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.

Atención Primaria en Salud en una región de la Amazonía colombiana: una aproximación al cotidiano

RESUMEN En 2016 comenzó en Colombia la implantación de un nuevo modelo de salud con foco en la atención primaria, siendo Guainía, en la Amazonía colombiana, la primera región en iniciar el test piloto. El objetivo de este estudio fue comprender el cotidiano de implementación de la atención primaria, en el marco del Modelo Integral de Atención en Salud, desde la perspectiva de indígenas y profesionales de la salud en Guainía, Colombia. Se trata de un estudio de caso único, con abordaje cualitativo, fundamentado en la sociología comprensiva del cotidiano. Los datos, recolectados mediante observación directa y entrevistas semiestructuradas con 26 profesionales de salud y 22 usuarios indígenas, fueron sometidos a análisis de contenido temático. Emergieron cinco categorías: ‘vivir en el puesto’, ‘resolver solo’, ‘el desafío de la cobertura territorial’, ‘comisiones de salud: solventando vacíos’ y ‘apoyo de líderes locales’. A pesar de la propuesta reestructurante traída por el nuevo modelo, se evidenció en el cotidiano la persistencia de un enfoque asistencialista y basado en la lógica curativista en la prestación de los servicios. Aunque los atributos de la atención primaria se ven comprometidos, se identificaron acciones cotidianas que pueden favorecer la integralidad en la atención y aportar a una transición exitosa.

Interculturality in the daily routine of primary health care: The case of the health model in Guainía, Colombia

Colombia is currently implementing a new health model, which is being tested initially in a region of the Amazon, with the main objective of primary health care with an intercultural approach. It is a cut of a doctoral thesis outlined by the case study methodology, which aimed to understand the daily construction process of primary health care from the perspective of indigenous and health professionals in Guainía, Colombia. Twenty-two indigenous users and 26 health professionals participated in the study, as well as three key participants. The data were collected through semi-structured interviews and direct observation, and were later transcribed and analyzed by Bardin's thematic content analysis technique. The results show that interculturality, as a permanent process of negotiations and articulations present in the daily lives of indigenous and health professionals, is a fundamental part of the construction of primary health care in Guainía. In it materializes the encounter and exchange of heterogeneous forms of thinking-knowledge, that allow new interpretations and reinventions of knowledge and practices in health, although this process is permeated by conflicts, ambiguities, asymmetries and contradictions.