Taiwan, Korea, and New Zealand. The OCD annual prevalence rates are remarkably consistent among these countries, ranging from 1.1/100 in Korea and New Zealand to 1.8/100 in Puerto Rico. The only exception is Taiwan (0.4/100), which has the lowest prevalence rates for all psychiatric disorders. The data for age at onset and comorbidity with major depression and the other anxiety disorders are also consistent among countries, but the predominance of obsessions or compulsions varies. These findings suggest the robustness of OCD as a disorder in diverse parts of the world.

The Spanish translation and cultural adaptation of the Diagnostic Interview Schedule for Children (DISC) in Puerto Rico

This article illustrates a comprehensive cross-cultural adaptation model used to translate into Spanish and to culturally adapt the Diagnostic Interview Schedule for Children (DISC). The process strived to identify similar phenomena to those identified by the original English version in a dissimilar context. To attain cross-cultural equivalency five important dimensions were addressed: semantic, technical, content, criterion and conceptual. To meet this challenge various steps were taken, including bilingual committee, back-translation, reliability and validity testing. The result is an instrument which could be used, not only in Puerto Rico, but also in other Spanish-speaking child and adolescent populations after appropriate cultural adaptations.

A cross-cultural adaptation of a psychiatric epidemiologic instrument: the diagnostic interview schedule's adaptation in Puerto Rico

The advent of the use of structured interview schedules that generate psychiatric diagnoses in epidemiologic studies has promoted an intense interest in its cross-cultural use. However, the valid use of these instruments across cultures requires a careful adaptation process which goes beyond mere language translation. In this article the authors illustrate the application of a comprehensive cross-cultural adaptation model to both the translation into Spanish and the adaptation to the population of Puerto Rico of a widely used psychiatric epidemiologic research instrument: the Diagnostic Interview Schedule (DIS). The process aimed to ensure the development of a research instrument that is not only in correct Spanish and comprehensible for most Spanish-speaking people, but also culturally adapted to Puerto Rico's population. Various steps were taken (including bilingual committee, back-translation, instrument testing and diagnostic comparisons) to address cross-cultural validity in five important dimensions (i.e., semantic, technical, content, criterion and conceptual equivalence). The result is an interview schedule that is not only linguistically and culturally adequate for the targeted population but also includes elements which can contribute to the development of the instrument both in its original English language and in its translated versions.

Appropriateness of DSM-III-R criteria for posttraumatic stress disorder

This research examines the DSM-IIIR criteria for posttraumatic stress disorder (PTSD). The study questions whether the psychiatric sequelae resulting from exposure to extraordinary traumatic events (stressor criterion A) do in fact differ from the sequelae resulting from exposure to more common yet stressful life experiences. The study also examines whether PTSD sequelae (criteria B-D) accurately describe the responses of victims even of extreme events fitting the DSM-III-R definition of stressor. The study included data from both St Louis victims exposed to floods and/or unsafe dioxin levels, and Puerto Rico victims of mudslides/flooding. Results showed that some of the common stressful events related more closely to PTSD symptoms than did the extraordinary events. Further, disaster exposure most strongly related to symptoms of reexperiencing (criterion B); symptoms relating to avoidance (criterion C) were particularly unreported. Results are discussed in terms of their implications for revision both of the PTSD criteria for DSM-IV, and of instruments designed to assess PTSD symptomatology.

Children of parents with psychiatric disorder in the community

The relationship between parental psychopathology and risk for maladjustment in the offspring was investigated in a community sample. The children of 130 parents who met criteria for 12 DIS/DSM-III disorders were compared to the children of 235 normal parents. Significantly more children of disturbed parents were functionally impaired and had higher scores in the parent and youth Child Behavior Checklist total behavior scores as compared to children of normal parents. These associations were maintained even after accounting for an adverse family environment, suggesting a strong relationship between parental and childhood psychopathology as well as a mediating influence of environmental adversity.

Alcoholism--North America and Asia. A comparison of population surveys with the Diagnostic Interview Schedule

The Diagnostic Interview Schedule (DIS) is a highly structured instrument that enables lay examiners to gather the clinical information necessary to generate psychiatric disorders according to the DSM-III, Feighner, and Research Diagnostic Criteria. It was developed originally as the diagnostic interview for the Epidemiologic Catchment Area (ECA) survey. Because it adheres to DSM-III and can be used by lay interviewers, thus making it practical for studies involving large samples, it has been used for other population surveys in North and South America, Europe, and Asia. This investigation compares the epidemiology of DSM-III-defined alcohol abuse and addiction in DIS-based population surveys cross-nationally (in St Louis, Mo; Edmonton, Canada; Puerto Rico; Taipei City, Taiwan; and South Korea). We found considerable variation in the lifetime prevalence of alcoholism but a similarity in the age of onset, the symptomatic expression, and the associated risk factors. We also found an inverse correlation between the prevalence of alcoholism and the strength of the association of the risk factors we examined. The work described herein demonstrates the utility of consistent definition and method in cross-cultural psychiatric research. The substantive findings have implications for the definition of alcoholism and for a better understanding of genetic and environmental interactions in its etiology.

Spiritism in Puerto Rico. Results of an island-wide community study

Using data from the first community-based, epidemiological survey of Puerto Rico, this paper examines the current prevalence of use of spiritist healers by Puerto Ricans, the role of spiritism in the provision of mental health services, and the association between spiritism and psychiatric disorders and symptoms. Those who visit spiritists were found to be more likely to work outside the home, to have a low family income, to have sought help for emotional problems from mental health professionals, and to have mild symptoms of depression.

[Psychiatric diagnostic classification in transcultural epidemiologic studies]

The utility of transcultural psychiatric epidemiology research is discussed as well as the methodological difficulties inherent in this type of investigation. The comparison across different cultures of the prevalence and incidence of mental illness in population studies can be used to obtain a better understanding of the risk and etiological factors involved in the development of specific psychiatric disorders. Nevertheless, most population studies have been carried out in developing countries mostly due to the complexity and high cost of these studies. As a consequence, a gap in psychiatric knowledge is created between the developed and developing countries resulting in the false notion that many of the psychiatric disorders observed in developed countries are universal to all human beings. The cross-cultural validity of certain psychiatric disorders based on the American Psychiatric Nosology (DSM III) are discussed. The article discusses the methodological difficulties which arise from the need of maintaining methods and criteria uniform in cross-cultural studies in order to allow comparisons, as well as the need of incorporating into the methodology the cultural differences existent in the manifestation or definition of the specific psychiatric disorders studied. Various possible methodologies are discussed which address this dilemma, such as the combination of empirical and ethnographic approaches and the cross-cultural comparison of empirically defined syndromes.

The Spanish Diagnostic Interview Schedule. Reliability and concordance with clinical diagnoses in Puerto Rico

A Spanish translation of the Diagnostic Interview Schedule (DIS) was assessed using samples of Puerto Rican patients and community subjects from the San Juan area. Concordance between DIS results from psychiatrists' interviews and from laypersons' interviews was similar to results with the DIS in mainland samples. Comparisons of laypersons' DIS results with psychiatrists' clinical diagnoses yielded generally poorer agreement. Levels of agreement improved when diagnoses were clustered into higher-rank categories. These results raise cultural issues related to the use of the DIS in Puerto Rico.

The prevalence of specific psychiatric disorders in Puerto Rico

An epidemiologic survey of the lifetime and six-month prevalence rates of several psychiatric disorders was conducted in Puerto Rico. This study, carried out in 1984, applied selected schedules of a Spanish translation of the Diagnostic Interview Schedule to a stratified, island-wide probability sample of the population. With few exceptions, prevalence rates in this study were similar to those obtained in the US communities studied in the Epidemiologic Catchment Area program. The demographic correlates of the disorders are reviewed, and differences between the results of this study and those of previous studies suggesting a higher rate of mental disorder among Puerto Rican populations are discussed.

[The Diagnostic Interview Schedule in Spanish: its translation and adaptation in Puerto Rico]

The process and results of the Puerto Rico's DIS Spanish translation and adaptation are described in this paper. The process is presented in the context of cross cultural research on psychiatric diagnoses and the translation and adaptation of diagnostic instruments for use across cultural boundaries. Several translation techniques were employed (bilingual committee, back-translation and instrument testing) to obtain an instrument in correct Spanish, comprehensible for most Spanish-speaking people as well as linguistically and culturally adapted to the Puerto Rican population. Its semantic, technical, contents and criterion equivalence with the English DIS were considered. The resulting instrument is not only a translation and adaptation of the original but it also presents some additional features which aim to enhance its diagnostic accuracy. A descriptive and quantitative comparison with the Karno et al's Spanish DIS version is also included as well as a discussion of its possible contribution to DIS transcultural use, specially in Hispanic cultures.