SOCW 6446

profileJodas1
ContentServer2.pdf

E M P I R I C A L R E S E A R C H

How Mental Health Interviews Conducted Alone, in the Presence of an Adult, a Child or Both Affects Adolescents’ Reporting of Psychological Symptoms and Risky Behaviors

Aubrey V. Herrera1 • Corina Benjet1 • Enrique Méndez1 • Leticia Casanova1 •

Maria Elena Medina-Mora1

Received: 26 November 2015 / Accepted: 6 January 2016 / Published online: 20 January 2016

� Springer Science+Business Media New York 2016

Abstract The normative process of autonomy develop-

ment in adolescence involves changes in adolescents’

information management typically characterized by

decreasing disclosure and increasing concealment. These

changes may have an important impact on the early detection

and timely treatment of mental health conditions and risky

behavior. Therefore, the objective was to extend our under-

standing of how these developmental changes in adolescent

disclosure might impact adolescent mental health interviews.

Specifically, we estimated the effects of third party presence

and type of third party presence (adult, child, or both) on

adolescents’ reports of psychiatric symptoms, substance use,

suicidal behavior, and childhood adversity. In this represen-

tative sample of 3005 adolescents from Mexico City (52.1 %

female), administered the World Mental Health Composite

International Diagnostic Interview (WMH-CIDI-A), adult

presence influenced reporting the most; in their presence,

adolescents reported more ADHD, parental mental illness

and economic adversity, but less panic disorder, PTSD, drug

use and disorder, and suicidal behavior. The presence of

children was associated with increased odds of reporting

conduct disorder, opportunity for drug use, parental criminal

behavior, neglect, and the death of a parent. While adolescent

information management strategies are normative and even

desirable as a means of gaining emotional autonomy, they

may also interfere with timely detection and treatment or

intervention for mental health conditions and risky behaviors.

Research and practical implications of these findings are

discussed.

Keywords Adolescence � Privacy � Information management � Social desirability � Mental health � Mexico

Introduction

The increasing autonomy of adolescence has important

implications for adolescents’ information management; in

other words, how much, what, to whom and under what

conditions adolescents disclose or conceal information

(Campione-Barr et al. 2015; Tilton-Weaver 2014). Auton-

omy development through the realignment of parent–child

relationships in adolescence is achieved through a process of

lessening parental control, and reduced parental knowledge

and adolescent willingness to disclose (Keijsers and Poulin

2013). This is important because the developmental decrease

in disclosure and increase in concealment specifically rela-

ted to risky behaviors and psychological distress might limit

timely detection and treatment of mental disorders during a

stage of development with high risk for the onset of psy-

chiatric disorder.

Disclosure by adolescents is mediated by adolescents’

attitudes regarding what parents have a right to know (Chan

et al. 2015). U.S. adolescents have been found to feel more

obligated to disclose to parents prudential information (de-

fined as information that pertains to one’s comfort, safety

and health such as risky behaviors) than personal (defined as

that pertaining to privacy, preferences, and control over

one’s body) or conventional information (that pertaining to

social norms) (Smetana et al. 2006). However, adolescents

who engage in risky behavior tend to disclose less about

prudential behaviors than personal or multifaceted ones.

& Corina Benjet [email protected]

1 Dirección de Investigaciones Epidemiológicas y

Psicosociales, Instituto Nacional de Psiquiatrı́a Ramón de la

Fuente, Calzada México-Xochimilco 101, San Lorenzo

Huipulco, 14400 México, D.F., Mexico

123

J Youth Adolescence (2017) 46:417–428

DOI 10.1007/s10964-016-0418-1

Adolescents fail to disclose prudential behaviors for fear of

disapproval or punishment (Smetana et al. 2009) whereas

they fail to disclosure personal information because they

consider such information legitimately under their personal

control and they do not feel obliged to share this domain of

information with parents (Smetana and Asquith 1994).

Additionally prior research has found that U.S. adolescents

disclose more to mothers than to fathers (Smetana et al.

2006) and more to mothers than to siblings (at least in early

adolescence, although this gap between mothers and siblings

narrows toward emerging adulthood; Campione-Barr et al.

2015). Both depressive symptomatology and risky behaviors

have been negatively associated to disclosure with both

parents and siblings (Campione-Barr et al. 2015; Kerr and

Stattin 2000; Laird et al. 2013).

Because adolescents do not seek treatment for them-

selves, detection and treatment of mental disorders and

risky health behaviors in adolescents requires detection by

an adult third party such as parent or teacher and thus

largely depends on adolescent disclosure and information

management. To evaluate sensitive topics with adolescents

in clinical settings and in research, including health risk

behavior, mental disorders, and adverse experiences, self-

reporting is commonly used to gather this information.

However, questions regarding adolescent self-report

stem from numerous findings of commonly discrepant

reports between adolescents and their parents (e.g., Jensen

et al. 1999; Rescorla et al. 2013; Salbach-Andrae et al.

2009; Seiffge-Krenke and Kollmar 1998). Most of these

aforementioned studies find that parents report more

externalizing symptoms, that adolescents report more

internalizing symptoms and that there are greater discrep-

ancies for externalizing than internalizing symptoms.

Conclusions from this research have suggested that neither

adolescent nor parent report should be considered true or

untrue, but rather that both informants likely contribute

useful albeit discrepant information related to clinically

meaningful conditions and associated impairment. The

possible exceptions are ADHD and oppositional defiant

disorder for which adolescents’ reports alone are found to

have less clinical validity (Jensen et al. 1999).

Why might adolescents or persons of any age use infor-

mation management strategies involving incomplete dis-

closure or concealment? When asked sensitive questions,

people might misreport information because they view the

questions as intrusive, worry that disclosure of the infor-

mation might bring negative consequences, or want to pre-

sent themselves in a more favorable light by responding in a

socially desirable manner (Holtgraves 2004; Johnson and

Van de Vijver 2002; Krumpal 2013; Tourangeau and Yan

2007). This misreporting or concealing of information for

sensitive topics is a notable source of error attributed to bias

in survey estimates, may also be relevant in clinical settings,

and is largely dependent on the situation (Krumpal 2013;

Tourangeau and Yan 2007). When filtering responses to be

more desirable or acceptable, respondents aim to avoid

embarrassment when speaking with either the interviewer or

a third party bystander who may be present (Holtgraves

2004; Krumpal 2013; Mneimneh 2012; Tourangeau and Yan

2007). If the bystander is already aware of the information

being asked and can serve as a ‘‘truth control,’’ the

respondent will be less inclined to report dishonestly

(Mneimneh 2012; Tourangeau and Yan 2007). Anonymous

reporting is an option in some cases, and several studies

suggest that anonymity increases truthful responses for

sensitive information (Krumpal 2013; Ong and Weiss 2000;

Tourangeau and Yan 2007). Contrasting this, anonymity

cannot be assumed to automatically increase the quality of

reporting, because confidential questionnaires may give the

same results as anonymous questionnaires (van de Looij-

Jansen et al. 2006). Additionally, a 2002 study by Newman

et al. reports that taking the human interviewer out of the

picture may reduce the chance that respondents will report

psychological symptoms due to the impersonal nature.

Another influence on self-reports is the respondent’s

culture. It dictates both what is deemed a desirable

response and the privacy, or lack thereof, of the interview

setting (Diop et al. 2015; Hofstede et al. 2010; Mneimneh

2012; Pollner and Adams 1994). For example, it is more

common in a collectivist culture for a family member or

friend to invade privacy, compared to an individualistic

culture, where privacy is more prioritized (Hofstede et al.

2010). Cultural norms may dictate how easy or difficult it

is for an interviewer to ask for privacy during the interview

(Mneimneh 2012). While Tilton-Weaver (2014) found that

relationship dynamics and adolescent delinquent behaviors

play a role in adolescents’ information management, she

suggested that future research should sample more diver-

gent cultures where strong expectations to conform to the

rules and expectations of parents and other adults might

affect this relationship. In one study with Japanese ado-

lescents, levels of adolescent disclosure to parents, and

perceptions of the obligation to disclose to parents were

less than typically found in U.S. adolescents (Nucci et al.

2014). These authors interpreted these results to reflect a

cultural tendency in Japan to view adolescents’ actions as

matters of personal responsibility. One of the few studies of

a Latino population, Puerto Rican adolescents in the U.S.,

showed that greater adherence to Latino family values was

associated with more disclosure and less lying to mothers

(not so with fathers) regarding prudential issues, but not

peer-multifaceted issues (Villalobos and Smetana 2012). A

comparison of U.S. adolescents from Mexican, Chinese

and European backgrounds found Mexican–American

youth to disclose risky prudential behaviors less to mothers

than European American teens (Yau et al. 2009). The

418 J Youth Adolescence (2017) 46:417–428

123

authors concluded that, since Mexican culture emphasizes

more conformity to external standards, that these adoles-

cents may have felt that they had more at stake than other

adolescents when violating parental rules.

Interview settings with the presence of a third party have

shown an association with how interviewees respond to

sensitive topics, especially underreporting or over reporting

of sensitive information (Diop et al. 2015; Krumpal 2013;

Taietz 1962; Tourangeau and Yan 2007). Information man-

agement in adolescence is likely to be more pronounced than

in other stages of life given the developmental process

toward autonomy on the one hand and the power of adults

over adolescents to punish on the other. Adolescents inter-

viewed at home, at school, or in a clinical setting, may have

varying willingness to disclose sensitive information

depending on the context. At home, typically in the presence

of third parties who may have the power to punish the ado-

lescent or disprove of certain behaviors, typically a parent,

adolescents tend to underreport risky health behaviors, such

as alcohol and substance use (Aquilino et al. 2000; Brener

et al. 2006; Hoyt and Chaloupka 1994; Kann et al. 2002;

Krumpal 2013). In Aquilino et al.’s 2000 study, the presence

of a sibling showed fewer effects on reporting. In these

general population household surveys, interviewing the par-

ticipants privately is often not possible. This problem may be

even more pronounced in developing countries where the

number of family members in the household may be larger,

including extended family members, while at the same time

the size of the home smaller with fewer private spaces

(Aquilino 1997; Mneimneh 2012). While reporting infor-

mation at school, in the presence of peers or friends, the

literature shows an over reporting of these risky health

behaviors, in order to gain acceptance or seem ‘‘cool’’

(Brener et al. 2006; Gfroerer et al. 1997; Hoyt and Chaloupka

1994; Kann et al. 2002). However, Davis et al.’s 2010 study

reports the opposite and finds that adolescents understate

alcohol consumption, in order to present themselves more

favorably. In clinical settings, it is usually possible to inter-

view the adolescent in private, where more confidentiality is

reassured, and thus, they may report more openly (Gans and

Brindis 1995).

Like risky health behaviors, mental disorders are a sen-

sitive, and often stigmatized, issue. For mental disorders,

there are no reliable biomarkers to diagnose disorders and,

thus, the use of standardized diagnostic interviews is the

main form of diagnosis (Kessler and Ustun 2004). With such

interviews, respondents may not want to report symptoms or

feel embarrassed to report them in the presence of a third

party (Epstein et al. 2001). However, Pollner and Adams

(1994) reported that the presence of a third party was not

related to reporting symptoms of possible mental disorders,

and responses likely reflected methodological, situational,

and cultural influences. Overall, there is scant literature

available concerning the impact of a third party presence,

such as a parent, a sibling or other family member, during

adolescent mental health interviews and none to our

knowledge in the adolescent population of Mexico City.

The Current Study

The objective of this article is to build on research in the area

of adolescent information management, extending our

understanding of how these developmental changes in ado-

lescent disclosure might impact adolescent mental health

interviews. More specifically, we estimate the effects of third

party presence on adolescents’ reports of psychiatric symp-

toms meeting diagnostic criteria, substance use, suicidal

behavior, and childhood adversity. Additionally, the effect is

examined by type of third party present (adult, child, or both).

Because the literature shows that adolescents often fail

to disclosure prudential information that they fear will get

them in trouble, we hypothesize that rates of psychiatric

disorders, substance use, and suicidality will be lower in

the presence of an adult, that rates of conduct problems and

substance use, will be higher when only children are pre-

sent, due to adolescents’ desire to show off in front of

peers, and that childhood adversities will be higher when

an adult is present, as parents are likely to already possess

this information and thus may serve as a ‘‘truth control’’.

Methods

Participants

Data were collected as part of the 2005 Mexican Adoles-

cent Mental Health survey, with 3005 adolescent partici-

pants, aged 12–17 years old, representative of the almost

two million adolescents living in Mexico City. They were

chosen from a stratified multistage area probability sample.

Census count areas, cartographically defined and updated

for the XII Population and Housing Census, were the pri-

mary sampling units for all strata. City blocks with prob-

ability proportional to size were chosen as the secondary

sampling units. The Kish method of random number charts

was used to randomly select one eligible adolescents from

each household, and the response rate was 71 %. As

described previously, the sociodemographic distribution

was similar to the distribution of the adolescent population

in Mexico City: one half female, nearly 80 % students,

two-thirds residing with both parents, and the socioeco-

nomic level of the parents typically being low (Benjet et al.

2009).

J Youth Adolescence (2017) 46:417–428 419

123

Procedures

Adolescents and their parents were given both a verbal and

written explanation of the study, followed by the parent or

guardian providing signed informed consent and the ado-

lescent providing assent. Adolescent interviews were con-

ducted in their home by extensively trained lay

interviewers and each participant and their family were

offered information on local mental health services. The

Internal Review Board of the National Institute of Psy-

chiatry Ramon de la Fuente approved this project.

Measures

The computer-assisted, fully structured adolescent version of

the World Mental Health Composite International Diag-

nostic Interview (WMH-CIDI-A; Kessler et al. 2009;

Merikangas et al. 2009) was administered to participants.

This research tool collects sociodemographic and other

information to generate diagnoses of DSM-IV disorders

(anxiety, mood, substance and disruptive behavioral disor-

ders), other risk behaviors such as substance use and suicidal

behavior, and risk factors such as childhood adversity. The

interviewer read each question aloud to the participant and

input responses directly into the computer. This computer-

assisted version includes complex logical skip patterns such

that each particular question posed was chosen by the

computer based on the previous responses of the participant.

Consistency check systems were in place to ensure that

inconsistent responses were probed and corrected.

Socio-Demographic Variables

The socio-demographic variables examined in this study were

asked about in the WMH-CIDI-A. This includes the sex of the

participants, age, family constellation, student status, parental

education and parental income. Family constellation was cat-

egorized as living with both biological parents or not living

with both biological parents (as reported by the adolescent).

Participants were considered students if currently enrolled as a

student. The adolescents were asked about the educational

attainment of each of their parents which was then categorized

as none/primary (six or less years of education), secondary

(7–9 years of education), high school (10–12 years of educa-

tion) or college (thirteen or more years of education); the score

of the parent with the highest level of education was used.

Parents reported family income was categorized into tertiles.

Psychiatric Disorder

The WMH-CIDI-A begins with a screening section which

includes a few screening questions for each disorder. Ado-

lescents who respond having ever experienced the symptoms

in the screening section then are asked more in depth ques-

tions for each disorder for which they screened positive. This

article reports the psychiatric disorders for which participants

met diagnostic criteria according to the diagnostic and sta-

tistical manual of mental disorders, fourth edition (DSM-IV;

American Psychiatric Association 1994) in the prior

12 months. All disorders used organic exclusion rules as well

as hierarchy definitions in order to avoid double counting of

disorders in the same person. The disorders are grouped as

follows: anxiety disorders (panic disorder, generalized anx-

iety disorder, agoraphobia, social phobia, specific phobia,

separation anxiety disorder and posttraumatic stress disorder

(PTSD)), mood disorders (major depressive disorder and

bipolar disorder (I and II)), disruptive behavior disorders

(intermittent explosive disorder, oppositional-defiant disor-

der, conduct disorder and attention-deficit/hyperactivity dis-

order) and substance use disorders (alcohol abuse or

dependence and drug abuse or dependence). A comparison of

diagnosis based on the adolescent CIDI with blinded clinical

interviews using the K-SADS showed generally good diag-

nostic concordance (Kessler et al. 2009).

Substance Use

The substance use section of the WMH-CIDI-A asks ado-

lescents about their lifetime use (defined as consumption of

the substance at least once at any time in one’s life) of

alcohol and illicit drugs, opportunity to use alcohol and

drugs, and substance abuse and dependence. The illicit drugs

included marijuana, cocaine in any of its forms, tranquilizers

or stimulants used without a medical prescription such as

methamphetamine, and other substances (e.g., heroin, inha-

lants, LSD, etc.) that were grouped as ‘‘other drugs.’’ Par-

ticipants were asked about each category of drugs openly and

then presented with a list of numerous different street names

for these drugs. The questions regarding opportunity to use

alcohol and drugs were posed after the questions about

alcohol and drug use such that opportunities to use alcohol

and drugs referred to all the alcohol and drugs previously

presented to the respondents. All participants were asked

about opportunities regardless of whether they had previ-

ously endorsed consuming any substance. Opportunity to use

alcohol and opportunity to use drugs were asked about sep-

arately and defined as having the opportunity to use any

substance regardless of whether or not the respondent did so.

They were given as an example that someone offered them

drugs or that they were present when others were using and

could have done so if he or she chose to.

Suidicial Behavior

The suicidal behavior section had a somewhat different

format than the other sections of the WMH-CIDI-A such

420 J Youth Adolescence (2017) 46:417–428

123

that the interviewer did not read the questions aloud to the

adolescent, but rather asked the respondent to report

whether they had experienced any of three experiences

which were printed in a booklet and referred to by letter.

These experiences were ‘‘Have you ever seriously thought

about committing suicide?,’’ ‘‘Have you ever made a plan

for committing suicide?,’’ and ‘‘Have you ever attempted

suicide?’’

Childhood Adversity

Twelve different types of childhood adversity were evalu-

ated and classified as present or not present using the same

criteria as the World Mental Health Survey Initiative (Green

et al. 2010). These included parental mental illness, parental

substance problems, parental criminal behavior, witnessing

family violence, physical abuse, sexual abuse, neglect, death

of a parent, parental divorce, other parent loss, life-threat-

ening physical illness, and economic adversity. Parental

pathology used questions from the family history research

diagnostic criteria interview and included parental mental

illness, substance problems, and criminal behavior (Endicott

et al. 1978). Physical abuse and witnessing family violence

were evaluated with a modified version of the Conflict

Tactics Scale (Strauss 1979). Neglect was assessed with

questions often used in child welfare studies (Courtney et al.

1998). Sexual abuse was determined by reading a definition

of rape and a definition of other forms of abuse or

molestation. To be consistent with the other World Mental

Health Surveys, chronic sexual abuse was defined as

reporting at least three episodes of sexual abuse thus rep-

resenting chronic sexual abuse as opposed to acute one time

trauma (Kessler et al. 2010). To assess parental loss, the

adolescents were asked whether they lived with both of their

parents all of their lives. Those who did not were asked

whether this was because their parents had separated or

divorced, a parent had died or some other reason. Those

endorsing separations of 6 months or more from either

parent for some other reason were classified as other par-

ental loss, with reasons ranging from having gone to

boarding school, having left home, or that their parent was in

prison. Physical illness is based on the adolescent’s report of

having experienced a life-threatening physical illness.

Family economic adversity was determined by the family

ever receiving money from a government assistance pro-

gram for poor families or by lack of parental employment

most or all of the time during the participant’s childhood.

Third Party Presence

An interviewer observation section at the end of the WMH-

CIDI-A, required the interviewer to register if anyone was

present during the interview aside from the adolescent, and

if so who. Those responses were categorized as follows: (1)

no one, (2) only children, (3) children and adults, or (4)

adults only.

Statistical Analysis

Data were weighted to adjust for non-response, differential

probabilities of selection, and post-stratification to the

adolescent population of Mexico City according to the year

2000 Census in the target sex and age range. The preva-

lence of reported DSM-IV diagnoses, substance use, sui-

cidal behavior and childhood adversity were calculated by

privacy category. Then, age- and sex-adjusted odds ratios

were calculated in SUDAAN software (Research Triangle

Institute 2009) for the association of privacy with the DSM-

IV diagnoses, substance use, suicidal behavior and child-

hood adversity.

Results

Only 42.7 % of interviews were conducted with the adoles-

cent alone, whereas children only were present in 3.4 % of

interviews, both children and adults were present in 4.8 %,

and at least one adult was present in 49.1 % of interviews. Of

the adults that were present 84.6 % was a parent. Sociode-

mographic characteristics are depicted in Table 1. Third

party presence varied by sex, age, and parental education. A

greater proportion of interviews with females, versus males,

had only children present; families with lower parental

education tended to have children present, as well. More

interviews were conducted alone when the interviewee was

an older adolescent versus a younger adolescent.

The association of third party presence with DSM-IV

diagnosis adjusted by age and sex is shown in Table 2.

Having only children present increases the probability of

reporting any disruptive behavior disorder (OR 1.74; 95 %

CI 1.21–2.51), which is explained primarily by the threefold

odds of reporting a conduct disorder in particular (CI

1.17–7.65). The presence of both children and adults also

increases the probability of reporting any disruptive behav-

ior disorder (OR 1.80; 95 % CI 1.05–3.10), but is explained

by the increased odds of reporting intermittent explosive

disorder (OR 2.35; 95 % CI 1.30–4.22). Having only adults

present increases the odds of reporting attention-deficit/hy-

peractivity disorder (ADHD) by 83 % (95 % CI 1.08–3.10)

but reduces the odds of reporting panic disorder (OR 0.62;

95 % CI 0.40–0.95), PTSD (OR 0.55; 95 % CI 0.35–0.86),

and a drug use disorder (OR 0.17; 95 % CI 0.07–0.38).

Table 3 presents the association of substance use and

third party presence, adjusted by age and sex. With only

children present, there are increased odds of reporting a

drug opportunity (OR 1.73; 95 % CI 1.10–2.70). Having

J Youth Adolescence (2017) 46:417–428 421

123

both children and adults present is unrelated to reporting of

substance use. However, when only adults are present,

odds are reduced by roughly half for reporting drug use

(OR 0.47; 95 % CI 0.31–0.73).

The association between suicidal behavior and third

party presence is shown in Table 4. Having children only

or children and adults present was unrelated to reporting of

suicidal behavior. However, having only adults present

reduces the odds of reporting suicidal behavior with ORs

ranging from 0.48 for suicide attempts to 0.68 for suicidal

ideation.

Table 5 depicts the association between childhood

adversity and third party presence. With only children

present, there is a greater probability of reporting the fol-

lowing: parental criminal behavior, neglect, and parent

death with ORs ranging from 1.88 for death of a parent to

2.44 for parental criminal behavior. When children and

adults are present, there is a greater probability of reporting

parental mental illness (OR 2.14; 95 % CI 1.34–3.41).

With only adults present, there is a greater probability of

reporting both parental mental illness (OR 1.39; 95 % CI

1.13–1.71) and economic adversity (OR 1.22; 95 % CI

1.01–1.46).

Discussion

The normative process of autonomy development in ado-

lescence involves changes in adolescents’ information

management typically characterized by decreasing disclo-

sure and increasing concealment of information (Campi-

one-Barr et al. 2015; Tilton-Weaver 2014). These changes

may have an important impact on the early detection and

timely treatment of mental health conditions and risky

behavior. These developmental changes in information

management depend on various factors including the

domain of the information managed and the person to

whom one discloses (mother, father, sibling, peer, other

adult) (Smetana et al. 2006; Campione-Barr et al. 2015).

While previous studies have found that less disclosure and

increased concealment is related to delinquent behavior

(Campione-Barr et al. 2015; Kerr and Stattin 2000; Laird

et al. 2013) and that there are important discrepancies

between children’s and parental reports of psychological

distress and risky behavior (Jensen et al. 1999; Rescorla

et al. 2013; Salbach-Andrae et al. 2009: Seiffge-Krenke

and Kollmar 1998), the purpose of this investigation was to

understand how the presence of third parties during

Table 1 Sociodemographic characteristics by third party presence in adolescent mental health interviews

Sociodemographic

characteristics

Third party presence df v2 p

No one present Children only Children and adults Adults only

n % se n % se n % se n % se

Sex 3 6.5 0.00

Male 631 51.96 2.06 40 40.98 4.26 55 38.62 3.38 697 49.83 1.06

Female 638 48.04 2.06 61 59.02 4.26 88 61.38 3.38 762 50.17 1.06

Age (years) 3 6.0 0.00

12–14 695 44.77 1.55 60 53.16 4.09 93 58.51 3.67 895 52.09 1.63

15–17 574 55.23 1.55 41 46.84 4.09 50 41.49 3.67 564 47.91 1.63

Living with parents 3 0.4 0.77

No (one/none) 428 33.86 1.15 37 39.17 6.51 50 36.13 5.20 499 34.51 1.07

Yes (both) 841 66.14 1.15 64 60.83 6.51 93 63.87 5.20 960 65.49 1.07

Current student 3 2.2 0.11

No 225 20.72 0.98 18 18.58 4.75 20 16.64 4.12 214 17.57 1.34

Yes 1044 79.28 0.98 83 81.42 4.75 123 83.36 4.12 1245 82.43 1.34

Parents’ education 9 3.3 0.01

None/primary 333 26.67 0.98 31 30.80 3.58 41 28.11 3.54 362 25.01 0.89

Secondary (7–9 years) 478 37.31 1.83 42 43.98 5.02 53 35.54 5.38 548 38.46 1.69

High school (10–12 years) 284 22.32 1.14 19 17.09 3.03 26 19.02 3.61 359 23.67 1.38

College (13? years) 173 13.71 1.00 9 8.12 1.88 23 17.33 3.32 190 12.86 0.85

Parents’ income 6 2.3 0.06

Low 459 35.58 1.95 43 44.77 4.36 50 35.41 3.51 545 37.60 1.46

Average 400 31.42 1.51 38 36.79 4.35 45 29.89 4.34 440 30.20 1.37

High 410 33.00 1.45 20 18.44 4.10 48 34.70 4.05 474 32.20 1.18

%s are weighted by sample design and non-response

422 J Youth Adolescence (2017) 46:417–428

123

adolescent mental health interviews influences the report-

ing of symptoms used to diagnosis disorders and other risk

behavior. We found that the presence of third parties

influences the responses provided by adolescents, but this

reporting varies according to whom is present and the type

of symptom or behavior asked about.

Adults present during the interview influence adolescent

disclosure the most; in the presence of only adults, adoles-

cents were more likely to report ADHD, parental mental

illness and economic adversity. Most adults present were the

parent, as such, they likely have better insight into their own

mental health and their family’s economic status compared to

adolescents, and thus may have stepped in to provide infor-

mation. Parents may also have observational insight regard-

ing their adolescent’s ADHD that the adolescent lacks or is

ashamed to mention. In fact, prior research has found ADHD

(as well as oppositional defiant disorder) to be the only dis-

orders for which adolescent report alone of symptoms is

unrelated to impairment (Jensen et al. 1999). Inattentive,

impulsive and hyperactive adolescents are likely to have little

insight into their condition due to the cognitive and atten-

tional characteristics of the disorder. While the presence of

adults was associated with greater odds of reporting the three

abovementioned conditions, it was also associated with

reduced odds of reporting the following seven conditions:

panic disorder, post traumatic stress disorder, drug abuse or

dependence, drug use, suicide ideation, suicide plan, and

suicide attempt. Our findings corroborate those of previous

studies (Aquilino et al. 2000; Brener et al. 2006; Kann et al.

2002; Krumpal 2013) indicating that adolescents are less

inclined to report risky behavior in the presence of third

parties who would disapprove and who have the authority to

punish them. The reduced odds of PTSD may be due to

adolescents’ not wanting to disclose to their parents or other

adult the traumatic event that led to the PTSD (such as a

sexual abuse). Prior research on the disclosure of sexual

Table 2 Association of third party presence with psychiatric diagnosis in adolescent mental health interviews

Psychiatric disorder Third party presence df v2 p

No one present

(reference group)

Children only Children and adults Adults only

OR OR 95 % CI OR 95 % CI OR 95 % CI

I. Anxiety disorders

Panic disorder 1.00 1.21 (0.32–4.52) 1.16 (0.39–3.39) 0.62 (0.40–0.95) 3 5.44 0.14

Generalized anxietv disorder 1.00 1.20 (0.16–8.94) 0.93 (0.08–10.41) 1.43 (0.53–3.86) 3 2.04 0.56

Agoraphobia 1.00 1.50 (0.64–3.50) 0.77 (0.28–2.16) 1.24 (0.84–1.83) 3 2.14 0.54

Social phobia 1.00 0.64 (0.31–1.32) 1.23 (0.60–2.53) 0.91 (0.68–1.20) 3 3.64 0.30

Specific phobia 1.00 1.18 (0.65–2.14) 1.20 (0.88–1.65) 1.02 (0.85–1.24) 3 1.42 0.70

Separation anxietv 1.00 0.98 (0.44–2.19) 1.19 (0.63–2.23) 0.97 (0.72–1.31) 3 0.52 0.92

Posttraumatic stress disorder 1.00 0.36 (0.04–2.93) 0.73 (0.22–2.44) 0.55 (0.35–0.86) 3 8.27 0.04

Any anxiety disorder 1.00 1.20 (0.69–2.09) 1.32 (0.96–1.82) 1.04 (0.88–1.22) 3 3.32 0.35

II. Mood disorders

Major depressive disorder 1.00 0.99 (0.48–2.02) 0.66 (0.31–1.40) 0.78 (0.54–1.13) 3 4.46 0.22

Bipolar disorder (broad) 1.00 1.37 (0.80–2.33) 1.22 (0.39–3.84) 1.07 (0.70–1.64) 3 1.70 0.64

Any mood disorder 1.00 1.09 (0.60–1.98) 0.78 (0.44–1.40) 0.85 (0.64–1.12) 3 3.88 0.27

III. Disruptive behavior disorders

Intermittent explosive disorder 1.00 1.16 (0.63–2.12) 2.35 (1.30–4.22) 1.05 (0.74–1.50) 3 8.96 0.03

Oppositional-defiant disorder 1.00 1.78 (0.94–3.39) 1.36 (0.64–2.87) 1.05 (0.82–1.36) 3 3.80 0.28

Conduct disorder 1.00 3.00 (1.17–7.65) 2.07 (0.81–5.24) 1.09 (0.60–1.99) 3 11.86 0.01

Attention-deficit/hvperactivitv disorder 1.00 0.50 (0.06–4.12) 2.75 (0.85–8.84) 1.83 (1.08–3.10) 3 11.39 0.01

Any disruptive behavior disorder 1.00 1.74 (1.21–2.51) 1.80 (1.05–3.10) 1.16 (0.91–1.46) 3 19.53 0.00

IV. Substance use disorders

Alcohol use disorder 1.00 0.66 (0.13–3.19) 1.40 (0.51–3.86) 1.08 (0.72–1.62) 3 0.99 0.80

Drug use disorder 1.00 0.90 (0.25–3.24) 0.74 (0.11–4.97) 0.17 (0.07–0.38) 3 21.24 0.00

Any substance use disorder 1.00 0.66 (0.21–2.10) 0.89 (0.34–2.33) 0.76 (0.54–1.06) 3 4.36 0.23

V. Any disorder 1.00 1.39 (0.82–2.34) 1.31 (0.94–1.82) 0.99 (0.84–1.17) 3 5.37 0.15

Regression models adjusted by sex and age

OR Odds ratio, 95 % CI 95 % confidence interval, italic shows significant ORs at p \ 0.05 Psychiatric disorders (the dependent variable) and privacy levels (the independent variable) are displayed as such for visual ease

J Youth Adolescence (2017) 46:417–428 423

123

abuse has shown many reasons why young people do not

disclose, including fear of not being believed, shame or self-

blame about the abuse, or fear of the consequences to

themselves or others of disclosure (McElvaney et al. 2014).

Why there might be reduced reporting of panic disorder is

unclear.

The presence of only children led to increased odds of

reporting conduct disorder, any disruptive behavior disorder,

opportunity for drug use, parental criminal behavior, child-

hood neglect, and the death of a parent. The threefold

increased reporting of conduct disorder might be due to the

adolescent ‘‘showing off’’ in front of their peers (Brener

et al. 2006). Impulse control disorders are marked by the

inability to resist a temptation or impulse to act in a way that

is harmful to the person or others. If the children present

during the interview have witnessed instances of the dis-

ruptive behavior, the affected adolescent might feel less

pressure to conceal what is already known and may even

feel compelled to disclose as not to appear to lie in front of

this person. Importantly, the symptoms of disruptive

behavior disorders can be observed and do not require the

adolescent to have disclosed these symptoms to the sibling

for the sibling to know them to be true. Finally, if the child

is a sibling, they have likely experienced the same

upbringing and can attest to childhood adversities, including

parental criminal behavior, childhood neglect, or death of a

parent. The adolescent may feel more compelled to disclose

these events knowing that the sibling knows this to be true.

When adults and children were present, there were

greater odds of reporting intermittent explosive disorder,

any disruptive behavior disorder, and parental mental ill-

ness. Again, if these third party members have witnessed

intermittent explosive bouts or disruptive behaviors, and

parental mental illness, there would be no need for the

adolescent to conceal it and he or she may even feel more

compelled to disclosure in order to not appear to be lying

in front of the third parties. Also, the parent may assist in

the reporting of this topic, even if the children were not

aware, in order to provide the most accurate assessment.

Interestingly, the presence of another person, either

adult or child, did not seem to influence reports of most

anxiety disorders (except panic and PTSD) or any mood

disorder, suggesting that overall symptoms of anxiety and

mood disorders may be considered less shameful or

embarrassing than those of other disorders. The presence

of a third party also did not influence reports of alcohol use

or disorder. This may be due to the cultural acceptance or

tolerance of adolescent drinking in Mexico City such that

adolescents do not feel the need to hide this from their

parents (Benjet et al. 2014).

Some limitations of the study must be acknowledged.

Directionality or causality cannot be ascertained for the

associations under question. It might be that a parent is lessT a

b le

3 A

ss o

c ia

ti o

n o

f th

ir d

p a rt

y p

re se

n c e

w it

h su

b st

a n

c e

u se

re p

o rt

s in

a d

o le

sc e n

t m

e n

ta l

h e a lt

h in

te rv

ie w

s

A lc

o h

o l

o p

p o

rt u

n it

y A

lc o

h o

l u

se D

ru g

o p

p o

rt u

n it

y D

ru g

u se

O R

9 5

% C

I O

R 9

5 %

C I

O R

9 5

% C

I O

R 9

5 %

C I

A d

u lt

(s )

o n

ly p

re se

n t

0 .9

4 (0

.7 7

– 1

.1 5

) 0

.9 1

(0 .7

5 –

1 .0

9 )

0 .9

0 (0

.7 7

– 1

.0 6

) 0 .4 7

(0 .3 1 – 0 .7 3 )

A d

u lt

(s )

a n

d c h

il d

(r e n

) p

re se

n t

1 .0

9 (0

.6 7

– 1

.7 7

) 1

.0 1

(0 .6

8 –

1 .4

8 )

1 .4

1 (0

.9 7

– 2

.0 3

) 0

.7 0

(0 .2

0 –

2 .4

0 )

C h

il d

(r e n

) o

n ly

p re

se n

t 1

.1 3

(0 .6

9 –

1 .8

5 )

0 .7

6 (0

.4 5

– 1

.3 0

) 1 .7 3

(1 .1 0 – 2 .7 0 )

1 .1

7 (0

.5 3

– 2

.6 2

)

N o

o n

e p

re se

n t

1 .0

0 1

.0 0

1 .0

0

v 2 =

1 .0

5 , p =

0 .7

9 v

2 =

1 .6

2 , p =

0 .6

6 v

2 =

1 4

.1 6

, p \

0 .0

0 1

v 2 =

1 3

.7 9

, p \

0 .0

0 1

R e g

re ss

io n

m o

d e ls

a d

ju st

e d

fo r

se x

a n

d a g

e

O R

O d

d s

ra ti

o ; 9 5 %

C I

9 5

% c o

n fi

d e n

c e

in te

rv a l,

it a li

c sh

o w

s si

g n

ifi c a n

t O

R s

a t p \

0 .0

5

424 J Youth Adolescence (2017) 46:417–428

123

likely to leave home alone or to allow a teenage son or

daughter with ADHD to be interviewed alone, and perhaps

an adolescent with a drug use disorder is more likely to be

found at home without a parent as parental neglect is

considered a risk factor for substance disorders (Snyder and

Merritt 2015). Or similarly, a parental death, parental

neglect and parental criminal behavior may lead to ado-

lescents’ being home with other children in the absence of

parental supervision. While these alternate explanations are

possible, it is important to keep in mind that, in all cases,

parents gave parental consent for the interview and an adult

was present somewhere in the household even if the

interview was conducted in a private room, thus mini-

mizing this explanation. Further studies should look at third

party presence and disclosure in an experimental design in

order to gain a fuller understanding of directionality and

causality. Despite these limitations, this study has

strengths, including sampling the general adolescent pop-

ulation of this area. This is notable, because nearly one-

third (31.8 %) of 15-17 year olds in Mexico are no longer

in school (Instituto Mexicano de la Juventud 2005), and

thus cannot be traced through studies that use only school

populations. Additionally, these data come from a devel-

oping country and a cultural context different from where

prior studies on the effect of third party presence have been

conducted, extending our knowledge of how privacy may

affect response bias in different cultural contexts.

The findings of this study have both research and

practice implications. While it is often not possible in

research to determine the privacy of an interview, espe-

cially in community studies, data such as these can provide

information for weighting prevalence estimates according

to if and who was present during the interview to obtain

more accurate estimates. In both research and clinical

Table 4 Association of third party presence with reports of suicidal behavior in adolescent mental health interviews

Lifetime suicidal ideation Lifetime suicidal plan Lifetime suicidal attempt

OR 95 % CI OR 95 % CI OR 95 % CI

Adult(s) only present 0.66 (0.54–0.81) 0.55 (0.36–0.83) 0.48 (0.30–0.76)

Adult(s) and child(ren)

present

0.49 (0.23–1.03) 0.60 (0.24–1.48) 0.47 (0.16–1.42)

Child(ren) only present 1.09 (0.63–1.86) 0.61 (0.22–1.68) 0.98 (0.42–2.26)

No one present 1.00 1.00 1.00

v2 = 34.14, p \ 0.001 v2 = 11.84, p \ 0.01 v2 = 12.55, p \ 0.01

Regression models adjusted for sex and age

OR Odds ratio, 95 % CI 95 % confidence interval, italic shows significant ORs at p \ 0.05

Table 5 Association of third party presence with reports of childhood adversity in adolescent mental health interviews

Third party presence df v2 p

No one present

(Reference group)

Children only Children and adults Adults only

OR OR 95 % CI OR 95 % CI OR 95 % CI

Parental mental illness 1.00 1.39 (0.82–2.37) 2.14 (1.34–3.41) 1.39 (1.13–1.71) 3 21.82 0.00

Parental substance problems 1.00 1.25 (0.56–2.76) 1.75 (0.83–3.67) 1.08 (0.76–1.53) 3 2.55 0.47

Parental criminal behavior 1.00 2.44 (1.31–4.56) 1.38 (0.64–2.98) 0.95 (0.68–1.33) 3 10.92 0.01

Witnessing family violence 1.00 1.10 (0.71–1.72) 1.05 (0.72–1.53) 0.75 (0.62–0.91) 3 12.23 0.01

Physical abuse 1.00 1.29 (0.78–2.13) 1.32 (0.84–2.07) 0.74 (0.59–0.91) 3 12.33 0.01

Sexual abuse 1.00 1.72 (0.69–4.26) 0.52 (0.14–1.94) 0.69 (0.38–1.27) 3 7.85 0.05

Neglect 1.00 2.23 (1.15–4.31) 0.49 (0.16–1.51) 0.98 (0.74–1.31) 3 14.44 0.00

Parent died 1.00 1.88 (1.05–3.35) 0.69 (0.24–1.96) 0.99 (0.62–1.60) 3 6.31 0.10

Parent divorce 1.00 0.82 (0.50–1.34) 0.93 (0.47–1.85) 0.90 (0.74–1.10) 3 1.37 0.71

Other parent loss 1.00 1.45 (0.74–2.82) 1.11 (0.73–1.70) 0.92 (0.75–1.13) 3 1.95 0.58

Physical illness 1.00 1.33 (0.68–2.58) 1.37 (0.71–2.62) 0.91 (0.63–1.33) 3 4.76 0.19

Economic adversity 1.00 1.24 (0.84–1.83) 1.04 (0.66–1.66) 1.22 (1.01–1.46) 3 6.62 0.09

Regression models adjusted by sex and age

OR Odds ratio, 95 % CI 95 % confidence interval, italic shows significant ORs at p \ 0.05 Childhood adversity (the dependent variable) and privacy levels (the independent variable) are displayed as such for visual ease

J Youth Adolescence (2017) 46:417–428 425

123

settings, these findings can orient the researcher or clinician

interviewing adolescents on whether or not to have a third

party present depending on the type of information one is

assessing in order to obtain less biased information. For

example, it might be beneficial to have a parent present

when assessing ADHD or family financial difficulties, but

if one is assessing PTSD or suicidal behavior one should

attempt a private interview. These findings also suggest

what types of disorders, behaviors and experiences are

more embarrassing or stigmatized in the Mexican adoles-

cent population. Interestingly, mood, most anxiety disor-

ders and alcohol use do not appear to be embarrassing to

these adolescents whereas panic disorder, PTSD, drug use

disorders and suicidal behavior may be. Such information

may be useful in order to target and reduce stigma asso-

ciated to these particular disorders. Finally, adolescents are

at a stage when they have more insight into their internal

feelings and have more information regarding their expe-

riences than other informants, yet may not be motivated to

disclose sensitive information in a clinical setting if they

did not choose to seek services, but rather were brought by

their parents or obliged by their schools, such that this is a

population that may be more affected by third party pres-

ence than those in other stages of life. Therefore, whether

to conduct adolescent mental health interviews alone or in

the presence of others, and the type of third party presence,

should be considered by both researchers and clinicians.

Conclusion

As adolescents develop, they have an increasing sense of

privacy and emotional autonomy (Smetana and Asquith

1994). Adolescents may disclose, partially disclose or even

conceal information that they consider either subject to

punishment or disapproval or not obliged to share (Smetana

et al. 2009). Expanding on prior knowledge of adolescents’

information management with parents and siblings (Cam-

pione-Barr et al. 2015; Chan et al. 2015; Laird et al. 2013;

Tilton-Weaver 2014) and findings regarding adolescent and

parental discrepancies on reports of adolescent risk behav-

iors and mental health (Jensen et al. 1999; Rescorla et al.

2013; Salbach-Andrae et al. 2009; Seiffge-Krenke and

Kollmar 1998), this study finds that, when interviewed by a

stranger, having an adult, child or both present impacts on

adolescents’ disclosure of prudential information. Disclo-

sure depended on the type of third party presence and type

of information solicited. Adolescent disclosure in this study

was most affected by adult presence, increasing disclosure

for a few topics (ADHD, parental mental illness and eco-

nomic adversity) and decreasing disclosure for many topics

(panic disorder, PTSD, drug use and disorder, and suicidal

behavior). Culture may also play a role in adolescents’

information management and this study is unique in pro-

viding insights into the information management of a rep-

resentative sample of adolescent from Mexico City. While a

previous study with Mexican–American adolescents found

that they disclose prudential information to mothers less

than European American adolescents (Yau et al. 2009),

disclosure for particular themes are likely dependent on the

cultural tolerance or acceptance of the behavior or condition

as well as the adolescent’s cultural belief on parent’s rights

to certain domains of information. While adolescent infor-

mation management strategies are normative and even

desirable as a means of gaining emotional autonomy, they

may also interfere with timely detection and treatment or

intervention for mental health conditions and risky behav-

iors. This study contributes an original understanding of

how adolescents manage information regarding sensitive

topics of mental health and health behaviors to a stranger

depending on the presence of third parties, the type of third

party present, and the type of solicited information.

Acknowledgments We thank the WMH staff for assistance with instrumentation and fieldwork.

Authors’ Contributions A.H. participated in the interpretation of the data and drafted the manuscript; C.B. conceived of the study,

coordinated the study, and participated in the drafting of the manu-

script; E.M. participated in the design and performed the statistical

analysis; L.C. coordinated quality control and the acquisition of data.

She received her masters of public mental health from the National

Autonomous University of Mexico; M.E.M.M. participated in the

design and coordination of the study.

Funding The Mexican Adolescent Mental Health Survey was supported by the National Council on Science and Technology and

Ministry of Education grant CONACYT-SEP-SSEDF-2003-CO1-22

and National Council on Science and Technology grant CB-2010-01-

155221 with supplementary support from Fundación Azteca. Writing

of this paper was possible through a U.S. Student Fulbright-Garcı́a

Robles research grant and the Mexico-U.S. Commission for Educa-

tional and Cultural Exchange (COMEXUS).

Conflicts of Interest The authors report no conflict of interests.

Ethical Approval This study was approved by the internal review committee of the National Institute of Psychiatry Ramón de la Fuente

Muñiz.

Human and Animals Rights All procedures performed in studies involving human participants were in accordance with the ethical

standards of the institutional and/or national research committee and

with the 1964 Helsinki declaration and its later amendments or

comparable ethical standards.

References

American Psychiatric Association. (1994). Diagnostic and statistical

manual of mental disorders, (DSM-IV) (4th ed.). Washington,

DC: American Psychiatric Association.

426 J Youth Adolescence (2017) 46:417–428

123

Aquilino, W. S. (1997). Privacy effects on self-reported drug use:

Interactions with survey mode and respondent characteristics.

NIDA Research Monograph, 167, 383–415.

Aquilino, W. S., Wright, D. L., & Supple, A. J. (2000). Response

effects due to bystander presence in CASI and paper-and-pencil

surveys of drug use and alcohol use. Substance Use & Misuse,

35(6–8), 845–867.

Benjet, C., Borges, G., Medina-Mora, M. E., Zambrano, J., &

Aguilar-Gaxiola, S. (2009). Youth mental health in a populous

city of the developing world: Results from the Mexican

Adolescent Mental Health Survey. Journal of Child Psychology

and Psychiatry, 50(4), 386–395.

Benjet, C., Borges, G., Méndez, E., Casanova, L., & Medina-Mora,

M. E. (2014). Adolescent alcohol use and alcohol use disorders

in Mexico City. Drug and Alcohol Dependence, 136, 43–50.

Brener, N. D., Eaton, D. K., Kann, L., Grunbaum, J. A., Gross, L. A.,

Kyle, T. M., & Ross, J. G. (2006). The association of survey

setting and mode with self-reported health risk behaviors among

high school students. Public Opinion Quarterly, 70(3), 354.

Campione-Barr, N., Lindell, A. K., Giron, S. E., Killoren, S. E., &

Greer, K. B. (2015). Domain differentiated disclosure to mothers

and siblings and associations with sibling relationship quality

and youth emotional adjustment. Developmental Psychology,

51(9), 1278–1291.

Chan, H. Y., Brown, B. B., & Von Bank, H. (2015). Adolescent

disclosure of information about peers: The mediating role of

perceptions of parents’ right to know. Journal of Youth and

Adolescence, 44(5), 1048–1065.

Courtney, M. E., Piliavin, I., Grogan-Kaylor, A., & Nesmith, A.

(1998). Foster youth transitions to adulthood: A longitudinal

view of youth leaving care. Madison, WI: Institute for Research

on Poverty.

Davis, C. G., Thake, J., & Vilhena, N. (2010). Social desirability

biases in self-reported alcohol consumption and harms. Addictive

Behaviors, 35(4), 302–311.

Diop, A., Le, K. T., & Traugott, M. (2015). Third-party presence

effect with propensity score matching. Journal of Survey

Statistics and Methodology, 3(2), 193–215.

Endicott, J., Andreasen, N., & Spitzer, R. L. (1978). Family history

research diagnostic criteria. New York, NY: New York State

Psychiatric Institute.

Epstein, J. F., Barker, P. R., & Kroutil, L. A. (2001). Mode effects in

self-reported mental health data. Public Opinion Quarterly,

65(4), 529–549.

Gans, J. E., & Brindis, C. D. (1995). Choice of research setting in

understanding adolescent health problems. Journal of Adolescent

Health, 17(5), 306–313.

Gfroerer, J., Wright, D., & Kopstein, A. (1997). Prevalence of youth

substance use: The impact of methodological differences

between two national surveys. Drug and Alcohol Dependence,

47(1), 19–30.

Green, J. G., McLaughlin, K. A., Berglund, P. A., Gruper, M. J.,

Sampson, N. A., Zaslavsky, A. M., et al. (2010). Childhood

adversities and adult psychiatric disorders in the national

comorbidity survey replication I: Associations with first onset

of DSM-IV disorders. Archives of General Psychiatry, 67,

113–123.

Hofstede, G., Hofstede, G. J., & Minkov, M. (2010). Cultures and

organizations: Software of the mind: Intercultural cooperation

and its importance for survival. New York, NY: McGraw-Hill.

Holtgraves, T. (2004). Social desirability and self-reports: Testing

models of socially desirable responding. Personality and Social

Psychology Bulletin, 30(2), 161–172.

Hoyt, G. M., & Chaloupka, F. J. (1994). Effect of survey conditions

on self-reported substance use. Contemporary Economic Policy,

12(3), 109–121.

Instituto Mexicano de la Juventud. (2005). Jóvenes Mexicanos:

Encuesta Nacional de Juventud [Mexican Youth: National Survey

of Youth 2005]. [consulted 2010 October 12]. http://cendoc.

imjuventud.gob.mx/investigacion/docs/ENJ2005-TomoI.swf.

Jensen, P. S., Rubio-Stipec, M., Canino, G., Bird, H. R., Dulcan, M.

K., Schwab-Stone, M. E., & Lahey, B. B. (1999). Parent and

child contributions to diagnosis of mental disorder: Are both

informants always necessary? Journal of the American Academy

of Child and Adolescent Psychiatry, 38(12), 1569–1579.

Johnson, T. P., & Van de Vijver, F. J. (2002). Social desirability in

cross-cultural research. In J. A. Harkness, F. J. R. van de Vijver,

& P. P. Mohler (Eds.), Cross-cultural survey methods (pp.

195–204). New York: Wiley Series in Survey Methodology.

Kann, L., Brener, N. D., Warren, C. W., Collins, J. L., & Giovino, G.

A. (2002). An assessment of the effect of data collection setting

on the prevalence of health risk behaviors among adolescents.

Journal of Adolescent Health, 31(4), 327–335.

Keijsers, L., & Poulin, F. (2013). Developmental changes in parent–

child communication throughout adolescence. Developmental

Psychology, 49(12), 2301–2308.

Kerr, M., & Stattin, H. (2000). What parents know, how they know it,

and several forms of adolescent adjustment: Further support for a

reinterpretation of monitoring. Developmental Psychology,

36(3), 366–380.

Kessler, R. C., Avenevoli, S., Green, J., Gruber, M. J., Guyer, M., He,

Y., et al. (2009). National comorbidity survey replication

adolescent supplement (NCS-A): III. Concordance of DSM-IV/

CIDI diagnoses with clinical reassessments. Journal of the

Academy of Child and Adolescent Psychiatry, 48, 386–399.

Kessler, R. C., McLaughlin, K. A., Green, J. G., Gruber, M. J.,

Sampson, N. A., Zaslavsky, A. M., et al. (2010). Childhood

adversities and adult psychopathology in the WHO World

Mental Health Surveys. British Journal of Psychiatry, 197,

378–385.

Kessler, R. C., & Ustun, T. B. (2004). The world mental health

(WMH) survey initiative version of the world health organiza-

tion (WHO) composite international diagnostic interview

(CIDI). International Journal of Methods in Psychiatric

Research, 13, 93–121.

Krumpal, I. (2013). Determinants of social desirability bias in

sensitive surveys: A literature review. Quality & Quantity, 47(4),

2025–2047.

Laird, R. D., Marrero, M. D., Melching, J. A., & Kuhn, E. S. (2013).

Information management strategies in early adolescence: Devel-

opmental change in use and transactional associations with

psychological adjustment. Developmental Psychology, 49(5),

928–937.

McElvaney, R., Greene, S., & Hogan, D. (2014). To tell or not to tell?

factors influencing young people’s informal disclosures of child

sexual abuse. Journal of Interpersonal Violence, 29(5), 928–947.

Merikangas, K. R., Avenevolli, S., Costello, E. J., Koretz, D., &

Kessler, R. C. (2009). National Comorbidity Survey Replication

adolescent supplement: I. Background and measures. Journal of

the American Academy of Child and Adolescent Psychiatry, 48,

367–379.

Mneimneh, Z. N. (2012). Interview Privacy and Social Conformity

Effects on Socially Desirable Reporting Behavior: Importance of

Cultural, Individual, Question, Design and Implementation

Factors (Doctoral dissertation, The University of Michigan).

Newman, J. C., Des Jarlais, D. C., Turner, C. F., Gribble, J., Cooley,

P., & Paone, D. (2002). The differential effects of face-to-face

and computer interview modes. American Journal of Public

Health, 92(2), 294–297.

Nucci, L., Smetana, J., Araki, N., Nakaue, M., & Comer, J. (2014).

Japanese adolescents’ disclosure and information management

with parents. Child Development, 85(3), 901–907.

J Youth Adolescence (2017) 46:417–428 427

123

Ong, A. D., & Weiss, D. J. (2000). The impact of anonymity on

responses to sensitive questions1. Journal of Applied Social

Psychology, 30(8), 1691–1708.

Pollner, M., & Adams, R. E. (1994). The interpersonal context of

mental health interviews. Journal of Health and Social Behavior,

35(3), 283–290.

Rescorla, L. A., Ginzburg, S., Achenbach, T. M., Ivanova, M. Y.,

Almqvist, F., Begovac, I., et al. (2013). Cross-informant

agreement between parent-reported and adolescent self-reported

problems in 25 societies. Journal of Clinical Child and

Adolescent Psychology, 42(2), 262–273.

Research Triangle Institute. (2009). SUDAAN (Version 10.0.141)

[Computer software]. Research Triangle Park, NC: Research

Triangle Institute.

Salbach-Andrae, H., Klinkowski, N., Lenz, K., & Lehmkuhl, U.

(2009). Agreement between youth-reported and parent-reported

psychopathology in a referred sample. European Child and

Adolescent Psychiatry, 18(3), 136–143.

Seiffge-Krenke, I., & Kollmar, F. (1998). Discrepancies between

mothers’ and fathers’ perceptions of sons’ and daughters’

problem behaviour: A longitudinal analysis of parent–adolescent

agreement on internalising and externalising problem behaviour.

Journal of Child Psychology and Psychiatry, 39(05), 687–697.

Smetana, J. G., & Asquith, P. (1994). Adolescents’ and parents’

conceptions of parental authority and personal autonomy. Child

Development, 65, 1147–1162.

Smetana, J. G., Metzger, A., Gettman, D. C., & Campione-Barr, N.

(2006). Disclosure and secrecy in adolescent-parent relation-

ships. Child Development, 77(1), 201–217.

Smetana, J. G., Villalobos, M., Tasopoulos-Chan, M., Gettman, D., &

Campione-Barr, N. (2009). Early and middle adolescents’

disclosure to parents about activities in different domains.

Journal of Adolescence, 32, 693–713.

Snyder, S. M., & Merritt, D. H. (2015). The influence of supervisory

neglect on subtypes of emerging adult substance use after

controlling for familial factors, relationship status, and individ-

ual traits. Substance Abuse, 36(4), 507–514.

Strauss, M. A. (1979). Measuring intrafamily conflict and violence:

The conflict tactics (CT) scales. Journal of Marriage and

Family, 41, 75–88.

Taietz, P. (1962). Conflicting Group Norms and the ‘‘Third’’ Person

in the Interview. American Journal of Sociology, 68(1), 97–104.

Tilton-Weaver, L. (2014). Adolescents’ information management:

Comparing ideas about why adolescents disclose to or keep

secrets from their parents. Journal of Youth and Adolescence,

43(5), 803–813.

Tourangeau, R., & Yan, T. (2007). Sensitive questions in surveys.

Psychological Bulletin, 133(5), 859.

van de Looij-Jansen, P. M., Goldschmeding, J. E., & de Wilde, E. J.

(2006). Comparison of anonymous versus confidential survey

procedures: Effects on health indicators in Dutch adolescents.

Journal of Youth and Adolescence, 35(4), 652–658.

Villalobos, M., & Smetana, J. D. (2012). Puerto Rican adolescents’

disclosure and lying to parents about peer and risky activities:

Associations with teens’ perceptions of Latino values. Journal of

Adolescence, 35, 875–885.

Yau, J. P., Tasopoulos-Chan, M., & Smetana, J. G. (2009). Disclosure

to parents about everyday activities among American adoles-

cents from Mexican, Chinese, and European backgrounds. Child

Development, 80(5), 1481–1498.

Aubrey V. Herrera B.S. works at the healthcare technology company Athenahealth in Austin, Texas. She received her Bachelor’s

in Public Health from the University of Texas at Austin following

which she was a recipient of the 2014–2015 Fulbright-Garcı́a Robles

research grant to study adolescent mental health in Mexico City.

Corina Benjet Ph.D. is a researcher at the National Institute of Psychiatry Ramón de la Fuente Muñiz and a professor at the National

Autonomous University of Mexico. She received her doctorate in

psychology from the National Autonomous University of Mexico.

Her research interests include adolescent mental health, psychiatric

epidemiology and the impact of trauma exposure upon mental health.

Enrique Méndez M.S. performs statistical analyses at the National Institute of Psychiatry Ramón de la Fuente. He received his masters of

science in statistics.

Leticia Casanova M.A. is a researcher at the National Institute of Psychiatry Ramón de la Fuente Muñiz. Her research interests include

alcohol abuse and its consequences, psychosocial functioning,

schizophrenia and psychoeducation.

Marı́a Elena Medina-Mora Ph.D. is the director of the National Institute of Psychiatry Ramón de la Fuente Muñiz. She received her

doctorate in psychology from the National Autonomous University of

Mexico. Her research interests include substance use, addiction,

mental health and public policy implications.

428 J Youth Adolescence (2017) 46:417–428

123

Journal of Youth & Adolescence is a copyright of Springer, 2017. All Rights Reserved.

  • How Mental Health Interviews Conducted Alone, in the Presence of an Adult, a Child or Both Affects Adolescents’ Reporting of Psychological Symptoms and Risky Behaviors
    • Abstract
    • Introduction
    • The Current Study
    • Methods
      • Participants
      • Procedures
      • Measures
        • Socio-Demographic Variables
        • Psychiatric Disorder
        • Substance Use
        • Suidicial Behavior
        • Childhood Adversity
        • Third Party Presence
      • Statistical Analysis
    • Results
    • Discussion
    • Conclusion
    • Acknowledgments
    • References