Objective:

To examine the association between disruptive behavior disorder (DBD) and mental health service or psychotropic medication use among Puerto Rican youth in two different contexts. Methods: Sample: Puerto Rican youth aged 10 through 13 years living in the South Bronx (SB) in New York (n=598) and two in San Juan, Puerto Rico (PR) (n=673). Measures: At each of 3 waves, caretakers were asked about any mental health service or medication used (past year). The DISC-4 was the diagnostic interview used to assess DBD (conduct and oppositional defiant disorders) as well as other disorders (ADHD, any depressive and any anxiety disorders). Composite measures of risk factors defined were also used.

Data Analysis:

We used GENMOD procedure (SAS) to relate DBD at baseline to service, medication and psychostimulant use over three waves, adjusting by child demographics, site and propensity scores representing site differences. Other diagnosis and risk variables were added subsequently.

Results:

At baseline, among DBD positive children, 61.3% used mental health services in the SB and 57.4% in PR. Psychostimulants were used by 23% in the SB and 20% in PR. DBD positive youth at baseline are more likely to use mental health services and medication over the three waves than DBD negative youth, after adjusting for site, age and gender differences. When other disorders and risk variables are controlled for, DBD does not predict service or any medication use anymore; however it still predicts psychostimulant use.

Conclusions:

While the likelihood of using services and any medication by DBD positive Puerto Rican youth seems to be explained by comorbid disorders and general risk variables, psychostimulant use is not. The same pattern of association is observed in the SB and PR, indicating that results are not context-dependent. Reasons for unjustified psychostimulant use by youth with DBD deserve further investigation.. KEY WORDS: epidemiology, disruptive behavior disorder (DBD), conduct disorder, oppositional defiant disorder, mental health service use, medication use, psychostimulant use.