Abstract The stress in urban settings is related to a greater request for personal resources to face situations of daily life, such as the commuting, since in big cities, people spend a lot of time on it, and sometimes is uncomfortable and annoying, which can cause stress. Commuting stress has been assessed, through commuting daily hassles, commuting stressful features and physiological responses, but it is possible assess it through emotional responses. The aim of this study was to develop and assess an exploratory scale of emotional responses for the study of commuting stress by public transport in an urban area of México that is densely populated. Method, a cross sectional design was used, in which a qualitative exploratory study was carried out through 23 individual semi-structured interviews and two focus group, where it was identified the main emotions experienced during the commuting stress to develop the items in the language of the population. Subsequently, those emotions were compared with emotions proposed in previous studies to complement the scale. Thus, 26 emotions were included to assess the commuting stress through emotional responses. Finally, two quantitative studies were carried out to assess the psychometric properties of the scale, in which 196 and 298 people participated, respectively. The scale was applied online in September 2020 and in April 2021. Results, from the 26 emotional stress responses were reduced to nine negative emotions in an Exploratory Factor Analysis (X2=1183, df=36, p=.001, KMO= .94, 60% variance, Alfa ordinal=.93). This solution was corroborated with a Confirmatory Factor Analysis (X2=41.87, d.f.=26, X2/d.f.=1.61, p=.025; RMR= .036, SRMR=.036, RMSEA=.045; GFI=.997, CFI=.999, TLI=.998). Conserve only nine negative emotions is due to statistical analysis but also because some emotions referred to conditions of physical exhaustion or body energy level. On the other hand, positive emotions were related with pleasant commuting situations, not with the commuting stress experience. Conclusion, the exploratory scale to assess the commuting stress through emotional responses presents acceptable values to be applied in this urban area of Mexico.

Resumen El traslado cotidiano entre la casa y el trabajo demanda un importante uso de recursos personales y puede llegar a ser estresante. El objetivo fue construir y evaluar una escala de respuestas emocionales por el estrés en el traslado en transporte público para la Zona Metropolitana del Valle de México de manera exploratoria. Método: Se realizó un estudio cualitativo a través de entrevistas semi estructuradas con el propósito de identificar emociones asociadas a la experiencia de estrés por el traslado para desarrollar los reactivos de acuerdo con el contexto. Posteriormente, dos estudios cuantitativos permitieron evaluar las propiedades psicométricas. Participaron 196 y 298 personas respectivamente. La aplicación de la escala se realizó en línea en septiembre de 2020 y abril de 2021. Resultados: la escala incluyó 26 respuestas emocionales asociadas al estrés. En el Análisis Factorial Exploratorio se redujo a nueve emociones negativas (X2=1183, gl=36, p=.001, KMO=.94, 60% de varianza explicada, Alfa ordinal=.93), corroboradas en el Análisis Factorial Confirmatorio (X2=41.87, gl=26, X2/gl=1.61, p=.025; RMR=.036, SRMR=.036, RMSEA=.045; GFI=.997, CFI=.999, TLI=.998). Conclusión: la propuesta exploratoria de la escala para evaluar las respuestas emocionales por el estrés en el traslado presenta valores adecuados para aplicarse en la Zona Metropolitana del Valle de México.

ABSTRACT Objective Estimate the cost-effectiveness ratio of a five-step brief intervention aimed at reducing the stress and symptoms of depression caused by living with an alcohol abuser. Methods The cost-effectiveness analysis was carried out with a decision tree, based on symptoms of depression measured on the CES-D scale. The effectiveness of the brief intervention was evaluated by comparing a group of indigenous women who received the intervention (n = 43) with a similar group who did not (n = 30). The groups were evaluated before, immediately after, and 12 months after the intervention, in the state of Hidalgo (Mexico). Pharmacological treatment was selected for comparison, using different estimates. Cost-effectiveness and incremental cost-effectiveness ratios were used to calculate the value of the remission of depressive symptoms. Sensitivity analyses were also conducted. Results The brief intervention turned out to be more effective than the pharmacological one in terms of the remission of depressive symptoms. Its cost was also lower ($US 31.24 versus $US 107.60). The brief intervention would cease to be cost-effective only if its cost increased by 338% or more, or if its effectiveness were 22.8% or less. Conclusions The five-step brief intervention is a cost-effective option that results in significant reductions in depressive symptoms in indigenous women caused by living with alcohol abusers. It is also an affordable option for primary mental health care.

RESUMEN Objetivo Estimar la razón de costo-efectividad de una intervención breve de cinco pasos dirigida a reducir el estrés y los síntomas depresivos causados por convivir con un consumidor excesivo de alcohol. Métodos El análisis costo-efectividad se realizó usando un árbol de decisión y se basó en los síntomas depresivos medidos con la escala CES-D. La efectividad de la intervención breve se evaluó comparando un grupo de mujeres indígenas que recibieron la intervención (n = 43) con otro similar sin intervención (n = 30). Los grupos se evaluaron antes, inmediatamente después de la intervención y a los 12 meses y se llevó a cabo en el Estado de Hidalgo, en México. El tratamiento farmacológico fue seleccionado como alternativa de comparación utilizando distintas estimaciones. Para evaluar el valor de la remisión de los síntomas de depresión se emplearon las razones de cos-to-efectividad y costo-efectividad incremental. Asimismo, se realizaron análisis de sensibilidad. Resultados La intervención breve resultó ser más efectiva que la farmacológica en la remisión de síntomas depresivos y su costo fue más bajo ($US 31,24 y $US 107,60, respectivamente). Solo si la intervención breve incrementara su costo por encima de 338% o si su efectividad fuera menor de 22,8% dejaría de ser costo-efectiva. Conclusiones La intervención breve de cinco pasos es una alternativa costo-efectiva con la cual se consiguen reducir significativamente los síntomas de depresión de las mujeres indígenas ocasionados por convivir con un consumidor excesivo de alcohol, así como una opción accesible para la atención de la salud mental en el primer nivel de atención.

Introduction Mental health can have different meanings in indigenous communities, which is why understanding mental problems requires studying the context. Knowledge of mental health in these communities sheds light on the population's perception of how they live and experience the stressful events that cause depressive symptomatology. The aim of this article is to analyze the link between the symptoms expressed in an indigenous population and the symptoms evaluated using the Depression Scale of the Center for Epidemiological Studies (CES-D) and its link with socio-demographic variables. Method The sample comprises indigenous women from the Mezquital Valley who attended medical consultations and were referred for psychological treatment since they were considered to be suffering from emotional malaise due to their inability to cope with living with a relative who was a heavy drinker. A mixed method that explores meanings was used to analyze the information. This method involves the analysis of quantitative and qualitative data that complement each other in order to understand the cultural context and influences. The quantitative analysis consisted of obtaining the score for depressive symptomatology and its link with socio-demographic variables such as academic achievement, age, occupation and marital status. Presence (experiencing the symptom in the week prior to the interview, regardless of the number of days) and persistence (experiencing the symptom from five to seven days) were analyzed. Results and discussion Sixty-two per cent obtained high scores for depressive symptomatology. The qualitative data indicate that the women expressed feelings that correspond to items in the CES-D. Working and being young constitute a protective factor that provides women with a social life and a degree of independence. The effectiveness of the CES-D as a screening instrument means that it can be applied in primary health care to alert professionals and ensure timely referral. Conclusion The CES-D scale is suitable for measuring depressive symptomatology in Mexico's indigenous population. However, these findings must be treated with caution because of the population's meanings and representations of health and illness.

Introducción En las comunidades indígenas la salud mental puede tener significados diferentes por lo que la comprensión de los problemas mentales requiere del estudio del contexto. Su conocimiento favorecería entender desde la perspectiva de la población cómo viven y experimentan los eventos estresantes que les ocasiona sintomatología depresiva. El objetivo de este artículo es analizar la relación entre los síntomas expresados en una población indígena, los síntomas evaluados con la Escala de Depresión del Centro de Estudios Epidemiologicos (CES-D)y su relación con variables sociodemográficas. Método El Instituto Nacional de Psiquiatría Ramón de la Fuente Muñiz, ha venido trabajando por más de diez años en los problemas relacionados con el consumo de alcohol en la comunidad indígena otomí del Estado de Hidalgo. Este trabajo es uno de los realizados en este campo. En este caso la muestra se integra por mujeres indígenas del Valle del Mezquital que asistieron a la consulta médica, y que fueron canalizadas a la atención psicológica por considerar que tenían malestares emocionales por no saber cómo enfrentar la situación de convivir con un familiar consumidor excesivo de alcohol. Para el análisis de la información se utilizó el método mixto, consistente en el análisis de datos cuantitativos y cualitativos que se complementan entre sí para comprender el contexto y explorar los significados y las influencias culturales. El análisis cuantitativo consistió en obtener el puntaje de la sintomatología depresiva y su relación con variables sociodemográficas de escolaridad, edad, ocupación y estado civil. Se analizó la presencia (experimentar el síntoma durante la semana previa a la aplicación sin importar el número de días) y la persistencia (padecer el síntoma de cinco a siete días). Resultados y discusión El 62% tuvo puntuaciones altas de sintomatología depresiva. Los datos cualitativos indican que las mujeres expresan sentimientos que corresponden a los reactivos de la CES-D. Trabajar y ser joven es un factor protector para la sintomatología, brinda a las mujeres una vida social y una esporádica independencia. La efectividad de la CES-D como instrumento de tamizaje, permite su aplicación en el nivel de atención primaria para alertar al profesional y hacer una canalización adecuada. Conclusión La escala de CES-D es adecuada para medir la sintomatología depresiva en una población indígena de México. Sin embargo, la interpretación deberá realizarse con cautela por los significados y representaciones del proceso salud-enfermedad en esta población específica.

The 2008 National Addictions Survey reports that dependence on alcohol consumption is higher in Mexico's rural and indigenous communities (10.6%) than in urban areas (9.5%), and that its consequences for the social and health environment are correspondingly greater. This is compounded by the marginalization and poverty of these regions and the scant resources available for dealing with health, particularly alcoholism. The study was carried out in the indigenous zone of El Mezquital in the state of Hidalgo. In this state, the National Addictions Survey (2008) reports that daily consumption is 1.4% and habitual consumption is 6.6% while the index of abuse and dependence is 6.8%, all of which are above the national mean of 0.8%, 5.3% and 5.5%, respectively. One of the consequences is having a mortality rate for hepatic cirrhosis of 40.2 for every 100 000 inhabitants, making this the area with the highest mortality rate from this cause in Mexico, which has an average rate of 26.3 cirrhosis-related deaths for every 100 000 inhabitants. The family is the most immediate group affected by the alcoholism of one of its members, which has severe implications for the psychological and physical health of the other members. Since little is known about the way families in Mexico's indigenous or rural zones deal with this problem, a research project was carried out to find out more about the situation. To this end, an ethnographic study was undertaken to identify the role of alcohol in everyday life and determine families' needs for support and the cultural challenges that must be overcome to undertake an intervention. The results of the ethnographic exploration showed that alcohol consumption is a deeply-ingrained custom in the community that provides group identity and solidarity, particularly for men. Its consumption is closely linked to work, particularly agricultural activities and construction. One important aspect was women's complaints that they did not know what to do about the consequences of excess alcohol consumption on the family's health and economy. In addition to this, a powerful patriarchal influence was identified that prevented women from seeking psychological assistance for the problem of alcohol abuse, which is essentially male. Poverty is one of the characteristics of the desert area of El Mezquital where this study was carried out. It constitutes yet another obstacle to seeking and requesting help, partly because of the adverse geographical conditions that limit transport. In addition to the scant transport services, there are communities in which the nearest health center is just over an hour's walk away. Moreover, families' scant resources are used to cover basic needs, ignoring both physical and mental health aspects. On the basis of an ethnographic study, an intervention program was linguistically and culturally adapted to provide support for families. This resulted in a specialized manual suitable for the region, designed to train health professionals to help relatives cope with a family member's excess consumption. This intervention was carried out between 2008 and 2009 and the results are presented in this study. Intervention model This brief intervention, based on the stress-coping-health model, is designed to help relatives find means of coping with their relatives' consumption in a more beneficial way for their health and to establish or strengthen support networks on the basis of their needs. Three coping styles have been documented: committed, tolerant and independent. The intervention consists of five steps that can be carried out in approximately five sessions. These involve: 1. Exploring family concerns; 2. Providing essential information on the effects of alcohol consumption; 3. Analyzing the coping styles used; 4. Exploring social support networks; and 5. Referring family members to specialized care, where necessary. Through these five stops, the intervention seeks to: a) Reduce the presence of physical and psychological symptomatology; b) Improve coping styles in a way that will benefit the relative's mental health and c) Reduce the presence of depressive symptomatology. Method Objective: The purpose of this study was to evaluate the effects of the brief intervention on relatives of a person who consumes excess amounts of alcohol and to compare these results with relatives who, despite having the same problem, refused to participate in the intervention program. Procedure: the intervention was carried out by two psychologists (facilitators). Health center personnel referred relatives to the facilitators (group that experienced the intervention). The intervention ended when the women felt confident enough to be able to use the new coping styles, which took between 4 and 6 sessions (which lasted from 6 to 8 weeks). The <<group without intervention>> consisted of those that did not agree to attend the sessions yet agreed to answer the questionnaires and be contacted 3 months later so that the questionnaires could be re-applied. The questionnaires were administered by three interviewers. On this occasion, they were invited to attend the intervention again, but no-one accepted. Sample: Sixty women aged 18 to 65 with problems due to a relative's alcohol consumption. Application of intervention: most of the intervention sessions were carried out at the community health centers. Instruments: Three questionnaires, adapted and validated for the zone, were used, namely the: Symptom Scale (SRT), Coping Questionnaire (CQ) and the Center for Epidemiological Studies Depression Scale (CES-D). Design: quasi-experimental, pre- and postintervention evaluation (3 months later) compared with a group without intervention. Data analysis: t tests were used to compare the initial mean scores for each instrument. A variance analysis of repeated measures was carried out to determine changes between the two groups (with and without the intervention) before and afterwards, for physical and psychological symptoms, depression levels and coping styles. Ethical considerations: The project was approved by the ethics committee of the National Institute of Psychiatry. Results It was found that the group that received the intervention experienced a significant drop in physical and psychological symptoms and depression, whereas these symptoms increased in the group without the intervention. The average number of committed and tolerant coping styles fell between the first and second measurement, while independent coping was maintained in the group with the intervention. Conversely, the group without the intervention maintained its committed and tolerant coping styles and significantly reduced its independent behavior. Discussion The analysis shows that the model can successfully be used in indigenous zones, since there was a reduction in the number of physical, psychological and depressive symptoms in the group that received the intervention. They also reduced their tolerant and committed coping styles and maintained their independent behavior, which involves a less stressful response. This in turn enables them to focus more on their personal needs and seek more beneficial alternatives for themselves and the rest of the family. In other words, the greater, the independence, the fewer the psychological symptoms. Conversely, in the group without the intervention, their symptoms not only continued but actually worsened over time, with group members continuing to use tolerant mechanisms, which produce more stress.

El consumo de alcohol en la región indígena del Estado de Hidalgo representa un problema de salud importante. Según la ENA 2008, el consumo diario es de 1.4%, el consuetudinario de 6.6% y el índice de abuso y dependencia de 6.8%, todos por encima de la media nacional de 0.8, 5.3 y 5.5%, respectivamente. Hidalgo presentó en 2007 una tasa de mortalidad por cirrosis hepática de 40.2 por cada 100 000 habitantes, primer lugar del país, que en promedio tiene una tasa de 26.3 habitantes por cada 100 000. La familia es el grupo más inmediato que se ve afectado por el consumo de alcohol, con implicaciones graves para la salud psicológica y física de sus miembros. Para conocer cómo enfrentan esta situación las familias en zonas indígenas del Estado de Hidalgo, se llevó a cabo un estudio etnográfico donde se encontró que el consumo de alcohol es una costumbre arraigada en la comunidad, que proporciona identidad y solidaridad de grupo. Un resultado relevante del estudio fue la queja de las mujeres de no saber qué hacer frente a las consecuencias que tiene el consumo excesivo de alcohol en la familia, así como la fuerte influencia patriarcal que limita a las mujeres para solicitar apoyo psicológico. La pobreza, las difíciles condiciones geográficas, transportes insuficientes y la prioridad de resolver necesidades básicas limitan la búsqueda de apoyo profesional. Como resultado de la exploración etnográfica, se identificó la necesidad de atención a las familias para encontrar mejores formas de enfrentar la problemática; por ello se adaptó un programa para ofrecer acciones de apoyo a familias indígenas. La intervención se llevó a cabo entre 2008 y 2009, los resultados se presentan en este trabajo. Modelo de atención: La intervención breve tiene como meta ayudar a los familiares a encontrar formas de enfrentar las situaciones de consumo de manera más benéfica para su salud y establecer o fortalecer redes de apoyo. Consta de cinco pasos: 1. Escuchar la problemática del familiar, 2. Brindar información relevante, 3. Analizar los estilos de enfrentamiento utilizados, 4. Búsqueda de fuentes de apoyo y 5. Canalización en caso de requerir atención especializada. Éstos se llevan a cabo en aproximadamente cinco sesiones. Material y método Objetivo: Evaluar los efectos de la intervención breve sobre la presencia de sintomatología física y psicológica, los estilos de enfrentamiento utilizados y la presencia de sintomatología depresiva, en personas que conviven con un familiar con consumo excesivo de alcohol. Muestra: 60 mujeres entre 18 y 65 años con problemas por el consumo de alcohol de un familiar (esposo o padre). Se integraron dos grupos, uno con intervención y otro sin ella. Para formar el primero, el personal de los centros de salud canalizó a los familiares con las orientadoras (dos psicólogas) para recibir atención, que concluía una vez que las mujeres manifestaban confianza para utilizar nuevos estilos de enfrentamiento, lo que ocurrió entre las sesiones cuatro y seis. El <<grupo sin intervención>> se formó con quienes, teniendo el problema, no aceptaron acudir a las sesiones, pero accedieron a contestar los cuestionarios y a ser contactadas cuatro meses después para responder los instrumentos. Instrumentos: Tres cuestionarios adaptados y validados para la zona: Escala de Síntomas (SRT), Cuestionario de Enfrentamientos (CQ) y Escala de Depresión CES-D. Diseño: Comparación antes y después de la intervención (tres meses después) con un grupo sin intervención. Análisis de datos: prueba t y análisis de varianza de medidas repetidas para determinar los cambios entre los dos grupos. El proyecto fue aprobado por el comité de ética del Instituto Nacional de Psiquiatría. Resultados El grupo que recibió la intervención tuvo una disminución significativa de síntomas físicos y psicológicos, así como de depresión, mientras que éstos aumentaron en el grupo sin intervención. Los enfrentamientos comprometido y tolerante disminuyeron entre la primera y segunda medición, mientras que el independiente se mantuvo en el grupo con intervención. Lo contrario ocurrió con el grupo sin intervención, quienes mantuvieron los enfrentamientos que implican más estrés. Discusión El modelo fue exitoso para la población indígena. Se hace una reflexión sobre los aspectos culturales de llevar a cabo una intervención de esta naturaleza.