Date of Award

Fall 1-10-2020

Degree Type


Degree Name

Master of Public Health (MPH)


Public Health

First Advisor

Monica Swahn, PhD, MPH

Second Advisor

Fatima Rodriguez, MD


Purpose: An estimated 75-85% of people with common and severe mental health disorders living in low- and middle-income countries do not have access to the treatment they need, despite the fact that effective treatments exist and can be successfully delivered in primary care settings. In the rural Sierra Madre Mountain region of Chiapas, Mexico, the rate of depression is almost twice the rate of the national average for Mexico. Rates of other mental health disorders in this region are not reported, but are likely high.

Methods: This study aims to report the prevalence of common and severe mental health disorders in the Sierra Madre Mountain region of Chiapas, Mexico, as well as the demographics and clinical characteristics of mental health patients. This is done by examining the medical records of mental health patients who visited a primary care clinic operated by Compañeros En Salud (CES) between 2017 and 2018. This study also provides preliminary results of health improvement for patients being treated through CES’s mental health program, measured by change in score on the Patient Health Questionnaire-9.

Results: Of the 12,718 unique patients who attended CES-operated clinics during the two-year study period, 856 (6.7%) had a mental health disorder. The majority had depression (54%), followed by anxiety (32%), psychosis (6% for schizophrenia, 2% for other types of psychosis), substance use disorder (2%) and bipolar disorder (1%). The ratio of men to women was one to four, and three-fourths of patients were between the ages of 19-49. Regarding patient health improvement, the average fall in PHQ-9 scores for all patients was 2.86 (CI: 1.75, 3.96) (p<0.0001). Thirty-five percent of patients fell into full remission and an additional 22% fell into partial remission. The only significant indicator of fall in PHQ-9 score was number of clinic visits (p=0.0005).

Conclusion: Compared to global and Mexico-specific rates of mental health, patients with mental health disorders in the rural Sierra are more frequently women and in their early to middle-ages. Patient health outcomes provides encouraging evidence of the positive effect of the mental health program, though there is a need to standardize follow-up with patients and data collection methods.

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Available for download on Thursday, December 10, 2020