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Purpose: The Adolescent Quality of Life-Mental Health Scale (AQOL-MHS) is designed to measure quality of life in clinical samples of Latino adolescents aged 12-18 years. Initial findings support its reliability, validity and conceptual model for use of its three domains (emotional regulation, self-concept and social context). Our current study tests the usefulness of the AQOL-MHS for tracking changes in HRQOL during the course of service use.Methods: Three waves of data were collected from 59 participants who were recruited from mental health clinics, where waves were spaced 4 months apart. Participants were receiving services at baseline assessment and were tracked for follow-up appointments regardless of treatment status. We analyze conventional reliability statistics for individual differences (e.g., Cronbach's alpha and test-retest correlations), and to estimate the reliability of change, we carried out a variance decomposition analysis.Results: The psychometric analyses from Chavez et al. (Qual Life Res 23(4):1327-1335, 2014) were replicated with comparable results. A generalizability theory (GT) analysis revealed that the AQOL-MHS domains can measure change reliably. The reliability estimates varied from .65 to .78. Although there was reliable change at the individual level, on the average the AQOL-MHS means improved only slightly over time.Conclusions: The reliability of change for all three scales in the AQOL-MHS was acceptable, but consistently lower than the Cronbach's alpha values for each wave. Future work will use this approach to adapt our current measure to provide a better reliability of within-person change and thus broaden its applicability for prospective use. [ABSTRACT FROM AUTHOR]

Analyses of healthcare expenditures and adequacy are needed to identify cost-effective policies and practices that improve mental healthcare quality. Data are from 2010 to 2012 electronic health records from three hospital psychiatry departments in Madrid (n = 29,944 person-years) and three in Boston (n = 14,109 person-years). Two-part multivariate generalized linear regression and logistic regression models were estimated to identify site differences in mental healthcare expenditures and quality of care. Annual total average treatment expenditures were $4442.14 in Boston and $2277.48 in Madrid. Boston patients used inpatient services more frequently and had higher 30-day re-admission rates (23.7 vs. 8.7%) despite higher rates of minimally adequate care (49.5 vs. 34.8%). Patients in Madrid were more likely to receive psychotropic medication, had fewer inpatient stays and readmissions, and had lower expenditures, but had lower rates of minimally adequate care. Differences in insurance and healthcare system policies and mental health professional roles may explain these dissimilarities. [ABSTRACT FROM AUTHOR]

The Adolescent Quality of Life-Mental Health Scale (AQOL-MHS) was designed to measure quality of life in clinical samples of Latino adolescents aged 12-18 years, but has also been used in community samples. The original measure included three factors: Emotional Regulation (ER), Self-Concept (SC) and Social Context (SoC). The goals of this study are to replicate the factor structure using confirmatory factor analysis (CFA), shorten the instrument and test the degree of measurement invariance across gender, age, and type of sample. Participants for the analyses (N = 354) came from two populations in the San Juan Metropolitan Area: (1) adolescents from randomly selected households, using a multi-stage probability sampling design (n = 295), and (2) adolescents receiving treatment at mental health clinics (n = 59). We first carried out a conceptual item analysis for item reduction purposes and then assessed dimensional, configural, metric and scalar invariance for each factor using the Mplus software system. The original 3-factor structure was replicated with comparable model fit in each treatment context. Metric invariance was attained for all three scales across groups. Either full or partial scalar invariance was also observed with DIF in a total of 6 items. Invariance testing supports the use of the abridged 21 item version of the AQOL-MHS to compare diverse individuals with little bias using observed scores, but for refined estimates the ideal scoring will be from a latent variable model. [ABSTRACT FROM AUTHOR]

Background: This article presents data on the psychometric properties of a new measure, the Adolescent Quality of Life Mental Health Scale (AQOL-MHS), designed to measure quality of life in clinical samples of Latino adolescents aged 12-18 years. Participants were recruited in Puerto Rico to have one of five prevalent mental health disorders. The initial instrument development was achieved through a grounded theory approach with the use of focus groups and in-depth interviews. Methods: We conducted two stages of exploratory factor analyses (EFA) on 60 candidate items. The first stage was to establish the number of factors to extract, and the second was to improve the model by selecting the best items. A final EFA model retained 31 items and 3 factors labeled Emotional Regulation (11 items), Self-Concept (10 items) and Social Context (10 items). Results: The instrument showed good internal consistency, test-retest reliability, and construct validity. The hypotheses-driven validity tests were all supportive of the AQOL-MHS. There was evidence for convergent validity and discriminant validity, and results for known-groups' validity were overwhelmingly supportive of the ability of the instrument to identify differences between groups. Conclusions: These preliminary findings support our conceptual model and the use of the AQOL-MHS domain and overall scores. We believe that this instrument will provide clinicians additional insight into the different aspects of quality of life that are important to adolescents with mental health problems. Therefore, we consider the AQOL-MHS a vital patient-centered outcome measure for assessment strategies in the prevention and treatment of this population. [ABSTRACT FROM AUTHOR]

This article documents the initial development of a Spanish mental health quality of life (QOL) instrument based on the adolescents' own assessment of important domains to their QOL. Using a grounded theory approach, we targeted five mental health disorders: attention deficit hyperactivity disorder, conduct disorder, oppositional defiant disorder, generalized anxiety disorder, and major depressive disorder. In-depth interviews ( n = 40) and three focus groups ( n = 20) were conducted and analyzed using qualitative methods to guide the development of items. A convenient sample of island Puerto Rican adolescents aged 12-18 was recruited from outpatient mental health clinics. Qualitative analysis revealed a total of 87 themes. They were distributed based on core QOL domains such as (1) Self, (2) Peers, (3) Family, (4) School, and (5) Environment. Items were written based on prevailing themes and using as closely as possible, words and phrases used by the adolescents to describe their views and perceptions of QOL. The goal for the AQOL-MHS is to pinpoint specific areas of health-related QOL for each psychiatric diagnostic group that will provide valuable information to assist both patients and providers set, define and evaluate adequate mental health treatment goals. [ABSTRACT FROM AUTHOR]

Latino children in the U.S. have high rates of unmet need for mental health services, perhaps due to biased perceptions of impairment and need for care by parents and providers. We tested this argument using an experimental vignette design. Vignettes described children with problems that varied on severity (mild vs. serious), nature of the problem (internalizing vs. externalizing), as well as gender and ethnicity (Latino vs. Anglo). Raters were Latino and Anglo parents ( N = 185) and providers ( N = 189). Vignettes with Latino names were viewed as more impaired by both parents and providers, and this effect was significantly stronger in Latino vignettes with less severe problems. Severity and Latino features of vignettes also interacted with judgments of need for service. At higher severity, vignettes with Anglo names were judged to need service more than vignettes with Latino names, despite the same judged levels of impairment. Results are discussed in the light of the unmet need for Latinos. [ABSTRACT FROM AUTHOR]

The article presents a study that investigates the persistency of mental health services administered to children in Puerto Rico. The study was conducted to children with age range of 4-17 years old who received mental health or substance abuse services using community and clinical samples collected from 1999-2000. The study revealed that children from clinical sample received persistent treatment and this is more frequent in males with ages 4-10 years old.

We reviewed the Spanish translation of the Youth Quality of Life Instrument-Research Version (YQOL-R) and culturally adapted the measure with Puerto Rican and Mexican American children and adolescents. The YQOL-R is a self-reported measure that includes four domains: Sense of Self, Social Relationships, Environment, and General Quality of Life. A total of 10 focus groups were conducted with children aged 9 to 11, adolescents aged 12 to 17, their parents, and mental health providers. Five focus groups were conducted in San Diego, California and five in San Juan, Puerto Rico. Eligible participants were recruited from children’s outpatient psychiatry clinics. We followed an iterative and recursive process in reviewing changes and modifications to the instrument using a bilingual committee and a Multi National Bilingual Committee. Greater semantic, content, and technical equivalence of the Spanish and English versions for the YQOL-R was achieved for the two largest U.S. Latino subgroups: Mexican Americans and Puerto Ricans. The cultural adaptation process revealed several important issues regarding the measurement of quality of life in different age groups. Additional items for school, relationships (both family and friends) and spare time suggested the need for a future children’s version of the instrument. For the adolescents, additional items were suggested in the areas of sexuality, intergenerational conflict and acculturative stress. [ABSTRACT FROM AUTHOR]

The test-retest reliability of the Spanish Diagnostic Interview Schedule for Children (DISC-IV) is presented. This version was developed in Puerto Rico in consultation with an international bilingual committee, sponsored by NIMH. The sample (N = 146) consisted of children recruited from outpatient mental health clinics and a drug residential treatment facility. Two different pairs of nonclinicians administered the DISC twice to the parent and child respondents. Results indicated fair to moderate agreement for parent reports on most diagnoses. Relatively similar agreement levels were observed for last month and last year time frames. Surprisingly, the inclusion of impairment as a criterion for diagnosis did not substantially change the pattern of results for specific disorders. Parents were more reliable when reporting on diagnoses of younger (4-10) than older children. Children 11-17 years old were reliable informants on disruptive and substance abuse/dependence disorders, but unreliable for anxiety and depressive disorders. Hence, parents were more reliable when reporting about anxiety and depressive disorders whereas children were more reliable than their parents when reporting about disruptive and substance disorders. [ABSTRACT FROM AUTHOR]