Psychometric Properties of the Generalized Anxiety Disorder 7-item Scale in Adolescents: An Effective Screening Tool for School and Community Settings.

OBJECTIVE: Anxiety disorders are prevalent among children and adolescents. Identifying anxiety symptoms in primary care, school, and community settings has implications for service planning, resource allocation, and prevention and treatment programming. The Generalized Anxiety Disorder 7-item (GAD-7) scale is a commonly used instrument for evaluating anxiety symptoms. Still, it has yet to be validated in vulnerable groups, such as Spanish-speaking adolescents who are at risk due to socioeconomic disadvantages. METHODS: This study aimed to examine the psychometric properties of the Spanish version of the GAD-7 for adolescents in a sample of middle and high school students in Puerto Rico. Secondary data from 566 students in fifth to twelfth grade in Puerto Rico were collected as part of a school-based services program. RESULTS: A confirmatory factor analysis evidenced the 1-factor structure of the GAD-7, while a test of invariance supported the equality of the factor loadings across gender and school level. The scores of the GAD-7 showed positive and significant correlations with the 8-item Patient Health Questionnaire depression scale-providing evidence of convergent validity-and the reliability estimates of the GAD-7 were adequate. CONCLUSION: Thus, the GAD-7 has optimal psychometric properties in terms of construct and convergent validity and internal consistency. It is a useful instrument for assessing anxiety in Spanish speaking youth in Puerto Rico.

Propiedades psicométricas de la “Escala de apoyo social del Estudio de resultados médicos” (MOS-SSS-A) entre adolescentes en Puerto Rico / Psychometric properties of the "Medical Outcomes Study Social Support Scale" (MOS-SSS-A) among adolescents in Puerto Rico

Este estudio tiene como objetivo examinar las propiedades psicométricas de la “Escala de apoyo social del Estudio de resultados médicos” (MOS-SSS-A) en una muestra de adolescentes en Puerto Rico. La muestra consistió en datos secundarios de 787 estudiantes, de entre 10 y 18 años de edad, que asistían a escuelas públicas ubicadas en el sureste y noreste de Puerto Rico. Realizamos un análisis factorial confirmatorio para probar la estructura factorial de la MOS-SSS-A. Además, se evaluaron las correlaciones entre el apoyo social percibido, la depresión y la ansiedad como evidencia de validez divergente. Los resultados indicaron un mejor ajuste cuando se utilizó el modelo original de cuatro factores. Las puntuaciones de apoyo social percibido se correlacionaron negativamente con las puntuaciones de depresión y ansiedad, que evidencian validez divergente. En conclusión, la MOS-SSS modificado para adolescentes (MOS-SSS-A) podría resultar un instrumento útil para la evaluación de su papel en la reducción o la prevención de psicopatologías, así como en el ofrecimiento de intervenciones tempranas para poblaciones en alto riesgo como los adolescentes de grupos minoritarios. (AU)

This study aims to examine the psychometric properties of the Medical Outcomes Study-Social Support Survey (MOS-SSS-A) in a sample of adolescents in Puerto Rico. The sample consisted of secondary data of 787 students, ranging in age from 10 to 18, who attended public schools located in the southeast and northeast of Puerto Rico. We conducted a confirmatory factor analysis to test the factorial structure of the MOS-SSS-A. Additionally, correlations among perceived social support, depression, and anxiety were evaluated as evidence of discriminant validity. Results indicated a better fit when using the four-factor original model. Perceived social support scores were negatively correlated with depression and anxiety scores, which evidence discriminant validity. In conclusion, the MOS-SSS modified for adolescents (MOS-SSS-A) could be a valuable instrument for evaluating its role in reducing or preventing psychopathologies and offering early interventions for high-risk populations such as adolescents from minority groups. (AU)

Cultural adaptation and psychometric properties of the Substance Abuse Self-Stigma Scale among Latinos with Substance Use Disorders: An effective screening tool for correctional and community settings.

The present study involves a psychometric evaluation of the Substance Abuse Self-Stigma Scale (SASSS), a 40-item dimensional measure of internalized or self-stigma developed by Jason Luoma and collaborators, among Latinos with Substance Use Disorders (SUDs). The current study's specific aim is to assess the psychometric properties (factor structure and reliability) of the translated and culturally adapted SASSS instrument in a cross-sectional study of individuals (n = 412) with SUDs with or without HIV from correctional facilities and community treatment programs. A confirmatory factor analysis evidenced the four-factor structure of SASSS. Results showed significant correlations with HIV felt stigma among those participants with co-occurring SUD and HIV (n=119), internalized shame, stigma-related interpersonal rejection due to substance abuse, symptoms of depression, substance use within the last 30 days, psychological flexibility, self-esteem, and self-efficacy, supporting good convergent validity. The measure showed a strong factor structure and adequate reliability estimates supporting its applicability to Latinos with SUDs from community and criminal justice settings. Findings are discussed in terms of their implications for studies of stigma impact and intervention.

Translation, cultural adaptation, and psychometric properties of the Spanish version of the Combat Exposure Scale (CES-S) with U.S. military Spanish speaking Latino veterans living in the Caribbean: A cross-sectional preliminary data study.

OBJECTIVE: The Combat Exposure Scale (CES) is one of the most used self-report instruments to assess various combat situations experienced by military personnel. This article presents a comprehensive translation and cultural adaptation of the CES to Spanish and its psychometric properties. METHOD: Fifty-five (n = 55) U.S. military Spanish-speaking Latino veterans diagnosed with combat-related PTSD were recruited from 2018 to 2020 to participate in this cross-sectional preliminary data study at the VA Caribbean Health Care System. The translation and cultural adaptation followed the recommendations by Chavez & Canino (2005). Statistical analysis included principal component factor analysis, internal consistency analysis, and content validity analysis. It included two different expert bilingual committees composed of veterans with combat experience and university professors at a doctoral level. RESULTS: The CES-S consists of seven items. The principal component factor analysis resulted in one factor and the content validity of =1. CES-S has an internal consistency of α=.84. CONCLUSION: The CES-S is suitable for its use with Spanish-speaking Latino veteran samples. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Randomized pilot trial of cognitive-behavioral therapy and acceptance-based behavioral therapy in the treatment of Spanish-speaking Latino primary care patients with generalized anxiety disorder.

The evidence base supporting the usefulness of traditional cognitive-behavioral therapy (CBT) and newer acceptance-based CBT treatments for generalized anxiety disorder (GAD) has grown over the past decades. GAD is prevalent among several Latino subgroups, particularly Puerto Ricans. However, there remains uncertainty regarding the appropriateness of these interventions for Spanish-speaking Latinos since they have been routinely excluded in both efficacy and effectiveness studies. As an initial step to bridge this gap, this pilot study examined the potential efficacy of two CBT interventions for GAD, traditional CBT and acceptance-based behavioral therapy (ABBT), in a sample of Spanish-speaking Latinos. Ninety primary care patients with GAD were randomly assigned to receive CBT (n=30), ABBT (n=30), or treatment as usual (TAU) (n=30). Excessive worry, the core feature of GAD, was assessed with the Penn State Worry Questionnaire (PSWQ), which is considered the gold standard measure of GAD-related worry. At follow-up, PSWQ scores for participants in the CBT and ABBT groups were statistically lower than those of the TAU group and statistically comparable to each other. CBT and ABBT reduced worry level to a greater degree than usual care by follow-up. Our findings provide preliminary, yet crucial data, which support the potential of both interventions targeting GAD symptoms among Spanish-speaking Latino primary care patients.

[Psychometric Properties of the Scale of Negative Attitudes Towards Trans People in Healthcare Providers in Puerto Rico]. / Propiedades psicométricas de la Escala de Actitudes Negativas hacia Personas Trans en proveedores de salud en Puerto Rico.

The ignorance towards the Trans people can cause healthcare providers to assume negative attitudes towards this population. It is relevant to understand with more amplitude the manifestations of stigma towards the Trans population using instruments whose psychometry is adequate. The main objective of the present study was to evaluate the reliability of the Scale of Negative Attitudes towards Trans People (EANT, in Spanish) and its factorial structure in healthcare providers in Puerto Rico. As a secondary objective, differences in attitudes towards Trans people between physical healthcare providers and mental healthcare providers were evaluated. The sample consisted of 67 healthcare providers recruited according to their availability. A point-biserial correlation, a Cronbach's alpha analysis, a Confirmatory Factor Analysis (CFA), and the non-parametric Mann-Whitney test were carried out to examine our objectives. The results confirmed that the EANT has a one-dimensional structure. The Cronbach's alpha internal consistency index of the scale was .75. No significant differences were found in attitudes towards Trans people between physical healthcare providers and mental healthcare providers. Finally, a discussion of the research findings is presented, as well as its limitations and contributions.

Effect of the Management of LGBTT+ Identity on Psychological Wellbeing.

The current study, guided by the Minority Stress Model (Meyer, 2003), seeks to examine the effect of sexual orientation or gender identity management (disclosure or concealment) in the relationship between internalized negative ideals (internalized homonegativity and internalized transnegativity) and psychological wellbeing in LGBTT+ people in Puerto Rico. Four instruments were translated from English to Spanish, two of them relating to the management of the minority identity, and two regarding the internalized negative ideals. Additionally, reliability measures were calculated for each instrument. The sample consisted of 203 participants, 165 identified as cisgendered, and 38 identified themselves as trans or another gender. Results suggested that internalized negative ideals predicted the minority identity management in LGBTT+ people. However, the relationship between the internalized negative ideals and psychological wellbeing was only confirmed in terms of sexual orientation and not of gender identity, which suggests that other factors may better explain wellbeing in trans people. A discussion is presented on these results' implications and the study's challenges and limitations due to the Covid-19 pandemic, and suggestions for further studies.

La presente investigación, guiada por el Modelo de Estrés de Minorías (Meyer, 2003), busca examinar el efecto del manejo de la orientación sexual o identidad de género, entiéndase divulgación u ocultación, en la relación de homonegatividad internalizada/transfobia internalizada con el bienestar psicológico en personas LGBTT+ en Puerto Rico. Se tradujeron cuatro instrumentos, dos relacionados al manejo de la identidad minoritaria (ocultación o divulgación), y dos sobre los ideales negativos internalizados, y se calculó su confiabilidad. La muestra consistió de 203 participantes, donde 165 se identificaron como cisgénero, y 38 como trans u otro género. Los hallazgos mostraron que los ideales negativos internalizados predijeron el manejo de la identidad minoritaria para las personas LGBTT+. No obstante, la relación entre los ideales negativos internalizados y el bienestar psicológico solo se confirmó para los ideales de la orientación sexual, y no de la identidad de género, lo cual sugiere que otros factores pueden explicar de forma más significativa el bienestar en las personas transgénero. Se presenta una discusión de las implicaciones de estos resultados. A su vez, se describen los retos y las limitaciones del estudio debido al COVID-19, así como recomendaciones para futuros estudios.

COVID-19 in Puerto Rico: Preliminary observations on social distancing and societal response toward a novel health stressor.

Countries worldwide are making wide-ranging attempts to stymie the outbreak of the 2019 novel coronavirus (COVID-19), and most of their efforts depend on the financial, structural, and social resources available. Given the increase in documented cases of COVID-19 in Puerto Rico, the extension of an aggressive and restrictive quarantine has been the correct step to slow down the potential contagion. Nevertheless, in this article, we discuss additional concrete actions that should be considered. This unprecedented scenario provides us the opportunity to rethink our limited resources based on a socioecological perspective, with the aim of creating efficiency and reducing the inequities that could accompany the pandemic. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Psychometric Properties of the OBCS Body Shame Scale in a Sample of Female Residents in Puerto Rico.

The purpose of this study is to analyze the psychometric properties of the Spanish version of the Body Shame scale within the Objectified Body Consciousness Scale (OBCS) in a sample of women living in Puerto Rico. The sample consisted of 117 heterosexual women. A confirmatory factor analysis was conducted to evaluate the structure of the scale and internal consistency was examined. Findings revealed that the 6-item Spanish version of the Body Shame scale shows better model-data fit than the original 8-item version. The results of the study support the use of the final 6-item version of the Body Shame scale in research and practice, given that it demonstrated appropriate structure and internal consistency. In conclusion, the findings support the use of the 6-item version of the Body Shame scale.

El propósito de este estudio es analizar las propiedades psicométricas de la versión española de la escala de Vergüenza Corporal en la Objectified Body Consciousness Scale (OBCS). La muestra estuvo compuesta de 117 mujeres heterosexuales que viven en Puerto Rico. Se realizó un análisis factorial confirmatorio para evaluar la estructura de la escala y se examinó la consistencia interna. Los resultados indican que la versión española de 6 items de la escala de Vergüenza Corporal mostró un mejor ajuste de los datos del modelo que la versión original de 8 ítems. Los resultados del estudio respaldan el uso de la versión final de 6 ítems de la escala de Vergüenza Corporal en la investigación y la práctica, dado que demostró una estructura apropiada y una consistencia interna adecuada. En conclusión, los resultados apoyan el uso de la escala de 6 ítems de vergüenza corporal.

Mediating Effect of Psychological Distress and Sexual Satisfaction in Puerto Ricans with Prostate Cancer.

Prostate cancer is the most diagnosed in the male population in Puerto Rico. However, it is little studied in the field of health, specifically in the field of clinical health psychology. The present study examines whether emotional distress and sexual satisfaction mediate the relationship between erectile dysfunction and quality of life and if erectile dysfunction is related to the treatment. For this, a quantitative exploratory design was used. The sample was 44 patients between the ages of 50 to 86 years. It was compiled by availability in different urologists' offices. For its collection, several meetings were held with specialists, a data collection logistics was established, in which the administrative staff identified the participants through their ICD 10 diagnoses. The participants completed four self-administered questionnaires, which most of them showed an appropriate Cronbach's Alpha. The results indicated that exist a low moderately significant relationship between treatment and erectile dysfunction (b = -0.35, 95% BcCI [-0.82, -0.03]) and that there is an indirect effect of psychological distress (b = -0.35, 95 % BcCI [-0.82, -0.03]) and sexual satisfaction (b = -.87, 95% BcCI [-2.18, -0.24] in the relationship between erectile dysfunction and the patient's quality of life. The preliminary data from the present study allow the offering of psychotherapeutic treatments focused on this population.

El cáncer de próstata es el más diagnosticado en la población de hombres en Puerto Rico. Sin embargo, es poco estudiado en el campo de la salud, específicamente en el campo de la psicología clínica de la salud. El presente estudio pretende examinar: si la angustia psicológica y la satisfacción sexual median la relación entre disfunción eréctil y calidad de vida, y si la disfunción eréctil se relaciona con el tratamiento que esté recibiendo la persona para tratar su condición. Para esto, se realizó un diseño exploratorio de tipo cuantitativo, con una muestra compuesta por 44 pacientes, entre las edades de 50 a 86 años. La misma fue recopilada por disponibilidad en diferentes oficinas de urólogos. Para su recolección, se realizaron varias reuniones con los especialistas donde se estableció la logística de recogido de datos, en la cual el personal administrativo identificó a los participantes a través de sus diagnósticos según el ICD 10. Los participantes completaron cuatro cuestionarios autoadministrables, los cuales, en su mayoría, mostraron un Alfa de Cronbach apropiado. Los resultados del estudio indican que existe una relación significativa moderada baja entre el tratamiento y la disfunción eréctil (b = −0.35, 95%BcCI [−0.82, −0.03]) y que existe un efecto indirecto de la angustia psicológica (b = −0.35, 95%BcCI [−0.82, −0.03]) y la satisfacción sexual (b = −.87, 95% BcCI [−2.18, −0.24] en la relación entre la disfunción eréctil y la calidad de vida del paciente. Los datos preliminares del presente estudio permiten el ofrecimiento de tratamientos psicoterapéuticos centrados en esta población.

Sex differences in traumatic events and psychiatric morbidity associated to probable posttraumatic stress disorder among Latino prisoners.

Latinos comprised 17.1% of the U.S. population and 33.1% of US prisoners, yet they are underrepresented in the psychopathology literature. Despite higher rates of trauma among incarcerated individuals than in the general population, most of the previous research in this area focused primarily on women samples, and very few studies examined sex differences in PTSD and traumatic experiences. In addition, there is a need for research assessing traumatic experiences and probable PTSD in men and women Latino inmates to inform culturally competent care and sex sensitive care for this vulnerable and underserved population. Our study examined whether men and women Latino inmates with probable Posttraumatic Stress Disorder (PTSD), based on the cut off 40 or more symptoms on the Davidson Trauma Scale (DTS), differed significantly by the number of event types experienced, the type of potentially traumatizing event, and in co-occurring psychiatric conditions. A multi-stage sample design was used to select a probabilistic sample of 1,331 inmates from 26 penal institutions in PR of which 1179 participated in the study. Bivariate associations were calculated for each type of traumatic event and probable PTSD. Mean number of types of potentially traumatizing event experienced was comparable for both sexes (F = 3.83, M = 3.74) yet sex differences were found in the nature of the event. Women with probable PTSD had higher rates of experiencing rape and sexual abuse. Men had higher rates of experiencing combat in war, a life-threatening accident, of witnessing violence, and being threatened with a weapon. Men with significant ADHD symptoms in childhood and with Generalized Anxiety Disorder (GAD) during adulthood were almost 5 and 7 times as likely to score above threshold on the DTS whereas women were >3 times as likely in the presence of ADHD symptoms in childhood or depression during adulthood. This study underscores the need to improve understanding of the clinical manifestations of trauma and co-occurring psychiatric conditions for appropriate sex sensitive interventions targeting Latinos living in prisons.

Assessing post-traumatic stress symptoms in a Latino prison population.

PURPOSE: The purpose of this paper is to assess the reliability and validity of the Spanish version of the Davidson trauma scale (DTS-S) and to determine the prevalence and correlates of post-traumatic stress disorder (PTSD) symptoms in a non-clinical random sample of prison inmates. DESIGN/METHODOLOGY/APPROACH: Probabilistic samples of 1,179 inmates from 26 penal institutions in Puerto Rico were selected using a multistage sampling design. Population estimates and correlations were obtained for PTSD, generalized anxiety and depression. The reliability, factor structure, and convergent validity of the DTS-S were assessed. Cross-validation was employed to confirm the results of the factor analyses. FINDINGS: Using the cut-offs adopted by the scale's author, 136 (13.4 percent) of the inmates are likely to have current PTSD and 117 (11.6 percent) reach the cut-off for sub-threshold PTSD. Confirmatory factor analysis generated two factors explaining 53 percent of the variance. High reliabilities were obtained for the total scale (α=0.95) and for the frequency and severity scales (α=0.90 and 0.91). Significantly higher DTS-S scores were found for females (t=2.26, p<0.025), for inmates diagnosed with depression or anxiety (t=2.02, p<0.05), and those reporting suicide attempts (t=4.47, p<0.0001). ORIGINALITY/VALUE: Findings support that the DTS-S is a reliable and valid measure to assess PTSD symptoms in Latino inmate populations and to identify individuals at risk for the disorder that require confirmatory diagnosis and clinical interventions.

Probable Posttraumatic Stress Disorder and Psychiatric Co-morbidity among Latino Primary Care Patients in Puerto Rico.

BACKGROUND: The present investigation was designed to study PTSD among inner city primary care patients in Puerto Rico. Specifically, we examined the rate of probable PTSD, PTSD co-morbidity with MDD and GAD, and the association of probable PTSD and co-occurring disorders with demographic, treatment, and alcohol related factors. METHODS: We screened 3,568 patients at primary care practices serving primarily low-income patients. The presence of probable PTSD was assessed with the Primary Care PTSD screen, major depression with the PHQ-9, and generalized anxiety disorder with the GAD Q-IV. RESULTS: Fourteen percent of our sample screened positive for probable PTSD. Among this group, 12% met criteria for co-morbid GAD without MDD and 15.9% for co-morbid MDD with/without GAD, whereas 72% of the patients with probable PTSD did not meet criteria for co-morbidity. Over 80% of the patients with probable PTSD indicated they were not receiving mental health treatment. Multiple logistic regression findings show that there were no significant differences in demographic and alcohol related factors by PTSD status. Multinomial logistic regression analysis revealed significant differences in the use of mental health treatment among the subgroups of patients with probable PTSD. As compared to patients with only probable PTSD, the use of mental health services was 4 times higher among patients with probable PTSD and MDD and over 2 1/2 times higher among patients with probable PTSD and GAD. CONCLUSION: The prevalence rate of probable PTSD in our sample was similar to the rates reported for soldiers after returning from deployment and for Latinos after the September 11 attacks. The high prevalence of probable PTSD and low use of mental health treatment among inner city primary care patients in our study, highlight the need of future research to obtain information on how to effectively target and treat Latino primary care patients in need of treatment for PTSD.

Prolonged exposure for the treatment of Spanish-speaking Puerto Ricans with posttraumatic stress disorder: a feasibility study.

BACKGROUND: Most of the empirical studies that support the efficacy of prolonged exposure (PE) for treating posttraumatic stress disorder (PTSD) have been conducted on white mainstream English-speaking populations. Although high PTSD rates have been reported for Puerto Ricans, the appropriateness of PE for this population remains unclear. The purpose of this study was to examine the feasibility of providing PE to Spanish speaking Puerto Ricans with PTSD. Particular attention was also focused on identifying challenges faced by clinicians with limited experience in PE. This information is relevant to help inform practice implications for training Spanish-speaking clinicians in PE. RESULTS: Fourteen patients with PTSD were randomly assigned to receive PE (n = 7) or usual care (UC) (n = 7). PE therapy consisted of 15 weekly sessions focused on gradually confronting and emotionally processing distressing trauma-related memories and reminders. Five patients completed PE treatment; all patients attended the 15 sessions available to them. In UC, patients received mental health services available within the health care setting where they were recruited. They also had the option of self-referring to a mental health provider outside the study setting. The Clinician-Administered PTSD Scale (CAPS) was administered at baseline, mid-treatment, and post-treatment to assess PTSD symptom severity. Treatment completers in the PE group demonstrated significantly greater reductions in PTSD symptoms than the UC group. Forty percent of the PE patients showed clinically meaningful reductions in PTSD symptoms from pre- to post-treatment. CONCLUSIONS: PE appears to be viable for treating Puerto Rican Spanish-speaking patients with PTSD. This therapy had good patient acceptability and led to improvements in PTSD symptoms. Attention to the clinicians' training process contributed strongly to helping them overcome the challenges posed by the intervention and increased their acceptance of PE.

Suicide ideation, plans, and attempts among general practice patients with chronic health conditions in Puerto Rico.

BACKGROUND: Little is known about suicidal ideation among general practice patients in Puerto Rico. In this study we examined the rates, severity, and correlates of suicidal ideation, plans, and attempts among general practice patients with chronic illnesses. This is important in targeting appropriate interventions and management approaches to minimize and prevent suicide. METHODS: We screened patients with chronic physical conditions at general practices. Suicidal ideation was assessed with the suicidality module of the Mini International Neuropsychiatric Interview. Major depression was assessed with the Patient Health Questionnaire depression module. The relationship between sociodemographic factors, depression and suicidal ideation was examined with multiple logistic regression analysis. Among the subgroup that acknowledged suicidal ideation, we used multinomial logistic regression analysis to estimate simultaneously the multivariate associations of depression and sociodemographic factors with suicidality risk levels. RESULTS: Of the 2068 patients screened, 15.4% acknowledged recent suicidal ideation. Among this group, 8.6% reported passive ideation, 3.7% active ideation without a plan, and 3.1% active ideation with a plan or attempt. According to multivariate logistic regression, suicidal ideation was higher among patients with moderately severe depression and severe depression than for those with milder symptoms. Patients aged 64 years or younger were over one and a half times more likely to acknowledge suicidal ideation than those aged 65 years and older. Compared with patients having a college degree, those with lower education had a twofold higher risk of suicidal ideation. Multinomial logistic regression analysis indicated that severe depression was associated with a higher likelihood of having a suicide plan or attempt. CONCLUSION: The findings of this study suggest that public health strategies focusing on the systematic identification of patients with increased depression severity and the implementation of evidence-based depression treatments are relevant for minimizing and preventing suicidal behavior among general practice patients with chronic health conditions.

Collaborative care for depressed patients with chronic medical conditions: a randomized trial in Puerto Rico.

OBJECTIVE: This study examined whether a collaborative care model for depression would improve clinical and functional outcomes for depressed patients with chronic general medical conditions in primary care practices in Puerto Rico. METHODS: A total of 179 primary care patients with major depression and chronic general medical conditions were randomly assigned to receive collaborative care or usual care. The collaborative care intervention involved enhanced collaboration among physicians, mental health specialists, and care managers paired with depression-specific treatment guidelines, patient education, and follow-up. In usual care, study personnel informed the patient and provider of the diagnosis and encouraged patients to discuss treatment options with their provider. Depression severity was assessed with the Hopkins Symptom Checklist; social functioning was assessed with the 36-item Short Form. RESULTS: Compared with usual care, collaborative care significantly reduced depressive symptoms and improved social functioning in the six months after randomization. Integration of collaborative care in primary care practices considerably increased depressed patients' use of mental health services. CONCLUSIONS: Collaborative care significantly improved clinical symptoms and functional status of depressed patients with coexisting chronic general medical conditions receiving treatment for depression in primary care practices in Puerto Rico. These findings highlight the promise of the collaborative care model for strengthening the relationship between mental health and primary care services in Puerto Rico.

Relationship between aggressive behavior, depressed mood, and other disruptive behavior in Puerto Rican children diagnosed with attention deficit and disruptive behaviors disorders.

OBJECTIVE: The present study was directed at examining the relationship between aggressive behavior, depressed mood, other disruptive behaviors in children diagnosed with ADHD or ODD disorders in Puerto Rico. METHODS: One hundred seventy six (176) students (127 males and 49 females) from 12 public elementary schools in the San Juan Area of Puerto Rico participated in the study. The participants were divided into a group of ADHD children who exhibited aggressive behavior, a group of ADHD children that did not show aggressive behavior, and a normal group. Several self-report measures were administered to the children and teachers. RESULTS: Our results indicate that the best predictor of aggressive behavior was the hyperactivity and impulsiveness for both ADHD males and females. In addition, depressed mood in both males and females was also a significant predictor of aggressive behavior in Puerto Rican ADHD children. However, in females the social problems variable was also found to be a significant grouping variable. CONCLUSION: The first conclusion of these results is that inattentiveness does not appear to be a relevant factor in ADHD Puerto Rican children who exhibit aggressive behavior. Second, we need to be cognizant to the fact that Puerto Rican ADHD children do exhibit high co-morbidity for aggressive behavior, depressed mood, and social problems. Thus, our diagnostic and treatment approaches with ADHD Puerto Rican children need to include an assessment of the social environment of the child and its effect on his emotional state, in particular his or her mood.