Mental Health Consequences of Violence in Mexico: A Qualitative Analysis of Needs

Background: Violence in Mexico has risen to epidemic levels, with far-reaching implications for mental health. Since 2007, violence associated with the Drug War in Mexico claimed the lives of over 220,000 people and resulted in more than 32,000 disappeared or missing people.  Exposure to violence can have long-lasting effects on individuals directly or indirectly affected by violence. This qualitative study explores Mexican health and social service providers' views on the mental health of communities affected by violence. 

Methods: Eighty semi-structured interviews were conducted with physicians (72%) and other health professionals (28%) including social workers, psychologists and nurses in five states of Mexico selected for their high incidence of violence. Purposive sampling was conducted through local public health agencies. Recruitment was in person or by telephone. Interviews focused on how violence affects mental health of patients, how providers perceive mental health services to be needed or provided in response to violence, as well as physical effects of violence related to mental health problems. Interviews were conducted in Spanish, recordings were transcribed, and coded thematically using ATLAS.ti, framework analysis was used to interpret key findings.

Results: Health professionals in all states reported an increase in mental health needs. Patients sought primary care services related to mental health for feelings of anxiety, stress, shortness of breath, insomnia, headaches, stomach aches and other issues. Bachelor’s level psychologists attend to mental health issues in many primary care centers, but often they were overbooked or did not deliver trauma-informed counseling. In many rural and poorer areas a psychologist was not part of the medical team, so individuals would need to travel longer distances to seek mental healthcare. The next level of mental healthcare is a tertiary psychiatric hospital, all of which are regional and require a referral diagnosis. As a result, patients went without mental health care due to an excess of demand, lack of services or referral, and long distances to a provider. Providers used words like “psychosis”, “nerves”, “fear” and “depression” to describe the mental health needs of patients seeking primary care services. Participants described an avoidance of talk about violence by both patients and professionals as a common way of coping and self-protection. Depressed economic activity is an indirect effect of violence that causes additional stress among community members and decreases health expenditures. If individuals had the means, migration was a reported response to violence.

Conclusions and Implications: Violence in Mexico bears a heavy burden on mental health. Individuals seek primary care services for mental health problems, but services are insufficient. This study underscores the importance of understanding the impact of violence in a low-resource environment.  It highlights the need for trauma-informed mental health services at the primary care level, especially in contexts affected by violence and with few stand along mental health services.  Awareness efforts are needed to inform the wider public of the mental health consequences of violence and available resources. System-level policies are needed to mitigate the lack of availability of mental healthcare in remote areas where violence occurs.