Poverty and Mental Health Outcomes in Mexican Adolescents

Adolescence is a transitional and vulnerable period in the life cycle. Particularly for those living in countries where access to mental health (MH) services is low, it is necessary to promote preventive interventions based on evidence. The purpose of this chapter is to analyze the adaptive and resilience processes in adolescents from different marginalizing communities. The theoretical and empirical foundations of the ecological-transactional perspective of adolescent development as a framework for understanding the adaptive processes and resilience in contextual adversity is reviewed, with the recognition of risk and protective factors at multiple levels and ecological settings.

Under this perspective, the authors provide data supporting the predictive role of stressful life events, coping, and family functioning in adaptive and nonadaptive outcomes in adolescents living diverse contexts of high-risk communities in Mexico City. These findings may contribute to early intervention programs based on empirical evidence with adolescents and families living in disadvantaged communities in schools and in clinical settings.

An ecological framework for understanding youth outcomes in high-risk contexts

For more than four decades, development researchers appear to be concerned with children and adolescents living in a situation of considerable adversity, including poverty or social marginalization, and thus trying to understand those mechanisms that draw them either to a path of psychopathology or to positive adaptation. The findings provided a set of questions regarding the traditional assumption that situations of risk and stress are “inevitable” linked to psychopathology. This questioning broke down previous schemes of child development, inviting new theoretical and methodological proposals to appear.

Thus, a more comprehensive and positive perspective about the human development emerged, which involves the possibility of positive adaptation together with the reconstruction, from experiences, in the face of adversity. With this, the focus extended toward the study of strengths despite significant stress and risk, also known as resilience. Its study is originated in the model of”developmental psychopathology,” proposed through longitudinal investigations made by Garmezy and Rutter with children living in contexts of poverty, psychosocial risk, and parents with mental disease.

Likewise, the model is based on multifactorial research carried out by Werner and Smith, among others, with vulnerable population which, contrary to predictions, presented positive adaptation. Developmental psychopathology represents a macroparadigm that resumes basic assumptions of both systemic and bioecological approaches. This perspective implies the intersection between the fields of clinical and human development and it also includes contributions from neurosciences, ethology, and psychiatry.

It is focused on children and adolescents within different ecological levels that involve risk, vulnerability, adaptation, and resilience, and it also recognizes the multidimensional nature of adaptation. For this reason, the evaluation and intervention methods are multifactorial, multilevel, and multireferential. Also known as “ecologic-transactional perspective” and “organizational model”, this new approach assumes that adaptation is the result of an organization of different systems that interact dynamically.

Adolescent mental health problems: risk and protective factors

The concept of risk borrowed from the medical model and then transferred to social sciences refers to those characteristics of a person, or of the environment, that limit, impede, or represent a threat for his development having as a consequence negative outcome. Statistically this involves a higher probability of presenting an alteration in the course of development in “critical” domains. Vulnerability entails personal and environmental factors that increase the negative effects of a risk condition.

Protection is a process in which individual and environmental factors participate and attenuate the impact of stress and risk. Because of their contribution to positive adaptation they are called protective and can be defined based on personal attributes such as coping, personality, self-efficacy, and also environmental ones like a functional family organization or family care. This perspective suggests that factors of risk and protection belong to multiple levels, from individual to contextual (family, school, community) and of a diverse domain (biological, psychological, and social), and throughout life.

What is mental health and mental health problems (MHP)? Mental health (MH) is defined as the “successful performance of mental function that results in productive activities, fulfilling relationships with other individuals and the ability to adapt to change and cope with adversity”. Mental health problems (MHP) include signs and symptoms which are not intense or lengthy enough so as to fulfill the criteria of a certain mental disorder.

The term mental or psychiatric disorder refers to the group of disorders diagnosed according to medical classification systems like DSM5 and ICD-10. These include a series of conditions characterized by thought, mood, or behavior disturbance (or a combination of them) and associated to an altered functioning or personal suffering. Children and adolescents constitute a third of the world’s population (2.2 billions) and a 90% of them live in low- and middle-income countries (LMIC) where they represent 50% of its population.

Adapting processes and resilience in multiple contexts

According to our previous statements, adolescents’ outcomes result from a complex process involving the dynamic interaction of multiple factors at multiple levels. A salient individual factor explaining the mechanism of adaptive or maladaptive outcomes is coping. However, in the field of resilience it is needed to take into account the social context of adolescents in order to analyze the relationship between stressful life events and coping in multiple contexts, clinical and nonclinical, in disadvantaged communities.

Stress life events and coping in disadvantaged communities

Adolescent stress approaches based in Lazarus’ transactional model emphasizes the importance of individual characteristics, stressors, and context. There is evidence that both, major and daily events or hassles, due to its frequency, intensity, and duration represent a high stress burden. However, according to the compensatory model of resilience positive events can buffer the negative effect of these stressors. Family stress theory shows that daily stressful experiences associated to a socioeconomic disadvantage usually generate family crises and mental health problems affecting whole family system and family members.

The “Context Model” (e.g., risk-stress model) suggests that families in disadvantaged societies are exposed to multiple risks, most of them related to a lack of money. Economic pressure represents a chronic stressor associated to mental health problems including anxiety and depression. Therefore, it supports the notion of relationship between economic hardship, family conflict, and emotional disorder.

In a Mexican context, it is reported that around 80% has experienced an adverse event in a year and that to a higher number of adversities there was also a higher probability of psychopathology. This coincides with previous data regarding stressors and internalizing an externalizing problem. The difference between youth risk, for instance, with or without suicidal ideation, drug consumers or nonconsumers and adolescents with or without psychopathology is the number, type, and source of stressors, generally related to family, in which, even normative life events, can be perceived negatively by adolescents.

Family functioning in clinical and nonclinical adolescent settings

Family represents the first scenario, which is at the same time the most natural and lasting one, of the individual-context interaction. Family factors are suggested to be a determinant in health during the course of life and among different cultures. Supportive parents and families are “crucial part in the improvement of global health”.

However, it is not possible to ignore the influence of macrostructural factors that shape the individual and familiar development such as the economic crisis that characterizes low- and middle-income countries (LMIC) like Mexico. The family unit is a reflection of contemporary transformation processes and there is no convergence with a unique family model as it was proposed in the sociological theories of the 1960s. It is hard to build a set of understandable generalizations of how family environments relate to the developmental life course from childhood to adolescence.

This may be a result of both a wide array of measurements that evaluate the same constructs and variables and the complexity of the relationships itself. The debate about the nature and impact of the psychosocial determinants in the trajectories and outcomes of the adolescent development is still open and to a certain level mediated by genetic factors. Still, it appears that there is a universal agreement in the understanding of human development as an interactive process between the individual and the context, particularly family context.

An ecological-transactional perspective encompasses a theoretical and methodological framework for a comprehensive understanding of youth outcomes. Although adolescents are regarded as healthy, the pressures of the globalized world imply multiple challenges and threats to their well- being. An increasing number of youth people suffer mental health problems and a gap between the needs and resource availability exists.

Although most of the knowledge about the risk and protective factors arises from developed countries research is needed in the resilience field, particularly in developing countries where most adolescents live. Poverty is linked to a number of adversities including stressful life events. However, the protective role of family factors and coping styles and strategies are just starting to be studied in these countries.

The interplay between stressful life events, coping, and family factors should be the basis to undertake research initiative as much as preventive intervention. Developmental trajectories in high risk settings moving to well-being and mental health or to psychopathology may be the result of this interplay

 

Author:Blanca Estela Barcelata‐Eguiarte and Maria Elena Márquez‐Caraveo