Academic journal article Bulletin of the World Health Organization

Treatment of Mental Disorders for Adolescents in Mexico City/Traitement Des Troubles Mentaux Chez Les Adolescentes De Mexico/Tratamiento De Los Adolescentes Con Trastornos Mentales En Mexico D.F

Academic journal article Bulletin of the World Health Organization

Treatment of Mental Disorders for Adolescents in Mexico City/Traitement Des Troubles Mentaux Chez Les Adolescentes De Mexico/Tratamiento De Los Adolescentes Con Trastornos Mentales En Mexico D.F

Article excerpt

Introduction

In Mexico, (1) as elsewhere, only a minority of adults with psychiatric disorders receive some form of treatment. (2-5) However, it is unclear to what extent this situation is similar for Mexican adolescents. Some studies of adult populations have shown that younger adult cohorts are more likely to receive care than older cohorts. (6) However, other studies, mostly conducted in developed countries, have begun to shed light on important shortfalls in the mental health care received by adolescents. (7-12)

In 2001-2002, the National Institute of Psychiatry in Mexico conducted the Mexico National Comorbidity Survey, (1) which is part of WHO's World Mental Health Survey Initiative. (13,14) Results for the urban Mexican adult population showed that fewer than one in five respondents with a 12-month prevalence of a psychiatric disorder used any service during the previous year and only one in every two respondents who used services received care that met minimal standards for adequacy. (3) In 2005, the National Institute of Psychiatry in Mexico conducted the Mexican Adolescent Mental Health Survey employing similar methodology. (15) We report here the rate of mental health service use in the previous year among these adolescents, the adequacy of treatments, and potential determinants of service use and treatment adequacy.

Methods

Participants

The survey was designed to be representative of the 1 834 661 adolescents aged 12-17 years that are permanent residents of private housing units in the Mexico City metropolitan area. The final sample included 3005 adolescent respondents selected from a stratified multistage area probability sample. In all strata, the primary sampling units were census count areas cartographically defined and updated by the Instituto Nacional de Estadistica, Geografia e Informatica. (16) All households within these city block units with adolescents aged 12-17 years were selected. One eligible member from each of these households was randomly selected. The response rate of eligible respondents was 71%.

Procedures

Fieldwork involving face-to-face interviews in the homes of the selected participants was carried out from March through August 2005 by interviewers who had received training in the Composite International Diagnostic Interview according to the WHO protocol stipulated for participating World Mental Health countries. A verbal and written explanation of the study was given to both parents and adolescents. Interviews were administered only to those participants for whom a signed informed consent from a parent and/or legal guardian and the adolescent was obtained. Although an adult had to be present in the home during the course of the interview, interviewers attempted to interview the adolescent privately, i.e. in another room. All study participants were given a mental health resources card with the contact information for different institutions where they could seek services should they wish to do so. The Human Subjects Committee of the National Institute of Psychiatry approved the recruitment, consent and field procedures.

Measures

Psychiatric disorders, service use and potential correlates were assessed in the Mexican Adolescent Mental Health Survey using the computer-assisted adolescent version of the World Mental Health Composite International Diagnostic Interview (WMH-CIDI-A). (17) The WMH-CIDI-A was adapted from the adult version WMH-CIDI 3.0 used in the Mexico National Comorbidity Survey and validated in diverse countries and cultures. (18) The diagnostic sections are similar to the adult version except that the language has been simplified to be more easily understood by younger respondents, examples were made more age appropriate (e.g. references to school instead of work), and criteria were changed to accommodate caveats made for adolescents in the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV). …

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