Severe food insecurity and mental health among women living in extreme poverty in Ceara, Brazil

Introdução: a insegurança alimentar tem efeitos importantes e agravantes na saúde humana, especialmente na saúde mental das mães e crianças.Objetivo: avaliar as inter-relações do Transtorno mental comum (TMC) e Insegurança Alimentar, em famílias assistidas por programa adicional de transferência de renda no Ceará.Método: estudo transversal foi realizado no Ceará, caracterizado como um dos estados mais pobres do país, em uma amostra de 484 famílias, com crianças menores de seis anos, beneficiárias do Cartão Mais Infância Ceará (CMIC), em 24 municípios. Foram analisados o perfil social e econômico das famílias, moradia, dados sobre a saúde e educação, violência, saúde mental, insegurança alimentar, trabalho e renda. Utilizou-se modelos de Regressão de Poisson, ajustados para o efeito amostral.Resultados: das 484 famílias, 86% encontravam-se em situação de IA;36% apresentavam IA Grave. A presença do TMC materno aumentou em 73% o risco de IA Grave na família (p<0,001). A análise de regressão, mostrou que o TMC se manteve como o fator de risco associado à IA Grave, com mães com TMC mostrando um risco ajustado 64% mais elevado, em comparação às outras mães (p=0,002). Não dispor de água tratada no domicílio, apresentou uma medida ajustada de 55% maior risco de IA Grave (p=0,011).Conclusão: as mães assistidas possuem elevada prevalência de TMC e com perfil de alta vulnerabilidade, sendo necessário suporte social e nutricional, acompanhamento da saúde mental dessas mulheres, para melhor cuidar dos filhos.Palavras-chave: segurança alimentar, criança, saúde mental, nutrição, avaliação de programas.

Backgroung: the prevalence of moderate or severe food insecurity (FI) in the world will reach 2.4 billion people in 2020. Common Mental Disorders (CMDs) affect one in five people, reaching all social classes.Objective: to examine the associations between CMDs and FI in the most vulnerable population, mothers of young children.Methods: population-based cross-sectional observational study, interviewing 484 families with children under six years of age, beneficiaries of the cash transfer program Cartão Mais Infância Ceará (CMIC), in 24 municipalities of Ceara. Poisson regression models were used, adjusted for the sampling effect.Results: 86% of the families were in a situation of FI, with 36% expressing a severe FI, a condition compatible with hunger. In relation to CMDs, it was observed that the prevalence of severe FI increased significantly, affecting 53% of mothers with CMDs against 31% of those without the disorder (p<0.001). Regression analysis showed that CMDs remained the risk factor most associated with severe FI, with mothers with CMDs having a 64% higher adjusted risk compared to other mothers (p=0.002). In the final model, the condition of not having treated water at home was associated with a 55% higher adjusted risk of severe FI (p=0.011), and two factors were close to statistical significance, namely: not feeling safe at home (possibility of domestic violence) and growing edible plants at home, with adjusted measures of 48% risk and 13% protection, respectively.Conclusion: 13% of this population live with very high rates of severe FI, compatible with hunger, concomitant with CMDs. As aggravating factors of severe FI and CMDs, public social support programs are necessary to have a real positive impact on the quality of life of this population.

Frequency of maternal stress and psychic risk in newborns who have been hospitalized in a neonatal intensive care unit / Frequência de estresse materno e de risco psíquico em recém-nascidos que foram hospitalizados em unidade de terapia intensiva neonatal

Abstract Objectives: describe the frequency of maternal stress and psychic risk indicators in newborns who were exposed to the neonatal intensive care unit (NICU) after hospital discharge. Methods: observational, analytical, cohort study, sample of 26 participants (13 exposed and 13 not exposed to the NICU). Maternal stress was assessed by Inventário de Sintomas de Stress para Adultos de Lipp (ISSL) (Lipp's Stress Symptoms Inventory for Adults) and psychological risk by Indicadores Clínicos de Risco para o Desenvolvimento Infantil (IRDI) (Clinical Risk Indicators for Child Development), 15 days after hospital discharge and at 4 months of corrected age. Results: the study found a frequency of stress of 23.1% in mothers of newborns who were exposed to NICUs and 38.5% of psychological risk in these newborns. The following associations were found: maternal stress and newborn exposure to the NICU (p=0.037); maternal stress and newborn exposure time to NICU (p=0.031); psychological risk and prematurity (p=0.014). There were no association between psychic risk and maternal stress; and there was no diference in the frequency of psychological risk between the groups of newborns. Conclusions: newborn hospitalization in the NICU is associated with maternal stress, but not with psychological risk. Prematurity can cause psychological risk. Maternal stress was not associated with psychological risk.

Resumo Objetivos: descrever a frequência de estresse materno e indicadores de risco psíquico em recém-nascidos que foram expostos à unidade de terapia intensiva neonatal (UTIN). Métodos: estudo observacional, analítico, coorte, amostra de 26 participantes (13 expostos e 13 não expostos a UTIN). O estresse materno foi avaliado pelo Inventário de Sintomas de Stress para Adultos de Lipp e o risco psíquico pelo IRDI (Indicadores Clínicos de Risco para o Desenvolvimento Infantil), 15 dias após a alta hospitalar e aos quatro meses de idade corrigida. Resultados: o estudo encontrou frequência de estresse de 23,1% nas mães de RN que foram expostos a UTIN e 38,5% de risco psíquico nestes bebês. Encontrou as seguintes associações: estresse materno e exposição do RN à UTIN (p=0,037); estresse materno e tempo de exposição do RN à UTIN (p=0,031); risco psíquico e prematuridade (p=0,014). Não encontrou associação entre risco psíquico e estresse materno; e não encontrou diferença na frequência de risco psíquico entre os grupos de RN. Conclusões: a internação do RN em UTIN está associada a estresse materno, mas não a risco psíquico. A prematuridade pode causar risco psíquico. O estresse materno não apresentou associação com risco psíquico.

The influence of caregiver attitudes and socioeconomic group on formal and informal mental health service use among youth.

BACKGROUND: Young people can receive mental health care from many sources, from formal and informal sectors. Caregiver characteristics/experiences/beliefs may influence whether young people get help and the type of care or support used by their child. We investigate facilitators/barriers to receiving formal and/or informal care, particularly those related to the caregiver's profile. METHODS: We interviewed 1,400 Brazilian primary caregivers of young people (aged 10-19), participants of a high-risk cohort. Caregivers reported on young people's formal/informal mental health care utilization, and associated barriers and facilitators to care. Data were also collected on youth mental health and its impact on everyday life; and caregiver characteristics-education, socioeconomics, ethnicity, mental health, and stigma. Logistic regression models were used to examine the relationship between caregiver and young people characteristics with formal/informal care utilization. RESULTS: Persistence and greater impact of youth mental health conditions were associated with a higher likelihood of care, more clearly for formal care. Caregiver characteristics, however, also played a key role in whether young people received any care: lower parental stigma was associated with greater formal service use, and lower socioeconomic class showed higher odds of informal care (mainly from religious leaders). CONCLUSIONS: This study highlights the key role of the caregivers as gatekeepers to child treatment access, particularly parental stigma influencing whether young people received any mental health care, even in a low resource setting. These results help to map barriers for treatment access and delivery for young people, aiming to improve intervention efforts and mental health support.

Elos Program's Efficacy Evaluation in School Management of Child Behavior: A Non-Randomized Controlled Trial / Avaliação da Eficácia do Programa Elos no Manejo Escolar do Comportamento Infantil: Um Ensaio Controlado Não Randomizado

Abstract The Elos Program resulted from a Brazilian cultural adaptation of the Good Behavior Game, a preventive strategy for classroom management to reduce aggressive and disruptive behaviors. The goal is to discuss the Elos Program's efficacy during its implementation in 16 elementary Brazilian public schools in two cities in 2016. The design was a non-randomized controlled trial with 80 classes in each group, experimental and control, involving 1,731 students. The study used the Generalized Estimating Equation model to verify the program's effect. Elos seemed to be effective in reducing aggressiveness and disruptive behavior in boys. These results are aligned with others GBG international studies and suggest that, after a randomized trial, the program would be ready to be disseminated in Brazil.

Resumo O Programa Elos é resultante da adaptação cultural brasileira do Good Behavior Game (GBG), uma estratégia preventiva para a gestão de sala de aula, visando diminuir comportamentos agressivos e disruptivos. O objetivo foi discutir a eficácia do Elos em sua implementação, em 16 escolas públicas de ensino fundamental, em duas cidades brasileiras, em 2016. Delineado como ensaio clínico controlado não randomizado, com 1.731 estudantes, em 80 turmas divididas entre experimental e controle, utilizou-se Generalized Estimating Equation para verificar o efeito do programa. Houve indicações da eficácia do Elos na redução da agressividade em meninos. Esses resultados estão alinhados com outros estudos internacionais do GBG e sugerem que, após um estudo randomizado, o programa estaria pronto para sua disseminação no Brasil.

Post-traumatic stress symptoms and post-traumatic growth in children and adolescents 12 months and 24 months after the earthquake and tsunamis in Chile in 2010: A longitudinal study.

On 27 February 2010, Chile experienced one of the strongest earthquakes in recorded history. The study aimed to evaluate post-traumatic stress symptoms (PTSS) and post-traumatic growth (PTG) in children and adolescents 12 months (T1) and 24 months (T2) after the earthquake and tsunamis in Chile in 2010. Three hundred twenty-five children and adolescents (47.4% girls; 52.6% boys) between the ages of 10 and 16 years participated in the study. The instruments included the Revised Post-traumatic Growth Inventory for Children by Kilmer et al., the Childhood PTSD Scale by Foa et al. and the Rumination Scale for Children by Cryder et al., as well as a scale to assess the severity of the event and a sociodemographic questionnaire. The PTSS and PTG scores decreased at T2. In addition, the main predictors of PTSS and PTG were disruptive experiences, losses after the event and intrusive and deliberate rumination during the previous year. These results enhance understanding of factors related to PTG, improve the ability to predict PTSS and PTG in children and adolescents following natural disasters, and inform the design of intervention strategies to promote better mental health in those affected.

Psychometric properties of a Brazilian adaptation of the Teacher Observation of Classroom Adaptation-Revised Scale for Children's Behavior / Propiedades psicométricas de la adaptación de la escala Teacher Observation of Classroom Adaptation-Revised (TOCA-R) para evaluar el comportamiento infantil en Brasil

Abstract The aim of this study was to describe the process of psychometric analysis of the Teacher Observation of Classroom Adaptation- Revised Scale (TOCA-R) for its use in Brazilian schools and to evaluate its validity and reliability. To evaluate the "Elos Program", which is the Brazilian culturally adapted version of the North American Program "Good Behavior Game", the TOCA-R was used. The researchers adapted the instrument in 2014, consisting of 33 items in a three-point ordinal response scale. A longitudinal quasi-experimental design with a single group was used. Participants were children aged 6 to 10 years evaluated by their teachers, before (n = 1448) and after (n = 673) the implementation of the Elos Program in 2014. The study involved initially four schools, 68 classes and their respective teachers. The analytical procedures were exploratory factorial analysis, confirmatory factorial analysis, longitudinal invariance analysis and reliability analysis by precision coefficients. The results of the exploratory factorial analysis showed an acceptable adjustment of five factors with 25 items, with a total explained variance of 60% and mean residual error of 0.02. The confirmatory factorial analysis expressed a satisfactory fit of the model (χ2 = 961, df = 265, RMSEA = .078, 95% IC [.07, .08], and CFI = 0.9). A configurational, metric and scalar invariance of latent structure was identified, which, together with the amplitude of variation of the precision coefficients between the instrument dimensions (α = .78, .92; ω = .76, .92), demonstrate evidence of validity and reliability for using the TOCA-R in evaluating the Elos Program in Brazilian schools.

Resumen El objetivo de este estudio fue realizar el análisis psicométrico de la escala Teacher Observation of Classroom Adaptation-Revised (TOCA-R) para su uso en escuelas brasileñas, y evaluar su validez y confiabilidad. Esta escala ha sido utilizada para evaluar el "Programa Elos", que es la versión brasileña culturalmente adaptada del programa norteamericano "Good Behavior Game". El instrumento fue adaptado por los investigadores en 2014 y está compuesto por 33 ítems con una escala de respuesta ordinal de tres puntos. En este estudio, se utilizó un diseño longitudinal cuasiexperimental de grupo único con los niños de 6 a 10 años, evaluados por sus maestros antes (n = 1448) y después (n = 673) de la implementación del Programa Elos en 2014. Se incluyeron cuatro ciudades brasileñas, 19 escuelas, 68 cursos y sus respectivos maestros, y los procedimientos analíticos fueron el análisis factorial exploratorio, el análisis factorial confirmatorio, el análisis de invariancia longitudinal y el análisis de confiabilidad por coeficientes de precisión. Los resultados del análisis factorial exploratorio mostraron un ajuste aceptable de cinco factores con 25 ítems, con una varianza total explicada del 60 % y un error residual medio de 0.02; el análisis factorial confirmatorio mostró un ajuste satisfactorio del modelo (χ2 = 961, df = 265, RMSEA = .078, IC 95 % = .07-.08, y CFI = 0.9); y se identificó la invariancia configuracional, métrica y escalar de la estructura latente, la cual, junto con la amplitud de variación de los coeficientes de precisión entre las dimensiones del instrumento (α = .78, .92; ω = .76, .92), da cuenta de evidencias de validez y confiabilidad que permiten utilizar la escala en la evaluación del Programa Elos en las escuelas brasileñas.

Prevalence of mental health problems in preschoolers and the impact of maternal depression.

A large number of children of depressed mothers have one or more mental disorders. This study aimed to evaluate the impact of maternal depression on the mental health of 4-5-year-old children of adolescent mothers, according to the hypotheses generated from the model of accumulation. Between October 2009 and March 2011, all pregnant adolescents who received prenatal care from the public health system in Pelotas (southern Brazil) were invited to participate in the study and have been prospectively followed. Of these individuals, 413 participants were evaluated in the postpartum period and when the child was 2-3 years old and 4-5 years old (current stage). The Strengths and Difficulties Questionnaire was used to assess mental health problems in children, and the Mini International Neuropsychiatric Interview (MINI)-Plus version was used to assess maternal depression. We applied a structured modeling approach to examine the relations between three different hypothesized life course models (accumulation, critical period, and mobility) and maternal depression. After selecting the most appropriate model, we used a logistic regression analysis to assess the effect of depression on mental health problems in 4-5-year-old children of adolescent mothers. We used the Chi square test to estimate the prevalence of mental health problems in 4-5-year-old children. The longer the time of exposure to maternal depression, the greater the probability that the child would present behavioral problems. Investments in strategies to prevent mental disorders beginning in the gestational period are important.

Intervenção baseada em um protocolo de terapia cognitivo comportamental: um relato de experiência com crianças no ambiente escolar / Intervention based on a protocol of cognitive behavioral therapy: an account of experience with children in the school environment

O presente artigo tem como objetivo relatar a experiência resultante da aplicação do protocolo preventivo da Terapia de Regulação Infantil (TRI-P) que baseia-se nos princípios da Terapia Cognitivo-Comportamental (TCC). A TRI-P é uma intervenção grupal e consiste em doze encontros semanais que tem por objetivo prevenir problemas de comportamento, que são consideradas fatores de risco para o desenvolvimento saúde mental em crianças. Participaram 17 crianças, de 7 a 9 anos matriculadas no turno integral de uma escola particular do interior do Rio Grande do Sul. Considerando o conjunto de dados qualitativos obtidos constatou-se que o trabalho em grupo oportunizou o fortalecimento de habilidades adquiridas durante a intervenção. Além disso, percebe-se que esta proposta de intervenção pode ser um diferencial no que diz respeito ao trabalho de prevenção e promoção de saúde dos alunos, evidenciando a importância do cuidado com saúde mental no ambiente escolar.

This article aims to report a protocol for the prevention of Terapia de Regulação Infantil (TRI-P) that is based on the principles of Cognitive-Behavioral Therapy (CBT). The TRI-P is an interventional gear and is used in encounters that aim to prevent behavioral problems, which are risk variables for mental development. Participants were 17 children, 7 and 9 years enrolled in the full shift of a private school in the interior of Rio Grande do Sul. The qualitative data set was found that the group work provided the strengthening of a series acquired during an intervention. In addition, it can be seen that this proposal of action can be a differential in what concerns the work of prevention and health promotion of the students, evidencing the importance of care with mental health in the school environment.

Emotional and behavioral problems: a school-based study in southern Brazil / Problemas emocionais e comportamentais: um estudo de base escolar no sul do Brasil

Abstract Introduction Mental health assessment in childhood needs to be carried out within a broader context that includes different factors. Objective To assess the prevalence of emotional and behavioral problems in schoolchildren and associated factors. Method A cross-sectional study was conducted with a school-based sample at 20 schools selected by systematic random sampling. Participants consisted of children aged 7-8 year old and their parents or primary caregivers. The Strengths and Difficulties Questionnaire (SDQ) was used to screen for the presence of emotional and behavioral problems in children. Results A total of 596 dyads were evaluated. The prevalence of emotional and behavioral problems was 30.0% among boys and 28.2% among girls. Hyperactivity/inattention were more prevalent among boys (p=0.015). Belonging to economically disadvantaged strata increased the likelihood of emotional and behavioral problems among schoolchildren by 71% (p=0.001), while having parents or caregivers with mental disorder increased by 2.2 times that probability (p<0.001). Conclusion: Our findings showed a high prevalence of emotional and behavioral problems among schoolchildren, as well as the influence of economic conditions and of the mental health of parents and caregivers on child mental health.

Resumo Introdução A avaliação da saúde mental na infância necessita ser realizada dentro de um contexto amplo que considere os diferentes fatores envolvidos. Objetivo Verificar a prevalência de problemas emocionais e comportamentais em escolares, bem como fatores associados. Método Estudo transversal, com amostra de base escolar em que foram selecionadas 20 escolas por amostragem aleatória sistemática. Participaram crianças com 7-8 anos e seus pais ou principais cuidadores. A presença de problemas emocionais e comportamentais nas crianças foi rastreada pelo Strengths and Difficulties Questionnaire (SDQ). Resultados Foram avaliadas 596 díades. A prevalência de problemas emocionais e comportamentais foi de 30,0% entre os meninos e 28,2% entre as meninas. Sintomas de hiperatividade/desatenção foram mais prevalentes entre meninos (p=0,015). Pertencer a camadas menos favorecidas economicamente aumentou em 71% a probabilidade de problemas emocionais e comportamentais entre os escolares (p=0,001), enquanto ter pais ou cuidadores com transtorno mental aumentou 2,2 vezes tal probabilidade (p<0,001). Conclusões: Nossos achados demonstram a elevada prevalência de problemas emocionais e comportamentais entre escolares, bem como a influência das condições econômicas e da saúde mental de pais e cuidadores sobre a saúde mental infantil.

Biological rhythm and emotional and behavioral problems among schoolchildren in Southern Brazil.

Emotional and behavioral problems have been considered an indicative of mental disorder in children. Mental health problems affect 10-20% of children and adolescents living in low-income and middle-income countries. Evidence suggests that disruptions in the biological rhythm may be a primary cause of emotional and behavioral changes, which affects several psychological functions and moods. Thus, this study aimed at verifying the association between biological rhythm and emotional and behavioral problems in schoolchildren living in Southern Brazil. This is a cross-sectional study with a school-based sample conducted between August 2015 and November 2016. The presence of emotional and behavioral problems in children was verified by the Strengths and Difficulties Questionnaire (SDQ), parents' version. This is a 25-item assessment questionnaire used to screen mental health problems in children and adolescents (from 4 to 17 years of age) in the last 6 months. The Biological Rhythm Interview of Assessment in Neuropsychiatry-Kids (BRIAN-K) was used to measure the degree of biological rhythm disruption. The BRIAN-K consists of 20 items; from among these, 17 items are added to generate a quantitative measure, with greater scores indicating more biological rhythm disruption. The final score can also be divided into four subscales: sleep, social rhythm, eating pattern and overall activities. A total of 609 children responded to the assessment instruments. With regard to parents or primary caregiver, 596 completed the assessment and 13 (2%) were not located or refused to participate in the study. Thus, 596 dyads were included in the analysis. Children with emotional and behavioral problems presented higher scores in all domains of BRIAN-K: sleep, social, activity, eating pattern and total score (p < 0.001). The following variables remained associated with emotional and behavioral problems after adjusted analysis: BRIAN-K total score (p < 0.001) and all subscales sleep (p < 0.001), social (p < 0.001), activity (p < 0.001) and eating pattern (p < 0.001). Children with emotional and behavioral problems presented higher biological rhythm disruption when compared with children without emotional and behavioral problems. Our study emphasizes the importance of biological rhythm and its influence on emotional and behavioral problems in schoolchildren. Early detection of any biological rhythm disruption may enhance further assessment of any eventual emotional and behavioral problem and even a psychopathology.

Sintomas depressivos, autorregulação emocional e suporte familiar: um estudo com crianças e adolescentes / Depressive symptoms, emotional self-regulation and family support: a study with children and adolescents / Síntomas depresivos, autorregulación emocional y suporte familiar: un estudio con ninõs y adolescentes

A depressão infantil acarreta prejuízos em diferentes contextos da vida, tanto das crianças quanto de seus familiares. O objetivo do estudo foi verificar a prevalência de sintomas depressivos para uma amostra de escolares e buscar a relação entre descritores de depressão, autorregulação emocional e percepção do suporte familiar. Como objetivos secundários, buscou-se diferenças entre sexo e idade. Participaram 546 crianças e adolescentes, sendo a maioria (n=276; 50,5%) meninos, com idades entre 8 a 18 anos (M=12,65; DP=1,84). Os instrumentos utilizados foram a Escala Baptista de Depressão Infantil, Bateria de Indicadores de Depressão Infantojuvenil, Escala de Autorregulação Emocional e Inventário de Percepção de Suporte Familiar. Os resultados indicaram prevalência de sintomatologia leve (4,8%), moderada (20,3%) e severa (15%). A depressão mostrou-se associada a dificuldades de autorregulação emocional e percepção do suporte familiar. Conclui-se que o entendimento acerca da expressão da sintomatologia depressiva pode contribuir para diagnóstico e intervenção precoces.

Child depression leads to losses in different contexts of life, for both children and their families. The aim of the study was to verify the prevalence of depressive symptoms for a sample of schoolchildren and to search for the relationship between descriptors of depression, emotional self-regulation and perception of family support. As secondary objectives, we sought differences between sex and age. There were 546 children and adolescents, the majority (n = 276, 50.5%) boys, aged 8 to 18 years (M = 12.65, SD = 1.84). The instruments used were the Baptist Scale for Child Depression, the Battery for Children's Depression Indicators, the Emotional Self-Regulation Scale, and the Family Support Perception Inventory. The results indicated a prevalence of mild (4.8%), moderate (20.3%) and severe (15%) symptomatology. Depression was associated with difficulties of emotional self-regulation and perception of family support. It is concluded that the understanding of the expression of depressive symptomatology can contribute to early diagnosis and intervention.

La depresión infantil acarrea perjuicios en diferentes contextos de la vida, tanto de los niños y de sus familiares. El objetivo del estudio fue verificar la prevalencia de síntomas depresivos para una muestra de escolares y buscar la relación entre descriptores de depresión, autorregulación emocional y percepción del soporte familiar. Como objetivos secundarios, se buscaron diferencias entre sexo y edad. En el caso de los niños y adolescentes, la mayoría (n = 276, 50,5%), con edades entre 8 a 18 años (M = 12,65, DP = 1,84). Los instrumentos utilizados fueron la Escala Baptista de Depresión Infantil, Batería de Indicadores de Depresión Infantojuvenil, Escala de Autorregulación Emocional e Inventario de Percepción de Soporte Familiar. Los resultados indicaron prevalencia de sintomatología leve (4,8%), moderada (20,3%) y severa (15%). La depresión se asoció a dificultades de autorregulación emocional y percepción del soporte familiar. Se concluye que el entendimiento acerca de la expresión de la sintomatología depresiva puede contribuir para el diagnóstico e intervención temprana.

Body Composition during Early Infancy and Mental Health Outcomes at 5 Years of Age: A Prospective Cohort Study of Ethiopian Children.

OBJECTIVE: To examine the relationship between body composition-specifically fat mass (FM) and fat-free mass (FFM)-in early infancy, and mental health outcomes in early childhood. STUDY DESIGN: In the Infant Anthropometry and Body Composition birth cohort study from Ethiopia, body composition was measured at birth and 1.5, 2.5, 3.5, 4.5, and 6 months of age. Mental health was assessed at 5 years of age using the approved Amharic version of the Strengths and Difficulties Questionnaire (SDQ), a parent report scale covering 4 different domains providing a total difficulties score. The associations of FM or FFM at birth as well as during early infancy, with SDQ score at 5 years of age were examined using multiple linear regression analyses. RESULTS: At 5 years of age, the mean ± SD for SDQ score was 10.4 ± 5.8. FM at birth was positively and FFM negatively associated with SDQ score. For each kg increase in FM at birth, the SDQ score at 5 years was 5.7 points higher (ß = 5.7; 95% CI, 1.4-10.0). In contrast, for each kilogram increase in FFM at birth, the SDQ score was 3.9 points lower (ß = -3.9; 95% CI, -7.0 to -0.8). Neither FM nor FFM accretion rate during early infancy were associated with SDQ score at 5 years of age. CONCLUSIONS: Fetal rather than infant body composition was associated with SDQ score at 5 years of age. Greater FFM accretion during fetal life may have contributed to more optimal neurobehavioral development during early life. However, the potential mechanisms underlying the observed associations need further investigation.

Child and Adolescent Mental Health in Haiti: Developing Long-Term Mental Health Services After the 2010 Earthquake.

This article presents an overview of child and adolescent mental health in Haiti, emphasizing the role of structural violence and the factors shaping child protection. The 2010 Haiti earthquake is discussed as an acute on chronic event that highlighted the lack of pre-existing formal biomedical mental health services and worsened the impact of structural violence. Considerations for long-term, sustainable, culturally relevant child and adolescent mental health care in Haiti are also provided.

Evaluación de síntomas ansiosos y etnicidad en población escolar de la comuna de San Pedro de Atacama / Assessment of anxiety symptoms and ethnicity in students from the San Pedro de Atacama district

La comuna San Pedro de Atacama (SPA) tiene alta población rural y étnica, grupos vulnerables, según la literatura, a problemas de salud mental. El objetivo de este trabajo es conocer la prevalencia de síntomas ansiosos en escolares e investigar sus diferencias respecto de variables étnicas, de edad y género. Para ello se utilizó la escala de auto reporte de ansiedad para niños y adolescentes (AANA). La muestra quedó constituida por 416 alumnos, de ellos se analizaron 335 escalas, cuya media de edad fue de 10 años. Un 60,3 por ciento obtuvo sobre el punto de corte para sospecha de trastorno de ansiedad. El género femenino tenía mayor sintomatología ansiosa, junto con el grupo etario de 7 a 11 años. No existió diferencias significativas para la variable étnica. Respecto a las subescalas, la distribución etaria de la fobia social fue diferente a lo reportado en la literatura, lo que podría derivar del contexto sociocultural, necesario de investigaren futuros trabajos.

The San Pedro de Atacama (SPA) district has an important number of rural and ethnic population, which according to the literature, is more vulnerable to mental health problems. The aim of this research is to determine the prevalence of anxiety symptoms in school age children and to study its differences in relation to ethnicity, age and gender. The AANA (self report anxiety scale for children and adolescents) was applied in a sample of 416 students, from which 335 questionnaires were analyzed (mean age: 10 years). A 60.3 percent of the students were above the cut point for suspicion of an anxiety disorder. Females had a higher number of symptoms of anxiety, as did the group with ages 7 to 11 years. There were no statistically significant differences for ethnicity. In the subscales, the age distribution for social phobia was found to be different from the one previously reported; this could be explained by the sociocultural context, which remains to be studied in future research.