Panorama del trabajo de investigación en epidemiología psiquiátrica en México: últimos 30 años
- Autores: Alberto Jiménez Tapia, Ietza Bojórquez Chapela, Claudia Blas García, Virginia Landa Velasco, Jorge j. Caraveo Anduaga
- Localización: Salud mental, ISSN 0185-3325, Vol. 28, Nº. 3, 2005, págs. 69-78
- Idioma: español
- Enlaces
- Dialnet Métricas: 1 Cita
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Resumen
- español
Los marcos de salud mental y las políticas que permiten su aplicación no pueden aislarse del contexto social, de las condiciones de salud de la población ni de las tendencias internacionales.
La epidemiología psiquiátrica ha permitido avanzar en los estudios históricos, el diagnóstico comunitario, la evaluación de servicios de salud, la determinación de riesgos, la descripción de cuadros clínicos, la identificación de nuevos síndromes, y sus probables causas, y en la realización de encuestas representativas y transnacionales en población general.
Este trabajo cumple cuatro objetivos: 1. presentar una perspectiva de lo hecho en México en los últimos 30 años; 2. hacer un análisis de las principales áreas exploradas; 3. identificar los diseños empleados y 4. enumerar las poblaciones en que se ha trabajado.
Método: Se recopilaron los artículos relacionados con la epidemiología psiquiátrica en México. La búsqueda del material se realizó en la base de datos del CISMAD de la Dirección de Investigaciones Epidemiológicas y Psicosociales del INPRF. Se revisaron 158 artículos publicados en revistas nacionales y extranjeras.
Resultados: En la década de 1970, el trabajo se enfocó hacia la realización de revisiones históricas. Se puso énfasis en el análisis del cuidado de los enfermos mentales, la enseñanza de la psiquiatría y el avance del conocimiento psiquiátrico. También se hicieron algunos estudios para conocer la frecuencia y las características de ciertos padecimientos.
En la década de 1980, se realizaron estudios con diseños transversales para conocer prevalencias de diferentes trastornos en la práctica médica, se evaluó la validez y la confiabilidad de instrumentos de detección y diagnóstico y se publicaron algunos ensayos sobre la importancia de conocer las necesidades y demandas de atención.
En la década de 1990 se condujeron estudios descriptivos en población rural y urbana de las determinantes principales del uso y los patrones de búsqueda de diferentes alternativas de atención. Se comenzó a investigar la esquizofrenia con revisiones y análisis de su situación en nuestro país. Así mismo se dieron a conocer los resultados de la primera Encuesta Nacional de Salud Mental; con ellos se pudo conocer la prevalencia de los trastornos psiquiátricos en niños, adolescentes y adultos.
A inicios del siglo XXI se investiga la prevalencia de trastornos a partir de criterios diagnósticos definidos. Durante este periodo se ha incorporado la Encuesta de Morbilidad Psiquiátrica a la primera generación del ICPE. En 2000, la OMS lanzó una iniciativa para realizar estudios epidemiológicos nacionales en diferentes países, y México fue el primero de Latinoamérica en participar.
Discusión: El trabajo realizado hasta ahora debe reconocerse; en este sentido, el desarrollo de las encuestas nacionales da cuenta de ello. Los estudios con población general permiten tener un panorama de las necesidades y los elementos necesarios para crear intervenciones preventivas.
A comienzos del siglo XXI, la epidemiología psiquiátrica en México está en una etapa en que destaca el uso de criterios diagnósticos estandarizados para obtener datos comparables con otros del propio país y de otras partes del mundo. Sin embargo, los diseños que se emplean limitan la exploración más rigurosa de la evolución temporal de los trastornos y sus factores de riesgo. Por otro lado, existen deficiencias en la evaluación de los servicios de salud, lo cual se podría resolver mediante la utilización de análisis costo-beneficio.
- English
Mental health frames and policies to enforce them cannot be excluded from the social context, neither the population's health conditions or the international tendencies. Their strategic place depends on the role they play in the global milieu, and on the benefits derived from what is done in terms of prevention and attention within the field.
Psychiatric epidemiology serves as a tool for knowing mental disorders distribution, the risk factors implied in their etiology and evolution, as well as the elements influencing their detection and treatment. But psychiatric epidemiology has remained behind other branches of epidemiology given the problems for conceptualizing and measuring mental disorders. Thus, most of the work has been basically descriptive.
Nevertheless it has been possible to move forward through historical series, analyses of community diagnosis, health services evaluation, risk measurement, description of clinical frames, identification of new syndromes and its related causes, and in carrying out national and international representative surveys in general population.
This paper has four objectives: 1. to present an overview of the work done in epidemiologic psychiatry in Mexico for the last 30 years; 2. to analyze the main areas explored; 3. to identify the most used designs; and 4. to enumerate the populations studied.
Method.
Articles about different aspects related to study and analysis of psychiatric epidemiology in Mexico were collected, including those reporting empirical results. The search was performed in a bibliographic database consulted in the Centro de Información en Salud Mental y Adicciones (CISMAD), located at the Instituto Nacional de Psiquiatría Ramón de la Fuente. Approximately 158 papers published in national and international journals were reviewed.
Results.
In the 1970's, work was aimed towards historical analysis seeking to provide an epidemiologic view of psychiatric disorders in Mexico. Interest was set on aspects related to attention of mental patients, the teaching of psychiatry, and in the advance of psychiatric knowledge. Some studies were done to have a look at the frequency and characteristics ofcertain diseases in unexplored populations.
During the 1980's there was a renewed interest in dissecting the status of epidemiologic psychiatry and mental health, together with an intention to state its role in the future. Cross sectional studies were performed to know the prevalence ofdifferent mental illnesses in medical care. Validity and reliability of several detection and diagnosis instruments were evaluated, and some essays about the importance of having a clear view of attention needs and demands were carried out.
At the beginning of the 1990's there were descriptive studies in rural and urban populations to describe the main elements determining the use of health services and the quest patterns for different attention options. New diagnosis instruments were used in subjects attending the first and second levels of care. Research on schizophrenia began with reviews and dissertations about its status in Mexico and other countries. Results of the Mental Health National Survey showing prevalence in general population were made public. Home base surveys made possible to know the scope of mental illness in children, adolescents, and adults. The use of epidemiology in child psychiatry allowed the inclusion of developmental psychopathology in the analysis of the interaction and interdependence of biological, psychological, and social variables.
The 21st century set the emergence of the first longitudinal reports on suicide. Work continues on the prevalence of mental illness and new approaches on risk factors are added. Research on the frequency of disorders from well-defined diagnosis criteria is signed. Use and abuse of substances, and violence against women are studied to know their effects on mental health.
The Survey on Psychiatric Morbidity was planned and conducted with great methodological rigor, and thus it was included in the first generation of ICPE studies, which has enabled data comparison on an international basis. Results have shown that depressive disorders are the most recurrent, whereas disorders related to substance abuse and dependence affect basically men, and that anxiety disorders are the most chronic.
In 2000, the World Health Organization launched an initiative to make national epidemiologic studies in different countries, and Mexico was the first Latin American country to participate. The National Psychiatric Epidemiology Survey initial results have confirmed that the prevalence of disorders along life is 28.6%, and that annual prevalence is 14%.
Discussion.
It is important to underline the need to pay attention to mental health problems from a preventive approach. In this respect, Mexico is a little behind and it is urgent to grow according to the advances, instruments, and techniques used in other countries.
It is also important to acknowledge the work done so far; in this sense, the development of national surveys accounts for it. General population studies allow for the generation of an overview of the needs and the basic issues to create preventive interventions.
Mexican epidemiologic psychiatry is in a developmental stage, stressed by the use of standardized diagnosis criteria to get comparable data (both from Mexico and other countries in the world). However, the study designs employed until now do not allow for the exploration of the temporary evolution of disorders and related factors to be more exhaustive. Besides, there are limitations in evaluating health services, which could be overcome through cost-effectiveness analyses.
In the national context it is notorious the lack of inquiring about the diagnosis boundaries, which should be one of the main directions of psychiatric epidemiology in the next years. This would be highly relevant taking into account that Mexico is a transition country that accepts and uses both European and American criteria.
It should be mentioned also that, although Mexico has the same kind of problems than other countries, research has shown they are smaller, which makes studies on protective and risk factors a priority for the future.
There are still certain aspects of epidemiology which remain practically untouched in research. For instance, it is important to focus on rural areas, on migrant populations, and on native groups to overcome the existing backwardness.
Another important topic in the prevention area is the work to do carried out with mental problems during childhood and adolescence. Longitudinal studies would mark the path to evaluate different types of factors: genetic, biologic, familiar, psychodyna-mic, social, and economic. It is also important to analyze the interaction among them to know its impact on etiology and on the development of psychopathology during life.
- español
