Prevalence of Child and Adolescent Psychiatric Disorders in Southeast Brazil

doi:10.1097/01.chi.0000120021.14101.ca

Journal of the American Academy of Child & Adolescent Psychiatry

Volume 43, Issue 6, June 2004, Pages 727-734

https://doi.org/10.1097/01.chi.0000120021.14101.ca Get rights and content

ABSTRACT

Objective

To describe the prevalence of DSM-IV disorders and the pattern of comorbidity in a population-based sample of 7- to 14-year-old Brazilian schoolchildren.

Method

Random sampling of schools (stratified into private, public rural, and public urban) was followed by random sampling of pupils from school lists. In 2000–2001, a total of 1,251 children were assessed for DSM-IV diagnoses using the Development and Well-Being Assessment, a structured multiinformant assessment supplemented by verbatim reports reviewed by clinicians.

Results

The response rate was 83%. The overall prevalence of DSM-IV disorders was 12.7% (95% confidence interval = 9.8%–15.5%), with 3.5% of children being assigned as not otherwise specified rather than operationalized diagnoses. The overall prevalence of psychiatric disorder was significantly higher than in a British study with the same measures and diagnostic procedures (12.7% versus 9.7%, p = .02).

Conclusions

Approximately one in eight schoolchildren in the study area in the southeast of Brazil have psychiatric disorders involving a level of distress or social impairment likely to warrant treatment. The gulf between need and provision is currently vast.

Section snippets

Setting

The study was carried out in Taubaté, a municipality of approximately 220,000 people living in a medium-sized city and its surrounding rural areas. It is situated in the southeast of Brazil, roughly midway between the giant cities of São Paulo and Rio de Janeiro. Taubaté, like the rest of Brazil, is characterized by marked socioeconomic inequalities, influencing school choice. Almost all affluent families send their children to private schools, whose fees are beyond the reach of the rest of the

Prevalence of Childhood Psychiatric Disorder

At least one DSM-IV diagnosis was present in 149 children, representing a prevalence of 12.7% (95% CI = 9.8%–15.5%) for Taubaté as a whole after adjusting for the oversampling of private and rural schools and weighting back to the general population. Just more than one fourth of all children with diagnoses (3.5% of the total sample) had nonoperationalized or not otherwise specified (NOS) diagnoses (anxiety NOS or disruptive disorder NOS) that failed to meet current DSM-IV operationalized

Overview

In a predominantly urban municipality in the southeast of Brazil, 13% of 7- to 14-year-old schoolchildren had at least one DSM-IV psychiatric disorder. Reported prevalence rates are likely to be conservative because to maximize the usefulness of our findings to service planners, we deliberately employed strict impact criteria to identify a group of children with a great need for services. The most prevalent disorders were oppositional, conduct, and anxiety disorders, followed by ADHD and

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From 1597 records screened and 302 full texts assessed for eligibility, 80 studies (N = 539,557) were included for meta-analysis. Urban residence was significantly associated with a higher prevalence of depression in developed countries (OR = 1.30, 95 % CI [1.17, 1.46], z = 4.75, p < .001), which was primarily driven by urban-rural differences in the general population age demographic (OR = 1.37, 95 % CI [1.22, 1.54], z = 5.38, p < .001).
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DNA methylation in regulatory elements of the FKBP5 and NR3C1 gene in mother-child binomials with depression
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The FKBP5 and NR3C1 genes play an important role in stress response, thus impacting mental health. Stress factor exposure in early life, such as maternal depression, may contribute to epigenetic modifications in stress response genes, increasing the susceptibility to different psychopathologies. The present study aimed to evaluate the DNA methylation profile in maternal-infant depression in regulatory regions of the FKBP5 gene and the alternative promoter of the NR3C1 gene.
We evaluated 60 mother-infant pairs. The levels of DNA methylation were analyzed by the MSRED-qPCR technique.
We observed an increased DNA methylation profile in the NR3C1 gene promoter in children with depression and children exposed to maternal depression (p < 0.05). In addition, we observed a correlation of DNA methylation between mothers and offspring exposed to maternal depression. This correlation shows a possible intergenerational effect of maternal MDD exposure on the offspring. For FKBP5, we found a decrease in DNA methylation at intron 7 in children exposed to maternal MDD during pregnancy and a correlation of DNA methylation between mothers and children exposed to maternal MDD (p < 0.05).
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When compared to offspring of mothers without BD, offspring of mothers with BD showed greater difficulty in maintaining biological rhythms and higher prevalence of EBP. Using the presence of EBP as the outcome, 75 % of the effect of mother's BD diagnosis was mediated by offspring's biological rhythms disruption.
Biological rhythms disruption in children fully mediates the effect of the mother's diagnosis of BD on the child's EBP. These data encourage the development of further studies to find effective strategies to prevent and treat biological rhythms disruption in offspring of mothers with BD.
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The 2004 Pelotas Birth Cohort is an ongoing, population-based, prospective birth cohort, including all hospital births occurring between Jan 1 and Dec 31, 2004, in the city of Pelotas, Brazil. When the children were aged 6 and 11 years, trained psychologists administered the Development and Well-Being Assessment clinical interview to caregivers to assess current child psychiatric disorders (anxiety disorders, mood disorders, ADHD and hyperactivity disorders, and conduct and oppositional disorders), and lifetime trauma exposure (ie, experiencing or witnessing life-threatening events) including interpersonal and non-interpersonal events. Analyses used multiple imputation and logistic regression models.
Of 4263 live births, 4231 children were included in the study sample, and 4229 (2195 [51·9%] boys and 2034 [48·1%] girls; 2581 [61·7%] with White mothers and 1600 [38·3%] with Black or mixed race mothers) were included in the imputed analyses. 1154 (34·3%) of 3367 children with complete data at age 11 years had been exposed to trauma by that age. After adjusting for confounders, at age 6 years, trauma was associated with increased odds of anxiety disorders (adjusted odds ratio 1·79 [95% CI 1·33–2·42]) and any psychiatric disorder (1·59 [1·22–2·06]), and at age 11 years, with any psychiatric disorder (1·45 [1·17–1·79]) and all four specific diagnostic classes of anxiety disorders (1·47 [1·04–2·09]), mood disorders (1·66 [1·08–2·55]), ADHD and hyperactivity disorders (1·47 [1·01–2·13]), and conduct and oppositional disorders (1·76 [1·19–2·61]). Interpersonal trauma and non-interpersonal trauma were each associated with increased odds of multiple psychiatric disorders, even when adjusting for their co-occurrence.
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For the Portuguese translation of the abstract see Supplementary Materials section.
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Studies were identified using databases (PsychoINFO, Pubmed, MEDLINER, EMBASE, Global Health, Academic Search Complete, Google Scholar). The initial search produced 139 articles. These were filtered for language, title, abstract, and full-text keyword identification to yield a final 20 articles to be included in this review.
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View all citing articles on Scopus

: This work was supported by a project grant from the Wellcome Trust.

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ARTICLEPrevalence of Child and Adolescent Psychiatric Disorders in Southeast Brazil

ABSTRACT

Objective

Method

Results

Conclusions

Section snippets

Setting

Prevalence of Childhood Psychiatric Disorder

Overview

J Am Acad Child Adolesc Psychiatry

J Am Acad Child Adolesc Psychiatry

J Am Acad Child Adolesc Psychiatry

J Am Acad Child Adolesc Psychiatry

J Am Acad Child Adolesc Psychiatry

Behavioral problems and competencies reported by parents of normal and disturbed children aged 4 through 16

Monogr Soc Res Child Dev

Estudo de prevalência de desordens mentais na infância em zona urbana de Salvador, Bahia

J Bras Psiquiatria

Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV)

Epidemiology of childhood disorders in a cross-cultural context

J Child Psychol Psychiatry

Estimates of the prevalence of childhood maladjustment in a community survey in Puerto Rico

Arch Gen Psychiatry

Testing of the NIMH Diagnostic Interview Schedule for Children (DISC) in a clinical population

Use and development of the Rutter Parents' and Teachers' Scales

Int J Methods Psychiatr Res

Determinants of reliability in psychiatric survey of children aged 6–12

J Child Psychol Psychiatry

Social factors associated with child mental health problems in Brazil—a cross-sectional survey

BMJ

ARTICLE
Prevalence of Child and Adolescent Psychiatric Disorders in Southeast Brazil