Community violence and internalizing mental health symptoms in adolescents: A systematic review.

PURPOSES: Mental disorders are responsible for 16% of the global burden of disease in adolescents. This review focuses on one contextual factor called community violence that can contribute to the development of mental disorders OBJECTIVE: To evaluate the impact of community violence on internalizing mental health symptoms in adolescents, to investigate whether different proximity to community violence (witness or victim) is associated with different risks and to identify whether gender, age, and race moderate this association. METHODS: systematic review of observational studies. The population includes adolescents (10-24 years), exposition involves individuals exposed to community violence and outcomes consist of internalizing mental health symptoms. Selection, extraction and quality assessment were performed independently by two researchers. RESULTS: A total of 2987 works were identified; after selection and extraction, 42 works remained. Higher exposure to community violence was positively associated with internalizing mental health symptoms. Being a witnessing is less harmful for mental health than being a victim. Age and race did not appear in the results as modifiers, but male gender and family support appear to be protective factors in some studies. CONCLUSION: This review confirms the positive relationship between community violence and internalizing mental health symptoms in adolescents and provides relevant information that can direct public efforts to build policies in the prevention of both problems.

The role of family meal frequency in common mental disorders in children and adolescents over eight months of follow-up.

OBJECTIVE: This study evaluated the influence of family meal frequency on the occurrence of common mental disorders (CMD) in children and adolescents over eight months of follow-up. DESIGN: Data from this longitudinal study were derived from the PAAPAS-Parents, Students, Community Health Agents, and Teachers for Healthy Eating-community trial. CMD were evaluated using the General Health Questionnaire. Frequency of family meals (breakfast and dinner) was categorized as "breakfast and dinner regularly with the family", "at least breakfast or dinner regularly with the family", and "does not have any meal regularly with the family." The effect of family meal frequency on CMD was analyzed using generalized estimation equations with log-binomial models for repeated measures. SETTING: This study was conducted in public schools (N = 18) of Duque de Caxias, Rio de Janeiro, Brazil, in 2016. PARTICIPANTS: Children (aged 9-11 years) and adolescents (aged 12-17 years) from the fifth and sixth grades (N = 2,743). RESULTS: These findings suggested that regular family meals were a protective factor for mental health. The adjusted relative risk of CMD was 0.75 (95% confidence interval = 0.69-0.83) for those who had two family meals regularly and 0.87 (95% confidence interval = 0.77-0.97) for those who had only one regular family meal, compared to students who had no regular family meals. CONCLUSIONS: Potential strategies that educate and encourage families about the mental health benefits of eating regular meals together must be explored and implemented.

INDICATORS OF ADIPOSITY ASSOCIATED WITH LOW BODY ESTEEM IN ADOLESCENTS.

OBJECTIVE: To investigate the association between weight status and anthropometric indicators of adiposity with body esteem. METHODS: Cross-sectional study including 305 adolescents from a public school in Rio de Janeiro, Brazil. Data were collected by a self-administered questionnaire and anthropometric measurements. The Body-Esteem Scale for Adolescents and Adults was used to evaluate total body esteem and the "appearance", "weight", and "attribution" domains. Body mass index (weight/stature2) was applied to assess weight status and waist circumference, the central body adiposity. The association between indicators of adiposity and body esteem was assessed using Student's t-test or Mann-Whitney's test and linear regression models, stratified by sex and age group. RESULTS: Overweight/obesity was observed in 46% of younger adolescents (10 to 13 year-old girls, 10 to 14 year-old boys), 38% of older boys (15 to 18 year old), and 16% of older girls (14 to 18 year old). For both boys and girls in the younger age group, body mass index and waist circumference (as continuous variables) were inversely associated with total body esteem and weight domain. Overweight/obesity was associated with the appearance body esteem domain only among younger male adolescents; no association was found between either the body mass index or waist circumference and the attribution domain. CONCLUSIONS: Indicators of adiposity were associated with low body esteem. These findings underscore the fact that considering adolescents' feelings concerning their body and appearance is important to promote a healthy control of weight.

Gender differences in the impact of sleep duration on common mental disorders in school students.

BACKGROUND: Common mental disorders (CMD) in children and adolescents can be initial and non-specific manifestations of more serious mental diseases and often persist into adulthood. Therefore, early detection is important, as is the identification of the factors that impact development. Insufficient sleep represents one of the most common and potentially remediable risks to mental health in children and adolescents for whom chronic sleep loss has become normal. This study aims to investigate the influence of sleep duration on CMD in schoolchildren and adolescents. METHODS: The data for this longitudinal study were derived from the community trial Parents, Students, Community Health Agents and Teachers for Healthy Eating (PAAPAS) in 2016 (N = 2743), with fifth and sixth graders from 18 public schools of Duque de Caxias, Rio de Janeiro, Brazil. CMD were assessed by the General Health Questionnaire (GHQ-12) at baseline and at a 9-month follow-up. Sleep duration was evaluated at baseline and was categorized as short, adequate or long according to age group. The effect of sleep duration on common mental disorders was analysed by sex using linear mixed-effects models. RESULTS: At baseline, the frequency of CMD was 33.2% and was higher in boys than in girls and higher among students with short sleep duration. There was an increase in the CMD score over time among girls with short sleep duration (p < 0.01). Among boys, a similar trajectory of the CMD score was observed in the subgroups with short and long sleep duration, but there was a significant reduction in the subgroup with long sleep duration (p = 0.05). CONCLUSION: Changes in common mental disorder patterns differ according to sex, and short sleep duration seems to be problematic for students' mental health. The promotion of health strategies that involve the family and school environment, such as later school hours, could help change this scenario.

Indicators of adiposity associated with low body esteem in adolescents / Indicadores de adiposidade associados com baixa estima corporal em adolescentes

ABSTRACT Objective: To investigate the association between weight status and anthropometric indicators of adiposity with body esteem. Methods: Cross-sectional study including 305 adolescents from a public school in Rio de Janeiro, Brazil. Data were collected by a self-administered questionnaire and anthropometric measurements. The Body-Esteem Scale for Adolescents and Adults was used to evaluate total body esteem and the "appearance", "weight", and "attribution" domains. Body mass index (weight/stature2) was applied to assess weight status and waist circumference, the central body adiposity. The association between indicators of adiposity and body esteem was assessed using Student's t-test or Mann-Whitney's test and linear regression models, stratified by sex and age group. Results: Overweight/obesity was observed in 46% of younger adolescents (10 to 13 year-old girls, 10 to 14 year-old boys), 38% of older boys (15 to 18 year old), and 16% of older girls (14 to 18 year old). For both boys and girls in the younger age group, body mass index and waist circumference (as continuous variables) were inversely associated with total body esteem and weight domain. Overweight/obesity was associated with the appearance body esteem domain only among younger male adolescents; no association was found between either the body mass index or waist circumference and the attribution domain. Conclusions: Indicators of adiposity were associated with low body esteem. These findings underscore the fact that considering adolescents' feelings concerning their body and appearance is important to promote a healthy control of weight.

RESUMO Objetivo: Investigar a associação entre a condição de peso e os indicadores antropométricos de adiposidade com a estima corporal. Métodos: Estudo transversal com 305 adolescentes de uma escola pública do Rio de Janeiro, Brasil. Os dados foram coletados utilizando um questionário autoaplicado e por meio de medidas antropométricas. A Escala de Estima Corporal para Adolescentes e Adultos foi utilizada para avaliar a estima corporal total e os domínios "aparência", "peso" e "atribuição". O índice de massa corporal (peso/estatura2) foi utilizado para avaliar a condição do peso e circunferência da cintura, a adiposidade central. A associação entre indicadores de adiposidade e estima corporal foi avaliada por meio dos testes t de Student ou Mann-Whitney e por modelos de regressão linear, estratificados por sexo e faixa etária. Resultados: Sobrepeso/obesidade foi observado em 46% dos adolescentes mais jovens (meninas de 10 a 13 anos, meninos de 10 a 14 anos), em 38% dos meninos de 15 a 18 anos e em 16% das meninas de 14 a 18 anos. Na faixa etária mais jovem, o índice de massa corporal e a circunferência da cintura (como variáveis contínuas) foram inversamente associados à estima corporal total e ao domínio peso, tanto em meninos quanto em meninas. O sobrepeso/obesidade associou-se ao domínio corporal 'aparência' apenas entre os meninos mais jovens. Nenhuma associação foi encontrada entre índice de massa corporal e a circunferência da cintura e o domínio atribuição. Conclusões: Os indicadores de adiposidade foram associados à baixa estima corporal. Esses achados ressaltam a importância de se levar em consideração a percepção dos adolescentes em relação ao seu corpo e aparência na promoção do controle de peso saudável.

Is living near green areas beneficial to mental health? Results of the Pró-Saúde Study.

OBJECTIVE: To investigate the association between exposure to green areas in the surroundings of the residence and the presence of common mental disorders among adults, according to different income strata. METHODS: Cross-sectional study with 2,584 participants from the Pró-Saúde Study (2006), residing in the city of Rio de Janeiro. Common Mental Disorders were measured using the General Health Questionnaire (GHQ-12) and exposure to green areas was measured using the normalized difference vegetation index, in buffers with radiuses between 100 and 1,500 meters around the residence. We used the mean and maximum normalized difference vegetation index categorized into quartiles. The study population was divided into three subgroups, according to the income: low, intermediate, and high. Odds ratios and their 95% confidence intervals were estimated with logistic regression models. The models were adjusted by sex and age, with and without inclusion of physical activity practice. RESULTS: The proportion of common mental disorders was 30% and 39% among men and women, respectively. The results of the adjusted models showed an inverse association between the presence of green areas in the surroundings of the residence and the occurrence of common mental disorders, in the buffer of 200 meters in the intermediate-income group and in the buffers of 400 and 1,500 meters in the low-income group. The odds ratio ranged from 0.52 (buffer of 1,500 meters) to 0.68 (buffer of 200 meters). The association found was independent of physical activity practice. CONCLUSIONS: The evidence found suggests the existence of a beneficial effect of urban green areas on the mental health of lower-income individuals. These findings can help in understanding how the urban environment can affect the mental health of the population.

Is living near green areas beneficial to mental health? results of the pró-saúde study / Morar perto de áreas verdes é benéfico para a saúde mental? resultados do estudo pró-saúde

ABSTRACT OBJECTIVE To investigate the association between exposure to green areas in the surroundings of the residence and the presence of common mental disorders among adults, according to different income strata. METHODS Cross-sectional study with 2,584 participants from the Pró-Saúde Study (2006), residing in the city of Rio de Janeiro. Common Mental Disorders were measured using the General Health Questionnaire (GHQ-12) and exposure to green areas was measured using the normalized difference vegetation index, in buffers with radiuses between 100 and 1,500 meters around the residence. We used the mean and maximum normalized difference vegetation index categorized into quartiles. The study population was divided into three subgroups, according to the income: low, intermediate, and high. Odds ratios and their 95% confidence intervals were estimated with logistic regression models. The models were adjusted by sex and age, with and without inclusion of physical activity practice. RESULTS The proportion of common mental disorders was 30% and 39% among men and women, respectively. The results of the adjusted models showed an inverse association between the presence of green areas in the surroundings of the residence and the occurrence of common mental disorders, in the buffer of 200 meters in the intermediate-income group and in the buffers of 400 and 1,500 meters in the low-income group. The odds ratio ranged from 0.52 (buffer of 1,500 meters) to 0.68 (buffer of 200 meters). The association found was independent of physical activity practice. CONCLUSIONS The evidence found suggests the existence of a beneficial effect of urban green areas on the mental health of lower-income individuals. These findings can help in understanding how the urban environment can affect the mental health of the population.

RESUMO OBJETIVO Investigar a associação entre a exposição às áreas verdes no entorno da residência e a presença de transtornos mentais comuns entre adultos, segundo diferentes estratos de renda. MÉTODOS Estudo seccional com 2.584 participantes do Estudo Pró-Saúde (2006), residentes na cidade do Rio de Janeiro. Os transtornos mentais comuns foram aferidos por meio do General Health Questionnaire (GHQ-12) e a exposição às áreas verdes pelo índice de vegetação por diferença normalizada, em buffers com raios entre 100 e 1.500 metros em torno da residência. Foram utilizados o índice de vegetação por diferença normalizada médio e máximo categorizado em quartis. A população do estudo foi dividida em três subgrupos, de acordo com a renda: baixa, intermediária e alta. Foram estimadas razões de chances e seus intervalos de 95% de confiança com modelos de regressão logística. Os modelos foram ajustados por sexo e idade, com e sem inclusão da prática de atividade física. RESULTADOS A proporção de transtornos mentais comuns foi de 30% e 39% entre homens e mulheres, respectivamente. Os resultados dos modelos ajustados mostraram associação inversa entre a presença de áreas verdes no entorno do domicílio e a ocorrência de transtornos mentais comuns, no buffer de 200 metros no grupo de renda intermediária e nos buffers de 400 e 1.500 metros no grupo de baixa renda. A razão de chances variou de 0,52 (buffer de 1.500 metros) a 0,68 (buffer de 200 metros). A associação encontrada foi independente da prática de atividade física. CONCLUSÕES As evidências encontradas sugerem a existência de um efeito benéfico de áreas verdes urbanas na saúde mental dos indivíduos de renda mais baixa. Tais achados podem ajudar na compreensão de como o meio ambiente urbano pode afetar a saúde mental da população.

Prevalência de depressão e fatores associados em mulheres atendidas pela Estratégia de Saúde da Família / Prevalence of depression and associated factors in women covered by Family Health Strategy

RESUMO Objetivo Avaliar a prevalência de depressão e os fatores associados em mulheres de 20 a 59 anos de áreas cobertas pela Estratégia de Saúde da Família de município da Zona da Mata Mineira. Métodos Trata-se de um estudo transversal, com mulheres de 20 a 59 anos cadastradas em duas Unidades de Saúde da Família, que utilizou um questionário contendo variáveis sociodemográficas, apoio social, autoavaliação de estado de saúde, estilo de vida, morbidade e saúde da mulher. O desfecho depressão foi avaliado segundo o Patients Health Questionnaire-9 (PHQ-9). Resultados Das 1.958 mulheres incluídas nesta análise, 28,5% encontram-se na faixa etária entre 30 e 39 anos; 15,4% não concluíram o ensino elementar; 54,5% não trabalham ou nunca trabalharam; 44,2% declararam não ser da raça branca. Fatores associados à ocorrência de depressão na população estudada: possuir baixa escolaridade, trabalhar atualmente e ter doença mental prévia. Como fatores de proteção observaram-se: ser casada ou viver com companheiro, realizar atividades físicas regularmente e relatar autoavaliação positiva de saúde. Conclusão Os resultados deste estudo revelam prevalência de depressão de 19,7% nas mulheres de 20 a 59 anos de áreas cobertas pela Estratégia de Saúde da Família, apontando para a necessidade de um cuidado especial na atenção primária à saúde às mulheres com baixa escolaridade, que trabalham, apresentam doença mental e não praticam exercícios físicos, de modo que se possa reduzir o sofrimento e promover a saúde. Ressalta-se a lacuna na utilização de instrumentos de rastreamento dos casos de depressão na atenção primária.

ABSTRACT Objective To assess the prevalence of depression and its associated factors in women aged 20 to 59 years at some areas with the coverage of Family Health Strategy in a city located at Zona da Mata Mineira. Methods It is a cross-sectional study with women aged 20-59 enrolled in two Primary Health Care Units making use of a questionnaire containing socio-demographic variables, social support, self-assessment of general health status, lifestyle, morbidity and women's health. Depression was evaluated according to Patients Health Questionnaire-9 (PHQ-9). Results From 1,958 women included in this analysis, 28,5% are aged 30-39; 15,4% did not finish High School; 54,5% do not work or have never worked and 44,2% defined themselves as not white. Factors associated with depression episodes in the population studied: lower educational background, currently having a job, previous diagnosis of psychiatric disorders. Protective factors which were observed: being married or living with a partner, practicing physical activities in a regular basis and reporting positive self-assessed health. Conclusion The results of this study reveal a prevalence of depression of 19.7% in women aged 20 to 59 years covered by the Family Health Strategy, pointing to the need for special care in primary health care for women with low schooling, who work, have mental illness, and do not exercise so that they can reduce suffering and promote health. It was observed a significant gap related to managing specific tools designed to screening depressive episodes in primary care.

Inequities in access to depression treatment: results of the Brazilian National Health Survey - PNS.

BACKGROUND: Despite depression being one of the most prevalent mental disorders in the world, access to treatment is still insufficient, especially in low- and middle-income countries. The aim of this study is to investigate differences in access to treatment for depression according to socio-demographic characteristics, geographical area and multi-morbidity in a nationally representative sample of individuals with depression. METHODS: This study analyses data from the National Health Survey (Pesquisa Nacional de Saúde - PNS), a Brazilian household-based nationwide survey, which comprises 60,202 adults (aged 18 years or older). Depression was evaluated through the Patient Health Questionnaire-9 (PHQ-9). Prevalence Ratios and corresponding 95 % confidence intervals (95%CI) were calculated using Poisson regression. RESULTS: The general prevalence of depression was 7.9 % (95 % CI 7.5 to 8.3). Among those with depression, 78.8 % did not receive any treatment, and 14.1 % received only pharmacotherapy. Multivariable analyses showed that being female, white, aged between 30 and 69 years, living in regions other than the North, having higher education and having multi-morbidities were independently associated with higher likelihood of access to any treatment. CONCLUSIONS: Most Brazilians with clinically relevant depressive symptoms are not receiving any treatment. Access to care is unequal, with the poor and those living in low resource areas having higher difficulties to access mental health care. Understanding these disparities is important for the provision of effective interventions aimed at reducing the prevalence of depression and inequities in access to mental health care.

The role of intimate partner violence and other health-related social factors on postpartum common mental disorders: a survey-based structural equation modeling analysis.

BACKGROUND: Although studies suggest the relevance of intimate partner violence (IPV) and other health-related social characteristics as risk factors for postpartum mental health, literature lacks evidence about how these are effectively connected. This study thus aims to explore how socio-economic position, maternal age, household and marital arrangements, general stressors, alcohol misuse and illicit drug abuse, and especially psychological and physical IPV relate in a framework leading to postpartum common mental disorder (CMD). METHODS: The study was carried out in five primary health care units of Rio de Janeiro, Brazil, and included 810 randomly selected mothers of children up to five postpartum months waiting for pediatric visits. The postulated pathways between exposures and outcome were based on literature evidence and were further examined using structural equation models. RESULTS: Direct pathways to postpartum CMD arose from a latent variable depicting socio-economic position, a general stressors score, and both IPV variables. Notably, the effect of psychological IPV on postpartum CMD ran partly through physical IPV. The effect of teenage pregnancy, conjugal instability and maternal burden apparently happens solely through substance use, be it alcohol misuse, illicit drug abuse or both in tandem. Moreover, the effect of the latter on CMD seems to be entirely mediated through both types of IPV. CONCLUSION: Although the theoretical model underlying the analysis still requires in-depth detailing, results of this study may have shed some light on the role of both psychological and physical IPV as part of an intricate network of events leading to postpartum CMD. Health initiatives may want to make use of this knowledge when designing preventive and intervention approaches.