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Fortuna LR, Álvarez K, Ramos Ortiz Z, Wang Y, Mozo Alegría X, Cook BL, Alegría M. Mental health, migration stressors and suicidal ideation among Latino immigrants in Spain and the United States. Eur Psychiatry 2016; 36:15-22. [PMID: 27311103 DOI: 10.1016/j.eurpsy.2016.03.001] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2015] [Revised: 02/12/2016] [Accepted: 03/08/2016] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Immigration stress appears to augment the risk for suicide behaviors for Latinos. Yet, specific risk factors that contribute to suicidal ideation (SI) among diverse Latino immigrant populations are not well established. METHODS Data were collected in Boston, Madrid and Barcelona using a screening battery assessing mental health, substance abuse risk, trauma exposure, demographics, and sociocultural factors. Prevalence rates of lifetime and 30-day SI were compared across sites. Logistic regression modeling was used to identify sociodemographic, clinical, and sociocultural-contextual factors associated with 30-day SI. RESULTS Five hundred and sixty-seven Latino patients from primary care, behavioral health and HIV clinics and community agencies participated. Rates of lifetime SI ranged from 29-35%; rates for 30-day SI were 21-23%. Rates of SI were not statistically different between sites. Factors associated with SI included exposure to discrimination, lower ethnic identity, elevated family conflict, and low sense of belonging (P<0.01). In the adjusted model, higher scores on depression, posttraumatic stress disorder, and trauma exposure were significantly associated with 30-day SI (OR=1.14, 1.04, and 7.76, respectively). Greater number of years living in the host country was significantly associated with increased odds of having SI (OR=2.22) while having citizenship status was associated with lower odds (OR=0.45). CONCLUSION Latinos suffering depression, trauma exposure, and immigration stressors are more likely to experience SI. Despite differences in country of origin, education, and other demographic factors between countries, rates of SI did not differ. Recommendations for prevention and clinical practice for addressing suicidal ideation risk among Latino immigrants are discussed.
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Affiliation(s)
- L R Fortuna
- Boston University Medical School, Boston Medical Center, Child and Adolescent Psychiatry, 850, Harrison Avenue, Dowling Building, 7th Floor, Boston, MA 02118 USA; Disparities Research Unit, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, 50, Staniford Street, Suite 830 Boston, MA 02114 USA
| | - K Álvarez
- Disparities Research Unit, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, 50, Staniford Street, Suite 830 Boston, MA 02114 USA
| | - Z Ramos Ortiz
- Disparities Research Unit, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, 50, Staniford Street, Suite 830 Boston, MA 02114 USA
| | - Y Wang
- Disparities Research Unit, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, 50, Staniford Street, Suite 830 Boston, MA 02114 USA
| | - X Mozo Alegría
- Hospital Universitari Vall d'Hebron, Paseo de la Vall d'Hebron, 119-129, 08035 Barcelona, Spain
| | - B L Cook
- Health Equity Research Lab, Cambridge Health Alliance and Harvard Medical School, 1035, Cambridge Street, Cambridge MA 02141 USA
| | - M Alegría
- Disparities Research Unit, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, 50, Staniford Street, Suite 830 Boston, MA 02114 USA.
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Vidal Mariño C, Polo del Rio R, Alegría M, Wang Y, Carmona R. Co-occurrence of PTSD and cardiovascular disease among ethnic/racial groups in the United States. Eur Psychiatry 2016. [DOI: 10.1016/j.eurpsy.2016.01.057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
IntroductionSome inconsistent evidence indicates experiences of trauma and the presence of symptoms of PTSD are associated with increased risk of cardiovascular diseases. This relation has rarely been explored with community samples including participants with PTSD symptoms or who fulfill criteria for PTSD disorders.ObjectivesWe identify those with a high number of PTSD symptoms and those fulfilling criteria for PTSD are more likely to have CVD than those without a PTSD syndrome or diagnosis. We examine rates of mental health access for those with PTSD and CVD.MethodsWe use Collaborative Psychiatric Epidemiology Surveys (CPES) to examine differences in trauma/PTSD prevalence and the association of prior trauma exposure and PTSD diagnoses with CVD (n = 13,286). CIDI was used to make psychiatric diagnoses and medical data was acquired regarding onset and severity of CVD.ResultsIndividuals with prior exposure to trauma and PTSD diagnoses had twice the likelihood of developing a cardiovascular disease as those without trauma exposure [OR = 1.77, 95% CI (1.0, 2.94)]. Having a PTSD diagnosis is a significant predictor of having a CVD for individuals who experienced a traumatic event.The probability of developing a CVD was higher when patients had prior diagnosis of substance abuse [OR = 1.36, 95% CI (1.11, 1.65)] or mental health disorders [OR = 1.43, 95% CI (1.10, 1.87) for depression; OR = 1.33, 95% CI (1.04, 1.69) for anxiety]. Men were almost twice as likely as women to be diagnosed with a CVD [OR = 1.67, 95% CI (1.37, 2.00)].ConclusionsExposure to trauma and the presence of PTSD symptoms are significantly associated with CVD.Disclosure of interestThe authors have not supplied their declaration of competing interest.
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Garcea O, Villa A, Cáceres F, Adoni T, Alegría M, Barbosa Thomaz R, Buzo R, Llamas López L, Rivera Kindel M. Early treatment of multiple sclerosis: a Latin American experts meeting. Mult Scler 2010; 15 Suppl 3:S1-S12. [PMID: 19965556 DOI: 10.1177/1352458509106419] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Patients with clinically isolated syndrome (CIS) by definition do not have multiple sclerosis (MS) but are at risk of developing it. While studies show earlier immunomodulating drug use is effective, treatment must consider likely patient prognosis. In this paper we review current diagnosis, prognosis, and treatment literature for patients with CIS within Latin American clinical settings. Latin American MS experts, convened by ACINDES (The Civil Association for Research and Development in Health), reviewed current CIS (and early MS) literature and drew consensus conclusions. Three subgroups addressed separate questionnaires on CIS issues: prognosis, diagnosis, and treatment. MRI can contribute to predicting MS risk in patients with CIS; in Latin America, investigation of haplotype presence associated with CIS would be appropriate. McDonald's criteria and subsequent revisions enable earlier, more accurate MS diagnosis. Type A evidence exists supporting all leading immunomodulating MS drugs for effective treatment of CIS with a high risk of conversion to MS. In conclusion, patients with CIS are usually young, with often-limited symptomatic manifestations, and must be adequately prepared to receive preventive treatment. This consensus review should contribute to the dialogue between physicians and patients.
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Affiliation(s)
- O Garcea
- Clinical Neuroimmunology and Multiple Sclerosis. Hospital Ramos Mejía, University Center of Neurology, School of Medicine. Buenos Aires University. Urquiza 609 (1221), Buenos Aires, Argentina.
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Alegría M, McGuire T, Vera M, Canino G, Freeman D, Matías L, Albizu C, Marín H, Calderón J. The impact of managed care on the use of outpatient mental health and substance abuse services in Puerto Rico. Inquiry 2002; 38:381-95. [PMID: 11887956 DOI: 10.5034/inquiryjrnl_38.4.381] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
This paper estimates the impact of managed care on use of mental health services by residents of low-income areas in Puerto Rico. A quasi-experimental design evaluates the impact of a low capitation rate on a minority population using three waves of data from a random community sample. Results indicate that two years after introducing managed care, privatization of mental health services had minimal impact on use. Advocates had hoped health care reform would increase access in comparison to access seen within the public system, while opponents feared profit motives would lead to decreased access. Neither forecast turned out to be correct. The question remains as to how to improve access for the poor with low capitation rates.
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Affiliation(s)
- M Alegría
- Center for Evaluation and Sociomedical Research, Graduate School of Public Health, University of Puerto Rico, San Juan 00936-5067, USA
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Alegría M, McGuire T, Vera M, Canino G, Albizu C, Marín H, Matías L. Does managed mental health care reallocate resources to those with greater need for services? J Behav Health Serv Res 2001; 28:439-55. [PMID: 11732246 DOI: 10.1007/bf02287774] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Evidence points to the existence of two coexisting inefficiencies in mental health care resource allocation: those with need receive too limited or no care while those with no apparent need receive services. In addition to reducing costs, managed mental health care is expected to reallocate treatment resources to those with greater need for services. However, there are no empirical findings regarding this issue. This study tests whether managed mental health care has had a differential impact by level of need. Data consist of three waves of a community sample with a control group. The study finds that managed care has not succeeded in reallocating resources from the unlikely to the definite "needers."
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Affiliation(s)
- M Alegría
- Graduate School of Public Health, Medical Sciences Campus, University of Puerto Rico, PO Box 365067, San Juan, PR 00936-5067.
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Bravo M, Ribera J, Rubio-Stipec M, Canino G, Shrout P, Ramírez R, Fábregas L, Chavez L, Alegría M, Bauermeister JJ, Martínez Taboas A. Test-retest reliability of the Spanish version of the Diagnostic Interview Schedule for Children (DISC-IV). J Abnorm Child Psychol 2001; 29:433-44. [PMID: 11695544 DOI: 10.1023/a:1010499520090] [Citation(s) in RCA: 111] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
The test-retest reliability of the Spanish Diagnostic Interview Schedule for Children (DISC-IV) is presented. This version was developed in Puerto Rico in consultation with an international bilingual committee, sponsored by NIMH. The sample (N = 146) consisted of children recruited from outpatient mental health clinics and a drug residential treatment facility. Two different pairs of nonclinicians administered the DISC twice to the parent and child respondents. Results indicated fair to moderate agreement for parent reports on most diagnoses. Relatively similar agreement levels were observed for last month and last year time frames. Surprisingly, the inclusion of impairment as a criterion for diagnosis did not substantially change the pattern of results for specific disorders. Parents were more reliable when reporting on diagnoses of younger (4-10) than older children. Children 11-17 years old were reliable informants on disruptive and substance abuse/dependence disorders, but unreliable for anxiety and depressive disorders. Hence, parents were more reliable when reporting about anxiety and depressive disorders whereas children were more reliable than their parents when reporting about disruptive and substance disorders.
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Affiliation(s)
- M Bravo
- Behavioral Sciences Research Institute and Department of Graduate Studies in Education, University of Puerto Rico, San Juan 00936-5067, USA
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Alegría M, McGuire T, Vera M, Canino G, Matías L, Calderón J. Changes in access to mental health care among the poor and nonpoor: results from the health care reform in Puerto Rico. Am J Public Health 2001; 91:1431-4. [PMID: 11527776 PMCID: PMC1446799 DOI: 10.2105/ajph.91.9.1431] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES Health care reforms associated with managed care may adversely affect the health care safety net for disadvantaged populations. This study compared changes in health care use among poor and nonpoor individuals enrolled in managed care. METHODS Data from 3 waves of a random community sample were collected on approximately 3,000 adults. Changes in use of mental health services were assessed in a pretest-posttest, quasi-experimental design. RESULTS Managed care increased use of specialty services among the nonpoor while maintaining the same level of use for the poor in the public sector. CONCLUSIONS Reallocation of mental health services may be a result of expanding Medicaid eligibility.
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Affiliation(s)
- M Alegría
- Graduate School of Public Health, University of Puerto Rico, San Juan 00936-5067, USA.
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Abstract
Between 1981 and 1995, approximately 5 million people from either Mexico, Cuba, Central America, or South America immigrated to the United States. Some regional studies have suggested that as Hispanic immigrants become acculturated to American society, their risk of mental illness increases sharply. This study examined the lifetime risk of psychiatric and substance use disorders among U.S. Hispanic subgroups and the specific role of nativity, parental nativity, language preferences, and other sociodemographic characteristics as risk factors for these disorders. The study used the National Comorbidity Survey (NCS), a national probability sample of 8098 U.S. adults aged 15 to 54. Selected DSM-III-R psychiatric diagnoses were collapsed into eight categories. When compared with non-Hispanic whites, Mexican-Americans were less likely to have any psychiatric disorder. After multivariate adjustment, acculturation items predicted greater risk of having any DSM-III-R disorders for Mexican-Americans and "other" Hispanics and greater risk of having a substance abuse disorder for Puerto Ricans, among other significant relationships. The results suggest that there is likely to be an increasing prevalence of psychiatric and substance use disorders among Hispanics that may be attributable to increasing levels of acculturation among the more than 5 million recent immigrants from Latin America.
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Affiliation(s)
- A N Ortega
- Yale University, Department of Epidemiology and Public Health, New Haven, Connecticut 06520-8034, USA
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Alegría M, Bijl RV, Lin E, Walters EE, Kessler RC. Income differences in persons seeking outpatient treatment for mental disorders: a comparison of the United States with Ontario and The Netherlands. Arch Gen Psychiatry 2000; 57:383-91. [PMID: 10768701 DOI: 10.1001/archpsyc.57.4.383] [Citation(s) in RCA: 132] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
BACKGROUND Variations in the relationships among income, use of mental health services, and sector of care are examined by comparing data from 3 countries that differ in the organization and financing of mental health services. METHODS Data come from the 1990-1992 National Comorbidity Survey (n = 5,384), the 1990-1991 Mental Health Supplement to the Ontario Health Survey (n = 6,321), and the 1996 Netherlands Mental Health Survey and Incidence Study (n = 6031). Analysis of the association between income and use of mental health services was carried out for the population that was between ages 18 and 54 years. Differential use of mental health treatment was examined in 3 sectors: the general medical sector, the specialty sector, and the human services sector. RESULTS No significant association between income and probability of any mental health treatment was observed for persons with psychiatric disorders in any of the 3 countries. However, there were significant differences among countries in the association between income and sector of mental health care treatment. In the United States, income is positively related to treatment being received in the specialty sector and negatively related to treatment being received in the human services sector. In the Netherlands, patients in the middle-income bracket are less likely to receive specialty care, while those in the high-income bracket are less likely to be seen in the human service sector. Income is unrelated to the sector of care for patients in Ontario. CONCLUSIONS Future research should examine whether differential access to the specialty sector for low-income people in the United States is associated with worse mental health outcomes.
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Affiliation(s)
- M Alegría
- Center for Evaluation and Sociomedical Research, School of Public Health, University of Puerto Rico, San Juan, USA.
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10
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Rodríguez Figueroa J, Irizarry Castro A, Alegría M, Vera M, Pérez Perdomo R. [Sociodemographic profile of a group of sex workers in Puerto Rico]. P R Health Sci J 1999; 18:53-7. [PMID: 10343987] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
Abstract
This research explored the sociodemographic characteristics, the health perceptions and the distinctive aspects of the sexual work of a group of women sexual workers (n = 311). The study interest was generating data relative to the use of injectable drugs, the prevalence of sexually transmitted diseases (STD), the prevalence of HIV and the risk behaviors of this population group. A remarkable characteristic of the group of women studied was their history of pregnancies at and early age. A high proportion of illness apparently related to the presence of sexually transmitted diseases and limited health care was observed.
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Affiliation(s)
- J Rodríguez Figueroa
- Centro de Investigaciones y Evaluación Sociomédica, Escuela Graduada de Salud Pública, Recinto de Ciencias Médicas, Universidad de Puerto Rico, San Juan
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Flores I, Pieniazek D, Morán N, Soler A, Rodríguez N, Alegría M, Vera M, Janini LM, Bandea CI, Ramos A, Rayfield M, Yamamura Y. HIV-1 subtype F in single and dual infections in Puerto Rico: A potential sentinel site for monitoring novel genetic HIV variants in North America. Emerg Infect Dis 1999; 5:481-3. [PMID: 10341345 PMCID: PMC2640772 DOI: 10.3201/eid0503.990328] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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Abstract
OBJECTIVES This study uses the recently developed Network-Episode Model (NEM) to examine the nature and correlates of utilization among Puerto Ricans reporting mental health problems. The NEM highlights two issues: (1) examining the patterns or combinations of lay and formal use that individuals employ and (2) reformulating how the availability and content of social networks influences patterns of care. METHODS Using data from the 1989 Mental Health Care Utilization Among Puerto Ricans Study (probability sample of 1,777 individuals living in low-income areas of the island), the authors focus on the patterns and correlates of use for 365 Puerto Ricans reporting service use for mental health problems in the previous year. RESULTS A combination of clustering and multinomial logit techniques indicates that there are six unique care patterns. Two patterns include the use of mental health providers and are associated with different contingencies. CONCLUSIONS In general, patterns of use are shaped by age, education, gender, and illness severity. Larger, more supportive networks decrease the use of patterns of care that include formal health care providers, and decrease direct entry into the mental health sector. These results are in line with NEM's predictions for lower class populations and help clarify inconsistencies in previous research on social networks. The implications of this perspective for health services research and treatment are discussed.
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Affiliation(s)
- B A Pescosolido
- Department of Sociology, Indiana University, Bloomington 47405, USA
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Vera M, Alegría M, Freeman DH, Robles R, Pescosolido B, Peña M. Help seeking for mental health care among poor Puerto Ricans: problem recognition, service use, and type of provider. Med Care 1998; 36:1047-56. [PMID: 9674622 DOI: 10.1097/00005650-199807000-00011] [Citation(s) in RCA: 53] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVES This study examines the effects of health, predisposing, and enabling factors on recognition of a mental health problem, use of formal mental health care, and contact with a specialized mental health provider. METHODS Interviews were conducted with a probability sample of 3,435 adults. The variables examined include measures of mental health; social and demographic factors; and enabling factors relevant to the help-seeking process. RESULTS Subjective and objective measures of mental health were associated with the recognition of a mental health problem. The objective assessment of definite need for services was relevant for the use of formal services. However, the subjects' perception of poor mental health was strongly related to receiving care from a mental health specialist. Although interaction with social networks is associated with use of formal services, low economic strain is related to receiving care from the specialty sector. CONCLUSIONS The results support the importance of using multiple measures of mental health problems. The finding that individuals' perceived economic strain increases the likelihood of receiving specialized care suggests that studies of economic barriers to the use of mental health services might benefit from the adoption of measures that assess perceived economic circumstances.
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Affiliation(s)
- M Vera
- Center for Evaluation and Sociomedical Research and Department of Administration, School of Public Health, Medical Sciences Campus, University of Puerto Rico, San Juan 00936-5067, USA
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14
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Irizarry Castro A, Alegría M, Vera M, Santos-Ortiz MC, Cruz López M. [Women abandoned by Social and Health Agencies. Challenge in the prevention of HIV/AIDS]. P R Health Sci J 1997; 16:401-7. [PMID: 9547832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The present study examined the role of an intervention directed to link a group of sexual workers with social and health services. The subjects receptivity to use these services was measured by the degree of acceptance that the selected agencies provided to the participants of this study. The present investigation included two groups of subjects consisting of sexual workers and other women that were at high risk of prostitution because of their social circumstances. The sample consisted of 92 women residents of either the San Juan area of other towns from the eastern part of Puerto Rico. The method of focal group and a agencies directory was utilized during the intervention. In addition, the attempt to establish a helpful relationship between the subject and the agency was also incorporated to the investigation. The present findings showed the presence of a considerable social distance between the agencies and the subjects studies. The use of the studied intervention failed to be an efficient strategy. The authors recommend to explore different and new intervention modalities that elicit significant social change. Moreover, these interventions should innovate the current treatments aimed at the social problems related to sexual work.
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Affiliation(s)
- A Irizarry Castro
- Centro de Investigación y Evaluación Socio económica, Escuela Graduada de Salud Pública, Universidad de Puerto Rico, San Juan 00936-5067
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Abstract
This paper examines the help-seeking process of mental health services in women with high depressive symptoms. The data are based on an island wide probabilistic sample (n = 1,062) of 18- to 64-year-old women living in low socioeconomic areas in Puerto Rico. Symptoms of depression were measured by the Center for Epidemiological Studies Depression Scale (CES-D). Results show that one out of three women living in poor residential areas report high depressive symptoms. Of these women with high depressive symptoms, only 12% seek help from a mental health specialist and 14.5% from a general health care provider to deal with their emotional problems. Some factors related to the use of mental health services are: presence of an occupational disability, head of household status, having private insurance, and having a regular source of care. These data suggest that women underutilize mental health services and overutilize physical health services to deal with their emotional problems. The lack of recognition of emotional problems by these women may explain the low utilization of mental health services.
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Affiliation(s)
- A L Jiménez
- Center for Evaluation and Sociomedical Research, School of Public Health, University of Puerto Rico, San Juan, Puerto Rico
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Ribera JC, Canino G, Rubio-Stipec M, Bravo M, Bauermeister JJ, Alegría M, Woodbury M, Huertas S, Guevara LM, Bird HR, Freeman D, Shrout PE. The Diagnostic Interview Schedule for Children (DISC-2.1) in Spanish: reliability in a Hispanic population. J Child Psychol Psychiatry 1996; 37:195-204. [PMID: 8682899 DOI: 10.1111/j.1469-7610.1996.tb01391.x] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
The reliability across time, informants and interviewers of the Spanish translation of the DISC-2.1 was tested on a Puerto Rican Hispanic sample using a test-retest design. Levels of reliability between clinic and community samples and between younger and older children were compared to explore the sources of low reliability for certain psychiatric disorders. Parents' reports tended to be more reliable than those of their children, although the difference was less obvious with older children. Reliability was generally higher for the externalizing disorders and when the second interviewer was a psychiatrist rather than a lay interviewer.
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Alegría M, Vera M, Freeman DH, Robles R, Santos MC, Rivera CL. HIV infection, risk behaviors, and depressive symptoms among Puerto Rican sex workers. Am J Public Health 1994; 84:2000-2. [PMID: 7998647 PMCID: PMC1615399 DOI: 10.2105/ajph.84.12.2000] [Citation(s) in RCA: 96] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
This paper examines the association of depressive symptoms with human immunodeficiency virus (HIV) infection and risk behaviors among 127 sex workers. Data were obtained by a structured interview and blood specimens tested for HIV. Findings showed a high prevalence rate of depressive symptoms for all sex workers regardless of HIV infection status. Results of a logistic regression analysis indicated that the use of injected drugs and engaging in unprotected intercourse with clients were strongly associated with a high level of depressive symptoms.
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Affiliation(s)
- M Alegría
- Center for Evaluation and Sociomedical Research, University of Puerto Rico, San Juan
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Freeman DH, Alegría M, Vera M, Muñoz CA, Robles RR, Jiménez AL, Calderón JM, Peña M. A receiver operating characteristic (ROC) curve analysis of a model of mental health services use by Puerto Rican poor. Med Care 1992; 30:1142-53. [PMID: 1453818] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
In this study, the contribution of four distinct domains of the Help Seeking-Decision Making model to predicting the use of mental health services is examined. Using a proposed methodology the authors assess the relevance of this model and its domains to mental services planning. The methodology combines logistic regression analysis and receiver operating characteristic (ROC) curves. Logistic regression analysis allows us to examine the individual variables of the model and generate predictions about use. ROC curves allow us to compare and interpret the relative contribution of a predisposing domain, a physical and mental health domain, an enabling-restrictive domain, and an organizational domain in correctly classifying users and nonusers of mental health services. The physical and mental health domain yielded a Somer's D-statistic of 0.7, which corresponds to an 85% correct classification of randomly selected pairs of users and nonusers. The study findings suggest that comparing ROC curves helps to describe and interpret the domains of the model that are relevant for making predictions about who will or will not use mental health services during a 1-year period.
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Affiliation(s)
- D H Freeman
- Department of Community and Family Medicine, Dartmouth Medical School, Hanover, NH
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Fernández-Feliberti R, Fernández SA, Colón C, Ramírez N, Alegría M, Cintrón K. Transfer of the tibialis anterior for calcaneus deformity in myelodysplasia. J Bone Joint Surg Am 1992; 74:1038-41. [PMID: 1522090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
We evaluated the results of transfer of the tibialis anterior in the management of calcaneus deformity in young patients who had myelodysplasia; fifteen patients (twenty-two feet) were operated on between 1978 and 1985. The neural deficit was at the fourth and fifth lumbar levels. The average age at the time of the operation was seven years and two months (range, two to nineteen years). The average age at the latest follow-up was thirteen years (range, five to twenty-four years). The average duration of follow-up was five years and ten months (range, two to eleven years). Seventeen feet (twelve patients) had a good result (no ulceration of the heel or osteomyelitis and correction of the calcaneus deformity), and five feet (three patients) had a poor result (persistent ulceration, signs of osteomyelitis, recurrent or persistent calcaneus deformity, or the need for additional operative intervention). Children who were less than five years old had a better outcome, as determined by the Fisher exact test (p less than 0.5).
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Bauermeister JJ, Alegría M, Bird HR, Rubio-Stipec M, Canino G. Are attentional-hyperactivity deficits unidimensional or multidimensional syndromes? Empirical findings from a community survey. J Am Acad Child Adolesc Psychiatry 1992; 31:423-31. [PMID: 1592773 DOI: 10.1097/00004583-199205000-00007] [Citation(s) in RCA: 55] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Factor analysis on teacher ratings of symptoms in a probability community sample of children aged 6 to 16 years (N = 614) yielded two factors: Inattention and Hyperactivity-Impulsivity. Subsequent cluster analyses on the scores of factorially derived scales for a subsample of 170 children with a diagnosis of attention deficit disorder with (ADDH) and without hyperactivity (ADDWO), or normals, resulted in five clusters that accounted for 88% of the variance. The existence of these clusters was confirmed using external validating criteria. The data support a bidimensional conceptualization of attention deficit disorder with hyperactivity, one dimension consisting of symptoms of inattention and another of symptoms of hyperactivity-impulsivity. The data also suggests that a condition very similar to the DSM-III-R description of undifferentiated attention-deficit disorder also exists as a distinct entity.
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Affiliation(s)
- J J Bauermeister
- Department of Psychology, University of Puerto Rico, Rio Piedras 00931
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Vera M, Alegría M, Freeman D, Robles RR, Ríos R, Ríos CF. Depressive symptoms among Puerto Ricans: island poor compared with residents of the New York City area. Am J Epidemiol 1991; 134:502-10. [PMID: 1897506 DOI: 10.1093/oxfordjournals.aje.a116122] [Citation(s) in RCA: 59] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
This paper compares the distribution and sociodemographic patterns of depressive symptoms among two groups of Puerto Ricans. The data employed for the analysis are from a probability sample of two communities of adults. Puerto Ricans living in poor residential areas on the Island (n = 1,658) and those living in the New York City area (n = 1,267). The first group was interviewed during 1989, and the second during 1984. Symptoms of depression were measured with the Center for Epidemiologic Studies Depression Scale. Results show that Puerto Ricans residing in the New York City area and the Island poor have similar levels of high depressive symptomatology, 28.1% and 28.6%, respectively. Results of the logistic regression analysis indicated that female sex, low educational level, low household income, and unemployment are predictors of high depressive symptoms for both samples. These results are similar to findings for other ethnic groups. For Puerto Ricans living in New York, the effect of interviewing in Spanish on high depressive symptoms diminishes after sex, education, and income variables are controlled.
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Affiliation(s)
- M Vera
- Center for Evaluation and Sociomedical Research, School of Public Health, University of Puerto Rico, San Juan
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Abstract
BACKGROUND This paper describes utilization of mental health services by poor Puerto Ricans living on the island. It examines the utilization rates, within health sectors, and settings for the provision of mental health services. METHODS Data are based on an islandwide probability sample of 18- to 64-year-old respondents living in low socioeconomic areas. We assessed need with the Psychiatric Symptom and Dysfunction Scales. RESULTS Approximately one-third of our study population (31.5%) met criteria for need. Of these, only 32% had received any mental health care in the past year. Need was significantly associated with use of physical or mental health services for mental health problems. We found those who needed services to be five times more likely than those who did not need services to have used one or both sectors of care at least once in the past year. Among the first group 21.8% used the physical health sector to deal with mental health problems in contrast with 17.9% who sought care in the mental health sector. In the physical health sector, subjects used the public and private settings equally. In the mental health sector, 70% of subjects used the public setting. CONCLUSIONS This suggests the nonpsychiatric physician as a main provider for mental health treatment.
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Affiliation(s)
- M Alegría
- Center for Evaluation and Sociomedical Research, University of Puerto Rico School of Public Health 00936-5067
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Vera M, Robles RR, Alegría M. Sociodemographic, cultural and interpersonal risk factors as indicators of mental health needs. P R Health Sci J 1988; 7:21-5. [PMID: 3375419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
The goal of this paper is to examine an integrated model of mental health needs which takes into consideration psychiatric symptoms and dysfunctions, behavioral dimensions, as well as socioeconomic and cultural factors. This model presupposes that specific life situations and positions of the respondent in different dimensions of the social structure are basic factors for the identification of mental health needs. The method of data collection was a personal interview with a sample of two hundred community members, 18 to 64 years, selected using a stratified random sampling based on the criteria of sex and age. Statistically significant differences were identified between age, sex, education, social role performance, subjective perceptions, and levels of mental health need. This evidence suggests that social roles and specific risk factors are basic elements in determining mental health needs.
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Affiliation(s)
- M Vera
- Center for Evaluation and Sociomedical Research, School of Public Health, University of Puerto Rico, San Juan 00936
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Alegría M, Robles RR, Vera M. Psychiatric symptomatology and health care utilization. P R Health Sci J 1988; 7:15-9. [PMID: 3375418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
This paper examines the relationship between psychiatric symptoms and dysfunctions and utilization of general and mental health services. A sample of two hundred community members, 18 to 64 years old, was selected using a stratified random sampling based on the criteria of sex and age. Respondents were categorized according to their aggregated scores on the validated Psychiatric Symptom and Dysfunction Scales. Patterns of utilization were ascertained according to identified levels of psychiatric symptoms. Results indicated that as the level of psychiatric symptoms increased so did the proportion of users of mental health services. Subjects scoring high in psychiatric symptomatology were also found to make more use of general health services and prescribed drugs than those with low levels of psychiatric symptoms and dysfunctions. Worth mentioning is the fact that 61.12% of the respondents, who were identified as in need of mental health services, reported that they had not received such services. This result suggests that other factors, in addition to psychiatric symptomatology, also influence the use of general and mental health services.
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Affiliation(s)
- M Alegría
- Center for Evaluation and Sociomedical Research, School of Public Health, University of Puerto Rico, San Juan 00936
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Robles RR, Martínez RE, Vera M, Alegría M. Health care services and sterilization among Puerto Rican women. P R Health Sci J 1988; 7:7-13. [PMID: 3375423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
This paper considers the variables related to the type of health care utilization for sterilization and family planning among Puerto Rican women. The study is based on a representative sample of 1,375 women between the ages of 15-49 years. The data shows that the majority of women used the private sector of health care for their sterilization. Younger women, women with a low level of education, unemployed, living in consensual marriages and those who had their children as adolescents, made more use of the public services for their sterilization. It is a well proven fact that women with the above mentioned characteristics are more socioeconomically deprived than the educated, married and working women. Thus, it is to be expected that this group of women does not have the economic resources needed to utilize the private health care system.
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Affiliation(s)
- R R Robles
- Center for Evaluation and Sociomedical Research, School of Public Health, University of Puerto Rico, San Juan 00936
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Robles R, Vera M, Alegría M, Martinez R. The use of epidemiological data in the planning and evaluation of mental health care programmes and services. World Hosp 1985; 21:64-6. [PMID: 10317674] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
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