Necesidades de atención en salud mental y uso de servicios en población mexicana con trastornos mentales graves / Mental health care needs and use of services in Mexican population with serious mental disorders

Resumen: Objetivo: Analizar las demandas de atención de los trastornos mentales graves (TMG) y factores asociados con la utilización de servicios en México. Material y métodos: Se llevó a cabo un estudio analítico transversal en dos fases: la primera con una base de datos nacional de servicios disponibles y su utilización; la segunda, una muestra de registros médicos de un hospital psiquiátrico. Resultados: La esquizofrenia es el TMG más prevalente; más de 50% de hospitalizados fueron hombres, con edad promedio 37 años. La utilización de servicios estuvo asociada con la edad (β=1.062; p=.000), ingreso familiar (β=1.000, p=.000) y no tener ocupación (β=3.407; p=.000). La población con esquizofrenia tiene cuatro veces más la probabilidad de requerir estar exenta de pago (β=4.158; p=.000). Conclusiones: La población con TMG es más vulnerable por la discapacidad funcional y social asociada; requiere de intervenciones específicas de salud acompañadas de una política de protección financiera adaptada a sus necesidades de atención.

Abstract: Objective: To analyze the mental health care needs of the serious mental disorders (SMD) and factors associated with the use of services in Mexico. Materials and methods: A cross-sectional analytical study was conducted in two phases, the first with a national database of available services and its utilization; the second, a sample of medical records of a psychiatric hospital. Results: Schizophrenia is the most prevalent MDS; more than 50% of those hospitalized were male, with an average age of 37 years. The use of services was associated with age (β=1.062, p=.000), family income (β=1.000, p=.000) and no laboral occupation (β=3.407, p=.000). The population with schizophrenia is four times more likely to require to be exempt from payment (β=4.158, p=.000). Conclusions: The population with SMD as schizophrenia is more vulnerable due to the associated functional and social disability and it requires specific heath interventions and a financial protection policy adapted to their mental health care needs.

Contextos y desafíos para la atención de la salud mental en el primer nivel. Una aproximación socioecológica / Contexts and challenges for mental health care at the first level. A socioecological approach

Resumen: Objetivo: Analizar la situación actual de la atención de la salud mental a partir de un análisis socioecológico, sustentado en las percepciones del personal y usuarios de centros de salud (CS) de la Ciudad de México (CDMX). Material y métodos: Estudio exploratorio descriptivo de métodos mixtos (CUALI → CUAN). En la fase cualitativa, se entrevistó al personal de 19 centros ubicados en tres delegaciones de la CDMX y, en la fase cuantitativa, se aplicó un cuestionario a pacientes. Resultados: Se identificó la influencia e interdependencia de diferentes factores que impactan la atención de la salud mental (SM). El personal de salud y pacientes reconocen escases de recursos que impactan la calidad del servicio, políticas públicas en SM que no siempre se concretan en la práctica y un modelo de atención que no permite ahondar en problemas emocionales. Conclusiones: Mejorar la atención de la SM en el primer nivel requiere de un trabajo reflexivo desde diversas ópticas.

Abstract: Objective: To analyze the current status of mental health care through a socioecological analysis, based on the perceptions of health center (HC) staff and users in Mexico City (CDMX). Materials and methods: Descriptive exploratory study of mixed methods (QUALI→ QUANT). During the qualitative phase, staff at 19 centers located in three Mexico City boroughs were interviewed and during the quantitative phase, a questionnaire was applied to patients. Results: The influence and interdependence of the various factors impacting mental health (MH) care were identified. Health personnel and patients mentioned limited resources, which impact service quality, public MH policies that are not always implemented in practice and a care model that does not make it possible to delve into emotional problems. Conclusions: Improving MH care at the primary care level requires reflective work from a variety of perspectives.

Malestar psicológico en mujeres con embarazo de alto riesgo / Psychological distress in high-risk pregnant women

La experiencia emocional de la mujer con embarazo de alto riesgo ante la maternidad es un tema poco estudiado, a pesar de la importancia que tiene preservar su salud emocional durante este proceso. Esta investigación analizó la experiencia de malestar psicológico en mujeres con embarazo de alto riesgo, según el riesgo médico diagnosticado, su vivencia de la maternidad y el papel que juegan la pareja, familia y redes de apoyo durante la gestación. Se realizó un estudio instrumental de casos múltiples. Se hicieron entrevistas semiestructuradas a 12 mujeres adultas con diagnóstico médico de embarazo de alto riesgo y se formaron tres grupos. Se realizó un análisis de significados de Kvale de los datos obtenidos. Los resultados mostraron que la vivencia de la maternidad y la manifestación de malestar psicológico en estas mujeres era diferente, dependiendo del riesgo médico diagnosticado. Además, podía ser de menor o mayor intensidad debido a la falta de planeación del embarazo, las experiencias obstétricas previas, no tener hijos vivos y contar con el apoyo de la pareja y la familia. Las mujeres con embarazo de alto riesgo vivían la maternidad como una experiencia dolorosa, con mucha angustia y miedo de perder el nuevo embarazo por complicaciones.

The emotional experience of maternity in high-risk pregnant women is a subject that has been seldom studied, despitethe importance of preserving the emotional health of women during this stage. This research analyzed the experience of psychological distress in women with high-risk pregnancy according to the medical risk diagnosed, their experience of maternity and the role of the partner, family and support networks during pregnancy. An instrumental multiple cases study was performed. By semi-structured interviews, we interviewed 12 adults’ women with medical diagnosis of high-risk pregnancy and three groups were formed. A Kvale analysis of meanings was performed on data. The results showed that the experience of motherhood and the manifestation of psychological distress in these women were different depending on the diagnosed medical risk; it may be of lower or higher intensity due to the lack of family planning, previous obstetric experiences, the lack of living children and also the support of the partner and the family. High-risk pregnant women lived mate I ty as a painful experience, with great anxiety and fear of losing the new pregnancy for medical complications.

Actitudes hacia la homoparentalidad: Validación psicométrica de dos escalas en una muestra de estudiantes mexicanos / Atitudes em relação à homoparentalidade: validação psicométrica de duas escalas numa amostra de estudantes mexicanos / Attitudes Towards Homoparentality: Psychometric Validation of two Scales in a Sample of Mexican Students

Introducción: La legalización del llamado matrimonio igualitario, y de la adopción de menores por parejas homosexuales, es un fenómeno reciente y que debe ser estudiado, para lo cual es necesario contar con medidas confiables que permitan dar cuenta de cómo la sociedad percibe esta nueva configuración familiar. Objetivo: Determinar las propiedades psicométricas de dos escalas: Actitudes frente a las familias Homoparentales (AFFH); y creencias acerca del ajuste de los niños de familias homoparentales (CANFH). Metodología: La AFFH, con 20 reactivos, fue diseñada para dar cuenta de las actitudes hacia las familias homoparentales. La CANFH tiene 14 reactivos organizados en las subescalas de oposición individual (OI) y oposición normativa (ON). Ambas escalas tienen afirmaciones que deben ser respondidas con opciones tipo Likert que van del 1 totalmente de acuerdo, al 5 totalmente en desacuerdo. La CANFH fue aplicada a 170 estudiantes universitarios (78 (46%) hombres, 92 (54%) mujeres. Media de edad: 18.4 DE+0.94), y la AFFH a 88 (35 (40%) hombres, 53 (60%) mujeres. Media de edad: 18.2 DE+0.84). Se determinaron las propiedades psicométricas por medio de análisis factorial y de consistencia interna. Resultados: La AFFH resultó con un α=0.91; los reactivos se organizaron en dos factores que explican 46.14% de la varianza. En el caso de la CANFH se confirmó la estructura factorial de dos subescalas explicativas de 65.49% de la varianza y con un α=0.94. Conclusiones: Los datos indican que ambas escalas poseen las propiedades psicométricas adecuadas para medir las actitudes de estudiantes mexicanos hacia las familias homoparentales y hacia los efectos que estas puedan tener en los menores adoptados...(AU)

Introduction: Same-sex marriage and adoption legalization constitute a growing and relatively new research field. Its study needs reliable and valid measures that allow to understand the society's perception about this new family order. Objective: Assess the psychometric properties of two scalesdevised to measure same-sex parenting attitudes: Attitudes toward Same-sex Families Scale (AFFH for its acronym in Spanish), and Scale on Beliefs about Children's Adjustment in Same-sex families (CANFH in Spanish). Methodology: AFFH scale is a 20-item measure designed to account for attitudes towards same-sex families. CANFH is a 14-item measure consisting of two scales, Individual Opposition (IO) and Normative Opposition (NO). Both are Likert scales with five response options (1. Strongly Agree to 5. Strongly Disagree). The CANFH was answered by 170 college students (78 (46%) males, 92 (54%) females; Average age: 18.4 SD 0.94), and the AFFH by 88 college students (35 (40%) males, 53 (60%) females, average age: 18.2 SD + 0.84). Results: AFFH items were organized into two factors that explained 46.14% of variance with a Cronbach's alpha of 0.91. CANFH items were grouped in a two factors structure that explained 65.49% of the variance (α = 0.94). Conclusions: CANFH and AFFH scales have adequate psychometric properties to measure Mexican college students' attitudes toward same-sex families and to assess the beliefs about children's adjustment in same-sex families...(AU)

Introdução: A legalização do chamado casamento do mesmo sexo e adoção de crianças por casais homossexuais, é um fenômeno recente, que deve ser estudado, para a qual é necessário ter medidas confiáveis que permitem ver como a sociedade percebe esta nova configuração familiar. Objetivo: determinar as propriedades psicométricas de duas escalas: Atitudes para com as famílias homoparentais (AFFH); e as crenças sobre o equilíbrio das crianças de famílias homoparentais. Metodologia: O AFFH, com 20 itens, foi projetado para explicar atitudes das famílias homoparentais. O CANFH tem 14 reagentes organizados em sub-escalas de oposição individual (OI) e oposição regulamentar (ON). Ambas as escalas são declarações que devem ser respondidas com opções de tipo Likert, entre 1 que significa estar de acordo e 5 que discorda totalmente (CANFH). O CANFH foi aplicado a 170 estudantes universitários (78 (46%) do sexo masculino, 92 (54%) mulheres com idade média: 18.4 + 0.94), e AFFH a 88 (35 (40%) do sexo masculino, 53 (60% ) mulheres média de idade. 18.2 + 0.84). Foram determinadas as propriedades psicométricas por meio de análise fatorial e consistência interna. Resultados: A AFFH foi α = 0.91 com reagentes foram organizados em dois fatores que explicam 46.14% da variância. No caso de a estrutura fatorial CANFH dois explicativa 65.49% da variância e um α = 0,94 subescalas foi confirmada. Conclusões: Os dados indicam que ambas as escalas têm o direito de medir as atitudes dos estudantes em relação homoparentais famílias mexicanas e para os efeitos que podem ter sobre as crianças adotadas propriedades psicométricas...(AU)

Exploración del malestar emocional expresado por mujeres que acuden a centros de atención primaria de la Ciudad de México: Un estudio cualitativo / Exploring the emotional distress of women who attend primary health care units in Mexico City: A qualitative study

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.

Evaluación del sistema de salud mental en México: ¿hacia dónde encaminar la atención? / Evaluation of the mental health system in Mexico: where is it headed?

OBJETIVO: Evaluar algunos indicadores clave del sistema de salud mental mexicano utilizando el Instrumento de Evaluación para Sistemas de Salud Mental de la Organización Mundial de la Salud (IESM-OMS). MÉTODOS: La estrategia utilizada para responder a los indicadores del IESM-OMS incluyó: i) Revisión de fuentes documentales, ii) Aplicación de cuestionarios y iii) Trabajo grupal utilizando la técnica de consenso con expertos. Para facilitar la recopilación de la información, se elaboró un cuestionario donde los indicadores fueron transformados en preguntas sencillas. Asimismo, se capacitó a las personas encargadas de recabar los datos y se realizó un seguimiento de dicha actividad. RESULTADOS: Del total del presupuesto asignado a la salud, solo 2% estaba destinado a la salud mental y, de ese porcentaje, 80% se empleaba para el funcionamiento de los hospitales psiquiátricos. El eje de la atención de la salud mental se encontraba en el hospital psiquiátrico y existían muy pocas unidades de hospitalización psiquiátrica en los hospitales generales y establecimientos residenciales, así como servicios específicos para niños y adolescentes. El acceso estaba limitado por la centralización del sistema de atención, ya que la mayoría de los establecimientos se ubicaban en las grandes ciudades. Solamente 30% de los servicios de atención primaria contaban con protocolos de evaluación y tratamiento para trastornos mentales. Finalmente, en los establecimientos de salud mental, la tasa de psiquiatras, médicos, enfermeros y psicólogos por cada 100 000 habitantes registró valores de 1,6, 1,3, 3,4 y 1,5 respectivamente. CONCLUSIONES: Para reducir la brecha entre la carga que representan los trastornos mentales y el presupuesto asignado para su atención, se requiere de un mayor financiamiento y una utilización de los recursos más racional, considerando al primer nivel como el eje de la atención. Asimismo, será necesario ampliar el número de especialistas, capacitar periódicamente al personal en los primeros niveles de atención e incrementar la participación del resto de la sociedad.

OBJECTIVE: Evaluate some of the key indicators that characterize the Mexican mental health system using the World Health Organization's Assessment Instrument for Mental Health Systems (WHO-AIMS). METHODS: The strategy for examining the WHO-AIMS indicators included: (i) a review of documentary sources; (ii) application of the questionnaire; and (iii) group work with a team of experts using the consensus technique. To facilitate collection of the data, a questionnaire was prepared in which the indicators were turned into simple questions. The people gathering the data were trained, and the activity was monitored. RESULTS: It was found that, of the total budget for health, only 2% is allocated for mental health, and, of that share, 80% is used in the operation of psychiatric hospitals. The pivotal point for mental health care is in the psychiatric hospital; there are very few psychiatric units in the general hospitals, few residential establishments, and few services targeted specifically to care for children and adolescents. Access is limited because of the centralized health care system, with the majority of establishments located in the large cities. Only 30% of primary care services have protocols for the evaluation and treatment of mental disorders. Finally, in the mental health facilities, the ratios of psychiatrists, other physicians, nurses, and psychologists per 100 000 population are 1.6, 1.3, 3.4, and 1.5, respectively. CONCLUSIONS: More funding will be needed in order to bridge the gap between the mental health burden and the budget allocated for its care, and resources will need to be used more rationally, with the first level of care becoming the pivot. In addition, it will be necessary to increase the number of specialists, offer periodic in-service training for personnel at the first level of care, and enlist greater participation by the rest of society.

Los nuevos empresarios: Trayectoria del uso a la venta de drogas en contextos de fiesta / The new businessmen: Pathways from drug use to drug dealing in party contexts

Drugs use at party contexts has increased in recent decades. Drugs dealing facilitates consumer access to substances, whose sales practices vary according to drugs use, places for the consumption and the drug social function. Drug dealing is socially constructed from a set of practices ranging from reasons to dealing and those related to the consolidation as a common practice. The aim of this research was to describe and analyze the drugs users' experience in party contexts, about their dealer's construction process. An interpretative multiple-case study with the snowball technique was carried out to get the participants. The information was obtained by a semi-structured interview and nonparticipant observation at the dealing places. The information obtained points out the group's participation on the selection of the dealer as the initiation of drugs dealing, the extroversion features and communication skills as an important profile to be a dealer; specially, the capability to satisfy the group's emotional request through the drugs. Also, benefits as acceptation, protection and the warmth from the group and the economical earning. The dealer/businessmen consolidation is socially constructed according to the new identity assumed, the group participation and the specific activities as a business.

El uso de drogas en contextos de fiesta se ha incrementado en las últimas décadas. El narcomenudeo facilita el acceso a sustancias de consumo, cuyas prácticas de venta varían conforme a la droga de uso, los espacios de consumo y la función de la droga en los grupos que la consumen. La venta de drogas implica una serie de prácticas que la construyen y que incluyen los motivos del inicio de venta, el proceso de desarrollo y las relacionadas con la consolidación de la venta como práctica habitual. El objetivo de esta investigación fue describir y analizar la experiencia de usuarios de drogas en contextos de fiesta respecto al proceso en que se construyen como dealers. Para lo anterior, se realizó un estudio interpretativo de casos múltiples, empleando la técnica de "bola de nieve" para captar a los participantes. La observación se obtuvo por medio de una entrevista semiestructurada y la observación no participante en escenarios de venta. Se obtuvo información relacionada con los elementos del salto del uso a la venta como la elección del dealer por el grupo, su perfil para ser elegido como la extroversión y habilidades de comunicación; y sobre todo su capacidad para satisfacer la demanda de emociones de los miembros de su grupo por medio de las drogas de venta. Además, de la aceptación, protección y afecto del grupo y las ganancias económicas. La consolidación como dealer/empresario se construye conforme se asumen una nueva identidad, la participación del grupo y las actividades específicas de la empresa.

Curanderos, malestar y "daños": una interpretación social / Folk healers, discomfort, and sorcery: a social interpretation

From within the framework of social representations theory, this research sought to explore magical-religious thoughts on sickness among users of traditional medicine. Introduction Ever since the dawn of time, magic and religion have been human resources for facing issues of health and sickness. In traditional Meso-America, sickness was believed to have four different causes: the breaking of natural laws, the will of the gods, the dates on the calendar, and the actions of human beings. These traditional beliefs blended in with Spanish Christian heritage and with the magical-religious beliefs of the slaves, giving place to the traditional medicine practiced currently in Mexico. Representations of health and sickness determine the choices people make between different healing options, thence our interest in understanding the social representations of these categories among users of traditional medicine and folk healing. Method Ten traditional medicine users from the State of Mexico were interviewed in depth regarding five thought categories: health/sickness, traditional medicine and folk healers, detection and treatment, reasons for choosing traditional medicine, and contrast between traditional and modern medicine. The interviews were analyzed qualitatively using Ethnograph 4.0. Results According to these ten informants, health and sickness have to do with intra and interpersonal wellbeing and discomfort. The magical-religious thoughts of the interviewees are witnessed by the classification they make of ailments, which can be physical, psychological or due to curses and witchcraft -this latter undetectable by doctors. Other beliefs are that many people can cause their own ailments, that folk healers can practice white magic (for doing good) or black magic (for doing evil), and that they have a "gift" for healing and prediction, through dreams or otherwise. Discussion The ways of understanding health and disease are not universal, they depend on social representation or the meaning that patients attribute to them. Traditional medicine is based on magical-religious thinking that explains the disease and contrasts with the official medicine interpretation.

La presente investigación tuvo como objetivo conocer, desde la teoría de las Representaciones Sociales, el pensamiento mágico-religioso que tiene sobre el malestar un grupo de usuarios de la medicina tradicional. Introducción La magia y la religión han sido herramientas que el hombre ha utilizado para enfrentar los problemas de salud-enfermedad que se le han presentado a lo largo de su existencia. La cosmovisión mesoame-ricana también estaba sustentada en un pensamiento mágico-religioso que daba sentido al malestar. La conquista produjo un mestizaje cultural en el que este tipo de pensamiento siguió vigente y que en la actualidad se manifiesta en la práctica de la medicina tradicional; de ahí la inquietud de indagar cómo se representan socialmente el malestar los sujetos que hacen uso de esta opción. Método Estudio cualitativo de tipo exploratorio-descriptivo. Se utilizó la entrevista a profundidad para explorar cinco categorías: salud-enfermedad, medicina tradicional y curanderos, detección y tratamiento, argumentos para la elección de la medicina tradicional, contraste entre medicina tradicional y oficial. Materiales e instrumentos: Audiograbadora, diario de campo. Población: Diez usuarios de la medicina tradicional del Estado de México. Análisis de datos: análisis de contenido mediante Ethno-graph 0.4. Consideraciones éticas: Participación voluntaria, confidencialidad y anonimato de los participantes. Resultados De acuerdo con los informantes, la salud-enfermedad tiene que ver con un sentimiento de bienestar-malestar intrapersonal e interpersonal. El pensamiento mágico-religioso se evidencia en la clasificación que hacen de las enfermedades, las cuales pueden ser físicas, psicológicas o de otro tipo: daños o brujerías que no pueden ser detectadas ni curadas por los médicos. Muchas veces una persona es la causante del problema. Los curanderos pueden dedicarse a la magia blanca (hacer el bien) o a la negra (perjudicar); poseen un "don" para curar, pueden ver en sus sueños y adivinar. Discusión Las formas de entender la salud-enfermedad conllevan la elección de aquellas opciones más compatibles con el tipo de pensamiento, ya sea empírico o mágico-religioso, que subyace a la interpretación del malestar, en concordancia con el grupo social al que el sujeto pertenece.

Utilización de servicios de atención a la salud mental en mujeres víctimas de violencia conyugal / Mental health services utilization among Mexican female victims of intimate partner violence

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.

La búsqueda de moderación en el consumo de alcohol: Adaptación de los conocimientos a la práctica / Searching moderation in alcohol consumption adjusting knowledge to practice

Alcohol abuse in Mexico has an enormous impact on people's health. This problem has led authorities to undertake actions to combat and reduce both consumption levels and their consequences. The interventions, focusing on handling problem drinkers -people who already show symptoms of dependence and consume more than one drug, including alcohol-, have proved their effectiveness in various scenarios. In the work setting, this problem is no exception and has also been a focus of concern and the implementation of actions to prevent excess alcohol consumption and provide care for persons beginning to display problems. However, implementing programs in the workplace has proved complicated. Other countries have found that many programs are not correctly evaluated or simply not evaluated, making it impossible to determine their effectiveness in solving the problems for which they were designed. Moreover, the personnel that implement them are not properly trained, programs are expensive to implement, and conflicts of interest tend to arise. In Mexico, low-cost, effective actions have been implemented for this population. However, the time available for undertaking preventive activities is limited, while the length of workers' shifts means that they do not have enough time for these activities. One current challenge is the Translation of Research as a tool for the development of efficient, simpler, more practical, and safer interventions, without ignoring the discovery of new information regarding health and disease prevention, as well as creating more efficient treatments and improving existing ones. Within this perspective, researchers worked to produce a brief intervention to reduce harmful alcohol consumption among the working population. It is based on the principles of cognitive social theory put forward by Bandura, in which alcohol consumption is regarded as learned behavior, that causes problems and may be replaced by healthy behaviors, provided dependence has not developed. Another of the components included is motivational theory, according to which the effectiveness of a particular form of treatment is related to individuals' motivation to continue it. The aim of this article is to describe the process of translation of research, derived from the implementation of cognitive social and motivational theories to adapt an intervention program designed in a comic book format that is easy to read and understand to teach workers with excess alcohol consumption to moderate their consumption. Method The work was carried out in two stages: Phase 1. Adaptation of a brief intervention to a comic book format. A comic was produced using the elements of a brief intervention. In order to ensure that the concepts put forward in the base theory were accessible to the target population, they were subjected to a process of cognitive laboratories following the methodology proposed by Beatty. The comic was produced to make the material easier to read and understand. The process began with a scriptwriter who translated the theoretical contents, together with the terms obtained in the cognitive laboratories into a story that would reflect the target population. This version was subjected to an evaluation described in stage 2. Phase 2. Evaluation of language, characters, contents, and format of comic. Participants: Researchers worked with 49 subjects from various firms and states in Mexico, 59.2% of whom were men, mostly between the ages of 24 and 42, and over half of whom were married (61.2%). Half had only completed high school or less. Instrument: The questionnaire contained demographic questions and indicators to evaluate the comic for: format, understanding of contents, characters, language, and perceived usefulness for reducing problem drinking, among other things. Procedure: Participants attended a training course during which they were asked to evaluate the comic. Each one was given a printed copy and a questionnaire. The subjects volunteered to participate and were guaranteed the confidentiality of the information they provided. Results Over 85% said that they were used to reading on a daily to weekly basis. Most of them thought that the illustrations were attractive and felt that the characters reflected the role they played in the story. They did not like the length of the comic or the fact that the drawings were extremely detailed, with too much text. They also disliked the font and the type of language used. Nearly 80% thought that the reading material was neither tedious nor dull. Most rated the story good or very good and thought that the title encouraged people to read it and that they would use it if they had drinking problems. They also identified themselves with the characters and the situations described in the comic. What they liked best was the way the topic was dealt with in a comic, the way the problem was highlighted, the type of language used (colloquial), the message given, the goal setting, the way they became involved in the reading, and the link between users and the family environment. Finally, the evaluations of the comic showed that some drawings were regarded as aggressive, the children's language did not match their parents', and the order of the dialogues was confusing. This moment in the translation of the intervention made it possible to make changes in several aspects included in the final version. The comic was given to a proofreader to correct spelling mistakes while maintaining the colloquial tone. Discussion This activity resulted in a comic in which the characters guide the workers through a series of strategies to reduce consumption. This complies with the principles of translating research by adapting the concepts derived from social and motivational cognitive theory, which have proved their effectiveness in dealing with addictive behaviors. The inclusion of experts from various areas made it possible to adapt knowledge, by incorporating strategies from the latter into a script that included the dialogues and sketched the characters that would form part of the story. The experts continued to participate during the evaluation process until the final version, with the definitive images, and final dialogues and exercises. Having the workers targeted by the intervention try out various aspects of the material made it possible to adjust the language, contents and the story told, the characters' performance and appearance and the way the exercises and dialogues were carried out. This also made it possible to see how useful the workers found it in reducing their own consumption or helping the people around them -family, co-workers and friends- to do so. In order to produce this sort of material, it is essential to use colloquial language that will be understood by the target population, which is the most delicate stage of the process since it involves the correct use of technical assumptions, since otherwise, one would work from a totally different perspective. This material can reach men of productive age, who are those that make less use of health services, meaning that it is a tool that covers this inaccessible sector of the population. However, the workers were also given the possibility of seeking help from specialists if they failed to achieve their objectives, in which case the comic achieves the objective of raising awareness. Lastly, one of the limitations of the material concerns the fact that the subject himself has to follow up his own progress, meaning that the adaptation must be carried out as rigorously as possible. It also implies that the material must be evaluated through an analysis of the changes that take place in workers as a result of using it. The next stage will therefore be to test the intervention through the comic in a controlled test and to evaluate its efficiency in reducing alcohol abuse problems, as well as the subject's possible progression to severe dependence.

El abuso en el consumo de alcohol en México es un problema de salud pública por lo que se han realizado diferentes acciones para reducir los niveles de consumo y las consecuencias derivadas de éste. Entre estas acciones hay intervenciones que han probado su eficacia en diferentes escenarios. En el ambiente laboral, sin embargo, ha sido complicado instrumentarlas, por el rechazo, el poco apoyo y el desinterés de funcionarios e instituciones, porque los empleados no disponen de tiempo en sus jornadas y por la falta de espacios para realizar actividades de prevención. Por esta razón es importante adaptar el conocimiento científico para el desarrollo de intervenciones eficientes, más simples, más prácticas y más seguras. Actualmente el proceso de traducción de la investigación es una vía para lograrlo. El objetivo de este artículo es describir este proceso mediante la adaptación de una intervención basada en las teorías cognitiva social y motivacional, cuyos conceptos se presentan en forma de estrategias guiadas por personajes en una historieta -de fácil lectura y comprensión- con la finalidad de que trabajadores que presentan consumo nocivo de alcohol aprendan a moderarlo. Método El trabajo se realizó en dos fases: Fase 1. Se creó la historieta para lograr que los conceptos planteados en la teoría base fueran accesibles a la población objetivo en un formato fácil de leer y entender. Fase 2. Evaluación de lenguaje, personajes, contenidos y formato de la historieta. Participantes: Cuarenta y nueve sujetos voluntarios de diferentes empresas y Estados de la República Mexicana, 59.2% hombres, la mayoría de entre 24 y 43 años, más de la mitad casados y con escolaridad de preparatoria o menos. Instrumento: Un cuestionario que contenía preguntas demográficas e indicadores para evaluar la historieta. Procedimiento: Los participantes se encontraban en un curso de capacitación, ahí se les dio una historieta y un cuestionario invitándolos a que ayudaran para evaluarla. La participación fue voluntaria y se garantizó la confidencialidad de la información proporcionada. Resultados En su mayoría las ilustraciones les resultaron agradables, consideraron a los personajes acordes con el papel que desempeñan en la historia, que la lectura del material no era tediosa o cansada, mencionaron que la historia era buena o muy buena y que el título motivaba a la lectura, que usarían la guía si tuvieran problemas con su consumo de alcohol, además de sentirse identificados con los personajes y las situaciones descritas. Lo que más les agradó es el modo en que se trató el tema en una historieta, el lenguaje utilizado, el mensaje que se les da, el planteamiento de metas, la forma de involucrarlos en la lectura, la relación del consumidor y la familia, cómo los van motivando, lo que sucede en la recaída y cómo se recupera el usuario. La información recabada fue utilizada para realizar la versión final de la historieta. Discusión El resultado fue un material de fácil lectura que permite su utilización individual, en momentos y lugares que cada persona deseé utilizar. Cumple con los principios de la traducción de la investigación al adaptar conceptos derivados de la teoría. Para lograrlo fue importante el uso de lenguaje coloquial que facilitó su lectura y la apropiación de los conocimientos por la población objetivo, esto implicó incluir cuidadosamente los supuestos teóricos para no distorsionar la perspectiva planteada originalmente. Esta intervención permite además llegar a grupos de difícil acceso como los hombres en edad productiva, que acuden poco a servicios de salud. Es necesario probar la intervención mediante la historieta, por ello la siguiente etapa será hacerlo mediante un ensayo controlado para evaluar su eficiencia para reducir los problemas de abuso de alcohol, así como la eventual progresión a la dependencia grave.

Estrategias utilizadas por un grupo de mujeres mexicanas para cuidar su salud emocional: autoatención y apoyo social / Strategies for taking care of emotional health among the Mexican women population: self-care and social support

OBJETIVO: Conocer las prácticas de autocuidado/autoatención utilizadas por un grupo de mujeres para aliviar malestares emocionales. MATERIAL Y MÉTODOS: Participaron 23 mujeres, habitantes de la Ciudad de México. Se realizaron entrevistas focalizadas mediante la técnica de entrevista de investigación social,cuyo propósito es favorecer la producción del discurso continuo sobre un tema determinado. La información se analizó con la técnica de categorización de significados, que consiste en clasificar el contenido de cada entrevista en categorías mutuamente excluyentes. RESULTADOS: Las prácticas de autoatenciónreúnen: conductas de autocontrol, remedios caseros, automedicación y actividades de relajación. El apoyo social proviene principalmente de otras mujeres; la pareja no se considera un apoyo significativo. CONCLUSIONES: Las mujeres encuentran estrategias que, si bien no solucionan por completo sus malestares emocionales, les permiten sobrellevar las situaciones vinculadas con éstos.

OBJECTIVE: To describe what kind of self care practices a group of women use to alleviate their emotional disorders. MATERIAL AND METHODS: A group of 23 women living in Mexico City answered open-ended questions about self care strategies. Focused interviews were carried out using a social research interview technique designed to encourage continuous discourse on a set topic. Data was analyzed using a significant classification technique, which involves placing the contents of each interview in mutually exclusive categories. RESULTS: Self care practices reported included self-control, home remedies, self-medication, relaxing activities and social support. Social support is mainly obtained from other women, since partners were not regarded as providing meaningful support. CONCLUSIONS: Self care practices start once the malaise begins and stop when the malaise ends. Although the strategies women use do not entirely solve their emotional disorders, they enable them to cope with such situations.

El uso de las terapias alternativas y complementarias en población mexicana con trastornos depresivos y de ansiedad: resultados de una encuesta en la Ciudad de México / The use of alternative and complementary therapies on the Mexican population with depressive and anxiety disorders: results of a survey in Mexico City

The use of therapeutic methods and assistance different from the officially recognized ones, in addition to self-care practices, has remained constant throughout history. The extensive interest in so-called alternative or complementary medicine (ACM) has occurred as a result of their growing use in various countries. International literature reports the growing use of alternative and/or complementary treatments by persons with emotional disorders, particularly depression or anxiety. Commonly mentioned alternatives include relaxation techniques, physical therapies, herbal treatment, chiropractice and spiritual healing. The National Survey on Psychiatric Epidemiology undertaken in Mexico (2002) reported that 6.5% of the individuals with affective disorders in the 12 months prior to the study used some kind of alternative medicine. This occurred in 7.3% of the individuals with anxiety disorders and 3.9% of those with disorders associated with substance use. Information from surveys conducted in Mexico City showed that from 18% to 20% of the individuals with depressive disorders, 18% had physical disorders and over a quarter of those with anxiety problems seek a solution to their suffering in various types of alternative medicine. The aim of this study is therefore to determine the therapeutic resources used by the population to treat emotional problems and to analyze the prevalence of these practices in individuals with anxiety or depressive disorders. Method The study was conducted on the inhabitants of six neighborhoods in Mexico City. They were all selected on the basis of the criteria established in a multi-stage, stratified random sample design. The stratification variable used was socio-economic level. The questionnaire included four sections: 1) socio-demographic characteristics; 2) use of 10 self-care and/or alternative service resources related to the presence of emotional disorder; 3) characteristics of the resources or services use and 4) prevalence of depressive and anxiety disorders. The ethical guidelines followed in this research included obtaining verbal informed consent and providing a clear explanation about the objectives of the research, and the way the dwelling and the persons were selected. The researchers stressed the interviewee's freedom to cancel the interview and guaranteed the confidential handling of the information. The diagnoses of mental disorders were obtained on the basis of the ICD-1 0 criteria. For the analysis of service use, the therapies were grouped into two categories, self care (home remedies, self-medication, physical activities, etc.) and alternative and/or complementary services (self-help groups, traditional Mexican medicine, clergy, etc.). Results Of the 361 of the individuals interviewed, 45.9% were men and 54.1% women, the mean age being 45 years old. The 54% of participants represent the high-middle class, and the 46% the low class. Nineteen point two percent of the sample met the diagnostic criteria for one or more disorders, at least once in their lifetime (12.7% in the men's group and 25.1% in the women's group). The prevalence of depressive episodes for women was 9.2% as opposed to 3.0% for men. In the case of anxiety disorders, the prevalence was 16.3% and 9.0%, respectively. Of the total sample 52.5% engaged in some form of self-help, while 28.2% had resorted to alternative systems for coping with emotional disorders at least once in their lives. Among the most commonly used self-help strategies were: enrolling in a physical activity (33.5%), seeking help from informal networks (28.5%) and using household remedies (16.1%). The use of alternative services included visiting a clergy (11.1%) and attending self-help groups (10.2%). The use of self-help and alternative therapies was more common among women. An analysis was undertaken of the type of service used among persons that had met the diagnostic criteria for one or more disorders and those that failed to do so. The group characterized by the presence of disorders undertook more self-help actions than those with no disorders (72.9% and 47.6%). The same trend was observed in the use of alternative services (52.9% and 22.1%). An analysis of the disorders, divided into two main groups, anxiety disorder and depressive episodes, showed that the prevalence of self-care practices (76.6% and 72.7% respectively) and the use of alternative medicines (53.2% and 59.1%) was similar. Most of the group with anxiety disorders reported that it used informal support networks (59.6%) and engaged in physical activities (53.2%). The 45.5% of those that experienced depressive episodes engaged in physical activities, 47.8% visited relatives and friends and 26.1% consulted a priest. The prevalence of self-care practices conducted in the 12 months prior to the survey showed a similar pattern throughout lifetime. Two logistic regression models were used to analyze factors related to the practice of self-care and the use of alternative and/or complementary therapies. The variables included in the models were sex, age, educational level, occupation and the presence of an anxiety or depression disorder. The logistic regression analysis showed that the probability of using self-care practices is higher in persons with an anxiety disorder (OR=3.11), women (OR= 1.74) and persons with a higher educational level (OR=1.93). The likelihood of using an alternative or complementary medicine increases among people experiencing a depressive episode (OR = 3.23) and anxiety disorders (OR=3.45). The people that sought help from relatives, friends or a priest stated that their reasons were <>, <> or <> The reasons for visiting the self-help groups were feeling sad or depressed, or trying to deal with problems related to their alcohol consumption. Those who used home remedies sought to soothe their <> and overcome their insomnia. The main reason for engaging in physical activity or performing curative practices adapted from other cultures, such as Bach Flowers or Reiki was to relax and <> Interviewees used vitamins or food supplements to cope with the <> or <> all of which are concepts underlying the idea of <> their state or condition. Discussion The use of self-care practices in response to the perception of emotional disorders is common in the interviewed population. This suggests that this type of practices could be regarded as a significant component of mental health care and should therefore be examined with more detail. The main focus should be the link between individuals' perception of their emotional illness or problems and the orientation of their self-care actions. An analysis of the group with disorders showed that a significant percentage of the population with one or more depressive episodes (26.1%) and anxiety disorders (26.1%) used alternative therapies in the 12 months previous to the study. The analysis conducted throughout this study suggests the need for health personnel to have basic knowledge of self-care practices and alternative medicine and to find out about the use of the latter by patients. It has been shown that having this knowledge can significantly improve the doctor-patient relationship, have a positive impact on treatment and help prevent potentially damaging interactions between conventional and alternative treatments. It also provides a better understanding of people's concepts of health and illness, and what they seek in the various medical systems. However, we still have a great deal to learn about the needs, expectations and demands of those that engage in these practices.

El uso de instancias asistenciales y terapéuticas diferentes a las oficialmente reconocidas, además de las prácticas de autocuidado, han mostrado su vigencia a lo largo de la historia. En la bibliografía nacional e internacional se reporta un creciente uso de medicinas alternativas y/o complementarias, principalmente entre personas con trastornos de depresión o ansiedad. Derivado de lo anterior, el objetivo del presente trabajo es conocer, mediante una encuesta en hogares, cuáles son los recursos terapéuticos y asistenciales que utiliza la población para tratar problemas emocionales, así como analizar la prevalencia de estas prácticas en personas con trastornos de ansiedad o depresión. Método La investigación se realizó entre los habitantes de seis colonias de la Ciudad de México. El trabajo de campo comprendió el periodo de agosto de 2006 a marzo de 2007. La selección de los entrevistados se hizo con un diseño muestral aleatorio estratificado y multietápico. La variable de estratificación fue el nivel socioeconómico. Originalmente se planteó la inclusión de tres niveles con el objetivo de hacer comparaciones entre ellos. Sin embargo, debido a la dificultad de acceder a la población de estrato alto, se seleccionaron colonias representativas de nivel socioeconómico bajo y medio alto. El instrumento estuvo conformado por cuatro secciones:1) datos sociodemográficos; 2) uso de diez recursos de autoatención y/o servicios alternativos ante la presencia de malestares emocionales; 3) características de los recursos o servicios utilizados y 4) prevalencia de trastornos depresivos y de ansiedad (a partir de los criterios del ICD-10). Entre los cuidados éticos se consideró el consentimiento informado de manera verbal y se enfatizó en la libertad del entrevistado para suspender la entrevista. Se aseguró el manejo confidencial de la información. Para el análisis del uso de servicios, las terapias se agruparon en dos categorías: prácticas de autocuidado (remedios caseros, automedicación, actividades físicas, etc.) y servicios alternativos y/o complementarios (grupos de autoayuda, medicina tradicional mexicana, consejeros espirituales, etc.). Resultados De las 361 personas entrevistadas, el 45.9% fueron hombres y el 54.1 % mujeres. La media de edad fue de 45 años, el 54% representó al estrato medio-alto y el 46% al bajo. El 19.5% de la muestra cumplió los criterios diagnósticos de uno o más trastornos alguna vez en la vida (12.7% hombres y 25.1% mujeres). La prevalencia de episodios depresivos fue de 9.2% para las mujeres y 3.0% para los hombres, y de trastornos de ansiedad 16.3% y 9.0%, respectivamente. En relación con la prevalencia de uso de servicios alguna vez en la vida, ante un malestar emocional, el 52.5% del total de la muestra realizó alguna práctica de autocuidado y el 28.2% recurrió a los sistemas alternativos. El uso de autocuidados y terapias alternativas fue más frecuente entre las mujeres. Se encontró que el grupo caracterizado por la presencia de trastornos realizó acciones encaminadas a los autocuidados (72.9%) en mayor proporción a aquellos sin trastornos (47.6%). La misma tendencia se observó en el uso de servicios alternativos (52.9% y 22.1% respectivamente). Además, se realizó un análisis de regresión logística cuyos resultados mostraron que existe una mayor probabilidad de realizar prácticas de autocuidado entre las mujeres (OR=1.74), cuando el nivel de escolaridad es mayor o igual a bachillerato (OR=1.93) y cuando se presenta algún trastorno de ansiedad (OR =3.11). La probabilidad de usar alguna medicina alternativa o complementaria aumenta 3.23 veces en personas con depresión y 3.45 con ansiedad. Discusión Los resultados de este trabajo hacen evidente la necesidad de capacitar al personal de salud sobre las medidas de autocuidado y las medicinas alternativas. Estos conocimientos pueden mejorar la relación médico-paciente e impactar positivamente en el tratamiento. Asimismo, los resultados de esta investigación permiten comprender mejor los conceptos que tienen las personas sobre salud y enfermedad, y las razones para acudir a los diversos sistemas médicos. Sin embargo, todavía tenemos que aprender mucho sobre las necesidades, las expectativas y las demandas de las personas que buscan esta ayuda.

Riesgos asociados al consumo de alcohol durante el embarazo en mujeres alcohólicas de la Ciudad de México

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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.

Enfermedades y padeceres por los que se recurre a terapeutas tradicionales de la Ciudad de México / Diseases and illnesses for which help is sought from traditional healers in Mexico City

OBJETIVO: Presentar los principales motivos de consulta con terapeutas tradicionales de la Ciudad de México. MATERIAL Y MÉTODOS: Se tomó como base los relatos de 16 médicos tradicionales de la Ciudad de México y 22 usuarios de este tipo de medicina. Los métodos utilizados para la recolección y an lisis de los datos son de corte cualitativo. El trabajo de campo se realizó en dos etapas. Durante la primera fase se hicieron observaciones con enfoque etnográfico; y en la segunda, se realizaron entrevistas focalizadas. RESULTADOS: De acuerdo con la percepción de los entrevistados, entre los principales motivos de consulta se encuentran los problemas amorosos, conflictos familiares, apuros económicos, estrés, tensión, nervios y angustias espirituales. Estos motivos de consulta no se pueden englobar como enfermedades en un sentido estricto, todos son problemas de salud que se manifiestan como padecimientos y solamente algunos se ubican en la categoría biomédica de enfermedades. Las personas que acuden con los terapeutas tradicionales no solamente buscan curarse de sus males, también desean obtener consejos acerca de sus problemas personales. DISCUSION: La información analizada en este trabajo permite señalar que existen diversas razones para explicar no solamente la supervivencia de la medicina tradicional, sino además su éxito en la vida actual, donde la ciencia y la tecnología han obtenido resultados sobresalientes, pero a cambio, la biomedicina ha olvidado la complejidad de la vida humana cotidiana y el valor de la atención personal, la compasión, la comprensión, la empatía y el uso del mundo simbólico para la solución de los conflictos y problemas de salud propios de la humanidad.

Variables demográficas asociadas con la depresión: diferencias entre hombres y mujeres que habitan en zonas urbanas de bajos ingresos

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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.

Ideación suicida y características aosicadas en mujeres adolescentes / Suicidal ideation and associated characteristics in adolescent women

Objetivo. Determinar la prevalencia de ideación suicida y el perfil sintomático e identificar las características sociodemográficas que distinguen a quienes tuvieron mayores puntajes de ideación suicida entre población adolescentes del Distrito Federal: estudiantes y pacientes por intento suicida. Material y métodos. El estudio fue transversal y ex-post-facto. Se analizó la información de dos muestras: 1 712 mujeres, estudiantes de enseñanza media -secundaria- y media superior -bachillerato- (mujestra escolar representativa en el D.F.), y 30 adolescentes mujeres internadas por intento suicida (muestra clínica). Resultados. La prevalencia, tanto de presencia como de persistencia de ideación suicida, fue má elevada en la muestra clínica; sin embargo, 11.8 por ciento de las adolescentes escolares presentaron todos los síntomas de ideación suicida de 1 a 7 días. Las características sociodemográficas que distinguieron a las estudiantes con mayores puntajes de ideación fueron: cursar secundaria, obtener calificaciones bajas, percibir como malo su desempeño escolar y haber interrumpido sus estudios. En la muestra clínica se analizaron las características que distinguieron a las jóvenes con un intento suicida, de aquellas con dos o más; las más significativas fueron: vivir solas con uno de sus padres y pensar en que su muerte sería posible. Conclusiones. La prevalencia de ideación suicida fue importante en la población escolar. Si se considera que este constructo psicológico tiene una fuerte asociación con el intento suicida y, más aún, con la conducta suicida múltiple, entonces resulta prioritario detectar adolescentes en riesgo y orientar esfuerzos preventivos entre las adolescentes escolares, tomando en cuenta las características sociodemográficas que se configuraron en riesgo para la ideación suicida