Barriers to Care of Suicidal Behavior in Mexico City: Health Personnel Experiences at the First Level of Care

Authors

  • Lourdes Gómez-García Universidad Nacional Autónoma de México, Doctorado en Ciencias Médicas, Odontológicas y de la Salud, Facultad de Medicina https://orcid.org/0000-0003-4579-0010
  • Luz Arenas-Monreal Instituto Nacional de Salud Pública
  • Rosario Valdez-Santiago Instituto Nacional de Salud Pública https://orcid.org/0000-0001-8434-9805
  • Mario Rojas-Russell Universidad Nacional Autónoma de México https://orcid.org/0000-0001-6644-1384
  • Claudia Iveth Astudillo-García Secretaría de Salud de México
  • Marcela Agudelo Botero Universidad Nacional Autónoma de México

DOI:

https://doi.org/10.17533/udea.rfnsp.e346540

Keywords:

access to health services, Mexico City, first level of care, health care providers, mental health, suicides

Abstract

Objective: To identify the existing barriers to the care of suicidal behavior from the perspective of mental health professionals at the first level of care in Mexico City.

Methodology: Qualitative exploratory study based on 35 semi-structured interviews conducted on health personnel from two national reference mental health facilities. The data were analyzed with Framework Analysis.

Results: The participants considered that suicidal behavior has not been prioritized among mental health disorders. The absence of public policies, work overload, lack of patient follow-up, among others, were identified as barriers to adequate and timely care.

Conclusions: Suicidal behavior prevention programs should consider the socioeconomic context of the population, the characteristics of health services, and the needs of health care providers. Professional training should be enhanced, and the referral and counter-referral system across levels of care should be improved.

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Author Biographies

Lourdes Gómez-García, Universidad Nacional Autónoma de México, Doctorado en Ciencias Médicas, Odontológicas y de la Salud, Facultad de Medicina

Doctorado en Ciencias Médicas, Odontológicas y de la Salud, Facultad de Medicina

Luz Arenas-Monreal, Instituto Nacional de Salud Pública

Doctora en Antropología Médica

Rosario Valdez-Santiago, Instituto Nacional de Salud Pública

Doctora en Ciencias en Salud Pública

Mario Rojas-Russell, Universidad Nacional Autónoma de México

Doctor en Ciencias de la Salud en Epidemiología

Claudia Iveth Astudillo-García, Secretaría de Salud de México

Doctora en Ciencias de la Salud en Epidemiología

Marcela Agudelo Botero, Universidad Nacional Autónoma de México

Profesora-investigadora

Centro de Investigación en Políticas, Población y Salud

Facultad de Medicina

Universidad Nacional Autónoma de México

References

(1). Crosby A, Ortega L, Melanson C. Self-directed violence surveillance: Uniform definitions and recommended data elements, Version 1.0. Atlanta (GA): Centers for Disease Control and Prevention, National Center for Injury Prevention and Control; 2011.

(2). Institute for Health Metrics and Evaluation (IHME). GBD Compare Seattle, WA [internet]; 2019 [citado 2021 may. 11]. Disponible en: http://vizhub.healthdata.org/gbd-compare

(3). Rivera-Rivera L, Fonseca-Pedrero E, Séris-Martínez M, et al. Prevalencia y factores psicológicos asociados con conducta suicida en adolescentes. Ensanut 2018-19. Salud Pública Mex. 2020;62(6):672-81. DOI: https://doi.org/10.21149/11555

(4). Valdez-Santiago R, Hidalgo-Solorzano E, Mojarro-Iñiguez M, et al. Attempted suicide among adolescents in Mexico: Prevalence and associated factors at the national level. Inj Prev. 2017;24(4):256-61. DOI: https://doi.org/10.1136/injuryprev-2016-042197

(5). Robinson J, Bailey E, Witt K, et al. What works in youth suicide prevention? A systematic review and meta-analysis. EClinicalMedicine. 2018;4-5:52-91. DOI: https://doi.org/10.1016/j.eclinm.2018.10.004

(6). Díaz-Castro L, Cabello-Rangel H, Medina-Mora ME, et al. Necesidades de atención en salud mental y uso de servicios en población mexicana con trastornos mentales graves. Salud Pública Mex. 2019;62(1):72-79. DOI: https://doi.org/10.21149/10323

(7). Martinez W, Galván J, et al. Barriers to integrating mental health services in community-based primary care settings in Mexico City: A qualitative analysis. Psychiatr Serv. 2017;68(5):497-502. DOI: https://doi.org/10.1176/appi.ps.201600141

(8). Saavedra Solano N, Berenzon Gorn S, Galván Reyes J. Salud mental y atención primaria en México. Posibilidades y retos. Aten Primaria. 2016;48(4):258-64. DOI: https://doi.org/10.1016/j.aprim.2015.05.005

(9). Valdez-Santiago R, Marín-Mendoza E, Gómez-García L, et al. Respuesta del sector salud a la conducta suicida de adolescentes en cinco estados de México: entre el desbordamiento y la precariedad. En: Valdez Santiago R, Arenas Monreal L, editores. Simplemente quería desaparecer… Aproximaciones a la conducta suicida de adolescentes en México. Cuernavaca, Morelos: Instituto Nacional de Salud Pública; 2019 [citado 2021 may. 4]. pp. 15-50. Disponible en: https://www.insp.mx/resources/images/stories/2019/Docs/190731_Conducta_suicida.pdf

(10). Borges G, Wilcox HC, Medina-Mora ME, et al. Suicidal behavior in the Mexican National Comorbidity Survey (M-NCS): Lifetime and 12-month prevalence, psychiatric factors and service utilization. Salud Mental [internet]. 2005 [citado 2021 may. 4]; 28(2):40-47. Disponible en: http://www.revistasaludmental.mx/index.php/salud_mental/article/view/1042/1040

Borges G, Orozco R, et al. Suicidio y conductas suicidas en México: retrospectiva y situación actual. Salud Pública Mex [internet]. 2010 [citado 2021 may. 4]; 52(4):292-304. Disponible en: https://saludpublica.mx/index.php/spm/article/view/6979/8934

Romero-Martínez M, Shamah-Levy T, Cuevas-Nasu L, et al. Encuesta Nacional de Salud y Nutrición 2018. Cuestionario de Salud de Adolescentes (10 a 19 años) [base de datos electrónica]. México: Instituto Nacional de Estadística y Geografía e Instituto Nacional de Salud Pública. 2020 [citado 2021 may. 11]. Disponible en: https://ensanut.insp.mx/encuestas/ensanut2018/descargas.php

Hooper LM, Epstein SA, Weinfurt KP, et al. Predictors of primary care physicians’ self-reported intention to conduct suicide risk assessments. J Behav Health Serv Res. 2012;39(2):103-15. DOI: https://doi.org/10.1007/s11414-011-9268-5

Valdez-Santiago R, Villalobos A, Arenas-Monreal L, et al. Comparative analysis of lifetime suicide attempts among Mexican adolescents, over the past 12 years. Int J Environ Res Public Health. 2021;18(10):1-13. DOI: https://doi.org/10.3390/ijerph18105419

Ibarra López AM, Sánchez Loyo LM, et al. Prevención y atención a los comportamientos suicidas: programas y estrategias de prevención del suicidio. En: Morfin López T, Ibarra López AM, editores. Fenómeno suicida: un acercamiento transdisciplinar. México: El Manual Moderno; 2015. pp. 29-45.

Valdez-Santiago R, Cruz-Bañares AL, et al. Living conditions of adolescents who have attempted suicide in Mexico. Int J Environ Res Public Health. 2020;17(16):1-12. DOI: https://doi.org/10.3390/ijerph17165990

O’Brien BC, Harris IB, Beckman TJ, et al. Standards for reporting qualitative research: A synthesis of recommendations. Acad Med. 2014;89(9):1245-51. DOI: https://doi.org/10.1097/ACM.0000000000000388

Donabedian A. Los espacios de la salud: aspectos fundamentales de la organización de la atención médica. México: Secretaría de Salud, Instituto Nacional de Salud Pública, Fondo de Cultura Económica; 1988.

Frenk J. El concepto y la medición de accesibilidad. Salud Pública Mex [internet]. 1985 [citado 2021 may. 4]; 27(5):438-5. Disponible en: https://saludpublica.mx/index.php/spm/article/view/422

Tanahashi T. Health service coverage and its evaluation. Bull World Health Organ [internet]. 1978 [citado 2021 may. 4]; 56(2):295-303. https://apps.who.int/iris/handle/10665/261736

Secretaría de Salud, Organización Panamericana de la Salud. Informe de la evaluación del sistema de salud mental en México utilizando el Instrumento de Evaluación para Sistemas de Salud Mental de la Organización Mundial de la Salud (IESM-OMS) [internet]. Secretaría de Salud; 2011 [citado 2021 may. 4]. Disponible en: https://www.who.int/mental_health/who_aims_country_reports/who_aims_report_mexico_es.pdf

Consejo Nacional de Evaluación de la Política de Desarrollo Social (CONEVAL). Medición de la pobreza. Pobreza municipal 2010-2015 [internet]. CONEVAL. 2015 [citado 2021 jul. 27]. Disponible en: https://www.coneval.org.mx/Medicion/Paginas/PobrezaInicio.aspx

Ritchie J, Spencer L, O’Connor W. Carrying out qualitative analysis. In: Ritchie J, Lewis J, editors. Qualitative research practice: A guide for social science students and researchers. London: Sage Publications; 2003. pp. 219-62.

Aday LA, Andersen R. A framework for the study of access to medical care. Health Serv Res[internet]. 1974 [citado 2021 may. 4]; 9(3):208-20. Disponible en: https://pubmed.ncbi.nlm.nih.gov/4436074/

Levesque JF, Harris MF, Russell G. Patient-centred access to health care: Conceptualising access at the interface of health systems and populations. Int J Equity Health. 2013;12:18. DOI: https://doi.org/10.1186/1475-9276-12-18

Penchansky R, Thomas JW. The concept of access: Definition and relationship to consumer satisfaction. Med Care. 1981;19(2):127-40. DOI: https://doi.org/10.1097/00005650-198102000-00001

ATLAS.ti Scientific Software Development GmbH. ATLAS.ti. Qualitative Data Analysis. 8.4.3 ed. Berlin; 2019.

Espeland K, Hjelmeland H, Loa Knizek B. A call for change from impersonal risk assessment to a relational approach: Professionals’ reflections on the national guidelines for suicide prevention in mental health care in Norway. Int J Qual Stud Health Well-being. 2021;16(1):1868737. DOI: https://doi.org/10.1080/17482631.2020.1868737

Organización Panamericana de la Salud (OPS). Prevención del suicidio: un imperativo global. OPS [internet]; 2014 [citado 2021 may. 11]. Disponible en: https://iris.paho.org/handle/10665.2/54141

Valdez-Santiago R, Marín-Mendoza E, Torres-Falcón M. Análisis comparativo del marco legal en salud mental y suicidio en México. Salud Pública Mex. 2021;63(4):554-64. DOI: https://doi.org/10.21149/12310

Chung D, Hadzi-Pavlovic D, Wang M, et al. Meta-analysis of suicide rates in the first week and the first month after psychiatric hospitalisation. BMJ Open. 2019;9(3):e023883. DOI: https://doi.org/10.1136/bmjopen-2018-023883

Fontanella CA, Warner LA, Steelesmith DL, et al. Association of timely outpatient mental health services for youths after psychiatric hospitalization with risk of death by suicide. JAMA Netw Open. 2020;3(8):e2012887. DOI: https://doi.org/10.1001/jamanetworkopen.2020.12887

Berenzon Gorn S, Saavedra Solano N, Medina-Mora Icaza ME, et al. Evaluación del sistema de salud mental en México: ¿hacia dónde encaminar la atención? Rev Panam Salud Pública. 2013;33(4):252-8. DOI: https://doi.org/10.1590/s1020-49892013000400003

Wakai S, Schilling EA, Aseltine RH, et al. Suicide prevention skills, confidence and training: Results from the Zero Suicide Workforce Survey of behavioral health care professionals. SAGE Open Medicine. 2020;8:2050312120933152. DOI: https://doi.org/10.1177/2050312120933152

Hagen J, Knizek BL, Hjelmeland H. Mental health nurses’ experiences of caring for suicidal patients in psychiatric wards: An emotional endeavor. Arch Psychiatr Nurs. 2017;31(1):31-37. DOI: https://doi.org/10.1016/j.apnu.2016.07.018

Zalsman G, Hawton K, Wasserman D, et al. Suicide prevention strategies revisited: 10-year systematic review. Lancet Psychiatry. 2016;3(7):646-59. DOI: https://doi.org/10.1016/S2215-0366(16)30030-X

Obando Medina C, Kullgren G, Dahlblom K. A qualitative study on primary health care professionals’ perceptions of mental health, suicidal problems and help-seeking among young people in Nicaragua. BMC Fam Pract. 2014;15:129. DOI: https://doi.org/10.1186/1471-2296-15-129

Alhamidi SA, Alyousef SM. Perceptions of mental health nurses toward caring for suicidal hospital inpatients in Saudi Arabia. Death Stud. 2020:1-10. DOI: https://doi.org/10.1080/07481187.2020.1801894

Fresán A, Guízar-Sánchez D, Yoldi-Negrete M, et al. Identifying risk factors for self-reported mental health problems in psychiatry trainees and psychiatrists in Mexico. Acad Psychiatry. 2021. DOI: https://doi.org/10.1007/s40596-021-01506-y

Johnson J, Hall LH, Berzins K, et al. Mental healthcare staff well-being and burnout: A narrative review of trends, causes, implications, and recommendations for future interventions. Int. J. Ment. Health Nurs. 2018;27(1):20-32. DOI: https://doi.org/10.1111/inm.12416

México, Secretaría de Salud. Programa de Acción Específico. Salud Mental y Adicciones 2020-2024. México: Secretaría de Salud [internet]; 2021 [citado 2021 jul. 27]. Disponible en: https://www.gob.mx/cms/uploads/attachment/file/626039/PAE_CONASAMA_26_3_21.pdf?fbclid=IwAR2uljl-I3h-jgHjmDhlKopRwNitgSkhcmAZVEdh2Vc0WPcNw3UBh-i9T50

Ivbijaro G, Kolkiewicz L, Goldberg D, et al. Suicide prevention and covid-19. Asia Pac Psychiatry. 2021;(13)3:e12482. doi: https://doi.org/10.1111/appy.12482

Published

2021-12-21

How to Cite

1.
Gómez-García L, Arenas-Monreal L, Valdez-Santiago R, Rojas-Russell M, Astudillo-García CI, Agudelo Botero M. Barriers to Care of Suicidal Behavior in Mexico City: Health Personnel Experiences at the First Level of Care. Rev. Fac. Nac. Salud Pública [Internet]. 2021 Dec. 21 [cited 2025 Dec. 15];40(1):e346540. Available from: https://revistas.udea.edu.co/index.php/fnsp/article/view/346540

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Servicios de salud

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