Depressive symptoms among patients at a clinic in the red light district of Tijuana, Mexico

ABSTRACT

Little is known about depression among structurally vulnerable groups living in Tijuana (e.g., migrants, deportees, substance users, sex workers, homeless people) who may be at high risk for poor mental health. This study investigates the prevalence and correlates of depressive symptoms among vulnerable patients receiving services at a free clinic in Tijuana, Mexico. A convenience sample of 584 adult Mexican patients completed an interviewer-administered questionnaire in English or Spanish that included the 8-item NIH PROMIS depression short form and measures of individual, social and structural factors affecting health. The prevalence of clinically significant depressive symptoms in our sample was 55%. In the multivariate analysis, female gender, poor/fair self-rated health, recent illicit drug use (past six months), feeling rejected (past six months), history of forced sex and history of violence were independently associated with increased odds of experiencing depressive symptoms. When stratified by gender, we found important differences in significant factors, including recent illicit drug use in men and deportation in women. Among study participants, prevalence of depressive symptoms exceeds prevalence rates reported elsewhere in the US-Mexico border region. These findings suggest that public health efforts to support mental health services in the border region are needed.

KEYWORDS:

• Mental health
• PROMIS depression short form
• Latinos
• migrants
• border health

Acknowledgements

We are grateful to the participants for sharing their time with us; without them, this study would not have been possible. We are grateful to our non-profit partner Prevencasa, AC, especially Luis Alberto Segovia and Liliana Pacheco, our study's interviewers and the doctors, students and volunteers who support the Health Frontiers in Tijuana Clinic's endeavors to provide care to the region's most vulnerable populations. We also thank our reviewers, whose insightful comments improved the quality of this paper. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health or the University of California Global Health Institute.

Disclosure statement

The authors have no conflicts of interest to disclose related to this study.

Notes on contributors

Natalie Ferraiolo is a fourth-year medical student at the University of California, San Diego School of Medicine who completed the University of California Global Health Institute GloCal Health Fellowship during the 2014-2015 year. Her interests include the mental health of vulnerable and underserved communities and the effects of adverse childhood experience on health.

Miguel Pinedo is a postdoctoral fellow with the Alcohol Research Group at the University of California, Berkeley. He previously earned his Ph.D. in Public Health from the University of California, San Diego. His research aims at better understanding the intersection between migration and health among Latino populations in the US and in Mexico; substance use and related harms, including HIV risk, among migrants and deportees in the US-Mexico border; and health disparities, mental health and access to care among Latino migrants.

Jessica McCurley is a fourth-year doctoral candidate in Clinical Psychology and an NIH T32 predoctoral fellow in Cardiovascular Epidemiology. Her research and clinical work focuses on psychosocial and sociocultural aspects of risk for chronic diseases, prevention of chronic cardiometabolic conditions (i.e. diabetes, obesity), and health disparities in migrant and refugee communities.

Jose Luis Burgos Assistant Professor in the Division of Global Public Health from the Department of Medicine at UCSD, currently specializes in HIV medicine, global health and development with emphasis on cost-effectiveness analysis of HIV, and tuberculosis intervention programs in resource-limited settings.

Adriana Carolina Vargas-Ojeda is a Pediatrician with a master’s degree in Higher Education Administration and a Ph.D. in Educational Sciences. As a professor at the School of Medicine and Psychology of the Autonomous University of Baja California (UABC), México, she teaches medical genetics to undergraduate medical students at the School of Medicine and Psychology, and teaches methodology to Health Sciences Doctoral Program graduate students. She has served as Dean of the School of Medicine and Vice-Chancellor of UABC, and has participated as a Mexican principal investigator for several successful binational training and research projects for undergraduate and postgraduate students (TIES, TIES 2, AITRP, Diabetes Wireless Tijuana, Cross-Border HIV/AIDS Training graduates, among others), and as an international site GloCal Fellowship mentor.

Michael A. Rodriguez is Professor and Vice Chair in the Department of Family Medicine at the David Geffen School of Medicine at UCLA, Director of the UCLA Blum Center on Poverty and Health in Latin America and Co-Director of the Center of Expertise on Migration and Health. His research activities include ethnic/racial health disparities, immigration, food insecurity, violence prevention, and development of research capacity in low- and middle-income countries.

Victoria D. Ojeda is an Associate Professor in the Division of Global Public Health in the Department of Medicine at UCSD. Her current research examines substance use, HIV/AIDS and mental health comorbidities, with a focus on migrant populations, including deportees, injection drug users and female sex workers.