Depression in Rural Communities and Primary Care Clinics in Chiapas, Mexico

To gather is to heal: Women's mental health circles in rural Chiapas, Mexico

In the rural villages of the Sierra Madre region of Chiapas, women experiencing hardship show signs of emotional distress that are diagnosed as depression and anxiety by health professionals. In this study, we critically analyze the impact of a pilot mental health group intervention (Women's Circles) facilitated by community mental health workers. The intervention consisted of eight structured sessions that included psychoeducation from a gender perspective, mindfulness exercises, interactive activities, arts and crafts, and sharing personal experiences. We carried out participant observation and 27 semi-structured interviews with the participants. The main outcomes were, first, that participants' moods improved, and second, that the improvement was mainly due to gathering with others and having someone to talk to. In addition, we observed that lessons during the Circles were often prescriptive, which, rather than creating a space for reflection on personal experiences, imposed globalized views of mental health and gender. In sum, we describe both the positive impact this program had on mental well-being and the problematic spreading of psychoeducation.

Risk Factors for the Mental Health of Adolescents from the Parental Perspective: Photo-Voice in Rural Communities of Ecuador

Mental health in adolescence is a very important topic worldwide, especially in rural areas. The implementation of Participatory Action Research (PAR) through the photo-voice method was a way to encourage adults to recognize problematic situations (at personal, family or community levels) that threaten the well-being of adolescents, but that in everyday life may go unnoticed by parents and caregivers. Our study aimed to identify risk factors for mental health in adolescents living in rural communities of Ecuador from the parental perspective through photographs and focus group discussions. The study sought to raise awareness of this issue at the family and community levels. The photo-voice method was conducted with the participation of 29 parents. The photographs and the collaborative construction of meanings allowed parents to have a better understanding about the importance of mental health and its benefit for adolescents. The principal risk factors mentioned by parents were stress, sleep deprivation, tiredness, poverty, difficulties in continuing education and alcohol consumption. In conclusion, we point out the importance of this intervention to explore the knowledge and understanding of the topic by parents as well as to communicate information that demystifies false beliefs around mental health.

Protecting vulnerable communities and health professionals from COVID-19 associated mental health distress: a comprehensive approach led by a public-civil partnership in rural Chiapas, Mexico

BACKGROUND

The COVID-19 pandemic has stricken mental health worldwide. Marginalized populations in low- and middle-income countries have been the most affected, as they were already experiencing barriers to accessing mental health care prior to the pandemic and are unequally exposed to the stressors associated with the health emergency, such as economic ravages or increased risk of complicated disease outcomes.

OBJECTIVE

The aim of this paper is to describe a comprehensive initiative resulting from a public-civil partnership to address the increased burden of mental health illness associated with the COVID-19 pandemic in rural Chiapas, Mexico.

METHODS

To address the emerging health needs of the general population and health professionals resulting from the pandemic, Compañeros En Salud (CES), a non-profit civil society organization based in Chiapas, implemented a comprehensive strategy to compensate for the shortage of mental health services in the region in collaboration with the Chiapas Ministry of Health. The strategy included three components: capacity building in mental health care delivery, psychosocial support to the general population, and provision of mental health care to CES collaborating staff. In this capacity building article, implementers from CES and the government share descriptive information on the specific interventions carried out and their beneficiaries, as well as a critical discussion of the strategy followed.

RESULTS

Through this strategy, we have been successful in filling the gaps in the public health system to ensure that CES-served populations and CES-collaborating health professionals have access to mental health care. However, further studies to quantify the impact of this intervention in alleviating the burden of mental health illnesses associated with the pandemic are needed.

CONCLUSIONS

The current situation represents an opportunity to reimagine global mental health. Only through the promotion of community-based initiatives and the development of integrated approaches will we ensure the well-being of marginalized populations.

Socioeconomic Factors Related to Prevalence, Severity, and Contact Coverage of Depression in Primary Health Care

Background

We determine factors related to the prevalence, severity, and contact coverage of depression using the Patient Health Questionnaire-9.

Methods

This cross-sectional study included 1059 individuals who applied to primary health care in Ankara before the onset of pandemic restrictions. Contact coverage was evaluated to include mental health care users.

Results

The prevalence of depression was 22.9%. Individuals who were unemployed (OR: 3.832; 95% CI: 2.053-7.151), women (OR: 1.646; 95% CI: 1.158-2.340), those without social support (OR: 1.933; 95% CI: 1.219-3.065), those who did not receive formal education (OR: 2.631; 95 % CI: 1.312-5.275), lower-income group (OR: 1.528; 95% CI: 1.071-2.180), and unmarried or divorced (OR: 2.644; 95% CI: 1.324-5.281) were found to be at risk of developing depression. Based on the linear regression model including patients diagnosed with depression, individuals who were unemployed (standardized β: 0.190), women (standardized β: 0.075), those without social support (standardized β: 0.096), and those who were unmarried or single (standardized β: 0.147) had the highest scale scores. Contact coverage for depression was 31.0%. Contact coverage was more likely in the upper-income group (OR: 2.239, 95% CI: 1.173-4.273).

Conclusion

Although depression is common among primary health care applicants, contact coverage is low. Developing screening programs for depression in primary health care may help improve community mental health. Socioeconomic factors that contribute to the emergence, severity, and contact coverage of depression indicate health inequalities. The development and severity of depression are mostly due to unemployment, which suggests the importance of employment-enhancing policies.

Prevalence of Depression and Generalized Anxiety Disorder Among Mexican Indigenous Adolescents and Young Adults: Challenges for Healthcare

Providing evidence on mental disorders in indigenous adolescents is critical to achieving universal health coverage (UHC). The prevalence of symptoms of depression and generalized anxiety disorder symptoms were estimated for 2082 adolescents aged 14-20 years in Chiapas, Mexico. Mental disorders were assessed using the 9-item Patient-Health Questionnaire and the 7-item Generalized Anxiety Disorder Scale. Among the adolescents evaluated, 35.8% suffered from depression or generalized anxiety disorder. Of those, 6.1% reported a previous diagnosis. 32.1% of adolescents with both mental disorders reported having attempted suicide. Gender, substance use, adverse living experiences and living conditions were correlated to the presence of depression and/or generalized anxiety disorder. It is mandatory for Mexican health authorities to develop effective instruments aiming to screen and diagnose mental health conditions in adolescents, as well as to provide timely treatment in primary health-care units.