Construcción de significados acerca de la salud mental en población adulta de una comunidad urbana marginal

• Autores: Fátima Flores Palacios, Jazmín Mora Ríos, Martha de Alba González
• Localización: Salud mental, ISSN 0185-3325, Vol. 26, Nº. 5, 2003, págs. 51-60
• Idioma: español
• Enlaces
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• Dialnet Métricas: 2 Citas
• Resumen
  • español

    Como parte de un estudio más amplio sobre representaciones sociales de la salud mental en población adulta de una comunidad urbana marginal, el objetivo de este trabajo consiste en conocer cómo se construyen los significados acerca de la salud mental, identificando la estructura del discurso de los entrevistados alrededor de este tema. La finalidad es lograr una aproximación más exploratoria y comprensiva de la manera en que le dan sentido y significado a los padecimientos emocionales en su vida diaria. La población de estudio pertenece a una comunidad del sur de la ciudad de México que se ubica en un asentamiento irregular que carece de todos los servicios (p. e. agua potable, drenaje, etc.).

    Se llevaron a cabo 16 entrevistas en profundidad con la población adulta de la comunidad, de la cual 70% fue de mujeres y 30% de varones. El rango de edades osciló entre los 27 y 58 años, y la edad promedio fue de 36 años. Los tópicos de estudio fueron los siguientes: a) descripción general de la comunidad, b) padecimientos percibidos y atribuciones en relación con los mismos, c) respuesta frente a estos malestares, d) redes sociales de apoyo y búsqueda de atención y e)significados de los conceptos relacionados con la salud mental. El análisis cualitativo de la información obtenida a partir de las entrevistas se efectuó mediante dos estrategias: a) análisis temático y b) análisis textual.

    El análisis temático se basó en la identificación de categorías y subcategorías a partir de las áreas de estudio. Para efectos de este trabajo, sólo se incluyeron la percepción de los padecimientos y las fuentes de preocupación. En los aspectos relacionados con la salud mental, el consumo de alcohol en adultos varones, el uso de drogas en adolescentes y la violencia intrafamiliar fueron los padecimientos más importantes percibidos en la comunidad; otras problemáticas manifestadas en este último grupo fueron los problemas de lenguaje y los trastornos del aprendizaje en los niños.

    Hubo otras fuentes de malestar relacionadas con la inseguridad percibida en la colonia, la falta de servicios y la corrupción de líderes y autoridades. El análisis textual se realizó a través de un programa especializado Alceste, versión 4.5 que permite la exploración del discurso libre de los sujetos. Se identificaron cuatro clases que reflejan el universo de la vida diaria o el contexto dentro del cual se presentan los padecimientos y malestares emocionales en la población estudiada: a) familia y ciclo vital, b) trabajo doméstico y extradoméstico, c) organización política y comunitaria y d)aspectos emocionales y comunicación intrafamiliar.

    Mientras que el discurso sobre las emociones y el trabajo doméstico y extradoméstico es eminentemente femenino, el de la esfera de la política y el de la organización comunitaria pertenecen al dominio masculino. El discurso sobre estados emocionales fue el más importante para la población de estudio, discurso que parece estar en estrecha relación no sólo con los problemas y dinámicas intrafamiliares, sino también con las diferentes etapas de la historia de la familia, así como con las condiciones sociales y materiales de vida.

    Se discuten los hallazgos sobre las implicaciones que tiene el empleo de estrategias complementarias de análisis con la finalidad de brindar una visión más integral del contexto sociocultural bajo el cual se viven los padecimientos, lo que permite ampliar la definición de lo que constituye un problema de salud mental desde la perspectiva de los miembros de la comunidad, pues sólo de esta forma se evidencia de qué manera dicho problema está indisolublemente ligado con las inequidades sociales y económicas, la discriminación de género, la violencia política, la desnutrición y las precarias condiciones de salud.

  • English

    The situation in which Latin America lives and the implications that economical crises have on mental health are a reality for many families struggling for survival. Particularly in Mexico, problems related to health and social security are notoriously lacking among the poorest sectors mental health being one of the most unattended areas. Different studies have consistently reported low use of mental health services among urban population. Regardless of the diverse reasons which explain this situation, the meanings that people attribute to their emotional distress are not seriously considered by attention care programs, thus broadening the existent gap between health professionals and the population who receives these services. As part of a wider study on social representations of mental health in adult population of a marginal urban community, the goal of this work is to know how the meanings regarding mental health are built, by identifying the structure of the discourse on this matter provided by interviewees. Our objective is to offer an exploratory and comprehensive approach to the way people feel and confer meaning to emotional distress in daily live. The population under study belongs to a community of 3,016 inhabitants located in the south of Mexico City: it is a poor setting which lacks all public services: drinking water, drainage, street lighting, transportation, etc. Sixteen in depth interviews were held with the adult population of the community. Participants were aged between 27 to 58 years, with an average age of 36 years; 70% were women and 30% men. The topics of study were: a) general description about the community, b) ailments perceived in the community and attributions to them, c) responses to these ailments, d) social support networks and care seeking, e) meanings of mental health-related concepts. Qualitative analysis of information was completed through two different strategies: a) thematic analysis and b) textual analysis. Thematic analysis was based on the identification of categories and subcategories from the issues being studied. This work only includes data about perception of distress and the sources of concern. Alcohol use in male adults, as well as teenage drug use, and family violence were the most important problems perceived by the community. Other problems were language and learning difficulties in children.

    The perceived insecurity of the district, the lack of public services and the corruption of leaders and authorities were the most common sources of concern. Textual analysis - Alceste software program was used to study the distribution of the vocabulary of this particular corpus of words. It was used to explore the field of social representation as associated to mental health discourse. This is a mathematical text classifier based on the development of statistic techniques applied to linguistic or discursive data analysis according to Benzécri. This methodology is focused on the statistic distribution of words succession that compose the statements of the text, disregarding the discourses syntax but considering the "co-occurrence" or simultaneous presence of various lexical items (nouns, adjectives, verbs) in the same sentence and excluding "tool words" from the analysis (conjunctions, prepositions, articles, negatives, etc.). For practical means, the program divides the text into pseudo-statements known as "elementary context units" (ECU), formed by successions from 8 to 20 lexical items (nouns, adjectives, verbs). Descending hierarchical classification is the main statistical procedure carried out through this program, it is similar to cluster analysis and it is derived from correspondence factor analysis. The program groups the ECU into classes, associated to a particular vocabulary. To interpret the classes it is necessary to take into account the specific vocabulary within the class which characterizes a particular contextual field. Analysis yielded four types of semantic levels related to the universe of daily life or the context of sufferings and emotional distress present among the studied population: a) family and vital cycle, b) domestic and extradomestic work, c) political and community organization, and d) emotional aspects and communication within the family. While the discourse about emotions as well as about domestic and extradomestic work is basically a female discourse, the sphere about politics and community organization belong to the male domain. The discourse about emotional aspects was the most important for the participants. It is interesting because among this population it has traditionally been considered that mental health related problems are a secondary factor compared to other health problems. Emotional aspects seem to be closely related not only to family problems and dynamics but also to the different stages of the family history, as well as to social and material life conditions. These findings provide information about the gender importance regarding the use of spaces, in the area of work. Women talked a lot about their work at home, child rising, and about private space reserved for family relations and reproduction. Men's most representative discourse was about politics, and community, and political power. However, even when female and male gender roles are clearly defined at a social representation level in the community, men are expected to be economic providers for their families and women should dedicate exclusively to nursing and caring for their family. In practice, women have a very active participation not only inside their families, performing activities traditionally appointed to men (e.g., bricklayer assistant) to increase family income, but also participating in the community work to supply then with basic services (such as lighting, water, etc.) In this sense, women constitute a high risk group. Besides being the main economic suppliers for their families, they carry out other activities under stress conditions, "hidden" from their partners who often maltreat and abuse them. Our findings are discussed in regard to the implications of using both textual and thematic analyses to offer a more comprehensive approach of the socio-cultural context in which the distress is experienced by the social actors involved in these processes. This allows to widen the definition of how mental health problems are considered, from the community members’ perspective. Only in this way the indissoluble link between mental health problems and social economic inequities, gender discrimination, political violence, malnutrition and precarious health conditions will be evidenced