EESM PeruvianAndes2003 EnglishVersion PDF

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ENGLISH VERSI0N
SPECIAL ISSUE DEDICATE T0 THE
GENERAL REP0RT
O F F l C l A L E N T l T Y O F T H E S P E C l A L l Z E D M E N T A L H E A L T H l N S T l T O T E ( S M H l I
II Annals of Mental Health 2003 / Volume XIX (3 and 4)
EPIDEMIOLOGICAL STUDY ON MENTAL HEALTH IN THE PERUVIAN ANDES - 2003
INSTITUTO NACIONAL DE SALUD MENTAL
Anales de Salud Mental is published by the Specialized Institute of Mental Health Honorio Delgado - Hideyo Noguchi.
It is dedicated to the dissemination and promotion of mental health from a multidisciplinary perspective.
Any articles to be published, magazines to be exchanged or any and all correspondence, including subscription
information requests, shall be sent to the editor at the following address:
Anales de Salud Mental
Jr. Eloy Espinoza Saldaa No. 709, Urb. Palao,
San Martn de Porres, Lima 31, Peru
Telephone: 482-0206; Fax: 482-9806
E-mail: insmhdhn@minsa.gob.pe
It is recommended that this document be referred to as:
Specialized Mental Health Institute. 2003 Epidemiological Study on Mental Health in the Peruvian Andes. General
Report. Anales de Salud Mental Vol. 19. Year 2003, Issues 1 and 2. Lima.
ISSN 1023-389X.
Main participants in the preparation of this report:
Javier E. Saavedra, M.D., Santos Gonzlez, M.D., Csar Malpartida, Licentiate in Psychology, Rolando Pomalima,
M.D., Yuri Cutipe, M.D., Yolanda Robles, Licentiate in Psychology, Ral Daz, M.D., Violeta Vargas, Licentiate in
Social Services, Vilma Paz, M.D., Flor Albuquerque, Licentiate in Nursing, Eduardo Bernal, M.D., Rommy Kendall,
M.D. We express our appreciation to Milagros Ramrez for her assistance in typing.
1 Annals of Mental Health 2003 / Volume XIX (3 and 4)
HONORIO DELGADO-HIDEYO NOGUCHI
EPIDEMIOLOGICAL STUDY ON MENTAL HEALTH
IN THE PERUVIAN ANDES 2003
ANALES DE SALUD MENTAL
Lima, Per-2003-Volumen 19, Issues. 1 and 2
OFFICIAL PUBLICATION OF THE
SPECIALIZED MENTAL HEALTH INSTITUTE
HONORIO DELGADO - HIDEYO NOGUCHI
EDITOR
Javier E. Saavedra, M.D.
SECRETARY OF EDITION
Flor de Mara Alburquerque Jaramillo, Licentiate in Nursing
EDITORIAL SECRETARY
Santiago Stucchi Portocarrero, M.D.
MEMBERS
Manuel Arellano Kanashiro, M.D.
Eduardo Bernal Garca, M.D.
D. Vilma Chuchn Calle, Master in Family Psychology.
Yuri Cutip Crdenas, M.D.
Santos Gonzles Farfn, M.D.
Santiago Mrquez Manrique de Lara, M.D.
Mara Mendoza Vilca, Licentiate in Nursing
Rolando Pomalima Rodrguez, M.D.
Yolanda Robles Arana, Master inClinical Psychology
J. Csar Sotillo Zevallos, M.D.
Emir Valencia Romero, Licentiate in Psychology
NATIONAL CONSULTING COMMITTEE
Javier Maritegui, M.D.
Delicia Ferrando, Licentiate in Antropology, Demographer
Pablo Macera, Ph.D. in History
Agustn Montoya, Ph. D. in Public Health
Mara Antonieta Silva, M.D.
Felipe McGregor, Reverend Father, +
Dr. Moiss Lemlij, M.D.
Wilfredo Mormontoy, Engineer
INTERNATIONAL CONSULTING COMMITTEE
Renato Alarcn, M.D. (Alabama, EE.UU)
Juan E: Mezzich, M.D. (Nueva York, EE.UU)
Germn Berrios, M.D. (Cambridge, Inglaterra)
Juan C. Negrete , M.D. (Montreal, Canad)
Eugene B. Brody, M.D. (Maryland, EE.UU)
Pierre Pichot, M.D. (Pars, Francia)
Carlos Castilla del Pino, M.D. (Crdova, Espaa)
Guillermo Vidal, M.D. (Buenos Aires, Argentina)
Raquel Cohen, M.D. (Miami, EE.UU)
Moiss Gaviria , M.D.(Chicago, EE.UU)
MINISTRY OF HEALTH
PILAR MAZZETTI SOLER, M.D.
Minister of Health
EDUARDO ZORRILLA SAKODA, M.D.
Vice Minister of Health
BOARD OF DIRECTORS - SIMH
MARTN NIZAMA VALLADOLID, M.D.
Director General
NO YACTAYO GUTIRREZ, M.D.
Deputy Director
NORMA MACHICADO, Licentiate
Managing Director
JAVIER E. SAAVEDRA CASTILLO, M.D.
Executive Director
Specialized Research and Teaching Bureau
SANTOS GONZLES FARFN, M.D.
Director
Epidemiological Bureau
SPONSORS
Cayetano Heredia Peruvian University
Academic Departament of Psychiatry
Peruvian Psychiatric Association
STUDY COORDINATOR
DEPUTY STUDY COORDINATOR
Santos Gonzlez, M.D.
SERVICE ACCESS AREA
ADDICTIONS AREA
Martn Nizama, M.D.
SUICIDAL BEHAVIOURS AREA
Freddy Vasquez, M.D.
Luis Matos, M.D.
Ysela Nicols, Licentiate in Psychology
PSYCHIATRIC DISABILITY AREA
Julio Huamn, M.D.
LIFE EVENTS AND MENTAL
HEALTH AREA
Santos Gonzalez, M.D.
POVERTY AND MENTAL
HEALTH AREA
Rolando Pomalima, M.D.
Csar Arellano, M.D.

PSYCHOGERIATRICS AREA
Vilma Paz, M.D.
Mariella Guerra, M.D.
MEMBERS RESPONSIBLE FOR THE STUDY, MAIN AREAS AND RESEARCHERS
QUALITY OF LIFE AREA
Yolanda Robles,
Licentiate in Psychology
Csar Malpartida,
Licentiate in Psychology
MENTAL HEALTH AREA
Csar Arellano, M.D.
Santos Gonzlez, M.D.
SOCIOCULTURAL AND
DISASTERS AREA
Eduardo Bernal, M.D.
AFFECTIVE DISORDERS AREA
Abel Sagstegui, M.D.
Luis Matos, M.D.
Horacio Vargas, M.D.
ANXIETY DISORDERS AREA
EATING DISORDERS AREA
Rolando Pomalima, M.D.
Yuri Cutip, M.D.
PSYCHOTIC DISORDERS AREA
Santiago Stucchi, M.D.
Ricardo Chirinos, M.D.
DOMESTIC VIOLENCE AREA
Ral Daz, M.D.
Violeta Vargas,
Licentiate in Social Services
GUEST COLLABORATORS
AND RESEARCHERS
Enrique Galli, M.D.
Jorge Castro, M.D.
SURVEY TEAM
Survey Consultant Sample Design
Alberto Padilla Trejo
Data Processing Consultant Quality Control
Olinda Yaringao Quispe
Head of Field Operations
Leoncio Ernesto Quezada Carrillo
Field Coordinators
Enrique Castillo Florin
Mary Helen Reyes Daz
Hern Arsenio Salazar Olivares
Field Supervisors
Flora Bendez Gamboa
Maruja Cangana Gutirrez
Milagros Roxana Castillo Gmez
Magali Divizzia Acosta
Miriam Esquivel Carrn
Marybel Galarreta Achahuanco
Sandra Elena Gmez Palac
Yrma Ochoa Janampa
Reina Francisca Vallejos Pereyra
SURVEYORS
Jhuliana Alfaro Ramos
Doris Amelia Angulo Reyes
Flor De Mara Araujo Colquehuanca
Luz Mara Ayala Cobeas
Valeriana Nivia Benites Huerta
Mnica Robertina Campos Rodrguez
Gaby Cdenas Aquino
Mnica De La Cruz Flores
Edgar Sal Gmez Ordez
Anita Mallca Gutirrez
Gloria Illescas Ayme
Mary Cecilia Martel Atencia
Patricia Graciela Martel Veramendi
Diana Rosario Molina Rondn
Gloria Morote Contreras
Gloria Maril Ore Medina
Ana Antonia Pariahuaman Herrera
Yuly Sadith Pedraza Gmez
Jenny Patricia Prez Hernando
Janeth Torres Reynaga
Anglica Rodrguez Zuta
Susana Ruiz Rubio
Mara Teresa Sandoval Pacahuala
Beatriz Ubaldo Jamaica
Lina Amrica Valverde Gonzlez
Luz Velarde Montalvo
Miryam Diana Vera Placencia
This study represents the confrmation of our vision and mission and the commitment undertaken by the
Institute on behalf of the countrys mental health. The effort made in the epidemiological study conducted in Lima has
left lasting impressions in each and every participant, from researchers to feld personnel, and has encouraged, even
more, their performance in this study. Therefore, we wish to recognize this new effort, assuming the risk of unintended
omissions.
We would like to express, in a very special way, our deepest recognition to the thousands of persons surveyed,
who in representation of the population understood the importance of their contribution on behalf of the community. We
wish to thank them for their patience, valuable time and, specially, for their kindness and hospitality. Thank you very
much.
To all members of the Executive Research Committee and of the specialized areas, for their inquisitive en-
thusiasm and their selfess commitment to understanding mental health in our community and who still believe in this
venture. To Enrique Galli, MD, who provided the frst Mini International Neuropsychiatric Interview (MINI) versions and
through the study conducted in Lima, contributed to the validation of this instrument, sharing valuable advice with us.
To our institutional management team: Giovanna Balln, Basilio Da Costa, Mabel Pico, Enrique Ticona, Irma
Atalaya, Mara Mendoza Jess, Efran Montesinos, Marita Zafra and Delia Ziga, who proved their experience and
professionalism in every stage of the research.
To the feld operation team: coordinators, supervisors and surveyors for their dedication and hard work, and
for their kindness and consideration with interviewees and researchers. Through them, we have learned more about the
genuine culture of Peru.
To the secretaries, Vilma Sotelo and Alicia Revilla, for their dedication and time spent away from their families
and to the digitisers for their effort. To Andrea Rubini, for her valuable and selfess contribution in revising and correcting
the questionnaire and feld documents.
To all our professional colleagues of the institution and outsiders for their positive or negative criticism; in both
cases it encouraged us to optimise the quality of the information. Our deep appreciation to all of them.
THE AUTHORS
ACKNOWLEDGMENTS
In 2002, the Specialized Institute of Mental Health Honorio Delgado Hideyo Noguchi conducted a research
in Metropolitan Lima and the Constitutional Province of El Callao to study the characteristics of mental health of the
population: prevalence of mental disorders, psychiatric disability and mental health-related handicaps, use of health care
services and identifcation of risk and protection factors. The results obtained confrmed the magnitude and relevance
of mental health problems in public health, as well as the signifcance of socioeconomic variables as health determining
factors. The conclusions derived from the study encouraged the team to extend the epidemiological studies to other
regions in the country.
The 2003 Epidemiological Study on Mental Health in the Peruvian Andes is the Governments frst technical
scientifc study in this area of the country. It aims at approaching the mental health situation in the region, giving priority
to the areas of great sensitivity: violence against women, suicidal behaviour, consumption of addictive substances,
depression and anxiety and the mental health of teenagers and senior adults. The study proposes an innovative
methodology, selecting four units of analysis: an adult, a married or cohabitant female, a teenager and a senior
adult. The expected result is to achieve a comprehensive vision of the mental health situation from a comprehensive
perspective.
The above mentioned study forms part of the institutional commitment to lead the research and contribute
with the creation of regulations on mental health, under the conviction that only a planned, organized and adequately
conducted study may provide valuable information for the development of projects or programs consistent with the
reality of the mental health situation in the country.
This report is the frst of a series of four publications on mental health in the Peruvian Andes. It offers an
overview of the mental health of the population through prevalences and relevant associations found in three cities of
the Peruvian Andes: Ayacucho, Cajamarca and Huaraz. The methodology describes the general objectives of each
study area, and its results shall be presented in subsequent specialized reports. Many of the calculated indicators shall
be used as grounds for future epidemiological evaluations and to observe and control the risk and protection factors
involved.
Martn Nizama Valladolid, M.D.
Director General
Specialized Institute of Mental Health
PRESENTATION
This study, developed in the Peruvian highlands, has used as references three cities located in the heart of
this region, making it necessary to know, at a closer range, the traits and characteristics of Ayacucho, Cajamarca and
Huaraz.
AYACUCHO
The city of Ayacucho, known as Huamanga, is the capital of the department of the same name and the seat
of the Libertadores-Huari Region. Located at 2,764 meters above sea level, it enjoys the warm dry climate found in
most cities of the Peruvian highlands. At 500 km. southeast of Lima, it can be reached by the Libertadores Highway
or through Huancayo. Its current population is estimated in 82,131 and it is known for its 33 churches within its urban
radius.
The fossil remains discovered in Ayacucho date back to more than 20 thousand years ago. Piquimachay
and Paccaicasa are proof of the regions ancient settlers, who developed into the Wari Culture, in todays province
of Huanta, which refused to submit to the domain of the Inca Empire. This resulted in great bloodshed which gave
Ayacucho its name, Corner of the Dead, in Quechua.
The climate and the good quality of the soil motivated the Spaniards to settle in the region, founding the city of
Ayacucho in 1539, followed by the founding of the University San Cristobal de Huamanga, in 1677. It is a heroic land;
it is in Ayacucho where the Independence of Peru and Latin America was consolidated. The national heroes, Maria
Parado de Bellido and Andres Avelino Cceres (also known as the Wizard of the Andes) were born in Ayacucho.
Ayacucho stands out for its agricultural and cattle production, for being the birthplace of folk music composers
and for its renowned handcrafts in Huamanga stone, altarpieces, silverwork, knits and carved gourds.
CAJAMARCA
Located in Perus northern highlands, it is crossed from north to south by the western mountain range of the
Andes. Its territory covers Perus three natural regions: coast, highlands and tropical rain forest. Its climate is mild and
dry; sunny by day and cold at night. Its capital, the city of Cajamarca, has a population of 140,000, located at an altitude
of 2,750 meters above sea level.
Cajamarca possesses beautiful Andean landscapes, where a fertile countryside and narrow, torrential rivers
reign. There are archeological sites from ancient and Colonial Peru such as the Inca Baths, the Ransom Room the Little
Windows of Otuzco, the Santa Apolonia Hill, the Cathedral, the church of San Francisco and the Belen architectural
complex.
Cajamarca is famous nationwide for its dairy cattle and cheeses. Cajamarcas fertile lands also have vast
underground areas rich in exportable minerals, mainly gold.
THE PERUVIAN
HIGHLANDS
HUARAZ
Huaraz, the capital of the Ancash department, lies northeast of Lima. It is a modern city, of 121,028 inhabitants
in contrast with other cities of the region as it was rebuilt from scratch after its complete destruction in the great
earthquake of 1970, where approximately 20 thousand people died and the city of Yungay disappeared. Ancash has
withstood other great tragedies. The great food of 1945 destroyed part of the city and during the food of 1962 the city
of Ranrahirca almost vanished from the map.
It is located at 3,080 meters above sea level, along the Santa River in the Callejon de Huaylas, between the
Black Mountain Range to the west and the White Mountain Range to the east, where the Huascaran, the highest snow-
capped peaks in Peru rises at 6768 meters above sea level. The climate is mild, with sunny days and cold nights.
From the Guitarrero caves to the Chavin Culture, this region is brimming with history and the natural charm
of its valleys and lakes, all framed by the White and Black Mountain Ranges, with the Callejon de Huaylas between
them.
EPIDEMIOLOGICAL STUDY ON MENTAL HEALTH
IN THE PERUVIAN ANDES - 2003
GENERAL REPORT
CONTENTS
BOARD OF DIRECTORS - SIMH.................................................................................................................. 05

MEMBERS RESPONSIBLE FOR THE STUDY, MAIN AREAS AND RESEARCHERS................................. 07
SURVEY TEAM.............................................................................................................................................. 08
ACKNOWLEDGMENTS................................................................................................................................. 11
PRESENTATION............................................................................................................................................ 13
THE PERUVIAN HIGHLANDS....................................................................................................................... 15
EPIDEMIOLOGICAL STUDY ON MENTAL HEALTH IN THE PERUVIAN ANDES - 2003 15
FOREWORD.................................................................................................................................................. 25
I. INTRODUCTION......................................................................................................................................... 27
1.1 FOUNDATIONS............................................................................................................................... 28
II. SITUATIONAL DIAGNOSIS OF MENTAL HEALTH ................................................................................. 29
2.1 MENTAL HEALTH............................................................................................................................ 29
2.2 FAMILY VIOLENCE......................................................................................................................... 30
2.3 ANXIETY, DEPRESSION AND OTHER DISORDERS.................................................................... 31
2.4 ADDICTIONS................................................................................................................................... 32
2.5 SENIOR ADULTS ............................................................................................................................ 33
2.6 SUICIDAL INDICATORS.................................................................................................................. 33
2.7 MENTAL DISORDERS AND DISABILITY........................................................................................ 34
2.8 ACCESS TO MENTAL HEALTH ASSISTANCE SERVICES............................................................ 34
2.9 POVERTY AND MENTAL HEALTH.................................................................................................. 35
2.10 LIFE EVENTS AND MENTAL HEALTH............................................................................................ 35
2.11 SOCIAL AND CULTURAL FACTORS AND MENTAL HEALTH........................................................ 36
2.12 DISCRIMINATION AND MENTAL HEALTH..................................................................................... 36
2.13 STIGMA AGAINST MENTAL DISORDERS...................................................................................... 36
III. OBJECTIVES............................................................................................................................................ 38
3.1 OBJECTIVES BY CHAPTER........................................................................................................... 38
IV. METHODOLOGY..................................................................................................................................... 39
4.1 TYPE OF DESIGN AND STUDY......................................................................................................... 39
4.2 SAMPLING DESIGN........................................................................................................................... 39
4.2.1 Target population................................................................................................................................. 39
4.2.2 Inference levels.................................................................................................................................... 39
4.2.3 Sampling framework and sampling units............................................................................................. 40
4.2.4 Stratifcation......................................................................................................................................... 40
4.2.5 Type of sample.................................................................................................................................... 40
4.2.6 Sample size and distribution................................................................................................................ 40
4.2.7 Units of Analysis.................................................................................................................................. 41
4.2.8 Procedures for the selection of samples.............................................................................................. 41
4.2.9 Criteria for inclusion of the people who answered the survey.............................................................. 42
V. DEFINITION OF OPERATIONAL VARIABLES............................................................................................. 43
5.1 SOCIO-DEMOGRAPHIC AND ASSOCIATED VARIABLES................................................................ 43
5.2 MENTAL HEALTH FACTORS.............................................................................................................. 43
5.3 CLINICAL DISORDERS....................................................................................................................... 45
5.4 DISABILITY AND LACK OF SKILLS.................................................................................................... 45
5.5 SERVICE ACCESS MODULE............................................................................................................. 46
5.6 INTRAFAMILY RELATIONSHIPS........................................................................................................ 46
5.7 COGNITIVE FUNCTIONS................................................................................................................... 47
5.8 SOCIOCULTURAL SYNDROMES AND MENTAL HEALTH................................................................ 48
VI. INSTRUMENTS USED TO PREPARE THE QUESTIONNAIRE................................................................. 48
6.1 DESIGN AND STRUCTURE OF THE QUESTIONNAIRE ON MENTAL HEALTH.................................. 49
6.1.1 Type of survey...................................................................................................................................... 49
6.1.2 Scope of survey................................................................................................................................... 49
6.2 METHOD OF INTERVIEW.................................................................................................................. 51
6.3 VALIDITY AND RELIABILITY.............................................................................................................. 51
6.4 OBTAINING VALIDITY AND RELIABILITY INDICATORS FROM THE STUDYS OWN DATA.............. 51
6.5 TRAINING IN THE USE OF TOOLS ................................................................................................... 52
6.6 ETHICAL CONSIDERATIONS............................................................................................................. 53
VII. FIELD OPERATION PROCEDURES......................................................................................................... 53
VIII. FIELD OPERATION RESULTS................................................................................................................. 54
IX. DATA PROCESSING AND ANALYSIS....................................................................................................... 54
SURVEY RESULTS........................................................................................................................................... 55
SAMPLE INFORMATION................................................................................................................................... 57
SAMPLE INFORMATION OF ADULTS SURVEYED............................................................................................. 61
CHARACTERISTICS OF ADULTS SURVEYED................................................................................................ 63
AGE.................................................................................................................................................................... 63
EDUCATION................................................................................................................................................... 63
MARITAL STATUS.......................................................................................................................................... 65
EMPLOYMENT............................................................................................................................................... 65
INCOME......................................................................................................................................................... 65
ADULT MENTAL HEALTH IN THE PERUVIAN ANDES............................................................................... 67
CHARACTERISTICS OF MENTAL HEALTH.................................................................................................. 67
Environment..................................................................................................................................... 67
Psychosocial stressors..................................................................................................................... 69
Discrimination................................................................................................................................... 71
Prevailing emotional states .............................................................................................................. 73
Personal satisfaction........................................................................................................................ 74
Work satisfaction.............................................................................................................................. 75
Quality of life..................................................................................................................................... 77
Disability or inability.......................................................................................................................... 77
Psychopathic factors........................................................................................................................ 78
Suicidal indicators............................................................................................................................ 78
Tendency towards violence.............................................................................................................. 82
Protecting factors............................................................................................................................. 82
CLINICAL DISORDERS................................................................................................................................. 83
Substance use................................................................................................................................. 87
Clinical disorders according to age groups...................................................................................... 90
POVERTY AND MENTAL HEALTH................................................................................................................ 90
MENTAL HEALTH BY CITIES........................................................................................................................ 92
EFFECTS OF POLITICAL VIOLENCE........................................................................................................... 94
CHILDHOOD EVENTS AND MENTAL HEALTH............................................................................................ 95
ACCESS TO CARE SERVICES..................................................................................................................... 97
SOCIO-CULTURAL SYNDROMES AND MENTAL HEALTH IN THE PERUVIAN ANDES................................ 100
STIGMA AGAINST MENTAL DISORDERS.................................................................................................... 102
CHARACTERISTICS OF SURVEYED MARRIED OR COHABITANT WOMEN OR PREVIOUSLY SO........... 105
AGE................................................................................................................................................................ 107
EDUCATION................................................................................................................................................... 107
MARITAL STATUS.......................................................................................................................................... 108
EMPLOYMENT.............................................................................................................................................. 108
INCOME......................................................................................................................................................... 109
MENTAL HEALTH OF SURVEYED MARRIED OR COHABITANT WOMEN OR PREVIOUSLY SO............. 111
GENERALITIES............................................................................................................................................. 111
Environment..................................................................................................................................... 111
States of mind.................................................................................................................................. 113
Family bonding................................................................................................................................. 115
Quality of life........................................................................................................................................ 115
Suicidal indicators................................................................................................................................ 116
CLINICAL DISORDERS..................................................................................................................................... 117
ABUSE OF MARRIED OR COHABITANT WOMEN.......................................................................................... 118
Mistreatment during courtship............................................................................................................. 118
Abuse towards women by current partner........................................................................................... 119
Psychosocial stressors in systematically mistreated women............................................................... 121
Prevailing emotional states of mind of mistreated married or cohabitant women................................... 122
Personal satisfaction in systematically mistreated married or cohabitant women................................... 122
Suicidal indicators for systematically mistreated married or cohabitant women...................................... 123
Protection factors................................................................................................................................. 124
Quality of life in systematically mistreated married or cohabitant women............................................... 124
Clinical conditions in systematically mistreated women.......................................................................... 125
CHARACTERISTICS OF TEENAGERS SURVEYED....................................................................................... 127
AGE.................................................................................................................................................................... 129
EDUCATION...................................................................................................................................................... 129
MARITAL STATUS............................................................................................................................................. 130
EMPLOYMENT.................................................................................................................................................. 130
MENTAL HEALTH OF TEENAGERS SURVEYED......................................................................................... . 131
GENERALITIES................................................................................................................................................. 131
Psychosocial stressors........................................................................................................................ 132
Prevailing emotional states .................................................................................................................. 132
Personal satisfaction............................................................................................................................ 133
Work satisfaction.................................................................................................................................. 134
Quality of life........................................................................................................................................ 134
Psychopathic factors............................................................................................................................ 135
Suicidal indicators................................................................................................................................ 135
Tendency towards violence.................................................................................................................. 138
Protection factors................................................................................................................................. 138
CLINICAL DISORDERS..................................................................................................................................... 139
Substance consumption....................................................................................................................... 139
ABUSED TEENAGERS..................................................................................................................................... 142
ACCESS TO SERVICES................................................................................................................................... 142
CHARACTERISTICS OF SENIOR ADULTS SURVEYED................................................................................. 145
AGE................................................................................................................................................................... 147

EDUCATION................................................................................................................................................... 147
MARITAL STATUS.......................................................................................................................................... 148
EMPLOYMENT............................................................................................................................................... 149
MENTAL HEALTH IN SENIOR ADULTS SURVEYED................................................................................... 151
GENERALITIES.............................................................................................................................................. 151
Prevailing emotional states............................................................................................................... 151
Quality of life..................................................................................................................................... 153
Disability or inability.......................................................................................................................... 154
Suicidal indicators............................................................................................................................. 155
Protection factors.............................................................................................................................. 155
Depressive episode in the senior adult............................................................................................. 156
Generalized anxiety disorder............................................................................................................ 157
Substance consumption................................................................................................................... 157
COGNITIVE DETERIORATION IN SENIOR ADULTS.................................................................................... 158
ABUSE OF SENIOR ADULTS........................................................................................................................ 160
ACCESS TO SERVICES................................................................................................................................ 160
CONCLUSIONS OF THE STUDY.................................................................................................................. 163
ADULTS.......................................................................................................................................................... 165
MARRIED OR COHABITANT OR PREVIOUSLY SO WOMEN...................................................................... 166
TEENAGERS.................................................................................................................................................. 166
SENIOR ADULT.............................................................................................................................................. 167
EXHIBIT A.......................................................................................................................................................... 169
MODULES EMPLOYED IN THE STUDY....................................................................................................... 171
EXHIBIT B.......................................................................................................................................................... 177
SAMPLING ERRORS AND COEFFICIENTS OF VARIATION....................................................................... 179
BIBLIOGRAPHY................................................................................................................................................. 205
25
In 2002, the Specialized Institute of Mental Health Honorio Delgado Hideyo Noguchi published the 2002
Metropolitan Epidemiological Study on Mental Health General Report (2002 MESMH) an institutional effort under my
direction. Such study was to be replicated in the Andean and Amazon areas of Peru in order to produce the frst national
map covering mental health problems.
Enrique GALLI, MD, Professor of Psychiatry at Cayetano Heredia Peruvian University described the 2002
MESMH as the best epidemiological study on mental health in the history of the Republic. This comment has been
endorsed by other professionals who refer to it in a rather uncommon but frequently way evidencing the need for
updated information produced thanks to the creativity of the different actors involved.
During the third year of my administration, in 2003, I had the honour of conducting and supervising the
Epidemiological Study on Mental Health in the Peruvian Andes (2003 ESMHPA) carried out by the same staff in
the cities of Huamanga (Ayacucho) Cajamarca and Huaraz and funded by the HD-HN-MHI, which again required
austerity, creativity and commitment, strengthening the institutional experience for undertakings of this nature. As far
as feld operations are concerned, we completed the study and initiated the analysis of results. This report completes
the research process that will greatly contribute to better awareness of mental health problems in Peru.
The 2003 ESMHPA has enabled the professionals of the Institute to increase their experience and produce
proper information in an international scenario where contributions from our country are still scarce. The data obtained,
in quantities never seen before, describe and explain the mental health phenomena of the Andean towns and inhabitants,
refecting the intercultural complexity of the country and the urgent need to use such data to adopt specifc and realistic
decisions in the pursuit of solutions to the problems revealed.
If the studies derived from the Committee for Truth and Reconciliation describing the damage caused by the
insanity of terrorist groups during the last decades of the 20th century show us a facet of a country subjected to the
whip of so-called saviours, the studies conducted by the Institute evidence once again that in the different scenarios
researched there is an urgent need for attention from political leaders in order to draw us closer as a nation where
rifts need to be narrowed more and more. Mental health in the researched cities expresses the effect of centuries
of centralism, ignorance, oblivion and exclusion of persons that have been estranged and hence do not have the
opportunity to obtain the right to social equality and justice.
It has been an honour to have lead the Institute and its research staff in the direction we have considered to
be the right one.
Hctor Tovar Pacheco, MD
Former Director of the HD-HN SMHI
FOREWORD
GENERAL REPORT
27
I. INTRODUCTION

The results of the Metropolitan Epidemiological Study on Mental Health conducted in the city of Lima and the
Constitutional Province of El Callao in 2002 (MESMH) have made it possible to learn about important mental health
factors regarding adults and teenagers, such as the high prevalence of depression and anxiety and their connection
with socioeconomic variables. Furthermore, the identifcation of unfavourable conditions regarding the mental health of
mistreated women and senior adults has been made possible. The multicultural nature of our country makes it necessary
to broaden research to other regions. From this point of view it is of utmost importance to study the psychosocial
variables in this population, given the socioeconomic and cultural conditions of the inhabitants of the Peruvian Andean
region with much higher poverty rates than those of Lima.
The impact of mental health in peoples everyday life, socioeconomic factors, overall well-being and quality of
life emphasizes the importance this issue has in the development of a country. According to the survey on the Burden of
Illnesses conducted by the World Health Organization (WHO) it has been estimated that mental and addiction disorders
are among the most serious worldwide and that by the year 2020, major depression will be the second most common
cause of disability in the world followed only by ischemic heart disease. The perspectives for developing countries are
even worse: it is estimated that major depression will be the leading cause of disability by 2020
2
. The study in Lima
confrmed the connection developing between mental health and economic factors, ratifying the fndings in international
reports
3 4
.
The political and socioeconomic context of the country is still unstable; poverty indicators are still high, as
well as employment and underemployment factors. These living conditions lead to stressful situations that favour an
increase of mental health problems. In this respect, the Peruvian Andes evidence the most depressing economic
indicators in the country, making it essential to learn about the mental health situation of these populations.
No nationwide epidemiological studies on mental health in the Andes region of this kind of magnitude has
ever been conducted. The most important studies have been performed in the area of family violence
5
and addiction
problems
6
, excluding all other mental health problems. This study sought to replicate the same study performed in
Metropolitan Lima and El Callao in three cities situated in the Peruvian Andes: Ayacucho, Cajamarca and Huaraz. The
study followed the same topics set forth in the study conducted in Lima, that is, psychiatric disorders and related factors,
as well as problems related to human individual or group relations and to behaviour patterns of individuals within society
that may have an impact on health and well-being. To this effect the instruments used for the Lima area were adjusted
as required. Research focused on the most prevalent psychiatric disorders, family violence and its relation with mental
28
health, the mental health of senior adults, and problems related to teenagers and adults, placing special emphasis on
fndings concerning suicidal indicators as in the research conducted in Lima. In addition to the topics proposed, other
concerning mental health were considered, such as: quality of life, performance and disability, life events and their
relations with psychiatric problems, economic factors, access to services, mental health in general, discrimination,
human development and a special chapter on cultural syndromes. It also included topics related to violence associated
with terrorism. A specifc feature of this study, also featured in the one conducted in Metropolitan Lima and El Callao,
is that all these factors were examined in a single household. Therefore, the possibility of obtaining important data by
crossing information will be very valuable for clinical, epidemiological and intervention purposes.
The results of this research will contribute to the standard diagnosis and to the design of mental health programs
in areas where there is no infrastructure for mental health services. Thus, it will be possible to establish assessment
indicators on human and fnancial resources to be invested in the feld of mental health in these areas.
1.1 FOUNDATIONS
To date there are no studies of epidemiological signifcance in the Peruvian Andes that apply a scientifc meth-
odology to identify conclusive information to be used in public policies while establishing bases for the assessment of
intervention programs.
This study is important, frst, because it may bring about development in inter-sector policies associated with
mental health, so neglected until today. Secondly, policies that consider variables linked to mental health which have
an effect on poverty could be generated. Thirdly, preventive actions in risk groups could focus better on more specifc
problems and therefore be better organized. Fourthly, it could increase access to these services, especially to vulner-
able groups. Finally, it would help by setting precedents in the region since no other similar study has been conducted
in the country and in Latin America.
The study would answer, among others, questions such as: What is the extent of and the main general mental
health problems in the urban populations of the Peruvian Andes? To what extent does violence against women in a rela-
tionship impact their mental health? What is the prevalence of addictive behaviour and what are the risk and protection
factors of such a behaviour? What is the extent of and the main mental health problems of the elderly in the Peruvian
Andes? What is the extent of suicide indicators in the Peruvian Andes population? What is the prevalence of the main
psychiatric disorders? What is the exact proportion of persons that do not receive any kind of attention for their mental
health problems? What inequality factors (socioeconomic, gender, educational and deep-rooted cultural factors) are
present among persons who have access to mental health services and those who do not? What is the extent of mental
health problems in the poor population as compared to the non-poor population of the Peruvian Andes? What is the
discrimination level perceived by the Peruvian Andes population? What are the characteristics of cultural syndromes
and their relation with clinical psychiatric syndromes? In what way do adverse life events relate to the development of
mental disorders?
From the point of view of social management, the result of the study would be considered as: First, a fundamental
instrument for the development of social communication projects; second, a starting point for the preparation of projects
covering a broad range of mental health problems; third, a basis for the study and development of infrastructure for ser-
vices in the area, with a social approach; and fourth, it would contribute to a better allocation of Government resources
in sensitive areas or issues.
GENERAL REPORT
29
2. SITUATIONAL DIAGNOSIS OF MENTAL HEALTH
The MESMH
1
conducted by our Institute in 2002 disclosed important information which evidenced tendencies
observed in previous studies in the mental health7 8 area confrming international observations regarding emotional
disorders, suicide indicators, problems due to the consumption of substances, intra-family violence and the intervention
of socioeconomic problems in mental disorders
9
. The results shall be presented according to the issues exposed.
2.1 MENTAL HEALTH
The study of mental health in the community is a hard task which is in permanent evolution. Murphy (1982)
10
demonstrated that the absence of pathology does not necessarily mean that good mental health exists. Corin E (1987)
indicates that the starting point is not merely the individual but the constant interaction between the persons and their
environment. Thus, Epidemiology has allowed the identifcation of the biological, psychological and determining factors
of mental health. Social Epidemiology especially supports the importance of understanding the infuence of social
processes such as education, employment and working conditions, income, class and social exclusion, (ethnic, racial,
gender, generational, and because of disabilities, social class and sexuality as well) child development, life styles,
social networks, physical surroundings among other on the health of people and communities.
14 15 16
It has thus
favoured the promotion of health, leading to the defnition of healthy goals in terms of living conditions, opportunity for
people to enjoy more years of quality-living, perception and awareness of problems and the possibility to participate in
their solution as a group.
From this perspective, the Metropolitan Epidemiological Study on Mental Health (2002 MESMH)
17
in Peru
demonstrated that the main problems in the country as perceived by the community, with respect to both men and
women regarding the city of Lima, were unemployment (58,1%). Poverty is perceived signifcantly less as a problem
(16,4%) followed by corruption, violence and political instability. However, people show great distrust towards political
authorities (91,7%) and towards police authorities (62,5%); they feel unprotected by the State (76%). Such situation
breeds disappointment most often (26,6%) followed by bitterness and rage (25,8%).
This same study revealed that the situations that produce the highest levels of stress in both men and women
are related to economic issues (39,7%), family health and the environment (45,7%). This result is larger than the
one found by the study performed by Perales and Col in 1996
18
with regard to the teenager population. There is a
considerable proportion of individuals who exhibit dissatisfaction with studies (29,5%), social relations (16,2%), salaries
(46,3%) - greater in the case of women in a relationship (50,8%) - and credit received at work (23,2%).
With respect to mental health protection factors of the population in Lima, the family is the main source of
psychosocial support (70,0%). Religion also constitutes an important resource to face daily problems.
In the Peruvian Andes there are no epidemiological studies with these characteristics. However, the political
violence that affected Peru during 1980 - 2000 cannot be cast aside considering the fact that it left dramatic consequences
and a large number of fatal victims, mainly affecting the Andean towns. Thus, greater concern for the rural and high
Andean villages has existed. Pederssen and Col
19
studied the mental health of high Andean populations in the village
of Huanta in Ayacucho, assessing the impact of political violence in the population. Results showed a prevalence of
73% regarding mental disorders in general and 24,8% of post-traumatic stress in people over 14 years old. It indicates,
however, that these after-effects are expressed in wider and more diverse forms of affiction and suffering, such as llaky
and akary. Stressors related to these results are not only derived from differential exposition to political violence, but
30
from social structure also, such as social inequality and exclusion, extreme poverty, and ethnic and racial discrimination.
On the other hand, 3 out of 4 persons exposed to violence did not report after-effects. This fact would indicate the
existence of protection factors such as the recovery capacity of persons and the community resilience.
Likewise, the Report of the Committee for Truth and Reconciliation
20
, explains through statistical reports and indi-
vidual statements, the differential impact of political violence on the health of the Peruvian Andes population, evidenc-
ing as well its relation to racial, ethnic, gender, social class and generational inequality. It points out that psychosocial
after-effects refer to individual levels (physical disability, mental health problems such as anxiety, irritability, stress,
diminishment of individual skills development, violent behaviour and alcohol abuse among other); family levels (dete-
rioration of couples and family relations, distrust, insecurity, abandonment and conficts, families stigmatised politically
and culturally , family disintegration, orphanage) communal levels (collective apathy, increase of inter-communal and
intra-communal conficts, conficts between people returning to the community and people who resisted and stayed,
massive and compulsive alcohol consumption, junior gangs, abandoned children (irregular adoptions, servants) loss of
cultural values.
2.2 FAMILY VIOLENCE
Studies on family violence are of great importance, due not only to its high prevalence in the country but to
the lack of services in rural zones as well, to the cost and medical and judicial proceedings, and to the beliefs, myths
and unreal notions on women which prevent those affected from receiving adequate help and support (Baca and Cols.,
1998). A 1999 study on violence against women conducted in Metropolitan Lima revealed that the violence rate in
general among couples was 20%, the aggressor being the male in 80% of the cases and the home the scenery of the
violent behaviour.

In similar proportion, the Demographic and Family Health Survey (2000) showed that 34% of women live
or have lived under control situations, 48% live or have lived humiliating situations, 25% live or have lived under
threatening situations, 41% have been pushed, hit, or physically attacked by their husband or partner. The study also
mentions that the highest incidence of child mistreatment occurs in places of greater poverty and social exclusion such
as in the Departments of Apurimac and Cajamarca. It is also related to the low education level of parents, where the
risk factors that bring about situations of mistreatment are not only related to a diffcult economic situation of families
and to unemployment, but to the tolerance towards corporal punishment that exists in our culture.
Pregnant teenagers who are rejected and alienated due to their situation or teenagers presenting a background
of sexual violence also constitute risk factors. In general, diverse studies conclude that one out of fve fertile women
in the City of Lima has been abused as a child, which confrms that infancy and adolescence are the most vulnerable
groups for sexual and psychological violence. Another characteristic in infant mistreatment is the inter-generational
recurrence. Women who were abused during childhood are twice as likely to mistreat their daughters.
On the other hand, a multicentre study establishes that the prevalence of physical or sexual violence throughout
the life of a couple clearly evidences that most of the male adults in Metropolitan Lima (51%) and in the Department of
Cusco (69%) are violent towards their partner (Guemes, Palomino and Ramos, 2002).
(3)
Another investigation studying
physical aggression during courtship revealed that 30% of men and 49% of women report having used some form of
aggression during said period. It mentioned also that a greater percentage of women had been involved in severe
physical attacks.
GENERAL REPORT
31
The Epidemiology Bureau of the Ministry of Health, through the Epidemiological Surveillance System for family
violence in 8 cities in the country, found that in 2000, 84,7% of victims were women and 15,2% men. The percentage
of children (under 15 years old) affected by family violence was 61%. According to the information obtained, in 24,9%
of the cases the husbands were the aggressors and in 34,7%, the partners. According to age groups the aggressors
were between 15 and 49 years old in 87% of cases; 72% included physical violence and 12,6% psychological violence.
The reasons were jealousy in 26,2% of cases, family problems in 38,9% and economic problems in 11,9%; 4,5% report
sexual aggression; 59,3% of aggressors were even-tempered in the moment of the attack, 35,6% had consumed
alcohol and 4,6% had consumed alcohol plus drugs. In this sense, substance abuse has been associated with violent
behaviour. Alcohol or drugs may be associated with violence due to pharmacological, psychological and sociological
factors that may modify the expression of intoxicated or aggressive behaviour.
24 25
The implications in the Andes are
evident because of the high prevalence of problems related to the consumption of alcohol in such regions.
With respect to violence in women, the 2002 Metropolitan Epidemiological Study on Mental Health included
as indicators, inappropriate sexual acts or sexual attempts, physical or verbal aggressions or abandonment, suffered
at least once in their life or in the last year. In general female spouses suffer considerably more mental health problems
than men, thus turning into a vulnerable group. The most prevailing clinical psychiatric disorder is the depressive
episode or major depression. Approximately 1 out of 9 females in a relationship suffer from depression and at present
1 out of 10 women suffer from generalized anxiety; 65,8% of women surveyed reported having experienced some kind
of abuse in their lives, that is, 2 out of every 3 women, with psychological violence as the most frequent type. This study
found that the mistreatment of women is caused by jealousy, male chauvinist behaviour, controlling partners and fts of
violence.

An important fnding in such study was noticing that in many cases the mistreatment or violence started with
their partners during courtship, presenting itself in the form of jealousy (50%) fts of violence (11,3%) and any kind of
mistreatment (69%). The lifetime prevalence of any kind of abuse by the current partner was 47%. However, 1 out of
every 5 women currently in a relationship is systematically mistreated, that is, she suffers diverse aggressions with
a frequency of one to two times per month. Mistreatment during courtship in the population of woman systematically
mistreated is 85,3%. Women who are systematically mistreated evidence much more severe mental health indicators
than those indicated for females in a relationship, with suicide indicators as the most contrasting, which double in
relative frequency when compared to women who are not mistreated systematically.
2.3 ANXIETY, DEPRESSION AND OTHER DISORDERS
There is no background for epidemiological studies on a grand scale conducted in the Peruvian Andes. The
most important studies were performed in the City of Lima. One of the frst epidemiological studies was conducted in
1969 by Maritegui and his collaborators in the District of Lince (Lima) through 2901 surveys which revealed a prevalence
of 18,75% regarding psychiatric disorders with 5,48% for psychoneurosis as a whole and 1,76% for alcoholism. The
most frequent problem was anxiety neurosis with 1,79% (in turn, the most frequent of all pathologies) anxious reaction
1,45% and depressive reaction 0,97%.26
Later, in 1983, in the District of Independencia (Lima), Minobe and his collaborators in a survey of 814 individuals,
using the Diagnostic Interview Scale/Diagnostic and Statistical Manual-III (DIS/DSM-III) 27 found a lifetime prevalence
28 and a six months prevalence 29 of the some psychiatric disorder representing 32,1% and 22,9%, respectively.
Problems caused by the consumption of alcohol were followed in frequency by emotional disorders (major and minor
depression) with a lifetime prevalence of 13,2% and a six months prevalence of 8,6% (2,2% men and 6,4% women),
a lifetime prevalence of anxiety disorders of 11,1% and a six months prevalence of 8,1%. In addition, this study found
prevalences of antisocial personality representing 3,1%, of severe cognitive deterioration, 1,5%, and of schizophrenia
and schizophreniform disorder, 0,6%. After this study no other researches of this nature were performed until 2002.
32
In 1993 Colareta conducted a research on the prevalence of psychiatric diseases in a rural community (Santa
Luca de Pacaraos Huaral) and found a punctual global prevalence of psychiatric diseases of 32%, with anxiety as the
leading disorder (9,1% besides abstinence syndrome) followed by depressive disorders (8% of sample leaving aside
uncomplicated grief and adjustment disorder) and alcoholism (8,6% of sample). The anxiety disorder not specifed in
any other part was the most frequent anxiety disorder (4,6% of sample) followed by generalized anxiety disorder (2,9%
of sample) panic disorder (0,6% of sample) and social phobia (0,6% of sample). The depressive disorder not specifed
in any other part was the most frequent depressive disorder (3,4% of sample) followed by major depression (2,3% of
sample) and dysthymia (2,3% of sample).0
The 2002 Metropolitan Study on Epidemiological Mental Health, conducted that year by the Specialized
Institute of Mental Health Honorio Delgado Hideyo Noguchi in 43 districts of Lima and El Callao comprising a
population of 2077 adults, found a current prevalence and a lifetime prevalence of any psychiatric disorder of 23,5%
and 37,3%, respectively. The lifetime prevalence showed that 18,2% corresponded to depressive episode, 9,9% to
generalized anxiety disorder, 7,9% to social phobia, 6% to post-traumatic stress disorder, 3,7% to panic disorder, 3,4%
to agoraphobia without panic disorder, 1,6% to obsessive-compulsive disorder, 1,2% to dysthymia, 1,1% to agoraphobia
with panic disorder, 1% to psychotic disorder and 0.1% to bipolar disorder.
This study evaluated lifetime prevalence, annual prevalence, six months prevalence and current prevalence
of the main clinical disorders according to the research criteria of the International Classifcation of Diseases, Tenth
Review (ICD-10).
2.4 ADDICTIONS
Addictions cause severe social problems, affect a great part of the population and are highly expensive. The
money involved in the sale of illegal drugs (not considering tobacco and alcohol) competes in volume with oil industry
earnings. Human and economic costs related to morbidity and mortality caused by drugs neutralize any money proft
governments may obtain through taxes and other economic measures in that feld. The 2002 Report on Worldwide
Health indicated that 8,9% of the total morbidity burden is due to the consumption of psychoactive substances.
Addictions, however, include not only the consumption of psychoactive substances but all conscious acts involving
changes of consciousness, mood, thoughts and behaviour that will keep individuals practicing acts that harm their
physical and mental health and their environment.
Addiction problems have been dragging on for decades. The study in the District of Independencia performed
20 years ago revealed that the most important problem was related to alcohol abuse and dependence, specially in
males with a lifetime prevalence of 18,6% and six months prevalence of 6,9%.8 9 Such situation has been confrmed
by national studies conducted from 1988 to 1998; the last studies performed by the Peruvian Government.6 The 1998
study revealed that around 1 million Peruvians are considered to be 30-day dependents.
The 2002 Metropolitan Epidemiological Study on Mental Health revealed that the lifetime prevalence of
consumption of non-alcoholic legal substances was 71,6%, while the prevalence of other non-alcoholic illegal substances
was 7,8%. Tobacco was the most consumed non-alcoholic legal substance (69,5%) while marijuana was the most
consumed non-alcoholic illegal substance (6,3%) followed by cocaine with 3,9%. The current consumption (in the last
week) of non-alcoholic legal and illegal substances was 22% and 0,2% respectively. According to the 2002 II National
Survey on Drug Prevention and Consumption conducted by DEVIDA (National Committee for Development and Life
Without Drugs) the lifetime prevalence of alcohol and tobacco consumption was 94,2% and 68% respectively, which led
to the conclusion that 11 million Peruvians had tried alcohol and more than 8 million had consumed tobacco.4
GENERAL REPORT
33
This study has evaluated the lifetime prevalence of consumption and the prevalence of substance abuse
during the last year, as well as substance dependence according to the criteria of the International Classifcation of
Diseases, Tenth Review (ICD-10). 31
2.5 SENIOR ADULTS
The progressive aging of populations will have a more outstanding impact in the frst decades of this millennium.
In the year 2000, 8,1% of the Latin American population was over 60 years old; in 2010 it will represent 9,6% and in
2020 12,4% of the population will be over 60 and more. 35 At present, there are around 2 million senior adults, and by
the year 2020, the population of senior adults is expected to rise to approximately 4 million.
The accelerated growth of the senior population in Latin America and the Caribbean forces us to review the
service policies for senior adults, expressing the urgent need to organize specifc areas covering all requirements
related to health, nutrition, education, and social life, among other. On the other hand, as aging is a progressive and
irreversible process for all human beings, a comprehensive evaluation of the senior adult is essential, since in this
stage there are converging biological, psychic, and social factors which will determine not only the extension, but also
the quality of life. It is pertinent to point out that polypathology and the presence of chronic degenerative illnesses are
frequent at this age. It is worthwhile to remark, in relation to mental health, the predominance of cognitive alteration,
depression and consummated suicides.
In the First World Assembly on Aging carried out in 1982, and in the last one carried out in March 2002, the
need for gerontological research was considered essential in order to provide the authorities with useful information that
will allow services to be planned which offer decent conditions for this stage in life.
According to the foregoing and considering that Peru is also involved in the demographic change due to the
increase of the senior adult population, it is necessary to learn about the reality of this group of people in our community.
In this respect, the Epidemiological Study on Mental Health conducted in the City of Lima and El Callao states that
while in the previous month the prevalence of the desire to die was 11,1%, no senior adult attempted to commit suicide.
The previous month prevalence of depressive episode was 9,8%. On the other hand, this same study revealed that
some degree of cognitive deterioration is found in around 10% of the senior adults over 60, considering they attended
school for at least eight years. Thus, one of the goals of this study was to learn about these fgures in other regions of
Peru, such as the case of the Peruvian Andes: Huaraz, Ayacucho and Cajamarca. Just as in other analysis units, this
group will be studied from the general standpoint of mental health, the presence of major depression, the existence of
cognitive problems and disabilities.
2.6 SUICIDAL INDICATORS
The studies conducted by Perales and his collaborators in 1995 and 1996 in the Districts of Rimac7 and
Magdalena8 showed worrying fgures which were confrmed not only by the results obtained from the 2002 ESMH
performed in Lima and El Callao regarding suicidal indicators, but by the generational upward trend shown. The lifetime
prevalence of the desire to die in adults, teenagers and senior adults was 30,3%, 29,1% and 27,8%, respectively, which
suggests that if the lifetime prevalence of a teenager today is similar to that of an adult and higher than that of a senior
adult, a substantial increase of these tendencies is being faced. Furthermore, the annual prevalence of the desire to
die is higher in teenagers (15,3%) compared to adults (8,5%) and senior adults (12,2%). Teenagers who reported their
desire to die in the last year indicated problems with their parents as the main reason, while adults mainly relate the
desire to die with problems with their partner. These fndings are coherent with the specifc prevalence of depressive
episode that rises to 8,6% in teenagers, and to 6,6% in adults.
34
Given that the socio-cultural factors between the Peruvian Andes and the City of Lima are quite different, the
study of these indicators in the region would help not only to consider regionalized policies, but to learn about certain
psychosocial and etiological dynamics concerning this problem as well. This study included as suicide indicator not only
the desire to die and the suicide attempt, but also the presence of active suicidal thoughts with the intention to address
suicidal behaviour in greater depth.
2.7 MENTAL DISORDERS AND DISABILITY
Psychiatric disorders have been greatly underestimated as a cause of disability, however, they constitute 5 of
the main 10 causes of disability and 47,2% of all the disability-adjusted life-year (DALY) in developed countries. It is
estimated that mental health problems account for 8,1% of DALY loss in relation with the total number of illnesses.
According to the World Health Organization (WHO), psychiatric disability accounts for more than 40% of
disabilities worldwide and affects especially the young population, evidencing at the same time the lowest rate for social
and working capacity recovery. According to that same information, the disabled population in Peru represents around
1,5 million to 2 million persons, of which 500,000 to 600,000 are children and teenagers. This population is usually
discriminated and suffers exclusion from certain social spheres, causing shortcomings in the personal development and
social integration.
In the mental health feld, it can be observed that mental disorders tend to become chronic and to produce
after-effects in the persons suffering from them, despite progress made with the treatment. Thus, due to different
reasons, progress in the rehabilitation of these disorders has not developed parallel to biological treatment
37
2.8 ACCESS TO MENTAL HEALTH ASSISTANCE SERVICES
Studies on access to mental health assistance services show that persons with lower income, less cultural
resources, and suffering from language discrimination and poor educational levels are the ones whose access to these
services is mainly affected38. In the Peruvian Andes, cultural infuence and its interrelation with educational levels are
specially signifcant when related to health problems owing to the fact that myths and prejudices are quite common,
where indigenous medicine could play an important role. The studies on access to mental health assistance services in
Lima and El Callao confrmed the importance of cultural factors for obtaining mental health assistance services, even
more than economic factors.
1
In Lima, 24,5% of the population that admits to having suffered mental health problems had access to health
assistance services. The factors that were found to have relation with the access included: age, marital status, family
communication, religious commitment and coverage in the insurance system. The reasons claimed by those not
seeking health care were, in order of frequency: I felt I had to overcome it alone 59,4%, I had no money 43,4%, no
trust 36,9%, doubts about physicians being able to handle the problem 30,8% and others. The foregoing evidences
the infuence of cultural and to some extent, economic factors. The poverty factor is not yet decisive with respect to
accessing mental health assistance in Metropolitan Lima, where cultural factors prevail.
There are no nationwide studies regarding access to mental health assistance services in the Peruvian Andes.
As a reference, the study on Determinants Factors for Access to Health Care Services in Peru, performed according to
the 2000 National Household Survey (National Institute of Statistics and Data Processing -INEI) found that populations
with lower income, rural, and with unsatisfed basic needs were the ones that accessed health care services less. On
the other hand, this survey only addressed physical problems and did not consider any question concerning mental
GENERAL REPORT
35
health.39 The National Household Survey on Quality of Living Ratings (2000 NSQLR) showed that health care (general)
is similar among men and women, greater in urban than in rural areas, tending to increase according to the income
level.40 It is possible that in the case of mental health other social and cultural variables may have an effect, as well
as previous indirect experiences with the system. Access to mental health assistance services has been measured
both through the perceived need for assistance (that is, those persons who have perceived mental health problems in
themselves) and the perceived need for assistance expressed through the different health care services, both public
and private, as well as in the cases detected and implicitly unidentifed by the person as mental health problems.
2.9 POVERTY AND MENTAL HEALTH
Recent national surveys show that over half the Peruvian population lives in poverty; in Lima this fgure is close
to one third of the population.41 For the Andean region such situation is much more disturbing. The overall economic
situation and the poverty levels of the country have a direct impact on health conditions due to the close relation existing
between the level of education and the hygiene practices of the population. This relation has been avoided in the
mental health feld because poverty indicators have tended to be related to more material connotations. Nonetheless,
bringing poverty closer to the concept of well-being creates a new perspective from which new arguments arise relating
it to mental health as well. From this point of view, poverty would affect not only the persons physical health, but their
mental health too.42 In its 2001 annual health report, the WHO emphasized the relation between poverty and mental
health, particularly with the depressive episode.
9

In the Peruvian sphere, the 2002 Metropolitan Epidemiological Study on Mental Health conducted in the City of
Lima and El Callao revealed a signifcant association between poverty indicators and anxiety and depressive disorders,
underlining the importance and need to consider the study of socioeconomic factors in mental health studies. Moreover,
studies on poverty in the country41 have found that poverty indicators are much higher in areas such as the Andean
region, where the percentage of people living in poverty is 72% of the population. Therefore, we fnd ourselves in an
environment that unfortunately not only favours an increase of mental health problems in deprived sectors, but also
affects their possibility to access health care services. In countries as poor as ours, it is essential to continue exploring
different scenarios in order to identify the variables that have an effect on mental health or on poverty so that more
specifc corrective measures and effective intervention or prevention measures may be structured. The purpose of the
study in this area was to explore the relation existing between the socioeconomic level expressed in terms of poverty
and the presence of mental health problems in the broadest sense in the population of the cities of Cajamarca, Huaraz
and Ayacucho.
2.10 LIFE EVENTS AND MENTAL HEALTH
Different clinical and epidemiological studies and in particular the classic Bowlby studies (1969, 1973, 1980)
have made it possible to associate adverse life events with the development of mental illness. There is suffcient
information, for example, to prove that parental separation, parental threats of abandonment, excessive control of
childrens behaviour and lack of attention in their care, among other, will cause emotional disturbances during adulthood.
The purpose of this research has been to obtain information regarding this relation in our population. To this effect, the
survey in the epidemiological study for the Peruvian Andes included questions concerning adverse life events in order
to compare them with the data obtained with the prevalence of mental disorders.
43
36
2.11 SOCIAL AND CULTURAL FACTORS AND MENTAL HEALTH
The health needs of the population in Peru have been being met for some time now by two parallel systems:
offcial or academic medicine and indigenous or traditional medicine.44 Morbidity studies in open populations and
experience gained by different researchers worldwide indicate that a signifcant majority (70 to 80%) of reported
episodes of disease is handled outside the offcial system of medical attention by alternative systems such as those
offered by the indigenous or traditional medicine, among others.
45
Information about this area is rich in quality, quantity and diversity owing to the studies conducted by Peruvian
and foreign scientists during the past 50 years.46 On the other hand, studies regarding the social, medical and folkloric
factors of indigenous or traditional medicine were not planned with methodological rigor47 and no data systematisation
was obtained. Likewise, an epidemiological study that would attempt to explore not only social and cultural syndromes,
but also their solutions, diagnostic and treatment strategies had never been performed before. Some research, although
incipient, has been accomplished on traditional spirituality and religiousness, as an act of resistance and identity as well
as of integration and solidarity.48 Finally, some results are shown in this module, although for the time being, they are
only considered to be hypothetic conclusions.
2.12 DISCRIMINATION AND MENTAL HEALTH
According to the Royal Spanish Language Academy, the word discrimination refers to the action and effect
of discriminating and in its frst sense, to separate, distinguish, or differentiate one thing from another, whereas in its
second sense, it means to treat a person or a group as inferior on account of racial, religious, political or other reasons.
Both senses must be combined to understand to some extent the discrimination process. The ability to discriminate in
the frst sense, is an essential ingredient for the development of human beings and probably one of the foundations on
which they survive as species.
A signifcant number of international studies endorse the importance of the relation between discrimination and
mental health. Discrimination as a psychosocial stress factor is considered as one of the most important secondary
stress elements associated to major stressful events, such as losing a job or exposure to violence.49Among the
reasons for discrimination, gender, sexual preferences,50racism,51 ethnics,52 social status,53 and even the mental
health condition itself,54 besides more subtle reasons, such as physical beauty, age, etc. are associated with mental
health. The mental health measuring tools used to evaluate the effects of discrimination were psychological distress, life
satisfaction, feeling of happiness and anxiety or depression symptoms.52 It seems that the prevalence of discrimination
would be very high. According to an epidemiological study conducted in the United States53, the great majority of
people have experienced some kind of major discrimination throughout their life and 30% consider they experience it in
their everyday life. For example, according to this study, 48% of those surveyed perceive at some point that people act
as if they were inferior; 40% perceive at some point poor service in restaurants or stores; 43% perceive at some point
that people act as if they were not intelligent.
2.13 STIGMA AGAINST MENTAL DISORDERS
There are programs worldwide that fght attitudes against persons with mental health problems and
discriminatory behaviours associated with these attitudes; however, there is evidence that the current work is still
insuffcient. The stigma has an impact not only on the people suffering from a mental disorder, but on their relatives as
well. Understanding how family members are affected in terms of their psychological response to the sick person and
their contact with psychiatric services could improve the relationship with the family.
GENERAL REPORT
37
The stigma attached to schizophrenia affects the patients and their relatives, health professionals, psychiatric
hospitals, anti-psychotic drugs and other therapies. The stigma against people suffering from schizophrenia is supported
by the following myths:
They are violent and dangerous
They may pass their illness on to others
They are insane
They cannot make decisions
They are unpredictable
They cannot work
They must be hospitalised or imprisoned
They have no hope for recover
They are mentally retarded
It is due to some witchcraft or curse
They were poorly taken care of during childhood
The consequences of the stigma may be summarized as follows:
Social isolation
Hopelessness
Fear of patients suffering from schizophrenia
Contempt and rejection
Less employment opportunities
Inadequate treatments
The stigma is fought by increasing the quality of life:
Reducing the symptoms experienced by the person through pharmacological treatment
Reducing adverse consequences of the illness
Improving the individuals social competence
Increasing family and social support in areas such as employment, home chores, socialization and recreation
The Epidemiological Study on Mental Health in the Peruvian Andes: Ayacucho, Cajamarca and Huaraz is
conducted within the framework of the mental health diagnosis study in Peru, initiated by the Specialized Institute of
Mental Health (IESM) in 2002, which plans to cover the main cities in the country. This report includes the main results
in three cities and some indicators by city. City-by-city reports and in-depth publications on specifc topics follow.
38
III. OBJECTIVES
This study consisted of 15 main sub-projects. This summary includes the objectives of each one of them.
3.1 OBJECTIVES BY CHAPTER
Identify the importance of mental health conditions such as the prevailing feelings of the population, sociopathic
behaviours, degree of family unity and support, quality of living, disability, discrimination, expressions of emotional
distress, etc. of the population in the cities of Ayacucho, Cajamarca and Huaraz in 2003.
Determine the prevalence of suicidal indicators in adults, senior adults and women, and in specifc groups such as
mistreated women in the cities of Ayacucho, Cajamarca and Huaraz in 2003.
Find the signifcance of the factors associated with family violence and their connection with the cities of Ayacucho,
Cajamarca and Huaraz in 2003.
Determine the prevalence, clinical factors, risk and protection factors related to addictive behaviour in the cities of
Ayacucho, Cajamarca and Huaraz in 2003.
Identify the sociodemographic characteristics, the prevalence of the most frequent mental and physical disorders
and the issues concerning mental health in general of the population over 60 years of age in the cities of Ayacucho,
Determine the magnitude, risk factors and factors associated with depressive disorder, anxiety and suicidal indicators
in teenagers over 12 years old in the cities of Ayacucho, Cajamarca and Huaraz in 2003.
Determine the prevalence and characteristics of eating disorders, risk and protection factors, in the cities of Ayacucho,
Estimate the prevalence of anxiety disorders (agoraphobia, panic disorder, generalized anxiety disorder, social
phobia, obsessive compulsive disorder, post-traumatic stress disorder) as well as issues related to quality of living,
and the effect and infuence of upbringing styles in the cities of Ayacucho, Cajamarca and Huaraz in 2003.
Estimate the prevalence of depressive disorders (dysthymia, major depression) and issues related with the quality of
living, and the effect and infuence of upbringing styles in the cities of Ayacucho, Cajamarca and Huaraz in 2003.
Estimate the prevalence of psychotic disorders (psychotic syndrome and bipolar disorder) and issues related with
the quality of living, and the effect and infuence of upbringing styles in the cities of Ayacucho, Cajamarca and
Huaraz in 2003.
Determine the magnitude and the factors that affect and are associated or interfere with equal access to health care
of people with mental health problems in the cities of Ayacucho, Cajamarca and Huaraz in 2003, both globally and
in specifc psychiatric pathologies.
GENERAL REPORT
39
Establish the magnitude and relation that exists between socioeconomic levels expressed as poverty and mental
health problems in the cities of Ayacucho, Cajamarca and Huaraz in 2003.
Explore factors related to traditional medicine, such as traditional medicine agents, popular or indigenous clinical
syndromes, diagnostic methods, therapeutic methods and the correlation between the clinical symptoms and signs
of popular or indigenous syndromes and the clinical psychiatric syndromes in the cities of Ayacucho, Cajamarca and
Huaraz in 2003.
Identify the human development level achieved by the population of the cities of Ayacucho, Cajamarca and Huaraz
in 2003.
Identify attitudes towards the stigma attached to mental disorders in the population of the cities of Ayacucho,
IV. METHODOLOGY
The 2003 Epidemiological Study on Mental Health in the Peruvian Andes consists of 15 chapters or major
topics. The procedures section will include therefore the procedures to be used in all the interviews for the project.
4.1 TYPE OF DESIGN AND STUDY
Descriptive epidemiological cross-sectional type.
4.2 SAMPLING DESIGN
4.2.1 TARGET POPULATION
The target population for this study includes in general people over 12 years old, living in individual households
in the cities of Ayacucho, Cajamarca and Huaraz.
These three cities are considered prototypes for the development of this research and are taken into account
as three different cultural groups that have experienced different social processes throughout the past 25 years.
4.2.2 INFERENCE LEVELS
The sample is designed to provide reliable results in the following inference levels:
Socioeconomic strata:
Not poor
Poor
Extremely poor
40
4.2.3 SAMPLING FRAMEWORK AND SAMPLING UNITS
The sampling framework of the National Institute of Statistics and Data Processing (INEI) is used, prepared
according to the Pre-survey of 1999.
For the purpose of this research, the sampling framework includes the following sampling units:
Primary sampling units: conglomerates or groups of adjoining houses organized in spatial blocks in consolidated
areas, and adjoining housing groups separated by established spaces in non-regulated settlements within the
urban area of the districts that make up the cities.
Conglomerates consisting of 80 households in average, ranging from 40 to 151.
Secondary sampling units: individual houses within each of the conglomerates selected in the frst stage.
Final sampling units: persons that meet the criteria in order to be included in the research modules.
4.2.4 STRATIFICATION
No explicit stratifcation has been made, as there is no information available to enable the identifcation of
differential factors of mental health associated with the distribution of the population in the surveyed cities. In this
respect, a systematic sample will enable a broader dispersion and spatial coverage of the population and allowing
post-stratifcation according to the results.
4.2.5 TYPE OF SAMPLE
It is a probability sampling, performed in three stages, using systematic selection proportional to the size of the
primary sampling units, selection of compact housing conglomerates during the second sampling stage and simple
selection of persons in the fnal stage among those who meet the eligibility criteria. The sample is weighted in order
to reproduce the demographic structure of the surveyed population.
4.2.6 SAMPLE SIZE AND DISTRIBUTION
The sample consists of 4 212 households for the 3 surveyed cities altogether.
In order to ensure a more or less constant accuracy level in each of the surveyed cities, the sample will be
distributed in three equal parts, each representing 1 404 households.
A total of 117 conglomerates will be selected in each of the cities and 2 compact segments of 6 households
each will be surveyed for each conglomerate, making a total of 12 households per conglomerate.
The 117 conglomerates of each city were distributed in proportion to the number of conglomerates in each
district, based on the information available in the sampling framework of the INEI.
GENERAL REPORT
41
Table 1 shows the distribution of the sample by cities and districts.
TABLE 1
DISTRIBUTION OF SAMPLES
City and Districts # Conglomerates
per City
# Conglomerates
per District
Households per
District
Households per
City
Huaraz
117 1 404
Huaraz 57 684
Independencia 60 720
Cajamarca
117 1 404
Cajamarca 111 1 332
Baos del Inca 6 72
Ayacucho
117 1 404
Ayacucho 71 852
Carmen Alto 11 132
San Juan
Bautista
23 276
Jess Nazareno 12 144
Total
351 351 4 212 4 212
4.2.7 UNITS OF ANALYSIS
Teenagers 12 to 17 years old
Married woman or cohabitant woman, woman head of household or spouse of head of household
Adult, 18 years of age or older
Senior adult, 60 years of age or older
4.2.8 PROCEDURES FOR THE SELECTION OF SAMPLES
The sampling of persons will be selected in three stages and independently in each city. The frst stage
will focus on the selection of conglomerates, the second stage on households within each of the conglomerates
selected in the frst stage and the fnal stage will focus on the selection of persons of each target population within
each selected household.
4.2.8.1 Selection of primary sampling units (PSU) or conglomerates
The PSU were selected systematically and with a probability proportional to the amount of households within
each of the districts. A total of 117 conglomerates were selected in each city.
In order to eliminate biases due to a non updated sampling framework, the feld personnel registered the
occupied houses in each of the selected conglomerates and the registers were completed in standardized forms.
42
4.2.8.2 Selection of secondary sampling units (SSU) or households
The SSU were selected in two compact segments of six consecutive houses in each conglomerate. The
segments were selected systematically, based on the number of occupied houses registered in the conglomerate,
with a random baseline defned in the selection table for such purpose, randomly created according to an even
distribution of probabilities. None of the selected houses were replaced.
The steps to select the houses were:
i) Determine the number of occupied houses in the conglomerate, taken from the register prepared by the feld
personnel.
ii) Locate in the selection table, the total number of occupied houses in the conglomerate.
iii) Start the frst group or compact segment with the house bearing the sequential occupied house order number
appearing in the column of the frst group of the table and carry out a survey of up to six households.
iv) Start the second group or compact segment with the house bearing the sequential occupied house order number
appearing in the column of the second group of the table and carry out a survey of up to six households.
4.2.8.3 Selection of fnal sampling units (FSU) or persons
The number of usual residents in each of the selected houses meeting the different eligibility criteria was
determined. A column was established in the household members registration sheet, where each of the eligible
persons within the target population was identifed. The persons to be surveyed were randomly selected using the
peoples selection table, except the female partner (woman head of the household or spouse of the head of the
household, regardless of her condition as married or cohabitant).
In households sheltering more than one family, only the persons that formed part of the main family were
considered.
None of the persons selected in each target population were replaced.
4.2.9 CRITERIA FOR INCLUSION OF THE PEOPLE WHO ANSWERED THE SURVEY
Teenagers ranging from 12 to 17 years old, with no communication problems. In the event of moderate or
severe mental problems preventing direct communication with the person, indirect interviews were conducted with
the head of the household. If the persons language was quechua, the communication was achieved through a
quechua-speaking surveyor.
Married or cohabitant woman, who is head of household or spouse (or former spouse) of the head of
household with no communication problems. If the persons language was quechua, the communication was
achieved through a quechua-speaking surveyor.
Adults over 18 years old, with no communication problems. In the event of moderate or severe mental
problems preventing direct communication with the person, indirect interviews were conducted with the head of the
household. If the persons language was quechua, the communication was achieved through a quechua-speaking
surveyor.
GENERAL REPORT
43
V. DEFINITION OF OPERATIONAL VARIABLES
The following operational variables have been agreed upon for this study, using experts opinions in several
cases.
5.1 SOCIO-DEMOGRAPHIC AND ASSOCIATED VARIABLES
Age - Will be recorded as a continuous quantitative variable according to analysis units.
Marital status - Single, married, cohabitant, separated, widow or divorced. This variable is measured using a
nominal scale.
Educational level - The following categories are recorded: none, pre-primary education/ kindergarten,
incomplete primary education, full primary education, incomplete secondary education, full secondary education,
baccalaureate, post secondary non-tertiary education, tertiary education and graduate studies. They are presented as
multiple alternatives and are measured on an ordinal scale, using the Metropolitan Epidemiological Study on Mental
Health (MESMH) questionnaire. For the purpose of determining number of study years, a year of education has been
considered for pre-primary education/kindergarten.
Poverty level according to family income and poverty line - It is a subjective evaluation based on whether
the family income provides for the basic needs of the person such as food, housing, health, education, clothing (basic
needs) and other non basic needs such as entertainment, hobbies, differential education, etc. Should the persons
answer that their family income does not even cover basic food needs, they would be considered as extremely poor;
should family income cover basic food needs but not other basic needs such as clothing and housing, they would be
considered poor; should all basic needs be covered they would be considered not poor, similar to the persons who are
able to cover all their basic needs plus other non basic needs such as entertainment and leisure. These variables are
measured on an ordinal scale through the MESMH questionnaire.
Poverty level.- Questions and answers on monthly consumption, as well as questions on the amount of
unsatisfed basic needs (physically inadequate houses, overcrowded homes, houses without bathrooms, homes with at
least one child who has not attended school, head of family with incomplete primary education and homes with three or
more persons per income recipient) and expenses level per consumption. These variables are measured on an ordinal
scale.
Kinship.- Parental relationship with regard to the married woman or in a relationship, measured on a nominal
scale.
Gender.- Male or female; nominal scale.
5.2 MENTAL HEALTH FACTORS
Quality of life - Physical, emotional, social and spiritual well being, measured on the Mezzichs Quality-of-Life
Index, on an interval scale.
44
Family unity - Strength of ties bonding family members, translated into behaviours such as mutual respect
and support, family pride, sharing of activities, principles and values, measured on an ordinal scale.
Family dynamics - Interaction of a group of persons who are related to each other, live together and have
some common situation, opinion or tendency.
Physical disability - Physical or mental disability of a person that causes personal, work and mental health
limitations, measured according to the Epidemiological Study on Mental Health in the Peruvian Andes (ESMHPA)
questionnaire on an ordinal scale.
Stress - Group of physical, chemical or emotional reactions experienced by a person in response to a
determined situation that involves demand, requirement, privation or abuse. This may be the source of a physical
disease or mental health disorder, such as anxiety, depression, among others. This variable is measured on a nominal
scale using the ESMHPA questionnaire.
Psychosocial stressor - Event existing in the family, work, social and community environment or in political
economic and cultural contexts which produces stress in the person surveyed.
Environmental stress - Stress experienced by a person due to stimulus produced by the persons physical
environment such as noises, bad odour, poor ventilation, reduced spaces which was measured on an ordinal scale.
Opinion on country problems - Subjective appreciation of the person surveyed regarding the main problems
of the country, measured on a nominal scale using the ESMHPA questionnaire.
Psychopathy - Trait of an antisocial personality characterized by dysfunctional behaviour in the personal,
family and social environment, measured through questions on a nominal scale with regards to actions such as lying or
taking part in criminal acts.
Psychological health - Mental condition of a person in a specifc moment, measured through questions
based on the Mental Health Questionnaire of Colombia.
Work satisfaction - Subjective evaluation made by the persons surveyed regarding the accomplishment of
their needs and expectations within the work environment in matters such as duties exercised, salary received, physical
environment, co-workers, work burden, appreciation or credit from bosses. This variable is measured on an ordinal
scale.
Personal satisfaction - Subjective evaluation made by the persons surveyed on the attainment of their needs,
wishes and personal expectations in relation to their physical appearance, intelligence, studies, social relations, and
economic situation. This variable is measured on an ordinal scale using the ESMHPA questionnaire.
Solidarity - Circumstantial support to the cause or enterprise of third parties, measured on a nominal scale
using the ESMHPA questionnaire.
Use of substances - Consumption patterns of a psychoactive drug that may cause harmful consumption or
dependence. This variable is measured on a nominal scale, using the research criteria of the International Classifcation
of Diseases, Tenth Revision (ICD-10) and the ESMHPA.
GENERAL REPORT
45
Use of free time - Administration of time not used for work or study in which entertainment or social activities
are carried out.
Religious tendencies - The interviewees affliation and/or religious participation expressed in their knowledge,
feelings and practices which is measured on a nominal scale through the ESMHPA questionnaire.
5.3 CLINICAL DISORDERS
Addictive Disorders - Consumption problems (harmful or dependant) of alcohol, tobacco and illegal
substances, measured on a nominal scale in accordance with an adaptation of the Mini International Neuropsychiatric
Interview (MINI) using the research criteria of the ICD-10.
Affective disorders - Depressive episode and dysthymia, measured on a nominal scale in accordance with a
MINI adaptation using the research criteria of the ICD-10.
Clinical disorders - Mental health disorders, such as anxiety disorders and affective and psychotic disorders,
measured on a nominal scale in accordance with a MINI adaptation using the research criteria of the ICD-10.
Anxiety disorders - All anxiety disorders that may be clinically diagnosed, such as generalized anxiety
disorder, social phobia, agoraphobia, panic disorder, obsessive compulsive disorder and post-traumatic stress disorder.
This variable is measured on a nominal scale in accordance with a MINI adaptation using the research criteria of the
ICD-10.
Eating disorders - Bulimia nervosa and anorexia nervosa, measured on a nominal scale in accordance with
a MINI adaptation using the research criteria of the ICD-10. The Eating Disorders Inventory (EDI-2) questionnaire has
also been used.
Psychotic disorders Measured on a nominal scale in accordance with a MINI adaptation, providing results
at syndrome levels.
5.4 DISABILITY AND LACK OF SKILLS
Lack of skill - When the individuals, without presenting a mental disorder, have not developed enough
personal skills to function in their social and working environment.
Psychiatric disability - Decrease of ability or loss of functioning capacity as a person in the family, social or
working environment due to mental disorder.
Physical disability - Limitation to develop as an individual in the social and working environment, due to
tissue lesion, functional or physiological alteration caused by traumatism or organic disease.
46
5.5 SERVICE ACCESS MODULE
Access to mental health care services - Questions and answers on access to health care services in relation
to mental health problems. Having been treated in any health care institution, such as an emergency centre, health
centre, polyclinic, general hospital, specialized centre shall be considered a positive reply. This is measured on a
nominal scale.
Obstacles in the process of seeking treatment.- Answer to questions on the reasons why there was no
access or late access to treatment; measured on a nominal scale.
Knowledge on mental health - Knowledge on the main psychiatric disorders and their treatment; measured
on a nominal scale.
Gender - Self-identifcation according to sexual role; gender and sex terms are usually used indistinctly.
Nevertheless, sex is understood specifcally as biological and physical characteristics that convert a person into a
male or a female at the moment of birth, while gender is considered to be the identifcation of sexual behaviour of the
community members. The relation between the different variables is measured on a nominal scale using the ESMHPA
questionnaire.
Prejudices toward mental health - Myths, popular concepts and suppositions as social representations that
infuence the individuals perception and behaviour.
5.6 INTRAFAMILY RELATIONSHIPS
Systematic abuse or mistreatment - Any kind of mistreatment or abuse with a frequency of once or twice a
month in the last year.
Upbringing styles - Ways and behaviours exhibited by parents toward their children that are considered
raising techniques and which may or may not cause future emotional problems.
Women mistreated during the courtship period - Inappropriate and inadequate behaviour of the current
or last companion during the courtship period, which include physical, sexual or psychological violence, as well as
infdelity, indifference, frequent lies, jealousy and excessive control, carelessness due to alcohol consumption and
chauvinist behaviour. This is measured on a nominal scale.
Violence towards children.- Verbal, physical, sexual abuse or indifference towards a child which may be
harmful, causing physical and psychological consequences; measured on a nominal scale in addition to using the
ESMHPA questionnaire.
Violence during the courtship period - Aggressive behaviour such as frequent yelling, fts of violence,
physical mistreatment, or forced sexual relationships.
Physical violence - Hitting, punching or shoving, assessed on an ordinal scale that measures the frequency
of the act.
GENERAL REPORT
47
Violence towards women - Physical, sexual or psychological abuse towards women that cause physical and/
or psychological damage. They include threats, emotional manipulation, humiliation, manipulation and abandonment;
considered to be synonymous with mistreatment towards women. This is measured on a nominal scale in addition to
using the ESMHPA questionnaire.
Violence due to abandonment - Situations in which the person has not been provided with medicines,
adequate clothing, medical care or other basic needs; considered to be synonymous with mistreatment due to
abandonment. This is evaluated on an ordinal scale that measures the frequency of the act.
Psychological violence - Insults, verbal aggressions, offences, blackmail, manipulation or humiliations.
Sexual violence - Inappropriate forced sexual acts against the persons will; considered to be synonymous
with sexual mistreatment. This is evaluated on an ordinal scale that measures the frequency of the act.
5.7 COGNITIVE FUNCTIONS
Daily life activities - Activities practiced everyday. They include: use of personal money, the capability to buy
things such as clothes and food, to turn the kitchen on or off to prepare coffee and meals, to keep up to date on the
current community, neighbourhood and family events, to be able to follow up and discuss events broadcasted through
any communication media, to be able to administer their own medications, to remember obligations, to walk on their
own around the neighbourhood, to be able to fnd their way back home and leave home alone. Daily life activities are
measured through the Pfeffer Scale.
Agnosia - Loss of ability to recognize persons, objects, sounds, shapes or smells which were once familiar;
measured on a nominal scale in addition to using the Folstein tests.
Comprehension - Mental ability to pay attention, understand and communicate adaptively; measured on a
nominal scale, using Folstein tests.
Concentration - Paying attention to a task over a period of time; measured on a nominal scale, using Folstein
tests.
Visuospatial construction - Visual perception of spatial relationships among objects; measured on a nominal
scale, using Folstein tests.
Disgraphy - Problems in written communication; measured on a nominal scale, using Folstein tests.
Memory - Psychic ability to retain and remember past experiences, facts, data or reasons related to a specifc
issue; measured on a nominal scale, using Folstein tests.
Orientation - An individuals awareness of self in relation to time, person, and place; measured on a nominal
scale, using Folstein tests.
48
5.8 SOCIOCULTURAL SYNDROMES AND MENTAL HEALTH
Curse, witchcraft- It is an indigenous syndrome of varied symptomatology and chronic evolution, very common
in the three Peruvian regions. Curses may present themselves in the form of physical, mental or moral symptoms.
Treatment is based on magic religious rituals associated with prayers and songs.
Fright - It is produced when the spirit leaves the body of a person due to a severe experience or accident that
causes fright or fear.
Evil eye, eyeing - Most frequent in children, it is produced by the magic act of a person staring at another
person.
Air - In traditional medicine, air is the most frequent etiological agent for a great number of diseases.
Chucaque - It is produced when a person experiences an embarrassing situation. The symptoms consist in
cephalalgia and digestive problems.
VI. INSTRUMENTS USED TO PREPARE THE QUESTIONNAIRE
Ten modules covering the different areas were prepared as described further on. These questionnaires were
planned based on the experience of teams specialized in the different areas and on the following tools:
Mental Health Questionnaire - Originally prepared in Colombia1 and used and adapted in previous studies
conducted by the Institute, both in adults and teen-agers1,7,8. An in-depth adaptation of this instrument was
prepared for this study through the pilot study and experts criteria. Its sections gather information on the use of
substances, antisocial behaviours, emotional distress symptoms, self-aggressiveness and hetero-aggressiveness,
social support, psychosocial stressors, etc.
Quality of Life Index - Prepared and validated by Mezzich and collaborators in a Spanish version55. It is a
questionnaire consisting of 10 items that cover the factors of quality of life most frequently used to evaluate
the quality of living concept. It covers factors such as physical and psychological well-being, self-care, and
independence at both working and interpersonal levels, social and emotional support, community support, sense of
fulflment, and global assessment as well. This instrument was adapted into a version for the Peruvian population.
EMBU (Egna Minen av Bardoms Uppfostran) (Own recalling about upbringing) - This is an instrument applied
in several European countries to evaluate upbringing attitudes in adult persons which results in four factors: rejection,
emotional warmth, overprotection and favoritism56. Only some items with greater burden were used for this study.
Mini Mental State Examination (MMSE) - Prepared by Folstein57, it is one of the most used cognitive evaluation
instruments which evaluates factors related to orientation, memory, attention, calculations, language and
constructive skills.
GENERAL REPORT
49
Pfeffer Questionnaire - An instrument that measures cognitive factors through an informant. When used together
with MMSE, it can detect suspicious cognitive deterioration of dementia. Both tests used together have proved to be
highly sensitive (95%) and specifc (84%).
Domestic Violence Questionnaire - A questionnaire was prepared based on the Metropolitan Study on violence
and related behaviours in Metropolitan Lima and El Callao, by Anicama and collaborators5. This questionnaire was
validated and used in the 2002 MESMH.
Mini International Neuropsychiatric Interview (MINI) Spanish Version CIE-1058 - Prepared by Sheehan,
Lecrubier and collaborators, it is an instrument that, based on the International Classifcation of Diseases, Tenth
Review (ICD-10) obtains standardized information about the main psychiatric disorders. It has been adapted to
the language in order to obtain lifetime prevalence, 12-month prevalence and six months prevalence in addition to
current prevalence.
Questionnaire on Factors Determining Access to Health Care Services in Peru59 - Prepared by the Institute
of Statistics and Data Processing (INEI). Some questions were selected and adapted to the mental health model.
Eating Disorders Inventory (EDI-2) - Prepared by Garner and Olmed (1984, 1986). EDI-2 is a valuable self-
assessment instrument, very much used to evaluate symptoms usually associated with anorexia nervosa (AN) and
bulimia nervosa (BN). It is an easily applicable self-assessment instrument, offering scores in 11 scales that are
clinically relevant in the case of eating disorders. This inventory has been adapted and validated for our country by
the staff responsible for the respective area and is in the process of being published.
6.1 DESIGN AND STRUCTURE OF THE QUESTIONNAIRE ON MENTAL HEALTH
This questionnaire description includes all the chapters of the Metropolitan Epidemiological Survey.
6.1.1 TYPE OF SURVEY
The survey shall be carried out by operation of law, that is, the surveyed population will consist of all usual
household residents.
6.1.2 SCOPE OF SURVEY
6.1.2.1 Geographical scope - The survey was conducted at an urban level in the cities of Ayacucho, Cajamarca
and Huaraz.
6.1.2.2 Time scope - The survey took place during the months of September, October and November, 2003.
6.1.2.3 Scope of topics and periods of reference - The scope of topics of the research comprises:
a. Demographic and socioeconomic variables
i. Characteristics of the house (day of interview)
ii. Education (day of interview)
iii. Family employment situation and income (last 3 months)
iv. Family expenses (previous month)
50
b. General mental health factors
i. Self-esteem (last 3 months)
ii. Psychopathic traits (day of interview, last 12 months, lifetime)
iii. Eating disorders and related problems (last 12 months)
iv. Trust (day of interview)
v. Family bonding (last 12 months)
vi. Feeling of social support (day of interview)
vii. Feeling of safety in their environment (day of interview)
viii. Quality of life (previous month)
ix. Behaviour at personal, work, social and family level (previous month)
x. Degree of knowledge of factors regarding mental health (day of interview)
xi. Gender-related problems (day of interview)
xii. Discrimination (lifetime, last 12 months)
xiii. Human development (current)
xiv. Stigma attached to mental health (current)
c. Cognitive function (day of interview)
d. Domestic violence
i. Violence against women (lifetime, last 12 months)
ii. Violence against children (lifetime)
e. Clinical psychiatric disorders according to the International Classifcation of Disease - Tenth Review (ICD-10)
i. Anxiety disorders (lifetime, annual, 6 months, current, access to services during the last 12 months)
a. Agoraphobia
b. Panic disorder
c. Social phobia
d. Obsessive-compulsive disorder
e. General anxiety disorder
f. Post-traumatic stress disorder
ii. Affective disorders (lifetime, annual, 6 months, current; access to services during the last 12 months)
a. Depressive episode
b. Dysthymia
c. Manic episode
iii. Eating disorders (current)
a. Bulimia nervosa
b. Anorexia nervosa
iv. Addiction disorders (last 12 months)
a. Alcohol (dependence/abuse)
b. Other drugs (dependence/abuse)
v. Psychotic episode (lifetime, annual, 6 months, current)
f. General access to mental health care services (last 6 months)
GENERAL REPORT
51
6.2 METHOD OF INTERVIEW
The direct interview method will be applied, with duly prepared and trained personnel who will visit the homes
selected during the phase of gathering of information.
6.3 VALIDITY AND RELIABILITY
The 2002 MESMH included a pilot program to test the survey in 100 households, 20 in each of the suburban
zones. Trials were conducted together with the specialist in order to improve the consistency, adapting the instrument
in this way. For the purpose of this study, the necessary adjustments were made and a trial run was carried out in 25
households, selecting areas of the city of Lima inhabited by people who came from the cities involved in the survey.
Types of validity
Construction validity -The item-total technique was performed through correlations (adjusted for a better
discrimination of the evaluated item). Final Alpha coeffcients ranged between 0,65 and 0,94 for the different items.
Construct validity - The composition of indicators (items) that make up dimensions (factors) and fnally the
variables of the study on Mental Health Survey were analysed through the use of multiple different techniques, such
as factorial analysis. The factorial matrixes provided high correlation rates and optimum levels of signifcance (p <
0,01).
Type of reliability
Internal consistency coeffcient: The measure of homogeneity of an instrument through its variability was
determined using Cronbachs Alpha statistics. The fnal Alpha coeffcients ranged between 0,65 and 0,94 for the
different items.
Equivalence coeffcient: This coeffcient is determined by correlating the scores of parallel forms of the same tool.
In the case of the epidemiological study, second interviews were conducted in a sample, which made it possible to
perform the comparability (high coeffcients of sensitivity and specifcity) of the information regarding prevalences
of the different pathologies. Thus, pathologic consistencies such as depression and anxiety cases, among others,
were detected.
Stability coeffcient: Test Retest. This method was used to improve the reliability of digital information. The study
project considers a data re-entry process. In this way, the correlation between databases could be established,
ensuring high reliability of data before preliminary and fnal analysis (Exploratory Data Analysis).
6.4 OBTAINING VALIDITY AND RELIABILITY INDICATORS FROM THE STUDYS
OWN DATA
Mini International Neuropsychiatric Interview (MINI)
This test evaluates diverse clinical disorders such as depression, anxiety, post-traumatic stress, social phobia
and agoraphobia, among others. The consistency rates measured through Kappa statistics in pilot studies have reported
quotients between 0,60 and 0,87, with best results for the charts that reported higher prevalence.
52
Mental Health Questionnaire; Division of Human Behaviour by MINSA, Colombia
This adapted questionnaire was processed through the validity of its content, the techniques of judges and
experts who improved its content and phrasing for specifc populations. Consistency degrees through the binomial
statistic had a signifcance of less than 1,6% in average (being less than 5% an acceptable degree).
Quality of Life Index; Mezzich and Collaborators
This scale was psychometrically processed with factorial analyses, which discriminated the independence of
factors that constitute the construct Quality of Life.
EMBU; Upbringing attitudes
This scale was validated through total item analysis using a section i.e. some items of it for the study.
Mini Mental State Exam (MMSE); Orientation, memory, attention, calculation, language and constructive
skills (Folstein)
The MMSE was validated through statistics, correlation between test questions and diagnostic criteria through
other related tools.
Domestic Violence Questionnaire
The content validity and the reliability analysis over 0,85 were the methodological indicators that validated the
information gathered.
Questionnaire on Factors Determining the Access to Health Care Services
Same as the foregoing item. Said factors were also related to other questions in the questionnaire regarding
the clinical area and respective treatments.
EDI 2; Eating Disorder Inventory
This scale discriminated the integration of each item with the test in general, through the variability analysis of
answers.
6.5 TRAINING IN THE USE OF TOOLS
Training activities
Training of the surveyors and supervisors by the authors was an important part of the epidemiological study.
Activities of the Pilot Study
The pilot study enabled the feasibility of the fnal study, that is, obtaining valid and reliable information.
GENERAL REPORT
53
Supervision activities
Supervision was constant, while information was gathered and for quality purposes, through the follow-up of
desk and quantitative analyses.
6.6 ETHICAL CONSIDERATIONS
An informed consent was requested prior to starting survey in each of the units of analysis.
VII. FIELD OPERATION PROCEDURES
a) Tool construction - The survey was adjusted and tested in 25 households of people who were born in the area to be
surveyed. This feld validity was carried out with four surveyors and one supervisor. This allowed the survey to be
validated, measuring the time, exploring the presence of analysis units and making fnal adjustments regarding the
survey.
b) A Surveyor Manual was prepared; it specifed the characteristics of questionnaires as well as feldwork organization,
surveyors duties, identifcation and selection of households, and general and specifc instructions for flling in the
questionnaire. The Supervisors Guide was included in the Manual.
c) All selected surveyors were psychologists or psychology graduates, or graduates from some other health feld, with
some feldwork experience, preferably in mental health work.
d) All selected supervisors were psychologists or psychology graduates, or graduates from some other health feld, with
feldwork experience or who had participated in the instrument validity process. The supervisors were responsible
for the surveys technical and administrative management and for ensuring the quality of the information. The
surveyors who passed the training process with the highest score were selected as supervisors.
e) Nine surveyors, three supervisors and one feld coordinator were required for each city.
f) The researchers of the National Institute of Mental Health (INSM) were responsible for the technical training of
supervisors and surveyors. The aim was to develop a deep understanding of the situations to be studied, focusing
on mental health issues and the possible problems to be found through the exploration of this kind of issues.
Emphasis was made on interview techniques and the special attention to be given. The training included a thorough
review of the questionnaires, and feld tests were carried out. The training took nine days; the frst two were spent in
revising conceptual factors and studying defnitions related to the study; the third and fourth days were dedicated to
handling the questionnaire; the ffth, sixth and seventh days to feld tests and, fnally, the eighth day was dedicated
to standardize procedures and discuss operating factors.
g) The surveyors collected all the information in a 10-week period; an average of 2,5 households per day was
considered.
54
h) Data compilation - The direct interview method was used. The main household was interviewed. All the family
members were registered to determine the eligibility criteria of the four analysis units: one female spouse, one
adult, one teenager and one senior adult. The female spouse, female head of the family or the wife of the head of
the family was selected. When the head of the family was not a female spouse, the selection was made at random
from a chart supplied.
i) A program for the consistency and quality control of the information to be recorded in the Database was structured.
The survey results were entered with the help of eight people dedicated to this task since the frst week of the survey.
The statistical analyses were carried out in a Pentium 4 computer using the SPSS statistics program for complex
samples Version 12.
j) Consistency of data was considered - The frst consistency was provided in the feld by supervisors. After data
was entered, consistency was mechanized using the referred program which detected omissions and logical
inconsistencies; variables were validated and extreme values were identifed for subsequent verifcation.
k) Data analysis - As described below.
VIII. FIELD OPERATION RESULTS
Out of the 4 212 households scheduled, 4 058 were visited; data was completely collected from 3 871
households (91,90%) and incompletely collected from 187 households (4,43%); 74 households rejected the interview
(1,75%); members were absent in 69 households (1,63%). The level of successful openness was 96,34%. No major
problems were found and the cooperation of the interviewees was very satisfactory.
IX. DATA PROCESSING AND ANALYSIS
The characteristics of the sample and of each research unit have been analysed for this report such as average
age, age groups, distribution by gender, occupation, education, socioeconomic level according to income and poverty
level. Descriptive statistical analyses were carried out such as frequencies and main tendency rates, and the respective
proportions were estimated. Thereafter, persons with mental health problems were described and prevalences were
estimated accordingly.
In this report some cut off factors such as age variables, poverty level and place of residence associated
to variables of mental health have been generally related. When mental health variables (for example, depression
versus non depression) and the related variables (sex, age, coverage of basic needs, area of residence) were nominal,
the chi-square statistic test was used to compare proportions with a signifcant level of 0,05, taking into account the
sampling design. Statistics were used in each case according to the aforementioned procedures and according to the
type of variable. The standard errors, confdence intervals, design effect (deff) and coeffcient of variation have also
been described in most of the estimates. In general it can be assumed that a coeffcient of variation of up to 14,99% is
acceptable. Thus, it is suggested that readers consult such statistics in the respective appendix.
The SPSS 12 Statistical Program was used for the complex samples.
SURVEY RESULTS
55
SURVEY RESULTS
SURVEY RESULTS
57
SAMPLE INFORMATION
SURVEY RESULTS
59
SAMPLE INFORMATION
A total of 4 212 households in the cities of Ayacucho, Cajamarca and Huaraz were surveyed for this work
employing specifc modules on married or cohabitant women, preferably the woman head of the family or the wife of the
head of the family, an adult, a teenager and a senior citizen. The last three were chosen randomly from the household
members who conformed to those characteristics. Therefore in some occasions some of the persons surveyed belonged
to more than one module. Table 2 shows the number of persons surveyed for each analysis unit.
TABLE 2
PERSONS SURVEYED AS PER ANALYSIS UNITS IN AYACUCHO,
CAJAMARCA AND HUARAZ - 2003
Persons Surveyed Frequency
Adults 3 895
Married or cohabitant Women 3 268
Senior citizens 717
Teenagers 1 568
The sample was distributed equally in the three cities, making sure that the representation considered the
socioeconomic standards of the surveyed populations. Table 3 shows the population which was taken into consideration
for the estimations according to cities.
TABLE 3
TOTAL WEIGHTED POPULATION AND DISTRIBUTION PER CITY
(ADULT POPULATION)
City Weighted %
Ayacucho 76 556 33,2
Cajamarca 101 277 43,9
Huaraz 53 080 23,0
Total 230 912 100,0
With regard to the socioeconomic situation, poverty levels were evaluated using the method of unsatisfed
basic needs (UBN) similar to the method employed by the National Institute of Statistics and Data Processing (INEI)
as well as a subjective estimate of the capacity to cover basic needs. In this sense, a direct question was asked to the
woman head of the family or to the wife of the head of the family inquiring if their income covered certain basic needs.
In Table 4a it can be seen that in relation to the UBN, 39,8% of households surveyed are poor and 12,4% are extremely
poor, and according to the perception regarding the capacity to cover basic needs, 41,8% of households are poor while
3,9% are extremely poor (Table 4b).
60
TABLE 4A
POVERTY LEVELS AS PER UNSATISFIED BASIC NEEDS (UBN)
EMHSP - 2003
Poverty Levels as per Unsatisfed
Basic Needs
%
Extremely poor 2 or more unsatisfed basic needs 12,4
Poor 1 unsatisfed basic need 27,4
Not poor No unsatisfed basic need 60,2
*UBN: Overcrowding, inadequate housing (walls or roof), toilets, water supply, electricity, drinking water, households with children who
do not attend school.
TABLE 4B
POVERTY LEVELS AS PER SELF-PERCEPTION
TO COVER BASIC NEEDS - EMHSP 2003
Poverty Level as per Self-Percep-
tion of Consumption
%
Extremely poor Not even basic dietary requirements
are covered
3,9
Poor Only basic dietary requirements are
covered
38,9
Not poor, average Only basic dietary requirements and
clothing, etc. are covered
52,2
Not poor Basic requirements and other needs
are covered
5,0
61
ADULTS
CHARACTERISTICS
SAMPLE INFORMATION OF
ADULTS SURVEYED
63
ADULTS
CHARACTERISTICS OF ADULTS SURVEYED
A total of 3 895 adults were surveyed and according to the technical sampling design this number represents
230 912 inhabitants located in the cities of Ayacucho, Cajamarca and Huaraz; in the sample these were distributed
in 41,3% males and 58,7% females. The results are based on the expanded population and balanced with regard to
gender (Table 5).
TABLE 5
TOTAL NUMBER OF ADULTS SURVEYED IN AYACUCHO,
CAJAMARCA AND HUARAZ 2003
Persons Surveyed Frequency Male Female
Total number (not weighted) 3 895 41,3% 58,7%
Expanded 230 912 48,6% 51,4%
AGE
The weighted average age of adults surveyed was 35,7 years old, with a very heterogeneous distribution,
that is, people who were between 18 to 94 years old. In accordance with age groups, the sample shows a positive
asymmetry with the highest percentage belonging to the group between 25 and 44 years old (Table 6).
TABLE 6
AGES OF ADULTS SURVEYED IN AYACUCHO, CAJAMARCA AND HUARAZ 2003
Average Age Mean Standard Deviation
Weighted 35,7 15,1
Not weighted 36,7 14,9
AGE GROUP WEIGHTED (%) NOT WEIGHTED (%)
18 - 24 28,7 25,4
25 - 44 46,2 51,1
45 64 19,4 17,2
65 and older 5,7 6,3
EDUCATION
Illiteracy is higher in females. This has a signifcant effect on the different opportunities of this group emphasizing
that gender plays a role in this inequality (Table 7).
64
TABLE 7
ADULTS THAT CANNOT READ OR WRITE IN AYACUCHO,
Illiteracy Rate %
Total 6,7
Males 1,5
Females 11,6
According to the sample surveyed the higher percentage represents a level of education above that of a
secondary education. In this sense, no signifcant differences are evident between males and females with regard
to education (Table 8). The difference in percentages between persons with no academic level and the illiteracy rate
shows that despite the fact people attend primary school they become illiterate due to lack of practice.
TABLE 8
LEVEL OF ADULT EDUCATION IN AYACUCHO,
Educational Level Total % Male % Female %
None 5,7 1,4 9,7
Pre-primary education / Kindergarten 0,1 0,0 0,2
Primary education 17,8 15,1 20,3
Secondary education 32,6 35,3 30,0
Baccalaureate 0,1 0,2 0,0
Post secondary non-tertiary education 18,3 17,0 19,5
Tertiary education 24,5 29,5 19,8
Graduate studies 0,9 1,5 0,4
65
ADULTS
MARITAL STATUS
With regard to marital status, 55,6% of adults are in a relationship (living together or married) and 5,8% are
separated or divorced (Table 9)
TABLE 9
ADULT MARITAL STATUS IN AYACUCHO, CAJAMARCA AND HUARAZ 2003
Marital Status Total % Male % Female %
Unmarried (cohabitant) 22,3 20,6 23,3
Separated 5,5 2,3 8,6
Divorced 0,3 0,2 0,3
Widowed 3,4 1,9 4,9
Married 33,3 34,1 32,6
Single 35,1 41,0 29,6
EMPLOYMENT
A total of 68,4% of men worked the previous week in comparison to 47% women (Table 10). Unemployment
fgures reach 11,1%, with a lower percentage for women.
TABLE 10
ADULT LABOUR SITUATION IN AYACUCHO, CAJAMARCA AND HUARAZ 2003
Work Situation Total
%
Male
%
Female
%
Worked the previous week 57,4 68,4 47,0
Looking for a job 11,1 17,2 7,7
INCOME
More than half of the women have an average income of less than S/. 300, much higher if compared with men;
at the same time, more men have an income above S/. 1 200 (Table 11).
66
TABLE 11
AVERAGE PERSONAL MONTHLY INCOME IN THE LAST THREE MONTHS (NUEVOS SOLES) IN AYACUCHO,
Income (Nuevos Soles) Total
%
Male
%
Female
%
Less than S/.300 36,6 25,5 51,5
S/. 301 to S/. 600 27,9 33,1 20,9
S/. 601 to S/. 1 200 26,1 28,4 22,9
More than S/. 1 200 9,4 12,9 4,7
(Exchange rate: US $ 1.00 = S/. 2.50 Nuevos Soles)
ADULTS
67
ADULT MENTAL HEALTH IN THE PERUVIAN ANDES
CHARACTERISTICS OF MENTAL HEALTH
Mental health comprises a state of personal well-being in which a group of people from the individuals
environment is involved in dynamic and plural interaction. Everything that the human beings experience has an infuence
on their state of mind, motivations, and on their expectations and projects for the future. Thus, a series of questions
were considered covering several contextual factors of the persons life, both at a macro level as well as at a level
regarding their close social development.
Environment
Both men and women perceive that the main problem of the country is unemployment, 51,1% and 46,5%,
respectively. Poverty follows in importance, considered more important to women (27,6%) than to men (18%). Next to
be considered are fnancial management and corruption, although in much lower percentages (Table 12). The majority
of people surveyed showed concern, sadness or sorrow and bitterness or rage when faced with these problems. There
are differences between both genders regarding the feelings of sorrow or sadness which affects women more (Table
13).
TABLE 12
MAIN PROBLEMS PERCEIVED IN THE COUNTRY BY THE ADULT POPULATION IN AYACUCHO, CAJAMARCA
AND HUARAZ - 2003
Problems
Perceived
Unemploy-
ment
%
Poverty
%
Financial
Management
%
Corruption
%
Crime
%
Violence
%
Other
%
Total 48,7 22,9 6,5 6,2 5,3 2,7 7,0
Male 51,1 18,0 8,5 7,4 4,3 1,7 8,8
Female 46,5 27,6 4,7 5,1 6,3 3,5 5,0
TABLE 13
EMOTIONAL RESPONSE TO NATIONAL PROBLEMS OF THE ADULT POPULATION IN AYACUCHO,
Emotional
States
Worry
%
Sadness,
Sorrow or
Depression
%
Bitterness,
Rage or
Anger
%
Helpless-
ness
%
Disappoint-
ment
%
Other
%
Total 37,3 22,6 15,2 6,8 6,0 12,3
Male 36,5 17,1 16,7 7,8 6,9 15,0
Female 38,0 27,7 13,7 5,8 5,3 9,6
68
The lack of monetary capital and fnancial credit emphasizes the importance to strengthen share capital which
is based on trust. This is more important in areas with lower economic means, such as the countrys mountain region
(Andes). The amount of trust shown for authorities and for the people of their surroundings provide an estimate of the
degree of trust they have in the system. There is distrust for political authorities, community leaders or mayors and
for police and military authorities as well, both male and female. There is more trust for the religious authorities and
teachers (Table 14).
TABLE 14
TRUST IN AUTHORITIES AND IN THE PEOPLE OF THEIR SURROUNDINGS SHOWN BY THE ADULT
POPULATION OF AYACUCHO, CAJAMARCA AND HUARAZ 2003
Trust None or Little
%
Some
%
Pretty or a Lot
%
POLICE AUTHORITIES
Total 71,4 24,3 4,3
Male 70,8 25,2 3,9
Female 71,9 23,4 4,7
MILITARY AUTHORITIES
Total 70,8 23,7 5,5
Male 66,6 26,2 6,9
Female 74,6 21,2 4,2
RELIGIOUS AUTHORITIES
Total 36,1 31,6 32,3
Male 41,2 32,5 26,3
Female 31,3 30,7 38,0
TEACHERS
Total 22,6 46,7 30,8
Male 20,6 46,4 33,0
Female 24,5 47,0 28,6
POLITICAL AUTHORITIES
Total 92,9 6,2 0,9
Male 93,9 5,3 0,7
Female 91,9 7,1 1,0
UNION LEADERS
Total 64,7 26,6 8,7
Male 62,5 24,8 12,6
Female 67,4 28,8 3,8
COMMUNITY LEADERS / MAYOR
Total 82,0 15,8 2,2
Male 80,5 17,5 2,0
Female 83,3 14,2 2,5
NEIGHBOURS
Total 60,9 29,4 9,7
CONTINUA...
ADULTS
69
Male 55,5 32,9 11,7
Female 66,1 26,1 7,8
JOURNALISTS
Total 60,4 32,8 6,9
Male 58,3 34,6 7,1
Female 62,3 31,0 6,6
With regard to safety perceived in their environment, the majority feel they are not protected by the State
(79,9%) and women feel they are less protected than men. This contrasts greatly with the feelings of protection shown
by the family and the belief in God, mainly in Latin American countries, which could represent one of its strengths and
a safeguard against mental health problems.
TABLE 15
PROTECTION FELT BY THE ADULT POPULATION IN AYACUCHO,
Protection Felt None or Little
%
Some
%
Pretty or a Lot
%
FROM THE STATE
Total 79,9 18,1 2,0
Male 77,2 20,5 2,3
Female 82,5 15,8 1,7
FROM THE FAMILY
Total 10,9 15,2 73,9
Male 11,2 16,6 72,5
Female 10,7 13,8 75,5
FROM GOD
Total 5,3 7,5 87,2
Male 7,4 10,3 82,3
Female 3,3 4,9 91,8
FROM THE COMMUNITY
Total 52,6 34,3 13,0
Male 48,5 37,8 13,7
Female 56,5 31,0 12,5
Psychosocial stressors
Psychosocial stressors and the stress they cause are not only directly related to the development of mental
health problems or disorders but also to physical problems of diverse nature. Their evaluation and measurement explain
to a certain extent the social and economic conditions found in the country. From the fgures shown it can be concluded
that more than a third of the population, both male and female, go through various high stress situations; the fgures are
higher in situations related to health and economic factors. It is worth noting that women show higher stress levels with
regard to all indicators (Table 16).
70
TABLE 16
MAGNITUDE OF TENSION IN THE ADULT POPULATION IN AYACUCHO, CAJAMARCA AND HUARAZ WHEN
FACED WITH DAILY STRESSORS - 2003
Type of Psychosocial Stressor None or Little
%
Some
%
Pretty or a Lot
%
WORK
Total 37,9 28,2 33,9
Male 39,9 30,5 29,6
Female 35,3 24,9 39,8
STUDY
Total 31,6 26,3 42,1
Male 35,0 28,2 36,8
Female 27,7 24,0 48,3
CHILDREN AND RELATIVES
Total 38,9 20,5 40,6
Male 44,1 22,2 33,6
Female 34,1 19,0 46,9
PARTNER
Total 51,0 17,7 31,3
Male 56,4 17,5 26,1
Female 45,5 17,8 36,7
MONEY
Total 27,3 31,0 41,7
Male 30,8 35,1 34,1
Female 24,0 27,2 45,9
HEALTH
Total 25,2 23,6 51,2
Male 29,8 24,8 45,4
Female 20,9 22,4 56,6
LEGAL MATTERS
Total 79,9 10,1 10,0
Male 79,8 11,7 8,5
Female 80,1 8,6 11,4
TERRORISM
Total 42,1 15,9 42,0
Male 50,2 15,8 34,0
Female 34,5 15,9 49,6
CRIME
Total 25,3 14,3 60,4
Male 30,0 15,2 54,7
Female 20,9 13,5 65,7
CONTINUA...
ADULTS
71
DRUG TRAFFICKING
Total 40,2 15,8 44,0
Male 44,5 16,3 39,3
Female 36,2 15,3 48,5
The indicator of traumatic experiences is of special interest due to the increase of violence experienced in the
Andes. These experiences describe situations in which surveyed persons witnessed some extremely traumatic event,
during which people died or their life was seriously threatened. These situations can, in many cases, be the cause of
pathologies such as post-traumatic stress disorder. In the case of the adult population, 41% has experienced such
situations, with higher fgures in the case of males (Table 17).
TABLE 17
TRAUMATIC EXPERIENCES LIVED BY THE ADULT POPULATION
OF AYACUCHO, CAJAMARCA AND HUARAZ - 2003
Traumatic Experiences %
Total 41,1
Male 44,9
Female 37,5
There are other sources of stress besides psychosocial stressors such as the environmental characteristics of
the dwelling place. The persons surveyed were asked about the physical characteristics of their surroundings and how
much it bothered them, taking into account noise, lack of ventilation, lack of space and bad odours. A high percentage
of people experienced high levels of environmental stress in some of these situations (Table 18).
TABLE 18
ADULT POPULATION WITH HIGH LEVELS OF STRESS DUE TO SOME ENVIRONMENTAL
CHARACTERISTIC IN AYACUCHO,
Population with High Levels of Environmental Stress %
Total 43,3
Male 40,7
Female 45,8
Discrimination
An important source of stress is related to discrimination some people may experience. In addition, measuring
the existing discrimination may provide information about the social representations in a country, and if it is necessary
or not to plan strategies to modify them. For this purpose the study has tried to take into account all sources of
discrimination, both during life as well as during the period of reference of one year. Table 19 shows that the population
has very frequently perceived discrimination due to their economic or social situation and their academic level. Women
feel however that sex discrimination is equally important.
72
TABLE 19
LIFE PREVALENCE OF REJECTION OR DISCRIMINATION ACCORDING TO
TYPES OF ADULT POPULATION IN AYACUCHO,
Discrimination
Prevailing
during life
%
Frequency During Previous Year
Never
%
Rarely or
Occasionally
%
Frequently or Quite
Frequently
%
GENDER
Total 7,3 95,0 4,4 0,5
Male 2,7 98,2 1,8 0,0
Female 11,7 92,1 6,9 1,0
AGE
Total 7,0 94,9 4,4 0,6
Male 6,3 95,7 4,0 0,4
Female 7,7 94,2 4,9 0,9
WEIGHT
Total 5,3 95,5 3,9 0,6
Male 3,3 97,2 2.4 0,3
Female 7,2 93,9 5,3 0,8
SKIN COLOUR
Total 2,4 98,5 1,4 0,1
Male 2,3 98,6 1,4 0,0
Female 2,5 98,3 1,4 0,2
CLOTHING
Total 5,4 96,2 3,4 0,4
Male 4,7 97,0 3,0 0,0
Female 6,1 95,5 3,8 0,7
ECONOMIC OR SOCIAL SITUATION
Total 11,5 91,8 7,1 1,0
Male 12,1 91,1 7,4 0,7
Female 10,9 91,8 6,9 1,4
LEVEL OF EDUCATION
Total 9,7 92,8 6,6 0,6
Male 7,9 94,1 5,3 0,6
Female 11,3 91,5 7,8 0,7
RELIGION
Total 4,1 96,9 2,6 0,6
Male 4,3 96,9 2,4 0,7
Female 3,9 96,9 2,7 0,4
CONTINUA...
ADULTS
73
FRIENDS
Total 3,9 97,0 2,7 0,3
Male 4,4 96,6 3,3 0,0
Female 3,4 97,3 2,1 0,6
PLACE OF BIRTH
Total 3,7 97,8 2,1 0,1
Male 4,4 97,3 2,6 0,1
Female 3,1 98,2 1,6 0,2
Prevailing emotional states
The Peoples common emotional states are not by nature pathological states but can provide a quick idea
of mood tendencies that can affect peoples quality of life. The frequency of such current states of mind has been
investigated and common everyday terms have been used. In the general population between 10% and 30% of people
experience quite frequently negative emotional states such as sadness, strain, distress, irritability and boredom. It must
be noted that women experience these states more than men, which is directly related to the presence of depressive or
anxiety disorders (Table 20).
TABLE 20
PREVALENCE OF EMOTIONAL STATES OF THE ADULT POPULATION
IN AYACUCHO, CAJAMARCA AND HUARAZ 2003
STATES OF MIND
Never
%
Sometimes or
occasionlly
%
Always or
Almost Alwayst
%
SAD
Total 2,7 80,6 16,7
Male 3,9 87,5 8,5
Female 1,5 74,2 24,3
TENSE
Total 9,1 77,8 13,1
Male 12,0 80,2 7,7
Female 6,3 75,4 18,2
DISTRESSED
Total 15,5 73,7 10,8
Male 19,5 74,7 5,8
Female 11,8 72,7 15,5
IRRITABLE
Total 14,0 73,0 13,0
Male 17,4 73,9 8,7
Female 10,9 72,1 17,0
CONTINUA...
74
WORRIED
Total 2,1 67,0 30,8
Male 3,0 75,5 21,4
Female 1,3 59,0 39,7
CALM
Total 2,5 39,7 57,9
Male 1,7 32,8 65,5
Female 3,2 46,1 50,6
HAPPY
Total 0,6 34,5 64,9
Male 0,3 27,9 71,8
Female 0,8 40,8 58,4
BORED
Total 17,8 71,6 10,6
Male 18,5 74,0 7,5
Female 17,2 69,3 13,5
OTHER
Total 89,7 4,5 5,8
Male 87,3 4,5 8,3
Female 92,4 4,6 3,1
Personal satisfaction
Personal satisfaction in the different areas of life is directly related to self-esteem. Self-esteem is built up
in a very complex manner since an early age through experiences with the environment. This interaction leads to
achievements which the persons may like or dislike, thus infuencing their personal self-worth. In a scale from 5 to 20,
the degree of personal satisfaction is at an average of 16,5 (Table 21).
With regard to specifc personal satisfaction, more than half of the persons surveyed show a considerable
satisfaction with regard to their physical aspect, intelligence, profession or trade studied or being studied and their social
relations. Nevertheless, this satisfaction is much lower with regard to the economic or educational level obtained. The
dissatisfaction with regard to the fnancial aspect (31,5%) is related to the poverty level (Table 22). In general terms
there is a tendency in women to experience lower degrees of satisfaction as compared with men.
TABLE 21
DEGREE OF GLOBAL PERSONAL SATISFACTION * IN THE ADULT POPULATION OF AYACUCHO,
Degree of Global Personal
Satisfaction (Scale 5 20)
Mean Standard
Deviation
Median Mode Percentile
25
Percentile
75
Total 16,5 2,5 17,0 18,0 15,0 18,4
Male 16,8 2,3 17,0 19,0 15,1 19,0
* Based on physical appearance, intelligence, economic level, studies, and social relations.
ADULTS
75
TABLE 22
DEGREE OF SPECIFIC PERSONAL SATISFACTION OF THE POPULATION
IN AYACUCHO, CAJAMARCA AND HUARAZ - 2003
Area
None or Little
%
Some
%
Pretty or a Lot
%
PHYSICAL APPEARANCE
Total 8,5 33,5 58,1
Male 6,2 32,1 61,7
Female 10,6 34,8 54,6
INTELLIGENCE
Total 9,4 29,5 61,1
Male 6,4 29,4 64,2
Female 12,3 29,6 58,1
ECONOMIC LEVEL
Total 31,5 48,0 20,5
Male 28,2 50,0 21,8
Female 34,7 46,1 19,2
PROFESSION OR OCCUPATION STUDIED
Total 14,4 26,7 58,9
Male 10,9 27,3 61,8
Female 18,4 26,0 55,6
LEVEL OF EDUCATION REACHED
Total 33,4 30,5 36,1
Male 27,8 32,8 39,4
Female 38,8 28,3 32,9
SOCIAL RELATIONS
Total 14,2 33,7 51,9
Male 12,4 33,0 54,6
Female 16,4 34,3 49,3
Work satisfaction
Unemployment and underemployment create unfavourable conditions for peoples mental health. Nevertheless, jobs
may be a source of negative states of mind. Thus, estimating the degree of work satisfaction is an important aspect with
respect to mental health. In general, more than half of the surveyed persons show an adequate degree of satisfaction.
at work. The degree of global satisfaction comes from adding the points obtained (from 1 to 4) in each of the specifc
factors converted to a system where 20 is the highest score (Tables 23 and 24).
76
TABLE 23
DEGREE OF WORK SATISFACTION OF THE ADULT POPULATION
Degree of Work Satisfaction
(Scale 5 20)
Mean Standard
Deviation
Median Mode P25 P75
Total 16,1 2,4 16,3 15,0 14,2 18,3
Male 16,2 2,6 16,7 15,0 15,0 18,3
Female 15,9 2,7 16,3 15,0 14,2 18,0
TABLE 24
DEGREE OF WORK SATISFACTION OF THE ADULT POPULATION
Work Factors None or Little
%
Some
%
Pretty or a Lot
%
ACTIVITIES OR FUNCTIONS PERFORMED
Total 9,0 33,0 58,0
Male 8,2 33,7 58,1
Female 10,0 32,1 57,9
WORKPLACE ENVIRONMENT
Total 11,3 38,7 50,0
Male 9,9 39,3 50,8
Female 13,1 37,8 49,1
CO-WORKERS
Total 7,6 36,2 56,2
Male 7,9 34,6 57,5
Female 6,9 39,0 54,0
DAILY WORKLOAD
Total 14,0 45,0 41,0
Male 12,9 45,3 41,8
Female 15,6 44,5 39,8
APPRECIATION OR CREDIT FROM BOSSES
Total 16,7 35,2 48,2
Male 16,5 37,4 46,1
Female 16,9 31,4 51,7
REMUNERATION
Total 43,5 42,8 13,7
Male 40,7 45,0 14,4
Female 47,3 39,9 12,9
ADULTS
77
Quality of life
Quality of life is a concept that involves areas such as physical and psychological well-being, self care, work
and interpersonal performance, socio-emotional support, community support, personal achievement and spiritual
satisfaction. The overall results corresponding to the Quality of Life Index41 on a scale from 1 to 10 (10 being excellent)
which is 7,80 is shown below. The value of this result will be best appreciated as a comparative indicator in further
studies, even though the fgure indicates an acceptable level of quality of life from the persons own perspective. Further
studies will show the specifc details of this indicator (Table 25).
TABLE 25
GLOBAL QUALITY OF LIFE OF THE ADULT POPULATION
Quality of Life of Population
(Scale 1-10)
Mean Standard
Deviation
Median Mode P25 P75
Total 7,8 1,2 7,8 8,1 7,0 8,6
Male 7,7 1,2 7,8 7,8 7,1 8,5
Female 7,8 1,2 7,9 7,4 7,0 8,6
Disability or inability
Disability or inability refers to the decrease in, loss or lack of capacity to function within the social and work
environment. The difference between both is that the former is a consequence of illness and the latter is the lack of or
insuffcient development of skills.
In this document general indicators are shown at the level of the population; subsequent reports will show the
specifc results of the population and those related to psychiatric pathology. In general, it is evident that about one ffth
of the population has at least one slight disability or inability (Tables 26 and 27).
TABLE 26
DISABILITY LEVEL OF THE ADULT POPULATION IN AYACUCHO,
Disability Level (Scale 5-20,
where 5 is lack of disability
Mean Standard
Deviation
Median Mode P25 P75
Total 5,6 1,7 5,0 5,0 5,0 5,0
Male 5,6 1,6 5,0 5,0 5,0 5,0
Female 5,7 1,8 5,0 5,0 5,0 5,0
78
TABLE 27
PERCENTAGE OF GENERAL ADULT POPULATION IN AYACUCHO, CAJAMARCA AND HUARAZ 2003
WITH AT LEAST ONE DISABILITY OR INABILITY
At least one Disability or Inability %
Total 21,2
Male 19,8
Female 22,5
Psychopathic factors
The peaceful and calm atmosphere that must exist among citizens is affected when a person systematically
breaks the rules and laws of society. Although there exists a defnite delinquent personality that has even been related
to genetic factors, in this occasion subtlest tendencies, sensitive to the changes and infuences of society have been
assessed. Permissiveness towards psychopaths measures peoples tolerance towards criminal behaviour such as
theft, while psychopathic tendencies allow conducts such as frequent lying, violence and theft. The former is found in
11,6% of the population and the latter in 4,7%, fgures that show an important percentage of individuals under these
conditions (Table 28).
TABLE 28
PSYCHOPATHIC FACTORS OF THE ADULT POPULATION IN AYACUCHO,
Psychopathic Factors
%
Permissiveness towards psychopaths
Total 11,6
Male 13,0
Female 10,3
Prevalence of psychopathic tendencies
Total 4,7
Male 6,8
Female 2,7
Suicidal indicators
This study has decided to investigate suicidal indicators in a more detailed manner, starting with its subtlest
forms such as the desire to die, specifc suicidal thoughts, the planning, and the attempt to commit suicide. These
indicators are more noticeable before the consummated suicide and more susceptible to preventive actions. This
survey does not maintain that the causes that explain one or the other, or the suicide itself, are necessarily the same;
nevertheless, there is a certain type of important connection. At frst glance it can been observed that indicators are
especially important regarding women, which show that the 12-month prevalence of the desire to die is 18,2%. This is
consistent with the fndings of prevailing emotional states and the presence of clinical disorders as shall be seen later.
ADULTS
79
Table 29 shows that 34,2% of the adult population in the cities of Ayacucho, Cajamarca and Huaraz has had a desire
to die at some point in their lives; 12,9% considered it in the previous year and 5,1% in the previous month. In relation
to more defnite suicidal ideas, 13,5% and 4,4% have at some point thoughts about taking their lives and suicide plans,
respectively. With regard to suicidal behaviour which denotes a more objective indicator accompanied by a great family
and fnancial impact, 2,9% of the population surveyed tried to commit suicide at some point in their lives, and 0,7% has
attempted to do so in the previous year. Considering the size of the sample and the level of accuracy, this last fgure
must be considered carefully; nevertheless, the tendency is clear: 12,1% of persons who tried to harm themselves still
consider this behaviour a possible solution.
TABLE 29
SUICIDAL INDICATORS IN THE ADULT POPULATION OF AYACUCHO,
Suicidal Indicators %
LIFETIME PREVALENCE OF THE DESIRE TO DIE 34,2
Male 22,8
Female 44,9
ANNUAL PREVALENCE OF THE DESIRE TO DIE 12,9
Male 7,3
Female 18,2
MONTHLY PREVALENCE OF THE DESIRE TO DIE 5,1
Male 2,2
Female 7,9
LIFETIME PREVALENCE OF THOUGHTS TO TAKE ONES LIFE 13,5
Male 8,6
Female 18,1
ANNUAL PREVALENCE OF THOUGHTS TO TAKE ONES LIFE 5,4
Male 3,2
Female 7,4
MONTHLY PREVALENCE OF THOUGHTS TO TAKE ONES LIFE 1,9
Male 1,1
Female 2,6
LIFETIME PREVALENCE OF SUICIDE PLANS 4,4
Male 2,9
Female 5,8
ANNUAL PREVALENCE OF SUICIDE PLANS 1,6
Male 1,0
Female 2,2
MONTHLY PREVALENCE OF SUICIDE PLANS 0,5
Male 0,4
Female 0,6
CONTINUA...
80
LIFETIME PREVALENCE OF SUICIDAL BEHAVIOUR 2,9
Male 1,7
Female 4,1
ANNUAL PREVALENCE OF SUICIDAL BEHAVIOUR 0,7
Male 0,4
Female 0,9
MONTHLY PREVALENCE OF SUICIDAL BEHAVIOUR 0,1
Male 0,2
Female 0,1
PREVALENCE OF SUICIDAL POTENTIAL 0,4
(12.1% of attempts)
Male 0,2
Female 0,5
Table 30 shows that the main reasons for wishing to die and having suicidal thoughts are: frst, problems with
couple; second, fnancial problems and third, problems with parents. With respect to suicidal attempts: frst, problems
with couple; second, problems with parents and third, fnancial problems. In the case of women, more than half of the
cases of suicidal attempts are related to the partner. In the case of men the distribution is more heterogeneous: fnancial
problems are the most frequent cause. It is probable that this is due to the fact that men feel they are responsible for the
fnancial welfare of the household more than women do.
TABLE 30
REASONS WHY THE ADULT POPULATION IN AYACUCHO, CAJAMARCA AND
HUARAZ DESIRED TO DIE OR ATTEMPTED SUICIDE - 2003
Topic Reasons for
Suicidal Desires
%
Reasons for Suici-
dal Attempts
%
PROBLEMS WITH SELF-IMAGE Total 0,7 0,0
Male 0,1 0,0
Female 1,0 0,0
PROBLEMS WITH PARENTS Total 17,8 25,9
Male 18,7 14,4
Female 17,4 30,6
PROBLEMS WITH CHILDREN Total 4,7 5,5
Male 3,2 0,0
Female 5,5 7,7
PROBLEMS WITH OTHER RELATIVES Total 6,4 8,7
Male 4,9 0,0
Female 7,1 12,2
CONTINUA...
ADULTS
81
PROBLEMS WITH PARTNER Total 30,7 42,1
Male 26,1 20,0
Female 33,0 51,1
PROBLEMS WITH FRIENDS Total 0,8 0,0
Male 1,0 0,0
Female 0,7 0,0
WORK-RELATED PROBLEMS Total 3,5 2,9
Male 6,8 2,8
Female 1,8 3,0
STUDY-RELATED PROBLEMS Total 5,3 2,8
Male 9,0 1,9
Female 3,5 3,1
FINANCIAL PROBLEMS Total 19,1 14,2
Male 18,8 24,1
Female 19,2 10,2
HEALTH PROBLEMS Total 9,4 2,8
Male 9,6 3,9
Female 9,3 2,4
FAMILY MEMBER HEALTH PROBLEMS Total 3,7 0,6
Male 1,3 1,9
Female 4,8 0,0
SEPARATION OF FAMILY MEMBER Total 3,3 7,4
Male 2,4 9,0
Female 3,7 6,7
DEATH OF PARTNER Total 2,0 0,0
Male 1,1 0,0
Female 2,4 0,0
DEATH OF CHILD Total 0,9 0,3
Male 1,0 0,0
Female 0,8 0,5
DEATH OF PARENT (S) Total 4,0 4,8
Male 4,1 11,3
Female 4,0 2,1
PROBLEMS DUE TO TRAUMATIC
EXPERIENCE
Total 3,3 3,2
Male 5,0 0,0
Female 2,5 4,5
NO OBVIOUS REASON Total 0,6 1,5
Male 0,5 2,3
Female 0,6 1,2
OTHER Total 11,9 9,6
Male 13,9 21,8
Female 10,9 4,7
82
Tendency towards violence
Violence is one of the main social problems that our society has had to face. In this case only prevailing
behaviours have been measured such as fghts with some type of weapon and child physical abuse, and it has been
found that 27,5% of the population has been involved in some of these types of behaviour. Subtler indicators have also
been considered such as homicidal thoughts (Table 31).
TABLE 31
TENDENCIES TOWARDS VIOLENCE OF THE ADULT POPULATION IN
AYACUCHO, CAJAMARCA AND HUARAZ - 2003
Indicator %
LIFETIME PREVALENCE OF VIOLENT TENDENCIES
Total 27,5
Male 38,2
Female 17,5
LIFETIME PREVALENCE OF HOMICIDAL THOUGHTS
Total 3,5
Male 4,4
Female 2,5
ANNUAL PREVALENCE OF HOMICIDAL THOUGHTS
Total 1,3
Male 1,8
Female 0,9
MONTHLY PREVALENCE OF HOMICIDAL THOUGHTS
Total 0,8
Male 1,0
Female 0,6
Protecting factors
Regarding feelings of family protection, the degree of family bonding is measured by considering feelings of
mutual respect and support, family pride or the sharing of principles and values. This area shows high levels which is a
positive factor compared to other psychosocial factors that threaten mental health. Similarly, the religious factor is very
important for the population and the majority relies on it in order to face daily challenges. Nevertheless, active religious
participation is relatively low.
ADULTS
83
TABLE 32
DEGREE OF FAMILY BONDING OF THE ADULT POPULATION
Degree of Family Bonding
(Scale 5-20)
Mean Standard
Deviation
Median Mode P25 P75
Total 18,3 2,4 19,2 20,0 17,5 20,0
Male 18,4 2,0 19,2 20,0 17,5 20,0
Female 18,2 2,3 19,2 20,0 17,5 20,0
TABLE 33
RELIGIOUS TENDENCIES OF THE ADULT POPULATION IN AYACUCHO,
Religious
Tendencies
God is Very
Important
%
Feels Gods
Protection
%
Goes to
Church or
Temple
%
Active Parti-
cipation
%
Reads
Religious
Books
%
Transmits
Religion
to Children
%
Thinks Reli-
gion Helps
to Solve
Problems
%
Total 87,1 86,3 78,9 15,2 53,8 42,0 66,1
Male 82,1 81,1 74,3 13,8 54,3 35,6 62,7
Female 91,9 91,1 83,1 16,4 53,3 47,7 69,3
CLINICAL DISORDERS
Table 34 shows the prevalence during a lifetime, 12-month, six months and at present per group of clinical
disorders according to the research criteria of the International Classifcation of Diseases (ICD), Tenth Review. In
general, women suffer from more depressive and anxiety disorders than men, who distinctly suffer from substance
abuse. More than a third of the population in Ayacucho, Cajamarca and Huaraz (37,3%) have at one point in their lives
suffered from a psychiatric disorder; close to one ffth in the last 12 or 6 months (21,6 - 19,8) and 16.2% was suffering
from it at the moment of the survey. As a group, anxiety disorders have been the most frequent. Nevertheless, the
prevalence considerably diminished last year, refected in the decrease of psychosocial stressors in the region. All
the same, if the annual prevalence is considered, the most frequent disorders are those caused by substance abuse
(10,5%) followed by depressive disorders (7,4%).
Tables 35, 36, 37 and 38 show the prevalence during a lifetime, 12-month, six months and at present of the
main psychiatric disorders of the population in Ayacucho, Cajamarca and Huaraz, as well as their distribution by gender.
With regard to prevalence in a lifetime, the most frequent disorder is the depressive episode (16,2%) followed by post-
traumatic stress (12,8%) and generalized anxiety disorder (8,2%) (Table 35). With regard to the annual prevalence (Table
36) it can be seen that the main psychiatric problems that these cities face are disorders caused by alcohol dependence
or abuse (10%) and depressive episode (7,2%). The latter affects females more frequently and the former about one
ffth of males. With regard to disorders in eating behaviour, although prevalence is low, reported risk behaviours are
moderate (5,3%) especially in women (7,4%) (Table 38).
84
TABLE 34
LIFETIME PREVALENCE, 12-MONTH PREVALENCE, SIX MONTHS PREVALENCE AND CURRENT
PREVALENCE OF PSYCHIATRIC DISORDERS IN GENERAL IN AYACUCHO,
Type of Disorder %
LIFETIME PREVALENCE OF ANY PSYCHIATRIC DISORDER*
Total 37,3
Male 38,0
Female 36,6
ANNUAL PREVALENCE OF ANY PSYCHIATRIC DISORDER*
Total 21,6
Male 26,4
Female 17,1
SIX MONTHS PREVALENCE OF ANY PSYCHIATRIC DISORDER**
Total 19,8
Male 25,2
Female 14,8
CURRENT PREVALENCE OF ANY PSYCHIATRIC DISORDER**
Total 16,2
Male 23,0
Female 9,8
LIFETIME PREVALENCE OF ANXIETY DISORDERS IN GENERAL
Total 21,1
Male 16,6
Female 25,3
ANNUAL PREVALENCE OF ANXIETY DISORDERS IN GENERAL
Total 6,6
Male 4,4
Female 8,6
SIX MONTHS PREVALENCE OF ANXIETY DISORDERS IN GENERAL
Total 5,6
Male 3,4
Female 7,6
CURRENT PREVALENCE OF ANXIETY DISORDERS IN GENERAL
Total 3,5
Male 2,1
Female 4,8
LIFETIME PREVALENCE OF DEPRESSIVE DISORDERS IN GENERAL
Total 17,0
CONTINUA...
ADULTS
85
Male 13,3
Female 20,5
ANNUAL PREVALENCE OF DEPRESSIVE DISORDERS IN GENERAL
Total 7,4
Male 5,7
Female 9,0
SIX MONTHS PREVALENCE OF DEPRESSIVE DISORDERS IN GENERAL
Total 6,0
Male 4,8
Female 7,1
CURRENT PREVALENCE OF DEPRESSIVE DISORDERS IN GENERAL
Total 3,7
Male 2,8
Female 4,4
ANNUAL PREVALENCE OF SUBSTANCE ABUSE OR DEPENDENCE
Total 10,5
Male 19,8
Female 1,6
* For substance abuse or dependence only the annual prevalence is included; for eating behaviour, only the current prevalence is considered.
** Includes the annual prevalence of substance abuse or dependence.
TABLE 35
LIFETIME PREVALENCE OF MAIN PSYCHIATRIC DISORDERS BY GENDER IN
Clinical Disorders as per ICD-10 Total
%
Male
%
Female
%
Psychotic disorders* 0,3 0,4 0,2
Bipolar disorder 0,1 0,2 0,1
Depressive episode 16,2 12,8 19,5
Dysthymia 1,2 0,6 1,8
Agoraphobia with/without panic disorder history 1,8 1,2 2,5
Post-traumatic stress disorder 12,8 9,7 15,8
Social phobia 2,9 2,4 3,3
Panic disorder 0,6 0,6 0,6
Generalized anxiety disorder 8,2 5,4 10,9
Obsessive compulsive disorder 0,4 0,4 0,4
* The MINI criteria consider psychotic disorders in terms of syndromes and not diagnostic categories. The presence of at least fve of the described criteria is
considered positive.
86
TABLE 36
ANNUAL PREVALENCE OF MAIN PSYCHIATRIC DISORDERS OF ADULT
POPULATION BY GENDER IN AYACUCHO, CAJAMARCA
AND HUARAZ 2003
%
Male
%
Female
%
Dysthymia* 0,5 0,1 0,8
Dependence or harmful consumption of alcohol 10,0 19,1 1,5
* Annual prevalence considers two years of diagnostic criteria.
TABLE 37
SIX MONTHS PREVALENCE OF MAIN PSYCHIATRIC DISORDERS OF
ADULT POPULATION BY GENDER IN AYACUCHO,
%
Male
%
Female
%
Dysthymia* 1,2 0,9 1,6
Agoraphobia, with/without panic disorder history 0,6 0,1 1,0
* Six months prevalence considers two years of diagnostic criteria.
ADULTS
87
TABLE 38
CURRENT PREVALENCE OF MAIN PSYCHIATRIC DISORDERS OF
ADULT POPULATION BY GENDER IN AYACUCHO,
%
Male
%
Female
%
Psychotic disorders* 0,1 0,2 0,0
Dysthymia ** 0,5 0,1 0,8
Bulimia nervosa 0,2 0,0 0,3
Anorexia nervosa 0,0 0,0 0,0
Tendency toward eating problems *** 5,3 3,0 7,4
** The current prevalence of dysthymia refers to two years according to diagnostic criteria.
*** People who at some time with the purpose of loosing weight have induced vomiting, taken laxatives, performed excessive physical exercise for more than two
hours per day, have taken appetite inhibitors or diuretics.

Substance use
From the viewpoint of the epidemiological surveillance, the general prevalence of use, the starting age and
the risky alcoholic behaviours are important, among others. Alcohol and tobacco are the most consumed substances,
followed by coca leaves, and in all cases alcohol consumption, abuse and dependence is more frequent among males.
Table 39 shows that, without considering alcohol, the lifetime prevalence of legal substances use is 66,3% while the
prevalence of illegal substances is 2,8%. The current consumption (in the previous month) of legal and illegal non-
alcoholic substances is around 23, 0% and 0,1% respectively. With regard to specifc substances, the illegal substance
most consumed at some point is marijuana (2%) followed by cocaine with 1,3%; the current prevalence (in the previous
month) is still signifcant for alcohol (46%) and tobacco (17,2%). (Table 40).

88
TABLE 39
LIFETIME PREVALENCE AND PREVIOUS MONTH PREVALENCE OF CONSUMPTION OF
NON-ALCOHOLIC SUBSTANCES IN GENERAL
OF ADULT POPULATION BY GENDER IN AYACUCHO,
Type of Substances and Period of Time
Total
%
Male
%
Female
%
Lifetime prevalence of consumption of non-alcoholic
substances in general (legal and illegal)
66,3 84,7 49,1
legal substances
66,3 84,6 49,1
illegal substances
2,8 5,4 0,3
Previous month prevalence of consumption of
substances in general (legal and illegal)
23,0 32,2 14,3
legal substances
23,0 32,1 14,3
illegal substances
0,1 0,1 0,0
TABLE 40
LIFETIME PREVALENCE AND PREVIOUS MONTH PREVALENCE OF MAIN
LEGAL AND ILLEGAL SUBSTANCE CONSUMPTION OF POPULATION
BY GENDER IN AYACUCHO, CAJAMARCA AND HUARAZ 2003
Type of Substance*
Total
%
Male
%
Female
%
Lifetime prevalence of alcohol consumption 96,5 98,3 94,8
Previous month prevalence of alcohol consumption 46,0 58,4 34,4
Lifetime prevalence of tobacco consumption 57,7 80,7 36,1
Previous month prevalence of tobacco consumption 17,2 28,3 6,7
Lifetime prevalence of tranquillisers consumption 0,6 0,4 0,9
Previous month prevalence of tranquillisers consumption 0,2 0,1 0,2
Lifetime prevalence of stimulants consumption 0,1 0,0 0,2
Previous month prevalence of stimulants consumption 0,0 0,0 0,0
Lifetime prevalence of coca leaves consumption 20,3 25,4 15,5
Previous month prevalence of coca leaves consumption 4,5 4,2 4,7
Lifetime prevalence of marijuana consumption 2,0 4,0 0,2
Previous month prevalence of marijuana consumption 0,04 0,07 0,0
Lifetime prevalence of cocaine consumption in general 1,3 2,7 0,0
Previous month prevalence of cocaine consumption in
general.
0,0 0,0 0,0
* Refers to the consumption of substances for pleasure or recreation, not for medical purposes, as could be the case of tranquillisers or some stimulants.
ADULTS
89
The starting age of consumption of different substances (Table 41) of most persons surveyed is between 17
and 32 years old on average, and the frst substance consumed at an early age is alcohol. Nevertheless, this starting
age refers to the current adult population; thus, it does not necessarily represent the consumption pattern at present.
TABLE 41
STARTING AGE OF CONSUMPTION OF MAIN SUBSTANCES
OF POPULATION IN AYACUCHO, CAJAMARCA AND HUARAZ - 2003
Type of Substance* Mean S.d. Median Mode Min Max
Starting age for alcohol consumption 17,61 5,0 18,0 18,0 3,0 55,0
Starting age for tobacco consumption 18,68 5,3 18,0 18,0 4,0 51,0
Starting age for tranquillisers consumption 31,98 9,0 32,0 39,0 18,0 55,0
Starting age for stimulants consumption 22,01 8,3 16,0 15,0 15,0 37,0
Starting age for CBP (cocaine paste)
consumption
23,73 8,3 23,0 25,0 15,0 60,0
Starting age for cocaine consumption 18,54 3,1 18,0 17,0 15,0 26,0
Starting age for coca leaves consumption 21,42 8,6 20,0 20,0 0,0 60,0
Starting age for marijuana consumption 18,91 4,1 18,0 17,0 13,0 33,0
Starting age for inhalants consumption 21,99 9,0 22,0 22,0 12,0 39,0
* Refers to the consumption of substances for pleasure or recreation, not for medical purposes, as could be the case of tranquillisers or some stimulants.
With regard to troubled behaviour due to alcohol consumption, the risky drinker has been defned as the
person who in a year, in three or more occasions, has drank in less than three hours the equivalent of a bottle of wine (or
three glasses of strong alcohol) showing a prevalence of 16,5%. With regard to substance consumption, only the yearly
prevalence has been considered. As mentioned above, the most frequent prevalence is alcohol abuse or dependence
and according to ICD-10 research criteria it represents 10%, followed by tobacco with 1,9% (Table 42).
TABLE 42
PREVALENCE OF ABUSE AND DEPENDENCE OF MAIN SUBSTANCES OF
THE POPULATION BY GENDER IN AYACUCHO, CAJAMARCA
AND HUARAZ - 2003
Type of Substance (Annual Prevalence)
Total
%
Male
%
Female
%
Risky alcohol drinker 16,5 29,6 4,2
Harmful use of alcohol or alcohol dependence 10,0 19,1 1,5
Harmful use of tobacco or tobacco dependence 0,9 1,6 0,2
Harmful use of cocaine or cocaine dependence 0,0 0,0 0,0
Harmful use of marijuana or marijuana dependence 0,01 0,02 0,0
Harmful use of other substances or dependence on other substances 0,0 0,0 0,0
Annual prevalence of harmful use of any substance 4,2 7,8 0,8
Annual prevalence of dependence on any substance 6,5 12,5 0,9
90
Clinical disorders according to age groups
The general distribution of clinical disorders is more or less uniform with no signifcant statistical fndings
except in the current prevalence of anxiety disorders where a lower prevalence is found among young people between
the ages of 18 and 24 years old (1,8%); a tendency to signifcant statistics in the abuse/dependence on alcohol can also
be found with a lower prevalence among adults over 65 years of age (2,3%) (Table 43).
TABLE 43
12-MONTHS, SIX MONTHS AND CURRENT PREVALENCE OF PSYCHIATRIC
DISORDERS BY AGE GROUPS IN THE ADULT POPULATION OF
Clinical Disorders
Age
18 - 24
%
Age
25 - 44
%
Age
45 - 64
%
Age
over 65
%
12-month prevalence of any psychiatric disorder 21,6 22,7 20,8 15,6
Six months prevalence of any psychiatric disorder 19,5 21,2 19,3 12,6
Current prevalence of any psychiatric disorder 15,3 17,2 16,4 11,8
12-month prevalence of anxiety disorders 5,7 7,6 5,8 5,7
Six months prevalence of anxiety disorders 4,5 6,3 5,3 5,7
Current prevalence of anxiety disorders (F=3,685
df1=2,954 df2=1028,15 p=0,012)
1,8 4,3 3,5 5,5
12-month prevalence of depressive disorders 8,6 7,2 5,8 8,0
Six months prevalence of depressive disorders 6,8 6,4 4,2 5,2
Current prevalence of depressive disorders 4,0 3,6 3,1 4,6
12-month prevalence of harmful consumption of
alcohol or alcohol dependence (F=2,630 df1=2,857
df2=994,24 p=0,052)
10,6 10,6 10,2 2,3
POVERTY AND MENTAL HEALTH
The relation between poverty and mental health was discussed at the beginning of the report. One of the
most important factors to be considered in social policies is the protection of the most vulnerable human groups. The
evaluation of poverty in this survey was based on the subjective estimates of the woman head of the family or of the
wife of the head of the family, measuring if the family income covered basic needs (food, clothes, health, education)
and non-basic needs (entertainment, differentiated education, etc.). Those members of a family who had diffculty
satisfying basic food needs are considered extremely poor; if they can satisfy their basic food needs but no other basic
needs they are considered poor; if they can satisfy their basic needs but no other needs they are considered basic
non poor and those family members who can satisfy their basic needs and other needs are considered not poor. It has
furthermore been included as an objective measurement of poverty the unsatisfed basic needs (UBN) which include
housing characteristics (or) overcrowding, toilets, drinking water, electricity and children old enough to study who do not
attend school. In this survey the association between the frst indicators and the general clinical disorders are shown. In
a subsequent report a more detailed analysis will be presented together with the method of unsatisfed basic needs. On
ADULTS
91
Table 44 it can be seen that there is no signifcant statistical association between the prevalence of psychiatric disorders
in the previous year and poverty measured through the subjective estimates of the wife of the head of the family with
regard to the satisfaction of needs with the family income. This is possibly due to the fact that poverty in the Andes
has distinctive characteristics that could be important or not for the development of mental health problems. Thus, it
is possible that stress associated with poverty is lower in cities like Lima; it might also be due to factors such as the
indicator used or the size of the sample. More in-depth studies will help to clarify these fndings.
TABLE 44
12-MONTHS, SIX MONTHS AND CURRENT PREVALENCE OF PSYCHIATRIC
DISORDERS BY POVERTY LEVELS, ACCORDING TO THE PERCEPTION
OF THE CAPACITY TO COVER BASIC NEEDS OF ADULT POPULATION
Clinical Disorders *
%
12-MONTH PREVALENCE OF ANY PSYCHIATRIC DISORDER
Not even basic needs are met 17,8
Only basic food needs are met 22,4
Only basic food and clothing needs are met 21,3
Basic needs and other needs are met 19,5
SIX MONTHS PREVALENCE OF ANY PSYCHIATRIC DISORDER
CURRENT PREVALENCE OF ANY PSYCHIATRIC DISORDER
12-MONTH PREVALENCE OF ANXIETY DISORDERS
SIX MONTHS PREVALENCE OF ANXIETY DISORDERS
CONTINUA...
92
CURRENT PREVALENCE OF ANXIETY DISORDERS
12-MONTH PREVALENCE OF DEPRESSIVE DISORDERS
SIX MONTHS PREVALENCE OF DEPRESSIVE DISORDERS
CURRENT PREVALENCE OF DEPRESSIVE DISORDERS
12-MONTH PREVALENCE OF ALCOHOL ABUSE/DEPENDENCE
* None of the disorders reach signifcant statistical differences
MENTAL HEALTH BY CITIES
An analysis of clinical disorders by cities has been added. In general terms a higher prevalence of psychiatric
disorders can be observed in the city of Ayacucho in comparison with the other cities in most of the periods of reference,
with the exception of the prevalence of depression in the previous year where no signifcant statistical differences were
found among the three cities (Table 45). In Ayacucho the situation is such that half of the population has experienced
at some point in their lives a psychiatric disorder which unquestionably refects the infuence of the atmosphere of
violence experienced in the last decades by people who have not recovered completely. In the following section other
fndings will be added in this respect. It can be seen that Ayacucho has a higher prevalence (in the previous year) of
psychiatric disorders and particularly of alcoholism (15%) in comparison with the other cities. Also, it shares with Huaraz
important fgures regarding anxiety disorders. The historical background of Huaraz must be borne in mind, specially the
natural disasters experienced in 1970. Generally speaking, Cajamarca shows more favourable fgures in mental health
although it has expectant depression levels.
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93
TABLE 45
12-MONTHS, SIX MONTHS AND CURRENT PREVALENCE OF PSYCHIATRIC DISORDERS BY CITIES OF
ADULT POPULATION IN AYACUCHO,
Psychiatric Disorders
Ayacucho
%
Cajamarca
%
Huaraz
%
Statistics
Lifetime prevalence of any psychiatric
disorder
50,6 28,3 34,9 F = 37,372
df1 = 1,914
p<0,001
12-month prevalence of any psychiatric
disorder
26,0 19,1 19,9 F = 5,637
df1 = 1,902
p = 0,004
Six months prevalence of any psychiatric
disorder in general
24,0 16,9 18,7 F = 7,070
df1 = 1,890
p = 0,001
Current prevalence of any psychiatric disorder
in general
21,2 13,5 14,1 F = 9,447
df1 = 1,925
p<0,001
Lifetime prevalence of anxiety disorders in
general
33,7 10,2 23,3 F = 66,307
df1 = 1,909
p<0,001
12-month prevalence of anxiety disorders in
general
8,2 4,3 8,4 F = 6,310
df1 = 1,887
p = 0,002
Six months prevalence of anxiety disorders in
general
7,3 3,2 7,5 F = 8,152
df1 = 1,887
p<0,001
Current prevalence of anxiety disorders in
general
5,1 1,8 4,3 F = 6,998
df1 = 1,891
p = 0,001
Lifetime prevalence of depressive disorders in
general
21,5 15,4 13,5 F = 7,421
df1 = 1,859
p = 0,001
12-month prevalence of depressive disorders in
general
6,5 8,4 6,7 n.s.
Six months prevalence of depressive disorders in
general
4,8 7,0 5,9 n.s.
Current prevalence of depressive disorders in
general
3,0 4,2 3,6 n.s.
12-month prevalence of alcohol abuse or
dependence
15,0 8,0 6,7 F = 14,553
df1 = 1,911
p<0,001
94
EFFECTS OF POLITICAL VIOLENCE
For this report two variables have been considered. On one hand, the frequency with which the people report
having experienced the loss of family members or material goods due to facts directly related to political violence
and, on the other hand, the relationship of such violence with psychiatric disorders. Nearly one third of the population
in Ayacucho, Cajamarca and Huaraz have suffered at least one personal loss, either human or material, with the
highest impact in the city of Ayacucho where two thirds of the population experienced some kind of loss and half of the
population lost a family member (Table 46a).
TABLE 46a
FREQUENCY OF HUMAN AND MATERIAL LOSSES DIRECTLY RELATED TO
VIOLENCE DURING THE TERRORIST PERIOD EXPERIENCED
BY THE ADULT POPULATION OF AYACUCHO,
Type of Loss
Ayacucho
%
Cajamarca
%
Huaraz
%
Total
%
Death of close family member
(parents, husband/wife, children)
12,1 1,1 1,5 4,9
Death of other family member
(not close member)
44,7 5,5 9,0 19,4
Family member missing 26,7 0,9 4,2 10,3
Witness of violent death 19,3 1,4 5,2 8,2
Family member arrested 24,3 1,6 6,9 10,4
Family member in prison 13,4 1,8 4,3 6,2
Loss of material goods 23,2 1,2 3,1 9,0
Change of domicile 29,1 1,4 4,3 11,3
At least one case of personal loss 66,2 9,8 20,0 31,0
Some family member died or is missing 52,8 7,1 12,2 23,5
In Table 46b the lifetime prevalence of some type of psychiatric disorder in persons who have lost a family
member increases considerably (50%) in relation to the prevalence of the whole population (Table 34) and to those who
did not report any family loss. This relation is maintained in the 12-month, six months and current prevalences. When
this relationship is analysed with groups of disorders, it can be found that the association is signifcantly maintained
regarding anxiety disorders, including current reference periods. In the case of depressive disorders, the relation is
signifcant only for lifetime prevalence.

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95
TABLA 46b
LIFETIME PREVALENCE OF PSYCHIATRIC DISORDERS ACCORDING TO
THE EXISTENCE OR ABSENCE OF PERSONAL LOSSES DUE TO VIOLENCE
DURING THE TERRORIST PERIOD OF THE ADULT POPULATION
Clinical Disorders
With Family
Member Dead or
Missing
%
Without Family
Member Dead
or Missing
%
Statistics
Lifetime prevalence of any psychiatric disorder 50,0 33,5 F = 42,970
df1 = 1
p<0,001
12-month prevalence of any psychiatric disorder 24,5 20,7 F = 3,381
df1 = 1
p = 0,067
Six months prevalence of any psychiatric disorder in general 22,5 19,0 F = 3,172
df1 = 1
p = 0,076
Current prevalence of any psychiatric disorder in general 19,2 15,3 F = 3,858
df1 = 1
p = 0,05
Lifetime prevalence of anxiety disorders in general 35,2 16,8 F = 66,307
df1 = 1,909
p<0,001
12-month prevalence of anxiety disorders in general 9,0 5,8 F = 8,815
df1 = 1
p = 0,003
Six months prevalence of anxiety disorders in general 7,7 4,9 F = 8,289
df1 = 1
p = 0,004
Current prevalence of anxiety disorders in general 5,8 2,8 F = 12,807
df1 = 1
p<0,001
Lifetime prevalence of depressive disorders in general 22,7 15,2 F = 12,239
df1 = 1
p = 0,001
12-month prevalence of depressive disorders in general 6,4 7,7 n.s.
Six months prevalence of depressive disorders in general 5,4 6,2 n.s.
Current prevalence of depressive disorders in general 3,1 3,8 n.s.
12-month prevalence of alcohol abuse or dependence 11,3 9,7 n.s.
CHILDHOOD EVENTS AND MENTAL HEALTH
For the purpose of this survey, the report on some styles of upbringing and their association with mental health
has been considered. Subsequent reports will analyse this issue in depth. It is must be emphasized that the information
on upbringing styles has been prepared based on memories with expected limitations; nevertheless, they are still
important. In general a higher prevalence of negative styles of upbringing in Ayacucho and over protection in Huaraz is
observed (Table 47a).
96
TABLE 47a
UPBRINGING STYLES AS INDICATED BY THE ADULT POPULATION
Type of Upbringing Experienced
Ayacucho
%
Cajamarca
%
Huaraz
%
Total
%
Statistics
Received more punishment than deserved 25,4 16,4 16,0 19,3 F = 15,160
df1 = 1,808
df1 = 629,079
p<0,00001
Allowed to do things, siblings were not
allowed to do
15,7 18,1 22,5 18,3 F = 4,613
df = 11,949
df2 = 678,155
p = 0,01085
If things went wrong parents tried to comfort
and encourage child
64,4 78,1 80,0 74,0 F = 22,216
df1 = 1,809
df2 = 629,474
p<0,00001
There was love and tenderness between
child and parents
84,4 92,3 90,0 89,1 F = 12,949
df1 = 1,756
df2 = 611,048
p = 0,00001
Was not allowed to do certain things other
children did because of fear that something
bad could happen
43,1 45,3 47,6 45,1 F = 0,909
df1 = 1,888
df2 = 657,189
p = 0,39845
Parents were very demanding with regard to
school grades, sports or similar activities
57,3 57,8 62,9 58,8 F = 1,945
df1 = 1,919
df2 = 667,776
p = 0,14575
Allowed to make own decisions, e.g., cho-
osing clothes, friends, studies, entertain-
ment, etc.
38,7 49,7 46,7 45,3 F = 8,661
df1 = 1,837
df2 = 639,410
p = 0,00031
Parents were not interested in knowing
childs opinions
26,8 25,0 25,4 25,7 F =,304
df1 = 1,967
df2 = 684,512
p = 0,73425
The anxiety of parents that something bad
could happen to child was exaggerated
30,0 30,1 39,1 32,2 F = 6,566
df1 = 1,985
df2 = 690,902
p = 0,00154
An increase in the prevalence of psychiatric disorders in the case of persons who experienced negative
upbringing styles can be seen in Table 47b. Child abuse considered as having received more punishment than deserved
has the highest impact in all disorders. Nevertheless, the lack of tenderness between the persons and their parents
must also be noted. In the case of depressive disorders the lack of tenderness between the individuals and their parents
is outstanding.
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97
TABLE 47b
LIFETIME PREVALENCE OF PSYCHIATRIC DISORDERS IN GENERAL
ACCORDING TO SOME STYLES OF UPBRINGING OF THE ADULT
POPULATION IN AYACUCHO, CAJAMARCA AND HUARAZ 2003
Lifetime Prevalence
Type of Upbringing
Experienced
Any
Disorder
(GP:37,3%)
Anxiety
Disorder
(GP:21,1%)
Depressive
Disorder
(GP:17,0%)
Received more punishment than deserved 50,0
(p<0,00001)
28,7
(p<0,00001)
23,6
(p<0,00001)
Allowed to do things siblings were not allowed to do 43,2
(p = 0,008)
25,8
(p = 0,01)
22,5
(p = 0,001)
If things went wrong parents did not try to comfort and
encourage child
43,9
(p = 0,00015)
28,0
(p<0,00001)
19,4
(p = 0,049)
There was no love and tenderness between child and
parents
48,8
(p = 0,00009)
29,1
(p = 0,00026)
24,0
(p = 0,00075)
Was not allowed to do certain things other children did
because of fear that something bad could happen
39,7
(p = 0,041)
22,3
(p = 0,204)
18,8
(p = 0,034)
Parents were very demanding with regard to school grades,
sports or similar activities
36,2
(p = 0,327)
19,7
(p = 0,062)
15,8
(p = 0,250)
Allowed to make own decisions, e.g., choosing clothes,
friends, studies, entertainment, etc.
34,1
(p = 0,0046)
16,7
(p<0,00001)
14,3
(p = 0,0019)
Parents were not interested in knowing childs
opinions
38,6
(p = 0,459)
20,4
(p = 0,583)
17,6
(p = 0,560)
The anxiety of parents that something bad could happen to
child was exaggerated
42,4
(p = 0,0007)
24,1
(p = 0,022)
19,0
(p =0,057)
ACCESS TO CARE SERVICES
The access to mental health care services shows certain peculiarities different from the access to physical
health care services due to the existing prejudices in the environment related to having psychiatric problems, among
others. Nevertheless, the participating factors are similar but expressed in different combinations. In this report, only the
results from the standpoint of perceived morbidity will be shown, that is, those persons who have perceived that they
have emotional or nervous problems and are in the position to decide if they need to look for mental health assistance
or not. As a frst step, in terms of satisfying the need, this is the group in which the social programs can start to work
with more quickly; from this stems its particular importance.
To the question if at some point in their lives they have suffered an emotional or nervous problem, 28% of the
patients (perceived morbidity) answered yes; of them, 16,7% (out of all surveyed persons) had identifed their problem
within the last six months. Considering the last 6-month as the period of reference it has been found that 13,9% of this
group had seek for some type of assistance to solve their problem (expressed perceived morbidity) while 86,1% did not
receive any type of medical assistance (Table 48). Of the 13,9% that received assistance, 6,3% attended the centres of
the Ministry of Health (MINSA), followed by 3,9% who sought assistance through ESSALUD (Peruvian Social Security
Health Insurance Institute). It must be pointed out that the majority of the expressed perceived morbidity is being taken
care of at general hospitals (Table 49). It can be said that the majority (59,2%) received some type of medication for
their problem, 22,3% received psychotherapy and 64% received counselling (Table 50).
98
TABLE 48
PERCEIVED MORBIDITY AND HELP SEEKING BEHAVIOR FOR MENTAL
HEALTH ASSISTANCE OF THE ADULT POPULATION IN AYACUCHO,
Need for Assistance %
Perceived morbidity for mental health in lifetime
(emotional or nervous problems)
Total 28,0
Male 22,8
Female 32,9
Perceived morbidity for mental health in the last six months
(mental health problems)
Total 16,7
Male 16,2
Female 17,3
Expressed perceived morbidity for mental health which was taken care of (% of
the perceived morbidity)
Total 13,9
Male 12,3
Female 15,3
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99
TABLE 49
HEALTH SERVICE CENTRES AND DISTRIBUTION OF THE PERCEIVED
MORBIDITY EXPRESSED FOR MENTAL HEALTH ASSISTANCE
OF THE ADULT POPULATION IN AYACUCHO,
Health Service Centres
Partials
%
Totals
%
MINISTRY OF HEALTH (MINSA) 6,3
(45,3 % of cases attended)
Primary health centres 1,4
Specialized hospital or institute 0,8
General hospital 4,1
ESSALUD 3,9
Primary health centre/polyclinic 1,4
PAAD offces (Decentralized Ambulatory
Care Program)
0,4
Mental health centre 0,3
ARMED FORCES 0,2
Armed Forces and Police Hospitals 0,2
PRIVATE 2,9
Private hospital 0,5
Private practice 2,4
OTHER 3,4 3,4
TABLE 50
TYPE OF TREATMENT RECEIVED DUE TO THE PERCEIVED AND EXPRESSED
MORBIDITY FOR ASSISTANCE OF ADULT POPULATION IN HEALTH
CENTRES IN AYACUCHO, CAJAMARCA AND HUARAZ - 2003
Type of Treatment
received due to Perceived
morbidity for Assistance
Medicine
%
Psychotherapy
%
Counselling
%
Herbs
%
Other
%
59,2 22,3 64,0 4,5 7,3
With regard to the reasons why a person did not seek any assistance for their emotional problem, the majority
(50,2%) believed that they should overcome it by themselves, followed by 37,2% who could not afford treatment, and
in third place, 30,2% lacked trust. It is evident that cultural factors play a very special role, as well as educational and
economic factors (Table 51).
100
TABLE 51
MAIN REASONS FOR NOT RECEIVING MEDICAL ATTENTION DESPITE
THE PERCEIVED MORBIDITY OF THE ADULT POPULATION
Reasons for
not attending
Health Centre
Should
overcome
problem by
themselves
%
Could not
afford it
%
Lack of trust
%
Did not
know where
to go
%
Would not
beneft from
it
%
Preferred
homemade
remedies
%
Shame
%
Total 50,2 37,2 30,2 27,0 15,2 13,3 13,0
SOCIO-CULTURAL SYNDROMES AND MENTAL HEALTH IN THE PERUVIAN
ANDES
Folkloric syndromes from ancient times described by researchers in traditional medicine in the area of folkloric
psychiatry, are still current, and identifed and acknowledged by the population surveyed; their lifetime prevalence is
shown in the following table (Table 52).
TABLE 52
LIFETIME PREVALENCE OF CULTURAL SYNDROMES
Cultural Syndromes Total
%
Susto (Fright) 23,5
Aire (Air) 19,2
Mal de ojo (Evil eye) 4,4
Ataque de Nervios (Nervous crisis) 1,6
Dao (Curse) 3,5
Chucaque (Some kind of headache or acute pain) 23,4
The persons who were consulted for any of these syndromes had experienced at some point in their lives:
a depressive episode, anxiety disorder or paranoid symptoms more frequently than the general population with the
exception of chucaque as shown in the following table (Table 53).
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101
TABLE 53
PERCENTAGE OF FOLKLORIC SYNDROMES AND LIFETIME PREVALENCE OF INDICATORS
OF ANXIETY DISORDER, DEPRESSIVE EPISODES AND PARANOID SYMPTOMS
OF THE ADULT POPULATIONIN AYACUCHO, CAJAMARCA AND HUARAZ 2003
(N = 3 895)
Lifetime Prevalence for Adults
SYNDROMES General Anxiety
Disorders
%
Depressive
Episode
%
Paranoid
Symptoms
(2 symptoms)
%
Susto (Fright) 32,8
(< 0,0001)
21,3
(0,0006)
12,4
(< 0,0001)
Aire (Air) 33,5
(< 0,0001)
20,9
(0,004)
12,5
(< 0,0001)
Mal de ojo (Evil eye) 26,8
(0,196)
18,4
(0,534)
16,1
(< 0,0003)
Ataque de Nervios (Nervous crisis) 31,6
(0,113)
36,5
(0,0004)
21,6
(< 0,0003)
Dao (Curse) 42,0
(< 0,0001)
22,8
(0,047)
19,0
(< 0,0001)
Chucaque (Some kind of headache or pain) 14,5
(0,0004)
17,8
(0,2202)
4,3
(0,003)
General Population 21,1 16,2 6,9
The surveyed population also identifed other folkloric and medical problems, as well as who were the
agents for the different models of consultation that solve them, as shown in the following table. The high percentage
of problems that remain without any type of attention is evident (Table 54).
TABLE 54
PERCENTAGE OF PROBLEMS AND AGENTS FOR THE DIFFERENT
MODELS OF CONSULTATION OF THE ADULT POPULATION
Models
Problems
Medical Model
%
Folkloric
Model
%
Other Models,
Not Medical,
Not Folkloric
%
No Model;
Remain
without any
Type of Assis-
tance
%
Anxiety Sadness
depression Nervousness
26,8 2,7 14,5 56,7
Madness 29,3 2,1 8,1 60
Bad luck, protection,
Infdelity, love spells
3,2 5,1 6,7 85
102
STIGMA AGAINST MENTAL DISORDERS
Table 55 shows the answers to the questions with regard to the identifcation of different types of problems as
mental disorders by the population as a previous step to the questions about the stigma related to mental disorders. It
is noticeable that almost 40% of the population does not consider depression as a mental disorder, leaving it unnoticed,
and that 3% of the population does not consider personality disorders as psychiatric pathology.
TABLE 55
IDENTIFICATION OF PROBLEMS AS MENTAL DISORDERS
Type of Problems Mental Disorder
Yes (%) No (%)
a) Excessive nervousness or phobias 61,8 38,2
b) Excessive sadness or depression 57,0 43,0
c) Psychosis or madness 89,9 10,1
d) Excessive consumption of alcohol and drugs 67,2 32,8
e) Character or personality problems 2,9 97,1
Table 56 shows the percentages in the answers of the general population of the Peruvian Andes regarding
questions about the stigma of mental disorders. The results show that 70% of the population react not accepting
persons with a mental illness but, in contrast, 47% are willing to provide some type of help. In the same sense, in the
case of relatives with mental illnesses, about 80% of the time the tendency is not to accept their illnesses. On the other
hand, 93% of the general population believe that if they should suffer from a mental disorder, their community would
not accept them. Nevertheless, the expectations of the general population of the Peruvian Andes is surprising, as 81%
considers that the persons suffering from mental illnesses can be rehabilitated and reintegrated into their community.
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103
TABLE 56
ATTITUDES TOWARD MENTAL ILLNESS OF THE ADULT
POPULATION IN AYACUCHO, CAJAMARCA AND HUARAZ - 2003
ANSWERS
Questions Would
accept the
person with
an illness
%
Would be
indifferent
to that
person
%
Would dis-
tance them-
selves from
that person
%
Would pro-
vide some
help
%
Would
reject the
person
%
Would hide
the person
%
Other
%
How would you react
towards a person with
a mental illness?
27,2 6,4 15,7 47,2 1,1 0,0 2,4
What would you do if
you had one or more
family members with a
mental illness?
18,4 0,2 1,2 78,1 0,7 0,3 1,1
If you suffered from a
mental illness, how do
you think your commu-
nity would react?
7,7 20,1 12,3 32,6 17,6 0,0 9,5
WOMEN
CHARACTERISTICS OF SURVEYED MARRIED
OR COHABITANT WOMEN
OR PREVIOUSLY SO
WOMEN
107
CHARACTERISTICS OF SURVEYED MARRIED OR COHABITANT WOMEN
OR PREVIOUSLY SO
The group surveyed consisted of 3 268 women, which corresponds to a weighted population of 75 319
inhabitants, according to the technical sampling design for the cities of Ayacucho, Cajamarca and Huaraz in the Peruvian
Andes (Table 57).
TABLE 57
TOTAL NUMBER OF SURVEYED MARRIED OR COHABITANT WOMEN INVOLVED IN A
RELATIONSHIP OR PREVIOUSLY IN AYACUCHO, CAJAMARCA AND HUARAZ - 2003
Number of Women Surveyed Frequency
Total sampling 3 268
Expanded 75 319
AGE
The average age of women surveyed is around 41,6 years old with a standard deviation of 14,2 years, which
shows a negative asymmetry in the composition of age groups, as can be seen in Table 58. More than 50% correspond
to the ages between 25 and 44 years old.
TABLE 58
AGES OF WOMEN SURVEYED FROM THE POPULATION OF
Age Group %
Under 18 years old 0,3
18 to 24 years old 9,3
Over 65 years old 7,8
EDUCATION
The rate of illiteracy of surveyed women is 16,5%, higher compared to 1,5% for males.
The highest percentage of surveyed women indicated having attended primary and secondary school (56,2%).
Within the level of tertiary education the distribution is similar for both genders (Table 59).
108

TABLE 59
LEVEL OF EDUCATION OF SURVEYED WOMEN IN AYACUCHO,
Level of Education %
None 13,7
Pre-primary education / Kindergarten 0,4
Primary education 29,2
Secondary education 27,0
Baccalaureate 0,0
Post-secondary non-tertiary education 14,7
Tertiary education 14,4
Graduate studies 0,5
MARITAL STATUS
More than three fourths of surveyed women (82%) indicated living together with a partner (married or
cohabitant). Almost one third (31,2%) belong to the group of unmarried cohabitants (Table 60).
TABLE 60
MARITAL STATUS OF SURVEYED WOMEN IN AYACUCHO,
Marital Status %
Cohabitant 31,2
Separated 10,6
Divorced 0,8
Widowed 6,4
Married 50,8
Single 0,2
EMPLOYMENT
A total of 53,3% of women had been working the previous week in comparison to 68.4% of men. A total of 6,5%
looked for a job during the previous week which suggests that there is a signifcant percentage that would be carrying
out housework or other activities (Table 61).
WOMEN
109
TABLE 61
EMPLOYMENT SITUATION OF SURVEYED WOMEN IN AYACUCHO,
Employment Situation
%
Worked the previous week 53,3
Was looking for a job during previous week 6,5
INCOME
Half of the surveyed women (52,2%) have an income of less than S/. 300; about one ffth (19,1%) earn
between S/. 301 and S/. 600; some (23,7%) earn more, between S/. 601 and S/.1 200 and only 5,1% earn more than
S/. 1 200. Women in a relationship have an income considerably lower than male adults (25,5% earn less than S/. 300;
33,1% earn between S/. 301 and S/. 600; 28,4% earn between S/. 601 and S/. 1200 and 12,9% earn more than S/.
1200). (Table 62).
TABLE 62
AVERAGE PERSONAL MONTHLY INCOME IN THE LAST THREE MONTHS
(NUEVOS SOLES) OF MARRIED OR COHABITANT WOMEN
Average Personal Monthly Income (Nuevos Soles) %
Less than S/.300 52,2
S/. 301 to S/. 600 19,1
S/. 601 to S/. 1 200 23,7
More than S/. 1 200 5,1
Exchange rate: US $ 1.00 = S/. 3.50 Nuevos Soles
WOMEN
111
MENTAL HEALTH OF SURVEYED MARRIED OR COHABITANT WOMEN OR
PREVIOUSLY SO
GENERALITIES
Environment
Approximately half of the women surveyed in the highlands (44.9%) perceive unemployment as the main
problem in the country. In second place, poverty. Terrorism and violence are perceived in lower percentages, 0,8% and
3,2% respectively (Table 63)
TABLE 63
MAIN PROBLEM PERCEIVED IN THE COUNTRY BY THE MARRIED OR
COHABITANT FEMALE POPULATION IN AYACUCHO,
Terrorism
%
Unemploy-
ment
%
Poverty
%
Corruption
%
Violence
%
Political
Instability,
no Trust in
Leadership
%
Crime
%
Other
%
0,8 44,9 29,5 5,0 3,2 1,3 6,2 15,3
Nearly half of the women surveyed (39,7%) who face these problems respond with concern and approximately
one third (29,5%) react with sorrow, sadness or depression; 13,2% respond with bitterness, anger and rage (Table
64).
TABLE 64
FEELINGS TOWARD MAIN NATIONAL PROBLEMS OF THE MARRIED
OR COHABITANT FEMALE POPULATION IN AYACUCHO,
Worry
%
Bitterness,
Anger and
Rage
%
Resignation
%
Indifference
%
Disappoint-
ment
%
Sorrow,
Sadness or
Depression
%
Impotence
Despair or
Distress
%
Other
%
39,7 13,2 1,4 0,9 4,9 29,5 6,8 3,6
Approximately 75% of the women surveyed do not trust or hardly trust police and military authorities. The
highest fgures for hardly any trust or no trust, regarding the women surveyed, correspond to political authorities (93,2%)
and community leaders (82,4%). (Table 65).
112

TABLE 65
TRUST IN AUTHORITIES IN THE MARRIED OR COHABITANT FEMALE
Trust In
None or Little
%
Some
%
A Lot
%
Police authorities 74,4 22,2 3,8
Political authorities 93,2 6,0 0,8
Military authorities 75,7 20,7 3,6
Religious authorities 30,7 28,7 40,5
Community leaders 82,4 15,1 2,5
Concerning the security they perceive in their surroundings, 83,6% of surveyed women point out that they
do not feel protected or feel little protection from the State. A high percentage feels protected by God and 71,2 % feel
protected by their family (Table 66).

TABLE 66
FEELINGS OF PROTECTION IN THE MARRIED OR COHABITANT FEMALE
Feeling of Protection
None or Little
%
Some
%
A Lot
%
From State 83,6 14,7 1,7
From family 11,6 17,2 71,2
From God 2,9 4,3 92,7
From community 56,5 30,0 13,5
It can be observed from Table 67 that around half of the surveyed women indicate work as the main stressor
(45,5%) children and relatives (51,9%) money (55,3%) health problems (58,1%) terrorism (50,7%) and drug traffcking
(49,3%).
WOMEN
113
TABLE 67
PSYCHOSOCIAL STRESSORS IN THE MARRIED OR COHABITANT FEMALE
POPULATION IN AYACUCHO, CAJAMARCA AND HUARAZ 2003
Kind of Stressor and Magnitude None or Little
%
Some
%
A Lot
%
Work 30,7 23,8 45,5
Study 39,6 21,0 39,4
Children and relatives 30,7 17,4 51,9
Partner 43,5 17,6 38,9
Money 19,1 25,6 55,3
Health 17,8 24,1 58,1
Terrorism 32,4 16,9 50,7
Drug traffcking 35,3 15,4 49,3
States of mind
The answer alternatives are not mutually exclusive in a surveyed person. Unfavourable states of mind always
or almost always felt, from highest to lowest in frequency are: concern (45,8%) sadness (29,3%) stress (23%) distress
(18,3%) and irritability (16,5%). On the other hand, 52,7% feel happy and 48,2% feel calm (Table 68).
TABLE 68
EMOTIONAL STATES IN THE MARRIED OR COHABITANT FEMALE
Prevalence of Emotional States Never
%
Sometimes or
Occasionally
%
Always or Al-
most Always
%
Sad 1,5 69,2 29,3
Tense 5,4 71,6 23,0
Distressed 10,1 71,6 18,3
Irritable 9,6 73,9 16,5
Worried 1,5 52,8 45,8
Calm 2,2 49,6 48,2
Happy 0,9 46,4 52,7
Bored 17,2 68,2 14,6
Other 90,3 3,1 6,5
With respect to personal satisfaction of women surveyed, 50% experience an acceptable degree of personal
satisfaction, 15.8 points out of 20 (Table 69).
114

TABLE 69
DEGREE OF PERSONAL SATISFACTION IN THE MARRIED OR
Degree of Personal Satisfaction
(Scale 5 - 20)
Mean Median Mode P25 P75
15,8 16,0 18,0 14,0 18,0
In relation to personal satisfaction with respect to some personal characteristics, more than half feel satisfed
(very) with their skin colour (64%), their intellectual level (53,9%), their physical aspect (53%). Approximately one ffth of
the women surveyed (17%) feel satisfed with their economic level; 38,9% dont feel or hardly feel satisfed with their
economic level and 25% dont feel or hardly feel satisfed with their studies (Table 70).
TABLE 70
DEGREE OF PERSONAL SATISFACTION IN THE MARRIED OR
Degree of Personal Satisfaction with:
None or Little
%
Some
%
A lot
%
Physical aspect 11,9 35,1 53,0
Skin colour 7,0 29,0 64,0
Intelligence 15,0 31,1 53,9
Economic level 38,9 44,1 17,0
Studies 25,0 24,1 51,0
Social relations 21,2 34,6 44,3
Work satisfaction
A total of 50% of women surveyed show a degree of acceptable work satisfaction (Table 71).
TABLE 71
WORK SATISFACTION IN THE MARRIED OR COHABITANT FEMALE
( Scale 5 - 20)
15,5 15,8 15,0 13,8 17,5
According to the different components of the subject of work satisfaction, it can be observed that 52,6% feel
satisfaction (a lot) with the activities or functions accomplished, 46,1% with the workplace environment, 50% with their
co-workers and 45,9% with the appreciation and credit they receive from their bosses. They feel average satisfaction
with the daily workload and 51,2% feel no or little satisfaction with their remuneration (Table 72).
WOMEN
115
TABLE 72
CHARACTERISTICS OF WORK SATISFACTION IN THE MARRIED OR
Degree of Work Satisfaction With:
None or Little
%
Some
%
A lot
%
Activities or functions performed 11,8 35,6 52,6
Workplace environment 15,1 38,9 46,1
Co-workers 10,5 39,2 50,3
Daily workload 18,5 44,5 37,0
Appreciation and credit from bosses 18,3 35,8 45,9
Remuneration 51,2 36,0 12,8
Family bonding
The degree of family bonding of women in a relationship is signifcantly high, with an average score of 18,2 in
a scale from 5 to 20 points (Table 73).
TABLE 73
FAMILY BONDING IN THE MARRIED OR COHABITANT FEMALE POPULATION
(Scale 5 - 20)
18,2 19,2 20,0 17,0 20,0
Quality of life
For women involved in a relationship or previously involved in a relationship, the quality of life is high in
average since a rate of 7,7 points in a scale from 0 to 10 points is obtained (Table 74).
116

TABLE 74
QUALITY OF LIFE IN THE MARRIED OR COHABITANT FEMALE POPULATION
Quality of Life Index of Married
or cohabitant Women
(Scale 1 - 10)
Mean Sx Median Mode P25 P75
7,7 0,004 7,8 8,3 7,0 8,6
Suicidal indicators
Suicidal indicators have been explored in a wide scope, from the desire to die to attempted suicide. The desire
to die represents the subtlest and most sensitive level. In that sense, 45,5% of the female population in a relationship
or who were once involved in a relationship has wished to die at some point in their lives. The suicidal thought explores
the cognitive aspect of a potentially suicidal conduct, which has been higher for married or cohabitant women when
compared to adult males, both in the lifetime prevalence (16,7% vs 8,6%) the monthly prevalence (2,3% vs 1,1%) as
well as in the annual prevalence (6,3 vs 3,2%) (Table 67).
Suicide attempts also involve behaviour showing a lifetime prevalence of 3,6%, fgure which is higher than in
adult males (1,7%) in addition to a monthly prevalence of 0,1% and an annual prevalence of 0,8% (Table 75).
TABLE 75
SUICIDAL INDICATORS IN THE MARRIED OR COHABITANT FEMALE
Period Total
%
Lifetime prevalence of the desire to die 45,5
Monthly prevalence of the desire to die 8,8
Annual prevalence of the desire to die 18,3
Lifetime prevalence of thoughts to take ones life
Monthly prevalence of thoughts to take ones life
Lifetime prevalence of thoughts to take ones life
16,7
2,3
6,3
Lifetime prevalence of suicide plans 5,1
Monthly prevalence of suicide plans 0,5
Annual prevalence of suicide plans 1,9
Lifetime prevalence of suicide attempts 3,6
Monthly prevalence of suicide attempts
Annual prevalence of suicide attempts
0,1
0,8
WOMEN
117
CLINICAL DISORDERS
The results of clinical disorders in married or cohabitant women report important fgures for lifetime prevalence
of any psychiatric disorder. Probably due to the period of political violence, the most frequent disorder according to
the lifetime prevalence has been post-traumatic stress disorder (17,4%). Nevertheless, if the annual prevalence is
considered, the most frequent disorder is depressive episode with 8,4%, followed by generalized anxiety disorder
(4,7%) and post- traumatic stress disorder (3,3%). Dysthymia has a current prevalence of 1%. It can be observed that
fgures are signifcantly higher in Ayacucho with regard to the lifetime prevalence of post-traumatic stress disorder
(Table 76).
TABLE 76
CLINICAL DISORDERS ACCORDING TO THE ICD 10 IN THE MARRIED OR
COHABITANT FEMALE POPULATION IN THE PERUVIAN ANDEAN CITIES OF
HUARAZ, AYACUCHO AND CAJAMARCA - 2003
Disorders as per the ICD 10 Huaraz
%
Ayacucho
%
Cajamarca
%
Total
%
Lifetime prevalence of any psychiatric disorder 37,5 54,5 25,9 37,8
12-month prevalence of any psychiatric disorder 18,2 20,9 14,2 17,3
Six months prevalence of any psychiatric disorder 16,1 19,0 11,9 15,2
Current prevalence of any psychiatric disorder 12,1 16,5 7,3 11,4
Lifetime prevalence of generalized anxiety disorders
in women in a relationship
12,7 18,7 6,6 11,9
12-month prevalence of generalized anxiety
disorders in women in a relationship
4,8 6,0 3,7 4,7
Six months prevalence of generalized anxiety
4,6 6,0 3,0 4,3
Current prevalence of generalized anxiety disorders
3,2 3,4 2,0 2,7
Lifetime prevalence of post-traumatic stress
17,3 30,2 8,1 17,4
12-month prevalence of post-traumatic stress
2,8 4,4 2,7 3,3
Six months prevalence of post-traumatic stress
2,3 4,3 2,2 2,9
Current prevalence of post traumatic stress
1,1 3,9 0,4 1,7
Lifetime prevalence of depressive episodes in
women in a relationship
13,5 23,3 14,8 17,3
12-month prevalence of depressive episode in
8,5 9,1 7,9 8,4
Six months prevalence of depressive episodes
7,5 7,6 6,8 7,2
Current prevalence of depressive episodes in
5,2 5,4 3,2 4,4
Lifetime prevalence of dysthymia in women in a
relationship
0,5 3,7 1,6 2,1
Current prevalence of dysthymia in women in a
relationship
0,1 1,6 1,1 1,0
118

ABUSE OF MARRIED OR COHABITANT WOMEN
The study carried out in the Peruvian Andes regarding the abuse of married or cohabitant women or previously
so has considered as indicators abuse at some point in their lives, inappropriate sexual activities or the attempt to
commit them, physical aggression, verbal aggression, neglect or abandonment. The lifetime prevalence of some type
of abuse against married or cohabitant women or previously so is 67,6%.
Mistreatment during courtship
A variety of inadequate behaviours during courtship carried out by the current partner (or former partner) was
found, with the prevalence of jealousy towards the partner representing the highest fgures (42,5%) followed by the
partners controlling behaviour (30,2%). Approximately one ffth state that their partners lied frequently (20,3%) neglected
her because of alcohol consumption (20,1%) and cheated on her (18,5%). The lowest prevalences correspond to the
perception of male chauvinistic attitudes (1%) forced intercourse (6,1%) and battering (8,2%) (Table 77).
TABLE 77
CHARACTERISTICS OF INADEQUATE TREATMENT BY CURRENT PARTNER
DURING COURTSHIP IN THE MARRIED OR COHABITANT (OR PREVIOUSLY SO)
FEMALE POPULATION IN AYACUCHO, CAJAMARCA AND HUARAZ 2003
Prevalence of mistreatment During Courtship by
Current Partner (or Former Partner)
%
Shouted at her frequently 9,2
Had violent spells 9,6
Cheated on her 18,5
Battered her 8,2
Forced her to have intercourse 6,1
Showed indifference 13,6
Lied to her a lot 20,3
Was too jealous 42,5
Controlled her too much 30,2
Neglected her because of alcohol 20,1
Had male chauvinistic attitudes 1,0
On the other hand, if an aggregate estimate is made regarding inadequate treatment towards women in a
relationship by the current or former partner during courtship, approximately two thirds of this sample (61,3%) is subject
to said inadequate treatments and almost one ffth (18,2%) suffer some kind of violence (Table 78).
WOMEN
119
TABLE 78
PREVALENCE OF INADEQUATE TREATMENT BY CURRENT (OR FORMER)
PARTNER DURING COURTSHIP IN THE MARRIED OR COHABITANT
(OR PREVIOUSLY SO) FEMALE POPULATION IN AYACUCHO,
Inadequate Treatment During Courtship TOTAL
%
Prevalence of inadequate treatment during courtship carried out by
current or former partner (at least one type of mistreatment)
61,3
Prevalence of some type of violence during courtship with current or
former partner
18,2
Abuse towards women by current partner
A sub-sample was selected to determine the women involved with a current partner, either through marriage
or cohabitation. Such sub-sample represented 82,8% of the total sample which, pondered or expanded, represents 61
900 women in a relationship in the population. Table 79 shows that almost one half of all surveyed women (48,5%) has
a lifetime prevalence of some type of abuse caused by the current partner. Insults and physical abuse follow in order
of frequency and approximately one in 10 women in a relationship is victim of sexual abuse (Table 79). If the fgures by
cities are observed, it can be determined that in most types of abuse the fgures are higher in Ayacucho, followed by
Cajamarca and Huaraz.
TABLE 79
LIFETIME PREVALENCE AND TYPES OF ABUSE BY CURRENT PARTNER
IN THE MARRIED OR COHABITANT FEMALE POPULATION IN THE
CITIES OF HUARAZ, AYACUCHO AND CAJAMARCA - 2003
Types of Abuse by Current Partner Huaraz
%
Ayacucho
%
Cajamarca
%
Total
%
Lifetime prevalence of some type of abuse 40,0 63,8 41,5 48,5
Sexual abuse 6,9 14,5 11,5 11,4
Physical abuse 29,8 50,1 28,3 35,8
Insults 34,5 58,8 35,9 43,1
Blackmailing, humiliation 16,1 30,5 16,6 21,0
Abandonment 5,7 24,9 9,3 13,6
With regard to the annual prevalence of any type of mistreatment by a partner, the data equally follow the same
gradient characteristic of the previous table, with high fgures in Ayacucho (Table 80).
120

TABLE 80
12-MONTH PREVALENCE OF ANY KIND OF MISTREATMENT BY PARTNER
IN THE MARRIED OR COHABITANT FEMALE POPULATION IN THE CITIES
OF HUARAZ, AYACUCHO AND CAJAMARCA - 2003
Huaraz
%
Ayacucho
%
Cajamarca
%
Total
%
12-month prevalence of any type of mistreatment by
current partner
19,6 42,7 25,4 29,8
Table 81 shows a prevalence of systematic abuse in Ayacucho which is almost double when compared with
the cities of Huaraz and Cajamarca. These fgures deserve an in-depth analysis for an adequate understanding.
TABLE 81
12-MONTH PREVALENCE OF SYSTEMATIC ABUSE BY CURRENT PARTNER
IN THE MARRIED OR COHABITANT FEMALE POPULATION IN THE CITIES
OF HUARAZ, AYACUCHO AND CAJAMARCA - 2003
Huaraz
%
Ayacucho
%
Cajamarca
%
Total
%
12-month prevalence of any systematic abuse by
current partner (at least once or twice a month)
5,5 13,6 6,9 8,8
In comparison with the fgures shown in Table 78 regarding inadequate treatment during courtship, said fgures
with respect to the population of systematically mistreated women rise to 80,5% vs 61,3% for women with a partner
in general. This difference is higher in the case of the prevalence of some type of violence (39,5% vs 18,2%). (Table
82).
TABLE 82
BACKGROUND OF SYSTEMATIC ABUSE BY CURRENT PARTNER IN THE POPULATION OF MISTREATED
MARRIED OR COHABITANT WOMEN
IN THE CITIES OF HUARAZ, AYACUCHO AND CAJAMARCA - 2003
Mistreatment Background %
Prevalence of inadequate treatment during courtship with current partner in systematically mistreated
women (at least once or twice a month)
80,5
Prevalence of some type of violence during courtship with current partner in systematically mistreated
39,5
As it is also the case of the general female married or cohabitant population and male adults, here too
systematically mistreated women do not trust or hardly trust police authorities (68,5%) or political authorities (76,9%)
(Table 83).
WOMEN
121
TABLE 83
TRUST IN AUTHORITIES IN THE POPULATION OF SYSTEMATICALLY
MISTREATED MARRIED OR COHABITANT WOMEN
Authorities
None or Little
%
Some
%
A Lot
%
Trust in police authorities in systematically mistreated women
(at least once or twice a month)
76,9 20,5 2,5
Trust in political authorities in systematically mistreated
94,7 4,4 0,9
The perception of feeling protected by family members is shared by almost half of the sample (49,9%) though
it is less when compared to the general married or cohabitant female population (71,2%) Table 66. On the other hand,
89,7% do not feel protected or feel little protection from the State, a fgure which is higher in comparison to the women
with a partner in general (83,6%) (Table 84)
TABLE 84
PROTECTION FELT BY THE POPULATION OF SYSTEMATICALLY
MISTREATED MARRIED OR COHABITANT WOMEN IN
Protection Felt
None or Little
%
Some
%
A Lot
%
From the State by systematically mistreated woman
89,7 9,1 1,2
From the family by systematically
mistreated women (at least once or twice a month)
17,6 32,5 49,9
Psychosocial stressors in systematically mistreated women
The psychosocial stressor that perturbs systematically mistreated women the most is lack of money (67,9%).
All others stressors affect more than half of all surveyed women. (Table 85).
122

TABLE 85
PSYCHOSOCIAL STRESSORS IN THE POPULATION OF SYSTEMATICALLY
MISTREATED MARRIED OR COHABITANT WOMEN IN AYACUCHO,
Type and Magnitude of Stressor for
Systematically Mistreated Women
None or Little
%
Some
%
A Lot
%
Work (frequency: at least once or twice a month) 16,3 26,5 57,2
Studies (frequency: at least once or twice a month) 19,5 27,1 53,4
Children and relatives (frequency: at least once or twice a
month)
18,3 15,8 65,9
Partner (frequency: at least once or twice a month) 17,0 19,9 63,1
Money (frequency: at least once or twice a month) 12,0 20,1 67,9
Prevailing emotional states of mind of mistreated married or cohabitant women
The highest prevalences of negative states of mind in mistreated women in a relationship correspond to
the following: worry (69,9%) sadness (54,5%) and tension (45,1%). These fgures are higher in relation to all women
surveyed (worry 45,8%, sadness 29,3% and stress 23%). Positive states of mind have the following frequencies: peace
of mind (22,7%) and happiness (26,9%) (Table 86)
TABLE 86
STATES OF MIND OF THE POPULATION OF SYSTEMATICALLY
MISTREATED MARRIED OR COHABITANT WOMEN
Prevalence of Emotional States of Mind
Never
%
Sometimes or
Occasionally
%
Always or
Almost Always
%
Sad 0,0 45,5 54,5
Tense 0,6 54,3 45,1
Distressed 2,5 58,9 38,6
Irritable 3,9 65,9 30,3
Worried 0,0 30,1 69,9
Calm 4,3 73,3 22,7
Happy 0,4 72,8 26,9
Bored 11,1 62,1 26,8
Other 95,9 4,1 0,0
Personal satisfaction in systematically mistreated married or cohabitant women
Personal satisfaction in systematically mistreated women in a relationship (average 14,7) is almost equally
experienced by women in a relationship in general (average 13,3) (Tables 69 and 87)
WOMEN
123
TABLE 87
DEGREE OF PERSONAL SATISFACTION IN THE POPULATION OF
SYSTEMATICALLY MISTREATED MARRIED OR COHABITANT
WOMEN IN AYACUCHO, CAJAMARCA AND HUARAZ - 2003
Degree of Personal Satisfaction
felt by Systematically Mistreated
Women in a Relationship
14,7 0,03 15,0 14,0 13,0 16,8

Suicidal indicators for systematically mistreated married or cohabitant women
The prevalence of thoughts about taking ones life or of suicide plans for systematically mistreated women
in a relationship is high. Two thirds of systematically mistreated women had the desire to die at some point in their
lives, while more had the desire to die during the previous year. In the case of explicit suicidal thoughts the data is
considerably higher, almost double, in relation to the total sample of women in a relationship: lifetime prevalence, 38,5%
vs16,7%, annual prevalence of 18,5% vs. 6,3% and monthly prevalence of 5,8% vs. 2,3% (Table 88)
TABLE 88
SUICIDE PLANS IN THE POPULATION OF SYSTEMATICALLY MISTREATED
MARRIED OR COHABITANT WOMEN IN AYACUCHO,
Prevalences %
Lifetime prevalence of the desire to die in
systematically mistreated women (at least once or twice a month)
66,7
Monthly prevalence of the desire to die in
19,4
12-month prevalence of the desire to die in
38,4
Lifetime prevalence of thoughts about taking ones life in
38,5
Monthly prevalence of thoughts to take ones life in
5,8
12-month prevalence of thoughts about taking ones life in
18,5
In this group of systematically mistreated women in a relationship, with regard to the suicide attempts or
suicidal behaviour, fgures are equally high and greater if compared to all surveyed women in a relationship. It shows,
for example, a lifetime prevalence of 8,5% vs 3,6%, a monthly prevalence of 0,5% vs 0,1% and an annual prevalence
of 2,5% vs 0,8%. The suicidal potentiality is 0,3%, similar to the total sample: 0,4%. (Table 89)
124

TABLE 89
SUICIDE ATTEMPT IN THE POPULATION OF SYSTEMATICALLY
AYACUCHO, CAJAMARCA AND HUARAZ
Prevalences %
Lifetime prevalence of suicide attempt in
8,5
Monthly prevalence of suicide attempt in
0,5
Annual prevalence of suicide attempt in
2,5
Prevalence of suicide potential present in
0,3
(3,5% of attempts)
Protection factors
The degree of family bonding in systematically mistreated women (16,9) is slightly higher than that of the
general female population in a relationship (15,5) (Tables 73 and 90)
TABLE 90
FAMILY BONDING IN THE POPULATION OF SYSTEMATICALLY
in Systematically Mistreated
Women (at Least Once or Twice
a Month)
16,6 0,04 16,7 20,0 15,0 19,2
Quality of life in systematically mistreated married or cohabitant women
Systematically mistreated women show an average quality of life (7,3). This fgure is lower when compared to
fgures of women in a relationship (Tables 74 and 91)
WOMEN
125
TABLE 91
QUALITY OF LIFE IN THE POPULATION OF SYSTEMATICALLY
AYACUCHO, CAJAMARCA AND HUARAZ 2003
Quality of Life Index in the
Population of Systematically
Mistreated Women, at Least
Once or Twice a Month
(Scale 1 - 10)
7,3 0,01 7,3 6,9 7,0 8,3
Clinical conditions in systematically mistreated women
Table 92 shows that the prevalences of clinical disorders in systematically mistreated women are generally
high. If these fgures are compared to clinical disorders observed in surveyed women in a relationship who are not
subject to systematic mistreatment, important differences can be evidenced, such as: the six months prevalence of
generalized anxiety disorders (10,7% vs 4,3%); the current prevalence of post-traumatic stress disorders (2,9% vs
1,7%); the six months prevalence of depressive episodes (major depression) (15,3% vs 7,4%), etc.
TABLE 92
SOME CLINICAL DISORDERS IN THE POPULATION OF SYSTEMATICALLY
MISTREATED MARRIED OR COHABITANT WOMEN IN AYACUCHO,
Clinical Disorder Total
%
Lifetime prevalence of post-traumatic stress disorders
in systematically mistreated married or cohabitant women
21,9
(vs 17,8% with no systematic mistreatment
F = 3,24 df1 =1 df2 = 348 p = 0,073
Current prevalence of post-traumatic stress disorder
2,9
(vs 1,7% with no systematic mistreatment)
F = 2,00 df1 =1 df2 = 348 p = 0,158
Six month prevalence of generalized anxiety disorder
10,7
F = 14,57 df1 =1 df2 = 348 p = 0,000
Six month prevalence of depressive episodes in systematically
mistreated married or cohabitant women (at least once or
twice a month)
15,3
F = 18,40 df1 =1 df2 = 348 p = 0,000
Current prevalence of depressive episodes in systematically
mistreated married or cohabitant women (at least once or
twice a month)
10,0
F = 17,63 df1 =1 df2 = 348 p = 0,000
Current prevalence of dysthymia
in systematically mistreated married or cohabitant women (at
least once or twice a month)
3,1
F = 13,96 df1 =1 df2 = 348 p = 0,000
TEENAGERS
127
CHARACTERISTICS OF
TEENAGERS SURVEYED
TEENAGERS
129
CHARACTERISTICS OF TEENAGERS SURVEYED
The number of teenagers surveyed was 1 568, a fgure which, according to the technical sampling design,
grants an inference of 51 824 teenage inhabitants of the Peruvian Andes (Ayacucho, Cajamarca and Huaraz). A
proportion of 47,1% males and 52,9% females is found in the sample (Table 93).
TABLE 93
TOTAL NUMBER OF TEENAGERS SURVEYED AND WEIGHTED
POPULATION ESMHPA -2003
Surveyed Frequency
Male
%
Female
%
Total sample 1 568 47,1 52,9
Weighted 51 824 47,4 52,6
AGE
The average age of teenagers surveyed is 14,5 years old, with similarities between the group aged 12-14 and
the group aged 15 - 17 (Table 94).
TABLE 94
AGE OF TEENAGERS SURVEYED ESMHPA-2003
Average Age Mean
Standard
Deviation
Weighted 14,5 1,6
Age group Weighted % Not weighted %
12 to 14 years old 49,7 48,6
15 to 17 years old 50,3 51,4
EDUCATION
The illiteracy rate is much lower compared to that of adults and is equal to the rate indicated in the 2002
MESMH (0,5%). According to the study sample, secondary education represents the highest percentage (Table 95).
130
TABLE 95
LEVEL OF EDUCATION OF THE TEENAGE POPULATION IN AYACUCHO,
CAJAMARCA AND HUARAZ -2003
Level of Education Total
%
Primary education 25,9
Secondary education 73,7
Baccalaureate 0,1
Post-secondary non-tertiary education 0,2
Tertiary education 0,1
MARITAL STATUS
A total of 92,2% of teenagers is single; 2,9% of teenage girls faced pregnancy at least once and 0.9% have
had abortions. These last fgures are remarkably higher in comparison to those shown in the 2002 MESMH.
EMPLOYMENT
It is important to assess the employment level of teenagers since it can usually be an indicator of family
economic problems: 11,4% of teenagers in Ayacucho, Cajamarca and Huaraz were working the previous week (Table
96) with a monthly average net income of S/. 97,8. (Exchange rate: US $ 1,00 = S/. 3,50 Nuevos Soles)
TABLE 96
EMPLOYMENT SITUATION OF TEENAGERS IN AYACUCHO,
Employment Situation Total
%
Worked the previous week 11,4
Is looking for a job 2,5
TEENAGERS
131
MENTAL HEALTH OF TEENAGERS SURVEYED
Teenagers fnd themselves in a process of development toward adulthood. The success of this stage frequently
determines success in life. There are problems of special importance like anxiety and depression disorders which easily
escape unnoticed by the adults. As in the case of adults, there are a series of questions related to contextual factors
both at the macro level as well as at the level of close social relations.
GENERALITIES
With relation to the problems the country is facing, the teenagers of the Peruvian Andes (Ayacucho, Cajamarca
and Huaraz) consider unemployment and poverty to be the main problems, followed by crime, corruption and violence,
which is similar to what the teenagers of Lima and Callao believe (MESMH - 2002) (Table 97). The majority feel sorrow,
sadness or depression, concern and anger towards these problems (Table 98).
TABLE 97
MAIN PROBLEMS IN THE COUNTRY PERCEIVED BY TEENAGERS
Problems Perceived % Problems Perceived % Problems Perceived %
Unemployment 27,6 Violence 7,5 Political instability 1,2
Poverty 25,7 Economic management 4,5 Lack of trust 1,2
Crime 11,8 Terrorism 2,5 Lack of leadership 1,0
Corruption 9,8 Drug traffcking 1,9 Other 3,0
TABLE 98
FEELINGS TOWARD NATIONAL PROBLEMS IN TEENAGERS
Feelings % Feelings % Feelings %
Sorrow, sadness or
depression
35,5 Disappointment 6,7 Helplessness 2,1
Worry 28,1 Bitterness 4,2 Distress or despair 1,5
Anger 10,6 Rage 3,9 Other 1,6
The low trust in political authorities (82,4%) as well as in community leaders(70,0%) is surprising; this contrasts
with complete trust shown for teachers (54,1%) religious authorities (43,1%) and doctors (47,1) (Table 99)
132
TABLE 99
TRUST IN AUTHORITIES IN THE TEENAGE POPULATION
OF AYACUCHO, CAJAMARCA AND HUARAZ
None or Little
%
Some
%
A Lot
%
Trust in police authorities 55,6 35,9 8,6
Trust in political authorities 82,4 15,4 2,2
Trust in teachers 16,9 29,0 54,1
Trust in religious authorities 27,5 29,4 43,1
Trust in community leaders 70,0 23,1 6,9
Trust in doctors 21,5 31,4 47,1
The main psychosocial stressors perceived by teenagers are crime (57,2%), health (54,3%) studies (43,3%)
and relatives (42,2%) (Table 100)
TABLE 100
MAGNITUDE OF TENSION OF DAILY STRESSORS IN THE TEENAGE
Type of Psychosocial Stressor
None or Little
%
Some
%
A Lot
%
Work 50,3 27,4 22,2
Studies 32,7 24,0 43,3
Relatives 40,9 16,9 42,2
Partner 68,7 15,9 15,4
Money 52,2 26,3 22,5
Health 25,3 20,4 54,3
Law 76,8 12,0 11,2
Crime 27,0 15,8 57,2
In relation to environmental stress, 42,5% perceive a high level of environmental stress (noise, ventilation,
odours, space); a similar fgure was indicated by teenagers living in Lima and El Callao (MESMH - 2002)
Although they are not pathological in themselves, emotional states may cause signifcant repercussions in the
quality of life of teenagers. Results are striking in relation to negative emotional states since 11,1% to 16,6% experience
sadness, tension, distress, irritability, or boredom. The tendency towards worry tends to be high, though it has to be
considered that in Spanish the word worry also bear some connotations of responsibility; this tendency was similar
in Lima and El Callao (Table 101).
TEENAGERS
133
TABLE 101
PREVAILING OF EMOTIONAL STATES AT THE MOMENT OF ASSESSMENT IN
THE TEENAGE POPULATION IN AYACUCHO, CAJAMARCA AND HUARAZ
Emotional
States
Sad
%
Tense
%
Distressed
%
Irritable
%
Worried
%
Calm
%
Happy
%
Bored
%
Other
%
Total 13,2 12,4 11,9 16,6 25,7 61,7 77,4 11,9 1,0
It is known that satisfaction with what one is or one does has an enormous infuence in the development of
a healthy self-esteem, specially in the early stages of life like in adolescence. The degree of personal satisfaction of
teenagers has been measured in a scale from 5 to 20, and a mean of 16,9 was found, similar to the mean found for
teenagers in Lima and El Callao (16,1) (MESMH - 2002) (Table 102). The main sources of satisfaction are intelligence,
physical appearance and social relations with 60,8%, 60,5% and 59,2%, respectively; 24,9% of teenagers surveyed
are not satisfed or hardly satisfed with their standard of living or economic level. Unlike what was found in teenagers in
Lima and El Callao, teenagers in Ayacucho, Cajamarca and Huaraz defne satisfaction more clearly in different factors
except with regard to the economic level where data similarly disperse in three categories (Table 103).
TABLE 102
DEGREE OF GLOBAL PERSONAL SATISFACTION IN THE TEENAGE
Degree of Global Personal Satisfaction
(Scale 5 20)
Estimates 16,9 17,4 20,0 15,3 18,9
TABLE 103
DEGREE OF PERSONAL SATISFACTION N THE TEENAGE POPULATION OF
AYACUCHO, CAJAMARCA AND HUARAZ 2003
Area
None or Little
%
Some
%
A Lot
%
Physical appearance 11,5 28,5 60,5
Education 14,2 30,0 55,9
Social relations 12,5 28,3 59,2
Skin colour 10,2 21,9 67,9
134
Work satisfaction
Considering the fact that many teenagers have to work to help and support their families, the evaluation of this
area is important. With respect to a global evaluation, the degree of work satisfaction is similar to the one indicated for
teenagers from Lima and El Callao (16,0 and 15,2, respectively) with workload (28,9%) and income (32,8%) being the
main reasons for dissatisfaction. It must be emphasized that co-workers represent a source of work satisfaction for 64%
of teenagers surveyed (Tables 104 and 105).
TABLE 104
DEGREE OF WORK SATISFACTION IN THE TEENAGE POPULATION OF
(Scale 5 20)
Media Mean Mode P25 P75
Total 16,0 16,7 20,0 13,8 18,0
TABLE 105
DEGREE OF WORK SATISFACTION IN THE TEENAGE POPULATION
Work Factors
None or Little
%
Some
%
A Lot
%
Activities or functions they carry out 15,1 29,1 55,8
Co-workers 9,0 26,4 64,7
Quality of life
Quality of life is a concept that involves areas such as physical and psychological well-being, self care, work
and interpersonal performance, socio-emotional support, communitarian support, personal achievement and spiritual
satisfaction. The global result corresponding to the Quality of Life Index on a scale from 1 to 10 (10 being excellent) is
7,8, a fgure which indicates an acceptable level. The value found is slightly similar to the value found in the teenagers
of the MESMH - 2002 (Table 106).

TEENAGERS
135
TABLE 106
QUALITY OF LIFE IN THE TEENAGE POPULATION IN AYACUCHO,
Quality of Life of the Population
(Scale 1 - 10)
Mean Standard
Deviation
Mode P25 P75
7,8 1,1 7,8 7,2 8,7
Psychopathic factors
Psychopathic behaviour can start since at an early age and can predict severe personality problems hard
to treat in adulthood. Permissiveness towards psychopaths measures peoples tolerance toward criminal behaviours
such as theft, while psychopathic tendencies are considered to be conducts such as frequent lying and violence, while
criminal tendencies are theft and other behaviours in open confict with the law. The results are similar to those found in
Lima and El Callao, for both permissiveness and tendencies (Table 107) (MESMH 2002).
TABLE 107
PSYCHOPATHIC FACTORS IN THE TEENAGE POPULATION
Psychopathic Factors %
Permissiveness towards psychopathic conduct 9,9
Prevalence of psychopathic tendencies 39,4
Prevalence of criminal tendencies 9,6
Suicidal indicators
Teenagers face processes of change which can affect their emotional states and make them prone to
pessimistic ideas about their future. As it is also the case with adults, suicide rates should serve as an indicator for early
intervention. This study looks at the components of the process which can lead to consummated suicide such as desire,
thought, planning and attempt or suicidal behaviour.

The fgures regarding these four categories are noteworthy. The desire to die shows the highest fgures followed
gradually by suicidal thoughts, planning and fnally the attempt. Nevertheless, all fgures are high and similar to those
found for teenagers in the MESMH - 2002.
Table 108 shows that 29,6% of the teenage population has experienced the desire to die at some point in
their lives; 15,9% considered it in the previous year and 6,9% in the previous month. In relation to suicidal behaviour in
teenagers, which shows a more serious affiction, 2,9% of the teenage population has tried to commit suicide at some
point in their lives, and 1,9% would have done it in the past year. The fgures are signifcantly higher in the group of
teenagers from 15 to 17 years old.
One third of teenagers who tried to harm themselves still considers such conduct as a possible solution (Table
108). This fgure is similar to the one found for teenagers in Lima and El Callao (MESMH - 2002).
136
TABLE 108
SUICIDAL INDICATORS IN THE TEENAGE POPULATION OF
Suicidal Indicators
Total
%
12 to 14 Years
Old
%
15 to 17 Years
Old
%
Desire to die
Lifetime prevalence 29,6 25,3 33,9
Monthly prevalence 6,9 6,3 7,5
12-month prevalence 15,9 13,2 18,7
Thoughts about taking ones life
Suicidal planning
Suicidal behaviour
Prevalence of suicidal potential 0,9 0,1 1,6
(30.2% of attempts)
According to Table 109 the reasons behind the desire to die and the attempt are related. Conficts with parents
(48,8% and 70,5%) stand out among the reasons why teenagers wish or attempt to take their own lives, specially at
ages between 15 and 17 years old (54,4 and 73,0%) followed by problems related to studies, other relatives, money
problems and past traumatic experiences, the latter options being overly manifested in teenagers between 15 and 17
years old who actually attempted suicide (11,4%). It is important to point out that the main causes of suicidal indicators
are found in the home itself, in the three cities of the Peruvian Andes and in Lima and El Callao as well (MESMH -
2002).
TEENAGERS
137
TABLE 109
REASONS WHY THE TEENAGE POPULATION IN AYACUCHO, CAJAMARCA
AND HUARAZ WISHES TO COMMIT SUICIDE OR ATTEMPTS SUICIDE - 2003
Topic
Ages
%
Reasons for
Suicidal Desires
%
Reasons for
Suicidal Attempts
%
Total 1,7 1,3
Problems with self image 12 to 14 1,6 0,0
15 to 17 1,8 1,7
Total 48,8 70,5
Problems with parents 12 to 14 41,1 62,7
15 to 17 54,4 73,0
Total 12,3 9,7
Problems with other relatives 12 to 14 12,4 4,6
15 to 17 12,3 11,3
Total 2,7 3,4
Problems with partner 12 to 14 1,8 0,0
15 to 17 3,4 4,6
Total 0,8 3,8
Work-related problems 12 to 14 0,0 0,0
15 to 17 1,4 4,9
Total 16,0 6,8
Study-related problems 12 to 14 15,0 23,7
15 to 17 16,8 1,3
Total 9,1 1,0
Economic problems 12 to 14 5,1 0,0
15 to 17 11,9 1,4
Total 3,5 0,0
Health problems 12 to14 3,2 0,0
15 to 17 3,7 0,0
Total 2,1 9,0
Problems due to traumatic experience 12 to 14 0,9 0,0
15 to 17 3,0 11,4
Total 6,5 13,2
Separation of family member 12 to 14 5,9 0,0
15 to 17 7,0 17,5
Total 5,4 2,0
Family member health problems 12 to 14 5,8 0,0
15 to 17 5,2 2,7
Total 5,2 1,9
Problems with friends 12 to 14 3,9 0,0
15 to 17 6,1 2,5
Total 15,8 10,0
Other 12 to 14 23,7 26,4
15 to 17 10,0 4,7
138
Tendency towards violence
Violence is one of the main social problems society has to face. In this study it was only measured by the
lifetime prevalence of behaviours such as fghts with some type of weapon and physical abuse to a younger child,
and it was found that 20,6% of the population has been involved in some of these types of behaviour, with no major
differences in age groups. The prevalence of homicidal thought, though relatively low, are striking (2,1%) from the point
of view of the population (Table 110). All these indicators are considerably lower than said indicators for teenagers in
Lima and El Callao (23,5% and 3,2%) (MESMH 2003)
TABLE 110
TENDENCIES TOWARD VIOLENCE OF THE TEENAGE POPULATION
Indicator Ages %
Prevalence of violent tendencies Total 20,6
12 to14 19,4
15 to17 21,7
Lifetime prevalence of homicidal thoughts Total 2,1
12 to14 0,6
15 to17 3,6
Monthly prevalence of homicidal thoughts Total 0,9
12-month prevalence of considerations or thoughts of homicidal nature Total 1,1
Protection factors
The degree of family bonding is measured by considering feelings of mutual respect and mutual support,
family pride, or the sharing of principles and values. This area shows high levels, which is a positive factor compared
to other psychosocial stressors which threaten mental health (Table 111). In the same way, the religious factor is as
important for the surveyed teenage population (85,7%) as it is in the teenage population in Lima and El Callao (MESMH-
2003) and the majority thinks religion helps to solve problems ( 68,5%).
TABLE 111
DEGREE OF FAMILY BONDING OF THE TEENAGE POPULATION
(Scale 5 - 20)
Total 17,5 18,3 20,0 15,8 20,0
TEENAGERS
139
CLINICAL DISORDERS
Table 122 shows the current prevalence of psychotic syndrome, depressive episodes, dysthymia, social phobia,
generalized anxiety disorder, anorexia and bulimia nervosa, according to the research criteria of the International
Classifcation of Diseases (ICD), Tenth Review. The most frequent clinical disorder is the depressive episode with 5,7%,
followed by generalized anxiety disorder with 5,5%. In relation to eating disorders, while the prevalence of anorexia
nervosa is 0,1%, bulimic behaviour is 4,0% and the tendency towards eating related problems is 5,9%. All these
prevalences are signifcantly lower compared to those found in the teenage population of Lima and El Callao (MESMH
- 2002), except generalized anxiety disorder, dysthymia and bulimic behaviour.
The differences regarding the distribution of prevalences by city is evident with Cajamarca, which shows
the lowest indicators for all pathologies except dysthymia and bulimia nervosa which do not differ signifcantly from
Huaraz and Ayacucho. Generalized anxiety disorder (7,8%) and depressive episodes (7,3%) stand out in Ayacucho and
Huaraz, respectively (Table 112).
TABLE 112
CURRENT PREVALENCE OF SOME PSYCHIATRIC DISORDERS
IN THE TEENAGE POPULATION OF AYACUCHO,
CAJAMARCA AND HUARAZ BY CITIES 2003
Clinical Conditions According to ICD-10
Total
%
Huaraz
%
Ayacucho
%
Cajamarca
%
Psychotic disorders* 1,5 2,5 1,7 0,7
Depressive episode 5,7 7,3 6,2 4,4
Dysthymia 0,8 1,0 0,7 0,9
Social phobia 3,1 4,3 3,9 1,6
Generalized anxiety disorder** 5,5 4,8 7,8 3,3
Bulimia nervosa 0,4 0,3 0,4 0,5
Bulimic behaviour*** 4,0 3,7 5,7 2,1
Anorexia nervosa 0,1 0,6 0,0 0,0
Tendency towards eating disorders**** 5,9 6,1 6,1 5,7
** Generalized Anxiety Disorder (GAD) criteria were adjusted when it was explicitly required that the person feel worry and tension in general. The same research
criteria used for adults was applied.
*** Bulimic behaviour means to have had at least two bulimic crisis per week in the last 3 months.
**** It refers to persons who engage in self-inducing vomiting, use of laxatives, excessive exercise for more than two hours a day or use of appetite suppressors or
diuretics in order to loose weight.
Substance consumption
Regarding teenagers, the information about the starting age of consumption seems to be more exact than
adults and the comparison can help to establish tendencies. As in adults and teenagers of Lima and El Callao, fgures
are higher for males in comparison to females. Alcohol consumption is superior to all other types of consumption, with a
lifetime prevalence of 66,4% and a monthly prevalence of 14,2%. In relation to problematic behaviour, there is a monthly
140
prevalence of alcohol drunkenness which corresponds to 2,2%. It must be noted that 27,4% of teenagers surveyed,
identifes at least one conduct related to alcohol abuse (Table 113). The lifetime prevalence of legal substances
consumption is 71,1%, while the lifetime prevalence of illegal substance consumption is 0,8%. The most consumed
non-alcoholic legal substance is tobacco (24,5%) followed by headache tablets (11,1%) and the coca leaf (9,5%) while
marijuana is the illegal substance most widely consumed at some point (0,5%) followed closely by inhalants (0,4%)
(Table 114).
TABLE 113
PREVALENCE OF ALCOHOL CONSUMPTION IN THE TEENAGE POPULATION
BY GENDER IN AYACUCHO, CAJAMARCA AND HUARAZ - 2003
Period and Type of Substance
Total
%
Male
%
Female
%
Lifetime prevalence of alcohol consumption 66,4 69,6 63,5
Monthly prevalence of alcohol consumption 14,2 15,2 13,4
Monthly prevalence of alcohol drunkenness 2,2 3,4 1,4
Current prevalence of some conduct related to alcohol abuse
(at least one conduct)
27,4 28,3 26,5
(at least two conducts)
4,2 6,0 2,7
(at least three conducts)
2,0 2,8 1,2
TABLE 114
LIFETIME PREVALENCE OF MAIN LEGAL AND ILLEGAL SUBSTANCE
CONSUMPTION IN THE TEENAGE POPULATION BY GENDER
Type of Substance
Total
%
Male
%
Female
%
Lifetime prevalence of legal substances consumption 71,1 74,2 68,2
Lifetime prevalence of illegal substances consumption 0,8 1,4 0,2
Lifetime prevalence of tobacco consumption 24,5 30,8 18,7
Lifetime prevalence of tranquillisers consumption 0,8 0,0 1,4
Lifetime prevalence of stimulants consumption 0,0 0,0 0,0
Lifetime prevalence of cocaine paste (CBP) consumption 0,1 0,2 0,0
Lifetime prevalence of marijuana consumption 0,5 0,8 0,1
Lifetime prevalence of cocaine consumption 0,1 0,2 0,0
Lifetime prevalence of inhalants consumption 0,4 0,9 0,0
Lifetime prevalence of headache pills consumption 11,1 9,0 13,0
Lifetime prevalence of cough syrup consumption 3,4 3,8 3,1
Lifetime prevalence of coca leaf consumption 9,5 9,7 9,3
TEENAGERS
141
The distribution by city of the prevalences of consumption of substances by teenagers shows signifcant
differences in the general consumption of legal substances and alcohol. There is a higher lifetime and monthly prevalence
of alcohol consumption in Ayacucho (74,0 and 15,3%) followed by Cajamarca with 63,2 and 16,7% (Table 115).
TABLE 115
LIFETIME PREVALENCE OF MAIN LEGAL AND ILLEGAL SUBSTANCE
CONSUMPTION IN THE TEENAGE POPULATION BY CITY
Type of Substance and Period
Total
%
Huaraz
%
Ayacucho
%
Cajamarca
%
Lifetime prevalence of alcohol consumption 66,4 56,4 74,0 63,2
Monthly prevalence of alcohol consumption 14,2 6,9 15,3 16,7
Monthly prevalence of alcohol drunkenness 2,2 1,4 2,0 2,8
Current prevalence of some conduct related to
alcohol abuse (at least one conduct)
27,4 16,4 36,9 22,5
alcohol abuse (at least two conducts)
4,2 2,7 4,2 5,1
alcohol abuse (at least three conducts)
2,0 1,1 1,9 2,5
Lifetime prevalence of legal substance consumption 71,1 62,6 79,2 66,5
Lifetime prevalence of illegal substance con-
sumption
0,8 0,0 0,8 1,1

The starting age of consumption of the different substances (Table 116) of most teenagers surveyed ranges
between 11 and 14 years old, earlier than the starting age in Lima and El Callao where children begin to consume drugs
between 13 and 14 years old according to MESMH - 2002.
TABLE 116
STARTING AGE OF MAIN SUBSTANCE CONSUMPTION IN THE TEENAGE
Type of Substance Media
%
Mean
%
Mode
%
Min
%
Max
%
Starting age for alcohol consumption 11,9 12,0 12,0 1,0 17,0
Starting age for tobacco consumption 13,4 14,0 14,0 5,0 17,0
Starting age for tranquillizers consumption 14,7 15,0 16,0 9,0 16,0
Starting age for CBP (cocaine paste) consumption 15,2 15,0 15,0 15,0 16,0
Starting age for cocaine consumption 11,7 11,0 11,0 11,0 14,0
Starting age for marijuana consumption 15,7 15,0 15,0 14,0 17,0
Starting age for inhalants consumption 12,1 13,0 15,0 6,0 15,0
Starting age for headache pills consumption 11,0 11,0 10,0 2,0 17,0
Starting age for cough syrup consumption 9,9 10,0 7,0 3,0 16,0
142
ABUSED TEENAGERS
Teenagers, like children and women, are at serious disadvantage to defend themselves from the aggressions
of persons in their environment; more than 65% of the teenage population has suffered some type of abuse at some time
in their life. The most frequent type of abuse is psychological (insults, verbal aggression, humiliations, manipulations)
with 55,3%, followed by physical abuse (blows, punches, pushing in disadvantageous circumstances) with 40,5% (Table
117). It is evident that these fgures are signifcantly higher than the fgures that correspond to the teenage population
of Lima and El Callao (MESMH - 2002) except for sexual abuse.
TABLE 117
LIFETIME PREVALENCE OF ABUSE EXPERIENCED BY TEENAGERS
Kind of Abuse %
Prevalence of any kind of abuse (sexual, physical or emotional) at some time 65,4
Prevalence of some kind of sexual abuse 2,5
Prevalence of some kind of physical abuse 40,5
Prevalence of some kind of psychological abuse 55,3
Prevalence of some type of negligence 13,1
ACCESS TO SERVICES
If mental health assistance services for adults in the countrys capital are insuffcient, the situation for teenagers
in the Peruvian Andes is even more so. There are very few professionals who specialize in teenage issues and they
are almost inexistent in the highlands. When evaluating the access to mental health assistance services for teenagers
the same problems are found related to prejudices from the population. As in the case with adults, this report will be
limited to the presentation of results from the point of view of the perceived morbidity, that is, those teenagers who have
perceived in themselves emotional or mental problems at some time in their lives.
When asked whether they have suffered some emotional or nervous problem at some point in their lives
(perceived need for assistance) 43,2% of surveyed teenagers answered positively, representing a higher fgure when
compared to teenagers in Lima and El Callao (29,8%). This fgure must be interpreted as mental health problems in
general. It was also found that 6% looked for some kind of assistance to solve the problem (expressed perceived
morbidity) while 94% did not get any type of medical assistance (Table 118). Of the 6% who did get help, 2% attended
the centres of the Ministry of Health (MINSA) followed by 1,4% who sought assistance through ESSALUD (Peruvian
Social Security Health Insurance Institute) (Table 119). In other words, there would be more perceived morbidity but less
seek for assistance than in teenagers of Lima and El Callao (MESMS - 2002)
TEENAGERS
143
TABLE 118
HEALTH ASSISTANCE IN THE TEENAGE POPULATION IN AYACUCHO, CAJAMARCA AND HUARAZ 2003
Need %
Perceived morbidity for mental health in lifetime
(mental health problems)
43,2
Help seeking behavior for mental health assistance in the last six months
(% of perceived morbidity)
6,0
TABLE 119
HEALTH SERVICE CENTRES AND THE DISTRIBUTION OF THOSE WHO SEEK
FOR MENTAL HEALTH ASSISTANCE IN THE TEENAGE POPULATION IN AYACUCHO,
Health Service Centres Partials % Totals %
MINISTRY OF HEALTH (MINSA) 2,0
(20,5 of cases attended)
Health and emergency centres 0,9
Specialized hospital or institute 0,1
ESSALUD 1,9
Emergency centre/polyclinic 0,5
PAAD offces (Decentralized Ambulatory Care Program) 0,0
Mental health centre 0,0
ARMED FORCES 0,0
Armed Forces and Police Hospitals 0,0
PRIVATE 1,8
Private hospital 1,0
Private practice 0,8
OTHER 3,1
(31,8 % of those helped)
With regard to the reasons why a person did not receive any assistance for their emotional problem, the
majority (55,9%) believed that they should overcome it by themselves, followed by 40,2% who did not know where to go
or search for help, 30,8% could not afford it and 32,9% lacked trust. It is evident that, as in the case for adults, cultural
factors play a very special role, as well as educational and economic factors (Table 120).
144

TABLE 120
MAIN REASONS FOR NOT RECEIVING MEDICAL ATTENTION DESPITE
THE PERCEIVED MORBIDITY OF THE TEENAGE POPULATION
Reasons for not
Attending Health Centre
%
Reasons for not
Attending Health Centre
%
Should overcome problem by myself 55,9 Parents did not consider it necessary 13,7
Could not afford it 30,8 Long waiting lists 10,8
Lack of trust 32,9 Fear to be seen as a mental patient 7,2
Doubted medical treatment
18,6
There were no mental health services
nearby
12,2
Did not know where to go 40,2 Neighbours would speak ill 6,5
Would not beneft from it 17,8 Not covered by medical insurance 4,6
Shame
19,9
Preferred to spend money on something
else
4,6
Preferred home remedies 6,9 Previous bad experience 5,7

SENIOR ADULTS SURVEYED
145
CHARACTERISTICS OF

147
CHARACTERISTICS OF SENIOR ADULTS SURVEYED
The number of senior adults surveyed in the three cities of the Peruvian Andes where the study was carried
out, Ayacucho, Cajamarca and Huaraz, was 717, and according to the sampling design it allows an inference to 22 191
inhabitants. The results are presented based on the expanded population. According to sex, the distribution of those
surveyed was 43,4% males and 56,6% females (Table 121).
TABLE 121
TOTAL NUMBER OF SENIOR ADULTS SURVEYED IN AYACUCHO,
Surveyed
Frequency Male
%
Female
%
Total sample (without weighting) 717 40,6 59,4
Expanded 22 191 43,4 56,6
AGE
The average age of senior adults surveyed was 70,7 years old. The persons between the ages of 60 and 74
represented the highest percentage (Table 122).
TABLE 122
AGE OF SENIOR ADULTS SURVEYED IN AYACUCHO,
CAJAMARCA AND HUARAZ-2003
AGE Mean
Weighted (standard deviation) 70,7 (8,2)
AGE GROUPS %
Young-old (60 to 74 years old) 69,2
Old-old (75 to 84 years old) 24,3
Oldest-old (85 or more) 6,5
EDUCATION
A high percentage of senior adults surveyed (34,5%) is illiterate. Taking gender into account, 48% of women
surveyed and 16% of males surveyed are illiterate (Table 123)
148

TABLE 123
ILLITERACY IN SENIOR CITIZENS OF AYACUCHO,
Illiteracy %
Total 34,5
Male 16,4
Female 48,7
In relation to levels of education, the highest percentage of senior adults surveyed has completed primary
education (39,9) and the group of people without education is very close in number (31,4%). In the distribution by
gender, the lack of education in women reaches 45,5%, while in men it is 13,1% (Table 124). Both the high percentage
of illiteracy and the marked differences in gender reveal fewer educational opportunities as well as the inequality in
which women have grown up.
TABLE 124
LEVEL OF EDUCATION OF THE SENIOR ADULT POPULATION
Grade of Schooling
Total
%
Male
%
Female
%
None 31,4 13,1 45,5
Pre-primary education/ Kindergarten 0,4 0,3 0,6
Primary education 39,9 47,9 33,7
Secondary education 12,0 16,1 8,9
Baccalaureate --- --- ---
Post-secondary non-tertiary education 7,4 8,6 6,5
Tertiary education 8,2 13,3 4,2
Graduate studies 0,6 0,6 0,6
MARITAL STATUS
A total 61,1% of senior adults surveyed is in a relationship (married or living together) and 36% is separated,
divorced or widowed; 2,9% remain single (Table 125)

149
TABLE 125
MARITAL STATUS OF SENIOR ADULTS IN AYACUCHO,
Marital Status Total
%
Unmarried (cohabitants) 7,7
Separated 8,8
Divorced 0,5
Widowed 26,7
Married 53,4
Single 2,9
EMPLOYMENT
A total of 34% of senior adults worked the week previous to the survey; in males this fgure reaches 41,5%
while among women it is 28,2%. The fgure of those looking for a job is low (Table 126).
TABLE 126
EMPLOYMENT SITUATION OF SENIOR ADULTS IN AYACUCHO,
Working Situation
Total
%
Male
%
Female
%
Worked the previous week 34,0 41,5 28,2
Is looking for a job 1,1 1,9 0,5

151
MENTAL HEALTH IN SENIOR ADULTS SURVEYED
GENERALITIES

The main mental health indicators of senior adults are presented following the same scheme used in this study
for the other units of analysis: adult, women in a relationship and teenagers.
Out of eleven daily stressors explored, more than one third of senior adults expresses experiencing high
tension with regard to eight of them. As was to be expected, what produces the greatest amount of tension is health,
followed by crime and economic problems (Table 127). With respect to health, it must be noted that the six month
prevalence of physical illness or accident in senior adults is 56,5%.
TABLE 127
MAGNITUDE OF TENSION IN THE SENIOR ADULT POPULATION OF
AYACUCHO, CAJAMARCA AND HUARAZ WHEN FACED
WITH DAILY STRESSORS 2003
Type of Pschychosocial Stressor
None or Little
%
Some
%
A Lot
%
Work 40,7 21,9 37,4
Studies 66,5 15,9 17,6
Children 37,4 20,8 41,8
Partner 51,8 12,9 35,3
Money 28,9 21,5 49,5
Health 20,4 18,6 60,9
Problems with the law 83,4 8,3 8,3
Terrorism 44,7 13,6 41,7
Crime 29,5 14,1 56,3
Drug traffcking 44,2 13,4 42,3
Other 88,6 3,7 7,7
When evaluating the frequency with which senior adults experience different states emotional , calmness and
happiness prevail. The conditions considered to be negative such as sadness, tension, distress, irritability and boredom
range from 15,7% to 30,2%. It is evident that women experience more negative states of mind when compared to men
(Table 128).
152

TABLE 128
PREVAILING EMOTIONAL STATES AT THE MOMENT OF ASSESSMENT
IN THE SENIOR ADULT POPULATION OF AYACUCHO,
CAJAMARCA AND HUARAZ-2003
Emotional
States
Sad Tense Distressed Irritable Worried Calm Happy Bored Other
Total 30,2 17,4 19,2 15,7 40,2 51,2 45,1 16,3 9,6
Male 18,7 10,8 15,4 12,3 32,2 62,0 57,6 12,1 13,1
Female 39,0 22,6 22,2 18,4 45,7 42,7 35,5 19,5 6,1
The degree of personal satisfaction with respect to different attributes and personal conditions is a refection of
self esteem. Considering a scale from 5 to 20, personal satisfaction in senior adults shows a mean of 15,74, with values
slightly higher for males (Table 129). Religion shows the highest degree of satisfaction while studies and economic level
have the lowest percentages (Table 130).
TABLE 129
PERSONAL SATISFACTION IN THE SENIOR ADULT POPULATION
Personal Satisfaction
(Scale 5 - 20)
Media (SD) Mean Mode Pc25 Pc75
Total 15,74 (2,8) 16,0 20,0 13,9 18,0
Male 16,33 (2,7) 16,6 20,0 15,0 18,5
Female 15,27 (2,8) 15,3 14,0 13,0 17,4
TABLE 130
PERSONAL SATISFACTION IN THE SENIOR ADULT POPULATION
Area
None or Little
%
Some
%
A Lot
%
Physical appearance 13,3 32,9 53,8
Skin colour 8,6 32,7 58,7
Profession or trade studied 24,7 25,7 49,6
Level of reached education 49,4 22,1 28,4
Religion 5,6 14,8 79,6
Friends or social acquaintances 19,3 31,1 49,6
Residence 10,3 25,4 64,2

153
Work satisfaction
Approximately one third of the sample of senior adults is still working, so the evaluation of work satisfaction
is important. On a scale from 5 to 20, those surveyed present a median of 15,67% of work satisfaction, being slightly
higher for males. With regard to the specifc components, the majority of senior adults states being very satisfed with
themselves, except for the income they earn (Tables 131 and 132).

TABLE 131
WORK SATISFACTION IN THE SENIOR ADULT POPULATION
(Scale 5 - 20)
Mean
(Standard Deviation)
Median Mode P25 P75
Total 15,67 (3,03) 16,0 15,0 13,75 17,5
Male 16,28 (2,89) 16,66 15,0 15,0 18,75
Female 14,92 (3,02) 15,0 15,0 13,0 17,5
TABLE 132
WORK SATISFACTION IN THE SENIOR ADULT POPULATION
Work Factor
None or Little
%
Some
%
A Lot
%
Activities or functions performed 11,4 34,0 54,5
Co-workers 14,7 34,7 50,5
Quality of life
The evaluation of the different personal and environment factors, such as physical and psychological well-being,
self care, work and interpersonal performance, socio- emotional support, community support, personal achievement
and spiritual satisfaction, allows estimations to be made regarding quality of life. On a scale from 1 to 10, the median of
the Quality of Life Index in the senior adult is 7,51 (Table 133).
154

TABLE 133
QUALITY OF LIFE IN THE SENIOR ADULT POPULATION IN AYACUCHO,
Quality of Life Index
(Scale 1 - 10)
Mean Median Mode Pc25 Pc75
Total 7,51 7,6 7,6 6,8 8,6
Male 7,67 7,6 6,8 6,8 8,8
Female 7,37 7,5 7,5 6,4 8,4
Disability or inability
The knowledge of the magnitude of functional disability to accomplish daily activities produced by some
pathological condition in the population of senior adults is particularly important for their autonomy. Specifc suffering of
some kind of disability rises to 19,5%, being higher in males than in females (Table 134). On a scale from 5 to 20, in
which 5 means no disability, there is a mean low level of disability among the persons surveyed (Table 135), similar for
both men and women. A high percentage of the population (45%) shows at least one disability ( Table 136).
TABLE 134
PHYSICAL DISABILITY IN THE SENIOR ADULT POPULATION
At Least One Physical Disability %
Total 19,5
Male 25,5
Female 14,8
TABLE 135
GENERAL LEVEL OF FUNCTIONAL DISABILITY IN THE SENIOR ADULT
POPULATION OF AYACUCHO, CAJAMARCA AND HUARAZ - 2003
General Level of Functional Disability
(Scale 5 20; 5 Representing no
Disability)
Mean (S.D.) Median Mode P25 P75
Total 6,81 (2,93) 5,0 5,0 5,0 7,0
Male 6,88 (2,90) 5,0 5,0 5,0 8,0
Female 6,76 (2,95) 5,0 5,0 5,0 7,0

155
TABLE 136
SOME KIND OF FUNCTIONAL DISABILITY BY GENDER IN THE SENIOR ADULT
POPULATION OF AYACUCHO, CAJAMARCA AND HUARAZ - 2003
At Least One Functional Disability or Inability %
Total 44,9
Male 47,4
Female 43,0
Suicidal indicators
Given the situations of loss to which the senior adult is exposed that can produce negative emotional states, it
is necessary to explore the problem of suicide and its magnitude. The lifetime, annual and previous month prevalences
of suicidal indicators considered are: the desire to die, thoughts about taking ones life, and suicide plans and behaviour.
The desire to die during ones lifetime represents 33,3% and attempted suicide, 0,6%. The desire to die during the
previous month showed 11,1%. It is important to note that last year and in the previous month the development of
suicide plans were close to 1%. All indicators, except suicide plans in the previous month, are higher among women
(Table 137).
TABLE 137
SUICIDE INDICATORS IN THE SENIOR ADULT POPULATION
Prevalence
Suicide Indicators
Lifetime
%
Annual
%
Monthly
%
Desire to die 33,3 16,0 11,1
Male 22,2 7,0 3,9
Female 42,1 23,0 16,8
Thoughts about taking ones life 7,3 3,9 2,3
Male 5,5 2,1 2,1
Female 8,7 5,4 2,6
Suicide plans 1,7 1,4 0,8
Male 1,0 1,0 1,0
Female 2,3 1,8 0,7
Suicidal behaviour 0,6 0,0 0,0
Male 0,5 0,0 0,0
Female 0,7 0,0 0,0
Protection factors
Family bonding and religious tendencies have been evaluated as protection factors for the health and well
being of the senior adult. The frst refers to the degree of feelings of mutual respect and support and the sharing of
values and projects. On a scale from 5 to 20, where 5 represents no bonding, the mean of those surveyed is 17,99
(Table 138). On the other hand, there are high percentages of positive attitudes and religious practices which constitute
an important element of support (Table 139).
156

TABLE 138
FAMILY BONDING IN THE SENIOR ADULT POPULATION OF
Family Bonding
(Scale 5 - 20)
Mean (s.d.) Median Mode P25 P75
Total 17,99 (2,57) 19,17 20,0 16,67 20,0
Male 18,13 (2,39) 19,17 20,0 16,67 20,0
Female 17,89 (2,70) 19,17 20,0 16,67 20,0
TABLE 139
RELIGIOUS TENDENCIES IN THE SENIOR ADULT POPULATION
Religious Tendencies %
God is very important 95,1
Goes to church or temple 90,2
Active participation 21,3
Reads religious texts 41,8
Transmits religion to children 50,7
Religion helps to solve problems 84,1
Preaches or teaches other people 29,3
Depressive episode in the senior adult
Table 140 shows the lifetime, 12-month, six months, and current prevalences of the depressive episode in
senior adults according to the research criteria of the International Classifcation of Diseases, Tenth Review (ICD -10).
The current prevalence of the depressive episode is 3,9%, with fgures greater among women. There are no differences
in the two age groups considered. Lifetime prevalence is 15,3%, showing the same described tendency.
TABLE 140
DEPRESSIVE EPISODE IN THE SENIOR ADULT POPULATION
Prevalences of Depressive Episode Lifetime
%
12-month
%
6 months
%
current
%
Total 15,3 5,0 4,1 3,9
Male 12,4 4,4 2,8 2,8
Female 17,6 5,5 5,1 4,8
Young-old (60-74) 15,2 4,9 4,1 3,9
Old-old or oldest-old (>75) 15,6 5,4 4,0 4,0

157
Generalized anxiety disorder
The current prevalence of generalized anxiety disorder in the senior adult population is 3,0%, with a higher
percentage in women and in the younger age group (Table 141).
TABLE 141
GENERALIZED ANXIETY DISORDER (EXCLUDING DEPRESSIVE EPISODE)
IN THE SENIOR ADULT POPULATION OF AYACUCHO,
Prevalence of generalized anxiety disorder
(excluding depressive episode
Lifetime
%
12-month
%
Current
%
Total 11,9 3,5 3,0
Male 7,0 2,5 2,3
Female 15,8 4,4 3,6
Young-old (60-74) 11,6 4,3 3,7
Old-old or oldest- old (>75) 12,7 1,8 1,3
Substance consumption
The lifetime prevalence of consumption of diverse substances in the senior adult population shows a clear
predominance of alcohol with 96%; tobacco consumption shows 30,6%, coca leaves 18,3%, headache tablets 3% and
sleeping pills 0,9%. The harmful annual prevalence of the two substances with higher lifetime prevalence (after alcohol)
is 0,3% for tobacco and 0,1% for coca leaves.
The annual prevalence of the harmful consumption pattern or alcohol dependency in the male population of
senior adults is 4,8%. For harmful consumption, the annual prevalence is 1,6%. This form of consumption is higher in
males and among the younger senior adults when compared with the older persons from this age group.(Table 142).
With respect to the 12-month prevalence of alcohol dependency, it rises to 3,2% keeping the same profle: higher
percentage for males as well as for the younger senior adults (Table 143).
TABLE 142
HARMFUL CONSUMPTION OF ALCOHOL IN THE ADULT SENIOR POPULATION
Prevalences of Harmful Alcohol Consumption 12-month
%
Total 1,6
Male 3,7
Female 0,0
Young-old (60-74) 2,3
Old-old or oldest-old (>75) 0,0
158

TABLE 143
ALCOHOL DEPENDENCY IN THE SENIOR ADULT POPULATION
Prevalence of Alcohol Dependence 12-month
%
Total 3,2
Male 6,6
Female 0,6
Young-old (60-74) 4,3
Old-old or oldest-old (>75) 0,6
COGNITIVE DETERIORATION IN SENIOR ADULTS
One of the problems related to the increase life expectancy is the increase in the prevalence of cognitive
deterioration or dementia syndromes, associated to diverse neurological conditions. Cognitive performance has been
expressed through the presence of a certain degree of deterioration and the presence of a probable dementia syndrome.
While all levels of education have been considered, with the exception of illiterates, the results of less than 8 years of
education must be taken into consideration in spite of the adaptations performed on the instruments. Nevertheless,
it has been decided to include these analyses since they confrm in some way the fndings of studies in this respect,
emphasizing the protecting role of education for dementia. In addition, when comparing the results obtained using the
Pfeffer scale which is less infuenced by the years of schooling, they are consistent with the results from the Mini Mental
State Examination (MMSE) adapted to less than 8 years of schooling. Table 144 shows averages obtained through the
MMSE, where the results for persons with less than 8 years of education showed lower and less constant fgures. Using
the cut-off score of 22 it can be seen that 7,7% of persons with 8 or more years of schooling presents some degree of
deterioration, while this fgure rises to 39,5% in persons with less than 8 years of schooling. As to gender, the condition
of deterioration is higher in women, and in those older (Table 145).
TABLE 144
COGNITIVE PERFORMANCE ACCORDING TO THE MMSE OF THE SENIOR
ADULT POPULATION ACCORDING TO YEARS OF SCHOOLING IN
Cognitive
Factors
Years of
Education
Mean Sx. Median Mode Min. Max. P25 P75
TOTAL 24,52 4,96 26,0 28,0 0,0 30,0 22,0 28,0
MMSE score 8 or more 26,73 2,93 27,0 29,0 13,0 30,0 25,0 29,0
(max. 30 pts) Less than 8 22,96 5,49 24,0 28,0 0,0 30,0 21,0 27,0
The MMSE scale was adapted for some items in order to apply it to people with less than 8 years of education. The illiterate were excluded.

159
TABLE 145
COGNITIVE PERFORMANCE INDICATING DETERIORATION ACCORDING
TO THE MMSE IN THE SENIOR ADULT POPULATION BY YEARS OF
SCHOOLING *,AGE GROUP AND GENDER IN AYACUCHO,
Indicative of Deterioration According to the MMSE (<22)
Years of Education
Less than 8
%
8 or more
%
Total
%
Total 39,5 7,7 26,8
Male 35,1 6,1 22,5
Female 44,8 10,0 32,3
Young-old (60-74) 31,0 5,8 20,1
Old-old or oldest-old (>75) 57,1 15,3 44,5
The MMSE scale was adapted for some items in order to apply it to persons with less than 8 years of education.*Illiterates were excluded
The loss of instrumental abilities in senior adults, using the cut-off score of 5 in the Pfeffer scale, shows 20,9%,
with higher scores for women and the older group.(Table 146). It follows the same trend set by the MMSE results.
TABLE 146
INSTRUMENTAL ACTIVITIES INDICATING DETERIORATION IN THE SENIOR
ADULT POPULATION OF AYACUCHO, CAJAMARCA AND HUARAZ 2003
Indicative of Deterioration According to Pfeffer Scale(>6) %
Total 20,9
Male 17,8
Female 23,3
Young-old(60-74) 12,1
Old-old or oldest- old (>75) 40,6
The study has considered the prevalence of dementia syndromes through the use of two instruments of
exploration, the MMSE for cognitive factors and the Pfeffer scale for instrumental activities of daily living. It has also
considered comparing senior adults with more than 8 years of education with those with less than 8 years of education.
Used together, the MMSE with a score of < 21 points and the Pfeffer Scale with >6 points indicate dementia. The
percentage of senior adults with 8 or more years of education who have both conditions: cognitive deterioration with
MMSE and deterioration in instrumental activities of daily living through the Pfeffer scale show 2,6% (Table 147) while
the prevalence for senior adults with less than 8 years of education is 11,4%.
160

TABLE 147
SENIOR ADULTS WITH COGNITIVE DETERIORATION SUSPECTED OF
DEMENTIA ACCORDING TO YEARS OF EDUCATION * IN
Cognitive factors Years of Education Mean
MMSE score(< 21 points)
Pfeffer score (> 6 points)
Total 7,9
8 or more 2,6
Less than 8 11,4
The MMSE scale was adapted for some items in order to apply it to persons with less than 8 years of education.*Illiterates were excluded.
ABUSE OF SENIOR ADULTS
In the last year, 9,2% of senior adults had been victim of some kind of abuse, and 1,6% had been subject to
systematic abuse. The most frequent form of abuse is verbal aggression, showing 6% for the last year (Table 148). Of
all senior adults who stated having been victims of abuse in the past year, only 9,8% received some kind of help.
TABLE 148
12-MONTH PREVALENCE OF SYSTEMATIC ABUSE OF SENIOR ADULTS
IN THE POPULATION OF AYACUCHO, CAJAMARCA AND HUARAZ - 2003
Kind of Abuse Total Systematic*
Any kind of abuse to senior adult 9,2 1,6
Inappropriate sexual behaviour or attempts 0,3 0
Blows, punches or pushing 0,8 0
Insults, verbal aggression or offences 6,0 1,2
Blackmailing, manipulation, or humiliation 1,6 0,2
Negligence 2,8 0,4
* Systematic abuse refers to mistreatment, according to kind, which happens at least once or twice a month.
ACCESS TO SERVICES
A frst approach to this problem is to determine the perceived morbidity, that is, a persons acknowledge that
they are having some kind of mental or emotional problem. With a period of reference of six months, 20,6% of adult
males fnd themselves in that situation; the perception of having a problem is greater in men. Among the group with
perceived morbidity, only 15,7% looks for assistance, which constitutes the perceived expressed morbidity. It is evident
that this search for assistance is higher among women (26,7%) than among men (4,9%) (Table 149).

161
TABLE 149
HEALTH ASSISTANCE IN THE SENIOR ADULT POPULATION OF AYACUCHO,
CAJAMARCA AND HUARAZ IN THE LAST SIX MONTHS - 2003
Perceived morbidity of Mental Health Problems in the Last Six
Months
%
Total 20,6
Male 23,3
Female 18,4
Help Seeking Behavior for Health Assistance which was Taken Care of in
the Last Six Months (% of Perceived Morbidity)
%
Total 15,7
Male 4,9
Female 26,7
Out of all senior adults that received some kind of assistance, 45,7% received assistance through ESSALUD,
33,5% in MINSA centres and 19,1% in private health centres (Table 150).
TABLE 150
HEALTH SERVICE CENTRES AND DISTRIBUTION OF THE PERCEIVED NEED
EXPRESSED FOR MENTAL HEALTH ASSISTANCE IN THE SENIOR ADULT
Health Service Centres Partials
%
Totals
%
MINSA 5,2
- Health and emergency centres (33,5% of cases attended)
- Specialized hospital or institute 1,8
- General hospital 31,7
ESSALUD 7,2
(45,7% of cases attended)
- Emergency centre/polyclinic 10,6
- PAAD offces (Decentralized Ambulatory
Care Program)
- Mental health centre 2,0
- General hospital 33,1
ARMED FORCES 0,3
- Armed Forces and Police Hospitals 1,7
PRIVATE 3,0
- Private hospital 7,9
- Private practice 11,3
OTHER 5,4
162
In relation to the reasons why the individuals did not seek medical attention for their emotional problem,
economic problems stand out (50,7%) followed by 48,5% who thought they should overcome it alone, 15,9% for a
lack of trust and 11,5% who did not go because of doubt in the capacity of doctor to treat the problem. It is evident that
cultural factors play a very special role, as well as educational and economic factors. It is important that dose to one
fourth say they preferred home remedies (Table 151).
TABLE 151
MAIN REASONS FOR NOT GETTING MEDICAL ATTENTION IN THE
SENIOR ADULT POPULATION OF AYACUCHO,
Reasons for not Going to a Health Centre %
Could not afford it 50,7
Should overcome problems by themselves 48,5
Did not know where to go 27,8
Preferred homemade remedies 21,8
Would not beneft from it 20,6
Lack of trust 15,9
Shame 11,7
Long waiting list 14,3
Doubted medical doctors can treat problem 11,5
There was no health service close by 9,6
CONCLUSIONS
163
CONCLUSIONS OF THE STUDY
CONCLUSIONS
165
ADULTS
1. Between 31,3% and 60,4% of the persons perceive a high level of tension due to psychosocial stressors, among
which delinquency and health are higher. Other stressors such as drug traffcking, diffculties in studying, terrorism,
economic problems and the family reach important levels.
2. The type of discrimination most perceived regards socioeconomic factors and educational levels, 11,5% and 9,7%,
respectively. The population has felt discriminated in these areas at some point in their life.
3. In the last month, between 10,8% and 30,8% of the population has signifcantly experienced negative emotional
states.
4. About one ffth of the population, both men and women, has a disability or a slight inability to function and to adapt
to their social and work environment.
5. There is permissiveness towards psychopathic conducts in one out of every ten persons, as well as a similar
percentage to psychopathic tendencies. Men recount more experiences with respect to violent tendencies.
6. A total of 34,2% of the population has had the desire to die at some time in their lives, and 12,9% has had this desire
in the last year; 2,9% of the population has attempted suicide at some time in their life. The most notable reasons
for their desire to die have been, in frst place, problems with their partner, and second, economic problems while the
main reasons for attempted suicide have been, frst, partner-related problems followed by problems with parents.
7. The current, 12-month and lifetime prevalence of any psychiatric disorder in the adult population has been 16,2%,
21,6% and 37,3%, respectively. Based on the 12-month prevalence, the most frequent disorders are alcohol abuse
or dependence, depressive episode and generalized anxiety disorder. A total of 10,0% of the population suffers
problems related to alcohol abuse or dependence to alcohol, to the extent that 19,1% of the male population suffers
from this problem.
8. The analysis between cities shows that the city of Ayacucho evidently displays higher indicators of psychiatric
problems; the prevalence of abuse or dependence to alcohol, which is about 15% of the population, is most striking.
In general, the city of Cajamarca tends to show more favourable fgures with regard to mental health although it
exhibits expected depressive levels.
9. About a third of the population has suffered at least one situation of loss (death of relatives, loss of goods or change
of residence) due to violence during the period of terrorism. These fgures rose to 2/3 in the case of Ayacucho where
23,5% of the population surveyed has suffered the loss of a relative, either due to death or disappearance. Such
losses have been related to a higher psychiatric morbidity with respect to anxiety and depressive disorders.
10. The help seeking behavior for mental health assistance in six months represents 13,9% of the total perceived
morbidity. This indicates the need to strengthen institutions so that there is greater access to mental health services
in the population surveyed.
11. The Folkloric Syndromes described since long ago by investigators in Traditional Medicine in the feld of Folkloric
Psychiatry are valid and are identifed and recognized by the population surveyed.
166

12. The population recognizes the following as agents of Traditional Medicine: medicine man, shaman, healer, prayer
man, witch doctor, bonesetter, masseurs/masseuse, empirical midwife and midwife, among others.
13. Around a ffth of the population surveyed, consulted at least once in their lives, about one of the following syndromes;
susto, chucaque and aire.
MARRIED OR COHABITANT OR PREVIOUSLY SO WOMEN
1. The illiteracy rate in women surveyed in the cities of Ayacucho, Cajamarca and Huaraz is 16,5%; 6,5% of the
married or cohabitant women looked for a job in last week.
2. Suicidal indicators are very high in married or cohabitant women, showing a lifetime prevalence of 45%; 18,3%
considered suicide in the last year and nearly one out of every ten in the last month; 3,6% attempted suicide at some
time in their lives.
3. In general, these women suffer from considerably more mental health problems than men, thus converting themselves
into a vulnerable group. The most prevailing clinical disorders are depressive episode or major depression; 8,4%
and 4,7% of the women have suffered depressive episodes and generalized anxiety disorders in the last year,
respectively.
4. Two thirds of the women who were married or cohabitant at the time of the study or were previously so, confrmed
having been subject to some kind of abuse in their lives, i.e. two out of every three women, psychological violence
being the most frequent.
5. A total of 61,3% of these women state they have received some kind of inadequate treatment from their current
partner (or previous partner) during courtship, while 18,2% was victim of some kind of violence during this period,
inficted by the partner to whom they are presently married or by their last cohabitation partner.
6. From the women presently married or cohabitant, 8,8% is systematically mistreated, i.e. they suffer different kinds
of aggressions with a frequency of one or two times per month. In the case of Ayacucho this fgure is 13,6%.
7. The different indicators are more severe for systematically mistreated women than in the case of the other women
(not systematically mistreated). There is a marked contrast with respect to suicidal indicators which duplicate in
frequency.
TEENAGERS
1. The teenager population surveyed is between 12 and 18 years of age; its level of education is predominantly
secondary education.
2. Three out of every 100 teenagers are looking for work and 11 out of every 100 are working earning an average
monthly income of S/.98
3. Teenagers of Ayacucho, Cajamarca and Huaraz, just like the teenagers of Lima and Callao, identify unemployment
and poverty as the main problems of the country generating feelings such as sadness, worry and anger.
CONCLUSIONS
167
4. Teenagers acknowledge that they trust teachers, doctors and religious authorities more than they trust police
authorities, politicians and community leaders.
5. The most frequent stressors among teenagers of Ayacucho, Cajamarca and Huaraz are crime, health, studies and
relatives, which are more signifcant than law matters, their partner and work.
6. Personally, teenagers feel satisfed with their intelligence, studies and social relations and less satisfed with the
economic situation.
7. Teenagers, who work, indicate that they are more satisfed with their co-workers in comparison to the workload and
the remuneration they receive.
8. Indicators showing personal and work satisfaction and self-evaluation of the quality of life are similar to those
indicators of teenagers in Lima and El Callao.
9. There are indications of social tolerance towards psychopathic behaviour in one out of every 10 teenagers.
10. Suicidal indicators in teenagers during the 12-month period of reference are higher than those of adults, with a clear
tendency to worsen. One out of every fve teenagers has had suicidal desires in the last year and they attribute them
to problems at home, specifcally with parents; this also occurs with teenagers in Lima and El Callao.
11. Just as the other units of analysis, family bonding represents a factor of protection.
12. Depressive episode has been found to be the most prevailing clinical disorder. One out if every 18 teenagers have
criteria for this diagnosis. This coincides with the presence of suicidal indicators in the magnitude found. In second
place is the generalized anxiety disorder.
13. Alcohol and tobacco are the most widely used substances, especially in Ayacucho and Cajamarca. The starting age
for use of such substances is between 12 and 13 years old; with respect to illegal substances it is 12 to 15 years old
(marijuana, cocaine and inhalants).
14. Teenagers also belong to vulnerable populations and are subject to negligence and abuse which is generally
psychological, although it can also be physical. It is more signifcant in these areas than in Lima and El Callao. More
than half the teenager population has suffered some kind of abuse in their lives.
15. There is also hardly any access to mental health services for teenagers. The lack of assistance is greater than that
which is offered in Lima and El Callao. In addition, stigmas towards mental health may be evidenced, which comes
from the family to a great extent. There is an urgent need to increase awareness of mental health issues.
SENIOR ADULT
1. Nearly three fourths of the senior adult population are between 60 and 74 years old. From the total number of
illiterates, nearly half are women (48,7%). One third of the senior adults were working the week before the survey,
predominantly the male senior adults.
168

2. The most characteristic stressors are health, crime and money. Senior adults express greater personal satisfaction
for religion, place of residence and skin colour and less satisfaction for studies and the economic situation.
3. Senior adults who are working are more satisfed with the activities they perform, the workplace environment and
their co-workers. More than half are dissatisfed with the remuneration they receive.
4. Approximately one fourth of the population has a physical disability, which is more common in males.
5. Though the desire to die in the last month occurred in 11% of the senior adults, none of the sample participants tried
to commit suicide. The protection factors are made up of family bonding, God as an important fgure and going to
church or temple.
6. The prevalence of depressive episodes in the last month is 3,9%, and it was predominant in females.
7. A total of 7,7% of adults 60 years or older with 8 or more years of schooling show a certain degree of cognitive
deterioration, while 2,6% show cognitive deterioration compatible with dementia syndrome. These fgures would be
much higher in persons with less years of schooling. Specialized tests indicate that starting at the age of 75 there is
a signifcant deterioration of cognitive functions in the senior adult population, being greater in females.
8. In the last year, approximately 1 out of 10 senior adults have suffered some kind of mistreatment, and the most
frequent types were: insults, verbal aggression or offences.
9. In the last year, nearly 5 out of every 100 senior adults have had problems with alcohol, either due to harmful use or
dependence. Out of every 6 persons that evidence harmful consumption of alcohol, 5 are male.
10. Nearly one fourth of the senior adults acknowledge that they have a mental health problem, especially males.
Nevertheless, a greater percentage of women seek medical attention. Half of them acknowledge that the principal
reason for not seeking assistance is the lack of money. A high percentage (48,5%) indicates that one of the motives
is the belief that they should overcome their health problems by themselves.
MODULES EMPLOYED
169
EXHIBIT A
DESCRIPTION OF THE MODULES
EMPLOYED IN THE STUDY
MODULES EMPLOYED
171
MODULES EMPLOYED IN THE STUDY
A. QUESTIONNAIRE ESMHPA A.00
HOUSEHOLD MEMBERS; this questionnaire has the following structure:
Cover page: Contains 11 questions regarding geographic identifcation and sample. Members registration
section.
Household data: 13 questions
Family index card: Contains the name, age, kinship, sex, and marital status; if primary education is incomplete,
if the person contributes to the household income and is an habitual resident, pertinent modules according
to selection criteria, appointment with the selected persons, code of personal result and degree of diffculty
encountered.
B. QUESTIONNAIRE ESMHPA.B1.01.A
INFORMATION MODULE - WOMAN; this questionnaire has the following structure:
Cover page: Contains the informed consent, identifcation, questions regarding geographic identifcation and
sample.
Demographic data: 22 questions
C. QUESTIONNAIRE ESMHPA.B2.01.B
INFORMATION MODULE - ADULT; this questionnaire has the following structure:
sample.
D. QUESTIONNAIRE ESMHPA.B3.01.C
INFORMATION MODULE - TEENAGER; this questionnaire has the following structure:
sample.
E. QUESTIONNAIRE ESMHPA.B4.01.D
INFORMATION MODULE - SENIOR ADULT; this questionnaire has the following structure:
sample.
172
F. QUESTIONNAIRE EESMSP.C.02
INTEGRAL HEALTH MODULE - ADULT has the following structure:
Opinion about the situation of the country: 2 questions
Trust and protection: 2 questions
Situations of stress: 1 question
Self-esteem: 1 question
Discrimination: 2 questions
Work satisfaction: 1 question
Assertiveness: 1 question
Psychopathy : 11 questions
Personal physical and psychological health: 5 questions
Suicidal indicators: 18 questions
Life events and upbringing styles: 3 questions
Factors of family dynamics: 7 questions
Use of free time: 4 questions
Religious life: 4 questions
Factors of the environment: 2 questions
Quality of life: 10 questions
Physical disability: 1 question
Adaptive functioning: 1 question
Human development: 8 questions
Stigma against mental health: 5 questions
G. QUESTIONNAIRE ESMHPA.B4.01.D
MODULE OF INTEGRAL HEALTH - TEENAGER has the following structure:
Opinion about the situation of the country: 3 questions
MODULES EMPLOYED
173
Trust and protection: 2 questions
Self- esteem: 1 question
Factors of the environment: 2 questions
Personal physical health and access: 6 questions
Substance use: 12 questions
Psychopathy : 11 questions
Solidarity: 1 question
Assertiveness: 1 question
Psychological health: 4 questions
Sexual life: 9 questions
Use of free time: 4 questions
Clinical disorders: 55 questions
H. QUESTIONNAIRE ESMHPA.B4.01.D
MODULE OF CLINICAL SYNDROMES A has the following structure:
Anxiety disorders: 113 questions
Affective disorders: 50 questions
Psychotic disorders: 15 questions
174
I. QUESTIONNAIRE ESMHPA.B4.01.D
MODULE OF CLINICAL SYNDROMES B has the following structure:
Eating disorders: 24 questions
Chemical addiction disorders: 43 questions
Nicotine addiction: 7 questions
Pathological game: 21 questions
J. QUESTIONNAIRE EESMSP.B4.01.D
ACCESS TO SERVICES MODULE has the following structure:
Access to mental health services: 29 questions
Knowledge about mental health and stigmas: 1 question
Relations of gender: 1 question
Access to physical health services: 5 questions
K. QUESTIONNAIRE ESMHPA.H.07
INTRAFAMILY RELATIONS MODULE has the following structure:
Violence against women: 34 questions
Violence against children: 20 questions
Eating behaviour of teenager: 6 questions
Upbringing styles: 5 questions
Hidden addictive behaviour of an adult relative: 5 questions
L. QUESTIONNAIRE ESMHPA.I.08
SENIOR ADULT MODULE has the following structure:
Personal physical health and access: 11 questions
Self-esteem: 1 question
Discrimination: 2 questions
MODULES EMPLOYED
175
Psychological health: 4 questions
Clinical disorders: 92 questions
Nicotine addiction: 7 questions
Violence against senior adults: 15 questions
M. QUESTIONNAIRE ESMHPA.J.09
MODULE OF COGNITIVE FUNCTIONS has the following structure:
Orientation: 10questions
Memory: 3 questions
Concentration: 1 question
Agnosia: 2 questions
Understanding: 4 questions
Disgraphy: 1 question
Visuospatial construction: 1 question
Indirect cognitive evaluation (Pfeffer): 1 question

N. QUESTIONNAIRE ESMHPA.K.10
SOCIOCULTURAL AND DISASTERS MODULE has the following structure:
Cultural syndromes: 15 questions
Disasters: 8 questions

SAMPLING ERRORS
EXHIBIT B
SAMPLING ERRORS AND
COEFFICIENTS OF VARIATION
SAMPLING ERRORS
179
SAMPLING ERRORS AND COEFFICIENTS OF VARIATION
A research with a survey by sampling may be affected by two types of errors:
a. Those produced during the feldwork, gathering and processing of information, referred to as non sampling errors,
and
b. Those that result from having worked with only one sample and not with the population as a whole, referred to as
sampling errors.
Survey samples are one of the many probable factors that may be extracted from the population using scienti-
fc sampling designs. They may provide results that are different from other samples and that may have been selected
with the same procedures but with different informing units. This variation among all the possible samples constitute the
sampling error, which is not known but is estimated from the information provided by the sample selected. The sampling
error is measured by means of the standard error which is defned as the square root of the variance of the estimated
statistics. The standard error allows one to measure the degree of precision from the sample and the confdence inter-
vals.
If in this way certain statistics calculated from the sample are taken, like a percentage, and if its standard
error is added and subtracted twice, an interval is obtained to which a level of trust of 95% is assigned contained in the
population percentage.
Besides the standard error, it is very important to know the design effect (deff) which is defned as the ratio
between the standard error of the design used and the standard error of the sample, assuming simple random sampling.
The deff value equal to 1,0 shall indicate that the design used is as effcient as the simple random sample of the same
size, while a value superior to 1,0, shall indicate that the use of conglomerates produced a higher variation.
The coeffcient of variation (v.c.) is a measure of relative dispersion that is used to compare the dispersion
or variability of two sets of data expressed in different units. The v.c. does not have units and its value is reliable and
representative if it is less than 15%.
180
Variable Sub
Categories
Estimated
Parameter
Standard
Error
Confdence
Interval
Deff Coeffcient of
Variation
GENERAL DATA- ADULTS
Weighted average age
Arithmetic mean 35,67% 0,32 35,03; 36,30 1,82 0,9
Worked the previous week Prevalence 57,4% 1,1 55,2; 59,6 2,00 1,9
Looking for work Prevalence 11,1% 1,1 9,1; 13,4 1,86 10,0
Illiteracy level Prevalence 6,7% 0,6 5,7; 7,9 1,99 8,4
Level of education None 5,7% 0,5 4,8; 6,7 1,76 8,6
Pre-primary
/ kindergarten
0,1% 0,1 0,0; 0,3 1,23 58,3
Primary 17,8% 0,9 16,0; 19,7 2,39 5,3
Secondary 32,6% 1,0 30,6; 34,6 1,84 3,1
Tertiary 0,1% 0,1 0,0; 0,3 1,39 56,2
Baccalaureate 18,3% 0,8 16,8; 19,9 1,67 4,3
Post-secondary
non-tertiary
24,5% 1,3 22,1; 27,2 3,55 5,3
Graduate studies 0,9% 0,2 0,6; 1,5 1,82 22,0
Average personal monthly
income
< 300 36,6% 1,4 33,9; 39,5 2,21 3,9
301 to 600 27,9% 1,2 25,6; 30,3 1,80 4,3
301 to 1200 26,1% 1,2 23,7; 28,5 1,95 4,6
> 1200 9,4% 0,9 7,8; 11,3 2,30 9,3
Poverty levels of family as per self-
perception of consumption
Not even basic
dietary requirements
are covered
3,9% 0,5 3,0; 5,0 2,65 12,8
Only basic dietary
requirements are covered
38,9% 1,6
35,8; 41,9 4,01 4,0
Only basic dietary &
clothing requirements are
covered
52,2% 1,5 49,2; 55,2 3,75 2,9
Basic requirements & other
needs are covered
5,0% 0,5
4,1; 6,1 1,98 9,7
MENTAL HEALTH OF THE ADULT
Main problem perceived in the country Unemployment 48,7% 1,2 46,3; 51,1 2,40 2,5
Poverty 22,9% 0,9 21,1; 24,8 1,95 4,1
Economic
administration
6,5% 0,6 5,4; 7,8 2,36 9,3
Corruption 6,2% 0,5 5,3; 7,3 1,73 8,1
Crime 5,3% 0,6 4,3; 6,5 2,39 10,4
Violence 2,7% 0,3 2,1; 3,3 1,31 11,0
Political instability 2,0% 0,4 1,4; 2,8 2,75 18,6
Lack of trust and leadership 1,7% 0,5 1,1; 2,8 4,36 50,4
Terrorism 0,4% 0,1 0,3; 0,7 1,11 25,2
Drug traffcking 0,4% 0,2 0,2; 0,9 2,04 34,2
None 0,2% 0,1 0,1; 0,4 1,07 37,7
Others 2,3% 0,4 1,7; 3,2 2,22 15,3
Feelings toward main national
problems
Worry 37,3% 1,2 34,9; 39,7 2,55 3,3
Sorrow, sadness or
depression
22,6% 1,0 20,7; 24,5 2,12 4,3
Disappointment 6,0% 0,5 5,2; 7,0 1,42 7,5
Bitterness, rage or anger 15,2% 1,3 12,8; 18,1 5,02 29,7
Helplessness 6,8% 0,7 5,5; 8,2 2,89 10,1
SAMPLING ERRORS
181
Variable Sub
Categories
Estimated
Parameter
Standard
Error
Confdence
Interval
Deff Coeffcient of
Variation
Feelings toward main national problems Resignation 1,5% 0,3 1,0; 2,1 1,78 17,5
Indifference 2,4% 0,3 1,8; 3,0 1,50 12,6
Frustration 2,3% 0,3 1,8; 2,9 1,56 13,1
Indignation 2,6% 0,3 2,0; 3,3 1,62 12,5
Desperation or distress 1,7% 0,2 1,3; 2,2 1,39 14,5
Other 1,8% 0,3 1,2; 2,5 2,19 17,6
Trust in police authorities None or little 71,4% 1,0 69,4; 73,2 1,77 1,3
Some 24,3% 0,9 22,5; 26,2 1,92 3,9
Pretty or a lot 4,3% 0,4 3,5; 5,3 1,88 10,3
Trust in military authorities None or little 70,8% 1,0 68,8; 72,7 1,82 1,4
Some 23,7% 0,9 22,0; 25,6 1,87 3,9
Pretty or a lot 5,5% 0,5 4,6; 6,6 1,95 9,2
Trust in religious authorities None or little 36,1% 1,1 34,0; 38,3 2,10 3,1
Some 31,6% 1,0 29,6; 33,6 1,82 3,2
Pretty or a lot 32,3% 1,1 30,3; 34,4 2,01 3,3
Trust in teachers None or little 22,6% 0,8 21,0; 24,3 1,58 3,7
Some 46,7% 1,3 44,2; 49,1 2,49 2,7
Pretty or a lot 30,8% 1,1 28,7; 32,9 2,12 3,5
Trust in doctors None or little 22,7% 0,9 21,0; 24,4 1,74 3,9
Some 45,6% 1,1 43,4; 47,7 1,88 2,4
Pretty or a lot 31,8% 1,0 29,9; 33,7 1,71 3,1
Trust in political authorities None or little 92,9% 0,6 91,7; 94,0 1,93 0,6
Some 6,2% 0,5 5,2; 7,4 2,00 8,8
Pretty or a lot 0,9% 0,2 0,6; 1,3 1,50 21,0
Trust in union leaders None or little 64,7% 2,6 59,3; 69,7 1,48 4,1
Some 26,6% 2,6 21,9; 31,9 1,62 9,6
Pretty or a lot 8,7% 1,7 5,8; 12,8 1,87 20,1
Trust in community leaders / mayor None or little 82,0% 0,9 80,2; 83,6 1,91 1,0
Some 15,8% 0,8 14,3; 17,4 1,85 5,0
Pretty or a lot 2,2% 0,3 1,7; 3,0 1,92 14,7
Trust in bosses None or little 27,2% 1,6 24,1; 30,5 1,64 6,0
Some 37,1% 1,8 33,7; 40,7 1,61 4,7
Pretty or a lot 35,7% 1,7 32,4; 39,2 1,60 4,9
Trust in neighbours None or little 60,9% 1,0 58,9; 62,9 1,78 1,7
Some 29,4% 1,0 27,6; 31,3 1,71 3,2
Pretty or a lot 9,7% 0,7 8,5; 11,1 1,93 6,8
Trust in journalists None or little 60,4% 1,1 58,3; 62,4 1,80 1,7
Some 32,8% 1,0 30,8; 34,8 1,77 3,1
Pretty or a lot 6,9% 0,5 5,9; 8,0 1,70 7,7
Protection felt from the State None or little 79,9% 0,9 78,1; 81,7 2,04 1,1
Some 18,1% 0,9 16,4; 19,9 2,06 4,9
Pretty or a lot 2,0% 0,3 1,5; 2,6 1,52 13,9
Protection felt from family None or little 10,9% 0,7 9,6; 12,5 2,13 6,7
Some 15,2% 0,8 13,6; 16,9 2,16 5,6
Pretty or a lot 73,9% 1,0 71,9; 75,9 2,10 1,4
182
Variable Sub
Categories
Estimated
Parameter
Standard
Error
Confdence
Interval
Deff Coeffcient of
Variation
Protection felt from union None or little 59,2% 2,8 53,6; 64,6 1,68 4,8
Some 26,3% 2,2 22,1; 30,9 1,32 8,5
Pretty or a lot 14,5% 2,1 10,8; 19,2 1,85 14,6
Protection felt from God None or little 5,3% 0,5 4,4; 6,4 1,90 9,3
Some 7,5% 0,6 6,4; 8,8 2,10 8,2
Pretty or a lot 87,2% 0,8 85,5; 88,8 2,45 1,0
Protection felt from community None or little 52,6% 1,0 50,6; 54,7 1,71 2,0
Some 34,3% 1,1 32,3; 36,5 1,97 3,1
Pretty or a lot 13,0% 0,8 11,6; 14,7 2,14 6,1
Protection felt from another person not
mentioned
None or little 69,5% 3,1 63,2; 75,2 4,01 4,4
Some 9,1% 1,3 6,8; 12,1 1,97 14,7
Pretty or a lot 21,4% 2,6 16,6; 27,0 3,77 12,3
Magnitude of tension when faced with
daily stressors: Work
None or little 37,9% 1,6 34,9; 41,0 2,51 4,1
Some 28,2% 1,3 25,6; 30,8 2,14 4,7
Pretty or a lot 33,9% 1,6 30,8; 37,1 2,81 4,7
daily stressors: Studies
None or little 31,6% 2,0 27,9; 35,6 1,60 6,2
Some 26,3% 1,9 22,7; 30,2 1,66 7,2
Pretty or a lot 42,1% 2,5 37,3; 47,0 2,24 5,9
daily stressors: Children and parents
None or little 38,9% 1,4 36,2; 41,6 2,91 3,5
Some 20,5% 1,0 18,7; 22,5 2,11 4,7
daily stressors: Money
None or little 27,35% 1,0 25,4; 29,3 1,94 3,6
Some 31,0% 1,0 29,0; 33,1 1,97 3,3
Pretty or a lot 41,7% 1,2 39,3; 44,1 2,38 2,9
daily stressors: Health
None or little 25,2% 1,0 23,3; 27,3 2,23 4,1
Some 23,6% 1,0 21,7; 25,6 2,07 4,1
Pretty or a lot 51,2% 1,3 48,7; 53,6 2,46 2,4
daily stressors: Matters with the law
None or little 79,9% 1,1 77,7; 82,0 2,28 1,4
Some 10,1% 0,9 8,5; 12,0 2,61 8,8
Pretty or a lot 10,0% 0,7 8,6; 11,5 1,84 7,4
daily stressors: Terrorism
None or little 42,1% 1,2 39,7; 44,6 2,48 2,9
Some 15,9% 0,8 14,3; 17,6 2,01 5,2
Pretty or a lot 42,0% 1,3 39,6; 44,5 2,52 3,0
daily stressors: Crime
None or little 25,3% 1,1 23,1; 27,6 2,72 4,5
Some 14,3% 0,8 12,8; 16,0 2,03 5,6
Pretty or a lot 60,4% 1,3 57,7; 63,0 2,97 2,2
daily stressors: Drug traffcking
None or little 40,2% 1,3 37,7; 42,8 2,74 3,2
Some 15,8% 0,9 14,1; 17,6 2,21 5,5
Pretty or a lot 44,0% 1,4 41,3; 46,7 3,02 3,1
daily stressors: Other problems
None or little 85,4% 2,2 80,5; 89,3 2,76 2,6
Some 3,8% 1,0 2,2; 6,4 2,00 27,1
Pretty or a lot 10,8% 1,9 7,6; 15,2 2,63 17,7
Prevalence of emotional state: Sadness Never 2,7% 0,3 2,1; 3,4 1,67 12,4
Sometimes or occasionally 80,6% 0,8 79,0; 82,2 1,64 1,0
Always or almost always 16,7% 0,8 15,2; 18,2 1,62 4,5
Prevalence of emotional state: Tense Never 9,1% 0,7 7,9; 10,5 2,12 7,3
SAMPLING ERRORS
183
Variable Sub
Categories
Estimated
Parameter
Standard
Error
Confdence
Interval
Deff Coeffcient of
Variation
Prevalence of emotional state: Distressed Never 15,5% 0,9 13,8; 17,5 2,65 6,1
Prevalence of emotional state: Irritability Never 14,0% 0,7 12,7; 15,5 1,57 4,9
Prevalence of emotional state: Worried Never 2,1% 0,3 1,6; 2,7 1,42 12,9
Prevalence of emotional state: Calm Never 2,5% 0,3 1,9; 3,2 1,60 12,7
Prevalence of emotional state: Happy Never 0,6% 0,2 0,3; 1,0 1,65 27,4
Prevalence of emotional state: Bored Never 17,8% 0,9 16,1; 19,6 2,18 5,1
Prevalence of emotional state: Other Never 89,7% 1,9 85,4; 92,8 2,58 2,1
Traumatic experiences Lifetime prevalence 41,1% 1,2 38,6; 43,5 2,52 3,0
Degree of personal satisfaction: Physical
appearance
None or little 8,5% 0,6 7,4; 9,6 1,58 6,6
Some 33,5% 1,1 31,4; 35,7 2,11 3,3
Degree of personal satisfaction: skin
colour
None or little 5,3% 0,5 4,4; 6,5 2,10 9,8
Some 26,7% 1,0 24,8; 28,8 2,01 3,8
Enough or a lot 67,9% 1,1 65,7; 70,0 2,14 1,6
Degree of personal satisfaction:
intelligence
None or little 9,4% 0,7 8,1; 10,9 2,31 7,5
Some 29,5% 1,0 27,5; 31,6 2,06 3,5
Enough or a lot 61,1% 1,2 58,6; 63,5 2,54 2,0
socioeconomic situation
None or little 31,5% 1,1 29,4; 33,8 2,30 3,6
Some 48,0% 1,1 45,9; 50,2 1,89 2,3
Enough or a lot 20,5% 0,9 18,7; 22,3 2,03 4,5
profession or trade studied (or studying)
None or little 14,4% 1,0 12,5; 16,5 1,98 7,1
Some 26,7% 1,1 24,5; 29,0 1,57 4,3
Enough or a lot 58,9% 1,4 56,0; 61,7 2,04 2,5
Degree of personal satisfaction: level of
education reached
None or little 33,4% 1,3 30,9; 35,9 2,74 3,8
Some 30,5% 1,0 28,6; 32,6 1,81 3,3
Enough or a lot 36,1% 1,2 33,8; 38,5 2,35 3,3
Degree of personal satisfaction: religion None or little 10,4% 0,6 9,2; 11,7 1,66 6,1
Some 20,7% 0,9 19,0; 22,5 1,92 4,4
Enough or a lot 69,0% 1,0 66,9; 70,9 1,87 1,5
Degree of personal satisfaction: social
relations
None or little 14,5% 0,7 13,1; 16,0 1,66 5,0
Some 33,7% 0,9 31,8; 35,5 1,54 2,8
Enough or a lot 51,9% 1,1 49,7; 54,0 1,88 2,1
Degree of personal satisfaction: place of
residence
None or little 14,1% 0,8 12,6; 15,6 1,93 5,5
Some 32,4% 1,1 30,4; 34,6 1,98 3,2
Enough or a lot 53,5% 1,2 51,2; 55,8 2,21 2,2
184
Variable Sub
Categories
Estimated
Parameter
Standard
Error
Confdence
Interval
Deff Coeffcient of
Variation
Discrimination due to: sex Lifetime prevalence 7,3% 0,6 6,3; 8,5 1,85 7,7
Discrimination due to: age Lifetime prevalence 7,0% 0,5 6,0; 8,1 1,68 7,5
Discrimination due to: weight Lifetime prevalence 5,3% 0,5 4,5; 6,4 1,77 8,9
Discrimination due to: skin colour Lifetime prevalence 2,4% 0,3 1,8; 3,1 1,77 13,5
Discrimination due to: clothing Lifetime prevalence 5,4% 0,5 4,6; 6,4 1,67 8,6
Discrimination due to: economic or social
situation
Lifetime prevalence 11,5% 0,7 10,2; 12,9 1,80 5,9
Discrimination due to: education level Lifetime prevalence 9,7% 0,7 8,5; 11,1 2,02 6,9
Discrimination due to: religion Lifetime prevalence 4,1% 0,4 3,4; 5,0 1,64 9,8
Discrimination due to: friends Lifetime prevalence 3,9% 0,4 3,2; 4,8 1,82 10,6
Discrimination due to: place of birth Lifetime prevalence 3,7% 0,4 3,0; 4,5 1,61 10,3
Discrimination due to: other reasons Lifetime prevalence 1,7% 0,2 1,3; 2,2 1,24 13,6
Degree of work satisfaction: with
activities or functions performed
None or little 9,0% 0,7 7,7; 10,5 1,52 8,0
Some 33,0% 1,3 30,6; 35,5 1,70 3,8
Pretty or a lot 58,0% 1,3 55,3; 60,6 1,75 2,3
workplace environment
None or little 11,3% 0,8 9,8; 13,0 1,57 7,3
Some 38,7% 1,4 36,0; 41,4 1,86 3,6
Pretty or a lot 50,0% 1,4 47,3; 52,8 1,87 2,8
co-workers
None or little 7,6% 0,8 6,2; 9,3 1,41 10,3
Some 36,2% 1,5 33,3; 39,2 1,62 4,2
Pretty or a lot 56,2% 1,6 53,1; 59,3 1,64 2,8
Degree of work satisfaction: with work
load
None or little 14,0% 0,9 12,3; 16,0 1,73 6,7
Some 45,0% 1,3 42,4; 47,6 1,70 2,9
Pretty or a lot 41,0% 1,3 38,4; 43,6 1,76 3,2
remuneration
None or little 43,5% 1,5 40,6; 46,4 2,11 3,4
Some 42,8% 1,4 40,0; 45,7 2,04 3,4
Pretty or a lot 13,7% 0,8 12,1; 15,5 1,45 6,2
appreciation or credit from bosses
None or little 16,7% 1,2 14,4; 19,1 1,36 7,2
Some 35,2% 1,6 32,0; 38,5 1,58 4,7
Pretty or a lot 48,2% 1,7 44,9; 51,5 1,51 3,5
Permissiveness towards psychopathic
conduct
Prevalence 11,6% 0,7 10,3; 13,1 1,92 6,1
Psychopathic tendencies Current Prevalence 4,7% 0,5 3,9; 5,7 1,80 9,6
Desire to die Lifetime prevalence 34,2% 1,0 32,2; 36,2 1,76 2,9
Desire to die Monthly prevalence 5,1% 0,4 4,3; 6,0 1,50 8,4
Thoughts to take ones life 12-month prevalence 5,4% 0,5 4,5; 6,5 1,96 9,3
Suicide plans Lifetime prevalence 4,4% 0,4 3,6; 5,2 1,58 9,4
Suicide plans Monthly prevalence 0,5% 0,1 0,3; 0,8 1,12 23,9
Suicide plans 12-month prevalence 1,6% 0,2 1,2; 2,1 1,35 14,5
Suicidal behaviour Lifetime prevalence 2,9% 0,3 2,3; 3,7 1,65 11,8
Suicidal behaviour Monthly prevalence 0,1% 0,1 0,1; 0,3 0,89 41,7
Suicidal behaviour 12-month prevalence 0,7% 0,1 0,5; 1,0 1,17 20,6
Prevalence of violent tendencies 12-month prevalence 27,5% 1,1 25,3; 29,8 2,54 4,1
Suicidal potential Current Prevalence 0,4% 0,1 0,2; 0,7 1,60 33,8
Homicidal considerations or thoughts Lifetime prevalence 3,5% 0,4 2,7; 4,4 2,13 12,3
Homicidal considerations or thoughts Monthly prevalence 0,8% 0,3 0,4; 1,7 4,55 37,7
Homicidal considerations or thoughts 12-month prevalence 1,3% 0,3 0,8; 2,2 3,34 25,3
SAMPLING ERRORS
185
Variable Sub
Categories
Estimated
Parameter
Standard
Error
Confdence
Interval
Deff Coeffcient of
Variation
Reasons that lead to suicidal behaviour Parents 25,9% 5,4 16,8; 37,8 1,96 20,7
Children 5,5% 3,4 1,6; 17,4 2,90 62,3
Other relatives 8,7% 4,0 3,4; 20,2 2,56 45,6
Partner 42,1% 5,5 31,9; 53,0 1,57 13,0
Work-related 2,9% 2,2 0,6; 12,5 2,30 76,8
Studies 2,8% 2,2 0,6; 12,3 2,29 78,9
Economic 14,2% 4,4 7,5; 25,2 2,07 31,1
Physical health 2,8% 1,6 0,9; 8,2 1,16 55,6
Family health 0,5% 0,5 0,1; 3,7 0,70 98,8
Family separation 7,4% 3,1 3,1; 16,4 1,88 42,7
Death of a child 0,3% 0,3 0,0; 2,4 0,44 98,9
Death of any of the parents 4,8% 2,4 1,8; 12,4 1,61 49,8
Traumatic experiences 3,2% 1,5 1,3; 7,9 0,92 46,3
No reason 1,5% 1,1 0,4; 6,1 1,03 71,4
Other 9,6% 2,8 5,3; 16,8 1,21 29,6
Religious tendencies Feels much or a lot
protection from God
86,3% 0,9 84,5; 88,0 2,54 1,0
God is enough or very
important
87,1% 0,8 85,5; 88,6 2,09 0,9
Goes to church or temple 78,9% 1,0 76,8; 80,9 2,45 1,3
Participates actively 15,2% 0,8 13,7; 16,7 1,73 5,1
Reads religious scriptures 53,8% 1,2 51,3; 56,2 2,36 2,3
Religious tendencies Transmits eligion to
children
42,0% 1,4 39,2; 44,8 3,16 3,4
Transmits religion to other
persons
26,4% 1,1 24,4; 28,5 2,15 4,0
Religion helps to solve
problems
66,1% 1,1 63,8; 68,3 2,25 1,7
High level of environmental stress Prevalence 43,3% 1,4 40,6; 46,1 3,21 3,3
Quality of life of the population Arithmetic mean 7,8%
Adult population with at least some
disability or inability
Prevalence 21,2% 1,1 19,1; 23,5 2,95 5,3
Any psychiatric disorder Lifetime prevalence 37,3% 1,2 34,9; 39,7 2,45 3,2
Any psychiatric disorder 12-month prevalence 21,6% 1,0 19,7; 23,6 2,23 4,5
Any psychiatric disorder Six months prevalence 19,8% 0,9 18,0; 21,7 2,20 4,7
Any psychiatric disorder Current Prevalence 16,2% 0,9 14,6; 18,0 2,16 5,3
Anxiety disorder Lifetime prevalence 21,1% 1,0 19,2; 23,1 2,30 4,7
Anxiety disorder 12-month prevalence 6,6% 0,6 5,5; 7,8 2,15 8,8
Anxiety disorder Six months prevalence 5,6% 0,5 4,6; 6,7 2,14 9,6
Anxiety disorder Current Prevalence 3,5% 0,4 2,8; 4,4 2,09 12,1
Generalized anxiety disorder Lifetime prevalence 8,2% 0,6 7,1; 9,5 1,86 7,3
Generalized anxiety disorder 12-month prevalence 3,2% 0,4 2,5; 4,0 1,91 12,2
Generalized anxiety disorder Six months prevalence 2,8% 0,4 2,2; 3,6 1,92 13,0
Panic disorder without agoraphobia 12-month prevalence 0,1% ,0 0,1; 0,3 068 35,1
Panic disorder without agoraphobia Six months prevalence 0,1% ,0 0,1; 0,3 0,68 35,1
Panic disorder without agoraphobia Current prevalence ,0% ,0 ,0; 0,1 0,50 57,9
Agoraphobia Lifetime prevalence 1,8% 0,3 1,3; 2,6 2,14 17,0
Agoraphobia 12-month prevalence 0,8% 0,2 0,5; 1,3 1,91 24,6
Agoraphobia Six months prevalence 0,6% 0,2 0,3; 1,1 1,94 28,4
Agoraphobia Current Prevalence 0,5% 0,2 0,3; 1,0 2,26 34,0
Social phobia Lifetime prevalence 2,9% 0,5 2,1 3,9 3,05 16,2
186
Variable Sub
Categories
Estimated
Parameter
Standard
Error
Confdence
Interval
Deff Coeffcient of
Variation
Social phobia 12-month prevalence 0,9% 0,2 0,6; 1,3 1,55 21,0
Social phobia Six months prevalence 0,7% 0,2 0,4; 1,1 1,64 24,2
Social phobia Current pevalence 0,4% 0,1 0,2; 0,6 1,16 28,6
Obsessive-compulsive disorder Lifetime prevalence 0,4% 0,1 0,2; 0,7 1,30 28,7
Obsessive-compulsive disorder 12-month prevalence 0,2% 0,1 0,1; 0,5 1,53 40,6
Obsessive-compulsive disorder Six months prevalence 0,1% 0,1 0,1; 0,3 0,86 42,0
Obsessive-compulsive disorder Current prevalence ,0% ,0 ,0; 0,2 0,72 64,4
Post-traumatic stress disorder Lifetime prevalence 12,8% 0,8 11,4; 14,4 2,10 6,0
Post-traumatic stress disorder 12-month prevalence 1,9% 0,3 1,4; 2,6 1,98 16,1
Post-traumatic stress disorder Six months prevalence 1,6% 0,3 1,1; 2,2 1,89 17,3
Post-traumatic stress disorder Current prevalence 0,7% 0,2 0,4; 1,2 1,86 26,0
Depressive disorders Lifetime prevalence 17,0% 0,9 15,3; 18,9 2,34 5,4
Depressive disorders 12-month prevalence 7,4% 0,5 6,4; 8,5 1,68 7,3
Depressive disorders Six months prevalence 6,0% 0,5 5,2; 7,0 1,49 7,7
Depressive disorders Current prevalence 3,7% 0,4 3,0; 4,4 1,38 9,6
Major depression Lifetime prevalence 16,2% 0,9 14,5; 18,1 2,43 5,6
Major depression 12-month prevalence 7,2% 0,5 6,2; 8,3 1,66 7,4
Major depression Six months prevalence 5,8% 0,5 5,0; 6,8 1,47 7,8
Major depression Current prevalence 3,5% 0,3 2,9; 4,2 1,29 9,6
Dysthymia Lifetime prevalence 1,2% 0,2 0,9; 1,7 1,33 16,6
Dysthymia Current prevalence 0,5% 0,1 0,3; 0,8 1,41 28,1
Bulimia nervosa Current prevalence 0,2% 0,1 0,1; 0,4 1,64 50,4
Tendency to eating problem Current prevalence 5,3% 0,5 4,4; 6,2 1,64 8,7
Psychotic disorders in general
(5 or more criteria)
Psychotic disorders in general (5 or more
criteria)
Current prevalence 0,1% 0,1 ,0; 0,4 2,12 81,9
Bipolar disorder Lifetime prevalence 0,1% 0,1 ,0; 0,3 1,24 50,3
Risky alcohol drinker 12-month prevalence 16,5% 1,0 14,6; 18,6 2,99 6,2
Alcohol dependence 12-month prevalence 6,2% 0,6 5,2; 7,3 2,07 8,9
Alcohol abuse 12-month prevalence 3,9% 0,4 3,1; 4,8 1,93 11,0
Dependence of alcohol abuse 12-month prevalence 10,0% 0,7 8,7; 11,5 2,19 7,1
Tobacco dependence 12-month prevalence 0,5% 0,1 0,3; 0,9 1,33 25,1
Cocaine base paste dependence 12-month prevalence 0%
Cocaine dependence 12-month prevalence 0%
Marijuana dependence 12-month prevalence 0% ,0 0; 0,1 0,42 100
Dependence to any substance 12-month prevalence 6,5% 0,6 5,5; 7,7 2,00 8,5
Abuse of any substance 12-month prevalence 4,2% 0,4 3,4; 5,2 1,87 10,4
Consumption of non alcoholic substances
in general
Consumption of non alcoholic legal
substances
Consumption of alcohol Lifetime prevalence 96,5% 0,3 95,8; 97,1 1,40 0,4
Consumption of tobacco Lifetime prevalence 57,7% 1,3 55,2; 60,2 2,57 2,2
Consumption of tobacco Monthly prevalence 17,2% 0,8 15,7; 18,8 1,80 4,7
Consumption of tranquillisers Lifetime prevalence 0,6% 0,2 0,4; 1,0 1,42 23,8
Consumption of tranquillisers Monthly prevalence 0,2% 0,1 0,1; 0,3 0,84 37,5
Consumption of stimulants Lifetime prevalence 0,1% ,0 ,0; 0,2 0,65 42,0
Consumption of coca leaves Lifetime prevalence 20,3% 1,2 18,0; 22,8 3,71 6,1
SAMPLING ERRORS
187
Variable Sub
Categories
Estimated
Parameter
Standard
Error
Confdence
Interval
Deff Coeffcient of
Variation
Consumption of coca leaves Monthly prevalence 4,5% 0,5 3,6; 5,5 1,98 10,4
Consumption of illegal substances Lifetime prevalence 2,8% 0,3 2,2; 3,5 1,74 12,5
Consumption of illegal substances Monthly prevalence 0,1% ,0 0,0; 0,2 1,16 73,7
Consumption of cocaine hydrochloride Lifetime prevalence 0,6% 0,1 0,4; 0,9 1,14 22,4
Consumption of cocaine base paste (CBP) Lifetime prevalence 0,9% 0,2 0,6; 1,4 1,97 23,7
Consumption of cocaine in general Lifetime prevalence 1,3% 0,2 0,9; 1,9 1,74 18,3
Consumption of substances in general Current prevalence 23,0% 0,9 21,2; 24,9 1,90 4,0
Consumption of legal substances Current prevalence 23,0% 0,9 21,2; 24,8 1,90 4,0
Starting age for stimulants consumption Arithmetic mean 22,01% 3,23 13,03; 30,98 0,79 14,7
Starting age for tranquillisers consumption Arithmetic mean 31,98% 1,89 28,04; 35,93 1,32 5,9
Starting age for CBP consumption Arithmetic mean 23,73% 1,46 20,72; 26,74 0,94 6,2
Starting age for cocaine consumption Arithmetic mean 18,54% 0,76 16,97; 20,12 1,5 4,1
Starting age for marijuana consumption Arithmetic mean 18,91% 0,54 17,83; 19,99 1,34 2,9
Starting age for ecstasy consumption Arithmetic mean 17,76% 1,13 3,35; 32,17 0,77 6,4
Starting age for coca leaves consumption Arithmetic mean 21,42% 0,39 20,66; 22,18 1,55 1,8
Starting age for inhalants consumption Arithmetic mean 21,99% 5,28 5,18; 38,80 1,40 24,0
Perceived morbidity for emotional or
nervous problems
Perceived morbidity as a result of specifc
emotional problems
Perceived morbidity for emotional or
nervous problems
Six months prevalence 16,7% 0,8 15,2; 18,4 1,94 4,9
Help seeking behavior for assistance and
taken care of at health centres
Assistance which was taken care of at
health and emergency centres
Prevalence 8,1% 3,0 3,9; 16,2 1,33 36,4
emergency centres and polyclinics of
ESSALUD
Prevalence 8,6% 3,1 4,1; 17,1 1,41 36,5
Assistance which was taken care by
PAAD ESSALUD clinics
Prevalence 2,6% 2,3 0,5; 13,3 2,26 85,9
Assistance and taken care of at
specialized institutes or hospitals
Prevalence 5,0% 2,8 1,6; 14,4 1,87 56,1
MINSA General Hospital
Prevalence 24,7% 4,8 16,4; 35,3 1,41 19,6
Assistance which was taken care of at the
mental health centre of ESSALUD
Prevalence 1,5% 1,1 0,4; 6,1 0,91 71,6
ESSALUD General Hospital
Prevalence 10,9% 2,9 6,4; 17,9 0,96 26,3
the hospitals of the Armed Forces and
Peruvian Police Force
Prevalence 1,2% 0,7 0,3; 3,9 0,52 62,4
private practice
Prevalence 14,1% 3,5 8,5; 22,4 1,14 24,8
private clinics
Prevalence 3,2% 2,0 1,0; 10,3 1,39 60,9
Assistance which was taken care of in
self-help groups
Prevalence 0,5% 0,5 0,1; 3,7 0,60 100
Assistance which was taken care of in
other health facilities
Prevalence 19,5% 5,0 11,5; 31,2 1,79 25,6
188
Variable Sub
Categories
Estimated
Parameter
Standard
Error
Confdence
Interval
Deff Coeffcient of
Variation
Type of treatment received due to mental
health assistance
Psychiatrist 14,8% 4,1 8,4; 24,8 1,52 27,8
Psychologist 36,5% 5,5 26,5; 47,8 1,47 15,0
General Physician 34,1% 5,4 24,4; 45,4 1,47 15,9
Neurologist 2,6% 1,6 0,8; 8,5 1,15 62,0
Social Worker 0,8% 0,8 0,1; 5,6 0,93 100
Nurse 2,4% 1,2 0,9; 6,2 0,66 48,7
Relative (not a doctor) 3,5% 2,7 0,7; 15,0 2,48 77,9
Other 5,3% 2,8 1,9; 14,3 1,74 52,2
Type of assistance received due to mental
health assistance
Medicine 59,2% 5,7 47,8; 69,8 1,51 9,6
Psychotherapy 22,3% 4,4 14,8; 32,1 1,27 19,8
Counselling 64,0% 5,4 52,9; 73,8 1,42 8,4
Herbs 4,5% 1,8 2,0; 9,8 0,87 40,2
Other 7,3% 3,1 3,1; 16,3 1,61 42,5
MENTAL HEALTH BY GEOGRAPHICAL CONES
disorder as per cities.
HUARAZ 34,9% 1,9 31,2; 38,8 1,49 5,5
AYACUCHO 50,6% 2,4 46,0; 55,3 2,95 4,7
CAJAMARCA 28,3% 1,6 25,3; 31,6 2,19 5,7
disorder as per cities
HUARAZ 19,9% 1,5 17,1; 23,1 1,33 7,7
AYACUCHO 26,0% 2,0 22,3; 30,1 2,72 7,7
CAJAMARCA 19,1% 1,4 16,5; 22,0 2,18 7,3
disorder as per cities
HUARAZ 18,7% 1,5 16,0; 21,7 1,27 7,8
AYACUCHO 24,4% 2,0 20,8; 28,5 2,78 8,1
CAJAMARCA 16,9% 1,3 14,5; 19,6 2,02 7,6
Lifetime prevalence of anxiety disorders
as per cities
HUARAZ 14,1% 1,3 11,7; 17,0 1,37 9,6
AYACUCHO 21,2% 1,8 17,9; 25,0 2,53 8,5
CAJAMARCA 13,5% 1,2 11,3; 16,0 2,11 8,9
Lifetime prevalence of anxiety disorders
as per cities
HUARAZ 23,3% 1,5 20,5; 26,5 1,17 6,5
AYACUCHO 33,7% 2,1 29,6; 38, 2,71 6,4
CAJAMARCA 10,2% 1,0 8,4; 12,5 2,02 10,1
12-month prevalence of anxiety disorders
as per cities
HUARAZ 8,4% 1,0 6,7; 10,5 1,10 11,5
AYACUCHO 8,2% 1,2 6,1; 11,0 2,71 15,2
CAJAMARCA 4,3% 0,7 3,1; 6,0 2,34 17,4
Six months prevalence of anxiety
disorders as per cities
HUARAZ 7,5% 0,9 5,9; 9,5 1,09 12,2
AYACUCHO 7,3% 1,2 5,2; 10,1 2,94 16,9
CAJAMARCA 3,2% 0,6 2,3; 4,6 1,93 18,3
Current prevalence of anxiety disorders
as per cities
HUARAZ 4,3% 0,7 3,2; 5,9 1,03 15,8
AYACUCHO 5,1% 1,0 3,5; 7,5 2,69 19,5
CAJAMARCA 1,8% 0,5 1,1; 3,0 2,12 25,8
Lifetime prevalence of depressive
HUARAZ 13,5% 1,2 11,2; 16,1 1,20 9,2
AYACUCHO 21,5% 1,8 18,3; 25,2 2,40 8,2
CAJAMARCA 15,4% 1,4 12,8; 18,5 2,74 9,3
12-month prevalence of depressive
HUARAZ 6,7% 0,8 5,2; 8,5 1,04 12,6
AYACUCHO 6,5% 0,8 5,1; 8,3 1,43 12,5
CAJAMARCA 8,4% 1,0 6,7; 10,5 2,11 11,5
Six months prevalence of depressive
HUARAZ 5,9% 0,8 4,5; 7,6 1,01 13,3
AYACUCHO 4,8% 0,7 3,6; 6,4 1,45 14,8
CAJAMARCA 7,0% 0,8 5,5; 8,7 1,74 11,6
SAMPLING ERRORS
189
Variable Sub
Categories
Estimated
Parameter
Standard
Error
Confdence
Interval
Deff Coeffcient of
Variation
Current prevalence of depressive
HUARAZ 3,6% 0,6 2,6; 4,9 0,92 16,5
AYACUCHO 3,0% 0,5 2,1; 4,2 1,26 17,6
CAJAMARCA 4,2% 0,6 3,1; 5,6 1,66 14,8
12-month prevalence of alcohol abuse or
dependence as per cities
HUARAZ 6,7% 0,9 5,1; 8,8 1,30 14,1
AYACUCHO 15,0% 1,6 12,1: 18,3 2,52 10,4
CAJAMARCA 8,0% 0,9 6,4; 10,1 2,03 11,6
POVERTY AND MENTAL HEALTH
Annual prevalence of any psychiatric
disorder in poverty groups as per
necessities covered by income earned
Not even basic food needs
are covered
17,8% 3,6 11,7; 26,0 1,37 20,4
Only basic food needs are
covered
22,4% 1,6 19,4; 25,7 2,27 7,2
Only basic food and other
basic needs are covered
21,3% 1,2 19,1; 23,7 1,65 5,4
Covers basic needs and
others
19,5% 3,8 13,0; 28,1 1,84 19,6
Not even basic food
needs are covered
16,7% 3,6 10,8; 24,9 1,40 21,4
covered
20,0% 1,5 17,2; 23,2 2,22 7,6
19,9% 1,1 17,8; 22,2 1,60 5,6
others
17,6% 3,5 11,7; 25,7 1,71 20,0
Current prevalence of any psychiatric
are covered
12,7% 3,2 7,6; 20,2 1,38 24,9
covered
16,9% 1,4 14,3; 19,9 2,16 8,3
16,0% 1,0 14,0; 18,1 1,69 6,6
others
15,3% 3,5 9,6; 23,4 1,83 22,6
Lifetime prevalence of any anxiety
are covered
25,3% 4,3 17,8; 34,8 1,51 17,2
covered
24,8% 1,9 21,3; 28,7 2,93 7,6
18,3% 1,0 16,3; 20,4 1,50 5,7
others
18,0% 3,0 12,8; 24,8 1,24 16,9
Annual prevalence of any anxiety disorder
in poverty groups as per necessities
covered by income earned
are covered
9,8% 3,0 5,3; 17,4 1,50 30,3
covered
7,1% 0,9 5,5; 9,2 2,02 13,1
5,8% 0,7 4,7; 7,3 1,59 11,1
others
7,4% 2,1 4,2; 12,8 1,30 28,7
Six months prevalence of any anxiety
are covered
8,3% 2,9 4,1; 16,0 1,65 34,8
covered
5,8% 0,8 4,4; 7,6 1,87 14,1
5,0% 0,6 4,0; 6,4 1,57 12,0
others
7,4% 2,1 4,2; 12,8 1,30 28,7
190
Variable Sub
Categories
Estimated
Parameter
Standard
Error
Confdence
Interval
Deff Coeffcient of
Variation
Current prevalence of any anxiety disorder
in poverty groups as per necessities
covered by income earned
are covered
6,0% 2,8 2,4; 14,3 2,02 45,7
covered
3,6% 0,6 2,6; 4,9 1,44 16,0
3,0% 0,5 2,3; 4,1 1,43 14,9
others
6,0% 2,0 3,1; 11,4 1,40 33,1
Lifetime prevalence of any depressive
disorder in poverty groups
as per necessities covered by income
earned
are covered
23,1% 3,8 16,5; 31,3 1,21 16,4
covered
19,6% 1,5 16,7; 22,8 2,29 7,9
14,5% 1,0 12,6; 16,7 1,81 7,2
others
18,9% 3,6 12,9; 27,0 1,66 18,9
Annual prevalence of any depressive
are covered
6,1% 2,1 3,0; 11,8 1,18 34,8
covered
7,7% 0,9 6,1; 9,6 1,68 11,5
7,2% 0,7 5,9; 8,7 1,49 9,7
others
7,3% 2,8 3,4; 15,1 2,32 38,4
Six months prevalence of any depressive
are covered
5,5% 2,1 2,6; 11,2 1,23 37,8
covered
6,0% 0,7 4,7; 7,6 1,45 12,2
6,0% 0,6 4,9; 7,5 1,53 10,7
others
5,5% 2,3 2,4; 12,1 1,98 41,4
Current prevalence of any depressive
are covered
2,2% 1,1 0,8; 5,9 0,87 50,3
covered
4,4% 0,5 3,4; 5,6 1,06 12,3
3,3% 0,5 2,4; 4,4 1,63 15,3
others
3,5% 1,6 1,4; 8,5 1,57 46,9
Annual prevalence of alcohol abuse or
dependence as per necessities covered
by income earned
are covered
5,2% 1,8 2,7; 10,0 0,96 33,8
covered
10,1% 1,2 8,1; 12,6 2,23 11,4
10,5% 1,0 8,8; 12,6 2,01 9,1
others
6,8% 1,8 4,0; 11,5 1,05 26,9
CLINICAL DISORDERS ACCORDING TO AGE
GROUPS
disorder as per age groups
18 to 24 years 33,7% 1,9 30,1; 37,5 1,82 5,6
25 to 44 years 36,7% 1,5 33,8; 39,7 1,82 4,1
45 to 64 years 43,9% 2,6 38,8; 49,2 2,16 6,0
>65 years 37,7% 4,1 30,1; 46,1 1,60 10,9
18 to 24 years 21,6% 1,6 18,5; 25,0 1,82 7,6
25 to 44 years 22,7% 1,4 20,1; 25,5 1,96 6,1
45 to 64 years 20,8% 2,1 17,0; 25,2 1,98 9,9
>65 years 15,4% 3,1 10,2; 22,7 1,69 20,4
SAMPLING ERRORS
191
Variable Sub
Categories
Estimated
Parameter
Standard
Error
Confdence
Interval
Deff Coeffcient of
Variation
18 to 24 years 19,5% 1,6 16,6; 22,8 1,8 8,1
25 to 44 years 21,2% 1,4 18,6; 23,9 2,0 6,4
45 to 64 years 19,3% 2,0 15,6; 23,5 1,96 10,4
>65 years 12,6% 2,5 8,5; 18,3 1,23 19,6
Current prevalence of any psychiatric
18 to 24 years 15,3% 1,4 12,7; 18,3 1,75 9,2
25 to 44 years 17,2% 1,3 14,8; 20,0 2,30 7,8
45 to 64 years 16,4% 1,9 12,9; 20,6 2,10 11,8
>65 years 11,8% 2,4 7,8; 17,4 1,26 20,6
18 to 24 years 16,3% 1,5 13,5; 19,6 2,00 9,5
25 to 44 years 20,9% 1,3 18,5; 23,5 1,79 6,1
45 to 64 years 28,1% 2,1 24,2; 32,4 1,63 7,4
>65 years 22,7% 3,6 16,4; 30,5 1,62 15,8
12-month prevalence of any anxiety
18 to 24 years 5,7% 1,0 4,0; 8,0 2,12 17,6
25 to 44 years 7,6% 0,9 6,0; 9,5 1,97 11,5
45 to 64 years 5,8% 1,0 4,1; 8,1 1,40 17,3
>65 years 5,7% 1,8 3,0; 10,6 1,41 32,4
Six months prevalence of any anxiety
18 to 24 years 4,5% 0,9 3,0; 6,6 2,14 20,0
25 to 44 years 6,3% 0,8 4,9; 8,1 1,91 12,5
45 to 64 years 5,3% 0,9 3,7; 7,4 1,34 17,8
>65 years 5,7% 1,8 3,0; 10,6 1,41 32,4
Current prevalence of any anxiety disorder
as per age groups
18 to 24 years 1,8% 0,4 1,2; 2,9 1,15 23,2
25 to 44 years 4,3% 0,7 3,1; 5,9 2,25 16,6
45 to 64 years 3,5% 0,8 2,3; 5,4 1,34 21,9
>65 years 5,5% 1,8 2,8; 10,5 1,44 33,4
18 to 24 years 15,7% 1,4 13,1; 18,7 1,73 9,0
25 to 44 years 16,1% 1,1 14,1; 18,3 1,59 6,7
45 to 64 years 19,0% 1,8 15,7; 22,9 1,64 9,6
>65 years 24,7% 3,8 17,9; 33,0 1,76 15,6
12-month prevalence of any depressive
18 to 24 years 8,6% 1,1 6,7; 11,0 1,71 12,7
25 to 44 years 7,2% 0,7 6,0; 8,7 1,33 9,7
45 to 64 years 5,8% 1,0 4,1; 8,2 1,51 18,0
>65 years 8,0% 2,6 4,2; 14,9 2,02 32,3
Six months prevalence of any depressive
18 to 24 years 6,8% 0,9 5,2; 8,8 1,52 13,6
25 to 44 years 6,4% 0,7 5,2; 7,8 1,39 10,6
45 to 64 years 4,2% 0,8 2,8; 6,2 1,34 20,0
>65 years 5,2% 1,5 2,9; 9,0 1,0 28,8
Current prevalence of any depressive
disorder as per age groups.
18 to 24 years 4,0% 0,8 2,8; 5,8 1,70 18,9
25 to 44 years 3,6% 0,5 2,8; 4,6 1,18 13,2
45 to 64 years 3,1% 0,7 1,9; 4,9 1,34 23,6
>65 years 4,6% 1,4 2,5; 8,3 1,02 31,0
12-month prevalence of alcohol abuse
and dependence as per age groups
18 to 24 years 10,6% 1,3 8,2; 13,4 2,06 12,4
25 to 44 years 10,6% 1,1 8,7; 12,9 2,19 10,1
45 to 64 years 10,2% 1,7 7,2; 14,1 2,51 17,0
>65 years 2,3% 1,2 0,8; 6,2 1,37 52,0
192
Variable Sub
Categories
Estimated
Parameter
Standard
Error
Confdence
Interval
Deff Coeffcient of
Variation
EFFECTS OF POLITICAL VIOLENCE
Frequency of human and material losses
of the surveyed due to violence during the
period of terrorism
Direct family (parents,
spouse, children)
4,9% 0,5 4,0; 5,9 2,03 10,1
Other relative not direct
family
19,4% 0,9 17,7; 21,1 1,86 4,4
Relative missing 10,3% 0,6 9,2; 11,4 1,35 5,5
Witness to violent death of
some person
8,2% 0,6 7,2; 9,4 1,68 6,9
Relative arrested 10,4% 0,7 9,1; 11,8 1,87 6,4
Relative imprisoned 6,2% 0,6 5,2; 7,5 2,28 9,3
Loss of goods 9,0% 0,6 7,9; 10,2 1,71 6,6
Change of residence 11,3% 0,7 9,9; 12,9 2,18 6,6
At least one situation of
personal loss
31,0% 1,0 29,0; 33,0 1,90 3,3
Some relative dead or
missing
23,5% 0,9 21,8; 25,3 1,73 3,8
disorder due to personal losses during the
period of terrorism and mental health
missing
50,0% 2,4 45,2; 54,8 2,22 4,9
No relative dead or missing 33,5% 1,3 31,0; 36,0 2,15 3,8
missing
35,2% 2,6 30,4; 40,4 2,67 7,3
missing
16,8% 0,9 15,1; 18,6 1,77 5,4
missing
22,7% 2,2 18,7; 27,3 2,48 9,6
missing
15,2% 1,0 13,5; 17,2 2,13 6,3
12-month prevalence of alcohol abuse
and dependence
missing
11,3% 1,4 8,7; 14,4 1,95 12,9
missing
9,7% 0,8 8,2; 11,3 2,13 8,1
SAMPLING ERRORS
193
Variable Sub
Categories
Estimated
Parameter
Standard
Error
Confdence
Interval
Deff Coeffcient of
Variation
GENERAL DATA: MARRIED OR COHABITANT WOMEN 2003
Age by age groups of the sample < 18 years 0,3% 0,1 0,1; 0,5 1,1 36,0
18 to 24 years 9,5% 0,6 8,4; 10,9 1,6 6,7
25 to 44 years 53,4% 1,0 51,5; 55,4 1,3 1,8
45 to 64 years 29,2% 0,9 27,5; 31,0 1,3 3,0
> 64 years 7,8% 0,5 6,8; 8,9 1,3 6,8
Marital status Unmarried cohabitant 31,2% 1,1 29,1; 33,4 1,9 3,5
Separated 10,6% 0,6 9,4; 11,9 1,4 5,9
Divorced 0,8% 0,2 0,5; 1,2 1,5 23,8
Widowed 6,4% 0,5 5,6; 7,4 1,2 7,2
Married 50,8% 1,2 48,5; 53,1 1,9 2,3
Single 0,2% 0,1 0,1; 0,5 1,4 41,7
Employment Worked the previous week 53,3% 1,1 51,2; 55,4 15,2 2,0
Looking for a job 6,5% 0,8 5,2; 8,3 1,5 12,1
Level of education None 13,7% 0,8 12,3; 15,4 1,8 5,8
Pre-primary / kindergarten 0,4% 0,1 0,2; 0,8 1,4 31,0
Primary 29,2% 1,0 27,2; 31,3 1,8 3,5
Secondary 27,0% 0,9 25,3; 28,8 1,4 3,3
Tertiary 0,0% 0,0 0,0; 0,2 1,0 10,0
Baccalaureate 14,7% 0,7 13,3; 16,2 1,5 5,1
Post-secondary
non-tertiary
14,4% 0,9 12,6; 16,3 2,5 6,6
Graduate studies 0,5% 0,2 0,3; 1,0 2,0 34,3
MENTAL HEALTH OF THE MARRIED OR COHABITANT WOMAN
Poverty 29,5% 1,1 27,5; 31,6 1,8 3,6
Corruption 5,0% 0,4 4,2; 6,0 1,3 8,7
Violence 3,2& 0,3 2,6; 4,0 1,3 10,9
Lack of trust and leadership 0,2% 0,1 0,1; 0,4 0,8 38,2
Terrorism 0,8% 0,2 0,5; 1,2 1,1 20,4
Other 1,7% 0,3 1,2; 2,4 1,9 18,2
Feelings toward main national problems Disappointment 4,9% 0,5 4,1; 5,9 1,5 9,3
Bitterness 3,0% 0,3 2,4; 3,8 1,3 11,4
Rage 2,3% 0,3 1,8; 3,0 1,3 13,1
Anger 7,9% 0,6 6,8; 9,1 1,4 7,2
Sorrow, sadness or
depression
29,5% 1,1 27,4; 31,7 1,9 3,7
Worry 39,7% 1,3 37,2; 42,3 2,3 3,3
Helplessness 4,6% 0,5 3,8; 5,7 1,8 10,5
Indignation 1,1% 0,2 0,7; 1,6 1,4 19,5
Resignation 1,4% 1,2 1,0; 1,9 1,2 16,0
Indifference 0,9% 0,2 0,6; 1,3 1,1 18,6
Other 1,1% 0,3 0,7; 1,8 2,1 23,6
Trust in police authorities None or little 74,0% 1,0 72,0; 75,8 1,7 1,3
Some 22,2% 0,9 20,4; 24,0 1,7 4,1
A lot 3,8% 0,4 3,2; 4,6 1,2 9,3
194
Variable Sub
Categories
Estimated
Parameter
Standard
Error
Confdence
Interval
Deff Coeffcient of
Variation
Trust in military authorities None or little 75,7% 1,0 73,7; 77,5 1,7 1,3
Some 20,7% 0,8 19,7; 22,4 1,5 4,1
A lot 3,6% 0,4 2,9; 4,5 1,5 11,0
Trust in religious authorities None or little 30,7% 1,0 28,8; 32,7 1,6 3,3
Some 28,7% 1,0 26,9; 30,7 1,5 3,3
A lot 40,5% 1,1 38,3; 42,8 1,8 2,8
Some 6,0% 0,5 5,0; 7,1 1,6 8,8
Trust in community leaders None or little 82,4% 0,8 80,7; 83,9 1,5 1,0
Some 15,1% 0,8 13,6; 16,7 1,6 5,2
A lot 2,5% 0,3 2,0; 3,3 1,4 12,5
Protection felt from the State None or little 83,6% 0,8 82,0; 85,0 1,5 0,9
Some 14,7% 0,8 13,3; 16,3 1,6 5,2
A lot 1,7% 0,2 1,3; 2,2 1,1 13,6
Protection felt from family None or little 11,6% 0,6 10,4; 12,9 1,3 5,5
Some 17,2% 0,7 15,9; 18,7 1,2 4,1
A lot 71,2% 0,9 69,5; 72,9 1,2 1,2
Protection felt from work union None or little 2,9% 3,0 2,3; 3,7 1,4 11,9
Some 4,3% 4,0 3,6; 5,1 1,2 8,9
A lot 92,7% 5,0 91,7; 93,7 1,3 0,6
Protection felt from God None or little 56,5% 1,0 54,5; 58,4 1,4 1,8
Some 30,0% 1,0 28,1; 31,9 1,5 3,2
A lot 13,5% 0,8 12,0; 15,2 1,9 6,1
Protection felt from community None or little 30,7% 1,4 28,1; 33,5 1,7 4,5
Some 23,8% 1,2 21,4; 26,3 1,6 5,2
A lot 45,5% 1,6 42,4; 48,6 2,0 3,5
None or little 39,6% 4,4 31,3; 48,4 1,8 11,1
Some 21,0% 3,3 15,2; 28,3 1,4 15,7
A lot 39,4% 4,6 30,8; 48,7 1,9 11,7
None or little 30,7% 1,3 28,3; 33,3 2,6 4,2
Some 17,4% 0,9 15,7; 19,3 2,0 5,3
A lot 51,9% 1,5 48,9-54,9 3,1 2,9
daily stressors: Partner
None or little 43,5% 1,3 40,9-46,2 2,1 3,1
Some 17,6% 0,8 16,1-19,3 1,3 4,6
A lot 38,9% 1,4 36,2-41,7 2,3 3,6
None or little 19,1% 0,9 17,5-20,9 1,6 4,5
Some 25,6% 0,9 23,8-27,5 1,6 0,37
A lot 55,3% 1,1 53,1-57,4 1,7 2,0
daily stressors:
Health
None or little 17,8% 0,9 16,1-19,6 1,8 5,0
Some 24,1% 1,0 22,2-26,2 1,9 4,2
A lot 58,1% 1,3 55,6-60,5 2,2 2,2
daily stressors: Terrorism
None or little 32,4% 1,2 30,1; 34,8 2,2 3,7
Some 16,9% 0,9 15,2; 18,7 1,9 5,3
A lot 50,7% 1,3 48,0; 53,3 2,4 2,6
SAMPLING ERRORS
195
Variable Sub
Categories
Estimated
Parameter
Standard
Error
Confdence
Interval
Deff Coeffcient of
Variation
daily stressors: Drug traffcking
None or little 35,3% 1,3 32,8; 37,9 2,5 3,7
Some 15,4% 0,9 13,8; 17,2 2,0 5,7
A lot 49,3% 1,4 46,5; 52,0 2,5 2,8
Prevalence of emotional state: Sadness Never 1,5% 0,2 1,1; 2,0 1,1 14,6
Prevalence of emotional state: Tense Never 5,4% 0,5 4,5; 6,4 1,5 8,8
Prevalence of emotional state: Distressed Never 10,1% 0,8 8,6; 11,8 2,5 8,1
Prevalence of emotional state: Irritability Never 9,6% 0,7 8,4; 11,0 1,7 6,8
Prevalence of emotional state: Worried Never 1,5% 0,3 1,0; 2,1 1,6 18,0
Sometimes or occasionally 52,8% 1,2 50,3; 55, 2,1 2,3
Prevalence of emotional state: Calm Never 2,2% 0,3 1,6; 2,9 1,7 14,8
Prevalence of emotional state: Happy Never 0,9% 0,2 0,6; 1,3 1,1 18,7
Prevalence of emotional state: Bored Never 17,2% 0,9 15,5; 18,9 1,8 5,1
Prevalence of emotional state: Other Never 90,3% 1,7 86,5; 93,2 1,8 1,9
appearance
None or little 11,9% 0,7 10,6; 13,4 1,6 5,9
Some 35,1% 1,0 33,0; 37,2 1,6 3,0
A lot 53,0% 1,1 50,8; 55,2 1,7 2,1
Degree of personal satisfaction: Skin
colour
None or little 7,0% 0,6 6,0; 8,3 1,7 8,3
Some 29,0% 1,1 26,9; 31,2 1,9 3,8
A lot 64,0% 1,2 61,6; 66,3 2,0 1,8
Intelligence
None or little 15,0% 0,9 13,4; 16,8 1,9 5,7
Some 31,1% 1,1 29,0; 33,3 1,9 3,6
A lot 53,9% 1,4 51,1; 56,5 2,5 2,5
Degree of personal satisfaction: Economic
level
None or little 38,9% 1,1 36,7; 41,1 1,8 2,9
Some 44,1% 1,1 41,8; 46,3 1,7 2,6
A lot 17,0% 0,8 15,5; 18,7 1,5 4,7
Degree of personal satisfaction: Studies None or little 25,0% 1,6 22,0; 28,2 2,0 6,3
Some 24,1% 1,4 21,4; 27,0 1,7 5,9
A lot 51,0% 2,0 47,1; 54,8 2,3 3,8
196
Variable Sub
Categories
Estimated
Parameter
Standard
Error
Confdence
Interval
Deff Coeffcient of
Variation
Degree of personal satisfaction: Social
relations
None or little 21,2% 0,9 19,4; 23,0 1,7 4,3
Some 34,6% 1,0 32,6; 36,6 1,6 2,9
A lot 44,3% 1,1 42,1; 46,5 1,7 2,5
Degree of work satisfaction: with activities
or functions performed
None or little 11,8% 0,9 10,2; 13,6 1,4 7,4
Some 35,6% 1,5 32,8; 38,6 1,8 4,2
A lot 52,6% 1,6 49,4; 55,8 2,0 3,1
workplace environment
None or little 15,1% 1,0 13,2; 17,1 1,3 6,4
Some 38,9% 1,4 36,1; 41,7 1,6 3,7
A lot 46,1% 1,5 43,1; 49,0 1,6 3,2
co-workers
None or little 10,5% 1,1 8,5; 12,9 1,3 10,5
Some 39,2% 1,7 35,9; 42,7 1,3 4,4
A lot 50,3% 1,9 46,5; 54,0 1,5 3,8
Degree of work satisfaction: with daily
workload
None or little 18,5% 1,0 16,5; 20,6 1,4 5,6
Some 44,5% 1,2 42,2; 46,9 1,1 2,7
A lot 37,0% 1,3 34,4; 39,7 1,5 3,6
appreciation or credit from bosses
None or little 18,3% 1,6 15,4; 21,6 1,1 8,6
Some 35,8% 1,9 32,2; 39,5 1,0 5,2
A lot 45,9% 2,0 42,0; 49,8 1,1 4,3
remuneration
None or little 51,2% 1,5 48,3; 54,1 1,6 2,9
Some 36,0% 1,5 33,1; 39,0 1,9 4,2
A lot 12,8% 0,9 11,1; 14,6 1,3 6,8
Suicidal considerations or thoughts Lifetime prevalence 16,7% 0,9 15,0; 18,5 1,91 5,3
Suicidal considerations or thoughts Monthly prevalence 2,3% 0,3 1,7; 3,1 1,75 14,7
Suicidal considerations or thoughts 12-month prevalence 6,3% 0,6 5,2; 7,6 2,17 9,7
Attempt (suicidal behaviours) Lifetime prevalence 3,6% 0,4 3,0; 4,4 1,21 9,8
Attempt (suicidal behaviours) Monthly prevalence 0,1% 0,1 0,1; 0,4 1,09 47,4
Generalized anxiety disorders in women in
a relationship
Post-traumatic stress disorder in women
in a relationship
Current Prevalence 1,7% 0,3 1,2; 2,5 2,1 18,8
Post-traumatic stress disorder in women
in a relationship
Depressive disorders in women in a
relationship
12-month prevalence 8,0% 0,7 6,8; 9,4 2,0 8,2
Major depression in women in a
relationship
Major depression in women in a
relationship
Current prevalence 4,7% 0,5 3,8; 5,8 1,8 10,3
Dysthymia in women in a relationship 1,0% 0,2 0,7; 1,5 1,5 20,4
vA BUSE OF MARRIED OR COHABITANT WOMEN
Some kind of abuse against women in a
relationship
Lifetime prevalence 67,6 1,2 65,3; 69,9 2,10 1,7
Shouted at her frequently 9,2 0,6 8,1; 10,4 1,34 6,3
Had violent spells 9,6 0,6 8,6; 10,8 1,23 5,8
Cheated on her 18,5 0,8 17,0; 20,1 1,42 4,3
Battered her 8,2 0,5 7,2; 9,3 1,28 6,5
Mistreatment during courtship by partner
(or former partner)
Forced her to have
intercourse
6,1 0,5 5,2; 7,0 1,21 7,5
Showed indifference 13,6 0,7 112,2; 15,1 1,61 5,5
SAMPLING ERRORS
197
Variable Sub
Categories
Estimated
Parameter
Standard
Error
Confdence
Interval
Deff Coeffcient of
Variation
Mistreatment during courtship by partner
(or former partner)
Lied to her a lot 20,3 0,8 18,7; 22,0 1,45 4,1
Was too jealous 42,5 1,1 40,4; 44,7 1,69 2,6
Controlled her too much 30,2 1,0 28,2; 32,2 1,64 3,4
Neglected her because of
alcohol
20,1 0,9 18,4; 21,8 1,63 4,4
Male chauvinist attitudes 29,3 1,0 27,4; 31,3 1,64 3,4
During courtship with current or former
partner
Mistreatment 61,3 1,2 58,9; 63,7 2,10 2,0
During courtship with current or former
partner
Some kind of violence 18,2 0,7 16,9; 19,7 1,20 4,0
By current partner Lifetime prevalence of
some kind of abuse
48,5 1,3 45,9; 51,0 1,88 2,7
Types of abuse by current partner Sexual abuse 11,4 0,8 10,0; 13,1 1,72 6,9
Physical abuse 35,8 1,2 33,4; 38,2 1,76 3,4
Insults 43,1 1,3 40,6: 45,6 1,82 2,9
Blackmailing, humiliation,
etc.
21,0 1,0 19,2; 23,0 1,61 4,7
Abandonment 13,6 0,9 11,9; 15,5 1,97 6,7
By current partner (at least once or twice
a month)
Prevalence of some
systematic abuse
8,8 0,6 7,6; 10,1 1,43 7,3
During courtship with current partner in
systematically mistreated women (at least
once or twice a month)
Mistreatment 80,5% 2,8 74,3; 85,4 1,21 3,5
During courtship with current partner in
Some kind of violence 39,5% 3,3 33,3; 46,1 1,08 8,3
Trust in police authorities in systematically
mistreated women (at least once or twice
a month)
None or little 76,9% 3,1 79,2; 82,5 1,36 4,1
Some 20,5% 3,1 15,2; 27,2 1,40 14,9
A lot 2,5% 1,4 0,8; 7,5 2,01 56,3
Trust in political authorities in
None or little 94,7% 1,8 89,7; 97,3 1,58 1,9
Some 4,4% 1,7 2,0; 9,4 1,69 39,3
Protection felt by the State in
None or little 89,7% 2,2 84,6; 93,3 1,25 2,4
Some 9,1% 2,1 5,7; 14,2 1,31 23,4
A lot 1,2% 0,7 0,4; 3,5 0,87 53,8
Protection felt by the family in
None or little 17,6% 2,7 12,9; 23,6 1,23 15,4
Some 32,5% 3,3 26,3; 39,3 1,22 10,2
A lot 49,9% 3,7 42,6; 57,2 1,36 7,5
daily stressors in systematically mistreated
women (at least once or twice a month):
Work or studies
None or little 16,3% 3,1 11,0; 23,5 1,06 19,3
Some 26,5% 4,1 19,3; 35,3 1,26 15,4
A lot 57,2% 4,8 47,7; 66,2 1,36 8,3
Children and parents
None or little 18,3% 2,7 13,6; 24,1 1,16 14,7
Some 15,8% 2,6 11,4; 21,6 1,21 16,3
A lot 65,9% 3,2 59,3; 71,9 1,11 4,9
Partner
None or little 17,0% 2,8 12,2; 23,3 1,37 16,5
Some 19,9% 2,7 15,1; 25,7 1,10 13,5
A lot 63,1% 3,3 56,3; 69,4 1,17 5,3
Money
None or little 12,0% 2,3 8,1; 17,4 1,27 19,6
Some 20,1% 2,8 15,2; 26,1 1,18 13,9
A lot 67,9% 3,7 60,3; 74,7 1,51 5,4
198
Variable Sub
Categories
Estimated
Parameter
Standard
Error
Confdence
Interval
Deff Coeffcient of
Variation
Current prevalence of signifcant states of
mind in systematically mistreated women
(at least once or twice a month): Sadness
Never
(at least once or twice a month): Tense
Never 0,6% 0,4 0,2; 2,5 0,8 71,5
(at least once or twice a month): Irritability
Never 3,9% 1,2 2,0; 7,2 1,0 32,0
(at least once or twice a month): Worried
Never 0,0% 0,0% 0,0; 0,0 0,0 0,0
(at least once or twice a month): Calm
Never 4,3% 11,7 1,9; 9,2 1,7 34,9
(at least once or twice a month): Happy
Never 0,4% 0,4 0,1; 2,7 0,9 99,6
(at least once or twice a month): Bored
Never 11,1% 2,4 7,2; 16,7 1,4 21,3
(at least once or twice a month): Other
Never 95,9% 4,1 75,6; 99,4 1,5 4,2
Suicidal considerations or thoughts in
Monthly prevalence 5,8% 1,9 3,1; 10,7 1,53 31,9
Annual prevalence 18,5% 3,4 12,7; 26,2 1,90 18,5
Suicidal behaviour in systematically
a month)
a month)
a month)
Annual prevalence 2,5% 1,3 0,9; 6,8 1,66 51,3
Systematically mistreated woman (at least
Prevalence of suicidal
potential
0,3% 0,3 0,0; 2,4 0,85 100,0
Traumatic experiences Lifetime prevalence 48,9% 3,6 41,9; 55,9 1,25 7,3
CLINICAL DISORDERS IN MISTREATED WOMEN
Generalized anxiety disorder in
systematically mistreated women involved
in a relationship (at least once or twice
a month)
Post-traumatic stress disorder in
a month)
Current prevalence 2,9% 1,1 1,4; 5,9 0,99 36,9
SAMPLING ERRORS
199
Variable Sub
Categories
Estimated
Parameter
Standard
Error
Confdence
Interval
Deff Coeffcient of
Variation
Post-traumatic stress disorder in
a month)
Depressive disorders in systematically
mistreated women involved in a
relationship (at least once or twice a
month)
Major depression in systematically
mistreated women involved in a
relationship (at least once or twice a
month)
Systematically mistreated women
involved in a relationship (at least once or
twice a month)
Current prevalence of
major depression
10,0% 2,0 6,8; 14,6 1,0 19,6
Systematically mistreated women involved
a month)
Current prevalence of
dysthymia
3,4% 1,2 1,7; 6,7 1,1 35,1
GENERAL DATA TEENAGERS
Age (Standard Deviation) 14,5 years 0,1 14,4; 14,6 1,7 0,4
Employment Looking for a job 2,5% 0,5 1,6; 3,9 1,7 21,7
Worked the previous week 11,4% 1,2 9,2; 14,0 2,4 10,8
MENTAL HEALTH OF THE TEENAGER
Poverty 25,7% 1,5 22,8; 28,7 1,9 5,9
Crime 11,8% 1,1 9,8; 14,2 2,0 9,5
Corruption 9,8% 0,9 8,1; 11,9 1,6 9,6
Violence 7,5% 0,8 6,1; 9,2 1,4 10,4
Economic administration 4,5% 0,6 3,4; 6,0 1,5 14,2
Terrorism 2,5% 0,5 1,7; 3,7 1,6 20,0
Drug traffcking 1,9% 0,4 1,2; 2,9 1,4 21,4
Lack of trust 1,2% 0,3 0,8; 2,0 1,1 23,7
Other 12,9% 0,5 2,1; 4,3 1,6 18,2
Some 15,4% 1,2 13,2; 17,8 1,7 7,6
A lot 2,2% 0,4 1,5; 3,3 1,5 20,1
Trust in teachers None or little 16,9% 1,2 14,7; 19,3 1,6 6,9
Some 29,0% 1,5 26,3; 32,0 1,7 5,0
A lot 54,1% 1,5 51,2; 57,0 1,4 2,7
None or little 32,7% 1,7 29,6; 36,1 1,9 5,1
Some 24,0% 1,4 21,4; 26,8 1,6 5,8
A lot 43,3% 1,8 39,8; 46,8 2,0 4,1
Prevailing emotional states Sadness 13,2% 1,0 11,3; 15,3 1,5 7,7
Tension 12,4% 1,1 10,3; 14,7 1,8 9,0
Distress 11,9% 1,0 10,0; 14,0 1,5 8,5
Irritability 16,6% 1,2 14,4; 19,0 1,6 7,0
Worry 25,7% 1,3 23,1; 28,4 1,5 5,2
Calm 61,7% 1,6 58,5; 64,8 1,7 2,6
Happy 77,4% 1,1 74,6; 79,9 1,7 1,7
200
Variable Sub
Categories
Estimated
Parameter
Standard
Error
Confdence
Interval
Deff Coeffcient of
Variation
appearance
None or little 11,5% 1,1 9,5; 13,8 1,8 9,4
Some 28,5% 1,4 25,9; 31,3 1,7 4,9
A lot 60,5% 1,6 56,8; 63,2 1,8 2,7
Degree of personal satisfaction: Social
relations
None or little 12,5% 1,0 10,7; 14,6 1,4 7,9
Some 28,3% 1,3 25,7; 30,9 1,4 4,7
A lot 59,2% 1,6 56,0; 62,3 1,7 2,7
Permissiveness towards psychopathic
conduct
Prevalence 9,9% 0,9 8,3; 11,9 1,5 9,3
Psychopathic tendencies Prevalence 39,4% 1,5 36,5; 42,4 1,5 3,8
Prevalence of criminal tendencies Prevalence 9,6% 0,9 8,0; 11,4 1,4 9,1
Suicidal considerations or thoughts Lifetime prevalence 9,8% 1,0 8,1; 12,0 1,8 10,1
Prevalence of violent tendencies Lifetime prevalence 20,6% 1,3 18,1; 23,3 1,7 6,4
Suicidal behaviour Lifetime prevalence 2,9% 0,5 2,0; 4,0 1,5 17,6
Prevalence of suicidal potentiality Prevalence 0,9% 0,3 0,5; 1,6 1,3 30,6
Homicidal considerations or thoughts Lifetime prevalence 2,1% 0,4 1,5; 3,1 1,3 19,5
Religious tendencies God is very important 85,7% 1,1 83,4; 87,8 1,6 1,3
problems
68,5% 1,6 65,4; 71,5 1,8 2,3
High level of environmental stress
(noise, ventilation, space, smells)
Prevalence 42,5% 1,7 39,1; 45,9 1,9 4,1
Quality of life in teenager population Arithmetic mean 7,8% 0,0 7,8; 7,9 1,9 0,5
Generalized anxiety disorder Six months prevalence 5,5% 0,8 4,1; 7,4 2,1 15,1
Depressive episode Current Prevalence 5,7% 0,7 4,5; 7,2 1,3 11,7
Dysthymia Current Prevalence 0,8% 0,2 0,4; 1,5 1,2 30,6
Anorexia nervosa Current Prevalence 0,1% 0,1 0,0; 0,4 0,7 61,6
Lower BMI (Body Mass Index) than the
critical threshold for height and weight
Prevalence 29,4% 1,6 26,3; 32,7 2,1 5,5
Current prevalence of bulimia nervosa Current prevalence 0,4% 0,2 0,2; 0,9 1,3 44,4
Bulimic behaviour Current prevalence 4,0% 0,6 3,0; 5,2 1,4 14,3
Prevalence of tendency towards eating
disorders
Prevalence 5,9% 0,7 4,7; 7,5 1,4 11,7
Monthly prevalence of psychotic disorders Monthly prevalence 1,5% 0,3 1,0; 2,3 1,2 22,1
Lifetime prevalence of alcohol
consumption
Average starting age for alcohol
consumption
Arithmetic mean 11,9 years 0,1 11,7; 12,1 1,5 1,0
Average starting age for alcohol
consumption according to age groups
4-7 years 6,3% 0,7 5,0; 7,9 1,5 11,6
8-12 years 27,6% 1,5 24,8; 30,6 1,8 5,4
13-17 years 31,9% 1,5 29,0; 35,0 1,7 4,7
Never 33,5% 2,0 29,8; 37,5 2,8 5,9
Monthly prevalence of alcohol
consumption
SAMPLING ERRORS
201
Variable Sub
Categories
Estimated
Parameter
Standard
Error
Confdence
Interval
Deff Coeffcient of
Variation
Prevalence of alcohol intoxication in the
previous month
Current prevalence of any behaviour
related to alcohol abuse
At least 1 criteria 27,4% 1,7 24,1; 30,9 2,4 6,3
At least 3 criteria 2,0% 0,4 1,4; 2,9 1,3 19,7
Tobacco consumption Lifetime prevalence 24,5% 1,5 21,6; 27,2 2,0 6,3
Starting age for tobacco consumption Arithmetic mean 13,4 years 0,1 13,2; 13,7 1,4 1,1
Tobacco consumption Monthly prevalence 7,3% 0,8 5,9; 9,1 1,5 10,8
Marijuana consumption Lifetime prevalence 0,5% 0,2 0,2; 1,2 1,7 47,9
Starting age for marijuana consumption Arithmetic mean 15,5 years 0,3 14,7; 16,2 0,8 1,8
Cocaine hydrochloride consumption Lifetime prevalence 0,1% 0,1 0,0; 0,5 1,1 79,7
Inhalants consumption Lifetime prevalence 0,4% 0,2 0,2; 1,0 1,1 38,9
Coca leaves consumption Lifetime prevalence 9,5% 1,0 7,7; 11,7 2,0 10,8
Prevalence of teenage pregnancy Lifetime prevalence 2,9% 0,8 1,7; 5,0 1,8 26,7
Prevalence of teenage abortion Lifetime prevalence 0,9% 0,6 0,2; 3,2 3,3 65,9
Prevalence of any type of abuse (sexual,
physical or emotional of teenagers) at
some time in their lives
Sexual abuse of teenagers Lifetime prevalence 2,5% 0,5 1,7; 3,8 1,9 21,2
Physical abuse of teenagers Lifetime prevalence 40,5% 1,7 37,2; 43,8 1,9 4,2
Psychological abuse of teenagers Lifetime prevalence 55,3% 1,6 52,2; 58,5 1,7 2,9
Abandonment of teenagers Prevalence 13,1% 1,3 10,8; 15,8 2,3 9,7
Perceived morbility for mental health
problems (Population with MH problems)
Help seeking behavior for assistance in
teenagers and taken care of at mental
health centres
Assistance expressed in teenagers and
taken care of at health and emergency
centres
Percentage of the
perceived need for
assistance which was
taken care of
0,9% 0,4 0,4; 2,1 1,3 42,6
taken care of at emergency centres and
polyclinics of ESSALUD
Percentage of the
perceived need for
taken care of
0,5% 0,2 0,2; 1,3 0,8 46,0
taken care of at specialized institutes and
hospitals
Percentage of the
perceived need for
taken care of
0,1% 0,1 0,1; 0,0 0,4 100,2
taken care of at MINSAGeneral Hospital
Percentage of the
perceived need for
taken care of
1,0% 0,4 0,5; 2,1 1,1 37,8
GENERAL DATA: SENIOR ADULTS
Age Arithmetic mean
70,6 0,4 69,91; 71,41 1,6 0,5
Age by age groups (15 years) Young-old (60-74 years) 69,2 2,0 65,1; 73,0 1,4 2,9
Old-old (75-84 years) 24,3 1,8 21,0; 28,1 1,3 7,4
Oldest-old (>=85) 6,5 1,2 4,5; 9,2 1,7 18,0
MENTAL HEALLTH OF SENIOR ADULTS
None or little 37,4 2,3 33,0; 41,9 1,6 6,1
Some 20,8 1,9 17,4; 24,7 1,5 8,9
A lot 41,8 2,3 37,4; 46,4 1,5 5,4
202
Variable Sub
Categories
Estimated
Parameter
Standard
Error
Confdence
Interval
Deff Coeffcient of
Variation
daily stressors: Partner
None or little 51,8 3,2 45,5; 58,1 1,5 6,2
Some 12,9 2,0 9,5; 17,4 1,3 15,6
A lot 35,3 3,2 29,2; 41,8 1,7 9,1
None or little 28,9 2,2 24,7; 33,5 1,7 7,7
Some 21,5 1,8 18,3; 25,2 1,3 8,1
A lot 49,5 2,2 45,3; 53,8 1,3 4,4
daily stressors: Health
None or little 20,4 1,8 17,1; 24,2 1,4 8,8
Some 18,6 1,9 15,3; 22,6 1,6 9,9
A lot 60,9 2,3 56,4; 65,3 1,6 3,7
Prevailing emotional states of mind Sadness 30,2 2,0 26,3; 34,3 1,4 6,8
Tension 17,4 1,8 14,1; 21,3 1,6 10,4
Distressed 19,2 1,9 15,8; 23,3 1,6 9,8
Irritability 15,7 1,6 12,8; 19,1 1,4 10,2
Worry 40,2 2,1 36,1; 44,5 1,4 5,3
Calm 51,2 2,2 46,9; 55,4 1,4 4,2
Happy 45,1 2,4 40,4; 50,0 1,7 5,4
None or little 16,3 1,6 13,4; 19,6 1,3 9,7
Degree of global personal satisfaction
(Scale 5 to 20)
Arithmetic mean 13,34 0,1 13,11; 13,57 1,8 0,9
appearance
None or little 13,3 1,5 10,6; 16,6 1,4 11,4
Some 32,9 2,1 28,9; 37,2 1,4 6,4
A lot 53,8 2,3 49,3; 58,2 1,4 4,2
Intelligence
None or little 21,7 2,2 17,7; 26,4 1,9 10,2
Some 32,1 2,1 28,1; 36,4 1,4 6,5
A lot 46,2 2,5 41,3; 51,2 1,8 5,5
Degree of personal satisfaction: economic
level
None or little 41,3 2,2 36,9; 45,8 1,5 5,4
Some 40,5 2,3, 36,1; 45,0 1,5 5,6
A lot 18,3 1,9 14,8; 22,4 1,8 10,6
profession or trade studied
None or little 24,7 3,6 18,3; 32,5 1,8 14,7
Some 25,7 3,5 19,5; 33,2 1,6 13,6
A lot 49,6 4,1 41,6; 57,6 1,7 8,3
social relations
A lot 19,3 1,8 16,0; 23,1 1,4 9,3
None or little 31,1 2,0 27,3; 35,1 1,3 6,4
Some 49,6 2,3 45,1; 54,2 1,5 4,7
Degree of global work satisfaction
(Scale 5 to 20)
Arithmetic mean 12,9 0,2 12,6; 13,3 1,2 1,5
Degree of work satisfaction:
with remuneration
A lot 53,6 3,6 46,4; 60,7 1,4 6,8
None or little 32,0 3,3 25,8; 38,8 1,4 10,4
Some 14,4 2,3 10,4; 19,6 1,2 16,1
Suicidal considerations or thoughts Lifetime prevalence 7,3 1,3 5,1; 10,3 1,8 17,8
Monthly prevalence 2,3 0,8 1,2; 4,4 1,8 32,5
Annual prevalence 3,9 1,1 2,2; 6,8 2,4 28,4
Suicidal behaviours Lifetime prevalence 0,6 0,3 0,2; 1,8 1,4 55,4
Monthly prevalence - - - - -
Annual prevalence - - - - -
SAMPLING ERRORS
203
Variable Sub
Categories
Estimated
Parameter
Standard
Error
Confdence
Interval
Deff Coeffcient of
Variation
Religious tendencies God is very important 95,1 0,9 93,2; 96,6 1,1 0,9
Participates actively 21,3 2,0 17,7; 25,4 1,7 9,3
Reads religious scriptures 41,8 2,6 36,9; 46,9 1,9 6,1
Transmits religion to
children
50,7 2,3 46,2; 55,3 1,6 4,6
problems
84,1 1,7 80,6; 87,2 1,5 2,0
Quality of life of the senior adult population
(Scale 1 to 10)
Arithmetic mean 7,51 0,07 7,38; 7,65 1,4 0,9
Level of disability of the senior adult
population (Scale 5 to 20)
Arithmetic mean 5,47 0,11 5,26; 5,68 1,4 1,9
Any functional disability or inability in the
senior adult population
Lifetime prevalence 44,9 2,4 40,3; 49,6 1,7 5,3
Any physical disability as per the informant Lifetime prevalence 19,5 1,9 16,1; 23,5 1,6 9,6
Current prevalence of depressive episode Current prevalence 3,9 0,8 2,7; 5,8 1,13 19,4
Generalized anxiety disorder
(without depression)
Current prevalence 3,0 0,8 1,8; 5,0 1,53 26,1
Perceived morbidity for mental health
problems (self-perception)
Six months prevalence 20,6 1,8 17,3; 24,3 1,43 8,7
Help seeking behavior for assistance and
taken care of at mental health centres
Six months prevalence 15,7 3,0 10,6; 22,6 1,01 19,3
emergency centres and polyclinics of
ESSALUD
Prevalence 10,6 5,5 3,7; 26,9 0,92 51,5
specialized institutes or hospitals
Prevalence 1,8 1,8 0,2; 12,1 0,54 100
MINSA General Hospital
Prevalence 31,7 10,2 15,4; 54,0 1,42 32,4
Assistance which was taken care of at the
mental health centre of ESSALUD
Prevalence 2,0 2,0 0,3; 13,3 0,60 100
ESSALUD General Hospital
Prevalence 33,1 12,4 14,1; 59,8 2,03 37,4
the hospitals of the Armed Forces and
Peruvian Police
Prevalence 1,7 1,7 0,2; 11,7 0,52 100
private practice
Prevalence 11,3 5,2 4,3; 26,2 0,80 46,3
Prevalence of mistreatment: inappropriate
sexual behaviour or attempts
12-month prevalence 0,3 0,3 0,0; 2,1 2,10 99,9
Prevalence of mistreatment: blows,
punches or pushing
Prevalence of mistreatment: insults, verbal
aggression or offences
Prevalence of mistreatment: blackmailing,
manipulations or humiliations
Prevalence of mistreatment: situation of
abandonment
COGNITIVE LEVEL OF FUNCTIONING
Global cognitive level of functioning
(FOLSTEIN) total score (for all levels of
education without considering illiterates
with alternative)
Arithmetic mean 24,5 0,3 23,9; 25,1 1,68 1,2
(FOLSTEIN) total score (8 or more years
of schooling, with alternative of 12 to 13
years)
Arithmetic mean 26,8 0,2 26,3; 27,3 1,27 0,9
204
Variable Sub
Categories
Estimated
Parameter
Standard
Error
Confdence
Interval
Deff Coeffcient of
Variation
(FOLSTEIN) total score (less than 8 years
of education. 12 or 13, 18 or 19, 22aa
or 22bb)
Arithmetic mean 23,0 0,4 22,1; 23,8 1,65 1,9
(FOLSTEIN) at 3 levels (8 or more years
of schooling, without alternative)
Abnormal (<20) 2,8 1,3 1,1; 7,0 1,19 47,0
Doubtful (20 to 25) 39,5 4,4 31,3; 48,4 1,46 11,0
Normal (>25) 57,6 4,4 48,8; 66,0 1,45 7,6
(FOLSTEIN) at 2 levels (cut <22) (less
than 8 years of schooling. 12 or 13, 18 or
19, 22aa or 22bb)
Abnormal (<22) 39,5 4,1 31,9; 47,8 1,82 10,3
Normal (>23) 60,5 4,1 52,2; 68,1 1,82 6,7
(FOLSTEIN) at 2 levels (cut <22) (8 or
more years of schooling, with alternative
of 12 to 13 years)
Abnormal (<22) 7,7 2,1 4,4; 13,0 1,15 27,3
Normal (>23) 92,3 2,1 87,0; 95,6 1,15 2,3
(FOLSTEIN) at 2 levels (cut <22) (all
years of education, without considering
illiterates with alternative)
Abnormal (<22) 26,8 2,9 21,5; 32,8 1,91 10,7
Normal (>23) 73,2 2,9 67,2; 78,5 1,91 3,9
Dementia syndrome (for all levels of
education, without considering illiterates
with alternative) 8 years of schooling
Presence 2,6 1,4 0,9; 7,4 1,17 53,9
Dementia syndrome (8 or more years
of schooling, with alternative of 12 to 13
years) by age group
60 to 74 0,0 0,0 0,0 0,0 0,0
75 or more 12,6 6,0 4,7; 29,9 1,03 47,6
Dementia syndrome (less than 8 years
of schooling. 12 or 13, 18 or 19, 22aa or
22bb) by age groups
60 to 74 6,5 2,8 2,7; 14,8 2,03 43,4
75 or more 22,3 5,6 13,1; 35,2 1,26 25,3
BIBLIOGRAPHY
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ANALES DE SALUD MENTAL
OFFICIAL ENTITY OF THE SPECIALIZED INSTITUTE OF
MENTAL HEALTH
VOLUME 19 2003 ISSUES 1 AND 2
GRAPHIC EDITOR:
MARIO A. URQUIZO VSQUEZ
PRINTED BY IMPRENTA GRAFICA COLORS 568-9503
DECEMBER 2004
ANALES DE
SALOD MENTAL
0FFICIAL ENTITY 0F SPECIALIZED INSTITUTE 0F MENTAL HEALTH
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