November 13, 2019

Gender and Mental Health: Implications for Global Mental Health Delivery in Compañeros En Salud - Mexico


Event recap written by: Louisa Hudson MSc, Research Assistant, Department of Global Health & Social Medicine, Harvard Medical School

Mercedes Aguerrebere, MD, MMSc brought to light insightful observations and questions around gender and mental health in Chiapas, Mexico. Dr. Aguerrebere is a physician working in comprehensive primary and mental health care. She has been working with Compañeros En Salud since 2013 and recently completed the MMSc-GHD program at Harvard Medical School. On Wednesday, November 13th, she shared her impressive thesis work with the Harvard Medical School community as a part of the MMSc-GHD Alumni in Action series.

Dr. Aguerrebere set the scene of Chiapas and Mexico, a rural and mountainous area bordering Guatemala. In Chiapas, 51% of the population live in rural areas and it is one of the poorest states in Mexico with 77% of people living in poverty. As for access to mental health care, there are about 210 psychologists and 4 psychiatrists for the whole country. Due to the colonial history of Mexico and specifically Chiapas, the cash crop is coffee and this continues to be the main source of income for the state and was a key feature of Dr. Aguerrebere’s study. In addition to the historical landscape of Chiapas, Dr. Aguerrebere discussed other forces that contributed to her thesis. Compañeros En Salud has observed that the 7th cause of consultation at their clinics, more than headaches, is depression and it is noticeably more common in women than men. Dr. Aguerrbere was curious as to what was causing these high rates in women and intimate partner violence (IPV) kept arising as a main trigger. This led Dr. Aguerrebere to investigate gender norms in the community and their interaction with IPV.

Dr. Aguerrebere’s study took place in 2017 in Laguana del Cofre, Montecristo. It was a mixed methods study, quantitatively identifying participants with depression but also using qualitative interviews to understand why and where interventions would be best placed. Some points of interest from the results are that: completing primary school and the male partner owning a coffee crop were protective factors and alcohol abuse by the male partner was a risk factor. Coffee crop ownership interacts with alcohol abuse as those with partners who owned coffee crops had a lower prevalence of IPV and a lower prevalence of their partners abusing alcohol and exhibiting high controlling behaviors versus those that do not own crops. Depression was most prevalent in women who were experiencing high controlling behaviors and IPV. An unexpected result was that many of the men reported suffering abuse themselves as children. Regarding the exploration of gender norms, a key finding was that men and women live in different spheres, although this is changing with the younger generations as they attend school together. Men and women in Chiapas take on traditional roles – the women maintain the house and 93% of their partners work in the coffee crops. These roles are deeply ingrained in the community, but parenting practices are changing and younger generations are shifting these norms. Dr. Aguerrebere also highlighted the issue of masculinity in this area and its association with controlling behaviors and a provider role. Men have significantly more social capital than women in Chiapas, and although alcohol and violence towards women is not permitted, punishments are not usually carried out.

The work done by Dr. Aguerrebere has influenced Compañeros En Salud and the community in Chiapas. There are community health workers working with the women; interventions for adolescents created through a lens of gender; early childhood development programs that involve parenting and safe attachment interventions working to include fathers; trauma informed care; and recognition of other mental illness in the community. This work by Dr. Aguerrebere reflects a common story of generational change and conflict as social and cultural norms change rapidly and start to affect the most rural populations, and all of this mixed with a history of colonialism and socioeconomic hardship.