Beyond direct exposure to violence: effects of living in disordered and violent communities on psychological distress in young Mexican people / Más allá de la exposición directa a la violencia: efectos de residir en comunidades desordenadas y violentas sobre el distrés psicológico entre jóvenes mexicanos / Além da exposição direta à violência: efeitos de viver em comunidades desordenadas e violentas sobre o estresse psicológico entre jovens mexicanos

Abstract: The association between community violence and mental health has been studied by reports of individual experiences, particularly in adolescents and youths, but little is known about the effect of living in disordered and violent communities. This study aims to determine the possible relation between living in disordered and violent community environments and psychological distress in Mexican adolescents and youths regardless of their individual experience of victimization and to assess the potential modifying effect of sex and age on this association. Data come from a cross-sectional survey with a representative sample of adolescents and youths living in Mexican municipalities, including 39,639 participants aged from 12 to 29 years. Disordered and violent community environments were assessed using reports from a secondary sample of adults who lived in the same communities as participants. Using exploratory factor analysis, three contextual variables related to disordered and violent community environment were created: social disorder, vandalism, and criminality. Multilevel linear regression models with random intercept were estimated. Adolescents and youths who lived in environments with higher social disorder had more psychological distress. Men in environments with greater vandalism had a higher level of psychological distress. Unexpectedly, women from communities with higher levels of crime had fewer symptoms. It is necessary to address the violence that exists in these communities, creating strategies that reduce not only crime, but also the social disorder and vandalism that could contribute to developing negative effects on mental health.

Resumen: La asociación entre la violencia comunitaria y la salud mental se ha evaluado mediante informes de experiencias individuales, especialmente de adolescentes y jóvenes, pero poco se sabe sobre el efecto de residir en comunidades desordenadas y violentas. El objetivo de este estudio fue comprobar si existe una relación entre residir en entornos comunitarios desordenados y violentos y el distrés psicológico en adolescentes y jóvenes mexicanos, independientemente de su experiencia individual de victimización, así como evaluar el posible efecto modificador del sexo y la edad en esta asociación. Los datos provienen de una encuesta transversal que tomó como muestra representativa a 39.639 adolescentes y jóvenes de entre 12 y 29 años, residentes en ciudades mexicanas. Los entornos comunitarios desordenados y violentos se evaluaron mediante informes de una muestra secundaria de adultos que residían en las mismas comunidades donde vivían los participantes. El análisis exploratorio de datos posibilitó crear tres variables contextuales relacionadas con el entorno comunitario desordenado y violento: desorden social, vandalismo y delincuencia. Se estimaron modelos de regresión lineal multinivel con intercepto aleatorio. Los adolescentes y jóvenes que residían en ambientes con mayor desorden social presentaron mayor distrés psicológico. Los varones en entornos con más vandalismo tenían un mayor nivel de distrés psicológico. Inesperadamente, las mujeres que viven en comunidades con mayores niveles de delincuencia tuvieron menos síntomas. Es necesario enfrentar la violencia existente en las comunidades para generar estrategias que reduzcan no solo la delincuencia, sino también el desorden social y el vandalismo que pueden contribuir al desarrollo de efectos negativos en la salud mental.

Resumo: A associação entre violência comunitária e saúde mental tem sido estudada por meio de relatos de experiências individuais, particularmente em adolescentes e jovens, mas pouco se sabe sobre o efeito de viver em comunidades desordenadas e violentas. O objetivo deste estudo é determinar se há relação entre viver em ambientes comunitários desordenados e violentos e estresse psicológico em adolescentes e jovens mexicanos, independentemente de sua experiência individual de vitimização, e avaliar o potencial efeito modificador do sexo e da idade sobre essa associação. Os dados são de uma pesquisa transversal com uma amostra representativa de adolescentes e jovens residentes em cidades mexicanas, incluindo 39.639 participantes com idades de 12 a 29 anos. Ambientes comunitários desordenados e violentos foram avaliados por meio de relatos de uma amostra secundária de adultos que viviam nas mesmas comunidades onde os participantes viviam. Por meio da análise exploratória de dados, foram criadas três variáveis contextuais relacionadas ao ambiente comunitário desordenado e violento: desordem social, vandalismo e criminalidade. Foram estimados modelos de regressão linear multinível com interceptação aleatória. Adolescentes e jovens que viviam em ambientes com maior desordem social apresentaram maior estresse psicológico. Homens em ambientes com mais vandalismo apresentaram maior nível de estresse psicológico. Inesperadamente, as mulheres de comunidades com níveis mais altos de criminalidade tiveram menos sintomas. É preciso enfrentar a violência existente nas comunidades, gerando estratégias que reduzam não só a criminalidade, mas também a desordem social e o vandalismo que possam contribuir para o desenvolvimento de efeitos negativos na saúde mental.

Depression and associated psychosocial factors following a legal abortion in Mexico

Introduction: Scientific evidence from the United States and European countries shows that women who have had an induced abortion are not more likely to become depressed and several factors may confound this outcome. In contrast, in the case of Latin America, there are practically no studies in this regard due to restrictive legislation prevailing in the region. This paper aims to determine the prevalence of a probable major depressive episode (PMDE) in women who have legally terminated a pregnancy by way of public service in Mexico City and whether there are any psychosocial factors reported by the international literature associated with this outcome. Method: In a cross-sectional study, 274 women aged 15 years or older were interviewed two weeks after undergoing a medical abortion between November 2018 and November 2019. The Center for Epidemiological Studies Depression Scale 35-item version (CES-D-R35) was used to measure the PMDE in a structured interview. Results: The prevalence of a PMDE was 15.8%. Multivariate logistic regression was used for adjusted analysis. Perceived abortion stigma ( OR = 6.74, 95% CI = 3.29-13.82), child sexual abuse (OR = 2.23, 95% CI = 1.01-4.93), and previous childless pregnancies (OR = 6.07, 95% CI = 1.52-24.21) were associated with PMDE. Conclusions: The prevalence of PMDE is similar to or lower than that reported in studies with women who continued a pregnancy; post-abortion counseling and clinical considerations should include the impact that stigma and gender-based violence have on women's mental health.

Introducción: Evidencia científica proveniente de los Estados Unidos y los países europeos indica que las mujeres que han tenido un aborto inducido no tienen más probabilidades de deprimirse y que hay varios factores que pueden intervenir para confundir este resultado. En el caso de América Latina, prácticamente no existen estudios al respecto debido a las legislaciones restrictivas imperantes. El objetivo de este artículo es determinar la prevalencia de un probable episodio depresivo mayor (PEDM) en mujeres que interrumpieron legalmente un embarazo en un servicio público en la Ciudad de México, y si hay algunos factores psicosociales reportados por la literatura internacional asociados con el resultado. Método: En un estudio transversal, se entrevistó a 274 mujeres de 15 años o más dos semanas después de someterse a un aborto médico entre noviembre del 2018 y noviembre del 2019. Se utilizó la versión de 35 reactivos de la Escala de Depresión del Centro para Estudios Epidemiológicos (CES-D-R35) para medir el PEDM en una entrevista estructurada. Resultados: La prevalencia de PEDM fue de 15,8 %. Se utilizó una regresión logística multivariada para el análisis ajustado. El estigma percibido por el aborto (OR = 6.74, IC 95 % = 3.29-13.82), el abuso sexual infantil (OR = 2.23, IC 95 % = 1.01-4.93) y los embarazos previos sin hijos (OR = 6.07, IC 95 % = 1.52-24.21) se asociaron con un PMDE. Conclusiones: La prevalencia de PEDM es similar o menor que la reportada en estudios con mujeres que continuaron un embarazo; el asesoramiento posaborto y las consideraciones clínicas deben incluir el impacto que el estigma y la violencia de género tienen en la salud mental de las mujeres.

Implications of the COVID-19 lockdown for the emotional well-being of the adult population in Mexico / Implicaciones del confinamiento por COVID-19 en el bienestar emocional de la población adulta en México

Abstract Introduction After several months of COVID-19 lockdown, addressing the implications related to the emotional distress and well-being of the population during confinement has become increasingly evident. Objective To explore, through a lexicometric and content-based approach, the responses related to discomfort and emotional well-being during the first confinement due to the COVID-19 lockdown. Method Subjects included 2,555 adults in Mexico, mainly women (78.3%), with an average age of 46. Data were drawn from an online survey published on social networks from June 3 to July 5, 2020. The open answers of the subjects about discomfort and emotional well-being during lockdown, together with suggestions to improve the handling of the pandemic, were analyzed using word frequency analysis (clouds) and thematic content analysis. Result Findings highlighted the implications of lockdown, including loss of social interaction, teleworking and overexposure to the news, associated with discomfort. In turn, activities related to self-care, doing household repairs, and sharing activities with the family were linked to well-being. Discussion and conclusion Findings show that time was a key factor to transition from well-being to boredom, where space and material resources played a preponderant role during confinement.

Resumen Introducción Tras largos meses, incluso años de enfrentar el confinamiento por la pandemia generada por la COVID-19, se ha hecho cada vez más evidente la importancia de abordar las implicaciones relacionadas con el bienestar y el malestar de la población durante el confinamiento. Objetivo Explorar, por medio de un abordaje lexicométrico y de contenido, las respuestas vinculadas al malestar y al bienestar emocional durante el primer confinamiento por la pandemia de COVID-19. Método Los participantes fueron 2,555 personas mexicanas adultas, principalmente mujeres (78.3%), cuya edad promedio fue de 46 años. Los datos provienen de una encuesta en línea difundida a través de las redes sociales en el periodo comprendido del 3 de junio al 5 de julio de 2020. Se analizaron las respuestas abiertas acerca de las atribuciones de los participantes acerca del malestar y bienestar emocional durante el confinamiento, así como algunas sugerencias para un manejo más adecuado de la pandemia empleando un análisis de frecuencia de las palabras (nubes) y un análisis temático de los contenidos. Resultados Los hallazgos remiten a las implicaciones del confinamiento. Entre ellas destaca la pérdida de la interacción social, el teletrabajo y la sobreexposición a las noticias, las cuales se asociaron con el malestar, mientras que las actividades relacionadas con el autocuidado y con realizar reparaciones en la casa, así como compartir actividades con la familia se vincularon con el bienestar. Discusión y conclusión Los hallazgos muestran que el tiempo fue un factor clave para transitar del bienestar al hastío, así como la disposición de espacios en el hogar y otros los recursos materiales cumplieron un papel preponderante durante el confinamiento.

Violencia en el hogar contra mujeres adultas durante el confinamiento por la pandemia de Covid-19 en México / Violence at home against adult women during the confinement by the Covid-19 pandemic in Mexico

Resumen: Objetivo: Analizar la prevalencia de violencia en el hogar y factores individuales, familiares y comunitarios asociados en mujeres adultas durante el confinamiento por Covid-19. Material y métodos: Se realizó un análisis secundario de la Encuesta Nacional de Salud y Nutrición 2020 sobre Covid-19 con representación nacional. Se utilizó un modelo de regresión logística ajustado por variables de interés. Resultados: La prevalencia fue de 5.8%. Los actos más reportados fueron gritos, insultos o amenazas (4.3%). La mayoría de las mujeres que reportaron cualquiera de los tipos de violencia ya la había experimentado antes del confinamiento. Los niveles bajos de bienestar (RM=1.96, IC95%: 1.28,2.99) y vivir en algún hogar donde se perdió un empleo por la contingencia (RM=1.96, IC95%: 1.41,2.73) resultaron asociados. Conclusiones: En las intervenciones de atención es necesario tomar en cuenta factores que profundizan la vulnerabilidad de las mujeres como la violencia preexistente y la pérdida de empleo.

Abstract: Objective: To analyze the prevalence of domestic violence in adult women during confinement derived from the Covid-19 pandemic and individual, familiar and communitarian associated factors. Materials and methods: A secondary analysis was carried out the 2020 National Health and Nutrition Survey on Covid-19, with national representation. A logistic regression model adjusted for the variables of interest was performed. Results: The prevalence was 5.8%. The most reported acts were shouting, insults or threats (4.3%). Most of the women who reported some type of violence in the home had already experienced it before the confinement. Low levels of well-being (OR= 1.96, 95%CI: 1.28,2.99), and living in a home where job was lost due to contingency (OR= 1.96, 95%CI: 1.41,2.73) were associated factors. Conclusions: In care interventions, it is necessary to take into account factors that deepen the vulnerability of women, such as pre-existing violence and loss of employment.

Emotional responses and coping strategies in adult Mexican population during the first lockdown of the COVID-19 pandemic: An exploratory study by sex / Respuestas emocionales y estrategias de afrontamiento en población adulta mexicana durante el primer confinamiento por la pandemia de COVID-19: un estudio exploratorio por sexo

Abstract Introduction The COVID-19 outbreak has involved a permanent and significant increase of fear and worries related to the virus and the measures taken to avoid contagion, such as confinement. Objective To explore the relationship between emotional responses and coping strategies used to face the first confinement among the Mexican adult population and inquire about differences by sex. Method An exploratory study was conducted through a self-administered online survey. It included questions about sociodemographic characteristics, emotions about pandemic information, and coping strategies. An informed consent form was presented prior to data collection. Chi square and Kruskal-Wallis were performed for bivariate analyses. Results A total of 2,650 participants completed the survey (21.6% were men). Significantly more men than women reported feeling calm (p < .001), hopeful (p = .011), and indifferent (p = .002). In contrast, more women, compared to men significantly reported feeling worried (p < .001), fearful (p < 0.001), and sad (p < .001). More women reported being emotionally close to other people (p = .027), seeking help from friends and family to share emotions and concerns (p < .001), and they frequently prayed as a coping strategy regardless of their emotions (p = .005). Discussion and conclusion While women are the least affected by the contagion and their symptoms are milder than in men, they present the most negative emotions, particularly of worry, but they also used more caring and helpful behaviors in comparison with men. These results can serve as a basis for developing research with a gender perspective that delves into the differences by sex found in this study.

Resumen Introducción El brote de COVID-19 ha implicado un aumento significativo y permanente en el miedo y las preocupaciones relacionadas con el virus y las medidas de mitigación, como el confinamiento. Objetivo Explorar la relación entre emociones y estrategias de afrontamiento utilizadas durante el primer confinamiento en población adulta mexicana e indagar sus diferencias por sexo. Método Estudio exploratorio mediante una encuesta en línea autoadministrada. Se obtuvo el consentimiento informado antes de recopilar la información. Se utilizó estadística no paramétrica para los análisis bivariados. Las respuestas de estrategias de afrontamiento se analizaron como variables cuantitativas y se reportaron las medias. Resultados Un total de 2,650 participantes completaron la encuesta (21.6% fueron hombres). Significativamente, más hombres que mujeres informaron sentirse calmados (p < .001), esperanzados (p = .011) e indiferentes (p = .002). Más mujeres, en comparación con los hombres, informaron sentirse significativamente preocupadas (p < .001), temerosas (p < .001) y tristes (p < .001). Más mujeres informaron estar emocionalmente cercanas a otras personas (p = .027), buscar ayuda de amigos y familiares para compartir emociones y preocupaciones (p < .001) y utilizar frecuentemente la oración como una estrategia de afrontamiento (p = .005). Discusión y conclusión Aunque las mujeres son las menos afectadas por el contagio en comparación con los hombres, son las que presentan las emociones más negativas, particularmente de preocupación. Sin embargo, también han utilizado más comportamientos de cuidado y ayuda. Estos resultados pueden servir como base para desarrollar investigación con perspectiva de género que profundice en las diferencias por sexo encontradas en este estudio.

Abuso sexual infantil en México: conductas de riesgo e indicadores de salud mental en adolescentes / Child sexual abuse in Mexico: risk behaviors and mental health indicators in adolescents

Resumen: Objetivo: Determinar la prevalencia de abuso sexual infantil (ASI) por sexo en adolescentes a partir de la Encuesta Nacional de Salud y Nutrición 2018-19 y analizar las asociaciones con características sociodemográficas, conductas de riesgo e indicadores de salud mental. Material y métodos: Se analizó el cuestionario para población adolescente (10-19 años), se estimaron prevalencias de ASI y se realizó un modelo de regresión logística ajustado por variables de interés. Resultados: La prevalencia nacional de ASI es de 2.5% (3.8% mujeres y 1.2% hombres). Entre las mujeres se encontró asociación con la edad, el estado conyugal, el tipo de localidad, el consumo excesivo de alcohol, la sintomatología depresiva y los pensamientos suicidas. Entre los hombres, se encontró asociación con el nivel socioeconómico, la sintomatología depresiva y los pensamientos suicidas. Conclusiones: Es urgente realizar estudios con mayor precisión y periodicidad y garantizar el acceso a los servicios de salud y de justicia posevento.

Abstract: Objective: To estimate the prevalence of child sexual abuse (CSA) in adolescent population with National Health and Nutrition Survey 2018-19 data. Materials and methods: Questionnaire for adolescents (10 to 19 years old) was analyzed and carry out a stratified analysis and a logistic regression model adjusted for variables of interest. Results: The prevalence of CSA in adolescent population is 2.5% (3.8% for women and 1.2% for men). Among women, CSA was associated with age, marital status, locality type, excessive alcohol consumption, depressive symptomatology and suicidal thoughts. Among men, CSA was associated with socioeconomical level, depressive symptomatology and suicidal thoughts. Conclusions: Studies with greater precision and periodicity as well as access to health and justice services are urgent.

Relationship between perceived stigma and depressive symptomatology in women who legally interrupt pregnancy in Mexico City / Relación entre estigma percibido y sintomatología depresiva en mujeres que interrumpen el embarazo legalmente en la Ciudad de México

Abstract Introduction Although the international literature suggests that women who interrupt a pregnancy in safe conditions do not develop mental health problems, it continues to be a highly stigmatized issue by broad social sectors. It is therefore not surprising that abortion stigma is one of the main factors associated with the presence of mental health problems in women who abort voluntarily. This study explores the association between perceived abortion stigma and depressive symptomatology. Method In a non-probabilistic convenience sample, 114 users of a Legal Interruption of Pregnancy Clinic in Mexico City were interviewed with a structured instrument. Results Respondents obtained low scores of internalized stigma and reported feeling confident that they had made the right decision to terminate their pregnancies, and at peace with themselves. The highest scores for abortion stigma were reported in the group with high depressive symptomatology, with no statistically significant differences being observed due to the sociodemographic characteristics explored. The participants in this study were more concerned about what others might think about their decision to terminate a pregnancy and about how their abortion might affect their relationship with them. Discussion and conclusion These concerns highlight the need to reduce the negative social stigma surrounding abortion and to provide interventions in the same direction among women who interrupt a pregnancy legally in order to reduce the risk of mental health problems such as depression.

Resumen Introducción A pesar de que la literatura internacional señala que las mujeres que interrumpen sus embarazos en condiciones seguras no desarrollan problemas de salud mental, sigue siendo una situación altamente estigmatizada por amplios sectores sociales. Por ello, no es de sorprender que el estigma por abortar sea uno de los principales factores asociados con la presencia de malestares en la salud mental de algunas mujeres que abortan voluntariamente. Este trabajo explora la asociación entre el estigma percibido por abortar y la sintomatología depresiva. Método En una muestra no probabilística y por conveniencia, 114 usuarias de una Clínica de Interrupción Legal del Embarazo de la Ciudad de México fueron entrevistadas con un instrumento estructurado. Resultados Las participantes obtuvieron bajas puntuaciones de estigma internalizado, reportaron sentirse seguras y en paz con ellas mismas por haber decidido interrumpir sus embarazos. Las puntuaciones más altas de estigma por abortar se reportaron en el grupo con sintomatología depresiva elevada, sin que existieran diferencias significativas por las características sociodemográficas exploradas. Las participantes en este estudio estaban más preocupadas por lo que otros pudieran pensar por su decisión de interrumpir su embarazo y por cómo podría afectar el aborto su relación con estas personas. Discusión y conclusión Estas preocupaciones evidencian la necesidad de disminuir el estigma social negativo que rodea al aborto y plantear intervenciones que actúen en el mismo sentido entre las mujeres que interrumpen legalmente un embarazo para disminuir el riesgo de presentar problemas de salud mental como la depresión.

Eventos potencialmente traumáticos y sintomatología postraumática en estudiantes de preparatoria / Potentially traumatic events and post-traumatic symptomatology in high school students

Resumen: Objetivo: Describir la ocurrencia de eventos potencialmente traumáticos (EPT) en estudiantes de preparatoria, medir la sintomatología postraumática subumbral en quienes aún sufren repercusiones de un EPT y asociar la sintomatología con variables sociodemográficas y características del EPT. Material y métodos: Estudio transversal analítico realizado en un muestra por conveniencia de 1000 estudiantes de tres preparatorias del Estado de México. Se aplicó la Escala para Estrés Postraumático en Universitarios Mexicanos. Se evaluó la presencia de síntomas y su frecuencia; la asociación con variables explicativas se realizó con modelos de regresión logística y cuantílica, respectivamente. Resultados: 80% reportó un EPT. De éstos, 79% aún sufría repercusiones actuales y casi la mitad de ellos presentó sintomatología. El sexo, número de eventos y características del EPT (cambios percibidos y gravedad) se encontraron asociados. Conclusiones: Los resultados sugieren intervenir tempranamente para disminuir el riesgo de desarrollar un trastorno.

Abstract: Objective: Describe the occurrence of potentially traumatic events (PTE) in high-school students, measure subthreshold post-traumatic symptomatology in those who still experience PTE repercussions and associate the symptomatology with sociodemographic and PTE characteristics. Materials and methods: Analytic transversal study carried out in a convenience sample of one thousand students from three high schools in the State of Mexico. The Scale for Post Traumatic Stress in University Students was applied. The presence of symptoms, their frequency and their association with explanatory variables was assessed by means of logistic and quantile logistic regression models, respectively. Results: 80% reported PTE. Of this, 79% still experienced current repercussions and almost a half presented symptomatology. Gender, number of events, and PTE characteristics (perceived and grave symptoms) were associated. Conclusions: Results suggest to intervene early to reduce the risk of developing a disorder.

Factors associated with HIV transmission risk in people with a severe mental illness. A narrative review / Factores asociados con el riesgo de transmisión de VIH en personas con un trastorno mental grave. Una revisión narrativa

Abstract Background. People with a severe mental illness (SMI) are a highly vulnerable group for the transmission risk of the human immunodeficiency virus (HIV). They have a higher seroprevalence compared with the general population and their life expectancy is shorter than those of people without the disease. This narrative review describes individual factors or those inherent to a person’s characteristics and the sociocultural factors conditioning sexual behaviour and prevention norms. Objective. The purpose of this narrative review is to describe individual and sociocultural factors associated with the risk of HIV in people with a severe mental illness. Method. 82 empirical studies published between 1981 and 2015, addressing HIV transmission risk factors and sociocultural dimensions related to vulnerability were selected. Four indexes were used for this purpose: ISI Web of Knowledge, Redalyc, SciELO, and PUBMED; and four multidisciplinary electronic databases: Ebscohost Web, ProQuest, Sage Publications and ScienceDirect. Results. The analysis based on coding and systematic categorization shows that people with SMI are more vulnerable to risk than the general population, with differentials based on the severity of the disease symptomatology and economic and sociocultural characteristics associated with HIV-related risk practices. Discussion and conclusion. The need to design longitudinal studies with mixed methodology is proposed to attain a deeper understanding of the interaction of factors associated and processes conditioning risk. In this population group, structural preventive programs that take into account social and gender inequality must be implemented.

Resumen Antecedentes. Las personas con trastornos mentales graves (TMG) constituyen un grupo de alta vulnerabilidad al riesgo de transmisión del virus de inmunodeficiencia humana (VIH). Asimismo, presentan una mayor seroprevalencia en comparación con la población en general y su esperanza de vida es más corta que la de personas sin TMS. La presente revisión narrativa describe los factores individuales e inherentes a las características de estas personas y los factores socioculturales que condicionan los comportamientos sexuales y las normas de prevención. Objetivo. Describir los factores individuales y socioculturales asociados con el riesgo de infección del VIH en personas con trastornos mentales graves. Método. Se seleccionaron 82 estudios empíricos publicados entre 1981 y 2015 sobre los factores asociados al riesgo de transmisión del VIH y dimensiones socioculturales relacionadas con la vulnerabilidad. Se utilizaron cuatro índices: ISI Web of Knowledge, Redalyc, SciELO y PUBMED; y cuatro bases de datos electrónicas multidisciplinarias: Ebscohost Web, ProQuest, Sage Publications y ScienceDirect. Resultados. Un análisis basado en la codificación y categorización sistemática muestra que las personas con TMG son más vulnerables al riesgo que la población general, con diferenciales basados en la gravedad sintomatológica de la enfermedad y en las características económicas y socioculturales que se asocian con prácticas de riesgo. Discusión y conclusión. Se propone desarrollar estudios con un diseño longitudinal y metodología mixta para alcanzar una comprensión más profunda de la interacción de factores asociados y procesos que condicionan el riesgo. Los programas preventivos estructurales realizados con este grupo de personas deben considerar las desigualdades sociales y la inequidad de género.

Identificación de estresores laborales y burnout en docentes de una secundaria para trabajadores del Distrito Federal / Identification of occupational stress and burnout in teachers of a secondary school in Mexico City

ANTECEDENTES: Los docentes enfrentan estresores y experiencias que los pueden conducir al denominado síndrome de burnout o desgaste profesional. OBJETIVO: Analizar la presencia y características del burnout y las fuentes de estrés percibidas por profesores de una secundaria para trabajadores de México, D.F. MÉTODO: Se utilizó una metodología mixta cuantitativa (Inventario de Burnout de Maslach [MBI] y el Cuestionario de Burnout para el Profesorado [CBP-R]) y cualitativa (explorando opiniones y comentarios sobre diferentes temas). RESULTADOS: El MBI mostró una consistencia interna aceptable en agotamiento emocional y falta de realización y el CBP-R en estrés de rol, burnout y falta de supervisión. Los docentes de tercer grado presentaron mayor agotamiento emocional, estrés de rol, falta de supervisión y burnout que los de niveles inferiores. Se encontró que el agotamiento emocional está influido por el estrés generado por los alumnos más conflictivos y violentos. Esto provoca a los docentes mayor sentimiento de vulnerabilidad e impotencia ante la posibilidad de convertirse en sus víctimas. DISCUSIÓN Y CONCLUSIÓN: Algunos de los problemas que los docentes enfrentan con sus alumnos son desmotivación y falta de interés para aprender, dificultades en el aprendizaje, consumo de sustancias, falta de disciplina y conductas antisociales. Es muy importante que canalicen los diferentes problemas a profesionales e instituciones de salud que los ayuden en estos aspectos. Por lo que se sugiere que los docentes de secundaria reciban una formación continua que les permita responder a las necesidades de su profesión.

BACKGROUND: Teachers are exposed to different work-related stressors and experiences. These may carry emotional and interpersonal problems deriving into the so-called burnout syndrome. OBJECTIVE: To analyze the presence and characteristics of the burnout syndrome, together with the stress sources perceived by the teachers of a junior high school in Mexico City. METHOD: A mixed quantitative (the Maslach Burnout Inventory [MBI] and the Teachers' Burnout Questionnaire [TBQ-R])-qualitative (method was used to explore opinions and comments on several issues) methodology was applied were used. RESULTS: The MBI showed an acceptable internal consistency in emotional exhaustion and lack of realization but not in depersonalization. The TBQ-R showed an acceptable internal consistency in role stress, burnout and lack of supervision. Third grade teachers showed higher degrees of emotional exhaustion, role stress, lack of supervision and burnout than first and second grade teachers. Qualitative results confirm that emotional exhaustion is influenced by the stress produced by the more conflictive and violent students. This causes in teachers a higher vulnerability and impotence feeling at the likelihood of becoming their victims. DISCUSSION AND CONCLUSION: Junior high teachers should receive a permanent training which allows them to respond to the needs of their career. Lack of motivation and interest in learning, difficulties in learning, substance abuse, lack of discipline and antisocial behaviors are among the problems teachers face with their students. We consider it is highly important they have the opportunity to channel the different problems to professionals and health institutions able to help them.

Violencia en el entorno laboral del trabajo sexual y consumo de sustancias en mujeres mexicanas / Violence in the work environment of sex work and substance use in a group of Mexican women

Objetivo Conocer la violencia que viven las trabajadoras sexuales en el ejercicio de su actividad y si ésta se asocia con su consumo de alcohol y otras sustancias. Método Es un estudio de campo tipo no experimental, descriptivo, con una muestra no probabilística de 103 trabajadoras sexuales seleccionadas por conveniencia. Se utilizó un instrumento diseñado ex profeso, consistente en una entrevista semi-estructurada. Resultados El 50.8% trabajaba en un bar, el 39.0% en la calle y el 10.2% en un cabaret. Más de la mitad (52.4%) refirió haber vivido experiencias violentas en el lugar de trabajo; de éstas, el 95.8% sufrió violencia física, el 26.0% violencia sexual y el 24.0% violencia emocional. Respecto a los actores involucrados en episodios violentos, en el 97.9% de los casos fueron compañeras de trabajo, en el 77.2%, clientes; en el 30.2%, propietarios o empleados de los bares y en el 25.0%, la policía. El 98% de las trabajadoras sexuales reportaron haber consumido alcohol en el último mes, el 23.3% cocaína y el 11.7% mariguana. Cabe señalar que 40% fuma tabaco. El 75% de las trabajadoras sexuales se reporta como bebedora alta. El 97% informó que generalmente los clientes las presionan para beber alcohol y un porcentaje similar refirió que consumen por las exigencias de los encargados de los lugares de trabajo. Las experiencias de violencia en el trabajo se asociaron con el consumo de cocaína [χ²= 6.417, (100, 1) gl p<.05] y de tabaco [2=7.486 (100,1) gl p<.01]. Esta asociación se mantuvo si la violencia había ocurrido en el último mes. El consumo de alcohol se relacionó con las experiencias de violencia física [χ²=5.180 (100,1)gl p<.05], y de violencia emocional [χ²=4.514 (100,1)gl p<.05]. Discusión Los resultados muestran que la violencia es una experiencia frecuente en su ambiente de trabajo, y es ejercida por múltiples actores; destaca el que se mencione a otras trabajadoras sexuales como quienes la ejercen, lo que no se reporta en la bibliografía. El consumo de alcohol y otras drogas se asocia con esta violencia, por lo que debe explorarse más este vínculo en futuros estudios. Se discuten los hallazgos, haciendo recomendaciones para la atención de esta problemática en las mujeres.

Objective The aim of this paper is to explore in women sex workers the violence they experience in the exercise of their activity, and if it is associated with alcohol use and the consumption of other substances such as cocaine, mariguana and tobacco. Method This is a descriptive, non-experimental study, developed with a non-random sample of 103 sex workers selected for convenience type field. The selection criteria were being between 18 and 65 years of age, being a sex worker, and literate. An expressly designed instrument consisting of a semi-structured interview was used. Results Regarding the workplace, 50.8% of them worked in bars, 39.0% on the streets, and 10.2% in cabarets. More than a half reported having suffered violent experiences in the workplace; of these, 95.8% experienced physical violence, 26.0%, sexual violence, and 24.0%, emotional violence. Regarding the actors involved in violent episodes, they were other sex workers (97%), customers (77.2%), owners or employees of bars (30.2%), and police (25.0%). Regarding substance use, 98% of the sex workers reported having consumed alcohol in the past month; 23.3%, cocaine; and 11.7%, marijuana. Likewise, 40% smoked tobacco. Seventy-five percent of the sex workers reported being a high drinker. Most of the women reported that customers generally pressed them in to drinking alcohol and a high percentage reported that they consumed it because of the demands of bar or cabaret managers. The experiences of workplace violence were associated with cocaine use (χ2 = 6.417 [100, 1] df p <.05) and tobacco (χ2 = 7.486 [100.1] gl p <.01). This association remained if violence had occurred in the last month. Alcohol consumption was associated with experiences of physical violence (χ2 = 5.180 [100.1] gl p <.05), and emotional abuse (χ2 = 4.514 [100.1] gl p <.05). Discussion The results show that violence is a common experience in the work environment of these women, and that this is carried out by multiple actors. Findings highlight that sex workers point out to other sex workers as those who exercise more violence. High alcohol use and the use of other drugs are associated with this violence, requiring future studies to explore in-depth this link. The findings are discussed, with recommendations for the care of these problems in female sex workers.

Evaluación de una intervención en línea para prevenir la violencia en población juvenil y adolescente: Resultados preliminares sobre su efectividad con profesionales de la salud / Evaluation of an online intervention evaluation to prevent violence in youths and adolescents: Preliminary results on its effectiveness with health professionals

El Modelo de Intervención Interactiva, denominado "Sin Violencia es Mejor", se deriva de la investigación psicosocial desarrollada en el Instituto Nacional de Psiquiatría Ramón de la Fuente Muñiz. Este trabajo tiene como fin evaluar la adquisición y consolidación de conocimientos, y la modificación de actitudes asociadas con la violencia en participantes de esta intervención en línea. La convocatoria fue abierta para personal de salud de todo el país. Participaron 132 prestadores de servicios de salud, a quienes se les aplicó un pre y post test mediante un cuestionario construido ad hoc para evaluar conocimientos sobre violencia y actitudes de intolerancia. Se analizaron las diferencias pre-post en todos los reactivos individualmente y por dimensión, y se reagruparon los reactivos para contar con tres dimensiones de mayor consistencia: 1. Conocimientos generales sobre la violencia (alpha=.50), 2. Tipos y efectos de la violencia (alpha=.63), 3. Actitudes de intolerancia (alpha=.58). Se encontraron diferencias significativas para la primera (t(131)=4.1, p<.000) y segunda dimensión (t(131)=6.6, p<.0001), pero no en la última, en la que, si bien hubo cambio, no alcanzó significancia estadística. Lo anterior apunta a un aumento en el conocimiento sobre los elementos que permiten reconocer un acto violento. Esto es significativo porque indica que, luego de la intervención, los participantes pueden reconocer si viven o ejercen violencia. El aumento del conocimiento de los participantes es consistente con la evaluación que éstos hicieron de los recursos de la intervención en línea, en términos de la relevancia y utilidad de la información. Aunque las actitudes suelen ser estables, pueden ser modificadas, ya sea por decisión propia o mediante una intervención externa. Los resultados indican que tras la intervención se observan menores niveles de intolerancia a la igualdad entre hombres y mujeres, si bien requiere profundizarse y mejorarse esta dimensión.

The Interactive Intervention Model, called "It is Better Without Violence", derives from psychosocial research carried out at the National Institute of Psychiatry Ramón de la Fuente Muñiz. The objective of this article is to evaluate the acquisition and consolidation of the knowledge, and the modification of the attitudes associated with violence in participants of this online intervention. The convening was open to health personnel from all over the country. One hundred and thirty-two health services providers participated. These were submitted to an ad hoc questionnaire to evaluate their knowledge on violence and intolerant attitudes, before and after the intervention. Pre- and post-intervention differences for all the items were analyzed individually and by dimension, and they were regrouped to render three dimensions with a higher consistency: 1. Overall knowledge about violence (α =.50), 2. Violence types and effects (α=.63), 3. Intolerant attitudes towards difference (α=.58). Significant differences were found for the first (t(131)=4.1, p<.000) and second (t(131)=6.6, p<.0001, dimensions, but not so for the last where the change did not reach statistical significance. This points out to an increase in the knowledge of the elements which allow for the recognition of a violent act. This is important because it indicates that, after the intervention, participants are able to identify if they suffer or exert violence. The increase in the knowledge of participants is consistent with their evaluation of the resources of the online intervention in terms of the relevance and usefulness of the information. Even though attitudes tend to be stable and harder to modify, lower levels of intolerance were observed after the intervention. Given that this dimension is associated with possible discrimination practices towards the "different ones" and these are associated with the exertion of violence, reviewing the intervention content and the instrument itself is proposed in order to achieve changes.

Medición del Trastorno por Estrés Postraumático (TEPT) en universitarios mexicanos / Measurement of Posttraumatic Stress Disorder (PTSD) in Mexican university students

Actualmente la violencia en diferentes ámbitos y contextos afecta de manera preocupante a México. Las experiencias traumáticas, comunes en algunas comunidades, pueden llegar a configurar problemas graves de salud mental en los individuos, entre ellos se cuenta el Trastorno por Estrés Postraumático (TEPT). El tener a la mano escalas que midan tanto los eventos susceptibles de ser traumáticos como la sintomatología postraumática, permitiría una evaluación rápida antes del diagnóstico formal y su utilización, principalmente en estudios epidemiológicos que permitan detectar el impacto de dichos sucesos en las personas y las comunidades. El objetivo del presente estudio consistió en la construcción de una escala de sucesos y síntomas asociados al TEPT en población mexicana universitaria, con el fin de obtener su confiabilidad y validez. Participaron 858 estudiantes de cuatro universidades públicas de Tejupilco, Estado de México. La muestra fue de 669 jóvenes de ambos sexos con edades de 18 a 25 años, quienes contestaron la escala en su totalidad. El índice de confiabilidad se obtuvo con una alfa de Cronbach y la validez de constructo mediante el análisis factorial. El suceso más frecuentemente encontrado fue la experiencia de muerte repentina de algún familiar y/o amigo cercano. La escala, como instrumento de tamizaje, obtuvo índices convenientes para ser aplicada en poblaciones similares. La consistencia interna resultó con una α=.95 y el análisis factorial arrojó cinco factores con una varianza total de 45.15%. Su diseño permite asociar los síntomas del último año a un suceso de vida específico, valorado por el mismo sujeto, como susceptible a ser traumático. Así, se detectó vulnerabilidad en la población juvenil estudiantil a padecer el TEPT o algún otro tipo de trastorno psiquiátrico derivado de los sucesos vividos. La identificación precoz podría sugerir la creación de servicios generales y especializados en salud mental, acompañados de acciones que reconozcan el valor de la Universidad como uno de los principales espacios sociales para jóvenes.

Nowadays violence in different aspects and contexts affects Mexico in a worrying manner. Common traumatic experiences in some communities might configure grave mental health problems in the individuals, among them posttraumatic stress disorder (PTSD). Having scales that measure events susceptible to become traumatic as well as posttrau-matic symptomatology would allow a fast assessment before formal diagnosis, to be mainly used in epidemiological studies that enable detecting the impact of these occurrences in vulnerable people and communities. The objective of the present study was to build a scale of events and symptoms associated to PTSD in a Mexican university population, in views to obtaining its reliability and validity. A total of 858 students from four public universities of Tejupilco, State of Mexico, Mexico, took part; they were between 18 and 25 years of age, and answered the scale in its entirety. The reliability index was obtained by means of Cronbach's alpha and the validity of the construct with factorial analysis. The most frequent event was the experience of sudden death of some relative and/or a close friend. The scale as a screening instrument obtained internal consistency indexes of α=0.95 and the factorial analysis yielded five factors with a total variance of 45.15%. Its design allows associating the symptoms of the previous year to a specific life event, valued by the same subject as susceptible to become traumatic, which permits its utilization on similar populations. The vulnerability of the young student population to suffer PTSD or any other sort of psychiatric disorder from experienced events was verified. Early detection could suggest general and specialized mental health services, accompanied by actions that recognize the value of university as one of the main social spaces for youths.

Significados sobre la prevención del riesgo de VIH en cibernautas con trastorno bipolar / The meaning of the prevention of HIV among internet users with bipolar disorder

Introduction The persons with affective bipolar disorder (ABD) constitute a vulnerable group to the infection of HIV; in spite of that, there has been little investigation about the preventive culture in this population. Objective To identify the meanings and practices about the prevention of the risk of HIV infection with persons having bipolar disorders, active members of the weblog "Foro Bipolarmexico". Methodology A quality ethnographic type study was carried out on the Mexican weblog, directed by and for persons with ABD. The sampling of forums of expression published from 2007 to 2010 were positive. An analysis of the contained inductive thematic was conducted and the ATLAS.ti was utilized for the process of the information. Results The meanings and the conditions implied in the construction of the practices on the prevention of the risk of transmission of HIV cover three levels: a) physic-biologic, where the symptomatology associated with the disorder is identified, and the use of medications are implicated in the altercation of desires and sexual practices; before this, the bloggers propose the execution of activities which would permit the canalization of sexual impulse, the change of medication and use of preservatives; b) the micro-social, in which enhanced conditions like communication deficiency with their psychiatrists and similarities on the disorders and their effects on sexuality, for which they promote open discussion on the changes experienced; and c) the macro-social, where the stigma of the disease is expressed in solitude and the difficulty of stable couples to relate, conditions that could counteract, so they suggested, with the social recognition of their potentials. The emphasis on the recuperation of significance constructed socially clearly showed that it is urgent to consider directed towards not only preventive interventions, but also to micro and macro social conditions which have a part in the vulnerability and infection of HIV.

Introducción Las personas con trastorno afectivo bipolar (TAB) constituyen un grupo vulnerable al contagio del VIH; a pesar de ello, poco se ha investigado sobre la cultura preventiva en esta población. Objetivo Identificar los significados y prácticas sobre la prevención del riesgo de transmisión de VIH en personas con trastorno bipolar, miembros activos del weblog "Foro Bipolarmexico". Metodología Se realizó un estudio cualitativo de tipo etnográfico en una weblog mexicana, dirigida por y para personas con TAB. El muestreo de foros de expresión publicados de 2007 a 2010 fue propositivo. Se realizó un análisis de contenido temático inductivo y para el procesamiento de la información se utilizó el software ATLAS.ti. Resultados Los significados y las condiciones implicadas en la construcción de prácticas sobre la prevención del riesgo de transmisión de VIH abarcan tres niveles: a) el psicobiológico, donde se identifica que la sintomatología asociada al trastorno y el uso de medicamentos están implicados en la alteración de deseos y prácticas sexuales; ante esto los blogueros proponen realizar actividades que permitan la canalización del impulso sexual, el cambio de medicamentos y utilizar preservativos; b) el microsocial, en el cual destacaron condiciones como la deficiente comunicación con sus psiquiatras y parejas sobre el trastorno y su efecto en la sexualidad, por lo que ellos promueven la discusión abierta sobre los cambios experimentados y c) el macrosocial, donde el estigma de la enfermedad se expresa en el aislamiento y dificultad para relacionarse con parejas estables, condiciones que podrían contrarrestarse, según sugieren, con el reconocimiento social de sus potencialidades. El énfasis en la recuperación de significados construidos socialmente evidenció que es apremiante considerar intervenciones preventivas dirigidas tanto a las prácticas de riesgo individuales como hacia las condiciones microsociales y macrosociales que participan en la vulnerabilidad al contagio de VIH.

Violencia interpersonal en jóvenes mexicanos y oportunidades de prevención / Interpersonal violence in Mexican young people and prevention opportunities

Objetivo. Estimar la prevalencia de daños a la salud a causa de la violencia interpersonal en adolescentes y adultos jóvenes. Material y métodos. Se presenta información sobre las consecuencias de la violencia en México. Los datos provienen de la Encuesta Nacional de Salud y Nutrición 2012 realizada entre octubre de 2011 y mayo de 2012. El análisis estadístico consistió en calcular prevalencias e intervalos de confianza al 95% para el grupo de adolescentes y jóvenes. Resultados. Cuatro de cada cien jóvenes ha presentado daños a la salud a causa de la violencia interpersonal. La prevalencia de violencia interpersonal es mayor entre los hombres (5.0% hombres, 3.3% mujeres) y el grupo de edad más vulnerable es el de los hombres de 20 a 29 años para las mujeres el hogar es un espacio donde una de cada cuatro reporta sufrir violencia (24.5%). Conclusiones. Es necesario implementar medidas integrales para la población joven, dirigidas a evitar que este problema siga creciendo tanto en frecuencia como en sus diversas expresiones y espacios.

Objective. To estimate the prevalence of health damage due to interpersonal violence in teenagers and young adults. Materials and methods. The consequences of violence in Mexico are presented in this analysis, with data from the National Health and Nutrition Survey 2012 conducted between October 2011 and May 2012. Statistical analysis consisted in calculating general and specific prevalences and intervals obtained at 95% confidence for the group of adolescents and young people. Results. Four of each hundred youngsters have presented health damage due to interpersonal violence. The prevalence of interpersonal violence is higher among men (5.0% men, 3.3% women), the most vulnerable age group is that of men 20 to 29 years old; one of four women reported domestic violence (24.5%). Conclusions. It is necessary to implement comprehensive measures for young people, designed to prevent this problem from growing in frequency as well as in its variety of forms and spaces.

¿Violencia episódica o terrorismo íntimo? Una propuesta exploratoria para clasificar la violencia contra la mujer en las relaciones de pareja / Episodic violence or intimate terrorism? An exploratory proposal to classify violence against women in the context of intimate couple relationships

Introduction The concern of this paper comes from a reflection on the phenomenon of violence against women in the context of intimate couple relationships. Even though studies dealing with the issue tend to focus on the presence of physical violence, it should not be forgotten that in the same relationships several types of emotional and sometimes sexual violence may co-exist. Violent men intentionally aim to create a threatening climate against women. To do so, they resort to devaluations, insults, threats, maltreatment, shouting, contempt, intolerance, humiliations, jealousy and accusations. Nevertheless, women are often unaware of many of them given the social tolerance towards overall abuse and the lack of institutional alternatives. There are, however, some difficulties to operationalize these behaviours. It is particularly difficult to measure the characteristic pattern followed by these relationships as this may involve very subtle forms of violence. Likewise, results obtained in the physical and psychological dimensions are usually kept as separate areas or they are presented at best in a mixed form to show the prevalences from the different surveys carried out. This article is a theoretical and statistical exercise aimed at constructing a typology of male violence against women. Its starting point is a proposal posing that in heterosexual relationships two types of violence are present. The first one may be called episodic violence, where one or both members of the couple carry out some violent act without the desire to control or dominate the other partner. In the other one, defined as intimate terrorism, the man acts out with the clear purpose of exerting both a violent and non-violent control and dominion over the woman's actions, thoughts, and emotions. Although it is certainly arguable, it might be interesting to analyze this classification for it is risky to suppose that there are couple relationships where a symmetry in the use of violence exists both on the part of men and women -that is, that women are as violent as men. It is risky because it distorts violence's gender nature by presupposing that the same behaviour may be exerted with the same physical and symbolic strength and that it will have similar consequences. However, we think it is worth taking it into account as a starting point for this analysis. To do so, a database derived from a study conducted among a sample of women attending general medical consultation was used. The main analysis axis was the indicator of having experienced a physically violent behaviour on the part of the partner during the last year. This was related to five emotional violence dimensions which represent different modalities as to their intentionality and impact. The groups thus formed were analyzed considering some variables which were previously regarded as associated to this form of violence, including demographic features, and some other features related to household income participation and the distribution of household keeping chores in the women's families. Specific features regarding the violent relationship, such as the motives behind the physical violence episodes and the role played by alcohol abuse on the part of the male partner in these episodes, were also considered. Method A database derived from a transversal ex post facto study conducted with a 345-women sample attending first-time or subsequent medical attention in a first level institution was analyzed. A structured questionnaire made up of different areas was applied. The following areas were included in this study: 1. Socio-demographic variables from each woman, her male partner and her family. 2. A violence severity scale containing 22 different types of physically violent behaviours from men against women, and 36 emotional violence types. A previous analysis of the latter showed five conceptually congruous dimensions: Devaluation, Threatening behaviours, Intimidation, Hostility, and Abusive expectations. 3. Features of both the relationship and the violent episodes. 4. Alcohol abuse on the part of the partner. To construct the typology, women who had experienced at least one physical violence attack by their partners during the last twelve months were classified, regardless of the frequency and severity of such behaviour. With this sub-sample, a multidimensional escalation analysis was performed with the five emotional violence dimensions reported and these were considered as <>. Decisions were then taken as to the configuration obtained and the women were classified in three groups considering both the presence and severity of the physical violence experienced and the frequency of the different forms of emotional violence. Based on these groups classification, variance and chi square analysis were carried out with the variables selected to observe whether these effectively differentiated the women from each group. Results The resulting emotional violence dimensions allowed us to obtain a typology of the sub-sample of women who had experienced physical violence (30% of the total). With this, three groups were formed: 1. episodic physical violence, including women who did not report any threats nor intimidation or devaluation (12.5%); 2. intimidating physical violence, including women who reported threats and intimidation and some or no devaluation (12.5%), and 3. intimate terrorism, which refers to women who suffered very frequent threats and intimidations together with occasional to frequent devaluations (5%). The latter is the highest risk group. Women belonging to this group were older (35 years) than those from the other two groups and so were their partners (40 years). They reported having more children and having lived longer with the abusing partner. Three out of each five had a paid job, mainly informal, and took charge of the money income responsibility of their households. Male partners were the main income providers only in 40% of the instances. Role genders in these families were very traditional as the male partners seldom helped with household keeping cores. Male partners had alcohol abuse-related problems and, in fact, one out of each three got aggressive when he had had any alcohol. The main reasons behind physical violence were male drunkenness, jealousy, and women protecting their offspring. At the other end are the women we classified in the episodic violence group. These were the youngest in the study even when compared to non-abused and intimidating violence victims. These women and their couple's household income participation, and the family members' participation in household keeping cores were similar to those in the no violence group. Their partners had also used alcohol in a comparable amount to that of the intimidating violence group. The main reasons underlying physical violence were male anger and male jealousy, and drunkenness to a lesser degree. Conclusions A considerable amount of women, nearly one out of each three, had experienced some form of physical violence in their couple relationship during the last year, and one out of each five had suffered violence in an abusive context of threats, intimidation and devaluation. Given this, it is important to focus on any type of physical violence as a part of a primary preventive perspective.

El presente trabajo es un ejercicio teórico y estadístico para construir una tipología de la violencia masculina hacia la mujer. Parte de una propuesta que plantea que en las relaciones heterosexuales ocurren dos tipos de violencia física. Uno de éstos puede denominarse violencia episódica, donde uno o ambos integrantes de la pareja realizan algún acto violento sin que esté presente el deseo de controlar o dominar al otro integrante. En el otro, definido como terrorismo íntimo, el hombre actúa con una clara intención de ejercer un control y dominio tanto violentos como no violentos sobre las conductas, pensamientos y emociones de la mujer. Los grupos construidos se analizan según algunas variables que previamente se ha considerado que se pueden asociar con esta forma de violencia, como las características demográficas, las características relacionadas con la participación económica y la distribución de las labores domésticas en las familias de las mujeres y las características específicas de la relación violenta, en particular el uso de alcohol por parte de la pareja. Método Se analizó una base de datos derivada de un estudio transversal y ex post facto realizado con una muestra de 345 mujeres que asistieron a atención médica de primera vez o subsecuente a una institución del primer nivel en el Distrito Federal. Para construir la tipología, se eligió a las mujeres que habían sufrido al menos una manifestación de violencia física por su pareja en los últimos 12 meses, y se realizó un análisis de escalamiento multidimensional a partir de cinco dimensiones de la violencia emocional. Con base en la clasificación de grupos, se realizaron análisis de varianza y de chi cuadrada con variables demográficas, y otras que la bibliografía ha reportado como relevantes. Resultados Un 30% de las mujeres había sufrido algún episodio de violencia física en el último año. Éstos se clasificaron de la siguiente manera: 1. con violencia física episódica, que incluye a aquellas que no reportaron amenazas, ni intimidación y devaluación (12.5% de la población total); 2. violencia física intimidatoria, que incluye mujeres que reportaron amenazas e intimidación y poca o ninguna devaluación (12.5% de la población total); y 3. terrorismo íntimo, referido a mujeres que sufrieron amenazas e intimidaciones muy frecuentes junto con una devaluación que va de <> a <> (5% de la población total). Este último grupo es el de más alto riesgo; las mujeres que lo integraron fueron de mayor edad que las de los otros grupos, al igual que sus parejas. Reportaron tener más hijos y más años de vivir con el maltratador, en promedio 18. Tres de cada cinco mujeres tenía un trabajo remunerado, en su mayoría de manera informal, y llevaban la responsabilidad económica del hogar, así como la carga de las actividades domésticas. Sus parejas tenían un consumo de alcohol problemático; de hecho, uno de cada tres se ponía agresivo al ingerirlo. Conclusiones No encontramos relaciones físicamente violentas libres de violencia emocional, ya que, aun cuando la violencia episódica ocurrió sin manifestaciones de amenazas, intimidación y devaluación, las mujeres sí reportaron comportamientos hostiles y expectativas abusivas de parte de sus parejas. Los resultados obtenidos en torno a las variables sociodemográficas, las relacionadas con la participación económica y con las actividades domésticas de las mujeres y sus familiares, y el consumo de alcohol, pueden utilizarse para elaborar un instrumento breve que permita la detección de mujeres en situación de alto riesgo de violencia de pareja. Además, permiten reflexionar en la necesidad de plantear políticas públicas estructurales para enfrentar este problema, como la creación de empleos dignos y bien remunerados para las mujeres. Destaca igualmente la importancia de contar con programas que aborden el consumo de alcohol y la violencia en los hombres, considerando ambos aspectos como ejes de la construcción de la masculinidad tradicional.

Los malestares masculinos: Narraciones de un grupo de varones adultos de la Ciudad de México / Male uneasiness: narratives from a male adult group from Mexico City

Introduction Distresses related to depressive conditions in men have not been sufficiently acknowledged, and yet less studied. The difference between distress and its attention is originated in factors such as a rigid and dual classification of the problem, a false conception that it is a <>, and the social stigma that leads men to accept and face negative emotional states that affect their life quality. This article shows the results of a qualitative study which sought to uncover the social construction of distress from a gender approach and to deepen the understanding about the way men live it and exteriorize it. The concept of loss was taken as a methodological strategy throughout the study to access the male distress experiences, considering that, before an emotionally meaningful loss or an unfavorable event, individuals may react using those experiences. Method Four adult men participated in the study; they were selected using an intensive intentional sampling strategy. We carefully selected only a few cases, seeking to characterize the object of study and to obtain profound information based on reality; they were males who had suffered an important loss. They received a detailed explanation of the study and its objectives, voluntarily accepted to participate and allowed the recording of the interviews. Confidentiality and anonymity were guaranteed. The information was gathered by means of in depth interviews and a thematic guide. We developed categories of analysis from the guide and the study objectives to classify data. Categories were grouped according to their meanings and they generated subcategories that allowed a deeper and more precise analysis. Results The analysis focused on the experiences of four men: Manuel (30 years old), Oscar (36), José (40), and Rodrigo (40). They lived in Mexico City. Manuel and Rodrigo completed high school education, while Oscar and José obtained a college degree. They had different marital status: Oscar is single, Rodrigo is a widower, José is separated from his wife, and Manuel lived together with his girlfriend. Their most important and emotionally meaningful losses, which had caused distress, are described as well as the relationship these had with other aspects of their masculine subjectivity, such as sexuality, the body, violence, sports and work. Loss of couple. Losing the couple was one of the most important experiences the four men lived. This had common causes: psychological and physical violence, cheating, and sexual dissatisfaction. Manuel and Rodrigo spoke about extremely violent episodes where they were beaten-up by their fathers and schoolmates during childhood, followed by brawls during youth as a way of gaining respect. They also said they later reproduced this violence in their relationships with women. Both were jealous and controlling men, but they used different ways to intimidate their couples. Manuel did not use physical, but psychological violence. Instead of psychologically controlling his couple, Rodrigo used to act violently against her. Different elements can be identified from the experience of these men, which entwine in the distress-gender-violence relationship: <> jealousy that triggers violence and using physical or psychological violence as a means for controlling and subordinating the couple. Once they committed and act of violence, they experienced guilt and fear of neglecting that lead them to the rarely kept promise of never doing it again. These events are usually minimized, naturalized, and hardly acknowledged. In the case of cheating, it is important to consider the context where breaking-up takes place, since it is necessary to incorporate other relevant elements of masculine subjectivity: the relationship with the body, the practice of sexuality, the forced heterosexuality, and the continuous evaluation of manhood through social pressure from other men (father, brothers, uncles, and friends). Manuel's experience represents an example of this, because his link with sports and the fitness world allowed him to model his body in order to keep an appealing figure for women and a vehicle for socializing with other men that had similar interests. Being a part of this fellowship allowed Manuel to become a personal trainer and to have several affairs while he was living together with his couple. He said his interest in women and the constant cheating had four basic reasons: the context where fitness takes place, living together for a long time with the same person, feeling sexually unsatisfied, and the realization that her partner showed little interest at home and in doing housework. Thus, in the relationship distress-gender-cheating, when she finds out about him cheating and decides to break-up with him and she leaves him, become the causes on Manuel's distress. José told that problems in his sexual life caused the end of his relationship. He lost his interest in sex and ceased contact with his wife for five or six years because on a genital infection. He also had diabetes since his youth, which also contributed to his lack of interest in sex. José was reluctant to seek medical or psychological help, so his wife decided not to stay with him anymore. Then he reacted with sorrow, impotence, and anger, feelings he considered as a depressive phase. Loss of health. The loss of health could be the result of a chronic illness or a severe injury. It was a distress generating experience for two of them, which had an important impact on their masculine identity in two basic axes: the body and the sexual life. The experiences of José and Manuel allow recognizing the difficulty that men face when they try to accept and admit their own illness and vulnerability, as well as their reticence for taking care of their bodies and health. José said his first painful event was when he was diagnosed with the diabetes at age 25; it was a total self-image change. <> who had to take medication for life. The most traumatic situation Manual had lived was when one of his girlfriends stabbed him in his heart during a fight. This changed the meaning of his life and body; he was downhearted for seven years, affecting his work and his social and sexual life. The origin of distress is beyond losing a couple or health in these cases, because, deep down this distress-health-gender relationship, the problem is in losing the ability to fight or in stopping being sexually active, and therefore in not being able to sustain the gender based commands. Loss of job. Oscar talked about one of this distress generating experiences. Even though he considered himself a competent architect, he had not reached a position where he could get enough social success and economic balance. His story offers the possibility of understanding the meaning of a well-paid job in the life of men: the notion of value as a self-reference, the illusion of self-nomination as someone different and unique, the possibility of recognition and appreciation from others, and the money and power. These elements interact to structure what seams to be one of the most important axes for masculine identity. Because when men cannot enter into the working world, they face crisis and distress periods, which in turn have negative repercussions on their gender identity. Male expressions before losses. There were some fundamental physical expressions of distress: muscular pain, difficult in sleeping, laziness, and untidy appearance. The most frequent emotional expressions included sadness, anger, rage, and vindictive impulses. Other manifestations were more related to the way they have learned to <> by repressing their feelings: not to cry, not to be vulnerable before others, not to show any feelings, and to endure pain.

Aplicación de la Escala de Depresión del Center of Epidemiological Studies en adolescentes de la Ciudad de México / Application of the revised version of the Center of Epidemiological Studies Depression Scale in adolescent students from Mexico City

OBJETIVO: Probar la validez de constructo, concurrente y externa, y la consistencia interna de la Escala de Depresión del Center for Epidemiologic Studies (CES-D-R) en adolescentes. MATERIAL Y MÉTODOS: Estudio transversal con dos cohortes de estudiantes de secundaria del DF. El cuestionario incluyó la CES-D-R y otras escalas sobre problemas relacionados con suicidio, violencia, exposición a oportunidades y consumo de drogas. La participación fue voluntaria y anónima. RESULTADOS: Se incluyó a 1 549 estudiantes (edad promedio, 14 años; DE=1.2). La escala mostró una estructura de seis factores (varianza explicada, 55 por ciento), consistencia interna excelente (a=0.93), discriminación significativa entre puntajes extremos (z=-3.695, p<0.001) y correlación positiva y significativa con la escala de ideación suicida de Roberts (r=0.685, p<0.001). CONCLUSIONES: La CES-D-R tiene excelentes características psicométricas en adolescentes mexicanos, por lo que es adecuada para la detección oportuna de depresión. Esto permite utilizarla en las vigilancias sistemáticas y periódicas en la población escolar para detectar necesidades de atención, prevención y promoción de la salud mental.

OBJECTIVE: To assess the internal consistency, as well as the construct, concurrent and external consistency of the Center for Epidemiologic Studies Depression Scale (CES-D-R) in Mexican adolescents. MATERIAL AND METHODS: The data are from two samples of middle-school students from Mexico City. The questionnaire included the CES-D-R and other scales for suicide problems, peer and family violence, and drug use. RESULTS: The sample included 1 549 students (mean age 14 years, SD=1.2). The CES-D-R showed a six-factor structure (explained variance, 55 percent) with an excellent internal consistency (a=0.93), a significant discriminative power for opposite scores (z=-3.695, p<0.001), and a positive significant correlation with the Roberts Suicidal Ideation Scale (r=0.685, p<0.001). CONCLUSIONS: The CES-D-R has excellent psychometric characteristics for Mexican adolescents and therefore is deemed as an adequate tool for the assessment of depressive symptoms in large samples to detect mental health needs and design preventive interventions.