Resumen de Variables demográficas asociadas con la depresión: diferencias entre hombres y mujeres que habitan en zonas urbanas de bajos ingresos
María Elena Medina-Mora Icaza, Shoshana Berenzon Gorn, Marcela Tiburcio Sainz
- español
El objetivo de este artículo es explorar la relación entre algunas variables sociodemográficas y la presencia de trastorno depresivo en una muestra de población urbana de bajos ingresos. Las variables que se han asociado consistentemente con estos padecimientos son el estado civil, el sexo y el nivel socioeconómico.
En relación con el estado civil, se ha observado que las personas casadas gozan de mejor salud que su contraparte soltera y se sienten más satisfechas con su vida. Asimismo, se ha señalado que las personas viudas o divorciadas tienen un mayor número de problemas psicológicos.
Diversos autores señalan que los problemas depresivos se asocian con un nivel de ingresos bajo. Se ha visto que la carencia de recursos conlleva niveles elevados de estrés, tristeza, aislamiento e incertidumbre. Esta situación se vuelve aún más complicada cuando se trata del sexo femenino. Las mujeres desempeñan numerosos papeles en la sociedad que las ponen en mayor riesgo de padecer trastornos mentales.
Método:
La investigación se realizó en cuatro comunidades que presentan principalmente un nivel socioeconómico medio-bajo y bajo, localizadas en el sur de la ciudad de México. Las comunidades seleccionadas comprenden las colonias Topilejo, Isidro Fabela y San Pedro Mártir, en la delegación Tlalpan, y una cuarta comunidad integrada por los barrios de San Marcos y San Juan, en la delegación Xochimilco.
Se utilizó un diseño muestral multietápico; en la primera etapa se seleccionaron manzanas, en la segunda, segmentos de viviendas y en la tercera, el individuo entrevistado. Con este proceso se obtuvo una muestra total de 1156 entrevistados; 49% de ellos fueron hombres y 51% mujeres.
La información se recopiló mediante un cuestionario de hogar que indaga acerca de las características generales de las personas incluidas en el cuestionario y algunos aspectos relacionados con las características de la vivienda. El diagnóstico de trastorno depresivo se obtuvo por medio de la entrevista diagnóstica CIDI versión 1.1, la cual permite hacer una evaluación de los trastornos mentales de acuerdo con las definiciones y los criterios de la Clasificación Internacional de las Enfermedades y el Manual Diagnóstico y Estadístico de los Trastornos Mentales de la Asociación Psiquiátrica Americana (APA).
Se solicitó la colaboración voluntaria del individuo elegido y se dio una explicación sobre los objetivos de la investigación, haciendo énfasis en el carácter confidencial de la misma. La entrevista tuvo una duración aproximada de 90 minutos. El análisis de los datos se realizó con el paquete estadístico SPSS, versión 10 para Windows.
Resultados:
Los resultados señalan que la mayor prevalencia de trastorno depresivo se presentó entre las mujeres, así como entre las personas que sufrieron una pérdida o ruptura familiar y en la población con menores recursos económicos.
Del mismo modo, las prevalencias de depresión fueron más elevadas entre los hombres y mujeres que perdieron a su pareja que entre sus contrapartes casadas. En cuanto a las diferencias entre los casados y los solteros, se observó que los hombres que nunca se han casado presentaron prevalencias ligeramente más bajas que los que tienen pareja. En el grupo de las mujeres se vio exactamente lo contrario, es decir, las solteras presentaron mucho más problemáticas depresivas que las casadas.
En los resultados también se pudo observar claramente cómo influyen las limitaciones económicas en la existencia del trastorno depresivo.
Los modelos de regresión logística muestran que particularmente en el caso de las mujeres la presencia del trastorno depresivo tiene que ver con la falta de pareja y con situaciones económicas desventajosas, como un bajo ingreso económico familiar, aunado a una familia numerosa y extensa, así como con cuestiones de responsabilidad y cumplimiento de roles sociales como ser jefe de la familia.
Por lo anterior, cualquier programa de prevención o intervención debe incluir, entre otros aspectos, herramientas para mejorar la capacidad de estas mujeres para generar ingresos, reforzar las redes de apoyo social y estimular su participación social y comunitaria, a fin de contribuir a mejorar sus recursos cognitivos y relacionales, y su autoestima. Las mujeres deben contar con información sobre el proceso patológico que las afecta y las opciones de atención. Para que estos programas resulten efectivos es necesario, sobre todo, que respondan a las preocupaciones de las mujeres y esto solo será posible si ellas participan como colaboradoras activas.
Pensar en la prevención e intervención de las mujeres jefas de familia es pensar también en la posibilidad de romper con el círculo vicioso de la reproducción del malestar en los hijos.
- English
This paper is aimed at exploring the relationship of some socio-demographic variables with the presence of depressive disorders among a low-income urban sample. Different variables have consistently been associated with such disorders, for instance, marital status, sex, and socio-economic status.
As to marital status, some studies show that married people have better health conditions and feel more satisfied with their lives than their unmarried counterparts. Similarly, it has been found that widowed or divorced people present a number of psychological problems.
Low-income population is also at high risk of suffering depressive symptoms, in this sense, some researchers have stated that the lack of resources is associated with sadness, high stress levels, isolation, uncertainty, and low access to health care and/or other sources of support.
According to the Mexican National Survey on Mental Health conducted with urban population over 18, the prevalence of depressive disorders is higher among widowers and divorced individuals -both males and females- than among their married counterparts. In addition, an association was found between depression, low schooling and unemployment.
A survey undertaken in Mexico City yielded similar results though gender differences were not explored; higher prevalences of depression were found for those who reported having lost their couple or marital break up than for those who were married or single. Other groups that had high depression prevalence were lower income individuals, and those with less schooling.
Couple relationships and other socio-demographic variables play a key role in the presence of depressive disorders. Thus, the present study is aimed at: a) analysing how marital status affects the presence of depressive disorders in men and women; b) exploring the role of low socio-economic level in the presence of depressive symptoms; c) exploring which combination of socio-demographic variables better predict the presence of depressive disorder in males and females Method:
This research was carried out in four low-income communities located in southern Mexico City. The selected communities include Topilejo, Isidro Fabela and San Pedro Mártir within the Tlalpan district, and the fourth community was constituted by the neighbourhoods of San Marcos and San Juan, in the Xochimilco district.
The research design was multistage; blocks were selected at the first stage, dwelling segments, at second stage, and finally, in the third stage the interviewed individual was selected. After this procedure, the final sample consisted of 1156 interviewees, 49% were males and 51% females.
The information was gathered through a household questionnaire that explores the general characteristics of the people living in the same dwelling listed on the questionnaire, such as relationship to the family head, age, sex, schooling and income. Some other aspects related to the dwelling characteristics were also explored.
Diagnosis of depressive disorder was obtained through the diagnostic interview CIDI version 1.1, which assesses the presence of mental disorders according to the criteria of the International Classification of Diseases (ICD) and the Diagnostic and Statistical Manual of Mental Disorders (DSM) of the American Psychiatric Association.
The selected interviewees participated voluntarily after the research objectives were explained; in addition, the terms of confidentiality were particularly emphasized. Each interview lasted 90 minutes on average. Data analysis were performed with the statistical program SPSS v. 10 for Windows.
Results:
The findings showed higher prevalence of depressive disorders among females, among people that experienced loss or family rupture and among those with lower economic resources.
Similarly, prevalence of depression was higher for men (6.1%) and women (18.3%) who had lost their spouse than for their married counterpart. As to differences between married and single people, the prevalence of depressive disorders in the group of men that had ever married was lower (4.9%) than the prevalence found in the group of married men (5.8%). The opposite was observed among females, since single women present more depressive problems (13.2%) than married women (5.3%).
Results also showed how economic difficulties have an effect on the presence of depressive disorders. However, differencesbetween married and single men with the lowest income were minimal.
Two logistic regression models show that, particularly among women, the presence of depressive disorder is related to the lack of a couple, economic disadvantages; for instance, low family income, belonging to a large extended family, and playing the social role of family head, which implies responsibility to a large extent.
Discussion:
The findings of the present study are consistent with previous research that report higher prevalence of depression among females, people without a couple and those with less economic resources.
Different authors have confirmed that problems of economic nature are consistently associated with depression problems. Lack of resources leads to high stress levels, sadness, isolation, among other troubles. This situation is more severe for females. Women play a number of social roles that put them at higher risk of suffering mental disorders. Nowadays, women still bear the responsibility of being wives, mothers, educators and care providers for many people, and have become an important part of the work force at the same time.
The deficiencies that female family heads must face in different areas not only increase the risk of suffering disorders such as depression and poor quality of life, but also jeopardize their children’s opportunities in the future.
Dejarlais and colleagues suggest that in order to improve these women’s mental health it is necessary to take actions in two ways. On the one hand, it is essential to deal with the factors related to the presence of female distress; on the other, it is crucial to provide attention to reduce the negative consequences.
In this way, any prevention or intervention program must include, among other elements, tools to expand women’s capabilities to have an income, reinforce social support networks, and to stimulate social and community participation in order to improve their cognitive and relational resources as well as self-esteem.
In addition, women must have information about the pathological process they undergo and attention options at their disposal, but to make these programs effective it is above all necessary to tailor them according to women’s concerns and needs. This can only be possible if women act as active collaborators.
Finally, to work on intervention and prevention programs for female family heads encloses the possibility of breaking the cycle that reproduces distress among their children.
