“No hay salud mental sin justicia social”: desigualdades, determinantes sociales y salud mental en Chile
Resumen
Las desigualdades en las condiciones de vida impactan negativamente sobre la salud mental de las personas y comunidades. Este artículo tiene por objetivo describir algunas de las principales líneas de investigación y reflexión en torno a la relación entre desigualdad y salud mental. Más que una revisión sistemática, se trata de una discusión orientada a contribuir al debate público en torno a las dimensiones materiales, simbólicas y subjetivas de la desigualdad, mencionando algunos mecanismos que permiten comprender su relación con la salud mental. Entre estas dimensiones abordamos las desigualdades de ingreso y de género, además de otras que han recibido menor atención en los estudios nacionales e internacionales: las desigualdades en la participación, en la interacción cotidiana, y las desigualdades socio-territoriales y en el uso del tiempo. Finalmente, mencionamos algunas limitaciones teóricas de la investigación tradicional sobre desigualdad en salud y sugerimos potenciales líneas de investigación que pueden orientar los estudios en torno a desigualdades y salud mentalPalabras clave:
salud mental, desigualdad, determinantes sociales, ChileReferencias
1. Organización Mundial de la Salud. Subsanar las desigualdades en una generación. Alcanzar la equidad sanitaria actuando sobre los
determinantes sociales de la salud. Ginebra: OMS, 2008
2. World Health Organization. Social determinants of mental health. Geneva: World Health Organization, 2014.
3. Picketty T. Le capital au XXIe siècle. Paris: Seuil, 2013.
4. Lund C, Carrie Brooke-Sumner, Florence Baingana, Emily Claire Baron, Erica Breuer, Prabha Chandra, Johannes Haushofer, et al. Social determinants of mental disorders and the Sustainable Development Goals: a systematic review of reviews. Lancet Psychiatry 2018; 5: 357-369.
5. Chiavegatto Filho A, Kawachi I, Wang Y, Viana M, Andrade L. Does income inequality get under the skin? A multilevel analysis of depression, anxiety and mental disorders in Sao Paulo, Brazil. Journal of Epidemiology and Community Health 2013; 67: 966-972.
6. Wilkinson R, Pickett K. Desigualdad. Un análisis de la (in)felicidad colectiva. Madrid: Turner, 2009.
7. Fryers T, Melzer D, Jenkins R. Social inequalities and the common mental disorders: a systematic review of the evidence. Soc Psychiatry Psychiatr Epidemiol 2003; 38: 229-237.
8. Patel V, Burns J, Dhingra D, Tarver L, Kohrt B, Lund C. Income inequality and depression: a systematic review and meta-analysis of the association and a scoping review of mechanisms. World Psychiatry 2018; 17: 76-89.
9. Wilkinson R, Pickett K. The inner level. How more equal societies reduce stress, restore sanity and improve everyone’s wellbeing. London: Penguin books, 2018.
10. Burns J, Tomita A, Kapadia A. Income inequality and schizophrenia: Increased schizophrenia incidence in countries with high levels of income inequality. International Journal of Social Psychiatry 2014; 60(2):185-196.
11. Collins PH. Intersectionality as critical social theory. Durham: Duke University Press, 2019.
12. Trygg N, Gustafsson P, Månsdotter A. Languishing in the crossroad? A scoping review of intersectional inequalities in mental health. Int Journal Equity Health 2019; 18: 115.
13. Subramanian S, Kawachi I. Income inequality and health: what have we learned so far? Epidemiology Review 2004; 26: 78-91.
14. Silva Ribeiro W, Bauer A, Andrade M, YorkSmith M, Pan P, Pingani L, et al. Income inequality and mental illness-related morbidity and resilience: a systematic review and meta-analysis. Lancet Psychiatry 2017; 4(7):554-562.
15. Cifuentes M, Sembajwe G, Tak S, Gore R, Kriebel D, Punnett L. The association of major depressive episodes with income inequality and the human development index. Social Science & Medicine 2008; 67(4):529-539.
16. Lund C, Breen A, Flisher A, Kakuma R, Corrigall J, Joska J, et al. Poverty and common mental disorders in low and middle income countries: a systematic review. Social Science and Medicine 2010; 71: 517-528.
17. Programa de Naciones Unidas para el Desarrollo. Desiguales. Orígenes, cambios y desafíos de la brecha social en Chile. Santiago: PNUD, 2017.
18. Sapelli C. Chile: ¿más equitativo? Santiago: Ediciones UC, 2016.
19. Savani K, Rattan A. A choice mind-set increases the acceptance and maintenance of wealth inequality. Psychological Science 2012; 23(7): 796-804.
20. Schneider S. Income inequality and its consequences for life satisfaction: What role do social cognitions play? Social Indicators Research 2012; 106(3): 419-438.
21. Layte R. The association between income inequality and mental health: testing status anxiety, social capital, and neo-materialist explanations. European Sociological Review 2012; 28(4): 498-511.
22. Buttrick N, Oishi S. The psychological consequences of income inequality. Soc Personal Psychol Compass 2017; 11: e12304.
23. Erdem Ö, Van Lenthe F, Prins R, Voorham T, Burdorf A. Socioeconomic inequalities in psychological distress among urban adults: The moderating role of neighborhood social cohesion. PLoS ONE 2016;11(6): e0157119.
24. Krause M, Güell P, Jaramillo A, Zilveti M, Jiménez JP, Luyten P. Changing communities and increases in the prevalence of depression: is there a relationship? Universitas Psychologica 2015; 14(4): 1259-1268.
25. Deaton A. Health, inequality, and economic development. Journal of Economic Literature 2003; 41(1): 113-158.
26. Stuckler D, Basu S. The body economic: Why austerity kills. New York: Basic Books, 2013.
27. Araya R, Zitko P, Markkula N. The impact of universal health care programmes on improving ‘realized access’ to care for depression in Chile. Administration and Policy in Mental Health and Mental Health Services Research 2018; 45(5): 790-799.
28. Barozet E. Looking ahead: what are the challenges for the middle classes? The case of Chile. In Middle Class: Expansion and consolidation in Latin America, Policy Brief Polis 2018, 18: 36-39.
29. Araujo K, Martucelli D. Desafíos comunes. Retrato de la sociedad chilena y sus individuos. Santiago: LOM, 2012.
30. Orchard M, Jiménez A. ¿Malestar de qué? Acerca de ciertos malentendidos entre malestar social y sufrimiento psíquico en Chile. En E. Radiszcz (ed.) Malestares y destinos del malestar. Santiago: Social Ediciones, 2016.
31. Layte R, Whelan C. Who feels inferior? A test of the status anxiety hypothesis of social inequalities in health. European Sociological Review 2014; 30(4): 525-535.
32. Wetherall K, Robb K, O’Connor R. Social rank theory of depression: A systematic review of self-perceptions of social rank and their relationship with depressive symptoms and suicide risk. Journal of Affective Disorders 2019; 246: 300-319.
33. Bourdieu P. La distinción. Criterio y bases sociales del gusto. Madrid: Taurus, 1988.
34. Jiménez-Molina A, Abarca-Brown G. Depresión en Chile: una mirada interseccional desde las ciencias sociales. En Rojas G, Depresión. Santiago: Editorial Universitaria (en prensa).
35. Mau S, Mewes J, Schöneck N. What determines subjective socio-economic insecurity? Context and class in comparative perspective. Socio-economic Review 2012; 10(4):655-682.
36. Orchard M. The moral economy of ‘respect’ in Chilean Society. PhD Thesis, School of Sociology and Social Policy, University of Nottingham, 2019.
37. Centro de Investigación en Conflicto y Cohesión Social (COES) Estudio Longitudinal Social de Chile (ELSOC). www.elsoc.cl
38. Organización Mundial de la Salud. Plan de Acción sobre Salud Mental 2015-2020. Ginebra: OMS, 2014.
39. Morrison L. Talking back to psychiatry: The psychiatric consumer/survivor/ex-patient movement. London: Routledge, 2005.
40. Barnes M, Bowl R. Taking over the asylum:Empowerment and mental health. Basingstoke: Palgrave, 2001.
41. Montenegro C, Cornish F. Historicising involvement: The visibility of user groups in the modernisation of the Chilean Mental Health System. Critical Public Health 2019; 29(1): 61-73.
42. Chuaqui J. Institucionalización Psiquiátrica: El caso de los Hogares Protegidos de la Región de Valparaíso, Chile. Psiquiatría y Salud Mental 2015; 32(2): 9.
43. Rose N. Mental health, stress, and the contemporary metropolis. In Keith M, Aruska A, De Souza Santos A (eds). Urban transformations and public health in the emergent city. Manchester: Manchester University Press, 2019.
44. Manning N. Sociology, biology and mechanisms in urban mental health. Social Theory & Health 2019; 17(1): 1-22.
45. Guite H, Clark C, Ackrill G. The impact of the physical and urban environment on mental well-being. Public Health 2006; 120(12):1117-1126.
46. Peen J, Schoevers R, Beekman A, Dekker J. The current status of urban-rural differences in psychiatric disorders. Acta Psychiatr Scand 2010;121(2):84-93.
47. Corcoran R, Marshall G. From lonely cities to prosocial places. In O. Sagan and E. Miller (eds.) Narratives of Loneliness. UK: Routledge, 2018, pp. 127-139.
48. Elliott I. Poverty and Mental Health: A review to inform the Joseph Rowntree Foundation’s Anti-Poverty Strategy. London: Mental Health Foundation, 2016.
49. van den Berg M, WendelVos W, van Poppel M, Kemper H, van Mechelen W, Maas J. Health benefits of green spaces in the living environment: A systematic review of epidemiological studies. Urban For Urban Green 2015;14(4):806-816.
50. McCay L, Abassi A, Abu-Lebdeh G, et al. Scoping assessment of transport design targets to improve public mental health. Journal of Urban Design and Mental Health 2017; 3:8.
51. Wang X, Rodríguez D, Sarmiento O, et al. Commute patterns and depression: Evidence from eleven Latin American cities. Journal of Transport & Health 2019; 14: 100607.
52. CEPAL. El tiempo, los tiempos, una vara de desigualdad. Santiago: CEPAL, 2005.
53. Weston G, Zilanawala A, Webb E, et al. Long work hours, weekend working and depressive symptoms in men and women: findings from a UK population-based study. J Epidemiol Community Health 2019; 73: 465-474.
54. Roxburgh S. “There just aren’t enough hours in the day”: the mental health consequences of time pressure. Journal of Health and Social
Behaviour 2004; 45(6): 115-131.
55. Strazdins L, Griffin A, Broom D, Banwell C, Korda R, Dixon J, Paolucci F, Glover J. Time scarcity: another health inequality? Environment and Planning 2011; 43: 545-559.
56. Basaure M, Sánchez B, Vera C. Desigualdad como tiranía del tiempo. Una indagación teórica y empírica del caso chileno. Centro de Estudios de Conflicto y Cohesión Social, Documento de trabajo n°32. Santiago: COES, 2018, pp. 1-49.
57. Programa de Naciones Unidas para el Desarrollo. Bienestar subjetivo: el desafío de repensar el desarrollo. Santiago: PNUD, 2012.
58. Rojas G, Araya R, Lewis G. Comparing sex inequalities in common affective disorders across countries: Great Britain and Chile. Social Science & Medicine 2005; 60: 1693-1703.
59. Salk R, Hyde J, Abramson L. Gender differences in depression in representative national samples: meta-analyses of diagnoses and symptoms. Psychological Bulletin 2017;143(8): 783.
60. Ministerio de Salud – Chile. Encuesta Nacional de Salud 2016-2017. Santiago: MINSAL, 2018
61. Hammarström A, Lehti A, Danielsson U, Bengs C, Johansson E. Gender-related explanatory models of depression: A critical evaluation of medical articles. Public Health 2009; 123: 689-693.
62. Leupp K. Even supermoms get the blues: Employment, gender attitudes, and depression. Society and Mental Health 2019; 9(3):316-333.
63. Yu S. Uncovering the hidden impacts of inequality on mental health: a global study. Translational Psychiatry 2018; 8: 98.
64. Yates-Doerr E. Reworking the social determinants of health: Responding to material-semiotic indeterminacy in public health interventions. Medical Anthropology Quarterly 2020; 34(3): 378-397.
65. Adams V, Behague D, Caduff C, Löwy I, Ortega F. Re-imagining global health through social medicine. Global Public Health 2019;14(10):1383-1400.
66. Braveman P, Gottlieb L. The social determinants of health: It’s time to consider the causes of the causes. Public Health Reports 2014; 129: 19-31.
67. Fassin D. The embodiment of inequality. AIDS as a social condition and the historical experience in South Africa. EMBO reports 2003; 4(1): S4-S9.
determinantes sociales de la salud. Ginebra: OMS, 2008
2. World Health Organization. Social determinants of mental health. Geneva: World Health Organization, 2014.
3. Picketty T. Le capital au XXIe siècle. Paris: Seuil, 2013.
4. Lund C, Carrie Brooke-Sumner, Florence Baingana, Emily Claire Baron, Erica Breuer, Prabha Chandra, Johannes Haushofer, et al. Social determinants of mental disorders and the Sustainable Development Goals: a systematic review of reviews. Lancet Psychiatry 2018; 5: 357-369.
5. Chiavegatto Filho A, Kawachi I, Wang Y, Viana M, Andrade L. Does income inequality get under the skin? A multilevel analysis of depression, anxiety and mental disorders in Sao Paulo, Brazil. Journal of Epidemiology and Community Health 2013; 67: 966-972.
6. Wilkinson R, Pickett K. Desigualdad. Un análisis de la (in)felicidad colectiva. Madrid: Turner, 2009.
7. Fryers T, Melzer D, Jenkins R. Social inequalities and the common mental disorders: a systematic review of the evidence. Soc Psychiatry Psychiatr Epidemiol 2003; 38: 229-237.
8. Patel V, Burns J, Dhingra D, Tarver L, Kohrt B, Lund C. Income inequality and depression: a systematic review and meta-analysis of the association and a scoping review of mechanisms. World Psychiatry 2018; 17: 76-89.
9. Wilkinson R, Pickett K. The inner level. How more equal societies reduce stress, restore sanity and improve everyone’s wellbeing. London: Penguin books, 2018.
10. Burns J, Tomita A, Kapadia A. Income inequality and schizophrenia: Increased schizophrenia incidence in countries with high levels of income inequality. International Journal of Social Psychiatry 2014; 60(2):185-196.
11. Collins PH. Intersectionality as critical social theory. Durham: Duke University Press, 2019.
12. Trygg N, Gustafsson P, Månsdotter A. Languishing in the crossroad? A scoping review of intersectional inequalities in mental health. Int Journal Equity Health 2019; 18: 115.
13. Subramanian S, Kawachi I. Income inequality and health: what have we learned so far? Epidemiology Review 2004; 26: 78-91.
14. Silva Ribeiro W, Bauer A, Andrade M, YorkSmith M, Pan P, Pingani L, et al. Income inequality and mental illness-related morbidity and resilience: a systematic review and meta-analysis. Lancet Psychiatry 2017; 4(7):554-562.
15. Cifuentes M, Sembajwe G, Tak S, Gore R, Kriebel D, Punnett L. The association of major depressive episodes with income inequality and the human development index. Social Science & Medicine 2008; 67(4):529-539.
16. Lund C, Breen A, Flisher A, Kakuma R, Corrigall J, Joska J, et al. Poverty and common mental disorders in low and middle income countries: a systematic review. Social Science and Medicine 2010; 71: 517-528.
17. Programa de Naciones Unidas para el Desarrollo. Desiguales. Orígenes, cambios y desafíos de la brecha social en Chile. Santiago: PNUD, 2017.
18. Sapelli C. Chile: ¿más equitativo? Santiago: Ediciones UC, 2016.
19. Savani K, Rattan A. A choice mind-set increases the acceptance and maintenance of wealth inequality. Psychological Science 2012; 23(7): 796-804.
20. Schneider S. Income inequality and its consequences for life satisfaction: What role do social cognitions play? Social Indicators Research 2012; 106(3): 419-438.
21. Layte R. The association between income inequality and mental health: testing status anxiety, social capital, and neo-materialist explanations. European Sociological Review 2012; 28(4): 498-511.
22. Buttrick N, Oishi S. The psychological consequences of income inequality. Soc Personal Psychol Compass 2017; 11: e12304.
23. Erdem Ö, Van Lenthe F, Prins R, Voorham T, Burdorf A. Socioeconomic inequalities in psychological distress among urban adults: The moderating role of neighborhood social cohesion. PLoS ONE 2016;11(6): e0157119.
24. Krause M, Güell P, Jaramillo A, Zilveti M, Jiménez JP, Luyten P. Changing communities and increases in the prevalence of depression: is there a relationship? Universitas Psychologica 2015; 14(4): 1259-1268.
25. Deaton A. Health, inequality, and economic development. Journal of Economic Literature 2003; 41(1): 113-158.
26. Stuckler D, Basu S. The body economic: Why austerity kills. New York: Basic Books, 2013.
27. Araya R, Zitko P, Markkula N. The impact of universal health care programmes on improving ‘realized access’ to care for depression in Chile. Administration and Policy in Mental Health and Mental Health Services Research 2018; 45(5): 790-799.
28. Barozet E. Looking ahead: what are the challenges for the middle classes? The case of Chile. In Middle Class: Expansion and consolidation in Latin America, Policy Brief Polis 2018, 18: 36-39.
29. Araujo K, Martucelli D. Desafíos comunes. Retrato de la sociedad chilena y sus individuos. Santiago: LOM, 2012.
30. Orchard M, Jiménez A. ¿Malestar de qué? Acerca de ciertos malentendidos entre malestar social y sufrimiento psíquico en Chile. En E. Radiszcz (ed.) Malestares y destinos del malestar. Santiago: Social Ediciones, 2016.
31. Layte R, Whelan C. Who feels inferior? A test of the status anxiety hypothesis of social inequalities in health. European Sociological Review 2014; 30(4): 525-535.
32. Wetherall K, Robb K, O’Connor R. Social rank theory of depression: A systematic review of self-perceptions of social rank and their relationship with depressive symptoms and suicide risk. Journal of Affective Disorders 2019; 246: 300-319.
33. Bourdieu P. La distinción. Criterio y bases sociales del gusto. Madrid: Taurus, 1988.
34. Jiménez-Molina A, Abarca-Brown G. Depresión en Chile: una mirada interseccional desde las ciencias sociales. En Rojas G, Depresión. Santiago: Editorial Universitaria (en prensa).
35. Mau S, Mewes J, Schöneck N. What determines subjective socio-economic insecurity? Context and class in comparative perspective. Socio-economic Review 2012; 10(4):655-682.
36. Orchard M. The moral economy of ‘respect’ in Chilean Society. PhD Thesis, School of Sociology and Social Policy, University of Nottingham, 2019.
37. Centro de Investigación en Conflicto y Cohesión Social (COES) Estudio Longitudinal Social de Chile (ELSOC). www.elsoc.cl
38. Organización Mundial de la Salud. Plan de Acción sobre Salud Mental 2015-2020. Ginebra: OMS, 2014.
39. Morrison L. Talking back to psychiatry: The psychiatric consumer/survivor/ex-patient movement. London: Routledge, 2005.
40. Barnes M, Bowl R. Taking over the asylum:Empowerment and mental health. Basingstoke: Palgrave, 2001.
41. Montenegro C, Cornish F. Historicising involvement: The visibility of user groups in the modernisation of the Chilean Mental Health System. Critical Public Health 2019; 29(1): 61-73.
42. Chuaqui J. Institucionalización Psiquiátrica: El caso de los Hogares Protegidos de la Región de Valparaíso, Chile. Psiquiatría y Salud Mental 2015; 32(2): 9.
43. Rose N. Mental health, stress, and the contemporary metropolis. In Keith M, Aruska A, De Souza Santos A (eds). Urban transformations and public health in the emergent city. Manchester: Manchester University Press, 2019.
44. Manning N. Sociology, biology and mechanisms in urban mental health. Social Theory & Health 2019; 17(1): 1-22.
45. Guite H, Clark C, Ackrill G. The impact of the physical and urban environment on mental well-being. Public Health 2006; 120(12):1117-1126.
46. Peen J, Schoevers R, Beekman A, Dekker J. The current status of urban-rural differences in psychiatric disorders. Acta Psychiatr Scand 2010;121(2):84-93.
47. Corcoran R, Marshall G. From lonely cities to prosocial places. In O. Sagan and E. Miller (eds.) Narratives of Loneliness. UK: Routledge, 2018, pp. 127-139.
48. Elliott I. Poverty and Mental Health: A review to inform the Joseph Rowntree Foundation’s Anti-Poverty Strategy. London: Mental Health Foundation, 2016.
49. van den Berg M, WendelVos W, van Poppel M, Kemper H, van Mechelen W, Maas J. Health benefits of green spaces in the living environment: A systematic review of epidemiological studies. Urban For Urban Green 2015;14(4):806-816.
50. McCay L, Abassi A, Abu-Lebdeh G, et al. Scoping assessment of transport design targets to improve public mental health. Journal of Urban Design and Mental Health 2017; 3:8.
51. Wang X, Rodríguez D, Sarmiento O, et al. Commute patterns and depression: Evidence from eleven Latin American cities. Journal of Transport & Health 2019; 14: 100607.
52. CEPAL. El tiempo, los tiempos, una vara de desigualdad. Santiago: CEPAL, 2005.
53. Weston G, Zilanawala A, Webb E, et al. Long work hours, weekend working and depressive symptoms in men and women: findings from a UK population-based study. J Epidemiol Community Health 2019; 73: 465-474.
54. Roxburgh S. “There just aren’t enough hours in the day”: the mental health consequences of time pressure. Journal of Health and Social
Behaviour 2004; 45(6): 115-131.
55. Strazdins L, Griffin A, Broom D, Banwell C, Korda R, Dixon J, Paolucci F, Glover J. Time scarcity: another health inequality? Environment and Planning 2011; 43: 545-559.
56. Basaure M, Sánchez B, Vera C. Desigualdad como tiranía del tiempo. Una indagación teórica y empírica del caso chileno. Centro de Estudios de Conflicto y Cohesión Social, Documento de trabajo n°32. Santiago: COES, 2018, pp. 1-49.
57. Programa de Naciones Unidas para el Desarrollo. Bienestar subjetivo: el desafío de repensar el desarrollo. Santiago: PNUD, 2012.
58. Rojas G, Araya R, Lewis G. Comparing sex inequalities in common affective disorders across countries: Great Britain and Chile. Social Science & Medicine 2005; 60: 1693-1703.
59. Salk R, Hyde J, Abramson L. Gender differences in depression in representative national samples: meta-analyses of diagnoses and symptoms. Psychological Bulletin 2017;143(8): 783.
60. Ministerio de Salud – Chile. Encuesta Nacional de Salud 2016-2017. Santiago: MINSAL, 2018
61. Hammarström A, Lehti A, Danielsson U, Bengs C, Johansson E. Gender-related explanatory models of depression: A critical evaluation of medical articles. Public Health 2009; 123: 689-693.
62. Leupp K. Even supermoms get the blues: Employment, gender attitudes, and depression. Society and Mental Health 2019; 9(3):316-333.
63. Yu S. Uncovering the hidden impacts of inequality on mental health: a global study. Translational Psychiatry 2018; 8: 98.
64. Yates-Doerr E. Reworking the social determinants of health: Responding to material-semiotic indeterminacy in public health interventions. Medical Anthropology Quarterly 2020; 34(3): 378-397.
65. Adams V, Behague D, Caduff C, Löwy I, Ortega F. Re-imagining global health through social medicine. Global Public Health 2019;14(10):1383-1400.
66. Braveman P, Gottlieb L. The social determinants of health: It’s time to consider the causes of the causes. Public Health Reports 2014; 129: 19-31.
67. Fassin D. The embodiment of inequality. AIDS as a social condition and the historical experience in South Africa. EMBO reports 2003; 4(1): S4-S9.
