Hepatitis C elimination among people who inject drugs in Mexico during the COVID-19 pandemic.

In 2019, Mexico was one of the first countries in Latin America to commit resources to achieve hepatitis C elimination by 2030. One year after this commitment, the global COVID-19 pandemic diverted attention to address immediate health needs to combat the spread of the disease. As a result, efforts to implement hepatitis C prevention and management programs were indefinitely postponed. Furthermore, populations at high risk of contracting the hepatitis C virus (HCV) and who bear the greatest burden of HCV national epidemic, including people who inject drugs and people who live with human immunodeficiency virus infection, remain exposed to extreme health disparities, which have potentially been exacerbated during the COVID-19 pandemic. In this article, we discuss the potential impact the COVID-19 pandemic has had on HCV elimination efforts in Mexico and the urgent need to resume them, since without these efforts, HCV elimination goals are likely not be achieved in the country by 2030.

En 2019, México fue uno de los primeros países en Latinoamérica en comprometer recursos para eliminar la hepatitis C antes de 2030. Un año después de este compromiso, la pandemia mundial de COVID-19 desvió la atención hacia las necesidades inmediatas de salud para combatir la propagación de esta última. Como resultado, los esfuerzos para implementar programas de prevención y manejo de la hepatitis C se suspendieron indefinidamente. Asimismo, las poblaciones con alto riesgo de contraer el virus de la hepatitis C y que representan el mayor peso de la epidemia nacional, como las personas que se inyectan drogas y las personas que viven con infección por el virus de la inmunodeficia humana, permanecen expuestas a disparidades de salud extremas que potencialmente se han exacerbado durante la pandemia de COVID-19. En este artículo discutimos el impacto potencial que la pandemia de COVID-19 ha tenido sobre los esfuerzos de eliminación de la hepatitis C en México y la necesidad urgente de reanudarlos, ya que sin ellos los objetivos de eliminación no se alcanzarán en el país en 2030.

Suicide ideation and behavior in Mexico: Encodat 2016.

OBJECTIVE: To provide updated information regarding the 12-month prevalence and associated sociodemographic factors for suicide ideation and behavior (plan and attempts) to substantiate preventive programs in Mexico. MATERIALS AND METHODS: Cross-sectional nationally representative survey, conducted during 2016 (n=56 877) among those 12-65 years old living in rural, urban and metropolitan dwellings. RESULTS: The prevalence of suicide ideation in the last 12-months was 2.3%, 0.8% of the sample reported a plan and 0.7% reported a suicide attempt. All three outcomes were about two times more common among females and suicide plan and attempt were less common among the elderly (50-65 years old). Suicide attempts were more common in urban than in rural areas. The state of Tabasco showed an increased prevalence of ideation, plan and attempts when compared to national average rates. CONCLUSIONS: Public health measures to diminish and treat suicidal behavior are urgently needed all over the country.

OBJETIVO: Dar información actualizada sobre la prevalencia de 12 meses y los factores sociodemográficos asociados para la ideación y el comportamiento suicida (plan e intentos) para fundamentar programas preventivos en México. MATERIAL Y MÉTODOS: Encuesta transversal representativa a nivel nacional, por sexo y grupos de edad, realizada durante 2016 (n = 56 877) entre personas de entre12 y 65 años de edad en zonas rurales, urbanas y metropolitanas. RESULTADOS: La prevalencia de ideación suicida en los últimos 12 meses fue de 2.3%, 0.8% de la muestra informó un plan y 0.7% informó un intento de suicidio. Los tres resultados fueron aproximadamente dos veces más comunes entre las mujeres y el intento de suicidio fue menos común entre los más viejos (50 a 65 años). Los intentos de suicidio fueron más comunes en las zonas urbanas que en las rurales. El estado de Tabasco mostró una mayor prevalencia de ideas, planes e intentos en comparación con las tasas promedio nacionales. CONCLUSIONES: Es urgente y necesario que existan medidas de salud pública para disminuir y tratar el comportamiento suicida en todo el país.

Eight-year incidence of psychiatric disorders and service use from adolescence to early adulthood: longitudinal follow-up of the Mexican Adolescent Mental Health Survey.

Half of mental disorders have their first onset before adulthood when the presence of a disorder may be particularly disruptive to developmental milestones. Retrospective prevalence estimates have been shown to underestimate the burden of mental illness and scarce data are available on the incidence of disorders throughout the adolescent period, especially in developing countries. Thus, the objective was to determine the incidence of mental disorders in an 8-year period from adolescence to young adulthood, onset of service use and their predictors in a Mexican cohort. 1071 respondents from a representative two-wave panel sample participated in the Mexican Adolescent Mental Health Survey in 2005 and in the follow-up survey in 2013. Disorders were evaluated with the World Mental Health Composite International Diagnostic Interview. 37.9% experienced the onset of a psychiatric disorder and 28.4% sought services for the first time. Substance use disorders had the greatest incidence, followed by mood and behavior disorders, anxiety disorders and lastly eating disorders. Sex, age, school dropout, childhood adversities and prior mental disorders predicted the onset of new disorders. Being female, having more educated parents and most classes of disorder predicted first time service use. These findings contribute to a paradigm shift in conceptions of mental disorder similar to how we think of common physical afflictions as near universal experiences across the life course, but less frequent at any given moment. Adolescents are particularly vulnerable. Therefore, public health policy should focus on early universal promotion of positive mental health and structural determinants of mental health.

The association of chronic adversity with psychiatric disorder and disorder severity in adolescents.

The purpose of this paper is to estimate the impact of chronic adversity on psychopathology in adolescents, taking into account the type of adversity, number of adversities experienced and type of psychiatric disorder, as well as to estimate the impact on severity of the disorder. A total of 3,005 male and female adolescents from the Mexican Adolescent Mental Health Survey aged 12-17 years were interviewed in a stratified multistage general population probability survey. Assessment of 20 DSM-IV disorders, disorder severity and 12 chronic childhood adversities were assessed with the adolescent version of the World Mental Health Composite International Diagnostic Interview (WMH-CIDI-A). Family dysfunction adversities including abuse presented the most consistent associations between chronic adversity and psychopathology and their impact was generally non-specific with regard to the type of disorder. Parental divorce, parental death and economic adversity were not individually associated with psychopathology. Among those with a psychiatric disorder, sexual abuse and family violence were associated with having a seriously impairing disorder. The odds of having a psychiatric disorder and a serious disorder increased with increasing numbers of adversities; however, each additional adversity increased the odds at a decreasing rate. While the study design does not allow for conclusions regarding causality, these findings suggest general pathways from family dysfunction to psychopathology rather than specific associations between particular adversities and particular disorders, and provide further evidence for the importance of family-focused intervention and prevention efforts.

Is hepatitis C virus (HCV) elimination achievable among people who inject drugs in Tijuana, Mexico? A modeling analysis.

BACKGROUND: In 2019, Mexico became the first Latin American country committed to hepatitis C virus (HCV) elimination, but the amount of intervention scale-up required is unclear. In Tijuana, HCV among people who inject drugs (PWID) is high; yet there is minimal and intermittent harm reduction, and involuntary exposure to compulsory abstinence programs (CAP) occurs which is associated with increased HCV risk. We determined what combination intervention scale-up can achieve HCV elimination among current and former PWID in Tijuana. METHODS: We constructed a dynamic, deterministic model of HCV transmission, disease progression, and harm reduction among current and former PWID parameterized to Tijuana (~10,000 current PWID, 90% HCV seropositive, minimal opiate agonist therapy [OAT] or high coverage needle/syringe programs [HCNSP]). We evaluated the number of direct-acting antiviral (DAA) treatments needed from 2019 to achieve elimination targets (80% incidence reduction, 65% mortality reduction by 2030) with: (a) DAAs alone, (b) DAAs plus scale-up of OAT+HCNSP (up to 50% coverage of OAT and HCNSP separately, producing 25% of PWID receiving both), (c) DAAs plus CAP scale-up to 50%. Scenarios examined the number of DAAs required if prioritized to current PWID or provided regardless of current injection status, and impact of harm reduction interruptions. RESULTS: Modeling suggests among ~30,000 current and former PWID in Tijuana, 16,160 (95%CI: 12,770-21,610) have chronic HCV. DAA scale-up can achieve the incidence target, requiring 770 treatments/year (95%CI: 640-970) if prioritized to current PWID. 40% fewer DAAs are required with OAT+HCNSP scale-up to 50% among PWID, whereas more are required with involuntary CAP scale-up. Both targets can only be achieved through treating both current and former PWID (1,710 treatments/year), and impact is reduced with harm reduction interruptions. CONCLUSIONS: Elimination targets are achievable in Tijuana through scale-up of harm reduction and DAA therapy, whereas involuntary CAP and harm reduction interruptions hamper elimination.

Geographical and socioeconomic disparities in opioid access in Mexico, 2015-19: a retrospective analysis of surveillance data.

BACKGROUND: In 2015, Mexico implemented regulatory changes and an electronic system to improve access to prescription opioids. We aimed to investigate trends in opioid dispensing after the implementation of these changes and assess how opioid dispensing varied geographically and by socioeconomic status. METHODS: In this retrospective analysis of prescription medication surveillance data, we analysed dispensing data for group 1 medications (all opioids, including morphine, methadone, hydromorphone, oxycodone, tapentadol, fentanyl, sufentanil, and remifentanil) obtained from the Federal Commission for the Protection against Sanitary Risk database for 32 states and six large metropolitan areas in Mexico. We calculated crude annual opioid prescriptions per 10 000 people at the national, state, and municipal levels. Adapting methods from the report of the Lancet Commission on Palliative Care and Pain Relief, we calculated the need for palliative opioids by state, and then assessed the observed opioid dispensing rates as a percentage of expected need by geographical socioeconomic status. Within the six major metropolitan areas, we mapped the geocoded location of opioid prescriptions and assessed the association between opioid dispensing and socioeconomic status as well as the association between opioid dispensing and time to US border crossing for areas on the US-Mexico border. FINDINGS: Between June 25, 2015, and Oct 7, 2019, opioid dispensing rates increased by an average of 13% (95% CI 6·8-19·6) per quarter (3 months). The overall national opioid dispensing rate during the study period was 26·3 prescriptions per 10 000 inhabitants. States with a higher socioeconomic status had higher opioid dispensing rates than states with lower socioeconomic status (rate ratio [RR] 1·88, 95% CI 1·33-2·58, p=0·00016) after controlling for the estimated opioid requirement per state, the presence of methadone clinics, and the presence of tertiary hospitals and cancer centres. The same association between opioid dispensing and socioeconomic status was observed in the metropolitan areas, and in those metropolitan areas on the US-Mexico border a 20% decrease (RR 0·80, 95% CI 0·75-0·86) in opioid dispensation was observed per each SD increase (SD 17·1 min) in travel time to the border. INTERPRETATION: Measures introduced by the Mexican federal Government to increase opioid access for patients with palliative care needs were only marginally successful in raising opioid prescription rates. Opioid access should be improved for patients with palliative care needs who live in geographical areas of lower socioeconomic status. FUNDING: US National Institutes of Health.

Cost-effectiveness of hepatitis C virus (HCV) elimination strategies among people who inject drugs (PWID) in Tijuana, Mexico.

BACKGROUND AND AIMS: In Latin America, Mexico was first to launch a hepatitis C virus (HCV) elimination strategy, where people who inject drugs (PWID) are a main risk group for transmission. In Tijuana, HCV seroprevalence among PWID is > 90%, with minimal harm reduction (HR). We evaluated cost-effectiveness of strategies to achieve the incidence elimination target among PWID in Tijuana. METHODS: Modeling study using a dynamic, cost-effectiveness model of HCV transmission and progression among active and former PWID in Tijuana, to assess the cost-effectiveness of incidence elimination strategies from a health-care provider perspective. The model incorporated PWID transitions between HR stages (no HR, only opioid agonist therapy, only high coverage needle-syringe programs, both). Four strategies that could achieve the incidence target (80% reduction by 2030) were compared with the status quo (no intervention). The strategies incorporated the number of direct-acting anti-viral (DAA) treatments required with: (1) no HR scale-up, (2) HR scale-up from 2019 to 20% coverage among PWID, (3) HR to 40% coverage and (4) HR to 50% coverage. Costs (2019 US$) and health outcomes [disability-adjusted life years (DALYs)] were discounted 3% per year. Mean incremental cost-effectiveness ratios (ICER, $/DALY averted) were compared with one-time per capita gross domestic product (GDP) ($9698 in 2019) and purchasing power parity-adjusted per capita GDP ($4842-13 557) willingness-to-pay (WTP) thresholds. RESULTS: DAAs alone were the least costly elimination strategy [$173 million, 95% confidence interval (CI) = 126-238 million], but accrued fewer health benefits compared with strategies with HR. DAAs + 50% HR coverage among PWID averted the most DALYs but cost $265 million, 95% CI = 210-335 million). The optimal strategy was DAAs + 50% HR (ICER $6743/DALY averted compared to DAAs only) under the one-time per-capita GDP WTP ($9698). CONCLUSIONS: A combination of high-coverage harm reduction and hepatitis C virus treatment is the optimal cost-effective strategy to achieve the HCV incidence elimination goal in Mexico.

Fentanyl is used in Mexico's northern border: current challenges for drug health policies.

BACKGROUND AND AIMS: Results from a recent study among 750 heroin users in three Mexico's northern border cities revealed an increase in white powder availability (also known as China white) and preference for this product among heroin users, as well as a general perception of increased overdose cases among this population. Here, we questioned whether those findings reflect an increased presence of heroin laced with fentanyl, which is associated with greater risks of overdose but that, until now, has not been described in Mexico. DESIGN: We tested fentanyl using highly sensitive test strips in syringe plungers, metal cookers and drug wrappings associated with heroin use. SETTING: Three injection sites in Tijuana, Baja California, México. PARTICIPANTS: Eighty-nine heroin users who interchanged paraphernalia for new syringes. MEASUREMENTS: We tested 59 residues of 'pure' white powder. The rest were white powder with black tar (n = 5) or white powder with crystal meth (n = 9), black tar with crystal meth (n = 1), black tar only (n = 13) and crystal meth only (n = 2). FINDINGS: Users believed that they consumed either white powder heroin, white powder heroin with crystal meth, white powder with black tar heroin or black tar heroin only. Analyses revealed that 93% (n = 55) of the 'pure' white powder samples had fentanyl. All (n = 9) the white powder samples mixed with crystal meth and 40% (n = 2) of the white powder with black tar were also laced with fentanyl. CONCLUSIONS: In a sample of 89 heroin users in Mexico, most white powder heroin users were unknowingly exposed to fentanyl, with fentanyl detected in 93% of white powder samples.

Opioid Crisis Along Mexico's Northern Border: Treatment Needs Mexican Opioid Crisis.

BACKGROUND: Heroin production for external markets and low rates of use in Mexico have had a long history. A recent shift toward an increase in use and related problems calls for the evaluation of treatment needs in order to draw recommendations for policies. METHODS: The objectives were to identify predictors of choice of treatment and barriers to care among persons that had been with no treatment. The study included a convenience sample of 600 face-to-face interviews of people 18 years of age and older and a rapid HIV and HCV tests in three cities on Mexico's Northern Border: Ciudad Juárez, San Luis Río Colorado and Tijuana. The choice of treatment (methadone, other pubic or private treatments with no experience with methadone maintenance and only self-help or religious care), was analyzed though a multiple logistic multimodal regression analysis. Informed consents to be interviewed and for HIC and HIV were signed by interviewers. RESULTS: The majority of persons interviewed were males (89.7%) with an average age of 40. Having emigrated to the United States and a greater length of heroin use predicted seeking methadone treatment versus public or private treatment or informal care. The most important barriers to care were lack of information and stigma. HIC, HIV and other infectious and chronic diseases including depression were often unattended. CONCLUSIONS: There is a need to reform treatment policies in order to cover this w emerging and demanding problem.

Social factors, weight perception, and weight control practices among adolescents in Mexico.

We evaluated the association of social factors and weight control practices in adolescents, and the mediation of this association by weight perception, in a national survey of students in Mexico ( n = 28,266). We employed multinomial and Poisson regression models and Sobel's test to assess mediation. Students whose mothers had a higher level of education were more likely to perceive themselves as overweight and also to engage in weight control practices. After adjusting for body weight perception, the effect of maternal education on weight control practices remained significant. Mediation tests were significant for boys and non-significant for girls.

Association between attempted suicide and academic performance indicators among middle and high school students in Mexico: results from a national survey.

BACKGROUND: Students' mental health is associated to academic performance. In high income countries, higher students' grades are related to lower odds of suicidal behaviors, but studies on other indicators of academic performance are more limited, specially in middle income countries. METHODS: Data from 28,519 middle and high school students selected with multistage clustered sampling in the Mexican National Survey of Student's Drug Use. Using a self-administered questionnaire, lifetime suicidal attempt and four indicators of academic performance were assessed: age inconsistency with grade level, not being a student in the last year, perceived academic performance and number of failed courses. Multiple logistic regression models were used to control for sociodemographic and school characteristics. RESULTS: The lifetime prevalence of attempted suicide was 3.0% for middle school students and 4.2% for high school students. Among middle school students, statistically adjusted significant associations of suicide attempt with academic performance indicators were: not being a student the year before, worse self-perceived performance and a higher number of failed courses; among high school students, predictors were failed courses and self-perceived academic performance, with ORs of 1.65 and 1.96 for the categories of good and fair/poor respectively, compared to those who reported very good performance. CONCLUSION: Self-perceived academic performance was the main indicator for suicide in both school levels. Suicide prevention efforts in Mexico's schools should include asking students about the perception they have about their own academic performance.

Prevalence and socio-demographic correlates of drug use among adolescents: results from the Mexican Adolescent Mental Health Survey.

AIMS: To estimate the life-time and 12-month prevalence of illicit drug use among Mexican adolescents, the age of onset of first drug use and the socio-demographic correlates. METHOD: A multi-stage probability survey of adolescents aged 12-17 years residing in the Mexico City Metropolitan Area was carried out in 2005. Adolescents were administered the computer-assisted adolescent version of the World Mental Health Composite International Diagnostic Interview by trained lay interviewers in their homes. The response rate was 71% (n = 3005). Descriptive and logistic regression analyses were performed considering the multi-stage and weighted sample design of the survey. FINDINGS: Of the adolescents, 5.2% have ever tried illicit drugs, 2.9% in the last 12 months. The most frequently used drugs are marijuana, followed by tranquilizers/stimulants. The median age of first use is 14 years. Correlates of life-time drug use are older age, having dropped out of school, parental drug problems, low religiosity and low parental monitoring. CONCLUSIONS: While drug use among Mexican adolescents is lower than among adolescents from other developed countries, its increasing prevalence with age and the narrowing male/female ratio calls for firm public health actions, particularly prevention strategies.

Drug use opportunities and the transition to drug use among adolescents from the Mexico City Metropolitan Area.

The earliest stage of drug involvement is being presented with the opportunity to use drugs. During adolescence these opportunities increase. Because of the scarcity of data for the Mexican population, the aim is to estimate the prevalence of drug use opportunities among Mexican adolescents, the prevalence of drug use among those who were presented with the opportunity, and the socio-demographic correlates of both. A multistage probability survey was carried out among 12-17 year olds from Mexico City. Adolescents were administered the adolescent version of the World Mental Health Composite International Diagnostic Interview. The response rate was 71% (n=3005). Descriptive and logistic regression analyses were performed considering the multistage and weighted sample design. Twenty-nine percent has had the opportunity to try illicit drugs; of those presented with an opportunity, 18% has done so. Males, older adolescents, school drop-outs, and those whose parent has had drug problems are more likely to have been exposed to drug use opportunities while more religious adolescents are less likely. Given the chance to try drugs, older adolescents and school drop-outs are more likely to do so and those with high parental monitoring and religiosity are less likely. These results suggest that less substance use among females in Mexico may be due in part to fewer opportunities to use since females were equally likely to use drugs given the opportunity. Given the increase in opportunity among older adolescents, preventive efforts should start by age 12 and with special attention to adolescents who have dropped out of school.

Eliminación de la hepatitis C en usuarios de drogas inyectadas en México durante la pandemia de COVID-19 / Hepatitis C elimination among people who inject drugs in Mexico during the COVID-19 pandemic

Resumen En 2019, México fue uno de los primeros países en Latinoamérica en comprometer recursos para eliminar la hepatitis C antes de 2030. Un año después de este compromiso, la pandemia mundial de COVID-19 desvió la atención hacia las necesidades inmediatas de salud para combatir la propagación de esta última. Como resultado, los esfuerzos para implementar programas de prevención y manejo de la hepatitis C se suspendieron indefinidamente. Asimismo, las poblaciones con alto riesgo de contraer el virus de la hepatitis C y que representan el mayor peso de la epidemia nacional, como las personas que se inyectan drogas y las personas que viven con infección por el virus de la inmunodeficia humana, permanecen expuestas a disparidades de salud extremas que potencialmente se han exacerbado durante la pandemia de COVID-19. En este artículo discutimos el impacto potencial que la pandemia de COVID-19 ha tenido sobre los esfuerzos de eliminación de la hepatitis C en México y la necesidad urgente de reanudarlos, ya que sin ellos los objetivos de eliminación no se alcanzarán en el país en 2030.

Abstract In 2019, Mexico was one of the first countries in Latin America to commit resources to achieve hepatitis C elimination by 2030. One year after this commitment, the global COVID-19 pandemic diverted attention to address immediate health needs to combat the spread of the disease. As a result, efforts to implement hepatitis C prevention and management programs were indefinitely postponed. Furthermore, populations at high risk of contracting the hepatitis C virus (HCV) and who bear the greatest burden of HCV national epidemic, including people who inject drugs and people who live with human immunodeficiency virus infection, remain exposed to extreme health disparities, which have potentially been exacerbated during the COVID-19 pandemic. In this article, we discuss the potential impact the COVID-19 pandemic has had on HCV elimination efforts in Mexico and the urgent need to resume them, since without these efforts, HCV elimination goals are likely not be achieved in the country by 2030.

Suicide ideation and behavior in Mexico: Encodat 2016 / Ideación e intento de suicidio en México: Encodat 2016

Abstract: Objective: To provide updated information regarding the 12-month prevalence and associated sociodemographic factors for suicide ideation and behavior (plan and attempts) to substantiate preventive programs in Mexico. Materials and methods: Cross-sectional nationally representative survey, conducted during 2016 (n=56 877) among those 12-65 years old living in rural, urban and metropolitan dwellings. Results: The prevalence of suicide ideation in the last 12-months was 2.3%, 0.8% of the sample reported a plan and 0.7% reported a suicide attempt. All three outcomes were about two times more common among females and suicide plan and attempt were less common among the elderly (50-65 years old). Suicide attempts were more common in urban than in rural areas. The state of Tabasco showed an increased prevalence of ideation, plan and attempts when compared to national average rates. Conclusions: Public health measures to diminish and treat suicidal behavior are urgently needed all over the country.

Resumen: Objetivo: Dar información actualizada sobre la prevalencia de 12 meses y los factores sociodemográficos asociados para la ideación y el comportamiento suicida (plan e intentos) para fundamentar programas preventivos en México. Material y métodos: Encuesta transversal representativa a nivel nacional, por sexo y grupos de edad, realizada durante 2016 (n = 56 877) entre personas de entre12 y 65 años de edad en zonas rurales, urbanas y metropolitanas. Resultados: La prevalencia de ideación suicida en los últimos 12 meses fue de 2.3%, 0.8% de la muestra informó un plan y 0.7% informó un intento de suicidio. Los tres resultados fueron aproximadamente dos veces más comunes entre las mujeres y el intento de suicidio fue menos común entre los más viejos (50 a 65 años). Los intentos de suicidio fueron más comunes en las zonas urbanas que en las rurales. El estado de Tabasco mostró una mayor prevalencia de ideas, planes e intentos en comparación con las tasas promedio nacionales. Conclusiones: Es urgente y necesario que existan medidas de salud pública para disminuir y tratar el comportamiento suicida en todo el país.

Barriers to accessing substance abuse treatment in Mexico: national comparative analysis by migration status.

BACKGROUND: We examined Mexican migrants' perceived barriers to entering substance abuse treatment and potential differences by gender. METHODS: This study analyzed a subset of household data collected in Mexico in 2011 via the Encuesta Nacional de Adicciones (National Survey of Addictions). A sample of 1,143 individuals who reported using illicit drugs was analyzed using multivariate negative binomial models to determine direct and moderated relationships of gender, migrant status, and drug dependence with perceived barriers to accessing treatment. RESULTS: Significant findings included disparities in drug dependence by migrant status. Compared with non-migrant men, women who have traveled to the United States was associated with fewer (1.3) barriers to access treatment. Fewer barriers to access care were associated with individuals residing in other regions of the country, compared to those living in Mexico City. CONCLUSIONS: Drug dependence, gender, migration status and regional location are factors associated with access to needed treatment. Implications for health care policy to develop treatment services infrastructure and for future research are discussed in the context of ongoing drug policy reform in Mexico.

The Mexican migration to the United States and substance use in northern Mexico.

AIMS: To examine the impact of migration to the United States on substance use and substance use disorders in three urban areas of northern Mexico. DESIGN: Cross-sectional survey of immigration-related experiences and life-time and past-year alcohol and drug use, in a representative sample of respondents aged 12-65 years. SETTING: Interviews were conducted in the cities of Tijuana, Ciudad Juarez and Monterrey during 2005. Respondents were classified into three groups: (i) 'return migrants', (ii) 'relatives of migrants' and (iii) 'others in the general population'. FINDINGS: A total of 1630 completed interviews were obtained for a response rate of 70.5%. 'Return migrants' were more likely to have used alcohol, marijuana or cocaine at least once in their life-time and in the last 12 months, more likely to develop a substance use disorder and more likely to have a 12-month substance use disorder compared with 'others in the general population'. Among 'return migrants', longer length of time in the United States and type of work performed as an immigrant were related to higher prevalence of substance use. Among 'relatives of migrants', migration experiences were not associated with increased prevalence of substance use compared with 'others in the general population'. CONCLUSION: This study found a link between migration to the United States and the transformation of substance use norms and pathology in Mexico. Future research on pre-migration involvement in substance use and data on the timing of events among return migrants is needed. Public health measures are likely to require cross-border coordination of research and service development.

Childhood psychosocial stressors and adult onset arthritis: broad spectrum risk factors and allostatic load.

Neural, endocrine, and immune stress mediators are hypothesized to increase risks of diverse chronic diseases, including arthritis. Retrospective data from the World Mental Health Surveys (N=18,309) were employed to assess whether adult onset of arthritis was associated with childhood adversities and early onset psychological disorder. Cox proportional hazard models assessed the association of number of childhood adversities and the presence of early onset psychological disorder with arthritis age of onset. Controlling for age, sex, and early onset mental disorder, relative to persons with no childhood adversities, persons with two adversities had an increased risk of adult onset arthritis (hazard ratio=1.27, 95% CI=1.08, 1.50), while persons with three or more adversities had a higher risk (HR=1.44, CI=1.24, 1.67). Early onset depressive and/or anxiety disorder was associated with an increased risk of adult onset arthritis after controlling for childhood adversities (HR=1.43, CI=1.28, 1.61). Since psychosocial stressors may be broad spectrum risk factors that increase risks of diverse chronic conditions in later life (e.g. arthritis, heart disease, diabetes, asthma, and chronic pain), prospective studies of childhood psychosocial stressors may be most productive if multiple disease outcomes are assessed in the same study. Results from this study provide methodological guidance for future prospective studies of the relationship between childhood psychosocial stressors and subsequent risk of adult onset arthritis.

Prevalence and correlates of drug use disorders in Mexico.

OBJECTIVE: To describe the prevalence of drug use disorders, the correlates of drug use, and the utilization of specialized treatment services for drug users among the Mexican urban population 18-65 years old. METHODS: The data were collected in 2001 and 2002 in the Mexican National Comorbidity Survey. The sample design was stratified probabilistically for six geographical areas of the country in a multistage process for census count areas, city blocks, groups of households, and individuals. The data were weighted, taking into account the probability of selection and the response rate. The information was collected using a computerized version of the World Mental Health Survey edition of the Composite International Diagnostic Interview. The weighted response rate for individuals was 76.6%. RESULTS: Overall, 2.3% of the population reported any illicit use of drugs in the preceding 12 months; marijuana and cocaine were the substances most often used. Low levels of education were significantly associated with use, abuse, and dependence. Use of any drug was significantly more common among those who were in the youngest age group (18-29 years), were male, or were living in the Northwest region of the country. Overall, 1.4% had a lifetime history of drug abuse or dependence, with this being much more common for men (2.9%) than for women (0.2%). The 12-month prevalence of drug abuse or dependence was 0.4% overall (0.9% for men, and 0.0% for women). The rate of treatment during the preceding 12 months for those with the 12-month criteria for abuse or dependence was 17.1%; 14.8% were seen in specialized treatment centers; 2.8% reported having attended self-help groups. CONCLUSIONS: A noticeable number of Mexicans have a drug use disorder, but demand for treatment is limited, in part due to stigma. Our results indicate that there is an urgent need to organize the specialized services for persons with a substance abuse disorder according to the prevalence of dependence on different substances and the variation in prevalence in the different regions of the country.

Prevalence, service use, and demographic correlates of 12-month DSM-IV psychiatric disorders in Mexico: results from the Mexican National Comorbidity Survey.

BACKGROUND: This paper describes the 12-month prevalence, severity and demographic correlates of 16 DSM-IV psychiatric disorders and service utilization in the Mexican urban population aged 18-65 years of age. This is representative of 75% of the national adult population. METHOD: The sample design was a strict probability selection scheme. The response rate was 76.6%. The World Mental Health Survey version of the Composite International Diagnostic Interview was installed on laptops and administered by lay interviewers. An international WHO task force carried out its translation into Spanish. RESULTS: The 12-month prevalence of any disorder was 12.1%. The most common disorders were specific phobia (4.0%), major depressive disorder (3.7%) and alcohol abuse or dependence (2.2%). The 12-month prevalence of very severe disorders was 3.7% of which only 24% used any services. Age was the only variable associated with any 12-month disorder, with the younger more likely to report any disorder. Income was associated with severity, with low and low-average incomes more likely to report a 12-month disorder. Females were more likely to report a mood and anxiety disorder, but less likely to report a substance disorder. The group of separated/widowed/divorced was more likely to report a mood and an impulse-control disorder. CONCLUSIONS: The results show that while psychiatric disorders are common in the Mexican population, very severe mental disorders are less common and there is extreme under-utilization of mental health services.