Resumen de El uso de terapias alternativas y complementarias en población mexicana con trastornos depresivos y de ansiedad: resultados de una encuesta en la Ciudad de México
Shoshana Berenzon Gorn, Sarahí Alanís Navarro, Nayehli Saavedra Solano
- español
El uso de instancias asistenciales y terapéuticas diferentes a las oficialmente reconocidas, además de las prácticas de autocuidado, han mostrado su vigencia a lo largo de la historia. En la bibliografía nacional e internacional se reporta un creciente uso de medicinas alternativas y/o complementarias, principalmente entre personas con trastornos de depresión o ansiedad. Derivado de lo anterior, el objetivo del presente trabajo es conocer, mediante una encuesta en hogares, cuáles son los recursos terapéuticos y asistenciales que utiliza la población para tratar problemas emocionales, así como analizar la prevalencia de estas prácticas en personas con trastornos de ansiedad o depresión.
Método La investigación se realizó entre los habitantes de seis colonias de la Ciudad de México. El trabajo de campo comprendió el periodo de agosto de 2006 a marzo de 2007. La selección de los entrevistados se hizo con un diseño muestral aleatorio estratificado y multietápico. La variable de estratificación fue el nivel socioeconómico. Originalmente se planteó la inclusión de tres niveles con el objetivo de hacer comparaciones entre ellos. Sin embargo, debido a la dificultad de acceder a la población de estrato alto, se seleccionaron colonias representativas de nivel socioeconómico bajo y medio alto.
El instrumento estuvo conformado por cuatro secciones:1) datos sociodemográficos; 2) uso de diez recursos de autoatención y/o servicios alternativos ante la presencia de malestares emocionales; 3) características de los recursos o servicios utilizados y 4) prevalencia de trastornos depresivos y de ansiedad (a partir de los criterios del ICD–10).
Entre los cuidados éticos se consideró el consentimiento informado de manera verbal y se enfatizó en la libertad del entrevistado para suspender la entrevista. Se aseguró el manejo confidencial de la información.
Para el análisis del uso de servicios, las terapias se agruparon en dos categorías: prácticas de autocuidado (remedios caseros, automedicación, actividades físicas, etc.) y servicios alternativos y/o complementarios (grupos de autoayuda, medicina tradicional mexicana, consejeros espirituales, etc.).
Resultados De las 361 personas entrevistadas, el 45.9% fueron hombres y el 54.1 % mujeres. La media de edad fue de 45 años, el 54% representó al estrato medio–alto y el 46% al bajo. El 19.5% de la muestra cumplió los criterios diagnósticos de uno o más trastornos alguna vez en la vida (12.7% hombres y 25.1% mujeres). La prevalencia de episodios depresivos fue de 9.2% para las mujeres y 3.0% para los hombres, y de trastornos de ansiedad 16.3% y 9.0%, respectivamente. En relación con la prevalencia de uso de servicios alguna vez en la vida, ante un malestar emocional, el 52.5% del total de la muestra realizó alguna práctica de autocuidado y el 28.2% recurrió a los sistemas alternativos. El uso de autocuidados y terapias alternativas fue más frecuente entre las mujeres.
Se encontró que el grupo caracterizado por la presencia de trastornos realizó acciones encaminadas a los autocuidados (72.9%) en mayor proporción a aquellos sin trastornos (47.6%). La misma tendencia se observó en el uso de servicios alternativos (52.9% y 22.1% respectivamente).
Además, se realizó un análisis de regresión logística cuyos resultados mostraron que existe una mayor probabilidad de realizar prácticas de autocuidado entre las mujeres (OR=1.74), cuando el nivel de escolaridad es mayor o igual a bachillerato (OR=1.93) y cuando se presenta algún trastorno de ansiedad (OR =3.11). La probabilidad de usar alguna medicina alternativa o complementaria aumenta 3.23 veces en personas con depresión y 3.45 con ansiedad.
Discusión Los resultados de este trabajo hacen evidente la necesidad de capacitar al personal de salud sobre las medidas de autocuidado y las medicinas alternativas. Estos conocimientos pueden mejorar la relación médico–paciente e impactar positivamente en el tratamiento. Asimismo, los resultados de esta investigación permiten comprender mejor los conceptos que tienen las personas sobre salud y enfermedad, y las razones para acudir a los diversos sistemas médicos. Sin embargo, todavía tenemos que aprender mucho sobre las necesidades, las expectativas y las demandas de las personas que buscan esta ayuda.
- English
The use of therapeutic methods and assistance different from the officially recognized ones, in addition to self–care practices, has remained constant throughout history. The extensive interest in so–called alternative or complementary medicine (ACM) has occurred as a result of their growing use in various countries. International literature reports the growing use of alternative and/or complementary treatments by persons with emotional disorders, particularly depression or anxiety. Commonly mentioned alternatives include relaxation techniques, physical therapies, herbal treatment, chiropractice and spiritual healing.
The National Survey on Psychiatric Epidemiology undertaken in Mexico (2002) reported that 6.5% of the individuals with affective disorders in the 12 months prior to the study used some kind of alternative medicine. This occurred in 7.3% of the individuals with anxiety disorders and 3.9% of those with disorders associated with substance use. Information from surveys conducted in Mexico City showed that from 18% to 20% of the individuals with depressive disorders, 18% had physical disorders and over a quarter of those with anxiety problems seek a solution to their suffering in various types of alternative medicine.
The aim of this study is therefore to determine the therapeutic resources used by the population to treat emotional problems and to analyze the prevalence of these practices in individuals with anxiety or depressive disorders.
Method The study was conducted on the inhabitants of six neighborhoods in Mexico City. They were all selected on the basis of the criteria established in a multi–stage, stratified random sample design. The stratification variable used was socio–economic level. The questionnaire included four sections: 1) socio–demographic characteristics; 2) use of 10 self–care and/or alternative service resources related to the presence of emotional disorder; 3) characteristics of the resources or services use and 4) prevalence of depressive and anxiety disorders.
The ethical guidelines followed in this research included obtaining verbal informed consent and providing a clear explanation about the objectives of the research, and the way the dwelling and the persons were selected. The researchers stressed the interviewee's freedom to cancel the interview and guaranteed the confidential handling of the information.
The diagnoses of mental disorders were obtained on the basis of the ICD–1 0 criteria. For the analysis of service use, the therapies were grouped into two categories, self care (home remedies, self–medication, physical activities, etc.) and alternative and/or complementary services (self–help groups, traditional Mexican medicine, clergy, etc.).
Results Of the 361 of the individuals interviewed, 45.9% were men and 54.1% women, the mean age being 45 years old. The 54% of participants represent the high–middle class, and the 46% the low class. Nineteen point two percent of the sample met the diagnostic criteria for one or more disorders, at least once in their lifetime (12.7% in the men's group and 25.1% in the women's group). The prevalence of depressive episodes for women was 9.2% as opposed to 3.0% for men. In the case of anxiety disorders, the prevalence was 16.3% and 9.0%, respectively.
Of the total sample 52.5% engaged in some form of self–help, while 28.2% had resorted to alternative systems for coping with emotional disorders at least once in their lives. Among the most commonly used self–help strategies were: enrolling in a physical activity (33.5%), seeking help from informal networks (28.5%) and using household remedies (16.1%). The use of alternative services included visiting a clergy (11.1%) and attending self–help groups (10.2%). The use of self–help and alternative therapies was more common among women.
An analysis was undertaken of the type of service used among persons that had met the diagnostic criteria for one or more disorders and those that failed to do so. The group characterized by the presence of disorders undertook more self–help actions than those with no disorders (72.9% and 47.6%). The same trend was observed in the use of alternative services (52.9% and 22.1%).
An analysis of the disorders, divided into two main groups, anxiety disorder and depressive episodes, showed that the prevalence of self–care practices (76.6% and 72.7% respectively) and the use of alternative medicines (53.2% and 59.1%) was similar. Most of the group with anxiety disorders reported that it used informal support networks (59.6%) and engaged in physical activities (53.2%). The 45.5% of those that experienced depressive episodes engaged in physical activities, 47.8% visited relatives and friends and 26.1% consulted a priest. The prevalence of self–care practices conducted in the 12 months prior to the survey showed a similar pattern throughout lifetime.
Two logistic regression models were used to analyze factors related to the practice of self–care and the use of alternative and/or complementary therapies. The variables included in the models were sex, age, educational level, occupation and the presence of an anxiety or depression disorder.
The logistic regression analysis showed that the probability of using self–care practices is higher in persons with an anxiety disorder (OR=3.11), women (OR= 1.74) and persons with a higher educational level (OR=1.93). The likelihood of using an alternative or complementary medicine increases among people experiencing a depressive episode (OR = 3.23) and anxiety disorders (OR=3.45).
The people that sought help from relatives, friends or a priest stated that their reasons were "to solve a family problema", "receive support" or "stop feeling sad." The reasons for visiting the self–help groups were feeling sad or depressed, or trying to deal with problems related to their alcohol consumption. Those who used home remedies sought to soothe their "nerves" and overcome their insomnia. The main reason for engaging in physical activity or performing curative practices adapted from other cultures, such as Bach Flowers or Reiki was to relax and "relieve stress." Interviewees used vitamins or food supplements to cope with the "feeling of weakness," or "lack of energy and strength" all of which are concepts underlying the idea of "improving" their state or condition.
Discussion The use of self–care practices in response to the perception of emotional disorders is common in the interviewed population. This suggests that this type of practices could be regarded as a significant component of mental health care and should therefore be examined with more detail. The main focus should be the link between individuals' perception of their emotional illness or problems and the orientation of their self–care actions.
An analysis of the group with disorders showed that a significant percentage of the population with one or more depressive episodes (26.1%) and anxiety disorders (26.1%) used alternative therapies in the 12 months previous to the study.
The analysis conducted throughout this study suggests the need for health personnel to have basic knowledge of self–care practices and alternative medicine and to find out about the use of the latter by patients. It has been shown that having this knowledge can significantly improve the doctor–patient relationship, have a positive impact on treatment and help prevent potentially damaging interactions between conventional and alternative treatments. It also provides a better understanding of people's concepts of health and illness, and what they seek in the various medical systems. However, we still have a great deal to learn about the needs, expectations and demands of those that engage in these practices.
