<>. Modelos explicativos sobre la depresión y el malestar emocional entre los adolescentes barceloneses (España). Primera parte / <>. Explanatory models of depression and emotional distress among adolescents in Barcelona (Spain). Part one

ABSTRACT

Introduction In recent years, adolescent mental health has become a health policy priority in the majority of OCDE and European countries. According to the World Health Organization, in Europe some two million children and adolescents suffer from some type of mental disorder, especially depression, which affects 4% of the adolescents between the ages of 12 and 17, and 9% of 18-year-olds. As is also the case for behavioural and anxiety disorders, rates of adolescent depression are on the rise. Several studies associate depression in adolescence with either current or future consumption of psychoactive substances, a diagnosis of severe mental disorder in adulthood, and suicide. Some studies highlight the importance of social factors and lifestyles in the etiology and prognosis of these types of disorders; for example, various forms of social discrimination, abusive parents, and bullying. The incidence and prevalence of depression appear to be increasing among adolescents, as well as self-reported distress among young people and so-called «negative mood states¼. Despite the importance of depression, sadness, and so-called «negative mood states¼ among adolescents, there is a clear lack of qualitative studies analyzing these phenomena, and especially of studies that provide knowledge about the perceptions and cultural models of this age group with respect to their own sense of distress and lay strategies for coping with adversity, and the role of social capital as a buffer against it. Objective and methods The objective of this article is to describe the adolescents' explanatory models (EMs) or lay perceptions on depression, sadness, and related factors. With this purpose we performed an ethnographic study in a sample of 49 students (age 15-16) in three public secondary-schools of Barcelona and its metropolitan area using semi-structured interviews, cultural-domains interviews, and focus groups. We employed content analysis and semantic network analysis for qualitative data, and frequency analysis, cultural-consensus analysis, and multidimensional scaling for quantitative data. Results The results outline that adolescents use their own nosologies to define depressive mood states such as «rallado¼, «burchado¼, «chof¼, or «deprimido¼. These categories are dichotomically organized between passive items (i.e. to feel sadness or loneliness) and active items (i.e. <>). The state of deprimido (being depressed) is related to feelings of physical weariness and apathy. It can be defined as «a culmination of situations that make you feel bad¼, including the sense of feeling misunderstood by peers and adults, feeling insecure when having to take decisions or with his/her physical appearance, alone or isolated or in a bad mood. A person that is depressed is someone who «isn't in the mood to even speak about anything¼, that finds him/herself bad because «things haven't turned out as they expected¼. This leads him/ her «to blame him/herself for things¼, to have «very low self-esteem¼, to not «leave the house¼, to «become closed within himself¼, to «build a wall¼ or a «bubble¼, to think that «nothing is worth anything¼ and that «the whole world is against him/her¼. One can cope with that state for being a «bad time in a person's life¼, but it can also become «a burden that is much more¼ or «an eternity that never ends¼. When we asked our adolescents, «how can you tell that a person is sad or worried?¼, their answers were varied. One of the most common is to show an oscilation between the passive characteristics of discomfort and its active correlate, between isolation and an uneasy response, despite this behavior not being premeditated. A person that is rallada, deprimida or burchada can appear «isolated from society¼ and feel unaccepted, alone, insecure, apathetic; he/she might «stop talking or interacting with others¼, find him/herself feeling «tired of everything¼, downcast, depressive, as if he/she had experienced un bajón (suddenly feeling down); distracted, serious and without smiling, or anxious and nervous, and because of that hurting others although unintentionally. He/she can also sigh and weep, have difficulties to «express him/herself¼, appear to have «changed¼ for not behaving as he/she normally does, or have a lost gaze. The perception that adolescents have of a person exhibiting characteristics such as rallada, triste, burchada, or deprimida is not isomorphic with the vision they hold of themselves when they suffered adversity or experienced discomfort in the past. For example, the category rallada is not used very much in these cases, perhaps in order to save a semantic stigmatizing load. They normally define expressions of discomfort in terms such as «a desire to forget about school, of people and of everything¼, «scream where no one can hear you¼, «break things or hit someone¼, self-inflict physical pain «to balance the pain from within with exterior pain¼, «make someone feel the same as I feel¼, «flee or run very far¼, or of locking oneself up in one's bedroom to «cry while listening to music¼. They also feel powerless before «the things that they can not confront¼, «inferior to others¼, worthless, guilty, with difficulties to concentrate and insomnia. The adolescents situate the causes of their afflictions in the universe of their interactions with family members, adults in general, and peers, within situations of pressure and overexertion in daily life. When we segmented dates by gender we observed that male adolescents prioritized the «school loads¼ before «relations with friends¼, while female adolescents a higher relevance to these followed by «affective relations¼. When we asked our informants, «In your opinion, what can be done to help a person your age that is in this state of sadness or discomfort?¼, the answers were very diverse, but coincided as a whole to empower sociability between peers. It is striking although congruent with available literature that they discard the possibility of accompanying or referring the affected person to a specific professional for help or even suggest him/her to speak to his/her parents, tutors or professors. As a matter of fact, adolescents constitute an age group characterized by their vague consideration of professional resources in their help-seeking processes. Discussion A fundamental reason for the avoidance of professional services by adolescents is the existence of an explanatory model that, contrary to expert discourses from the «psy¼ field, understands afflictions as products of the social world. If the causes of discomfort are a result of social interactions (conflicts between equals, states of solitude and isolation, lack of recognition or prestige, dissonances with the models of the body and person, problems in the development of their autonomy against the tutelage of adults, etc.), the restitution of wellbeing must structure itself on those same relations and on that same independence in regards to the adult world. Our data points to a need to establish dialogical strategies of intervention. Insofar as adolescents show explanatory models different to the expert and adult systems in general, it is easy for them to feel indifferent to the interventions that do not involve them as active agents. They want to be protagonists of their own stories. For this reason, the promotion of participation and the dialogue of information (expert and lay) are guidelines that, in our opinion, must be present in any intervention in this field. In these strategies we find the possibility of reconverting lay explanatory models and social capital in a fundamental axis of mental health programs for adolescents.

RESUMEN

Introducción En los últimos años, la salud mental de los adolescentes se ha convertido en una prioridad de las políticas sanitarias en la mayoría de los países de la OCDE y, especialmente, en Europa. La razón está justificada. Según la OMS, se calcula que dos millones de menores y jóvenes europeos sufren algún tipo de trastorno mental, entre los que destaca la depresión que afecta 4% de los adolescentes de entre 12 y 17 años y 9% de los jóvenes de 18 años. Junto con los trastornos de ansiedad y de conducta, ello dibuja una tendencia a la alza. A pesar de la relevancia de la depresión, la tristeza y los denominados «estados de ánimo negativos¼ entre los y las adolescentes, existe un claro déficit de investigaciones cualitativas que analicen estos fenómenos, principalmente si hablamos de investigaciones que permitan conocer las percepciones y modelos culturales de este grupo de edad con respecto a su propio malestar, así como sobre sus estrategias profanas para afrontar la adversidad y el papel de su capital social. Esta ausencia de investigaciones entra en contradicción con la importancia que estas variables adquieren en la salud mental y la salud pública contemporáneas. Objetivo y métodos El objetivo de este artículo es analizar los modelos explicativos o percepciones profanas de los adolescentes sobre la depresión, la tristeza y sus factores asociados. Con este propósito se realizó un estudio etnográfico en una muestra de 49 estudiantes (de edad entre 15 y 16 años) en tres centros públicos de enseñanza secundaria de Barcelona y su área metropolitana mediante entrevistas semiestructuradas, entrevistas de dominios culturales y grupos focales. Se empleó el análisis de contenido y de redes semánticas para los datos cualitativos obtenidos y el análisis de frecuencia, de consenso cultural y el escalado multidimensional para los datos cuantitativos. Resultados Los adolescentes utilizan sus propias nosologías para definir sus estados de ánimo como «rallado¼, «burchado¼, «chof¼ o «deprimido¼. Estas categorías se organizan entre un polo pasivo (sentirse triste o solo, por ejemplo) y otro activo (i.e., «estar enfadado¼). Las expresiones del malestar depresivo son detectadas entre los iguales por la gestualidad (i.e., «el rostro¼, «la mirada¼) y el comportamiento (i.e., aislamiento social), pero sólo de forma marginal por el bajo rendimiento académico. Las causas de la depresión se vinculan con los conflictos en las relaciones interpersonales con iguales y adultos. No obstante, el proceso de búsqueda de salud o ayuda más común implica a los iguales, ya que los adultos son percibidos únicamente como un recurso para situaciones de gravedad inusual. De hecho, los adolescentes constituyen un grupo de edad caracterizado por considerar vagamente los recursos profesionalizados en sus procesos de búsqueda de ayuda. Discusión Una razón fundamental de la evitación de los servicios profesionales de atención por parte de los adolescentes barceloneses es la existencia de un modelo explicativo que, a diferencia de los discursos expertos en el campo «psi¼, entiende las aflicciones como productos del mundo social. Si las causas del malestar derivan de las interacciones sociales, la restitución del bienestar debe conformarse a partir de estas mismas relaciones y también de esta misma independencia con respecto al mundo adulto. Si bien los resultados de nuestra investigación no son extrapolables a la población adolescente catalana en general, éstos indican la necesidad de establecer estrategias dialógicas de intervención que permitan reconvertir los modelos explicativos legos y el capital social de los adolescentes en un eje fundamental de los programas en salud mental.