Letter to the editor: COVID-19; an opportunity to study mental health at the individual and population levels

Relaciones y procesos de familias en confinamiento por COVID-19 narradas por madres

Highlights: Las relaciones familiares se ven afectadas por el confinamiento y las medidas sociales de restricción para evitar el contagio por COVID-19. Las familias experimentan un proceso de transición para adquirir nuevas formas de vida y encontrar un equilibrio cuando se enfrentan a la pandemia. El proceso expresa no solo las consecuencias negativas, si no también evidencia las emociones y actitudes positivas, donde se observan cambios que se vinculan a la estructura de la familia. La teoría fundamentada permite develar la realidad de las familias, lo que arroja un entendimiento sobre la nueva normalidad, basado en la descripción de las relaciones y procesos vividos. Introducción: El estado de alarma que provoco COVID-19, obligó a que se tomaran medidas sociales de restricción, esperando reducir los contagios, incluyendo el confinamiento, que impactó diversos aspectos de la vida humana, ha tenido efecto considerable en la dinámica familiar, provocando que permanezcan en casa acrecentando el afrontamiento de las situaciones de crisis, experimentando un proceso de transición a nuevas formas de vida. Objetivo: analizar las relaciones y procesos que viven las familias ante el confinamiento por COVID-19 narradas por las madres. Materiales y métodos: estudio cualitativo de teoría fundamentada, se realizaron entrevistas a profundidad a cinco madres de familia. Resultados: los resultados obtenidos emergieron de una categoría central “adquisición de nuevas formas de vida” y tres categorías que la sustentan: 1. Afrontando el inicio de la pandemia; 2. Adaptando la nueva normalidad en familia y 3. Adoptando las consecuencias de la pandemia en la vida cotidiana. Discusión: El proceso que han mostrado las familias mexicanas ante el COVID-19 se vive diferente al de otros países, la convivencia en los hogares fue de las afectadas ya que se compromete la libertad con la que viven día a día. Conclusión: Las participantes expresaron que durante la pandemia por COVID-19, la familia vivió un proceso de transición para poder adquirir nuevas formas de vida, las cuales incluían hábitos, costumbres y estructuras que cubrieran sus necesidades requeridas en ese momento, este proceso incluyó diferentes etapas (afrontamiento, adaptación y adopción).  Como citar este artículo: Pedraza Valdez Ana Luisa, Maldonado Cervantes Karla Aimee, García Solano Beatriz. Relaciones y procesos de familias en confinamiento por COVID-19 narradas por madres. Revista Cuidarte. 2023;14(1):e2347.  http://dx.doi.org/10.15649/cuidarte.2347

Racial and ethnic differences in perception of provider cultural competence among patients with depression and anxiety symptoms: a retrospective, population-based, cross-sectional analysis

BACKGROUND

Racial and ethnic minorities face disparities in access to health care. Culturally competent care might lessen these disparities. Few studies have studied the patients' view of providers' cultural competence, especially in psychiatric care. We aimed to examine the associations of race, ethnicity, and mental health status with patient-reported importance of provider cultural competence.

METHODS

Our retrospective, population-based, cross-sectional study used data extracted from self-reported questionnaires of adults aged at least 18 years who participated in the US National Health Interview Survey (NHIS; 2017 cycle). We included data on all respondents who answered supplementary cultural competence questions and the Adult Functioning and Disability survey within the NHIS. We classified participants as having anxiety or depression if they reported symptoms at least once a week or more often, and responded that the last time they had symptoms the intensity was "somewhere between a little and a lot" or "a lot." Participant answers to cultural competency survey questions (participant desire for providers to understand or share their culture, and frequency of access to providers who share their culture) were the outcome variables. Multivariable ordinal logistic regressions were used to estimate adjusted odds ratios (aORs) for the outcome variables in relation to sociodemographic characteristics (including race and ethnicity), self-reported health status, and presence of symptoms of depression, anxiety, or both.

FINDINGS

3910 people had available data for analysis. Mean age was 52 years (IQR 36-64). 1422 (39·2%, sample weight adjusted) of the participants were men and 2488 (60·9%) were women. 3290 (82·7%) were White, 346 (9·1%) were Black or African American, 31 (0·8%) were American Indian or Alaskan Native, 144 (4·8%) were Asian American, and 99 (2·6%) were Mixed Race. 380 (12·5%) identified as Hispanic ethnicity and 3530 (87·5%) as non-Hispanic. Groups who were more likely to express a desire for their providers to share or understand their culture included participants who had depression symptoms (vs those without depression or anxiety symptoms, aOR 1·57 [95% CI 1·13-2·19], p=0·008) and participants who were of a racial minority group (Black vs White, aOR 2·54 [1·86-3·48], p=0·008; Asian American vs White, aOR 2·57 [1·66-3·99], p<0·001; and Mixed Race vs White, aOR 1·69 [1·01-2·82], p=0·045) or ethnic minority group (Hispanic vs non-Hispanic, aOR 2·69 [2·02-3·60], p<0·001); these groups were less likely to report frequently being able to see providers who shared their culture (patients with depression symptoms vs those without depression or anxiety symptoms, aOR 0·63 (0·41-0·96); p=0·030; Black vs White, aOR 0·56 [0·38-0·84], p=0·005; Asian American vs White, aOR 0·38 [0·20-0·72], p=0·003; Mixed Race vs White, aOR 0·35 [0·19-0·64], p=0·001; Hispanic vs non-Hispanic, aOR 0·61 [0·42-0·89], p=0·010). On subgroup analysis of participants reporting depression symptoms, patients who identified their race as Black or African American, or American Indian or Alaskan Native, and those who identified as Hispanic ethnicity, were more likely to report a desire for provider cultural competence.

INTERPRETATION

Racial and ethnic disparities exist in how patients perceive their providers' cultural competence, and disparities are pronounced in patients with depression. Developing a culturally competent and humble approach to care is crucial for mental health providers.

FUNDING

None.