Resumen

TIBURCIO SAINZ, Marcela; NATERA REY, Guillermina  y  BERENZON GORN, Shoshana. Mental health services utilization among Mexican female victims of intimate partner violence. Salud Ment [online]. 2010, vol.33, n.3, pp.243-248. ISSN 0185-3325.

Violence against women is one of the main problems that affect life quality around the world due to severe injuries, serious mental health problems, as well as reproductive and sexual difficulties. Different studies show that the majority of abused women present an immediate reaction of distress which, if not treated, might turn into more severe emotional conditions such as post-traumatic stress disorder, major depression, psychosomatic symptoms, anxiety disorder, alcohol and/or drug abuse. The information about service utilization by abused women is controversial. Some studies estimate that health care services utilization is more frequent among abused women. For instance, a study carried out in the United States suggests that the likelihood of using health care services is twice as high among women who had suffered violence as compared to women who had not been abused. In contrast, other studies point that abused women deal with several difficulties to receive attention. This information is consistent with the idea that mental health problems prevent abused women from acknowledging the severity of their situation and, thus, they have more difficulties to protect themselves, to seek help, and to identify the institutions they can resort to. The majority of studies reporting service utilization by violence victims focus on injury care at emergency rooms, while the information about the attention of violence-related mental health problems and the expenditure it represents is scarcer. There are data suggesting that formal sources of health care are not the first choice due to a number of barriers which can be cultural (beliefs and values) or structural (limited availability and accessibility). Moreover, when women finally reach formal services, their demands are not totally fulfilled. Only a few studies have been carried out in Mexico. For example, a national survey with a representative sample of women who attended public health care services showed that 21.5% had suffered some form of violence from an intimate partner and 25% of them had never talked about that problem with a service provider, mainly because they lacked trust, they were ashamed or because they considered it as a private problem. The objective of this study is to determine the prevalence of mental health problems among a sample of female victims of intimate partner violence, to analyze the characteristics of mental health services utilization, and the reasons to seek help in this group. The data reported herein are part of a household survey which included four low income communities in the Southern area of Mexico City. The survey required multistage sampling: blocks were selected in the first stage, dwelling segments at stage two, and the final stage consisted in the random selection of one person aged 15 or older, living in the selected household, Spanish speaking, and without major mental diseases that would prevent him/her to answer the questionnaire. This procedure yielded a final sample of 1156 individuals, 49% males and 51% females. This study considers only a sub-sample of women who reported having an abusive male partner by the time of the survey (n=135). The questionnaire used includes several sections: 1. sociodemographic data and dwelling characteristics, 2. mental health services utilization, 3. a few sections of the CIDI v.1.1, 4. the Spanish version of the Danger Assessment Scale adapted to Mexican population. The interviewees agreed to participate voluntarily after the objectives and terms of confidentiality were explained; the questionnaire was administered through individual interviews by trained personnel. The section on intimate partner violence was completed only by women who had a male partner at the moment. The services considered in this study include Medical services: physician, family practitioner or other specialist (gynecologist, cardiologist, etc.), nurse, first level clinic. Mental health specialist: psychiatrist, psychologist, nurse specialized in mental health care. Alternative services: curanderos (folk practitioners), herbalist, spiritists, acupuncture, Bach's flowers, Reiki therapists, masseuses, bone and muscle therapists. Religious ministers: priest, spiritual counselors, rabbi, etc. The final sample includes 135 women who had suffered some form of violence; 30% were aged between 35 and 44 years and 26% were 25 to 34 years old. Most of them were housewives and 65% attained elementary school. As to the presence of psychiatric symptoms, 8.8% met the criteria for depressive disorder and 21.7% met criteria for anxiety disorder. When women who suffered physical violence are considered separately, the proportion of individuals with a depressive disorder is significantly higher (16%) than the proportion of women who had not suffered physical violence. Women diagnosed with depressive disorder reported physical violence (66.7%), being forced into sexual intercourse (50%), and threatens of death (33.3%). On the other hand, control over daily activities was the most frequent form of violence reported by women with anxiety disorder (55.2%). Out of all women who reported at least one form of violence, only 16.2% sought help to treat mental health problems. Nearly 42% of women with depressive disorders sought help with mental health specialists and 25% with a general practitioner. As to anxiety disorders, no significant differences were found as to service utilization. The main reason to seek help for those who presented any disorder was to think they really needed help, followed by feeling very nervous and crying all the time. Reasons for not seeking help include not knowing what to do and being ashamed. In general, these findings are consistent with previous studies reporting low utilization of mental health care services by victims of violence. The proportion increases when depressive or anxiety symptoms are present; however, the number of women seeking help remains low. These results are relevant since research on service utilization by abused women has focused on emergency rooms, while little attention has been placed on mental health services. Data must be considered with caution since this is a cross-sectional study and it is not possible to establish the temporal sequence of events; nevertheless, they provide evidence of a clear relation among mental disorders and violence.

Palabras llave : Intimate partner violence; mental health; service utilization.

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