Mental health from childhood to adolescence predicts excessive weight and body composition at 18 years.

OBJECTIVE: To investigate the association of mental health in childhood and adolescence with four outcomes at 18 years: ultra-processed food (UPF) consumption, body mass index (BMI), excessive weight (EW), and body composition, including fat mass (FM) and fat free mass (FFM) in kg, FM index (FMI) and FFM index (FFMI) in kg/m2. METHODS: Cohort study in which The Development and Well-Being Assessment (DAWBA) (6 and 11 years) and the MINI International Neuropsychiatric Interview (MINI) (18 years) provided information on internalizing (INT), externalizing (EXT) and any mental disorder (ANY). The exposure was classified in: "never", "at 6 and/or 11 years", "at 18 years only" and "at 6, 11, and 18 years". Linear and logistic regression were run. All analyses were stratified by sex. RESULTS: A total of 2722 participants were analyzed. At 18 years, female with EXT disorders at 6 and/or 11 years presented higher BMI (ß: 1.70; 0.18-3.23), FM (ß: 4.74; 1.42-8.06), and FMI (ß: 1.53; 0.28-2.79) than those who never had. The odds of EW at 18 years was also higher in females with EXT disorders at 6 and/or 11 years (OR: 3.39; 1.56-7.36) and at the three time points (OR: 7.08; 1.69-29.59). Males with EXT disorders at 6 and/or 11 years presented higher FM (ß: 4.45; 1.85-7.06) and FMI (ß: 1.47; 0.63-2.31). CONCLUSIONS: Among children and adolescents showing symptoms of EXT disorders, weight should be monitored carefully, thus ultimately contributing to reduce the burden of EW in adolescence.

Towards a better understanding of real-world home-visiting programs: a large-scale effectiveness study of parenting mechanisms in Brazil.

BACKGROUND: The scale-up of parenting programmes to support early childhood development (ECD) is poorly understood. Little is known about how and when early interventions are most effective. Sustainability of ECD programming requires a better understanding of the mechanisms of real-world interventions. We examined the effects on caregiving practices of Primeira Infância Melhor (PIM), a state-wide home-visiting programme in Brazil. METHODS: This propensity score matched, longitudinal, quasiexperimental study uses data from the 2015 Pelotas Birth Cohort. We matched children who received PIM at any age with other cohort children on 25 key covariates. Sensitivity, guidance and responsiveness were assessed using video-recorded play tasks. Coerciveness and the parent-child relationship were assessed using the Parenting and Family Adjustment Scales. All parenting outcomes were examined at age 4 years. Separate moderation analyses were conducted for each effect modifier: family income, child age and duration of participation. RESULTS: Out of 4275 children in the cohort, 797 were enrolled in PIM up to age 4 years. 3018 children (70.6%) were included in the analytic sample, of whom 587 received PIM and 2431 were potential controls. We found a positive effect of PIM on responsiveness (ß=0.08, 95% CIs 0.002 to 0.16) and sensitivity (ß=0.10, 95% CIs 0.02 to 0.19). No effect was found for any secondary outcomes. Moderation analyses revealed a stronger positive effect on sensitivity for low-income parents (ß=0.18, 95% CIs 0.03 to 0.34). CONCLUSION: A state-wide, home-visiting programme in Brazil improved aspects of responsive caregiving. Effects were more pronounced for low-income families, suggesting benefits of purposeful targeting.

Early risk factors for conduct problem trajectories from childhood to adolescence: the 2004 Pelotas (BRAZIL) Birth Cohort.

Conduct problems are associated with an increased risk of a wide range of physical, mental, and social problems. However, there is still uncertainty about how early risk factors differentiate different developmental patterns of conduct problems and whether findings replicate across diverse social contexts. We aimed to identify developmental trajectories of conduct problems, and test early risk factors, in the 2004 Pelotas Birth Cohort in Brazil. Conduct problems were measured at ages 4, 6, 11, and 15 years from caregiver reports on the Child Behaviour Checklist (CBCL) and Strengths and Difficulties Questionnaire (SDQ). Conduct problem trajectories were estimated using group-based semi-parametric modeling (n = 3938). Multinomial logistic regression was used to examine associations between early risk factors and conduct problem trajectories. We identified four trajectories: three with elevated conduct problems, including early-onset persistent (n = 150; 3.8%), adolescence-onset (n = 286; 17.3%), and childhood-limited (n = 697; 17.7%), and one with low conduct problems (n = 2805; 71.2%). The three elevated conduct problem trajectories were associated with a wide range of sociodemographic risk factors, prenatal smoking, maternal mental health, harsh parenting, childhood trauma, and child neurodevelopmental risk factors. Early-onset persistent conduct problems were particularly associated with trauma, living without a father figure, and attention difficulties. The four trajectories of conduct problems from ages 4 to 15 years in this Brazilian cohort have similar longitudinal patterns to those identified in high-income countries. The results confirm previous longitudinal research and developmental taxonomic theories on the etiology of conduct problems in a Brazilian sample.

Maternal depression and child development at 3 years of age: a longitudinal study in a Brazilian child development promotion program.

BACKGROUND: We tested the hypothesis that children of non-depressed mothers perform better in a developmental test at 3 years than children of depressed mothers. METHOD: Longitudinal analysis from a trial to assess the impact of a child development promotion program in 30 Brazilian municipalities. Mothers and children were appraised at first-year post-partum, 1 and 3 years after enrollment. Child development was assessed through the Ages and Stages Questionnaire (ASQ3) and maternal depression through the Edinburgh Postnatal Depression Scale (EPDS). Crude and adjusted beta coefficients were obtained by linear regression before and after multiple imputation. RESULTS: In total, 2098 mother/child dyads were included and 8.2% of the mothers had persistent depressive symptoms. There was a decrease in ASQ3 as the number of follow-ups with EPDS ≥ 10 increased (p for trend <0.001). In adjusted analysis, the direction of the association persisted but lost statistical significance. After multiple imputation, children from mothers with EPDS ≥ 10 in three follow-ups presented a decrease of about 14 points in ASQ3 (adjusted beta coefficient = -13.79; -22.59 to -5.00) (p for trend = 0.001). CONCLUSIONS: Identification of women at increased risk of depression should be among the primary health care sector priorities in maternal and child health in Brazil. IMPACT: In our population study, almost one in every ten women presented persistent depression symptoms across the first 3 years postpartum. In adjusted analysis there was a detrimental impact of persistent maternal depression on child development at 3 years of age. The persistent exposure to maternal depression across early childhood negatively influences children's development. Considering its prevalence, identification of women at increased risk of depression should be among the primary health care sector priorities in maternal and child health in Brazil.

Pathways from maternal depression to child resilience: Socioeconomic, family, and individual factors in the 2004 Pelotas (Brazil) birth cohort.

Background: The negative impacts of maternal depression on child mental health outcomes are well-documented. However, some children show adaptive functioning following exposure to maternal depression, demonstrating resilience. In a large birth cohort from Brazil, a middle-income country, we examined direct and indirect pathways, considering socioeconomic, family, and individual factors, contributing to the development of resilience. Methods: Using data from the 2004 Pelotas Birth Cohort (N = 4231), we restricted the sample to those exposed to maternal depression up to age 6 years (depression present at ≥2 out of 5 assessment waves; n = 1132; 50% boys). Resilience was defined as scoring below or equal to the mean of the unexposed group on all four problem subscales of the parent-report Strengths and Difficulties Questionnaire at age 11 years. We examined pathways from socioeconomic status (SES; measured at birth) to resilience via cognitive stimulation (CS) (at 24 and 48 months) and Intelligence quotient (IQ) (at 6 years), and from CS to resilience via IQ, using counterfactual mediation. Results: A minority of children exposed to maternal depression showed resilience (12.4%). There was evidence of indirect pathways from SES to resilience via CS (odds ratio (OR) = 1.76, 95% confidence interval (CI) 1.02-3.38) and IQ (OR = 1.19, 95% CI 1.01-1.42), such that higher SES was associated with resilience via both higher levels of CS and higher IQ, which, in turn, were each positively associated with resilience. Furthermore, there was evidence of a direct (OR = 1.86, 95% CI 1.01-3.76) and total effect (OR = 1.94, 95% CI 1.05-3.89) of CS on resilience, even after controlling for SES. However, these effects varied depending on how persistent and severe depression was defined. Conclusions: These findings suggest that CS in early childhood may represent a modifiable protective factor for children exposed to maternal depression and a promising intervention target to promote child resilience in the context of maternal depression exposure.

Risk factors for executive function impairment in adolescence: an analysis of data from the 2004 Pelotas Birth Cohort study

Objective: To investigate risk factors associated with impaired attention-related executive functions (EFs) at age 11 and working memory at age 15. Methods: Data from participants of the population-based 2004 Pelotas Birth Cohort at ages 11 (n=3,582) and 15 (n=1,950) were analyzed. The study measured attentional control, cognitive flexibility, and selective attention using the Test of Everyday Attention for Children (TEA-Ch). Spatial working memory was assessed by the Cambridge Neuropsychological Test Automated Battery (CANTAB). Logistic regression was employed to explore the relationship between perinatal and childhood exposures and EF impairment. Results: Low maternal education had a significant negative impact on EFs. At age 11, it was associated with decreased attentional control (OR = 3.04; 95%CI 2.09-4.43), and at age 15, it was linked to impaired spatial working memory (OR = 2.21; 95%CI 1.58-3.09). Additional risk factors included low household income, black or brown maternal skin color, high parity, prematurity, low birth weight, and multiple siblings. Breastfeeding, regardless of duration, was found to be a protective factor against impaired cognitive flexibility (OR = 0.38; 95%CI 0.22-0.65). Conclusion: This study underscores the lasting impact of perinatal exposures on EF development. Policies that mitigate the negative effects of risk factors and promote EF development, especially among vulnerable populations, are needed.

Risk factors for executive function impairment in adolescence: an analysis of data from the 2004 Pelotas Birth Cohort study.

OBJECTIVE: To investigate risk factors associated with impaired attention-related executive functions (EFs) at age 11 and working memory at age 15. METHODS: Data from participants of the population-based 2004 Pelotas Birth Cohort at ages 11 (n=3,582) and 15 (n=1,950) were analyzed. The study measured attentional control, cognitive flexibility, and selective attention using the Test of Everyday Attention for Children (TEA-Ch). Spatial working memory was assessed by the Cambridge Neuropsychological Test Automated Battery (CANTAB). Logistic regression was employed to explore the relationship between perinatal and childhood exposures and EF impairment. RESULTS: Low maternal education had a significant negative impact on EFs. At age 11, it was associated with decreased attentional control (OR = 3.04; 95%CI 2.09-4.43), and at age 15, it was linked to impaired spatial working memory (OR = 2.21; 95%CI 1.58-3.09). Additional risk factors included low household income, black or brown maternal skin color, high parity, prematurity, low birth weight, and multiple siblings. Breastfeeding, regardless of duration, was found to be a protective factor against impaired cognitive flexibility (OR = 0.38; 95%CI 0.22-0.65). CONCLUSION: This study underscores the lasting impact of perinatal exposures on EF development. Policies that mitigate the negative effects of risk factors and promote EF development, especially among vulnerable populations, are needed.

Changes in the diagnosis of depression among nursing professionals during the COVID-19 pandemic: A longitudinal study.

AIMS: To identify changes in mental health status among nursing professionals in a Brazilian municipality during the COVID-19 pandemic. DESIGN: An observational and longitudinal study. METHODS: Using the Patient Health Questionnaire-9, the presence of depressive symptoms was evaluated among 690 nursing professionals in the city of Pelotas, Brazil, at two moments: June/July 2020 and June/July 2021. RESULTS: 13.0% incidence of depressive symptoms was identified; as well as 12.2% remission; 24.1% persistence and 50.7% absence. Among the factors associated with the worst prognoses we can mention female gender, greater workload, feeling of overload, illness of family members or friends due to COVID-19 and use of psychotropic drugs CONCLUSIONS: There was significant mobility in the diagnosis of depression among the professionals studied during the period analysed, with incidence of new cases of significant depression and greater than the number of remissions. In addition to sociodemographic aspects, traumatic experiences and exposure to continuous overload were associated with persistence and incidence of new cases. IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE: With the advent of the COVID-19 pandemic, several studies have shown an increase in depressive symptoms among nursing professionals; however, understanding the long-term effects of this scenario is still a challenge. IMPACT: What problem did the study address? This study investigates changes in the mental health status of nursing professionals working at different care levels, taking the prevalence of screening for depression as a proxy, during a period of a year during the COVID-19 pandemic. What were the main findings? Between both data collection moments, 2020 e 2021, there was a significant percentage of professionals with persistent depression, in addition to a significant proportion of incident cases that slightly exceeded the number of remissions and the factors associated with the worst prognoses were sociodemographic aspects such as gender and emotional stressors like illness of family members or close friends due to COVID-19, in addition to those related to the organisation and support provided by the services, such as workload and feeling of overload. Where and on whom will the research have an impact? This study will impact the nursing professionals and in role of the health services in order to establishing actions that contribute to minimising the deleterious effects of the pandemic on the mental health of their Nursing teams. REPORTING METHOD: The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines were adopted in this study. PATIENT OR PUBLIC CONTRIBUTION: No Patient or Public Contribution.

Intimate partner violence victimisation and its association with maternal parenting (the 2015 Pelotas [Brazil] Birth Cohort): a prospective cohort study.

BACKGROUND: Intimate partner violence (IPV) is highly prevalent in low-income and middle-income countries and has been a major obstacle towards reaching global health targets for women and children. We aimed to investigate cross-sectional and longitudinal associations between IPV victimisation and maternal parenting practices of young children in a population-based birth cohort study in Brazil. METHODS: The 2015 Pelotas Birth Cohort is an ongoing, prospective cohort, including all hospital births occurring between Jan 1 and Dec 31, 2015, in the city of Pelotas, Brazil. When children were aged 4 years, mothers reported on emotional, physical, and sexual IPV victimisation in the past 12 months. Parenting outcomes were assessed through filming the mother and child in interactive tasks at age 4 years and maternal interviews at ages 4 years and 6-7 years. Interactive tasks were filmed at the Centre for Epidemiological Research facilities. Directly observed outcomes included negative (eg, coercive) and positive (eg, sensitivity and reciprocity) parenting interactions independently coded by a team of psychologists. Self-reported parenting was measured using the subscales on quality of parent-child relationship, positive encouragement, parental consistency, and coercive behaviour of the Parenting and Family Adjustment Scales questionnaire. Unadjusted and adjusted linear regression analyses were performed to assess the associations. FINDINGS: Of the 4275 livebirths enrolled in the cohort, 3730 mother-child dyads were included in our analytical sample at age 4 years and 3292 at age 6-7 years. After adjusting for all potential confounders, emotional IPV and physical or sexual IPV were associated with the following self-reported parenting outcomes: poor parent-child relationship quality (emotional IPV: p=0·011), lower parental consistency (emotional IPV: p<0·001, physical or sexual IPV: p=0·0053), and more coercive behaviour (emotional IPV: p<0·001, physical or sexual IPV: p=0·0071) at age 4 years. Associations were not observed for self-reported positive encouragement and filmed parenting outcomes in fully adjusted models. Longitudinally, IPV at age 4 years predicted similar outcomes when children were aged 6-7 years. INTERPRETATION: In this large cohort study, maternal IPV victimisation was consistently associated with poorer parent-child relationship, decreased parental consistency, and increased harsh parenting reported by mothers of young children. As well as initiatives to prevent IPV, parenting interventions focused on supporting the capacity of caregivers to provide nurturing care delivered at key stages early in the life course are crucial. FUNDING: Wellcome Trust. TRANSLATION: For the Portuguese translation of the abstract see Supplementary Materials section.

Depression and anxiety among the University community during the Covid-19 pandemic: a study in Southern Brazil.

This study aimed to assess the mental health of a University community in South Brazil during the COVID-19 pandemic. A cross-sectional web-based survey was conducted between July-August 2020 through a self-administered questionnaire. All University staff and students were eligible. Depression was measured using the Patient Health Questionnaire-9 and anxiety by the Generalized Anxiety Disorder-7. To evaluate the effect of social distancing and mental health factors on outcomes, Poisson regression models with robust variance were performed, estimating Prevalence Ratios (PR) and 95% Confidence Intervals (95%CI). 2,785 individuals participated in the study. Prevalence of depression and anxiety were 39.2% (95%CI 37.3-41.1) and 52.5% (95% CI 50.6-54.4), respectively. Undergraduate students showed a higher prevalence of the outcomes. Not leaving the house routinely, mental health care, and previous diagnosis of mental illness were associated with both outcomes. Those with a previous medical diagnosis of depression had a 58% (PR 1.58; 95%CI 1.44; 1.74) and anxiety a 72% (PR 1.72; 95%CI 1.56; 1.91) greater prevalence of depression than their peers. An alarming prevalence of psychopathologies was observed. Despite the well-known benefits of social distancing to public health, it requires a surveillance on the population's mental health, especially students and those with previous mental illness diagnosis.

Prevalence of adolescent risk behaviors at 11 and 15 years of age: data from the 2004 Pelotas birth cohort

Objectives: The objective of this study was to investigate the prevalence of the following risk behaviors: experimentation with cigarettes, electronic cigarettes, alcohol, substances, delinquent behavior, and sex at age 15, stratified by sex and socioeconomic position. We also investigated the prevalence of cigarette and alcohol experimentation at age 11 and the persistence and cumulative incidence of these behaviors between 11 and 15 years of age. Methods: In this cohort study, we included 3,491 11-year-olds and 1,949 15-year-olds from the 2004 Pelotas Birth Cohort. All outcomes were identified via confidential questionnaires and were analyzed as binary variables. Results: At age 11, there was a higher prevalence of cigarette experimentation among boys. At age 15, there was a higher prevalence of experimentation with alcohol, cigarettes, and substances among girls; experimentation with cigarettes and sex were more prevalent among those in a low socioeconomic position. We found a high cumulative incidence of alcohol experimentation, as well as persistent alcohol experimentation, in both boys and girls. Conclusions: Further research should clarify causal paths of the high prevalence of risk behaviors during adolescence and its increase among girls.

Course of depression during the first 2 years postpartum among Brazilian women enrolled in a conditional cash transfer program.

BACKGROUND: Women living in low- and middle-income countries are more exposed to known risk factors for depression occurrence and persistency over time. AIM: Our aim was to investigate the course of depression in the first 2 years postpartum among Brazilian women enrolled in a cash transfer program. METHOD: Longitudinal analysis of baseline (T0; mean 3.7 months postpartum) and first follow-up data (T1; mean 18.6 months postpartum) from a trial to assess the impact of a child development promotion program in 30 municipalities from six Brazilian states. The program does not include any interventions against maternal depression. The Edinburgh Postnatal Depression Scale (EPDS) at cutoff ⩾10 was applied. Women were categorized into four groups based on EPDS at T0 and T1: absence of depression, persistence, discontinuity, or emergence pattern. Adjusted Poisson regressions were run using a multilevel hierarchical model. RESULTS: Two thousand eight hundred sixty-three women were assessed. Prevalence of depression was 26.4% [24.8, 28.1] at T0 and 24.4% [22.8, 26.0] at T1. Persistence, discontinuation, and emergence were found in 14.1% [11.3, 17.6%], 12.8% [11.4, 14.3%], and 10.2% [8.0, 13.0], respectively. In adjusted analyses, the persistence pattern was directly associated with parity and inversely associated with schooling of the woman and of the child's father. Living with husband/partner and support from the child's father and family members during pregnancy were protective against persistence. The discontinuity and the emergence patterns were not associated with any of the exposure variables. CONCLUSIONS: Depressive symptoms were highly prevalent during the first 2 years postpartum. About half of the women with depression at T1 were persistent cases that could have been detected earlier. Screening for maternal depression should be an essential component in every encounter of women with health professionals in primary health care settings.

Prevalence of adolescent risk behaviors at 11 and 15 years of age: data from the 2004 Pelotas birth cohort.

OBJECTIVES: The objective of this study was to investigate the prevalence of the following risk behaviors: experimentation with cigarettes, electronic cigarettes, alcohol, substances, delinquent behavior, and sex at age 15, stratified by sex and socioeconomic position. We also investigated the prevalence of cigarette and alcohol experimentation at age 11 and the persistence and cumulative incidence of these behaviors between 11 and 15 years of age. METHODS: In this cohort study, we included 3,491 11-year-olds and 1,949 15-year-olds from the 2004 Pelotas Birth Cohort. All outcomes were identified via confidential questionnaires and were analyzed as binary variables. RESULTS: At age 11, there was a higher prevalence of cigarette experimentation among boys. At age 15, there was a higher prevalence of experimentation with alcohol, cigarettes, and substances among girls; experimentation with cigarettes and sex were more prevalent among those in a low socioeconomic position. We found a high cumulative incidence of alcohol experimentation, as well as persistent alcohol experimentation, in both boys and girls. CONCLUSION: Further research should clarify causal paths of the high prevalence of risk behaviors during adolescence and its increase among girls.

Maternal depression trajectories in childhood, subsequent maltreatment, and adolescent emotion regulation and self-esteem: the 2004 Pelotas birth cohort.

This study aimed to examine the impact of maternal depressive symptoms trajectories on 15-year-old adolescents' self-esteem and emotion regulation and test the mediating role of child maltreatment in this association. The 2004 Pelotas Birth Cohort is an ongoing cohort study originally comprised of 4231 live births in a southern Brazilian city. We examined a subsample of 1949 adolescents at age 15 years. Maternal depressive symptoms were assessed using the Edinburgh Postnatal Depression Scale. Trajectories of maternal depression from 3 months until the 11-year follow-up were calculated using a group-based modeling approach. Child maltreatment at age 11 years was measured using the parent-report version of the Parent-Child Conflict Tactics Scale. Adolescent outcomes at age 15 years were assessed by the self-report version of the Rosenberg Self-esteem Scale and the Emotion Regulation Index for Children and Adolescents. Path model analysis was conducted using a structural equation modeling framework in Mplus software. All maternal depression trajectories were negatively associated with offspring self-esteem and emotion regulation compared to the reference group (low depression trajectory). There was a significant indirect effect of maternal depression trajectories on emotion regulation mediated via child maltreatment. No evidence of moderation by sex was found for any pathway. The effects of maternal depression on adolescents' emotion regulation are partly mediated by child maltreatment at age 11.

Prevalence of self-reported lifetime medical diagnosis of depression in Brazil: analysis of data from the 2019 Brazilian National Health Survey.

OBJECTIVES: To assess the prevalence of and factors associated with the lifetime medical diagnosis of depression in Brazil. DESIGN: Population-based, cross-sectional study. SETTING: Analysis of data from the 2019 Brazilian National Health Survey. PARTICIPANTS: 90 846 individuals aged ≥15 years were included. OUTCOME MEASURE: The self-reported medical diagnosis of depression at some point in one's life was the main outcome. Prevalence ratios (PRs) with 95% CIs were calculated by Poisson regression with robust variance. The independent variables included the geographical area of residence, sociodemographic characteristics, current smoking status, alcohol abuse, daily screen time, and the presence of physical disorders and mental health comorbidities. RESULTS: The self-reported lifetime prevalence of medical diagnosis of depression was 9.9% (95% CI 9.5% to 10.2%). The probability of having received a medical diagnosis of depression was higher among urban residents (PR 1.23; 95% CI 1.12 to 1.35); females (2.75; 2.52 to 2.99); those aged 20-29 years (1.17; 0.91 to 1.51), 30-39 years (1.73; 1.36 to 2.19), 40-49 years (2.30; 1.81 to 2.91), 50-59 years (2.32; 1.84 to 2.93) and 60-69 years (2.27; 1.78 to 2.90) compared with those under 20 years; white-skinned people (0.69 (0.61 to 0.78) for black-skinned people and 0.74 (0.69 to 0.80) for indigenous, yellow and brown-skinned people compared with white-skinned people); those with fewer years of education (1.33(1.12 to 1.58) among those with 9-11 years, 1.14 (0.96 to 1.34) among those with 1-8 years and 1.29 (1.11 to 1.50) among those with 0 years compared with those with ≥12 years of education); those who were separated/divorced (1.43; 1.29 to 1.59), widowed (1.06; 0.95 to 1.19) and single (1.01; 0.93 to 1.10) compared with married people; smokers (1.26; 1.14 to 1.38); heavy screen users (1.31; 1.16 to 1.48) compared with those whose usage was <6 hours/day; those with a medical diagnosis of a physical disorder (1.80; 1.67 to 1.97); and individuals with a medical diagnosis of a mental health comorbidity (5.05; 4.68 to 5.46). CONCLUSION: This nationwide population-based study of self-reported lifetime medical diagnosis of depression in Brazil showed that the prevalence was almost 10%. Considering the current Brazilian population, this prevalence corresponds to more than 2 million people who have been diagnosed with depression at some point in their lives.

Avaliação do Programa Criança Feliz: um estudo randomizado em 30 municípios brasileiros / Evaluation of the Happy Child Program: a randomized study in 30 Brazilian municipalities

Resumo O Programa Criança Feliz (PCF) atinge 1,4 milhão de crianças brasileiras menores de três anos com visitas domiciliares visando o desenvolvimento neuropsicomotor. Com base em modelo conceitual, avaliou-se implementação e impacto do PCF em estudo randomizado, em 30 municípios. Ao todo 3.242 crianças foram alocadas para o grupo intervenção (GI) ou controle (GC), sendo 80,0% acompanhadas prospectivamente durante três anos. O desenvolvimento foi avaliado pelo Ages and Stages Questionnaire (ASQ3). Análises por intenção de tratar mostraram escores médios de 203,3 no GI e 201,3 no GC. Análises adicionais com variáveis instrumentais e emparelhamento por escores de propensão tampouco mostraram efeito, uma vez que o número de contatos recebidos não esteve associado aos escores ASQ3. Tampouco foi observado impacto sobre estimulação, interações responsivas ou atributos psicológicos das crianças. As visitas foram interrompidas durante 12 meses devido à COVID-19, sendo substituídas por contatos virtuais. O estudo de implementação revelou baixa cobertura no GI, contaminação do GC, deficiências na gestão e baixa qualidade das visitas em muitos municípios. O estudo não demonstrou impacto do PCF implementado sob condições de rotina e fornece elementos para seu aprimoramento.

Abstract The Happy Child Program (Programa Criança Feliz - PCF, in Portuguese) reaches 1.4 million Brazilian children under three years of age with home visits aimed at promoting neuropsychomotor development. Based on a conceptual model, PCF implementation and impact were evaluated in a randomized study in 30 municipalities. A total of 3,242 children were allocated to the intervention (IG) or control (CG) group, 80.0% of whom were prospectively followed up from late 2018 to late 2021. Development was assessed by the Ages and Stages Questionnaire (ASQ3). During the three-year study period, visits were replaced by virtual contacts for an average of 12 months due to COVID-19. At the endline survey, intent-to-treat analyses showed mean scores of 203.3 in the IG and 201.3 in the CG. Additional analyses using instrumental variables and propensity scores matching also showed no effect, since the number of contacts with the program was not associated with ASQ3 scores. No impact was observed on stimulation, responsive interactions or psychological attributes of children. The implementation study revealed low coverage in the IG, contamination of the CG, deficiencies in management and low quality of visits in many municipalities. The study did not demonstrate an impact of PCF implemented under routine conditions, but provides elements for its improvement.

Associations between childhood trauma and childhood psychiatric disorders in Brazil: a population-based, prospective birth cohort study.

BACKGROUND: Childhood trauma is a proposed transdiagnostic risk factor for psychopathology, but epidemiological evidence from low-income and middle-income countries (LMICs) is scarce. We investigated associations between trauma and child psychiatric disorders in a birth cohort in Brazil. METHODS: 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. OUTCOMES: 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. INTERPRETATION: A considerable mental health burden associated with childhood trauma is already evident by middle childhood in this sample from Brazil. Evidence-based efforts to reduce the incidence of childhood trauma in Brazil and address its consequences are urgently needed. FUNDING: Children's Pastorate, WHO, National Support Program for Centres of Excellence, Brazilian National Research Council, Brazilian Ministry of Health, São Paulo Research Foundation, University of Bath, Wellcome Trust. TRANSLATION: For the Portuguese translation of the abstract see Supplementary Materials section.

Evaluation of the Happy Child Program: a randomized study in 30 Brazilian municipalities. / Avaliação do Programa Criança Feliz: um estudo randomizado em 30 municípios brasileiros.

The Happy Child Program (Programa Criança Feliz - PCF, in Portuguese) reaches 1.4 million Brazilian children under three years of age with home visits aimed at promoting neuropsychomotor development. Based on a conceptual model, PCF implementation and impact were evaluated in a randomized study in 30 municipalities. A total of 3,242 children were allocated to the intervention (IG) or control (CG) group, 80.0% of whom were prospectively followed up from late 2018 to late 2021. Development was assessed by the Ages and Stages Questionnaire (ASQ3). During the three-year study period, visits were replaced by virtual contacts for an average of 12 months due to COVID-19. At the endline survey, intent-to-treat analyses showed mean scores of 203.3 in the IG and 201.3 in the CG. Additional analyses using instrumental variables and propensity scores matching also showed no effect, since the number of contacts with the program was not associated with ASQ3 scores. No impact was observed on stimulation, responsive interactions or psychological attributes of children. The implementation study revealed low coverage in the IG, contamination of the CG, deficiencies in management and low quality of visits in many municipalities. The study did not demonstrate an impact of PCF implemented under routine conditions, but provides elements for its improvement.

O Programa Criança Feliz (PCF) atinge 1,4 milhão de crianças brasileiras menores de três anos com visitas domiciliares visando o desenvolvimento neuropsicomotor. Com base em modelo conceitual, avaliou-se implementação e impacto do PCF em estudo randomizado, em 30 municípios. Ao todo 3.242 crianças foram alocadas para o grupo intervenção (GI) ou controle (GC), sendo 80,0% acompanhadas prospectivamente durante três anos. O desenvolvimento foi avaliado pelo Ages and Stages Questionnaire (ASQ3). Análises por intenção de tratar mostraram escores médios de 203,3 no GI e 201,3 no GC. Análises adicionais com variáveis instrumentais e emparelhamento por escores de propensão tampouco mostraram efeito, uma vez que o número de contatos recebidos não esteve associado aos escores ASQ3. Tampouco foi observado impacto sobre estimulação, interações responsivas ou atributos psicológicos das crianças. As visitas foram interrompidas durante 12 meses devido à COVID-19, sendo substituídas por contatos virtuais. O estudo de implementação revelou baixa cobertura no GI, contaminação do GC, deficiências na gestão e baixa qualidade das visitas em muitos municípios. O estudo não demonstrou impacto do PCF implementado sob condições de rotina e fornece elementos para seu aprimoramento.

Associação entre temperamento e o uso de práticas da medicina alternativa e complementar / Association between temperament and the use of complementary and alternative medicine practices / Asociación entre temperamento y uso de prácticas de medicina alternativa y complementaria

Trata-se de um estudo brasileiro, transversal, mediado pela Internet com o objetivo de descrever como diferenças temperamentais associam-se ao uso de oito práticas de medicina alternativa e complementar (MAC): ioga, meditação, reiki, acupuntura, massagem, tai chi chuan, homeopatia e floral. A amostra foi composta por 22.415 indivíduos, sendo 69,5% mulheres, com idade média de 28,8 anos (DP = 9,1). As práticas mais utilizadas foram massagem e ioga e as variáveis sexo, idade, renda e diagnóstico psicopatológico ao longo da vida associaram-se a todas as práticas, exceto com tai chi chuan. Análise inferencial se baseou em modelo de regressão logística e os resultados foram calculados com base na razão de chances com intervalo de confiança de 95%. Observou-se que manifestações adaptativas de traços e de tipos psicológicos, associaram-se a maiores chances de praticar MAC. Resultados sugerem que perfis com maior regulação emocional tendem a utilizar mais frequentemente MAC e, possivelmente, obter benefícios. (AU)

The present study is a cross-sectional web-based survey conducted in Brazil aiming to describe how individual differences in temperament traits and types could predict the use of the following eight categories of complementary and alternative medicine (CAM): yoga, meditation, reiki, acupuncture, massage, tai chi chuan, homeopathy, and flower remedies. The sample consisted of 22,415 individuals, 69.5% of whom were women, with a mean age of 28.8 years (SD= 9.1). The most commonly used practices were massage and yoga and the variables sex, age, income, and psychopathological diagnosis throughout life were associated with all practices, except tai chi chuan. The inferential analysis relied on logistic regressions and results were calculated based on the odd ratios with 95% confidence intervals. Adaptive manifestations of psychological traits and types were associated with greater use of complementary and alternative medicine practices. Results suggested that profiles with greater emotional regulation tend to use CAM more frequently and possibly obtain benefits. (AU)

Se trata de un estudio brasileño, transversal, mediado por Internet, con el objetivo de describir cómo las diferencias temperamentales se asocian con el uso de ocho prácticas de medicina alternativa y complementaria (MAC): yoga, meditación, reiki, acupuntura, masaje, tai chi chuan, homeopatía y floral. La muestra estuvo compuesta por 22.415 individuos, de los cuales 69,5 % eran mujeres, con una edad media de 28,8 años (DS= 9,1). Las prácticas más utilizadas fueron el masaje y el yoga, y las variables sexo, edad, renta y diagnóstico psicopatológico a lo largo de la vida se asociaron a todas las prácticas, excepto al tai chi chuan. El análisis inferencial se basó en un modelo de regresión logística y los resultados se calcularon con base en la odds ratio con un intervalo de confianza del 95 %. Se observó que las manifestaciones adaptativas de rasgos y tipos psicológicos se asociaron con mayores posibilidades de practicar MAC. Los resultados sugieren que los perfiles con mayor regulación emocional tienden a usar MAC con mayor frecuencia y, posiblemente, obtienen beneficios. (AU)