First drug-checking study at an electronic festival and fentanyl detection in the central region of Mexico.

BACKGROUND: Perception of drug adulteration has increased in Mexico, but there is little research on adulterants and toxicity. The aim of this study was to identify drug composition in an electronic music outdoor festival nearby Mexico City. METHODS: The participants completed a questionnaire with demographic data, harm reduction strategies, drug-use patterns, history, and the drug they expected to find. We took a small sample of each substance and prepared it for drug checking. A two-section drug testing station was placed within the grounds of the festival. Interaction with participants occurred at the front part. Drug checking was conducted at the rear part. The service was free of charge, voluntary and confidential. Forty persons aged 22 to 48 years participated (mode = 28), of which 92.5% were male, most (82.5%) were single. Through the Substance Analysis Program of "ReverdeSer Collective," we conducted the testing with the attendants that provided 51 drug samples, following ethical and biosafety protocols. We used colorimetry, Fourier Transform Infrared Spectroscopy, and fentanyl immunoassay strips for sample analysis. RESULTS: Substances of choice among attendants were psychostimulants (MDMA and other amphetamine-like drugs) and hallucinogens. Most samples contained what the users expected plus adulterants. Main adulterants were methylene-dioxy-ethyl-amphetamine, methylene-dioxy-propyl-amphetamine, hydroxyamphetamine, and the selective serotonin reuptake inhibitor venlafaxine. Fentanyl was present in 2 out of 4 cocaine samples and in 14 of the 22 confirmed MDMA samples. CONCLUSIONS: Some of the adulterants found pose serious health risks, especially fentanyl, amphetamine-like substances, and venlafaxine. Therefore, it is urgent to monitor these adulterants at electronic music festivals and to implement prevention, treatment, and harm reduction public policies. Naloxone distribution and drug-assisted therapies should be part of government programs in Mexico.

Changes in Attitudes toward People with Substance Use Disorder: A Comparative Study of the General Population in Mexico.

BACKGROUND: Substance use disorders are among the most stigmatized conditions worldwide. People with substance use disorder (PWSUD) are often considered responsible for their use of drugs. The objectives are to analyze changes in Mexican attitudes toward PWSUD in the general population over the period 2011 to 2016 and to use the latest Mexican household survey to determine which segments of the population are most likely to have negative attitudes. METHODS: Two representative national household surveys employing similar methodologies were conducted in Mexico in 2011 and 2016 with persons aged 12-65 years. Participants were asked about their attitudes toward PWSUD, and changes were compared across GLM. RESULTS: The surveys found a decrease from 2011 to 2016 in the number of respondents who considered PWSUD "sick" or in "need of help" and an increase in the number who believed they were "selfish" or "criminal". The 2016 survey found that men, people 18 years of age or older, people who do not use drugs and people with lower educational levels were the groups with the most negative attitudes toward PWSUD. CONCLUSIONS: These results suggest that it may not be recognized that PWSUD may have a health problem and that this helps to increase stigmatization towards this population.

Genome-Wide Analysis of Disordered Eating Behavior in the Mexican Population.

Alterations in eating behavior characterized eating disorders (ED). The genetic factors shared between ED diagnoses have been underexplored. The present study performed a genome-wide association study in individuals with disordered eating behaviors in the Mexican population, blood methylation quantitative trait loci (blood-meQTL), summary data-based Mendelian randomization (SMR) analysis, and in silico function prediction by different algorithms. The analysis included a total of 1803 individuals. We performed a genome-wide association study and blood-meQTL analysis by logistic and linear regression. In addition, we analyzed in silico functional variant prediction, phenome-wide, and multi-tissue expression quantitative trait loci. The genome-wide association study identified 44 single-nucleotide polymorphisms (SNP) associated at a nominal value and seven blood-meQTL at a genome-wide threshold. The SNPs show enrichment in genome-wide associations of the metabolic and immunologic domains. In the in silico analysis, the SNP rs10419198 (p-value = 4.85 × 10-5) located on an enhancer mark could change the expression of PRR12 in blood, adipocytes, and brain areas that regulate food intake. Additionally, we found an association of DNA methylation levels of SETBP1 (p-value = 6.76 × 10-4) and SEMG1 (p-value = 5.73 × 10-4) by SMR analysis. The present study supports the previous associations of genetic variation in the metabolic domain with ED.

Genome-wide association study of psychiatric and substance use comorbidity in Mexican individuals.

The combination of substance use and psychiatric disorders is one of the most common comorbidities. The objective of this study was to perform a genome-wide association study of this comorbidity (Com), substance use alone (Subs), and psychiatric symptomatology alone (Psych) in the Mexican population. The study included 3914 individuals of Mexican descent. Genotyping was carried out using the PsychArray microarray and genome-wide correlations were calculated. Genome-wide associations were analyzed using multiple logistic models, polygenic risk scores (PRSs) were evaluated using multinomial models, and vertical pleiotropy was evaluated by generalized summary-data-based Mendelian randomization. Brain DNA methylation quantitative loci (brain meQTL) were also evaluated in the prefrontal cortex. Genome-wide correlation and vertical pleiotropy were found between all traits. No genome-wide association signals were found, but 64 single-nucleotide polymorphism (SNPs) reached nominal associations (p < 5.00e-05). The SNPs associated with each trait were independent, and the individuals with high PRSs had a higher prevalence of tobacco and alcohol use. In the multinomial models all of the PRSs (Subs-PRS, Com-PRS, and Psych-PRS) were associated with all of the traits. Brain meQTL of the Subs-associated SNPs had an effect on the genes enriched in insulin signaling pathway, and that of the Psych-associated SNPs had an effect on the Fc gamma receptor phagocytosis pathway.

Association of MGAT4C with major neurocognitive disorder in the Mexican population.

BACKGROUND: Neurocognitive disorders (NCDs) are characterized by cognitive decline. Most genetic studies of NCDs have been focused on single-nucleotide polymorphism; other genetic variations, such as copy number variants (CNV), have been less explored. The aim of the present study was to explore CNVs associated with NCDs in a small sample of Mexican individuals and search for the frequency in a larger replication sample of individuals at high-risk for or diagnosed with NCDs. METHOD: The exploratory analysis analyzed whole-genome CNVs associated with NCDs in 1335 individuals, of whom 35 were diagnosed with NCDs and 1300 were population-based controls. Whole-genome CNVs were derived from PsychArray and the PennCNV algorithm. The frequency of associated CNVs in a sample of 277 individuals diagnosed with NCDs and 70 high-risk individuals was then determined using RT-PCR. RESULTS: The exploratory analysis identified one deletion associated with NCDs (p = 0.007) affecting the gene MGAT4C (Mannosyl (Alpha-1,3-)-Glycoprotein Beta-1,4-N-Acetylglucosaminyltransferase, Isozyme C). In the replication sample, a frequency of 3.97% was found in individuals diagnosed with NCDs and 1.43% in high-risk individuals. CONCLUSIONS: An association between a rare CNV on MGAT4C and cognitive impairment was found in this sample of the Mexican population. Nevertheless, studies with larger sample sizes are needed in order to further explore the association.

Cannabis Use in People With Obsessive-Compulsive Symptomatology: Results From a Mexican Epidemiological Sample.

Recent studies suggest that the endocannabinoid system could play an important role in the physiopathology of obsessive-compulsive disorder (OCD). There are reports of effective treatment with derivatives of tetrahydrocannabinol (THC). The study of the genetic factor associated with psychiatric disorders has made possible an exploration of its contribution to the pharmacological response. However, very little is known about the genetic factor or the prevalence of cannabis use in the Mexican population with OCD. The objective of this study is to compare the prevalence of use and dependence on cannabis in individuals with obsessive-compulsive symptomatology (OCS) with that of individuals with other psychiatric symptoms (psychosis, depression, and anxiety), and to explore the association between genetic risk and use. The study includes a total of 13,130 individuals evaluated in the second stage of the 2016 National Survey of Drug, Alcohol, and Tobacco Use (Encodat 2016), with genetic analysis (polygenic risk scoring) of a subsample of 3,521 individuals. Obsessive symptomatology had a prevalence of 7.2% and compulsive symptomatology a prevalence of 8.6%. The proportion of individuals with OCS who had ever used cannabis was 23.4%, and of those with cannabis dependency was 2.7%, the latter figure higher than that in individuals with other psychiatric symptoms (hypomania, 2.6%; anxiety, 2.8%; depression, 2.3%), except psychosis (5.9%). Individuals with OCS who reported using cannabis had an increased genetic risk for cannabis dependence but not for OCD. We thus cannot know how the increased genetic risk of cannabis dependence in people with OCD is influenced by their pharmacological response to derivatives of THC. The results, however, suggest paths for future studies.

The Identification of Admixture Patterns Could Refine Pharmacogenetic Counseling: Analysis of a Population-Based Sample in Mexico.

Pharmacogenetic analysis has generated translational data that could be applied to guide treatments according to individual genetic variations. However, pharmacogenetic counseling in some mestizo (admixed) populations may require tailoring to different patterns of admixture. The identification and clustering of individuals with related admixture patterns in such populations could help to refine the practice of pharmacogenetic counseling. This study identifies related groups in a highly admixed population-based sample from Mexico, and analyzes the differential distribution of actionable pharmacogenetic variants. A subsample of 1728 individuals from the Mexican Genomic Database for Addiction Research (MxGDAR/Encodat) was analyzed. Genotyping was performed with the commercial PsychArray BeadChip, genome-wide ancestry was estimated using EIGENSOFT, and model-based clustering was applied to defined admixture groups. Actionable pharmacogenetic variants were identified with a query to the Pharmacogenomics Knowledge Base (PharmGKB) database, and functional prediction using the Variant Effect Predictor (VEP). Allele frequencies were compared with chi-square tests and differentiation was estimated by FST. Seven admixture groups were identified in Mexico. Some, like Group 1, Group 4, and Group 5, were found exclusively in certain geographic areas. More than 90% of the individuals, in some groups (Group 1, Group 4 and Group 5) were found in the Central-East and Southeast region of the country. MTRR p.I49M, ABCG2 p.Q141K, CHRNA5 p.D398N, SLCO2B1 rs2851069 show a low degree of differentiation between admixture groups. ANKK1 p.G318R and p.H90R, had the lowest allele frequency of Group 1. The reduction in these alleles reduces the risk of toxicity from anticancer and antihypercholesterolemic drugs. Our analysis identified different admixture patterns and described how they could be used to refine the practice of pharmacogenetic counseling for this admixed population.

[Risky eating behaviors in student population in Mexico City: trends 1997-2003]. / Conductas alimentarias de riesgo en población estudiantil del Distrito Federal: tendencias 1997-2003.

OBJECTIVE: The main purpose of this study was to identify the trends of risky eating behaviors among student population in Mexico City in the period 1997-2003 and its relationship with sex age and family head educational level. METHODS: Data from the 1997 (N = 9,755), 2000 (N = 3,286) and 2003 (N = 3,062) Drug and Alcohol Prevalence in Student Population of Mexico City Survey's were analyzed. These are representative data of students of junior high, high school and technical schools in Mexico City, with a mean age of 14.5 years (SD = 1.9). Eating behaviors were assessed with a brief questionnaire developed following DSM-IV diagnostic criteria. Risky eating behaviors and the number of risk indicators were compared by sex, age and family head educational level. RESULTS: The results showed an overall increase in the percentage of males (from 1.3% in 1997 to 3.8% in 2003), and females (3.4% in 1997 to 9.6% in 2003) who showed 3 or more risky eating behaviors. The analysis by age groups showed an increase in all but 16-17 year old males, and in all females, being 12-13 year old males and 18-19 year old females the most affected. Regarding the type of risk indicators in both sexes and across all age groups, an increase in preoccupation towards gaining weight and the use of purging and restrictive methods to loose weight was observed. Body weight overestimation decreased in males, while in females showed an increase along with binges in the 2000 survey but showed a decrease after that (2003 survey). The relationship between the family head educational level and risky eating behaviors did not show a regular pattern among males, while a positive relationship between both variables was found among females. CONCLUSIONS: A first overall view of the situation of risky eating behaviors among adolescent students in Mexico City and the changes observed in the period studied. An increase of these behaviors was observed along the period of study, being younger males and older females the most affected, as well as women whose family head showed higher educational level.

Attitudes towards safe consumption sites among police and people with lived experience in Tijuana, Mexico: initial report from the field / Actitudes sobre salas de consumo seguro entre policía y personas con experiencia vivida en Tijuana, México: informe inicial de campo

Abstract Introduction Mexico northern border has high levels of heroin use. For more than 10 years, the country has implemented several harm reduction interventions to reduce the risks associated with drug use. New strategies such as Safe Consumption Sites (SCS) must be considered as a next step to service vulnerable populations and increase their health outcomes. Objective This report seeks to measure and compare attitudes on a potential SCS intervention in Tijuana among police and people with lived experience (PLE) in heroin use in the city. Method Two parallel studies on police practices and everyday experiences of heroin users in Tijuana were able to ask similar questions about attitudes toward SCS and its implementation in the city. They conducted quantitative interviews with 771 active police officers and 200 PLE while in rehabilitation services. Results Both groups showed a high personal support for SCS of nearly 82% and a perceived implementation success around 80%. Officers reported 58.9% peer support for SCS while PLE 79%. Around 76% of both groups agreed that a SCS would help to improve their personal health. Finally, 86.2% of the officers would refer people to a SCS while 62.5% of PLE would use the service. Discussion and conclusions The strong positive attitudes from police officers and PLE towards SCS in the city of Tijuana reported in both studies indicate the possibility of a successful implementation of a SCS. This intervention would represent an innovative way to protect PLE from police harassment and victimization, helping reduce HIV and HCV risk behaviors while improving community health.

Resumen Introducción En la frontera norte de México hay niveles altos de consumo de heroína. Durante más de 10 años, el país ha implementado diversas intervenciones de reducción de daños para minimizar los riesgos asociados con el uso de sustancias. Los sitios de consumo seguro (SCS) se deben considerar como una opción que brinde servicios a poblaciones vulnerables para mejorar su salud. Objetivo Este reporte mide y compara actitudes entre policías y personas con experiencia vivida (PEV) en uso de heroína en Tijuana, relacionadas con una posible implementación de SCS en la ciudad. Método Dos estudios paralelos sobre prácticas policiales y experiencias cotidianas de usuarios de heroína en Tijuana incluyeron preguntas similares sobre actitudes hacia los SCS y su implementación en la ciudad. Se realizaron 771 entrevistas cuantitativas con oficiales de policía y 200 con PEV internadas en centros de rehabilitación. Resultados Ambos grupos mostraron un alto apoyo hacia los SCS cercano al 82% y un éxito percibido en implementación del 80%. Los oficiales reportaron 58.9% de apoyo entre pares a las SCS y del 79% entre PEV. Un 76% en ambos grupos coincidieron que un SCS ayudaría a mejorar su salud personal. Finalmente, el 86.2% de los oficiales referirían hacia un SCS, mientras que 62.5% de PEV las usarían. Discusión y conclusiones Las actitudes hacia los SCS indican una posible implementación exitosa de SCS en la ciudad. Esta intervención representaría una forma innovadora de disminuir el acoso y victimización policial hacia las PEV, reduciendo los factores de riesgo de VIH y VHC, mejorando la salud comunitaria.

National trends in alcohol consumption in Mexico: results of the National Survey on Drug, Alcohol and Tobacco Consumption 2016-2017 / Tendencias nacionales del consumo de alcohol en México: resultados de la Encuesta Nacional de Consumo de Drogas, Alcohol y Tabaco 2016-2017

Abstract: Introduction: Worldwide, binge drinking of alcohol has increased, especially among young people. In Mexico, various epidemiological sources allow us to account for the growth this pattern of consumption has had. Given this context, the Encuesta Nacional de Consumo de Drogas 2016-2017 (ENCODAT) shows the evolution in alcohol consumption. Objective: To determine the prevalence and national and regional trends, as well as state variations of alcohol consumption in the population aged 12 to 65. Method: The ENCODAT 2016-2017 is a random, probabilistic, and multi-stage study with national and state representation. The sample consisted of 56 877 people who answered a standardized questionnaire through ACASI (self-administered computer interviews) that collects information about the use of tobacco, alcohol, and medical and illegal drugs. Results: Binge drinking past month increased from 12.3% to 19.8% from 2011 to 2016. A similar situation occurs in daily use (from .8% to 2.9%) and weekly binge drinking (from 5.4% to 8.5%). The age of onset has remained stable since 2011 (16.6 years for men, 19.2 years for women in 2016). Meanwhile, 2.2% reported alcohol dependence. The states with the highest prevalence of binge drinking are Nuevo León (30.3%), Jalisco (27.7%) and, Coahuila (27.5%). Discussion and conclusion: The results show that alcohol use increased with respect to 2011, especially in women; data on treatment seeking indicate that women who use alcohol are also the least likely to seek help. Given this context, it is necessary to have specialized spaces that provide treatment in keeping with use-based needs and gender condition.

Resumen: Introducción: A nivel internacional, el consumo excesivo de alcohol ha aumentado, principalmente entre la población joven. En México, diversas fuentes epidemiológicas dan cuenta del crecimiento de este patrón de consumo. Dado este contexto, la Encuesta Nacional de Consumo de Drogas, Alcohol y Tabaco 2016-2017 (ENCODAT) muestra la evolución en el consumo de alcohol. Objetivo: Conocer las prevalencias y tendencias nacionales y regionales, así como las variaciones estatales del consumo de alcohol en la población de 12 a 65 años. Método: La ENCODAT 2016-2017 es un estudio aleatorio, probabilístico y polietápico con representatividad nacional y estatal. En la muestra participaron 56 877 personas que contestaron un cuestionario estandarizado mediante ACASI (entrevistas auto-administradas por computadoras), que recaba información sobre consumo de tabaco, alcohol y drogas médicas e ilegales. Resultados: El consumo excesivo en el último mes se incrementó de 12.3% a 19.8% de 2011 a 2016. Una situación similar ocurre en el consumo diario (de .8% a 2.9%) y consuetudinario (de 5.4% a 8.5%). La edad de inicio se ha mantenido estable desde 2011 (16.6 años hombres; 19.2 años mujeres en 2016). En tanto, el 2.2% reportó dependencia al consumo de alcohol. Las entidades con las prevalencias más altas en consumo excesivo son Nuevo León (30.3%), Jalisco (27.7%) y Coahuila (27.5%). Discusión y conclusión: Los resultados muestran que el consumo de alcohol creció con respecto a 2011, especialmente en mujeres. Datos sobre la asistencia a tratamiento, indican que éstas son también quienes menos acuden. Dado este contexto, es necesario contar con espacios especializados que brinden atención conforme a las necesidades de consumo y de condición de género.

Magnitude and extent of gambling disorder in the Mexican population / Magnitud y extensión del juego patológico en la población mexicana

Abstract: Introduction: Gambling disorder is characterized by an uncontrollable need to gamble, lack of control over gambling, prioritizing gambling over other activities, and continuing to gamble despite the negative consequences this entails. Worldwide, between .1% and 5% of people show signs of problem gambling and between .1% and 2.2% present a positive result in gambling disorder criteria. Objective: To determine the extent of the problem of gambling disorder in Mexico and to identify and analyze the demographic groups in which it occurs. Method: ENCODAT 2016-2017 is a probabilistic, multi-stage survey with national and state representativeness. The sample comprises 56 877 people who answered a standardized questionnaire that collects information on addictive substance use and other areas such as gambling disorder. Results: A total of 24.5% of the population aged 12 to 65 have played a betting game at lifetime. Men have higher statistically significant prevalences than women in nearly all types of gambling and in six of the nine symptoms of gambling disorder. In Mexico, .3% of the target population meet the criteria for gambling disorder, with adolescents showing the highest percentage (.4%). Discussion and conclusion: It is necessary to reinforce public policies for this issue that include the development of preventive actions targeting the adolescent and youth population in Mexico, and to ensure the adequate monitoring of authorized centers.

Resumen: Introducción: El juego patológico se caracteriza por la necesidad incontrolable de jugar, la falta de control sobre el juego, la prioridad de jugar sobre otras actividades y de continuar jugando a pesar de las consecuencias negativas. A nivel mundial, entre .1% y el 5% de las personas muestra señales de juego problemático y del .1% al 2.2% presenta un resultado positivo en los criterios de juego patológico. Objetivo: Conocer la extensión del problema del juego patológico en México e identificar y analizar los grupos demográficos en los que se presenta. Método: La ENCODAT 2016-2017 es una encuesta probabilística y polietápica con representatividad nacional y estatal. La muestra fue de 56 877 personas, las cuales contestaron un cuestionario estandarizado que recaba información sobre consumo de sustancias adictivas y otras áreas como el juego patológico o ludopatía. Resultados: El 24.5% de la población de 12 a 65 años ha jugado algún juego de azar alguna vez en la vida. Los hombres presentan prevalencias estadísticamente significativas más altas que las mujeres en casi todos los tipos de juegos y en 6 de los 9 síntomas de juego patológico. En el país, el .3% de la población objetivo cumple con los criterios para juego patológico, y los adolescentes muestran el mayor porcentaje (.4%). Discusión y conclusión: Es necesario reforzar políticas públicas sobre el tema que incluyan el desarrollo de acciones preventivas dirigidas a la población adolescente y joven del país, así como incidir en el monitoreo adecuado de los centros autorizados.

Sociodemographic and personal factors related to depressive symptomatology in the Mexican population aged 12 to 65.

OBJECTIVE: To describe the prevalence of depressive symptoms in the Mexican population, aged 12 to 65 years, by identifying the main related socio-demographic and personal factors. METHODS: Data are drawn from the National Survey on Addictions 2008 (ENA 2008), a random, probabilistic, multistage study. A randomly selected sub-sample of 22,962 persons answered the section on depressive symptomatology, measured with the Center for Epidemiologic Studies Depression Scale (CES-D). RESULTS: The total prevalence for depressive symptomatology was 5.1%; the prevalence was 7.5% for women and 2.5% for men. For women, more evidence of depressive symptoms was seen in the central region, whereas for men, symptoms were homogeneous across the country. Factors related to the presence of depressive symptoms include being divorced (in women) or widowed (in men), having lower educational attainment, perceiving one's place of residence as unsafe, displaying alcohol abuse or dependence, being a regular drug consumer (in men) and having been sexually abused (males and females). CONCLUSIONS: The regional distribution of depressive symptomatology in women indicates the need for region-specific prevention programs that take into account the different social problems that affect women's emotional well-being. More research is also needed to support the early identification and intervention of men suffering from depression.

Contextual factors associated with marijuana use in school population / Factores contextuales asociados con el consumo de marihuana en población estudiantil

Abstract Introduction Marijuana use among the student population has increased in Mexico and Latin America. There are social, interpersonal and individual factors associated with the onset and continuation of marijuana use. These include the availability of drugs in the community, opportunity for use, low perceived risk of harm from marijuana use and social tolerance by family and close friends. Moreover, these factors increase the probability of experimenting with other drugs, polysubstance use and dependence. Objective To identify the relationship between the level of urbanization, drug availability, exposure to opportunity for use, risk perception and social tolerance of the level of marijuana use among Mexican middle and high school students. Method The results are drawn from various surveys conducted in Mexico City and the National Survey of Drug Use among Students 2014. A total of 114 364 middle and high school students participated (49.8% boys and 50.2% girls). Results Of the respondent 10.6% had used marijuana at least once (12.9% boys and 8.4% girls). The variables that predicted higher marijuana use were drug use approval by family and best friend,, the level of urbanization and low risk perception. Discussion and conclusion Action must be taken on the factors mentioned to decrease the availability and use of drugs in the environment, and raise awareness of their consequences. These elements must be introduced systematically and creatively into preventive programs in this area.

Resumen Introducción El consumo de mariguana en población estudiantil se ha incrementado en México y América Latina. Existen factores sociales, interpersonales e individuales asociados con el inicio y la continuación de su consumo. Entre ellos encontramos la disponibilidad de drogas en la comunidad, la oportunidad de consumo, la baja percepción de riesgo por consumir mariguana, la tolerancia social de la familia y la de los amigos cercanos. Además, estos factores aumentan la probabilidad de experimentar con otras drogas, ser policonsumidor y producir dependencia. Objetivo Conocer la relación entre el nivel de urbanización, la disponibilidad de drogas, la exposición a la oportunidad de consumo, la percepción de riesgo y la tolerancia social con el nivel de consumo de mariguana en los estudiantes mexicanos de secundaria y bachillerato. Método Los resultados parten de diversas encuestas realizadas en la Ciudad de México y de la Encuesta Nacional de Consumo de Drogas en Estudiantes 2014. Participaron 114 364 alumnos de secundaria y bachillerato (49.8% hombres y 50.2% mujeres). Resultados El 10.6% consumieron mariguana alguna vez (12.9% hombres y 8.4% mujeres). Las variables predictoras de un mayor consumo de mariguana fueron la tolerancia ante el consumo de drogas de la familia y del mejor amigo, el nivel de urbanización y una baja percepción de riesgo. Discusión y conclusión Es necesario incidir en los factores señalados con objeto de disminuir la disponibilidad y el consumo de drogas en el entorno, así como en el conocimiento real de sus consecuencias. Estos elementos deben introducirse sistemática y creativamente en los programas preventivos del área.

Tendencias del uso de drogas en la Ciudad de México: Encuesta de estudiantes, octubre 2012 / Drug use trends in Mexico City: 2012 students survey

Introducción Los estudios epidemiológicos en nuestro país muestran un incremento en el consumo de drogas ilegales y de alcohol. La edad de inicio también ha disminuido, especialmente en el consumo de alcohol. Por su parte, el consumo de inhalables se ha incrementado en forma importante, especialmente entre las mujeres jóvenes. Son diversos los factores asociados al consumo de drogas, pero de manera importante destacan el desarrollo de estrategias de resistencia, junto con sus habilidades sociales subyacentes, así como los estilos parentales de crianza. Método La presente es una encuesta probabilística en población escolar de secundarias y bachilleratos de la Ciudad de México que se levantó en noviembre del 2012, con representación a nivel de cada Delegación. La muestra fue de 26 503 alumnos. La información se obtuvo mediante un cuestionario estandarizado y validado en encuestas anteriores. Resultados El consumo de tabaco disminuyó significativamente (de 44.3% a 41.0%), el 32.9% de los adolescentes comenzó a utilizar tabaco antes de los 13 años. El 68.2% consumió alcohol alguna vez; en tanto que la edad de inicio promedio de consumo de esta sustancia se mantuvo en los 12.6 años. La prevalencia de consumo de drogas alguna vez aumentó de 21.5% a 24.4%. La mariguana es la droga de preferencia en la población estudiantil (15.9%). También se encontraron incrementos en la presencia de abuso sexual, mientras que el intento suicida disminuyó. Discusión Los resultados muestran el continuo crecimiento que tiene esta problemática, aunque los inhalables se mantuvieron constantes y el tabaco disminuyó de manera importante. Dado estos resultados, es una tarea preponderante dedicar más esfuerzos a la prevención con estudios e intervenciones evaluadas para preescolar y primaria, así como para los padres de familia y los maestros.

Introduction Epidemiological studies in our country show increases in the consumption of illegal drugs and alcohol. The age of onset has decreased, especially regarding alcohol use. Meanwhile, consumption of inhalants has increased significantly, especially among young women. There are several factors associated with drug use, but the development of resistance strategies, along with its underlying social skills and parenting styles, stand out in a significant way. Method Data comes from a probabilistic survey carried out in November 2012, with students from 7th to 12th school grades, in Mexico City, which was representative for each of its districts. The sample was 26 503 students. Information was obtained through a questionnaire standardized and validated in previous surveys. Results Tobacco consumption decreased significantly (44.3% to 41.0%); 32.9% of the adolescents began its use before age 13. Lifetime consumption of alcohol was 68.2%, while the average age of onset of cannabis use remained at 12.6 years. Lifetime prevalence of any drug use increased from 21.5% to 24.4%. Marijuana was the first drug of choice among students (15.9%). Increases were also found in sexual abuse rate, while suicide attempt decreased. Discussion Although inhalants use remained stable and tobacco use decreased significantly, results show the continued growth of drug use. Given this context, concentrating more efforts in prevention with studies and evaluated interventions for pre-school and elementary school students, as well as for parents and teachers, is a preponderant task.

Sociodemographic and personal factors related to depressive symptomatology in the Mexican population aged 12 to 65 / Fatores sociodemográficos e pessoais relacionados à sintomatologia depressiva na população mexicana entre 12 e 65 anos

OBJECTIVE: To describe the prevalence of depressive symptoms in the Mexican population, aged 12 to 65 years, by identifying the main related socio-demographic and personal factors. METHODS: Data are drawn from the National Survey on Addictions 2008 (ENA 2008), a random, probabilistic, multistage study. A randomly selected sub-sample of 22,962 persons answered the section on depressive symptomatology, measured with the Center for Epidemiologic Studies Depression Scale (CES-D). RESULTS: The total prevalence for depressive symptomatology was 5.1%; the prevalence was 7.5% for women and 2.5% for men. For women, more evidence of depressive symptoms was seen in the central region, whereas for men, symptoms were homogeneous across the country. Factors related to the presence of depressive symptoms include being divorced (in women) or widowed (in men), having lower educational attainment, perceiving one's place of residence as unsafe, displaying alcohol abuse or dependence, being a regular drug consumer (in men) and having been sexually abused (males and females). CONCLUSIONS: The regional distribution of depressive symptomatology in women indicates the need for region-specific prevention programs that take into account the different social problems that affect women's emotional well-being. More research is also needed to support the early identification and intervention of men suffering from depression.

OBJETIVO: Conhecer a prevalência de sintomas depressivos a nível nacional na população de 12 a 65 anos e identificar os principais fatores sociodemográficos e pessoais associados. MÉTODO: Os dados foram obtidos da Pesquisa Nacional de Adições (ENA 2008), um estudo aleatório e probabilístico. Uma sub-amostra de 22.962 indivíduos responderam a seção de sintomas depressivos medida com a Escala de Depressão do Centro de Estudos Epidemiológicos (CES-D). RESULTADOS: A prevalência de sintomas depressivos foi de 5,2%; 7,5% em mulheres e 2,5% em homens. Entre as mulheres, os sintomas se apresentaram mais na região central do país e, entre os homens, a distribuição geográfica foi homogênea. Os fatores que se associaram aos sintomas depressivos foram estar divorciado (mulheres) ou viúvo (homens), ter nível educacional inferior, sentir sua residência como um local não seguro, apresentar dependência de álcool, ser usuário regular de drogas (homens) e abuso sexual. CONCLUSÕES: A distribuição regional de sintomatologia depresiva em mulheres indica a necessidade regional de orientação para prevenção, levando em conta que as distintas problemáticas sociais podem afetar seu bem-estar emocional. Entre os homens, mais estudos são necessários para identificação precoce da depressão.

El consumo de drogas en México: Resultados de la Encuesta Nacional de Adicciones, 2011 / Drug use in Mexico: Results from the 2011 National Addictions Survey

Introduction In the international context, Mexico is a country with low drug use level, in turn, it shows an increase when considering the most recent epidemiologic trends. In order to maintain an updated analysis of drug use in general population and to identify the most at risk groups, the National Survey of Addictions (ENA) was held in 2011. Objetive The aim of the study was to determine the lifetime prevalence for any drug and any illegal drug use at a national and regional level, in population aged 12 to 65 years. Also, to acknowledge drug consumption trends since 2002 in Mexico. Material and methods ENA 2011 survey is a randomized, multistage probabilistic study. It is representative at a national level and also for eight regions of the country, including rural and urban population. The sample was 3 849 adolescents and 12 400 adults who answered a computerized version of a standardized questionnaire containing sections of tobacco, alcohol, medical drugs (opiates, tranquilizers, sedatives, amphetamines) and illegal drugs (marijuana, cocaine, crack, hallucinogens, inhalants, heroin and methamphetamines). All participants read and signed an informed consent. Emphasis was made on the voluntary and confidential use of the information. Results The national lifetime prevalence of any drug grew between 2002 and 2011, increasing significantly from 5.0% to 7.8%, while consumption of any illegal drugs increased from 4.1% to 7.2%. By sex, in men, any drug use increased from 8.6% to 13%. Illegal drugs increased from 8.0% to 12.5%. In women, use of any drug increased from 2.1% to 3.0% and use of any illegal drug increased from 1.0% to 2.3%. Marijuana is the first drug of choice (6.5%) followed by cocaine (3.6%). Considering regions, any drug consumption grew significantly in the Western (5.5% to 10.3%), Northeast (5.5% to 10.3%), North Central (7.5% to 9.2%) and South Central (4.2% to 7.5%). As for illegal drugs, there is also a statistically significant increase in these regions, however, growth was proportionally bigger in South Central region, going from 3.5% to 6.8%. Conclusions Results from this study indicate a growth in the consumption of illegal drugs from 2002 to 2011, especially in marijuana. It also shows that men from 18 to 34 years are the most affected by this consumption, while increases in adolescent men have been low. Moreover, the study shows that those who have received some type of prevention, showed a smaller consumption prevalence, indicating that further work is needed in this area with young people to consolidate activities of health promotion and drug use prevention, working with infant population is needed, including a systematic evaluation of the actions mentioned above. In the international context, data from this study confirms that Mexico continues reporting low levels of drug consumption.

Introducción En el contexto internacional, México es uno de los países con bajo nivel de consumo de drogas, pero que, a su vez, reporta un incremento si se consideran las tendencias epidemiológicas más recientes. Con la finalidad de mantener un diagnóstico actualizado del consumo de drogas en la población general y de identificar los grupos en mayor riesgo, se llevó a cabo la Encuesta Nacional de Adicciones 2011 (ENA). Objetivo Conocer la prevalencia alguna vez en la vida de uso de cualquier droga y de cualquier droga ilegal a nivel nacional y regional en población de 12 a 65 años. Así como conocer las tendencias que ha seguido el consumo a partir de 2002. Material y métodos La ENA 2011 es un estudio aleatorio, probabilístico y polietápico con representatividad nacional y para ocho regiones del país. Incluye poblaciones rurales y urbanas. La muestra fue de 3 849 adolescentes y 12 400 adultos quienes contestaron un cuestionario estandarizado en versión computarizada que contiene las secciones de tabaco, alcohol, drogas médicas (opiáceos, tranquilizantes, sedantes, anfetaminas) e ilegales (mariguana, cocaína, crack, alucinógenos, inhalables, heroína y metanfetaminas). Todos los participantes leyeron y firmaron una carta de consentimiento informado. Se hizo énfasis en el carácter voluntario y confidencial de la información. Resultados La prevalencia de consumo de cualquier droga alguna vez en la vida a nivel nacional creció significativamente entre 2002 y 2011 al pasar de 5.0% a 7.8%, mientras que el consumo de cualquier droga ilegal incrementó de 4.1% a 7.2%. Por sexo, en los hombres el consumo de cualquier droga pasó de 8.6% a 13% y de drogas ilegales de 8.0% a 12.5%. En las mujeres, la primera aumentó de 2.1% a 3.0% y la segunda de 1.0% a 2.3%. Las drogas de preferencia continúan siendo la mariguana (6.5%) y la cocaína (3.6%). A nivel regional el consumo de cualquier droga creció significativamente en la Occidental (5.5% a 10.3%), Nororiental (5.5% a 10.3%), Norcentral (7.5% a 9.2%) y Centro Sur (4.2% a 7.5%). En cuanto a las drogas ilegales, también se encuentra un incremento estadísticamente significativo en estas regiones, sin embargo el crecimiento fue proporcionalmente mayor en la región Centro Sur, al pasar de 3.5% a 6.8%. Conclusiones Los resultados de la ENA señalan un crecimiento en el consumo de drogas ilegales de 2002 a 2011, especialmente de la mariguana. Asimismo, se observa que los hombres de 18 a 34 años son la población más afectada por dicho consumo, mientras que en los adolescentes el aumento ha sido mínimo. Por otra parte, el estudio muestra que quienes han recibido algún tipo de prevención presentan las prevalencias de consumo más pequeñas, lo cual indica que es necesario seguir trabajando en esta área con los jóvenes para consolidar las acciones de promoción de la salud y prevención; así como trabajar más con la población infantil, con una evaluación sistemática de todas estas acciones. En el contexto internacional los datos confirman que México continúa con niveles bajos de consumo.

[Prevalence of violent events and post-traumatic stress disorder in the Mexican population]. / Prevalencia de sucesos violentos y de trastorno por estrés postraumático en la población mexicana.

OBJECTIVE: To report the rate of exposure to different violent events, their demographic correlates, the prevalence of Post-Traumatic Stress Disorder (PTSD), and the impact on quality of life. MATERIAL AND METHODS: The National Survey of Psychiatric Epidemiology is representative of the Mexican urban population aged 18 to 65. The survey was undertaken in 2001 and 2002 using the Composite International Diagnostic Interview (CIDI- 15) computerized version. The statistical analyses take into account the multistage, stratified, and weighted sample design. Kaplan-Meier and logistic regressions were performed. RESULTS: Sixty-eight percent of the population has been exposed to at least one stressful life event. Exposure varies by sex (rape, harassment, and sexual abuse are more frequent in women; accidents and being a victim of burglary among men) and by age (more frequent in children, adolescents, young adult women, and the elderly). By sex, 2.3% of women and 0.49% of men present PTSD. Rape, harassment, kidnapping, and sexual abuse are the events most associated with PTSD. CONCLUSIONS: The results suggest the need to increase treatment coverage to attend the consequences of violence, taking into consideration the important gender and age variations.

[Early onset depression: prevalence, course, and treatment seeking delay]. / La depresión con inicio temprano: prevalencia, curso natural y latencia para buscar tratamiento.

OBJECTIVE: To estimate the prevalence of early onset depression in the Mexican population and compare its natural history, comorbidity and treatment latency between early onset and adult onset depression. MATERIAL AND METHODS: The National Survey of Psychiatric Epidemiology (ENEP) is representative of the Mexican urban population aged 18 to 65. The diagnostic instrument is the Composite International Diagnostic Interview (CIDI). Statistical analysis was performed with descriptive and logistic regression analyses, considering the multistage, stratified and weighted sample design of the survey. RESULTS: Two percent of the Mexican population has suffered from depression as children or adolescents, with an average 7 episodes during their lifetime (compared with 3 episodes for adult onset); the first episode lasted a mean of 31 months (compared with 16 for adult onset) and generally did not receive any treatment. CONCLUSIONS: The longer duration of the first episode and the greater number of lifetime episodes for subjects with early onset is attributed to the lack of early detection and of timely treatment of depression in Mexican youth. The English version of this paper is available at: http://www.insp.mx/salud/index.html.

Tendencias del consumo de drogas de 1998 a 2005 en tres ciudades de la zona norte de México: Ciudad Juárez, Monterrey y Tijuana / Trends of drug use 1998 to 2005 in three cities in the northern zone of Mexico: Ciudad Juarez, Monterrey and Tijuana

Drug use in Mexico has been on the rise since the 1970s. Nonetheless, this problem has exhibited important variations in the different regions of Mexico. To document these trends, the National Institute of Psychiatry Ramón de la Fuente (INP) has performed household surveys on addictions in different Mexican cities. In the 1970s and early 1980s surveys were conducted in the following cities: Mexico City, La Paz, Baja California Sur; Mexicali, Baja California Norte; Monterrey, Nuevo León; San Luis Potosí, San Luis Potosí; and Puebla, Puebla, among others. The first national survey in urban population was carried out in 1 988, and was repeated in 1993 and 1998, while the first national survey to included rural population was conducted in 2002, which is being followed by another study currently in the field. The student population has also been extensively studied, and has been included in three national drug surveys and studies performed in different entities. Antecedents Results from these surveys show that drug use has not increased in a uniform fashion throughout the Mexican Republic and both student and household surveys have demonstrated higher rates in the northwestern region of the country comprising the states of Baja California, Sonora and Chihuahua, which have exhibited above-average drug use on comparison with the remaining regions of the country. The most frequently consumed drug by the population is marihuana. The 1988 national household survey registered a rising prevalence in use of 2.9% in Mexican population aged 12-65 years of individuals who had used drugs at some time during their lifetime; in 1993 this prevalence increased to 3.32% and in 1998 to 4.70%; while in 2002 the percentage demonstrated a slight decrease to 3.48%. In 1988, the second place in drug preferences of the population was inhalants with a prevalence of drug use at some time during their lifetime of 0.76%; by 1993, the second place was occupied by cocaine. Prevalence of use of the latter was 0.33% in 1988; by 1993, cocaine increased to 0.56% and to 1.45% in 1998, presenting a slight decrease in use in 2002 (1.23%). From 1988-2002 non-prescribed medical drugs consumed were found in the third place in population preference. Objective This article compared drug use rates observed in three cities on or near Mexico's northern border with the U. S.: Ciudad Juarez, Chihuahua; Tijuana, Baja California Norte, and Monterrey, Nuevo León, were studied as part of the 1 998 national survey on addictions by selecting independent representative samples of these localities and with a new survey of these entities in 2005. Method The 1998 national survey of addictions was carried out in a representative sample of Mexican urban population (in localities of 2500 inhabitants). Independent samples were drawn from inhabitants living in several cities throughout Mexico. In this article we report the drug-use trends for three of these cities (Ciudad Juarez, Monterrey and Tijuana) by comparing the rates observed in 1998 with the results of a new wave of household surveys conducted in 2005 in the same cities using comparable methodology. Samples in both periods included population 12-65 years of age residing in households. Sample design was stratified by means of the following: several stages with localities (Áreas Geoestadísticas Básicas, AGEBS, its acronym in Spanish, census tracts); blocks of houses within the selected localities; segments of houses within sample blocks, and one individual per household as the selection unit in each stage. Sample size in Tijuana was 466 and 553 in 1998 and 2005, respectively, while sample sizes for Ciudad Juarez were 472 in 1998 and 606 in 2005, and for Monterrey this was 637 in 1998 and 675 in 2005, and the non-response rate was 23% in 1 998 and 20.3% in 2005. Instruments for obtaining information employed in both time frames considered were similar. Two types of questionnaires were administered: a household questionnaire that included sociodemographic information on all household inhabitants in the sample and their housing conditions and an standardized individual questionnaire administered in a face-to-face interview that collected information on the following: prevalence and use patterns of tobacco, alcohol, five types of illegal drugs (marihuana, cocaine, heroin, hallucinogens, amphetamine-type stimulants and other drugs); four types of medical pharmaceuticals utilized without a prescription (narcotics, stimulants, tranquilizers and sedatives), determining consequences and services utilization. In this article tobacco and alcohol use is not reported. This questionnaire has been extensively tested and used in previous surveys. Interviewers were persons academically prepared in the Social Sciences and trained in the logistics of the several survey stages and extensively supervised during field work. Results Highest rates of use were observed in Tijuana and Ciudad Juarez in contrast with Monterrey, which had lower rates. When use of any drug was considered, an increase in lifetime use from 1998-2005 was observed in all three cities; when use during the past year was contemplated, an increase was observed from 1998-2005 from 2.8-4.8% in the case of Ciudad Juarez and in Monterrey from 1.3%-2.0%, while these rates for Tijuana decreased from 5.4%-4.01%. Reports of use during the previous month fell in Tijuana from 4.4%-2.81 % and in Monterrey this decreased from 1.1 %-0.71 %, while in Ciudad Juarez drug use rates during the previous month increased from 2.4%-3.24%. It is important to mention that there was no statistical significance in any of the different prevalences types. Lifetime use of medical drugs without prescription increased in Tijuana and in Monterrey, while in Ciudad Juarez this remained stable from 1998-2005. In 2005, use of medical drugs decreased in Ciudad Juarez from 1.2%-0.88% and in Tijuana from 1.3%-1 .28%, while in Monterrey no use was detected in 1998, but 0.48% of interviewees did reported drug use in 2005. Previous-month use increased in Tijuana from 0.7%-1 .28% and in Monterrey this ranged from no use in 1998 to 0.48% by contrast in Ciudad Juarez previous-month drug use fell from 1.2-0.88%. In referring only to use of any illegal drug (excluding medical pharmaceutical), lifetime use increased in all three cities from 1998-2005; lifetime use doubled in Monterrey and Ciudad Juarez, while use during the previous year decreased in Tijuana from 4.4%-3.25% and increased in Ciudad Juarez from 1.6%-3.98% and in Monterrey from 1.3%-1 .52%. Prior-month increased in Ciudad Juarez from 1.2%-2.42%, while this exhibited a decrease in Tijuana from 3.9%-2.05% and in Monterrey from 1.1%-0.23%. Data also indicate that a high proportion of individuals in Monterrey have used only one drug; these percentages rose in the 1998-2005 period from 3.7%-8.96% numbers of the poly-drug users doubled in Tijuana from 4%-8.44% and in Ciudad Juarez from 3.2%-7.43%; in Tijuana this was due to an increase among males, and in Ciudad Juarez the number of poly-drug users increased in both genders.

El consumo de drogas en México ha ido en aumento. En la década de 1970, el Instituto Nacional de Psiquiatría realizó las primeras encuestas de hogares sobre el tema de las adicciones en población de distintas ciudades del país: la Ciudad de México, La Paz, B.C.S.; Mexicali, B.C.; Monterrey, N.L.; San Luis Potosí, S.L.P., y Puebla, Pue, entre otras y ha documentado las tendencias del problema y sus variaciones regionales. A nivel nacional se han realizado en hogares cuatro encuestas en 1988, en 1993, en 1998 y en 2002, denominadas <>. Asimismo se han levantado tres encuestas nacionales sobre drogas entre la población estudiantil, las cuales han dado cuenta de que el consumo de drogas no se ha incrementado de manera uniforme en el país, sino que tanto en las encuestas estudiantiles como entre las de adicciones ha resaltado la zona noroccidental, conformada por estados como Baja California, Sonora y Chihuahua, donde se tienen las mayores cifras de consumo de drogas en la República Mexicana. Las encuestas de adicciones indican que la droga que más ha consumido alguna vez en la vida la población urbana de 12 a 65 años es la mariguana, con los siguientes porcentajes: en 1988, 2.99%; en 1993, 3.32%; en 1998, 4.70%; y en la medición de 2002 disminuyó ligeramente a 3.48%. En 1988, el segundo lugar lo ocupaban los inhalables con 0.76%, pero en las demás mediciones ocupa este lugar la cocaína, con 0.56% en 1 993; 1.45% en 1998 y en 2002, 1.23%. En el tercer lugar se encuentran las drogas médicas consumidas sin prescripción desde 1988 hasta 2002. Este artículo presenta una comparación de las prevalencias de uso de drogas en tres ciudades de la Encuesta Nacional de Adicciones de 1998 con respecto a la Encuesta de ciudades de 2005 de las tres ciudades siguientes: Ciudad Juárez, Monterrey y Tijuana. La Encuesta Nacional de Adicciones de 1998 se realizó en una muestra representativa de la población urbana de todo el país (en localidades de más de 2500 habitantes). En esta encuesta, las 32 entidades del país se dividieron en tres regiones y también se obtuvieron muestras en ciudades fronterizas que fueron: Tijuana, Ciudad Juárez y Matamoros y en tres zonas metropolitanas que fueron: La ciudad de México, Guadalajara y Monterrey. La muestra fue de 12015 entrevistas completas. La encuesta de ciudades de 2005 se realizó en cuatro ciudades que fueron: Querétaro, Monterrey, Ciudad Juárez y Tijuana. Sin embargo, para efectos de este trabajo, solamente se comparan las tres últimas. Las dos encuestas tuvieron como objetivo a la población de 12 a 65 años de edad. En ambas se aplicaron dos cuestionarios: el de hogar con datos socioeconómicos y otro individual, cuyas secciones de consumo de drogas fueron iguales. El muestreo en ambas encuestas fue multietápico, probabilístico y estratificado, y en la última etapa se seleccionó a un individuo de cada hogar con un rango de edad de 12 a 65 años. Se obtuvo una no respuesta de 23% en 1998 y de 20.3% en 2005.

Los malestares masculinos: Narraciones de un grupo de varones adultos de la Ciudad de México / Male uneasiness: narratives from a male adult group from Mexico City

Introduction Distresses related to depressive conditions in men have not been sufficiently acknowledged, and yet less studied. The difference between distress and its attention is originated in factors such as a rigid and dual classification of the problem, a false conception that it is a <>, and the social stigma that leads men to accept and face negative emotional states that affect their life quality. This article shows the results of a qualitative study which sought to uncover the social construction of distress from a gender approach and to deepen the understanding about the way men live it and exteriorize it. The concept of loss was taken as a methodological strategy throughout the study to access the male distress experiences, considering that, before an emotionally meaningful loss or an unfavorable event, individuals may react using those experiences. Method Four adult men participated in the study; they were selected using an intensive intentional sampling strategy. We carefully selected only a few cases, seeking to characterize the object of study and to obtain profound information based on reality; they were males who had suffered an important loss. They received a detailed explanation of the study and its objectives, voluntarily accepted to participate and allowed the recording of the interviews. Confidentiality and anonymity were guaranteed. The information was gathered by means of in depth interviews and a thematic guide. We developed categories of analysis from the guide and the study objectives to classify data. Categories were grouped according to their meanings and they generated subcategories that allowed a deeper and more precise analysis. Results The analysis focused on the experiences of four men: Manuel (30 years old), Oscar (36), José (40), and Rodrigo (40). They lived in Mexico City. Manuel and Rodrigo completed high school education, while Oscar and José obtained a college degree. They had different marital status: Oscar is single, Rodrigo is a widower, José is separated from his wife, and Manuel lived together with his girlfriend. Their most important and emotionally meaningful losses, which had caused distress, are described as well as the relationship these had with other aspects of their masculine subjectivity, such as sexuality, the body, violence, sports and work. Loss of couple. Losing the couple was one of the most important experiences the four men lived. This had common causes: psychological and physical violence, cheating, and sexual dissatisfaction. Manuel and Rodrigo spoke about extremely violent episodes where they were beaten-up by their fathers and schoolmates during childhood, followed by brawls during youth as a way of gaining respect. They also said they later reproduced this violence in their relationships with women. Both were jealous and controlling men, but they used different ways to intimidate their couples. Manuel did not use physical, but psychological violence. Instead of psychologically controlling his couple, Rodrigo used to act violently against her. Different elements can be identified from the experience of these men, which entwine in the distress-gender-violence relationship: <> jealousy that triggers violence and using physical or psychological violence as a means for controlling and subordinating the couple. Once they committed and act of violence, they experienced guilt and fear of neglecting that lead them to the rarely kept promise of never doing it again. These events are usually minimized, naturalized, and hardly acknowledged. In the case of cheating, it is important to consider the context where breaking-up takes place, since it is necessary to incorporate other relevant elements of masculine subjectivity: the relationship with the body, the practice of sexuality, the forced heterosexuality, and the continuous evaluation of manhood through social pressure from other men (father, brothers, uncles, and friends). Manuel's experience represents an example of this, because his link with sports and the fitness world allowed him to model his body in order to keep an appealing figure for women and a vehicle for socializing with other men that had similar interests. Being a part of this fellowship allowed Manuel to become a personal trainer and to have several affairs while he was living together with his couple. He said his interest in women and the constant cheating had four basic reasons: the context where fitness takes place, living together for a long time with the same person, feeling sexually unsatisfied, and the realization that her partner showed little interest at home and in doing housework. Thus, in the relationship distress-gender-cheating, when she finds out about him cheating and decides to break-up with him and she leaves him, become the causes on Manuel's distress. José told that problems in his sexual life caused the end of his relationship. He lost his interest in sex and ceased contact with his wife for five or six years because on a genital infection. He also had diabetes since his youth, which also contributed to his lack of interest in sex. José was reluctant to seek medical or psychological help, so his wife decided not to stay with him anymore. Then he reacted with sorrow, impotence, and anger, feelings he considered as a depressive phase. Loss of health. The loss of health could be the result of a chronic illness or a severe injury. It was a distress generating experience for two of them, which had an important impact on their masculine identity in two basic axes: the body and the sexual life. The experiences of José and Manuel allow recognizing the difficulty that men face when they try to accept and admit their own illness and vulnerability, as well as their reticence for taking care of their bodies and health. José said his first painful event was when he was diagnosed with the diabetes at age 25; it was a total self-image change. <> who had to take medication for life. The most traumatic situation Manual had lived was when one of his girlfriends stabbed him in his heart during a fight. This changed the meaning of his life and body; he was downhearted for seven years, affecting his work and his social and sexual life. The origin of distress is beyond losing a couple or health in these cases, because, deep down this distress-health-gender relationship, the problem is in losing the ability to fight or in stopping being sexually active, and therefore in not being able to sustain the gender based commands. Loss of job. Oscar talked about one of this distress generating experiences. Even though he considered himself a competent architect, he had not reached a position where he could get enough social success and economic balance. His story offers the possibility of understanding the meaning of a well-paid job in the life of men: the notion of value as a self-reference, the illusion of self-nomination as someone different and unique, the possibility of recognition and appreciation from others, and the money and power. These elements interact to structure what seams to be one of the most important axes for masculine identity. Because when men cannot enter into the working world, they face crisis and distress periods, which in turn have negative repercussions on their gender identity. Male expressions before losses. There were some fundamental physical expressions of distress: muscular pain, difficult in sleeping, laziness, and untidy appearance. The most frequent emotional expressions included sadness, anger, rage, and vindictive impulses. Other manifestations were more related to the way they have learned to <> by repressing their feelings: not to cry, not to be vulnerable before others, not to show any feelings, and to endure pain.