Improving mental health of young people is a major societal challenge, particularly among the high numbers of young people living in deprived urban areas. To identify factors associated with depression and anxiety among young people in deprived urban areas in South America. This case-control study recruited adolescents (age 15-16 years) and young adults (age 20-24 years) from education and community settings in deprived areas in Bogotá, Colombia; Buenos Aires, Argentina; and Lima, Peru, between April 2021 and November 2022. Participants who met threshold criteria for self-reported depression or anxiety. Community controls who did not meet the criteria were identified. Sociodemographic characteristics, stressful life events before and during the past year, substance use, social capital, sports and arts activities, social media engagement. Depression, assessed using the 8-item Patient Health Questionnaire (range, 0-24, with higher scores indicating greater symptom severity), and anxiety, assessed using the 7-item Generalized Anxiety Disorder questionnaire (range, 0-21, with higher scores indicating greater symptom severity), were defined by threshold scores higher than 9. Various factors were compared between groups with and without anxiety and depression in multivariable logistic regression, testing for interactions by age group. Of 2402 analyzed participants, 1560 (64.9%) were female, 1080 (45.0%) were adolescents, and 1322 (55.0%) were young adults; 1437 (59.8%) met the criteria for depression and/or anxiety, and 965 (40.2%) were controls. In a multivariable model, female gender (OR, 1.99 [95% CI, 1.65-2.40), more than 2 stressful life events in the previous year (OR, 1.67 [95% CI, 1.40-2.01]), more than 7 stressful life events before the previous year (OR, 1.52 [95% CI, 1.27-1.81), lifetime consumption of sedatives (OR, 2.26 [95% CI, 1.65-3.14]), participating in arts activities in the past 30 days (OR, 1.22 [95% CI, 1.01-1.48]), and stronger engagement with social media (OR, 1.59 [95% CI, 1.34-1.89]) were independently associated with increased odds of depression and anxiety, while sports activities were associated with reduced odds (OR, 0.80 [95% CI, 0.67-0.96]). The odds of having depression and/or anxiety symptoms associated with lifetime use of sedatives were higher among adolescents (OR, 6.54 [95% CI, 3.33-14.27]) than among young adults (OR, 2.54 [95% CI, 1.79-3.66]) (P = .01 for interaction). In this case-control study, female gender, stressful life events, substance use, arts activities, and social media engagement were associated with greater odds of depression and anxiety, while sport activities were associated with lesser odds. The findings suggest that policies for improving mental health in deprived urban neighborhoods in South America and related research should consider similar factors associated with mental distress in adolescents and young adults.

BACKGROUND:Depression and anxiety are the most common mental disorders in the world. Screening tools allow early diagnosis and intervention, preventing disease progression and reducing years lost to disability. Internationally, the most widely used screening instruments for depression and anxiety symptoms are the Patient Health Questionnaire (PHQ-8) and the Generalised Anxiety Disorder (GAD-7). Both have been validated in various countries; however, these studies mostly focused on the adult population and clinical settings. OBJECTIVE:This study assessed the psychometric properties of the PHQ-8 and GAD-7 in adolescents and young adults in deprived urban areas of three of the largest Latin American cities. We evaluated the internal structure, measurement invariance, internal consistency, and divergent validity through correlations with the Manchester Short Assessment of Quality of Life (MANSA). METHODS:The study included 1056 adolescents (ages 15-16) and 1306 young adults (ages 20-24) from Bogotá (Colombia), Buenos Aires (Argentina), and Lima (Peru). Confirmatory factor analysis was performed using the Weighted Least Squares Mean and Variance (WLSMV) adjusted estimator with polychoric matrices to assess the internal structure of the model. Measurement invariance was evaluated through multi-group factor analysis. Divergent validity was examined using Spearman's rho by correlating MANSA with the PHQ-8 and GAD-7. Finally, internal consistency was assessed with Cronbach's alpha and McDonald's omega. RESULTS:Our study found that the PHQ-8 and the GAD-7 exhibited good goodness-of-fit indices for a one-dimensional model. Both scales achieved measurement invariance across different sociodemographic variables, including gender, country, education level, and age group. On the other hand, the PHQ-8 (rs = -0.52) and GAD-7 (rs = -0.46) showed a negative correlation with the MANSA, suggesting divergent validity between the higher scores on depressive and anxious symptoms are associated with lower quality of life. Finally, the PHQ-8 and GAD-7 showed adequate internal consistency in all cases evaluated (ω and α > 0.8). CONCLUSIONS:Both the PHQ-8 and the GAD-7 showed good goodness-of-fit indices for a unidimensional theoretical model, adequate psychometric properties, and evidence of invariance for gender, age group, education level, and country. These findings highlight the reliability and versatility of these instruments in identifying urban young people with emotional distress in Latin America.

Background Stressful life events (SLEs) are associated with increased risk of depression or anxiety. Coping mechanisms may moderate this relationship but little is known on this topic in young people or in Latin America.Aim To investigate whether coping strategies predict odds of depression and/or anxiety and moderate the relationship between SLEs and depression and/or anxiety in young people in Peru, Lima and Bogotá.Method Using case–control data from people aged 15–24, we used logistic regression to examine associations between coping mechanism, SLEs and caseness for depression or anxiety, adjusting for sociodemographic and socioeconomic factors. We included interaction terms to model whether this association varied depending on coping mechanisms (positive cognitive restructuring, problem focused, support seeking, distraction, avoidant).Results We included 1437 cases and 965 controls. Cases reported less use of positive cognitive restructuring (OR 0.66; 95% CI 0.57 to 0.75) and problem-focused coping (OR 0.82; 95% CI 0.73 to 0.93), and more use of avoidance than controls (OR 1.33; 95% CI 1.19 to 1.50) in adjusted models. They had greater odds of reporting lifetime (OR 1.07; 95% CI 1.04 to 1.10) and past-year (OR 1.05; 95% CI 1.01 to 1.10) SLEs than controls. We found weak but consistent evidence of effect modification; the association between lifetime SLEs and case–control status was stronger in those who used less support seeking (p=0.09), problem-focused coping (p=0.08) or positive cognitive restructuring (p=0.09).Conclusions Relationships between SLEs, coping mechanisms and depression/anxiety appear similar in these Latin American cities to other contexts. Active coping strategies may ameliorate the impact of SLEs on mental health of young people.

Background Studies have shown that adolescents and young adults are less likely to seek mental health (MH) services. This research aims to identify the factors associated with using specialized MH services among young people in deprived urban Latin American areas. Methods The study included 1345 adolescents (15–16 years) and young adults (20–24 years) with symptoms of anxiety and/or depression. We collected data on predisposing, enabling, and need factors related to using specialized MH services. We compared the differences in service use using a chi-square test and determined the association using Poisson regression. Results 18.9% of participants used specialized MH services in the previous three months. Youth whose parents received MH treatment had a 51% and 57% higher prevalence of using MH services, as those whose parents had education beyond secondary school were 64% more likely to use these services. Participants with severe levels of anxiety symptoms and self-recognition of experiencing anxiety symptoms had an 88% and 117% higher prevalence of using MH services; otherwise, severity levels of depression were not associated with the use of MH services. Specific symptoms of depression or anxiety reported on the PHQ-8 and GAD-7 scales were linked to the use of these services. Furthermore, experiencing three or more stressful life events and low and moderate levels of resilience were associated with a 48%, 74%, and 60% greater likelihood of using MH services. Conclusion Less than one in five participants accessed specialized MH services in the last three months. Predisposing, enabling, and need factors influencing service use include parental history of MH treatment, parents with education beyond secondary school, severe anxiety, self-recognition of ever experiencing anxiety, severe life events, and low resilience.

BackgroundLatin American youth have a high prevalence of mental health disorders and face major socioeconomic and public safety problems. This study assesses the association between stressful life events (SLEs) and depression, anxiety, and quality of life among adolescents and young adults from deprived neighbourhoods of Latin America.MethodsThe sample consisted of 2,402 participants, between adolescents (15–16 years) and young adults (20–24 years), from Bogotá (Colombia), Buenos Aires (Argentina), and Lima (Peru), assessed in 2021–2022 and recruited in education and community settings and social media. We evaluated the most frequent recent and distant SLEs (occurred in the previous year and more than a year ago, respectively), the relationship between SLEs and severity of depression (PHQ-8), anxiety (GAD-7), and quality of life (MANSA), and we tested for differences by gender and age group.ResultsThe most common recent and distant SLEs were related to public safety issues and financial distress. Accidents and school suspensions were more frequent among men, and sexual harassment and bullying among women. Every additional reported recent SLE increased the odds of mild, moderate, and severe depression (18, 17, and 25%, respectively) and anxiety (10, 17, and 21%, respectively) symptoms. Similar trends were found with distant SLEs and depression (8, 9, and 11% for mild, moderate, and severe symptoms, respectively) and anxiety (9, 11, and 12%, respectively). Furthermore, a higher number of recent and distant SLEs were associated with lower quality of life (β = −0.05, p < 0.001, 95% CI [−0.06, −0.04] and β = −0.04, p < 0.001, 95% CI [−0.05, −0.03], respectively). The relationship between mental distress and quality of life of recent SLEs seems stronger than the one from distant SLEs, and recent SLEs may have a higher impact on adolescents’ mental health compared with young adults.ConclusionBoth recent and distant SLEs are related to mental distress and quality of life. Policies and programmes should aim to enhance public and health safety, as well as improve individual, family, and community protective factors that could mitigate the effect of SLEs on Latin American youth.

Background: Reducing anxiety and depression in adolescents is a global health priority. Personal and social resources (e.g., hobbies and socialising) may reduce distress. Yet, there is insufficient understanding of how adolescents use such resources to reduce distress.Objective: To identify resources that reduced distress in the everyday lives of adolescents and whether resource use differed according to symptoms of anxiety and depression.Methods: The experience sampling method was used, a longitudinal method requiring participants to report on context and mood at randomly selected moments across a week. A total of 5 558 reports were contributed by 151 adolescents, including 90 with symptoms of anxiety and/or depression. The study was conducted in the poorest neighbourhoods of Bogotá, Buenos Aires, and Lima.Results: Multi-level modelling indicated that using resources was significantly associated with less nervousness and sadness. Adolescents with symptoms of anxiety and/or depression were less likely to use some resources (e.g., sport). Cross-level interactions showed the efficacy of resources differed according to the severity of symptomatology. For adolescents with symptoms of anxiety and depression, some resources (e.g., peer support) improved mood, while others (e.g., music listening) did not.Discussion: Personal and social resources are important for reducing distress in the everyday life of adolescents, giving insight into potential interventions to help mitigate symptoms of anxiety and depression before escalation. Further research could assess the quality of experiences (e.g., appraisal) to deepen understanding of how engagement promotes resilience.Conclusions: Care must be taken when recommending resource use, since some forms (e.g., music listening) may be unhelpful to adolescents with symptoms of anxiety and depression.

Objectives To systematically review 1-year recovery rates for young people experiencing depression and/or anxiety who are not receiving any specific mental health treatment. Design Systematic review and meta-analysis. Data sources MEDLINE, Embase, PsycINFO, Web of Science and Global Health were searched for articles published from 1980 through to August 2022. Eligibility criteria Articles were peer-reviewed, published in English and had baseline and 1-year follow-up depression and/or anxiety outcomes for young people aged 10–24 years without specific treatment. Data extraction and synthesis Three reviewers extracted relevant data. Meta-analysis was conducted to calculate the proportion of individuals classified as recovered after 1 year. The quality of evidence was assessed by the Newcastle-Ottawa Scale. Results Of the 17 250 references screened for inclusion, five articles with 1011 participants in total were included. Studies reported a 1-year recovery rate of between 47% and 64%. In the meta-analysis, the overall pooled proportion of recovered young people is 0.54 (0.45 to 0.63). Conclusions The findings suggest that after 1 year about 54% of young people with symptoms of anxiety and/or depression recover without any specific mental health treatment. Future research should identify individual characteristics predicting recovery and explore resources and activities which may help young people recover from depression and/or anxiety. PROSPERO registration number CRD42021251556.

Background: Improving mental health of young people is a major societal challenge. We aimed to identify risk and protective factors for depression and anxiety among young people in deprived urban areas in South America.Methods: Case-control study of adolescents (15-16 years) and young adults (20-24 years) living in deprived areas in Bogotá [Colombia], Buenos Aires [Argentina] and Lima [Peru], recruited from education and community settings between April 2021 and November 2022. We identified participants who met threshold criteria for self-reported depression or anxiety (scores of ˃ 9 on PHQ-8 and/or GAD-7), and community controls who did not. Various risk and protective factors were compared between these groups in multivariable logistic regression, testing for interactions by age group.Findings: Of 2402 eligible participants, 1437 met criteria for depression or anxiety and 965 were controls. In a multivariable model, female gender (OR 1·99, 95% CI 1·65-2·4), more life events in the previous year (OR 1·67, 95% CI 1·40-2·01) and before (OR 1·52, 95% CI 1·27-1·81), life-time consumption of sedatives (OR 2·26, 95% CI 1·65-3·14), participating in arts activities (OR 1·22 95% CI 1·01-1·48) and stronger engagement with social media (OR 1·59, 95% CI 1·34-1·89) were all independently associated with increased odds of depression and anxiety, while sports activities were associated with reduced odds (OR 0·80, 95% CI 0·67-0·96). Use of sedatives had a statistically significantly stronger association with symptoms in adolescents than in young adults.Interpretation: Policies for improving mental health in deprived urban neighbourhoods in South America and related research should consider similar factors associated with mental distress in adolescents and young adults. They include gender and life events, but also the behaviour of young people in form of drug abuse, arts activities and engagement with social media, whilst sport activities might be protective.Funding: Medical Research Council (MR/S03580X/1).Declaration of Interest: We declare no competing interests.Ethical Approval: The informed assent and consent processes for adolescents and young adults throughout the three countries were carried out either by telephone with an audio recording, by sending a photo or scan of the printed and signed document, or via an online form. Signatures were collected digitally or during an in-person meeting with potential participants. In the case of adolescents, the participants were required to give assent and for their legal guardian/parent to provide consent through the above listed methods. All participants were reimbursed for their time and participation in completing the questionnaires through vouchers or cash, equivalent to $10 US dollars in each country´s currency. The study protocol and all procedures were approved by the Institutional Review Boards (IRB) of Universidad de Buenos Aires on October 2nd, 2020, Pontificia Universidad Javeriana on November 20th, 2020 (FM-CIE-1138-20), and Universidad Peruana Cayetano Heredia on November 16th, 2020 (Constancia 581-33-20), as well as the Research Ethics Committee of Queen Mary, University of London, on November 16th, 2020 (QMERC2020/02).

Purpose Working mothers are at greater risk for postpartum depression. Maternity leave characteristics, including length, wage replacement and employment protection, could have relevant implications for mothers’ mental health. We propose to explore whether there is an association between maternity leave characteristics and postpartum depression. Methods We conducted a systematic review searching for randomized controlled trials, quasi-experimental, cohort or cross-sectional studies on five databases using search terms including maternity and parental leave and depression, as well as references in relevant articles. We identified 500 articles and included 23 of those. We used the EPHPP Quality Assessment Tool for Quantitative Studies to assess the quality of the studies. Results Paid and longer maternity leaves tend to be associated with a reduction of postpartum depression symptoms in high-income countries. No studies explored the association between employment protection and postpartum depression. The quality of studies ranged from strong to weak, mostly influenced by study design. Conclusion More restrictive maternity leave policies tend to be associated with higher rates of postpartum depression, although more research needs to be conducted in the Global South.

Background: Arts-based methodologies can be beneficial to identify different representations of stigmatized topics such as mental health conditions. This study used a theater-based workshop to describe manifestations, representations, and potential causes of depression and anxiety as perceived by adolescents and young adults. Methods: The theater company Teatro La Plaza conducted three online sessions with a group of adolescents and another with a group of young adults from Lima, Peru. The artistic outputs, which included images, similes, monologues, and narrations, were used to describe the experiences of depression and anxiety symptoms following a content analysis using posteriori categories. Results: Seventeen participants joined the sessions. The artistic outputs showed: physical, behavioral, cognitive, and emotional manifestations of depression and anxiety; a perception that both disorders have a cyclical nature; and an awareness that it is often difficult to notice symptom triggers. The mandatory social isolation due to the COVID-19 pandemic was highlighted as an important symptom trigger, mostly linked to anxiety. Conclusions: The findings are consistent with the literature, especially with regard to the manifestations, representations, and potential causes that trigger depression and anxiety. Using arts-based methods allowed adolescents and young adults to expand the articulation of their representations of mental disorders.

Objective To explore which resources and activities help young people living in deprived urban environments in Latin America to recover from depression and/or anxiety.Design A multimethod, qualitative study with 18 online focus groups and 12 online structured group conversations embedded into arts workshops.Setting This study was conducted in Bogotá (Colombia), Buenos Aires (Argentina) and Lima (Peru).Participants Adolescents (15–16 years old) and young adults (20–24 years old) with capacity to provide assent/consent and professionals (older than 18 years of age) that had experience of professionally working with young people were willing to share personal experience within a group, and had capacity to provide consent.Results A total of 185 participants took part in this study: 111 participants (36 adolescents, 35 young adults and 40 professionals) attended the 18 focus groups and 74 young people (29 adolescents and 45 young adults) took part in the 12 arts workshops. Eight categories captured the resources and activities that were reported by young people as helpful to overcome mental distress: (1) personal resources, (2) personal development, (3) spirituality and religion, (4) social resources, (5) social media, (6) community resources, (7) activities (subcategorised into artistic, leisure, sports and outdoor activities) and (8) mental health professionals. Personal and social resources as well as artistic activities and sports were the most common resources identified that help adolescents and young adults to overcome depression and anxiety.Conclusion Despite the different contexts of the three cities, young people appear to use similar resources to overcome mental distress. Policies to improve the mental health of young people in deprived urban settings should address the need of community spaces, where young people can play sports, meet and engage in groups, and support community organisations that can enable and facilitate a range of social activities.

Antecedentes: Los medios de comunicación son una de las fuentes que modelan las representaciones de la salud mental. Sólo un estudio previo realizado en Perú ha analizado las noticias sobre la salud mental en los medios de comunicación. Objetivo: describir cómo se representa la salud mental en la prensa escrita de alcance nacional en el Perú. Método: se utilizó la técnica de análisis de contenido. Se realizó una búsqueda de artículos a partir de una lista de términos relacionados con salud mental en 30 ediciones de dos diarios de circulación nacional del año 2016. Se identificaron 351 artículos, de los cuales se extrajo información sobre los términos de salud mental utilizados, el nivel de contenido de salud mental, la presencia de fuentes citadas, la inclusión de personajes y la valoración atribuida a estos. Resultados: 271 artículos (77.21%) contenían términos referidos a salud mental, pero sin ser desarrollados, 51 (14.53%) abordaban la salud mental de manera parcial, y solo 29 (8.26%) lo hacían como tema principal. Entre los 80 artículos que abordaban la salud mental de manera parcial o principal, solo 32 (40%) citaban fuentes. Finalmente, de los 59 artículos que hacían referencia a personajes, 29 (49.15%) los describían de manera negativa. Conclusiones: la prensa escrita suele utilizar términos de salud mental, pero sin desarrollar el tema en profundidad. El uso de fuentes es infrecuente y no se cita a personas con afecciones de salud mental. Al describirlas, se destaca su inestabilidad y peligrosidad. Estos hallazgos sugieren que la prensa escrita podría contribuir al fortalecimiento del estigma relacionado con la salud mental.

Background: Sexual harassment in the workplace (SHWP) is highly prevalent and has a negative impact, including depression, on its victims, as well as a negative economic impact resulting from absenteeism and low productivity at work. This paper aims to outline the available evidence regarding the prevention of depressive symptoms among workers through policies and interventions that are effective in preventing SHWP. Methods: We conducted two systematic reviews. The first focused on the association of depression and SHWP, and the second on policies and interventions to prevent SHWP. We conducted a meta-analysis and a narrative synthesis, respectively. We identified 1831 and 6107 articles for the first and second review. After screening, 24 and 16 articles were included, respectively. Results: Meta-analysis results show a prevalence of depression of 26%, as well as a 2.69 increased risk of depression among workers who experience SHWP. Variables such as number of harassment experiences and exposure to harassment from coworkers and other people increase this risk. Conclusions: There is limited evidence regarding the effectiveness of policies and training to prevent SHWP, mostly focused on improvements in workers’ knowledge and attitudes about SHWP. However, there is no available evidence regarding its potential impact on preventing depression.

Background Task-shifting and technology in psychological interventions are two solutions to increasing access to mental health intervention and overcoming the treatment gap in low and middle-income countries. The CONEMO intervention combines a smartphone app with support from non-specialized professionals, aiming to treat depression in patients with diabetes and/or hypertension. The aim of this paper is to describe the process of recruitment, training and supervision of the non-specialized professionals who participated in the CONEMO task-shifting intervention in Brazil and Peru. Methods We described and analyzed data related to the recruitment, training and supervision of 62 nurse assistants from the health system in Sao Paulo, Brazil, and three hired nurses in Lima, Peru. The data were collected from information provided by nurses and nurse assistants, supervisor records from supervision meetings and the CONEMO platform database. Results We found that task-shifting was feasible using existing resources in Sao Paulo and additional human resources in Lima. Training and supervision were found to be crucial and well received by the staff; however, time was a limitation when using existing human resources. Ensuring technological competence prior to the start of the intervention was essential. Group supervision meetings allowed non-specialized professionals to learn from each other’s experiences. Conclusion Carefully considering recruitment, training and supervision of non-specialized professionals is important for effective task-shifting when delivering an mHealth intervention for depression. Opportunities and challenges of working in different health systems are described, which should be considered in future implementation, either for research or real settings. Trial registration NCT028406662 (Sao Paulo), NCT03026426 (Peru).

Importance Depression is a leading contributor to disease burden globally. Digital mental health interventions can address the treatment gap in low- and middle-income countries, but the effectiveness in these countries is unknown. Objective To investigate the effectiveness of a digital intervention in reducing depressive symptoms among people with diabetes and/or hypertension. Design, Setting, and Participants Participants with clinically significant depressive symptoms (Patient Health Questionnaire-9 [PHQ-9] score ≥10) who were being treated for hypertension and/or diabetes were enrolled in a cluster randomized clinical trial (RCT) at 20 sites in São Paulo, Brazil (N=880; from September 2016 to September 2017; final follow-up, April 2018), and in an individual-level RCT at 7 sites in Lima, Peru (N=432; from January 2017 to September 2017; final follow-up, March 2018). Interventions An 18-session, low-intensity, digital intervention was delivered over 6 weeks via a provided smartphone, based on behavioral activation principles, and supported by nurse assistants (n = 440 participants in 10 clusters in São Paulo; n = 217 participants in Lima) vs enhanced usual care (n = 440 participants in 10 clusters in São Paulo; n = 215 participants in Lima). Main Outcomes and Measures The primary outcome was a reduction of at least 50% from baseline in PHQ-9 scores (range, 0-27; higher score indicates more severe depression) at 3 months. Secondary outcomes included a reduction of at least 50% from baseline PHQ-9 scores at 6 months. Results Among 880 patients cluster randomized in Brazil (mean age, 56.0 years; 761 [86.5%] women) and 432 patients individually randomized in Peru (mean age, 59.7 years; 352 [81.5%] women), 807 (91.7%) in Brazil and 426 (98.6%) in Peru completed at least 1 follow-up assessment. The proportion of participants in São Paulo with a reduction in PHQ-9 score of at least 50% at 3-month follow-up was 40.7% (159/391 participants) in the digital intervention group vs 28.6% (114/399 participants) in the enhanced usual care group (difference, 12.1 percentage points [95% CI, 5.5 to 18.7]; adjusted odds ratio [OR], 1.6 [95% CI, 1.2 to 2.2]; P = .001). In Lima, the proportion of participants with a reduction in PHQ-9 score of at least 50% at 3-month follow-up was 52.7% (108/205 participants) in the digital intervention group vs 34.1% (70/205 participants) in the enhanced usual care group (difference, 18.6 percentage points [95% CI, 9.1 to 28.0]; adjusted OR, 2.1 [95% CI, 1.4 to 3.2]; P < .001). At 6-month follow-up, differences across groups were no longer statistically significant. Conclusions and Relevance In 2 RCTs of patients with hypertension or diabetes and depressive symptoms in Brazil and Peru, a digital intervention delivered over a 6-week period significantly improved depressive symptoms at 3 months when compared with enhanced usual care. However, the magnitude of the effect was small in the trial from Brazil and the effects were not sustained at 6 months. Trial Registration ClinicalTrials.gov: NCT02846662 (São Paulo) and NCT03026426 (Lima).

Objetive. Medir el precio, disponibilidad y asequibilidad de insulina y metformina, como comparador, en farmacias públicas y privadas en seis regiones del Perú. Métodos. Estudio transversal con uso de la metodología adaptada de la Organización Mundial de la Salud/Acción Internacional para la Salud (OMS/AIS). Se encuestaron farmacias públicas y privadas de seis regiones del Perú. Se recolectaron datos de disponibilidad y precio de insulina (todos los tipos) y metformina en presentación de 850 mg. La disponibilidad se expresa en porcentajes y los precios se reportan en medianas. La asequibilidad se define como el número de días que debe laborar una persona con el salario mínimo para cubrir el costo de un mes de tratamiento. Resultados. La disponibilidad en farmacias públicas es de 63,2% para insulina regular y 68,4% para isófana-NPH, pero se observaron diferencias de disponibilidad entre los niveles de atención y entre las regiones. En farmacias privadas, la variedad de insulina es mayor, pero la disponibilidad es menor del 11%. La mediana de precios para la insulina humana en farmacias privadas fue entre tres a cuatro veces mayor que en farmacias públicas. En comparación, la disponibilidad de metformina alcanza 89,5% en farmacias públicas y 77,7% en privadas. La asequibilidad en farmacias públicas para un mes de tratamiento con insulina humana o metformina genérica es menor a lo percibido por un día laborable. Conclusiones. El precio de insulinas humanas y de metformina genérica en farmacias públicas es asequible. Sin embargo, se necesitan esfuerzos para mejorar su disponibilidad en las regiones y los niveles de atención.

Objective. Measure and compare the price, availability, and affordability of insulin and metformin in public and private pharmacies in six regions of Peru. Methods. Cross-sectional study using the World Health Organization/Health Action International (WHO/HAI) revised methodology. Public and private pharmacies in six regions of Peru were surveyed. Data were collected on availability and prices for insulin (all types) and 850 mg metformin. Availability is expressed as percentages and prices are reported in medians. Affordability is defined as the number of days that a person must work at minimum wage to cover the cost of one month of treatment. Results. Availability in public pharmacies is 63.2% for regular insulin and 68.4% for NPH (isophane) insulin, but differences in availability were observed between levels of care and between regions. Private pharmacies have a greater variety of insulin, but availability is less than 11%. The median price of human insulin was three to four times higher in private pharmacies than in public pharmacies. In comparison, availability of metformin was 89.5% in public pharmacies and 77.7% in private ones. Affordability in public pharmacies for one month of treatment with human insulin or generic metformin is less than one day's wages. Conclusions. The price for human insulin and generic metformin in public pharmacies is affordable. However, efforts are needed to improve their availability in the different regions and levels of care.

BACKGROUND:Smartphone apps could constitute a cost-effective strategy to overcome health care system access barriers to mental health services for people in low- and middle-income countries. OBJECTIVE:The aim of this paper was to explore the patients' perspectives of CONEMO (Emotional Control, in Spanish: Control Emocional), a technology-driven, psychoeducational, and nurse-supported intervention delivered via a smartphone app aimed at reducing depressive symptoms in people with diabetes, hypertension or both who attend public health care centers, as well as the nurses' feedback about their role and its feasibility to be scaled up. METHODS:This study combines data from 2 pilot studies performed in Lima, Peru, between 2015 and 2016, to test the feasibility of CONEMO. Interviews were conducted with 29 patients with diabetes, hypertension or both with comorbid depressive symptoms who used CONEMO and 6 staff nurses who accompanied the intervention. Using a content analysis approach, interview notes from patient interviews were transferred to a digital format, coded, and categorized into 6 main domains: the perceived health benefit, usability, adherence, user satisfaction with the app, nurse's support, and suggestions to improve the intervention. Interviews with nurses were analyzed by the same approach and categorized into 4 domains: general feedback, evaluation of training, evaluation of study activities, and feasibility of implementing this intervention within the existing structures of health system. RESULTS:Patients perceived improvement in their emotional health because of CONEMO, whereas some also reported better physical health. Many encountered some difficulties with using CONEMO, but resolved them with time and practice. However, the interactive elements of the app, such as short message service, android notifications, and pop-up messages were mostly perceived as challenging. Satisfaction with CONEMO was high, as was the self-reported adherence. Overall, patients evaluated the nurse accompaniment positively, but they suggested improvements in the technological training and an increase in the amount of contact. Nurses reported some difficulties in completing their tasks and explained that the CONEMO intervention activities competed with their everyday work routine. CONCLUSIONS:Using a nurse-supported smartphone app to reduce depressive symptoms among people with chronic diseases is possible and mostly perceived beneficial by the patients, but it requires context-specific adaptations regarding the implementation of a task shifting approach within the public health care system. These results provide valuable information about user feedback for those building mobile health interventions for depression.