Alfabetización en salud mental en adolescentes españoles y su relación con las características sociodemográficas / Mental health literacy in spanish adolescents and its relationship with sociodemographic characteristics

Fundamentos: diferentes estudios identifican la alfabetización en salud y/o salud mental (asm) como factores protectores contra el desarrollo de un problema de salud mental. El objetivo de este trabajo fue determinar el grado de alfabetización en salud mental de la población adolescente de barcelona, así como su relación con variables sociodemográficas y educativas.métodos: se realizó un estudio transversal en barcelona durante el curso 2017-2018. Participaron 1.032 jóvenes entre trece y diecisiete años. Se recogieron las siguientes variables: sexo; edad; nacionalidad; nivel socioeconómico (rdhpc); y nota media escolar. La asm se midió mediante los test de conocimientos emhl (reconocimiento de problemas mentales y conocimientos en salud mental; rango 0-10 cada parte), estigma (cami: rango 10-50, y ribs: rango 4-20) y búsqueda de ayuda (ghsq: rango de 1 a 7). Se realizó análisis de regresión lineal múltiple ajustando el efecto de variables sociodemográficas sobre la puntuación de cada escala.resultados: la puntuación media (desviación típica) del emhl test fue de 7,28 (1,27) y 4,24 (1,14), respectivamente, obteniendo mayor pun-tuación las chicas, rdhpc altas, nota excelente y con nacionalidad española. La mayor diferencia de puntuación en emhl, ajustando por el resto de variables, correspondió a los adolescentes con nota media excelente y con índice rdhpc elevado (respecto a la categoría basal, beta=0,72 y 0,52, respectivamente). La puntuación media del estigma fue 27,6 (4,47) para cami y 8,83 (3,36) para ribs. Las variables relacionadas con una mayor diferencia de puntuación respecto a la categoría basal y ajustado por el resto de variables fueron: sexo (chico=1,54) y nota académica (excelente=-2,38) para cami, y nacionalidad (extranjera=0,82) y nota académica (excelente=-1,30) para ribs. La puntuación media de ribs fue 8,83 (3,36), siendo la mayor diferencia de puntuación respecto a la categoría basal la nacionalidad extranjera (beta=0,82) y tener una nota de excelente (1,30). La búsqueda de ayuda fue mayor en padres/madres y amigos, con diferencias según sexo y nacionalidad.conclusiones: el nivel de alfabetización de salud mental es medio-bajo. Mientras que género, nacionalidad y resultados académicos son los factores que se relacionan con conocimientos y estigma, el nivel socioeconómico se relaciona únicamente con conocimientos en salud mental.(AU)

Background: different studies identify mental health literacy as a protective factor for developing a mental health problem. The aim of this paper was to determine the degree of mental health literacy of the adolescent population of barcelona, and its relationship with socio-de-mographic and educational variables.methods: a cross-sectional study was carried out in barcelona during the 2017-2018 academic year. A total of 1,032 young people between thirteen and seventeen years of age participated. The following variables were collected: sex, age, nationality, socioeconomic status (rdhpc) and average school grade. The aim was to determine the degree of mental health literacy (knowledge, stigma and help-seeking) of the adolescent population of barcelona, and its relationship with socio-demographic and educational variables. Multiple linear regression analysis was performed adjusting for the effect of sociodemographic variables on the score of each scale.results: the mean score (standard deviation) of the emhl test was 7.28 (1.27) and 4.24 (1.14) respectively, with higher scores obtained by girls, high rdhpc, excellent score and spanish nationality. The greatest difference in emhl scores, adjusting for the rest of the variables, corresponded to adolescents with an excellent mean score and a high rdhpc index (with respect to the baseline category, beta=0.72 and 0.52 respectively). The mean stigma score was 27.6 (4.47) for cami and 8.83 (3.36) for ribs. The variables related to a greater difference in score with respect to the baseline category and adjusted for the rest of the variables were: gender (boy=1.54) and academic grade (excellent=-2.38) for cami, and nationality (foreign=0.82) and academic grade (excellent=-1.30) for ribs. The mean ribs score was 8.83 (3.36) with the largest difference in score from baseline being foreign nationality (beta=0.82) and having a grade of excellent (1.30). Help-seeking was higher in parents and friends, with differences according to gender and nationality.conclusions: the level of mental health literacy is medium-low. While gender, nationality and educational attainment are the factors that are related to knowledge and stigma, socio-economic status is only related to mental health literacy.(AU)

Stigma towards Child and Adolescent Mental Health Problems among Fathers and Mothers. A Cross-sectional Study / [El estigma de los padres y madres hacia los problemas de salud mental de niños y adolescentes. Un estudio transversal]

Background: Stigma toward child and adolescent mental health problems among parents has been understudied, despite its importance. Method: Sociodemographic variables, stigma associated with mental health problems in childhood and adolescence, myths about suicide, familiarity with mental health, and seeking professional help were assessed in a cross-sectional study in a Spanish sample (N = 268). Descriptive analyses, mean difference and regression models were carried out. Results: The results reveal medium levels of stigma, the presence of myths about suicide and average familiarity with mental health. Mothers and a higher level of education, showed lower levels of stigma and fewer myths about suicide. A regression model explains the 44% of the variance with myths about suicide, stigma and familiarity with mental health as predictors of seeking professional help attitudes. Conclusions: Stigma, myths surrounding suicide, and parental unfamiliarity with mental health may act as barriers to appropriate diagnosis and treatment. Practical implications and recommendations are discussed.(AU)

Antecedentes: La estigmatización de los problemas de salud mental en niños y adolescentes en los padres y madres no se ha estudiado lo suficiente a pesar de su importancia. Método: Se evaluaron variables sociodemográficas, el estigma asociado con los problemas de salud mental en la infancia y la adolescencia, mitos sobre el suicidio, conocimiento de la salud mental y la búsqueda de ayuda profesional en un estudio exploratorio transversal en una muestra española de padres y madres (N = 268). Se realizaron análisis descriptivos, de diferencia de medias y modelos de regresión. Resultados: Los resultados revelan un nivel medio de estigma, la presencia de mitos sobre el suicidio y un conocimiento medio con la salud mental. Las madres y un mayor nivel educativo mostraron menores niveles de estigma y menos mitos sobre el suicidio. El 44% de la varianza de la búsqueda de ayuda profesional se explica a través de los mitos sobre el suicidio, el estigma y el conocimiento de la salud mental como predictores de las actitudes de búsqueda de ayuda profesional. Conclusiones: Se establecen recomendaciones prácticas, subrayando cómo el estigma, los mitos sobre el suicidio y la falta de conocimiento de los progenitores de la salud mental pueden actuar como barreras para un diagnóstico y tratamiento adecuados. Se discuten las implicaciones prácticas y las recomendaciones.(AU)

VIH y derechos humanos: acción política para alcanzar ZERO estigma / HIV and human rights: political action to achieve ZERO stigma

Los objetivos de desarrollo sostenible 10.2 y 10.3 ponen de manifiesto la importancia de fomentar la eliminación de leyes discrimi-natorias, así como de implantar políticas y prácticas orientadas a la inclusión social, económica y política de los grupos sociales vulnerables. En este sentido, abordar la discriminación y el estigma asociados al VIH sigue siendo una asignatura pendiente dentro de los países que conforman la Unión Europea. De ahí que esta cuestión haya sido una prioridad política de la Presidencia española del Consejo de la Unión Europea, reflejada en la Reunión de Alto Nivel VIH y derechos humanos. Acción política para alcanzar CERO estigma. En esta reunión se abordaron diferentes estrategias y acuerdos para promover la eliminación del estigma y la discriminación asociada al VIH en diferentes ámbitos y dimen-siones sociales, políticas e institucionales.(AU)

According to Sustainable Development Goals 10.2 and 10.3, it is imperative to promote the elimination of discriminatory laws, as well as implement policies and practices for the inclusion of vulnerable social groups on the social, economic and political fronts. In this regard, HIV-related discrimination and stigma remain unaddressed in many European Union countries. Fighting HIV-related stigma has been one of the main priorities of the Spanish Presidency of the Council of the European Union. This commitment was reflected in the High Level Meeting entitled HIV and Human Rights. Political action to achieve ZERO stigma. This meeting provided an opportunity to discuss a variety of strategies and agreements for eradicating stigma and discrimination associated with HIV in a variety of social, political, and institutional contexts.(AU)

Estigma público en niños hacia personas con enfermedad mental / Public Stigma in Children Towards People With Mental Illness

Se analizó cómo la familiaridad que los adultos tenían con la enfermedad mental y la valoración más o menos positiva de sus experiencias al respecto influían en el estigma de los menores a su cargo. El estigma fue medido en términos de negación de ayuda por parte de los niños hacia un igual con enfermedad mental. La muestra fue de 56 niños de sexto de primaria y un tutor legal de cada uno. Se empleó el Attribution Questionnaire–8 for Children, la escala Level Of Familiarity y una escala de Likert para la valoración. Se halló una correlación positiva y estadísticamente significativa entre la familiaridad de los adultos y el estigma de los menores. A mayor familiaridad, menor estigma. Se debatió si las actitudes estigmatizantes medidas lo serían realmente o no en la infancia, siendo recomendable seguir profundizando al respecto y validar el Attribution Questionnaire–8 for Children en España. (AU)

We analyzed how the familiarity that adults had with mental illness and the more or less positive appraisal of their experiences in this regard influenced the stigma of their children. Stigma was measured in terms of children’s absence of pity or compassion, denial of help, and discrimination or segregation toward a peer with mental illness. The sample consisted of 56 sixth grade children and a responsible adult for each of them. The Attribution Questionnaire-8 for Children, the Level Of Familiarity Scale and a Likert scale were used for assessment. A positive and statistically significant correlation was found between adult familiarity and child denial of help. The higher the familiarity, the lower the stigma. It was recommended that further research be carried out, that the Attribution Questionnaire-8 for Childrenbe validated in Spain and to carry out interventions to prevent stigma in schools. (AU)

Estigma y salud mental en pacientes con diagnóstico de cáncer / Stigma and mental health in patients with a cancer diagnosis

Objetivo: Determinar la relación entre el estigma y la salud mental en pacientes diagnosticados con cáncer. Material y Método: Estudio correlacional con una muestra no probabilística de 250 pacientes diagnosticados con cáncer, entre 26 y 72 años (85,2% mujeres y 14,8% varones). La recolección de datos se llevó a cabo en un centro de salud privado mediante el Cuestionario de estigma percibido, experimentado e internalizado, el Cuestionario de Salud del Paciente-4 (PHQ-4), y una ficha de características sociodemográficas. El análisis de datos se realizó con el coeficiente de correlación de Pearson, y se analizó la magnitud de los efectos con los criterios deGignac y Szodorai. Resultados: Se identificaron asociaciones inversas de efecto grande entre la salud mental y el estigma percibido (r = -0,362), el estigma experimentado (r = -0,413) y el estigma internalizado (r = -0,479). Conclusiones: Los resultados respaldan que, a mayor estigma percibido, experimentado e internalizado, son menores las puntuaciones en la salud mental de los pacientes con diagnóstico de cáncer (AU)

Objective: To determine the relationship between stigma and mental health in patients diagnosed with cancer. Material and Methods: Correlational study with a non-probabilistic sample of 250 patients diagnosed with cancer, between 26 and 72 years of age (85.2% women and 14.8% men). Data collection was carried out in a private health center using the Perceived, Experienced and Internalized Stigma Questionnaire, the Patient Health Questionnaire-4 (PHQ-4), and a sociodemographic characteristics form. Data analysis was performed using Pearson's correlation coefficient, and the magnitude of the effects was analyzed using the Gignac and Szodorai criteria. Results: Large effect inverse associations were identified between mental health and perceived stigma (r = -0.362), experienced stigma (r = -0.413) and internalized stigma (r = -0.479). Conclusions: The results support that the higher the perceived, experienced, and internalized stigma, the lower the mental health scores of patients with a cancer diagnosisObjective: To determine the relationship between stigma and mental health in patients diagnosed with cancer. Material and Methods: Correlational study with a non-probabilistic sample of 250 patients diagnosed with cancer, between 26 and 72 years of age (85.2% women and 14.8% men). Data collection was carried out in a private health center using the Perceived, Experienced and Internalized Stigma Questionnaire, the Patient Health Questionnaire-4 (PHQ-4), and a sociodemographic characteristics form. Data analysis was performed using Pearson's correlation coefficient, and the magnitude of the effects was analyzed using the Gignac and Szodorai criteria. Results: Large effect inverse associations were identified between mental health and perceived stigma (r = -0.362), experienced stigma (r = -0.413) and internalized stigma (r = -0.479) (AU)

Estigma público en niños hacia personas con enfermedad mental / Public Stigma in Children Towards People With Mental Illness

Se analizó cómo la familiaridad que los adultos tenían con la enfermedad mental y la valoración más o menos positiva de sus experiencias al respecto influían en el estigma de los menores a su cargo. El estigma fue medido en términos de negación de ayuda por parte de los niños hacia un igual con enfermedad mental. La muestra fue de 56 niños de sexto de primaria y un tutor legal de cada uno. Se empleó el Attribution Questionnaire–8 for Children, la escala Level Of Familiarity y una escala de Likert para la valoración. Se halló una correlación positiva y estadísticamente significativa entre la familiaridad de los adultos y el estigma de los menores. A mayor familiaridad, menor estigma. Se debatió si las actitudes estigmatizantes medidas lo serían realmente o no en la infancia, siendo recomendable seguir profundizando al respecto y validar el Attribution Questionnaire–8 for Children en España. (AU)

We analyzed how the familiarity that adults had with mental illness and the more or less positive appraisal of their experiences in this regard influenced the stigma of their children. Stigma was measured in terms of children’s absence of pity or compassion, denial of help, and discrimination or segregation toward a peer with mental illness. The sample consisted of 56 sixth grade children and a responsible adult for each of them. The Attribution Questionnaire-8 for Children, the Level Of Familiarity Scale and a Likert scale were used for assessment. A positive and statistically significant correlation was found between adult familiarity and child denial of help. The higher the familiarity, the lower the stigma. It was recommended that further research be carried out, that the Attribution Questionnaire-8 for Childrenbe validated in Spain and to carry out interventions to prevent stigma in schools. (AU)

Activisme contra l’estigma: Exploració d’activitats de sensibilització al context sanitari / Activism against stigma: Exploring awareness-raising activities in the healthcare context

L’estigma que pateixen les persones amb diagnòstics de salut mental és quelcom freqüent dins l’àmbit sanitari. Entitats i campanyes de lluita contra l’estigma han centrat els seus esforços en la disminució de la discriminació en aquest àmbit. La figura de l’activista és fonamental per tal de que les pròpies persones que han experimentat aquest estigma siguin protagonistes d’aquest canvi.El nostre objectiu en aquest estudi ha estat aprofundir en l’experiència que les i els activistes contra l’estigma en salut mental tenen en participar en accions de sensibilitza-ció al context sanitari. Hem realitzat una anàlisi temàtica d’entrevistes semiestructurades a cinc activistes. S’han identificat dos blocs temàtics: Estigma i Activisme. El bloc d’Estigma consta dels temes Prejudicis, Conductes discriminatòries i Autoestigma, mentre que el bloc d’Activisme està compost pels temes Efectes positius, Estratègies i Impacte. El present estudi ens ha permès conèixer en profunditat les experiències subjectives d’estigma dins l’àmbit sani-tari a través de l’experiència de les persones participants en campanyes per combatre’l i en-tendre per què l’activisme pot ser una estratègia beneficiosa per sensibilitzar els professionals i per al benestar i apoderament dels propis activistes. (AU)

Stigma suffered by people labelled with mental health diagnoses is something frequent within the healthcare context.Anti-stigma organizations and campaigns have focused their efforts on reducing discrimination in this area. The activist figure is fundamental for people who have experienced this stigma to be the protagonists of this change. Our aim in this study has been to deepen the experience that anti-stigma activists in mental health have when participating in actions to raise awareness in the healthcare context. We carried out a thematic analysis of semi-structured interviews conducted with five activists. We identified two thematic blocks: Stigma and Activism. The Stigma block consists of the themes Prejudice, Discriminatory Behav-iours, and Self-Stigma, while the Activism block is composed of the themes Positive Effects, Strategies, and Impact. The present study has allowed us to have deeper knowledge of the subjective experiences of stigma in the healthcare field through the experience of partici-pants in campaigns to combat it, and to understand why activism can be a beneficial strategy to raise awareness among professionals and for the well-being and empowerment of the activ-ists themselves. (AU)

Compreendendo o termo gordofobia médica a partir da perspectiva de pessoas gordas / Understanding the term medical fatphobia from the perspective of fat people

Resumo O ativismo gordo tem como objetivo unir e mobilizar pessoas gordas, a fim de romper com a inviabilização de seus corpos e denunciar a gordofobia. Há algum tempo, o ativismo vem impulsionando a expressão "gordofobia médica" para denunciar a opressão vivenciada dentro dos serviços de saúde. Este artigo tem como objetivo compreender o termo, a partir da percepção de pessoas gordas. É uma pesquisa qualitativa, com dados coletados por meio de um questionário virtual direcionado a pessoas gordas ou ex-gordas, que alcançou 515 respondentes de todas as regiões do Brasil. Os dados foram analisados utilizando a análise temática, com a criação de seis categorias. Entre os principais resultados, pode-se compreender que a gordofobia médica envolve: despreparo, desrespeito e autoritarismo; reprodução de estereótipos, repulsa e preconceito, desumanização da pessoa gorda, diagnóstico superficial e generalizante, desprezo da queixa, foco no peso e negligência, e precarização do acesso e dos cuidados em saúde. Conclui-se que o estudo auxilia na compreensão do termo gordofobia médica, o que facilita o seu reconhecimento e prevenção na área da saúde.

Abstract Fat activism aims to unite and mobilize fat people to break with the impracticability of these bodies and denounce fatphobia. For some time now, activism has been pushing the expression "medical fatphobia" to denounce the oppression experienced by fat people within health services. This article aims to understand the term, from the perspective of fat people. This is a qualitative research, with data were collected via a virtual questionnaire aimed at fat or formerly fat people, which reached 515 respondents from all regions of Brazil. Data were analyzed using thematic analysis, with the creation of six categories. Among the main results, it can be understood that medical fatphobia involves: unpreparedness, disrespect and authoritarianism; reproduction of stereotypes, disgust and prejudice; dehumanization of the fat person; superficial and generalizing diagnosis; dismissal of the complaint, focus on weight and negligence; and precarious access to the health care. In conclusion, the work helps in understanding the term medical fatphobia, which facilitates its recognition and prevention in the health field.

Enfrentamento do estigma relacionado ao peso corporal no cuidado em saúde: impactos de um curso educativo em profissionais de saúde / Tackling weight stigma in healthcare: impacts of an educational course on health care professionals

Introdução:O estigma relacionado ao peso corporal, presente entre profissionais e estudantes da área da saúde, prejudica a saúde e o cuidado de pessoas com sobrepeso e obesidade, e deve ser combatido. Objetivo:Este artigo visa relatar os resultados obtidos por meio da aplicação de um curso educativo sobre estigma relacionado ao peso corporal e o cuidado em saúde. Métodos:A aplicação ocorreu com 11 profissionais de saúde e teve desenho misto. No componente quantitativo, foi realizada análise estatística dos resultados iniciais e finais obtidos por meio da Escala de Atitudes Antiobesidade (AFAT), com realização de teste t pareado (nível de significância de p ≤ 0,05). No componente qualitativo, foi realizada análise de conteúdo temática de uma atividade final dissertativa sobre ideias que ficaram marcadas a partir do curso. Feedbacksestruturados a respeito da qualidade do material foram preenchidos. Resultados:As análises estatísticas não identificaram alterações entre os valores iniciais e finais da AFAT (p >0,05), com escore geral médio inicial de 0,418 e final de 0,419. Cinco temas emergiram da análise de conteúdo, os quais demonstram aprendizagem quanto à multifatorialidade da obesidade; reconhecimento de implicações interseccionais; compreensão dos impactos do estigma no cuidado em saúde; estímulo ao pensamento crítico; e considerações sobre o curso, no geral, bem avaliado de forma consistente. Conclusão:O instrumento quantitativo não indicou mudança; contudo, as análises qualitativas demonstram que o curso promoveu compreensão ampliada sobre os temas discutidos, bem como a reflexão e a autocrítica das/os profissionais.

Introduction:Weight stigma, present among health professionals and students, harms the health and healthcare of people with overweight and obesity and must be combated. Objective:This article aims to report the results obtained through a test application of an educational course on weight stigma and healthcare. Methods:The test was carried out with 11 healthcare professionals and had a mixed design. In the quantitative component, statistical analysis was carried out on the initial and final results obtained using theAntifat Attitudes Scale (AFAT), with a paired t test (significance level of p ≤ 0.05). In the qualitative component, a thematic content analysis was carried out with data produced in a final dissertation activity about ideas that were highlighted from thecourse. Structured feedback regarding the quality of the material was completed. Results:Statistical analyzes did not identify changes between initial and final AFAT values (p >0.05), with an initial overall average score of 0.418 and final of 0.419. Five themes emerged from the content analysis, which demonstrate learning regarding the multifactorial nature of obesity; recognition of intersectional implications; understanding of impacts of stigma on health care; stimulation of critical thinking; and considerations about the course, overall, consistently well evaluated. Conclusion: The quantitative instrument did not indicate change, however, qualitative analysis indicated that the course promoted expanded understanding of the topics discussed, as well as reflection and self-criticism by professionals.

Acesso e qualidade da alimentação: percepção da população em situação de rua / Acceso y calidad de la alimentación: percepción de personas en situación de calle / Access to food and food quality: perception of the homeless population

Resumo Objetivo Compreender a percepção do acesso e da qualidade da alimentação para a população em situação de rua. Métodos Estudo descritivo qualitativo, realizado em um Centro de Referência da População de Rua na região centro-sul de Belo Horizonte (MG). Utilizou-se roteiro semiestruturado para a realização das entrevistas de 18 participantes. A coleta de dados ocorreu entre dezembro de 2020 e janeiro de 2021. A análise temática do material, proposta por Bardin, possibilitou a elaboração de três categorias empíricas. Resultados O público entrevistado era masculino, com idade média de 43 anos e tempo médio de situação de rua de 44,6 meses. O acesso à alimentação foi proveniente das doações de alimentos, refeições em instituições governamentais e aquisições ao dispor de renda. Foram relatadas dificuldades quanto à quantidade e qualidade dos alimentos, à aquisição das refeições nos fins de semana, aos sentimentos de medo e angústia perante a fome, à falta do alimento e pelo estigma social, agravados pela COVID-19. Conclusão Diante do cenário de iniquidades sociais, o direito ao acesso à alimentação não é garantido, sendo necessária a implementação de políticas públicas de proteção social que garantam os direitos básicos.

Resumen Objetivo Comprender la percepción del acceso y de la calidad de la alimentación según personas en situación de calle. Métodos Estudio descriptivo cualitativo, realizado en un Centro de Referencia de Personas de la Calle en la región centro-sur de Belo Horizonte (Minas Gerais). Se utilizó un guion semiestructurado para realizar entrevistas a 18 participantes. La recopilación de datos se realizó entre diciembre de 2020 y enero de 2021. El análisis temático del material, propuesto por Bardin, permitió la elaboración de tres categorías empíricas. Resultados El público entrevistado era masculino, de 43 años de edad promedio y tiempo promedio de situación de calle de 44,6 meses. El acceso a la alimentación fue proveniente de donaciones de alimentos, comidas en instituciones gubernamentales y adquisiciones al disponer de ingresos. Las personas relataron dificultades con relación a la cantidad y calidad de los alimentos, a la adquisición de comida los fines de semana, a los sentimientos de miedo y angustia ante el hambre, a la falta de alimentos y al estigma social, agravados por el COVID-19. Conclusión Ante el escenario de iniquidades sociales, el derecho al acceso a la alimentación no está garantizado, por lo cual es necesario implementar políticas públicas de protección social que garanticen los derechos básicos.

Abstract Objective To understand the perception of access to food and food quality for the street population. Methods This qualitative descriptive study was performed in a Reference Center for the Homeless Population in the south-central region of Belo Horizonte (MG). A semi-structured script was used to conduct interviews with 18 participants. Data collection occurred between December 2020 and January 2021. The thematic analysis of the material, as proposed by Bardin, made it possible to elaborate three empirical categories. Results The public interviewed was male, with a mean age of 43 years, and a mean time on the streets of 44.6 months. Access to food came from donations, meals at government institutions, and acquisition when income was available. Difficulties were reported regarding the quantity and quality of food, acquisition of meals on weekends, feelings of fear and anguish in the face of hunger, lack of food, and social stigma, which were aggravated by COVID-19. Conclusion As in this scenario of social inequalities the access to food is not guaranteed, implementing public policies of social protection is necessary to guarantee basic rights.

La discapacidad y su configuración como signo de otredad: una mirada historiográfica / Disability and its configuration as a sign of otherness: a historiographic perspective

El presente artículo, construido a partir de una revisión historiográfica, aborda a la discapacidad como signo, cifrado en las corporalidades de las personas en distintos contextos geográficos y momentos históricos de occidente en los cuales, el signo de la discapacidad aparece cifrada en otros signos, como “el estigma”, “la raza”, “lo monstruoso”, “lo freak” y “lo patológico”. El abordaje de estos signos, nos permite observar como la posición social de las personas en situación de discapacidad ha ido transformándose a lo largo del tiempo, al igual que los distintos dispositivos de dominación y violencia que atravesaron y aún atraviesan, a las corporalidades y subjetividades de las personas signadas por la marca de la “otredad”.(AU)

This article, built from a historiographic review, approaches disability as a sign, encrypted in the corporealities of people in different geographical contexts and historical moments of the West in which the sign of disability appears encrypted in other signs, such as “stigma”, “race”, “the monstrous” and “the freak”. The approach to these signs allows us to observe how the social position of people with disabilities has been transformed over time, as well as the different devices of domination and violence that crossed and still cross the corporealities and subjectivities of people marked by the “otherness” mark.(AU)

Depression and associated psychosocial factors following a legal abortion in Mexico

Introduction: Scientific evidence from the United States and European countries shows that women who have had an induced abortion are not more likely to become depressed and several factors may confound this outcome. In contrast, in the case of Latin America, there are practically no studies in this regard due to restrictive legislation prevailing in the region. This paper aims to determine the prevalence of a probable major depressive episode (PMDE) in women who have legally terminated a pregnancy by way of public service in Mexico City and whether there are any psychosocial factors reported by the international literature associated with this outcome. Method: In a cross-sectional study, 274 women aged 15 years or older were interviewed two weeks after undergoing a medical abortion between November 2018 and November 2019. The Center for Epidemiological Studies Depression Scale 35-item version (CES-D-R35) was used to measure the PMDE in a structured interview. Results: The prevalence of a PMDE was 15.8%. Multivariate logistic regression was used for adjusted analysis. Perceived abortion stigma ( OR = 6.74, 95% CI = 3.29-13.82), child sexual abuse (OR = 2.23, 95% CI = 1.01-4.93), and previous childless pregnancies (OR = 6.07, 95% CI = 1.52-24.21) were associated with PMDE. Conclusions: The prevalence of PMDE is similar to or lower than that reported in studies with women who continued a pregnancy; post-abortion counseling and clinical considerations should include the impact that stigma and gender-based violence have on women's mental health.

Introducción: Evidencia científica proveniente de los Estados Unidos y los países europeos indica que las mujeres que han tenido un aborto inducido no tienen más probabilidades de deprimirse y que hay varios factores que pueden intervenir para confundir este resultado. En el caso de América Latina, prácticamente no existen estudios al respecto debido a las legislaciones restrictivas imperantes. El objetivo de este artículo es determinar la prevalencia de un probable episodio depresivo mayor (PEDM) en mujeres que interrumpieron legalmente un embarazo en un servicio público en la Ciudad de México, y si hay algunos factores psicosociales reportados por la literatura internacional asociados con el resultado. Método: En un estudio transversal, se entrevistó a 274 mujeres de 15 años o más dos semanas después de someterse a un aborto médico entre noviembre del 2018 y noviembre del 2019. Se utilizó la versión de 35 reactivos de la Escala de Depresión del Centro para Estudios Epidemiológicos (CES-D-R35) para medir el PEDM en una entrevista estructurada. Resultados: La prevalencia de PEDM fue de 15,8 %. Se utilizó una regresión logística multivariada para el análisis ajustado. El estigma percibido por el aborto (OR = 6.74, IC 95 % = 3.29-13.82), el abuso sexual infantil (OR = 2.23, IC 95 % = 1.01-4.93) y los embarazos previos sin hijos (OR = 6.07, IC 95 % = 1.52-24.21) se asociaron con un PMDE. Conclusiones: La prevalencia de PEDM es similar o menor que la reportada en estudios con mujeres que continuaron un embarazo; el asesoramiento posaborto y las consideraciones clínicas deben incluir el impacto que el estigma y la violencia de género tienen en la salud mental de las mujeres.

Estigma en mujeres de peso alto a través de un análisis fenomenológico interpretativo

Tener peso alto es una característica que ha sido devaluada y denigrada socialmente, convirtiendo a las personas de cuerpos grandes en víctimas de estereotipos, prejuicios y discriminación, lo que se ha denominado estigmatización por el peso, fenómeno que ocurre especialmente en mujeres. El objetivo de este estudio fue describir las experiencias de estigma de peso de mujeres con obesidad que viven en el sur de Chile. Participaron seis mujeres entre 20 y 57 años a través de entrevistas semi-estructuradas realizadas de manera remota. Mediante Análisis Fenomenológico Interpretativo se identificaron cuatro supratemas y diversos subtemas, los supratemas son: 1. La obesidad como parte de la persona. 2. Las experiencias de sentirse discriminada. 3. Todo gira en función del peso. 4. Lo que la sociedad piensa de la obesidad, los que en su conjunto permiten caracterizar la experiencia de vivir con obesidad y sufrir el estigma asociado al peso en distintos ámbitos de sus vidas, incluso en contextos sanitarios. Las consecuencias de esta experiencia son diversas y negativas, destacando el impacto que tiene en su autoestima y las constantes emociones negativas que derivan de las situaciones de discriminación. Estos resultados ponen de manifiesto la importancia de avanzar hacia la diversidad y aceptación corporal, lo que supone un desafío a la sociedad en general y en particular a los proveedores de salud, ya que se requiere de intervenciones libres de prejuicios y orientadas a la salud y el bienestar de las personas.

Carrying a high weight is a characteristic that has been devalued and socially denigrated, turning people with large bodies into victims of stereotypes, prejudice, or discrimination, which has been called weight stigmatisation, a phenomenon that occurs especially in women. The aim of this study was to describe the weight stigma experiences of women with obesity who live in southern Chile. Six women between 20 and 57 years of age participated in semi-structured interviews conducted remotely. Through Interpretative Phenomenological Analysis four supra-themes and several sub-themes were identified, the supra-themes are: 1. Obesity as part of the person. 2. Experiences of feeling discriminated. 3. Everything is about weight. 4. what society thinks of obesity, which together allow characterising the experience of living with obesity and suffering the weight stigma in different areas of their lives, including in health contexts. The consequences of this experience are diverse and negative, highlighting the impact it has on their self-esteem and the constant negative emotions that derive from discrimination situations. These results highlight the importance of moving toward body diversity and acceptance, which is a challenge for society in general and health care providers in particular, as it requires interventions free from prejudice and orientated to the health and well-being of individuals.

Normality and mental health: The ethical dimension / Normalidad y salud mental: La dimensión ética

Abstract This article applies the concept of normality, in both its descriptive and normative connotations, to the field of mental health, emphasizing its ethical undertones in different cultural and situational contexts. Ethics is defined as the linguistic justification of morals, and bioethics is characterized by arguments based on dialogical, discursive, and deliberative processes. Bioethical decision-making influences human relationships and has implications for diagnosis, prognosis, interventions, and evaluation of therapeutic results and outcomes. Normality in mental health should be reformulated on bioethical principles to avoid being a source of stigma and discrimination, at a time when human diversity and cultural change impose a redefinition of conceptual boundaries and depathologization of different forms of behavior and experience.

Resumen Se aplica el concepto de normalidad en sus connotaciones descriptiva y normativa al campo de la salud mental, destacando su tonalidad ética en diferentes contextos culturales y situacionales. Se define la ética como la justificación lingüística de la moral y se caracteriza a la bioética como fuente de argumentos basados en procesos dialógicos, discursivos y deliberativos. La toma de decisiones en clave bioética influencia las relaciones humanas y posee implicaciones para el diagnóstico, el pronóstico, las intervenciones y la evaluación de resultados y consecuencias. La normalidad en salud mental debiera ser reformulada sobre la base de principios bioéticos a fin de impedir ser fuente de estigma y discriminación en una época en que la diversidad y el cambio cultural imponen una redefinición de límites conceptuales y la despatologización de diferentes formas de conducta y vivencia.

Atualizações acerca da saúde mental de pessoas que vivem com HIV: uma revisão integrativa

O Vírus da Imunodeficiência Humana (HIV) tem repercutido na consecução de diversos estigmas para as pessoas que vivem com HIV (PVHIV), em uma sociedade mantenedora do olhar discriminatório. Isso ocorre apesar dos avanços a respeito do entendimento fisiopatológico, formas de transmissão e terapêutica. Este estudo visa identificar as correlações entre o adoecimento mental nas PVHIV. Trata-se de uma revisão integrativa, realizada nas bases de dados PubMed, BVS e SciELO, com triagem de 843 estudos, sendo 12 deles selecionados a partir dos critérios de elegibilidade. Identificou-se maior prevalência de transtornos mentais nos HIV-positivos, sobretudo de depressão, influenciados por fatores sociodemográficos que favorecem a perpetuação desse cenário. Este estudo contribui para o entendimento das necessidades psicossociais e pressupõe acolhimento do serviço de saúde e familiar, além da ampliação de pesquisas que incluam a saúde mental, como foco para a qualidade e integralidade da atenção à saúde das PVHIV.

Schizophrenia is associated with severe consequences / Asociación de la esquizofrenia con consecuencias graves

Schizophrenia is an illness that affects millions of individuals. It is typically accompanied by positive, negative and cognitive symptoms. These symptoms are typically associated with the onset and progression of schizophrenia. However, aside from these known symptoms, there are consequences of having schizophrenia. In particular, metabolic syndrome, early death and suicide, diseases, lowered pain perception, sexual dysfunction, aggressive behavior/victimization, stigma, and cognitive deficit are all consequences of having schizophrenia. In this paper, we review the various consequences of having schizophrenia. These consequences should be monitored for, much like the typical symptoms, but are usually omitted from treatment. (AU)

La esquizofrenia es una enfermedad que afecta a millones de individuos, y que normalmente se acompaña de síntomas positivos, negativos y cognitivos. Dichos síntomas están normalmente asociados al inicio y progresión de la esquizofrenia. Sin embargo, aparte de estos síntomas conocidos, existen consecuencias de padecer esquizofrenia. En particular, el síndrome metabólico, la muerte prematura y el suicidio, las enfermedades, la disminución de la percepción del dolor, la disfunción sexual, el comportamiento agresivo/victimización, el estigma, y el déficit cognitivo son consecuencias de padecer esquizofrenia. En este documento, revisamos las diversas consecuencias del padecimiento de esquizofrenia. Deberán supervisarse dichas consecuencias, al igual que los síntomas típicos, aunque normalmente se omiten del tratamiento de la enfermedad. (AU)

Vivências de gordofobia médica em serviços de saúde no Brasil / Experiences of medical fatphobia in health services in Brazil / Experiencias de gordofobia médica en servicios de salud en Brasil

Objetivo: categorizar as vivências de gordofobia médica em serviços de saúde no Brasil. Método: estudo retrospectivo e misto, com abordagem exploratório sequencial, realizado entre janeiro de 2021 e janeiro de 2022. Os dados foram coletados manualmente, por meio da ferramenta de busca avançada e através da hashtag "gordofobia médica", no Twitter e no Instagram, respectivamente. E foram analisados por meio de análise temática. Resultados: encontrou-se 476 registros e 75 foram selecionados. Teve-se como categorias temáticas, estímulo não solicitado a medidas cirúrgicas para o emagrecimento; falta de atenção às queixas principais dos pacientes; violências psicológicas, verbais e/ou físicas associadas ao excesso de peso; e gordofobia como barreira para o acesso à saúde. Além disso, foram relatadas percepções de consequências à saúde como, abandono de tratamento, prejuízos à saúde mental e prejuízos à saúde materno-infantil. Conclusão: as características dos relatos evidenciam a sub-representação dos homens em debates relacionados à obesidade, hegemonia do saber biomédico perante questões sociais, estreitamento do acesso à saúde e contribuição negativa para a saúde física e mental das pessoas.

Objective: to categorize experiences of medical fatphobia in health services in Brazil. Method: retrospective and mixed study, with a sequential exploratory approach, carried out between January 2021 and January 2022. Data were collected manually, through the advanced search tool and through the hashtag "medical fatphobia", on Twitter and Instagram, respectively. And they were analyzed through thematic analysis. Results: 476 records were found and 75 were selected. Thematic categories were: unsolicited stimulus to surgical measures for weight loss; lack of attention to patients' main complaints; psychological, verbal and/or physical violence associated with being overweight; and fatphobia as a barrier to access to health. In addition, perceptions of health consequences were reported, such as treatment abandonment, damage to mental health and consequences for maternal and child health. Conclusion: the characteristics of the reports show the underrepresentation of men in debates related to obesity, hegemony of biomedical knowledge in the face of social issues, narrowing of access to health and negative contribution to people's physical and mental health.

Viruela del mono y hombres que tienen sexo con hombres: la necesidad de tratarla con una perspectiva desestigmatizante / Monkeypox and men who have sex with men: we need to treat it with a destigmatizing perspective

La viruela del mono es una zoonosis, que se transmite por contacto estrecho, y que ha producido recientemente un gran broteepidémico en zonas no endémicas, calificado como Emergencia de Salud Pública de importancia internacional por la OrganizaciónMundial de la Salud (OMS). La respuesta tibia y tardía a nivel global, y el enfoque estigmatizante sobre los hombres que tienen sexocon hombres (los principales afectados) promovido por la opinión pública, algunos científicos, agentes sociopolíticos y medios decomunicación, podrían ser algunos de los motivos por los que aún no se ha contenido la epidemia. El estigma asociado a la enfer-medad produce daños severos en sus víctimas y dificulta las acciones dirigidas al control de la enfermedad, como ya ocurrió conel VIH. Para limitar el estigma y contener el brote, los científicos deben dirigir la difusión de información científicamente validada,educar a la población sobre prevención, sobre sintomatología, sobre cómo actuar en caso de sospecha y sobre la importancia de noestigmatizar. También se debe actuar sobre las víctimas del estigma para eliminar sus consecuencias y fomentar su autoeficacia. Lasintervenciones de salud deben realizarse con los actores políticos y sociales para integrar la evidencia en la normativa y procedimientos, así como para facilitar la acción de la Salud Pública. Asimismo, los expertos deben colaborar con los medios de comunicaciónpara facilitar una comunicación en salud adecuada y amonestar las malas prácticas. De igual forma, se debe mejorar la relaciónentre organizaciones y profesionales sanitarios e individuos estigmatizados para optimizar su acceso y retención en los sistemassanitarios. El objetivo del presente estudio fue hacer una revisión sobre la respuesta estigmatizante de algunos agentes políticos, demedios de comunicación y de la opinión social ante la epidemia de viruela del mono, exponer las graves consecuencias del estigma...AU)

Monkeypox is a zoonosis, which is transmitted by direct and close contact, and has recently produced a large epidemic outbreak innonendemic areas, classified as a Public Health Emergency of international concern by the World Health Organization. The globaldoubting and delayed response, and the stigmatizing approach to men who have sex with men promoted by public opinion, somescientists, sociopolitical agents, and the media, could be some of the reasons why the epidemic has not yet been contained. Thestigma around the disease produces severe injuries to its victims and obstructs actions aimed at controlling the disease, as occurredwith HIV in the past. To limit stigma and contain the outbreak, scientists should lead the diffusion of scientifically validated information, educate the population about prevention, symptoms, how to react in case of suspicion and the importance of not contributingto others’ stigmatization. Interventions must also be conducted on victims of stigma to counter act its consequences and encouragetheir selfefficacy. Public health interventions should be carried out in collaboration with political and social actors to integrateevidence into regulations and procedures and facilitate public health interventions. Experts should also work together with the mediato facilitate proper health communication and warn about bad practices. Similarly, the relationship between organizations and healthprofessionals and stigmatized individuals must be improved to optimize their access and retention in health systems. The objective ofthis study was to review the stigmatizing response of some political agents, the media and social opinion to the Monkeypox epidemic,to highlight the consequences of stigma on the patients and the control of the disease. And to establish a series of recommendationsto treat this situation effectively through a non-stigmatizing approach.(AU)

Revisión sobre el estigma en salud mental en población militar / Review on the stigma associated with mental health problems in the current military context

Objetivo: Realizar una revisión sobre el estigma asociado a los problemas de salud mental en el contexto militar. Método: Se realizó una revisión sistemática de la literatura empleando las bases de datos PubMed, Psycinfo y Scielo con las palabras clave mental health, stigma y military personnel desde 2016 hasta 2022. Resultados: Se obtuvieron un total de 84 artículos potencialmente relevantes, y tras la aplicación de los criterios de inclusión, se seleccionaron los 22 artículos sobre los que se analizan los resultados (n=31789) y se extraen las conclusiones. Conclusiones: El estigma asociado a los problemas de salud mental es un fenómeno que dificulta la búsqueda de ayuda psicológica para resolverlos. Se encuentra mayor presencia de este estigma en la población militar que en la civil, y mayor reticencia a buscar tratamiento. Se han identificado variables que actúan facilitando o dificultando la decisión de buscar ayuda profesional en la población militar. Algunos ejércitos están implementando campañas anti-estigma. No se encontraron estudios realizados en las Fuerzas Armadas Españolas. (AU)

Objective: To conduct a review on the stigma associated with mental health problems in the current military context. Methods: A systematic review of the literature was carried out using the databases PubMed, Psycinfo and Scielo with the keywords “mental health”, “stigma” and “military personnel” from 2016 to 2022. Results: A total of 84 potentially relevant articles were obtained, and after applying the inclusion criteria, the 22 articles on which the results are analyzed (n=31789) were selected and conclusions are drawn. Conclusions: The stigma associated with mental health problems is a phenomenon that hinders the search for psychological help to solve them. This stigma is found to be more prevalent in the military population than in the civilian population, and there is greater reluctance to seek treatment. Variables have been identified that facilitate or hinder the decision to seek professional help in the military population. Some armies are implementing anti-stigma campaigns. No studies were found in the Spanish Armed Forces. (AU)