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Exposure to trauma can be life-changing - and researchers are learning more about how traumatic events may physically change our brains. But these changes are not happening because of physical injury, rather our brain appears to rewire itself after these experiences. Understanding the mechanisms involved in these changes and how the brain learns about an environment and predicts threats and safety is a focus of the ZVR Lab at the Del Monte Institute for Neuroscience at the University of Rochester, which is led by assistant professor Benjamin Suarez- Jimenez, Ph.D.

"We are learning more about how people exposed to trauma learn to distinguish between what is safe and what is not. Their brain is giving us insight into what might be going awry in specific mechanisms that are impacted by trauma exposure, especially when emotion is involved," said Suarez-Jimenez, who began this work as a post-doctoral fellow in the lab of Yuval Neria, Ph.D., professor at Columbia University Irving Medical Center.

Their research, recently published in Communications Biology, identified changes in the salience network - a mechanism in the brain used for learning and survival - in people exposed to trauma (with and without psychopathologies, including PTSD, depression, and anxiety). Using fMRI, the researchers recorded activity in the brains of participants as they looked at different-sized circles - only one size was associated with a small shock (or threat). Along with the changes in the salience network, researchers found another difference - this one within the trauma-exposed resilient group. They found the brains of people exposed to trauma without psychopathologies were compensating for changes in their brain processes by engaging the executive control network - one of the dominate networks of the brain.

"Knowing what to look for in the brain when someone is exposed to trauma could significantly advance treatments," said Suarez-Jimenez, a co-first author with Xi Zhu, PhD, Assistant Professor of Clinical Neurobiology at Columbia, of this paper. "In this case, we know where a change is happening in the brain and how some people can work around that change. It is a marker of resilience."

Adding the element of emotion

The possibility of threat can change how someone exposed to trauma reacts - researchers found this is the case in people with post-traumatic stress disorder (PTSD), as described in a recent study in Depression & Anxiety. Suarez-Jimenez, his fellow co-authors, and senior author Neria found patients with PTSD can complete the same task as someone without exposure to trauma when no emotion is involved. However, when emotion invoked by a threat was added to a similar task, those with PTSD had more difficulty distinguishing between the differences.

The team used the same methods as the other experiment - different circle sizes with one size linked to a threat in the form of a shock. Using fMRI, researchers observed people with PTSD had less signaling between the hippocampus - an area of the brain responsible for emotion and memory - and the salience network - a mechanism used for learning and survival. They also detected less signaling between the amygdala (another area linked to emotion) and the default mode network (an area of the brain that activates when someone is not focused on the outside world). These findings reflect a person with PTSD's inability to effectively distinguish differences between the circles.

"This tells us that patients with PTSD have issues discriminating only when there is an emotional component. In this case, aversive; we still need to confirm if this is true for other emotions like sadness, disgust, happiness, etc.," said Suarez-Jimenez. "So, it might be that in the real-world emotions overload their cognitive ability to discriminate between safety, danger, or reward. It overgeneralizes towards danger."

"Taken together, findings from both papers, coming out of a NIMH funded study aiming to uncover neural and behavioral mechanisms of trauma, PTSD and resilience, help to extend our knowledge about the effect of trauma on the brain," said Neria, lead PI on this study. "PTSD is driven by remarkable dysfunction in brain areas vital to fear processing and response. My lab at Columbia and the Dr. Suarez-Jimenez lab at Rochester are committed to advance neurobiological research that will serve the purpose of development new and better treatments that can effectively target aberrant fear circuits."

Suarez-Jimenez will continue exploring the brain mechanisms and the different emotions associated with them by using more real-life situations with the help of virtual reality in his lab. He wants to understand if these mechanisms and changes are specific to a threat and if they expand to context-related processes.

Additional authors include co-first authors John Keefe, Ph.D., of Albert Einstein College of Medicine and Xi Zhu, Ph.D., of Columbia University Irving Medical Center, Amit Lazarov, Ph.D., of Columbia University Irving Medical Center, Ariel Durosky of the University of Tulsa, Oklahoma, Sara Such of the University of Pennsylvania, Caroline Marohasy of the University of Washington, Seattle, and Shmuel Lissek of the University of Minnesota, Minneapolis. The research was supported by the National Institute of Mental Health.

Additional authors on the Communications Biology paper include co-first author Xi Zhu, Ph.D., Amit Lazarov, Ph.D., Scott Small, M.D., of Columbia University Irving Medical Center, Ariel Durosky of the University of Tulsa, Oklahoma, Sara Such of the University of Pennsylvania, Caroline Marohasy of the University of Washington, Seattle, Tor Wager, Ph.D., of Dartmouth College, Martin Lindquist, Ph.D. of Johns Hopkins, and Shmuel Lissek, Ph.D., of the University of Minnesota. The research was supported by the National Institute of Mental Health.

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Researchers reveal how trauma changes the brain

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Researchers have found exposure to traumatic events may physically change the brain, including the mechanism used for learning and survival. These findings could significantly advance future treatments.

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Conceptualizing cultures of violence and cultural change

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Conceptualizing cultures of violence and cultural change

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Beyond direct exposure to violence: effects of living in disordered and violent communities on psychological distress in young Mexican people

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Beyond direct exposure to violence: effects of living in disordered and violent communities on psychological distress in young Mexican people

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The association between community violence and mental health has been studied by reports of individual experiences, particularly in adolescents and youths, but little is known about the effect of living in disordered and violent communities. This ...

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“I Don’t Want to Disappear”: How Mexico’s Criminal Violence Reshapes Women’s Lives

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“I Don’t Want to Disappear”: How Mexico’s Criminal Violence Reshapes Women’s Lives | International Crisis Group

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As crime rises in Mexico, women are in particular danger – of “disappearance”, kidnapping, sexual assault and murder. The state has taken some steps to address this crisis, but it can do much more.

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Article #1 - World Report 2025: Rights Trends in Mexico

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Article #1 - World Report 2025: Rights Trends in Mexico

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World Report 2025: Rights Trends in Mexico

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President Claudia Sheinbaum Pardo, who took office in October, inherited a human rights crisis rooted in extreme violence by organized crime groups and widespread abuse by state agents with near total impunity. Her predecessor, Andrés Manuel López Obrador (2018-2024) made little progress addressing these challenges.

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Stay up to date on the state of human rights in Mexico with the latest research, campaigns and education material from Amnesty International.

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The Permeating Effects of Violence on Health Services and Health in Mexico

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The Permeating Effects of Violence on Health Services and Health in Mexico

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✉Corresponding Author: Laura Vargas, University of Pennsylvania, Philadelphia, PA 19104-4217, USA. lxv2000nursing.upenn.edu

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The Permeating Effects of Violence on Health Services and Health in Mexico

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Mexico’s violence related to organized crime activity has grown to epidemic levels in the last 12 years. We interviewed 22 Mexican health care providers from five states to examine how violence impacts health care services and health. We transcribed…

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Beyond direct exposure to violence: effects of living in disordered and violent communities on psychological distress in young Mexican people

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Beyond direct exposure to violence: effects of living in disordered and violent communities on psychological distress in young Mexican people

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Mental health disorders have become of interest to public health due to their increasing frequency . Mexico holds a high prevalence of mental disorders. The lifetime prevalence of depression in the population aged 12 years and older is 32.5% . At the same time, the rate of community violence has remained high, with crime incidence rates exceeding 35,000 crimes per 100,000 inhabitants/year from 2012 to 2017 . These figures are an underestimation of the problem due to the high percentage of unreported crimes, estimated at around 93% in the last five years . Adolescents and youths are more exposed to community violence than adults ,,. Moreover, they have a high prevalence of mental disorders such as depression, anxiety, substance use, and suicide in comparison to general population .

Community violence is any deliberate act (including threats and use of force) to cause physical harm to a person or persons in a community or neighborhood ,,. It can be experienced directly (victimization) or indirectly (witnesses and hearing about). Other acts imply that informal rules of order are being broken, decreasing the sense of respect and civility ,. These incivilities people experience include physical, such as vandalism, and social ones, such as disruptive disputes, careless neighbors, loitering, and alcohol consumption, which may increase exposure to community violence .

Individuals who have experienced or witnessed community violence are more likely to experience mental health-related problems ,. Also, people who are aware of the acts of community violence in their neighborhood could suffer the effects on their mental health, even without being victims or witnesses ,. In other words, it must be recognized that community violence not only affects people who suffer from it directly, but that it also creates a social environment that affects all the inhabitants of a locality. Interpersonal violence, vandalism, and social disorder create a social environment that is adverse to the security feeling required to conduct daily activities peacefully.

People who are aware of community violence in their neighborhoods and perceive themselves as vulnerable could develop neurotransmitter hyperactivity. This state produces a sustained alert, placing the individual in a hypersensitivity or aggression state accompanied by anxiety, which will favor the development of psychological distress . Psychological distress can encourage social isolation, contributing to the development of mental disorders ,. Consequently, it is possible to assume that the negative effect of community violence in mental health could stem from different mechanisms.

Evidence shows that, as expected, the higher the exposure to community violence, the greater the negative mental health outcomes . However, most studies that evaluated this relation tends to define exposure to community violence as victimization or the witnessing of violent acts in a community. Few studies have considered the effect of specifically living in a violent community on mental health over and above individual victimization experiences but results are inconsistent ,,,,,,,. Contextual variables must be employed to know this effect. Most of these studies used criminal or homicide records or indexes based on these records to confirm this type of variables and assess their relation with mental health ,,,. Overall, three studies found the expected relationship between living in a violent community and negative mental health outcomes ,,. In Scotland, higher exposure to crime was associated with a higher likelihood of reporting mental disorder and the prescription of antipsychotic drugs . Colombian adolescents who lived in places with more homicides showed more mental disorders . Higher crime rates were associated with higher depression symptoms in American adolescents . In a study carried out in the United States population, violent crime was not associated with internalizing symptoms such as depression or anxiety .

Moreover, two other studies in American people (one with adolescents and one with youths ), measured exposure to a violent community by parental reports. The study with youths found that higher exposition to community violence was associated with more depression and anxiety symptoms , whereas the study with adolescents found no relation between community violence and internalizing symptoms . Finally, only one study used a community sample composed of adults from the same places as participants, finding the expected relationship, i.e., exposure to community violence was related to more internalizing symptoms .

Age and sex could modify the relation between living in a violent community and psychological distress. Women are more likely to have negative mental health outcomes than men 26. González S. La salud mental en México. Director General de los Servicios de Salud Mental. http://www.conadic.gob.mx/doctos/salmen.htm (accessed on 01/Mar/2022). ,²⁶
http://www.conadic.gob.mx/doctos/salmen.... , but the latter are more exposed to community violence . Similarly, youths have a higher exposure to community violence than adolescents ,, although they also have better coping mechanisms .

Therefore, the analysis of the relation of living in a disordered and violent community environments over and above individual victimization experiences with psychological distress will give us a comprehensive overview to recognize if effects only stem from being a victim of violence or also from inhabiting community violence environments.

This study aimed to determine the possible relationship between living in a disordered and violent community environment measured at a contextual level and the presence of psychological distress in Mexican adolescents and youths regardless of their experiences of interpersonal community violence. We also sought to evaluate the potential modifying effect of sex and age in this relationship.

Study design

A secondary analysis of the Survey of Social Cohesion for the Prevention of Violence and Crime (ECOPRED, acronym in Spanish) databases was developed. ECOPRED is a cross-sectional survey carried out by the Mexican National Institute of Geography and Statistics (INEGI, acronym in Spanish) that targeted young Mexicans living in large cities. The data were collected from October 6 to December 9, 2014, and included households from 47 cities across the country ,. The selected cities belonged to the Mexican National Program for the Social Prevention of Violence and Crime and were identified as those that required greater short-term attention . At least one city from each state was chosen, and the sample was representative of the level of each city. The selection of the households was made by probabilistic, stratified, single-stage, and conglomerate sampling. For the final selection of households, three-stage sampling was used (select census tracts within cities, select blocks within census tracts, and select houses within blocks) .

In the selected households, two questionnaires were applied. The first questionnaire was answered by the household head regardless of their age. It was considered as a household head the person who was part of the household and was recognized as the head by its members, regardless of sex . To answer the second questionnaire, a family member aged from 12 to 29 years who was not the head of the household was selected. In case of more than one member with these characteristics, only one was randomly chosen. This questionnaire was not applied in households without members with these characteristics. This study found a 13.12% non-response rate, of which 3.49% refer to incomplete interviews, and 9.63%, to households without information despite being inhabited .

For this study, the population of interest included adolescents and youths. The households included in the sample totaled 80,802. Around half of these households had no adolescents or youths. Participants who answered the questionnaire for adolescents and youths were included in the analysis (n = 40,366). Those who did not answer all questions related to psychological distress (n = 181) and those whose parents interfered with the interview (n = 546) were excluded. The analytical sample consisted of 39,639 adolescents and youths.

Outcome

The measurement of psychological distress was based on the responses of participants (adolescents and youth) to an 8-item inventory about psychological distress symptoms during the last year that could be answered with "yes" or "no" ( Table 1). Exploratory factor analysis (EFA) was performed by the principal component factor method . Except for one item ("reassuring yourself by hitting objects," factorial load < 0.4), all were grouped into a single factor (Cronbach's alpha, α = 0.63). The variable was constructed from the sum of the affirmative answers, obtaining a scale from 0 (no affirmative answers) to 7 (all affirmative answers).

Exposure

The secondary sample (according to household heads) was used to measure violent community environments. This community sample managed to adjust contextual variables to assess the exposure. These variables were the only ones that were generated using information from household heads rather than from the participants. In this questionnaire, a scale on 16 acts of incivilities and crimes in the neighborhood was included . It had four response options: never (scored with 0), infrequent, frequent, and very frequent (scored with 3). Data from the household heads who completed the scale was used regardless of whether adolescents or youths lived in the household and regardless of the age of the household head (n = 80,802). The EFA was conducted (principal component factor method with oblique rotation) and three factors emerged ( Table 2). Then, three exposure variables were constructed: (a) social disorder, with eight items (e.g., making noise, drinking alcohol on the streets, α = 0.77); (b) vandalism, with three items (e.g., tagging walls, scratching cars, α = 0.57); and (c) criminality, with four items (e.g., robbing or assaulting and threatening or extorting, α = 0.75).

The contextual variables were constructed at the level of census tracts. In Mexico, the census tracts are called "basic geostatistical area" (AGEB, acronym in Spanish). AGEB includes from 1 to 50 blocks in which the population is socioeconomically homogeneous . The homogeneity of the responses within the AGEB was evaluated via intraclass correlation coefficient (ICC). For social disorder, it totaled 0.28 (95% confidence interval - 95%CI: 0.27, 0.29), for vandalism, 0.16 (95%CI: 0.15, 0.16), and for criminality, 0.30 (95%CI: 0.29, 0.31). The values of household heads' responses for every variable were aggregated to obtain a value for each census tract. Subsequently, for each variable, the median by AGEB was estimated and was assigned to each participant according to the AGEB in which they lived. Social disorder was categorized in quartiles. For vandalism and criminality, three categories were formed according to the assigned values: 0, more than 0 to 1, and more than 1.

Modifying variables

It was considered that sex and age could be modifying variables between living in a disordered and violent community (social disorder, vandalism, and criminality) and psychological distress. When the modifying effect was identified, the main analysis was performed stratifying by sex, age, or both. Otherwise, sex and age were included in the analysis as confounding variables. For sex, it was considered male and female and for age, participants were separated into those who were aged from 12 to 18 years (adolescents) and those from 18 to 29 years (youths).

Interpersonal violence

Interpersonal community violence identifies victims of any type of community violence during the last year. It was constructed with the responses to the question: "During 2014 (from January up to now), did any of the following situations happen to you...?", which included 10 situations: teasing, hiding personal objects, physical aggression, robbery without violence, robbery with violence, threats, extortion, virtual violence, or sexual abuse (touching and sexual encounters). The situations were considered when participants experienced them in public places such as squares, markets, parks, or on the street.

Covariates

Occupation was distributed in four categories (study, work, study and work, and neither study nor work). Depending on whether participants had moved to the neighborhood, four categories were formed: always lived in the area, moved more than 10 years ago, moved from 5 to 10 years ago, or moved less than 5 years ago.

Economic hardships were measured according to answers to the 10-item scale, in which one item had insufficient answers and was excluded ( Table 3). The response options for the other nine items were: true, false, does not apply, and does not know or did not answer. True or false answers were used. In total, seven items were selected because they belong to the same factor in the EFA with oblique rotation (e.g., have enough food, have enough money to buy clothes and shoes). The number of hardships was added and three groups were formed (none, 1 or 2, and 3 to 7 hardships). Household heads' education was classified into four categories: primary or less (including primary and no instruction), junior high school (including technical career with completed junior high school), high school (including normal basic, high school, and high school with completed technical career), and bachelor or more (including master's and PhD degrees). Overall, four geographic regions were defined according to the ubication of the cities (north, west, center, and south).

After the interviews, interviewers indicated the level of intervention from guardians. An ordinal variable was generated with a scale from 0 (in which the adult was absent) to 5 (in which the adult was interested in knowing the questionnaire without interfering with the interviews).

Statistical analysis

Analysis was run on Stata, version 15 ( https://www.stata.com). Considering the survey design, weighted relative frequencies were estimated to know the distribution of each variable. Weighted means of distress symptoms were obtained according to exposures.

To select the variables to adjust the models, means of psychological distress were estimated according to each covariate (data not shown). Comparisons between categories were made using 95%CI. Moreover, weighted relative frequencies of the community violence variables were estimated according to covariates (data not shown). The chi-squared test was used to identify differences between categories. To identify the relationship between exposure to violent community environments and psychological distress symptoms, a first crude model was carried out. A second model was adjusted for sex, age, occupation, economic hardships, region, moving from the neighborhood, and parental intervention. The third model was adjusted for the variables of the second model plus interpersonal community violence. Moreover, 95%CI were estimated for each model.

Multilevel linear regression models were estimated using the identification of census tracts as the random intercept. These models recognize and consider the homogeneity of participants within the AGEB since living in the same AGEB share the exposure to disorder, community violence, and other social characteristics . For psychological distress, an ICC of 0.07 (95%CI: 0.06, 0.08) was obtained, which justifies the use of multilevel models considering the AGEB as a random intercept.

To test whether sex and age were modifying variables, the same models were estimated including the interactions of these variables with the three exposure variables. An interaction was considered significant if p < 0.100. This cutoff for significance level was selected to identify small effects on interactions . Moreover, confidence intervals were estimated to know the certainty of the identified interactions . If the interactions were significant, analyses were carried out that were stratified by sex, age, or both.

Ethical aspects

Although participation in the ECOPRED was compulsory because it was part of the governmental system of information , no penalty in case was applied for not participating. Thus, 100% of the responses were unable to be obtained . Confidentiality was guaranteed to participants. The ethics of the conducted analysis was granted by the Ethics Committee at the Division of Biological and Health Sciences at the Metropolitan Autonomous University Xochimilco (Mexico).

The mean age of participants was 18.7 years (standard deviation - SD: 4.7), of which just over half were adolescents. The proportion of males was slightly higher than that of females (51.1% vs. 48.9%). Around half of participants were studying and reported no economic hardships. Most household heads have secondary education or less. Just over 40% had always lived in the same neighborhood, whereas about a fifth had changed neighborhood 10 or more years ago ( Table 4). The highest proportion came from northern Mexico. Just over 20% had experienced some type of interpersonal violence in the community. More than half of the interviews were conducted without the presence of guardians.

Compared to males, more females studied or neither studied nor worked, had more economic hardships, and experienced less community interpersonal violence. More adolescents were studying, and, compared to them, youths have been victims of interpersonal violence in a higher proportion.

The average of psychological distress symptoms in females and youths exceeded that of males and adolescents, respectively ( Table 5). Psychological distress symptoms tended to be higher in the fourth quartile of social disorder than in the first quartile but were significant only in adolescent females. Among males in the category with higher vandalism showed more psychological distress symptoms. Adolescent females showed the highest mean of distress symptoms if vandalism was higher, whereas, female youths, showed the opposite. In adolescents, psychological distress was higher when more criminal acts occurred. Youths had more psychological distress symptoms when fewer criminal acts occurred. Adolescents and youths of both sexes who experienced interpersonal community violence had greater psychological distress than those who reported no victimization from this type of act.

Interactions with sex occurred for social disorder, vandalism, and criminality, whereas, with age, the interaction occurred only with criminality in females ( Table 6).

Table 7 shows multilevel models. Participants had higher psychological distress in the highest quartiles of social disorder; these differences remained after adjusting for other covariables in both sexes, except in males when adjusting for interpersonal community violence. The men under a higher occurrence of acts of vandalism had higher psychological distress symptoms than their counterparts. This difference remained after adjustment for all variables. Conversely, men who lived in places with more criminality had less psychological distress symptoms than those who lived in places with low criminality, but it emerged only after adjusting for all covariates. Female youths in an area with higher criminality were associated with fewer psychological distress symptoms in both unadjusted and adjusted models.

A representative sample of Mexican adolescents and youths living in different cities of the country showed a relation between exposure to three patterns of disordered and violent community environments and symptoms of psychological distress. These patterns refer to social disorder, vandalism, and criminality, which, although they may be related, should be studied separately since the association of each one with negative mental health outcomes may be different. Based on the existing evidence ,, it was expected that the participants most exposed to disordered and violent communities would also have more psychological distress. Our study found this relationship between social disorder and psychological distress in both sexes and between vandalism and psychological distress in men. Criminality was unrelated to psychological distress or showed an opposite relationship. It was possible to recognize age and sex as modifiers of the relationship between disordered and violent community environments and psychological distress.

The relationship between social disorder and vandalism with psychological distress was independent of interpersonal experiences of community violence (except for social disorder in males). These acts can produce discomfort, increase fear, and generate a threat perception even without being a victim of interpersonal violence, which would favor the development of psychological distress .

Sex modified the relationship between social disorder and vandalism with psychological distress. Although males and females showed that psychological distress was higher in those who lived with higher social disorder, the relationship disappeared in males after adjusting for interpersonal community violence. Regarding vandalism, only men who lived in communities in which these acts occurred more frequently had more psychological distress. Perhaps, these differences could be explained by men's greater exposure to this disorder in community environments because they spend more time on the streets and participate in disordered and vandalistic acts more frequently than women . Thus, men may be used to social disorder, which would only increase psychological distress if accompanied by interpersonal community violence. However, vandalism increases psychological distress regardless of the interpersonal community violence. Women tend to be afraid and perceive insecurity in the streets , which makes them take some precautions and prefer to stay at home or avoid public places . But even with these precautions, social disorder cannot be avoided, which causes discomfort and increases psychological distress.

Contrary to our expectations, criminality was not related to psychological distress. Even youths showed an inverse relationship. These results agree with what was observed in youths in the United States ,,, in which places with greater community violence had fewer effects on mental health. This inverse association has potential explanations. First, at the contextual level, it has been observed that communities that have experienced traumatic events tend to increase their social cohesion. Closer relationships within a community could contribute to overcoming adverse situations . A similar phenomenon could occur in communities with criminal acts , i.e., this type of adversity generates greater social cohesion, which benefits inhabitants by enabling them to carry out their activities without suffering the effects of criminality.

Second, at the individual level, it is likely that the people who stay in this type of environment have undergone adaptation or normalization . In some populations, exposure to violence could generate biological hypo-reactivity, reducing bodily responses to this type of event . Most ECOPRED participants had never changed neighborhoods or had moved 10 years ago or more, which would explain that they could have experienced a process of adaptation and normalized the crimes occurring in their community. Moreover, criminality tends to remain stable in neighborhoods , which favors the adaptation process.

Third, it is possible that people have changed their behavior, enabling them to live with greater tranquility. Echoing the theory of protection motivation , individuals who are known to be vulnerable and are aware of the risk to which they are exposed by living in an environment in which criminal acts occur probably take the necessary measures in such a way that, although they live in an environment with exposure to violence, they can experience it as safe. Finally, they perceive the probability of being victim of this type of act as low. The frequency of criminal acts was lower than the acts of vandalism and social disorder. Therefore, and considering the changes in inhabitants' behavior, the chances of being a victim of criminal acts decrease, reducing psychological distress.

Our study has the following strengths: (1) a representative sample of household heads, which enabled the construction of contextual variables on disordered and violent community environments; (2) the investigation of different dimensions of disordered and violent community environments were investigated enabled us to recognize specific forms of exposure to disordered and violent communities that could affect mental health outcomes in different ways; (3) the analysis stratified by sex and age helped to evaluate the effect of these variables on the associations under examination; and (4) the development of this study represented 47 Mexican cities, which included at least one city in each Federal Entity.

However, some important limitations are linked to the secondary analysis of the data: (1) the inventory of psychological distress used still requires validation. Most symptoms in this inventory were associated with anxiety, and only one was related to depression. However, although an unvalidated scale, its items resemble those of other scales used to measure psychological distress (e.g., Kessler 6) ; (2) because of its cross-sectional design, we were unable to establish any causal relationships. Although psychological distress would hardly explain the indices of community violence, people who suffered from a violent environment may have moved elsewhere; and (3) notably, it is not possible to distinguish whether some participants were the perpetrators of the studied acts of community violence with the available information.

In summary, Mexican urban youths showed a relationship between living in disordered and violent community environments with psychological distress over and above individual victimization experiences. Females from environments in which acts of social disorder occur and males from communities with higher levels of vandalism had higher psychological distress. Criminality was unrelated or had an inverse relationship with psychological distress, particularly in women.

These findings are important since they provide the necessary evidence to address the disorder and violence experienced in communities. It is necessary to generate strategies that reduce social disorder and vandalism within communities, which will favor a decrease in psychological distress in adolescents and youths. Moreover, these results allow us to propose future research to further develop our knowledge of the relationship between living in a disordered and violent community environment and its effects on mental health. It would be important to use previously validated instruments to assess psychological distress and other problems related to mental health to evaluate consistency with our results. Moreover, it would be necessary to compare what happens between young people who participate as perpetrators of acts of community violence and those who avoid participating in these acts. Finally, it is important to consider the social factors that could influence this relationship; it is necessary to evaluate the role of variables such as social capital or social cohesion as possible moderators of the identified relationships.

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Beyond direct exposure to violence: effects of living in disordered and violent communities on psychological distress in young Mexican people

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Mental health disorders have become of interest to public health due to their increasing frequency . Mexico holds a high prevalence of mental disorders. The lifetime prevalence of depression in the population aged 12 years and older is 32.5% .