Illicit drug use research in Latin America: epidemiology service use, and HIV.

The purpose of this article is to review the research status of illicit drug use and its data sources in Latin America, with particular attention to the research that has been produced in the past 15 years in epidemiology of illicit drug use services utilization, and relationship between HIV and drug use. This article complements the series of articles that are published in this same volume which examine drug abuse research (epidemiology, prevention, and treatment) and HIV prevention in Latinos residing in the United States. This review resulted from extensive international and national searches using the following databases: Current Contents Connect, Social and Behavioral Sciences; EBSCO; EMBASE(R) Psychiatry; Evidence Based Medicine (through OVID); Medline, Neurosciences, PsychINFO, Pubmed, BIREME/PAHO/WHO--Virtual Health Library, and SciELO. Papers selected for further review included those published in Spanish, English, and Portuguese in peer-reviewed journals. From the evidence reviewed, it was found that the published research literature is heavily concentrated on descriptive epidemiologic surveys, providing primarily prevalence rates and general information on associated factors. Evidence on patterns of service delivery and HIV prevention and treatment is limited. The cumulative scope of this research clearly indicates variability in quantity and quality of research across Latin American nations and the need for greater uniformity in data collection elements, methodologies, and the creation of international collaborative research networks.

Prevalencia de trastornos mentales y uso de servicios: resultados preliminares del Estudio nacional de salud mental. Colombia, 2003 / Prevalence of Mental Disorders and use of Services: Preliminary Results from of the National Study of Mental Health, Colombia, 2003

Este estudio forma parte de la Encuesta mundial de salud mental (EMSM), de la Organización Mundial de la Salud (OMS) y describe la prevalencia de trastornos mentales, las variaciones en la distribución geográfica de los trastornos, los correlatos sociodemográficos y la utilización de servicios en la población urbana adulta. El Estudio nacional de salud mental Colombia 2003 (ENSM) se basa en un diseño probabilístico, multietápico y estratificado para cinco regiones del país, cuya población blanco fue la población no institucionalizada, que tiene un hogar fijo, de 18 a 65 años de edad y que vive en áreas urbanas. La tasa de respuesta ponderada fue de 87,7%. El instrumento utilizado es la versión computarizada de la Entrevista diagnóstica internacional compuesta (versión certificada 15), que proporciona diagnósticos de acuerdo con el DSMIV y la CIE-10. Alrededor del 56% de la muestra fueron mujeres, el 37% tenían entre 18 y 29 años, de las cuales el 26% reportó únicamente estudios primarios y el 45%, estudios secundarios. El 40,1% de la población reportó haber tenido alguna vez en su vida uno o más de los 23 trastornos basados en el DSM-IV, el 16,0% de la muestra evidenció trastornos mentales en los últimos doce meses y el 7,4% presentó alguno en los últimos treinta días. Los trastornos más frecuentemente reportados alguna vez en la vida fueron los de ansiedad (19,3%), seguido por los trastornos del estado de ánimo (15,0%) y los trastornos por uso de sustancias (10,6%). El 4,9% de la población estudiada ha intentado suicidarse alguna vez en la vida y el 1,3% lo ha intentado en los últimos treinta días. Sólo una de cada diez personas con un trastorno mental y sólo una de cada cinco con dos o más trastornos mentales dijo recibir servicios de cualquier tipo en el último año. Esto representa un reto para el sistema de salud y demuestra la necesidad de enfocar atención y recursos hacia el tratamiento oportuno de enfermedades mentales.

This study comprises part of the World Mental Health Survey (WMH) of the World Health Organization (WHO) and describes the prevalence of mental disorders, variations in the geographic distribution of disorders, the sociodemographic correlates and the utilization of services in the adult urban population. The Estudio Nacional de Salud Mental Colombia 2003 (ENSM) is based on a probabilistic, multistage and stratified sampling design within 5 regions of Colombia. The target population was urban non-institutionalized inhabitants of permanent dwellings, between the ages of 18 to 65 years. The response rate was 87.7%. The instrument used for this study was a computerized version of the Composite International Diagnostic Interview (CIDI) (registered version 15) that provides diagnoses in agreement with the Statistical Manual of Mental Disorders-IV and the International Classification of Disease, edition 10. Fiftysix percent of the sample was female, 37% was between the ages of 18 and 29 years old, and 26% had only a primary education while 45% had secondary education. Lifetime prevalence rates were calculated at 40.1% for any of the 23 DSM-IV disorders included in the CIDI, 16% for the past 12 months, and 7.4% for the past 30 days. Anxiety disorders were most frequently reported (19.3% lifetime prevalence rates) followed by affective disorders (15.0%) and substance use disorders (10.6%). Lifetime rates for suicide attempts for the overall sample were calculated at 4.9% with 1.3% reported suicide attempts in the past 30 days. The data indicates that only one out of every 10 individuals with one mental disorder and only one out of every five with two or more mental disorders receives any type of treatment. This represents a challenge to the system of health care and demonstrates the need to focus our attention and resources toward the treatment of mental disorders.

Psychosocial stressors associated with Mexican migrant farmworkers in the midwest United States.

Although estimates suggest that there are upwards of 5 million migrant farmworkers in the United States, scant research has explored the stressors associated with their lifestyle. Contrary to previous work, the present study directly explored migrant farmworkers' own perceptions of what is difficult in their lives. The purposes of the present study were to qualitatively explore, from a phenomenological standpoint, the stressors associated with living as a migrant farmworker in the Midwest United States; and to determine the stressors that were most strongly related to symptoms of anxiety and depression. The findings indicated that 18 stressors were commonly experienced by the migrant farmworkers and that the farmworkers experienced overall elevated levels of anxiety and depression. A number of stressors that were not previously reported in the literature were identified. The stressors of "rigid work demands" and "poor housing conditions" were significantly associated with higher levels of anxiety and "low family income/living in poverty" and "rigid work demands" were significantly associated with depression. Implications of findings and prevention strategies are discussed.

Exploring the mental health of Mexican migrant farm workers in the Midwest: psychosocial predictors of psychological distress and suggestions for prevention and treatment.

The purposes of the present study were threefold: (a) to assess the prevalence levels of anxiety and depression in a sample of Mexican migrant farm workers in the midwestern United States; (b) to explore the relationships among acculturative stress, anxiety, and depression; and (c) to examine the variables that best predict anxiety and depression. The overall sample revealed elevated levels of anxiety and depression. Migrant farm workers with heightened levels of acculturative stress were more likely to report high levels of anxiety and depression. Family dysfunction, ineffective social support, low self-esteem, lack of agreement with the decision to migrate, high education levels, high levels of acculturative stress, and high levels of anxiety were significantly associated with high depression levels. The overall findings suggest that migrant farm workers who experience elevated levels of acculturative stress may be at risk for experiencing high levels of anxiety and depression. The findings highlight the importance of establishing prevention and treatment services for migrant farm workers that aim to increase levels of emotional support, self-esteem, and coping skills.

Psychosocial predictors of anxiety among immigrant Mexican migrant farmworkers: implications for prevention and treatment.

This study examined predictors of anxiety symptomatology among immigrant Mexican migrant farmworkers in the Midwest. Its purposes were to assess the prevalence of anxiety symptoms, to examine the relationship between acculturative stress and anxiety, and to determine the variables that best predict anxiety. Heightened levels were found for overall anxiety and in the cognitive, affective, and physiological expressions of anxiety. Elevated acculturative stress, low self-esteem, ineffective social support, lack of control and choice in living a migrant farmworker lifestyle, low religiosity, and high education were significantly related to high anxiety. Findings suggest that migrant farmworkers who experience elevated acculturative stress are susceptible to the development of anxiety-related disorders and highlight the importance of establishing prevention and treatment services for migrant farmworkers.

Cognitive, affective, and physiological expressions of anxiety symptomatology among Mexican migrant farmworkers: predictors and generational differences.

Scant research has examined the mental health of migrant farmworkers in the United States. The purposes of the present study were threefold: to assess the prevalence levels of anxiety symptoms in a sample of Mexican migrant farmworkers in the Midwest United States; to examine the relationship between acculturative stress and anxiety; and to determine the variables that significantly predict anxiety. High levels were found for overall anxiety and in the cognitive, affective, and physiological expressions of anxiety. Elevated acculturative stress, low self esteem, ineffective social support, lack of control and choice in the decision to live a migrant farmworker lifestyle, low religiosity, and high education were significantly related to high anxiety levels. The overall findings suggest that Mexican migrant farmworkers who experience high acculturative stress may be at risk for developing anxiety-related disorders. The findings highlight the necessity of establishing prevention and treatment services for migrant farmworkers that increase levels of emotional support, self esteem, and coping skills.