Asociación entre las tasas de homicidio y de suicidio en Colombia, 2017 / Association between homicide and suicide rates in Colombia, 2017

El contexto socioeconómico guarda relación significativa con las tasas de homicidio y de suicidio1. Por un lado, se plantea que las condiciones socioeconómicas adversas incrementan las tasas de homicidio y de suicidio en una población por el incremento de los comportamientos agresivos y violentos tanto hacia otros como contra sí mismos2. Y por el otro, se considera que el malestar socioeconómico solo incrementa los homicidios, con reducción o mantenimiento de la tasa de suicidio, lo que resulta en aumento de la proporción entre homicidios y suicidios, es decir, en países con situación socioeconómica favorable, se reducen los homicidios y se elevan los casos de suicidios porque, si no se encuentra una causa externa al malestar, como desempleo o pobreza, la violencia hacia a uno mismo se multiplica3. De la misma manera, se postula que las situaciones de conflictos armados, o guerras propiamente dichas, afectan a la tasa de suicidios; las muertes por suicidio se reducen significativamente y las muertes por la guerra se multiplican de modo exponencial.

The socio-economic context is significantly related to homicide and suicide rates1 . On the one hand, it is argued that adverse socio-economic conditions increase homicide and suicide rates in a population by increasing aggressive and violent behaviour both towards others and towards oneself2. On the other hand, it is considered that socio-economic distress only increases homicides, with a reduction or maintenance of the suicide rate, which results in an increase in the ratio between homicides and suicides, i.e. in countries with a favourable socio-economic situation, homicides are reduced and cases of suicide increase because, if no external cause of the distress is found, such as unemployment or poverty, violence towards oneself multiplies3. In the same way, it is postulated that situations of armed conflict, or wars per se, affect the suicide rate; suicide deaths are significantly reduced and war deaths multiply exponentially4.

Trastornos por consumo de sustancias: entre las inequidades y el estigma / Substance use disorders: Between inequities and stigma

Las personas que reúnen criterios para trastornos por consumo de sustancias (TCS) son víctimas, con frecuencia, del complejo estigma-discriminación (CED), no solo por parte de la sociedad en general, sino también por profesionales de la salud y por el autoestigma. No obstante, por la relación de los TCS con factores biológicos predisponentes y condiciones sociales adversas, se considera que estos son "autoinducidos". Asimismo, se conoce que en los TCS se presentan cambios biológicos, psicológicos o del desarrollo que menoscaban la decisión de abandono y la persistencia en el consumo, a pesar de las consecuencias negativas físicas, emocionales y sociales. El CED relacionado con el TCS es un estresor que deteriora aún más la calidad de vida de las personas consumidoras y, al mismo tiempo, se configura como una barrera de acceso a servicios de salud. Es necesario diseñar e investigar la efectividad de estrategias para reducir el CED relacionado con TCS en diferentes poblaciones y contextos.

People who meet criteria for substance use disorders (SUD) are often victims of the stigma-discrimination complex (SDC) not only by the society in general, but also by health professionals and the presence of self-stigma. However, because of the relationship of the SUD with predisposing biological factors and adverse social conditions, SUD are considered 'self-induced'. Likewise, it is known that SUD presents biological, psychological or developmental changes that undermine the decision of abandonment and persistence in consumption, despite negative physical, emotional and social consequences. The SDC related to SUD is a stressor that deteriorates the quality of life of consumers and, at the same time, it is configured as a barrier to access to health services. It is necessary to design and investigate the effectiveness of strategies to reduce SDC related to SUD in different populations and settings.

Interrupción voluntaria del embarazo en Colombia: aportes al debate desde la salud mental pública / Voluntary Interruption of Pregnancy in Colombia: Contributions to the Debate from Public Mental Healt

Los problemas relacionados con la salud mental de la población no dejarán de existir por el solo hecho de eludirlos o no abordarlos. Históricamente, la prohibición y la recomendación de comportamientos, ligadas más a una perspectiva de higiene mental, han predominado en la psiquiatría colombiana. En las últimas décadas, una más amplia y exhaustiva participación en la búsqueda de soluciones a problemas de salud mental pública y en debates de trascendencia nacional ha subsanado una ausencia injustificable que dejó vacíos notorios en cómo el país afrontó la violencia sociopolítica, la inequidad y la desigualdad social, el empobrecimiento de la población, el consumo de sustancias legales e ilegales, la exclusión, la estigmatización y la discriminación de colectivos enteros (afrocolombianos, pueblos originarios, LGBTTTIIQAH, etc.) y, más lamentable aún, de la mayoría de la población colombiana: las mujeres.

Problems related to the mental health of the population will not cease to exist simply by avoiding them or not addressing them. Historically, the prohibition and recommendation of behaviors, linked more to a mental hygiene perspective, have predominated in Colombian psychiatry. In recent decades, a broader and more exhaustive participation in the search for solutions to public mental health problems and in debates of national importance has corrected an unjustifiable absence that left glaring gaps in how the country dealt with socio-political violence, inequity and violence. social inequality, the impoverishment of the population, the consumption of legal and illegal substances, the exclusion, stigmatization and discrimination of entire groups (Afro-Colombians, indigenous peoples, LGBTTTIIQAH, etc.) and, even more regrettable, of the majority of the Colombian population: women.

Valoración psicométrica de la Escala Breve para Racismo Moderno / Psychometric assessment of a brief Modern Racism Scale

Objetivo Conocer la consistencia interna de la Escala para Racismo Moderno (EMR) en estudiantes de medicina de Bucaramanga, Colombia. Métodos Un total de 352 de estudiantes, media para la edad de 20,0 años (DE=1,9), informó la actitud hacia los afrocolombianos; el 59,4 % de los participantes eran mujeres. Los estudiantes completaron la versión de 10 incisos de EMR. Se calcularon alfa de Cronbach y omega de McDonald como coeficiente de consistencia interna. Análisis de factores exploratorios se realizaron para proponer una versión breve. Resultados La versión de 10 puntos mostró alfa de Cronbach 0,48 y omega de McDonald de 0,15. Una versión breve (incisos 1, 4, 5, 7 y 8) presentó alfa de Cronbach de 0,64 y omega de McDonald de 0,65. Esta versión presentó un factor principal responsable del 41,6 % de la varianza total. Conclusiones Una versión corta en español del MRS muestra un mejor desempeño psicométrico que la versión original. Se necesitan más investigaciones para corroborar estos hallazgos o hacer los ajustes según las regiones culturales colombianas.(AU)

Objective To find the internal consistency of the Modern Racism Scale (MRS) among medical students in Bucaramanga, Colombia. Methods A total of 352 medical students, mean age=20.0 years (SD=1.9) reported their attitudes towards Afro-Colombians; 59.4 % were women. Students completed the 10-item version of MRS. Cronbach alpha and McDonald omega were calculated. Exploratory factor analyses were done to propose a brief version of the MRS. Results The 10-item version showed a Cronbach alpha of 0.48 and a McDonald omega of 0.15. The short version, the Brief Modern Racism Scale (BMRS) (items 1, 4, 5, 7 and 8) presented a Cronbach alpha of 0.64 and McDonald omega of 0.65. The BMRS showed one salient factor responsible of 41.6 % of the total variance. Conclusions A Spanish-language short version of the MRS shows better psychometric performance than the original version. Further study is needed to corroborate these findings or make adjustments for Colombian cultural regions.(AU)

[Psychometric assessment of a brief Modern Racism Scale]. / Valoración psicométrica de la Escala Breve para Racismo Moderno.

Objective To find the internal consistency of the Modern Racism Scale (MRS) among medical students in Bucaramanga, Colombia. Methods A total of 352 medical students, mean age=20.0 years (SD=1.9) reported their attitudes towards Afro-Colombians; 59.4 % were women. Students completed the 10-item version of MRS. Cronbach alpha and McDonald omega were calculated. Exploratory factor analyses were done to propose a brief version of the MRS. Results The 10-item version showed a Cronbach alpha of 0.48 and a McDonald omega of 0.15. The short version, the Brief Modern Racism Scale (BMRS) (items 1, 4, 5, 7 and 8) presented a Cronbach alpha of 0.64 and McDonald omega of 0.65. The BMRS showed one salient factor responsible of 41.6 % of the total variance. Conclusions A Spanish-language short version of the MRS shows better psychometric performance than the original version. Further study is needed to corroborate these findings or make adjustments for Colombian cultural regions.

[Association between inequality and suicide rate in Colombia (1994-2013)]. / Asociación entre desigualdad y tasa de suicidio en Colombia (1994-2013).

INTRODUCTION: Income inequality is directly related to the mental health of the population. However, the relationship between income inequality and suicide rates in Colombia has still not been explored. OBJECTIVE: To estimate the relationship between inequality and suicide rates in Colombia from 1994 to 2013. METHODS: An ecological study was conducted, in which the correlation was estimated (Spearman) between inequality (Gini coefficient) and suicide rate between 1994 and 2013, according to official information available from the National Administrative Department of Statistics (DANE), and the National Institute of Forensic Science and Forensic Medicine. RESULTS: A Gini coefficient between 0.53 and 0.60 (median, 0.65 [interquartile range, 0.54-0.57]) was observed, and suicide rates were between 3.84 and 5.26 (median, 4.20 [4.08-4.86]). The correlation between inequality and suicide rates was positive and statistically significant (r=.70; p<.001). CONCLUSIONS: There is a positive association between economic inequality and suicide rate in Colombia. It is important to achieve greater equity in the distribution of income to reduce suicide rate in the country.

Asociación entre desigualdad y tasa de suicidio en Colombia (1994-2013) / Association between inequality and suicide rate in Colombia (1994-2013)

Introducción: La desigualdad en los ingresos económicos se relaciona directamente con la salud mental de los ciudadanos. No obstante, a la fecha no se ha explorado la relación entre la desigualdad en ingresos y la tasa de suicidio en Colombia. Objetivo: Estimar la correlación entre desigualdad y tasa de suicidio en Colombia entre 1994 y 2013. Métodos: Se realizó un estudio ecológico en el que se estimó la correlación de Spearman entre desigualdad (coeficiente de Gini) y tasa de suicidio entre 1994 y 2013, según la información oficial disponible en el Departamento Administrativo Nacional de Estadística (DANE) y el Instituto Nacional de Ciencias Forenses y Medicina Legal. Resultados: Se observó un coeficiente de Gini entre 0,53 y 0,60 (mediana, 0,65[intervalo intercuartílico, 0,54-0,57]) y las tasas de suicidio estuvieron entre 3,84 y 5,26 (mediana, 4,20 [4,08-4,86]). La correlación entre desigualdad y tasa de suicidio fue positiva y estadísticamente significativa (r = 0,70; p < 0,001). Conclusiones: Se observa una asociación positiva entre desigualdad económica y tasa de suicidio en Colombia. Es importante lograr mayor equidad en la distribución de los ingresos para reducir la tasa de suicidio en el país.

Introduction: Income inequality is directly related to the mental health of the population. However, the relationship between income inequality and suicide rates in Colombia has still not been explored. Objective: To estimate the relationship between inequality and suicide rates in Colombia from 1994 to 2013. Methods: An ecological study was conducted, in which the correlation was estimated (Spearman) between inequality (Gini coefficient) and suicide rate between 1994 and 2013, according to official information available from the National Administrative Department of Statistics (DANE), and the National Institute of Forensic Science and Forensic Medicine. Results: A Gini coefficient between 0.53 and 0.60 (median, 0.65[interquartile range, 0.54-0.57]) was observed, and suicide rates were between 3.84 and 5.26 (median, 4.20 [4.08-4.86]). The correlation between inequality and suicide rates was positive and statistically significant (r=.70; p<.001). Conclusions: There is a positive association between economic inequality and suicide rate in Colombia. It is important to achieve greater equity in the distribution of income to reduce suicide rate in the country.

Estigma y salud mental en personas víctimas del conflicto armado interno colombiano en situación de desplazamiento forzado / Stigma and Mental Health in Victims of Colombia's Internal Armed Conflict in Situation of Forced Displacement

Introducción: El prolongado fenómeno de violencia sociopolítica colombiana generó un alto número de víctimas, muchas de quienes sufrieron un continuo proceso de desplazamiento interno y del complejo estigma-discriminación. Objetivo: Postular por qué en Colombia las víctimas del conflicto armado interno en situación de desplazamiento (VCAISD) fueron estigmatizadas-discriminadas. Resultados: El estigma afecta a la salud mental no solo porque representa un estresor importante para las personas y los colectivos discriminados, sino también porque da cuenta de las desigualdades e inequidades que se observan en salud. Inicialmente, debido a que las VCAISD no se consideraron como tales, sino responsables de la situación, las desigualdades sociales y económicas que debieron afrontar dieron cuenta parcialmente de la baja categorización o estatus que recibieron, posiblemente por la deficiente construcción de capital social en el país. Asimismo, las VCAISD sufren de estigma y discriminación intersectorial por otras características como sexo, orientación sexual y origen étnico-racial o por reunir criterios de trastorno mental. Conclusiones: Se necesita un proceso de desarrollo social inclusivo para las VCAISD que reduzca los múltiples complejos estigma-discriminación y garantice el derecho a la salud mental.

Background: The prolonged sociopolitical phenomenon of Colombian violence generated a high number of victims, many of whom suffered a continual process of internal displacement and stigma-discrimination complex. Objective: To postulate possible mechanisms by which victims of Colombia's internal armed conflict in a situation of forced displacement were stigmatized and discriminated. Results: Stigma affects mental health, not only because it represents a major stressor for discriminated individuals and groups, but also because it accounts for inequalities and inequities in health. Initially, as the victims of the internal armed conflict in situation of forced displacement were not considered as such, but as responsible for the situation. Thus, they had to cope with the social and economic inequalities, explained partially by low categorization or status that they received, possibly due to poor construction of social capital in the country. Also, victims of the internal armed conflict suffer from intersectional stigma and discrimination due to other characteristics such as gender, sexual orientation, ethnic-racial origin, or meeting criteria for a mental disorder. Conclusions: An active process of inclusive social development is required for the displaced victims of the armed conflict,in order to reduce multiple stigma and ensure their mental health.

Estigma: barrera de acceso a servicios en salud mental / Stigma: Barrier to Access to Mental Health Services

Introducción: El estigma percibido supone una barrera sociocultural para el acceso a servicios de salud mental y priva a las personas que reúnen criterios de trastorno mental de la posibilidad de disfrutar de atención integral e integrada. Objetivo: Actualizar los mecanismos institucionales por los cuales el estigma, percibido y perpetrado, relacionado con los trastornos mentales se configura como una barrera de acceso a la salud mental. Resultados: El estigma como barrera para el acceso a servicios de salud mental se materializa con la reducción de solicitud de atención, la escasa asignación de recursos a salud mental, el proceso sistemático de pauperización de las personas que los padecen, el incremento del riesgo de implicaciones en delitos y el contacto con el sistema legal y en invisibilización de la vulnerabilidad de estas personas. Conclusiones: Se necesita un proceso estructurado de sensibilización y educación de los distintos colectivos para promover el conocimiento sobre los trastornos mentales, favorecer la rehabilitación psicosocial en comunidad y la inclusión social y laboral. En Colombia, es necesario estudiar la frecuencia y las variables asociadas al estigma relacionado con trastornos mentales. Este conocimiento permitirá la implementación de acciones para favorecer la inclusión social de las personas que reúnen los criterios de trastorno mental.

Background: The perceived stigma represents a sociocultural barrier to access mental health services and prevents individuals who meet criteria for a mental disorder the possibility of receiving comprehensive and integred care. Objective: To update institutionalmechanisms bywhich stigma related to mental disorders, perceived and perpetrated, acts as a barrier to mental health access. Results: Stigmaas abarriertoaccesstomentalhealthservicesisduetoa reduction inservice requests, the allocation of limited resources to mental health, the systematic process of impoverishment of the people who suffer a mental disorder, increased risk of crime, and implications in contact with the legal system, and the invisibility of the vulnerability of these people. Conclusions: Structured awareness and education programs are needed to promote awareness about mental disorders, promote community-based psychosocial rehabilitation, and reintegration into productive life process. In Colombia, the frequency and variables associated with the stigma of mental disorders needs to be studied. This knowledge will enable the implementation of measures to promote the social and labor inclusion of people who meet the criteria for mental disorders.

[Stigma and Mental Health in Victims of Colombia's Internal Armed Conflict in Situation of Forced Displacement]. / Estigma y salud mental en personas víctimas del conflicto armado interno colombiano en situación de desplazamiento forzado.

BACKGROUND: The prolonged sociopolitical phenomenon of Colombian violence generated a high number of victims, many of whom suffered a continual process of internal displacement and stigma-discrimination complex. OBJECTIVE: To postulate possible mechanisms by which victims of Colombia's internal armed conflict in a situation of forced displacement were stigmatized and discriminated. RESULTS: Stigma affects mental health, not only because it represents a major stressor for discriminated individuals and groups, but also because it accounts for inequalities and inequities in health. Initially, as the victims of the internal armed conflict in situation of forced displacement were not considered as such, but as responsible for the situation. Thus, they had to cope with the social and economic inequalities, explained partially by low categorization or status that they received, possibly due to poor construction of social capital in the country. Also, victims of the internal armed conflict suffer from intersectional stigma and discrimination due to other characteristics such as gender, sexual orientation, ethnic-racial origin, or meeting criteria for a mental disorder. CONCLUSIONS: An active process of inclusive social development is required for the displaced victims of the armed conflict,in order to reduce multiple stigma and ensure their mental health.

[Stigma: Barrier to Access to Mental Health Services]. / Estigma: barrera de acceso a servicios en salud mental.

BACKGROUND: The perceived stigma represents a sociocultural barrier to access mental health services and prevents individuals who meet criteria for a mental disorder the possibility of receiving comprehensive and integred care. OBJECTIVE: To update institutional mechanisms by which stigma related to mental disorders, perceived and perpetrated, acts as a barrier to mental health access. RESULTS: Stigma as a barrier to access to mental health services is due to a reduction in service requests, the allocation of limited resources to mental health, the systematic process of impoverishment of the people who suffer a mental disorder, increased risk of crime, and implications in contact with the legal system, and the invisibility of the vulnerability of these people. CONCLUSIONS: Structured awareness and education programs are needed to promote awareness about mental disorders, promote community-based psychosocial rehabilitation, and reintegration into productive life process. In Colombia, the frequency and variables associated with the stigma of mental disorders needs to be studied. This knowledge will enable the implementation of measures to promote the social and labor inclusion of people who meet the criteria for mental disorders.