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RESUMEN Las redes sociales son espacios virtuales, en los que millones de adolescentes alrededor del mundo se comunican libremente acerca de temas relevantes para su desarrollo y entretenimiento. La literatura internacional indica que, la exposición a contenidos relacionados con el consumo de alcohol y marihuana, contribuye al desarrollo de una menor percepción de riesgo al consumo, y una mayor tolerancia social hacia el uso de estas drogas. La presente investigación tuvo como objetivo explorar la percepción del consumo de alcohol y marihuana, que aparece en las redes sociales, en una muestra de 35 estudiantes de bachillerato. Se realizó un estudio cualitativo exploratorio a través de cuatro grupos focales, integrados por alumnos de bachillerato de la ciudad de Xalapa, Veracruz, de ambos sexos, de entre 15 y 19 años de edad, provenientes de distintos contextos socioeconómicos. El contenido de las entrevistas grupales fue transcrito y analizado, utilizando la metodología de la teoría fundamentada. Los resultados indican que, las redes sociales eran la principal fuente de información de los estudiantes, sobre la disponibilidad y los efectos del alcohol y la marihuana, sobrepasando a la televisión, los padres y los profesores. Los estudiantes percibieron el contenido sobre el consumo de drogas en las redes sociales, como una extensión de la presión de sus pares para iniciarse en el consumo de alcohol y marihuana.
ABSTRACT Social networks are virtual spaces in which millions of teenagers around the world communicate freely about themes relevant to their development and entertainment. International literature indicates that constant exposure to social networks' content related to alcohol and marijuana consumption contributes to the development of a more tolerant perception of drugs and their use. The aim of this qualitative study was to explore the perceptions of high school students regarding the alcohol and marijuana consumption posts on social networks in a sample of 35 high school students. Four focus groups were conducted with a sample of high school students from the city of Xalapa, Veracruz. Participants were both males and females whose ages ranged between 15 and 19 years and had different scio-economic backgrounds. The focus groups verbatim was transcribed and analyzed using a grounded theory approach. Results they indicated that the content posted on social networks was participants' main source of information about the effects and availability of alcohol and marijuana, surpassing television, teachers and parents. The online content was perceived as an extension of the peer pressure teenagers experienced to start using drugs.
ABSTRACT
RESUMEN: Antecedentes: El estudio del consumo de solventes inhalables en México se inició en la década de 1970 y a pesar de que por periodos ha disminuido el interés en el mismo, éste no ha desaparecido y debido a que el consumo prevalece entre la población joven, es relevante actualizar el estado del arte en la materia. Objetivo: Identificar el estado del conocimiento sobre los solventes inhalables, las consecuencias, las alternativas de prevención y su tratamiento en las cuatro últimas décadas en México. Método: Se realizó una búsqueda bibliográfica entre agosto y septiembre de 2014, de los artículos publicados entre 1970 y 2014 sobre el consumo de solventes inhalables en México. Se integraron publicaciones incluidas en el archivo histórico de la Dirección de Investigaciones Epidemiológicas y Psicosociales, en la revista SALUD MENTAL, Medline, Elsevier y Scielo México. Resultados: Se identificaron 1083 artículos, 83 cumplieron con todos los criterios para ser incluidos en el análisis. Estos trabajos se realizaron en diferentes poblaciones: grupos marginales, integrantes de bandas juveniles, niños en situación de calle, adultos y menores recluidos en centros de detención, sexoservidoras, personas que acuden a solicitar tratamiento, estudiantes y población general. Discusión y conclusión: Se identificaron diferentes aspectos relevantes de la población consumidora de solventes inhalables en nuestro país, así como acciones pendientes en materia de investigación, con lo que se pueden desarrollar programas de prevención y tratamiento que atiendan las necesidades específicas de estos grupos, ya que son pocos los programas existentes y algunos no han tenido seguimiento o evaluación.
ABSTRACT: Background: The study about the misuse of inhalant solvents started in Mexico during the 1970, although the interest in this subject decreased during some periods, its consumption continued among the young population, thus, it is relevant to update the state of the art on this matter. Objective: Identify the state of knowledge on inhalant abuse, its consequences, prevention and the treatment alternatives in Mexico in the last four decades. Method: We performed a bibliographical inquiry between August and September 2014 on the papers published between 1970 and 2014 about inhalant solvents consumption in Mexico. It integrated the publications included in the historical archive of the Epidemiological and Psycho-social Research Direction, Mental Health Journal, Medline, Elsevier and Scielo México. Results: After revision, 83 out of 1083 papers fulfilled all the criteria that we considered for inclusion in the analysis. This body of work has been performed on different population segments: marginalized groups, juvenile gang members, children in street situation, adults and minors secluded in detention centers, sex workers, people seeking treatment, students, and the general population. Discussion and conclusion: The several relevant aspects of the consumer population of inhalant solvents in Mexico were identified. Detection of this ample profile of individuals at risk could serve as the basis for the development of prevention and treatment programs to attend to the specific needs of these groups, since the programs currently in progress are scarce and some of them have not had follow up assessments or have not been evaluated at all.
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La presencia de malestar emocional -que se define como el conjunto de sensaciones subjetivas que percibe una persona de que su bienestar sufre una merma y que se manifiesta por síntomas inespecíficos- puede constituir un factor de riesgo para la aparición de enfermedades mentales, sobre todo en personas con vulnerabilidades biológicas y psicosociales. Estudios recientes señalan que los servicios de atención primaria reciben un número, cada vez mayor, de personas con malestares que no cubren los criterios diagnósticos de una enfermedad, ya sea mental o física, fenómeno que es más frecuente en las mujeres. El objetivo de este trabajo es analizar los malestares emocionales de un grupo de mujeres que acude a instituciones de atención primaria de la Ciudad de México, así como sus percepciones y vivencias sobre la atención recibida, con el propósito de identificar necesidades de atención. Para recopilar la información se utilizaron técnicas e instrumentos propios de la metodología cualitativa. La información se codificó y analizó conforme al método de "categorización de significados" propuesto por Kvale. Los resultados mostraron que los principales detonantes de los malestares emocionales en las participantes se asocian con las preocupaciones que enfrentan cotidianamente (como falta de dinero, problemas con los hijos y violencia intrafamiliar) y, en otros casos, con la vivencia de experiencias traumáticas de violencia y abuso sexual, pasadas y presentes. Los datos demuestran también que las mujeres no hablan directamente de su malestar emocional, pero que tampoco lo detecta el personal de salud o que, cuando lo hace, le resta importancia. Lo anterior se relaciona con las condiciones actuales del servicio, que no ofrece una atención integral y adolece de una visión psicosocial.
Emotional distress is the subjective sensation of diminishment in well-being which manifests itself in a number of unspecific symptoms. It might be a risk factor for the development of mental illness, especially among individuals with psychosocial or biological vulnerability. Recent studies show that primary health care services receive a growing number of patients who suffer distress, but do not fulfill the diagnostic criteria of a mental or physical illness. This phenomenon is more frequent among women. The objective of this paper is to analyze the emotional distress experienced by a group of women who attended primary health care institutions in Mexico City, as well as their perceptions and experiences around the attention received, in order to identify their treatment needs. Data was gathered through techniques and instruments pertaining qualitative methodology. The information was coded and analyzed according to the meaning categorization method developed by Kvale. The results show that the main triggers of emotional distress are associated to daily life worries (lack of money, problems with children, domestic violence, among others). In some cases, it is associated as well with traumatic events, such as violence and sexual abuse in the past or at present. Data also suggest that women do not talk about emotional distress directly during medical consultations and that health care professionals do not identify distress or minimize its importance. These aspects are related to the current characteristics of the service, which lacks a comprehensive approach and a psychosocial point of view.
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Violence against women is one of the main problems that affect life quality around the world due to severe injuries, serious mental health problems, as well as reproductive and sexual difficulties. Different studies show that the majority of abused women present an immediate reaction of distress which, if not treated, might turn into more severe emotional conditions such as post-traumatic stress disorder, major depression, psychosomatic symptoms, anxiety disorder, alcohol and/or drug abuse. The information about service utilization by abused women is controversial. Some studies estimate that health care services utilization is more frequent among abused women. For instance, a study carried out in the United States suggests that the likelihood of using health care services is twice as high among women who had suffered violence as compared to women who had not been abused. In contrast, other studies point that abused women deal with several difficulties to receive attention. This information is consistent with the idea that mental health problems prevent abused women from acknowledging the severity of their situation and, thus, they have more difficulties to protect themselves, to seek help, and to identify the institutions they can resort to. The majority of studies reporting service utilization by violence victims focus on injury care at emergency rooms, while the information about the attention of violence-related mental health problems and the expenditure it represents is scarcer. There are data suggesting that formal sources of health care are not the first choice due to a number of barriers which can be cultural (beliefs and values) or structural (limited availability and accessibility). Moreover, when women finally reach formal services, their demands are not totally fulfilled. Only a few studies have been carried out in Mexico. For example, a national survey with a representative sample of women who attended public health care services showed that 21.5% had suffered some form of violence from an intimate partner and 25% of them had never talked about that problem with a service provider, mainly because they lacked trust, they were ashamed or because they considered it as a private problem. The objective of this study is to determine the prevalence of mental health problems among a sample of female victims of intimate partner violence, to analyze the characteristics of mental health services utilization, and the reasons to seek help in this group. The data reported herein are part of a household survey which included four low income communities in the Southern area of Mexico City. The survey required multistage sampling: blocks were selected in the first stage, dwelling segments at stage two, and the final stage consisted in the random selection of one person aged 15 or older, living in the selected household, Spanish speaking, and without major mental diseases that would prevent him/her to answer the questionnaire. This procedure yielded a final sample of 1156 individuals, 49% males and 51% females. This study considers only a sub-sample of women who reported having an abusive male partner by the time of the survey (n=135). The questionnaire used includes several sections: 1. sociodemographic data and dwelling characteristics, 2. mental health services utilization, 3. a few sections of the CIDI v.1.1, 4. the Spanish version of the Danger Assessment Scale adapted to Mexican population. The interviewees agreed to participate voluntarily after the objectives and terms of confidentiality were explained; the questionnaire was administered through individual interviews by trained personnel. The section on intimate partner violence was completed only by women who had a male partner at the moment. The services considered in this study include Medical services: physician, family practitioner or other specialist (gynecologist, cardiologist, etc.), nurse, first level clinic. Mental health specialist: psychiatrist, psychologist, nurse specialized in mental health care. Alternative services: curanderos (folk practitioners), herbalist, spiritists, acupuncture, Bach's flowers, Reiki therapists, masseuses, bone and muscle therapists. Religious ministers: priest, spiritual counselors, rabbi, etc. The final sample includes 135 women who had suffered some form of violence; 30% were aged between 35 and 44 years and 26% were 25 to 34 years old. Most of them were housewives and 65% attained elementary school. As to the presence of psychiatric symptoms, 8.8% met the criteria for depressive disorder and 21.7% met criteria for anxiety disorder. When women who suffered physical violence are considered separately, the proportion of individuals with a depressive disorder is significantly higher (16%) than the proportion of women who had not suffered physical violence. Women diagnosed with depressive disorder reported physical violence (66.7%), being forced into sexual intercourse (50%), and threatens of death (33.3%). On the other hand, control over daily activities was the most frequent form of violence reported by women with anxiety disorder (55.2%). Out of all women who reported at least one form of violence, only 16.2% sought help to treat mental health problems. Nearly 42% of women with depressive disorders sought help with mental health specialists and 25% with a general practitioner. As to anxiety disorders, no significant differences were found as to service utilization. The main reason to seek help for those who presented any disorder was to think they really needed help, followed by feeling very nervous and crying all the time. Reasons for not seeking help include not knowing what to do and being ashamed. In general, these findings are consistent with previous studies reporting low utilization of mental health care services by victims of violence. The proportion increases when depressive or anxiety symptoms are present; however, the number of women seeking help remains low. These results are relevant since research on service utilization by abused women has focused on emergency rooms, while little attention has been placed on mental health services. Data must be considered with caution since this is a cross-sectional study and it is not possible to establish the temporal sequence of events; nevertheless, they provide evidence of a clear relation among mental disorders and violence.
Existe controversia en cuanto al uso de servicios por parte de las mujeres víctimas de violencia. Algunos estudios estiman que, debido al gran número de padecimientos que se asocian con la violencia de pareja, el uso de servicios de atención a la salud es más frecuente entre las mujeres que sufren maltrato. En contraste, otras investigaciones señalan que las mujeres sometidas a abusos enfrentan más dificultades para recibir atención a la salud. Este último dato coincide con la idea de que los problemas de salud mental que padecen las mujeres maltratadas les impiden reconocer la gravedad de su situación y, en consecuencia, tienen mayores dificultades para protegerse, buscar ayuda e identificar las instituciones a las que pueden recurrir. La mayoría de los reportes sobre la utilización de servicios por mujeres víctimas de violencia se centra en la atención de lesiones físicas en salas de urgencias, mientras que es más escasa la información sobre la atención de problemas de salud mental asociados a la violencia y los costos que ésta genera. El objetivo del presente trabajo es analizar la prevalencia de trastornos mentales, las características del uso de servicios de salud mental y las razones para buscar ayuda en un grupo de mujeres víctimas de violencia. Los datos forman parte de una encuesta de hogares realizada en cuatro comunidades de bajos ingresos del sur de la Ciudad de México. Se realizó un muestreo multietápico: en la primera etapa se eligieron las manzanas, en la segunda se escogieron segmentos de viviendas y en la etapa final se seleccionó de manera aleatoria a una persona mayor de 15 años que viviera de manera habitual en el hogar seleccionado, que hablara español y cuyas facultades mentales no presentaran problemas serios que impidieran realizar la entrevista. Se obtuvo una muestra de 1156 individuos; este trabajo considera únicamente una submuestra de mujeres que tenían pareja del sexo opuesto al momento de realizar la entrevista y que reportaron haber sufrido por lo menos alguna forma de violencia (n=135). El cuestionario comprende las siguientes secciones: 1. datos sociodemográficos; 2. utilización de servicios de atención a la salud mental, donde las modalidades consideradas son: servicio médico, especialista en salud mental, servicios alternativos, ministro religioso; 3. algunos módulos del CIDI versión 1.1; 4. una versión en español de la Escala de Evaluación del Peligro adaptada a la población mexicana. Del total de la muestra, 8.9% cubrieron los criterios de trastorno depresivo y 21.7% los criterios de trastorno de ansiedad. Las mujeres diagnosticadas con trastorno depresivo reportaron con mayor frecuencia violencia física (66.7%), relaciones sexuales forzadas (50%) y amenazas de muerte (33.3%). Por otra parte, el control de las actividades diarias fue la forma de violencia más reportada por las entrevistadas con trastorno de ansiedad (55.2%). Del total de mujeres que reportaron maltrato, 16.2% buscaron ayuda para atender sus problemas de salud mental. El 41.7% de las que cubrieron los criterios de trastorno depresivo recurrieron a especialistas en salud mental y 25% a médicos generales. En cuanto a los trastornos de ansiedad, no se observaron diferencias significativas respecto al uso de servicios. En general, los resultados son congruentes con estudios previos en que se reporta una escasa utilización de servicios de atención por mujeres que sufren violencia. Si bien es cierto que esta proporción aumenta ante la presencia de trastornos depresivos o de ansiedad, el número de mujeres que solicitan ayuda profesional es bajo. Estos hallazgos son relevantes en tanto que la investigación sobre el uso de servicios por parte de mujeres maltratadas se ha concentrado en la asistencia a salas de urgencia, dejando de lado las necesidades de atención especializada en salud mental.
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Summary: Alcohol has been acknowledged as one of the psychotropic drugs consumed in nearly all cultures. The study of alcohol use among indigenous and rural communities from an anthropological perspective highlights the function of alcohol in the social cohesion, and tends to minimize the consequences of consumption. This research adopts a complementary paradigm more closely linked to the acknowledgement of the significant increase in alcohol availability, coupled with its excessive promotion and the lack of support services for other related social, economic and even religious problems. Two groups are affected by excessive drinking: consumers and their closest social nucleus, i.e. the family, both of which require assistance. The aim of this article is to describe the process followed to adapt to the indigenous context a brief intervention model to support the drinkers' families, which is based upon the stress-strain-coping-support model and has proved useful in helping to deal with the dilemmas faced by relatives concerned with a family member's excessive drinking. The adaptation process included four research phases involving different qualitative methods: 1. feasibility, which includes the initial ethnographic research, 2. the adaptation of instruments and psycho-educational materials, 3. the development of an intervention manual and finally, 4. the development of cost-benefit evaluation indicators. The data are drawn from two small indigenous communities located in the arid zone of Valle del Mezquital, in the state of Hidalgo, 300 km from Mexico City. Various strategies drawn from qualitative methods were used in the different phases, i.e. individual interviews with key informants and community members, focus groups, field notes, cognitive laboratories, and the application of semi-structured and structured questionnaires. Different factors were identified as potential challenges for intervention: The existence of a patriarchal organization, fear of gossip, the different perceptions of alcohol consumption, linguistic connotations, poverty, time constraints, and the right not to inform the participants exert. It is crucial to increase awareness in order to improve well-being through various means. Women must be offered alternative responses to a dominant patriarchal structure, by helping them overcome the fear of discussing their problems, taking care not to offend their traditions and encouraging mechanisms that will weaken the power of gossip. Likewise, men must be convinced of the harmfulness of alcohol consumption and its effects on the family.
Resumen: El alcohol se reconoce como una de las drogas psicotrópicas que se consumen en casi todas las culturas. El estudio del consumo de alcohol en las comunidades indígenas y rurales desde la perspectiva antropológica resalta el papel del alcohol en la cohesión social y tiende a minimizar las consecuencias del consumo. Esta investigación adopta un paradigma complementario que considera el incremento significativo en la disponibilidad del alcohol y la excesiva promoción que recibe, así como la falta de servicios de apoyo para atender otros problemas sociales, económicos e incluso religiosos que se relacionan con el consumo. Al menos dos grupos son afectados por el consumo excesivo de alcohol: los bebedores y su núcleo social más cercano, es decir, la familia, y ambos requieren atención. El objetivo de este artículo es describir el proceso que se siguió para adaptar al contexto indígena un modelo de intervención breve para apoyar a las familias de los consumidores. La intervención se basa en el modelo estrés-tensión-enfrentamiento-apoyo, y ha mostrado ser útil para ayudar a las familias a lidiar con los dilemas que enfrentan en relación con el consumo de alcohol de alguno de sus integrantes. El proceso de adaptación consta de cuatro fases de investigación: 1. factibilidad, que incluye una investigación etnográfica inicial, 2. adaptación de instrumentos y material psicodidáctico, 3. desarrollo de un manual de intervención, 4. desarrollo de indicadores para la evaluación del costo-beneficio. La información proviene de dos pequeñas comunidades localizadas en la región árida del Valle del Mezquital, en el estado de Hidalgo, a 300 km de la Ciudad de México. En la investigación se emplearon diferentes métodos cualitativos: entrevistas individuales con informantes clave y miembros de la comunidad, grupos focales, laboratorios cognitivos y la aplicación de cuestionarios semiestructurados y estructurados. Se identificaron diferentes retos para la intervención; entre ellos, la existencia de una estructura de organización patriarcal, el temor al chisme, las percepciones del consumo de alcohol, las connotaciones lingüísticas, la pobreza, las limitaciones de tiempo y el derecho a no informar que ejercen los participantes. Es crucial incrementar la conciencia en relación con la necesidad de lograr mayor bienestar. También es necesario ofrecer a las mujeres respuestas alternativas frente a la estructura patriarcal dominante sin transgredir sus tradiciones ni debilitar el poder del chisme. Por último se requiere sensibilizar a los hombres respecto a los daños que se asocian al consumo excesivo de alcohol y la forma en que éste afecta a la familia.
ABSTRACT
resumen está disponible en el texto completo
SUMMARY The present paper is a part of a broader research project aimed at adapting a brief intervention model to help families cope with substance abuse for its application to an indigenous population. Due to cultural differences between urban and indigenous contexts, the adaptation of psychological instruments to assess the intervention outcomes is a major need. Poortinga and Van de Vijver point out that transferring an instrument from the cultural group where it has been designed to another group is a common and economic practice; however, it can lead to invalid conclusions. For this reason, the adaptation must be pursued according to a thorough systematic process in order to develop reliable, understandable, and culture-sensitive instruments. Cognitive laboratories are among the different methods to evaluate instruments previous to its final application. Its main utility is to generate information about the quality of an instrument and about the way a single question is interpreted, accepted or rejected in different cultural groups. The objective of this article is to adapt the Coping Questionnaire (CQ), the Symptom Rating Test (SRT) and the Center for Epidemiologic Studies Depression Scale (CES-D) for its use in indigenous population through the cognitive laboratories method. The main interest is to develop instruments to assess psychological distress and how people cope with excessive drinking in the Mezquital Valley. To accomplish this objective, a two-phase study was carried out. Language adaptation for all three instruments was completed in phase 1, while the validation and identification of the psychometric properties of the new version took place during phase 2. The study was carried out in a community located in Municipio del Cardonal, Hidalgo, where around 60% of the population aged 5 or older speak an indigenous language, mainly Otomi also known as Ñahñu. The participants in phase 1 were 43 bilingual (Spanish-Ñahñu) women aged between 16 and 60 years, whose main activity was housekeeping. Women were contacted at community meetings, and they agreed to participate voluntarily once the objectives of the study were explained. They were also asked to authorize the recording of the interviews. The language adaptation was performed through the concurrent probing method of cognitive laboratory in its individual modality. Each one of the original items and answer options were read aloud as many times as needed. Immediately following the response, every participant was asked: What does this question mean?, Could you rephrase it?, How would you explain this question to another person in your community?. All comments were taken into account to rewrite each item. The instructions of all three questionnaires were also simplified to facilitate understanding. As a result of this procedure, the phrasing of 26 out of the 30 items of the CQ changed. The way the SRT questions were written was adjusted so that they could be used in an interview, which is why nearly all the items were modified. As for the CES-D, 9 items were modified, while 11 remained as in the original. Through this method, versions that were easier to understand were achieved, since commonly used terms among the population being studied were incorporated, which in turn reduced the time required to apply the three questionnaires. During the second phase, the researchers proceeded to validate the final version of the three instruments with a non-probabilistic study of 191 women who were contacted in the health center of the municipal head town; these were inhabitants of 30 of the 92 communities comprising the Municipio del Cardonal. All of them spoke Spanish, 65.8% were aged between 26 and 45 (X=35.2, SD=10.05), 29.5% had completed their primary school studies, while 26% had finished junior high school. Their main activity was housekeeping (69.9%), while 78.5% of the interviewees said they were in close contact with a person who drank heavily. The three instruments were applied individually by a previously trained psychologist and nurse, which took an average of 25 minutes. The power of discrimination of each item was determined. Those in which no significant differences were found between groups at either end of the spectrum were excluded from the factorial analyses. Factorial analyses were undertaken for the main components using Oblimin rotation to obtain the factorial structure of each instrument and eventually the overall internal reliability and that of each sub-scale was obtained. In the case of the CQ, the best solution was obtained by testing a 27-item structure distributed among three factors that explained 41.6% of the variance (23.6%, 10.5% and 7.4%, respectively). The first of these, called assertive engagement, includes 11 items that ex- plore coping styles such as control, tolerance, assertiveness and support for the users, which have a reliability rate of .8147. The second factor, called emotional engagement consists of 12 items referring to emotional reactions, avoidance and inaction, with a reliability rate of .8411. The third factor consists of four items referring to actions involving the search for independence, with a reliability rate of .6689. Cronbach's alpha for the overall scale was .8707. The final version of the SRT consisted of 29 items. Two factors were obtained that explained 32.5% of the total variance (26.3% and 6.2%, respectively). The first of these comprises 17 items exploring physical health, the reliability of this scale being .8557. The second factor consists of 12 items that explore psychological aspects, which together obtained a reliability rate of .8222. The reliability of the 29-item scale was .9012, while the total mean was 19.4 (SD=9.7). The adapted version of the CES-D consists of 19 items (alpha=. 9105) comprising three factors. Factor 1 comprises 11 items which together had a reliability of .9031 and which is known as negative affect. Factor 2 consists of five items that explore interpersonal relations, with a reliability rate of .7581. The structure of the third factor, consisting solely of three items, includes symptoms related to positive affect, the reliability of these three items being .6051. The methodology of cognitive laboratories proved extremely useful in translating the items into an equivalent language without affecting the validity and reliability of the instruments, since the statistical analyses show that the adapted versions of the instruments have appropriate psychometric characteristics, with acceptable reliability levels. As for the factorial analysis, the factorial structure of the CQ reported by Orford et al. was not corroborated. Nevertheless, the structure found in this study provides a better reflection of the way alcohol consumption problems are dealt with in this population where actions tending towards independence are uncommon, while emotional engagement strategies are much more frequent. At the same time, the SRT structure proved very similar to that mentioned in other research conducted in Mexico. The highest percentages of answers on the scale of physical symptoms agree with other studies that document a high degree of somatization among Mexican women. The CES-D structure was found to differ from Radloff 's original, although the behavior of positive affect items was very similar to that found among Mexican women of rural origin from Jalisco and female teenagers from Zacatecas. The findings of this study should be regarded cautiously, since the sample from which the data were taken is not representative of the Otomi population. However, they help to distinguish certain particularities of the way depressive symptomatology is expressed in women of Ñahñu origin and to increase knowledge of the cultural variations of coping.
ABSTRACT
resumen está disponible en el texto completo
Summary: Alcoholism is among the main worldwide public health problems and it affects men and women differentially. Several studies show that, when compared to men, women develop more severe dependence, more family and social consequences and experience more difficulties to stop drinking. Differences on the impact that substance abuse has on women's life and health are related to the roles, functions and social expectancies placed on them concerning the continuity and care for the rest of the family. For this reason, alcohol intake constitutes a special problem since it affects the health of both the mother and her offspring. Alcoholic women have a higher risk of suffering obstetric complications during pregnancy, such as placenta insufficiency, intrauterine development retardation, early placenta detachment, spontaneous abortion, stillbirth and pre-term delivery. Alcohol abuse during pregnancy is also associated with low weight offspring, congenital abnormalities and further behavioral and learning difficulties. In some countries, drinking during pregnancy is considered an offense which requires legal action. In some cases, women may be put in jail until delivery and lactation. In other regions, children welfare authorities view drinking during pregnancy as a form of aggression or neglect. Such measures prevent women from searching prenatal attention which in its case might lead to severe health consequences for the mother, the embryo and the society. Estimates of alcohol consumption during pregnancy around the world vary considerably and figures range from 4.1% to 83%. However, the variation might be related to the amount of alcohol units and the period of time considered in each measurement. A case-control study in Naucalpan, Mexico, found that 11% of the women interviewees admitted having drank during pregnancy, 5% of the mothers in the control group and 2% of the case group stopped drinking during lactation. Still, any of the considered variables was found to predict postnatal mortality through logistic regression analyses. Another study performed with data from the 1988 National Survey on Addictions documents that alcohol intake during pregnancy is a risk factor for congenital abnormalities (OR=3.4). The available data about the risks associated with drinking during pregnancy in Mexico comes from research in general population, while little is known about clinical population. For this reason, the objectives of this article are: 1. to analyze the characteristics of alcohol consumption in a group of women who sought help to stop drinking, 2. to identify family history of alcohol abuse in this group and 3. to explore the consequences of drinking on their offspring. In this case study, interviews were held with 200 women who attended two treatment agencies in Mexico City due to alcohol consumption problems. The questionnaire used includes the Spanish version of the CIDI-SAM and other sections to explore drinking during pregnancy and lactation, as well as family history of alcoholism. Selection criteria were: 1. aged 18 or older, 2. seeking help for the first time, 3. physical and mental conditions that would allow to answer the questionnaire, 4. having drank during the previous year. Women agreed to participate voluntarily once the objectives of the study were explained and confidentiality assured. Personnel of both treatment agencies administered the questionnaire and interviews lasted 60 minutes average. The diagnostics of alcohol dependence were obtained according to DSM-IV criteria. Data were analyzed with the statistical program SPSS v. 10, for Windows. A total of 134 women reported having been pregnant at least once, and 57.5% of them admitted having drank alcoholic beverages during pregnancy. Age ranged from 18 to 61 years (mean=40), 50% were married or living with a partner, 18% were divorced or separated and 13% had never married. The number of children ranged from 1 to 12 with a mean of 3. High percentages of family history of alcohol abuse were found among this group (93.5%): mostly the father (72.7%), siblings (63.6%) and the partner (48.1%). Significant differences in family history of alcohol use were found between women who drank during pregnancy and those who did not drink. Around 66% reduced alcohol intake after the confirmation of pregnancy; however, 26% continued drinking as usual and 6.5% started drinking at this period. The mean number of drinks consumed per drinking occasion during pregnancy was 3.5, being the traditional beverage pulque (48.8%) and beer (34.9%) the preferred beverages. In addition, 9.2% also took medical drugs. At least three out of the seven criteria proposed in DSM-IV for alcohol dependency were met by 70.3% of the women who drank during pregnancy. More severe dependence was found among the women who drank during pregnancy than among the group of women who abstained. As to the consequences of drinking, 12% of the women reported spontaneous abortion, 13.7% pre-term deliveries, 5.5% stillbirth, 6.8% congenital abnormalities and 13.7% low birth weight. When comparing women who drank and those who did not during pregnancy, significant differences were found in the percentage of pre-term deliveries (X2=5.63; p=0.01) and congenital abnormalities (X2=4.22; p=0.05). A number of logistic regression models was assessed using three independent variables: drinking during pregnancy, frequency of alcohol consumption and severity of dependence. Dependent variables, on the other hand, were spontaneous abortion, pre-term delivery, stillbirth, congenital abnormalities, low birth weight, alcohol use by the offspring and drinking problems in the offspring. The analysis shows that alcohol consumption during pregnancy is related to pre-term deliveries (OR=7.9), and alcohol use by the offspring (OR=2.1). Severity of dependence is related as well to low birth weight (OR=3.7) and further drinking problems in the offspring (OR=2.7). Likewise, drinking every day or almost every day is also related to later drinking problems in their children (OR=2.9). Finally, having siblings who drink (OR=2.11) and meeting alcohol dependency (OR=2.21) criteria are factors that predict alcohol consumption during pregnancy. These results are consistent with other studies that report positive family history of alcohol abuse among alcoholic women. The proportion of women who stopped drinking during pregnancy (42.5%) is higher than the one reported by other authors. Prevalence of spontaneous abortion, stillbirth and congenital abnormalities are higher than the prevalence reported among general population. These findings suggest that women with severe dependence face more difficulties to stop drinking during pregnancy in spite of the social stigma imposed to future mothers who drink. The results provide some elements that support an association of alcohol abuse during pregnancy with adverse pregnancy outcomes. Nevertheless, the impact of fetal alcohol exposure responds to a complex model where a number of interacting factors, longitudinal reaserch is needed to determine the weight of each participating variable and the underlying relationship between them.
ABSTRACT
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Summary This paper is aimed at exploring the relationship of some socio-demographic variables with the presence of depressive disorders among a low-income urban sample. Different variables have consistently been associated with such disorders, for instance, marital status, sex, and socio-economic status. As to marital status, some studies show that married people have better health conditions and feel more satisfied with their lives than their unmarried counterparts. Similarly, it has been found that widowed or divorced people present a number of psychological problems. Low-income population is also at high risk of suffering depressive symptoms, in this sense, some researchers have stated that the lack of resources is associated with sadness, high stress levels, isolation, uncertainty, and low access to health care and/or other sources of support. According to the Mexican National Survey on Mental Health conducted with urban population over 18, the prevalence of depressive disorders is higher among widowers and divorced individuals -both males and females- than among their married counterparts. In addition, an association was found between depression, low schooling and unemployment. A survey undertaken in Mexico City yielded similar results though gender differences were not explored; higher prevalences of depression were found for those who reported having lost their couple or marital break up than for those who were married or single. Other groups that had high depression prevalence were lower income individuals, and those with less schooling. Couple relationships and other socio-demographic variables play a key role in the presence of depressive disorders. Thus, the present study is aimed at: a) analysing how marital status affects the presence of depressive disorders in men and women; b) exploring the role of low socio-economic level in the presence of depressive symptoms; c) exploring which combination of socio-demographic variables better predict the presence of depressive disorder in males and females Method: This research was carried out in four low-income communities located in southern Mexico City. The selected communities include Topilejo, Isidro Fabela and San Pedro Mártir within the Tlalpan district, and the fourth community was constituted by the neighbourhoods of San Marcos and San Juan, in the Xochimilco district. The research design was multistage; blocks were selected at the first stage, dwelling segments, at second stage, and finally, in the third stage the interviewed individual was selected. After this procedure, the final sample consisted of 1156 interviewees, 49% were males and 51% females. The information was gathered through a household questionnaire that explores the general characteristics of the people living in the same dwelling listed on the questionnaire, such as relationship to the family head, age, sex, schooling and income. Some other aspects related to the dwelling characteristics were also explored. Diagnosis of depressive disorder was obtained through the diagnostic interview CIDI version 1.1, which assesses the presence of mental disorders according to the criteria of the International Classification of Diseases (ICD) and the Diagnostic and Statistical Manual of Mental Disorders (DSM) of the American Psychiatric Association. The selected interviewees participated voluntarily after the research objectives were explained; in addition, the terms of confidentiality were particularly emphasized. Each interview lasted 90 minutes on average. Data analysis were performed with the statistical program SPSS v. 10 for Windows. Results: The findings showed higher prevalence of depressive disorders among females, among people that experienced loss or family rupture and among those with lower economic resources. Similarly, prevalence of depression was higher for men (6.1%) and women (18.3%) who had lost their spouse than for their married counterpart. As to differences between married and single people, the prevalence of depressive disorders in the group of men that had ever married was lower (4.9%) than the prevalence found in the group of married men (5.8%). The opposite was observed among females, since single women present more depressive problems (13.2%) than married women (5.3%). Results also showed how economic difficulties have an effect on the presence of depressive disorders. However, differencesbetween married and single men with the lowest income were minimal. Two logistic regression models show that, particularly among women, the presence of depressive disorder is related to the lack of a couple, economic disadvantages; for instance, low family income, belonging to a large extended family, and playing the social role of family head, which implies responsibility to a large extent. Discussion: The findings of the present study are consistent with previous research that report higher prevalence of depression among females, people without a couple and those with less economic resources. Different authors have confirmed that problems of economic nature are consistently associated with depression problems. Lack of resources leads to high stress levels, sadness, isolation, among other troubles. This situation is more severe for females. Women play a number of social roles that put them at higher risk of suffering mental disorders. Nowadays, women still bear the responsibility of being wives, mothers, educators and care providers for many people, and have become an important part of the work force at the same time. The deficiencies that female family heads must face in different areas not only increase the risk of suffering disorders such as depression and poor quality of life, but also jeopardize their children's opportunities in the future. Dejarlais and colleagues suggest that in order to improve these women's mental health it is necessary to take actions in two ways. On the one hand, it is essential to deal with the factors related to the presence of female distress; on the other, it is crucial to provide attention to reduce the negative consequences. In this way, any prevention or intervention program must include, among other elements, tools to expand women's capabilities to have an income, reinforce social support networks, and to stimulate social and community participation in order to improve their cognitive and relational resources as well as self-esteem. In addition, women must have information about the pathological process they undergo and attention options at their disposal, but to make these programs effective it is above all necessary to tailor them according to women's concerns and needs. This can only be possible if women act as active collaborators. Finally, to work on intervention and prevention programs for female family heads encloses the possibility of breaking the cycle that reproduces distress among their children.
ABSTRACT
Objetivo. Evaluar el riesgo para el uso excesivo de etanol en personas con historia familiar positiva de consumo de alcohol (HF+). Material y métodos. Los datos corresponden a una muestra de población general (n= 8 890) y fueron recopilados a partir de una encuesta nacional de adicciones en población urbana de México, realizada en 1988. Se determinaron medidas epidemiológicas de frecuencia y asociación considerando los antecedentes de HF+ como factor de exposición. Resultados. La prevalencia actual del consumo consuetudinario de alcohol fue de 13.7 por ciento para los hombres y 0.6 por ciento para las mujeres, las cifras para el síndrome de dependencia fueron 9.9 por ciento para hombres y 0.6 por ciento para las mujeres. Los hombres con HF+ tienen dos veces más probabilidad de desarrollar el síndrome de dependencia que aquellos con HF-. La razón de momios en el grupo de mujeres fue de 1.27. Conclusiones. Se observaron patrones diferenciales por sexo en la transmisión de problemas de consumo. El consumo de los padres representa un factor de riesgo importante para el desarrollo del síndrome de dependencia de los hijos. El texto completo en inglés de este artículo está disponible en: http://www.insp.mx/salud/index.html