Municipality-Level Predictors of COVID-19 Mortality in Mexico: A Cautionary Tale.

OBJECTIVE: Local characteristics of populations have been associated with coronavirus disease 2019 (COVID-19) outcomes. We analyze the municipality-level factors associated with a high COVID-19 mortality rate (MR) of in Mexico. METHODS: We retrieved information from cumulative confirmed symptomatic cases and deaths from COVID-19 as of June 20, 2020, and data from most recent census and surveys of Mexico. A negative binomial regression model was adjusted, the dependent variable was the number of COVID-19 deaths, and the independent variables were the quintiles of the distribution of sociodemographic and health characteristics among the 2457 municipalities of Mexico. RESULTS: Factors associated with high MRs from COVID-19, relative to quintile 1, were diabetes and obesity prevalence, diabetes mortality rate, indigenous population, economically active population, density of economic units that operate essential activities, and population density. Among factors inversely associated with lower MRs from COVID-19 were high hypertension prevalence and houses without sewage drainage. We identified 1351 municipalities without confirmed COVID-19 deaths, of which, 202 had high and 82 very high expected COVID-19 mortality (mean = 8 and 13.8 deaths per 100,000, respectively). CONCLUSION: This study identified municipalities of Mexico that could lead to a high mortality scenario later in the epidemic and warns against premature easing of mobility restrictions and to reinforce strategies of prevention and control of outbreaks in communities vulnerable to COVID-19.

Intimate partner violence types and symptoms of common mental disorders in a rural community of Chiapas, Mexico: Implications for global mental-health practice.

This paper examines the scope and characteristics of male-to-female intimate partner violence in southern rural Chiapas, Mexico, and its association with depression and anxiety symptoms, highlighting the role of partner controlling behaviors. Participants were selected by random sampling. One-hundred and forty-one women >15 years participated in the study. Data was obtained through an adapted version of the National Survey of the Dynamics of Household Relationships (ENDIREH) intimate partner violence scale, the Patient Health Questionnaire-9 for depression symptoms and the Generalized Anxiety Disorder-7 for anxiety symptoms. Quantitative results indicated a 66.4% lifetime prevalence of physical and/or sexual IPV among ever-partnered women 15 years or older (95% CI: 57.5-74.5%). Forty percent (95% CI: 32.0-49.7%) of them reported having experienced physical and/or sexual violence with high partner control (HC-IPV), and 25.8% (95% CI: 18.5-34.3%) reported having experienced physical and/or sexual violence with low or moderate partner control (MC-IPV). Lifetime experience of HC-IPV was significantly associated with moderate-severe depression symptoms (RR = 5.8) and suicidality (RR = 2.08). While partner alcohol abuse was associated with a 3.06 times higher risk of lifetime physical and/or sexual IPV, 30.9% of women mentioned that their partners were never drunk when violence occurred. Interestingly, high partner alcohol abuse was more frequent among women who reported HC-IPV compared to MC-IPV. Implications for global mental health practice are discussed.

Clinical Impact of the COVID-19 Pandemic in Mexican Patients with Thoracic Malignancies.

BACKGROUND: Accumulated evidence indicates that patients with lung cancer are a vulnerable population throughout the pandemic. Limited information is available in Latin America regarding the impact of the pandemic on medical care. The goal of this study was to describe the clinical and social effect of COVID-19 on patients with thoracic cancer and to ascertain outcomes in those with a confirmed diagnosis. MATERIALS AND METHODS: This cohort study included patients with thoracic neoplasms within a single institution between March 1, 2020, and February 28, 2021. All variables of interest were extracted from electronic medical records. During this period, the Depression Anxiety and Stress Scale 21 (DASS-2) was applied to evaluate and identify more common psychological disorders. RESULTS: The mean age for the total cohort (n = 548) was 61.5 ± 12.9 years; non-small cell lung cancer was the most frequent neoplasm (86.9%), advanced stages predominated (80%), and most patients were under active therapy (82.8%). Any change in treatment was reported in 23.9% of patients, of which 78.6% were due to the COVID-19 pandemic. Treatment delays (≥7 days) were the most frequent modifications in 41.9% of cases, followed by treatment suspension at 37.4%. Patients without treatment changes had a more prolonged progression-free survival and overall survival (hazard ratio [HR] 0.21, p < .001 and HR 0.28, p < .001, respectively). The mean DASS-21 score was 10.45 in 144 evaluated patients, with women being more affected than men (11.41 vs. 9.08, p < .001). Anxiety was reported in 30.5% of cases, followed by depression and distress in equal proportions (18%). Depressed and stressed patients had higher odds of experiencing delays in treatment than patients without depression (odds ratio [OR] 4.5, 95% confidence interval [CI] 1.53-13.23, p = .006 and OR 3.18, 95% CI 1.2-10.06, p = .006, respectively). CONCLUSION: Treatment adjustments in patients with thoracic malignancies often occurred to avoid COVID-19 contagion with detrimental effects on survival. Psychological disorders could have a role in adherence to the original treatment regimen. IMPLICATIONS FOR PRACTICE: The pandemic has placed an enormous strain on health care systems globally. Patients with thoracic cancers represent a vulnerable population, with increased morbidity and mortality rates. In Mexico, treatment modifications were common during the pandemic, and those who experienced delays had worse survival outcomes. Most treatment modifications were related to a patient decision rather than a lockdown of health care facilities in which mental health impairment plays an essential role. Moreover, the high case fatality rate highlights the importance of improving medical care access. Likewise, to develop strategies facing future threats that may compromise health care systems in non-developed countries.

Depression in Rural Communities and Primary Care Clinics in Chiapas, Mexico.

Depression is a leading cause of disability worldwide and can be diagnosed and treated in primary care clinics. No studies to date have demonstrated the prevalence of depression in rural, primary care settings in Mexico. The objective of this study is to describe the prevalence of visits for depression in primary care settings in one group of rural communities within Chiapas, Mexico. We performed a cross-sectional, retrospective study of depression prevalence in primary care clinics in the Sierra region of Chiapas, Mexico during the calendar year of 2014. We determined the average depression prevalence is 7.9% (6 community clinics, n = 4555). The prevalence of depression in rural Chiapas, Mexico is much higher than the Mexican national average of 4.0-4.5% found in a home-based survey. Further efforts to understand the causes, develop improved mental health services in primary care, and reduce the higher burden of depression in rural communities in Mexico are urgently needed.

Validity and Utility of the Patient Health Questionnaire (PHQ)-2 and PHQ-9 for Screening and Diagnosis of Depression in Rural Chiapas, Mexico: A Cross-Sectional Study.

BACKGROUND: Depressive disorders are frequently under diagnosed in resource-limited settings because of lack of access to mental health care or the inability of healthcare providers to recognize them. The Patient Health Questionnaire (PHQ)-2 and the PHQ-9 have been widely used for screening and diagnosis of depression in primary care settings; however, the validity of their use in rural, Spanish-speaking populations is unknown. METHOD: We used a cross-sectional design to assess the psychometric properties of the PHQ-9 for depression diagnosis and estimated the sensitivity and specificity of the PHQ-2 for depression screening. Data were collected from 223 adults in a rural community of Chiapas, Mexico, using the PHQ-2, the PHQ-9, and the World Health Organization Quality of Life BREF Scale (WHOQOL- BREF). RESULTS: Confirmatory factor analysis suggested that the 1-factor structure fit reasonably well. The internal consistency of the PHQ-9 was good (Cronbach's alpha > = 0.8) overall and for subgroups defined by gender, literacy, and age. The PHQ-9 demonstrated good predictive validity: Participants with a PHQ-9 diagnosis of depression had lower quality of life scores on the overall WHOQOL-BREF Scale and each of its domains. Using the PHQ-9 results as a gold standard, the optimal PHQ-2 cutoff score for screening of depression was 3 (sensitivity 80.00%, specificity 86.88%, area under receiver operating characteristic curve = 0.89; 95% confidence interval [0.84, 0.94]). CONCLUSION: The PHQ-2 and PHQ-9 demonstrated good psychometric properties, suggesting their potential benefit as tools for depression screening and diagnosis in rural, Spanish-speaking populations.