RESUMO
OBJECTIVE: To identify the independent psychosocial and risk behavior correlates of suicidal ideation and attempts. METHOD: The relationships between suicidal ideation or attempts and family environment, subject characteristics, and various risk behaviors were examined among 1,285 randomly selected children and adolescents, aged 9 through 17 years, of whom 42 (3.3%) had attempted suicide and 67 (5.2%) had expressed suicidal ideation only. The youths and their parents were enumerated and interviewed between December 1991 and July 1992 as part of the NIMH Methods for the Epidemiology of Child and Adolescent Mental Disorders (MECA) Study. RESULTS: Compared with subjects with suicidal ideation only, attempters were significantly more likely to have experienced stressful life events, to have become sexually active, to have smoked more than one cigarette daily, and to have a history of ever having smoked marijuana. After adjusting for sociodemographic characteristics, a statistically significant association was found between suicidal ideation or attempt and stressful life events, poor family environment, parental psychiatric history, low parental monitoring, low instrumental and social competence, sexual activity, marijuana use, recent drunkenness, current smoking, and physical fighting. Even after further adjusting for the presence of a mood, anxiety, or disruptive disorder, a significant association persisted between suicidal ideation or attempts and poor family environment, low parental monitoring, low youth instrumental competence, sexual activity, recent drunkenness, current smoking, and physical fighting. CONCLUSION: Low parental monitoring and risk behaviors (such as smoking, physical fighting, alcohol intoxication, and sexual activity) are independently associated with increased risk of suicidal ideation and attempts, even after adjusting for the presence of psychiatric disorder and sociodemographic variables.
Assuntos
Cognição , Assunção de Riscos , Tentativa de Suicídio/psicologia , Adolescente , Estudos de Casos e Controles , Criança , Estudos Transversais , Feminino , Humanos , Funções Verossimilhança , Masculino , Porto Rico , Risco , Tentativa de Suicídio/prevenção & controle , Estados UnidosRESUMO
OBJECTIVES: First, to investigate whether there is covariation between risk behaviors, including suicidality, in a community probability sample of children and adolescents; and second, to investigate whether risk behavior is associated with selected potential correlates. METHOD: A sample of 9- to 17-year-old youths (N = 1,285) and their caretakers were interviewed in the Methods for the Epidemiology of Child and Adolescent Mental Disorders (MECA) Study. The risk behaviors were marijuana smoking, alcohol use, intercourse, fighting, cigarette smoking, and suicidal ideation/attempts. Relationships between the risk behaviors were described using odds ratios. Linear regression analyses of an index of risk behavior on the selected potential correlates of risk behavior were conducted. RESULTS: There were significant relationships between all pairs of risk behaviors. The score on the index of risk behavior was associated with stressors, lack of resources, family psychiatric disorder, psychopathology, and functional impairment. CONCLUSIONS: Clinicians should be alerted to the possibility of risk behaviors, especially in children and adolescents engaging in other risk behaviors and those with inadequate resources, stressors, functional impairment, or psychopathology.
Assuntos
Assunção de Riscos , Transtornos do Comportamento Social/etiologia , Transtornos do Comportamento Social/psicologia , Tentativa de Suicídio/psicologia , Adolescente , Criança , Connecticut , Feminino , Georgia , Humanos , Modelos Lineares , Masculino , New York , Razão de Chances , Psicologia do Adolescente , Psicologia da Criança , Porto Rico , Fatores de Risco , Estudos de Amostragem , AutorrevelaçãoRESUMO
The correspondence between Diagnostic and Statistical Manual (3rd ed.) (DSM-III) diagnoses and statistically derived syndromes was examined within a community sample of children and adolescents in Puerto Rico. Specifically, the extent to which behavior dimensions, derived from the Child Behavior Checklist and the Youth Self-Report, corresponded to psychiatric diagnoses, derived from parent and child versions of the Diagnostic Interview Schedule for Children, was examined. The alternative approaches for assessing psychopathology in children and adolescents were compared against external validators. The results indicated a meaningful convergence between DSM-III diagnoses and statistical syndromes; however, a one-to-one correspondence did not emerge. Little evidence was found for "diagnostic thresholds." There was no evidence of the superiority of either the statistically derived syndromes or the DSM-III diagnoses. The incorporation of a measure of impairment improved the validity of both approaches. Adding parental reports to the self-reports of adolescents yielded little gain in the validity of either the statistical or diagnostic approach. The implications for the definition and assessment of child and adolescent disorders are discussed.
Assuntos
Transtornos do Comportamento Infantil/diagnóstico , Transtornos Mentais/diagnóstico , Escalas de Graduação Psiquiátrica/estatística & dados numéricos , Adolescente , Comportamento do Adolescente , Criança , Transtornos do Comportamento Infantil/classificação , Transtorno Depressivo/classificação , Transtorno Depressivo/diagnóstico , Diagnóstico Diferencial , Feminino , Humanos , Masculino , Transtornos Mentais/classificação , Porto Rico , Reprodutibilidade dos Testes , Síndrome , Terminologia como AssuntoRESUMO
Secondary analyses of the data from the Puerto Rico Child Psychiatry Epidemiologic Study were done to provide information on the comorbidity of four major diagnostic domains (attention deficit disorders, conduct/oppositional disorders, depression and anxiety disorders). A high level of comorbidity was found among these four domains of child and adolescent psychopathology. In general the patterns of comorbidity were not affected by whether the data was put together by a clinician or by means of a computer algorithm scoring a structured interview. The patterns were not affected in any major way by who the informants were in the diagnostic process. Minor differences were found in certain comorbidity patterns depending on the sex and age of the subjects. Comorbidity was associated with level of impairment and to service utilization.
Assuntos
Transtornos de Ansiedade/epidemiologia , Transtorno do Deficit de Atenção com Hiperatividade/epidemiologia , Transtornos do Comportamento Infantil/epidemiologia , Transtorno Depressivo/epidemiologia , Adolescente , Transtornos de Ansiedade/diagnóstico , Transtornos de Ansiedade/psicologia , Transtorno do Deficit de Atenção com Hiperatividade/diagnóstico , Transtorno do Deficit de Atenção com Hiperatividade/psicologia , Criança , Transtornos do Comportamento Infantil/diagnóstico , Transtornos do Comportamento Infantil/psicologia , Comorbidade , Estudos Transversais , Transtorno Depressivo/diagnóstico , Transtorno Depressivo/psicologia , Feminino , Humanos , Incidência , Masculino , Determinação da Personalidade/estatística & dados numéricos , Psicometria , Porto Rico/epidemiologiaRESUMO
One of the issues confronting the field of child psychiatric epidemiology is devising ways to aggregate discrepant reports from multiple informants obtained in structured diagnostic assessments of children and adolescents. The present report uses data from an epidemiological community survey to attempt to address this issue. The results obtained through statistical procedures designed to identify the "optimal" informant for specific symptomatic criteria and diagnoses do not seem to offer a clear-cut advantage over a simple combinatorial rule that identifies symptomatic criteria as positive when they are acknowledged as positive by either parent or child informants.
Assuntos
Transtornos do Comportamento Infantil/diagnóstico , Transtornos do Comportamento Infantil/epidemiologia , Determinação da Personalidade/estatística & dados numéricos , Adolescente , Criança , Transtornos do Comportamento Infantil/psicologia , Pré-Escolar , Estudos Transversais , Feminino , Humanos , Incidência , Masculino , Programas de Rastreamento , Psicometria , Porto Rico/epidemiologiaRESUMO
One of the uses of the Child Behavior Checklist is as a screening instrument for childhood psychopathology in two-phase designs. The present report involves a two-phase epidemiological survey conducted in Puerto Rico in which the CBCL was used as a screening instrument during the first stage, and children were evaluated clinically during the second stage. The data indicate that in using the CBCL for screening for psychopathology in children, parent information is most informative, particularly for children in the adolescent age group. Nevertheless, the data also reinforce the need to obtain teacher information with the Teacher Report Form to enhance screening sensitivity. In this population, the data obtained with the Youth Self-Report were found to be of limited usefulness for screening purposes.
Assuntos
Transtornos do Comportamento Infantil/epidemiologia , Testes de Personalidade/estatística & dados numéricos , Adolescente , Criança , Transtornos do Comportamento Infantil/diagnóstico , Transtornos do Comportamento Infantil/psicologia , Pré-Escolar , Estudos Transversais , Feminino , Humanos , Incidência , Masculino , Programas de Rastreamento , Psicometria , Porto Rico/epidemiologiaRESUMO
The desirability of incorporating a measure of impairment to the categorization of childhood psychopathology in the community is examined. The use of the Children's Global Assessment Scale (CGAS) for this purpose is recommended. The choice of 61 (definite case) and 71 (probable case) as cutpoints on the Children's Global Assessment Scale is supported empirically by the data on service utilization, parental perceived need, and behavior problem scores obtained in the Puerto Rico Child Psychiatry Epidemiological Study.
Assuntos
Sintomas Afetivos/epidemiologia , Transtornos do Comportamento Infantil/epidemiologia , Adolescente , Sintomas Afetivos/diagnóstico , Criança , Transtornos do Comportamento Infantil/diagnóstico , Pré-Escolar , Estudos Transversais , Feminino , Humanos , Incidência , Masculino , Escalas de Graduação Psiquiátrica , Porto Rico/epidemiologiaRESUMO
U.S. mainland and Puerto Rican nonreferred samples were compared via the Child Behavior Checklist (ages 4 to 16), Teacher's Report Form (ages 6 to 16), and Youth Self-Report (ages 12 to 16). Problem scores were significantly higher in parent and teacher ratings of Puerto Rican than mainland subjects, but were significantly lower in self-ratings by Puerto Rican adolescents. Adolescents in both cultures reported significantly more problems than their parents or teachers did. Most of the significant cross-cultural differences in parent, teacher, and self-ratings of competencies showed more favorable scores for the mainland subjects. High referral rates, a high prevalence of DSM diagnoses, and low scores on the Children's Global Assessment Scale are consistent with the high problem rates reported by Puerto Rican parents and teachers but not with the lower rates reported by adolescents. Different clinical cutoffs may be needed for all assessments in the mainland versus Puerto Rico.
Assuntos
Comparação Transcultural , Transtornos Mentais/epidemiologia , Adolescente , Criança , Pré-Escolar , Estudos Transversais , Feminino , Humanos , Masculino , Porto Rico , Valores de Referência , Estados UnidosRESUMO
Data are presented on risk factors for childhood psychopathology derived from a study of an island-wide probability sample of children in Puerto Rico aged 4 through 16 years. Analyses estimated the effects of 12 demographic, health, and family variables on the probability of being a "case," using two different operational definitions of caseness, as well as on the probability of receiving the diagnoses of oppositional disorder, attention deficit disorder, separation anxiety, depression, functional enuresis, and adjustment disorder. When compared to other findings, the results from these analyses indicate that the relationship between maladjustment and the risk factors evaluated does not appear to be culturally specific.
Assuntos
Transtornos Mentais/epidemiologia , Adolescente , Fatores Etários , Criança , Pré-Escolar , Humanos , Transtornos Mentais/psicologia , Porto Rico , Fatores de Risco , Fatores Sexuais , Classe SocialRESUMO
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-à-vis the availability of mental health services on the island reflected a major public health problem.