Impacto en la salud mental de los niños y adolescentes de Lima Metropolitana en el contexto de la COVID-19

Mental health problems in children and adolescents have a high incidence in Peru and worldwide. However, studies on the psychological repercussions of the pandemic of Covid-19 on children and adolescents in Peru are insufficient. The general objective was to identify the magnitude of the major mental health problems in the child and adolescent population in Lima (Peru) related to Covid-19. This study was descriptive-transversal. The sample was of 2639 children and adolescents. We used the following instruments: demographic and socioeconomic file; Questionnaire on experiences, behaviors and impact related to Covid-19; International Neuropsychiatric Interview for Children and Adolescents; Family Violence Questionnaire; “How is your Family” Questionnaire; Adolescent Family Process Scale; Parental Behavior Inventory and Questionnaire on determinants of access to health services in Peru. Among issues of parental behavior perceived by adolescents, we found that almost a half of them seldom experienced conflicts with their mothers or fathers. Fear to have some beloved being ill or dead because of Covid-19 was the most frequent among children between 6 to 11 years old and adolescents (63.0% and 63.3%, respectively); 44.4% of children from 1.5 to 5 years old, 60.3% of children from 6 to 11 years old and 59.3% of adolescents suffered physical abuse. The fear of separating from an attachment figure is present in 45.7% among children from 6 to 11 years old. More than 80% (n = 2227) of the sample had some kind of health insurance. One third (n = 870) had emotional and behavioral problems, of which 714 did not received care. It is concluded that, in the six months prior to the survey, the major clinical disorders, as well as physical, psychological and sexual abuse in the child and adolescent population increased compared with pre-pandemic time. Frequency of communication between parents and their children from 1.5. to 11 years old had some improvement. Access to services is a critical point in care.Los problemas de salud mental en niños y adolescentes tienen una elevada incidencia en el Perú y a nivel mundial. Sin embargo, los estudios sobre las repercusiones psicológicas de la pandemia de Covid-19 en niños y adolescentes en el Perú son insuficientes. El objetivo general fue identificar la magnitud de los principales problemas de salud mental en la población infanto-juvenil de Lima (Perú) relacionados con la Covid-19. El estudio fue descriptivo-transversal. La muestra estuvo conformada por 2639 niños(as) y adolescentes. Se emplearon los siguientes instrumentos: Ficha demográfica y socioeconómica, Cuestionario sobre experiencias, conductas e impacto relacionadas a la Covid-19, Entrevista Neuropsiquiátrica Internacional para Niños y Adolescentes, Cuestionario de Violencia Familiar, Cuestionario “Como es tu Familia”, Escala Adolescent Family Process, Inventario de Conductas Parentales y Cuestionario sobre Determinantes del Acceso a los Servicios de Salud en el Perú. Entre los aspectos de la conducta parental percibidos por los adolescentes, se halló que alrededor de la mitad de ellos experimentaban rara vez un conflicto con sus madres o padres. El miedo a que algún ser querido enferme o muera por la Covid-19 fue el más frecuente en los niños(as) de 6 a 11 años y en los adolescentes (63% y 63.6% respectivamente). El 44.4% de los informantes de los niños de 1.5 a 5 años, refirieron que utilizaban el castigo físico, frente a un 60.3% en niños(as) de 6 a 11 años. Los adolescentes reportaron haberlo sufrido en un 59.3%.  El miedo a separarse de una figura de apego se presentó en un 45.7% de niños(as) de 6 a 11 años. Más del 80% (n = 2227) de la muestra contaba con algún seguro de salud. La tercera parte de la muestra (n = 870) presentó problemas emocionales y/o de conducta, de los cuales 714 no recibieron atención. Se concluye que, en los seis meses previos a la encuesta, los principales trastornos clínicos, así como el maltrato físico y psicológico y el abuso sexual en la población infanto-juvenil se incrementaron en comparación con la época de pre-pandemia. La frecuencia de la comunicación entre padres y sus hijos de 1.5 a 11 años tuvo una cierta mejoría. El acceso a servicios es un punto crítico en la atención

International comparisons of behavioral and emotional problems in preschool children: parents’ reports from 24 societies

International comparisons were conducted of preschool children’s behavioral and emotional problems as reported on the Child Behavior Checklist for Ages 1½–5 by parents in 24 societies (N¼19,850). Item ratings were aggregated into scores on syndromes; Diagnostic and Statistical Manual of Mental Disorders–oriented scales; a Stress Problems scale; and Internalizing, Externalizing, and Total Problems scales. Effect sizes for scale score differences among the 24 societies ranged from small to medium (3–12%). Although societies differed greatly in language, culture, and other characteristics, Total Problems scores for 18 of the 24 societies were within 7.1 points of the omnicultural mean of 33.3 (on a scale of 0–198). Gender and age differences, as well as gender and age interactions with society, were all very small (effect sizes<1%). Across all pairs of societies, correlations between mean item ratings averaged .78, and correlations between internal consistency alphas for the scales averaged .92, indicating that the rank orders of mean item ratings and internal consistencies of scales were very similar across diverse societies

The association between aggressive and non-aggressive antisocial problems as measured with the Achenbach System of Empirically Based Assessment: A study of 27,861 parent-adolescent dyads from 25 societies

Aggression (e.g., assaulting others, bullying, oppositionality; AGG) and non-aggressive rule-breaking (e.g., lying, stealing, vandalism; RB) appear to constitute meaningfully distinct dimensions of antisocial behavior. Despite these differences, it is equally clear that AGG and RB are moderately-to-strongly intercorrelated with one another. To date, however, we have little insight into the sampling and methodologic characteristics that might moderate the association between AGG and RB. The current study sought to evaluate several such moderators (i.e., age, sex, informant, and society) in a sample of 27,861 parent-adolescent dyads from 25 societies. AGG and RB were assessed with the well-known Child Behavior Checklist and Youth Self-Report (Achenbach & Rescorla, 2001). Results revealed small effects of informant and adolescent sex, such that the association between AGG and RB was stronger for parents' reports than for adolescents' self-reports, and for boys than for girls. The association also varied by society. Unexpectedly, the specific operationalization of 'aggression' emerged as a particularly strong moderator, such that the association was stronger for a general measure of AGG than for a more focused measure of physical aggression per se. Such findings inform our understanding of similarities and differences between aggressive and non-aggressive antisocial problems. (C) 2015 Elsevier Ltd. All rights reserved

Cross-informant agreement between parent-reported and adolescent self-reported problems in 25 societies

We used population sample data from 25 societies to answer the following questions: (a) How consistently across societies do adolescents report more problems than their parents report about them? (b) Do levels of parent-adolescent agreement vary among societies for different kinds of problems? (c) How well do parents and adolescents in different societies agree on problem item ratings? (d) How much do parent-adolescent dyads within each society vary in agreement on item ratings? (e) How well do parent-adolescent dyads within each society agree on the adolescent's deviance status? We used five methods to test cross-informant agreement for ratings obtained from 27,861 adolescents ages 11 to 18 and their parents. Youth Self-Report (YSR) mean scores were significantly higher than Child Behavior Checklist (CBCL) mean scores for all problem scales in almost all societies, but the magnitude of the YSR-CBCL discrepancy varied across societies. Cross-informant correlations for problem scale scores varied more across societies than across types of problems. Across societies, parents and adolescents tended to rate the same items as low, medium, or high, but within-dyad parent-adolescent item agreement varied widely in every society. In all societies, both parental noncorroboration of self-reported deviance and adolescent noncorroboration of parent-reported deviance were common. Results indicated many multicultural consistencies but also some important differences in parent-adolescent cross-informant agreement. Our findings provide valuable normative baselines against which to compare multicultural findings for clinical samples

International comparisons of emotionally reactive problems in preschoolers: CBCL/11/2-5 findings from 21 societies

Our goal was to conduct international comparisons of emotion regulation using the 9-item Emotionally Reactive (ER) syndrome of the Child Behavior Checklist for Ages 11/2-5. We analyzed parent ratings for 17,964 preschoolers from 21 societies, which were grouped into 8 GLOBE study culture clusters (e.g., Nordic, Confucian Asian). Omnicultural broad base rates for ER items ranged from 8.0% to 38.8%. Rank ordering for mean item ratings varied widely across societies (omnicultural Q = .50) but less so across culture clusters (M Q = .66). Societal similarity in mean item rank ordering varied by culture cluster, with large within-cluster similarity for Anglo (Q = .96), Latin Europe (Q = .74), Germanic (Q = .77), and Latin American (Q = .76) clusters, but smaller within-cluster similarity for Nordic, Eastern Europe, and Confucian Asian clusters (Qs = .52, .23, and .44, respectively). Confirmatory factor analyses of the ER syndrome supported configural invariance for all 21 societies. All 9 items showed full to approximate metric invariance, but only 3 items showed approximate scalar invariance. The ER syndrome correlated . 65 with the Anxious/Depressed (A/D) syndrome and .63 with the Aggressive Behavior syndrome. ER items varied in base rates and factor loadings, and societies varied in rank ordering of items as low, medium, or high in mean ratings. Item rank order similarity among societies in the same culture cluster varied widely across culture clusters, suggesting the importance of cultural factors in the assessment of emotion regulation in preschoolers

International comparisons of emotionally reactive problems in preschoolers : CBCL/11/2-5 findings from 21 societies

Our goal was to conduct international comparisons of emotion regulation using the 9-item Emotionally Reactive (ER) syndrome of the Child Behavior Checklist for Ages 11/2-5. We analyzed parent ratings for 17,964 preschoolers from 21 societies, which were grouped into 8 GLOBE study culture clusters (e.g., Nordic, Confucian Asian). Omnicultural broad base rates for ER items ranged from 8.0% to 38.8%. Rank ordering for mean item ratings varied widely across societies (omnicultural Q = .50) but less so across culture clusters (M Q = .66). Societal similarity in mean item rank ordering varied by culture cluster, with large within-cluster similarity for Anglo (Q = .96), Latin Europe (Q = .74), Germanic (Q = .77), and Latin American (Q = .76) clusters, but smaller within-cluster similarity for Nordic, Eastern Europe, and Confucian Asian clusters (Qs = .52, .23, and .44, respectively). Confirmatory factor analyses of the ER syndrome supported configural invariance for all 21 societies. All 9 items showed full to approximate metric invariance, but only 3 items showed approximate scalar invariance. The ER syndrome correlated . 65 with the Anxious/Depressed (A/D) syndrome and .63 with the Aggressive Behavior syndrome. ER items varied in base rates and factor loadings, and societies varied in rank ordering of items as low, medium, or high in mean ratings. Item rank order similarity among societies in the same culture cluster varied widely across culture clusters, suggesting the importance of cultural factors in the assessment of emotion regulation in preschoolers

International comparisons of autism spectrum disorder behaviors in preschoolers rated by parents and caregivers/teachers

This study tested international similarities and differences in scores on a scale comprising 12 items identified by international mental health experts as being very consistent with the Diagnostic and Statistical Manual of Mental Disorders (5th ed.) category of autism spectrum disorder. Participants were 19,850 preschoolers in 24 societies rated by parents on the Child Behavior Checklist for Ages 11/2-5; 10,521 preschoolers from 15 societies rated by caregivers/teachers on the Caregiver-Teacher Report Form, and 7380 children from 13 societies rated by both types of informant. Rank ordering of the items with respect to base rates and mean ratings was more similar across societies for parent ratings than caregiver/teacher ratings, especially with respect to the items tapping restricted interests and repetitive behaviors. Items 80. Strange behavior; 63. Repeatedly rocks head or body; 67. Seems unresponsive to affection; and 98. Withdrawn, doesn't get involved with others had low base rates in these population samples across societies and types of informants, suggesting that they may be particularly discriminating for identifying autism spectrum disorder in young children. Cross-informant agreement was stronger for the items tapping social communication and interaction problems than restricted interests and repetitive behaviors. The findings support the feasibility of international use of the scale for autism spectrum disorder screening in population samples.University of Vermont(undefined

International Epidemiology of Child and Adolescent Psychopathology II: Integration and Applications of Dimensional Findings From 44 Societies

Objective: To build on Achenbach, Rescorla, and Ivanova (2012) by (a) reporting new international findings for parent, teacher, and self-ratings on the Child Behavior Checklist, Youth Self-Report, and Teacher's Report Form; (b) testing the fit of syndrome models to new data from 17 societies, including previously underrepresented regions; (c) testing effects of society gender, and age in 44 societies by integrating new and previous data; (d) testing cross-society correlations between mean item ratings; (e) describing the construction of multisociety norms; (f) illustrating clinical applications. Method: Confirmatory factor analyses (CFAs) of parent, teacher, and self-ratings, performed separately for each society; tests of societal, gender, and age effects on dimensional syndrome scales, DSM-oriented scales, Internalizing, Externalizing, and Total Problems scales; tests of agreement between low, medium, and high ratings of problem items across societies. Results: CFAs supported the tested syndrome models in all societies according to the primary fit index (Root Mean Square Error of Approximation [RMSEA]), but less consistently according to other indices; effect sizes were small-to-medium for societal differences in scale scores, but very small for gender, age, and interactions with society; items received similarly low, medium, or high ratings in different societies; problem scores from 44 societies fit three sets of multisociety norms. Conclusions: Statistically derived syndrome models fit parent, teacher, and self-ratings when tested individually in all 44 societies according to RMSEAs (but less consistently according to other indices). Small to medium differences in scale scores among societies supported the use of low-, medium-, and high-scoring norms in clinical assessment of individual children. J. Am. Acad. Child Aclolesc. Psychiatry; 2012; 51(12):1273-1283

Effects of individual differences, society, and culture on youth-rated problems and strengths in 38 societies

Background: Clinicians increasingly serve youths from societal/cultural backgrounds different from their own. This raises questions about how to interpret what such youths report. Rescorla et al. (2019, European Child & Adolescent Psychiatry, 28, 1107) found that much more variance in 72,493 parents' ratings of their offspring's mental health problems was accounted for by individual differences than by societal or cultural differences. Although parents' reports are essential for clinical assessment of their offspring, they reflect parents' perceptions of the offspring. Consequently, clinical assessment also requires self-reports from the offspring themselves. To test effects of individual differences, society, and culture on youths' self-ratings of their problems and strengths, we analyzed Youth Self-Report (YSR) scores for 39,849 11-17 year olds in 38 societies. Methods: Indigenous researchers obtained YSR self-ratings from population samples of youths in 38 societies representing 10 culture cluster identified in the Global Leadership and Organizational Behavioral Effectiveness study. Hierarchical linear modeling of scores on 17 problem scales and one strengths scale estimated the percent of variance accounted for by individual differences (including measurement error), society, and culture cluster. ANOVAs tested age and gender effects. Results: Averaged across the 17 problem scales, individual differences accounted for 92.5% of variance, societal differences 6.0%, and cultural differences 1.5%. For strengths, individual differences accounted for 83.4% of variance, societal differences 10.1%, and cultural differences 6.5%. Age and gender had very small effects. Conclusions: Like parents' ratings, youths' self-ratings of problems were affected much more by individual differences than societal/cultural differences. Most variance in self-rated strengths also reflected individual differences, but societal/cultural effects were larger than for problems, suggesting greater influence of social desirability. The clinical significance of individual differences in youths' self-reports should thus not be minimized by societal/cultural differences, which-while important-can be taken into account with appropriate norms, as can gender and age differences

Testing syndromes of psychopathology in parent and youth ratings across societies

As societies become increasingly diverse, mental health professionals need instruments for assessing emotional, behavioral, and social problems in terms of constructs that are supported within and across societies. Building on decades of research findings, multisample alignment confirmatory factor analyses tested an empirically based 8-syndrome model on parent ratings across 30 societies and youth self-ratings across 19 societies. The Child Behavior Checklist for Ages 6–18 and Youth Self-Report for Ages 11–18 were used to measure syndromes descriptively designated as Anxious/Depressed, Withdrawn/Depressed, Somatic Complaints, Social Problems, Thought Problems, Attention Problems, Rule-Breaking Behavior, and Aggressive Behavior. For both parent ratings (N = 61,703) and self-ratings (N = 29,486), results supported aggregation of problem items into 8 first-order syndromes for all societies (configural invariance), plus the invariance of item loadings (metric invariance) across the majority of societies. Supported across many societies in both parent and self-ratings, the 8 syndromes offer a parsimonious phenotypic taxonomy with clearly operationalized assessment criteria. Mental health professionals in many societies can use the 8 syndromes to assess children and youths for clinical, training, and scientific purposes