[Determining Factors in the Access to Mental Health Services by the Adult Colombian Population]. / Factores que determinan el acceso a servicios de salud mental de la población adulta en Colombia.

INTRODUCTION: Access to mental health services by people with mental disorders has traditionally been limited, and is associated with attitudinal, social, and structural variables. OBJECTIVE: To analyse the factors that determine access to mental health services by the adult population (18-44 years old) in Colombia, from the results obtained in the 2015 National Mental Health Survey. MATERIAL AND METHODS: Analysis of variables of access to attention in mental health care for adults. The reasons for not consulting were classified as barriers of behavioural supply and demand. To analyse the factors associated with access to mental health services in the Colombian adult population, the use of health services in the last 12 months for emotional, nervous or mental health problems was taken into account, as well as associated variables such as demographic characteristics, occupational activity, affiliation to social security, and health status variables. The relationships between these variables were estimated using bivariate multinomial logistic regression models. RESULTS: Rural residence, being married, and having a chronic disease were associated with the decision to consult or not to consult the doctor. CONCLUSIONS: Further studies should be conducted to evaluate the situation as regards mental health care access, as well as to determine the potential factors associated with these limitations.

Factores que determinan el acceso a servicios de salud mental de la población adulta en Colombia / Determining Factors in the Access to Mental Health Services by the Adult Colombian Population

Resumen Introducción: Tradicionalmente el acceso a servicios de salud mental de las personas con trastornos mentales ha sido limitado, y ello se asocia a variables conductuales, sociales y estructurales. Objetivo: Analizar los factores que determinan el acceso a servicios de salud mental de la población adulta (18 a 44 años) en Colombia, a partir de los resultados obtenidos en la Encuesta Nacional de Salud Mental 2015. Material y métodos: Análisis de variables de acceso a consulta en atención a salud mental para adultos. Se clasificaron las razones de consulta en barreras de acceso por oferta o demanda comportamental. Para el análisis de los factores asociados a acceso a los servicios de salud mental en la población adulta colombiana, se tuvo en cuenta el uso de los servicios de salud en los últimos 12 meses por problemas emocionales, nerviosos o de salud mental y las características demográficas, actividad laboral, afiliación a régimen de seguridad social y variables de estados de salud. Las asociaciones entres estas variables se estimaron mediante modelos bivariables de regresión logística multinomial. Resultados: Se encontraron asociaciones entre residir en áreas rurales, estar casado y padecer una enfermedad crónica con la decisión de consultar al médico o no. Conclusiones: Se deben realizar más estudios que permitan evaluar la situación del acceso a servicios de atención en salud mental, y que permitan encontrar los posibles factores relacionados que limiten al mismo.

Abstract Introduction: Access to mental health services by people with mental disorders has traditionally been limited, and is associated with attitudinal, social, and structural variables. Objective: To analyse the factors that determine access to mental health services by the adult population (18-44 years old) in Colombia, from the results obtained in the 2015 National Mental Health Survey. Material and methods: Analysis of variables of access to attention in mental health care for adults. The reasons for not consulting were classified as barriers of behavioural supply and demand. To analyse the factors associated with access to mental health services in the Colombian adult population, the use of health services in the last 12 months fo emotional, nervous or mental health problems was taken into account, as well as associated variables such as demographic characteristics, occupational activity, affiliation to social security, and health status variables. The relationships between these variables were estimated using bivariate multinomial logistic regression models. Results: Rural residence, being married, and having a chronic disease were associated with the decision to consult or not to consult the doctor. Conclusions: Further studies should be conducted to evaluate the situation as regards mental health care access, as well as to determine the potential factors associated with these limitations.

Physician migration: views from professionals in Colombia, Nigeria, India, Pakistan and the Philippines.

There has been much debate recently about several issues related to the migration of physicians from developing to developed countries. However, few studies have been conducted to address these issues in a systematic fashion. In an attempt to begin the process of generating systematic data, we designed and distributed a questionnaire addressing several core issues surrounding physician migration to respondents selected on the basis of their special expertise or experience in India, Nigeria, Pakistan, Colombia, and the Philippines. The issues addressed relate to the reasons physicians migrate to developed countries, how migration is related to the structure of medical education, the effect that migration has on the health care infrastructure of developing countries, and various policy options for dealing with physician migration. Though responses varied somewhat by country, a desire for increased income, greater access to enhanced technology, an atmosphere of general security and stability, and improved prospects for one's children were the primary motivating factors for physician migration. A majority of respondents believed that physicians in developing counties are provided with highly specialized skills that they can better utilize in developed countries, but respondents were ambivalent with respect to the utility of educational reform. Responses varied significantly by country with regard to whether physician migration results in physician shortages, but there was widespread agreement that it exacerbates shortages in rural and public settings. With respect to policy options, increasing physician income, improving working conditions, requiring physicians to work in their home countries for a period following graduation from medical school, and creating increased collaboration between health ministries in developed and developing countries found the most favor with respondents.