Search

The Spanish DIS was applied to a community probability sample in an island-wide survey of the prevalence of psychiatric disorders in Puerto Rico. The prevalence of "severe cognitive impairment" as measured by the DIS Mini-mental State Examination (DIS/MMSE) is significantly higher than that reported in similar studies in US communities. The total sample (N = 1532) was used to study the impact of demographic variables and other psychiatric diagnoses on DIS/MMSE scores. Educational level was by far the strongest predictor of total scores as well as of scores on individual items. Issues are discussed and recommendations are made related to the use of this test in Hispanic populations of low educational level.

This paper examines the effect of the cultural category ataques de nervios on responses to the Puerto Rican Diagnostic Interview Schedule (DIS), a Spanish version of structured psychiatric diagnostic interview developed for the NIMH Epidemiologic Catchment Area study. An ataque de nervios scale was created from the Somatization items of the DIS to explore the effect of this culturally meaningful category of distress on responses to a standard psychiatric interview. Analysis of 1,513 cases from a representative sample of the island of Puerto Rico indicated that people reporting ataque symptoms fit the social characteristics described for ataques sufferers in the ethnographic literature. Qualitative data indicated that Puerto Ricans were reporting ataques de nervios in the panic section of the DIS. Questions are raised about the validity of the somatization and panic sections of the DIS in cross-cultural research with Hispanics.

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.

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.

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.

An abridged somatization construct (the Somatic Symptom Index) derived from the Diagnostic Interview Schedule's somatization disorder items was tested on community epidemiological samples to examine its prevalence, risk factors, and predictive value. The construct had a high prevalence (range, 4.4% to 20% compared with .03% to 0.7% for the full DSM-III somatization disorder diagnosis), was related to low socioeconomic status, female gender, older chronological age, and Hispanic ethnic background. The presence of this construct determined preferential use of medical services and predicted high indices of disability. The Somatic Symptom Index may have practical utility for clinical and community studies of somatoform phenomena.

Puerto Ricans and other Hispanics have traditionally used the nuclear and extended family as vital support systems to deal with stress. Some Puerto Rican migrant families living in the United States have been suspected of being at high risk for mental health problems precisely because they lack extended family supports. Working together as bilingual co-therapists, the authors found that a systems-oriented family therapy approach is effective and syntonic with the culture of Hispanic migrants. They provide a clinical vignette and warn therapists about the potential problems in differentiating dysfunctional family patterns from culturally sanctioned behaviors.

The Children's Global Assessment Scale (CGAS), a measure of overall severity of disturbance, is an adaptation of the Global Assessment Scale for adults. Data obtained on the CGAS during a pilot study in Puerto Rico demonstrate high interrater reliability and both concurrent and discriminant validity. A discriminant function was generated that highly correlates with other measures of impairment. Use of the CGAS can be of heuristic value to complement other methods of diagnostic categorization.

This paper reviews recent research that used the Diagnostic Interview Schedule (DIS) to characterize medically unexplained symptoms and their clustering in clinical and community populations. While the type of symptom(s) differed little across samples, the distribution of a less restrictive construct of somatization ('abridged' somatization) showed interesting differences across the various groups. The authors propose that in view of its relatively high prevalence, abundant psychiatric comorbidity and the simple and unintrusive nature of the assessment, use of the abridged construct may have practical value particularly when exploring psychopathology among medical and community populations.

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.

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.