Search

The prevalence of mental health problems constitutes an open challenge for modern societies, particularly for low and middle-income countries with wide gaps in mental health support. With this in mind, five datasets were analyzed to track mental health trends in Mexico City during the pandemic's first year. This included 33,234 responses to an online mental health risk questionnaire, 349,202 emergency calls, and city epidemiological, mobility, and online trend data.The COVID-19 mental health risk questionnaire collects information on socioeconomic status, health conditions, bereavement, lockdown status, and symptoms of acute stress, sadness, avoidance, distancing, anger, and anxiety, along with binge drinking and abuse experiences. The lifeline service dataset includes daily call statistics, such as total, connected, and abandoned calls, average quit time, wait time, and call duration. Epidemiological, mobility, and trend data provide a daily overview of the city's situation.The integration of the datasets, as well as the preprocessing, optimization, and machine learning algorithms applied to them, evidence the usefulness of a combined analytic approach and the high reuse potential of the data set, particularly as a machine learning training set for evaluating and predicting anxiety, depression, and post-traumatic stress disorder, as well as general psychological support needs and possible system loads.

IntroductionCardiovascular diseases (CVD) are the leading cause of death globally. This burden of disease is particularly high among healthcare workers (HCW). However, adherence to treatment of well-known cardiovascular risk conditions (CRC) still represents a challenge, even among healthcare workers (HCW). Since the identification of modifiable related factors is a prerequisite for developing effective public health interventions, the purpose of this study was to develop a predictive model for adherence to pharmacological treatment (APT) for CRC in HCW, using psychological variables related to CVD mortality, such as the type A behavior pattern, perceived stress, depression, anxiety and attitudes toward treatment adherence.MethodsAn anonymous online survey was completed by a non-probabilistic sample of 1,377 Mexican HCW from tertiary public hospitals, with a diagnosis of only one of the following CRC: ischemic heart disease, diabetes, high blood pressure or dyslipidemia. Sociodemographic questionnaires and self-reported measures were used to collect data: PSS-14 for perceived stress, Type A Behavior Pattern Withdrawal Scale, HADS for anxiety and depression symptoms, the Attitudes toward Medication Scale and the Therapeutics Adherence Scale for Patients with Chronic Diseases.ResultsAnxiety and depression symptoms were higher in the group with risk for non-adherence, while perceived stress and positive attitudes toward medication were higher in the group with likelihood of adherence (p ≤ 0.05). The Type A behavior pattern and sociodemographic variables did not differ between groups. In a regression model, positive attitudes toward medication and perceived stress doubled APT (OR = 2.04, CI95% = 1.39–2.97; OR = 2.02, CI95% = 1.71–2,39, respectively) whereas depression decreased its likelihood (OR = 0.61, CI95% = 0.58–0.73).DiscussionIn conclusion, psychoeducation for patients with CRC should include information on the advantages of medication for treating their condition, even if they are HCW. Promoting adaptative coping skills to handle daily stressful events, including their CRC, could reduce the level of stress that could increase their APT but also their cardiovascular risk. Moreover, our data provide evidence regarding the importance of identifying and treating depressive symptoms as part of the standard care of this population.

IntroductionPediatricians in training are a population at risk for anxiety and depression: they face long working hours, they are confronted with the suffering and death of a vulnerable population and may have personal characteristics that put them in danger. Nonetheless, few studies have looked at their prevalence and associated factors. We aimed to compare demographic, professional activities, adversities and perfectionism personality features between a group of pediatricians in training with depression and/or anxiety and a group of pediatricians in training without depression nor anxiety and, to identify the variables that increase the probabilities of depression and/or anxiety in pediatricians in training.MethodsPediatric residents who voluntarily answered an online survey distributed via personal and institutional social media channels from October 2019 to April 2021, as part of a cross-sectional study with medical specialists and residents from Mexico were included. Demographic information, professional activities and adversities, perfectionism personality features (Multidimensional Perfectionism Scale), depression and anxiety (ICD-11 PHC) were evaluated. For comparison purposes Chi-square tests (χ2) and independent sample t-tests were used. A logistic regression analysis was used to identify those variables that increase the probabilities of depression and/or anxiety.Results934 pediatric residents answered the survey. 11.6% reported having depression and 20% anxiety. Being single, a history of anxious or depressive episodes, being the resident in charge of a patient who died, aggressions from colleagues and a high concern for errors were associated with current depression and/or anxiety.DiscussionScreening for depressive and anxious symptoms should be routinely performed from entry to the residency to favor early intervention. A shift from promoting perfectionism to a more compassionate training could serve a population facing so many adversities.

IntroductionDespite the propagation of virtual mental health services for vulnerable groups during COVID-19 pandemic, the implementation and evaluation of remote evidence-based practices (EBP) to manage them in low- and middle-income countries remains scarce. In the current study, we describe and evaluate the implementation process and clinical impact of brief, remote, manualized EBP for crisis intervention and suicide risk management among healthcare workers attending patients with COVID-19 (COVID-19-HCWs) in Mexico.MethodsThe implementation process comprised community engagement of volunteer mental health specialists, creation of new clinical teams with different disciplines and skills, intervention systematization through manuals and education through 4-h remote training as main strategies. Mexican COVID-19-HCWs who had used a free 24-h helpline rated their pre- and post-intervention emotional distress. Therapists recorded patients’ pre-intervention diagnosis, severity, and suicide risk, the techniques used in each case, and their post-treatment perception of COVID-19-HCWs’ improvement at the end of the intervention.ResultsAll techniques included in the intervention manual were employed at least in one case (n = 51). At the beginning of the intervention, 65.9% of the COVID-19-HCWs were considered moderately ill or worse according to Clinical Global Impression-Severity (CGI-S) scores, whereas at the end, 79.4% of them were perceived as much or very much improved according to CGI-Improvement scores (CGI-I), and their emotional distress had been significantly reduced (p

Aim: This study aimed to identify whether clinicians’ gender, clinical experience, and personal attitudes influenced their perception of criminality of specific sexual behaviours, their judgments about criminal liability if mentally disordered, and the need for treatment as part of criminal settings for those having ICD-11 paraphilic disorders. Method: In a secondary analysis of data only vignettes with the least (do not meet paraphilic disorder diagnostic requirements) and most extreme (met paraphilic disorder diagnostic requirements) descriptions of ICD-11 frotteuristic, coercive sexual sadism, and exhibitionistic arousal patterns and related behavior were randomly presented to participants. A total of 1,101 clinicians rated one to three vignettes (a total of 1,884) answering questions regarding diagnosis, criminal features, and their own attitudes. Results: The ICD-11 diagnostic guidelines were adequately used to distinguish paraphilic disorders from non-pathological arousal patterns.Vignette severity was the most important predictor for clinicians’ determination that a crime was committed. Results showed an interaction of the classification of paraphilic disorders, clinicians’ gender, and personal attitudes with judgments about concepts associated with criminality, criminal liability if a diagnosis was indicated, and the need for treatment in forensic settings. Conclusions: Increased formal education, clinical training about these disorders, and evidence-based treatment guidelines are required to avoid biases that may come from preconceived ideas and personal attitudes. Laws and policies that unnecessarily restrict the treatment of these patients in non-forensic settings—for example, when the individual is distress about the arousal pattern but no crime has been committed—should be examined.

Fear of recurrence is one of the main affectations of cancer survivors. In Latin-American exist a lack of evidence on the subject and of valid instruments to measure it. The objective of this study was to determine the psychometric properties of the Concerns About Recurrence Scale in Mexican breast cancer survivors. An instrumental study was carried out with 200 women breast cancer survivors with a mean age of 53 years old and a mean survival of 52.5 months. A confirmatory factor analysis of the original version of the scale identified four factors that explained 77 % of the variance and satisfactory goodness of fit indicators: CFI = .967, TLI = .957, SRMR = .035, RMSEA = .071 as well as high internal consistency α = .945. Significant associations were also identified between general fear subscale, anxiety subscale of the HADS and total HADS score (r = .638 and r = .607; p = .01). The CARS presented adequate validity, reliability and factorial structure. It is recommended for usage in clinical care and research with Mexican breast cancer survivors.

Abstract Background In order to end the HIV epidemic by 2030, combination HIV prevention including pre-exposure prophylaxis (PrEP) should be widely available, especially for the most vulnerable populations. In Latin America and the Caribbean (LAC), only 14 out of 46 countries have access to PrEP. In Brazil and Mexico, PrEP has been provided at no cost through the Public Health System since 2017 and 2021, respectively. Thus, HIV physicians’ perspectives about PrEP and other prevention strategies may differ. This study aimed to compare awareness, knowledge, and attitudes related to PrEP and other prevention strategies among HIV physicians from Brazil and Mexico. Methods Cross-sectional, web-based survey targeting physicians who prescribe antiretrovirals from both countries. Participants answered questions on socio-demographic, medical experience, awareness, knowledge, and attitudes towards PrEP and other HIV prevention strategies. We stratified all variables per country and compared frequencies using Chi-square, Fisher exact, and Wilcoxon-Mann-Whitney tests, as appropriate. Results From January–October 2020, 481 HIV physicians were included: 339(70.5%) from Brazil, 276(57.4%) male, and median age was 43 years (IQR = 36–53). Awareness of PrEP did not differ between Brazil and Mexico (84.6%), while awareness of other prevention strategies, including post-exposure prophylaxis and new PrEP technologies, was higher in Brazil. More Brazilians perceived U=U as completely accurate compared to Mexicans (74.0% vs. 62.0%, P

Epidemiological evidence has linked an array of sociodemographic and psychosocial factors with an increased risk of developing psychosis. However, research in samples from low- and middle-income countries is still scarce. This study used a Mexican sample to explore (i) sociodemographic and psychosocial differences between individuals with and without a positive screen for Clinical High-Risk for psychosis (CHR), and (ii) sociodemographic and psychosocial factors associated with screening positive for CHR. The sample consisted of 822 individuals from the general population who completed an online survey. Of the participants, 17.3% (n = 142) met the CHR screening criteria. Comparisons between those who screened positive (CHR-positive group) and those who did not (Non-CHR group) showed that participants in the CHR-positive group were younger, had a lower educational level, and reported more mental health problems than the Non-CHR group. Furthermore, relative to the Non-CHR group, the CHR-positive group had a greater prevalence of medium/high risk associated with cannabis use, a higher prevalence of adverse experiences (bullying, intimate partner violence, and experiencing a violent or unexpected death of a relative or friend), as well as higher levels of childhood maltreatment, poorer family functioning, and more distress associated with the COVID-19 pandemic. Groups did not differ in sex, marital/relationship status, occupation, and socio-economic status. Finally, when examined in multivariate analyses, the variables associated with screening positive for CHR were: having an unhealthy family functioning (OR = 2.75, 95%CI 1.69–4.46), a higher risk associated with cannabis use (OR = 2.75, 95%CI 1.63–4.64), a lower level of education (OR = 1.55, 95%CI 1.003–2.54), having experienced a major natural disaster (OR = 1.94, 95%CI 1.18–3.16), having experienced a violent or unexpected death of a relative or friend (OR = 1.85, 95%CI 1.22–2.81), higher levels of childhood emotional abuse (OR = 1.88, 95%CI 1.09–3.25), physical neglect (OR = 1.68, 95%CI 1.08–2.61), and physical abuse (OR = 1.66, 95%CI 1.05–2.61), and higher COVID-related distress (OR = 1.10, 95%CI 1.01–1.20). An older age was a protective factor for screening positive for CHR (OR = 0.96, 95%CI 0.92–0.99). Overall, the findings highlight the importance of examining potential psychosocial contributors to psychosis vulnerability across different sociocultural contexts to delineate risk and protective processes relevant to specific populations and better target preventive intervention efforts.

AIM: This article describes the general characteristics of community-based mental healthcare in Mexico. METHODS: Data from national surveys, special studies and statistics from the national information system during the period 20012017 are used. Available information on health systems, new regulations and the innovations implemented are reviewed, as well as research on psychosocial interventions conducted within the country. RESULTS: Data show a fragmented health system with services for workers and those without social security or private care. This is a treatment system essentially based on tertiary healthcare and not integrated into the general health system, with a significant treatment gap and delay in relation to the first treatment. At the same time, a slow but steady increase in the level of care provided at primary healthcare level and in specialized community services has been observed. This trend has been accompanied by an increase in the number of medical doctors, psychologists and, to a lesser extent, psychiatrists, incorporated into the primary healthcare services. At the same time, no new psychiatric hospitals have been built; there has been a proportional reduction in psychiatric beds but no increase in mental health services or beds allocated to first contact hospitals. Research initiatives have analysed the barriers to reform, and efficient interventions have been developed and tested for the community and for primary healthcare; special interventions are available for the most vulnerable but no formal efforts have been to facilitate their implementation. CONCLUSIONS: Evidence is available regarding the implementation of the transition from reliance on tertiary healthcare to reinforced primary care. At the same time, parity, financial protection, quality and continuity of care remain major challenges.

BackgroundPsychiatrists are at high risk of developing burnout and mental health problems mainly due to their emotionally demanding jobs, difficult working conditions, long working hours, and poor work-life balance. As leisure activities are associated with better physical and mental health, engaging in these activities has been recommended as a measure to improve the wellbeing of healthcare workers. However, it is unclear the extent of which psychiatrists and trainees are involved in leisure activities, what type of activities they prefer, or how these impact their self-perceived health, stress, confidence in stress management, and satisfaction with their social support.ObjectiveThe aim of this study was to identify differences in self-perceived health, perceived stress, confidence in stress management, and satisfaction with social support, between psychiatrists and trainees who engage in different leisure activities, compared with those who do not.MethodsThis was a cross-sectional study, including Mexican psychiatrists (n = 355) and trainees (n = 330) who agreed to participate through an online survey.Results73.1% of participants engaged in some leisure activity, being solitary-passive activities the most reported. Those who have a leisure activity reported lower stress, greater confidence in stress management, and more satisfaction with their social support. Passive-solitary activities were associated with less perceived stress and better confidence in stress management, while active-solitary and social activities were associated with better satisfaction with social support.ConclusionPsychiatrists' and trainees' wellbeing benefits from engagement in leisure activities, which should be part of their daily schedules to reduce stress, and potentially improve their mental health.

The primary objective of this study was to evaluate the measurement of invariance by sex, age, and educational level of an online version of the Generalized Anxiety Disorder Scale in a five-item version (GAD-5). Configural, metric, scalar, and strict invariance were evaluated using data from 79,473 respondents who answered a mental health questionnaire during the COVID-19 pandemic in Mexico. The sex variable was classified as male or female; age was categorized as minors, youth, young adults, adults, and older adults; and educational level was divided into basic, upper secondary, higher, and graduate education. To test for configural invariance, confirmatory factor models were constructed. For metric invariance, equality restrictions were established for the factor loadings between the construct and its items; for scalar invariance, equality restrictions were established between the intercepts; strict variance implied the additional restriction of the residuals. Statistical analysis was performed in R software with the lavaan package. The results show that with respect to sex, age, and educational level, configural and metric measurement invariance was confirmed (ΔCFI < 0.002; ΔRMSEA < 0.015). However, with respect to scalar and strict invariance, the results showed significant differences regarding the fit model (ΔCFI > 0.002; ΔRMSEA > 0.015). We conclude that the GAD-5 presents configural and metric invariance for sex, age, and educational level, and scalar invariance for sex and age groups. However, the scale does not demonstrate strict invariance. We discuss the implications and suggest that this result could be related to the evaluation of sociodemographic variables.

Introduction. This article presents the history and rationales of conceptualization and classification of homosexuality and transgender identity in both ICD and DSM. We review the efforts that have been made (and those that remain pending) to improve psychiatric classifications with new scientific knowledge, changing social attitudes and human rights standards. Method. We conducted a literature search of the classification of homosexuality and transgender identity as mental disorders. Result. We provide a historical description of these concepts in ICD and DSM, including fundamental points of disagreement as well as arguments that have been effective in achieving changes in both classifications. Conclusions. Fundamental changes have been made in the International Classification of Diseases Eleventh Revision (ICD-11) in terms of the classification of sexual orientation and gender identity based on scientific evidence and the ICDs public health objectives. These changes might support the provision of accessible and high-quality healthcare services, and are responsive to the needs, experience and human rights of the populations involved.

BackgroundThe COVID-19 pandemic has created a public mental health crisis. Brief, valid electronic tools are required to evaluate mental health status, identify specific risk factors, and offer treatment when needed.ObjectiveTo determine the construct validity, reliability, and measurement invariance of a brief screening tool for mental health symptoms by sex, loss of loved ones, personal COVID-19 status, and psychological care-seeking during the COVID-19 pandemic. Furthermore, the aim involved establishing a predictive pattern between the mental health variables.MethodA total sample of 27,320 Mexican participants, with a mean age of 32 years (SD = 12.24, range = 18–80), 67% women (n = 18,308), 23.10% with a loss of loved ones (n = 6,308), 18.3% with COVID-19 status (n = 5,005), and 18.40% seeking psychological care (n = 5,026), completed a questionnaire through a WebApp, containing socio-demographic data (sex, loss of loved ones, COVID-19 status, and psychological care-seeking) and the dimensions from the Posttraumatic Checklist, Depression-Generalized Anxiety Questionnaires, and Health Anxiety-Somatization scales. We used the confirmatory factor analysis (CFA: through maximum likelihood to continuous variable data, as an estimation method), the invariance measurement, and the structural equational modeling (SEM) to provide evidence of the construct validity of the scale and the valid path between variables. We analyzed the measurement invariance for each dimension by comparison groups to examine the extent to which the items showed comparable psychometric properties.FindingsThe tool included eight dimensions: four posttraumatic stress symptoms -intrusion, avoidance, hyperactivation, and numbing, as well as depression, generalized anxiety, health anxiety, and somatization The tool’s multidimensionality, was confirmed through the CFA and SEM. The participants’ characteristics made it possible to describe the measurement invariance of scales because of the participants’ attributes. Additionally, our findings indicated that women reported high generalized anxiety, hyperactivation, and depression. Those who lost loved ones reported elevated levels of intrusion and health anxiety symptoms. Participants who reported having COVID-19 presented with high levels of generalized anxiety symptoms. Those who sought psychological care reported high levels of generalized anxiety, intrusion, hyperactivation, and health anxiety symptoms. Our findings also show that intrusion was predicted by the avoidance dimension, while health anxiety was predicted by the intrusion dimension. Generalized anxiety was predicted by the health anxiety and hyperactivation dimensions, and hyperactivation was predicted by the depression one. Depression and somatization were predicted by the health anxiety dimension. Last, numbing was predicted by the depression and avoidance dimensions.Discussion and OutlookOur findings indicate that it was possible to validate the factor structure of posttraumatic stress symptoms and their relationship with depression, anxiety, and somatization, describing the specific bias as a function of sociodemographic COVID-19-related variables. We also describe the predictive pattern between the mental health variables. These mental health problems were identified in the community and primary health care scenarios through the CFA and the SEM, considering the PCL, depression, generalized anxiety, health anxiety, and somatization scales adapted during the COVID-19 pandemic. Therefore, future studies should describe the diagnosis of mental health disorders, assessing the cut-off points in the tool to discriminate between the presence and absence of conditions and mental health cut-off points. Community and primary care screening will lead to effective early interventions to reduce the mental health risks associated with the current pandemic.LimitationsFuture studies should follow up on the results of this study and assess consistency with diagnoses of mental health disorders and evaluate the effect of remote psychological help. Moreover, in the future, researchers should monitor the process and the time that has elapsed between the occurrence of traumatic events and the development of posttraumatic stress and other mental health risks through brief electronic measurement tools such as those used in this study.

Objective: The mental health problems and perceived needs of healthcare workers involved with coronavirus disease (COVID-19) may vary due to individual and contextual characteristics. The objective of this study was to evaluate healthcare workers’ mental health problems during the common COVID-19 exposure scenario in Mexico, comparing those on the frontline with other healthcare workers according to gender and profession, determining the main risk factors for the most frequent mental health problems. Methods: A cross-sectional online study was conducted with a non-probabilistic sample of 5,938 Mexican healthcare workers who completed brief screening measures of mental health problems and ad hoc questions about sociodemographic professional characteristics, conditions related to increased risk of COVID-19 infection, life stressors during the COVID-19 emergency, and perceived need to cope with COVID-19. Results: The identified mental health problems were insomnia, depression, and posttraumatic stress disorder (PTSD), all of which were more frequent in frontline healthcare workers (52.1, 37.7, and 37.5%, respectively) and women (47.1, 33.0 %, and 16.3%, respectively). A lack of rest time was the main risk factor for insomnia (OR = 3.1, 95%CI 2.6-3.7, p ≤ 0.0001). Mourning the death of friends or loved ones due to COVID-19 was the main risk factor for depression (OR = 2.2, 95%CI 1.8-2.7, p ≤ 0.0001), and personal COVID-19 status was the main risk factor for PTSD (OR = 2.2, 95%CI 1.7-2.9, p ≤ 0.0001). Conclusion: The most frequent mental health problems during the common exposure scenario for COVID-19 in Mexico included the short-term psychological consequences of intense adversity. A comprehensive strategy for preventing mental health problems should focus on individuals with cumulative vulnerability and specific risk factors.

HIV self-testing (HIVST) is an essential tool within the combined HIV prevention package and has been available in Latin America since 2015. However, HIVST use among key populations remains low. This study describes awareness, willingness, and barriers to HIVST among MSM in Brazil, Mexico, and Peru. A cross-sectional web-based survey was advertised in two geosocial networking apps (Grindr and Hornet) and Facebook in 2018. We included cisgender men ≥18 years old who self-reported HIV-negative status. We used multivariable Poisson regression models to calculate adjusted prevalence ratios (aPR) to assess the factors associated with willingness to use HIVST for each country. A total of 18,916 completed the survey, 59% from Brazil, 30% from Mexico, and 11% from Peru. Overall, 20% of MSM had never tested for HIV. Awareness and willingness to use HIVST were higher in Brazil than in Peru and Mexico (p < .001). Across the countries, the patterns of association of willingness with HIVST barriers were similar. Most participants think post-test counseling is essential and that dealing with a positive result would be difficult (aPR 1.13 to 1.37, range of aPRs across the three countries). Having the knowledge to deal with a positive HIVST resulted in increased willingness to use HIVST (aPR range: 1.11 to 1.22), while a lack of trust in HIVST compared to HIV testing in clinics was inversely associated (aPR range: 0.80 to 0.90). In general, willingness to use HIVST was associated with higher income (aPR range: 1.49 to 1.97), higher education (aPR range: 1.13 to 1.42), and willingness to use PrEP (aPR range: 1.19 to 1.72). Efforts to increase HIVST knowledge and resolve perceived barriers are warranted, especially among MSM with lower income and education from Brazil, Mexico, and Peru. Personalized virtual counseling could be crucial among this population. In addition, those willing to use HIVST are also willing to use PrEP. It indicates that HIVST delivery could be incorporated into PrEP programs within the Brazilian Public Health System and eventually in Mexico and Peru.

Background: The health crisis associated with the COVID-19 pandemic is causally linked to negative mental health symptoms in the same way as other diseases such as Ebola.Objective: The purpose of this paper is to describe the relationship between mental health symptoms, binge drinking, and the experience of abuse during the COVID-19 lockdown.Method: We surveyed 9,361 participants, all Mexican, with an average age of 33 years old (SD = 10.86). In this group of people, we found out that 59% were single (5,523), 71% were women (6,693). Forty-six percentage were complying with lockdown procedures (4,286), 50% were partially complying (4,682), and 4% were not complying at all (393). The invitation to participate was open from April 24th to April 30th during the second stage of the pandemic in Mexico, in 2020, characterized by voluntary complete lockdown staying at home. Thus, we used a cross-sectional online survey design to assess mental health risk factors related to the COVID-19 pandemic. The survey was available on a WebApp designed by Linux®, PHP®, HTML®, CSS®, and JavaScript®. We calculated descriptive and inferential analysis to describe the mental health average distribution as a function of the lockdown, binge drinking, and experience of abuse. To calculate the reliability and validation of the subscales, we used Cronbach's Alpha and Factor Loading. We run the confirmatory factor loading analysis, and we described the relationship between each latent variable and its item factor load, obtained through structural modeling equations, derived from 179 iterations and 207 parameters (t[1,171] = 28,079.418, p < 0.001). We got a CFI of 0.947, a TLC of 0.940, an RMSEA of 0.049 (0.049–0.050), and an SRMR of 0.048.Findings: The results indicated that reported attitudes such as avoidance, sadness, withdrawal, anger, and anxiety were associated with acute stress, which was linked to an anxiety condition caused by uncertainty about achieving or maintaining overall good health.Discussion and Prospects: People in lockdown mentioned a sudden increase in alcohol consumption. They lived episodes of physical and emotional abuse, in contrast with those who stated that they did not go into lockdown or consume alcohol, or experienced abuse.Limitations: Further studies should diagnose mental health conditions as part of the impact of COVID-19, ensure their follow-up, and assess the effect of providing remote psychological care. There is a need to explore methods to curb the increase in the number of people affected by post-traumatic stress disorder.

Objective. To analyze the mental health care needs of the serious mental disorders (SMD) and factors associated with the use of services in Mexico. Materials and methods. A cross-sectional analytical study was conducted in two phases, the first with a national database of available services and its utilization; the second, a sample of medical records of a psychi­atric hospital. Results. Schizophrenia is the most prevalent MDS; more than 50% of those hospitalized were male, with an average age of 37 years. The use of services was associated with age (β=1.062, p=.000), family income (β=1.000, p=.000) and no laboral occupation (β=3.407, p=.000). The population with schizophrenia is four times more likely to require to be exempt from payment (β=4.158, p=.000). Conclusions. The population with SMD as schizophrenia is more vulnerable due to the associated functional and social disability and it requires specific heath interventions and a financial protection policy adapted to their mental health care needs.

IntroductionPrEP awareness in Latin America has been poorly characterized, with studies in Brazil, Mexico, and Peru highlighting awareness of 65% among gay, bisexual and other men who have sex with men (MSM). We assessed the association between higher risk of HIV infection, indicative of PrEP eligibility, and PrEP awareness among MSM from these countries.MethodsThis was a secondary analysis of a web-based survey advertised on social media platforms from March-June 2018 in Brazil, Mexico and Peru. Eligible individuals were cisgender MSM, ≥18 years old, HIV negative or of unknown status, who lived in these countries, and provided informed consent. Higher risk of HIV infection was defined as having 10 or more points in the HIV Risk Index for MSM (HIRI-MSM). We used multivariable Poisson regression models to calculate adjusted prevalence ratios (aPR) testing the association between higher risk for HIV and PrEP awareness.ResultsAfter exclusions, 19,457 MSM were included in this analysis. In Brazil, 53.8% were classified as higher risk for HIV, 51.9% in Mexico, and 54.2% in Peru. Higher risk for HIV was minimally associated with PrEP awareness among those in Brazil (aPR 1.04, 95% CI 1.01, 1.06), but no such association was observed in Mexico or Peru. Having more than a high school education, high income, daily use of geosocial networking (GSN) applications, and substance use were associated with PrEP awareness.ConclusionHigher risk of HIV infection was associated with increased PrEP awareness in Brazil. However, this association was weak indicating that PrEP awareness could be strengthened with further prevention efforts. In the remaining countries, results were non-conclusive between risk and awareness. Interventions to increase PrEP awareness are paramount to increase PrEP willingness and uptake and in turn prevent new HIV infections. Social media platforms could play an important role to achieve this goal.

Introducción: la evaluación como componente del proceso de enseñanza-aprendizaje centra la atención de directivos, docentes y estudiantes, por su relevancia, de dar a conocer los resultados en la formación del estudiante, la calidad del desempeño del docente y la eficacia del proceso educativo. Objetivo: demostrar la pertinencia de la evaluación formativa contextualizada en la disciplina Filosofía y Sociedad, de la carrera de Medicina, para la formación integral del profesional. Método: El estudio contempló aquellos métodos y procedimientos propios de una metodología cualitativa, como: entrevista, observación y análisis de documentos, con sus respectivas modalidades. Resultados: El análisis de los instrumentos evaluativos aplicados por el colectivo pedagógico del Departamento de Filosofía e Historia y sus resultados, los análisis de los controles a clases realizados en el periodo 2015 al primer semestre del curso lectivo, unido a las entrevistas individuales y grupales a docentes y estudiantes, constató que los docentes diseñan las evaluaciones homogéneas, sin considerar la diversidad en el aula, las características propias de los estudiantes, sus ritmos y estilos de aprendizaje; en los estudiantes se confirmó que se maximiza la ansiedad, la baja autoestima al no reconocerse el esfuerzo realizado e incluso manifiestan desmotivación por la asignatura. Conclusiones: La propuesta contribuye a modificar la evaluación de los aprendizajes del alumnado y elevar las exigencias de las competencias profesionales del profesor universitario, así como generar un clima de calidad de la enseñanza y desmitificar la aversión por la disciplina Filosofía y Sociedad, a través del empleo eficiente de métodos, técnicas e instrumentos evaluativos del aprendizaje formativo contextualizado, como herramienta valiosa para incidir en la formación integral del educando, además de retroalimentarnos del trabajo del docente que se realiza e incide en la eficacia del Proceso Docente Educativo. Palabras clave: evaluación, evaluación diferenciada, contextualizada, formativa, proceso de enseñanza-aprendizaje.

Objective: To describe self-reported experiences of gender incongruence related to discomfort and body changes to be more congruent to the desired gender, and to examine whether experiences of psychological distress related to gender identity were more strongly related to the experience of gender incongruence per se or to experiences of social rejection. Methods: This field study used a structured interview design in a purposive sample of transgender adults (aged >18 years or older) receiving health-care services in two main reference centers in Brazil. Results: A high proportion of participants (90.3%, n=93) reported experiencing psychological distress related to their gender identity and report having experienced social rejection related to their gender identity during the interview index period and that rejection by friends was the only significant predictor for psychological distress. Conclusions: Gender incongruence variables were not significant predictors of distress. This result supports the recent changes proposed by the Word Health Organization in ICD-11 to move transgender conditions from the Mental and Behavioral Disorders chapter to a new chapter on Sexual Disorders and Conditions Related to Sexual Health.

Como parte del desarrollo de la onceava versión de la Clasificación Internacional de Enfermedades y Problemas de Salud Relacionados (CIE-11), la Organización Mundial de la Salud está conduciendo una serie de estudios de campo de casos controlados utilizando un novedoso y potente método para evaluar la aplicación por parte de clínicos de las guías diagnósticas para los trastornos mentales y del comportamiento. Este artículo describe el estudio de campo de casos controlados para los Trastornos específicamente relacionados con el estrés. Con base en una metodología experimental de vinetas, ˜ 1.738 profesionales de la salud mental diagnosticaron casos estandarizados específicamente disenados ˜ para evaluar diferencias clave entre las guías propuestas para la CIE-11 y las que les corresponden en la CIE-10. Diversos cambios propuestos para la CIE-11, incluyendo la adición del TEPT complejo y del Trastorno por duelo prolongado, produjeron mejores decisiones diagnósticas en comparación con la versión previa del manual. Sin embargo, se identificaron también áreas en las que las guías no se aplicaron de manera consistente, como el requisito diagnóstico de re-experimentación para el TEPT, lo que informó revisiones específicas para mejorar las guías diagnósticas, que serán evaluadas en futuros estudios basados en la clínica con pacientes reales en escenarios relevantes.

Objective: Disorders characterized by “distressing unexplained somatic symptoms” are challenging. In the ICD-11 Primary Health Care (PHC) Guidelines for Diagnosis and Management of Mental Disorders (ICD-11 PHC), a new category, bodily stress syndrome (BSS), was included to diagnose patients presenting unexplained somatic symptoms. The present study investigated the association of BSS with anxiety, depression, and four subgroups of physical symptoms in a Brazilian primary health care (PHC) sample. Methodology: As part of the international ICD-11 PHC study, 338 patients were evaluated by their primary care physicians, followed by testing with Clinical Interview Schedule (CIS-R) and World Health Organization Disability Assessment Schedule, Version 2.0 (WHODAS 2.0). BSS was diagnosed in the presence of at least three somatic symptoms associated with incapacity. The association between anxiety, depression, and four subgroups of physical symptoms with being a BSS case was analyzed. Results: The number of somatic symptoms was high in the overall sample of 338 patients (mean = 8.4), but even higher in the 131 BSS patients (10.2; p < 0.001). Most BSS patients (57.3%) had at least three symptoms from two, three, or four subgroups, and these were associated with anxiety and depression in 80.9% of these patients. The symptom subgroup most strongly associated with “being a BSS” case was the non-specific group (OR = 6.51; 95%CI 1.65-24.34), followed by musculoskeletal (OR = 2,31; 95%CI 1.19-4.72). Conclusion: Somatic symptoms were frequent in a sample of PHC patients in Brazil. In the present sample, one third were BSS cases and met the criteria for at least two symptom subgroups, supporting the hypothesis that different functional symptoms are related to each other.

Introducción: el presente estudio evaluativo se centra en el proceso Enseñanza-Aprendizaje. Su objeto es: el instrumento evaluativo de la asignatura Morfofisiología IV. Objetivo: caracterizar la calidad del examen de dicha unidad curricular, aplicado a los estudiantes del primer año de la carrera de Medicina, de la Facultad de Ciencias Médicas de Holguín. Métodos: se identificaron las áreas de las ciencias básicas, y las preguntas utilizadas en el examen. Se determinó la correspondencia entre el fondo de tiempo de los contenidos y su exploración, y se realizó el análisis de los siguientes indicadores de calidad: índice de dificultad, índice de discriminación D, correlación del punto biserial y correlación alfa de CronbachResultados: en el examen, predominaron los contenidos de Bioquímica; no hubo correspondencia entre el fondo de tiempo dedicado a cada tema y la cantidad de ítems presentes ;y predominaron las preguntas de test objetivo. Ambos instrumentos fueron clasificados como medianamente fácil, con correspondencia entre el índice de dificultad por preguntas y su discriminación. El examen a través del coeficiente alfa de Cronbach, mostró confiabilidad en su consistencia interna. Conclusiones: a pesar de las diferencias encontradas, la calidad del instrumento aplicado demostró un examen medianamente fácil; lo que explica el elevado número de aprobados. Para diseñar estos instrumentos evaluativos, es necesario incrementar la preparación metodológica del Comité Académico de dicha especialidad. Palabras clave: evaluación, instrumento evaluativo, unidad curricular, indicadores de calidad.

Las metodologías basadas en viñetas se utilizan frecuentemente para examinar los procesos de toma de decisiones, incluyendo los de profesionales sanitarios. No obstante, existen dudas respecto a si las viñetas reflejan adecuadamente los fenómenos del “mundo real” permitiendo así resultados y conclusiones válidas. Ofrecemos una visión de las características, variaciones de diseño, fortalezas y debilidades de estos estudios para examinar cómo los profesionales forman juicios clínicos (como el diagnóstico y tratamiento). Siendo “híbridos” de las encuestas tradicionales y los métodos experimentales, estos estudios pueden ofrecer tanto la alta validez interna de los experimentos como la alta validez externa de las encuestas, al aislar múltiples factores predictivos del comportamiento de los clínicos. Un diseño adecuado para poner a prueba preguntas específicas acerca de los juicios y la toma de decisiones permite resultados altamente generalizables a la “vida real”, sin las limitaciones éticas, prácticas y científicas de los métodos alternativos (como la observación, el auto-informe, la evaluación de pacientes estandarizados, o el análisis de archivos clínicos). Concluimos con recomendaciones metodológicas que se ilustran tras una descripción del uso de las metodologías de viñetas para investigar las decisiones diagnósticas de los clínicos en los estudios de campo controlados de la clasificación de los trastornos mentales y del comportamiento en la CIE-11.

Objective: To compare the presence of criteria listed in the DSM-5 and ICD-10 diagnostic manuals in a Brazilian sample of transgender persons seeking health services specifically for physical transition. Methods: This multicenter cross-sectional study included a sample of 103 subjects who sought services for gender identity disorder in two main reference centers in Brazil. The method involved a structured interview encompassing the diagnostic criteria in the two manuals. Results: The results revealed that despite theoretical disagreement about the criteria, the manuals overlap regarding diagnosis confirmation; the DSM-5 was more inclusive (97.1%) than the ICD-10 (93.2%) in this population. Conclusions: Although there is no consensus on diagnostic criteria on transgenderism in the diversity of social and cultural contexts, more comprehensive diagnostic criteria are evolving due to society’s increasing inclusivity.

Objetivo: Explorar la relación entre las fuentes y el tipo de apoyo instrumental brindado a las mujeres con Cáncer de Mama (CM) con la modificación de roles y actividades cotidianas en las pacientes y sus allegados. Método: Se realizó un estudio cualitativo centrado en la etnografía de 9 pacientes con CM. A través del software MAXQDA v10, se hizo un análisis temático del discurso para posteriormente elaborar tablas cruzadas para el análisis de las variables en estudio. Resultados: Para estas mujeres, la familia nuclear constituye la principal fuente de apoyo instrumental, al mismo tiempo que son quienes suelen modificar más sus actividades cotidianas y roles sociales. Las mujeres con CM expresan dificultad para delegar principalmente actividades del hogar debido a 3 razones: la responsabilidad de madre, la sensación de utilidad y una ideología tradicional de género. Conclusiones: El impacto del cáncer en la mujer tiene consecuencias únicas, debido al papel central que ellas asumen en la vida familiar. Los movimientos funcionales, afectivos y relacionales que ocurren en la familia ante un diagnóstico de CM parece ser un hecho frecuente y de gran trascendencia, que ha sido poco estudiado en nuestra población. Estos aspectos deben ser considerados como un elemento importante en la comprensión y el soporte que se debe otorgar a las mujeres con CM y a sus familias.

Se examinaron las opiniones de psicólogos y psiquiatras de habla inglesa y española acerca de los diagnósticos problemáticos, ausentes y estigmatizantes en la CIE-10 y DSM-IV, y de la necesidad de una clasificación nacional. Se llevó a cabo un análisis de contenido de las preguntas abiertas de las encuestas de WHO-WPA y WHO-IUPsyS. Se incluyeron a 3.222 participantes de 35 países. El grupo diagnóstico considerado más problemático fue trastornos específicos de la personalidad, especialmente entre psiquiatras, por la falta de validez y de especificidad. El trastorno por estrés postraumático complejo fue el diagnóstico que se sugirió incluir con mayor frecuencia, sobre todo por psicólogos, para dar cuenta de los procesos y consecuencias distintos del trauma complejo. La esquizofrenia fue el diagnóstico que se consideró más frecuentemente como estigmatizante, principalmente por psiquiatras, debido a la falta de conocimiento público. Del 14,4% que percibieron la necesidad de una clasificación nacional, dos tercios fueron de África o Latinoamérica. Las razones fueron que se deben considerar la diversidad socio-histórica en la expresión de psicopatología, las diferencias en la percepción de lo que es o no patológico y la existencia de síndromes culturales. Se discuten las implicaciones para el desarrollo y diseminación de la CIE-11.

La depresión constituye un problema importante de salud pública. En el mundo, representa la cuarta causa de discapacidad en cuanto a la pérdida de años de vida saludables. En México ocupa el primer lugar de discapacidad para las mujeres y el noveno para los hombres. La depresión tiene una alta co-ocurrencia con otros trastornos como la ansiedad, el consumo de sustancias, la diabetes y las enfermedades cardiacas. Pese al impacto que tiene este trastorno, una gran proporción de personas no acude a tratamiento, retrasa mucho la búsqueda de ayuda, o bien no recibe la asistencia adecuada. El propósito de este ensayo es exponer el resultado de una breve revisión de investigaciones que permiten ubicar la depresión como un problema de salud pública en México. Se abordan la prevalencia y los factores asociados, las brechas de atención, el uso de servicios y los tratamientos disponibles. Al final se plantean algunas de las implicaciones para la investigación y para las políticas públicas.Depression is an important public health problem. It is the fourth cause of disease in the world in terms of lost years of healthy life. In Mexico, it ranks first in terms disability for women and ninth for men. There is a high comorbidity between depression and other mental disorders such as anxiety and substance abuse, as well as other serious and chronic physical conditions (e.g. diabetes, and heart disease). Despite the impact of depressive disorders in the quality of life of the population, there is a large proportion of people who don't get treatment, delaying seeking help and thus don't receive adequate assistance. The aim of this paper is to present an analysis of depression status in the Mexican population from a public health perspective; it includes prevalence and associated factors, gaps in care, characteristics of the use of services and treatments available. The paper concludes with a presentation of the implications for research and mental health policy in Mexico.

OBJECTIVE: To establish the relationship between affectivity and social support profile and the presence and severity of depression and anxiety among women with breast cancer. METHOD: 235 patients completed measures of depression, anxiety, affectivity and social support. RESULTS: Variables that predicted depressive symptoms were as follows: positive affectivity in last weeks, negative affectivity in last weeks, number of people that bring support to the patient, negative affectivity in general and illness time of evolution. Variables that predicted anxiety symptoms: negative affectivity in last weeks, positive affectivity in last weeks, negative affectivity in general and number of people that bring support to the patient. CONCLUSION: In congruence with previous reports among other kind of populations, a low average of positive affectivity and high negative affectivity explained depression and anxiety comorbidity. Additionally, more evidence about the association between these mental disorders and the level of social support is documented in patients with breast cancer.

The aim of the present study was to develop and to evaluate a guide to communicate the presence and treatment of Papanicolaou alterations that suggest dysplasia or cervical cancer. Method: A sample of 97 women with abnormal smear test referred to diagnosis and treatment at a third level hospital were interviewed pre and post an informative session systematized in the proposed guide, to compare the degree of information about their condition and treatment and their perception of emotional support from health professionals. Results: The communication guide were developed according evidence based treatment model. We documented a pre-post clinical and statistical difference in the level of information about their condition and treatment (3.97 + 3.15 vs. 8.15 + 2.65; t= -7.27, df= 53, p≤.0001), and a tendency of increment in the percentage of patients that perceived emotional support from health professionals (62.3% vs. 100%; chi square=31.18, df=1, p=.07). Conclusions: The guide presented here constitutes a useful material to improve communication of these conditions and its treatment among Hispanic women with low level of education.

OBJETIVO: O objetivo do estudo foi examinar o papel do gênero no endosso dos sintomas incluídos tanto na Classificação Internacional de Doenças-10ª Edição quanto no Manual Diagnóstico e Estatístico de Transtornos Mentais-4ª Edição. MÉTODO: Seiscentos pacientes tratados por problemas ligados ao álcool em serviços ambulatórios de saúde no México foram avaliados com o Módulo sobre Abuso de Substâncias da Composite International Diagnostic Interview. RESULTADOS: A análise fatorial confirmatória com a Classificação Internacional de Doenças-10ª Edição e o Manual Diagnóstico e Estatístico de Transtornos Mentais-4ª Edição produziu dois fatores, que incluíram uma combinação de abuso/uso nocivo de álcool e sintomas de dependência, que explicaram 40% e 49,2% da variância total, respectivamente. No grupo de pacientes abuso/uso nocivo, os sintomas e as consequências sociais diferiram entre os gêneros: síndrome de abstinência, falta de controle e problemas jurídicos foram mais frequentes nos homens, enquanto as mulheres apresentaram maiores taxas de tentativas de abandonar o álcool e dificuldades para realizar atividades diárias. Fatores específicos de gênero diferenciaram abuso/uso nocivo da dependência, como a perda de controle e o tempo gasto para beber, no caso dos homens, e do desejo de beber entre as mulheres, de acordo com os critérios de dependência do Manual Diagnóstico e Estatístico de Transtornos Mentais-4ª Edição, e presença de sintomas físicos em homens, problemas sociais/família, e desejo e esforço fútil de parar de beber em mulheres, segundo o critério de dependência da Classificação Internacional de Doenças-10ª Edição. CONCLUSÃO: Futuros sistemas de classificação da toxicomania devem levar em conta as diferenças entre os sexos, a fim de ajudar a suprimir a lacuna de tratamento para as mulheres.OBJECTIVE: The objective of the study was to examine the role of gender in the endorsement of symptoms included in both the International Classification of Diseases-10th Edition and the Diagnostic and Statistical Manual of Mental Disorders-4th Edition. METHOD: Six hundred patients treated for alcohol-related problems in outpatient services in Mexico were evaluated with the Substance Abuse Module of the Composite International Diagnostic Interview. RESULTS: Confirmatory factor analyses using the International Classification of Diseases-10th Edition and Diagnostic and Statistical Manual of Mental Disorders-4th Edition criteria produced two factors that included a combination of abuse/harmful alcohol use and dependence symptoms, which explained 40% and 49.2% of the total variance, respectively. In the abuse/harmful use groups of patients, symptoms and social consequences differed according to gender: withdrawal syndrome, lack of control and legal problems were more frequent in men, while women exhibited higher rates of attempts to give up alcohol and difficulties to accomplish daily activities. Specific gender-related factors differentiated abuse/harmful use from dependence, such as loss of control and time spent to drink in the case of men and desire to drink among women, according to the Diagnostic and Statistical Manual of Mental Disorders-4th Edition dependence criteria; and presence of physical symptoms in men and family/social problems, craving, and futile effort to stop drinking in women, according to the International Classification of Diseases-10th Edition dependence criteria. CONCLUSION: Future classification systems of substance abuse disorders should take into account differences between genders in order to help closing the treatment gap for women.