1. Assessing Mental Health Among Latino Consumers of Mental Health Services Susan V. Eisen, PhD, Mariana Gerena, PhD, Gayatri Ranganathan, MS, Pradipta Seal MS, Dharma Cortés, PhD, Glorisa Canino, PhD, Sergio Aguilar-Gaxiola, MD, PhD, Vivian Febo, PhD, Cristina Magaña, PhD, and Jesús Soto, PhD Sergio Aguilar-Gaxiola, MD, PhD, Vivian Febo, PhD, Cristina Magaña, PhD, and Jesús Soto, PhD Boston University School of Public Health,Center for Health Quality, Outcomes & Economics Research, VA Hospital, Bedford, MA, Boston University School of Public Health, Center for Health Quality, Outcomes & Economics Research, VA Hospital, Bedford, MA, Northeastern University, University of Puerto Rico and California State University, Fresno Supported by grant R01 MH58240 from the National Institute of Mental Health Abstract #128854, Session #4184 Objectives To articulate the rationale and need for developing and validating assessment instruments among people from different cultures Describe methods used in assessing reliability and validity of assessment instruments Evaluate the reliability, validity and responsiveness of the Spanish BASIS-24 survey Discuss the challenges faced in evaluating mental health treatment outcomes of Latinos. These groups account for 70% of US Latino populationProcedures Inpatients were enrolled at participating sites and completed baseline assessments within 72 hours of admission and up to 48 hours before discharge Outpatients were enrolled and assessed at intake and 30-60 days later Why adapt into Spanish? A growing, vulnerable population Largest single, minority group in U.S. (14.5% of population in 2005 Census Fact Finder) Socio-economically disadvantaged Worse on many health indicators (e.g., affective disorders and comorbidity) Limited access to mental health services Conclusion Data Analysis Confirmation of factor structure: inpatient and outpatient samples were combined and confirmatory factor analysis using LISREL was conducted. Reliability and validity analyses were conducted for inpatients and outpatients separately. Change over time: from admission to discharge for inpatients, and from intake to 1-month follow-up for outpatients. Sample Characteristics (n=594) Background Rates of reported mental illness (both diagnosis and symptomatic expression) vary across cultures Culturally and linguistically appropriate measures to assess quality and outcomes of treatment among minority populations are needed Study Sample (n=594) Spanish speaking adults from 3 Latino groups: Puerto Rico, Mexico and Dominican Republic Receiving mental health services in one of three regions: Boston, MA; San Juan, PR; Fresno, CA Puerto Ricans and Dominicans from Boston, MA (n=201) Puerto Ricans from San Juan, PR (n=218) Mexican-Americans from Fresno, CA (n=175) Total N = 283 inpatients and 311 outpatients Concurrent Validity: Correlations with other health/mental health measures Correlations with Clinician Ratings Mean* Change in BASIS-24 Scores: Admission to Discharge for Inpatients Intake to 1-mo. follow-up for Outpatients Internal Consistency and Test-Retest Reliability Subscale Inpatient (N=283) Outpatient (N=311) Depression/Functioning.29***.30*** Interpersonal Problems.13*.22** Self-Harm.45***.27*** Emotional Lability.18*.09 Psychosis.35***.31*** Alcohol/Drug Use.44***.17* Inpatient (n=265)Outpatient (n=256) BASIS-24 Subscale Time 1Time 2Effect Size Time 1 Time 2 Effect Size Depression/ Functioning 2.12 (1.10) 1.68 (1.02).452.12 (0.96) 1.84 (1.00).33 Interpersonal Relationships 1.53 (1.02) 1.23 (0.92).341.65 (0.97) 1.61 (0.97).05 Self-Harm 1.30 (1.30).85 (1.11).380.68 (1.05) 0.48 (0.88).21 Emotional Lability 2.01 (1.10) 1.82 (1.14).162.29 (0.93) 1.95 (1.06).36 Psychotic Symptoms 1.56 (1.26) 1.08 (1.07).431.26 (1.04) 1.05 (1.08).23 Alcohol/Drug Use 0.86 (1.18) 0.67 (1.02).220.69 (1.03) 0.52 (0.90).20 Summary Score 1.83 (0.83) 1.45 (0.76).521.79 (0.69) 1.55 (0.76).42 All values are statistically significant at p<.001 1 Cronbach’s alpha 2 Intraclass correlation coefficient (N=25 inpatients and 25 outpatients) Inpatient (N=283) Outpatient (N=311) Subscale# itemsα1α1 ICC 2 α1α1 Depression/ Functioning 6.84.72.82.86 Interpersonal Problems 5.70.51.72.76 Self-Harm2.80.81.86 Emotional Lability3.61.43.60.89 Psychosis4.73.59.73.79 Alcohol/Drug Use4.85.89.83.85 Summary Score24.88.76.87 Inpts (N=283) Outpts (N=311) AgeN%N% 18-243713.15317.0 25-346121.68326.7 35-448329.36721.5 45-547727.27323.5 55 +258.93511.3 Gender Male14250.211837.9 Female14149.819362.1 Ethnicity Puerto Rican19268.117255.7 Mexican7024.810333.3 Dominican207.13411.0 Education < 8 th grade7727.510735% Some h.s.9232.98427.5 H.S. grad/GED4014.34314.1 Some college4616.45919.3 College grad258.9123.9 Unemployed20873.824077.8 Primary Psychiatric Diagnosis Schizophrenia11039.4227.8 Depression9032.216358.0 Bipolar4415.882.8 Alcohol/Drug186.5196.8 Anxiety31.14114.6 Other145.0289.9 Insurance Commercial3913.9278.7 Medicare155.3227.0 Medicaid18867.119161.4 Uninsured2910.47022.5 *Scores range from 0…4. Higher values mean greater symptom severity. All differences are statistically significant except int. relationships for outpatients. *p<.05, **p<.01, ***p<.001 Inpatients (N=283) Outpatients (N=311) SF-12 ® MCS.60.65 SF-12 ® PCS.37.40 Global Mental Health.49.62 Satisfaction with Life.48.64 Confirmatory Factor Analysis Adjusted Goodness of Fit Index (AGFI).89 Root Mean Square Error of Approximation (RMSEA).057 Standardized Root Mean Squared Residual (SRMR).051 Comparative Fit Index (CFI).91 Non-normed Fit Index (NFI).90 Factor structure confirmation was slightly better for Spanish-speaking Latinos than for Latinos using the English BASIS-24 Reliability and validity were adequate for most domains. All domains showed improvement following inpatient and outpatient treatment with small to moderate effect sizes.