Prevalence of child and adolescent mental disorders in Chile: a community epidemiological study.

BACKGROUND: In Latin America, there is limited research on the prevalence of mental disorders in children and adolescents. This Chilean survey is the first national representative survey in the Latin American region to examine the prevalence of diagnostic and statistical manual-IV (DSM-IV) psychiatric disorders in the region in children and adolescents. METHODS: Subjects aged 4-18 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 of affective, anxiety, conduct and substance use disorders, and supplemented with questionnaires examining family risk factors, family income, and service utilization. The parent or the primary caretaker was interviewed for children, aged 4-11, using the DISC-IV; however, adolescents, aged 12-18, were directly interviewed. RESULTS: A sample of 1558 children and adolescents was evaluated. Using the most stringent DISC-IV impairment algorithm, the prevalence rate for any psychiatric disorders was 22.5% (19.3% for boys and 25.8% for girls). The prevalence rate was higher among the children, aged 4-11, in comparison with adolescents, aged 12-18 (27.8% and 16.5%, respectively). Less than half of the subjects in need of services sought some form of assistance. Nearly a quarter of those using services did not present with a psychiatric diagnosis in the past year. Comorbidity was found in 24.8% of those with a disorder, but only 6.3% 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 reevaluate mental health services provided to children and adolescents in Latin America.

Inteligencia y Conductas Delictuales enAdolescentes Chilenos / Intelligence and criminal behavior in chilean adolescents

Este estudio compara el rendimiento intelectual de 100 jóvenes varones (12-17años) que han infringido la ley, con el de 100 jóvenes no infractores. Los resultados indican quelos jóvenes infractores de ley presentan una mayor proporción de CIs totales inferiores al promedioen comparación con los jóvenes no infractores. Al descontar el efecto de la escolarización y NSE,las diferencias de CI entre ambos grupos siguen siendo significativas, aunque menos extremas. Losresultados concuerdan con los hallazgos de otros estudios respecto al menor CI en jóvenes infractores de ley, particularmente en el CI verbal. Estos resultados son de importancia en la planificación deestrategias de rehabilitación, reescolarización y reinserción social de estos adolescentes.

Prevalence of child and adolescent psychiatric disorders in Santiago, Chile: a community epidemiological study.

PURPOSE: To determine the prevalence of DSM-IV psychiatric disorders in a representative sample of children and adolescents living in Santiago, Chile, as part of a national sample. METHOD: Subjects aged 4-18 were selected using a stratified multistage design. First, ten municipalities/comunas of Santiago were selected; then the blocks, homes, and child or adolescent to be interviewed were chosen. Psychology graduate students administered the Spanish-language, computer-assisted version of DISC-IV that estimated DSM-IV 12-month prevalence. RESULTS: A total of 792 children and adolescents were evaluated, with a participation rate of 76.7%. The most stringent impairment DSM-IV DISC algorithm for psychiatric disorders revealed a prevalence of 25.4% (20.7% for boys and 30.3% for girls). The majority of the diagnoses corresponded to anxiety and affective disorders. Prevalence was higher in children aged 4-11 (31.9%) than in adolescents aged 12-18 (18.2%). This difference was mainly accounted for by disruptive disorders in the younger age group. Anxiety disorders had the highest prevalence, although impairment was low. In contrast, most children and adolescents with affective disorders were impaired. CONCLUSIONS: In Santiago, the prevalence of psychiatric disorders in children and adolescents was high. This study helps raise awareness of child and adolescent mental health issues in Spanish-speaking Latin America and serves as a basis for improving mental health services.

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

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% of participation. Using the most stringent impairment algorithm, the prevalence rate for any psychiatric disorder was 16.8%, being 16.5% in boys and 17.1% 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% and 16.8% 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.

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.

Estudio epidemiológico de sucesos traumáticos, trastorno de estrés post-traumático y otros trastornos psiquiátricos en una muestra representativa de Chile / Epidemiology of trauma, PTSD and other psychiatric disorders in a representative population of Chile

In the last decade, our understanding of posttraumatic stress disorder (PTSD) has progressed from studies of war veterans and specific disaster victims to studies that examine the epidemiology of PTSD in the United States (USA) population. Epidemiologic data on PTSD in developing countries is an understudied area with the majority of studies were developed in the USA and other developed countries. Of the few epidemiological surveys undertaken in other countries, most of them have focused its interest on the prevalence rates of PTSD and its risk factors for following specific traumatic events. Besides increasing the international normative and descriptive data base on PTSD, an examination of prevalence rates and risk factors for PTSD in a socio-political and cultural context (that is markedly different to established market economies) can deepen our understanding of the phenomenology and determinants of PTSD. Although many psychiatric diagnoses can be related with previous traumatic experiences, PTSD has been identified as a disorder that requires a previous traumatic exposure for its diagnosis. A growing literature strongly suggests that early exposure to traumatic events disrupts crucial normal stages of childhood development and predisposes children to subsequent psychiatric sequelae. A series of epidemiological studies has demonstrated that childhood sexual abuse is associated with a range of psychiatric disorders in adulthood that includes mood, anxiety, and substance use disorders, even after adjusting for possible confounds, such as family factors and parental psychopathological disorders or other childhood adversities. There is little evidence of diagnostic specificity of childhood sexual abuse, although a consistent finding has been that alcohol and drug disorders are more strongly related to childhood sexual abuse than other psychiatric disorders. Other forms of childhood traumas have been less well studied. This article reviews the findings of an epidemiological study that took place in Chile and examined prevalence rates of PTSD, traumatic events most often associated with PTSD, comorbidity of PTSD with other lifetime psychiatric disorders, gender differences in PTSD as well as trauma exposure in a representative sample of Chileans. This article also reported a comparison of prevalence rates of various psychiatric disorders among persons who reported the first trauma during their childhood, those who reported the first trauma during their adulthood, and those with no trauma history. The study was based on a household-stratified sample of people defined by the health service system to be adults (aged 15 years and older). The study was designed to represent the population of Chile. This analysis is limited to three geographically distinct provinces, chosen as being representative of the distribution of much of the population. The interviews were administered to a representative sample of 2390 persons aged 15 to over 64 years. The measures used were the DSM-III-R PTSD and antisocial personality disorder modules from the Diagnostic Interview Schedule and modules for a range of DSM-III-R diagnoses from the Composite International Diagnostic. Traumatic events were categorized into one of 11 categories: military combat, rape, physical assault, seeing someone hurt or killed, disaster, threat, narrow escape, sudden injury/ accident, news of a sudden death or accident, other event (e.g. kidnapping, torture), or other experience. The translation into Spanish was conducted using the protocol outlined by the World Health Organization. The interviewers were all university students in their senior year studying social sciences. Taylor series linearization method was used to estimate the standard errors due to the sample design and the need for weighting. The analysis was conducted using procedures without replacement for non-respondents. The region, province, comuna, and district selected were used as the defined strata. Logistic regression with the corresponding 95% confidence interval was used to examine associations among PTSD, demographic risk factors, and trauma type. To examine whether the association between PTSD and gender could be explained by other risk factors, multivariate logistic regression analyses were also conducted. The first analysis found that the lifetime prevalence of PTSD was 4.4% (2.5% for men and 6.2% for women). Among the traumatic events, rape was most strongly associated with PTSD diagnosis. Among those exposed to traumas, women were significantly more likely to develop PTSD than men, after controlling for assaultive violence. The second analysis revealed that exposure to a lifetime trauma was associated with a higher probability of psychiatric morbidity in comparison with no trauma exposure. Traumas with childhood onset were significantly related to lifetime panic disorder, independent of number of lifetime traumas and demographic differences. This revealed that women had more probabilities than men of developing PTSD once they are exposed to trauma, independent of previous traumas, experiences of sexual assault, other violent experiences or level of education. Some authors have proposed that women have a higher vulnerability than men to develop PTSD and that there are sex differences in brain morphology, in the social interpretation of trauma, or/and in the peritraumatic dissociative experience. Although many theories have been proposed to explain this gender difference in PTSD, more research is needed to evaluate them empirically. This study highlights the importance of investigating the prevalence of PTSD, the patterns of comorbidity of PTSD, as well as gender differences of PTSD in non-English speaking countries. Although Chile has a different historical and socio-cultural context with respect to other countries in which the epidemiology of PTSD has been examined, in general, this study achieved similar results as those found in other studies. The results showed that PTSD is not an uncommon psychiatric illness, it is associated with a high degree of psychiatric comorbidity, it is more likely to predate other psychiatric disorders. Also, the results showed that men are more likely to be exposed to traumas than women, women are more likely than men to develop PTSD, and that PTSD is associated with relatively high treatment utilization. However, compared to another country in Latin America, such as Mexico, Chile has a lower prevalence of PTSD and trauma exposure, which may due to socio-economic factors, such as less inequity between the wealthy and the poor and less violence, crime, and poverty in Chile than Mexico. These studies also suggest that traumatic events that occur in childhood are related to specific disorders rather than those that occurred later in life. Individuals with childhood interpersonal trauma exposure are more likely to suffer from lifetime panic disorder, agoraphobia or PTSD compared to those who experience interpersonal trauma as an adult. However, research should examine the specificity of these disorders in relation to various types of childhood traumas. Limitations of the current study include the use of lay interviewers who, despite acceptable levels of reliability and validity, may be less accurate than clinicians as interviewers. Also the retrospective recall of lifetime disorders is likely to be less accurate than a more recent time frame. The sample used in this study does not show nation wide perspective, because the Southern portion of the country which includes much of the indigenous population was excluded. This study, like most epidemiological studies, did not use an-depth or validated index of trauma, which may have diluted findings. Since this study was cross-sectional, a direct cause-effect relationship cannot be assumed between trauma exposure and subsequent disorders.

Durante la década de 1990 en los Estados Unidos (EU), el conocimiento sobre el trastorno de estrés post-traumático (TEPT) evolucionó de estudios específicos en un principio, sobre veteranos de guerra y sobre víctimas de desastres, a estudios epidemiológicos más tarde, sin embargo, la epidemiología del TEPT en países en desarrollo ha sido un área poco estudiada hasta ahora. Los expertos en el área de trauma han propuesto que los sucesos traumáticos que ocurren en la niñez son más perjudiciales para la salud mental que aquellos que ocurren más tarde en la vida. Este trabajo revisa los resultados de un estudio epidemiológico llevado a cabo en Chile. Específicamente, se revisan los resultados sobre las tasas de prevalencia del TEPT, traumas asociados más frecuentemente con él, así como la comorbilidad de este trastorno con otros trastornos psiquiátricos a lo largo de la vida. Igualmente se analizaron las diferencias del TEPT en cada sexo, así como la exposición a traumas en una muestra representativa de chilenos. Además se comparó la prevalencia de trastornos psiquiátricos en personas que sufrieron su primer trauma durante la niñez, durante la edad adulta, o que no reportaron traumas durante su vida. En estos estudios epidemiológicos se usaron módulos del TEPT y trastorno de personalidad antisocial (TPA) de la entrevista diagnóstica siguiendo los criterios del DSM-III-R (DIS-III-R). Para evaluar el resto de los trastornos psiquiátricos se usó la Entrevista Diagnóstica Internacional Compuesta (CIDI). Estos instrumentos fueron administrados en tres ciudades chilenas a 2390 personas mayores de 15 años. Para estimar los errores estándares (EE) debido al diseño de la muestra y a la necesidad de ajuste se usó el método Taylor de linearización seriada. También se usó un análisis de regresión logística para examinar la relación entre el TEPT, los factores demográficos de riesgo y el tipo de trauma. Además se utilizó la regresión logística multivariada para evaluar si la relación entre el TEPT y el sexo pudiera ser explicada por medio de otros factores de riesgo, así como para calcular las tasas y la oportunidad relativa (razón de productos cruzados) de trastornos psiquiátricos a lo largo de la vida. El primer análisis arrojó que la prevalencia de TEPT a lo largo de la vida fue de 4.4% (2.5% para hombres y 6.2% para mujeres). De los hechos traumáticos reportados, la violación sexual tuvo una correlación más alta con el TEPT que los demás hechos traumáticos. Las mujeres tuvieron más probabilidades de experimentar TEPT que los hombres, después de controlar la variable asalto violento. El segundo análisis evidenció que los que habían sufrido traumas a lo largo de la vida tuvieron mayor probabilidad de tener un trastorno psiquiátrico en comparación con aquellos que no reportaron traumas. También se encontró que los que sufrieron su primer trauma durante la infancia tuvieron más probabilidad de desarrollar trastornos de pánico a lo largo de la vida que aquellos que sufrieron su primer trauma en la edad adulta, independientemente del número de traumas que sufrieron y de las diferencias demográficas. Aunque Chile tiene un contexto histórico-cultural y una economía diferente a otros países en los que se ha estudiado anteriormente la epidemiología del TEPT, el presente estudio reflejó tendencias similares a las reportadas en estudios previos. Los hallazgos expuestos enfatizan la importancia de investigar la prevalencia del TEPT, los patrones de comorbilidad del TEPT y las diferencias de sexo en la prevalencia del TEPT en diferentes países. También estos resultados sugieren que los sucesos traumáticos en la infancia (y no en la adultez) pueden estar relacionados con la ocurrencia de trastornos psiquiátricos específicos.

Estudio epidemiológico de sucesos traumáticos, trastorno de estrés post-traumático y otros trastornos psiquiátricos en una muestra representativa de Chile.

SUMMARYIn the last decade, our understanding of posttraumatic stress disorder (PTSD) has progressed from studies of war veterans and specific disaster victims to studies that examine the epidemiology of PTSD in the United States (USA) population. Epidemiologic data on PTSD in developing countries is an understudied area with the majority of studies were developed in the USA and other developed countries. Of the few epidemiological surveys undertaken in other countries, most of them have focused its interest on the prevalence rates of PTSD and its risk factors for following specific traumatic events. Besides increasing the international normative and descriptive data base on PTSD, an examination of prevalence rates and risk factors for PTSD in a socio-political and cultural context (that is markedly different to established market economies) can deepen our understanding of the phenomenology and determinants of PTSD. Although many psychiatric diagnoses can be related with previous traumatic experiences, PTSD has been identified as a disorder that requires a previous traumatic exposure for its diagnosis. A growing literature strongly suggests that early exposure to traumatic events disrupts crucial normal stages of childhood development and predisposes children to subsequent psychiatric sequelae. A series of epidemiological studies has demonstrated that childhood sexual abuse is associated with a range of psychiatric disorders in adulthood that includes mood, anxiety, and substance use disorders, even after adjusting for possible confounds, such as family factors and parental psychopathological disorders or other childhood adversities. There is little evidence of diagnostic specificity of childhood sexual abuse, although a consistent finding has been that alcohol and drug disorders are more strongly related to childhood sexual abuse than other psychiatric disorders. Other forms of childhood traumas have been less well studied.This article reviews the findings of an epidemiological study that took place in Chile and examined prevalence rates of PTSD, traumatic events most often associated with PTSD, comorbidity of PTSD with other lifetime psychiatric disorders, gender differences in PTSD as well as trauma exposure in a representative sample of Chileans. This article also reported a comparison of prevalence rates of various psychiatric disorders among persons who reported the first trauma during their childhood, those who reported the first trauma during their adulthood, and those with no trauma history.The study was based on a household-stratified sample of people defined by the health service system to be adults (aged 15 years and older). The study was designed to represent the population of Chile. This analysis is limited to three geographically distinct provinces, chosen as being representative of the distribution of much of the population. The interviews were administered to a representative sample of 2390 persons aged 15 to over 64 years.The measures used were the DSM-III-R PTSD and antisocial personality disorder modules from the Diagnostic Interview Schedule and modules for a range of DSM-III-R diagnoses from the Composite International Diagnostic. Traumatic events were categorized into one of 11 categories: military combat, rape, physical assault, seeing someone hurt or killed, disaster, threat, narrow escape, sudden injury/ accident, news of a sudden death or accident, other event (e.g. kidnapping, torture), or other experience. The translation into Spanish was conducted using the protocol outlined by the World Health Organization. The interviewers were all university students in their senior year studying social sciences.Taylor series linearization method was used to estimate the standard errors due to the sample design and the need for weighting. The analysis was conducted using procedures without replacement for non-respondents. The region, province, comuna, and district selected were used as the defined strata. Logistic regression with the corresponding 95% confidence interval was used to examine associations among PTSD, demographic risk factors, and trauma type. To examine whether the association between PTSD and gender could be explained by other risk factors, multivariate logistic regression analyses were also conducted.The first analysis found that the lifetime prevalence of PTSD was 4.4% (2.5% for men and 6.2% for women). Among the traumatic events, rape was most strongly associated with PTSD diagnosis. Among those exposed to traumas, women were significantly more likely to develop PTSD than men, after controlling for assaultive violence. The second analysis revealed that exposure to a lifetime trauma was associated with a higher probability of psychiatric morbidity in comparison with no trauma exposure.Traumas with childhood onset were significantly related to lifetime panic disorder, independent of number of lifetime traumas and demographic differences.This revealed that women had more probabilities than men of developing PTSD once they are exposed to trauma, independent of previous traumas, experiences of sexual assault, other violent experiences or level of education. Some authors have proposed that women have a higher vulnerability than men to develop PTSD and that there are sex differences in brain morphology, in the social interpretation of trauma, or/and in the peritraumatic dissociative experience. Although many theories have been proposed to explain this gender difference in PTSD, more research is needed to evaluate them empirically.This study highlights the importance of investigating the prevalence of PTSD, the patterns of comorbidity of PTSD, as well as gender differences of PTSD in non-English speaking countries. Although Chile has a different historical and socio-cultural context with respect to other countries in which the epidemiology of PTSD has been examined, in general, this study achieved similar results as those found in other studies.The results showed that PTSD is not an uncommon psychiatric illness, it is associated with a high degree of psychiatric comorbidity, it is more likely to predate other psychiatric disorders. Also, the results showed that men are more likely to be exposed to traumas than women, women are more likely than men to develop PTSD, and that PTSD is associated with relatively high treatment utilization.However, compared to another country in Latin America, such as Mexico, Chile has a lower prevalence of PTSD and trauma exposure, which may due to socio-economic factors, such as less inequity between the wealthy and the poor and less violence, crime, and poverty in Chile than Mexico. These studies also suggest that traumatic events that occur in childhood are related to specific disorders rather than those that occurred later in life.Individuals with childhood interpersonal trauma exposure are more likely to suffer from lifetime panic disorder, agoraphobia or PTSD compared to those who experience interpersonal trauma as an adult. However, research should examine the specificity of these disorders in relation to various types of childhood traumas.Limitations of the current study include the use of lay interviewers who, despite acceptable levels of reliability and validity, may be less accurate than clinicians as interviewers.Also the retrospective recall of lifetime disorders is likely to be less accurate than a more recent time frame. The sample used in this study does not show nation wide perspective, because the Southern portion of the country which includes much of the indigenous population was excluded. This study, like most epidemiological studies, did not use an-depth or validated index of trauma, which may have diluted findings. Since this study was cross-sectional, a direct cause-effect relationship cannot be assumed between trauma exposure and subsequent disorders.

Psychiatric epidemiology of the elderly population in Chile.

OBJECTIVES: Little attention has been given to the prevalence rate of mental illness among elderly adults in Latin America. The prevalence rates for psychiatric disorders in Chile among those 65 and older compared with younger individuals, and the prevalence rate of psychiatric disorders among those age 75 and older are presented. DESIGN: A stratified random sample of 2,659 individuals. SETTING: Four provinces representative of the Chile's population were surveyed. PARTICIPANTS: Adults age 15 and older were interviewed; however, the analysis is limited to those over age 20. MEASUREMENTS: The Composite International Diagnostic Interview was administered to obtain Diagnostic and Statistical Manual of Mental Disorders, Third Edition-R diagnoses. Lifetime and 12-month prevalence rates were estimated. RESULTS: Of the 2,659 interviewed 352 were over age 64. Overall, elderly adults had lower prevalence rates of lifetime disorders than the younger population, 20% in comparison with 34%. Dysthymia, agoraphobia, simple phobia, and alcohol dependence disorders were noted to be less common among elderly subjects. Those over the age of 64 in comparison with those over the age of 74 had higher prevalence rates of disorders. A sizable proportion of the disorders among older adults began after the age of 59. One third of elderly respondents with major depression had a late onset disorder. Service utilization was similar between elderly individuals and younger respondents, except for use of specialized psychiatric services, which was lower among elderly adults. CONCLUSIONS: Both lifetime and 1-year prevalence of mental disorders were less common in older than in younger persons; however, among elderly adults late onset disorders were not uncommon. Additional studies of the prevalence rates of disorders among older individuals in Latin America are needed for public health planning.

Regional differences in psychiatric disorders in Chile.

BACKGROUND: Psychiatric epidemiological surveys in developing countries are rare and are frequently conducted in regions that are not necessarily representative of the entire country. In addition, in large countries with dispersed populations national rates may have low value for estimating the need for mental health services and programs. METHODS: The Chile Psychiatric Prevalence Study using the Composite International Diagnostic Interview was conducted in four distinct regions of the country on a stratified random sample of 2,978 people. Lifetime and 12-month prevalence and service utilization rates were estimated. RESULTS: Significant differences in the rates of major depressive disorder, substance abuse disorders, non-affective psychosis, and service utilization were found across the regions. The differential prevalence rates could not be accounted by socio-demographic differences between sites. CONCLUSIONS: Regional differences across countries may exist that have both implications for prevalence rates and service utilization. Planning mental health services for population centers that span wide geographical areas based on studies conducted in a single region may be misleading, and may result in areas with high need being underserved.

Lifetime and 12-month prevalence of DSM-III-R disorders in the Chile psychiatric prevalence study.

OBJECTIVE: Although several epidemiological studies of the prevalence of psychiatric disorders have been conducted in Latin America, few of them were national studies that could be used to develop region-wide estimates. Data are presented on the prevalence of DSM-III-R disorders, demographic correlates, comorbidity, and service utilization in a nationally representative adult sample from Chile. METHOD: The Composite International Diagnostic Interview was administered to a stratified random sample of 2,978 individuals from four provinces representative of the country's population age 15 and older. Lifetime and 12-month prevalence rates were estimated. RESULTS: Approximately one-third (31.5%) of the population had a lifetime psychiatric disorder, and 22.2% had a disorder in the past 12 months. The most common lifetime psychiatric disorders were agoraphobia (11.1%), social phobia (10.2%), simple phobia (9.8%), major depressive disorder (9.2%), and alcohol dependence (6.4%). Of those with a 12-month prevalence diagnosis, 30.1% had a comorbid psychiatric disorder. The majority of those with comorbidity had sought out mental health services, in contrast to one-quarter of those with a single disorder. CONCLUSIONS: The prevalence rates in Chile are similar to those obtained in other studies conducted in Latin America and Spanish-speaking North American groups. Comorbidity and alcohol use disorders, however, were not as prevalent as in North America.

Epidemiology of trauma, post-traumatic stress disorder (PTSD) and co-morbid disorders in Chile.

BACKGROUND: In this study we examined the prevalence rates of post-traumatic stress disorder (PTSD), types of trauma most often associated with PTSD, the co-morbidity of PTSD with other lifetime psychiatric disorders, which disorders preceded PTSD, and gender differences in PTSD and trauma exposure in a representative sample of Chileans. METHOD: The DSM-III-R PTSD and antisocial personality disorder modules from the Diagnostic Interview Schedule (DIS) and modules for a range of DSM-III-R diagnoses from the Composite International Diagnostic Interview (CIDI) were administered to a representative sample of 2390 persons aged 15 to over 64 years in three cities in Chile. RESULTS: The lifetime prevalence of PTSD was 4.4% (2.5% for men and 6.2% for women). Among persons exposed to trauma, rape was most strongly associated with PTSD. Onset of PTSD significantly increased the risk of developing each of the 10 other tested disorders. Among those exposed to trauma, women were significantly more likely to develop PTSD, after controlling for assaultive violence. CONCLUSIONS: This study highlights the importance of investigating the prevalence of PTSD, patterns of co-morbidity of PTSD, and gender differences in PTSD in non-English-speaking countries.

[Service use patterns among adults with mental health problems in Chile]. / Patrones de uso de servicios entre adultos con problemas de salud mental, en Chile.

OBJECTIVE: To describe the patterns in the use of general health services and specialized health services among adults with mental health problems in Chile, as well as those persons' level of satisfaction with the services. The overall objective was to optimize the use of the limited resources available for mental health care in the countries of the Americas, especially Chile. METHODS: The diagnoses and the patterns of use of mental health services were obtained from the Chilean Study of Psychiatric Prevalence (Estudio Chileno de Prevalencia Psiquiátrica). That representative research on the adult population of Chile was based on a stratified random sample of 2,987 people 15 years old and older, done over the period of 1992 to 1999. The psychiatric diagnoses were obtained using the Composite International Diagnostic Interview (CIDI). The interviewees were also asked about their use of general health care services and of mental health services in the preceding six months, as well as any barriers to accessing the services. RESULTS: More than 44% of the interviewees had had contact with some type of health service during the six months prior to the study, but only 5.6% received specialized care. Those who presented with a diagnosis of obsessive-compulsive disorder or of panic disorder consulted more frequently, but not in specialized centers. Consumption of substances such as alcohol and drugs as well as antisocial personality disorder were associated with a low level of consultation. When asked about sources of assistance for mental health problems, the majority of the interviewees mentioned only the formal health care system. More than 75% of the interviewees said that they were satisfied or very satisfied with the care that they had received. CONCLUSIONS: Our results confirm the existence of a wide gap between the need for care and the treatment that is actually received. The informal and folkloric alternative resources (priests, family members, healers, herbalists, etc.) were used less frequently than is generally believed to be true. The indirect barriers of access to services--linked to a lack of knowledge and to stigma--were more frequent than were the direct barriers. A sizable number of people who did not have a positive diagnosis on the CIDI utilized mental health services.

Prevalencia de trastornos psiquiátricosen Latinoamérica: revisión crítica / Prevalence of Psychiatric Disorders in Latin America: A Critical Review

Introducción: La forma como se conducen las investigaciones en epidemiología psiquiátrica en América Latina ha impedido que los resultados sean ampliamente conocidos; además, se han realizado pocos estudios comparativos. Objetivo: Comparar y analizar la prevalencia de trastornos psiquiátricos en Latinoamérica. Metodología: Revisión y comparación de estudios latinoamericanos. Resultados: Estudios de tercera generación llevados a cabo sobre muestras de población general en América Latina destacan tasas semejantes de depresión mayor, exceptuando un estudio en Colombia. Se observan mayores tasas de uso de alcohol o de trastornos asociados en Colombia y en un estudio en Lima. Tres estudios realizados en Estados Unidos con hispanos muestran consistentemente tasas mayores de problemas relacionados con el alcohol que los encontrados en todos los estudios realizados en Suramérica. La tasa de trastornos ansiosos en Chile fue más alta que la de depresión mayor, lo cual es replicado en otros estudios de la subregión sur. La baja tasa de comorbilidad en el estudio chileno se replica en Ciudad de México. Las tasas de uso de servicios de Estados Unidos, México y Chile no parecen diferir significativamente. Conclusiones: Se requieren medidas objetivas de discapacidad y análisis más precisos acerca de las necesidades de uso de servicios, comorbilidad médica y prevalencia de tasas de enfermedad mental grave.

Introduction: The way in which research on psychiatric epidemiology has been conducted in Latin America has impaired results from being widely known; additionally, few comparative studies have been carried out. Objective: To compare and analyze the prevalence of psychiatric disorders in Latin America. Methods: Review and comparison of Latin- American studies. Results: Third generation studies carried out within samples of the general population in Latin America note similar rates of mayor depression, with the exception of a study in Colombia. Higher rates of alcohol use or related disorders were observed in Colombia and in a study in Lima. Three studies conducted in the United States with hispanics consistently show higher rates of alcohol-related problems than those found in all the studies done in South America. The rate of anxiety disorders in Chile was found to be higher than that of mayor depression, a finding that is replicated in other south sub-region studies. the low rate of comorbidity in the chilea study is replicated in Mexico city. the rates of use of services in the united states, Mexico and Chile do no seem to differ significantly. Conclusions: Objective incapacity measurements and more precise analysis on the needs of use of services, medical comorbidity and prevalence of rates on serious mental illness are required.

Patrones de uso de servicios entre adultos con problemas de salud mental, en Chile / Service use patterns among adults with mental health problems in Chile

OBJETIVO: Describir el patrón de uso de servicios generales y especializados entre los adultos con problemas de salud mental, así como su nivel de satisfacción con dichos servicios, con la finalidad de contribuir a optimizar los escasos recursos disponibles en la Región para la atención de la salud mental, particularmente en lo que corresponde a Chile. MÉTODO: Los diagnósticos y los patrones de uso de los servicios de salud mental se obtuvieron del Estudio Chileno de Prevalencia Psiquiátrica (ECPP), una investigación representativa de la población adulta del país, basada en una muestra aleatoria estratificada de 2 987 personas de 15 años y más, que abarcó el período de 1992 a 1999. Los diagnósticos psiquiátricos se obtuvieron por medio del instrumento de entrevista denominado Composite International Diagnostic Interview (CIDI). Asimismo, se preguntó a los entrevistados acerca del uso de servicios generales y de salud mental en los seis meses precedentes y sobre las dificultades que encontraron para acceder a ellos. RESULTADOS: Más de 44 por ciento de los entrevistados tuvieron contacto con algún tipo de servicio de salud durante los 6 meses previos al estudio, pero solo 5,6 por ciento recibieron atención especializada. Quienes presentan los diagnósticos de trastorno obsesivo y de pánico consultan con mayor frecuencia, pero no en centros especializados. El consumo de sustancias tóxicas y la personalidad antisocial se relacionaron con un bajo nivel de consulta. El sistema formal de salud es la opción que más se menciona como recurso de ayuda. Más de 75 por ciento refieren satisfacción o gran satisfacción con la atención recibida. CONCLUSIONES: Se confirma la existencia de una amplia brecha entre las necesidades de atención y el tratamiento realmente recibido. Los recursos alternativos informales y folclóricos (sacerdote, familiares, curanderos, hierbateros [yerberos], etc.) se utilizan con una frecuencia menor de la esperada. Las barreras indirectas de acceso a los servicios resultan claramente más frecuentes y se vinculan con desconocimiento y estigma. Un número importante de personas sin diagnóstico positivo en la entrevista CIDI hace uso de los servicios de salud mental.

Objective. To describe the patterns in the use of general health services and specialized health services among adults with mental health problems in Chile, as well as those persons' level of satisfaction with the services. The overall objective was to optimize the use of the limited resources available for mental health care in the countries Methods. The diagnoses and the patterns of use of mental health services were obtained from the Chilean Study of Psychiatric Prevalence (Estudio Chileno de Prevalencia Psiquiátrica). That representative research on the adult population of Chile was based on a stratified random sample of 2 987 people 15 years old and older, done over the period of 1992 to 1999. The psychiatric diagnoses were obtained using the Composite International Diagnostic Interview (CIDI). The interviewees were also asked about their use of general health care services and of mental health services in the preceding six months, as well as any barriers to accessing the services. Results. More than 44% of the interviewees had had contact with some type of health service during the six months prior to the study, but only 5.6% received specialized care. Those who presented with a diagnosis of obsessive-compulsive disorder or of panic disorder consulted more frequently, but not in specialized centers. Consumption of substances such as alcohol and drugs as well as antisocial personality disorder were associated with a low level of consultation. When asked about sources of assistance for mental health problems, the majority of the interviewees mentioned only the formal health care system. More than 75% of the interviewees said that they were satisfied or very satisfied with the care that they had received. Conclusions. Our results confirm the existence of a wide gap between the need for care and the treatment that is actually received. The informal and folkloric alternative resources (priests, family members, healers, herbalists, etc.) were used less frequently than is generally believed to be true. The indirect barriers of access to services­linked to a lack of knowledge and to stigma­were more frequent than were the direct barriers. A sizable number of people who did not have a positive diagnosis on the CIDI utilized mental health services

Psychiatric disorders among the Mapuche in Chile.

BACKGROUND: The Mapuche are the largest indigenous group in Chile; yet almost all data on the mental health of indigenous populations are from North America. AIM: The study examines the differential DSM-III-R prevalence rates of psychiatric disorders and service utilization among indigenous and non-indigenous community residence. METHODS: The Composite International Diagnostic Interview (CIDI) was administered to a stratified random sample of 75 Mapuche and 434 non-Mapuche residents of the province of Cautín. Lifetime prevalence and 12-month prevalence rates were estimated. RESULTS: Approximately 28.4% of the Mapuche population had a lifetime, and 15.7% a 12-month, prevalent psychiatric disorder compared to 38.0% and 25.7%, respectively, of the non-Mapuche. Few significant differences were noted between the two groups; however, generalized anxiety disorder, simple phobia, and drug dependence were less prevalent among the Mapuche. Service utilization among the Mapuche with mental illness was low. CONCLUSIONS: This is a preliminary study based on a small sample size. Further research on the mental health of indigenous populations of South America is needed.

Population prevalence of psychiatric disorders in Chile: 6-month and 1-month rates.

BACKGROUND: Few South American studies have examined current prevalence rates of psychiatric disorders. AIMS: To examine prevalence rates in a nationally representative adult population from Chile. METHOD: The Composite International Diagnostic Interview was administered to a stratified random sample of 2978 individuals from four provinces representative of the country's population. Six-month and 1-month prevalence rates were estimated. Demographic correlates, comorbidity and service use were examined. RESULTS: Nearly a fifth of the Chilean population had had a psychiatric disorder during the preceding 6 months. The 6-month and 1-month prevalence rates were 19.7% and 16.7% respectively. For the 6-month prevalence the five most common disorders were simple phobia, social phobia, agoraphobia, major depressive disorder and alcohol dependence. Less than 30% of those with any psychiatric diagnosis had a comorbid psychiatric disorder and the majority of them had sought treatment from mental health services. CONCLUSIONS: Current prevalence studies are useful indicators of service needs. People with comorbid psychiatric conditions have high rates of service use. The low rate of comorbidity in Chile merits further study.

Use of mental health services in Chile.

OBJECTIVE: S: To address the growing burden of mental illness in Latin America, a better understanding of mental health service use and barriers to care is needed. Although many Latin American countries have nationalized health care systems that could potentially improve access to care, significant barriers to care remain. The authors report the results of a study examining mental health service utilization in the general population of Chile. METHODS: The data were drawn from the Chile Psychiatric Prevalence Study, a national household survey of 2,987 persons aged 15 years and older conducted in 1992-1999. As part of the survey, psychiatric diagnoses were obtained by using the Composite International Diagnostic Interview, and respondents were asked about their use of general and mental health care services in the past six months and about their experience of barriers to treatment. RESULTS: More than 44 percent of respondents reported use of any health care services in the past six months, and 20 percent reported use of mental health services. Of the respondents who met criteria for a psychiatric disorder, a large proportion (62 percent) did not receive mental health care. Increasing severity of the psychiatric disorder correlated with increasing frequency of overall help seeking, but only a small proportion of the respondents with a psychiatric disorder sought specialized mental health services. Regional disparities and inequities in access to care were found. In addition, indirect barriers to mental health care, such as stigma and misconceptions about the course of psychiatric disorders, were important deterrents to service utilization, particularly among persons with lower socioeconomic status. CONCLUSIONS: To reduce the burden of mental illness in Chile, additional efforts are needed to address both the direct and the indirect barriers to mental health care, including regional inequities in access to care.

[Chilean study on the prevalence of psychiatric disorders (DSM-III-R/CIDI) (ECPP)]. / Estudio chileno de prevalencia de patología psiquiátrica (DSM-III-R/CIDI) (ECPP).

BACKGROUND: The Diagnostic and Statistic Manual (DSM) solved the problem of diagnostic criteria for psychiatric diseases. Highly structured interviews such as Composite International Diagnostic Interview (CIDI) allow the evaluation of psychiatric disorders in large samples, with great accuracy. AIM: To report the prevalence rates of psychiatric disorders in a representative sample of Chilean individuals. MATERIAL AND METHODS: The CIDI was administered to 2978 Chilean individuals coming form four provinces. Lifetime and prevalence rates of psychiatric disorders, based in the third revision of the DSM, were calculated. RESULTS: Thirty six percent of the population had a psychiatric disorder at least once in their lifetime and 23% had a disorder in the last six months. The most common lifetime diagnoses were agoraphobia in 11%, major depressive disorders in 9%, dysthymia in 8% and alcohol dependence in 6%. Only 49% of those with a psychiatric disorder sought medical care, while 4% of those individuals considered devoid of psychiatric illnesses, consulted in a mental health facility. CONCLUSIONS: The prevalence of psychiatric disorders in the Chilean population is similar to that of other Spanish speaking populations in Latin or North America.

Depresión en estudios de campo / Depression in field studies

Se identifican y discuten diferentes conceptos y definiciones de depresiónsin encontrar acuerdos definitivos, a pesar de lo cual se concluye que se debe disponer de cifras para desarrollar servicios adecuadamente. Se presentan las prevalencias comunitarias de los trastornos afectivos de la provincia de Iquique, Chile, junto con los resultados obtenidos previamente en otras dos provincias(Concepción y Santiago). El estudio se realizó en una muestra estratificada de 2.469 adultos entrevistados con el CIDI de la OMS. Los resultados son comparados entre ellos y también con datos de estudio norteamericanos similares. El aumento sostenido de la prevalencia de trastornos afectivos, en especial el de la depresión mayor, queda demostrado