Epidemiología del TDAH en niños y adolescentes chilenos / Epidemiology of ADHD in children and adolescents of Chile

ADHD prevalence, associated factors, comorbidity and service use are reported for a sample of 1,558 children and adolescents, belonging to four provinces in Chile. The sample is weighted in each step for selection bias. Psychiatric disorders and impairment are assessed with computerized in-home DISC-IV interviews, and a questionnaire regarding socioeconomic and family variables and service use. Estimates of prevalence rates are obtained by means of STATA 11.0 software, with complex sample design. Multivariate logistic regression is used to determine which factors were the best predictors for mental disorders. Participation rate is 82.4 %. The prevalence of ADHD is 10 %, and the most prevalent subtype is the hyperactive/impulsive, with no gender differences. Both hyperactive/impulsive and combined subtypes are more prevalent in children 4-11 than in adolescents. The most prevalent comorbidities are anxiety disorders and oppositional disorder. Anxiety is the more prevalent comorbid disorder in girls and correlated with a combined subtype. Perception of good family functioning, adolescent age and school dropout have a negative association with ADHD diagnosis, while maltreatment shows a positive correlation. Over 50 % of children and adolescents diagnosed with ADHD have used services in the last year. This is the first comprehensive community study of psychiatric disorders in children and adolescents in a South American country. It yields information for child and adolescent mental health programmes in Chile and contributes to cross-cultural epidemiological research.

Se describe la prevalencia del TDAH, los factores asociados, la comorbilidad y el uso de servicios, en una muestra de 1.558 niños y adolescentes, pertenecientes a cuatro provincias de Chile. En cada etapa del diseño muestral, se efectúa un pesaje para manejar el sesgo de selección. La presencia de trastornos psiquiátricos y la discapacidad son evaluados en el hogar, a través de la entrevista computarizada DISC-IV y de un cuestionario sobre variables socioeconómicas y familiares, junto al uso de los servicios. Las estimaciones de las tasas de prevalencia son obtenidas, por medio de un software, STATA 11.0, con diseño de muestra complejo. Se utilizó la regresión logística multivariada, para determinar qué factores eran los mejores predictores para trastornos mentales. La tasa de participación es del 82.4%. La prevalencia del TDAH es del 10%, y el subtipo de mayor prevalencia, es el hiperactivo / impulsivo, sin diferencias de género. Ambos subtipos hiperactivo/ impulsivo y combinado, demuestran mayor prevalencia en niños de 4-11 años, que en adolescentes. Las comorbilidades más frecuentes, son los trastornos de ansiedad y el trastorno oposicionista. La ansiedad, es la comorbilidad más frecuente del trastorno en las niñas y se correlacionó con el subtipo combinado. La percepción de un buen funcionamiento familiar, la edad de los adolescentes y la deserción escolar disminuyen el riesgo de presentar TDAH, mientras que el antecedente de maltrato lo aumenta. Más del 50% de los niños y adolescentes que han sido diagnosticados con TDAH, han utilizado servicios en el último año. Este es el primer estudio amplio en la comunidad, en trastornos psiquiátricos en niños y adolescentes, en un país de América del Sur. Ofrece información para programas de Salud Mental en Niños y Adolescentes en Chile y contribuye a la investigación epidemiológica transcultural.

Salud mental infanto-juvenil en Chile y brechas de atención sanitarias / Prevalence of psychiatric disorders among Chilean children and adolescents

Background: Psychiatric disorders that appear during childhood or adolescence should be a public health priority. Aim: To report the results of a national representative survey in the Latin American region examinig the prevalence of DSM-IV psychiatric disorders in children and adolescents. Material and Methods: Subjects aged 4 to 18 years were selected using a stratified multistage design. The Diagnostic Interview Schedule for Children Version IV (DISC-IV) was used to obtain 12-month DSM-IV diagnoses, and was supplemented with questionnaires examining family riskfactors, socioeconomic status and service use. Results: A sample of1558 children and adolescents (51% males) was evaluated. Fifty three percent of the sample were children aged 4 to 11 years and the rest were adolescents aged 12 to 18 years. The prevalence rate for any psychiatric disorder without impairment was 38.3% (33.5% for boys and 43.3% for girls). The prevalence rate was higher among children as compared to adolescents (42.9% and 33.2%, respectively). A third of participants receiving a diagnosis sought some form of assistance. Nearly a quarter of those using services, did not have a psychiatric diagnosis in the past year. Comorbidity was found in 27% of those with a disorder, but only 7% had three or more diagnoses. Conclusions: The prevalence of psychiatric disorders in Chile is high among children and adolescents. This study highlights the increasing need to re-evaluate mental health services provided to children and adolescents in our country.

Epidemiología de trastornos mentales infanto juveniles en la Provincia de Cautín / Prevalence of mental health disorders among children and adolescents living in southern Chile

Background: The knowledge about prevalence of psychiatric disorders in all age groups is fundamental to plan an adequate mental health care. Aim: To determine the prevalence of DSM-IV psychiatric disorders in a representative sample of children and adolescents living in the province of Cautin, Chile. Material and Methods: Subjects aged between 4 and 18 years were selected in an aleatory stratified multistage fashion. As part of a national sample, four counties in Cautín were selected, then blocks, homes and the child or adolescent to be interviewed. Psychology graduate students applied the Spanish computer version of DISC-IV, as well as a questionnaire on family risk factors, socioeconomic index and service use. Results: A sample of 272 children and adolescents was evaluated, obtaining 93,4 percent of participation. Using the most stringent impairment algorithm, the prevalence rate for any psychiatric disorder was 16.8 percent, being 16.5 percent in boys and 17.1 percent in girls and mainly explained by anxiety and affective disorders. Prevalence was practically the same in the group aged 4 to 11 years than in those aged 12 to 18 years (16.7 percent and 16.8 percent respectively). Prevalence of anxiety disorders was the highest, but less associated with impairment. On the other hand, all children and adolescents with affective disorders were impaired. Conclusions: The prevalence of psychiatric disorders in Cautín is high in children and adolescents.