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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.
Asunto(s)
Trastorno Depresivo Mayor , Trastornos Relacionados con Sustancias , Adolescente , Adulto , Niño , Preescolar , Trastorno Depresivo Mayor/epidemiología , Etnicidad , Femenino , Humanos , Masculino , New York , Psicopatología , Puerto Rico/epidemiología , Trastornos Relacionados con Sustancias/epidemiología , Adulto JovenRESUMEN
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.
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Conducta del Adolescente/etnología , Desarrollo del Adolescente , Heterosexualidad/etnología , Homosexualidad/etnología , Conducta Sexual/etnología , Adolescente , Niño , Femenino , Humanos , Masculino , Ciudad de Nueva York/etnología , Estudios Prospectivos , Puerto Rico/etnologíaRESUMEN
Suicidal behavior increases substantially during early adolescence, a critical understudied developmental period. This study reports on the prevalence of suicidal ideation, suicide attempts, and course of suicidal ideation among Puerto Rican early adolescents, a high-risk group for suicidal behavior in adulthood. Gender differences and the prospective association of psychiatric disorders with course of suicidal ideation are examined. Participants were 1228 Puerto Rican adolescents (ages 10-13 at wave 1; 48% female) and parents, selected through probability-based sampling, assessed yearly across three waves. Adolescents and parents reported via Diagnostic Interview Schedule for Children-IV about 12-month suicide attempts and suicidal ideation (further categorized as never present, onset, recurrence, and remission), mood and anxiety disorders; parents reported on disruptive disorders. Over the three waves, 9.5% early adolescents thought about suicide and 2.1% attempted suicide. In adjusted multinomial regression models, compared to those with never present suicidal ideation, female gender was related to onset of suicidal ideation (OR = 2.60; 95% CI, 1.22-5.55). Disruptive disorders were related to onset (OR = 5.80; 95% CI, 2.06-16.32) and recurrence of suicidal ideation (OR = 5.07, 95% CI, 1.14-22.47), mood disorders were related to remission (OR = 14.42, 95% CI, 3.90-53.23), and anxiety disorders to onset of suicidal ideation (OR = 3.68, 95% CI, 1.75-7.73). Our findings inform strategies tailored for early adolescents. To address onset of suicidal ideation, prevention should focus on girls and those with anxiety or disruptive disorders. When ideation is recurrent, interventions oriented to reduce disruptive behavior and its consequences may help achieve remission.
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Trastornos Mentales/epidemiología , Ideación Suicida , Intento de Suicidio/estadística & datos numéricos , Adolescente , Niño , Femenino , Humanos , Estudios Longitudinales , Masculino , Puerto Rico/epidemiología , Factores SexualesRESUMEN
HIV infection among young populations is increasing worldwide. Adolescents in mental health treatment have demonstrated higher rates of HIV risk behavior than their peers. This first risk behavior study of youth in psychiatric treatment in Brazil reports findings from a cross-sectional national sample of emerging adult psychiatric patients (18-25 years old). The prevalence of lifetime unprotected sex was 65.9%. Multiple logistic regression indicated that being married/in union; sex under the influence of alcohol/drugs; physical violence; earlier sexual debut; and depressive/substance use disorders were associated with unsafe sex. Interventions and services that address these risks during this critical developmental window are urgently needed.
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We examined the associations between perceived mental illness stigma and HIV risk and protective behaviors among adults with severe mental illness (SMI) in Rio de Janeiro, Brazil. We measured mental illness stigma across three domains ("Personal Experiences," "Perceived Attractiveness," and "Relationship Discrimination"), and examined the relationship between experiences of stigma in each domain and HIV risk and protective behaviors over the past 3 months in 98 outpatients with SMI. Those who reported greater "Relationship Discrimination" stigma were significantly more likely to be sexually active and to have unprotected sex; they were significantly less likely to report deliberately having fewer partners as a way to protect themselves from HIV. The role of stigma in unprotected sexual behavior should be examined further and considered in any HIV prevention intervention for people with SMI.
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Atención Ambulatoria , Trastorno Bipolar/psicología , Trastorno Depresivo Mayor/psicología , Infecciones por VIH/psicología , Prejuicio , Trastornos Psicóticos/psicología , Esquizofrenia/diagnóstico , Sexo Inseguro/psicología , Población Urbana , Adolescente , Adulto , Anciano , Brasil , Escalas de Valoración Psiquiátrica Breve , Femenino , Infecciones por VIH/prevención & control , Servicios de Salud , Humanos , Entrevista Psicológica , Masculino , Persona de Mediana Edad , Psicología del Esquizofrénico , Autoimagen , Encuestas y Cuestionarios , Adulto JovenRESUMEN
We conducted the first study to examine rates of sexual activity, sexual risk behaviors, sexual protective behaviors, injection drug use (IDU), needle sharing, and knowledge about HIV/AIDS among outpatients with severe mental illness (SMI) in Rio de Janeiro, Brazil. Using a measure with demonstrated reliability, we found that 42% of 98 patients engaged in vaginal or anal sex within the past three months. Comorbid substance use disorder was significantly associated with sexual activity. Only 22% of sexually active patients used condoms consistently, despite having better HIV knowledge than those who were sexually abstinent. Overall, 45% of patients reported not engaging in any HIV protective behaviors. There were no reports of drug injection. Adults with SMI in Brazil are in need of efficacious HIV prevention programs and policies that can sustain these programs within mental health treatment settings.
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As in other countries worldwide, adults with severe mental illness (SMI) in Brazil are disproportionately infected with HIV relative to the general population. Brazilian psychiatric facilities lack tested HIV prevention interventions. To adapt existing interventions, developed only in the US, we conducted targeted ethnography with adults with SMI and staff from two psychiatric institutions in Brazil. We sought to characterize individual, institutional, and interpersonal factors that may affect HIV risk behavior in this population. We conducted 350 hours of ethnographic field observations in two mental health service settings in Rio de Janeiro, and 9 focus groups (n=72) and 16 key-informant interviews with patients and staff in these settings. Data comprised field notes and audiotapes of all exchanges, which were transcribed, coded, and systematically analyzed. The ethnography identified and/or characterized the institutional culture: (1) patients' risk behaviors; (2) the institutional setting; (3) intervention content; and (4) intervention format and delivery strategies. Targeted ethnography also illuminated broader contextual issues for development and implementation of HIV prevention interventions for adults with SMI in Brazil, including an institutional culture that did not systematically address patients' sexual behavior, sexual health, or HIV sexual risk, yet strongly impacted the structure of patients' sexual networks. Further, ethnography identified the Brazilian concept of "social responsibility" as important to prevention work with psychiatric patients. Targeted ethnography with adults with SMI and institutional staff provided information critical to the adaptation of tested US HIV prevention interventions for Brazilians with SMI.
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Aculturación , Antropología Cultural , Infecciones por VIH/prevención & control , Trastornos Mentales/clasificación , Adolescente , Adulto , Brasil , Femenino , Grupos Focales , Humanos , Masculino , Persona de Mediana EdadRESUMEN
As in other countries worldwide, adults with severe mental illness in Brazil have elevated rates of HIV infection relative to the general population. However, no HIV prevention interventions have been tested for efficacy with psychiatric patients in Brazil. We conducted participatory research with local providers, community leaders, patient advocates, and patients using an intervention adaptation process designed to balance fidelity to efficacious interventions developed elsewhere with fit to a new context and culture. Our process for adapting these interventions comprised four steps: (1) optimizing fidelity; (2) optimizing fit; (3) balancing fidelity and fit; and (4) pilot testing and refining the intervention. This paper describes how these steps were carried out to produce a Brazilian HIV prevention intervention for people with severe mental illness. Our process may serve as a model for adapting existing efficacious interventions to new groups and cultures, whether at a local, national, or international level.