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To deal effectively with the understanding, description and classification of mental morbid conditions, we must address the intricate concept of disease, illness or disorder in mental health. To do so, one needs to consider biological, psychological and social frameworks. These levels of analysis can offer avenues for greater understanding of the bases of illness as well as better ways of formulating its description and classification. Conceptual, epistemological and empirical data analyses are relevant and necessary. All these efforts should be aimed at serving and advancing the main purposes of classification and diagnosis, the chief encompassing one being enhancement of clinical care and public health. Although no definition of mental disorder may strictly embrace every condition of concern, some flexible definitional guidelines within a biopsychosocial framework may be helpful for advancing psychiatric nosology.

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OBJECTIVE: This report reviews population studies of child and adolescent mental health carried out in Latin America over the past 15 years. Also considered is the issue of how to meet the needs of children and adolescents who may present mental health problems in Latin America, given that most of them live in poverty in economies that are underdeveloped, providing limited resources. METHOD: Ten studies from six different countries were identified that employed some form of randomized sampling method and used standardized instruments for assessment. The authors present a summary of the main characteristics of these studies, highlighting methodological features that may account for differences in the rates obtained. RESULTS: Overall, a similar pattern of prevalence and risk factors for mental health problems in children and adolescents in Latin American countries emerged. Moreover, rates of disorders in these children are similar to the 15 to 20% found in other countries. These findings are similar to those observed when adult mental health problems are considered. Prevention and treatment strategies are discussed and the peculiarities of the delivery of mental health services for children and adolescents are explored. CONCLUSIONS: Future research needs to focus on understanding of resilience and formal and informal mental health delivery systems of care available in different Latin American countries. Such research has high potential for ameliorating the prevention and treatment of child and adolescent mental health problems in this region of the world.

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Culturally competent diagnostic systems are necessary for an effective and ethical clinical practice, as cultural diversity of patients increase around the world. Latin American psychiatrists hold a long-standing commitment to this enterprise. Recently, two main Latin American adaptations to the international psychiatric classification have emerged: the Cuban Glossary of Psychiatry, and the project of the Latin American Guide for Psychiatric Diagnosis (GLADP). Keeping ICD-10 as the basis for nosological organization, GLADP is being developed with contributions by mental health professionals from Latin American countries. GLADP comprises 4 parts: (1) historical and cultural framework, (2) comprehensive diagnosis and formulation, (3) psychiatric nosology and (4) appendixes.

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La calidad de la atención en salud mental para los niños depende, no sólo de los servicios especializados de salud mental. Un factor adicional importante es la efectividad con que los proveedores de atención primaria de salud, por ejemplo, pediatras y maestros, identifican, tratan y refieren a niños con problemas emocionales y conductuales. Existe evidencia de que la utilización de instrumentos de tamizajede diversos problemas y/o niveles de difusión psicosocial incrementa la detección de tales problemas por parte del personal de atención primaria de salud. El presente estudio constituye la validación de la Escala de Salud del Niño, una escala para uso en atención primaria infantil, destinada a detectar casos psicosociales. Dicha escala ha sido desarrollada en Guatemala y esta basada en los criterios de diagnóstico y clasificación psiquiatricos interna-cionales. Empleando una muestra de 1820 sujetos pertenecientes a tres grupos poblacionales (psiquiátrico, pediátrico y escolar), la Escala de Salud del Niño permitió discriminar entre caso psicosocial y no caso. Los resultados de la validez de criterio, confiabilidad, sensibilidad y especificidad, sugieren que esta escala es un instrumento adecuado para la detección de casos psicosociales en atención primaria.

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Se evaluaron la depresión y la autoestima como replicación y extensión del estudio de Berganza y Aguilar (1992) sobre Depresión en Adolescentes Guatemaltecos. Se encontraron niveles significativos de depresión en los adolescentes (28.78 por ciento) y las diferencias de género persistieron, presentando las mujeres mayores porcentajes de depresión que los varones (36.61 vs.21.56 por ciento). Se midió la autoestima total, lo mismo que la autoestima global, familiar, académica, física y social. Se encontró una correlación negativa significativa entre la depresión y la autoestima (r = - .612, p < .05). Usando un análisis de regresión, se encontró que la autoestima y sus componentes contribuian significativamente a los niveles de depresión: Total (37.4 por ciento), global (25.7 por ciento), académica (14.9 por ciento), física (20.5 por ciento), familiar (22.8 por ciento), y social (19.2 por ciento). Se discuten las implicaciones de estos resultados y su relación con el Modelo Económico Transaccional en Adolescentes Guatemaltecos (Berganza y Aguilar, 1989).

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