Strategic Alliances in Global Health: Innovative Perspectives in the Era of Sustainable Development.

This article discusses current challenges in the field of global health and the World Health Organization's (WHO) strategies to address them. It highlights the importance of measuring the health impacts of global recession and globalization and the need for human-centered approaches to sustainable development. Emphasis is placed on commitment to health equity and the use of strategic partnerships for health at global, national, and local levels. Improving the health and well-being of populations, as well as public health equity, are core principles of the 2030 Agenda for the Sustainable Development Goals (SDGs). These principles are expressed in SDG 3, which promotes universal access to health services and systems and recognizes global health as a basic human right. It highlights the importance of strategic partnerships to combat emerging health crises, improve public health indices, and address the burden of chronic disease. These partnerships are contemplated in SDG 17 and are manifested in different modalities, such as network governance, cross-sector collaboration, public-private partnership, and social participation. This diversity of alliances has played an important role in scaling up and strengthening universal health systems around the world, including in Latin America and the Caribbean. The text concludes by presenting the essential characteristics of these inter-organizational and inter-institutional alliances in the field of global health.

Unpacking participation in healthcare governance: Lessons from two local health councils in Brazil and Spain.

This paper describes and compares the integration of cross-sector actors' participation into the governance of two local health councils, one located in Salvador de Bahia (Brazil) and the other in the Canary Islands (Spain). Based on the cross-national comparative research conducted as part of a doctoral thesis, a qualitative design based on secondary data analysis was proposed on the three stages of the organisational integration process of participation. We used information from individual semi-structured interviews (n = 70), situational observation, focus groups, literature review, and field notes to understand participatory processes of networking between multiple cross-sector actors and to show how such processes might be associated with innovative practices. For these innovations to be successfully implemented, stakeholders need to acquire adequate competencies in cross-sector collaboration, enabling them to learn about new organisational practices and to adapt the network of actors to the often unpredictable influences of contextual factors.

Mental health needs and accessing specialised healthcare in Mexican children with mental disorders: gender- and diagnosis-dependent differences.

BACKGROUND: Access describes factors that influence the initial contact or use of services, emphasising both the characteristics of patients and the health resources that influence the use of health services. AIMS: To compare Mexican boys and girls with mental disorders, with respect to primary diagnosis, symptom onset, and seeking and accessing specialised mental health services (SMHS). METHOD: Longitudinal data were collected from primary caregiver-reported assessments of 397 child-caretaker dyads (child mean age 12.17 years, range 5-18 years, 63% male) that were obtained in two psychiatric hospitals specialising in child mental healthcare. Student t-tests and χ2-tests were applied to compare boys and girls regarding their diagnosis and variables associated with the seeking of and access to SMHS. RESULTS: Hyperkinetic disorder was the most prevalent diagnosis in boys, whereas depressive disorder and anxiety disorder were most prevalent in girls. The mean age at symptom onset for boys was 7 years, compared with 10 years for girls. Hyperkinetic disorder had the earliest symptom onset (mean 5.9 years), followed by depressive disorder (mean 9.8 years) and anxiety disorder (mean 12 years). Delayed access to SMHS was associated with initially seeking care from a psychologist, whereas quicker access was associated with affiliation with the (now defunct) Popular Insurance, a programme that served low-income and uninsured individuals. CONCLUSIONS: Programmes aimed at children's mental health education and early intervention should consider gender- and diagnosis-related differences in symptom onset and trajectory. Access to SMHS might be improved by rapid identification by parents, educators, primary-care physicians and psychologists.

Analysis of Educational Attainment in a Mexican Psychiatric Patient Population with Bipolar or Psychotic Disorders.

Schizophrenia has been associated with premorbid poor educational performance and low educational attainment (EA). However, some studies have found positive associations between psychotic disorders and excellent scholastic performance. In the present study, we examined the association between EA and several clinical and nonclinical characteristics in psychiatric patients diagnosed with psychotic or bipolar disorders. Data were obtained from the files of 1132 patients who entered a major Mexico City psychiatric hospital during the years 2009-2010 for the treatment of psychotic symptoms and who were subsequently diagnosed with schizophrenia, bipolar, schizoaffective, or another psychotic disorder. Chi-squared tests, t-tests, and Cox regression analysis were applied to explore associations between EA and factors including gender, familial history of mental illness, premorbid personality characteristics, age of symptom onset, diagnosis, civil status, and current employment. Family history of mental illness decreased the hazard of having lower EA (B = -0.137, p = 0.025, ExpB = 0.872, 95% CI = 0.774-0.983), while a schizophrenia diagnosis independently increased it (B = 0.201, p = 0.004, ExpB = 1.223, 95% CI = 1.068-1.401). In male patients (but not in females), family history of mental illness was significantly associated with higher EA, while in female patients, premorbid schizoid-like personality characteristics were associated with lower EA. For both genders, lower EA was associated with having more children and being employed in manual labor, while higher EA was associated with professional employment. Conclusions: Compared with bipolar disorder, a schizophrenia diagnosis is associated with lower EA; however, familial history of mental illness and premorbid schizoid-like characteristics independently favor higher and lower EA in males and females, respectively. Since lower EA is generally associated with a lower economic status, special preventative attention should be given to students at high risk for schizophrenia, particularly those displaying a schizoid-like personality.

Governance in mental healthcare policies during the COVID-19 pandemic in Mexico.

The COVID-19 pandemic has become the greatest burden of disease worldwide and in Mexico, affecting more vulnerable groups in society, such as people with mental disorders (MD). This research aims to analyze the governance processes in the formulation of healthcare policies for people with MD in the face of the COVID-19 pandemic. An analytical qualitative study, based on semi-structured interviews with key informants in the healthcare system was conducted in 2020. The study followed the theoretical-methodological principles of the Governance Analytical Framework (GAF). The software ATLAS.ti-V.9 was used for inductive thematic analysis, classifying themes and their categories. To ensure the proper interpretation of the data, a process of triangulation among the researchers was carried out. The findings revealed that in Mexico, the federal Secretary of Health issued guidelines for mental healthcare, but there is no defined national policy. Decision-making involved multiple actors, with different strategies and scopes, depending on the type of key-actor and their level of influence. Majority of informants described a problem of implementation in which infection control policies in the psychiatric population were the same as in the general populations which decreased the percentage of access to healthcare during the pandemic, without specific measures to address this vulnerable population. The results suggest that there is a lack of specific policies and measures to address the needs of people with mental disorders during the COVID-19 pandemic in Mexico. It also highlights the importance of considering the role of different actors and their level of influence in the decision-making process.

Impacto de los determinantes sociales de la salud sobre la tasa de contagios por COVID-19 / Impact of the social determinants of health on the rate of infections by COVID-19

RESUMEN Objetivo Analizar el impacto entre los determinantes sociales en salud en México y la tasa de contagios por COVID-19. Método Estudio ecológico cuantitativo a nivel nacional y municipal. Las principales variables fueron tasa de contagios por COVID-19, población total no hablante de español, ingreso per cápita, pobreza e índice de desarrollo humano (IDH). La tasa media nacional de contagios fue de 2 880/100 000 habitantes. Se aplicó la prueba T-test y, para determinar la fuerza de asociación entre la tasa de contagios y las variables, se aplicó la prueba de correlación de Pearson. Resultados Las entidades con menos tasa de población no hablante de español tuvo la menor tasa de contagios por COVID-19. El análisis de correlación mostró que los estados con tasas de contagio por COVID-19 por arriba de la media nacional tienen mejores condiciones de desarrollo. Discusión En nuestros resultados se revela una correlación negativa entre las tasas contagios por COVID-19 y la variable pertenecer a población indígena. Es necesario analizar desde la perspectiva de las comunidades las necesidades para afrontar escenarios de pandemia.

ABSTRACT Objective To analyze the impact between the social determinants in health and the rate of COVID-19 infection. Methods Quantitative ecological study at national and municipal levels. The main variables were COVID-19 infection rate, total non-Spanish-speaking population, per capita income, poverty, and human development index (HDI). The average national infection rate was 2 880/100 000 inhabitants. The T-test was applied, and Pearson's correlation test was performed to determine the strength of the association between the infection rate and the variables. Results Entities with the lowest rate of non-Spanish-speaking population had the lowest rate of COVID-19 infections. The correlation analysis showed that states with COVID-19 infection rates above the national average have better development conditions. Discussion Our results reveal a negative correlation between COVID-19 infection rates and the variable belonging to an indigenous population. It is necessary to analyze from the perspective of the communities the needs to face pandemic scenarios.

The Analytical Framework of Governance in Health Policies in the Face of Health Emergencies: A Systematic Review.

The Governance Analytical Framework (MAG) defines governance as a social fact, endowed with analyzable and interpretable characteristics, through what it calls observable constitutive elements of governance: the problem, the actors, the social norms, the process of decision-making and scope or nodal points; in the sense that each society develops its modes of governance, its decision-making or conflict resolution systems among its members, its norms, and institutions. In this perspective, the purpose of this article was to carry out a systematic review of the scientific literature to understand the role of governance in health policies in health emergencies, such as that caused by the SARS-CoV-2. The systematic review was designed based on the methodology proposed in the PRISMA (Preferred Reporting Items for Systematic Review and Meta-Analysis) Declaration. The literature search was carried out in six databases: Psychology and Behavioral Sciences, APA-PsycInfo, MEDLINE, eBook Collection (EBSCOhost), PubMED, and MedicLatina, published in the last 5 years. Fifteen articles that met quality and evidence criteria were analyzed. The governance approach alluding to the health emergency problem in health policies was the most addressed by the authors (80%), followed by a description of the actors (40%), the process of decision-making spaces (33%), and ultimately, social norms or rules with 13%. Formulating a coherent set of global health policies within a large-scale global governance framework is mostly absent. Although the countries adopt international approaches, it is a process differentiated by the social, economic, and political contexts between countries, affecting heterogeneous health outcomes over the pandemic.

Family History of Psychiatric Disorders and Clinical Factors Associated With a Schizophrenia Diagnosis.

BACKGROUND: Schizophrenia (SCH) and bipolar disorder (BD) have both shared and unique genetic risk factors and clinical characteristics. The aim of the present study was to identify potential risk factors significantly associated with SCH, relative to a BD reference group. METHODS: Data were obtained from medical records of patients that entered a major Mexico City hospital during 2009-2010 presenting psychotic symptoms (n = 1132; 830 cases of SCH, 302 cases of BD; 714 men and 418 women). SCH and BD diagnoses were compared with respect to a number of family and clinical characteristics. Logistic and linear regression analyses were used to respectively identify factors selectively associated with the SCH diagnosis relative to the BD diagnosis and explore the relationship between PANSS scores and parental age at time of birth to the age of SCH onset. RESULTS: Patients with SCH showed greater functional impairment than those with BD. Family history of mental illness, premorbid schizoid-like personality, and obstetric trauma were significantly associated with the SCH diagnosis. The association of obstetric trauma with SCH was greatest in male patients with a family history of mental illness. In women, increased paternal and decreased maternal age at time of the patient's birth were associated with an earlier age of SCH onset. CONCLUSION: Male gender, showing premorbid schizoid-like personality, familial SCH, and obstetric trauma are risk factors that distinguish SCH from BD. Additionally, our results suggest that risk for SCH relative to BD may be importantly influenced by interactions between familial risk, gender, and obstetric trauma.

Gobernanza en el sistema de salud ante la pandemia por Covid-19 en México / Governance in health system in the face of the Covid-19 pandemic in Mexico

Resumen: Objetivo: Analizar la gobernanza en el sistema de salud en México, en las políticas frente a la pandemia por Covid-19. Material y métodos: Estudio cualitativo, analítico, realizado entre junio y noviembre de 2020. Se analizaron 41 entrevistas semiestructuradas que se aplicaron a actores clave del sistema de salud y que se organizaron en el software ATLAS.ti 9. El análisis se adhirió a los principios teórico-metodológicos del Marco Analítico de Gobernanza. Resultados: El problema: la formulación de políticas fue centralizada; los actores: sólo los altos mandos participan en las decisiones; las normas: los valores sociales y el liderazgo determinan su nivel de responsabilidad; toma de decisiones: los altos mandos reconocieron poder para proponer modificaciones al Marco Normativo; los nodos: las políticas federales fueron adaptadas a nivel estatal de manera diferenciada. Conclusiones: La gobernanza centralizada, los niveles diferenciados de convocatoria de los actores, su poder de decisión, acuerdos, responsabilidad y liderazgo, definieron el alcance de la gobernanza y, a su vez, el nivel de respuesta ante la pandemia por Covid-19.

Abstract: Objective: Analyze governance in the Mexican health system, with regards to policies to combat the Covid-19 pandemic. Materials and methods: Qualitative, analytic study carried out from June to November, 2020. Forty-one semi-structured interviews with key actors in the health system were analyzed and organized in ATLAS.ti-v.9 software. The analysis followed theoretical-methodological principles of the Governance Analytical Framework. Results: The problem: the policy-making was centralized; the actors: only high level actors participated in the decisions; decision-making: high level actors recognized power to propose modifications in the regulatory framework; nodes: federal policies were adapted at the state level in a differential manner. Conclusions: Centralized governance, differential levels of convocation of actors, decision-making power, level of agreements, as well as responsibility and leadership, all defined the reach of governance and, in turn, the level of response to the Covid-19 pandemic.

Incidence of catastrophic healthcare expenditure and its main determinants in Mexican households caring for a person with a mental disorder.

BACKGROUND: There are few studies on the impact of out-of-pocket mental health care expenditures and sociodemographic factors on the probability of Mexican households to incur catastrophic healthcare expenditures (CHE). OBJECTIVE: The goal of the present study was to estimate the incidence of CHE and its main determinants among the households of persons with mental disorders (MD) in Mexico. METHODS: A cross-sectional survey was conducted, including 387 households of persons with MD. The estimation of the CHE was obtained by the health expenditure distribution method. A Logistic Regression (LR) was used to identify the determinants of probability variation of CHE occurrence. Since we expected a proportion of CHE between 20% and 80%, we assume linearity in the probability function, therefore we additionally used an Ordinary Least Squares (OLS) model. RESULTS: In our sample, the incidence of CHE was 34.8%. The two mental illnesses most frequently associated with CHE were schizophrenia and hyperactive disorder (35.5% and 32.6% of CHE cases, respectively). The regression coefficients showed that for each unit (US$53.77) increase in income, the probability of CHE was reduced by 8.6%, while for each unit increase in hospitalization or medication expenditures, the probability of CHE increased by 12.9% or 19%, respectively. For each additional household member, the probability of CHE increased by 3%, and households with a male patient had a 7% greater probability of CHE. CONCLUSION: Household income, household size, hospitalization and medication expenses, and sex of the patient were significant predictors of CHE for households caring for a person with MD.

The Impact of Health Policies and Sociodemographic Factors on Doubling Time of the COVID-19 Pandemic in Mexico.

Background. The doubling time is the best indicator of the course of the current COVID-19 pandemic. The aim of the present investigation was to determine the impact of policies and several sociodemographic factors on the COVID-19 doubling time in Mexico. Methods. A retrospective longitudinal study was carried out across March-August, 2020. Policies issued by each of the 32 Mexican states during each week of this period were classified according to the University of Oxford Coronavirus Government Response Tracker (OxCGRT), and the doubling time of COVID-19 cases was calculated. Additionally, variables such as population size and density, poverty and mobility were included. A panel data model was applied to measure the effect of these variables on doubling time. Results. States with larger population sizes issued a larger number of policies. Delay in the issuance of policies was associated with accelerated propagation. The policy index (coefficient 0.60, p < 0.01) and the income per capita (coefficient 3.36, p < 0.01) had a positive effect on doubling time; by contrast, the population density (coefficient -0.012, p < 0.05), the mobility in parks (coefficient -1.10, p < 0.01) and the residential mobility (coefficient -4.14, p < 0.01) had a negative effect. Conclusions. Health policies had an effect on slowing the pandemic's propagation, but population density and mobility played a fundamental role. Therefore, it is necessary to implement policies that consider these variables.

Gobernanza en el sistema de salud ante la pandemia por Covid-19 en México.

Objetivo. Analizar la gobernanza en el sistema de salud en México, en las políticas frente a la pandemia por Covid-19. Material y métodos. Estudio cualitativo, analítico, realizado entre junio y noviembre de 2020. Se analizaron 41 entrevistas semiestructuradas que se aplicaron a acto-res clave del sistema de salud y que se organizaron en el software ATLAS.ti 9. El análisis se adhirió a los principios teórico-metodológicos del Marco Analítico de Gobernanza. Resultados. El problema: la formulación de políticas fue centralizada; los actores: sólo los altos mandos participan en las decisiones; las normas: los valores sociales y el liderazgo determinan su nivel de responsabilidad; toma de decisio-nes: los altos mandos reconocieron poder para proponer modificaciones al Marco Normativo; los nodos: las políticas federales fueron adaptadas a nivel estatal de manera diferen-ciada. Conclusiones. La gobernanza centralizada, los niveles diferenciados de convocatoria de los actores, su poder de decisión, acuerdos, responsabilidad y liderazgo, definieron el alcance de la gobernanza y, a su vez, el nivel de respuesta ante la pandemia por Covid-19.

Suicide Rate, Depression and the Human Development Index: An Ecological Study From Mexico.

Objective: To assess the contribution of depression, the human development index (HDI) including the health, education and income indexes as well as the households structure to the suicide rate in Mexican population from 15 to 49 years old. Methods: An ecological cross-sectional study was carried out in people between 15 and 49 years old. The health index (HI), education index (EI), income index (II), and HDI were constructed. The suicide rate, educational level, per capita income, poverty, and rate of households were collected from official databases. Pearson's correlation coefficient (r) was used to determine the strength between the suicide rate and the per capita income, unemployment, poverty, HI, EI, II, HDI, non-family household, and depression incidence rate. A multiple linear regression model was used to know the association between suicide rates and HDI. Results: The suicide rate was 8.76/100,000 inhabitants. The HDI of the 32 Mexican states were low 16%, middle 41%, high 22%, and extremely high 13%. A direct and positive intensity relationship between suicide rate and non-family households, was found (r = 0.352; p < 0.001); on the other hand, the suicide rate is significantly and negatively related to family households with Pearson (r = -0.350; p < 0.001). Conclusion: The states of the Mexican Republic with the highest prevalence of non-family households had a positive association with the suicide rate. Based on the result of this study, it is possible to assume that, as the HDI increases, there is a greater possibility of living alone and having suicidal behavior.

Cost-effectiveness analysis of interventions to achieve universal health coverage for schizophrenia in Mexico / Análisis costo-efectividad de las intervenciones para alcanzar la cobertura universal en salud para esquizofrenia en México

Abstract Introduction To achieve universal coverage in mental health, it is necessary to demonstrate which interventions should be adopted. Objective Analyze the alternatives of pharmacological and psychosocial treatment in Mexico for patients diagnosed with schizophrenia, as well as Early Intervention in Psychosis Program. Method The Extended cost effectiveness analysis (ECEA), it is implemented under scenario the option of treatment in Mexico, which includes: typical or atypical antipsychotic medication plus psychosocial treatment, assuming that all the medications will be provided to the patient, a measure of effectiveness is the years of life adjusted to disability (DALYs). Results The effect of Universal Public Financing (UPF) is reflected in avoiding 147 DALYs for every 1,000,000 habitants. In addition, has a positive effect in the avoided pocket expenditures from US $ 101,221 to US $ 787,498 according to the type of intervention. Increasing government spending has a greater impact on the poorest quintile, as a distributive effect of the budget is generated. Respect to the value of insurance, the quintile III is the one who is most willing to pay for having insurance, on the other hand, in the highest income quintile, the minimum assurance valuation was observed. Discussion and conclusion The reduction in out-of-pocket spending is uniform across all quintiles; "Early Intervention in Psychosis Program" is not viable for middle income countries, as México. The ECEA is a convenient method to assess the feasibility and affordability of mental health interventions to generate information for decision makers.

Resumen Introducción Para lograr la cobertura universal en salud mental es necesario demostrar qué intervenciones deberían ser adoptadas. Objetivo Analizar las alternativas de tratamiento farmacológico y psicosocial para pacientes con esquizofrenia incluidas, así como un Programa de Intervención Temprana en Psicosis. Método El análisis costo efectividad extendido (ECEA) se implementó bajo un escenario que incluye: medicación antipsicótica típica o atípica más tratamiento psicosocial, asumiendo que todos los medicamentos serán provistos a los pacientes, la medición de la efectividad en términos de DALYs. Resultados El efecto del financiamiento público universal se refleja en evitar 147 DALYs por cada 1, 000,000 de habitantes. Además, tiene un efecto positivo en evitar pagos de bolsillo de US $ 101,221 a US $ 787,478 de acuerdo con el tipo de intervención. Incrementar el gasto del gobierno tiene un gran impacto sobre los quintiles más pobres como efecto distributivo del presupuesto. El quintil III de ingreso tiene mayor disposición a pagar el aseguramiento mientras que el quintil más rico tiene menor disposición a pagarlo. Discusión y conclusión La reducción de los gastos de bolsillo es uniforme en todos los quintiles de ingreso, pero el "Programa de Intervención Temprana en Psicosis" no es viable generalizarlo para países de ingreso medio, como México. El ECEA es un método conveniente para evaluar la factibilidad y asequibilidad de intervenciones en salud mental para generar información para los tomadores de decisiones.

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.

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

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 psychi- atric 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 (ß=1.062, p=.000), family income (ß=1.000, p=.000) and no laboral occupation (ß=3.407, p=.000). The population with schizophrenia is four times more likely to require to be exempt from payment (ß=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.

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 (ß=1.062; p=.000), ingreso familiar (ß=1.000, p=.000) y no tener ocupación (ß=3.407; p=.000). La población con esquizofrenia tiene cuatro veces más la probabilidad de requerir estar exenta de pago (ß=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.

[Cost analyses of medical care for schizophrenia and depression in México, 2005-2013]. / Análisis de costos de atención médica para esquizofrenia y depresión en México para el periodo 2005-2013.

The study aimed to analyze the costs of medical care for mental disorders in the Mexican health system. This was a retrospective cross-sectional evaluation study. As markers for the problem, the study selected two of the principal psychological processes in mental disorders in recent years: depression and schizophrenia. Annual accumulated incidence was identified based on epidemiological reporting by type of institution in 2005-2013. The mean annual case management cost was determined with the instrumentation and consensus technique, identifying the production functions, types of inputs, costs, and amounts of inputs ordered, concentrated in the mean case matrix. Finally, an econometric adjustment factor was applied to control the inflationary effect for each year in the study period. Mean annual case management cost was USD 2,216.00 for schizophrenia and USD 2,456.00 for depression. All the institutions in the Mexican health system showed upward and constant epidemiological and economic trends. The total cost for the two disorders in the last year of the period (2013) was USD 39,081,234.00 (USD 18,119,877.00 for schizophrenia and USD 20,961,357.00 for depression). The largest impact for the two disorders combined was in institutions serving the population without health insurance (USD 24,852,321.00) versus the population with private insurance (USD 12,891,977.00). The cost of meeting the demand for services for the two disorders differs considerably between institutions that treat the population with private health service versus the population without, and is higher in the latter. The study's epidemiological and economic indicators provide evidence for decision-making in the use and allocation of healthcare resources for these two disorders in the coming years.

El objetivo fue identificar los costos de la atención para enfermedades de salud mental en el sistema de salud de México. Se trata de una investigación evaluativa de tipo transversal retrospectivo. Se seleccionaron como trazadores del problema dos de las principales demandas de salud mental en los últimos años: depresión y esquizofrenia. La incidencia acumulada anual se identificó a partir del reporte epidemiológico por tipo de institución para el periodo 2005-2013. El costo del manejo anual de caso promedio se determinó a partir de la técnica de instrumentación y consenso, identificando las funciones de producción, el tipo de insumos, los costos y cantidad de insumos requeridos, concentrados en la matriz de caso promedio. Finalmente, se aplicó un factor de ajuste econométrico para controlar efecto inflacionario para cada año del periodo de estudio. El costo promedio del manejo anual de un caso en dólares americanos para esquizofrenia fue de 2.216,00 y para depresión 2.456,00. Para todas las instituciones del sistema de salud se observan tendencias epidemiológicas y económicas crecientes y constantes. El costo total para ambas enfermedades para el último año del periodo (2013) fue de USD 39.081.234,00, USD 18.119.877,00 para esquizofrenia y USD 20.961.357,00 para depresión. El mayor impacto para ambas enfermedades está en las instituciones para población no asegurada (USD 24.852.321,00) vs. población asegurada (USD 12.891.977,00). El costo de satisfacer la demanda de servicios para ambas enfermedades difiere considerablemente entre las instituciones que se ocupan de la población asegurada vs. población no asegurada, siendo mayor el de las segundas. Los indicadores epidemiológicos y económicos de este estudio contribuyen a la generación de evidencias para tomar decisiones en el uso y asignación de recursos para los servicios de salud que demandarán ambas enfermedades en los próximos años.

O trabalho teve como objetivo identificar os custos na atenção médica para doenças mentais no sistema de saúde no México. Trata-se de uma pesquisa de avaliação de tipo transversal retrospectiva. Foram selecionados como marcadores do problema dois dos principais processos psíquicos de doenças mentais nos últimos anos: depressão e esquizofrenia. A incidência acumulada anualmente foi identificada a partir do relatório epidemiológico por tipo de instituição no período de 2005-2013. O custo médio da gestão anual de caso foi determinado a partir da técnica de instrumentação e consenso, identificando-se as funções de produção, o tipo de insumos, os custos e quantidade de insumos solicitados, concentrados na matriz de caso médio. Por fim, foi aplicado um fator de ajuste econométrico para controlar o efeito inflacionário para cada ano do período de estudo. O custo médio da gestão anual de um caso em dólares americanos para esquizofrenia foi de 2.216,00 e para depressão 2.456,00. Para todas as instituições do sistema de saúde observam-se tendências epidemiológicas e econômicas crescentes e constantes. O custo total para ambas as doenças no último ano do período (2013) foi de USD 39.081.234,00 - USD 18.119.877,00 para esquizofrenia e USD 20.961.357,00 para depressão. O maior impacto para ambas as doenças encontra-se nas instituições para população sem seguro médico (USD 24.852.321,00) vs. população com seguro privado (USD 12.891.977,00). O custo a fim de poder satisfazer a demanda dos serviços para as duas doenças é diferente consideravelmente entre as instituições que se ocupam da população com seguro médico privado vs. população sem seguro médico, sendo maior o das segundas. Os indicadores epidemiológicos e econômicos deste estudo contribuem para a geração de evidências para a tomada de decisões no uso e atribuição dos recursos orientados aos serviços de saúde que vão ser demandados por causa das duas doenças nos próximos anos.

Análisis de costos de atención médica para esquizofrenia y depresión en México para el periodo 2005-2013 / Cost analyses of medical care for schizophrenia and depression in México, 2005-2013 / Análises de custos da atenção médica para esquizofrenia e depressão no México no período de 2005-2013

El objetivo fue identificar los costos de la atención para enfermedades de salud mental en el sistema de salud de México. Se trata de una investigación evaluativa de tipo transversal retrospectivo. Se seleccionaron como trazadores del problema dos de las principales demandas de salud mental en los últimos años: depresión y esquizofrenia. La incidencia acumulada anual se identificó a partir del reporte epidemiológico por tipo de institución para el periodo 2005-2013. El costo del manejo anual de caso promedio se determinó a partir de la técnica de instrumentación y consenso, identificando las funciones de producción, el tipo de insumos, los costos y cantidad de insumos requeridos, concentrados en la matriz de caso promedio. Finalmente, se aplicó un factor de ajuste econométrico para controlar efecto inflacionario para cada año del periodo de estudio. El costo promedio del manejo anual de un caso en dólares americanos para esquizofrenia fue de 2.216,00 y para depresión 2.456,00. Para todas las instituciones del sistema de salud se observan tendencias epidemiológicas y económicas crecientes y constantes. El costo total para ambas enfermedades para el último año del periodo (2013) fue de USD 39.081.234,00, USD 18.119.877,00 para esquizofrenia y USD 20.961.357,00 para depresión. El mayor impacto para ambas enfermedades está en las instituciones para población no asegurada (USD 24.852.321,00) vs. población asegurada (USD 12.891.977,00). El costo de satisfacer la demanda de servicios para ambas enfermedades difiere considerablemente entre las instituciones que se ocupan de la población asegurada vs. población no asegurada, siendo mayor el de las segundas. Los indicadores epidemiológicos y económicos de este estudio contribuyen a la generación de evidencias para tomar decisiones en el uso y asignación de recursos para los servicios de salud que demandarán ambas enfermedades en los próximos años.

The study aimed to analyze the costs of medical care for mental disorders in the Mexican health system. This was a retrospective cross-sectional evaluation study. As markers for the problem, the study selected two of the principal psychological processes in mental disorders in recent years: depression and schizophrenia. Annual accumulated incidence was identified based on epidemiological reporting by type of institution in 2005-2013. The mean annual case management cost was determined with the instrumentation and consensus technique, identifying the production functions, types of inputs, costs, and amounts of inputs ordered, concentrated in the mean case matrix. Finally, an econometric adjustment factor was applied to control the inflationary effect for each year in the study period. Mean annual case management cost was USD 2,216.00 for schizophrenia and USD 2,456.00 for depression. All the institutions in the Mexican health system showed upward and constant epidemiological and economic trends. The total cost for the two disorders in the last year of the period (2013) was USD 39,081,234.00 (USD 18,119,877.00 for schizophrenia and USD 20,961,357.00 for depression). The largest impact for the two disorders combined was in institutions serving the population without health insurance (USD 24,852,321.00) versus the population with private insurance (USD 12,891,977.00). The cost of meeting the demand for services for the two disorders differs considerably between institutions that treat the population with private health service versus the population without, and is higher in the latter. The study's epidemiological and economic indicators provide evidence for decision-making in the use and allocation of healthcare resources for these two disorders in the coming years.

O trabalho teve como objetivo identificar os custos na atenção médica para doenças mentais no sistema de saúde no México. Trata-se de uma pesquisa de avaliação de tipo transversal retrospectiva. Foram selecionados como marcadores do problema dois dos principais processos psíquicos de doenças mentais nos últimos anos: depressão e esquizofrenia. A incidência acumulada anualmente foi identificada a partir do relatório epidemiológico por tipo de instituição no período de 2005-2013. O custo médio da gestão anual de caso foi determinado a partir da técnica de instrumentação e consenso, identificando-se as funções de produção, o tipo de insumos, os custos e quantidade de insumos solicitados, concentrados na matriz de caso médio. Por fim, foi aplicado um fator de ajuste econométrico para controlar o efeito inflacionário para cada ano do período de estudo. O custo médio da gestão anual de um caso em dólares americanos para esquizofrenia foi de 2.216,00 e para depressão 2.456,00. Para todas as instituições do sistema de saúde observam-se tendências epidemiológicas e econômicas crescentes e constantes. O custo total para ambas as doenças no último ano do período (2013) foi de USD 39.081.234,00 - USD 18.119.877,00 para esquizofrenia e USD 20.961.357,00 para depressão. O maior impacto para ambas as doenças encontra-se nas instituições para população sem seguro médico (USD 24.852.321,00) vs. população com seguro privado (USD 12.891.977,00). O custo a fim de poder satisfazer a demanda dos serviços para as duas doenças é diferente consideravelmente entre as instituições que se ocupam da população com seguro médico privado vs. população sem seguro médico, sendo maior o das segundas. Os indicadores epidemiológicos e econômicos deste estudo contribuem para a geração de evidências para a tomada de decisões no uso e atribuição dos recursos orientados aos serviços de saúde que vão ser demandados por causa das duas doenças nos próximos anos.

Governance and mental health: contributions for public policy approach.

OBJECTIVE: To analyze the conceptualization of the term governance on public mental health programs. METHODS: In this systematic review, we analyzed the scientific literature published in the international scenario during 15 years (from 2000 to 2015). The databases analyzed were: Medline, CINAHL, PsycINFO and PubMed. Governance and mental health were the descriptors. We included relevant articles according to our subject of study and levels of analysis: (i) the concept of governance in mental health; (ii) process and decision spaces; (iii) strategic and pertinent actors who operate in the functioning of the health system, and (iv) social regulations. We excluded letters to the editor, news articles, comments and case reports, incomplete articles and articles whose approach did not include the object of study of this review. RESULTS: We have found five conceptualizations of the term governance on mental health in the area of provision policies and service organization. The agents were both those who offer and those who receive the services: we identified several social norms. CONCLUSIONS: The concept of governance in mental health includes standards of quality and attention centered on the patient, and incorporates the consumers of mental healthcare in the decision-making process. OBJETIVO: Analizar la conceptualización del término gobernanza en las políticas de salud mental. MÉTODOS: En esta revisión sistemática se analizó literatura científica publicada en el ámbito internacional durante 15 años (de 2000 hasta 2015). Las bases de datos analizadas fueron: Medline, CINAHL, PsycINFO y PubMed. Los descriptores fueron gobernanza y salud mental. Fueron incluidos artículos relevantes de acuerdo a nuestro objeto de estudio y niveles de análisis: (i) concepto de gobernanza en salud mental; (ii) proceso y espacios de decisión; (iii) actores estratégicos y de interés que intervienen en el funcionamiento del sistema de salud, y (iv) normas sociales. Se excluyeron cartas al editor, noticias, comentarios y reporte de caso, artículos incompletos y artículos que no incluyeran en su abordaje el objeto de estudio de esta revisión. RESULTADOS: Se reportaron cinco conceptualizaciones del término gobernanza en salud mental en el ámbito de políticas de provisión y organización de servicios. Los actores fueron desde proveedores a usuarios de servicios; se identificaron diversas normas sociales. CONCLUSIONES: El concepto de gobernanza en salud mental incorpora estándares de calidad y atención centrada en el paciente, e incluye a los usuarios en la toma de decisiones.

[Indicators of governance in mental health policies and programmes in Mexico: a perspective of key actors]. / Indicadores de gobernanza en políticas y programas de salud mental en México: una perspectiva de actores clave.

OBJECTIVE: To analyse the role of Mexico's mental health system governance in the development of mental health policies and programmes, from the perspective of its own actors. METHODS: A map was developed for identifying the actors in Mexico's mental health system. A guide was designed for in-depth interviews, which were recorded and arranged in categories for their analysis. The Atlas-ti v.7 software was used for the organisation of qualitative data and Policy Maker v.4 was used to determine the position and influence of actors within the health system. RESULTS: The actors were identified according to their level of influence in mental health policies: high, medium and low. Actors with a high level of influence participate in national policies, actors with medium influence are involved in regional or local policies and the participation of actors with a low level of influence is considered marginal. CONCLUSIONS: This study facilitated understanding of governance in mental health. The level of influence of the actors directly affects the scope of governance indicators. Relevant data were obtained to improve policies in mental health care.