Desigualdad socioeconómica y salud mental: revisión de la literatura latinoamericana

Mental health among adolescents exposed to social inequality in Latin America and the Caribbean: a scoping review

Background and objective

Adolescents from Latin America and the Caribbean grow up in a context of social inequality, which diminishes their well-being and leads to impaired emotional-cognitive development. To understand the problem, it is important to synthesize the available research about it. This study aims to explore the knowledge about adolescents' mental health in Latin America and the Caribbean exposed to social inequality.

Methods

A systematic scoping review was conducted encompassing a search in five databases (Medline, CINAHL, PsycINFO, Scopus, and LILACS) in June 2022. Articles of various typologies were included without time limit. After two rounds of screening, relevant data were manually extracted and synthesized into self-constructed themes using thematic analysis.

Results

Out of 8,825 retrieved records, 42 papers were included in the final review, with a predominance of quantitative approaches. The synthesis revealed two main analytical themes: (a) defining social inequality, wherein intersecting inequalities produce discrimination and determine conditions for social vulnerability; (b) social inequality and mental health, which highlights the association between socio-structural difficulties and emotional problems, amplifying vulnerability to mental ill health and poor mental health care.

Conclusion

The scientific evidence reveals that social inequality is related to impaired well-being and mental ill health on the one hand and a lack of access to mental health care on the other hand.

A Longitudinal Study of the Psychological State of Teachers Before and During the COVID-19 Outbreak in Mexico

The COVID-19 outbreak significantly impacted people's lives. Within the education system, the teaching mode drastically changed to adapt to the social distancing restrictions due to the pandemic. Consequently, teachers have been facing challenges associated with remote learning in addition to those of the pandemic. The aim of the present study was to assess the psychological state among teachers at two stages: pre-pandemic (November 2019) and during the pandemic (June-July 2020 and June-July 2021). Information regarding demographic data, depression, anxiety, and stress (DASS-21), and burnout syndrome (MBI-ES) was collected using validated questionnaires. Results showed a significantly higher scores as well as a higher prevalence in the DASS-21 and the MBI-ES scales, on the second measurement taken during the pandemic compared to the pre-pandemic period and the first evaluation during the pandemic. During the second evaluation on pandemic stage, female teachers of ≥45 years of age with a college-level of education, 11 years of teaching experience, and currently teaching at preschools and primary schools were significantly associated with higher anxiety, stress, EE, and burnout scores. In addition, female teachers aged ≥45 years reported higher PD and PA scores. Finally, an association between burnout syndrome and depression was identified in the evaluations carried out during the pandemic considering both the total sample and the analysis per gender. The study shows that teachers' mental health has been negatively affected by the pandemic. Efforts from the education system and health authorities are crucial to design and implement strategies to improve teachers' mental health during the fight against COVID-19.

Role of the arts in the life and mental health of young people that participate in artistic organizations in Colombia: a qualitative study

BACKGROUND

Adolescents and young adults are vulnerable to developing mental distress. However, evidence suggests that more than half of the young people with symptoms of depression and anxiety overcome their distress within a year. However, there is little research on the exact resources that young people use and help them to recover. The aim of this study was to explore how arts activities can support the recovery of young people engaged with arts organizations in Bogota.

METHODS

We recruited 38 participants from two arts organizations in Bogotá and conducted six focus groups embedded within artistic workshops. The type of activities in the workshops varied reflecting the different teaching methods of the two organizations. The focus group discussions were recorded and analyzed using thematic analysis.

RESULTS

Five themes explained how arts activities can help young people participating in artistic organizations to overcome mental distress: i) allowing the expression of emotions; ii) helping to manage and transform emotions; iii) distracting from problems; iv) facilitating social support and relationships; and v) contributing to the identity of young people.

CONCLUSIONS

For young people who participate in artistic organizations, the arts are a resource for overcoming negative emotions such as anxiety, depression, and sadness. The beneficial role of arts activities includes different process of managing, expressing, and distracting from distress, and it differs depending on whether arts are perceived as a professional vocation or a hobby.

"Breaking Down": Afflictions and Treatments During Times of Crisis in Buenos Aires

Based on the ethnographic research carried out on speech-based therapies at health centers in marginalized areas of the Buenos Aires Metropolitan Area, this article problematizes the "breaking down" or "being broken" as a local language of afflictions that emerges from the rapidly deteriorating material living conditions related to downward social mobility. Specifically, I analyze how these discomforts turn into narrative in terms of economic and political subjective and collective crises, which combine and hybridize personal experiences with mainstream discourses of the country's recent history. Based on a brief analysis of the changing relationships between psychoanalysis and poverty in the Buenos Aires area, I also examine how speech-based approaches classify these afflictions as "social issues," external to their logic, as they resist to be entirely subdued to current psychological knowledge, categories, and techniques.

Working and non-working conditions related to the presence of depressive symptoms in women workers with subsistence jobs in the centre of Medellín, 2015-2019

OBJECTIVE

To determine the working and non-working conditions related to depressive symptoms in informal workers in the centre of Medellín in 2015-2019.

METHODS

Cross-sectional study with analytical intention and primary sources of information. Data collection with assisted survey in one of its union headquarters in 2016, after a pilot test and standardisation of pollsters. A total of 291 women workers were taken as a census, and their working and non-working conditions were explored.

RESULTS

The women had an average age of 45 years, ≤5 years of schooling, low and middle-income housing, and income below the 2016 minimum wage. About 60% suffered moderate-severe food insecurity, and received no state benefits. They were mainly the head of the family, with 1 or 2 dependents, and were responsible for the work at home. They worked at least 8 h a day, 6 or 7 days a week, with parents or relatives selling in the street, and at least 20 years in their work. About 60% had a partner, 21.6% with family dysfunction, and 15.4% moderate-severe depressive symptoms. Living in one room or a slum, with a low socioeconomic status and moderate-severe family dysfunction were associated with, and contributed to the explanation of, moderate-severe depressive symptoms.

CONCLUSIONS

The non-working conditions that are associated with and explain the moderate-severe depressive symptoms of female workers can be modified with actions that impact on the social determinants of health.

Health in Conflict Zones: Analyzing Inequalities in Mental Health in Colombian Conflict-Affected Territories

Objectives: Colombia’s civil conflict and persistent socio-economic disparities have contributed to mental health inequalities in conflict-affected territories. We explore the magnitude of mental health inequalities, contributing socio-economic factors, and sociodemographic characteristics that explain these differences.

Methods: The study draws on data collected in 2018, using the household survey Conflicto, Paz y Salud (CONPAS) applied to 1,309 households in Meta, Colombia. Logistic regression and decomposition analysis were used to analyze the risk of mental health disorders, measured with the Self-Reporting Questionnaire -20 (SRQ-20).

Results: Individuals with lower socio-economic status are at a higher risk for mental health disorders. Forced displacement accounts for 31% of the measured mental health inequalities. Disparities in employment, education level, disability and conflict incidence between municipalities are other contributing factors. Women and people with disabilities are respectively 2.3 and 1.2 times more prone to present a mental health disorder.

Conclusion: It is necessary to tackle the identified risk factors and sociodemographic circumstances that contribute to mental health inequalities in conflict-affected territories, as these hinder adequate/equitable access to mental health services.

Confirmatory Factor Analysis and Internal Consistency of the Suicidal Ideation Scale of the Center for Epidemiological Studies Depression Among Colombian Adolescents

The current study tested the one-dimensionality of the Center for Epidemiological Studies Depression Scale for Suicidal Ideation (CES-D-SI) and its reliability among high school students in Santa Marta, Colombia. A total of 1,462 tenth and eleventh-grade students from public and private schools completed the CES-D-SI. The students were between 13 and 17 years (M = 16.0, SD = 0.8), 60.3% were female, and 55.3% were in the tenth grade. A confirmatory factor analysis (CFA) was conducted, and the chi-square, root mean square error of approximation (RMSEA), comparative fit index (CFI), Tucker-Lewis index (TLI), and standardized root mean square residual (SRMR) statistics were calculated. The internal consistency of the dimension was calculated using Cronbach's alpha and McDonald's omega coefficients. The results of the CFA were as follows: chi-square = 26.51, df =2, p = .001; RMSEA = .092; 90% confidence interval = .063-.124; CFI = .983; TLI = .950; and SRMR = .019. Cronbach's alpha coefficient was .75, and McDonald's omega coefficient was .77. As conclusions, the scale exhibited a unidimensional structure similar to that in other studies and presented good reliability values. Hence, its use is recommended to screen suicidal ideation in school-aged adolescents in Santa Marta, Colombia.

Social inequalities and prevalence of depressive symptoms: a cross-sectional study of women in a Mexican border city, 2014

Objective.

To assess the association between intersectional disadvantage and clinically significant depressive symptoms (CSDS), describing the magnitude of social inequalities in the prevalence of symptoms among adult women in Tijuana, Mexico.

Methods.

This was a cross-sectional study. CSDS were assessed using the Centers for Epidemiological Studies Depression Scale among a probability sample of 2 345 women from 18 – 65 years of age in 2014. CSDS prevalence was calculated according to categories of three social stratifiers: socioeconomic status (SES), educational attainment, and fertility (number of children). Social inequality was measured with the slope index of inequality (SII) and the concentration index (CIx). Intersectionality among stratifiers was explored descriptively and with multivariable regression analysis.

Results.

CSDS prevalence was 17.7% (95%CI: 15.1% – 21.0%). The SII and CIx showed inequity in all social stratifiers. The absolute difference in CSDS prevalence between the lowest and highest ends of the SES gradient was 21.9% (95%CI: 21.5% – 22.4%). Among the most disadvantaged women, i.e., those at the intersection of lowest SES, lowest educational attainment, and highest fertility, the CSDS prevalence was 39.5% (95% CI: 26.0% – 52.9%).

Conclusions.

Disadvantage along multiple axes was associated with CSDS. Efforts to improve the mental health of women should include equity-oriented policies that address its social determinants.

Decir el malestar y malestar en el decir en los márgenes urbanos de Buenos Aires

Basada en la etnografía realizada en contextos de desigualdad y pobreza (2013-2017), este artículo problematiza las relaciones entre los mal-estares, los cambios en las las condiciones materiales de vida y las psicoterapias entre aquellos conjuntos que viven de trabajos precarios y flexibles en el área metropolitana de Buenos Aires. Específicamente, el objetivo consiste en examinar los modos de enunciación de ciertos mal-estares en términos de ensambles frágiles e inestables, hechos de diferentes materiales e insumos, orígenes, y cronologías en estos contextos sociales. Revisando las orientaciones y argumentos dominantes en la antropología del sufrimiento, se exploran otros modos de abordar estos mal-estares, por las características particulares que aquellos asumen en estas poblaciones.

When Life Becomes a Burden at the Urban Margins of Buenos Aires

Based on ethnographic research carried out in the metropolitan area of Buenos Aires, in this article, I analyze the logic of the burden for workers of segregated populations who live on the urban margins under the neoliberal regime. Unlike other languages of afflictions, the language of the logic of the burden resists being subdued completely to psy technologies. In this article, I argue that this challenges how development programs in Buenos Aires metropolitan areas have caused afflictions to people who live in contexts of urban poverty and seek their well-being, led by promises to reach it through work.

An assessment of awareness of mental health conditions and its association with socio-demographic characteristics: a cross-sectional study in a rural district in Bangladesh

Background

To assess the level of awareness, knowledge and help-seeking attitudes and behaviours in relation to mental health conditions (MHCs) and associations with socio-demographic characteristics of a rural district of Bangladesh.

Methods

We recruited 2425 adult samples (18–90 years) from a Cross-sectional study in Narial district of Bangladesh. Data on awareness, knowledge, help-seeking attitudes and practice in relation to six MHCs were collected. The MHCs were classified as common (depression, anxiety and drug addiction), and severe (psychosis, dementia and bipolar disorder). Associations of MHCs with socio-demographic characteristics were assessed using Chi-square tests. Rasch analysis was performed to transform the latent attribute (awareness) of MHCs from ordinal to interval scale. Multiple regression analysis was performed to determine how the socio-demographic characteristics contribute to the combined awareness score of MHCs.

Results

Of 2425 participants, 17 (0.7%) were cognizant of all the awareness construct of MHCs, and 1365 (56.28%) were not aware of any of MHCs. The prevalence of awareness of MHCs such as depression (8.5%), anxiety (6.2%), psychosis (3.5%), and bipolar disorder (3.3%), was found to be very low. Awareness was significantly lower in older adults, and in women. Higher levels of education (β 1.77, 95% confidence interval (CI): 1.58–1.97) associated with common MHCs and (β 0.81, 95% CI: 0.67–0.95) those associated with severe MHCs contributed significantly to increased awareness as opposed to having no or primary level of education. Availability of sufficient funds when applied to common MHCs (β 0.43, 95% CI: 0.26–0.61) and severe MHCs (β 0.25, 95% CI: 0.13–0.38) appeared to be more effective in boosting awareness compared to unstable financial situations. Almost 100% of the participants who were aware of the MHCs demonstrated positive attitudes towards seeking medical or psychological counselling.

Conclusions

Awareness of MHCs appeared to be very limited. However, knowledgeable participants were found to be very receptive to medical or psychological counselling. For improving awareness of MHCs need to conduct various intervention programs in particular those campaigns that focus on women, older adults, low SES and people up to the primary levels of education.

Electronic supplementary material

The online version of this article (10.1186/s12913-019-4385-6) contains supplementary material, which is available to authorized users.

Trastornos por consumo de sustancias: entre las inequidades y el estigma

Las personas que reúnen criterios para trastornos por consumo de sustancias (TCS) con frecuencia son víctimas del complejo estigma-discriminación (CED), no sólo por parte de la sociedad general, sino también por profesionales de la salud y la presencia de autoestigma. No obstante, la relación de los TCS con factores biológicos predisponentes y condiciones sociales adversas se considera que estos son ‘autoinducidos’. Asimismo, se conoce que en los TCS se presentan cambios biológicos, psicológicos o del desarrollo que menoscaban la decisión de abandono y la persistencia en el consumo, a pesar de las consecuencias negativas físicas, emocionales y sociales. El CED relacionado con el TCS es un estresor que deteriora aún más la calidad de vida de las personas consumidoras y, al mismo tiempo, se configura como una barrera de acceso a servicios de salud. Es necesario diseñar e investigar la efectividad de estrategias para reducir el CED relacionado con TCS en diferentes poblaciones y contextos.

A Review of Clinical and Economic Evaluations Applied to Psychotropic Therapies Used in the Treatment of Schizophrenia in Argentina

Schizophrenia is considered a serious mental disorder that affects over 21 million people worldwide, and is associated with disability that frequently affects the patient's educational and working performance. In Argentina, two of the most widely used antipsychotics in the treatment of this disorder are haloperidol and risperidone. Both are provided free to patients without health coverage in public healthcare facilities. In this paper we seek to review the clinical and economic benefits of prescribing psychotropic therapies based on haloperidol (a first-generation antipsychotic that is part of the butyrophenone group of drugs) versus risperidone [an atypical or second-generation antipsychotic (neuroleptic) drug] in adult patients who have been diagnosed with schizophrenia. To achieve this objective, an exhaustive search of relevant articles published between 2006 and April 2017 was conducted. This literature search showed that intermittent treatment usually fails to prevent relapses due to irregular protection, therefore continuous treatment is more effective. Although the injectable formats of both drugs [haloperidol depot and long-acting injectable risperidone (LAIR)] have not proven to have significant differences with regard to clinical effectiveness vis-à-vis the tablet formats, they showed a lower cost-effectiveness ratio by reducing patients' relapses. Moreover, LAIR exhibits superior cost effectiveness compared with haloperidol depot. Haloperidol is less expensive than risperidone but is less cost effective; in comparison with haloperidol, treatment with risperidone produces (1) an improvement in quality-adjusted life-years, and (2) a significant reduction in negative symptoms. In most cases, antipsychotic treatments are effective in controlling the positive and negative symptoms associated with schizophrenia, allowing patients to live in their communities without any impairments. However, it is extremely important to combine pharmacological treatment with other measures that constitute psychosocial therapy.

Prevalence and comorbidity of common mental disorders and associations with suicidal ideation in the adult population

OBJECTIVES

Little information exists on the association between comorbidities of mental disorders and suicidal ideation in developing countries. The current study examined the relationship between the presence of comorbid mental disorders and suicidal ideation in the adult population.

METHODS

This cross-sectional study was conducted using the cluster random sampling method in 3 steps. Data were collected from a household assets survey and the self-administered 28-item General Health Questionnaire as first step in screening, and the Persian version of the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition - Text Revision was used in the second stage to determine the prevalence of mental disorders. Bivariate and multivariate analysis were used to investigate the associations between mental disorders and suicidal ideation.

RESULTS

Of the 763 participants, 199 (26.1%) had 1 or more mental disorder. Forty-two (71.4%) subjects with comorbidities had a history of suicidal ideation, whereas 59 (7.7%) of all participants had a history of suicidal ideation. We found that major depressive disorder and obsessive-compulsive disorder were the most predictive of suicidal ideation in both sexes. The odds ratio for suicidal ideation associated with having 3 comorbid disorders was 2.70 (95% confidence interval [CI], 1.40 to 14.12) in males and 3.06 (95% CI, 1.25 to 15.22) in females.

CONCLUSIONS

Consistent with pervious data, our results confirmed that mental disorders and comorbidities of mental disorders were important predictors of suicidal ideation. Our findings are very useful for applied intervention programs to reduce the suicide rate in regions in which it is high.

Area-level disadvantage and alcohol use disorder in northern Mexico

BACKGROUND

In Mexico, the Northern States are highly impacted by alcohol consumption and associated problems. Little is known about the association between contextual social disadvantage and alcohol use disorder in this region.

METHODS

Information from 1265 current drinkers surveyed in the U.S.-Mexico Study on Alcohol and Related Conditions (UMSARC) was combined with official data on neighborhood disadvantage (index of urban marginalization, a composite of ten indicators of area-level social disadvantage) for 302 neighborhoods. Using statistical marginal models, we estimated the association of neighborhood disadvantage with alcohol use disorder (AUD; based on DSM-5 criteria), alone and with adjustment for individual and contextual covariates. We also tested for moderation of neighborhood disadvantage effects by sex, education, internal migration and border area.

RESULTS

There was a statistically significant increase in the odds of AUD of 59% (AOR=1.59; 95%CI=1.03, 2.46) for every one-point increase on the neighborhood disadvantage scale, after adjustment for covariates. A significant interaction between sex and neighborhood disadvantage was indicated by two measures of additive interaction (AP=0.55; p<0.001 and S=2.55; p<0.001), with higher neighborhood disadvantage related to higher prevalence of AUD for men but not for women. No moderation effects were observed for education, internal migration or border area.

CONCLUSIONS

Neighborhood disadvantage is a risk factor for AUD independent of other variables, specifically in men. Studies of contextual variables offer the possibility for understanding the role of collective circumstances on individuals in society. Future studies of alcohol use in this geographic area should consider effects of contextual determinants such as disadvantage.

[The challenge of inclusion in mental health: an analysis of a community center and its work with social bonds]

Social inclusion is a key component of transformations in mental health care, because it takes into account the benefits of community life for both those with mental illness and the other members of the community. In order to understand the scope of inclusion within mental health, 45 participants of a community center linked to a psychiatric hospital discharge program which explicitly seeks to provide social inclusion were interviewed. The possible changes in social relationships between users and other community members based in their sustained daily interactions in the community center were explored. Results suggest that the building of social bonds, as part of informal support networks, is one of the benefits of attending the community center. Positive changes in ideas regarding people with "mental illness" were also observed, although these ideas seemed to be more connected to the notion of integration than to social inclusion.

Psychotherapy, psychoanalysis and urban poverty in Argentina

Based on ethnographic research carried out in the Buenos Aires Metropolitan Area, this paper examines the views of social actors on the psychoanalytically-oriented psychotherapy focused on marginalized populations. From Foucault's perspective on the forms of truth-telling, the aim of this paper is to analyze, as a preliminary research report, treatments according to the native ways of speaking and listening, which dominate the description of therapeutic experiences of patients who come to the treatment without any professional intermediation. The neoliberal transformations of the past decades in Argentina changed both the landscape of the public health system and the daily lives of marginalized people. Considering such changes, this paper examines the ways in which verbal actions (speaking and listening) take place in psychotherapy and mark the course not only of treatments but also the temporal rhythms of their development, and their various levels of efficacy. Finally, the discussion focuses on how ways of speaking and listening in treatments are modeled not only by institutional dynamics but also by the characteristics these verbal activities take in everyday life under the logics of power that prevail over them.

Prevalence and Correlates of Hazardous Drinking among Female Sex Workers in 13 Mexican Cities

AIMS

To describe the prevalence and correlates of hazardous drinking among female sex workers (FSWs) at 13 sites throughout Mexico.

METHODS

FSWs (N = 1089) who were enrolled in a brief sexual risk reduction intervention (Mujer Segura) were queried about their sexual risk and substance use practices and their work contexts. Participants were classified as hazardous or non-hazardous drinkers based on the Alcohol Use Disorders test (AUDIT-C). Logistic regression models were used to examine individual, contextual, and community-level factors as correlates of hazardous drinking.

RESULTS

Ninety-two percent of participants reported alcohol consumption in the past month. Among drinkers (N = 1001), 83% met AUDIT-C criteria for hazardous drinking. Factors that were independently associated with hazardous drinking included: drug use in the past month (adjusted odds ratio (AOR) = 3.31; 95% CI 1.29-8.45), being a cigarette smoker (AOR = 1.71; 95% CI 1.13-2.58), being a barmaid or dance hostess (AOR = 3.40; 95% CI 1.95-5.91), alcohol use before or during sex with clients (AOR = 7.78; 95% CI 4.84-12.52), and working in a city with a higher marginalization index (AOR = 1.07; 95% CI 1.04-1.11).

CONCLUSIONS

Findings support the high prioritization by public health authorities of alcohol prevention and treatment programs for FSWs.

Socioeconomic and Geographic Inequalities of Internet Addiction in Korean Adolescents

The aim of this study was to evaluate the social economic and geographic influences on Internet addiction in Korean youth using the Korean Youth Risk Behavior Web-Based Survey. Middle and high school students (n=73,238) were randomly selected from the respondents to a web-based survey using two-stage stratified complex sampling. A Geographical Information System was used to generate a Korean map of the level of Internet addiction for each province and complex sampling lower case logistic regression was used to investigate the relationship between social economic status (SES) and Internet addiction. Gyeonggi-do and Gyeongsang-namdo provinces have a higher total scores of Internet addiction. There were associations between Internet addiction and low SES (OR=1.504, 95% CI 1.156-1.956, p<0.01). There may need to be at multilevel approach which recognizes the different levels of need in provinces as well as trying to understand why the differences arise at an individual level.

Social inequalities in mental health: results from the EU contribution to the World Mental Health Surveys Initiative

PURPOSE

The objective of the present study was to provide updated data from nine European countries about the impact of social inequalities in the prevalence of common mental disorders.

METHODS

Cross-sectional household survey of a representative sample of the adult general population of Belgium, Bulgaria, Germany, Italy, The Netherlands, Northern Ireland, Portugal, Romania and Spain. In total, 34,395 individuals were included. Social inequalities in 12-month mood, anxiety and alcohol-related disorders were evaluated.

RESULTS

In Europe, income seems not to be related to the prevalence of mental disorders. Unemployment and disablement are associated with mental disorders. Lower educational level augments the risk for mood disorders. Living in small (rural) areas decreases the risk for mood disorders and living in urban settings increases it. Northern Ireland, Portugal and Belgium are the countries with the highest risks for mental disorders.

CONCLUSIONS

Despite some contradictions with previous literature, in Europe there are social inequalities in the prevalence of mental disorders. However, income showed not to be associated with inequalities in mental health. Being younger, unemployed or disabled, with no education or incomplete primary studies, living in urban settings, and in Northern Ireland, Portugal or Belgium were associated to an augmented prevalence of mental disorders. Policy makers could focus on mental health promotion and mental disorders prevention programmes for risk groups such as unemployed/disabled individuals. Support to vulnerable groups (unemployed or those with less education) and mental health literacy can improve European citizens' mental health.

Effect of social capital and personal autonomy on the incidence of depressive symptoms in the elderly: evidence from a longitudinal study in Mexico

OBJECTIVES

To estimate the effect of social capital (SC) and personal autonomy (PA) on the depressive symptoms (DS) in older people living in poverty.

METHOD

Longitudinal study of elderly participants in the impact evaluation study of a non-contributory pension program in Mexico. For this study we selected the group of older people without significant DS at baseline. PA, SC indicators and covariates were measured at baseline. Using the Geriatric Depression Scale, the incidence of DS was assessed at a follow-up interview after 11 months. The effect of SC and autonomy on the occurrence of DS was estimated by using a multilevel logistic regression model.

RESULTS

Of the various indicators of PA, not being dependent in daily functioning, and being able to read/write were associated with lower risk of DS. A higher level of SC at baseline was associated with lower incidence of DS in women (odds ratio; OR = 0.73, p < 0.01), while for men there was no significant association (OR = 1.04, p = 0.69).

CONCLUSIONS

PA and SC proved to be protective factors against the onset of DS in women. For men, only PA was a protective factor. Future studies need to explore in what ways that PA and SC may reduce risk of DS as well as the role of gender differences.

Disordered eating and substance use among a female sample of Mexican adolescents

The relation between disordered eating and substance use was examined among Mexican female adolescents in a probabilistic sample of 2537 high school students in central Mexico, stratified by marginalization status and migratory intensity, obtained during 2006 ?2007 school year. The Brief Disordered Eating Questionnaire and the World Health Organization and United Nations Division of Narcotic Drugs recommendations for substance use assessments were used. Prevalence and odds ratios for disordered eating and substance use items were calculated separately across low and high marginalization groups. Study's implications and limitations are noted, as well as future research and prevention strategies are suggested.

Psychiatric disorders, comorbidity, and suicidality in Mexico

BACKGROUND

Prior studies have reported that psychiatric disorders are among the strongest predictors of suicidal behavior (i.e., suicide ideation, plans, and attempts). However, surprisingly little is known about the independent associations between each disorder and each suicidal behavior due to a failure to account for comorbidity.

METHODS

This study used data from a representative sample of 5782 respondents participating in the Mexican National Comorbidity Survey (2001-2002) to examine the unique associations between psychiatric disorders and suicidality.

RESULTS

A prior psychiatric disorder was present in 48.8% of those with a suicide ideation and in 65.2% of those with an attempt. Discrete-time survival models adjusting for comorbidity revealed that conduct disorder and alcohol abuse/dependence were the strongest predictors of a subsequent suicide attempt. Most disorders predicted suicidal ideation but few predicted the transition from ideation to a suicide plan or attempt.

LIMITATIONS

M-NCS is a household survey that excluded homeless and institutionalized people, and the diagnostic instrument used did not include an assessment of all DSM-IV disorders which would increase the comorbidity discussed here.

CONCLUSIONS

These results reveal a complex pattern of associations in which diverse psychiatric disorders impact different parts of the pathway to suicide attempts. These findings will help inform clinical and public health efforts aimed at suicide prevention in Mexico and other developing countries.

Intrahousehold disparities in women and men's experiences of water insecurity and emotional distress in urban Bolivia

This study is one of the first to examine the links connecting water insecurity, gender, and emotional distress. The article presents quantitative and qualitative analyses of interview data collected from randomly selected pairs of male and female household heads (n=48) living under the same household-level conditions of water insecurity., The results provide partial confirmation of past findings that women are more likely than men to be burdened with everyday water responsibilities. However, there were no significant differences between men's and women's experiences in household water emergencies (i.e., water shortages and last-ditch attempts to buy water) and reports on some measures of emotional distress (i.e., worry, annoyance, and anger with family members). The results suggest that intrahousehold gender disparities may be mitigated in times of severe water scarcity. The discussion raises questions about the comparability of men's and women's expressions of emotional distress.