Challenges of Perinatal Depression Care in Mexico City Health Centers.

Background: Perinatal depression is a common mental disorder regarded as a severe public health problem. Studies have shown that incorporating mental health care into primary health services that provide pregnancy care makes it easier for women to seek help for depressive symptoms. In this context, the following question is of interest: How prepared are primary health services in Mexico City that provide pregnancy and postpartum care to treat perinatal depression? This article seeks to explore the perceptions and knowledge of perinatal depression in health professionals and analyze the barriers to its care at primary care centers in Mexico City. Methods: An exploratory study with a qualitative approach was conducted. Doctors, nurses, social workers who provide maternal and childcare, mental health personnel, and the directors of four centers were interviewed. Interviews were audio-recorded and transcribed for thematic analysis. Results: Most primary care personnel are unaware of the Official Standard that recommends providing maternal mental health care during the perinatal period. There is no initiative for its incorporation into routine care. A significant barrier to its implementation is health professionals' biased, stereotyped perception of perinatal depression, motherhood, and the role of women. Other barriers include the workload of health professionals, the division of care between professionals, and the lack of communication between the latter. Women with psychological symptoms are not referred to mental health staff in a timely manner. Social workers are in closer contact with women and are more willing to address their emotional distress. Conclusion: Maternal mental health care, contingent on pregnancy, childbirth, and puerperium care at primary care centers is currently not possible due to the lack of knowledge, barriers, and directors' dependence on hospital management decisions.

Doctoring and mothering during the SARS-COV2 pandemic: Characteristics of physicians-mothers during COVID-19 and their impact on mental health / Medicina y maternidad durante la pandemia por SARS-COV2: Características de médicas madres de familia durante la Covid-19 y su impacto en la salud mental

Abstract Introduction During COVID-19, health workers faced increased stress accentuated by gender roles, such as motherhood. Objective This study analyzed the characteristics of a group of physicians-mothers, its impact on mental health, and their experiences during this pandemic. Method Mixed methods study using an online survey to investigate sociodemographic, family, emotional, and professional aspects, in addition to the personal experience of 537 doctors-mothers during the first stage of COVID-19. Results Due to the pandemic, most of the participants changed their daily activities. The hours dedicated to professional work (HM = 5.08, p< .0001), childcare (HM = 3.74, p< .0001), and food planning and preparation (HM = -6.96, p< .0001) were increased, while the hours dedicated to physical exercise (MH = 8.67, p< .0001) and personal care (MH = 9.54, p< .0001) decreased. It has been pointed out that this pandemic has generated a lack of well-defined spaces, resulting in multitasking. Fear and guilt were two common words in the speeches of the participants. Fear of getting sick and dying, or fear of infecting their families. Guilt at feeling that they did not play a good role either as doctors or as mothers. Most common psychological symptoms were insomnia, sadness or discouragement, and constant worry or tension. Discussion and conclusion The pandemic evidenced and exacerbated both the disparities faced by these female doctors in the medical field, as well as the inequity in housework and home-care. The loss of boundaries between the public and the private showed the mothers-doctor struggling to reconcile their personal and professional life with substantial repercussions for their mental health.

Resumen Introducción Durante el COVID-19, los trabajadores de la salud enfrentaron mayor estrés, acentuado por los roles de género, como la maternidad. Objetivo Analizar las características de un grupo de madres médicas, su impacto en la salud mental, y sus experiencias durante esta pandemia. Método Estudio de métodos mixtos mediante una encuesta en línea que indagó aspectos familiares, emocionales, profesionales y la experiencia personal de 537 madres médicas durante la primera etapa del COVID-19. Resultados Por la pandemia, las participantes cambiaron sus actividades diarias. Asimismo, incrementaron el número de horas dedicadas al trabajo profesional (HM = 5.08, p< .0001), el cuidado de niños (HM = 3.74, p< .0001) y la planificación y preparación de alimentos (HM = -6.96, p< .0001). Disminuyeron las horas dedicadas al ejercicio físico (MH = 8.67, p< .0001) y al cuidado personal (MH = 9.54, p< .0001). Señalaron que esta pandemia generó una falta de espacios definidos, lo que favoreció el multitasking. Miedo y culpa fueron dos palabras habituales en los discursos de las participantes. También miedo a enfermarse y morir, o miedo a contagiar a sus familias. Culpabilidad por sentir que no desempeñaron un buen papel ni como médicas ni como madres. Los síntomas psicológicos más comunes fueron insomnio, tristeza y tensión constante. Discusión y conclusión La pandemia evidenció y exacerbó las disparidades que enfrentan estas doctoras en el campo de la medicina y la inequidad en las tareas del hogar. La pérdida de los límites entre lo público y lo privado mostró a las médicas madres conciliando su vida personal y profesional, con repercusiones sustanciales para su salud mental.

Factors Associated with Sexual Debut in Mexican Adolescents: Results of the National Survey on Drug Use among Students in 2014.

INTRODUCTION: Although first sexual experience (understood as first sexual intercourse) is one of the most commonly assessed characteristics of adolescents, recent research emphasizes the importance of understanding other related social factors. This study highlights factors associated with first sexual experience in a nationally representative sample of adolescent students in Mexico. AIMS: The goals of this study were (i) to determine the proportion of adolescents aged 12-17 who had had their first sexual experience; (ii) to identify the factors associated with first sexual experience; and (iii) to analyze the conditions (condom use, substance use) in which first sexual experience takes place. METHOD: The data presented in this study are drawn from the 2014 National Survey on Drug Use in Students (Spanish acronym ENCODE), undertaken with the purpose of identifying the prevalence of drug use and associated variables, including sexual activity, in Mexican students. Kaplan-Meier analysis was used to estimate the probability of first sexual experience at a given age, taking sex as an outcome variable and age as a follow-up period. Logistic regression was used to assess possible factors for sexual initiation. MAIN OUTCOME MEASURES: Validated standard questionnaires were used to assess sociodemographic characteristics, first sexual experience (framed as first sexual intercourse), frequency of sexual relations, sexual partners, sexual preference (framed as preferred sex of partners), substance use, having a physical illness or a behavioral problem, condom or other contraceptive use, as well as the absence or presence of parents, parents' educational attainment, and parents' substance use. RESULTS: A total of 26,187 students aged 12-17 participated. Of this total, 14.8% had already had their first sexual experience, at a median age of 15; 64.5% used some type of contraceptive, and 53.2% used condoms. Proportional probabilities for having first sexual experience using age as a follow-up period showed that the probability of having sex earlier was higher among boys than girls: the probability of having sex at age of 15 was 26.5% for boys and 13.9% for girls. Predictors of first sexual experience included substance use (alcohol OR = 2.5, tobacco OR = 2.6, and other drugs OR = 2.3), having a mother who used drugs (OR= 2.2), sexual preference (female homosexual, OR = 2.2), and sex (male, OR = 2.1). CONCLUSIONS: Boys are more likely to have had a first sexual experience than girls. Future strategies should incorporate specifically targeted elements with different messages that consider adolescents' sex and age. Barragán V, Berenzon S, Tiburcio M, et al. Factors Associated with Sexual Debut in Mexican Adolescents: Results of the National Survey on Drug Use among Students in 2014. J Sex Med 2019;16:418-426.

A bittersweet relationship: What does it mean to be the caregiver of a patient with bipolar disorder?

BACKGROUND: As with most of the chronic illnesses, the changes and consequences brought on by bipolar disorder (BD) are not exclusive to the patient and often spread to those around them, especially for direct caregivers of these patients. It is known that there is a significant emotional and physical toll among persons who coexist daily with those who suffer from this disorder. OBJECTIVE: Aware of the importance of the role played by informal caregivers (especially the family) in the stability and evolution of patients with bipolar disorder, this study seeks to explore the perception that family members responsible for bipolar persons have of themselves as caregivers of these patients. METHOD: This is a qualitative study using a phenomenological design, for which the technique of focused or semi-structured interviews was employed. Ten caregivers of people with diagnosis of BD agreed to participate. RESULTS: Within the family, it is a single individual who has the role of caregiver. Experiences and meanings that are generated into the nucleus of the patient-caregiver relationship are full of ambivalence and involve many aspects worthy of analysing, such as the development of identities, the feminization of patient care, the process of therapeutic decision-making and the evolution of the disease. CONCLUSIONS: It is necessary to integrate evaluation and attention for patients' caregivers, recognizing them as individuals and elucidating their constructed meanings and the dynamics established in their relationship with patients. In this way, there would be a more integrative clinical approach of the patient-caregiver relationship, considering not only the necessary pharmacological treatments but also accompanying both patient and family, along the path they travel as they experience BD.

Perceptions of Mexican women regarding barriers in mental Heath Services in primary care.

BACKGROUND: The recent mental health care reforms in Mexico call for the regular evaluation of the services provided. This involves analyzing the opinions of those who utilize them on a daily basis, particularly women, since they are the main health service users. This study explores the barriers to mental health care perceived by a group of women attending primary care centers. METHOD: A qualitative methodological approach was chosen. The participants were purposively selected, using the snowball technique. Semi-structured interviews were analyzed using the thematic analysis. RESULTS: Three sets of factors representing barriers to care were identified in the participants' discourse. The first is linked to systemic barriers such as a lack of familiarity with the way the service operates, and irregularities in the consultations and appointment schedules that are not always geared to women's needs. The second concerns the social stigma associated with emotional and/or mental disorders and their care while the third involves the characteristics of psychologists and their professional work. CONCLUSIONS: In order to overcome some of the barriers identified, users should be given information on the work of mental health professionals, which would help dispel certain misconceptions and sensitize them to the importance of this type of treatment in achieving overall health. There is also a need to make psychologists aware of the living conditions and socio-cultural context of the women who attend these health facilities.

"This Is How We Work Here": Informal Logic and Social Order in Primary Health Care Services in Mexico City.

People who work in health care facilities participate in a shared set of tacit agreements, attitudes, habits, and behaviors that contribute to the functioning of those institutions, but that can also cause conflict. This phenomenon has been addressed tangentially in the study of bureaucratic practices in governmental agencies, but it has not been carefully explored in the specific context of public health care centers. To this end, we analyzed a series of encounters among staff and patients, as well as the situations surrounding the services offered, in public primary care health centers in Mexico City, based on Erving Goffman's concepts of social order, encounter, and situation, and on the concepts of formal and informal logic. In a descriptive study over the course of 2 years, we carried out systematic observations in 19 health centers and conducted interviews with medical, technical, and administrative staff, and psychologists, social workers, and patients. We recorded these observations in field notes and performed reflexive analysis with readings on three different levels. Interviews were recorded, transcribed, and analyzed through identification of thematic categories and subcategories. Information related to encounters and situations from field notes and interviews was selected to triangulate the materials. We found the social order prevailing among staff to be based on a combination of status markers, such as educational level, seniority, and employee versus contractor status, which define the distribution of workloads, material resources, and space. Although this system generates conflicts, it also contributes to the smooth functioning of the health centers. The daily encounters and situations in all of these health centers allow for a set of informal practices that provide a temporary resolution of the contradictions posed by the institution for its workers.

Barriers to Integrating Mental Health Services in Community-Based Primary Care Settings in Mexico City: A Qualitative Analysis.

OBJECTIVE: Despite the high prevalence of mental disorders in Mexico, minimal mental health services are available and there are large gaps in mental health treatment. Community-based primary care settings are often the first contact between patients and the health system and thus could serve as important settings for assessing and treating mental disorders. However, no formal assessment has been undertaken regarding the feasibility of implementing these services in Mexico. Before tools are developed to undertake such an assessment, a more nuanced understanding of the microprocesses affecting mental health service delivery must be acquired. METHODS: A qualitative study used semistructured interviews to gather information from 25 staff in 19 community-based primary care clinics in Mexico City. Semistructured interviews were analyzed by using the meaning categorization method. In a second phase of coding, emerging themes were compared with an established typology of barriers to health care access. RESULTS: Primary care staff reported a number of significant barriers to implementing mental health services in primary care clinics, an already fragile and underfunded system. Barriers included the following broad thematic categories: service issues, language and cultural issues, care recipient characteristics, and issues with lack of knowledge. CONCLUSIONS: Results indicate that the implementation of mental health services in primary care clinics in Mexico will be difficult. However, the information in this study can help inform the integration of mental health into community-based primary care in Mexico through the development of adequate evaluative tools to assess the feasibility and progress of integrating these services.

Predicting Women's Utilization of Primary Care Mental Health Services in Mexico City.

OBJECTIVE: To analyze factors associated with and predicting Mexican women seeking primary care mental health services (PCMHS) and provide suggestions to increase PCMHS utilization. METHOD: We administered a questionnaire to (N = 456) female patients in Mexico City primary care clinics. We conducted chi-square analyses of seeking PCMHS and sociodemographic variables, perceptions of and experiences with PCMHS. Our results and literature review guided our logistic regression model. RESULTS: Women referred to a mental health provider (MHP; odds ratio [OR] = 10.81, 95% CI = 3.59-32.51), whose coping mechanisms included talking to a MHP (OR = 5.53, 95% CI = 2.10-14.53), whose primary worry is loneliness (OR = 8.15, 95% CI = 1.20-55.10), and those who follow doctor's orders; were more likely to seek PCMHS (OR = 0.28, 95% CI = 0.09-0.92). CONCLUSIONS: Primary care providers play a fundamental role in women's decisions to seek PCMHS. Proper referrals to PCMHS should be encouraged.

Acceptability and barriers to treatment for perinatal depression: An exploratory study in Mexican women / Aceptación y barreras al tratamiento para depresión perinatal: Estudio exploratorio en mexicanas

Background Depression is frequently experienced during the perinatal period. In Mexico, it has received very little attention from researchers and health service providers. It is well known that untreated depression is one of the leading causes of disability in women. Objective This study seeks to explore: 1. the recognition of perinatal depression among pregnant and postpartum women; 2. the acceptance of various modalities of treatment for depression, and 3. the perception of the barriers to receive treatment. Material and methods For this descriptive, exploratory study, 41 women in the third trimester of pregnancy and 30 women between the fourth and sixth postpartum weeks were interviewed. The study was conducted at a health center and a general hospital. The interview included demographic and obstetric data; depressive symptomatology (PHQ-2); open questions on the recognition of perinatal depression and scales relating to the acceptance of treatment modalities and barriers to access health services. Results Almost all the women had heard of the term postpartum depression, while one quarter did not know the causes of this disorder, which was attributed to an inability to face new challenges, emotional and hormonal changes, and lack of social support. The majority considered that it is not easy to speak about their unhappiness or discomfort, and that people would not understand if pre- or post-partum women felt sad or depressed in this period. Individual psychotherapy was the treatment with the highest level of acceptance, while medication, during pregnancy or breastfeeding, was the least accepted. The main barriers to treatment were: lack of time; institutional procedures; being unable to afford care and not having anyone to look after the children. Conclusions These results constitute a preliminary approach to the care needs for depression during the perinatal period. Women's awareness that help is required may not suffice to encourage them to seek assistance due to instrumental barriers and attitudes to treatment. In order to ensure effective care, it is necessary for the official norms regulating the health care for women and babies in this period to include treatment for mental disorders.

Antecedentes La depresión es un estado frecuente en el periodo perinatal. En México ha recibido muy poca atención por parte de investigadores y prestadores de servicios. Se sabe que la depresión no tratada es una de las causas más importantes de discapacidad en las mujeres. Objetivo Explorar: 1. el reconocimiento de la depresión perinatal en embarazadas y puérperas, 2. la aceptación de diferentes modalidades de atención para la depresión y 3. la percepción de las barreras para asistir a tratamiento. Material y métodos En este estudio descriptivo y exploratorio se entrevistó a 41 mujeres en el tercer trimestre del embarazo y a 30 entre la cuarta y sexta semanas del posparto. El estudio se llevó a cabo en un centro de salud y en un hospital general. La entrevista incluyó: datos demográficos y obstétricos; sintomatología depresiva (PHQ-2); preguntas abiertas sobre el reconocimiento de la depresión perinatal y escalas relativas a la aceptación de diversas modalidades de tratamiento y barreras para acudir a servicios de salud. Resultados Casi todas habían escuchado el término depresión posparto; una cuarta parte desconocía las causas de este trastorno, el cual fue atribuido a no saber enfrentar los nuevos retos, cambios emocionales, cambios hormonales y falta de apoyo social. La mayoría consideró que no es fácil hablar de tristeza o malestar en este periodo y que la gente tampoco lo entendería. La psicoterapia individual fue el tratamiento con mayor aceptación; los medicamentos, durante el embarazo o lactancia, los menos aceptados. Las principales barreras al tratamiento fueron: la falta de tiempo, los trámites institucionales, la imposibilidad de pagarlo y la carencia de cuidado para los hijos. Conclusiones Estos resultados constituyen una primera aproximación a los requisitos de atención de la depresión en el periodo perinatal. El reconocimiento de la necesidad de ayuda por parte de las mujeres puede no ser motivo suficiente para que acudan a buscarla debido a las barreras instrumentales y las actitudes hacia el tratamiento. Para poder brindar una atención efectiva es necesario que las normas oficiales, que regulan el cuidado de la salud de mujeres e infantes en este periodo, incluyan una atención a los trastornos mentales.

Intimate partner violence and depressive symptoms in pregnant Mexican women: national survey results.

OBJECTIVES: To analyze the link between intimate partner violence (IPV) reported in the past year and depressive symptoms in pregnant Mexican women. MATERIAL AND METHODS: The data were obtained from the National Addictions Survey (ENA) 2008. For the purposes of this paper, we analyzed a sample of women over 18 who reported being pregnant at the time of the interview (n = 250). When this number is weighted at the population level, it represents 881,575 women across the country. The χ2 test was used to analyze demographic characteristics, prevalence of depressive symptoms and intimate partner violence. A multiple logistic regression was performed to estimate predictors of depressive symptoms during pregnancy. RESULTS: The prevalence of any type of intimate partner violence (IPV) was 5.4% and of depressive symptoms was 16.2% (CES-D ≥ 16). A total of 53.4% of pregnant women who reported IPV during the past year had depressive symptoms whereas this occurred in 14.1% of those who had not been victimized. The variables that predicted depressive symptoms during pregnancy were having been a victim of IPV (OR = 6.23) and having nine years or less of schooling (OR = 5.26). Working outside the home and family income level did not increase the risk of depressive symptoms in this population. CONCLUSIONS: This population study, representative at the national level, provides an initial overview of the link between intimate partner violence and depressive symptoms in pregnant women in México. The results highlight the need to expand research on the topics covered, as well as to detect both phenomena in a timely manner during pregnancy in order to propose the necessary care.

Placer, transformación y tratamiento: uso de las medicinas alternativas para problemas emocionales en la Ciudad de México / Pleasure, transformation and treatment: use of alternative medicines to treat emotional illnesses in Mexico City

Se presenta un análisis del uso de las medicinas alternativas para la atención de problemas emocionales. La información se obtuvo de 36 entrevistas de investigación social realizadas en la Ciudad de México, se analizó mediante la categorización de significados, y bajo un modelo propuesto por Bishop et al. (2008). Las prácticas y recursos fueron utilizadas como tratamiento complementario, alternativo o convencional, también como experiencias placenteras y procedimientos de transformación personal. Con los tres primeros tipos de uso se atendieron padecimientos específicos; como "experiencias placenteras", se buscó obtener bienestar psicológico; y con la última modalidad, se obtuvo orientación para intervenir adecuadamente en alguna situación problemática. La categorización de Bishop et al. (2008) resultó útil para integrar prácticas que aún cuando son ampliamente usadas y cuentan con legitimidad social, se ignoran en el campo de la salud. Con estas prácticas se pretende ampliar el repertorio de recursos de cuidado y satisfacer necesidades que los servicios formales no cubren.

[Depression: state of the art and the need for public policy and action plans in Mexico]. / Depresión: estado del conocimiento y la necesidad de políticas públicas y planes de acción en México.

Depression is an important public health problem. It is the fourth cause of disease in the world in terms of lost years of healthy life. In Mexico, it ranks first in terms disability for women and ninth for men. There is a high comorbidity between depression and other mental disorders such as anxiety and substance abuse, as well as other serious and chronic physical conditions (e.g. diabetes, and heart disease). Despite the impact of depressive disorders in the quality of life of the population, there is a large proportion of people who don't get treatment, delaying seeking help and thus don't receive adequate assistance. The aim of this paper is to present an analysis of depression status in the Mexican population from a public health perspective; it includes prevalence and associated factors, gaps in care, characteristics of the use of services and treatments available. The paper concludes with a presentation of the implications for research and mental health policy in Mexico.

Depresión: estado del conocimiento y la necesidad de políticas públicas y planes de acción en México / Depression: state of the art and the need for public policy and action plans in Mexico

La depresión constituye un problema importante de salud pública. En el mundo, representa la cuarta causa de discapacidad en cuanto a la pérdida de años de vida saludables. En México ocupa el primer lugar de discapacidad para las mujeres y el noveno para los hombres. La depresión tiene una alta co-ocurrencia con otros trastornos como la ansiedad, el consumo de sustancias, la diabetes y las enfermedades cardiacas. Pese al impacto que tiene este trastorno, una gran proporción de personas no acude a tratamiento, retrasa mucho la búsqueda de ayuda, o bien no recibe la asistencia adecuada. El propósito de este ensayo es exponer el resultado de una breve revisión de investigaciones que permiten ubicar la depresión como un problema de salud pública en México. Se abordan la prevalencia y los factores asociados, las brechas de atención, el uso de servicios y los tratamientos disponibles. Al final se plantean algunas de las implicaciones para la investigación y para las políticas públicas.

Depression is an important public health problem. It is the fourth cause of disease in the world in terms of lost years of healthy life. In Mexico, it ranks first in terms disability for women and ninth for men. There is a high comorbidity between depression and other mental disorders such as anxiety and substance abuse, as well as other serious and chronic physical conditions (e.g. diabetes, and heart disease). Despite the impact of depressive disorders in the quality of life of the population, there is a large proportion of people who don't get treatment, delaying seeking help and thus don't receive adequate assistance. The aim of this paper is to present an analysis of depression status in the Mexican population from a public health perspective; it includes prevalence and associated factors, gaps in care, characteristics of the use of services and treatments available. The paper concludes with a presentation of the implications for research and mental health policy in Mexico.

Population study of depressive symptoms and risk factors in pregnant and parenting Mexican adolescents.

OBJECTIVE: To study the prevalence of, severity of, and risk factors for depressive symptoms in a probabilistic sample of Mexican adolescent mothers. METHODS: A sample of adolescents aged 13-19 years, drawn from a national survey, was interviewed in relation to severity of depressive symptoms [Center for Epidemiological Studies Depression Scale (CES-D) 16-23 and CES-D > 24] and pregnancy or parenting status. RESULTS: Depressive symptoms (CES-D 16-23) ranged from 2.3% in the first postpartum semester to 32.5% in the second trimester of pregnancy; high depressive symptoms (CES-D > 24) ranged from 3.0% in the second postpartum semester to 24.7% in mothers of an infant more than 1 year old. Significant differences between groups were in mothers in the second gestation trimester, who had significantly more symptoms than those who had never been pregnant and those in the first postpartum semester. In those with high symptomatology, no significant differences were observed between groups. A multinomial logistic regression model used to estimate the likelihood of depression found increased risk of depressive symptoms (CES-D 16-23) in those without a partner in the first, second, or third trimester of pregnancy; in the second postpartum semester; and with a child over the age of 1 year. Increased risk of high symptomatology (CES-D > 24) was found in those not in school or with a child over the age of 1 year. CONCLUSIONS: Depressive symptoms entail an enormous burden of disease for the mother and mental health risks to the infant; mothers should therefore be targeted in prevention and intervention actions.

Population study of depressive symptoms and risk factors in pregnant and parenting Mexican adolescents / Estudio poblacional sobre los síntomas depresivos y los factores de riesgo en adolescentes mexicanas embarazadas o con hijos

OBJECTIVE: To study the prevalence of, severity of, and risk factors for depressive symptoms in a probabilistic sample of Mexican adolescent mothers. METHODS: A sample of adolescents aged 13-19 years, drawn from a national survey, was interviewed in relation to severity of depressive symptoms [Center for Epidemiological Studies Depression Scale (CES-D) 16-23 and CES-D > 24] and pregnancy or parenting status. RESULTS: Depressive symptoms (CES-D 16-23) ranged from 2.3 percent in the first postpartum semester to 32.5 percent in the second trimester of pregnancy; high depressive symptoms (CES-D > 24) ranged from 3.0 percent in the second postpartum semester to 24.7 percent in mothers of an infant more than 1 year old. Significant differences between groups were in mothers in the second gestation trimester, who had significantly more symptoms than those who had never been pregnant and those in the first postpartum semester. In those with high symptomatology, no significant differences were observed between groups. A multinomial logistic regression model used to estimate the likelihood of depression found increased risk of depressive symptoms (CES-D 16-23) in those without a partner in the first, second, or third trimester of pregnancy; in the second postpartum semester; and with a child over the age of 1 year. Increased risk of high symptomatology (CES-D > 24) was found in those not in school or with a child over the age of 1 year. CONCLUSIONS: Depressive symptoms entail an enormous burden of disease for the mother and mental health risks to the infant; mothers should therefore be targeted in prevention and intervention actions.

OBJETIVO: Estudiar la prevalencia, la gravedad y los factores de riesgo de los síntomas depresivos en una muestra probabilística de madres adolescentes de México. MÉTODOS: En una muestra de adolescentes de 13 a 19 años de edad tomadas de una encuesta nacional se efectuaron entrevistas relacionadas con la gravedad de los síntomas depresivos (Center for Epidemiological Studies Depression Scale [CES-D] 16 a 23 y CES-D > 24) y la situación de embarazo o de crianza. RESULTADOS: Los síntomas depresivos (CES-D de 16 a 23) variaron de 2,3 por ciento en el primer semestre después del parto a 32,5 por ciento en el segundo trimestre del embarazo; los síntomas depresivos graves (CES-D > 24) fueron desde 3,0 por ciento en el segundo semestre posparto hasta 24,7 por ciento en las madres de un niño mayor de 1 año de edad. Se observaron diferencias significativas entre los grupos en las madres que se encontra-ban en el segundo trimestre de la gestación, que presentaron significativamente más síntomas que las mujeres que nunca habían estado embarazadas y que las que estaban en el primer semestre posparto. En las mujeres con síntomas graves, no se observaron diferencias significativas entre los grupos. Mediante un modelo de regresión logística polinómico usado para calcular la probabilidad de depresión se detectó un mayor riesgo de padecer síntomas depresivos (CES-D 16 a 23) en las mujeres sin una pareja que se encontraban en el primer, segundo o tercer trimestre del embarazo; en el segundo semestre después del parto; y en las mujeres con un niño mayor de 1 año. En las mujeres que no concurrían a la escuela y en aquellas con un niño mayor de 1 año se encontró un mayor riesgo de presentar síntomas graves (CES-D > 24). CONCLUSIONES: Los síntomas depresivos implican una carga de morbilidad impor-tante para la madre y riesgos para la salud mental del lactante; por lo tanto, las acciones de prevención y de intervención deben dirigirse a las madres.

Gender-related issues in the diagnosis and classification of alcohol use disorders among Mexican patients seeking specialized services.

OBJECTIVE: The objective of the study was to examine the role of gender in the endorsement of symptoms included in both the International Classification of Diseases-10th Edition and the Diagnostic and Statistical Manual of Mental Disorders-4th Edition. METHOD: Six hundred patients treated for alcohol-related problems in outpatient services in Mexico were evaluated with the Substance Abuse Module of the Composite International Diagnostic Interview. RESULTS: Confirmatory factor analyses using the International Classification of Diseases-10th Edition and Diagnostic and Statistical Manual of Mental Disorders-4th Edition criteria produced two factors that included a combination of abuse/harmful alcohol use and dependence symptoms, which explained 40% and 49.2% of the total variance, respectively. In the abuse/harmful use groups of patients, symptoms and social consequences differed according to gender: withdrawal syndrome, lack of control and legal problems were more frequent in men, while women exhibited higher rates of attempts to give up alcohol and difficulties to accomplish daily activities. Specific gender-related factors differentiated abuse/harmful use from dependence, such as loss of control and time spent to drink in the case of men and desire to drink among women, according to the Diagnostic and Statistical Manual of Mental Disorders-4th Edition dependence criteria; and presence of physical symptoms in men and family/social problems, craving, and futile effort to stop drinking in women, according to the International Classification of Diseases-10th Edition dependence criteria. CONCLUSION: Future classification systems of substance abuse disorders should take into account differences between genders in order to help closing the treatment gap for women.

Questões relacionadas ao gênero no diagnóstico e classificação de transtornos por uso de álcool entre pacientes mexicanos que buscam serviços especializados / Gender-related issues in the diagnosis and classification of alcohol use disorders among Mexican patients seeking specialized services

OBJETIVO: O objetivo do estudo foi examinar o papel do gênero no endosso dos sintomas incluídos tanto na Classificação Internacional de Doenças-10ª Edição quanto no Manual Diagnóstico e Estatístico de Transtornos Mentais-4ª Edição. MÉTODO: Seiscentos pacientes tratados por problemas ligados ao álcool em serviços ambulatórios de saúde no México foram avaliados com o Módulo sobre Abuso de Substâncias da Composite International Diagnostic Interview. RESULTADOS: A análise fatorial confirmatória com a Classificação Internacional de Doenças-10ª Edição e o Manual Diagnóstico e Estatístico de Transtornos Mentais-4ª Edição produziu dois fatores, que incluíram uma combinação de abuso/uso nocivo de álcool e sintomas de dependência, que explicaram 40 por cento e 49,2 por cento da variância total, respectivamente. No grupo de pacientes abuso/uso nocivo, os sintomas e as consequências sociais diferiram entre os gêneros: síndrome de abstinência, falta de controle e problemas jurídicos foram mais frequentes nos homens, enquanto as mulheres apresentaram maiores taxas de tentativas de abandonar o álcool e dificuldades para realizar atividades diárias. Fatores específicos de gênero diferenciaram abuso/uso nocivo da dependência, como a perda de controle e o tempo gasto para beber, no caso dos homens, e do desejo de beber entre as mulheres, de acordo com os critérios de dependência do Manual Diagnóstico e Estatístico de Transtornos Mentais-4ª Edição, e presença de sintomas físicos em homens, problemas sociais/família, e desejo e esforço fútil de parar de beber em mulheres, segundo o critério de dependência da Classificação Internacional de Doenças-10ª Edição. CONCLUSÃO: Futuros sistemas de classificação da toxicomania devem levar em conta as diferenças entre os sexos, a fim de ajudar a suprimir a lacuna de tratamento para as mulheres.

OBJECTIVE: The objective of the study was to examine the role of gender in the endorsement of symptoms included in both the International Classification of Diseases-10th Edition and the Diagnostic and Statistical Manual of Mental Disorders-4th Edition. METHOD: Six hundred patients treated for alcohol-related problems in outpatient services in Mexico were evaluated with the Substance Abuse Module of the Composite International Diagnostic Interview. RESULTS: Confirmatory factor analyses using the International Classification of Diseases-10th Edition and Diagnostic and Statistical Manual of Mental Disorders-4th Edition criteria produced two factors that included a combination of abuse/harmful alcohol use and dependence symptoms, which explained 40 percent and 49.2 percent of the total variance, respectively. In the abuse/harmful use groups of patients, symptoms and social consequences differed according to gender: withdrawal syndrome, lack of control and legal problems were more frequent in men, while women exhibited higher rates of attempts to give up alcohol and difficulties to accomplish daily activities. Specific gender-related factors differentiated abuse/harmful use from dependence, such as loss of control and time spent to drink in the case of men and desire to drink among women, according to the Diagnostic and Statistical Manual of Mental Disorders-4th Edition dependence criteria; and presence of physical symptoms in men and family/social problems, craving, and futile effort to stop drinking in women, according to the International Classification of Diseases-10th Edition dependence criteria. CONCLUSION: Future classification systems of substance abuse disorders should take into account differences between genders in order to help closing the treatment gap for women.