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Perspectives of intellectual disability in Mexico: Epidemiology, policy, and services for children and adults

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Gregorio Katz
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María Elena Márquez-Caraveo at Hospital Psiquiátrico Infantil "Dr. Juan N. Navarro"
María Elena Márquez-Caraveo
  • Hospital Psiquiátrico Infantil "Dr. Juan N. Navarro"
Eduardo Lazcano-Ponce
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Abstract

Intellectual disability is a public health issue, which has largely been overlooked in Mexico. The magnitude of this problem is unknown; few programs exist for adults and mental health professionals focus mainly on identifying treatable comorbidities. In Mexico, there is an example of a best practice in social integration. This program has benefited hundreds of adults with intellectual disability by teaching four basic abilities: practical academic skills; vocational skills; independent living skills; and skills for community integration. In a sociocultural and economic context such as Mexico's, social integration programs are feasible and necessary in order to provide an organized social response to the health, social, and vocational needs of people with intellectual disability and should become part of public policy.
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Perspectives of intellectual disability in Mexico: epidemiology,
policy, and services for children and adults
Gregorio Katz
a
, Maria E. Ma
´rquez-Caraveo
b
and Eduardo Lazcano-Ponce
c
Introduction
The extent of actual disabilities in the Mexican population
is unknown. The most recent estimate is based on a 2003
national survey conducted by the National Institute of
Public Health that measures self-perception of health [1].
This survey documented that 9% of the total population
in the country had some degree of difficulty in mobility,
mental functioning, mood, normal activities, pain, and/or
social functioning. This puts the number of people in
Mexico with a disability at roughly 9.7 million, with a
prevalence of intellectual disability of 3% or 3 million
people [2]. In spite of the magnitude of this figure, the
medical unit that provides the most care for childhood
psychiatric disorders in Mexico City (Hospital Psiquia
´trico
Infantil ‘Dr Juan N. Navarro’) reported in 2009 only
444 diagnostic incident cases of mental retardation in
Mexico City, which has approximately 20% of the coun-
try’s total population. This suggests very low coverage and
little demand for specialized medical services by families
with children with intellectual disability.
Any estimate of the epidemiological indicators of intel-
lectual disability in Mexico faces a variety of methodo-
logical problems. First, psychiatric hospitals for the adult
population neither refer to nor quantify intellectual dis-
ability as a primary diagnosis. In addition, population
surveys of psychiatric disorders in adolescents [3
] and in
the population over 18 years of age [4,5] have used the
Composite International Diagnostic Interview (CIDI
certified version 15 World Health Organization, 2001),
which does not include a validated questionnaire for the
diagnosis of intellectual disability; it is, therefore, impos-
sible to know its magnitude. In summary, the prevalence
of intellectual disability in Mexico has not been esta-
blished; the hospitals that provide psychiatric care
underestimate the presence of intellectual disability in
children; and, in the adult population, diagnosis and
follow-up of people with intellectual disability are
virtually nonexistent.
In Mexico, the underreporting and/or misclassification of
intellectual disability by mental health professionals is
evident. The competencies and abilities of these pro-
fessionals are oriented toward identifying the high comor-
bidity of psychopathologies in this multifactorial morbid
condition. In order to classify the true extent of intellec-
tual disability as a public health problem, the CIDI will
need to be modified to include a series of questions that
allow for the identification of people with intellectual
disability.
Social exclusion and lack of public policies
for intellectual disability in Mexico: the
common denominator
Organized, governmental normalization programs for
people with intellectual disability to foster social and
a
Universidad Nacional Auto
´noma de Me
´xico,
b
Hospital
Psiquia
´trico Infantil ‘Dr Juan N. Navarro’, Ciudad de
Me
´xico and
c
Instituto Nacional de Salud Pu´blica,
Cuernavaca, Morelos, Me
´xico
Correspondence to Dr Eduardo Lazcano-Ponce,
Director del Centro de Investigacio
´n en Salud
Poblacional, Instituto Nacional de Salud Pu´ blica,
Avenida Universidad 655, Colonia Sta. Ma.
Ahuacatitla
´n. Cuernavaca, Morelos 62100, Mexico
Tel: +52 777 3 29 30 03; fax: +52 777 3 11 11 48;
e-mail: elazcano@insp.mx
Current Opinion in Psychiatry 2010, 23:432–435
Purpose of review
Intellectual disability is a public health issue, which has largely been overlooked in
Mexico. The magnitude of this problem is unknown; few programs exist for adults and
mental health professionals focus mainly on identifying treatable comorbidities.
Recent findings
In Mexico, there is an example of a best practice in social integration. This program has
benefited hundreds of adults with intellectual disability by teaching four basic abilities:
practical academic skills; vocational skills; independent living skills; and skills for
community integration.
Summary
In a sociocultural and economic context such as Mexico’s, social integration programs
are feasible and necessary in order to provide an organized social response to the
health, social, and vocational needs of people with intellectual disability and should
become part of public policy.
Keywords
intellectual disability, Mexico, public health
Curr Opin Psychiatry 23:432–435
ß2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
0951-7367
0951-7367 ß2010 Wolters Kluwer Health | Lippincott Williams & Wilkins DOI:10.1097/YCO.0b013e32833ad9b5
labor inclusion are lacking in the Latin American region,
and because of the absence of public policies – social,
labor, and health policies – intellectual disability could
be considered the most disadvantaged of all the disad-
vantaged in Mexico and other poor countries. And yet,
intellectual disability is a multifactorial, morbid condition
that involves dependency on the family, a higher fre-
quency of comorbidity, enormous catastrophic expenses
that impoverish families, and cultural patterns that result
in stigmatization, discrimination, and segregation. Thus,
in Mexico, people with intellectual disability could be
considered ‘invisible’ citizens as they do not have uni-
versal access to medical services and because there are no
official programs to foster independence.
The reality of social exclusion of people with intellectual
disability is directly proportional to the degree of poverty
[6] and is conceptually related to three components. The
first of these is economic deprivation, which means
insufficient family income, inadequate job training, and
a lack of job opportunities for this population. The second
component is social deprivation, in which the families
themselves segregate people with intellectual disability
from the community where the likelihood of disruption of
social and family ties is greater in this vulnerable popu-
lation. In addition, in Mexico, there are few charitable
organizations or community-based groups that work to
address this situation. Together, these elements lead to
marginalization, the modification of social behavior, and
the lack of participation in community activities. More-
over and very important is that people with intellectual
disability experience a progressive deterioration in health
and, unfortunately, there is no universal healthcare cover-
age. The third component is the absence of political
representation and, consequently, of social empower-
ment, which is directly proportional to the lack of parti-
cipation in decisions that affect their daily life.
In summary, social and labor exclusion of people with
intellectual disability in Mexico and Latin America leads
not only to poverty and greater catastrophic expenses for
the family, but also to insecure life and work conditions.
It also results in greater deterioration in the disability
itself and poor quality of life due to increased comorbid-
ity, including obesity due to a sedentary lifestyle, poor
oral–dental health, decline in mental health, particularly
depression, and, especially in Mexico, early-onset dia-
betes mellitus [7].
Intellectual disability and civil society: a
predominance of philanthropic and charitable
organizations
In Mexico, according to the national directory of people
with intellectual disability, there are 567 organizations
that provide intellectual disability services and care;
however, most of these organizations only serve those
less than 18 years of age (http://www.inegi.gob.mx/est/
contenidos/espanol/metodologias/registros/sociales/dir_
discapacidad2.pdf). The majority of these groups are
nongovernmental organizations created by parents,
whose work has primarily a philanthropic and charitable
context and yet many of these groups act without regard
to scientific evidence. One organization, CONFE
(Mexican Confederation of Organizations for Persons
with Intellectual Disability; http://www.confe.org.mx/),
offers a job training program for adults with intellectual
disability, with the limitation that it does not provide
independent living or social inclusion skills; these inter-
ventions are local and have very limited coverage. Most
programs developed in Mexico are the result of isolated
anecdotal, nonscientific evidence, have had little impact
on the affected population, and have been unsuccessful
in altering public policies. Additionally, once people
reach the age of 18 years, government no longer provides
services over the course of their adult lives, an indication
that intellectual disability has not been considered, even
in meetings organized by civil societies, as was the case in
the recent Second Continental Congress of Community
Based Rehabilitation of the Americas in Oaxaca 2010, in
which the topic of normalization and independence
for people with intellectual disability was absent
(http://superacionoaxaca.wordpress.com/2010/02/13/ter
cera-reunion-ordinaria-del-consejo-estatal-de-personas-
con-discapacidad-en-oaxaca/).
Intellectual disability and public policies in
Mexico: absence of interventions based on
scientific evidence
Education policies for people with intellectual disability
implemented in Mexico have been oriented toward the
creation of schools for special education and the integ-
ration of children and adolescents with intellectual dis-
ability in primary education [8]. Although these strategies
are useful for promoting diversity in the classroom, they
are centered on academics and not useful for promoting
independent living skills; in addition, specialized teacher
training is inefficient in understanding the needs of
the intellectual disability population, particularly when
attempting to use a classroom integration model.
The National Program for the Development of Persons
with Disabilities 2009–2012 (PRONADDIS, abbrevi-
ation in Spanish; http://www.conadis.salud.gob.mx/des
cargas/pdf/PRONADDIS.pdf) states that its purpose is
to contribute to the comprehensive development and full
inclusion of persons with disabilities and their families in
the social, political, and productive life of the country,
with complete respect for their human rights. Never-
theless, the program does not include guidelines for fos-
tering normalization for people with intellectual disability
Perspectives of intellectual disability in Mexico Katz et al. 433
nor does it suggest external evaluations to promote inter-
ventions based on scientific evidence. It operates using a
supportive approach with no specific proposal for the
promotion of independence. Thus, it is greatly influenced
by the charitable and philanthropic overview, without
considering the state’s obligation to provide an organized
social response for the most vulnerable people in society –
the people with intellectual disability.
Another reason for intellectual disability to be a forgotten
health problem in Mexico is that the most influential
Mexican institution on the prevention and care of psy-
chiatric disorders, the National Psychiatric Institute
(INP), in its healthcare or national research priorities
has not included people with intellectual disability
who are 18 years and older.
Search for independence and normalization:
an example of good practice and promotion
of social and work integration in Mexico
Self-determination on living and working in the com-
munity is the primary indicator of quality of life [9], and,
therefore, the greatest expectation of parents of people
with intellectual disability is the inclusion of their chil-
dren into the community [10], within the Mexican con-
text [11]. In this respect, community centers may be an
effective alternative in achieving this goal, as has been
widely documented for people with intellectual disability
living independently in residential placement acquiring
more skills and adaptive behaviors [12]. Katz et al. [12]
referred to programs that assist in the normalization
process for people with intellectual disability in Mexico.
These have been very successful for over 25 years in
benefiting adults with intellectual disability. These pro-
grams have achieved optimal rehabilitation for all those
individuals who present with below average intelligence,
with or without associated neurological symptoms,
enabling them to function to their greatest potential.
The acquired experience in Mexico provides evidence of
the usefulness, feasibility, and relevance of normalization
programs for local and regional sociocultural contexts
[13]. Taking into account the above, the National Insti-
tute of Public Health, in collaboration with the govern-
ment of the State of Mexico, developed an interinstitu-
tional collaboration for 2010 to provide an organized
social response for adults with intellectual disability. This
collaboration has the following objectives:
(1) Creation of state and regional programs for people
with intellectual disability, aimed at fostering inde-
pendence, through the development of social and
working skills.
(2) Identification of job positions, solicited by the local
Business Coordination Committee, which could be
feasibly occupied by people with intellectual dis-
ability.
(3) Development of a model for skills training and com-
petencies according to the profile of the specific
job position.
(4) Promotion of investment in human capital for the
training of health and educational professionals;
therefore, creating specialized educational programs
that foster independent living skills for people with
intellectual disability.
(5) Evaluation of the impact on government, families,
and labor, in terms of cost–benefit of job training and
workforce integration for persons with intellectual
disability.
(6) Provide available scientific evidence that will justify
universal health coverage for people with intellectual
disability.
(7) Develop a study to evaluate intellectual disability
and its determinants, in its contextual relation with
poverty and economical development.
(8) Training health professionals for early diagnosis and
identification of comorbid conditions in people with
intellectual disability.
Conclusion
Scientific evidence on intellectual disability is the base
for an organized social response.
(1) In terms of health policies related to intellectual
disability in Mexico, the scarcity of human resources
is evident. In addition, the lack of knowledge for
early diagnosis and management guidelines is
observed because of the absence of specific training
for health and education professionals [14].
(2) In this environment, the higher frequency of health
needs by this vulnerable group requires good access
to primary care and services [15].
(3) In order to achieve a successful inclusion in the
community of people with intellectual disability
who live in small residential groups, the need for
certain primary components has been suggested.
These include self-determination developed through
previous training, sufficient skills for community and
home living, the absence of behavioral problems,
periodic planning for recreational activities, good
distribution of free time, and ongoing encouragement
for maintaining contact with families as well as
personal relationships.
(4) Additionally, and very important, is acceptance and
assimilation into the community. This experience
has been previously documented in Mexico and its
impact may be relevant to the creation of public
policies for intellectual disability in the region
[16
] that provide an organized social response not
434 Mental retardation and developmental disorders
only with respect to health needs but particularly also
with respect to social and labor inclusion.
Acknowledgements
The present study was supported by the National Institute of Public
Health of Mexico and The Center for Integral Training and Development
(CADI, per its abbreviation in Spanish). The affiliate did not influence or
participate in the interpretation of the information; in writing the article;
or in the decision to submit the article for publication.
There are no competing interests. G.K. is director of The Center for
Integral Training and Development and E.L.P. is Director of the
Research Center for Population Health in the National Institute of
Public Health of Mexico.
References and recommended reading
Papers of particular interest, published within the annual period of review, have
been highlighted as:
of special interest
 of outstanding interest
Additional references related to this topic can also be found in the Current
World Literature section in this issue (p. 485).
1Palma-Coca O, Olaiz-Ferna
´ndez G. Methods of the Mexican National Per-
formance Assessment Survey. Salud Pu
´blica Me
´x 2005; 47 (sup 1):66– 78.
2Lazcano-Ponce E, Rangel-Eudave G, Katz G. Intellectual disability and its
effects on society. Salud Publica Mex 2008; 50 (Suppl 2):s119–s120.
3
Benjet C, Borges G, Medina-Mora ME, et al. Diferencias de sexo en la
prevalencia y severidad de trastornos psiquia
´tricos en adolescentes de la
Ciudad de Me
´xico. Salud Mental 2009; 31:155–163.
This is a report of a population-based study on psychiatric disorders in Mexico that
did not consider information on intellectual disability.
4Medina-Mora ME, Borges G, Mun
˜oz CL, et al. Prevalence of mental disorders
and service use: Results of national survey of psychiatric epidemiology in
Mexico. Salud Mental 2003; 26:1– 16.
5Medina-Mora ME, Borges G, Benjet C, et al. Psychiatric disorders in Mexico:
lifetime prevalence in a nationally representative sample. Br J Psychiatry 2007;
190:521– 528.
6Emerson E. Poverty and people with intellectual disabilities. Ment Retard Dev
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7Olaiz G, Rojas R, Aguilar C, et al. Diabetes mellitus in Mexican adults: results
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S331– S337.
8Garcıa Cedillo I. De la discapacidad a las necesidades educativas especiales,
en La integracio
´n educativa en el aula. Principios, Fnalidades y Estrategias,
Me
´xico. 2000: 45– 52.
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14 Christian L, Snycerski SM, Singh NN, Poling A. Direct service staff and their
perceptions of psychotropic medication in noninstitutional settings for people
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585– 593.
16
Katz G, Rangel G, Lazcano-Ponce E. Discapacidad intelectual. Me
´xico:
McGraw Hill; 2010.
This is a book in Spanish on intellectual disability and its effects on society in the
context of Mexico and Latin America. The chapters include cutting-edge concept s,
perspectives and research on the social and health needs of individuals with
intellectual disability in Latin America. The chapters discuss etiopathogenesis, and
diverse social, ethical, and rights-related issues of intellectual disability persons. In
this book was included information about access to and quality of health and social
services, sexual and reproductive rights and responsibilities, the need for policy
and interventions to promote physical activity and healthy lifestyles in this popula-
tion, and ways of organizing free time in order to guarantee mental health and well
being.
Perspectives of intellectual disability in Mexico Katz et al. 435
... No obstante, como tema de salud pública se enfatiza la subestimación de la DI en México. 11 La investigación epidemiológica y no sólo los datos generales censales, permitiría confirmar la existencia de hasta cuatro millones de personas con DI en México (suponiendo una prevalencia que se asemeje a la internacional de 1-4%). El Manual Diagnóstico y Estadístico de los trastornos mentales (DSM-IV), estratifica al RM en leve (CI=50-69/70), con 85% de los casos; moderado (CI=35-49), el 10%; intenso (CI=20-34), el 4% y profundo (CI=<20), el 1%. ...
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... No obstante, como tema de salud pública se enfatiza la subestimación de la DI en México. 11 La investigación epidemiológica y no sólo los datos generales censales, permitiría confirmar la existencia de hasta cuatro millones de personas con DI en México (suponiendo una prevalencia que se asemeje a la internacional de 1-4%). El Manual Diagnóstico y Estadístico de los trastornos mentales (DSM-IV), estratifica al RM en leve (CI=50-69/70), con 85% de los casos; moderado (CI=35-49), el 10%; intenso (CI=20-34), el 4% y profundo (CI=<20), el 1%. ...
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Chapter
  • Mar 2016
Fully revised, this new edition reviews the most up-to-date and clinically relevant information on the mental health and behavioral problems of people with intellectual, developmental and learning disabilities, also previously known as mental retardation. Providing the latest evidence base from the literature and embracing clinical experience, it covers the essential facts and concepts relating to coexisting medical and psychiatric disorders, with new and updated chapters on mental health and epilepsy, schizophrenia spectrum disorders, personality disorders, and mental health problems in people with autism and related disorders. The disorder-based chapters are complemented by chapters on carer and family perspectives, possible future developments and contributions highlighting the principles of assessment, management and services from global and historical perspectives. This is essential hands-on practical advice for psychiatrists, psychologists and all other mental health professionals including nurses, therapists, social workers, managers, service providers and commissioners.
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People with Disabilities and Mental Health Disorders in Mexico: Rights and Practices
Chapter
Full-text available
  • Jan 2018
Services for people with disabilities in Mexico’s urban facilities or anywhere in the country are classified as dismal at best and torturous at worst. Unfortunately, limited information is available on services for those with disabilities and for treatment of mental health disorders in rural areas of Mexico. Generally, in Mexico only a minority of adults with mental health disorders receives some form of treatment, with younger adults more likely to receive care than older adults. Evidence indicates that people with mental health disorders are inadequately served. This chapter explores cultural beliefs about wellness, the status of people with disabilities and mental health disorders, and barriers to treatment in Mexico. The chapter concludes with a focus on improving services.
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Mental health services for children and adolescents with learning disabilities: A review of research on experiences of service users and providers
Article
  • Aug 2015
Accessible summary Many policies and initiatives have been developed to improve mental health services for children with learning disabilities. Children with learning disabilities and their parents, however, experience many barriers accessing mental health services. Service providers identified a lack of resources as a barrier to meeting the needs of children with learning disabilities. Current research offers suggestions on what can be improved, but further research is needed to identify what models of service would work best for children with learning disabilities. Abstract Background: Children and young people with learning disabilities experience high rates of mental health problems. Methods: The present study reviewed the literature on mental health services for children with learning disabilities, to identify known models of service provision and what has been experienced as effective or challenging in providing good services. Results: Children with learning disabilities and their parents experience barriers accessing mental health services that are related to a lack of information and perceptions of services as being inadequate. Service providers identified a lack of resources as a barrier to meeting needs. Although positive experiences are also observed, many parents have found services to be inappropriate or overwhelming. Conclusion: Research linking population need to available resources, and service models to services users’ outcomes would be valuable to make clear recommendations on how mental health services can address the needs of this group more effectively.
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Perception of service needs by parents with intellectual disability, their significant others and their service workers
Article
Full-text available
  • May 1998
  • RES DEV DISABIL
It is well recognized in the literature that parents with intellectual disability require support and social services. There is growing interest in these services being responsive to parent-identified concerns, particularly as it has been suggested that parents’ concerns may differ from those reported by service workers, family members, or friends. In the Australian study reported here, the views of parents with intellectual disability, their significant others and service workers were sought on parents’ service needs on 20 items incorporating child care, social and community living, and domestic skills. There were significant differences in the perceptions of the parents, workers, and significant others on the help parents needed. Several gaps in services were also identified. From the parents’ perspective, their greatest unmet needs were in the community participation area, specifically with help to explore work options, to know what community services are available and how to access these, and to meet people and make friends.
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Diabetes mellitus in Mexican adults: Results from the 2000 National Health Survey
Article
Full-text available
  • Jan 2007
OBJECTIVE: To show the prevalence of diabetes mellitus (DM) and its associated factors in adults, using data derived from the 2000 National Health Survey (NHS). MATERIAL AND METHODS: The 2000 NHS was conducted between November 1999 and June 2000. An adult questionnaire was administered to 45 294 subjects 20 years of age and older. Capillary glucose levels, weight, height and blood pressure were obtained. Individual weighted factors were considered in the statistical analysis, as was the survey's complex sampling design to obtain variances using SUDAAN 7.5.6. RESULTS: The national prevalence of DM in adults ages 20 years and older was 7.5% (95% CI: 7.1-7.9). The prevalence was 7.8% in women and 7.2% in men. It was higher according to age: 2.3% in adults 40 years or younger and 21.2% in those older than 60 years of age. In the urban population, prevalence was 8.1% and in the rural population it was 6.5%. The disease was more frequent in the northern region of the country (8.4%) and in the Mexico City metropolitan area (8.1%). DM was more frequent in the population with the least amount of schooling (9.9%), the lowest income (8.1%), high blood pressure (13.7%), hypercholesterolemia (23.3%) microalbuminuria (15.5%) and renal disease (12.3%). Using multivariate logistic regression, stratified by gender, variables associated with DM were identified: age, little schooling, family history of DM, high blood pressure, renal disease or hypercholesterolemia in both genders. Abdominal obesity was associated with DM in women only and living in an urban area was associated with DM only in men. The highest associations were observed with age, family history of DM, and microalbuminuria. CONCLUSION: Results from the 2000 NHS show that DM represents a serious public health problem in Mexico. The impact increases when DM affects populations with social or economic factors that limit access to treatment. Data reported in this paper are useful to the implementation of screening and prevention programs. These results confirm that DM should be screened in first-degree family members and everyone who has one or more metabolic syndrome components (high blood pressure, dyslipidemia, obesity and microalbuminuria).
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Diabetes mellitus en adultos mexicanos. Resultados de la Encuesta Nacional de Salud 2000
Article
Full-text available
  • Jan 2007
  • SALUD PUBLICA MEXICO
Objetivo. Mostrar la prevalencia de la diabetes mellitus (DM) y los factores asociados con esta enfermedad en adultos a partir de datos de la Encuesta Nacional de Salud 2000 (ENSA 2000). Material y métodos. Se realizó una entrevista, entre noviembre de 1999 y junio de 2000, a 45 294 sujetos de 20 años de edad y mayores. Se obtuvieron valores de glucosa capilar, peso, talla y tensión arterial. Para el análisis estadístico se utilizaron los factores de expansión individuales, y para el cálculo de las varianzas se tomó en consideración el diseño complejo de la encuesta mediante SUDAAN 7.5.6. Resultados. La prevalencia nacional de DM en adultos de 20 y más años de edad fue de 7.5% (IC95% 7.1-7.9). En las mujeres fue de 7.8% y en los hombres de 7.2%. La prevalencia aumentó en relación directa con la edad, 2.3% antes de los 40 años y 21.2% después de los 60. En la población urbana la prevalencia fue de 8.1% y en la rural de 6.5%. La enfermedad fue más frecuente en la región norte del país (8.4%) y en el área metropolitana de la Ciudad de México (8.1%). Asimismo, fue más frecuente en la población con menor escolaridad (9.9%), menor ingreso (8.1%), hipertensión arterial (13.7%), hipercolesterolemia (23.3%), microalbuminuria (15.5%) y enfermedad renal (12.3%). Mediante modelos de regresión logística multivariada, estratificados por sexo, se identificaron como variables asociadas con la presencia de DM la edad, la baja escolaridad, el antecedente familiar de DM y la coexistencia de hipertensión arterial, enfermedad renal o hipercolesterolemia en ambos sexos. La obesidad abdominal se relacionó con DM sólo en las mujeres; la residencia en una zona urbana se vinculó con DM exclusivamente en los hombres. Las acciones más fuertes se observaron con la edad, el antecedente familiar de DM y la microalbuminuria. Conclusiones. Los datos de la Encuesta Nacional de Salud 2000 son prueba del grave problema de salud que representa la DM para México. Su efecto se magnifica al afectar con mayor frecuencia a grupos de población cuyos factores sociales o económicos limitan su acceso al tratamiento. Los datos informados son útiles para la institución de programas de escrutinio y prevención. Los resultados confirman que la diabetes debe ser motivo de investigación en familiares de primer grado e individuos que tengan uno o más de los componentes del síndrome metabólico (hipertensión, dislipidemia, obesidad y microalbuminuria).
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Poverty and People with Intellectual Disabilties
Article
Full-text available
  • Jun 2007
Epidemiological studies have consistently reported a significant association between poverty and the prevalence of intellectual disabilities. The available evidence suggests that this association reflects two distinct processes. First, poverty causes intellectual disabilities, an effect mediated through the association between poverty and exposure to a range of environmental and psychosocial hazards. Second, families supporting a child with intellectual disabilities and adults with intellectual disabilities are at increased risk of experiencing poverty due to the financial and social impact of caring and the exclusion of people with intellectual disabilities from the workforce. It is likely that the association between poverty and intellectual disabilities accounts in part for the health and social inequalities experienced by people with intellectual disabilities and their families. Implications for policy and practice are discussed in relation to the funding of services for people with intellectual disabilities and preventative approaches to addressing the health and social inequalities experienced by people with intellectual disabilities and their families.
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Sex differences in the prevalence and severity of psychiatric disorders in adolescents from Mexico City
Article
  • Mar 2009
The first and only nationally representative prevalence estimates of psychiatric disorders in Mexico (the Mexican National Comorbidity Survey) indicate sex differences in the expression of psychopathology and early ages of onset for most disorders, often in the adolescent years. Studies from other countries have shown that sex differences in the pattern of psychopathology vary by life stage, which in part, may be explained by different ages of onset for varying disorders. These studies also suggest that many of the sex differences in the prevalence of disorders emerge during the adolescent years. However, scarce data is available on the epidemiology of adolescent psychopathology in Mexico, and much less regarding possible sex differences in the patterns of prevalence, severity and ages of onset. The purpose of this report, therefore, is to estimate sex differences in the 12-month prevalence and severity of 17 psychiatric disorders (using DSM-IV diagnostic criteria) as well as ages of onset in adolescents from Mexico City metropolitan area. Materials and methods This article provides data from the Mexican Adolescent Mental Health Survey. This survey has a multistage probability design and is representative of adolescents between 12 and 17 years old who reside in the Mexico City metropolitan area. The final sample included 3005 adolescents selected from a stratified multistage area probability sample. In all strata, the primary sampling units were census count areas cartographically defined and updated in 2000 by the Mexican National Institute of Statistics, Geography and Informatics (INEGI). Two hundred census count areas were selected with probability proportional to size. Secondary sampling units were city blocks, four of which were selected with probability proportional to size from each census count area. All households within these selected city blocks with adolescents aged 12 to 17 were selected. One eligible member from each of these households was randomly selected using the Kish method of random number charts. The response rate of eligible respondents was 71%. The adolescents were interviewed in their homes by trained lay interviewers using the computerized adolescent version of the World Mental Health Composite International Diagnostic Interview (WHM-CIDI-A 3.0). The average length of the interview was two and a half hours. A verbal and written explanation of the study was given to both parents and adolescents. Interviews were administered only to those for whom signed informed consent from a parent and/or legal guardian were obtained as well as the adolescent agreement. Because of the stratified multistage sampling design, data was subsequently weighted to adjust for differential probabilities of selection and non-response. Post-stratification to the total Mexico City Metropolitan Area adolescent population according to the year 2000 Census in target age and sex ranges were also performed. For prevalence estimates, due to this complex sample design and weighting, estimates of standard errors for proportions were obtained by the Taylor series linearization method using the SUDAAN software. Sex differences were evaluated using Wald χ2 tests. Statistical significance was based on two-tailed design tests evaluated at the .05 level of significance. Ages of onset for psychiatric disorders were estimated using discrete time survival analyses with person-years as the unit of analysis which in this article are presented as Kaplan-Meier curves. Results The most prevalent individual disorders in both sexes were specific phobia (15.6% for males, 26.1% for females) and social phobia (10.0% for males, 12.4% for females). For females, the most frequent disorders that follow in magnitude after these two types of phobias are, in decreasing order, major depression (7.6%), oppositional defiant disorder (6.9%), agoraphobia without panic (4.7%) and separation anxiety disorder (3.6%). On the other hand, for males, the most frequent disorders after specific and social phobia are oppositional defiant disorder (3.7%), alcohol abuse (3.4%) and conduct disorder (3.3%). Overall, females reported a larger number of disorders and a greater prevalence of any disorder. With regards to disorder severity, mood disorders have the greatest proportion of severe cases and anxiety disorders the smallest proportion of severe cases. While this pattern is found for both males and females, there are sex differences in severity such that females have a greater proportion of severe cases overall (25.5% were severe cases compared to 18.9% for males). The earliest ages of onset were found in anxiety disorders, followed by impulse control disorders, and mood disorders with substance use disorders having the latest ages of onset. The ages of onset for anxiety, mood and substance use disorders are similar between males and females. However, males developed at earlier ages the onset of impulse control disorders than females, and this is due primarily to oppositional defiant disorder rather than to attention deficit hyperactivity disorder or to conduct disorder. Discussion The greater overall prevalence and severity of psychiatric disorders in adolescent females in comparison to adolescent males suggests that adolescence may be a period of greater vulnerability for females. Our findings with regards to a higher prevalence of mood and anxiety disorders in adolescent females in comparison to males are consistent with those reported in the international literature. However, our findings of more impulse control disorders in females than males are inconsistent with most international reports excepting a study of Finnish adolescents in which adolescent girls reported more internalizing and externalizing disorders than their male counterparts. The greater prevalence of impulse control disorders in our study is due to oppositional defiant disorder, not attention deficit hyperactivity or conduct disorder. The lack of sex differences in substance use disorders is consistent with recent findings in Mexican adolescents which show a narrowing of the sex gap difference in substance use. There are both biological and psychosocial theories which may explain the greater vulnerability in adolescent girls such as gender role intensification and socialization during adolescence; a higher exposure to adversity, stress and negative life events; as well as a greater reactivity of the hypothalamic-pituitary-adrenal axis when confronted with stress. Study limitations include the willingness of participants to disclosure sensitive or potentially embarrassing information as well as potential sex differences in willingness. While females reported more disorders and greater severity of disorders overall, sex differences in response style are not likely, since females reported more of many, but not all disorders. A further limitation is the use of trained lay interviewers instead of clinicians. The development and use of fully structured diagnostic instruments such as the CIDI have greatly helped to tackle this limitation in general population surveys and data suggest that diagnoses provided by these fully structured instruments approximate adequately clinical diagnoses. Keeping in mind these limitations, the results of this study are relevant for clinical practice as well as for the epidemiological surveillance of our population to guide service planning and public health policy.
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Direct service staff and their perceptions of psychotropic medication in non-institutional settings for people with intellectual disability
Article
  • May 1999
Previous studies have surveyed a variety of service providers in school and institutional settings, and reported a pervasive lack of education and training with regard to the use of psychotropic medication in people with intellectual disability. Because an increasing number of people with intellectual disability are living in the community and since many of these people receive psychotropic medications, the present study extended research in this area by surveying direct service staff to determine their perceptions, knowledge and opinions with regard to the use of psychotropic medication in non-institutional settings for individuals with developmental disabilities. Consistent with the findings of previous studies, a majority of the 334 respondents in the present study reported that they had not received adequate training in the area of drug treatment The knowledge and skills deficits of direct service staff appear to represent a significant barrier to the appropriate monitoring and management of pharmacotherapy for individuals with intellectual disability. Therefore, a systematic training programme to educate direct service staff about psychotropic medication needs to be designed, implemented and disseminated on a broad scale.
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Enhanced Self-Determination of Adults with Mental Retardation as an Outcome of Moving to Community-Based Work or Living Environments
Article
  • Nov 2001
In recent years, the self-determination construct has received increased international visibility and utilization in the field of intellectual disability (ID). This has resulted in efforts to promote skills enhancing self-determination, and in efforts to change how adult services are funded to allocate resources to increase consumer control and direction. An important component to consider in both of these efforts is the role of the environment on self-determination. The present study examined the self-determination, autonomy and life choices of individuals with ID before and after they moved from a more restrictive work or living environment. The self-determination of adults with ID was measured for an average 6-months before and after a move from a more restrictive living or working environment to a community-based setting. Paired-sample t-tests indicated that there were significant changes, in each case in a more adaptive direction, in self-determination, autonomous functioning and life choices following a move to a less restrictive environment. The present findings contribute to emerging evidence that the self-determination of individuals with ID is limited by congregate living or work settings which limit opportunities for choice and decision-making. Alternatively, more normalized, community-based environments support and enhance self-determination. Because self-determination has been linked to positive adult outcomes and enhanced quality of life, it is important to consider ways to enable people with ID to live and work in their communities.
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Engagement in meaningful activity and "active support" of people with intellectual disabilities in residential care
Article
  • Sep 2002
  • RES DEV DISABIL
Forty-nine adults with learning disabilities living in 13 small staffed homes in England were studied as part of larger projects in 1997 and again in 2000. A pre-test/post-test comparison group design was used to assess differences in staff implementation of "active support," service user engagement in meaningful activities and adaptive behaviour. Homes which adopted active support showed significantly increased engagement in meaningful activity and adaptive behaviour between 1997 and 2000. A comparison group showed no significant change.
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Specialist health services for people with learning disability in Scotland
Article
  • Dec 2002
People with intellectual disability (ID) are known to have a high prevalence of health needs, and to require access to specialist health services in addition to primary care and generic secondary care health services. However, there is no national database of each locality's specialist health service provision. Such a record would highlight variation in provision and enable benchmarking. A 15-item questionnaire was developed which included questions on ID health services and staffing levels. This was sent to the chief executive of each of the 15 identified National Health Service primary care trusts/health boards which provide ID services in Scotland. The same questionnaire was also sent to the lead clinician/clinical director of each service. The results were converted to per 100 000 population per trust and presented in cumulative frequency tables to allow benchmarking. A response rate of 100% was achieved. The results show a wide range in the type of services provided by each locality in Scotland. Only three services (21%) have completed the process of resettlement. There was a wide-ranging variability in the number of beds/day places and professionals employed per 100 000 population per trust. There is widespread diversity in the service provision between different parts of Scotland. Geographical distances and responsibilities for service provision to remote and rural communities did not appear to account for these differences.
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Psychiatric disorders in Mexico: Lifetime prevalence in a nationally representative sample
Article
  • Jul 2007
No national data on lifetime prevalence and risk factors for DSM-IV psychiatric disorders are available in Mexico. To present data on lifetime prevalence and projected lifetime risk, age at onset and demographic correlates of DSM-IV psychiatric disorders assessed in the Mexican National Comorbidity Survey. The survey was based on a multistage area probability sample of non-institutionalised people aged 18-65 years in urban Mexico. The World Mental Health Survey version of the Composite International Diagnostic Interview was administered by lay interviewers. Of those surveyed, 26.1% had experienced at least one psychiatric disorder in their life and 36.4% of Mexicans will eventually experience one of these disorders. Half of the population who present with a psychiatric disorder do so by the age of 21 and younger cohorts are at greater risk for most disorders. Our results suggest an urgent need to re-evaluate the resources allocated for the detection and treatment of psychiatric illnesses in Mexico.
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