Declared a UNESCO World Heritage Site, the city of Guanajuato, with its 194,500 inhabitants (INEGI, 2020), is one of the most beautiful in Mexico. Its labyrinthine and cobblestone streets, squares, colorful facades, unique topography, staircases, and lively atmosphere transport local, national, and international visitors to a different world (https://www.mexicodesconocido.com.mx/ciudad-de-guanajuato.html). This city is nestled in the state of the same name, which has become the center of the automotive industry in Mexico, producing 10.2% of the national production of auto parts. However, the dynamics of modern life have created favorable conditions for chronic stress, triggering states of anxiety and depression in its population.

Between 2021 and 2022, in the state of Guanajuato, 63,014 psychological care sessions were provided to minors (31%), with those related to depression increasing from 8,390 to 9,826 and those for anxiety rising from 8,514 to 11,022 (Guanajuato Health System, 2022). During the COVID-19 pandemic, over 281,900 mental health care sessions were conducted in the state of Guanajuato. Of these, 29% were for anxiety and 20% for depression, with 60% belonging to women and 40% to men, mostly in the 18 to 29 age group. In 2022, 65,888 patients were attended, providing a total of 297,530 consultations, with a mental health workforce of 9.76 psychologists per 100,000 inhabitants (Guanajuato Health Secretariat, 2022). Guanajuato has thus ranked sixth nationally for anxiety and depression issues (ENBIARE, 2021).

The multi-causal analysis of the increase in anxiety and depression in Guanajuato is complex. However, it can be attributed to its system of social inequality and poverty, leading to a life condition filled with uncertainty. Lack and confusion of values have triggered an existential crisis and hopelessness in people, along with traumatic life experiences that contribute to stress due to fears and distrust. Everyday factors contributing to the manifestation of these conditions include sedentary lifestyles and excessive use of technology. Only 3 out of 10 Guanajuatenses over the age of 10 engage in any form of physical activity. In 2021, 70% of the Guanajuato population did not exercise, and teenagers aged 10 to 14 were most affected, with 71% reducing their activity due to confinement (ENSANUT, 2021).

Technology is used as a resource for entertainment and control, across all age groups, without regulation in its use. Globally, 27% of adults consider themselves addicted to technology; 50% of teenagers consider themselves addicted; and 48% of those spending more than five hours with their phones have reported feelings of depression, isolation, or suicide (Common Sense Media, 2018).

The increase in mental disorders of anxiety and depression brings about a society characterized by individuals with low self-esteem, sadness, anger, distrust, dissatisfaction, apathy, degenerative organic diseases, lower academic performance, reduced work proactivity, overexertion, and suicide (466 cases in 2022 - https://periodicocorreo.com.mx/suicidios-en-guanajuato-durante-2022-suman-466-casos/), among other consequences. Public perception is further stigmatized towards individuals with these disorders due to misinformation and discrimination.

Due to the structural causes and prevailing conditions causing anxiety and depression in Guanajuato, comprehensive attention is needed. This should consider economic, social, and environmental aspects with focused intervention from different stakeholders, specialists, and mental health units involved. Therefore, the Ayni Guanajuato team promotes the coordination of efforts to combat the prevailing situation related to anxiety and depression in the state, addressing its causes and consequences. Locally, it is an opportunity to fight for the containment of the silent pandemic of depression and anxiety in the city.

1. Development of the intersectoral articulation process: In horizontal working groups with representatives from different sectors, in an atmosphere of psychological trust, a contrast of knowledge takes place to establish a common perspective and the specific contribution from each specialty for the comprehensive care of the overall issue of anxiety and depression.
2. Design and implementation of the situational diagnosis: Identification and diagnosis of the current situation regarding anxiety and depression conditions in the city of Guanajuato. Definition of the methodology, the instrument or instruments to be applied, the representative sample, the collection of information, its systematization, and the generation of conclusions and recommendations for the type and stages of the intervention, beneficiary registry, etc.
3. Educational training for mental hygiene and health: Design and execution of a psychosocioeducational training model for mental health and the prevention of anxiety and depression. Conducting participatory workshops based on the personal experiences of each participant, gradually reflecting on the individual sense of life, family, school, and community environment, as well as human and social development, as a general framework for practicing a mentally healthy life for each participant. It is aimed at individuals and families, as well as students and representatives of rural communities and urban neighborhoods.
4. Dissemination of information on anxiety and depression disorders: Raising awareness among the general population about the presence of anxiety and depression disorders, classified as a silent pandemic. Designing and producing dissemination materials for a permanent campaign through local mass media, addressing knowledge, awareness, and consciousness regarding the incidence of mental disorders, their prevention, and mental hygiene. This includes cultural and informational events.
5. Primary care for diagnosed individuals: Reinforcement in the application of specialized professional care protocols for individuals with symptoms or diagnosed with mental disorders of anxiety and depression, through official and private mental health services.

Direct results 

1. Development of the intersectoral articulation process.

1.1. A functional intersectoral articulation model, involving human, economic, and material resources.

1.2. An articulated and operational Change Network.

1.3. Four sectors of society (social, governmental, academic, and business) with their representatives interacting in the articulation process. It is intended that each working group has representation with at least 3 attendees from each sector.

1.4. A common work agenda with communication mechanisms, objectives, and goals agreed upon among the sectors involved in coordinated working groups.

1.5. At least 80% of the instances that impact the treatment of anxiety and depression across different sectors are coordinated.

2. Design and implementation of the situational diagnosis.

2.1. A common situational diagnosis on anxiety and depression in Guanajuato, Gto. This will be the basis for establishing the strategy for the psychosocioeducational process, media involvement, prevention, and primary care.

2.2. A package of recommendations for the type and stages of the intervention.

2.3. A registry of beneficiaries, including those who have been attended to and those potentially to be attended to, diagnosed with some mental disorder of anxiety and depression. This registry will facilitate addressing their needs and providing the necessary follow-up.

3. Educational training for mental hygiene and health.

3.1. Two models of human development for the prevention and treatment of anxiety and depression.

3.2. At least 300 participants in community-level training processes.

3.3. At least 50 school groups, with 30 members in each group, from the 432 schools of all educational levels currently existing in the municipality of Guanajuato (https://app.seg.guanajuato.gob.mx/ceo/), participating in training processes.

4. Dissemination of information on anxiety and depression disorders.

4.1. A permanent informative, promotional, and preventive campaign.

4.2. At least 3 socio-cultural informative events. These events aim to inform attendees about the silent pandemic of anxiety and depression and its relationship with daily life, along with complementary activities such as regional dance groups, popular concerts, photo exhibitions, film screenings, theater, etc.

5. Primary care for diagnosed individuals.

5.1. Standardized diagnoses.

5.2. Identification and outreach to affected populations.

5.3. Preventive mental health care.

5.4. Referral and care for at least 70,000 individuals diagnosed with anxiety and depression disorders.

Expected impact

Reduce the population suffering from anxiety in Guanajuato by 15% in two years.

Reduce the population suffering from depression in Guanajuato by 10% in two years.

Ensure that at least 10% of the informed population incorporates knowledge and values that enhance their psychological well-being and mental health within one year.

Improve the mental health of at least 50% of individuals attended to in the public health system within two years.

• Department of Health of the State of Guanajuato (SSG)
  
• Department of Education of Guanajuato (SEG)
• State System for the Integral Development of the Family (DIF Estatal)
• University of Guanajuato (UG)
• Contact with Empathy SC
• College of Psychologists of Guanajuato AC
• Business Coordinating Council of the City of Guanajuato (CCEG)

• Javier Manzano Macedo, General Coordinator Esfera Espacio de Encuentro (javier@esferagto.com)
• Patricia Elián Sánchez Stevenson, Director, Municipal System for the Integral Development of the Family (DIF)(p.sanchez@difguanajuatocapital.com)