2004, Number 4
ESP, Escala breve para identificar malestar emocional en la práctica médica de primer nivel: características psicométricas
Valdez SR, Salgado SVN
Full text
Language: Spanish
References: 31
Page: 55-62
PDF size: 196.77 Kb.
ABSTRACT
The World Health Organization, in its report "Mental Health in the World" released in 2001 (WHO, 2002), suggests that approximately 450 million people in the world suffer some type of neurological or mental disorder; however, only a minority receive professional attention for their problems. Depression is the fourth disorder in terms of the weight of illness when measured in DALY’ s and it is the cause of losing one out of every ten years of healthy life, particularly in women, among whom depression is the most important cause of the weight of illness. In Mexico, according to recent data, depression is the disorder for which adult population seek help more frequently in first-level community-health centers in Mexico City, with a distribution of 34% of women and 1% men. Depression manifests itself in two women for every man, thus determining that the disability caused by mental or neurological disorders be 30% among women and only 12% among men. Similar results have been reported in our country, where depression affects women more severely and frequently than men. On the other hand, it has been documented that general physicians are able to identify only about one-half of the patients suffering disorders. De la Fuente and colleagues suggest that, according to previous research in this field, when brief and adequate screening tools are administered, the identification of mental problems by the general physician increases notably. The identification of possible cases with diagnosis of depression is an extremely useful prevention action because it allows to conduct early interventions of subclinic cases, which if not detected on time, could evolve into major depression.Purpose: The purpose of this study was to conduct a series of statistical analyses aimed at determining the psychometric characteristics and the usefulness of a brief screening scale, the Personal Health Scale (ESP, Escala de Salud Personal), to identify generalized psychological or emotional distress and depressive symptomatology among women users of primary and secondary health care clinics of the three largest institutions of the health sector in Mexico: SSA, IMSS, and ISSSTE.
Method: We used the responses of 8,249 women who participated in the National Survey of Violence against Women conducted in 2003 (Encuesta Nacional de Violencia hacia las Mujeres, ENVIM) by the Women’s Health Program and the Mexican National Institute of Public Health. In this national survey, the ESP was used to assess generalized psychological distress. This instrument was analyzed, obtaining descriptive statistics, reliability and validity (construct and criteria). We identified the presence and persistence of the emotional distress and determined a cut-off point for the scale, as well as the risk profiles.
Results: The ESP obtained a group mean of 16.3 (S.D.±:5.5). It showed a high reliability (Cronbach Alpha of .85). The following were the items with the highest means for presence and persistence: «Have you felt tired?», «Have you felt nervous?» and «Have you felt tense or worried?». The factor analyses provided a threefactor solution with eigen values higher than 1. The identified factors were: 1. Negative affect (4 items, accounting for 44.0% of the variance); 2. Interpersonal relations (3 items, accounting for 12.1% of the variance; and 3. Flat affect (3 items, accounting for 3.7% o the variance). The combination of all three factors accounted for 63.4% of the total variance of the ESP. The cutoff point was determined using the group’s mean value plus one standard deviation (16.3±5.5=21.8). Cases were grouped above and below the cut-off point. Sixteen percent of the women obtained scores of 22 and higher, suggesting the presence of some type of affective disorder, such as generalized psychological distress, depressive symptomatology or anxiety. An additional validation of the instrument was conducted by categorizing cases versus no-cases and three items that were indicators of wellbeing: Self-perception of health status, current use of medication or home remedies, and reporting a health problem. Findings revealed that 51.7% of the «cases» reported having a regular health status and one fourth reported their health was «bad» or «very bad»(p‹.000). Most cases (62.3%) reported that, at the time the survey was conducted, they were taking some type of medication (p‹.000) and were suffering health problems in the last month (75.5%) (p‹.000). When analyzing the characteristics of this high risk group (scores of 22 and higher), we found that the group was formed by women with the lowest levels of education (illiterate and incomplete elementary school); they were 35 years and older; they were not receiving any help from any official programs aimed at helping the poor (Oportunidades); they were affiliated to the IMSS; and had been diagnosed with at least one physical health problem.
Conclusion: The results of this study indicate that the ESP is a brief and easy tool for use in the general medical practice to identify the presence of generalized psychological distress, anxiety, somatization and conflicts among women users of health services provided by the public health sector. The ESP was easily understood even by patients with a very low level of literacy. Based on the fact that only a very small proportion of the population suffering mental problems receives attention for these types of ailments because of the absence of timely identification of the condition, it seems reasonable to propose the mandatory utilization of a tool such as the ESP for general practitioners in the first level of attention of the three largest health institutions in the health sector (IMSS, ISSSTE and SSA).
REFERENCES
SNELL WE JR: Men’s and women’s emotional disclosures: The impact of disclosure recipient, culture, and the masculine role. En : Snell WE Jr. (ed.). New Directions in the Psychology of Gender Roles: Research and Theory. Cape Girardeau, MO: Snell Publications. 2002. WEB: http://cstl-la.semo.edu/snell/ books/gender/gender.htm.