RESUMO
Background: Healthcare providers are one of the main groups that contribute to the stigmatization of people with mental disorders. Apathy, accusation, fatalism, and morbid curiosity are the most common forms of stigmatization encountered, and these are associated with inadequate treatment, reduced treatment adherence, decreased help-seeking behavior, an increased risk of relapse, and complications with other medical conditions. The aim of this study was to examine the psychometric properties of an adapted Spanish version of the Opening Minds Stigma Scale (OMS-HC) for healthcare providers in Mexico and identify certain stigmatizing attitudes within this group. Methods: An ex-post facto cross-sectional observational study was conducted with 556 healthcare providers in Mexico, with an average age of 29.7 years, who were mostly women (80.4%). Validity was examined through confirmatory factor analysis. Differences according to gender, discipline, occupation, and educational level were analyzed using multivariate methods. Results: The factor structure of the OMS-HC, consisting of three subscales identified by the original authors of the instrument (attitudes of healthcare providers towards people with mental illness, secrecy/help-seeking, and social distance), was confirmed. The model demonstrated good fit (x2/df = 2.36, RMSEA = 0.050, CFI = 0.970, TLI = 0.962, SRMR = 0.054, NFI = 0.950, PNFI = 0.742). Internal consistency was found to be adequate (α = 0.73, ω = 0.76) for the scale itself and slightly lower than acceptable for the subscales. Significant differences were found by discipline, educational level, and, for student providers, by academic semester. Higher scores were observed on the OMS-HC scale among nursing and medical professionals, undergraduate students, and those in early semesters. Conclusions: The Spanish version of the OMS-HC has demonstrated adequate psychometric properties and could be a useful tool to facilitate research on this topic in Mexico, and to carry out comparative studies with healthcare personnel in other Spanish-speaking countries.
Assuntos
Atitude do Pessoal de Saúde , Pessoal de Saúde , Humanos , Feminino , Adulto , Masculino , Psicometria , Estudos Transversais , México , Pessoal de Saúde/educaçãoRESUMO
Hundreds of thousands of undocumented Mexican immigrants were deported from the United States or returned to Mexico voluntarily in the past two decades, taking with them their US-born citizen children (USCC). A family's relocation-forced deportation or voluntary return-and the subsequent settlement and adjustment to Mexico affect everyone's well-being. We interviewed 18 USCC whose parents were forcibly deported and 18 whose parents returned voluntarily about their circumstances, experiences, and perceptions. Four categories of relocation and adjustment issues emerged. USCC with deported parents felt the sudden and harsh arrest, detention, deportation, and separation from parents, and family reunification after deportation. Those in the voluntary-return group told of concerns about the planned separation and relocation to Mexico. Both groups experienced issues of family reintegration and adjustment to a new environment. While relocation prompted similarities and differences in families' settlement, issues unique to families played a part in children's adjustment. Clinicians in both the United States and Mexico must take into consideration the nature of the relocation, families' distinctive reactions, and the individual child's experience as some USCC will remain in Mexico and others will return to the US Mexican clinicians will encounter USCC still settling and adjusting to Mexico, and USCC who decide to remain permanently in Mexico. US clinicians may encounter USCC facing the challenges of re-entering American society, joining educational institutions, and becoming part of the labor force. USCC forming families may feel the impact of their pasts in parenting dynamics.
Assuntos
Deportação , Pais , Criança , Humanos , Estados Unidos , México , Poder Familiar , EmoçõesRESUMO
INTRODUCTION: Implementation of evidence-based care for heavy drinking and depression remains low in global health systems. We tested the impact of providing community support, training, and clinical packages of varied intensity on depression screening and management for heavy drinking patients in Latin American primary healthcare. MATERIALS AND METHODS: Quasi-experimental study involving 58 primary healthcare units in Colombia, Mexico and Peru randomized to receive: (1) usual care (control); (2) training using a brief clinical package; (3) community support plus training using a brief clinical package; (4) community support plus training using a standard clinical package. Outcomes were proportion of: (1) heavy drinking patients screened for depression; (2) screen-positive patients receiving appropriate support; (3) all consulting patients screened for depression, irrespective of drinking status. RESULTS: 550/615 identified heavy drinkers were screened for depression (89.4%). 147/230 patients screening positive for depression received appropriate support (64%). Amongst identified heavy drinkers, adjusting for country, sex, age and provider profession, provision of community support and training had no impact on depression activity rates. Intensity of clinical package also did not affect delivery rates, with comparable performance for brief and standard versions. However, amongst all consulting patients, training providers resulted in significantly higher rates of alcohol measurement and in turn higher depression screening rates; 2.7 times higher compared to those not trained. CONCLUSIONS: Training using a brief clinical package increased depression screening rates in Latin American primary healthcare. It is not possible to determine the effectiveness of community support on depression activity rates due to the impact of COVID-19.
Assuntos
Consumo de Bebidas Alcoólicas/psicologia , Alcoólicos/psicologia , Depressão/terapia , Adulto , Consumo de Bebidas Alcoólicas/efeitos adversos , Consumo de Bebidas Alcoólicas/prevenção & controle , Intoxicação Alcoólica/psicologia , Alcoolismo/diagnóstico , Colômbia/epidemiologia , Comorbidade , Atenção à Saúde , Depressão/psicologia , Transtorno Depressivo/psicologia , Transtorno Depressivo/terapia , Feminino , Humanos , Masculino , Programas de Rastreamento/métodos , México/epidemiologia , Pessoa de Meia-Idade , Peru/epidemiologia , Atenção Primária à Saúde/métodos , Atenção Primária à Saúde/tendências , Encaminhamento e Consulta , Detecção do Abuso de Substâncias/métodosRESUMO
In this study, we investigate the subjective experience of a group of individuals, diagnosed with schizophrenia, undergoing outpatient treatment in four psychiatric clinics in Mexico City. Our objective is to use the paradigm of intersectionality to explore the most common forms of stigma and discrimination faced by people with this illness, as well as the coping resources they employ. The major contribution of this study is its use of in-depth interviews and thematic analysis of the information obtained to identify the importance of sociocultural aspects of participants' experience of their illness. Schizophrenia, for them, was a problem of "nerves," whose origins were linked to magical or religious elements they attributed to their illness and which influenced their response to it. This resignification was useful to participants as a coping resource; it helped them find meaning and significance in their experience of the illness.
Assuntos
Adaptação Psicológica , Esquizofrenia/diagnóstico , Psicologia do Esquizofrênico , Estigma Social , Adulto , Relações Familiares , Feminino , Humanos , Relações Interpessoais , Masculino , México , Pessoa de Meia-Idade , Esquizofrenia/etnologia , Autoimagem , EstereotipagemRESUMO
This paper describes a plan for the attention of addictions from a public health perspective; it defines strengths of this perspective and its limitations to face the special challenges that the problem represents for social policies; adopts a wider perspective that includes the integration of health and social issues in measuring policy results having as a main aim the benefit of the person and of the communities with a perspective of the populations well being. It describes the challenge the country faces as producer, route of traffic and rates of consumption, analyzes briefly the evidence of public policies and makes a series of recommendations.
Assuntos
Saúde Pública , Transtornos Relacionados ao Uso de Substâncias/prevenção & controle , Guias como Assunto , Humanos , Internacionalidade , MéxicoRESUMO
This article forms part of a collaborative study in which research teams from Canada and Mexico participated. The general objective is to describe the cultural adaptation and semantic validation of three instruments for measuring stigma and mental illness in Mexico City. The criteria of understanding, acceptance, relevance and semantic integrity were used to adapt the following instruments: The Internalized Stigma Inventory (ISMI), the Opinions on Mental Illness Survey (OMI) and the Devaluation and Discrimination Scale (DDS). Four Individual interviews and four group interviews were carried out with 37 informants from different groups (health personnel, persons with diagnostic of mental disorders, relatives and the general population). Lastly, an analysis was carried out on the contents of the information obtained. The instruments proved to be culturally appropriate for the population in Mexico in the various groups studied. The adapted versions would be useful for establishing comparative analyses with other countries. The scope and limitations of the process of semantic equivalence were analyzed in the transcultural research.
Este trabajo forma parte de un estudio colaborativo en el que participan equipos de investigación en Canadá y México. El objetivo general consiste en describir el proceso de adaptación cultural y validación semántica de tres instrumentos de medición sobre el estigma y la enfermedad mental en la Ciudad de México. A partir de los criterios de comprensión, aceptación, relevancia e integridad semántica se adaptaron los siguientes instrumentos: el Inventario de Estigma Internalizado (ISMI), el Cuestionario de Opiniones hacia la Enfermedad Mental (OMI) y la Escala de Percepción de la Devaluación y Discriminación hacia la Enfermedad Mental (DDS). Para ello se llevaron a cabo cuatro entrevistas individuales y cuatro grupales con 37 informantes de diversos sectores (personal de salud, personas con diagnóstico de trastorno mental grave, familiares y población general). Finalmente se efectuó un análisis de contenido de la información obtenida. Los instrumentos adaptados fueron culturalmente apropiados para la población de los diferentes grupos estudiados en México. Las versiones adaptadas serán de utilidad para establecer análisis comparativos con otras regiones. Se analizan los alcances y limitaciones del proceso de equivalencia semántica en la investigación transcultural.
RESUMO
El artículo presenta una propuesta para la atención del problema de las adicciones desde un enfoque de salud pública, define sus alcances y limitaciones frente a los retos del fenómeno, especialmente para la formulación de políticas; se suma a las propuestas que buscan integrar los temas sociales en la evaluación del resultado de las acciones y que proponen como meta última el bien de la persona y de las comunidades con una perspectiva de bienestar para la población. Describe el reto que enfrenta México en su papel como país productor, de tránsito y de consumo, analiza brevemente la evidencia sobre las políticas públicas y hace una serie de recomendaciones al respecto.
This paper describes a plan for the attention of addictions from a public health perspective; it defines strengths of this perspective and its limitations to face the special challenges that the problem represents for social policies; adopts a wider perspective that includes the integration of health and social issues in measuring policy results having as a main aim the benefit of the person and of the communities with a perspective of the populations well being. It describes the challenge the country faces as producer, route of traffic and rates of consumption, analyzes briefly the evidence of public policies and makes a series of recommendations.
Assuntos
Humanos , Saúde Pública , Transtornos Relacionados ao Uso de Substâncias/prevenção & controle , Guias como Assunto , Internacionalidade , MéxicoRESUMO
This paper offers a conceptual overview of a neglected field. Evidence is presented to suggest that, globally, addiction is sufficiently stressful to cause pain and suffering to a large but uncounted number of adult affected family members (AFMs), possibly in the region of 100 million worldwide. A non-pathological stress-strain-coping-support model of the experience of AFMs is presented. The model is based on research in a number of different sociocultural groups in Mexico, England, Australia and Italy and aims to be sensitive to the circumstances of AFMs in low and middle income countries and in minority ethnic and indigenous groups as well to those of majorities in wealthier nations. It highlights the social and economic stressors of many kinds which AFMs face, their lack of information and social support, dilemmas about how to cope, and resulting high risk for ill-health. The public sector and personal costs are likely to be high. Attention is drawn to the relative lack of forms of help designed for AFMs in their own right. A 5-Step form of help aiming to fill that gap is briefly described. Family members affected by addiction have for too long been a group without a collective voice; research and action using the model and method described can make a contribution to changing that state of affairs.