Adaptación cultural de instrumentos de medida sobre estigma y enfermedad mental en la Ciudad de México / Cultural adaptation of instruments to measure stigma and mental illness in Mexico City

This article forms part of a collaborative study in which research teams from Canada and Mexico participated. The general objective is to describe the cultural adaptation and semantic validation of three instruments for measuring stigma and mental illness in Mexico City. The criteria of understanding, acceptance, relevance and semantic integrity were used to adapt the following instruments: The Internalized Stigma Inventory (ISMI), the Opinions on Mental Illness Survey (OMI) and the Devaluation and Discrimination Scale (DDS). Four Individual interviews and four group interviews were carried out with 37 informants from different groups (health personnel, persons with diagnostic of mental disorders, relatives and the general population). Lastly, an analysis was carried out on the contents of the information obtained. The instruments proved to be culturally appropriate for the population in Mexico in the various groups studied. The adapted versions would be useful for establishing comparative analyses with other countries. The scope and limitations of the process of semantic equivalence were analyzed in the transcultural research.

Este trabajo forma parte de un estudio colaborativo en el que participan equipos de investigación en Canadá y México. El objetivo general consiste en describir el proceso de adaptación cultural y validación semántica de tres instrumentos de medición sobre el estigma y la enfermedad mental en la Ciudad de México. A partir de los criterios de comprensión, aceptación, relevancia e integridad semántica se adaptaron los siguientes instrumentos: el Inventario de Estigma Internalizado (ISMI), el Cuestionario de Opiniones hacia la Enfermedad Mental (OMI) y la Escala de Percepción de la Devaluación y Discriminación hacia la Enfermedad Mental (DDS). Para ello se llevaron a cabo cuatro entrevistas individuales y cuatro grupales con 37 informantes de diversos sectores (personal de salud, personas con diagnóstico de trastorno mental grave, familiares y población general). Finalmente se efectuó un análisis de contenido de la información obtenida. Los instrumentos adaptados fueron culturalmente apropiados para la población de los diferentes grupos estudiados en México. Las versiones adaptadas serán de utilidad para establecer análisis comparativos con otras regiones. Se analizan los alcances y limitaciones del proceso de equivalencia semántica en la investigación transcultural.

Reframing political violence and mental health outcomes: outlining a research and action agenda for Latin America and the Caribbean region

In recent decades, the number of people exposed to traumatic events has significantly increased as various forms of violence, including war and political upheaval, engulf civilian populations worldwide. In spite of widespread armed conflict, guerrilla warfare and political violence in the Latin American and Caribbean region, insufficient attention had been paid in assessing the medium and long-term psychological impact and additional burden of disease, death, and disability caused by violence and wars amongst civilian populations. Following a review of the literature, a few central questions are raised: What is the short, medium and long-term health impact of extreme and sustained forms of violence in a given population? How political violence is linked to poor mental health outcomes at the individual and collective levels? Are trauma-related disorders, universal outcomes of extreme and sustained violence? These questions lead us to reframe the analysis of political violence and mental health outcomes, and reexamine the notions of trauma, after which a research and action agenda for the region is outlined. In the concluding sections, some basic principles that may prove useful when designing psychosocial interventions in post-conflict situations are reviewed.

Em décadas recentes, o número de pessoas expostas a eventos traumáticos tem aumentado significativamente, bem como formas de violência como guerras e revoluções políticas, que subjugam populações civis em todo o mundo. Apesar da dispersão dos conflitos armados, guerrilhas e violência política na América Latina e Caribe, atenção insuficiente tem sido dada para avaliar o impacto psicológico a médio e longo prazo e o peso das doenças, mortes, e invalidez provocadas pela violência e guerra contra populações civis. Algumas perguntas centrais são levantadas, a partir de revisão da literatura: qual o impacto na saúde da população, a curto, médio e longo prazo, ao vivenciar violências extremas e continuadas? Como a violência política se relaciona com saúde mental pobre, individual e coletiva? As desordens relacionadas aos traumas são conseqüências universais da violência extrema e continuada? Essas perguntas conduzem-nos a reformular a análise da violência política e de suas conseqüências sobre a saúde mental, e a reexaminar as noções de trauma e a agenda da pesquisa e ação para a região. Ao final, são apresentados alguns princípios básicos que podem ser úteis ao se projetar intervenções psicossociais.

Reformulando a violência política e efeitos na saúde mental: esboçando uma agenda de pesquisa e ação para a América Latina e região do Caribe / Reframing political violence and mental health outcomes: outlining a research and action agenda for Latin America and the Caribbean region

Em décadas recentes, o número de pessoas expostas a eventos traumáticos tem aumentado significativamente, bem como formas de violência como guerras e revoluções políticas, que subjugam populações civis em todo o mundo. Apesar da disseminação dos conflitos armados, guerrilhas e violência política na América Latina e Caribe, atenção insuficiente tem sido dada para avaliar o impacto psicológico a médio e longo prazo e o peso das doenças, mortes, e invalidez provocadas pela violência e guerra contra populações civis. Algumas perguntas centrais são levantadas, a partir de revisão da literatura: qual o impacto na saúde da população, a curto, médio e longo prazo, por vivenciar violências extremas e continuadas? Como a violência política se relaciona com pobre saúde mental individual e coletiva? As desordens relacionadas aos traumas são conseqüências universais da violência extrema e continuada? Essas perguntas nos levam a reformular a análise da violência política e de suas conseqüências sobre a saúde mental e a reexaminar as noções de trauma e a agenda da pesquisa e ação para a região. Ao fim, são apresentados alguns princípios básicos que podem ser úteis ao se projetar intervenções psicosociais.

In recent decades, the number of people exposed to traumatic events has significantly increased as various forms of violence, including war and political upheaval, engulf civilian populations worldwide. In spite of widespread armed conflict, guerrilla warfare and political violence in the Latin American and Caribbean region, insufficient attention had been paid in assessing the medium and long-term psychological impact and additional burden of disease, death, and disability caused by violence and wars amongst civilian populations. Following a review of the literature, a few central questions are raised: What is the short, medium and long-term health impact of extreme and sustained forms of violence in a given population? How political violence is linked to poor mental health outcomes at the individual and collective levels? Are trauma-related disorders, universal outcomes of extreme and sustained violence? These questions lead us to reframe the analysis of political violence and mental health outcomes, and reexamine the notions of trauma, after which a research and action agenda for the region is outlined. In the concluding sections, some basic principles that may prove useful when designing psychosocial interventions in post-conflict situations are reviewed.

El desarrollo humano y la salud mental: Perspectivas socioculturales y apuntes metodológicos / Human development and mental health: sociocultural perspectives and methodological notes

Se discuten las perspectivas socioculturales de los conceptos salud mental y desarrollo bio-psico-social del ser humano. Se señala que en ciencias sociales, el abordaje de la salud y enfermedad se realiza desde dos tendencias principales: cultural y social; las cuales no son contrapuestas sino complementarias. La influencia de los patrones culturales en la generación de ciertas enfermedades se hace evidente en el reconocimiento de los efectos patogénicos y patoplásticos de los estilos de vida. Los cambios culturales y los patrones de crianza son otros ejemplos de lo anterior. El enfoque sociocultural considera al hombre como un ser biológico que vive en un grupo humano específico y que es portador y a la vez creador de cultura; es decir, estudia las diferentes estrategias culturales desarrolladas por los diversos grupos humanos en sus negociaciones con el ambiente. Las investigaciones socioculturales de la salud y enfermedad se realizan desde tres tendencias fundamentales: 1) El estudio del "discurso popular ", es decir lo que una población particular dice sobre la salud y enfermedad; 2) El estudio delo que una población hace por mantener la salud y luchar contrala enfermedad; 3) El estudio de los condicionantes culturales y los determinantes socioeconómicos de los fenómenos salud y enfermedad. Por último, se discuten algunos problemas de método que se enfrentan en la investigación en salud mental y desarrollo humano.

Sociocultural views about mental health and bio-psyco-social human development were reviewed. Health and illness in social sciences are discussed from cultural and social trends. The recognition of pathogenic and pathoplastic affects of life styles is evidenced by the influence of cultural models. Cultural changes and rearing models are other examples. Sociocultural view regards man as a biological existence living in specific social groups, being a carrier and creator of culture; sociocultural views study different cultural strategies develop by several human groups on their enviormental transactions. Sociocultural research considers three fundamental trends about health and illness: 1) The study of popular speechõ (what a particular population says about health and illness); 2) The study of what a particular population performs in order to maintain heatlh and fight against illness, 3) The study of cultural conditioners and socioeconomic determinants about health and illness phenomena /why(. Finally, methodological problems in health and illness research are reviewed.

El impacto de la pobreza, el racismo y la violencia política sobre la salud mental de los pueblos latinoamericanos / Impact poverty, racism and political violence on mental health of Latin American population

Se hace un análisis de la actual situación geográfica, económica y política de las minorías étnicas del mundo y de América Latina. Los conflictos armados ocasionan destrucción, muerte, desplazamientos internos y externos, desintegración social, pobreza extrema y aumento en la incidencia de enfermedades somáticas y mentales. Se plantea que en América Latina se está dando la tercera transición epidemiológica, donde coexisten las enfermedades infecciosas y degenerativas con problemas psicosociales y mentales y enfermedades derivadas de problemas comportamentales. Se analiza también el impacto de los proyectos de desarrollo, del racismo ambiental y de los nuevos estresores sobre las poblaciones indígenas locales. Se destacan los estudios peruanos sobre migrante y las repercusiones que la violencia política tiene sobre la salud individual y colectiva. Se plantea que la situación de salud de los pueblos y naciones indoamericanas es resultante de la interacción del pasado colonial, de una historia de violencia y aculturación forzada, de la situación de pobreza sostenida y marginación social y de continua proceso de cambio social. Se concluye que es necesario entender cuáles son los factores de orden político, social y cultural, relevantes en los problemas de salud física y mental y cómo interactúan entre sí; este conocimiento permitirá el desarrollo de estrategias alternativas e intervención innovadoras para aliviar el sufrimiento y promover la justicia, equidad, seguridad y la paz.

An analysis of the current geographic, economic and political situation of the ethnic minorities in Latin American and worldwide is carried out. Wars occasion destruction, death, internal and external migration, social disintegration, extreme poverty and increase of the incidence of somatic and mental diseases. It is outlined that Latin American is running into a third epidemiological transition where infectious and degenerative diseases coexist with psychosocial and mental disorders, as well as with diseases originated on behavioral problems. The impact of developmental projects, environmental racism and new stressors for local indigenous population are analyzed. The Peruvian study on migrant populations and the effects that political violence has on individual and collective health is enhanced. It is outlined that the health situation in Indo-American populations and countries is a result of the interaction of a colonial past, a history of violence and forced acculturation, a situation of extreme and sustained poverty and social margination, as well as the continuous process of social changes. As a conclusion, it is necessary to discover the outstanding factors of political, social and cultural order on the physical and mental health problems and their interaction. This knowledge will afford the development of alternative strategies and innovative interventions in order to light the suffering and to promote justice, equity, security and peace.