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Día Mundial de la Salud Mental 2018

Los jóvenes y la salud mental en un mundo cambiante.

Es difícil imaginar volver a crecer y más cuando crecer implica lidiar con nuestro mundo hoy. Crecer en un mundo donde hay que lidiar con violaciones de derechos humanos, guerras y violencia en todos los ambientes. El mundo dividido, el acceso a Internet, los delitos informáticos, acoso cibernético, los videojuegos violentos, la socialización y la actividad física disminuidas. Todo esto entre tantas cosas ha dado como resultado el aumento en el número de suicidios y el abuso de sustancias, las poblaciones vulnerables, la población de jóvenes LGBTQ aún más.
Los adultos jóvenes y los adolescentes son las poblaciones de mayor riesgo para el desarrollo de enfermedades mentales, muchas veces graves y hasta el momento, pocas estrategias existen para educar sobre la salud mental.
La adolescencia y los primeros años de la edad adulta son una época de la vida en la que ocurren muchos cambios, por ejemplo, cambiar de escuela, dejar el hogar y comenzar la universidad o un nuevo trabajo. Pueden ser tiempos emocionantes o de ansiedad y estrés. La necesidad de crear una identidad, sentirse unido a un gripo tanto real como virtual puede ser un factor más de riesgo. El uso creciente de las tecnologías en línea, aunque con los beneficios que trae, puede traer presiones adicionales. La inminencia de los desastres, vivir en áreas afectadas por emergencias humanitarias como conflictos o epidemias complica aún más estos años de riesgo.

Dra. Silvia Morales Chainé

Las adicciones en la Juventud

En las últimas dos décadas, el consumo de alcohol y otras drogas en México ha mostrado una tendencia al incremento. Es necesario disponer de estrategias en consejo breve para la prevención efectiva de las adicciones, de fácil acceso a la mayor parte de la población.
Aun cuando, de acuerdo con la Oficina de la ONU contra las Drogas y la Delincuencia (UNODC 2010) el consumo de drogas en el mundo se ha estancado, 200 mil personas al año mueren debido a éstas y una de cada 200 personas es dependiente. Uno de los grandes problemas con respecto al tratamiento de personas con adicciones consiste en la poca disponibilidad de este servicio. De acuerdo con la misma fuente, menos de cinco personas que necesitan ayuda la recibe. Como referencia, durante 2010, 230 millones de personas (5% de la población mundial) tomaron drogas al menos una vez durante ese año, mientras que 27 millones desarrollaron el trastorno por consumo de drogas. A finales de siglo el número de usuarios dependientes se podría elevar a 300 millones. Anualmente, por consumo de alcohol mueren 2.3 millones y por consumo del tabaco 5.1 millones de personas.
En México, el consumo de drogas está aumentando principalmente entre los adolescentes. Por ejemplo, en el 2002 el .5% de la población adolescente consumía marihuana, mientras que en el 2008 lo hizo el 1.2% y en 2011 el 1.3% de los jóvenes. Sin embargo, los estudiantes de secundaria y preparatoria consumen principalmente drogas legales, tales como el alcohol (42.9%) y el tabaco (12.3%). Respecto a las drogas ilegales, la marihuana es la más popular (1.3%), seguida por la cocaína (0.4%), de acuerdo con los datos proporcionados por la ENA (2011).

Dr. Leonardo de Benito

Cyber Bullying (Acoso escolar)

Ciberbullying es un término que se utiliza para describir cuando un niño o adolescente es molestado, amenazado, acosado, humillado, avergonzado o abusado por otro niño o adolescente, a través de Internet o cualquier medio de comunicación como teléfonos móviles o tablets.
Se caracteriza por que el acoso se da entre dos iguales, en este caso, menores. Es importante distinguirlo, ya que existen otras prácticas en la que se involucran adultos y que se denominan simplemente ciberacoso o acoso cibernético, con las consecuencias legales que tienen los actos de un mayor de edad en contra de un menor.
El ciberbullying no es algo que ocurra una sola vez y además se presenta de distintas formas, desde insultos, discriminación o burla sobre características físicas, forma de vestir, gustos, hacer pública información o fotografías que avergüenzan a la víctima, robo de identidad y suplantación, hasta amenazas de daño físico y otros cargos que pueden ser tipificados como delincuencia juvenil.
Algunas formas de ciberbullying son:
• Acoso por mensajería instantánea (Whatsapp, Messenger, Facebook, SMS);
• Robo de contraseñas;
• Publicaciones ofensivas en Blogs, foros, sitios web y redes sociales como Facebook, Twitter u otras;
• Encuestas de popularidad para humillar o amedrentar.

Dr. Hamid Vega

La salud mental de las minorías:

Algunas de las causas que incrementan el riesgo de desarrollar enfermedad mental se deben a la variabilidad de la composición poblacional. Pertenecer a alguna minoría incrementa el riesgo de enfermedad mental.
Aquí abordaremos las minorías sexuales.
Actualmente, la tolerancia hacia las minorías sexuales se ha convertido en una bandera de lucha política y es sinónimo de progresismo en otras sociedades. La hegemonía de lo heterosexual tiene un impacto permanente y directo sobre la vida de las personas homosexuales, en tanto las sitúa en una posición social desventajosa y estigmatizada. Sentirse parte de un grupo social devaluado socialmente no sólo influirá en el plano más íntimo, como es el reconocimiento ante sí mismo de sentimientos homoeróticos, sino también lo hará en la esfera pública, mediando en la calidad de las relaciones que se establecen con el entorno. Es posible constatar diferencias significativas entre hombres heterosexuales y hombres homosexuales en la dimensión integración social y esto es relevante como indicador de salud mental, en tanto se espera que una persona se sienta parte de la sociedad al punto de desarrollar sentimientos de pertenencia y lazos sociales.
El estudio de la salud mental de las minorías sexuales (MS) aparece, de manera inicial, con la clasificación de la homosexualidad como un trastorno mental durante los años 60’s e inicios de 70’s. Este abordaje buscaba principalmente descalificar a esta orientación sexual como un trastorno mental que requería de tratamiento médico para corregirlo y llevar a la persona a un “correcto estado” de heterosexualidad. Este debate termina aparentemente en 1973, cuando la Asociación Psiquiátrica Americana, elimina la homosexualidad como trastorno mental en la segunda edición de su Manual Diagnóstico y Estadístico de los Trastornos Mentales, mejor conocido como DSM. Sin embargo, la herencia de esta época patologizante persiste hasta nuestros días.
Los resultados en la salud mental de las MS son variados y dependen del tipo de padecimiento mental que se trate. Sin embargo, todos coinciden en que las prevalencias de trastornos mentales de cualquier tipo son mayores en las MS. Los trastornos afectivos, de ansiedad, por uso de sustancias o la conducta suicida son más frecuentes en las MS, en comparación con la población general. Se ha demostrado que la depresión es el trastorno afectivo que más se presenta en las MS, ya sea de manera única, recurrente o crónica. Los trastornos por uso de sustancias, especialmente el consumo de etanol ha tenido resultados contradictorios. Por un lado, algunos estudios mencionan que la diferencia de consumo no es distinta entre las MS y la población general, pero otros afirman que sí existe diferencia cuando se consideran los diferentes patrones de consumo. Es decir, al parecer no hay diferencias cuando se evalúa como dependencia a etanol, pero cuando se trata de un consumo episódico y en grandes cantidades en periodos cortos de tiempo, por ejemplo, los fines de semana, las MS tienden a presentar más este patrón de consumo que la población general. En términos de riesgo a la salud esto es importante, considerando las conductas de riesgo que se asocian con estos patrones de consumo de etanol. Cabe destacar que, dentro de los grupos que conforman a las MS, todavía existen diferencias que son importantes destacar. Es decir, los adolescentes pertenecientes a las MS, tienen mayor probabilidad de presentar algún trastorno mental, además de mayor dificultad de afrontamiento, en comparación con los adultos. Igualmente, las personas bisexuales pueden tener un mayor impacto en su funcionalidad general, derivado de algún trastorno mental, en comparación con otras orientaciones o identidades sexuales. El resultado más lamentable y con mayor efecto demostrado, consecuencia de una mala salud mental es la conducta suicida. Tanto los intentos como los suicidios consumados no solo representan el mayor problema de salud mental para los integrantes de las MS, sino también es el de mayor impacto en términos individuales y sociales.
La salud mental de las MS es un problema de salud pública que debe atenderse para disminuir el impacto que ésta tiene en el pleno desarrollo de las personas, con el objetivo de alcanzar la igualdad en todos los integrantes de una sociedad. Sin importar la orientación o identidad sexual de una persona, los cambios estructurales e institucionales necesarios para alcanzar y acercar a las MS a los servicios de salud mental deben ser adaptados y dar respuesta a sus necesidades particulares.

A pesar de los avances de equidad en la salud, las disparidades en el cuidado de la salud mental persisten. Los grupos minoritarios tienen:
• menos posibilidad de tener acceso a servicios de salud mental,
• menos probabilidad de usar los servicios comunitarios de salud mental,
• más probabilidad de usar las salas de emergencia y
• más probabilidad de recibir atención médica de menor calidad.
La falta de cuidado de salud mental de calidad y el pobre acceso a los servicios contribuyen a resultados de salud mental negativos, como el suicidio, entre las poblaciones de minorías.

Dra. Jacqueline Cortes

Depresión en la juventud:

La Depresión en Jóvenes es una preocupación de la Salud Pública, es más frecuentes en las mujeres, afecta hasta al 8% de los Adolescentes y la Conducta Suicida es una de las consecuencias más peligrosas de esta enfermedad. La Organización Mundial de la Salud (OMS) estima que más de 800 mil personas en el mundo se suicidan cada año. Es la segunda causa de muerte entre el grupo de edad entre los 15 y 29 años. De acuerdo con la OMS, la tasa de suicidio se elevó de 5 en el 2012 a 9.9 suicidios por cada 100 mil habitantes para el 2015. Los Intentos de Suicidio son tres veces más frecuentes en mujeres que en los hombres. Las causas más frecuentes por lo que las mujeres se suicidan son por Infelicidad, amores no correspondidos y factores asociados como el abuso de sustancias, aislamiento social, dificultad en las relaciones interpersonales, desesperanza, impulsividad, pérdida del sentido de la vida, Experiencias traumáticas tempranas, abuso físico y/o Sexual, haber estado expuesto a conducta suicida de otros etc.
Suicidio en la juventud:
Hasta el 50% de los adolescentes que se suicidan, expresan sus intenciones a un amigo o pariente 24 horas antes de la Conducta Suicida (CS). Las alucinaciones en las depresiones graves suelen ser una sola voz con discurso suicida o despectivo y los Delirios incluyen temas de culpa, enfermedad física, nihilismo, incapacidad personal y a veces persecución, estos síntomas pueden estar presentes al menos en el 50% de las depresiones psicóticas de adolescentes. Hasta un 17% de ellos pudo haber sido tratado primero por abuso de sustancias. Las autolesiones no suicidas (ALNS) son uno de los factores de riesgo para Intento de Suicidio (InS) y Suicidio Consumado. De los que se autolesionan 70% de los jóvenes han tenido al menos un InS. Además de que si hay este antecedente el riesgo de suicidio aumenta 1.7% a los 5 años, 2.4% a los 10 años y 3% a los 15 a. Se ha visto que si hay episodios repetidos de ALNS el 5% se suicidan en los siguientes 5 años.
Violencia en la pareja adolescente:
Uno de los temas desarrollados es el de violencia en la pareja adolescente. En términos generales podemos decir que los hombres tienden a abusar más físicamente de sus parejas, pero el patrón opuesto ocurre en el abuso psicológico. Existe una bidireccionalidad de la violencia, así como la violencia de pareja en el ámbito universitario es un problema invisibilizado (es decir se percibe si la observan en el otro, pero no se percibe la propia). En un estudio realizado se encontró que las estudiantes femeninas entre 12 y 24 años son víctimas de violencia por parte de su pareja desde etapas muy tempranas. Los tipos de violencia más frecuentes eran los empujones, la falta de respeto, hacer sentir inferior al adolescente e insultar o gritar palabras desagradables a la pareja. La violencia se presenta desde estudiantes de secundaria, sin embargo, es mayor en los de preparatoria. También se encontró que a mayor depresión mayor violencia. Las conductas de riesgo vinculadas con la violencia incluyen abuso de alcohol, consumo de tabaco, bajo rendimiento escolar y antecedente de relaciones sexuales. Este 10 de octubre Día Mundial de la Salud Mental en donde la OMS tiene el lema “Los Jóvenes y la Salud Mental en un Mundo en Transformación”, también se habla de la importancia de enfocarnos en la prevención, identificación y tratamiento oportuno de los problemas de salud mental y los factores que hay alrededor, en esta población vulnerable

Dra. Yariela Delgadillo

Servicios de salud mental para la juventud en México

La atención a la salud mental de los jóvenes ha sido objeto de interés en las últimas décadas gracias a un gran número de evidencia que ha demostrado que la perdida de la salud mental en esta etapa aumenta el riesgo de discapacidad en años posteriores.
En México hay 37, 504, 392 de jóvenes de 12 a 29 años, lo que representa el 31.4% de la población total, ellos son la mayor fuerza del país. En esta etapa de la vida la salud mental es más vulnerable debido a la transición y grandes retos a los que se enfrentan los jóvenes
La Encuesta de Salud Mental en Adolescentes (Benjet, 2009) realizada en la Ciudad de México y área metropolitana, estimó que los trastornos de ansiedad son los que se presentan a edades más tempranas, los trastornos afectivos y de impulsividad inician en promedio entre los 11 y 12 años, mientras que los trastornos por uso de sustancias se presentan a edades más tardías 13-14 años. El INEGI identificó algunos indicadores de salud mental en la Encuesta Nacional de los Hogares 2017 y reportó que el 33% de los mayores de 12 años manifestaron datos de depresión, 70% manifestó que los síntomas se presentaron algunas veces al año, 12% semanalmente y 10% diariamente. Pese a la elevada prevalencia y la discapacidad asociada a los trastornos psiquiátricos en esta población, menos de uno de cada siete acudió el año anterior a algún servicio para solicitar atención y de los que acudieron solo la mitad recibió un tratamiento que podría considerarse mínimamente adecuado.

Brecha y barreras de atención.

Existe una brecha importante entre las necesidades de salud mental de los jóvenes y el uso de servicios. Este acceso a los servicios se ve limitado por los siguientes factores:
1. La baja prioridad que se le asigna a la salud mental. Lo cual se refleja en el escaso financiamiento que se otorga a este tema, menos del 2% del presupuesto para salud es para la salud mental y de ese porcentaje el 80% es para el funcionamiento de los hospitales psiquiátricos que conforman el tercer nivel de atención, quedando sólo un 20% de presupuesto para atención primaria y prevención.
2. Las barreras geográficas. En nuestro país la mayoría de los servicios de salud mental se ubican en las grandes ciudades.
3. La resistencia y dificultades que existen para incorporar la salud mental en la atención primaria y en hospitales generales. En la Ciudad de México, solo el 30% de los establecimientos de atención primaria cuentan con protocolos de evaluación y tratamiento para condiciones claves de salud mental.
4. El eje de la atención sigue siendo el hospital psiquiátrico. Las personas con enfermedades mentales llegan directamente al tercer nivel. Para recibir atención especializada y acceder a un diagnóstico preciso pasan varios años, entre otras razones debido al estigma hacia la enfermedad, la psiquiatría y el tratamiento.
5. Hay una fragmentación entre las instituciones, que favorece la aplicación de modelos diversos de atención, duplicados y en ocasiones ineficientes y costosos.
6. El número de especialistas y su distribución. En 2016 se publicó que 4393 médicos con especialidad en psiquiatría ejercían en el país, lo que representa 3.7 psiquiatras por 100,000 habitantes, de los cuales 60% se ubica en la Ciudad de México, Jalisco y Nuevo León. En cuanto al área de la salud mental infantil, se estima que hay 225 especialistas en psiquiatría infantil y del adolescente, es decir 0.69 por 100 000 habitantes menores de 15 años (Heinze y cols.). Estas cifras nos muestran que no contamos con el suficiente personal en el área de la salud mental, para atender las necesidades de la población.

Servicios de atención a la salud mental

Actualmente, se cuenta con 41 hospitales psiquiátricos que brindan atención intrahospitalaria, ubicados en la Ciudad de México y en todos los estados, excepto en Guerrero, Morelos, Nayarit, Querétaro, Quintana Roo y Tlaxcala; la mayoría administrados por sus respectivas Secretarías de Salud.
Se calcula que hay aproximadamente 5 camas por 100,000 habitantes, de las cuales únicamente el 3% están reservadas para niños y adolescentes (IESM-OMS). Hay 13 unidades de internamiento psiquiátrico en hospitales generales con aproximadamente 147 camas, lo que representa el 2% del total de camas y de estas solo el 8% (12 camas) es para los adolescentes del país (IESM-OMS).
En la Ciudad de México se cuenta con seis unidades para la atención a la salud mental de adolescentes y adultos jóvenes; el Hospital Psiquiátrico Infantil Dr. Juan N. Navarro, el Hospital Psiquiátrico Fray Bernardino Álvarez, el Hospital Psiquiátrico Dr. Samuel Ramírez Moreno y tres Centros Comunitarios de Salud Mental (Zacatenco, Iztapalapa y Cuauhtémoc). En 2017, brindaron 109,620 consultas a población de 10 a 19 años y 42,620 a jóvenes de 20 a 29 años.
Se requieren servicios de atención a la salud mental más eficientes y efectivos, por lo cual la OMS ha puesto desde 2008 un gran empeño en reforzar la prestación de servicios a través de la puesta en práctica del Programa de acción para superar las brechas en salud mental (mhGAP) que promueve la capacitación de personal del primer nivel de atención que logre identificar, diagnosticar y tratar oportunamente a las personas con algún trastorno mental.
Además, se propone que, para lograr la prevención y asistencia eficaces, es esencial que:
• Exista una mayor conciencia pública sobre los problemas de salud mental y un respaldo social generalizado hacia los jóvenes con el objetivo de preservar su salud mental, comenzando con los padres, la escuela y la comunidad (UNICEF, 2011).
• Mejore la inversión pública y la participación de los sectores social, de salud y de educación en programas integrales, integrados y basados en evidencia. :
• Un desarrollo sano durante la infancia y la adolescencia contribuye a una buena salud mental. Hay que trabajar y mejorar las habilidades sociales, la capacidad para resolver problemas y la autoconfianza ya que así podemos prevenir algunos problemas de salud mental, como los trastornos de la conducta, la ansiedad, la depresión y los trastornos alimentarios, además de otros comportamientos de riesgo (por ejemplo, los relacionados con las conductas sexuales, el abuso de sustancias o los comportamientos violentos).
• Los problemas de salud mental en los jóvenes representan un importante reto para la salud pública de todo el mundo. Las medidas preventivas pueden evitar que aparezcan y/o permanezcan alteraciones en la salud mental. Además, una intervención temprana limita la gravedad de estos.
• El apoyo a la salud mental, su prevención y su tratamiento oportuno reduce la carga que pesa sobre los sistemas de atención de la salud.
• Los trabajadores de la salud deben contar con el conocimiento y las competencias necesarias para comunicarse bien con los jóvenes, detectar precozmente posibles problemas de salud mental y ofrecer el tratamiento oportuno.
• Se deben vincular diversos sectores para la realización de políticas y programas para la atención de la salud mental y el fortalecimiento de los servicios de atención para prestar el apoyo necesario.

Aprovechemos este año para enfatizar las necesidades de nuestros jóvenes. Es hora de tomar una posición y exigir más para los jóvenes del mundo.

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  246. If you vacation overseas it is important that you should have got a valid passport. You can expect to be unable to enter into the continent unless you have one. The following will assist help you to getting a reasonable passport so that you can journey anyplace you choose. Always study just before arranging travel. Discover web sites which contain evaluations of prospective locations. Ask other people who have traveled there. This will help you to anticipate precisely what you will come across. If you may be driving to the spot, load a family member or buddy in on your location and prepared route to get there. If one thing would happen to you while traveling, he or she could warn representatives of the intended spot as well as the roads you might have been touring on. If you’re concerned about venturing by yourself, especially when you’re a girl, you should look at consuming some self-protection sessions before heading. This method for you to find out simple methods to get away from a mugger or rapist in cases where you have to. Most locations use a handful of schools that train personal-safeguard at sensible charges. Dump the fanny load. In addition you look the a part of a traveler, a fanny load up is normally straightforward pickings to get a crook. In the event you want the benefit in the fanny load, think about obtaining a multiple-budget traveling vest alternatively. These carry just as much but retain the items near the body where they are less hazardous. If you’re understanding of the smell of products (or maybe don’t like them!) try getting some little candle lights together with you on your trip. This will help to mask the fragrance of the products the maids use and also the scents will also help loosen up you. Some aromas can also sooth you and give you a much better night’s sleep. Vacationing can be something that most of us like to do, and many of us visit different places every possibility we receive. But it might be expensive and dangerous from time to time. Make sure you’re following this vacation guidance before you take the next trip. You’ll be grateful that you just did.

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