Race/ethnicity and insurance status as factors associated with ADHD treatment patterns

Using data from the 1997-2000 Medical Expenditure Panel Survey (MEPS), disparities in different stages of attention-deficit/hyperactivity disorder (ADHD) health care were investigated, from initial detection to follow-up physician visits and psychotherapy appointments. Differences in ADHD diagnoses, stimulant usage, and health-care visits were examined by age, race/ethnicity, region, and type of insurance. Major significant findings were: (1) children without insurance had lower levels of care in all stages relative to children with insurance, (2) Hispanic-American and African-American children were less likely to be diagnosed with ADHD by parent report than were white American children, and (3) African-American youths with ADHD were less likely to initiate stimulant medication relative to white American children. Implications for expanding childhood health insurance coverage, and for future work on minority mental health care in regard to ADHD, are discussed.     

Psychometric evaluation of a measure of Beck's negative cognitive triad for youth: applications for African-American and Caucasian adolescents

A measure of Beck's negative cognitive triad, the Cognitive Triad for Children (CTI-C), was evaluated for its psychometric properties and utility with a community sample of 880 African-American and Caucasian adolescents. High-school students ranging from 14 to 17 years of age completed the CTI-C, the Children's Depression Inventory (CDI) and the Children's Attributional Style Questionnaire-Revised (CASQ-R) on two occasions 4 months apart. The CTI-C was found to be internally consistent, Cronbach's alpha=.90, to have acceptable test-retest reliability, r=.70, and concurrent validity as demonstrated by a significant correlation with the CASQ-R, r=.53. A principal factor analysis with promax rotation did not yield support for Beck's tripartite model of negative cognitions about the self, world, and future but rather yielded three factors with a combination of cognitions from all three domains. African American adolescents who reported more maladaptive cognitions on the CTI-C reported fewer depressive symptoms on the CDI 4 months later compared to their Caucasian counterparts, suggesting some limitation to using the CTI-C to predict depressive symptoms in African-American youth; however, Factor 1 derived from a factor analysis with the sample was more consistent in predicting future symptoms among both African-American and Caucasian adolescents. This factor consisted largely of positively worded items, offering some support for low positive affect as a predictor of depressive symptoms in adolescents.     

Social phobia and separation anxiety symptoms in community and clinical samples of children and adolescents

OBJECTIVE: To examine the developmental progression and pattern of self-reported symptoms of social phobia (SP) and separation anxiety (SA) in community (n = 2,384) and clinical (n = 217) samples of children and adolescents, using a cross-sectional method. METHOD: Subjects were cross-classified by age, gender, and race. Using mean scores on the SP and SA subscales of the Multidimensional Anxiety Scale for Children, 4 categories of children were established: HighSP/HighSA, HighSP/LowSA, LowSP/HighSA, and LowSP/LowSA. Data were analyzed using a generalized logit model. RESULTS: Community sample: Preadolescents and females reported more symptoms of HighSP/HighSA and LowSP/HighSA than adolescents and males. White children reported more symptoms of HighSP/LowSA, while the opposite pattern was found among African-American children. Clinical sample: Similar to the community sample, preadolescents reported more symptoms of HighSP/HighSA. However, clinical males reported more symptoms of LowSP/HighSA than clinical females. CONCLUSIONS: In general, adolescents endorsed more symptoms of SP and fewer symptoms of SA than preadolescent children. Irrespective of age, white children endorsed more symptoms of SP and fewer symptoms of SA than African-American children. In the community sample, preadolescent boys endorsed more symptoms of SA and fewer symptoms of SP, suggesting a possible referral bias.     

Effects of gender and ethnicity on duty-related posttraumatic stress symptoms among urban police officers

We studied 655 urban police officers (21% female, 48% white, 24% black, and 28% Hispanic) to assess ethnic and gender differences in duty-related symptoms of posttraumatic stress disorder (PTSD). We obtained self-report measures of: a) PTSD symptoms, b) peritraumatic dissociation, c) exposure to duty-related critical incidents, d) general psychiatric symptoms, e) response bias due to social desirability, and f) demographic variables. We found that self-identified Hispanic-American officers evidenced greater PTSD symptoms than both self-identified European-American and self-identified African-American officers. These effects were small in size but they persisted even after controlling for differences in other relevant variables. Contrary to expectation, we found no gender differences in PTSD symptoms. Our findings are of note because: a) they replicate a previous finding of greater PTSD among Hispanic-American military personnel and b) they fail to replicate the well-established finding of greater PTSD symptoms among civilian women.     

Factorial invariance of the CES-D in low socioeconomic status African Americans compared with a nationally representative sample

This study examined the factor structure of the Center for Epidemiologic Studies Depression Scale (CES-D) in low socioeconomic status African Americans (n=426). Confirmatory factor analysis indicated that the four factors-(1) depressed affect, (2) positive affect, (3) somatic complaints, and (4) interpersonal problems-of the CES-D scale previously found in the general population were supported in this sample. These results were cross-validated in other nationally representative samples of African-American participants (n=988) and Caucasians (n=666), and the four-factor structure of the CES-D scale replicated in all three groups in this study. An alternative model was also tested with the factors depressed affect and somatic complaints combined as a single factor, a finding often reported in minority groups. Results indicated a significantly poorer fit for the three-factor model compared with the four-factor model for all three groups. In addition, higher loading differences were significantly evident between African-American and Caucasian groups, while higher loading similarities were found between the two African-American groups. These findings provide further evidence of measurement equivalency of the CES-D scale in samples with differential characteristics including race and socioeconomic status.     

The German version of the revised Adolescent Sleep-Wake Scale (rASWS) – A validation study in pediatric pain patients and school children

ObjectiveSleep problems are common in children and adolescents with chronic pain. The revised Adolescent Sleep-Wake Scale (rASWS) is an internationally well-established instrument to assess sleep quality in adolescents. So far, no German version is available. The study aimed to provide a validated German version of the rASWS, specifically for use in children and adolescents with chronic pain.MethodsThe translated questionnaire was validated in a sample of N = 159 pediatric outpatients with chronic pain (8–17 years; 65.4% female), who presented to a specialized pediatric pain center. For cross-validation a community sample of N = 1348 school children was analyzed.ResultsConfirmatory factor analysis was conducted to examine the factor structure of the original 10-item 3-factor model in the sample of children and adolescents with chronic pain, which showed poor model fit. Model modifications were carried out by deleting 3 items with low factor loadings stepwise. The overall model fit of the final 3-factor model containing 7 items was excellent. Cronbach's α of the derived scales ranged from 0.74 to 0.86. Cross-validation in a community sample of school children confirmed the superiority of the 7-item model. The convergent validity of the measure was proved by moderate correlations between the rASWS and self-reported sleep problems. Associations with chronic pain characteristics were evident for pain-related disability.ConclusionsThe use of the 7-item version of the rASWS for German-speaking children and adolescents with and without chronic pain is recommended as a self-report measure of sleep quality.     

Paranoia in African-American men receiving inpatient psychiatric treatment

The present study tested a continuum model of paranoid symptom expression in a sample of African-American men receiving inpatient treatment in a state psychiatric hospital. The continuum measure comprised the scales of Distrust (DST), Perceived Hostility of Others (PHO), and False Beliefs and Perceptions (FBP) from the Psychiatric Epidemiology Research Interview (PERI), reflecting mild to severe paranoia, in the order listed. They were interviewer administered with other self-report symptom measures, within three weeks of hospital admission, by ethnically matched interviewers. A multivariate model with repeated measures for the continuum of paranoia revealed that scores on the PERI paranoia scales correlated similarly with scores on the Fenigstein measure of interpersonal paranoia, but correlated differentially with the Politic/Law subscale of the Cultural Mistrust Inventory, a measure of cultural paranoia. Diagnosis and treatment of African-American men for mental health problems in correctional and inpatient settings should be sensitive to the distinction between clinical and cultural aspects of their experiences.     

Psychometric properties of the Spence Children's Anxiety Scale (SCAS) in Mainland Chinese children and adolescents

This study examined the psychometric properties of the Spence Children's Anxiety Scale (SCAS) in a Mainland Chinese community sample. The 38-item Chinese version of SCAS was administered to 1878 children and adolescents. Multiple group confirmatory factor analyses supported a common 6-factor model of SCAS for children and adolescents, and for boys and girls. The internal consistency and test-retest reliability of SCAS were satisfactory. Convergent and divergent validity of SCAS were supported by significant correlations with a measure of anxiety to a greater extent than with a measure of depression. Adolescents reported higher anxiety levels than children, and girls reported higher anxiety levels than boys. Compared to other studies, anxiety symptoms of Chinese children were found at a moderate level, but anxiety symptoms of Chinese adolescents were found at a high level. Our findings suggest that the SCAS is suitable for assessing anxiety symptoms in Mainland Chinese children and adolescents.     

Outcome Assessment of the Medicaid Managed Care Program in Harris County (Houston)

Nowadays, managed care has taken over the management of the Medicaid program in most states of the nation. The patients treated in the public sector managed care system are very vulnerable and at high risk. Thus, we decided to measure the impact of managed care in the public-sector population of Texas. To this end, we assessed the treatment outcome at the Harris County Psychiatric Center (HCPC). Our results showed that after the implementation of the Medicaid managed care program in Houston, the bed utilization at HCPC decreased by 32% and the readmission rate increased by 21%; concomitantly, the length of stay decreased from 15.6 days to 9.3 days. Additionally, African-American and Hispanic-American patients were more negatively affected than Caucasian patients. Undoubtedly, the implementation of the Medicaid managed care system in Texas has led to untoward effects in the quality of care provided to the most disadvantaged population of the state.     

Ethnic difference in periodic limb movements in children

BACKGROUND: Epidemiological studies have suggested that ethnicity is a risk factor for sleep-disordered breathing (SDB) and that African-American children are three times more likely than Caucasian children to have SDB. Ethnic differences in sleep architecture and other routinely assessed sleep parameters have not been critically assessed, thus the aim of this study was to compare sleep characteristics in African-American and Caucasian children. METHODS: A total of 41,363 sleep questionnaires were mailed to parents of children aged 5-7 years in Jefferson County, KY. Parents of snoring and non-snoring children were invited to have their child undergo overnight polysomnography. RESULTS: Complete questionnaires were returned by 9872 families (23% response rate). Of these, 689 agreed to undergo polysomnography, and 542 complete polysomnograms were obtained (5.7% of questionnaire respondents). There were 391 Caucasian and 151 African-American children with a mean age of 6.7+/-0.5 years who underwent overnight polysomnographic evaluation. No differences between groups were observed for sleep latency, total sleep time, sleep efficiency, or rapid eye movement (REM) latency. African-American children had slightly increased stage 3 sleep (6.0+/-2.8% vs. 5.4+/-2.8%; p=0.01), although the total proportion of slow wave sleep was similar. Higher respiratory arousal index (3.6+/-6.5/h vs. 1.4+/-2.7/h; p<0.001) and total arousal index (11.5+/-5.2/h vs. 9.8+/-4.8/h; p<0.001) emerged in African-American children, who were more likely to have mild SDB (AHI>1:34% in African-American vs. 24% in Caucasian; p=0.017) and SDB (AHI>5: 22.5% vs. 7%; p<0.001). However, Caucasian children were more likely to have periodic leg movements during sleep (PLMS; 16.5% vs. 7% in AA; p=0.004). The odds ratio for a Caucasian child to have PLMS was 2.6 (95% confidence interval (CI) 1.3-5.3; p=0.006). Furthermore, in the absence of SDB, the odds ratio for a Caucasian child to have PLMS was 9.5 (95% CI: 2.2-39.9; p=0.002). CONCLUSIONS: African-American and Caucasian children have similar sleep architecture. African-American children are more likely to display respiratory disturbances during sleep, while PLMS are significantly more prevalent among Caucasian children.