Mental health problems, violence and other environmental risk factors among disadvantaged Brazilian children and adolescents

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The Psychological Impact of Living Under Violence and Poverty in Brazil
Citações (Scopus)
Bordin I.A.
Curto B.M.
Paula C.S.
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Epidemiological surveys on child/adolescent mental health are scarce in developing countries. In Brazil, prevalence rates based on screening instruments varied according to informant: parents (13.5%-35.2%), adolescents (12.6%-13.1%) and teachers (8.3%- 10.3%). When applying diagnostic interviews, rates of psychiatric disorders varied from 7.0% to 12.7%. Because poverty is closely related to both child psychopathology and child maltreatment, researchers from Universidade Federal de São Paulo had the initiative of conducting the first Brazilian epidemiological study on intrafamilial violence in a disadvantaged community of a violent city. The main objectives of the Brazilian Studies of Abuse in the Family Environment (BrazilSAFE) were (1) to estimate the prevalence of mental health problems among 6- to 17-year-olds and (2) to verify whether severe physical punishment of a child is associated with specific types of mental health problems when taking into account the influence of other potential correlates from different domains. A cross-sectional study was conducted in an urban poor neighborhood of Embu, a city located in the great metropolitan area of São Paulo city. From a probabilistic sample of clusters that included all eligible households (women aged 15-49 years with a son/daughter aged 0-17 years), one mother-child pair was randomly selected per household (n = 813; response rate: 82.4%). Our sample of 480 6- to 17-year-olds included subjects with complete data on the Child Behavior Checklist (CBCL/6-18) and on 12 potential correlates. Trained interviewers applied standardized instruments to mothers at the local health centre. Adolescents were interviewed to report on their mental health. CBCL/6-18 identified children/adolescents with internalizing problems only, externalizing problems only, and both problems (comorbidity). Potential correlates from four domains were examined: child (gender, age, severe physical punishment, ever witnessing marital violence); mother (education, unemployment, anxiety/depression, marital violence); father (absence, unemployment, drunkenness); and family (socioeconomic status). Prevalence of mental health problems overall was 24.6% (20.7%-28.5%) when combining information from parents and adolescents and considering subjects with and without global impairment. When requiring global impairment, prevalence was reduced to 7.3% (5.0%-9.6%). Risk factors for internalizing problems alone included female gender, older age (11-17 years), maternal anxiety/depression and having a mother currently working for pay. Female gender and maternal anxiety/depression were also risk factors for comorbidity. Severe punishment was associated with a more than twofold increase in the risk of comorbidity. When maternal anxiety/depression was absent, children/adolescents exposed to severe punishment were almost eight times more likely to present externalizing problems only than those not exposed, but when maternal anxiety/depression was present, exposed and non-exposed children/adolescents were equally at risk for externalizing problems alone. Among 11- to 17-year-olds, those without a residing father were at greater risk for externalizing problems only than those with a father, but among 6- to 10-year-olds, those with and without a father were equally at risk for externalizing problems alone. The high prevalence rates observed are in accordance with rates reported for other low-income Brazilian populations of similar age. Regarding violence exposure, severe physical punishment was a more relevant risk factor for child/adolescent psychopathology than witnessing marital violence or having a mother victimized by severe marital violence. Our results suggest that severe physical punishment is involved in the development of externalizing problems alone or in combination with internalizing problems, but not relevant for the development of internalizing problems alone. © 2010 by Nova Science Publishers, Inc. All rights reserved.
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