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Órgano Oficial del Instituto Nacional de Psiquiatría Ramón de la Fuente Muñiz

2002, Number 2

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Salud Mental 2002; 25 (2)

Los trastornos psiquiátricos y el abuso de sustancias en México: Panorama epidemiológico

Caraveo-Anduaga JJ, Colmenares BE

Language: Spanish
References: 18
Page: 9-15
PDF size: 104.29 Kb.


ABSTRACT

Developmental psychopathology in adults has focused in the study of comorbidity. The objective of this report is to present the prevalence of specific psychiatric disorders in terms of the DSMIII-R and to revise and discuss some of the results of comorbidity found between substance use and psychiatric disorders in Mexico City as compared to other results that have emerged from the analyses in the International Consortium of Psychiatric Epidemiology (ICPE). The importance of this type of comorbidity relies on the fact that: 1) lifetime mental and substance comorbidity is associated with chronicity; 2) impairment and suicidal risk is increased; 3) prevention of the development of this comorbidity could have important prevention effects; 4) the understanding of the patterns and correlates of the onset of this type of comorbidity is an urgent need.
Method: Data were obtained through a household survey in a representative stratified sample of the adult population aged 18 to 65 years in Mexico City, excluding its conurban areas. The response rate was 60.4%. The total sample was 1 932 subjects, although for the ICPE comparisons only the 1 734 subjects, aged 18 to 54 years, were included. An amended version of the Composite International Diagnostic Interview 1.1 (CIDI) was used and diagnoses were made following the DSM-III-R criteria. Odds ratios were obtained to measure the association between substance use and psychiatric disorders.
Results: Depressive disorders (major depression and dysthymia) were two times more frequent in women than in men — 100 and 18/1000 vs. 55 and 9/1000, respectively— while mania was more frequent in males (21/1000 males vs. 9/1000 females). Agoraphobia, social and simple phobias also predominated in females (51, 29 and 34/1000 women vs. 29, 16 and 23/1000 men, respectively) while generalized anxiety and panic disorder did not show clear gender differences.
As a whole, lifetime prevalence of psychiatric disorders showed that 1) rates for any affective or anxiety disorder are similar; 2) alcohol intake was 8.6 times higher than any other substance; 3) 18.6% (one fifth) of the alcohol users presented alcohol problems and 7.5% developed alcohol dependence; 4) 14.4% of drug users developed associated problems, and 6.7% developed drug dependence. Psychiatric disorders were more common among females while substance use disorders predominated in males.
Psychiatric morbidity in Mexico City was lower as compared to other sites, including the emigrant Mexican population studied at Fresno, Cal.
Nevertheless, patterns of comorbidity were similar to those found in other sites. The severity of substance use showed a higher risk of being associated with other psychiatric disorders. Anxiety disorders, as opposed to affective disorders, tended to precede substance abuse and dependence. Mexican emigrants showed higher prevalence of anxiety (two times more frequent) and substance abuse and dependence (six times more frequent) in direct relationship with the time living outside Mexico as compared to the population in Mexico City.
Conclusions: The patterns of comorbidity are not exclusive of any culture. Nevertheless, social organization and culture seem to play a role in favoring or protecting against the risk of developing psychopathology. As anxiety disorders showed, earlier age of onset in all sites should be considered, and efforts towards surveillance of mental health during infancy and adolescence should be emphasized.


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