RESUMO
While the classification of psychiatric disorders has been critiqued for failing to adequately account for culture, the inclusion of the Cultural Formulation Interview (CFI) in the DSM-5 has been viewed as a promising development for the inclusion of cultural factors in diagnosis and treatment of mental illness. In this study, we assess the appropriateness, acceptability, and clinical utility of the CFI among outpatients in a Mexican psychiatric hospital. Our assessment included observations of psychiatric residents' application of the CFI with 19 patients during routine outpatient visits, along with pre- and post-CFI interviews to determine providers' and patients' views of the CFI. The CFI was generally well received by providers and patients, viewed as a way of building trust and increasing providers' understanding of contextual factors influencing mental illness, such as social support. However, the CFI questions specifically related to "culture" were of limited effect and both patients and providers did not view them as useful. We discuss implications for the clinical assessment of cultural factors influencing mental health and illness and for the incorporation of the CFI in Mexican clinical settings.
Assuntos
Assistência à Saúde Culturalmente Competente/normas , Manual Diagnóstico e Estatístico de Transtornos Mentais , Entrevista Psicológica/normas , Transtornos Mentais/diagnóstico , Transtornos Mentais/terapia , Adulto , Antropologia Médica , Feminino , Hospitais Psiquiátricos , Humanos , Masculino , Serviços de Saúde Mental/organização & administração , México , Pessoa de Meia-Idade , Pacientes Ambulatoriais/psicologia , Apoio Social , Adulto JovemRESUMO
This article examines the sociocultural determinants of Nicaraguan women's use of Depo-Provera as a means of contraception. The prevalence of Depo-Provera in Nicaragua is high and increasing compared to other Central American countries. Drawing on data from structured interviews with 87 women and from focus groups with 32 women, we show how women's preference for Depo is shaped by both gendered inequalities and socioeconomic constraints. We employ basic statistical tests to analyse correlations between women's marital status and socioeconomic status (SES) with contraceptive use. Our statistical findings show significant associations between use of Depo and both marital status and SES, such that women who are married or in conjugal unions and women with lower SES are more likely to use Depo. To help explain women's use of Depo-Provera in Nicaragua, we situate our findings within the context of gender, culture, and power, reviewing the contested history of Depo-Provera in the developing world and dynamics of gender inequality, which constrain women's contraceptive choices. We conclude with suggestions for reproductive health programming in Nicaragua and beyond, arguing that gender equity and addressing socioeconomic barriers to family planning remain priorities for the achievement of global reproductive health.
Assuntos
Comportamento de Escolha , Comportamento Contraceptivo , Saúde Reprodutiva , Fatores Socioeconômicos , Adolescente , Adulto , Feminino , Grupos Focais , Humanos , Entrevistas como Assunto , Pessoa de Meia-Idade , Nicarágua , Pesquisa Qualitativa , Fatores Sexuais , Adulto JovemRESUMO
In this paper, I describe an embodied form of emotional distress expressed by Nicaraguan grandmothers caring for children of migrant mothers, "pensando mucho" ("thinking too much"). I draw on ethnographic fieldwork and semi-structured exploratory interviews about pensando mucho conducted with grandmother heads-of-household to show the cultural significance of this complaint within the context of women's social roles as caregivers in transnational families. Adopting an interpretive and meaning-centered approach, I analyze the cultural significance of pensando mucho as expressed through women's narratives about the impacts of mother outmigration on their personal and family lives. I show how women use pensando mucho to express the moral ambivalence of economic remittances and the uncertainty surrounding migration, particularly given cultural values for "unity" and "solidarity" in Nicaraguan family life. I also discuss the relationship between pensando mucho and dolor de cerebro ("brainache") as a way of documenting the relationship between body/mind, emotional distress, and somatic suffering. The findings presented here suggest that further research on "thinking too much" is needed to assess whether this idiom is used by women of the grandmother generation in other cultural contexts to express embodied distress in relation to broader social transformations.