Exploring perceptions of the mental health of youth in Mexico: A qualitative study

Abstract

Limited information is available regarding the mental health of children and adolescents in Mexico (Paula, Duarte, & Bordin, 2007). The purpose of this exploratory qualitative study was to examine the construct of mental health of children and adolescents from the emic perspective of key informants in Mexico. Utilizing qualitative methods of inquiry and analysis, this study yielded a coding hierarchy representing key informants, descriptions of the valued mental health outcomes, socialization influences, stressors, and the resources available for supporting the mental health of children and adolescents in Mexico. The results of these efforts may inform the future development and evaluation of culture-specific definitions and interventions regarding the construct of mental health. Unique contributions to the literature included: (a) the focus on the mental health of youth in Mexico; (b) examining how educational outcomes for youth in Mexico was influenced by their mental health; and (c) the use of qualitative methods of inquiry compared to previous research use of quantitative measures to examine mental health in Mexico (e.g. surveys, self-report questionnaires). Limitations and suggestions for future research are discussed.

Keywords

adolescents children mental health Mexico qualitative service providers youth

There are more than 26 million school-age children in Mexico (Jimerson, Stewart, Skokut, Cardenas, & Malone, 2009). While it is important to address the needs of the mental health of these children, there is limited information regarding the mental health of children and adolescents as well as the availability, accessibility, and utilization of mental health services for this population in Mexico (Paula et al., 2007). To date, most research on mental health in Mexico has focused on adults aged 18- to 65-years-old (Alarcón & Aguilar-Gaxiola, 2000; Borges, Wang, Medina-Mora, Lara, & Chiu, 2007; Wang et al., 2007), despite global data indicating that mental health problems often begin in childhood (Power, 2003; WHO, 2005) and are most often identified and treated in educational settings (Belfer, 2008). Assessing the mental health of youth may be challenging, in part, due to the use of diagnostic classification systems developed for adults and a lack of consideration of the role that culture plays in the development and manifestation of mental health problems (Belfer, 2008; Robles-Pina, Defrance, & Cox, 2008). As such, there is a need to integrate a developmental as well as cultural understanding of mental health problems in children and adolescents with the current diagnostic classification systems (Belfer, 2008), which will, in turn, inform the development and implementation of mental health programs and services appropriate for youth with distinct cultural backgrounds (Nastasi et al., 2007).

Culture is an important consideration when conducting research on how mental health problems develop in children as well as what treatments should be implemented (Isaacs, Huang, Hernandez, & Echo-Hawk, 2005) because ‘what it means to be mentally healthy is subject to many different interpretations that are rooted in value judgments that may vary across cultures' (United States Department of Health and Human Services [USDHHS], 1999, p. ix). In fact, the validity of research using measures standardized in Western cultures and then applied to other cultures has come into question (Niblo & Jackson, 2004). Culturally sensitive research on mental health must therefore consider the target culture's ideas, language, beliefs, values, and behavioral norms, which in turn will lead to an increase in the acceptability, integrity, and social validity of subsequent interventions informed by the assessment (Hitchcock et al., 2005).

The use of both an emic and etic perspective of inquiry is critical to the study of culture using qualitative methodologies (Nastasi, Moore, & Varjas, 2004; Varjas, Nastasi, Moore, & Jayasena, 2005). An emic perspective provides information from members of the target culture about how elements of a construct manifest themselves in culture-specific forms; whereas the etic perspective is a universal understanding of that construct (Triandis, 2000). An emic perspective allows researchers to add to the existing etic (universal) knowledge about a given construct (i.e. mental health of youth) by gaining an in-depth understanding and knowledge of a particular culture (Niblo & Jackson, 2004). Thus, an emic perspective provides a culture-specific understanding of an etic construct (Nastasi et al., 2004).

Rationale for this study

In an effort to gather culture-specific information (Niblo & Jackson, 2004) regarding mental health of youth world-wide, researchers are conducting an international project entitled Promoting Psychological Well-Being Globally (PPWBG; Nastasi, 2008). The PPWBG project is sponsored by the Society for the Study of School Psychology (SSSP) and the International School Psychology Association (ISPA) and represents a first step in understanding the mental health of children and adolescents worldwide from a socio-cultural perspective. As a component of the larger PPWBG project, the purpose of this exploratory qualitative study was to begin to generate a culture-specific construct of mental health for youth in Mexico. Using qualitative methodologies, researchers can tailor universal (etic) elements of psychological theories toward a ‘Mexican psychology’ by incorporating more culturally relevant elements (Kunkel, Hector, Góngora Coronado, & Castillo Vales, 1989). Thus, the expected outcome of utilizing a qualitative method of inquiry is a more in-depth understanding of both emic (culture-specific) and etic (universal) perspectives of mental health in Mexico. Areas of interest this exploratory qualitative study sought to examine included: (a) how key informants define mental health; (b) perceptions of culturally valued competencies for youth; (c) the socio-cultural norms that influence the socialization of youth; (d) the stressors that influence mental health; and (e) what resources are available for supporting mental health.

Method

Context and participants

This study was conducted in Xalapa, Veracruz in Mexico. There are nearly seven million people living in the State of Veracruz, 44% of whom live in rural and indigenous areas, and 34% of whom are under the age of 14-years-old (Malott & Martinez, 2006). Poverty is a regional concern as evidenced by an earned income per capita of $3600 per year and many people living without public water, drainage, and electricity (Malott & Martinez, 2006). Xalapa, the capital city of Veracruz, has a population of approximately 413,000 (Instituto Nacional de Estadística, Geografía e Informática, 2006). Eight key informants (i.e. mental health service providers) were identified from the professional fields of sociology, health, psychology, and education and the number of years participants worked in their respective professions ranged from three to 34 years (M = 17; SD = 11). All participants self-identified as Mexican and the majority of the participants were female (63%).

Recruitment procedures and instrumentation

Participants (i.e. key informants) who met the criteria for inclusion in this study were identified using a purposive sampling method (Nastasi, 2009) ‘allowing the study to be grounded in a local context’ (Whitley & Crawford, 2005, p. 110). Criteria for key informant (Schensul, Schensul, & LeCompte, 1999) selection included experts who worked with children and adolescents and experts in the field of mental health. Snowball sampling, a procedure by which participants referred the researcher tonew participants, was used to recruit and interview additional participants (Noy,2008).

Consent and demographic forms (available in both English and Spanish) were completed prior to the start of each interview. The semi-structured interviews were guided by pre-determined open-ended questions and lasted approximately one hour. English and Spanish versions of the interview questions were made available for participants. After the interview, each participant was asked to provide feedback regarding the phrasing of the interview questions to ensure cultural appropriateness of the interview protocol for future research purposes. Interviews were audio-taped and the majority of the interviews (n = 7) were conducted in Spanish by a bilingual researcher. Interviews were transcribed in Spanish, and subsequently translated to English by a bilingual graduate student. The Spanish to English translations were then verified by a second bilingual graduate student to ensure a consistent and valid translation (Wild et al., 2005). The translated interviews were then imported into the Atlas.ti 5.0 computer software program.

Data analysis

Data collection, analysis, and interpretation using qualitative methodology involves a recursive process in which the researcher is continuously developing, examining, and refining codes based on the data (Nastasi, 2009). Analysing qualitative data in amanner which yields trustworthy results (i.e. credible, dependable, transferable, and confirmable) is a systematic multistep process (Nastasi, 2009) which includes: (1)preparing the data; (2) making decisions about the coding process; (3) preparing coders; (4) coding the data; and (5) theme/pattern analysis. Codes developed based on existing theory were applied to the data (i.e. deductive coding) and new codes emerged based on themes derived from the data (i.e. inductive coding; Nastasi, 2009; Varjas et al., 2005). The benefit of using this deductive-inductive coding process is that an etic theory on the construct of mental health will be modified to reflect an emic view of mental health from the perspective of the Mexican key informants.

A pre-determined coding system (i.e. deductive coding; Varjas et al., 2005) was applied and new codes derived from the data were identified, defined, and integrated into the existing coding hierarchy (i.e. inductive coding) to reflect key informants' views regarding mental health and psychologically healthy schools and communities in Mexico. Two researchers independently applied the coding hierarchy to a subset of the interviews, compared results, and discussed and resolved any discrepancies. This recursive coding process continued until the recommended inter-rater reliability (IRR) of 90% was achieved (M = 92%; Bakeman & Gottman, 1986) to ensure the accuracy of coding. The coding hierarchy continued to be refined by adjusting definitions of existing codes and generating new codes as appropriate. Researchers then moved to independently coding the remaining interviews, and consistency checks were conducted by the researchers on 10% of the remaining interviews to ensure that the application of codes remained consistent and thus, prevented coder drift (M = 94%; LeCompte, 1999).

Results

Qualitative data analysis of this exploratory study yielded a coding hierarchy (see Figure 1) in which service providers described the mental health of youth in Mexico. The coding hierarchy consisted of seven Level 1 codes: Definitions of mental health, culturally valued competencies, socialization practices, Stressors, reaction to stressors, support/resources, and reaction to support. In addition, Level 2 codes were identified for six of the seven Level 1 codes. Findings are summarized below and quotations from the interviewees are provided.

Figure 1.

Coding hierarchy. This figure depicts the Level 1 codes and their respective Level 2 codes that emerged from interviews with service providers.

Mental health

For the Level 1 code of Mental Health, service providers were asked to define the term mental health. Instead of providing a definition, service providers responded to this question with descriptions of mental health which often described illness: ‘… people in general… tend to use more common words like “demented”, “sick people”, and “crazy”’. This description of mental health was provided by one respondent: ‘… there has been little information generated in terms of the importance of mental health. Culturally, there's still this idea that getting help for mental health is because one is sick. The idea is that mental health is not important; rather, that it is something for someone who is sick, someone who is crazy’.

In addition, key informants often reported that provisions for the mental health of children and adolescents were non-existent. This participant stated: ‘That is, the children are not seen as a specific social group with specific needs and specific rights, but rather it would seem that the children are part of a process to become adults; that is, the important thing is to be an adult and not a child. There is [no] type of job [for] therapy with the children. It doesn't exist’.

Culturally valued competencies

The Level 1 code of culturally valued competencies was defined in this study as those abilities or behaviors that one performs which were expected in the Mexican culture. Participants provided descriptions of these competencies in terms of either positive (behaviors considered socially acceptable) or negative (behaviors considered socially unacceptable) abilities. In addition, themes were identified that further described those behaviors valued in the culture and categorized into Level 2 sub-codes: Personal, social, and academic (see Table 1 for examples).

Table 1.

Culturally valued competencies

	Positive behaviors (desired)	Negative behaviors (undesired)
Personal	Respectful	Lack of supervision
	Tolerant	Egocentrism
	Accepting	Lack of education from the parents
	Disciplined	Parents neglecting children
	Caring & warm	Parents not teaching values and rules
	Providing boundaries & responsibilities
	Provide food, shelter, & safe home environment
Social	Respect and caring of others	Exclusion of others
	Cooperative	Rivalry between children
	Supporting the community	Discrimination
	Simpatía	Discrimination
Academic	Able to read & write	Low grades in school
	Good grades	Being employed
	Speak a second language	Not completing homework assignments
	Speak a second language	Teacher's lack of communication with parents

Personal competencies (Level 2) was defined as those abilities or behaviors within an individual that were valued by society. According to participants, children's abilities to exhibit personal competencies were influenced by genetic and environmental factors: ‘[problems] that are not the hereditary type [genetic] but the ones that have to do with environmental factors in the family’. Thus, parents were expected to demonstrate personal competencies such as providing boundaries, guidance, supervision as well as food, shelter, and a safe home environment for children: ‘… that everything has a nucleus, and it's the family. If they [the family] don't provide boundaries, responsibilities and rules, the child will not do it’.

Social competencies (Level 2) was defined as those behaviors and/or ideals that were expected of people when interacting with others. Examples of social competencies included respect and caring of others, supporting the community, socializing and working together. One service provider stated that: ‘Better bonds of daily life will be discovered which avoid the high rate of violence, the high rate of immorality, of intolerance. So I think those would be the results that we are looking for’. Academic competencies (Level 2) was defined as those behaviors that were performance-oriented and related to academic endeavors. Examples of academic competencies included performing well in academics, completing assignments, coming to school prepared, as well as recruiting the teacher's involvement in the academic process: ‘The most common problems at school was the lack of follow through in activities such as homework, such as bringing the necessary materials'.

Socialization practices

The Level 1 code of socialization practices was defined in this study as how one becomes socialized according to socio-cultural norms including how one facilitates the development of education of the child. Five Level 2 themes (family, community, school, government and media) were identified that described the responses from service providers regarding the various influences on the socialization practices of youth in Mexico. Socialization practices within the family (Level 2) were defined as family members who were personally related to and responsible for well-being and education of values and expectations for children and adolescents (e.g. parent, sibling, grandparent, aunt, or uncle). According to respondents, the family was a major influence on children and adolescents' acquisition of socio-cultural norms. Respondents reported there has been an increase in a lack of parental supervision due to economic hardship requiring fathers to find work far from home and mothers working outside the home resulting in ‘no development of values'.

Socialization practices in the community (Level 2) referred to those people in the local community where a child lives who may facilitate socialization skills or knowledge (e.g. peers, community services, specialists, therapists, psychologists, priests). Respondents discussed the influence of community. This participant stated ‘We do a lot of socializing and working and doing together. So that doing together is part of what we do normally’.

Socialization practices at school (Level 2) referred to those people (e.g. teachers, administrators, and other school personnel) and/or practices related to academic endeavors and facilitate the education of youth. At school, respondents similar to the following participant stated often discussed the role of the teacher in facilitating the development of children's socialization: ‘… he/she [the teacher] can be influential in such a way, that the teacher would be, well, almost a psychologist or a very caring person who wishes to develop all the abilities that children possess'.

Socialization practices influenced by the government (Level 2) was defined as the role the government plays in facilitating the socialization and education of children. According to respondents, the government is expected to provide families with services that support and educate families about the well-being of children: ‘… unfortunately [some families do] not have the means and, therefore, it becomes the state's obligation to give the family all the elements necessary for children to receive a good education and a good mental health’.

Finally, the media (Level 2) emerged as a source of information for youth in Mexico. The influence of the media was defined as the extent to which the media influenced what children learn (e.g. television, radio, internet, video games). One respondent stated that ‘… children stay by themselves for long periods of time and asa result, there is no development of habits, … there's no development of values andsometimes the values are projected through television, the internet, and videogames…’.

Stressors

The Level 1 code of stressors was defined in this study as any risk factor that could potentially impede an individual's normal development, cause psychological distress, or negatively affect psychological adjustment. Themes were identified that described the responses from service providers regarding stressors and categorized into three Level 2 sub-codes: family, community, and school.

Stressors influenced by the family (Level 2) were defined as events or situations within the family that had the potential to cause psychological distress or negatively affect psychological adjustment. Examples of stressors in the family provided by respondents included substance abuse (i.e. drugs, alcohol), overcrowding in the home, abuse (physical, emotional, and sexual), malnutrition, divorce, and child abandonment. Participants also reported that due to economic hardship, fathers increasingly were being forced to find work far from home, mothers were working outside the home, and even the children were being asked to help with the financial support of the family. One participant stated: ‘In this country there are a lot of children who work. They go to elementary school in the morning and they work in the afternoon’.

Stressors influenced by the community (Level 2) were defined as community expectations or situations that had the potential to cause psychological distress or negatively affect mental health. Examples of stressors at the community level discussed by service providers included poverty, prostitution, gangs, lack of knowledge about mental health, and lack of affordable mental health services. Extreme poverty was reported as a stressor by all participants as negatively impacting the mental health of children: ‘In Mexico we actually have a very difficult economic situation that has a great impact on children and adolescents'.

Stressors influenced by school (Level 2) were defined as school-related expectations that had the potential to cause psychological distress or negatively affect mental health. Examples of stressors at school discussed by service providers included low academic performance, peer pressure, marginalized status/discrimination, being excluded, lack of access to education, and limited resources for teachers. One service provider stated, ‘Once inside the school, it also has to do with their social role. Many of them feel discriminated against; many of them feel that because of their financial situation, they were less than other children’.

Reaction to stressors

The Level 1 code reaction to stressors was defined in this study as how an individualresponded to stress or problems, including emotional, cognitive, and behavioral responses. Limited information was provided by participants regarding how people in Mexico reacted or coped with stress. General themes identified in the responses by service providers were categorized into two Level 2 sub-codes: positive reactions to stress and negative reactions to stress.

Positive reactions to stress (Level 2) was defined as those responses to stressors, emotional, cognitive, and/or behavioral which lead to or promoted mental health. Examples of positive reactions to stress included seeking support from a priest, teacher, and/or government run programs. Positive reactions to stress were discussed by participants in broad terms such as seeking out help or recognizing that help is needed. For example, one participant stated: ‘And when these problems present themselves, it's important that they know that they have to seek help from the specialists or the people who can help support them’.

Negative reactions to stress (Level 2) was defined as those responses, emotional, cognitive, and/or behavioral which impeded mental health. Examples of negative reactions to stress included emotional (psychological) problems, increased aggression, denial, insecurity, withdrawal, giving up, and suicide. One participant reported: ‘… there are those who are aware of what's going on and see it as a responsibility [to seek help] and there are those who deny it… and don't want to perceive it for what it is'.

Support/resources

The Level 1 code of support/resources was defined as those sources of social support or resources available in the social-cultural environments that facilitate coping with stress or addressing mental health problems. Themes identified under support (resources) were categorized under three Level 2 sub-codes: family, community, and school.

The Level 2 sub-code family referred to those resources available within the family which provided support/help to the child and/or facilitates coping with stress. In the family, this participant stated: ‘Home, for us—the support from home is fundamental’. Respondents discussed the importance of family in providing support to children: ‘at a family level, … it's very important that in that stage of adolescence, they feel understood and that they have help …’. However, respondents often spoke about the lack of support for families: ‘But the mother, even though she wants to do it, she can't because she doesn't have someone to do it with’.

The community (Level 2) code referred to those resources available within the community (i.e. local, state, and federal level) which provided support/help to the child and/or facilitated coping with stress. Most of the participants commented on the limited availability and accessibility of mental health resources for a majority ofthe citizens of Mexico, particularly for lower socioeconomic status (SES) groups. This participant stated that ‘mental health consists of a group or class. It's very expensive. Mental health is not, at least not in Mexico and in Xalapa, it's not within everyone's reach’.

The Level 2 sub-code school referred to those resources available within the school setting which provided support/help to the child and/or facilitates coping with stress. One respondent reported that the school ‘… can do a lot in the way that it creates a culture for… mental health. It is saying that we learn how we should work with the parents so that the children develop in a healthy way’. However, when discussing availability of resources for children with mental health problems, one respondent stated: ‘So, the resources that the school has to give children with emotional problems a satisfactory response is very limited’.

Reaction to support/resources

The Level 1 code of reaction to support/resources described any references made by service providers as to how an individual responds to support or help from others, including emotional, cognitive, and behavioral responses. Themes from this Level 1 code were categorized into two Level 2 sub-codes: positive reactions and negative reactions.

Respondents reported positive reactions to support included an increase in the public awareness of mental health and well-being and one respondent stated that ‘Mental health problems in Mexico… are being tended to with more resources. It's becoming easier to decide to see a psychologist, a psychotherapist, someone professional who is working in the health field- more so than in past years'. Therefore, respondents indicated that continuing to increase public awareness about the importance of mental health was important. For example, this participant stated that ‘the task is in going out, going to the school, going to the community and explaining in a very simple manner why mental health is important’.

Negative reactions to support were discussed by service providers. For example, one respondent stated: ‘Well, like I said, unfortunately, the responses can be very diverse because there are those who are aware of what's going on and see it as a responsibility and there are those who deny it and close themselves off completely from all reasoning and don't want to perceive it for what it is'.

The availability of quality mental health programs, lack of qualified mental health providers, limited economic means, and perceived social stigma impacted whether people in Mexico seek services for mental health: ‘Well, it's a path of personal growth but the stigma or the criticism that people go there because they have problems still exists'. Service providers frequently reported that most people in Mexico generally believed that ‘… that going to a psychologist was for crazy people;… rather people do not see the field of psychology as help but like, psychology was only for crazy people and I am not crazy’.

Discussion

The purpose of this exploratory qualitative study was to examine the construct of mental health of children and adolescents from the emic perspective of key informants in Mexico. Findings from this study provided a more in-depth understanding and knowledge of mental health for this population. Thus, this study contributed to the existing literature in several ways. One significant contribution has been the findings (definitions of mental health, culturally valued competencies, socialization practices, stressors, reaction to stressors, support/resources, and reaction to support) regarding the mental health of children and adolescents in Mexico, due to the limited information available for this population (Paula et al., 2007). The current study also examined how the mental health of youth in Mexico related to educational settings where most mental health services for youth are provided (Belfer, 2008). Finally, whereas previous research (Alarcón & Aguilar-Gaxiola, 2000; Belfer & Rohde, 2005; Borges et al., 2007; Wang et al., 2007) utilized quantitative measures (e.g. surveys, self-report questionnaires) to investigate mental health in Mexico, the current study employed qualitative methods of inquiry (i.e. semi-structured interviews) which allowed researchers to investigate both the emic and etic components (Niblo & Jackson, 2004) of mental health from service providers' perspectives.

The focus of this exploratory study was on the mental health of children and adolescents in Mexico, whereas previous research focused on adults (Alarcón & Aguilar-Gaxiola, 2000; Borges et al., 2007; Slone et al., 2006; Wang et al., 2007). Findings from this study yielded a coding hierarchy representing key informants, descriptions of mental health, socialization influences, stressors, and resources available for supporting the mental health of children and adolescents in Mexico. These codes contributed toward a more in-depth understanding of mental health in Mexico from an emic perspective. Therefore, service providers responded to interview questions related specifically to the mental health of youth in Mexico: How mental health was defined, what stressors influenced the mental health of this population, and how mental health was supported.

Respondents reported that the constructs of ‘mental health’, ‘mental well-being’, and ‘mental illness' were not terms typically used by the general population in Mexico. Rather, participants provided descriptions of mental health for youth interms of the absence of mental illness. Consistent with previous research (US Department of Health and Human Services, 1999), the respondents in this study discussed mental health as points on a continuum between mental health and mental illness. Respondents also reported that mental health plays an important role in people's overall health and productivity (US Department of Health and Human Services, 1999).

In addition, key informants described factors that influenced the mental health of youth and their access to services in Mexico. Consistent with previous research (Belfer & Rohde, 2005), poverty was raised by respondents as a factor that negatively influenced the mental health of children and adolescents in Mexico. Economics often were reported by key informants as a driving force in family decision-making and that most families in Mexico could not afford mental health services (Borges et al., 2006). When financial resources are limited, families tend to focus on meeting basic needs (e.g. food, water, shelter) before they can focus on other needs (i.e. mental health) relevant to living (Cook, Jimerson, & Begeny, 2010). Factors identified by key informants as stressors which influenced the mental health of children and adolescents in Mexico included family difficulties, homelessness, child labor, separationfrom adult caregivers, and lack of human rights for children and adolescents. Reactions to these stressors were seen as producing negative mental health outcomessuch as depression, withdrawal, behavioral aggression, and school truancy. Participants also reported that factors such as marginalization, discrimination, poverty, lack of health insurance, stigma associated with mental illness, and lack of adequate services were likely to preclude access and use of mental health services for many individuals (Belfer & Rohde, 2005; Borges et al., 2006).

Another unique contribution to the literature was this study's focus on the relationship between mental health and education for children in Mexico. Thus, key informants responded to questions related to how educational outcomes for youth in Mexico were influenced by their mental health. Participants reported that families experiencing economic hardship often did not send their children to school; rather children were expected to help their families by working in the fields or in the streets (Mallot & Martinez, 2006). Key informants also reported that many schools in Mexico have limited resources (e.g. school counselors, psychologists) available for youth with mental health problems. Despite the limited resources, respondents reported that the community and school are still considered large sources of support for mental health services despite economic adversity increasingly affecting how families function.

Finally, an additional contribution to the literature was this study's use of qualitative methods of inquiry to examine the emic and etic components of mental health of children and adolescents in Mexico (Niblo & Jackson, 2004). The use of open-ended questions in semi-structured interviews allowed the researchers to obtain detailed descriptions of service provider's perceptions of mental health of children and adolescents in Mexico. This information allowed the researchers to build on the universal aspects of mental health (etic perspective) by adding the various ways mental health can be expressed within the specific culture of Mexico (emic perspective; Niblo & Jackson, 2004). Thus, the etic definition of mental health will be adapted toward a culture-specific definition (emic) of mental health in Mexico and subsequently lead to the development of culture-specific interventions and programs that promote the mental health of children and adolescents (Nastasi et al., 2004; Nastasi et al., 2007).

Limitations and future research

There were several factors which may limit the researchers' ability to generalize the findings of this study. The first factor was the number (n = 8) of key informants interviewed. Due to the limited literature regarding the mental health of children in Mexico (Paula et al., 2007), this study should be considered a beginning effort (i.e. exploratory) toward investigating this topic. Therefore, ‘rather than attempting to develop a normative perspective’ (Nastasi, 2009, p. 32), the key informants from this exploratory study were interviewed in an effort to inform future research. Key informants from this study not only provided information related to the mental health of youth in the State of Veracruz in Mexico, they also provided feedback regarding the acceptability of and the cultural appropriateness (e.g. language, meaning) of the interview protocol for future research efforts (Nastasi et al., 2004).

The second factor was the limited representativeness of the participants (e.g.gender, occupation), which restricts the researchers' ability to develop a normative perspective of the mental health of youth in Mexico. The current study investigated the perceptions of mental health services providers and did not include perspectives of multiple stakeholders (e.g. youth, parents). Information from sources such as children and their families is needed in order to develop a more culture-specific understanding of the mental health of youth in Mexico (Nastasi, 2008; Nastasi et al., 2004).

A related third factor was that this study was conducted in one city in Mexico (i.e.Xalapa). ‘The primary goal of qualitative inquiry is to capture naturally occurring phenomena from the emic (insider's; research participant's) versus etic (outsider's; researcher's) perspective’ (Nastasi, 2009, p. 31). Future research should be conducted to gather more information from other regions of Mexico in order to continue to develop a culture-specific understanding of mental health of youth in Mexico. This research represents an important first step in this process by gaining an emic understanding of the construct of mental health of children and adolescents in the State of Veracruz.

Footnotes

Note

Lisa Wells, MEd, is a Doctoral Student of School Psychology at Georgia State University in the Department of Counseling and Psychological Services in Atlanta, Georgia. Her primary research interests include families of children experiencing difficulties in schools due to multicultural issues and families of young children at risk for developing emotional/behavioral disorders. Address: Counseling & Psychological Services, PO Box 3980, Georgia State University, Atlanta, GA, 30302-3980, USA. Email: blwells@bellsouth.net

Kris Varjas, PsyD, is an Associate Professor of School Psychology at Georgia State University in the Department of Counseling and Psychological Services and is a research faculty member of the Center for Research on School Safety, School Climate, and Classroom Management both in Atlanta, Georgia. Her research interests include investigation of bullying, cyberbullying, and school climate; mental health prevention and intervention; and research on issues related to lesbian, gay, bi-sexual, and questioning youth. Address: Counseling & Psychological Services, PO Box 3980, Georgia State University, Atlanta, GA, 30302-3980, USA. Email: kvarjas@gsu.edu

Catherine Cadenhead, PhD, is a Clinical Assistant Professor of School Psychology at Georgia State University in the Department of Counseling and Psychological Services in Atlanta, Georgia. Her primary research interests are in the area of typical and atypical development of children and adolescents. Address: Counseling & Psychological Services, PO Box 3980, Georgia State University, Atlanta, GA, 30302-3980, USA.

Catalina Morillas, MEd, is a School Counselor at GIVE Center West in Norcross, Georgia. Her primary research interest is in the area of multicultural issues, particularly in the areas of Latino and LGBTQIQ youth. Address: 2822 Eastwood Drive Decatur, GA 30032, USA.

Ashley Morris, EdS, recently completed her EdS in Professional School Counseling and is currently working as a High School Counselor in Gwinnett County Georgia. Her research interests are in the area of student motivation and engagement. Address: 2979 Randolph Road NE, Atlanta, GA 30345, USA.

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