Respuestas ante la ausencia familiar en la migración de adolescentes no acompañados en México.

OBJETIVO: Conocer las diferentes respuestas de adolescentes centroamericanos que migran solos en México ante la ausencia familiar. Material y métodos. Se utilizaron métodos cualitativos y visuales (entrevistas semiestructuradas, técnica de elicitación visual, taller de dibujo y análisis temático). Se entrevistaron migrantes de entre 14 y 19 años no acompañados y trabajadores en servicios para migrantes. RESULTADOS: Se identificaron tres respuestas: independización, resiliencia y formación de redes de apoyo fuera de la familia tradicional. Conclusión. Las diferentes respuestas muestran que la familia -como núcleo de personas cercanas- es una necesidad humana y la reunificación familiar debe ser prioridad cuando ésta es viable. Sin embargo, falta reconocimiento institucional de la complejidad de las múltiples situaciones familiares de adolescentes migrantes. Esta falta puede justificar su deportación sin debido análisis de la situación.

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

OBJECTIVE: To analyze the mental health care needs of the serious mental disorders (SMD) and factors associated with the use of services in Mexico. MATERIALS AND METHODS: A cross-sectional analytical study was conducted in two phases, the first with a national database of available services and its utilization; the second, a sample of medical records of a psychi- atric hospital. RESULTS: Schizophrenia is the most prevalent MDS; more than 50% of those hospitalized were male, with an average age of 37 years. The use of services was associated with age (ß=1.062, p=.000), family income (ß=1.000, p=.000) and no laboral occupation (ß=3.407, p=.000). The population with schizophrenia is four times more likely to require to be exempt from payment (ß=4.158, p=.000). CONCLUSIONS: The population with SMD as schizophrenia is more vulnerable due to the associated functional and social disability and it requires specific heath interventions and a financial protection policy adapted to their mental health care needs.

OBJETIVO: Analizar las demandas de atención de los trastornos mentales graves (TMG) y factores asociados con la utilización de servicios en México. MATERIAL Y MÉTODOS: Se llevó a cabo un estudio analítico transversal en dos fases: la primera con una base de datos nacional de servicios disponibles y su utilización; la segunda, una muestra de registros médicos de un hospital psiquiátrico. RESULTADOS: La esquizofrenia es el TMG más prevalente; más de 50% de hospitalizados fueron hombres, con edad promedio 37 años. La utilización de servicios estuvo asociada con la edad (ß=1.062; p=.000), ingreso familiar (ß=1.000, p=.000) y no tener ocupación (ß=3.407; p=.000). La población con esquizofrenia tiene cuatro veces más la probabilidad de requerir estar exenta de pago (ß=4.158; p=.000). CONCLUSIONES: La población con TMG es más vulnerable por la discapacidad funcional y social asociada; requiere de intervenciones específicas de salud acompañadas de una política de protección financiera adaptada a sus necesidades de atención.

[Contexts and challenges for mental health care at the first level. A socioecological approach]. / Contextos y desafíos para la atención de la salud mental en el primer nivel. Una aproximación socioecológica.

OBJECTIVE: To analyze the current status of mental health care through a socioecological analysis, based on the perceptions of health center (HC) staff and users in Mexico City (CDMX). MATERIAL AND METHODS: Descriptive exploratory study of mixed methods (QUALI→ QUANT).During the qualitative phase, staff at 19 centers located in three Mexico City boroughs were interviewed and during the quantitative phase, a questionnaire was applied to patients. RESULTS: The influence and interdependence of the various factors impacting mental health (MH) care were identified. Health personnel and patients mentioned limited resources, which impact service quality, public MH policies that are not always implemented in practice and a care model that does not make it possible to delve into emotional problems. CONCLUSIONS: Improving MH care at the primary care level requires reflective work from a variety of perspectives.

OBJETIVO: Analizar la situación actual de la atención de la salud mental a partir de un análisis socioecológico, sustentado en las percepciones del personal y usuarios de centros de salud (CS) de la Ciudad de México (CDMX). MATERIAL Y MÉTODOS: Estudio exploratorio descriptivo de métodos mixtos (CUALI → CUAN). En la fase cualitativa, se entrevistó al personal de 19 centros ubicados en tres delegaciones de la CDMX y, en la fase cuantitativa, se aplicó un cuestionario a pacientes. RESULTADOS: Se identificó la influencia e interdependencia de diferentes factores que impactan la atención de la salud mental (SM). El personal de salud y pacientes reconocen escases de recursos que impactan la calidad del servicio, políticas públicas en SM que no siempre se concretan en la práctica y un modelo de atención que no permite ahondar en problemas emocionales. CONCLUSIONES: Mejorar la atención de la SM en el primer nivel requiere de un trabajo reflexivo desde diversas ópticas.

[Mental health and primary care in Mexico. Opportunities and challenges]. / Salud mental y atención primaria en México. Posibilidades y retos.

OBJECTIVE: To present the conditions that favour or limit the integration of mental health into health centres, based on the perceptions of health workers and on observations made by researchers. DESIGN: A study was conducted between April 2012 and February 2014 using a non-participant observation technique plus interviews with health professionals. SETTING: Descriptive exploratory study conducted in 19 health centres in Mexico City. METHOD: The selection of centres and participants was intentional, followed by the snowball technique in order to reach data saturation. Two guides were use, one for collecting information during the observation and the other one for interviews. The observations were registered in field notes, while the interviews were audio recorded. All collected information was stored in Word files. The analysis of field notes consisted of three levels of reading, and the interview analysis was based on "categorisation of meanings" proposed by Kvale (1996). RESULTS: The aspects that favour or limit the integration of mental health services involve three broad categories: a) programs and methods that organise services, b) infrastructure and material resources and, c) human and information resources. CONCLUSIONS: Actions targeted at including mental health into productivity reports and into already established goals, would contribute to the integration of mental health care, as well as promoting the idea that mental health is part of overall health, and to increase the public investment in health.

[Evaluation of the mental health system in Mexico: where is it headed?]. / Evaluación del sistema de salud mental en México: ¿hacia dónde encaminar la atención?

OBJECTIVE: Evaluate some of the key indicators that characterize the Mexican mental health system using the World Health Organization's Assessment Instrument for Mental Health Systems (WHO-AIMS). METHODS: The strategy for examining the WHO-AIMS indicators included: (i) a review of documentary sources; (ii) application of the questionnaire; and (iii) group work with a team of experts using the consensus technique. To facilitate collection of the data, a questionnaire was prepared in which the indicators were turned into simple questions. The people gathering the data were trained, and the activity was monitored. RESULTS: It was found that, of the total budget for health, only 2% is allocated for mental health, and, of that share, 80% is used in the operation of psychiatric hospitals. The pivotal point for mental health care is in the psychiatric hospital; there are very few psychiatric units in the general hospitals, few residential establishments, and few services targeted specifically to care for children and adolescents. Access is limited because of the centralized health care system, with the majority of establishments located in the large cities. Only 30% of primary care services have protocols for the evaluation and treatment of mental disorders. Finally, in the mental health facilities, the ratios of psychiatrists, other physicians, nurses, and psychologists per 100 000 population are 1.6, 1.3, 3.4, and 1.5, respectively. CONCLUSIONS: More funding will be needed in order to bridge the gap between the mental health burden and the budget allocated for its care, and resources will need to be used more rationally, with the first level of care becoming the pivot. In addition, it will be necessary to increase the number of specialists, offer periodic in-service training for personnel at the first level of care, and enlist greater participation by the rest of society.

"I Don't Want to Be Here." returning from the U.S. to Mexico and emotional distress: A qualitative study.

The psychosocial impact on people who were deported to Mexico from the United States or were forcibly returned tends to be greater than on those who return voluntarily. This text examines the way the emotional discomfort experienced by a group of Mexicans who were returned in these ways is constructed, through the analysis of anthropological interviews conducted with five women and thirteen men in which the following phases were explored: pre-migration, stay in the United States, return and reinsertion. This discomfort began in the pre-migration stage, during which they experienced various forms of disempowerment caused by the socioeconomic conditions of Mexico that determine the migratory trajectory, including reintegration. If, despite the disadvantages accumulated during the pre-migration phase, migrants manage to partly reverse their material and psychosocial disempowerment during their stay in the United States, on their return to a context such as Mexico, both their disempowerment and emotional discomfort are exacerbated. We therefore consider that the harm associated with the migratory saga will continue for an indefinite number of years following a person's return to Mexico and must be treated as a social rather than a clinical problem.

Interpersonal Violence and Psychological Well-Being: Perspectives of Low-Income Patients, Social Workers, and Medical Doctors in Mexico City, Mexico.

The violence epidemic in Mexico is becoming more widespread. Using a social-ecological framework, the current study sought to understand interpersonal violence among those impoverished communities in Mexico City, Mexico. Participants were recruited from Community Health Centers located within districts that were densely populated, had high rates of poverty and marginalization, and where people experience complex social needs. Semi-structured interviews were conducted with patients, social workers, and medical doctors (N = 15) who were either receiving or providing services in these centers. Data were analyzed using an inductive, thematic approach. Analysis resulted in three themes: (a) interpersonal violence permeates all settings in which people live and interact; (b) social and cultural factors increase the risk of becoming a perpetrator or victim of interpersonal violence; and (c) interpersonal violence is closely intertwined with mental health. Rapid changes within gender roles and expectations in Mexico, combined with widening income inequality, are shifting dynamics within families that may be inherently linked to interpersonal violence. Our findings support the conceptualization of interpersonal violence at the four levels of the social-ecological framework: individual, relationship, community, and societal. Prevention and interventions for violence reduction must be applied across the four levels simultaneously. Community-level efforts should go toward strengthening existing community health centers and equipping primary care providers with training and resources on the screening and triaging of patients encountering interpersonal violence.

Social Vulnerability and Emotional Distress in Older Adults: A Study in Primary Care Centers in Mexico City.

OBJECTIVES: To analyze the association between social vulnerability and emotional distress in older adults (OAs) visiting health centers in Mexico City, to describe the strategies and services used by OAs when they experience emotional distress, and to determine whether emotional distress is addressed in these primary care settings. METHODS: A sequential exploratory mixed method. In the first phase, qualitative information was collected through semi-structured interviews with 17 OAs. The information obtained was used to construct the instrument used in the second phase, which obtained quantitative data from 61 OAs. RESULTS: The main causes of emotional distress were feelings of loneliness, unemployment, and problems with children. The main actions used to address this distress were seeking support from family and friends, "hanging on," and engaging in religious practices. A total of 29.5% indicated that their doctor asked about emotional distress; 23% said they were referred to a psychologist, but few took this advice. CONCLUSIONS: The presence of emotional distress in OAs is not an individual health problem but rather the result of their living conditions and environment.

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

Resumen: Objetivo: Analizar las demandas de atención de los trastornos mentales graves (TMG) y factores asociados con la utilización de servicios en México. Material y métodos: Se llevó a cabo un estudio analítico transversal en dos fases: la primera con una base de datos nacional de servicios disponibles y su utilización; la segunda, una muestra de registros médicos de un hospital psiquiátrico. Resultados: La esquizofrenia es el TMG más prevalente; más de 50% de hospitalizados fueron hombres, con edad promedio 37 años. La utilización de servicios estuvo asociada con la edad (β=1.062; p=.000), ingreso familiar (β=1.000, p=.000) y no tener ocupación (β=3.407; p=.000). La población con esquizofrenia tiene cuatro veces más la probabilidad de requerir estar exenta de pago (β=4.158; p=.000). Conclusiones: La población con TMG es más vulnerable por la discapacidad funcional y social asociada; requiere de intervenciones específicas de salud acompañadas de una política de protección financiera adaptada a sus necesidades de atención.

Abstract: Objective: To analyze the mental health care needs of the serious mental disorders (SMD) and factors associated with the use of services in Mexico. Materials and methods: A cross-sectional analytical study was conducted in two phases, the first with a national database of available services and its utilization; the second, a sample of medical records of a psychiatric hospital. Results: Schizophrenia is the most prevalent MDS; more than 50% of those hospitalized were male, with an average age of 37 years. The use of services was associated with age (β=1.062, p=.000), family income (β=1.000, p=.000) and no laboral occupation (β=3.407, p=.000). The population with schizophrenia is four times more likely to require to be exempt from payment (β=4.158, p=.000). Conclusions: The population with SMD as schizophrenia is more vulnerable due to the associated functional and social disability and it requires specific heath interventions and a financial protection policy adapted to their mental health care needs.

From self-care to hospitalization: bipolar patients' health care practices in Mexico.

BACKGROUND: New research is continually improving the comprehension of bipolar disorder (BD). However, many challenges remain to be addressed, such as understanding the health care practices (HCPs) chosen by bipolar patients and the determinants of seeking treatment. MATERIAL: Using a qualitative approach, we studied the HCPs of six patients with BD through focused interviews. DISCUSSION: Even patients who report using primarily allopathic care usually test out and combine different HCPs. CONCLUSION: Pathways to care in BD are composed of a combination of HCPs because patients need to develop a stock of potential treatment alternatives to deal with the suffering involved in living with BD.

Contextos y desafíos para la atención de la salud mental en el primer nivel. Una aproximación socioecológica / Contexts and challenges for mental health care at the first level. A socioecological approach

Resumen: Objetivo: Analizar la situación actual de la atención de la salud mental a partir de un análisis socioecológico, sustentado en las percepciones del personal y usuarios de centros de salud (CS) de la Ciudad de México (CDMX). Material y métodos: Estudio exploratorio descriptivo de métodos mixtos (CUALI → CUAN). En la fase cualitativa, se entrevistó al personal de 19 centros ubicados en tres delegaciones de la CDMX y, en la fase cuantitativa, se aplicó un cuestionario a pacientes. Resultados: Se identificó la influencia e interdependencia de diferentes factores que impactan la atención de la salud mental (SM). El personal de salud y pacientes reconocen escases de recursos que impactan la calidad del servicio, políticas públicas en SM que no siempre se concretan en la práctica y un modelo de atención que no permite ahondar en problemas emocionales. Conclusiones: Mejorar la atención de la SM en el primer nivel requiere de un trabajo reflexivo desde diversas ópticas.

Abstract: Objective: To analyze the current status of mental health care through a socioecological analysis, based on the perceptions of health center (HC) staff and users in Mexico City (CDMX). Materials and methods: Descriptive exploratory study of mixed methods (QUALI→ QUANT). During the qualitative phase, staff at 19 centers located in three Mexico City boroughs were interviewed and during the quantitative phase, a questionnaire was applied to patients. Results: The influence and interdependence of the various factors impacting mental health (MH) care were identified. Health personnel and patients mentioned limited resources, which impact service quality, public MH policies that are not always implemented in practice and a care model that does not make it possible to delve into emotional problems. Conclusions: Improving MH care at the primary care level requires reflective work from a variety of perspectives.

Salud mental y atención primaria en México. Posibilidades y retos / Mental health and primary care in Mexico. Opportunities and challenges

OBJETIVO: Exponer las condiciones que favorecerían o limitarían la integración de la salud mental a los centros de salud de acuerdo con las percepciones del personal y las observaciones realizadas. DISEÑO: Durante abril del 2012 a febrero del 2014 se utilizó la técnica de observación no participativa y se realizaron entrevistas al personal. EMPLAZAMIENTO: Estudio exploratorio descriptivo realizado en 19 centros de salud situados en la Ciudad de México. MÉTODO: La selección de los centros y del personal fue intencionada, seguida de la técnica de bola de nieve hasta alcanzar la saturación de datos. Se emplearon 2 guías, una para recoger información durante la observación y la otra para realizar las entrevistas. El registro de las observaciones se hizo en notas de campo, mientras que las entrevistas de audio se grabaron. Toda la información recopilada se almacenó en archivos de Word. El análisis de las notas de campo consistió en 3 niveles de lectura y el de las entrevistas en la categorización de significados propuesta por Kvale (1996). RESULTADOS: Los aspectos que favorecen o limitan la integración de los servicios de salud mental involucran 3 grandes categorías: a) programas y formas de organización de los servicios, b) infraestructura y recursos materiales y c) recursos humanos e información. CONCLUSIONES: Contribuiría a la implementación de la atención a la salud mental: incluir en la productividad y metas las acciones dirigidas a la salud mental; fomentar la idea de que la salud mental forma parte de la salud general y la inversión estatal en salud

OBJECTIVE: To present the conditions that favour or limit the integration of mental health into health centres, based on the perceptions of health workers and on observations made by researchers. DESIGN: A study was conducted between April 2012 and February 2014 using a non-participant observation technique plus interviews with health professionals. SETTING: Descriptive exploratory study conducted in 19 health centres in Mexico City. METHOD: The selection of centres and participants was intentional, followed by the snowball technique in order to reach data saturation. Two guides were use, one for collecting information during the observation and the other one for interviews. The observations were registered in field notes, while the interviews were audio recorded. All collected information was stored in Word files. The analysis of field notes consisted of three levels of reading, and the interview analysis was based on «categorisation of meanings» proposed by Kvale (1996). RESULTS: The aspects that favour or limit the integration of mental health services involve three broad categories: a) programs and methods that organise services, b) infrastructure and material resources and, c) human and information resources. CONCLUSIONS: Actions targeted at including mental health into productivity reports and into already established goals, would contribute to the integration of mental health care, as well as promoting the idea that mental health is part of overall health, and to increase the public investment in health

Actitudes hacia la homoparentalidad: Validación psicométrica de dos escalas en una muestra de estudiantes mexicanos / Atitudes em relação à homoparentalidade: validação psicométrica de duas escalas numa amostra de estudantes mexicanos / Attitudes Towards Homoparentality: Psychometric Validation of two Scales in a Sample of Mexican Students

Introducción: La legalización del llamado matrimonio igualitario, y de la adopción de menores por parejas homosexuales, es un fenómeno reciente y que debe ser estudiado, para lo cual es necesario contar con medidas confiables que permitan dar cuenta de cómo la sociedad percibe esta nueva configuración familiar. Objetivo: Determinar las propiedades psicométricas de dos escalas: Actitudes frente a las familias Homoparentales (AFFH); y creencias acerca del ajuste de los niños de familias homoparentales (CANFH). Metodología: La AFFH, con 20 reactivos, fue diseñada para dar cuenta de las actitudes hacia las familias homoparentales. La CANFH tiene 14 reactivos organizados en las subescalas de oposición individual (OI) y oposición normativa (ON). Ambas escalas tienen afirmaciones que deben ser respondidas con opciones tipo Likert que van del 1 totalmente de acuerdo, al 5 totalmente en desacuerdo. La CANFH fue aplicada a 170 estudiantes universitarios (78 (46%) hombres, 92 (54%) mujeres. Media de edad: 18.4 DE+0.94), y la AFFH a 88 (35 (40%) hombres, 53 (60%) mujeres. Media de edad: 18.2 DE+0.84). Se determinaron las propiedades psicométricas por medio de análisis factorial y de consistencia interna. Resultados: La AFFH resultó con un α=0.91; los reactivos se organizaron en dos factores que explican 46.14% de la varianza. En el caso de la CANFH se confirmó la estructura factorial de dos subescalas explicativas de 65.49% de la varianza y con un α=0.94. Conclusiones: Los datos indican que ambas escalas poseen las propiedades psicométricas adecuadas para medir las actitudes de estudiantes mexicanos hacia las familias homoparentales y hacia los efectos que estas puedan tener en los menores adoptados...(AU)

Introduction: Same-sex marriage and adoption legalization constitute a growing and relatively new research field. Its study needs reliable and valid measures that allow to understand the society's perception about this new family order. Objective: Assess the psychometric properties of two scalesdevised to measure same-sex parenting attitudes: Attitudes toward Same-sex Families Scale (AFFH for its acronym in Spanish), and Scale on Beliefs about Children's Adjustment in Same-sex families (CANFH in Spanish). Methodology: AFFH scale is a 20-item measure designed to account for attitudes towards same-sex families. CANFH is a 14-item measure consisting of two scales, Individual Opposition (IO) and Normative Opposition (NO). Both are Likert scales with five response options (1. Strongly Agree to 5. Strongly Disagree). The CANFH was answered by 170 college students (78 (46%) males, 92 (54%) females; Average age: 18.4 SD 0.94), and the AFFH by 88 college students (35 (40%) males, 53 (60%) females, average age: 18.2 SD + 0.84). Results: AFFH items were organized into two factors that explained 46.14% of variance with a Cronbach's alpha of 0.91. CANFH items were grouped in a two factors structure that explained 65.49% of the variance (α = 0.94). Conclusions: CANFH and AFFH scales have adequate psychometric properties to measure Mexican college students' attitudes toward same-sex families and to assess the beliefs about children's adjustment in same-sex families...(AU)

Introdução: A legalização do chamado casamento do mesmo sexo e adoção de crianças por casais homossexuais, é um fenômeno recente, que deve ser estudado, para a qual é necessário ter medidas confiáveis que permitem ver como a sociedade percebe esta nova configuração familiar. Objetivo: determinar as propriedades psicométricas de duas escalas: Atitudes para com as famílias homoparentais (AFFH); e as crenças sobre o equilíbrio das crianças de famílias homoparentais. Metodologia: O AFFH, com 20 itens, foi projetado para explicar atitudes das famílias homoparentais. O CANFH tem 14 reagentes organizados em sub-escalas de oposição individual (OI) e oposição regulamentar (ON). Ambas as escalas são declarações que devem ser respondidas com opções de tipo Likert, entre 1 que significa estar de acordo e 5 que discorda totalmente (CANFH). O CANFH foi aplicado a 170 estudantes universitários (78 (46%) do sexo masculino, 92 (54%) mulheres com idade média: 18.4 + 0.94), e AFFH a 88 (35 (40%) do sexo masculino, 53 (60% ) mulheres média de idade. 18.2 + 0.84). Foram determinadas as propriedades psicométricas por meio de análise fatorial e consistência interna. Resultados: A AFFH foi α = 0.91 com reagentes foram organizados em dois fatores que explicam 46.14% da variância. No caso de a estrutura fatorial CANFH dois explicativa 65.49% da variância e um α = 0,94 subescalas foi confirmada. Conclusões: Os dados indicam que ambas as escalas têm o direito de medir as atitudes dos estudantes em relação homoparentais famílias mexicanas e para os efeitos que podem ter sobre as crianças adotadas propriedades psicométricas...(AU)

Malestar psicológico en mujeres con embarazo de alto riesgo / Psychological distress in high-risk pregnant women

La experiencia emocional de la mujer con embarazo de alto riesgo ante la maternidad es un tema poco estudiado, a pesar de la importancia que tiene preservar su salud emocional durante este proceso. Esta investigación analizó la experiencia de malestar psicológico en mujeres con embarazo de alto riesgo, según el riesgo médico diagnosticado, su vivencia de la maternidad y el papel que juegan la pareja, familia y redes de apoyo durante la gestación. Se realizó un estudio instrumental de casos múltiples. Se hicieron entrevistas semiestructuradas a 12 mujeres adultas con diagnóstico médico de embarazo de alto riesgo y se formaron tres grupos. Se realizó un análisis de significados de Kvale de los datos obtenidos. Los resultados mostraron que la vivencia de la maternidad y la manifestación de malestar psicológico en estas mujeres era diferente, dependiendo del riesgo médico diagnosticado. Además, podía ser de menor o mayor intensidad debido a la falta de planeación del embarazo, las experiencias obstétricas previas, no tener hijos vivos y contar con el apoyo de la pareja y la familia. Las mujeres con embarazo de alto riesgo vivían la maternidad como una experiencia dolorosa, con mucha angustia y miedo de perder el nuevo embarazo por complicaciones.

The emotional experience of maternity in high-risk pregnant women is a subject that has been seldom studied, despitethe importance of preserving the emotional health of women during this stage. This research analyzed the experience of psychological distress in women with high-risk pregnancy according to the medical risk diagnosed, their experience of maternity and the role of the partner, family and support networks during pregnancy. An instrumental multiple cases study was performed. By semi-structured interviews, we interviewed 12 adults’ women with medical diagnosis of high-risk pregnancy and three groups were formed. A Kvale analysis of meanings was performed on data. The results showed that the experience of motherhood and the manifestation of psychological distress in these women were different depending on the diagnosed medical risk; it may be of lower or higher intensity due to the lack of family planning, previous obstetric experiences, the lack of living children and also the support of the partner and the family. High-risk pregnant women lived mate I ty as a painful experience, with great anxiety and fear of losing the new pregnancy for medical complications.

Exploración del malestar emocional expresado por mujeres que acuden a centros de atención primaria de la Ciudad de México: Un estudio cualitativo / Exploring the emotional distress of women who attend primary health care units in Mexico City: A qualitative study

La presencia de malestar emocional -que se define como el conjunto de sensaciones subjetivas que percibe una persona de que su bienestar sufre una merma y que se manifiesta por síntomas inespecíficos- puede constituir un factor de riesgo para la aparición de enfermedades mentales, sobre todo en personas con vulnerabilidades biológicas y psicosociales. Estudios recientes señalan que los servicios de atención primaria reciben un número, cada vez mayor, de personas con malestares que no cubren los criterios diagnósticos de una enfermedad, ya sea mental o física, fenómeno que es más frecuente en las mujeres. El objetivo de este trabajo es analizar los malestares emocionales de un grupo de mujeres que acude a instituciones de atención primaria de la Ciudad de México, así como sus percepciones y vivencias sobre la atención recibida, con el propósito de identificar necesidades de atención. Para recopilar la información se utilizaron técnicas e instrumentos propios de la metodología cualitativa. La información se codificó y analizó conforme al método de "categorización de significados" propuesto por Kvale. Los resultados mostraron que los principales detonantes de los malestares emocionales en las participantes se asocian con las preocupaciones que enfrentan cotidianamente (como falta de dinero, problemas con los hijos y violencia intrafamiliar) y, en otros casos, con la vivencia de experiencias traumáticas de violencia y abuso sexual, pasadas y presentes. Los datos demuestran también que las mujeres no hablan directamente de su malestar emocional, pero que tampoco lo detecta el personal de salud o que, cuando lo hace, le resta importancia. Lo anterior se relaciona con las condiciones actuales del servicio, que no ofrece una atención integral y adolece de una visión psicosocial.

Emotional distress is the subjective sensation of diminishment in well-being which manifests itself in a number of unspecific symptoms. It might be a risk factor for the development of mental illness, especially among individuals with psychosocial or biological vulnerability. Recent studies show that primary health care services receive a growing number of patients who suffer distress, but do not fulfill the diagnostic criteria of a mental or physical illness. This phenomenon is more frequent among women. The objective of this paper is to analyze the emotional distress experienced by a group of women who attended primary health care institutions in Mexico City, as well as their perceptions and experiences around the attention received, in order to identify their treatment needs. Data was gathered through techniques and instruments pertaining qualitative methodology. The information was coded and analyzed according to the meaning categorization method developed by Kvale. The results show that the main triggers of emotional distress are associated to daily life worries (lack of money, problems with children, domestic violence, among others). In some cases, it is associated as well with traumatic events, such as violence and sexual abuse in the past or at present. Data also suggest that women do not talk about emotional distress directly during medical consultations and that health care professionals do not identify distress or minimize its importance. These aspects are related to the current characteristics of the service, which lacks a comprehensive approach and a psychosocial point of view.

Evaluación del sistema de salud mental en México: ¿hacia dónde encaminar la atención? / Evaluation of the mental health system in Mexico: where is it headed?

OBJETIVO: Evaluar algunos indicadores clave del sistema de salud mental mexicano utilizando el Instrumento de Evaluación para Sistemas de Salud Mental de la Organización Mundial de la Salud (IESM-OMS). MÉTODOS: La estrategia utilizada para responder a los indicadores del IESM-OMS incluyó: i) Revisión de fuentes documentales, ii) Aplicación de cuestionarios y iii) Trabajo grupal utilizando la técnica de consenso con expertos. Para facilitar la recopilación de la información, se elaboró un cuestionario donde los indicadores fueron transformados en preguntas sencillas. Asimismo, se capacitó a las personas encargadas de recabar los datos y se realizó un seguimiento de dicha actividad. RESULTADOS: Del total del presupuesto asignado a la salud, solo 2% estaba destinado a la salud mental y, de ese porcentaje, 80% se empleaba para el funcionamiento de los hospitales psiquiátricos. El eje de la atención de la salud mental se encontraba en el hospital psiquiátrico y existían muy pocas unidades de hospitalización psiquiátrica en los hospitales generales y establecimientos residenciales, así como servicios específicos para niños y adolescentes. El acceso estaba limitado por la centralización del sistema de atención, ya que la mayoría de los establecimientos se ubicaban en las grandes ciudades. Solamente 30% de los servicios de atención primaria contaban con protocolos de evaluación y tratamiento para trastornos mentales. Finalmente, en los establecimientos de salud mental, la tasa de psiquiatras, médicos, enfermeros y psicólogos por cada 100 000 habitantes registró valores de 1,6, 1,3, 3,4 y 1,5 respectivamente. CONCLUSIONES: Para reducir la brecha entre la carga que representan los trastornos mentales y el presupuesto asignado para su atención, se requiere de un mayor financiamiento y una utilización de los recursos más racional, considerando al primer nivel como el eje de la atención. Asimismo, será necesario ampliar el número de especialistas, capacitar periódicamente al personal en los primeros niveles de atención e incrementar la participación del resto de la sociedad.

OBJECTIVE: Evaluate some of the key indicators that characterize the Mexican mental health system using the World Health Organization's Assessment Instrument for Mental Health Systems (WHO-AIMS). METHODS: The strategy for examining the WHO-AIMS indicators included: (i) a review of documentary sources; (ii) application of the questionnaire; and (iii) group work with a team of experts using the consensus technique. To facilitate collection of the data, a questionnaire was prepared in which the indicators were turned into simple questions. The people gathering the data were trained, and the activity was monitored. RESULTS: It was found that, of the total budget for health, only 2% is allocated for mental health, and, of that share, 80% is used in the operation of psychiatric hospitals. The pivotal point for mental health care is in the psychiatric hospital; there are very few psychiatric units in the general hospitals, few residential establishments, and few services targeted specifically to care for children and adolescents. Access is limited because of the centralized health care system, with the majority of establishments located in the large cities. Only 30% of primary care services have protocols for the evaluation and treatment of mental disorders. Finally, in the mental health facilities, the ratios of psychiatrists, other physicians, nurses, and psychologists per 100 000 population are 1.6, 1.3, 3.4, and 1.5, respectively. CONCLUSIONS: More funding will be needed in order to bridge the gap between the mental health burden and the budget allocated for its care, and resources will need to be used more rationally, with the first level of care becoming the pivot. In addition, it will be necessary to increase the number of specialists, offer periodic in-service training for personnel at the first level of care, and enlist greater participation by the rest of society.

Curanderos, malestar y "daños": una interpretación social / Folk healers, discomfort, and sorcery: a social interpretation

From within the framework of social representations theory, this research sought to explore magical-religious thoughts on sickness among users of traditional medicine. Introduction Ever since the dawn of time, magic and religion have been human resources for facing issues of health and sickness. In traditional Meso-America, sickness was believed to have four different causes: the breaking of natural laws, the will of the gods, the dates on the calendar, and the actions of human beings. These traditional beliefs blended in with Spanish Christian heritage and with the magical-religious beliefs of the slaves, giving place to the traditional medicine practiced currently in Mexico. Representations of health and sickness determine the choices people make between different healing options, thence our interest in understanding the social representations of these categories among users of traditional medicine and folk healing. Method Ten traditional medicine users from the State of Mexico were interviewed in depth regarding five thought categories: health/sickness, traditional medicine and folk healers, detection and treatment, reasons for choosing traditional medicine, and contrast between traditional and modern medicine. The interviews were analyzed qualitatively using Ethnograph 4.0. Results According to these ten informants, health and sickness have to do with intra and interpersonal wellbeing and discomfort. The magical-religious thoughts of the interviewees are witnessed by the classification they make of ailments, which can be physical, psychological or due to curses and witchcraft -this latter undetectable by doctors. Other beliefs are that many people can cause their own ailments, that folk healers can practice white magic (for doing good) or black magic (for doing evil), and that they have a "gift" for healing and prediction, through dreams or otherwise. Discussion The ways of understanding health and disease are not universal, they depend on social representation or the meaning that patients attribute to them. Traditional medicine is based on magical-religious thinking that explains the disease and contrasts with the official medicine interpretation.

La presente investigación tuvo como objetivo conocer, desde la teoría de las Representaciones Sociales, el pensamiento mágico-religioso que tiene sobre el malestar un grupo de usuarios de la medicina tradicional. Introducción La magia y la religión han sido herramientas que el hombre ha utilizado para enfrentar los problemas de salud-enfermedad que se le han presentado a lo largo de su existencia. La cosmovisión mesoame-ricana también estaba sustentada en un pensamiento mágico-religioso que daba sentido al malestar. La conquista produjo un mestizaje cultural en el que este tipo de pensamiento siguió vigente y que en la actualidad se manifiesta en la práctica de la medicina tradicional; de ahí la inquietud de indagar cómo se representan socialmente el malestar los sujetos que hacen uso de esta opción. Método Estudio cualitativo de tipo exploratorio-descriptivo. Se utilizó la entrevista a profundidad para explorar cinco categorías: salud-enfermedad, medicina tradicional y curanderos, detección y tratamiento, argumentos para la elección de la medicina tradicional, contraste entre medicina tradicional y oficial. Materiales e instrumentos: Audiograbadora, diario de campo. Población: Diez usuarios de la medicina tradicional del Estado de México. Análisis de datos: análisis de contenido mediante Ethno-graph 0.4. Consideraciones éticas: Participación voluntaria, confidencialidad y anonimato de los participantes. Resultados De acuerdo con los informantes, la salud-enfermedad tiene que ver con un sentimiento de bienestar-malestar intrapersonal e interpersonal. El pensamiento mágico-religioso se evidencia en la clasificación que hacen de las enfermedades, las cuales pueden ser físicas, psicológicas o de otro tipo: daños o brujerías que no pueden ser detectadas ni curadas por los médicos. Muchas veces una persona es la causante del problema. Los curanderos pueden dedicarse a la magia blanca (hacer el bien) o a la negra (perjudicar); poseen un "don" para curar, pueden ver en sus sueños y adivinar. Discusión Las formas de entender la salud-enfermedad conllevan la elección de aquellas opciones más compatibles con el tipo de pensamiento, ya sea empírico o mágico-religioso, que subyace a la interpretación del malestar, en concordancia con el grupo social al que el sujeto pertenece.

Los nuevos empresarios: Trayectoria del uso a la venta de drogas en contextos de fiesta / The new businessmen: Pathways from drug use to drug dealing in party contexts

Drugs use at party contexts has increased in recent decades. Drugs dealing facilitates consumer access to substances, whose sales practices vary according to drugs use, places for the consumption and the drug social function. Drug dealing is socially constructed from a set of practices ranging from reasons to dealing and those related to the consolidation as a common practice. The aim of this research was to describe and analyze the drugs users' experience in party contexts, about their dealer's construction process. An interpretative multiple-case study with the snowball technique was carried out to get the participants. The information was obtained by a semi-structured interview and nonparticipant observation at the dealing places. The information obtained points out the group's participation on the selection of the dealer as the initiation of drugs dealing, the extroversion features and communication skills as an important profile to be a dealer; specially, the capability to satisfy the group's emotional request through the drugs. Also, benefits as acceptation, protection and the warmth from the group and the economical earning. The dealer/businessmen consolidation is socially constructed according to the new identity assumed, the group participation and the specific activities as a business.

El uso de drogas en contextos de fiesta se ha incrementado en las últimas décadas. El narcomenudeo facilita el acceso a sustancias de consumo, cuyas prácticas de venta varían conforme a la droga de uso, los espacios de consumo y la función de la droga en los grupos que la consumen. La venta de drogas implica una serie de prácticas que la construyen y que incluyen los motivos del inicio de venta, el proceso de desarrollo y las relacionadas con la consolidación de la venta como práctica habitual. El objetivo de esta investigación fue describir y analizar la experiencia de usuarios de drogas en contextos de fiesta respecto al proceso en que se construyen como dealers. Para lo anterior, se realizó un estudio interpretativo de casos múltiples, empleando la técnica de "bola de nieve" para captar a los participantes. La observación se obtuvo por medio de una entrevista semiestructurada y la observación no participante en escenarios de venta. Se obtuvo información relacionada con los elementos del salto del uso a la venta como la elección del dealer por el grupo, su perfil para ser elegido como la extroversión y habilidades de comunicación; y sobre todo su capacidad para satisfacer la demanda de emociones de los miembros de su grupo por medio de las drogas de venta. Además, de la aceptación, protección y afecto del grupo y las ganancias económicas. La consolidación como dealer/empresario se construye conforme se asumen una nueva identidad, la participación del grupo y las actividades específicas de la empresa.

[Diseases and illnesses for which help is sought from traditional healers in Mexico City]. / Enfermedades y padeceres por los que se recurre a terapeutas tradicionales de la Ciudad de México.

OBJECTIVE: The aim of this paper is to describe the main reasons why people consult traditional healers in Mexico City. MATERIAL AND METHODS: The narrative of 16 traditional healers and 22 users of this type of medicine is the main source of information. This study used a qualitative approach. The field work was carried out in two stages. The first phase involved a series of observations with an ethnographic approach. During the second phase, focused interviews were held with selected informants. RESULTS: According to participants, the main reasons for consulting traditional healers were problems with romance and love, family conflicts, economic hardships, stress,tension, nervousness and spiritual distress. These motives cannot be considered diseases in a strict sense; they were all health problems manifested as illnesses that caused suffering and only some of them could be classified as diseases within the biomedical model. People go to traditional healers not only to cure their diseases but also to obtain advice about their personal problems. As a result, traditional medicine becomes an additional option for treating human suffering, not only physical, but moral and psychological as well. DISCUSSION: The information analyzed in this paper indicates that diverse reasons exist which explain not only the survival of traditional medicine, but also its importance in present life,where science and technology have obtained outstanding results, but biomedical medicine has forgotten the complexity of daily human life and the importance of personal attention, compassion, understanding, empathy and the use of the symbolic world to solve the conflicts and health problems characteristic to humanity.