"I Don't Want to Be Here." returning from the U.S. to Mexico and emotional distress: A qualitative study.

The psychosocial impact on people who were deported to Mexico from the United States or were forcibly returned tends to be greater than on those who return voluntarily. This text examines the way the emotional discomfort experienced by a group of Mexicans who were returned in these ways is constructed, through the analysis of anthropological interviews conducted with five women and thirteen men in which the following phases were explored: pre-migration, stay in the United States, return and reinsertion. This discomfort began in the pre-migration stage, during which they experienced various forms of disempowerment caused by the socioeconomic conditions of Mexico that determine the migratory trajectory, including reintegration. If, despite the disadvantages accumulated during the pre-migration phase, migrants manage to partly reverse their material and psychosocial disempowerment during their stay in the United States, on their return to a context such as Mexico, both their disempowerment and emotional discomfort are exacerbated. We therefore consider that the harm associated with the migratory saga will continue for an indefinite number of years following a person's return to Mexico and must be treated as a social rather than a clinical problem.

Social Vulnerability and Emotional Distress in Older Adults: A Study in Primary Care Centers in Mexico City.

OBJECTIVES: To analyze the association between social vulnerability and emotional distress in older adults (OAs) visiting health centers in Mexico City, to describe the strategies and services used by OAs when they experience emotional distress, and to determine whether emotional distress is addressed in these primary care settings. METHODS: A sequential exploratory mixed method. In the first phase, qualitative information was collected through semi-structured interviews with 17 OAs. The information obtained was used to construct the instrument used in the second phase, which obtained quantitative data from 61 OAs. RESULTS: The main causes of emotional distress were feelings of loneliness, unemployment, and problems with children. The main actions used to address this distress were seeking support from family and friends, "hanging on," and engaging in religious practices. A total of 29.5% indicated that their doctor asked about emotional distress; 23% said they were referred to a psychologist, but few took this advice. CONCLUSIONS: The presence of emotional distress in OAs is not an individual health problem but rather the result of their living conditions and environment.

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

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). MATERIAL 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.

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.

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.

Salud mental y atención primaria en México. Posibilidades y retos / Mental health and primary care in Mexico. Opportunities and challenges

OBJETIVO: Exponer las condiciones que favorecerían o limitarían la integración de la salud mental a los centros de salud de acuerdo con las percepciones del personal y las observaciones realizadas. DISEÑO: Durante abril del 2012 a febrero del 2014 se utilizó la técnica de observación no participativa y se realizaron entrevistas al personal. EMPLAZAMIENTO: Estudio exploratorio descriptivo realizado en 19 centros de salud situados en la Ciudad de México. MÉTODO: La selección de los centros y del personal fue intencionada, seguida de la técnica de bola de nieve hasta alcanzar la saturación de datos. Se emplearon 2 guías, una para recoger información durante la observación y la otra para realizar las entrevistas. El registro de las observaciones se hizo en notas de campo, mientras que las entrevistas de audio se grabaron. Toda la información recopilada se almacenó en archivos de Word. El análisis de las notas de campo consistió en 3 niveles de lectura y el de las entrevistas en la categorización de significados propuesta por Kvale (1996). RESULTADOS: Los aspectos que favorecen o limitan la integración de los servicios de salud mental involucran 3 grandes categorías: a) programas y formas de organización de los servicios, b) infraestructura y recursos materiales y c) recursos humanos e información. CONCLUSIONES: Contribuiría a la implementación de la atención a la salud mental: incluir en la productividad y metas las acciones dirigidas a la salud mental; fomentar la idea de que la salud mental forma parte de la salud general y la inversión estatal en salud

OBJECTIVE: To present the conditions that favour or limit the integration of mental health into health centres, based on the perceptions of health workers and on observations made by researchers. DESIGN: A study was conducted between April 2012 and February 2014 using a non-participant observation technique plus interviews with health professionals. SETTING: Descriptive exploratory study conducted in 19 health centres in Mexico City. METHOD: The selection of centres and participants was intentional, followed by the snowball technique in order to reach data saturation. Two guides were use, one for collecting information during the observation and the other one for interviews. The observations were registered in field notes, while the interviews were audio recorded. All collected information was stored in Word files. The analysis of field notes consisted of three levels of reading, and the interview analysis was based on «categorisation of meanings» proposed by Kvale (1996). RESULTS: The aspects that favour or limit the integration of mental health services involve three broad categories: a) programs and methods that organise services, b) infrastructure and material resources and, c) human and information resources. CONCLUSIONS: Actions targeted at including mental health into productivity reports and into already established goals, would contribute to the integration of mental health care, as well as promoting the idea that mental health is part of overall health, and to increase the public investment in health

[Mental health and primary care in Mexico. Opportunities and challenges]. / Salud mental y atención primaria en México. Posibilidades y retos.

OBJECTIVE: To present the conditions that favour or limit the integration of mental health into health centres, based on the perceptions of health workers and on observations made by researchers. DESIGN: A study was conducted between April 2012 and February 2014 using a non-participant observation technique plus interviews with health professionals. SETTING: Descriptive exploratory study conducted in 19 health centres in Mexico City. METHOD: The selection of centres and participants was intentional, followed by the snowball technique in order to reach data saturation. Two guides were use, one for collecting information during the observation and the other one for interviews. The observations were registered in field notes, while the interviews were audio recorded. All collected information was stored in Word files. The analysis of field notes consisted of three levels of reading, and the interview analysis was based on "categorisation of meanings" proposed by Kvale (1996). RESULTS: The aspects that favour or limit the integration of mental health services involve three broad categories: a) programs and methods that organise services, b) infrastructure and material resources and, c) human and information resources. CONCLUSIONS: Actions targeted at including mental health into productivity reports and into already established goals, would contribute to the integration of mental health care, as well as promoting the idea that mental health is part of overall health, and to increase the public investment in health.

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.

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

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.

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.

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.

Medicinas alternativas en la ciudad de México. Un análisis semiótico en medios impresos / Alternative medicines in Mexico City. A semiotic analysis in print media

Las medicinas alternativas vistas como recursos terapéuticos, el cuerpo como objeto de estudio, las ideas sobre salud que corren paralelas al campo médico, las relaciones de los medios masivos de comunicación con la formación de saberes y de individuos. Aspectos puntuales del mundo convocados para comprender en un modesto costado, que clase de sociedad somos y como hablamos de eso que somos. Los temas antes mencionados surgieron de la lectura de investigaciones previas en las cuales el problema central era la utilización de recursos y servicios diferentes a la biomedicina para el cuidado de la salud. Estudios realizados en Estados Unidos y Canadá, algunos países de Europa, Brasil y México. En el primer país mencionado, abundan las encuestas. Con base en los conocimientos sabemos que las personas que utilizan esta clase de medicinas cuentan con una serie de saberes consecuentes con sus decisiones y acciones orientadas a la restitución de su bienestar y salud. Los saberes suelen comprender ideas, creencias y nociones sobre la enfermedad, la salud (noción que a veces resulta bastante compleja e insólita), la muerte, la vida, el cuerpo, entre otros. Entendemos que los saberes son producciones culturales y sociales que cambian de manera constante. Cuando se trata de recursos y cuidados para la salud, los saberes y la utilización de formas de curar distintas o nuevas se afectan de manera recíproca. Por ejemplo, recursos como la aplicación de las flores de Bach para aliviar el estrés, la práctica del yoga para mejorar la concentración, el masaje para adelgazar, responden a saberes precisos sobre la salud, el cuerpo, etcétera y circulan notoriamente, digamos "en el aire" de la Ciudad de México, es decir, entre los habitantes de la Ciudad de México

Narraciones de usuarios del Sistema Wewepahtli: problemas mentales y medicina tradicional en la Ciudad de México / Narrations from users of the Wewepahtli System: mental problems and traditional medicine in Mexico City

El presente trabajo se ocupa de las prácticas de salud propuestas por la medicina denominada Wewepahtli o "grandísima sanación". Esta medicina es promovida por los miembros del grupo La Continua Tradición Tetzkatlipoka en la Ciudad de México. Me intereso, de forma particular, en las personas que recurren a este servicio debido a padecimientos de índole mental. El estudio busca profundizar en esta medicina así como examinar los métodos utilizados por las personas que recurren a ellos además de responder preguntas, las más de las veces comunes, acerca de la efectividad de los métodos y la influencia que tienen sobre las personas. El propósito del presente trabajo es comprender la forma en como intervienen las practicas curativas ofrecidas por la medicina wewepahtli en los padecimientos mentales de algunos usuarios. Por otra parte, también me he propuesto realizar una aproximación a la construcción del cuerpo a partir de las narraciones de las personas que han asistido a esta medicina. Esta última inquietud responde a la concepción de cuerpo por parte de la wewepahtli y la actualización de esta noción en sus sesiones curativas. El estudio está basado en la evidencia discursiva de las personas que han recurrido a este sistema médico y en la revisión de una serie de documentos como historias clínicas, un directorio y propaganda, todos elaborados por los médicos de la continua tradición tetzkatlipoka (en adelante me referiré a esta como la tetzkatlipoka o la tradición). Antes de abundar en el trabajo que se realizó con los usuarios de la wewepahtli, me parece importante comentar algunas características que distinguen a este sistema medico de otras prácticas (y practicantes) reunidas dentro de la medicina tradicional mexicana. En primer lugar destaca el alto grado de sistematización tanto de los métodos de curación como de la transmisión de su saber