Effectiveness of a Mobile App to Increase Risk Perception of Tobacco, Alcohol, and Marijuana Use in Mexican High School Students: Quantitative Study.

BACKGROUND: Young people have the highest rate of drug use worldwide. Recent data from Mexico in this population show that the prevalence of illicit drug use doubled between 2011 and 2016 (2.9%-6.2%), with marijuana being the one with the highest increase (2.4%-5.3%), but also point out that alcohol and tobacco use have remained steady or decreased. Mexican adolescents are at high risk for drug use owing to a low perception of risk and the availability of drugs. Adolescence is an ideal period to reduce or prevent risky behaviors using evidence-based strategies. OBJECTIVE: In this study, we aimed to test the short-term effectiveness of a mobile intervention app ("What Happens if you Go Too Far?" ["¿Qué pasa si te pasas?"]) that seeks to increase risk perception of tobacco, alcohol, and marijuana use in a sample of Mexican high school students. METHODS: A nonexperimental evaluation based on pretest-posttest design was used to measure the effectiveness of a preventive intervention using a mobile app, "What Happens If You Go Too Far?" The dimensions analyzed were knowledge of drugs and their effects, life skills, self-esteem, and risk perception. The intervention was conducted on a high school campus with 356 first-year students. RESULTS: The sample included 359 first-year high school students (mean 15, SD 0.588 years; women: 224/359, 62.4% men: 135/359, 37.6%). The intervention increased the overall risk perception of tobacco (χ24=21.6; P<.001) and alcohol use (χ24=15.3; P<.001). There was no significant difference in the perception that it is dangerous to smoke 5 cigarettes, and there was a marginal difference in the perception that it is very dangerous to smoke 1 cigarette or to use alcohol or marijuana. We used a generalized estimating equation method to determine the impact of the variables on risk perception. The results showed that knowledge about smoking increased the risk perception of smoking 1 cigarette (odds ratio [OR] 1.1065, 95% CI 1.013-1.120; P=.01), and that knowledge about marijuana use (OR 1.109, 95% CI 1.138-1.185; P=.002) and self-esteem (OR 1.102, 95% CI 1.007-1.206; P=.04) produced significant increases in the risk perception of consuming 5 cigarettes. Resistance to peer pressure and assertiveness also increased the perceived risk of using tobacco and alcohol. CONCLUSIONS: The intervention has the potential to increase the perception of risk toward drug use in high school students by providing knowledge about the effects and psychosocial risks of drug use and by strengthening life skills that are associated with increased risk perception. The use of mobile technologies in intervention processes may broaden the scope of preventive work for adolescents.

Psychometric properties of the Cognitive Appraisal Inventory for Patients with Chronic Pain in Mexican population / Propiedades psicométricas del Inventario de Evaluación Cognoscitiva para pacientes con dolor crónico en población mexicana

Abstract Introduction Cognitive assessment is the process whereby individuals assess the effect an adverse circumstance has on their well-being (primary assessment) and their ability to cope with it (secondary assessment), which is closely related to the emotional and behavioral response they show as a result. Objective To determine the validity and internal consistency of the Spanish version of the Cognitive Assessment Inventory (CAI) for patients with chronic pain for Mexican population. Method A total of 191 adults with chronic pain completed the Spanish version of the CAI, as well as self-report measures of disability, daily activities, anxiety, and depression. Results The confirmatory factor analysis for each type of primary cognitive assessment included in the CAI yielded models with satisfactory goodness of fit and Cronbach's α indices (loss/damage: CMIN/DF = 1.132, NFI = .935, CFI = .992, AGFI = .939, SRMR = .046, RMSEA = .026, α = .73; threat: CMIN/DF = 1.132, NFI = .935, CFI = .992, AGFI = .939, SRMR = .046, RMSEA = .026, α = .81; and challenge: CMIN/DF = 1.567, NFI = .939, CFI = .977, AGFI = .926, SRMR = .044, RMSEA = .055, α = .86). Cognitive assessments of loss/harm and threat were positively associated with the degree of disability, depression, and anxiety, and negatively associated with the performance of daily activities. The opposite occurred with the cognitive assessment of challenge. Discussion and conclusion The Spanish version of the CAI is a valid, quick, easy, and reliable tool for evaluating the primary cognitive assessment of pain, a construct closely related to physical disability and emotional suffering in response to this experience, which may be modified through brief cognitive interventions.

Resumen Introducción La evaluación cognoscitiva es el proceso mediante el cual un individuo valora el efecto que ejerce una circunstancia adversa en su bienestar (evaluación primaria) junto con las capacidades con que cuenta para afrontarla (evaluación secundaria), con ello guarda una estrecha relación con la respuesta emocional y conductual que despliega en consecuencia. Objetivo Determinar la validez y consistencia interna de la versión en español del Inventario de Evaluación Cognoscitiva (IEC) para pacientes con dolor crónico en población mexicana. Método Un total de 191 adultos con dolor crónico completaron la versión en español del IEC, así como medidas de autorreporte de discapacidad, actividades cotidianas, ansiedad y depresión. Resultados El análisis factorial confirmatorio para cada tipo de evaluación cognoscitiva primaria incluida en el IEC arrojó modelos con índices de bondad de ajuste y α de Cronbach satisfactorios (pérdida/daño: CMIN/DF = 1.132, NFI = .935, CFI = .992, AGFI = .939, SRMR = .046, RMSEA = .026, α = .73; amenaza: CMIN/DF = 1.132, NFI = .935, CFI = .992, AGFI = .939, SRMR = .046, RMSEA = .026, α = .81; y desafío: CMIN/DF = 1.567, NFI = .939, CFI = .977, AGFI = .926, SRMR = .044, RMSEA = .055, α = .86). Las evaluaciones cognoscitivas de pérdida/daño y de amenaza se asociaron positivamente con el grado de discapacidad, depresión y ansiedad, y de forma negativa con la ejecución de actividades cotidianas. Lo contrario ocurrió con la evaluación cognoscitiva de desafío. Discusión y conclusión La versión en español de la IEC es una herramienta fácil, rápida, válida y confiable para evaluar la evaluación cognoscitiva primaria del dolor, constructo íntimamente relacionado con la discapacidad física y el sufrimiento emocional ante esta experiencia susceptible de modificación mediante intervenciones cognoscitivas breves.

Psychosocial Correlates of Suicidal Behavior among Adolescents under Confinement Due to the COVID-19 Pandemic in Aguascalientes, Mexico: A Cross-Sectional Population Survey.

Background: Suicide and suicidal behaviors were already a global public health problem, producing preventable injuries and deaths. This issue may worsen due to the COVID-19 pandemic and may differentially affect vulnerable groups in the population, including children, adolescents, and young adults. The current study evaluated the association of affective variables (depression, hopelessness, and anxiety), drug use (alcohol, tobacco, and others), emotional intelligence, and attachment with suicidal behaviors. Methods: A state-wide survey included 8033 students (51% female, 49% male; mean age of 16 years) from science and technology high-schools using a standardized questionnaire that was distributed online. Multinomial logistic regression models tested associations between suicidal behaviors and several covariates. The analyses accommodated the complex structure of the sample. Results: Approximately 21% of all students reported a suicidal behavior (11% with a low-lethality suicide attempt, 6% with self-injuries, and 4% with a high-lethality suicide attempt). Variables associated with higher odds of suicidal behavior included: female sex, depression, hopelessness, anxiety, alcohol and tobacco use, childhood trauma, and having to self-rely as issues affecting attachment, and low self-esteem. Security of attachment was associated with lower odds of suicidal behavior. Conclusions: The complexity of suicidal behavior makes it clear that comprehensive programs need to be implemented.

Depressive disorder and psychosocial indicators in high school and college students from Mexico City: data from two censuses / Trastorno depresivo e indicadores psicosociales en estudiantes de bachillerato y de licenciatura de la Ciudad de México: datos de dos censos

Abstract Introduction Almost 5% of the Mexican general population (18-65 years old) has suffered depression once in their lives, and 2% of them more than once without receiving treatment. Objetive To measure the prevalence of depressive disorder and to calculate its relationship with psychosocial indicators. Method Data were collected through two censuses with high school and college students from a university in Mexico City (n = 116 214). Participants completed the CES-D and other scales. Multivariate logistic regression models were used. Results The prevalence of depressive disorder was 16%. Predictors of depressive disorder were: having suffered psychological or sexual violence, having a family member who had been injured during an assault, history of depression in the family, poor quality in family and social relationships, among others. Discussion and conclusion The prevalence of depressive disorder increases with age. As prevention and treatment at an early age are essential, intervention and monitoring strategies must be created and systematized taking gender and other elements into account, such as the relationship with the parents, violence, and a history of depression in the family.

Resumen Introducción Casi el 5% de la población general de México (18-65 años) ha sufrido depresión una vez en su vida y 2% la ha sufrido más de una vez sin haber recibido tratamiento. Objetivo Medir la prevalencia del trastorno depresivo y calcular su relación con algunos indicadores psicosociales. Método Los datos fueron recolectados por medio de dos censos con estudiantes de bachillerato y de licenciatura en la Ciudad de México (n = 116 214). Los participantes completaron el CES-D y otras escalas. Se usaron modelos de regresión logística multivariable. Resultados La prevalencia del trastorno depresivo fue del 16%. Los predictores del trastorno depresivo fueron: haber sufrido violencia psicológica o sexual, tener un miembro de la familia que hubíera sido herido durante un asalto, antecedentes de depresión en la familia, mala calidad en las relaciones familiares y sociales, entre otros. Discusión y conclusión La prevalencia del trastorno depresivo aumenta con la edad. Como la prevención y el tratamiento a una edad temprana son esenciales, se deben crear y sistematizar estrategias de intervención y monitoreo que tomen en cuenta el género y otros elementos, como la relación con los padres, violencia e historia de depresión en la familia.

Needs assessment of informal primary caregivers of patients with borderline personality disorder: psychometrics, characterization, and intervention proposal / Evaluación de las necesidades de los cuidadores primarios informales de pacientes con trastorno límite de la personalidad: psicometría, caracterización y propuesta de intervención

Abstract Introduction Informal Primary Caregivers (IPC) of people with borderline personality disorder (BPD) experience a significant burden, making it important to determine their specific needs. Objectives Cross-sectional study aimed at adapting and establishing the reliability of the Questionnaire on the Needs of Family Members of People with Severe Mental Disorders to identify felt and unfelt needs that may or may not have been met in IPCs of patients with BPD and suggest intervention strategies to effectively address them. Method The adapted version of the instrument was completed by 80 IPCs of patients with confirmed BPD diagnosis. Results Cronbach's alpha coefficients for different groups of needs evaluated through the instrument were: Knowledge/information = .77, Instrumental support = . 78, Participation = .63, and Personal support = .74; and for the total score = .86. The most important unmet felt needs were: 1. having information on interventions for patients and caregivers, legal and administrative aspects, and available support services; 2. having coping skills to deal with crises and manage patients' risk behaviors; 3. receiving professional care to reduce stress; and 4. being listened by health professionals, express their personal opinions, and need for rest. Conclusions The adapted instrument showed satisfactory internal consistency in IPCs of patients with BPD. The results highlight the urgent need for interventions for this population, focusing on psychoeducation, assertiveness training, stress management, and problem solving.

Resumen Introducción Los cuidadores primarios informales (CPI) de pacientes con trastorno límite de personalidad (TLP) soportan una pesada carga, por lo que es importante conocer sus necesidades específicas. Objetivos Estudio transversal dirigido a adaptar y determinar la confiabilidad del Cuestionario de Necesidades de Familiares de Personas con Trastornos Mentales Graves a fin de identificar las necesidades sentidas y no sentidas que han sido satisfechas o no en los CPI de pacientes con TLP y sugerir estrategias de intervención para que reciban una atención efectiva. Método Ochenta CPI de pacientes con diagnósticos confirmado de TLP completaron la versión adaptada del instrumento. Resultados Los coeficientes alpha de Cronbach para los cuatro grupos de necesidades evaluadas mediante el instrumento fueron: Conocimientos/información = .77, Apoyo instrumental = .78, Participación = .63, y Apoyo personal = .74; y para el total de la escala = .86. Las necesidades sentidas y no satisfechas que destacaron fueron: 1. tener información de intervenciones para el paciente y los cuidadores, aspectos legales y administrativos, y servicios disponibles para apoyarse; 2. contar con herramientas para afrontar crisis y manejar conductas de riesgo de los pacientes; 3. ser atendidos profesionalmente para reducir el estrés; y 4. ser escuchados por los profesionales de salud y tomados en cuenta en relación con sus opiniones personales y necesidad de descanso. Conclusiones El instrumento adaptado mostró una consistencia interna satisfactoria en CPI de pacientes con TLP. Los resultados resaltan la necesidad urgente de intervenciones para esta población, enfocadas en psicoeducación, entrenamiento asertivo, manejo del estrés ansiedad y solución de problemas.

Relationship between perceived stigma and depressive symptomatology in women who legally interrupt pregnancy in Mexico City / Relación entre estigma percibido y sintomatología depresiva en mujeres que interrumpen el embarazo legalmente en la Ciudad de México

Abstract Introduction Although the international literature suggests that women who interrupt a pregnancy in safe conditions do not develop mental health problems, it continues to be a highly stigmatized issue by broad social sectors. It is therefore not surprising that abortion stigma is one of the main factors associated with the presence of mental health problems in women who abort voluntarily. This study explores the association between perceived abortion stigma and depressive symptomatology. Method In a non-probabilistic convenience sample, 114 users of a Legal Interruption of Pregnancy Clinic in Mexico City were interviewed with a structured instrument. Results Respondents obtained low scores of internalized stigma and reported feeling confident that they had made the right decision to terminate their pregnancies, and at peace with themselves. The highest scores for abortion stigma were reported in the group with high depressive symptomatology, with no statistically significant differences being observed due to the sociodemographic characteristics explored. The participants in this study were more concerned about what others might think about their decision to terminate a pregnancy and about how their abortion might affect their relationship with them. Discussion and conclusion These concerns highlight the need to reduce the negative social stigma surrounding abortion and to provide interventions in the same direction among women who interrupt a pregnancy legally in order to reduce the risk of mental health problems such as depression.

Resumen Introducción A pesar de que la literatura internacional señala que las mujeres que interrumpen sus embarazos en condiciones seguras no desarrollan problemas de salud mental, sigue siendo una situación altamente estigmatizada por amplios sectores sociales. Por ello, no es de sorprender que el estigma por abortar sea uno de los principales factores asociados con la presencia de malestares en la salud mental de algunas mujeres que abortan voluntariamente. Este trabajo explora la asociación entre el estigma percibido por abortar y la sintomatología depresiva. Método En una muestra no probabilística y por conveniencia, 114 usuarias de una Clínica de Interrupción Legal del Embarazo de la Ciudad de México fueron entrevistadas con un instrumento estructurado. Resultados Las participantes obtuvieron bajas puntuaciones de estigma internalizado, reportaron sentirse seguras y en paz con ellas mismas por haber decidido interrumpir sus embarazos. Las puntuaciones más altas de estigma por abortar se reportaron en el grupo con sintomatología depresiva elevada, sin que existieran diferencias significativas por las características sociodemográficas exploradas. Las participantes en este estudio estaban más preocupadas por lo que otros pudieran pensar por su decisión de interrumpir su embarazo y por cómo podría afectar el aborto su relación con estas personas. Discusión y conclusión Estas preocupaciones evidencian la necesidad de disminuir el estigma social negativo que rodea al aborto y plantear intervenciones que actúen en el mismo sentido entre las mujeres que interrumpen legalmente un embarazo para disminuir el riesgo de presentar problemas de salud mental como la depresión.

Relación entre supervisión parental y conducta antisocial en menores infractores del Estado de Morelos / Relationship between parent supervision and anti-social behavior in juvenile offenders from the state of Morelos

Resumen: INTRODUCCIÓN: La supervisión parental comprende: cuidado de los hijos, conocimiento de su paradero y actividades y adaptación. Para que ésta se dé es necesario que exista comunicación y apoyo entre padres e hijos, de manera que el ambiente familiar sea agradable. Por otro lado, se ha encontrado que la inconsistencia o ausencia de ésta es un factor de riesgo de la conducta antisocial y, en casos más graves, de delincuencia en los hijos. OBJETIVO: Conocer cuál es la relación que existe entre el ambiente familiar, la supervisión parental y la gravedad de la conducta antisocial en menores infractores. MÉTODO: La población estuvo conformada por menores infractores de un Centro Tutelar del Estado de Morelos. El instrumento se aplicó a 86 hombres. RESULTADOS: La comunicación del hijo fue un predictor de: 1. el manejo de reglas y conocimiento de pares, y 2. el conocimiento de las actividades del hijo. Esto último es lo que predice de manera significativa la gravedad de la conducta antisocial. DISCUSIÓN Y CONCLUSIÓN: De acuerdo con los hallazgos, es importante que exista un ambiente familiar basado en la comunicación y el apoyo, que fomente una comunicación más libre de los adolescentes con sus padres, de manera que la supervisión parental se consiga más fácilmente. Esto ayudará para que los jóvenes no se involucren en comportamientos que los puedan llevar a delinquir.

Abstract: INTRODUCTION: Parental supervision is constituted by a series of correlated parental behaviors involving children care, knowing their where abouts, which activities they are performing, and the situation of their adaptive processes. In order for parental supervision to take place, it is necessary that communication and mutual support exist between mother and father, as well as between parents and children so that the family environment becomes pleasant. Supervision is one of the most studied factors related to anti-social behavior, and it has been observed that its absence or inconsistency allows for the occurrence of anti-social behavior, which in the more serious cases leads to delinquency. OBJECTIVE: To know the relationship between family environment, supervision and the seriousness of anti-social behavior in juvenile offenders confined in a state penitentiary from Morelos. METHOD: A survey was used to collect data from a population of 86 juvenile male offenders from a state penitentiary located in Morelos. RESULTS: Parent-children communication and support are interrelated and form the familiar environment. Thus, children's communication predicts proper supervision and monitoring, specifically in the area of knowing children's activities, which, at the same time, predict less serious anti-social behavior. DISCUSSION AND CONCLUSION: It is important that families have an environment based on communication and support. It is also relevant to encourage adolescents to freely communicate with their parents so supervision and monitoring become common elements that help adolescents to stay away from behaviors that could lead them to crime.

Evaluación de la efectividad de una intervención interactiva para el manejo del estrés en profesionales de la salud / Evaluation of the efectiveness of an interactive intervention for stress management in health professionals

ANTECEDENTES: Los efectos del estrés dependen de la percepción de los estresores y de las habilidades para afrontar situaciones estresantes. OBJETIVO: Evaluar una intervención interactiva para desarrollar recursos y habilidades para un manejo adecuado del estrés en profesionales de la salud. MÉTODO: Esta intervención se probó utilizando un Cédula diseñada para evaluar componentes de Conocimientos, Habilidades y Actitudes sobre manejo del estrés, conformada por 17 afirmaciones para dimensión de Conocimientos, 11 sobre Habilidades para manejo del estrés; y 20 sobre Actitudes para reaccionar ante el estrés. Participaron 165 profesionales y pasantes de carreras afines. Se hicieron análisis estadísticos para comparar los puntajes de los tres componentes antes y después de la intervención utilizando la prueba t de Student, se aplicó la prueba de McNemar para comparar los resultados. RESULTADOS: Sobre la efectividad de la intervención, en los análisis de comparación de los puntajes, se encontraron diferencias estadísticamente significativas a favor de la intervención en los tres componentes: Conocimientos (t = -9.77, gl = 164, p = .000), Habilidades (t = -10.19, gl = 164, p = .000) y Actitudes (t = -4.80, gl = 164, p = .000).Los análisis por reactivo mostraron incrementos estadísticamente significativos en el número de respuestas correctas después de la intervención en los tres componentes. DISCUSIÓN Y CONCLUSIÓN: Los resultados de esta intervención interactiva fueron estadísticamente significativos en Conocimientos, Habilidades y Actitudes para manejo del estrés. Además de ser una intervención innovadora, breve, basada en la traslación del conocimiento (4 semanas), y disponible en Internet, la evidencia de su efectividad hace que se perfile como una herramienta válida para el manejo adecuado del estrés.

BACKGROUND: The effects of stress depend on the perception of stressors and a person's skills for coping with stressful situations. OBJECTIVE: Evaluate an interactive intervention to develop resources and skills for proper stress management among healthcare professionals. METHOD: This intervention was tested using a chart designed to evaluate the knowledge, skills and attitudes components of stress management, consisting of 17 statements about Knowledge, 11 about Stress management; 20 about Attitudes for reacting to stress. A total of 165 professionals and interns from related careers participated. Statistical analyses were conducted to compare the scores of the three components before and after the intervention using the Student's t test. McNemar's test was used to compare the results. RESULTS: In regard to the effectiveness of the intervention, an analysis of the comparison of scores found statistically significant differences in favor of intervention in the three components: Knowledge (t = -9.77, df = 164, p = .000), Skills (t = -10.19, df = 164, p = .000) and Attitudes (t = -4.80, df = 164, p = .000). The item analysis showed statistically significant increases in the number of correct answers after the intervention in the three components. DISCUSSION AND CONCLUSION: The results of this interactive intervention were statistically significant in Knowledge, Skills and Attitudes for stress management. In addition to being a brief, innovative intervention, based on knowledge translation (4 weeks) and available on the Internet, the evidence of its effectiveness suggests it is a valid tool for proper stress management.

Depresión en adolescentes. Un problema oculto para la salud pública y la práctica clínica / Depression among adolescents. A hidden problem for public health and clinical practice

La depresión constituye un grave problema de salud pública que requiere mayor y mejor atención. En el presente ensayo revisamos el panorama epidemiológico de la depresión en adolescentes de México y discutimos algunas estrategias para su detección temprana y atención oportuna.La sintomatología depresiva es prevalente en jóvenes y adultos en México, como en muchos otros países, con una mayor proporción de casos entre las mujeres. Los jóvenes en condiciones socio-urbanas más conflictivas muestran tasas más elevadas de depresión.Si bien los trastornos depresivos son más prevalentes en las mujeres, en los hombres sus consecuencias pueden tener repercusiones de gravedad aún mayores que en las mujeres. El estigma hacia la depresión en los hombres puede conducir a que se intente enmascarar los síntomas mediante conductas de alto riesgo. Las mujeres tienen mayores tasas de intento de suicidio, pero en los hombres los intentos son más letales. Las tasas de suicidio consumado en varones son más altas en la mayoría de los países del mundo, y México no es la excepción. Pese a las barreras y escasos recursos en las instituciones de salud y educación, será necesario continuar desarrollando alternativas que permitan una mejor atención de la problemática de salud mental en la población joven, aun cuando sus necesidades no puedan ser expresadas directamente o que los motivos de consulta sean "otros", frecuentemente enmascarados por conductas problemáticas, como la violencia y las adicciones, entre otras.

Depression is an important public health problem that requires more and better attention. In the present work we review epidemiologic studies of depression among adolescents in Mexico and discuss strategies that may help in earlier identification and referral of potential cases for timely care.In summary, depressive symptoms are prevalent among adolescents and adults in Mexico as in many other countries, with a higher ratio of female cases. Young people experiencing the most challenging socio-urban situations have higher rates of depression.Even though depressive disorders are more prevalent among females, consequences may be even worse for males. The authors posit that, among males, stigma attached to depression might lead to attempts to hide depressive symptoms by masking them through high-risk behaviors (e.g., alcohol, drug use, and violence, among others). Women may have higher rates of suicide attempts, but the case-fatality rate of suicide attempts is higher among males.Despite of barriers and resource scarcity among healthcare and educational institutions, it is necessary to continue to develop alternatives that will lead to better attention of mental health issues among the youth, even when their mental health needs are not expressed directly or their chief complaints are in regard to "other" health issues.

Estudio de la depresión en estudiantes de la Ciudad de México y del Estado de Michoacán por medio de la versión revisada de la CES-D / Study of depression in students from Mexico City and from the State of Michoacan using the revised version of the CES-D

Antecedentes La prevalencia de la depresión es cada vez mayor en los adolescentes y se relaciona con factores como el nivel socioeconómico, la historia familiar con problemas de depresión y de consumo de alcohol, experiencias con la violencia, abuso físico o sexual, así como consumo de tabaco y de drogas ilegales, todas las cuales aumentan el riesgo de otras conductas problemáticas. Objetivo Describir los síntomas depresivos en adolescentes de la Ciudad de México y del Estado de Michoacán. Método Se hicieron dos estudios transversales con muestras no probabilísticas (N=2127), utilizando las categorías clínicas de la Escala CESD-R. Resultados Un 12% de la muestra calificó dentro de la categoría de síntomas de probable episodio depresivo mayor (EDM) (13.3% D.F. y 9.2% Michoacán).La proporción fue significativamente mayor en las mujeres (χ² = 56.294, gl= 2, p<.001). Los estudiantes de la Ciudad de México tuvieron una proporción significativamente mayor de síntomas de probable EDM que los estudiantes de Michoacán (χ² = 30.78, gl= 2, p<.001). Discusión y conclusión Dada la proporción de adolescentes que presentaron síntomas clínicamente significativos, es necesario crear acciones de información, sensibilización y capacitación para padres, educadores, profesionales de la salud y adolescentes en cuanto a la relevancia de atender la depresión y mejorar el acceso a los servicios de atención especializada. La CESD-R puede ser una alternativa rápida para la detección oportuna del probable episodio depresivo mayor, pero faltaría construir el mecanismo para derivar a los individuos en riesgo a los servicios de salud mental pertinentes, así como estrategias para garantizar que éstos sean de calidad.

Background The prevalence of depression is increasing among adolescents. Depression is related to factors such as socioeconomic status, family history of problems with depression and alcohol use, experiences with violence, physical or sexual abuse and use of tobacco and illicit drugs. These may increase the risk of other problematic behaviors. Objective To describe the depressive symptoms in adolescents from Mexico City and the State of Michoacan. Method Data were generated with the revised version of the CES-D. Two cross-sectional studies with non-probabilistic samples were conducted (N=2127). Results A total of 12% of the adolescents had symptoms of a probable major depressive episode (MDE) (13.3% from Mexico City and 9.2% from Michoacan). The proportion of probable MDE was significantly higher among women (χ2 = 56.294, DF = 2, p <.001). The students from Mexico City had a significantly higher proportion of subjects with probable MDE than the ones from Michoacan (χ2 = 30.78, DF = 2, p <.001). Discussion and conclusion The proportion of students who had clinically significant symptoms underlines the need for information, awareness, training for parents, teachers, health professionals and adolescents for addressing the relevance for attending depression and to improve the access to health care services. Although the CESD-R may be a quick alternative for an early detection of a probable major depressive episode, it would be necessary to build a referral mechanism to mental health care services for individuals at risk, as well as strategies to ensure its quality.

Correlatos psicosociales de depresión y riesgo de suicidio en trabajadoras sexuales del Estado de Hidalgo, México / Social correlates of depression and suicide risk in sexual workers from Hidalgo, Mexico

Los datos disponibles sobre la salud mental en trabajadoras sexuales en México son escasos. Sin embargo la poca evidencia disponible muestra que las prevalencias de depresión y problemática suicida son mucho más elevadas que en la población general. El objetivo de este artículo es explorar los factores psicosociales que se relacionan con la depresión y el riesgo de suicidio en una muestra de 103 trabajadoras sexuales del Estado de Hidalgo, México. Los resultados muestran que las frecuencias de depresión y riesgo de suicidio fueron más elevadas que en las mujeres de la población general (39.8 y 3.0%, respectivamente). Las variables que predijeron estos malestares fueron la mala relación con la madre, los efectos perjudiciales del consumo de alcohol sobre la salud física y las actividades domésticas, la violencia de la pareja y la violencia sexual. Es necesario considerar estos resultados para propiciar acciones que reduzcan o eliminen la violencia de pareja, fomenten la adquisición de habilidades para el manejo de las consecuencias negativas de la violencia, así como implementar estrategias para reducir el daño ocasionado por el consumo de alcohol en este grupo poblacional en situación de vulnerabilidad.

Available data on mental health among female sex workers in Mexico are scarce. The scarce evidence shows that the prevalence of depression and suicidal problems is much higher than in the general population. The objective of this article was to explore the psychosocial factors associated with depression and suicide risk in a sample of 103 sex workers from the state of Hidalgo, Mexico. Among them, the frequency of depression and suicide risk was higher than for women in the general population (39.8% and 3.0%, respectively). The variables that predicted these illnesses were a bad relationship with the mother, the negative health effects due to alcohol use, partner violence, and sexual violence. It is necessary to consider these results to promote actions that reduce or eliminate partner violence, promote the acquisition of skills to manage the negative consequences of violence and implement strategies to reduce the harm caused by alcohol consumption in this vulnerable group of the population.

[Quality of life in patients with bone tumors, a comparison between different treatments]. / Calidad de vida en pacientes con tumores oseos, una comparacion entre diferentes tratamientos.

INTRODUCTION. Previously, amputation was the only treatment option for patients with malignant bone tumors. Due to technological, medical and surgical advances, the number of survivors and years of survival has been increasing, and thus, the interest in evaluating the impact of this disease on quality of life. OBJECTIVE. To evaluate the health related quality of life reported by patients with bone tumors undergoing different treatments (no surgery/amputation/salvage). MATERIAL AND METHODS. Patients (n = 85) with bone tumors over the age of 18, both sexes, from the Instituto Nacional de Rehabilitación of Mexico City were included, divided into three groups according to type of treatment. The study design was cross-sectional, descriptive of a nonrandom sample. Quality of life was assessed with the Inventory of Quality of Life and Health (InCaViSa). Data were analyzed using descriptive statistics, comparisons between patients with different treatments were evaluated with multivariate analysis of covariance and Sidak post hoc tests. RESULTS. Statistically significant differences were detected in six of the twelve areas of quality of life that are assessed by the scale: physical functioning, isolation, body perception, treatment attitude leisure time and daily life. Health related quality of life in the study group is best for those patients who received amputation compared with the other treatments, while patients limb salvage procedures are those with greater impairment.

Propiedades psicométricas de la escala "Dificultades en la Regulación Emocional" en español (DERS-E) para adolescentes mexicanos / Psychometric properties of the "Difficulties in Emotion Regulation Scale" in spanish (DERS-E) in Mexican adolescents

Introduction Emotional Dysregulation (ED) is the decreased capacity to experiment and differentiate an ample range of emotions, as well as to monitor, evaluate and modify intense emotional states. ED is associated with the most frequent emotional problems such as depression, anxiety, and with maladaptive behaviors thought to serve an emotion and impulsivity regulating function, including deliberate self-harm. The Difficulties in Emotion Regulation Scale (DERS) was developed for adults, has good internal consistency (Cronbach's α=0.93), and good test-retest reliability (r=0.88). Objectives To translate and determine the psychometric properties of the Spanish version of the DERS (DERS-E) in a nonclinical Mexican adolescent's sample. Method 455 students of a public junior high school in Mexico City participated; the mean age was 13.1 ±.95 years old. The scale was administrated in groups of 40 students, who concurrently answered the Spanish version of the following measures: i) Self-injury Schedule; ii) Beck Depression Inventory; and iii) Plutchik's Impulsivity Scale. Results The first confirmatory factorial analysis (CFA) showed that the data did not replicate the original six-factor structure with 36 items (χ2=22339.4, df= 6, p<0.05). An exploratory factorial analysis showed that the data adjusted with a 24 items and 4-factor model (corroborated with a second CFA: χ2=259.729, df=230, p>0.05); the subscales Cronbach' a were from .85 to .68. The validity through contrasted groups and the correlation with concurrent scales showed significant results (Pearson's r of .51 to .76, p<0.05). Conclusions The DERS-E with adolescents did not replicate the factorial structure of the original scale, but showed a similar and multidimensional structure of four factors and showed good psychometric properties with respect to internal consistency and concurrent validity.

La desregulación emocional (DE) es la capacidad disminuida para experimentar y diferenciar un amplio rango de emociones, así como para monitorear, evaluar y modificar estados emocionales intensos. La DE se ha asociado a los más frecuentes padecimientos, como depresión, ansiedad y conductas desadaptativas, incluidas la impulsividad y las autolesiones no suicidas. La escala Difficulties in Emotion Regulation Scale (DERS por sus siglas en inglés) fue desarrollada para evaluar estas dificultades en adultos, posee una buena consistencia interna (α de Cronbach=0.93) y buena confiabilidad test-retest (r=0.88). Objetivos Traducir y determinar las propiedades psicométricas de la DERS en español (DERS-E) en una muestra no clínica de adolescentes mexicanos. Método Participaron 455 estudiantes de una escuela secundaria pública de la Ciudad de México, de los cuales 226 eran hombres (49.7%) y 229 mujeres (50.3%); la edad promedio fue de 13.1±.95 años. La escala fue administrada grupalmente (grupos de 40 estudiantes), quienes contestaron concurrentemente los inventarios de: i) Autolesiones, ii) Depresión de Beck, iii) Impulsividad de Plutchik. Resultados El primer análisis factorial confirmatorio (AFC) mostró que los datos no replicaban la estructura original de seis factores con 36 reactivos (χ²=22339.4, gl=6, p<0.05). Un análisis factorial exploratorio mostró que los datos se ajustaban a un modelo de 24 reactivos y cuatro factores (corroborados con un segundo AFC: χ²=259.729, gl=230, p>0.05). Las alphas de Cronbach de cada subescala tuvieron un rango entre .85 y .68. La validez por medio de grupos contrastados y la correlación con las medidas concurrentes mostraron resultados significativos (r de Pearson de .51 a .76, p<0.05). Discusión y conclusiones La DERS-E con adolescentes no replicó la estructura factorial de la escala original, pero sí presentó una estructura similar, multidimensional, con cuatro factores y mostró buenas características psicométricas, tanto de consistencia interna como de validez concurrente.

Enfocando la depresión como problema de salud pública en México / Targeting depression as a public health problem in Mexico

The present review aims at analyzing the magnitude and social impact of depression, as well as exploring models that help to understand the strategies needed to address this public health problem. The literature reveals that 9.2% of the general population has had a depressive episode and one in five persons will have an episode by age 75. Lower rates are observed in low and mid income in comparison to those with high income. These differences are not due to personal income, the probability of greater severity or delay in diagnosis, and are more likely related to cultural differences. Greater risk is observed among females, people younger than 60 years, marital status as single, widowed or divorced, and low educational attainment. The deleterious effect of depression on productivity is well established (27 days lost in the past year, on average, per case). The association with diabetes, hypertension, cardio vascular disease, drug use, suicide, and other risk behaviors has been frequently observed. Although unresolved questions remain about the presence or not of common risk factors and the chain of causality, it is a known fact that the combination of physical and mental disorders causes greater disability. With regard to the healthcare system, patients with depression and/or anxiety have higher utilization rates and healthcare costs, particularly among elderly patients. This healthcare overutilization is related with the low rates of diagnosis and adequate treatment of depression. About 26% of depression cases will not be diagnosed and, although a large proportion of patients have contact with healthcare services, nearly 30% never receive help for their depression. New treatment models that overcome barriers, understanding the sociocultural factors related with the problem, and addressing depression at the primary level of healthcare are urgent in Mexico.

El objetivo de la presente revisión es analizar la magnitud y el impacto social de la depresión, así como explorar modelos que permitan comprender mejor las estrategias necesarias para su atención. Los reportes revelan que 9.2% de la población general ha padecido un episodio de depresión, que una de cada cinco personas sufrirá uno antes de llegar a los 75 años y que los más jóvenes presentan tasas mayores. Tasas más bajas se observan en países de ingreso bajo y medio, en contraste con países de ingreso alto. Diferencias no relacionadas con la gravedad o el retraso en el diagnóstico probablemente se vinculen con diferencias culturales. Las mujeres, las personas sin pareja y el bajo nivel de educación se asocian con mayor riesgo. El efecto deletéreo en productividad (media de 27 días perdidos en el último año) es indiscutible. La asociación con diabetes, hipertensión y trastornos cardiacos, entre otras, ha sido frecuentemente investigada. Si bien no es clara la presencia o no de factores de riesgo comunes y la cadena de causalidad, la combinación de trastornos físicos y mentales genera más discapacidad. La depresión ha sido asociada a otras conductas como adicciones, suicidio y violencia, particularmente en jóvenes. En cuanto a los efectos en el sistema de salud, diversos estudios han demostrado que los pacientes con depresión tienen mayores tasas de utilización y mayores costos asociados, particularmente con ancianos. Esta sobreutilización está relacionada con la baja proporción de diagnóstico y tratamiento certero. El 26% de las personas no serán diagnosticadas y, a pesar de que una elevada proporción de pacientes contactaron con los servicios de salud, cerca del 30% nunca recibió ayuda. Nuevos modelos de atención que incluyan el abatimiento de las barreras, el entendimiento de los factores socioculturales y la inclusión del manejo primario de la depresión son urgentes.

Escala de Depresión del Centro de Estudios Epidemiológicos (CES-D) en México: análisis bibliométrico / Center of Epidemiological Studies of Depression Scale (CES-D) in Mexico: bibliometric analysis

The CES-D is a screening instrument to measure depressive symptoms during the last week. It is useful and easy to use because no trained staff is needed to administer and score it. Interest in depression has been consistent in Mexico in recent years, and the CES-D is one of the most used scales. The goal of this paper is to present a bibliometric analysis of scientific papers reporting data obtained with the scale; the papers had to be published in a scientific journal with a reviewing board, a group of peer reviewers and be ISNN registered. Materials were found in EBSCOhost and Google Scholar databases. 80 papers were published between 1986 and 2011. An average of three papers was published every year. Most of the studies were developed in Mexico City and nationwide; there was a bi-national study, a multinational one, and four in several states combined. The journals with the highest number of papers were: SALUD MENTAL, Salud Pública de México, and Revista Mexicana de Psicología. There were 17 institutions involved in coordinating the studies; six of them were international. 41% of the studies were conducted with adolescents, 32% with women, and 90% in urban contexts. There are some areas which need further study to build a more comprehensive understanding about the distribution and characteristics of depressive symptoms and hence new studies must be designed to include understudied groups and populations.

La Escala de Depresión del Centro de Estudios Epidemiológicos (CES-D) es un instrumento de tamizaje para la detección de casos de depresión con base en su sintomatología durante la última semana. La CES-D ha demostrado ser una herramienta útil y económica en formato autoaplicable en virtud de que no requiere personal especializado para su calificación y es autoaplicable. Reconocida la importancia de la depresión, el interés por su investigación ha sido consistente en México durante las últimas décadas y la CES-D ha sido uno de los instrumentos más empleados. El objetivo de este trabajo es presentar un análisis bibliométrico de las publicaciones científicas sobre su uso en México. Los artículos seleccionados tenían que estar publicados en revistas científicas con comité editorial, cuerpo académico de dictaminadores e ISSN. Las búsquedas se hicieron en EBSCOhost y Google Académico. Se analizaron 80 artículos, desde 1986 hasta julio de 2011. El promedio por año fue de tres artículos; 2007 y 2008 fueron los años con más publicaciones. La mayor cantidad de investigaciones se ha realizado en el Distrito Federal y a nivel nacional; hay una investigación binacional, otra multinacional y cuatro en entidades federativas combinadas. Las revistas con mayor cantidad de publicaciones fueron: SALUD MENTAL (27 artículos), Salud Pública de México (11 artículos) y la Revista Mexicana de Psicología (cinco artículos). Diecisiete instituciones (con predominio del Instituto Nacional de Psiquiatría Ramón de la Fuente) han sido responsables de las investigaciones; seis de ellas, a nivel internacional. 41.25% con adolescentes, 32.5% con mujeres y 90% en contextos urbanos, con predominio en la población general y en adolescentes estudiantes. Existen áreas por explorar para contar con un panorama más completo sobre las características y distribución de la sintomatología depresiva, por lo que habría que diseñar estudios con grupos y poblaciones menos explorados.

Depresión y consumo de alcohol y tabaco en estudiantes de bachillerato y licenciatura / Depression and alcohol consumption and tobacco in high school and undergraduate

Depression is an emotional upset that disrupts the psycho-affective sphere and is associated with different risk behaviors, as alcohol and tobacco use, among young people. The aim of this study is to analyze the differences on depression in four groups of high school and college students (1. alcohol users, 2. tobacco users, 3. alcohol and tobacco non-users, and 4. alcohol and tobacco users). A census was conducted with 116 214 students with a mean age of 15 and 19 years. Heavy alcohol and tobacco use was more frequent in men. A factorial ANOVA analysis was used to compare depressive symptoms between heavy drinkers (4 or more drinks per occasion) and heavy smokers (4 or more cigarettes per day) by sex and school level. More depressive symptoms were found in college students (M = 9.7) than in the high school ones (M = 9.5, p<0.05). The group of alcohol and tobacco users showed higher levels of depressive symptoms (M=11.3) than the alcohol only (M=10.5) and tobacco only users (M=10.7). Women showed more depressive symptoms (M=10.3) than men. Results point out the need for early detection and intervention, and for more monitoring strategies to develop actions for reducing alcohol and tobacco use in this population and, eventually, depressive outcomes.

La depresión es un malestar emocional que trastoca la esfera psicoafectiva y se asocia con distintas conductas de riesgo como el consumo de alcohol y de tabaco, particularmente en la población joven. El objetivo de este estudio fue analizar las diferencias que existen respecto a la depresión en cuatro grupos de adolescentes (1. consumidores de alcohol, 2. consumidores de tabaco, 3. no consumidores de alcohol ni de tabaco y 4. consumidores de alcohol y tabaco) estudiantes de Bachillerato o Licenciatura. Se realizó un censo con 116 214 estudiantes, con un promedio de edad, en nivel medio superior, de 15 años y de 19 años en nivel superior. El consumo elevado fue más frecuente en los hombres de ambos niveles educativos. Se hizo un análisis de varianza (ANOVA) factorial para determinar las diferencias en la sintomatologia depresiva entre aquéllos que presentaban consumo elevado de alcohol (cuatro o más copas por ocasión) y de tabaco (cuatro o más cigarrillos al dia) por nivel educativo y sexo. Se encontró sintomatologia depresiva más elevada en los estudiantes de nivel superior (M=9.7), en contraste con los jóvenes de medio superior (M=9.5) (p<0.05). Al comparar la sintomatologia depresiva entre los grupos de consumo, los resultados indicaron mayores puntajes en el grupo de consumidores de alcohol y tabaco (M=11.3), seguidos de usuarios excesivos de tabaco solamente (M=10.7) y de alcohol solamente (M=10.5). Las mujeres de ambos niveles educativos presentaron una mayor sintomatologia depresiva (M=10.3), seguidas de los hombres de nivel superior (M=9) y los hombres de nivel medio superior (M=8.8). Los resultados favorecen el desarrollo de acciones de detección e intervención temprana y el monitoreo de esta población.

Confiabilidad y validez de la escala de depresión CES-D en un censo de estudiantes de nivel medio superior y superior, en la Ciudad de México / Reliability and validity of the depression scale CES-D in high school and college students from Mexico city: Results from a census

Introduction Depression and its symptoms are becoming one of the most important health problems worldwide. The impact of depression on the productive life of people, and the burden it represents because of its co-morbidity, is growing. Some authors estimate that depression is the second cause for the global loss of years of healthy life and the first one in developed countries. An increasing proportion of teenage population has mental health issues. Depression and its symptoms are among the most common, but they are not an epidemic problem yet, although spread enough as to maintain interest in its current impact and in its negative consequences over individual health. Depression has a prominent place among mood disorders in Mexico (4.5%), and women are who mostly suffer it (5.8%), which has remained consistent over time. Different difficult situations occur during adolescence along with depression, depressive mood, and depressive symptoms. This situation may be related to changes and processes that occur during this period when individuals cope with situations they cannot handle, which in turn become stressful. Therefore, it is necessary to study and to work with adolescents in order to be able to differentiate affective, cognitive, somatic, and behavioral expressions, which are proper to this stage, from those possibly caused by an illness that could have negative consequences. Adolescent depression influences mood and the way individuals live unpleasant or annoying experiences, thus it affects almost every aspect of life and becomes a risk factor for psychiatric and behavioral problems. However, there are some areas that need more research, for example: the specific characteristics and expressions of the problem including gender comparisons and using designs with special groups. Data show that depression is growing in adolescents; therefore it is a priority to work on detection and prevention to reduce its impact on mental health and to develop cost-effective intervention strategies. One way to do this is using valid-reliable screening tools because they are cheap, and methodologically-logistically useful. The Center for Epidemiological Studies Depression Scale (CES-D) has been used in different studies with Mexican adolescents, and has proven to have good psychometric characteristics. The CES-D has never been used with an entire population in a great scale study. The objective of this paper is to measure the validity and reliability of the scale (construct, concurrent, and external validity, as well as internal consistency) in a population of high school and college freshman students from Mexico City. Method Design. The study was a census made with high school and college freshman students during 2009. Data were collected in 22 schools. Population. A sample of 58568 students participated in the census. The mean age was 1 7 years old (±2.7). Most of the students lived in homes with one to four other persons at the moment of the study (55.4%); 86% said that only their father worked at that moment, and 59.4 said that only the mother; 79.7% of the students lived with both parents, and 1 7.9% only with their mother; 57403 students (98.0% of the population) completed the CES-D in the age range of 14-24 years: 27264 (47.5%) men, and 30139 (52.5%) women. Instrument. The Automated Medical Examination (Examen Médico Automatizado-EMA) is a diagnostic questionnaire designed by the General Directorate of Medical Services (Dirección General de Servicios Médicos) of the Universidad Nacional Autónoma de México (UNAM). It is a questionnaire with four self-report forms that collect information about the physical and mental health, the family, and the general context of every student. This information is used to create a diagnosis of vulnerability and a predictive profile for developing prevention programs, as well as research protocols that help in promoting a culture for health care. The CES-D was included for the measurement in 2009. Results Overall internal consistency was adequate (α=.83). Internal consistency was tested by sex; the coefficient was higher for women (α=.84). Factor analysis generated a four-factor solution (explained variance 54.1%); each factor had good internal consistency and theoretical agreement. The scale showed a significant discriminative power for opposite scores (z=-l44.121, p<.001), and a positive significant correlation with the Okasha Suicidality Scale (rΦ=.325, p = .000). A cut-off point of 16 or higher was established to identify students with high depressive symptomatology. 14.7% of the participants in this study had high depressive symptomatology (11.1% men, 1 7.9% women). Conclusions The CES-D is a valid and reliable epidemiological instrument for different populations. Since depression is a complex and dynamic phenomenon, it is important to evaluate the psychometric properties of any instrument used to measure it. The results of this study showed that the CES-D maintains its internal consistency as well as good concurrent-external validity. Coefficients are higher for women and they increase with age; thus, it would be necessary to refine some aspects to measure younger subjects in a more consistent manner. The data proved that CES-D is a useful instrument for distinguishing different levels of depressive symptomatology; this is relevant because the scale is often used in collective contexts, allowing systematic monitoring of depression with good cost-effective results. Monitoring is also important to keep acceptable levels of emotional wellbeing in student population. Development and refinement of instruments such as the CES-D would potentially lead to opportune and reliable detection of adolescents who may be at risk for suffering mental health problems. This would facilitate implementing more stable and continuous prevention and attention programs to reduce the negative impact of depression in the short term.

Introducción La depresión y sus manifestaciones sintomatológicas son parte de los principales problemas de salud entre la población mundial y su impacto en la vida productiva ha aumentado con respecto a otras enfermedades. En México, esta tendencia y sus consecuencias negativas en el desarrollo hacia la adultez justifican la necesidad de atenderla y prevenirla. A través de instrumentos de tamizaje válidos y confiables como la Escala de Depresión del Centro de Estudios Epidemiológicos [Center for Epidemiological Studies of Depression Scale: CES-D) diseñada en 1977 por Radloff, ha sido posible detectar posibles casos clínicos de depresión en diversos estudios con adolescentes escolares. Sin embargo, hasta ahora no se había documentado su comportamiento en una población de estudiantes a gran escala. Método El levantamiento de la información se realizó en agosto de 2009, previo al inicio del ciclo escolar. Se obtuvo información de 57403 alumnos, de los cuales 47.5% fueron hombres y 52.5% mujeres, con una edad promedio de 17 años (±2.7). Instrumento. La CES-D se incorporó en los formatos del Examen Médico Automatizado (EMA) quese utilizaron para realizar el levantamiento censal entre los alumnos de nuevo ingreso a bachillerato o licenciatura. Resultados Consistencia inferna y validez de constructo. La consistencia interna de la escala global mostró un índice satisfactorio (α=0.83). Los índices de contabilidad fueron adecuados para todos los grupos de edad. El análisis factorial con extracción de componentes principales y rotación oblicua arrojó una estructura de cuatro factores con valores Eigen mayores a uno, que explican 54.1% de la varianza; los coeficientes de consistencia interna y concordancia teórica resultaron satisfactorios: Afecto deprimido, Afecto positivo, Somatización e Interpersonal (como un indicador integrado por sólo dos reactivos). Validez concurrente por medio de grupos contrastados. En la prueba de grupos contrastados se compararon los puntajes globales de la CES-D que se situaron por debajo del percent i I 25 versus aquéllos por arriba del percentil 75. Se utilizó una comparación de promedios de Mann-Whitney, que mostró diferencias estadísticamente significativas entre los cuartiles contrastados (z = -144.121, p<.001). Validez externa. Se analizó mediante su asociación con la Escala de Expectativas de Vivir-Morir de Okasha (que también se aplica en el EMA), obteniendo una correlación positiva y significativa entre quienes tuvieron sintomatología depresiva elevada y quienes manifestaron deseos de morir (rΦ, = 0.325, p = .000). Detección de sintomatología depresiva elevada. La definición operacional de la sintomatología depresiva elevada se definió con el punto de corte (PC) de la CES-D con base en la media más una desviación estándar (PC> 1 6) con lo que se detectó una frecuencia de sintomatología depresiva elevada de 14.7% (n = 8,197): 11.1% en varones y 1 7.9% en mujeres. Conclusiones Los resultados muestran que en poblaciones tan grandes como la del presente estudio, la CES-D es una herramienta útil y adecuada, breve y fácil de aplicar y analizar para establecer un monitoreo que dé respuesta a una de las necesidades más apremiantes en la población escolar: la detección de la sintomatología depresiva elevada como un aspecto importante del malestar emocional. Sirve, además, para determinar la magnitud de la problemática y arribar a su prevención y, de ser el caso, instrumentar acciones para su tratamiento. La relevancia de los resultados obtenidos radica en que se trata de población escolar que puede llegar a requerir atención y prevención oportunas en salud mental en etapas tempranas de la enfermedad, incluso antes de la confirmación diagnóstica en los servicios especializados. Esta detección deriva en beneficios para la población escolar y en estrategias funcionales de atención adecuada y costo-efectivas.

Programas de prevención de tabaquismo para mujeres adolescentes / Smoking prevention programs for girls

In recent years, the number of women who use tobacco has increased rapidly. Among youngsters, gender gap is closing, and the proportion of girls who smoke is already very similar to that of boys, with the added complication that the girls are more vulnerable to addiction, and tobacco use has severe consequences for their health and the well-being of their future children. The key to facing tobacco epidemic is prevention by strengthening protective factors and reducing risk factors that lead to smoking onset. School environment is the most valuable resource for anti-smoking programs. These efforts are commonly focused on elementary and secondary students because experimentation with tobacco and adoption of smoking behavior occur at this stage. There are three intervention models in schools: 1. Information model (or rational), 2. Social skills model (or affective), and 3. Social influence model, which emphasizes social environment as a critical factor in tobacco use. In this model the children are informed about the immediate negative effects of smoking (unfavorable effects on appearance, economic costs and social consequences such as rejection by others). The model also conveys a positive image of non-smokers as rational people, and a negative one of a smoker as someone vulnerable to advertising tricks. It uses the peer group for showing resistance to pressure and how to adopt and to maintain the decision not to smoke, and it teaches how to identify influences from tobacco advertising, peers and family. The social influence programs tend to be the most effective strategy for achieving at least some delay in onset of tobacco use. It is necessary to develop appropriate programs for each age and for a specific gender. Recently, researchers have begun using programs based on computer systems and Internet to prevent teen smoking. The aim of this study was to design, implement and evaluate two different types of tobacco prevention programs, tailored specifically for teenage girls. The programs were computer games and an interactive workshop, as well as the combination of both of them (games plus workshop). It was suggested that in treatment groups versus control group, smoking susceptibility scores (i.e., lack of a firm commitment to not smoke) would be lower in post test. It was also hypothesized that the games plus workshop group would affect the scores of the associated variables with susceptibility, and that changes would remain in the follow-up. Material and methods 537 student girls in the three grades of secondary school were asked to answer the Smoking Susceptibility Scale. Out of this group, 160 girls that obtained the highest scores were selected, because they were considered at risk of becoming regular smokers. Six variables related with smoking susceptibility were also measured: Belief in the addictive property of tobacco, beliefs in smoking benefits, empathy with smoking victims, negative attitudes toward tobacco industry, skills rejecting social pressure to smoke, and identification of diseases associated with smoking in women. The Smoking Susceptibility Scale was applied at three moments of the measurement: A pretest (one week before programs starting), a post test (the last day of the program or programs), and a follow-up (four months after implementing the post test). In the last two occasions, the instruments of variables related with susceptibility were also applied. The two types of prevention programs (computer games and interactive workshop) were based on the social influence model. The purpose of the games was that the girls acquire skills to recognize and resist social pressures to smoke exerted by both the tobacco industry through advertising strategies, and their peers. The interactive workshop was designed according to the strategies of anti-smoking messages that have proved to be effective in order to prevent smoking; the immediate negative consequences suffered by smokers and the physical and psychological vulnerability of women produced by smoking were also highlighted. A mixed 4 inter-groups X 3 intra-groups design was applied (4 treatments: Computer games, interactive workshop, games plus workshop, control, X 3 measurement times: Pretest, post test, follow-up). The 160 participants were randomly assigned to one of the four treatment groups. The study consisted of four phases: pre test, treatment (one week later), post test (on completion of program implementation) and follow-up (four months after the post test). Results There was an immediate effect of the three treatments on the smoking susceptibility by contrasting pre test versus post test, but games plus workshop group had more effect than games or workshop ones. When comparing post test and follow-up measurements in the games plus workshop group versus the control group, it was found that smoking susceptibility scores of the treatment group stayed unchanged. For related variables, the girls who participated in the games plus workshop group had higher scores than the control group in the belief of tobacco addictive property, in empathy with smoking victims, in the negative attitude toward the tobacco industry, in the refusal skills towards social pressure to smoke, and in the identification of diseases associated with smoking in women, and lower scores on beliefs in the benefits of smoking (attractive appearance, emotional well-being, popularity and social acceptance). At the follow-up, it was observed that attitudes toward tobacco companies became even more negative and that participants identified more diseases caused by smoking in women than in the post test, i.e., the treatment effect was strengthened. Discussion The main guideline in the construction of smoking behavior prevention programs evaluated in this study was its focus on adolescent girls. Furthermore, they were only addressed to those adolescents with high scores on smoking susceptibility, due to the intention of using the available resources more efficiently. Another criterion taken into a count in order to build these programs was the shortness of the intervention. The results showed that smoking susceptibility on the participants of each one of the three treatment groups decreased from the pre test to the post test, but the decline was even greater in the games plus workshop group. The smoking susceptibility of the games plus workshop group remained low in the follow-up after four months of its implementation, which did not occur with the workshop or games groups alone. It appears that the more elements used in the prevention programs the greater their impact will be. Compared with the control group, the majority of variables related with smoking susceptibility were affected by the games plus workshop treatment. In conclusion, the combination of preventive programs for smoking addiction constructed in this study specifically for girls with the implementation of psychosocial principles and the use of computer technology decreased the smoking susceptibility on participants, as well as most of the related variables. Moreover, their effects persisted at least for a period of four months. Computer games, which were of interest to participants, could be easily installed on computer rooms of secondary schools, and even uploaded in the Internet, and its effects could be enhanced by an interactive workshop, which promotes interpersonal contact and discussion of false beliefs regarding tobacco use that girls support. The girls at risk who change their smoking susceptibility as a result of their participation in these smoking prevention programs will avoid the severe consequences of using tobacco and will gain years of healthy life for themselves and their descendants.

El consumo de tabaco en las mujeres se ha incrementado aceleradamente. Entre los adolescentes, la brecha de género se está estrechando, ya que el porcentaje de fumadoras es ya muy similar al de los varones, con el agravante de que ellas son más vulnerables a la adicción al tabaco y su consumo tiene serias consecuencias para su salud y la de sus futuros hijos. La principal alternativa para enfrentar la epidemia de tabaquismo es la prevención. Existen básicamente tres modelos de intervención antitabaco en las escuelas: modelo de información, modelo de habilidades sociales y modelo de influencia social, el cual ha mostrado ser el más efectivo para lograr, al menos, retrasar el inicio del consumo. Se ha señalado que es necesario desarrollar programas adecuados específicos para cada edad y género. El propósito de la presente investigación fue construir, aplicar y evaluar dos diferentes tipos de programas de prevención del tabaquismo (juegos de computadora y taller interactivo) y la combinación de ambos (¡uegos+taller), dirigidos específicamente a mujeres adolescentes. Material y métodos De las 537 mujeres estudiantes de secundaria que contestaron la Escala de Susceptibilidad Tabáquica, las 160 adolescentes que obtuvieron los puntajes más altos fueron asignadas aleatoriamente a uno de cuatro grupos de tratamiento: Juegos de computadora, Taller interactivo, Juegos+taller y Control. Los programas se desarrollaron con base en el modelo de influencia social. El estudio constó de cuatro fases: premedición, tratamiento, pos-medición y seguimiento (cuatro meses después). Se evaluaron además seis variables precurrentes de la susceptibilidad tabáquica: creencia en la propiedad adictiva del tabaco, creencias en los beneficios de fumar, empatia hacia las víctimas del tabaco, actitud negativa hacia las tabacaleras, habilidades de rechazo ante la presión social para fumar e identificación de enfermedades asociadas con el tabaco en las mujeres. Resultados La susceptibilidad tabáquica de las participantes en los tres grupos de tratamiento disminuyó significativamente de la premedición a la post-medición, pero los efectos persistieron en el seguimiento sólo en el grupo de Juegos+taller. Respecto de las variables precurrentes, quienes participaron en el grupo Juegos+taller obtuvieron puntajes más altos que las del grupo control en la creencia en la propiedad adictiva del tabaco, en la empatia hacia las víctimas del tabaco, en la actitud negativa hacia las tabacaleras, en las habilidades de rechazo a la presión social para fumar y en la identificación de las enfermedades asociadas con el tabaco en las mujeres, y menores puntajes en las creencias en los beneficios de fumar (apariencia atractiva, bienestar emocional, popularidad y aceptación social). En el seguimiento se observó que las actitudes hacia las tabacaleras se hicieron aún más negativas y las participantes señalaron más enfermedades causadas por el tabaco en las mujeres, que en la posmedición, es decir, se reforzó el efecto del tratamiento. Discusión La combinación de los programas preventivos de la adicción al tabaco para mujeres adolescentes construidos en este estudio con la aplicación de principios psicosociales y la utilización de tecnología computacional, disminuyeron la susceptibilidad tabáquica de las participantes, así como la mayoría de las variables precurrentes. Además, sus efectos persistieron durante un periodo de cuatro meses. Los programas podrían aplicarse fácilmente en el ámbito escolar: los juegos de computadora podrían instalarse en los salones de cómputo o colocarse en Internet, y su efecto se reforzaría con el taller interactivo, el cual es de intervención breve y propicia el contacto interpersonal y la discusión de las creencias falsas respecto del consumo de tabaco que sostienen las adolescentes. Las chicas en riesgo tabáquico que cambien su susceptibilidad como consecuencia de su participación en estos programas evitarán las serias consecuencias del consumo de tabaco y ganarán años de vida sana para ellas y sus descendientes.

Aplicación de la Escala de Depresión del Center of Epidemiological Studies en adolescentes de la Ciudad de México / Application of the revised version of the Center of Epidemiological Studies Depression Scale in adolescent students from Mexico City

OBJETIVO: Probar la validez de constructo, concurrente y externa, y la consistencia interna de la Escala de Depresión del Center for Epidemiologic Studies (CES-D-R) en adolescentes. MATERIAL Y MÉTODOS: Estudio transversal con dos cohortes de estudiantes de secundaria del DF. El cuestionario incluyó la CES-D-R y otras escalas sobre problemas relacionados con suicidio, violencia, exposición a oportunidades y consumo de drogas. La participación fue voluntaria y anónima. RESULTADOS: Se incluyó a 1 549 estudiantes (edad promedio, 14 años; DE=1.2). La escala mostró una estructura de seis factores (varianza explicada, 55 por ciento), consistencia interna excelente (a=0.93), discriminación significativa entre puntajes extremos (z=-3.695, p<0.001) y correlación positiva y significativa con la escala de ideación suicida de Roberts (r=0.685, p<0.001). CONCLUSIONES: La CES-D-R tiene excelentes características psicométricas en adolescentes mexicanos, por lo que es adecuada para la detección oportuna de depresión. Esto permite utilizarla en las vigilancias sistemáticas y periódicas en la población escolar para detectar necesidades de atención, prevención y promoción de la salud mental.

OBJECTIVE: To assess the internal consistency, as well as the construct, concurrent and external consistency of the Center for Epidemiologic Studies Depression Scale (CES-D-R) in Mexican adolescents. MATERIAL AND METHODS: The data are from two samples of middle-school students from Mexico City. The questionnaire included the CES-D-R and other scales for suicide problems, peer and family violence, and drug use. RESULTS: The sample included 1 549 students (mean age 14 years, SD=1.2). The CES-D-R showed a six-factor structure (explained variance, 55 percent) with an excellent internal consistency (a=0.93), a significant discriminative power for opposite scores (z=-3.695, p<0.001), and a positive significant correlation with the Roberts Suicidal Ideation Scale (r=0.685, p<0.001). CONCLUSIONS: The CES-D-R has excellent psychometric characteristics for Mexican adolescents and therefore is deemed as an adequate tool for the assessment of depressive symptoms in large samples to detect mental health needs and design preventive interventions.