Etnoepidemiología y salud mental: perspectivas desde América Latina

https://doi.org/10.18294/sc.2020.2786

Publicado 11 septiembre 2020 Open Access


Naomar Almeida-Filho PhD en Epidemiología. Investigador I-A del Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq). Profesor Titular jubilado, Instituto de Saúde Coletiva, Universidade Federal da Bahia. Profesor Visitante, Instituto de Estudios Avançados, Universidade de São Paulo, Brasil. image/svg+xml




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Palabras clave:

Etnoepidemiología, Metodología, Salud Mental, Antropología Médica, Psiquiatría Transcultural


Resumen


En este ensayo, exploro las implicaciones teóricas y metodológicas de un abordaje etnoepidemiológico, que busca integrar hallazgos de investigaciones en salud mental con nuevos modelos conceptuales. Con este propósito, en primer lugar, evalúo las raíces y los usos del término “etnoepidemiología” para designar tres tipos de estrategias de investigación para la producción de conocimiento científico: tipo I (estudios de factores de riesgo socioculturales y grupos de riesgo definidos étnicamente); tipo II (estudios de modelos populares de distribución y ocurrencia de enfermedades en poblaciones); y tipo III (estudios etnográficos de proyectos y líneas de investigación epidemiológica). Como ejemplo, se presentan y discuten características metodológicas seleccionadas de tres estudios en los que he participado. Posteriormente detallo los desarrollos metodológicos derivados de esta experiencia de hacer investigación, generando nuevos modelos para la investigación transcultural y transdisciplinaria de las prácticas en salud mental y, por último, en las conclusiones, comento algunas implicaciones generales del estudio de los problemas de salud mental desde un punto de vista etnográfico y epidemiológico integrado, en sociedades diversas y profundamente desiguales, como las de la América Latina contemporánea.


Referencias bibliográficas


1. Berkman L, Kawachi I. A historical framework for social epidemiology. En: Berkman L, Kawachi I, (eds.). Social epidemiology. New York: Oxford University Press; 2000. p. 3-12.

2. Krieger N. Epidemiology and the people’s health: Theory and context. New York: Oxford; 2011.

3. Fleck AC, Ianni FA. Epidemiology and anthropology: some suggested affinities in theory and method. Human Organization. 1957;16(4):38-40.

4. Cassel J. Factors involving sociocultural incongruity and change: Appraisal and implications for theoretical development. Milbank Memorial Fund Quarterly. 1967;45(2):1109-1110.

5. Myers V. Towards a synthesis of ethnographic and survey methods. Human Organization. 1977;36(3):244-251.

6. Susser M. Epidemiology, health & society: Selected Papers. New York: Oxford University Press; 1987.

7. Inhorn M. Medical anthropology and epidemiology: divergences or convergences? Social Science & Medicine. 1995;40(3):285-290.

8. Morgan DL. Practical strategies for combining qualitative and quantitative methods: Applications to health research. Qualitative Health Research. 1998;8(3):362-376.

9. Trostle J. Epidemiology and culture. New York: Cambridge University Press; 2005.

10. Breilh J. Epidemiología crítica: ciencia emancipadora e interculturalidad. Buenos Aires: Lugar Editorial; 2003.

11. Laurell AC. Trabajo y salud: Estado del conocimiento. En: Franco S, Nunes E, Breilh J, Laurell AC. Debates en Medicina Social. Quito: OPS, ALAMES; 1991. p. 249-321.

12. Gonçalves RB. Medicina y história: Raíces sociales del trabajo médico. México: Siglo Veintiuno Editores; 1984.

13. Castellanos PL. Epidemiología, salud pública, situación de salud y condiciones de vida. En: Barata R, (ed.) Condições de vida e situação de saúde. Rio de Janeiro: Fiocruz, Abrasco; 1997. p. 24-32.

14. Kleinman A. Anthropology and psychiatry: The role of culture in cross cultural research on illness. British Journal of Psychiatry. 1987;151:447-454.

15. Littlewood R. From categories to contexts: A decade of the “new cross cultural psychiatry”. British Journal of Psychiatry. 1990;156(3):308-327.

16. Caravedo B, Rotondo H, Mariategui J. Estudios de psiquiatría social en el Perú. Lima: Ediciones del Sol; 1963.

17. Mariategui J, Samanez F. Sociocultural change and mental health in the Peru of today. Social Psychiatry. 1968;3:35-40.

18. Mariategui J, Alva V, De Leon O. Epidemiología psiquiátrica en un distrito urbano de Lima in an urban district of Lima. Revista de Neuro-Psiquiatría. 1969;184-197.

19. Lovell AM, Read UM, Lang C. Genealogies and anthropologies of global mental health. Cultural Medicine Psychiatry. 2019;43:519-547.

20. Almeida-Filho N. Por una etnoepidemiología (esbozo de un nuevo paradigma epidemiológico). Cuadernos Médico-Sociales, 1992;6:43-47.

21. Massé R. Culture et santé publique. Montreal: Gaëtan Morin; 1995.

22. Bibeau G. Une troisième voie en santé publique. Ruptures - Revue Transdisciplinaire en Santé. 1999;6(2):209-236.

23. Sy A. Socio/Ethno-epidemiologies: proposals and possibilities from the Latin American production. Health Sociology Review. 2017;26(3):293-307.

24. Almeida-Filho N. Becoming modern after all these years: social change and mental health in Latin America. Culture, Medicine and Psychiatry. 1998;22(3):285-316.

25. Almeida-Filho N. La ciencia tímida: Ensayos hacia la deconstrucción de la epidemiología. Buenos Aires: Lugar Editorial; 2000.

26. Almeida-Filho N, Fernandes RCP, Larrea C, Silva LAV. Construindo a etnoepidemiologia. En: Almeida-Filho N, Barreto ML, (org.). Epidemiologia & saúde: Fundamentos, métodos, aplicações. Rio de Janeiro: Guanabara Koogan; 2011. p. 386-394.

27. Almeida-Filho N, Bibeau G. Hacia una etnoepidemiología de la salud mental: Percepciones desde Latinoamérica. En: Mezzich J, Lolas-Stepke F, (eds.). Imágenes de la psiquiatría latinoamericana. Buenos Aires: Sciens; 2013, p. 51-60.

28. Massé R. Pour une ethno-épidémiologie critique de la détresse psychologique à la Martinique. Sciences Sociales et Santé. 2001;19(1):45-74.

29. Agar M. Recasting the “Ethno” in “Epidemiology.” Medical Anthropology. 1994;16(4):391-403.

30. Fernandes RC. Uma leitura sobre a perspectiva etnoepidemiológica. Ciência & Saúde Coletiva. 2003;8(3): 765-774.

31. Hersch-Martínez P. Sociocultural epidemiology: an essential approach. Salud Pública de México. 2013;55(5):512-518.

32. Langdon EJ. Os diálogos da antropologia com a saúde: contribuições para as políticas públicas. ACENO: Revista de Antropologia do Centro Oeste. 2015;2(4):55-77.

33. Singer M. (2020) Ethno-Epidemiological Methodology. In: International Encyclopedia of the Social Sciences (Encyclopedia.com) [Internet]. 2020 [citado 10 mar 2020]. Disponible en: https://tinyurl.com/yasrfkws

34. Wilbert W, Haiek G. Phytochemical screening of a Warao pharmacopoeia employed to treat gastrointestinal disorders. Journal of Ethnopharmacology. 1991;34(1):7-11.

35. Kunstadter P, Kunstadter S, Leepreecha P, Podhisita C, Mai L, Thao C, Thao R, Yang WS. Causes and consequences of increase in child survival rates - Ethno-epidemiology among the Hmong of Thailand. Human Biology. 1992;64(6):821-841.

36. Tajima I, Sonoda K. Ethno-epidemiology of Cancer. Tokyo: The Japanese Cancer Association; 1996.

37. Last J. A Dictionary of Epidemiology. New York: Oxford University Press; 2000.

38. Cronly MPJ, Clatts MC. The risk environment of heroin use initiation: Young women, intimate partners, and “drug relationships”. Substance Use & Misuse. 2015;50(6):771-782.

39. Luber GE. An explanatory model for the Maya Ethnomedical Syndrome Cha’lam tsots. Journal of Ecological Anthropology. 1999;3(1):14-23.

40. Shankar AV, Gittelsohn J, Pradhan R, Dahal B, West K. Night blindness, diet and health in Nepalese children: An ethno-epidemiological investigation of local beliefs. Ecology of Food and Nutrition. 2000;39(3):199-223.

41. Lee D, Yip A, Leung T, Chung T. Ethno-epidemiology of postnatal depression: Prospective multivariate study of sociocultural risk factors in a Chinese population in Hong Kong. British Journal of Psychiatry. 2004;184(1):34-40.

42. Valera B, Sohani Z, Rana A, Poirier P, Anand S. The ethno-epidemiology of obesity. Canadian Journal Cardiology. 2015;31(2):131-141.

43. Thompson SJ, Gifford SM. Trying to keep a balance: The meaning of health and diabetes in an urban Aboriginal community. Social Science & Medicine. 2000;51(10):1457-1472.

44. Imbert G. Vers une étude ethnoépidémiologique du diabète de type 2 et de ses complications. Santé Publique. 2008;20(2):113-124.

45. Trotter RT. Drug use, AIDS, and ethnography: advanced ethnographic research methods exploring the HIV epidemic. NIDA Research Monograph. 1995;157:38-64.

46. Singer M, Stopka T, Cara S, Springer K, George B, Kaveh K, Gorry de Puga A, Heimer R. The social geography of AIDS and hepatitis risk: qualitative approaches for assessing local differences in sterile syringe access among injection drug users. American Journal of Public Health. 2000;90(7):1049-1056.

47. Clatts M, Welle D, Goldsamt LA. Reconceptualizing the interaction of drug and sex risk among MSM speed users: toward an ethno-epidemiology. AIDS and Behavior. 2001;5(2):115-130.

48. Clatts MC, Welle DL, Goldsamt LA, Lankenau SE. An ethno-epidemiological model for the study of trends in illicit drug use: reflections on the ‘emergence’ of crack injection. International Journal of Drug Policy. 2002;13(4):285-295.

49. Pach III A, Gorman EM. An ethno-epidemiological approach for the multi-site study of emerging drug abuse trends: the spread of methamphetamine in the United States of America. Bulletin on Narcotics. 2002;54(1-2):87-102.

50. Moore D, Dray A, Green R, Hudson S, Jenkinson R, Siokou C, Perez P, Bammer G, Maher L, Dietze P. Extending drug ethno-epidemiology using agent-based modelling. Addiction. 2009;104(12):1991-1997.

51. McNeil R, Small W, Wood E, Kerr T. Hospitals as a ‘risk environment’: an ethno-epidemiological study of voluntary and involuntary discharge from hospital against medical advice among people who inject drugs. Social Science & Medicine. 2014;105:59-66.

52. Sönmez S, Apostolopoulos Y, Tanner AE, Massengale K, Brown M. Ethno-epidemiological research challenges: Networks of long-haul truckers in the inner city. Ethnography. 2015;17(1):111-134.

53. Tasosa WD. Ethno-epidemiology of alcohol use among Zimbabwean migrants living in the United Kingdom. [Doctoral Thesis]. Sheffield: Sheffield Hallam University; 2018.

54. Fals-Borda O. The application of participatory action research in Latin America. In: Albrow M, King E, (eds.). Globalization, Knowledge and Society. London: Sage Publications; 1990. p. 79-97.

55. Small W, Milloy MJ, McNeil R, Maher L, Kerr T. Plasma HIV-1 RNA viral load rebound among people who inject drugs receiving antiretroviral therapy (ART) in a Canadian setting: an ethno-epidemiological study. AIDS Research and Therapy.2016;13:26.

56. Uchoa E, Barreto SM, Firmo JO, Guerra HL, Pimenta FG, Lima e Costa MF. The control of schistosomiasis in Brazil: an ethno-epidemiological study of the effectiveness of a community mobilization program for health education. Social Science & Medicine. 2000;51(10):1529-1541.

57. Nations M, Firmo JOA, Lima-Costa MF, Uchôa E. Balking blood pressure “control” by older persons of Bambuí, Minas Gerais State, Brazil: an ethno-epidemiological inquiry. Cadernos de Saúde Pública. 2011;27(Suppl 3):S378-S389.

58. Gonçalves H, Gigante D. Work, schooling, and reproductive health: an ethno-epidemiological study of adolescent women belonging to a birth cohort. Cadernos de Saúde Pública. 2006;22(7):1459-1469.

59. Gonçalves H, Hallal PC, Amorim TC, Araújo CLP, Menezes AMB. Fatores socioculturais e nível de atividade física no início da adolescência. Revista Panamericana de Salud Pública. 2007;22(4):246-253.

60. Béhague DP, Gonçalves H, Cesar Gomes V. Anthropology and epidemiology: learning epistemological lessons through a collaborative venture. Ciência & Saúde Coletiva. 2008;13(6):1701-1710.

61. Nunes M, Paim J. An ethno-epidemiological study on urban violence in Salvador, Bahia State, Brazil: summary executions as an object of study. Cadernos de Saúde Pública. 2005;21(2):459-468.

62. Dourado I, Silva LA, Magno L, Lopes M, Cerqueira C, Prates A, Brignol S, MacCarthy S. Construindo pontes: a prática da interdisciplinaridade, Estudo PopTrans: um estudo com travestis e mulheres transexuais em Salvador, Bahia, Brasil. Cadernos de Saúde Pública. 2016;32(9):e00180415.

63. Acioli MD. O processo de alcoolização entre os Pankararu: um estudo em etnoepidemiologia. [Tese doutorado]. Campinas: Universidade Estadual de Campinas, Faculdade de Ciencias Médicas; 2002.

64. Saavedra LP, Câmara S. Desnutrição infantil em indígenas Mbyá-Guarani: estudo etnoepidemiológico. Revista Brasileira de Medicina de Família e Comunidade. 2010;17(5):24-32.

65. Trostle J. Anthropology and epidemiology in the twentieth century: a selective history of collaborative projects and theoretical affinities, 1920 to 1970. In: Janes C, Stall R, Gifford S, (eds.). Anthropology and epidemiology: Interdisciplinary approaches to the study of health and disease. Dordrecht: Springer Netherlands; 1986. p. 59-94.

66. Hubert A. Applying anthropology to the epidemiology of cancer. Anthropology Today. 1990;6(5):16-18.

67. Pitts M, McMaster J, Hartmann T, Mausezahl D. Lay beliefs about diarrhoeal diseases: their role in health education in a developing country. Social Science & Medicine. 1996;43(8):1223-1228.

68. Susser I, Stein Z. Culture, sexuality, and women’s agency in the prevention of HIV/AIDS in southern Africa. American Journal of Public Health. 2000;90(7):1042-1048.

69. Menéndez EL. Antropologia médica e epidemiologia: processo de convergência ou processo de medicalização? In: Alves P, Rabelo MC, (org.). Antropologia da saúde: traçando identidade e explorando fronteiras. Rio de Janeiro: Relume-Dumará; 1998. p. 71-93.

70. Haro JA, (org.). Epidemiología Sociocultural: Un diálogo en torno a su sentido, métodos y alcances. Buenos Aires: Lugar Editorial; 2010.

71. Menéndez E. Epidemiología sociocultural: propuestas y posibilidades. Región y Sociedad. 2008;20(Esp. 2):5-50.

72. Ayres JR. Acerca del riesgo: Para comprender la epidemiología. Buenos Aires: Lugar Editorial; 2005.

73. Almeida-Filho N, Mari J, Coutinho E, França J, Fernandes J, Andreoli S, Busnello E. Brazilian multicentric study of psychiatric morbidity: Methodological features and prevalence estimates. British Journal of Psychiatry. 1997;171:524-529.

74. Mari J, Almeida-Filho N, Coutinho E, Andreolli S, Miranda C, Streiner D. The epidemiology of psychotropic use in the city of São Paulo. Psychological Medicine. 1993;23:467-474.

75. Rothman K, Greenland S. Modern Epidemiology. Philadelphia: Lippincott-Raven; 1998.

76. Almeida-Filho N, Lessa I, Magalhaes L, Araujo MJ, Aquino E, James S, Kawachi I. Social inequality and depressive disorders in Bahia, Brazil: interactions of gender, ethnicity, and social class. Social Science & Medicine. 2004;59(7):1339-1353.

77. Almeida-Filho N, Lessa I, Magalhaes L, Araujo MJ, Aquino E, James S, Kawachi I. Social inequality and alcohol consumption-abuse in Bahia, Brazil: interactions of gender, ethnicity and social class. Social Psychiatry and Psychiatric Epidemiology. 2005;40(39):214-222.

78. Almeida-Filho N, Lessa I, Magalhaes L, Araujo MJ, Aquino E, Mari JJ. Co-occurrence patterns of anxiety, depression and alcohol use disorders. European Archives of Psychiatry and Clinical Neuroscience. 2007;257(7):423-431.

79. Brown P. Popular epidemiology and toxic waste contamination: lay and professional ways of knowing. Journal of Health and Social Behavior. 1992;33(3):267-281.

80. Davidson C, Davey-Smith G, Frankel SJ. Lay epidemiology and the prevention paradox: the implications of coronary candidacy for health education. Sociology of Health and Illness. 1990;13(1):1-19.

81. Larrea C. La cultura de los olores: Una aproximación a la antropología de los sentidos. Quito: Ediciones Abya-Yala; 1997.

82. Caprara A. La divinitá che cura. Lecce: Argo, Fondazione Angelo Celli; 2011.

83. Kleinman A. Patients and healers in the context of culture. Berkeley: University of California Press; 1980.

84. Corin E, Uchoa E, Bibeau G, Koumare B. Articulation et variations des systèmes de signes, de sens et d’action. Psychopathologie Africaine. 1992;24(2):183-204.

85. Corin E. The social and cultural matrix of health and disease. In: Evans RG, Barer ML, Marmor TR, (eds.). Why are some people healthy and others not? The determinants of the health of populations. Hawthorne: Aldine; 1994. p. 93-132.

86. Bibeau G, Corin E. Culturaliser l’épidémiologie psychiatrique: Les systèmes de signes, de sens et d’action en santé mentale. In: Charest P, Trudel F, Breton Y, (eds.). Marc-Adélard Tremblay ou la construction de l’anthropologie québécoise. Québec: Presses de L Úniversité Laval; 1994. p. 213-234.

87. Bibeau G. Cultural psychiatry in a creolizing world: Questions for a new research agenda. Transcultural Psychiatry. 1997;34(1):9-42.

88. Kottak CP. Assault on paradise: Social change in a Brazilian Village. New York: Mc Graw-Hill; 1992.

89. Scheff TJ. The labelling theory of mental illness. American Sociological Review. 1974;39(3):444-452.

90. Davis N. Labeling theory in deviance research: a Critique and reconsideration. Sociological Quarterly. 1972;13(4):447-474.

91. Link BT, Cullen FT. The labeling theory of mental disorder: a review of the evidence. In: Mental Disorder in Social Context. London: Jai Press; 1990.

92. Caroso C, Rodrigues N, Almeida-Filho N, Corin E, Bibeau G. When healing is prevention: Afro-Brazilian religious practices related to mental disorders and associated stigma in Bahia, Brazil. Curare Journal for Ethnomedicine. 1997;12:195-214.

93. Kawachi I, Berkman LF. Social ties and mental health. Journal of Urban Health. 2001;78(3):458-467.

94. Caroso C, Rodrigues N, Almeida-Filho N. Manejo comunitário em saúde mental e experiência da pessoa. Horizontes Antropológicos. 1998;4(9):63-83.

95. Rodrigues NB, Caroso C. A sina de Curar: a palavra de um terapeuta religioso. Horizontes Antropológicos. 1999;5(12):183-212.

96. Caroso C, Rodrigues N, Almeida-Filho N. Nem tudo na vida tem explicação”: exploração sobre causas de doenças e seus significados. In: Leibing A. Tecnologias do corpo: uma antropologia das medicinas no Brasil. Rio de Janeiro: Nau; 2004. p. 145-173.

97. Knorr-Cetina K. Epistemic cultures: How the sciences make knowledge. Cambridge: Harvard University Press; 1999.

98. Latour B, Woolgar M. Laboratory life: The social construction of scientific facts. Beverly Hills: Sage; 1979.

99. Martin E. Flexible bodies: the role of immunity in American culture. Boston: Beacon Press; 1994.

100. Rabinow P. Making PCR: A story of biotechnology. Chicago: University of Chicago Press; 1996.

101. Lynch M. Scientific practice and ordinary action. Cambridge: Cambridge University Press; 1997.

102. Biagioli M, (ed.). The science studies reader. New York: Routledge; 1999.

103. Long D, Hunter C, van der Geest S. When the field is a ward or a clinic: Hospital ethnography. Anthropology & Medicine. 2008;15(2):71-78.

104. Geissler PW. Public secrets in public health: Knowing not to know while making scientific knowledge. American Ethnologist. 2013;40(1):13-34.

105. Morgan-Trimmer S, Wood F. Ethnographic methods for process evaluations of complex health behaviour interventions. Trials. 2016;17:232.

106. Silva LAV. Práticas de mediação na pesquisa epidemiológica sob o ponto de vista etnográfico. História, Ciências, Saúde-Manguinhos. 2009;16(1):109-128.

107. Larrea-Killinger C, Rego RF, Strina A, Barreto ML. Epidemiologists working together with anthropologists: lessons from a study to evaluate the epidemiological impact of a city-wide sanitation program. Cadernos de Saúde Pública. 2013;29(3):461-474.

108. Lock M, Scheper-Hughes N. A critical interpretive approach in medical anthropology: Rituals and routines of discipline and dissent. In: Johnson T, Sargent C, (eds.). Medical Anthropology: A handbook of theory and practice. Westport: Greenwood Press; 1990. p. 47-72.

109. Testa M. Saber en salud: La construcción del conocimiento. Buenos Aires: Lugar Editorial; 1997.

110. Samaja J. Epistemologia e Epidemiologia. In: N. Almeida-Filho N, Barata R, Barreto M, Veras R, (eds.). Teoria epidemiológica hoje: Fundamentos, tendências, perspectivas. Rio de Janeiro: Fiocruz, Abrasco; 1998. p. 23-36.

111. Samaja J. A reprodução social e a saúde. Salvador: Casa da Saúde; 2000.

112. Bibeau G. At work in the fields of public health: The abuse of rationality. Medical Anthropological Quarterly. 1997;11(2):246-256.

113. Kleinman A. The new wave of ethnographies in medical anthropology. In: Kleinman A. Writing at the Margin. Berkeley: University of California Press; 1995. p. 193-256.

114. Samaja J. Epistemología y metodología: Elementos para una teoría de la investigación científica. Buenos Aires: EUDEBA; 2005.

115. Baum F. Researching public health: Behind the qualitative-quantitative methodological debate. Social Science & Medicine. 1995;40:459-468.

116. Desrosiers A. La partie pour le tout: Comment généraliser? La préhistoire de la contrainte de représentativité. Journal de la Société de Statistique de Paris. 1988;129(1-2):97-116.

117. Elliott D, Thomas TK. Lost in translation?: On collaboration between anthropology and epidemiology. Medicine Anthropology Theory. 2017;4(2):1-17.

118. Berger R. Now I see it, now I don’t: Researcher’s position and reflexivity in qualitative research. Qualitative Research. 2015;15(2):219-234.

119. Huby G, Hart E, McKevitt C, Sobo E. Addressing the complexity of health care: the practical potential of ethnography. Journal of Health Services Research & Policy. 2007;12(4):193-194.

120. Richards L. Qualitative teamwork: Making it work. Qualitative Health Research. 1999;9(1):7-10.

121. Barry CA, Britten N, Barber N, Bradley C, Stevenson F. Using reflexivity to optimize teamwork in qualitative research. Qualitative Health Research. 1999;9(1):26-44.

122. Morse JM. Approaches to qualitative-quantitative methodological triangulation. Nursing Research. 1991; 40(2):120-123.

123. Janesick V. The dance of qualitative research design: Metaphor, methodolatry, and meaning. In: Denzin N, Lincoln Y, (eds.). Handbook of Qualitative Research. Thousand Oaks: Sage; 1994. p. 281-300.

124. Almeida-Filho N. Complejidad y transdisciplinariedad en el campo de la salud colectiva: evaluación de conceptos y aplicaciones. Salud Colectiva. 2006;2(2):123-146.