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Suicidal behavior is a serious health issue that affects the adolescent population and that may be prevented through evidence-based approaches. There are many risk factors involved in suicidal behavior, but there are few studies encompassing the complex relationships between them. This study tested the similarity between two latent class models from two different epidemiological samples of middle-school students and evaluated if the multinomial regression model replicated the associations between the classes and the psychosocial variables. Data of 4013 adolescents from the Mexican states of Campeche and Querétaro were included in LCA to characterize suicide behavior and associated factors. The most likely latent class membership was used as the outcome in multinomial regression models. The model with data from Querétaro was consistent with the previous LC model from Campeche. The four latent classes were nearly identical for both populations and can be defined as follows: 1) "No Problems," included 73% of the adolescents; 2) "Drug Use Only," comprised 7% of the adolescents; 3) "Suicidal Behavior, No Depression," captured 8% of the adolescents (25% reported binge drinking in the past month, 50% self-inflicted injuries, and 43% low-lethality suicide attempt); 4) "Depression and Suicidal Behavior," comprised 12% of the sample (66% met criteria for Major Depressive Episode, 28% reported binge drinking in the past month, and 11% had a high-lethality suicide attempt). The congruence between the models and the consistency with identified factors highlight the need for appropriate and effective prevention strategies to minimize risk factors and reinforce protective factors in the adolescent population.

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BACKGROUND: There is serious concern over the increase in mental health problems during the coronavirus disease 2019 (Covid-19) pandemic. METHODS: Based on data from two Mexican National Health and Nutrition Surveys conducted in 2018-2019 and 2020 (n = 17,925 and 4,913, respectively), we estimated the prevalence of suicide attempts among adolescents 10-19 years old in the previous year. We constructed a multivariate logistic regression model adjusted by sociodemographic characteristics and contextual variables for the Covid-19 pandemic. RESULTS: The prevalence of suicide attempts in the previous year was similar in both surveys. We found that women, youth in urban localities and individuals living in households where a family member had lost her/his job as a result of the Covid-19 contingency were more likely to attempt suicide compared to their counterparts. On the other hand, attending classes online proved to be a protective factor (aOR=0.3, 95% CI=0.1, 0.8, p = 0.022). LIMITATIONS: The principal limitation of our study concerned the restricted size of our sample for the 2020 survey wave. CONCLUSIONS: Population-level policies aimed at providing economic protection and helping youth to return to school would exert a favorable impact on the mental health and suicidal behavior of youths.

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OBJECTIVE: To compare the occurrence of suicide attempts across nationally representative samples of the Mexican adolescent population over the past 12 years, and to analyze its association with sociodemographic, lifestyle and mental-health indicators. METHODOLOGY: Data were drawn from the 2006, 2012 and 2018 National Health and Nutrition Surveys (n = 25,056; 21,509; and 17,925 adolescents, respectively). Estimates were based on standardized measurements. RESULTS: The estimated lifetime prevalence rates of suicide attempts were 1.1% in 2006, 2.7% in 2012, and 3.9% in 2018, indicating a 3.4-fold increase. Across the three survey periods, women yielded rates nearly three times higher than men. Lifetime prevalence grew the most among adolescents aged 13-15 years. Compared to the other respondents, the odds of lifetime suicide attempts proved seven times as high for those who had been sexually abused during their childhood, five times as high for those who had been diagnosed with a depressive disorder, three times as high for those who had suffered physical aggression and twice as high for those who had smoked 100+ cigarettes in their lifetimes and those who consumed alcohol. CONCLUSION: The sharp increase in suicide attempts in Mexico calls for an urgent public-health response via universal and targeted interventions supported by national policy and sustained federal funding.

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Background: Suicide and suicidal behaviors were already a global public health problem, producing preventable injuries and deaths. This issue may worsen due to the COVID-19 pandemic and may differentially affect vulnerable groups in the population, including children, adolescents, and young adults. The current study evaluated the association of affective variables (depression, hopelessness, and anxiety), drug use (alcohol, tobacco, and others), emotional intelligence, and attachment with suicidal behaviors. Methods: A state-wide survey included 8033 students (51% female, 49% male; mean age of 16 years) from science and technology high-schools using a standardized questionnaire that was distributed online. Multinomial logistic regression models tested associations between suicidal behaviors and several covariates. The analyses accommodated the complex structure of the sample. Results: Approximately 21% of all students reported a suicidal behavior (11% with a low-lethality suicide attempt, 6% with self-injuries, and 4% with a high-lethality suicide attempt). Variables associated with higher odds of suicidal behavior included: female sex, depression, hopelessness, anxiety, alcohol and tobacco use, childhood trauma, and having to self-rely as issues affecting attachment, and low self-esteem. Security of attachment was associated with lower odds of suicidal behavior. Conclusions: The complexity of suicidal behavior makes it clear that comprehensive programs need to be implemented.

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Suicide rates in Mexico have increased and have more than doubled in the state of Aguascalientes over the past 10 years. Few studies have been able to control for family, neighborhood, and occupational environment factors that may confound the association between psychosocial characteristics and suicidal behavior. We study suicidal behavior among adolescents and young adults in Mexico utilizing epidemiologic research strategies to overcome prior research deficiencies. In a case-control study with youth and adults 14-42 years of age, recent cases of severe suicidal behavior (n = 150) were individually matched with up to three controls who had never had a suicidal attempt by age and sex, as well as within familial, neighborhood, and occupational contexts (n = 353). Data were collected through standardized face-to-face interviews to measure suicidal behavior and several covariates, including family relations, psychological resources, hopelessness, depression, self-esteem, stress, impulsivity, anxiety, and substance use. All measures demonstrated good to excellent precision and accuracy. Compared with their matched controls, cases perceived life events as more stressful and had worse depression and familial relationships; poorer development of affective, religious, and social resources; higher levels of hopelessness and impulsive behavior; and lower self-esteem. Evidence from multivariate analysis suggests highly probable MDE combined with low self-esteem and the use of two or more drugs in the past month more clearly differentiate cases and controls and, therefore, may best predict suicidal attempt among adolescents and young adults in Aguascalientes, Mexico.

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BACKGROUND: While research suggests that chronic childhood adversities may be predictors of alcohol use disorders, little is known of their influence on accelerated transitions through stages of alcohol involvement. We estimated the speed of transition from first opportunity (to first drink, regular drinking) to alcohol use disorder, by type and number of childhood adversities experienced. METHODS: Nine-hundred-and-fifteen individuals participated in the Mexican Adolescent Mental Health Survey (a stratified multistage probabilistic sample), first as adolescents (12-17 years of age) and again eight years later as young adults (19-26 years of age). The WHO World Mental Health Composite International Diagnostic Interview (WMH-CIDI) assessed DSM-IV alcohol use disorders and twelve chronic childhood adversities. We calculated random coefficient models to estimate the association of childhood adversities with speed through stages of alcohol use involvement. RESULTS: Mean time from opportunity to disorder was 4.08 years and the average growth rate was 1.36 years between each stage of involvement. Some, but not all, childhood adversities accelerated the growth rate, decreasing latency between each stage of alcohol use involvement from 1.36 to 0.93 years for witnessing family violence, 0.87 years for having a life-threatening illness, 0.79 years for sexual abuse to 0.77 years for physical abuse (p < 0.01). CONCLUSIONS: There is a narrower window of opportunity to prevent progression through stages of alcohol involvement in youth who have experienced certain childhood adversities. Our findings are consistent with the dimensional approach of childhood adversity that distinguishes between experiences of threat and deprivation that might differentially influence neurological development.

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AIM: To determine the prevalence of drug and substance abuse among high school students in Jalisco and its association with the severity of health, behavior and psychosocial problems in order to provide evidence for possible prevention and treatment needs. METHODS: A multi-stage random sample of Jalisco high school students was given a paper-and-pencil survey based upon an adapted version of the drug use screening inventory (DUSI) (n = 24699; n = 2832). The DUSI showed adequate psychometric characteristics in this population. The statistical analyses accommodated the complex survey design with attention to unequal probability of selection and clustering of participants within schools and regions. RESULTS: An estimated 44% of the students had smoked tobacco, one in five students was a current smoker, and one in four students used to smoke but had not smoked for one year or more. By contrast, 6.8% of the students reported having used marijuana, cocaine, or both. Behavioral problems, deviant peer affiliation, and troubled families were independently associated with drug use. One in two students who used tobacco or alcohol had used these drugs in the past year (46% and 54%, respectively), and one in four students who used marijuana or cocaine in their lifetime had used those drugs in the past year (28% in both cases). CONCLUSION: The rates of cocaine use as well as the proportion of current users were higher than expected among high school students and indicate changing patterns of drug use in Mexico. These results corroborate that the general trend of drug use by youth in Mexico is increasing. Results from this study help us better understand the needs of at-risk youth and the need for new treatment and prevention strategies.

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Suicide is an important public health problem that requires a preventive approach. The present study aimed at assessing suicidal behaviors and their relations with other psychosocial factors in Campeche, Mexico, in order to inform the design of potential preventive interventions. A multistage probability sample of 2386 students representative of all middle schools of the state of Campeche, Mexico, took a standardized, paper-and-pencil survey covering selected psychosocial constructs including suicide behavior, depression, drug use, familial relationships, locus of control, impulsivity, and self-esteem, among others. Latent classes were identified and multinomial logistic regression was used to analyze associations between class membership and psychosocial covariates. An estimated 8% of the middle school population in Campeche had three or more psychosocial problems in the past month including drug use, major depression episode symptoms, as well as suicidal problems like attempts and self-inflicted injuries. Four latent classes were identified, one with lowest risk and three with varying characteristics in terms of binge alcohol and other drug use, depression, and suicide behaviors. Associations between psychosocial covariates and latent class were observed, as predicted based on a multi-dimensional theoretical framework. Heterogeneity across "High-Risk" groups and their potential determinants highlight the need for differentiated, specialized efforts ranging from universal to indicated interventions. Given the high level of risk factors in this population, universal preventive interventions should aim at building resiliency among youth by helping them develop an array of coping resources, as well as by creating a more nurturing psychosocial environment.

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La depresión constituye un grave problema de salud pública que requiere mayor y mejor atención. En el presente ensayo revisamos el panorama epidemiológico de la depresión en adolescentes de México y discutimos algunas estrategias para su detección temprana y atención oportuna.La sintomatología depresiva es prevalente en jóvenes y adultos en México, como en muchos otros países, con una mayor proporción de casos entre las mujeres. Los jóvenes en condiciones socio-urbanas más conflictivas muestran tasas más elevadas de depresión.Si bien los trastornos depresivos son más prevalentes en las mujeres, en los hombres sus consecuencias pueden tener repercusiones de gravedad aún mayores que en las mujeres. El estigma hacia la depresión en los hombres puede conducir a que se intente enmascarar los síntomas mediante conductas de alto riesgo. Las mujeres tienen mayores tasas de intento de suicidio, pero en los hombres los intentos son más letales. Las tasas de suicidio consumado en varones son más altas en la mayoría de los países del mundo, y México no es la excepción. Pese a las barreras y escasos recursos en las instituciones de salud y educación, será necesario continuar desarrollando alternativas que permitan una mejor atención de la problemática de salud mental en la población joven, aun cuando sus necesidades no puedan ser expresadas directamente o que los motivos de consulta sean "otros", frecuentemente enmascarados por conductas problemáticas, como la violencia y las adicciones, entre otras.

Depression is an important public health problem that requires more and better attention. In the present work we review epidemiologic studies of depression among adolescents in Mexico and discuss strategies that may help in earlier identification and referral of potential cases for timely care.In summary, depressive symptoms are prevalent among adolescents and adults in Mexico as in many other countries, with a higher ratio of female cases. Young people experiencing the most challenging socio-urban situations have higher rates of depression.Even though depressive disorders are more prevalent among females, consequences may be even worse for males. The authors posit that, among males, stigma attached to depression might lead to attempts to hide depressive symptoms by masking them through high-risk behaviors (e.g., alcohol, drug use, and violence, among others). Women may have higher rates of suicide attempts, but the case-fatality rate of suicide attempts is higher among males.Despite of barriers and resource scarcity among healthcare and educational institutions, it is necessary to continue to develop alternatives that will lead to better attention of mental health issues among the youth, even when their mental health needs are not expressed directly or their chief complaints are in regard to "other" health issues.

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Depression is an important public health problem that requires more and better attention. In the present work we review epidemiologic studies of depression among adolescents in Mexico and discuss strategies that may help in earlier identification and referral of potential cases for timely care. In summary, depressive symptoms are prevalent among adolescents and adults in Mexico as in many other countries, with a higher ratio of female cases. Young people experiencing the most challenging socio-urban situations have higher rates of depression. Even though depressive disorders are more prevalent among females, consequences may be even worse for males. The authors posit that, among males, stigma attached to depression might lead to attempts to hide depressive symptoms by masking them through high-risk behaviors (e.g., alcohol, drug use, and violence, among others). Women may have higher rates of suicide attempts, but the case-fatality rate of suicide attempts is higher among males. Despite of barriers and resource scarcity among healthcare and educational institutions, it is necessary to continue to develop alternatives that will lead to better attention of mental health issues among the youth, even when their mental health needs are not expressed directly or their chief complaints are in regard to "other" health issues.

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PURPOSE: Determine the structure of depressive symptoms among adolescents and older adults through the person-centered approach of latent class analysis (LCA). METHODS: The study is based on data from two independent samples collected in Mexico City (2,444 adolescents and 2,223 older adults) which included the revised version of the CES-D. The presence or absence of depressed mood (dysphoria), diminished pleasure (anhedonia), drastic change in weight, sleep problems, thinking and concentration difficulties, excessive or inappropriate guilt, fatigue, psychomotor agitation/retardation, and suicide ideation were used in LCA to determine the structure of depressive symptoms for adolescents and older adults. RESULTS: Adolescents reported higher excessive or inappropriate guilt compared to older adults, while older adults had higher proportions of anhedonia, sleep problems, fatigue, and psychomotor agitation/retardation. Similar proportions were found in other symptoms. The LCA analysis showed the best fit with four latent classes (LC): LC 1, "symptoms suggestive of major depressive episode (MDE)" with prevalence of 5.9 % (n = 144) and 10.3 % (n = 230) among adolescents and older adults, respectively; LC 2, "probable MDE symptoms" 18.2 % (n = 446) and 23.0 % (n = 512); LC 3, "possible MDE" 27.7 % (n = 676) and 21.8 % (n = 485); LC 4, "without significant depressive symptoms" 48.2 % (n = 1,178) and 44.8 % (n = 996). The differences in item thresholds between the two groups (adolescents vs. older adults) were statistically significant (Wald test = 255.684, df = 1, p < 0.001). CONCLUSIONS: This study documented important similarities and differences in the structure of depressive symptoms between adolescents and older adults that merit acknowledgment, further study, and consideration of their potential clinical and public health implications.

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BACKGROUND: Depression is a well-recognised problem in the elderly. The aim of this study was to determine the factors associated with predictors of change in depressive symptoms, both in subjects with and without baseline significant depressive symptoms. METHODS: Longitudinal study of community-dwelling elderly people (>60 years or older), baseline evaluations, and two additional evaluations were reported. Depressive symptoms were measured using a 30-item geriatric depression scale, and a score of 11 was used as cut-off point for significant depressive symptoms in order to stratify the analyses in two groups: with significant depressive symptoms and without significant depressive symptoms. Sociodemographic data, social support, anxiety, cognition, positive affect, control locus, activities of daily living, recent traumatic life events, physical activity, comorbidities, and quality of life were evaluated. Multi-level generalised estimating equation model was used to assess the impact on the trajectory of depressive symptoms. RESULTS: A number of 7882 subjects were assessed, with 29.42% attrition. At baseline assessment, mean age was 70.96 years, 61.15% were women. Trajectories of depressive symptoms had a decreasing trend. Stronger associations in those with significant depressive symptoms, were social support (OR.971, p<.001), chronic pain (OR 2.277, p<.001) and higher locus of control (OR.581, p<.001). In contrast for those without baseline significant depressive symptoms anxiety and a higher locus of control were the strongest associations. CONCLUSIONS: New insights into late-life depression are provided, with special emphasis in differentiated factors influencing the trajectory when stratifying regarding basal status of significant depressive symptoms. LIMITATIONS: The study has not included clinical evaluations and nutritional assessments.

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OBJECTIVE: Depression in the older individuals is associated with multiple adverse outcomes, such as high health service utilization rates, low pharmacological compliance, and synergistic interactions with other comorbidities. Moreover, the help-seeking process, which usually starts with the feeling "that something is wrong" and ends with appropriate medical care, is influenced by several factors. The aim of this study was to explore factors associated with the pathway of help seeking among older adults with depressive symptoms. METHODS: A cross-sectional study of 60-year or older community dwelling individuals belonging to the largest health and social security system in Mexico was carried out. A standardized interview explored the process of seeking health care in four dimensions: depressive symptoms, help seeking, help acquisition, and specialized mental health. RESULTS: A total of 2322 individuals were studied; from these, 67.14% (n = 1559) were women, and the mean age was 73.18 years (SD = 7.02); 57.9% had symptoms of depression; 337 (25.1%) participants sought help, and 271 (80.4%) received help; and 103 (38%) received specialized mental health care. In the stepwise model for not seeking help (χ(2) = 81.66, p < 0.0001), significant variables were female gender (odds ratio (OR) = 0.7, 95% confidence interval (CI) 0.511-0.958, p = 0.026), health-care use (OR 3.26, CI 95% 1.64-6.488, p = 0.001). Number of years in school, difficulty in activities, Short Anxiety Screening Test score, and indication that depression is not a disease belief were also significant. CONCLUSIONS: Appropriate mental health care is rather complex and is influenced by several factors. The main factors associated with help seeking were gender, education level, recent health service use, and the belief that depression is not a disease. Detection of subjects with these characteristics could improve care of the older individuals with depressive symptoms.

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Introduction Depression in the elderly is of interest because of its relationship with increased demand for health services, as well as the low frequency of diagnosis. Objective To determine the frequency of depressive symptoms (DS) among elderly beneficiaries in Mexico City by the revised scale of depression of the Center for Epidemiologic Studies of the United States (CES-DR) and the Yesavage Geriatric Depression Scale (GDS). Materials and methods In the first phase of the study we evaluated the presence of significant DS with the 30-item GDS. Those with scores of 11 or more were considered positive and were included in the second phase. In this phase were added a random sample with negative scores. All participants completed the second phase of the revised CES-DR. The 80 percentile was used in this study with a cut-off of 57 points. Results A total of 7449 elderly were included in the first phase. The prevalence of reported significant DS with the GDS was 21.7% (n = 1.616) (IC-95%, 20.4-23.0). The sample for the second phase included 2 923 elderly. The mean age was 70.8 years, 61.7% were women. Twelve percent (95% CI, 9.2-15.3) showed significant DS of major depression, 7.5% (95% CI, 6.3-8.9) was rated as probable, 17.2% (95% CI, 13.022.3) possible, 2.6% (95% CI, 2.2-3.1) sub-threshold depression episode and 60.7% (95% CI, 56.2-65.1) with no significant DS episodes of major depression. Significant frequency of major depression SD is presented using the GDS and CESDR was 6.5% (95% CI, 3.3-12.4). Conclusions The expression of the identified significant SD CES-DR is different from what is reported to the GDS. The CES-DR is more sensitive and specific to identify the presence of depressive symptoms.

Introducción La depresión en el anciano resulta de interés por su relación con el incremento de la demanda de servicios de salud, así como por su baja frecuencia de diagnóstico. Objetivo Determinar la frecuencia de los síntomas depresivos (SD) entre ancianos derechohabientes de la Ciudad de México, mediante la escala revisada de depresión del Centro de Estudios Epidemiológicos de los Estados Unidos (CES-DR) y la Escala de Depresión Geriátrica de Yesavage (GDS). Materiales y métodos En la primera fase del estudio se evaluó la presencia de SD significativos con la GDS de 30 ítems. Aquéllos con puntaje de 11 o más fueron considerados como positivos y se incluyeron en la segunda fase. En esta fase se agregó una muestra aleatoria con puntajes negativos. Todos los participantes en la segunda fase completaron la versión revisada del CES-DR. El percentil 80 se utilizó en este estudio con un punto de corte de 57 puntos. Resultados Un total de 7449 adultos mayores fueron incluidos en la primera fase. La prevalencia de SD significativos reportada con el GDS fue de 21.7% (n=1,616) (IC-95%, 20.4-23.0). La muestra para la segunda fase incluyó 2923 adultos mayores. La media de edad fue de 70.8 años, el 61.7% eran mujeres. El 12.0% (IC-95%, 9.2-15.3) presentó SD significativos de depresión mayor, 7.5% (IC-95%, 6.3-8.9) fue calificado como probable, 17.2% (IC-95%, 13.0-22.3) como posible, 2.6% (IC-95%, 2.2-3.1) con episodio de depresión sub-umbral y 60.7% (IC-95%, 56.265.1) sin SD significativos de episodios de depresión mayor. La frecuencia de SD significativos de depresión mayor que se presentó utilizando el GDS y el CESDR fue de 6.5% (IC-95%, 3.3-12.4). Conclusiones La expresión de SD significativos identificada con el CES-DR es diferente a lo que se reporta con el GDS. La CES-DR permite identificar la presencia de síntomas de depresión de manera más sensible y específica.

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The present review aims at analyzing the magnitude and social impact of depression, as well as exploring models that help to understand the strategies needed to address this public health problem. The literature reveals that 9.2% of the general population has had a depressive episode and one in five persons will have an episode by age 75. Lower rates are observed in low and mid income in comparison to those with high income. These differences are not due to personal income, the probability of greater severity or delay in diagnosis, and are more likely related to cultural differences. Greater risk is observed among females, people younger than 60 years, marital status as single, widowed or divorced, and low educational attainment. The deleterious effect of depression on productivity is well established (27 days lost in the past year, on average, per case). The association with diabetes, hypertension, cardio vascular disease, drug use, suicide, and other risk behaviors has been frequently observed. Although unresolved questions remain about the presence or not of common risk factors and the chain of causality, it is a known fact that the combination of physical and mental disorders causes greater disability. With regard to the healthcare system, patients with depression and/or anxiety have higher utilization rates and healthcare costs, particularly among elderly patients. This healthcare overutilization is related with the low rates of diagnosis and adequate treatment of depression. About 26% of depression cases will not be diagnosed and, although a large proportion of patients have contact with healthcare services, nearly 30% never receive help for their depression. New treatment models that overcome barriers, understanding the sociocultural factors related with the problem, and addressing depression at the primary level of healthcare are urgent in Mexico.

El objetivo de la presente revisión es analizar la magnitud y el impacto social de la depresión, así como explorar modelos que permitan comprender mejor las estrategias necesarias para su atención. Los reportes revelan que 9.2% de la población general ha padecido un episodio de depresión, que una de cada cinco personas sufrirá uno antes de llegar a los 75 años y que los más jóvenes presentan tasas mayores. Tasas más bajas se observan en países de ingreso bajo y medio, en contraste con países de ingreso alto. Diferencias no relacionadas con la gravedad o el retraso en el diagnóstico probablemente se vinculen con diferencias culturales. Las mujeres, las personas sin pareja y el bajo nivel de educación se asocian con mayor riesgo. El efecto deletéreo en productividad (media de 27 días perdidos en el último año) es indiscutible. La asociación con diabetes, hipertensión y trastornos cardiacos, entre otras, ha sido frecuentemente investigada. Si bien no es clara la presencia o no de factores de riesgo comunes y la cadena de causalidad, la combinación de trastornos físicos y mentales genera más discapacidad. La depresión ha sido asociada a otras conductas como adicciones, suicidio y violencia, particularmente en jóvenes. En cuanto a los efectos en el sistema de salud, diversos estudios han demostrado que los pacientes con depresión tienen mayores tasas de utilización y mayores costos asociados, particularmente con ancianos. Esta sobreutilización está relacionada con la baja proporción de diagnóstico y tratamiento certero. El 26% de las personas no serán diagnosticadas y, a pesar de que una elevada proporción de pacientes contactaron con los servicios de salud, cerca del 30% nunca recibió ayuda. Nuevos modelos de atención que incluyan el abatimiento de las barreras, el entendimiento de los factores socioculturales y la inclusión del manejo primario de la depresión son urgentes.

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BACKGROUND: Studying youthful drug involvement in the Republic of Chile, we sought to replicate North American research findings about the earliest stages of drug involvement (e.g., initial opportunities to use tobacco and alcohol, and transitions leading toward illegal drug use). METHODS: A nationally representative multistage probability sample of middle and high school students was drawn; 30,490 youths completed surveys that assessed age at first drug exposure opportunities and first actual drug use. Cox discrete-time survival models accommodate the complex sample design and provide transition probability estimates. RESULTS: An estimated 39% of the students had an opportunity to use cannabis, and 70% of these transitioned to actual cannabis use. The probability of cannabis use and the conditional probability of cannabis use (given opportunity) are greater for users of alcohol only, tobacco only, and alcohol plus tobacco, as compared to non-users of alcohol and tobacco. Male-female differences in cannabis use were traced back to male-female differences in drug exposure opportunities. CONCLUSION: In Chile as in North America, when cannabis use follows alcohol and tobacco use, the mechanism may be understood in two parts: users of alcohol and tobacco are more likely to have opportunities to try cannabis, and once the opportunity occurs, they are more likely to use cannabis. Male-female differences do not seem to be operative within the mechanism that governs transition to use, once the chance to use cannabis has occurred.

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OBJECTIVE: To examine the relationship between components of social networks and health-related quality of life (HRQL) in older adults with and without depressive symptoms. MATERIAL AND METHODS: Comparative cross-sectional study with data from the cohort study "Integral Study of Depression", carried out in Mexico City during 2004. The sample was selected through a multi-stage probability design. HRQL was measured with the SF-36. Geriatric Depression Scale (GDS) and the Short Anxiety Screening Test (SAST) determined depressive symptoms and anxiety. T-test and multiple linear regressions were conducted. RESULTS: Older adults with depressive symptoms had the lowest scores in all HRQL scales. A larger network of close relatives and friends was associated with better HRQL on several scales. Living alone did not significantly affect HRQL level, in either the study or comparison group. CONCLUSIONS: A positive association between some components of social networks and good HRQL exists even in older adults with depressive symptoms.

OBJETIVO: Examinar la relación entre componentes de redes sociales y calidad de vida relacionada con la salud (CVRS) de adultos mayores con o sin síntomas depresivos. MATERIAL Y MÉTODOS: Estudio transversal comparativo con datos de la cohorte "Estudio Integral de Depresión", realizado en la Ciudad de México en 2004. La muestra fue seleccionada por diseño probabilístico multietápico. La CVRS se midió con SF-36, mientras que Geriatric Depression Scale y Short Anxiety Screening Test determinaron síntomas de depresión y ansiedad. El análisis consistió de prueba T y regresiones lineales múltiples. RESULTADOS: Ancianos con síntomas de depresión reportaron puntuaciones más bajas en todas las escalas de CVRS; una red más grande de familiares y amigos se asoció con mejor CVRS en varias escalas. Vivir solo no afectó la CVRS en grupos de estudio y comparación. CONCLUSIONES: Existe una asociación positiva de algunos componentes de las redes sociales con la CVRS, incluso en ancianos con síntomas depresivos.

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OBJECTIVE: To examine the relationship between components of social networks and health-related quality of life (HRQL) in older adults with and without depressive symptoms. MATERIAL AND METHODS: Comparative cross-sectional study with data from the cohort study 'Integral Study of Depression', carried out in Mexico City during 2004. The sample was selected through a multi-stage probability design. HRQL was measured with the SF-36. Geriatric Depression Scale (GDS) and the Short Anxiety Screening Test (SAST) determined depressive symptoms and anxiety. T-test and multiple linear regressions were conducted. RESULTS: Older adults with depressive symptoms had the lowest scores in all HRQL scales. A larger network of close relatives and friends was associated with better HRQL on several scales. Living alone did not significantly affect HRQL level, in either the study or comparison group. CONCLUSIONS: A positive association between some components of social networks and good HRQL exists even in older adults with depressive symptoms.

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Objective: to test that drug abuse and dependence would be greater among those who have: higher depression, a family with dysfunctional cohesion and adaptability, greater exposure to stressful situations; maladaptive coping strategies. Methods: a case-control study design was used, with three controls matched to each case by on age, sex, and neighborhood of residence. The sample included 218 cases and 677 controls. Results: cases of drug abuse and dependence were estimated to have higher odds of elevated depression symptoms, as well as high psychosocial stress from maladaptive school adjustment, compared to controls. Cases of drug dependence had higher odds to maladaptive family cohesion and adaptation, as well as higher odds of exposure to high-impact stress related to family separations, as well as family communication problems. Conclusions: findings indicate that drug abuse and dependence are significantly related to maladaptative adjustment indicators, family disfunctionality and affective disorders.

Objetivo: este estudio pretende probar que las posibilidades de abuso o dependencia de drogas son mayores entre jóvenes con un modelo maladaptativo para afrontar el estrés y aliviar la ansiedad y la depresión. Métodos: estudio de casos y controles, con tres controles pareados a cada caso según edad, sexo y colonia de residencia. La muestra comprendió 218 jóvenes con abuso o dependencia de drogas ilícitas y 677 no usuarios. Resultados: comparados con los no usuarios, los jóvenes con abuso y dependencia tuvieron síntomas más elevados de depresión y alta tensión psicosocial derivada de un ajuste escolar maladaptativo. Hay mayores posibilidades de dependencia de drogas entre quienes señalan cohesión y adaptabilidad familiar maladaptativas y presentan estrés de alto impacto relacionado con separaciones familiares o con problemas de comunicación familiar. Conclusiones: los hallazgos indican que el abuso y dependencia de drogas están relacionados con indicadores de ajuste maladaptativo, con el deterioro de las relaciones familiares y con signos de malestar afectivo. La diversidad de factores identificados confirma la conveniencia de aplicar modelos multifactoriales para la comprensión del fenómeno.

RESUMO

OBJECTIVE: To determine the psychometric qualities of the CES-DR and GDS scales in the elderly and compare them to clinical psychiatric diagnoses. MATERIAL AND METHODS: The first phase consisted of home interviews for determining the psychometric qualities of the GDS and CES-DR scales. In the second phase, psychiatrists conducted diagnostic interviews. The sample consisted of 534 participants older than 60 years of age insured by the Mexican Institute of Social Security. RESULTS: First phase: Cronbach's alpha for the GDS was 0.87 and 0.86 for CES-DR. The GDS factorial analysis found eight factors that could explain 53.5 percent of the total variance and nine factors that explained 57.9 percent in the CES-DR. Second phase: Compared to the psychiatric diagnoses, CES-DR reported a sensitivity of 82 percent and a specificity of 49.2 percent; GDS reported 53.8 percent sensitivity and 78.9 percent specificity. CONCLUSIONS: CES-DR and GDS scales have high reliability and adequate validity but the CES-DR reports higher sensitivity.

RESUMEN OBJETIVO: Determinar las propiedades psicométricas de las escalas CES-DR y GDS para depresión en población anciana y compararlas con el diagnóstico clínico psiquiátrico. MATERIAL Y MÉTODOS: La primera fase consistió en entrevistas en casa para determinar las propiedades psicométricas. En la segunda fase, los psiquiatras condujeron entrevistas diagnósticas. La muestra consistió en 534 participantes de 60 años y más asegurados por el Instituto Mexicano del Seguro Social. RESULTADOS: Primera fase: Alfa de Cronbach para el GDS y CES-DR fue de 0.87 y 0.86, respectivamente. El análisis factorial del GDS reportó ocho factores que explicaron 53.5 por ciento de la varianza, comparado con nueve del CESDR que explicaron 57.9 por ciento. Segunda fase: Comparado con el diagnóstico psiquiátrico, el CES-DR reportó una sensibilidad de 82 por ciento y una especificidad de 49.2 por ciento comparado con 53.8 por ciento y 78.9 por ciento, respectivamente del GDS. CONCLUSIONES: Las escalas CES-DR y GDS tienen consistencia y adecuada validez pero el CES-DR reporta más alta sensibilidad.

Assuntos