Relación entre sobrecompromiso y síntomas somáticos en enfermeras de un hospital de II nivel en Perú

Objetivo : Determinar la relación entre sobrecompromiso y síntomas somáticos en enfermeras de un hospital de II nivel en Perú. Material y métodos : Investigación observacional, transversal y correlacional, con una muestra probabilística de 106 enfermeras. Se aplicó el Cuestionario de Siegrist y Meter para medir sobrecompromiso y desequilibrio esfuerzo recompensa, y el Cuestionario de Salud (PHQ15) para síntomas somáticos. Se construyó un modelo de regresión logística, considerando variables sociodemográficas y laborales. Resultados : En las enfermeras que presentaron síntomas somáticos moderados-graves, el 68,3% tuvo un nivel de sobrecompromiso alto. El modelo de regresión mostró que sobrecompromiso (OR = 6,25, p < 0,01), tiempo laboral (OR = 0,74, p < 0,01) y la condición de personal (nombrado o contratado, OR = 49,20, p < 0,01) influyeron en el nivel de síntomas somáticos. El modelo discriminó correctamente el 79% (IC 95%: 0,70 - 0,88) de los casos con síntomas somáticos, siendo el valor 0,43, el que se usò para la clasificaciòn en leve-mìnimo y moderado-grave con una sensibilidad de 73% y especificidad del 74%. Conclusión : Se corroboró una relación significativa entre sobrecompromiso y síntomas somáticos, con un modelo predictivo que logró un nivel elevado de discriminación para identificar personal de enfermería en riesgo.

SUMMARY Objective : To determine the relationship between over commitment and somatic symptoms among nurses in a type II hospital in Peru. Methods : A cross-sectional study with a probabilistic sample of 106 participants was carried-out. The Siegrist and Meter questionnaire was applied to measure over commitment and imbalance effort-recompense and the Health Questionnaire (PHQ15) was applied to evaluate somatic symptoms. A logistic regression model was built considering sociodemographic and labor variables. Results : The 68.3% of nurses that presented with moderate to severe somatic symptoms had a high level of over commitment. The regression model showed that over commitment (OR = 6.25, p < 0.01), time in the working place (OR = 0.74, p < 0.01) and labor status (staff or hired temporarily OR = 49.20, p < 0.01) influenced the level of somatic symptoms. The model discriminated well the 79% (95% CI: 95%: 0.70 - 0.88) of somatic cases. A value of 0.43 was selected to discriminate between mild to moderate-severe with a sensitivity of 73% and 74% specificity. Conclusions : A signifcant correlation between over commitment and somatic symptoms ws found. The regression model attained a high discriminative level to identify nurses at risk.

Los trastornos psicosomáticos en el niño y el adolescente / The psychosomatic disorders in children and adolescents

Los trastornos psicosomáticos se caracterizan por manifestaciones somáticas de origen no patológico y poseen una significativa prevalencia en niños y adolescentes; sin embargo, resulta difícil identificarlos, pues no existe un consenso adecuado para su diagnóstico y las investigaciones acerca del tema son insuficientes. Lo anterior condujo a efectuar el presente artículo, en el que se abordan aspectos etiopatogénicos y clinicoepidemiológicos que proporcionan los principales elementos para identificar dichos trastornos y establecer un diagnóstico acertado; asimismo se destaca que estas afecciones son frecuentes en poblaciones infantojuveniles con rasgos de introversión y/o antecedentes personales y familiares de enfermedades físicas y mentales, y que su causa es multifactorial, aunque entre los muchos factores sobresalen la vulnerabilidad al estrés, la disfunción familiar, la sobreprotección parental, así como también las situaciones precipitantes (acoso escolar, separación de los padres, abuso sexual) y las perpetuadoras; estas últimas están condicionadas por los beneficios primario y secundario que los menores obtienen de estos padecimientos.

The psychosomatic disorders are characterized by somatic signs of non-pathological origin which possess a significant prevalence in children and adolescents; however, it is difficult to identify them, because there is no appropriate consent for its diagnosis and the investigations about the topic are insufficient. That is the reason why we decided to carry out the present work, in which some etiopathogenic, clinical and epidemiological aspects are approached that provide the main elements to identify these disorders and to establish a good diagnosis; it is also relevant that these disorders are frequent in juvenile populations with introversion features and/or personal and family history of physical and mental diseases, with multifactorial cause, although among the many relevant factors we can mention vulnerability to stress, family dysfunction, parental overprotection, as well as the precipitant situations (school harassment, parents' separation, sexual abuse) and the permanent situations; the latter are conditioned by the primary and secondary benefits that minors obtain with these sufferings.

Relevancia de la menopausia y del apoyo social en las diferencias en salud entre mujeres y hombres / Relevance of the Menopause and Social Support in Gender Differences in Health

RESUMEN Se analizó la relevancia de la menopausia y el apoyo social en las diferencias en salud entre mujeres y hombres mediante un estudio transversal realizado con 710 mujeres y 606 hombres de la población general española con edades entre 20 y 65 años. Se encontró que, aunque en la juventud apenas había diferencias entre hombres y mujeres, a partir de la perimenopausia las mujeres informaban de más insomnio y síntomas vasomotores que los hombres, así como de más dolor durante la postmenopausia. El apoyo social percibido se asociaba con mejor salud, sobre todo en las mujeres en postmenopausia y premenopausia.

ABSTRACT This study examined the relevance of the menopause and social support in gender differences in health. A cross-sectional survey of a general population sample comprising 710 women and 606 men, aged between 20 and 65 was carried out. No health differences were found between younger men and women. However, perimenopausal women reported more insomnia and vasomotor symptoms, as well as they reported more pain than men through the postmenopause. Perceived social support was associated with better health, especially in premenopausal and postmenopausal women.

Síntomas somáticos en preadolescentes de 10 a 12 años con sobrepeso u obesidad / Somatic symptoms in preadolescents aged 10-12 years with overweight or obesity

Resumen: INTRODUCCIÓN: Numerosos estudios han relacionado la obesidad y el sobrepeso con síntomas físicos, psicológicos y sociales, pero son escasos los trabajos que examinan la presencia de síntomas somáticos en niños con exceso de peso. OBJETIVO: Conocer si existen diferencias en la manifestación de síntomas somáticos en preadolescentes de 10 a 12 años en función de su categoría ponderal (normopeso y sobrepeso/obesidad), así como en otras variables relacionadas con la enfermedad (veces en el último mes que han estado enfermos, que han acudido al médico o que han faltado a clase por estar enfermos y existencia de enfermedades en los miembros de su familia). MÉTODO: Se trata de un estudio transversal de casos y controles en el que participaron 668 preadolescentes, de los que 301 presentaban normopeso y 367 exceso de peso (obesidad o sobrepeso). Los participantes completaron el Children's Somatization Inventory que examina la presencia de síntomas gastrointestinales, pseudoneurológicos y dolor. Para el análisis de los datos se llevó a cabo un análisis multivariado de la varianza. RESULTADOS: No se hallaron diferencias significativas en función de la categoría ponderal en la manifestación de síntomas somáticos. Las diferencias fueron significativas únicamente en función del sexo, presentando las niñas más síntomas gastrointestinales que los niños (F [1,666] = 8.71; p = .003). Al examinar la sintomatología en cada subgrupo, se hallaron diferencias entre los niños con normopeso y obesidad/sobrepeso, mostrando estos últimos más falta de energía o cansancio (χ2 = 5.35; p < .05), dificultad para respirar (χ2 = 7.51; p < .01), convulsiones (χ2 = 4.12; p < .05) y mala digestión (χ2 = 4.89; p < .05). Además, fue mayor el porcentaje de niños con normopeso que no tiene ningún familiar enfermo respecto a los que presentaron obesidad o sobrepeso (χ2 = 2.47; p < .01). DISCUSIÓN Y CONCLUSIÓN: En su conjunto, los resultados confirman la necesidad de valorar de forma exhaustiva y multidisciplinar la sintomatología física y psicológica de los niños y niñas obesos y con sobrepeso, para poder ofrecer una intervención exitosa, no sólo centrada en la reducción de peso, sino en la mejora de su calidad de vida.

Abstract: INTRODUCTION: Numerous studies have linked obesity and overweight with physical, psychological and social symptoms, but few of them have examined the presence of somatic symptoms in children or adolescents with obesity or overweight. OBJECTIVE: To examine somatic symptoms in preadolescents from 10 to 12 years old depending on their weight category (normal weight and overweight/obesity), as well as other variables related to the disease (times that preadolescents had been sick, had gone to the doctor or had been absent to class for having a disease in the last month, and existence of diseases in the members of their family). METHOD: A cross-sectional study was carried out with 668 pre-adolescents; 301 of them showed normal weight and 367 showed overweight or obesity. They completed the Children's Somatization Inventory that examines gastrointestinal symptoms, pseudoneurological symptoms, and pain. A multivariate analysis of the variance was performed to analyse the data. RESULTS: No significant differences in gastrointestinal symptoms, pseudoneurological symptoms and pain in function of the weight category were found. Differences were only significant in function of gender, showing girls more gastrointestinal symptoms than boys (F [1,666] = 8.71; p = .003). When examining each somatic symptom, differences were found depending on the weight category, showing participants with overweight or obesity more fatigue (χ2 = 5.35; p < .05), breathing problems (χ2 = 7.51; p < .01), seizures (χ2 = 4.12; p < .05), and poor digestion (χ2 = 4.89; p < .05). The percentage of participants with overweight or obesity who had a sick relative was higher comparing to those with normal weight (χ2 = 2.47; p < .01). DISCUSSION AND CONCLUSION: Overall, the results highlight the importance of examining physical and psychological symptoms in pre-adolescents with overweight or obesity to develop a successful intervention focused not only on the weight reduction but also in the improvement of their quality of life.

Aplicación de la terapia de afrontamiento del estrés en dos poblaciones con alto estrés: pacientes crónicos y personas sanas / Effectiveness of stress management therapy in two populations with high stress: chronic patients and healty people

Introduction Stress is currently considered a health risk factor. Numerous studies have shown that people with high levels of perceived stress present a greater number of complaints at both the physical and psychological levels. In this context, programs have been developed directed toward adequately coping with stress, and the effectiveness of these programs on the symptomatology of a psychological nature in healthy persons with a high level of perceived stress has been shown. However, there have been fewer studies that have shown whether this type of therapy affects the somatic symptomatology of healthy people in any way. On the other hand, programs for chronically ill patients directed toward achieving a better adaptation to their life conditions are equally effective. A population that presents considerably high levels of stress is the one consisting of people suffering from a chronic illness. Thus, through the immunological modulation it produces, the stress may be exacerbating the course of the disease. One prototype of this is systemic lupus erythematosus (SLE). SLE is a syndrome whose clinical expression depends on the degree to which there is a convergence of an immune regulation disorder and a strong genetic base, hormonal influence, and various exogenous agents. SLE can be manifested by general malaise, fever, fatigue, weight loss, skin rashes, joint inflammation, anemia, inflammation of the lymphatic glands, lowering of the defenses against infection, and cardiac, kidney, neurological, and pulmonary alterations. This autoimmune disease is usually associated with high levels of pain and impairment in different systems, producing high levels of stress in the patients who suffer from it. Nevertheless, although stress has already been shown to be one environmental factor that can produce a worsening in lupus symptoms, there have been no studies carried out with the objective of testing the effectiveness of stress management therapy and its physical and emotional consequences in these patients. For this reason, this study has a double objective: on the one hand, to corroborate, once again, the efficacy of cognitive-behavioural stress management therapy in the control of certain psychological processes and, on the other hand, to take one more step by testing whether there is a reduction in the perception of self-reported somatic symptoms both in healthy people and in those with a chronic disease. Material and method Fifty-two people participated in this study. Twenty-two were patients with lupus from the University Hospital in Granada. The other 30 were people without chronic diseases who attended the Psychological Attention Service at the University of Granada to receive therapy for coping with stress, as they claimed to have high levels of it. To evaluate the level of stress, we used the Stress Vulnerability Inventory by Beech, Burns and Scheefield, and the Scale of Recent Life Experiences (SRLE) by Kohn and Macdonald. To evaluate depression, we used the Beck Depression Inventory (BDI), and for anxiety, the Trait Anxiety Inventory (STAI-R) by Spielberger, Gorsuch and Lushene. For the self-reported somatic symptoms, we used the Revised Somatic Symptoms Scale (SSS-R) by Sandín, Valiente and Chorot. In addition, in the patients with SLE, the SLEDAI index, or Index of Activity of the Disease, was obtained. The therapy received was cognitive-behavioural in nature, and it was carried out during 13 sessions which were grouped in the following blocks: Conceptualization of the stress, cognitive restructuring; Deactivation techniques; Approaching the self-management of the pain; Social skills; Time control and organization; Personality pattern and its relationship with health; Anger management; Humour and optimism as coping strategies. Results Results showed that both groups presented a statistically significant reduction in stressful life experiences [F(1 .50) = 28.6; p<.000], vulnerability to stress [F(1 .50) = 1 05.25; p<0.000], depression [F(1 .50) = 68.33; p<0.000], and anxiety [F(1 .49) = 54.53; p<0.000] after the treatment. Moreover, the effect size of these variables was high in the group of patients with lupus and in the group of healthy patients, although it was higher in the latter group. Likewise, both groups presented a statistically significant improvement in the physical function, producing a reduction in the perceived somatic symptoms [F(1 .48) = 37.7; p<0.000] after the treatment. Furthermore, the effect of the treatment was high in both groups. Discussion This paper addresses a critically important issue: the effectiveness of cognitive-behavioral intervention in ameliorating psychosocial stress and enhancing the well-being of individuals with lupus and the group of people with high stress. In this improvement, there was not only a significant reduction in the score on vulnerability to stress and stressful life experiences, but a reduction in the levels of anxiety and depression and somatic symptoms. The findings of improvements in somatic symptoms suggest that this intervention might facilitate coping and change the cognitive appraisals of symptoms. Likewise, the impact of the intervention on psychosocial outcomes (depression, anxiety and perceived vulnerability to stress) may have implications for longer-term health behaviors and health outcomes. Although this reduction is significant in both groups, the effect size is greater in the group of people with high stress than in the group of lupus patients. Specifically, the somatic symptoms where a lower effect of the therapy was observed were the immunological, respiratory, musculoskeletal, and dermatological symptoms, which coincide with the most characteristic symptoms of lupus. This study supports, therefore, the importance of stress management programs not only to reduce the amount of stress, but also to improve the emotional variables and physical condition, both in people with chronic diseases and in healthy people with a high level of stress. The cognitive-behavior therapy is a new effective line of action in dealing with lupus, being necessary an overall integrated view of the patients with lupus, treating the clinical and psychological aspects.

Introducción Actualmente, el estrés se considera un factor de riesgo para la salud. Diversos estudios ponen de manifiesto que altos niveles de estrés presentan mayor número de quejas, tanto en el nivel físico como psicológico. En este contexto, se han desarrollado programas dirigidos a un adecuado afrontamiento del estrés, que han resultado eficaces en la modificación de variables emocionales. Sin embargo, no se ha estudiado la eficacia de la terapia en la mejoría de síntomas somáticos. Por otra parte, existen enfermedades en que, por la modulación inmunológica que produce, el estrés puede actuar exacerbando el curso de ésta. Un prototipo de lo anterior es el lupus eritematoso sistémico (LES), enfermedad de carácter autoinmune que suele conllevar importantes niveles de dolor y deterioro de diferentes sistemas, con lo que a su vez produce altos niveles de estrés en los pacientes que lo padecen. También está ampliamente demostrado que el estrés puede actuar como exacerbador de la enfermedad. Pese a ello, no se ha llevado a cabo ningún estudio que tenga como objetivo comprobar la eficacia de la terapia de afrontamiento al estrés por sus consecuencias físicas y emocionales. Por ello, el objetivo de este estudio ha sido valorar la eficacia de la terapia cognitivo-conductual en el manejo del estrés para comprobar si disminuye la percepción de los síntomas somáticos autoinformados, tanto en personas sanas como en personas con lupus. Material y método En este estudio han participado 52 personas, de las cuales 22 eran pacientes con lupus y 30 eran personas con alto estrés. Para evaluar el nivel de estrés hemos utilizado el Inventario de Vulnerabilidad al Estrés y la Escala de Experiencias Vitales Recientes (SRLE); para evaluar la depresión, el Inventario de Depresión de Beck (BDI); para la ansiedad, el Inventario de Ansiedad Rasgo (STAI-R); y para los síntomas somáticos autoinformados, la Escala de Síntomas Somáticos-Revisada (ESS-R). Además, en los pacientes con LES, se obtuvo el índice SLEDAI o índice de actividad de la enfermedad. Ambos grupos se evaluaron en las diferentes variables psicológicas descritas previamente antes y después del tratamiento. La terapia recibida fue de tipo cognitivo-conductual y se desarrolló a lo largo de 13 sesiones de hora y media. Resultados Los resultados mostraron que ambos grupos presentaban una reducción estadísticamente significativa en experiencias vitales estresantes [F(1 .50) = 28.6; p<0.000], vulnerabilidad al estrés [F(1.50) = 105.25; p<0.000], depresión [F(1.50) = 68.33; p<0.000] y ansiedad [F(1 .49)=54.53; p<0.000] después del tratamiento. El tamaño del efecto en estas variables fue alto tanto en el grupo de pacientes con lupus como en el grupo de personas sanas, siendo mayor en este último. Asimismo, ambos grupos presentaron una mejora estadísticamente significativa de la función física y se produjo una disminución de los síntomas somáticos percibidos [F(1 .48) = 37.7; p<0.000] después del tratamiento. Además, aunque es alto en ambos grupos, el efecto del tratamiento es mayor en el grupo de personas con alto estrés percibido. Discusión Nuestros datos indican que la terapia de afrontamiento del estrés influye positivamente tanto en el grupo de personas con alto estrés como en el grupo de pacientes de lupus. En dicha mejoría disminuyen de forma significativa las puntuaciones de vulnerabilidad al estrés, experiencias vitales estresantes, ansiedad y depresión. Por otro lado, con respecto a los síntomas somáticos experimentados por ambos grupos, los resultados muestran un descenso de la percepción de los mismos. Aunque esta disminución es significativa, el tamaño del efecto es mayor en el grupo de personas con alto estrés. Este estudio apoya, por tanto, la importancia de un programa de afrontamiento del estrés no sólo para disminuir la cantidad de estrés, sino para mejorar las variables emocionales y el estatus físico tanto en personas con enfermedades crónicas como en personas sanas, pero con alto estrés.

Roles sexuales y salud mental en una muestra de la población general española / Sex roles and mental health in a sample of the general Spanish population

Research on gender differences in health has generally shown that women report higher levels of minor psychiatric morbidity than men. One of the explicative variables for these findings is the different social roles of women and men. Sex role ideology refers to beliefs about appropriate roles for each gender, and is relevant from a psychological point of view because it is associated with self-definition, interactions between men and women and social relations. Most societies consider that women and men are different and consider that they should adopt different roles. These roles determine different social behaviors. Masculinity and femininity refer to feature differences, behaviours and interests assigned by society to each gender. The other two gender role categories proposed by Sandra Bem are androgyny (characterized by the presence of feminine and masculine characteristics) and an undifferentiated sex role (referring to individuals who have low levels of masculine or feminine characteristics). Classic theories on sex typing and gender role differences between women and men have suggested that such differences have been considered as normal and healthy, since they reflect social norms regarding appropriate behaviour in women and men. Furthermore, there is a tendency within mental health professionals who view masculine men and feminine women as normal and healthy. Nevertheless, research on this matter has not provided empirical evidence in relation to such hypotheses. It has also been suggested that reversing gender ideals can be stressful for men and women because such ideals are socially imposed, and therefore, obstruct self-regulation and are connected to the external representation of self-value. The aim of the current study is to find out whether there are mental health differences in a sample of the general Spanish population among the categories of sex role proposed by Sandra Bem. These categories are: masculine, which refers to individuals with high scores in masculinity and low scores in femininity; feminine, which comprises those individuals with high scores in femininity and low scores in masculinity; androgynous, which includes individuals with high scores in masculinity and femininity; and undifferentiated, which gathers those individuals with low scores in masculinity and femininity. The sample included 197 women and 140 men from the general population who voluntarily took part in the study. Participants ranged in age from 17 to 74 years, with a mean of 32.2 years (SD = 12.2), and with different social and demographic characteristics. They were assessed using the Bem Sex Role Inventory (BSRI), the Goldberg General Health Questionnaire (GHQ-28) and the Self-Esteem Inventory (SEQ). In order to know whether there were any statistically significant differences in health according to sex roles, and whether these interacted with gender, analysis of variance(ANOVA)and multivariate analysis of variance (MANOVA) were performed. The factors in all of them were the four sex role categories (androgynous, masculine, feminine and undifferentiated) and gender (men, women); and the dependent variables were the scores in GHQ-28 in the first group of analysis, and the two self-esteem factors in the second. In the MANOVA where the dependent variables were the four GHQ-28 scales of symptoms, we found that the interaction between sex roles and gender was statistically significant. When performing the analysis independently for each gender, we found that in the male sample there were statistically significant differences only according to sex roles in somatic symptoms. Men with undifferentiated sex roles showed fewer somatic symptoms than men with feminine or androgynous sex roles. In the female sample, we found statistically significant differences according to sex roles in somatic, anxiety and insomnia symptoms. Post hoc analysis with the Bonferroni adjustment showed that statistically significant differences occurred between the female groups with undifferentiated and androgynous sex roles. The latter female group showed fewer somatic, anxiety and insomnia symptoms. The analysis of the differences between women and men in mental health symptoms showed statistically significant differences in somatic, anxiety and insomnia symptoms. Women obtained higher average scores than men. However, there were no statistically significant differences in depressive symptoms nor social dysfunction. When the two factors from the self-esteem questionnaire were considered as dependent variables, the analyses of variance showed that the interaction between sex roles and gender was not statistically significant. Gender main effects were not statistically significant either, however sex role main effects were statistically significant. Post hoc analysis with the Bonferroni adjustment showed that individuals with an undifferentiated sex role evaluated themselves more negatively, and individuals with a masculine sex role evaluated themselves less negatively than those with a feminine sex role. There was no difference in self-confidence between individuals with androgynous sex roles and individuals with a masculine sex role, but both groups showed greater self-confidence than those individuals with feminine or undifferentiated sex roles. The latter group showed less self-confidence than individuals with a feminine sex role. These findings show that sex-typed individuals do not have better mental health or higher self-esteem than androgynous and undifferentiated individuals. Therefore, as in many other studies in other sociocultural settings, our results confirm the lack of empirical evidence for the traditional perspective that masculinity is better for men and femininity is better for women. Our data shows the complexity of relationships between sex roles and health, which depend on gender and on the kind of mental health indicator used. Therefore, while social dysfunction and depressive symptoms seem to be independent from sex role and gender, the effects of sex role on somatic, anxiety and insomnia symptoms were different for women and men. Whereas in the male sample, those with undifferentiated sex roles were the ones showing fewer somatic symptoms, in the women's sample, those with an androgynous sex role were the ones showing less somatic and anxiety and insomnia symptoms compared to those with an undifferentiated sex role. Nevertheless, self-esteem factors showed the highest differences between the various sex role categories. These factors seem to be the same for women and men. For example, we found that individuals with undifferentiated sex roles show higher negative self-worth and lower self-confidence than individuals classified in the other roles. In addition, individuals with a masculine sex role also value themselves less negatively and have higher self-confidence than individuals with a feminine sex role. Lastly, individuals classified in the androgynous sex role have similar self-confidence levels to those with a masculine sex role. The type of mental health symptoms where statistically significant. Differences between women and men are found, these differences were the same as those found in the female sample with regard to sex roles. This seems to indicate the relevance that sex roles have in mental health (in each gender), as some authors have highlighted. However, this study has some limitations to take into account when interpreting the results. Firstly, it is a transversal study, therefore we can talk about association, but not cause-and-effect relations between sex roles and health. Secondly, the sample is not random therefore it is not possible to generalize these results to the population.

Las investigaciones sobre las diferencias de género en salud mental generalmente muestran que los niveles de menor morbilidad psiquiátrica son mayores en las mujeres que en los hombres, siendo una de las variables explicativas de tales diferencias los roles sociales diferenciados en función del sexo. La ideología de los roles sexuales se refiere a las creencias respecto a qué roles son los adecuados para mujeres y hombres. Esto es relevante desde el punto de vista psicológico porque se asocia con la definición de sí-mismo, con las interacciones entre hombres y mujeres y con las relaciones sociales. La mayoría de las sociedades considera que mujeres y hombres son diferentes y deben ocupar roles distintos, por lo que los socializan de forma distinta. Y la masculinidad y la feminidad se refieren a las diferencias en rasgos, conductas e intereses que la sociedad ha asignado a cada uno de los géneros. Las teorías clásicas sobre las diferencias entre mujeres y hombres en roles de género y en tipificación sexual planteaban que tales diferencias eran normales y saludables, ya que reflejaban las normas sociales sobre la conducta apropiada para cada sexo. Además, los profesionales en salud mental tienden a ver a los hombres masculinos y a las mujeres femeninas como normales y sanas. Sin embargo, los resultados de las investigaciones no han aportado evidencia empírica de tales supuestos. Además, recientemente se ha reconocido que la inversión en los ideales de género puede ser estresante para hombres y mujeres porque se trata de ideales impuestos socialmente, dificultan la autorregulación y están relacionados con la representación externa de la autovalía. Pese a ello, la evidencia empírica no es concluyente, habiéndose realizado la mayoría de estudios sobre roles sexuales y salud con muestras anglosajonas, por lo que se desconoce si tal relación se da también en otras culturas. El objetivo del presente trabajo es conocer si existen diferencias en salud mental, en una muestra de la población general española, entre las cuatro opciones de rol sexual propuestas por Sandra Bem: masculinidad, feminidad, androginia e indiferenciación. La muestra estuvo formada por 337 personas de la población general que participaron voluntariamente en el estudio, sus edades oscilaron entre los 17 y 74 años (M = 32.2, SD = 12.2) y presentaron diferentes características sociodemográficas. Las muestras fueron evaluadas con el Bem Sex Role Inventory (BSRI), con el Cuestionario de salud general de Goldberg (GHQ-28) y con el Inventario de autoestima (Self-Esteem Inventory, SEQ). En los resultados encontramos que la asociación entre roles sexuales y salud mental depende del tipo de indicador de salud utilizado. Además, en la sintomatología somática, de ansiedad y de insomnio, también se encontró una relación estrecha con el género. En la muestra de hombres, los clasificados como indiferenciados presentaron menor sintomatología somática respecto a los clasificados como femeninos o como andróginos, mientras que en la muestra de mujeres las clasificadas como indiferenciadas fueron las que tuvieron más síntomas somáticos, de ansiedad e insomnio respecto a las andróginas. El análisis de las diferencias entre mujeres y hombres en sintomatología de salud mental mostró que se daban diferencias estadísticamente significativas en sintomatología somática, de ansiedad e insomnio, teniendo las mujeres puntuaciones medias más altas que los hombres. Sin embargo, no se obtuvieron diferencias estadísticamente significativas en sintomatología depresiva ni en disfunción social. Dichas diferencias coinciden con las obtenidas en la muestra de mujeres al analizar las diferencias en salud mental en función de los roles sexuales. Ello indica la relevancia que los roles sexuales pueden tener en las diferencias de género en salud mental, como han señalado algunos autores. Los resultados de este estudio muestran que el seguimiento de los roles sexuales tradicionales no conllevan a una mejor salud mental. En conclusión, como se ha encontrado en varios estudios realizados en otros entornos socio-culturales nuestros resultados confirman la falta de apoyo empírico para el modelo tradicional en el cual la masculinidad es mejor para los hombres y la feminidad para las mujeres.

Trastorno depresivo mayor en México: la relación entre la intensidad de la depresión, los síntomas físicos dolorosos y la calidad de vida

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SUMMARY Background: Major Depressive Disorder (MDD) is a disease associated to emotional, vegetative and physical symptoms, including for the latter those pain-related symptoms. MDD has a high prevalence rate with a substantial burden of illness, and it expected that by 2020 it will become the second cause of world disability. The diagnosis of MDD is difficult due to the high prevalence of painful physical symptoms, and also due to the fact these symptoms are more evident that the embedded emotional ones. Over 76% of patients with MDD, report painful physical symptoms observed, like headache, abdominal pain, back pain and unspecific-located pain; observing these symptoms can even predict depression severity. In addition, the likelihood of psychiatric disease increases, importantly, with the number of physical symptoms observed; moreover, the remission of physical symptoms predicts the complete remission in MDD. We present an observational, prospective study to examine the clinical profile of Mexican outpatients suffering MDD and determine the relationship between depression severity, painful physical symptoms in quality of life and depression. Methods: Adult patients with current episodes of MDD, treated with antidepressants were included. MDD was defined according to the criteria of the Statistical Manual of Mental Disorders - 4th Edition (DSM-IV) or in the International Classification of Diseases and Related Health Problems, 10th Revision (ICD-10). Patients should have been free of depression symptoms prior to the current episode for at least 2 months. Duration of current episode should not exceed two years. Treatment-resistant patients and those with other psychiatric diagnosis were excluded. Treatment-resistance was defined as: a) a failure to respond to treatment when two different antidepressants were employed at therapeutic doses for at least four weeks each, b) when the subject was previously treated with IMAO inhibitors, c) when electro-convulsive therapy (ECT) was previously employed. Other exclusion criteria comprise previous or current diagnosis of schizophrenia, schizophreniform or schizoaffective disorder, bipolar disorder, dementia or mental impairment. Patients were selected in 34 centers in Mexico. Patients were classified according to the presence (SFD+) or absence (SFD-) of painful physical symptoms using the Somatic Symptom Inventory (SSI); SFD+ was defined as scores ≥ 2 for the pain-related items in the SSI (items 2, 3, 9, 14, 19, 27 and 28). Visual Analogue Scale (VAS) quantified pain severity (cervical pain, headache, back pain, shoulder pain, interference of pain in daily activities and vigil-time with pain). HAMD17 and CGI-S determined depression severity, while the Quality of Life in Depression Scale (QLDS) quantified subjective well-being. Linear regression models were employed to compare groups for VAS, HAMD17, CGI-S, and QLDS, to fit the confusions or clinical predictors when needed. Proportions between groups were established with Fisher exact test or logistic regression. Significance levels were established at 0.005 due to the observational nature of the study. In the result tables, standard deviation (SD) is reported as a variation around the mean value as Mean ± SD, and 95% confidence intervals are denoted 95% IC. Results: A total of 313 patients were enrolled in the study. All of the enrolled patients were Mexican, almost them were women and had at least a previous MDD episode. Painful physical symptoms were reported by 73.7% of patients, these patients were classified into the SFD+ group. Neither statistical nor clinical significant differences between the SFD+ and SFD- groups were found when analyzing socio-demographic variables (age, gender, ethnical origin) and disease history variables (number of previous episodes of MDD, in the last 24 months, duration of current episode). At baseline, patients had a CGI-S mean score of 4.6 and HAMD17 of 26.3. HAMD17 mean score (27.1) in SFD+ patients was significantly higher (p<0.0001) than the SFD- patients (23.8), but nonsignificant differences between groups were found for the subscales central, Maier & retard. CGI-S scores were similar between SFD+ and SFD-; 4.6 and 4.5 respectively (p>0.05). Prevalent painful physical symptoms were also the most painful, when a five-point scale was employed to measure severity, and comprised muscular pain (84.9%), cervical pain (84.2%) and headache (83.5%). SFD+ patients had higher pain severity in all VAS scales (p<0.0001), with perceived severity scores twice as large when compared to SFDgroup. In particular, the global pain VAS reported average values of 49.0 and 19.7 for the SFD+ and SFD- groups respectively. Patients came to the first psychiatric consultation treated with psychotherapy (27.9%), antidepressants (37.3%), anxiolytics (28.6%) and analgesics (9.7%); more than 50% of all patients were not taking any drugs or receiving psychotherapy for treatment of MDD at baseline. Analgesics were used only by 9.7% of patients for the treatment of painful physical symptoms in their current MDD episode. No significant differences between groups were found when comparing the use of psychotherapy, antidepressants, anxiolytics, antipsychotics, mood stabilizers or analgesics. Quality of life was poor for all patients, but significantly worse in the SFD+ group than in the SFD- group (QLDS scores of 23.2 and 20.0 respectively, p<0.001). Discussion: The diagnosis and symptoms manifestation can be influenced by local socio-cultural factors, in particular cultural differences are associated with the prevalence of painful physical symptoms, but this finding is not consistent. The results of this study can be extrapolated to the MDD Mexican population, as selection criteria comprised only operative diagnosis criteria, and not enrollment into the study took place due to the presence of painful physical symptoms. Patients included into the study presented a moderate to severe disease as measured with the HAMD17 scores. The high prevalence of painful physical symptoms in patients with depression was confirmed in this study; it has been reported the patients report pain-related symptoms as the main (even the only) symptom when consulting general practitioners. Painful physical symptoms in MDD include headache, cervical pain, back pain or neck pain; the presence of painful physical symptoms in depression is associated to higher intakes medication, but in this study more than 50% of subjects were not receiving any treatment, including psychotherapy. The treatment of MDD is by no means optimal, as only 30%- 40% of these patients reach complete remission of symptoms with their first antidepressant. Psychological symptoms respond to antidepressant treatment, but in general, this is not the case for the physical symptoms. The lack of efficacy can be explained as a failure in the treatment of these painful physical symptoms. Resolving these symptoms is even a predictor for the complete remission of MDD; the evidence might suggest that treatment of emotional and physical manifestations of depression could improve successful-treatment rates. Conclusion: As found in other reports, a high prevalence of painful physical symptoms was found in MDD patients. Increase in pain severity is associated with higher HAMD17 scores but not CGI-S scores; this discrepancy in the final rates obtained with both scales suggests that both emotional and physical dimensions of MDD should be considered when the clinical assessment is performed. We concluded that clinical judgment of Mexican psychiatrists differs between their global impression and a semi-structured interview in the same patient and therefore is fundamental that the clinical evaluation consists of both emotional and physical manifestations as important components of MDD.

Relación entre nivel de consumo de alcohol, salud mental y síntomas somáticos en un grupo de trabajadores de la industria gastronómica y hotelera de la Ciudad de México

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Abstract: In facilitating the presence of risk behaviors for health, some conditions inherent to the gastronomical and hotel industry may significantly affect the people working in this market. Among them are non-regular working days, temporary employment, law salaries, problems at work, low professional prestige, minimum development opportunities, bad relationships with managers, and unsafe conditions in the job environment. In comparison with other work areas, this is one of the sectors with higher risk of problems related to alcohol use, mainly due to the availability of the substance in the work place, to the social pressure, to the working schedules, and to the way people cope with stress at work. Due to movements, rhythm, and techniques used in the activities performed in this kind of job, it is possible to develop bones and muscles alterations, and because of constant changes in labor shifts circadian cycles suffer disruptions that lead to different somatic symptomatologies. Studies in workers have shown that problematic alcohol consumption is present in 33-44% of this population. Other studies have found prevalences up to 24% of mental disorders in workers. The Department of Labor has reported that, as part of work diseases, mental and behavioral disorders increased its prevalence of 0.3% in 1999 to 1.9% in 2003. On the other hand, some studies report an association between mental disorders, somatization, and alcohol use in general population. People spend a considerable portion of their lives at their work places and working in gastronomic and hotel industry implies high risk for health. The objective of this paper is to know the association among alcohol use, the number of symptoms regarding mental health problems, and the level of discomfort caused by somatic symptoms in a sample of gastronomic and hotel industry workers from Mexico City. Material and method Population and sample Sampling was non-random, on convenience, and by quota. The sample included 194 men, over 18 years old, who were working at companies from the gastronomic and hotel industry in Mexico City. Most of the subjects were under 45 years old, over half of them studied until junior high school. The most frequent position among the subjects was waiter. Working days vary, depending on the day and time banquets and receptions are programmed. Over two thirds of the subjects mentioned having three or less years working in this kind of job. Questionnaire The short version of the AUDIT (first three questions) was used to establish the level of alcohol use. This version allows to rate subjects in three levels, according to the amount and frequency of consumption: low risk use, risk use, and dangerous use. The five-item Mental Health Inventory (MHI-5) was used to determine the presence of mental health problems. The MHI-5 is a screening test that measures non-psychotic affective disorders, according to DSM-IV criteria, with no reference to specific disorders. The Symptoms Check List-90 (SCL-90) was used to identify psychological stress derived from somatic symptoms. The three scales have good levels of reliability and validity. The field team talked to the managers of the training department at the union, because all the subjects in the sample were affiliated, to get permission to collect the information. No invasive techniques were used nor any other type of intervention. Subjects responded to the questionnaire gathered in groups inside a training room. The fieldwork involved trained interviewers, whose training was voluntary. All the workers accepted to participate and to respond the questionnaire through a verbal agreement. Participation was anonymous and neither the union representatives nor the managers had access to individual questionnaires, which granted confidentiality. The union representatives acknowledged a global report that intended to make them aware of the magnitude of the alcohol use and mental health problems among their affiliates. SPSS 10 software was used to analyze data. Results A total of 44.2% of the subjects reported drinking four or more drinks per occasion; 60.9% of them mentioned they had drunk six or more drinks per occasion during the last year; 55.5% of the workers were located in a low risk consumption level; 43.1% had a risky consumption level, and 10.4% consumed at a dangerous level. Results regarding mental health showed that a quarter of the subjects «have felt uneasy¼ (26.1%), 16.7% «have felt happy¼, 9.7% «have felt sad and melancholic¼, 8.4% «have felt down or as if nothing could cheer them up¼, and 4.3% «have been very nervous¼. A cut-off score of 16 or higher allowed identifying 11% of cases with symptoms of a possible mental health problem. Most of the subjects (69.6%) mentioned having experienced at least one somatic symptom during the last month. The ones that caused more discomfort were muscular pain (17.6%), backaches (12%), headaches (9.7%), weakness in some part of the body (7.1%), and nausea (6.7%). A cut-off score of eight or higher allowed to identify 14.7% of cases with somatic symptomatology that caused psychological distress. A Pearson correlation analysis was performed and the results showed a significant association between the level of alcohol consumption and the discomfort due to somatic symptoms (pr=.404^><.01). Significant associations were also found between the mental health state and the discomfort due to somatic symptoms (pr=.339 ^><.01), and between the level of alcohol consumption and the mental health state (pr=.260 ^><.01). Discussion and conclusions The percentage of alcohol consumers, the amount of alcohol consumed, the frequency of consumption, and the prevalence of problematic consumption were higher in this group of workers when compared to employees from other occupations. This can be the result of a mayor substance availability within gastronomic and hotel work environments. The association between alcohol use and the number of symptoms of mental health problems may be an indicator of co-morbidity between both conditions. It is also possible that the association is related to excessive alcohol use as a way to cope with emotional problems. The somatic symptoms with the highest prevalence were part of the somatization scale, but there is a possibility that they are indicators of an illness or disease derived from the labor activity instead of indicators of somatic symptoms. On the other hand, whether alcohol use increases frequency of mental and physical troubles or that consumption is present as a reaction to these troubles, more research is necessary to know more about these variables co-morbidity because these relate to the presence of accidents, problems at work, social and family problems, as well as economic burden. The use of screening scales in working settings is important because it reduces costs and helps to identify related problems. In addition, they are easy to use at factories and businesses without interfering with the manufacturing processes. Nevertheless, it is important to use more specific instruments with identified cases. This would permit a more precise diagnosis and, if necessary, to refer subjects to institutions that provide specialized health care. To have such a structure would reinforce protective factors for subjects to cope with the risks inherent to their professional activity. Limitations and suggestions Conclusions are valid only for the workers in this sample because of the sampling method and they cannot be applied to all the workers of the gastronomic and hotel industry. So far, studies about substance use in working settings have focused on men population; however, women are an important segment that researchers should consider investigating to collect information that can sustain proper and necessary actions.

Burnout y síntomas somáticos cardiovasculares en enfermeras de una institución de salud en el Distrito Federal / Burnout syndrome and cardiovascular somatic symptoms in nurses from a health facility in the Distrito Federal

Introducción: El Burnout se presenta con relativa frecuencia en el personal que labora en instituciones de salud como una respuesta psicosocial afectiva de encontrarse emocionalmente agotado, se manifiesta por actitudes y sentimientos negativos hacia las personas con las que se trabaja. Objetivos: 1) Identificar el nivel de Burnout en un grupo de enfermeras de una institución de salud en el Distrito Federal; 2) Determinar la relación entre el Síndrome de Burnout, los síntomas somáticos cardiovasculares y las cifras de presión arterial. Metodología: En 109 enfermeras, se evaluó el nivel de Burnout con el Cuestionario Maslach Burnout Inventory-General Survey (MBIG-S) en versión CORE con dos subescalas: agotamiento emocional (0.85) y despersonalización (0.78); un cuestionario de síntomas cardiovasculares y un protocolo de puntos estimados de presión arterial puntual en el puesto de trabajo. Resultados: En 67% de las enfermeras predominó el Burnout en nivel medio; los niveles bajo y alto se presentaron en 19% y 14% respectivamente. Se obtuvo correlación significativa (r=348 p<0.01) entre los síntomas cardiovasculares y Burnout; al igual que con el componente de agotamiento emocional (r=374 p<0.01). La relación entre las cifras de TA y Burnout no fue significativa. Conclusiones: La relación significativa entre los síntomas cardiovasculares y Burnout, indican subjetivamente una primera manifestación de enfermedad cardiovascular, que posteriormente puede ser somatizada. En el caso de agotamiento emocional y síntomas cardiovasculares, se plantea la hipótesis de que a mayor cansancio físico y emocional percibido en y por el trabajo hay un aumento en la presencia de síntomas de enfermedad cardiovascular.

Introduction: Burnout syndrome is relatively often present in personnel who work in health facilities as an affective psychosocial response of showing oneself emotionally exhausted; it is manifested through negative attitudes and feelings toward workers. Cardiovascular diseases are de most significant among the produced physical alterations. Objectives: 1) To identify the level of Burnout Syndrome within a group of nurses in a health facility in the Distrito Federal; 2) To determine the relation between Burnout Syndrome, cardiovascular somatic symptoms, and blood pressure measurements. Methodology: In 109 nurses Burnout score was assessed through Maslach Burnout Inventory-General Survey (MBIG-S) Core version with two subscales: emotional tiredness(0.85) and depersonalization (0.78); a questionnaire of cardiovascular symptoms and a protocol of estimated points of blood pressure at work. Results: 67% of nurses were predominant with medium Burnout score; low and high levels were represented with 19% and 14% respectively. It was obtained a significant correlation (r=348 p<=0.01) between the cardiovascular symptoms and Burnout syndrome, as well as with the component of emotional tiredness (r=374 p<=0.01). The relation between blood pressure and Burnout Syndrome it did not show significance. Conclusions: The significant relation between cardiovascular symptoms and Burnout syndrome showed subjectively a first manifestation of cardiovascular disease which can be physically exposed latter. In the case of emotional tiredness and cardiovascular symptoms, a hypothesis is founded: as long as physical and emotional tiredness are perceived in and by working, there is an increment in presence of cardiovascular disease.