Skip to main content

The impact of perinatal and socioeconomic factors on mental health problems of children from a poor Brazilian city: a longitudinal study

Social Psychiatry and Psychiatric Epidemiology volume 46, pages 381–391 (2011)Cite this article

Abstract

Background

Low birth weight and preterm birth, and social disadvantage may negatively affect mental health of children, but findings have been inconsistent.

Objectives

To assess the influence of perinatal and social factors on mental health problems in children aged 7–9 years.

Methods

A random sample of 805 births in São Luís, Brazil was studied in 1997/1998 and again in 2005/2006. Perinatal, socioeconomic and demographic variables were assessed within 24 h after delivery. The Strengths and Difficulties Questionnaire (SDQ) was used to assess mental health problems in the children. Simple and multiple Poisson regressions were used for statistical analysis.

Results

The overall prevalence of mental health problems in the total sample was 47.7%. The prevalences of emotional and conduct problems were 58.2 and 48.8%, respectively. Only paternal age (<20 years) was associated with mental health problems as measured by the full SDQ scale (prevalence ratio PR = 1.27). Children born to single mothers (PR = 1.31) and those with birth weight from 1,500 to 2,499 g (PR = 1.18) and from 2,500 to 2,999 g (PR = 1.17) had a higher risk of emotional problems, but those from low income families had a lower risk (PR = 0.80). Children with a father of less than 20 years had a higher risk of having problems with their peers (PR = 1.75). A maternal education of 9 years or over was inversely associated with peer (PR = 0.70) and conduct problems (PR = 0.73). Girls had a lower risk of conduct (PR = 0.77) and hyperactivity problems (PR = 0.68). A maternal education of 4 years or less increased the risk of hyperactivity (PR = 1.48).

Conclusions

Socioeconomic and demographic conditions were better predictors of mental health problems in children than birth weight or preterm birth. However, since most effect sizes were small most mental health problems were, unexplained by the variables in the study.

This is a preview of subscription content, access via your institution.

Access options

Buy single article

Instant access to the full article PDF.

43,34 €

Price includes VAT (Finland)
Tax calculation will be finalised during checkout.

Fig. 1

References

  1. Andrade SA, Santos DN, Bastos AC, Pedromonico MR, de Almeida-Filho N, Barreto ML (2005) Family environment and child’s cognitive development: an epidemiological approach. Rev Saude Publica 39:606–611

    PubMed  Article  Google Scholar 

  2. Barros AJ, Hirakata VN (2003) Alternatives for logistic regression in cross-sectional studies: an empirical comparison of models that directly estimate the prevalence ratio. BMC Med Res Methodol 3:21

    PubMed  Article  Google Scholar 

  3. Bhutta AT, Cleves MA, Casey PH, Cradock MM, Anand KJ (2002) Cognitive and behavioural outcomes of school-aged children who were born preterm: a meta-analysis. JAMA 288:728–737

    PubMed  Article  Google Scholar 

  4. Cabrera NJ, Tamis-LeMonda CS, Bradley RH, Hofferth S, Lamb ME (2000) Fatherhood in the twenty-first century. Child Dev 71:127–136

    PubMed  Article  CAS  Google Scholar 

  5. Cardoso VC, Simoes VM, Barbieri MA, Silva AA, Bettiol H, Alves MT, Goldani MZ (2007) Profile of three Brazilian birth cohort studies in Ribeirao Preto, SP and São Luís, MA. Braz J Med Biol Res 40:1165–1176

    PubMed  Article  CAS  Google Scholar 

  6. CNDSS (2008) Relatório Final da Comissão Nacional sobre Determinantes Sociais da Saúde: As Causas Sociais das Iniqüidades em Saúde no Brasil. In: Editora Fiocruz, p 216

  7. Cury CR, Golfeto JH (2003) Strengths and Difficulties Questionnaire (SDQ): a study of school children in Ribeirao Preto. Rev Bras Psiquiatr 25:139–145

    PubMed  Article  Google Scholar 

  8. DeWolfe N, Byrne JM, Bawden HN (2000) ADHD in preschool children: parent-rated psychosocial correlates. Dev Med Child Neurol 42:825–830

    PubMed  CAS  Google Scholar 

  9. Elhamid AA, Howe A, Reading R (2009) Prevalence of emotional and behavioural problems among 6–12 year old children in Egypt. Soc Psychiatry Psychiatr Epidemiol 44:8–14

    PubMed  Article  Google Scholar 

  10. Ferriolli SH, Marturano EM, Puntel LP (2007) Family context and child mental health problems in the family health program. Rev Saude Publica 41:251–259

    PubMed  Article  Google Scholar 

  11. Fitzgerald M, Jeffers A (1994) Psychosocial factors associated with psychological problems in Irish children and their mothers. Econ Soc Rev 25:285–301

    Google Scholar 

  12. Fleiss JL, Williams JB, Dubro AF (1986) The logistic regression analysis of psychiatric data. J Psychiatr Res 20:195–209

    PubMed  Article  CAS  Google Scholar 

  13. Fleitlich B, Goodman R (2001) Social factors associated with child mental health problems in Brazil: cross sectional survey. BMJ 323:599–600

    PubMed  Article  CAS  Google Scholar 

  14. Fleitlich BW, Goodman R (2000) Epidemiologia. Rev Bras Psiquiatr 22:02–06

    Article  Google Scholar 

  15. Gale CR, Martyn CN (2004) Birth weight and later risk of depression in a national birth cohort. Br J Psychiatry 184:28–33

    PubMed  Article  Google Scholar 

  16. Gilliom M, Shaw DS (2004) Codevelopment of externalizing and internalizing problems in early childhood. Dev Psychopathol 16:313–333

    PubMed  Article  Google Scholar 

  17. Goldberg DP, Gater R, Sartorius N, Ustun TB, Piccinelli M, Gureje O, Rutter C (1997) The validity of two versions of the GHQ in the WHO study of mental illness in general health care. Psychol Med 27:191–197

    PubMed  Article  CAS  Google Scholar 

  18. Goodman R (2001) Psychometric properties of the Strengths and Difficulties Questionnaire. J Am Acad Child Adolesc Psychiatry 40:1337–1345

    PubMed  Article  CAS  Google Scholar 

  19. Goodman R (1997) The Strengths and Difficulties Questionnaire: a research note. J Child Psychol Psychiatry 38:581–586

    PubMed  Article  CAS  Google Scholar 

  20. Goodman R, Neves dos Santos D, Robatto Nunes AP, Pereira de Miranda D, Fleitlich-Bilyk B, Almeida Filho N (2005) The Ilha de Mare study: a survey of child mental health problems in a predominantly African-Brazilian rural community. Soc Psychiatry Psychiatr Epidemiol 40:11–17

    PubMed  Article  CAS  Google Scholar 

  21. Halpern R, Figueiras AC (2004) Environmental influences on child mental health. J Pediatr (Rio J) 80:S104–S110

    Google Scholar 

  22. Hille ET, den Ouden AL, Saigal S, Wolke D, Lambert M, Whitaker A, Pinto-Martin JA, Hoult L, Meyer R, Feldman JF, Verloove-Vanhorick SP, Paneth N (2001) Behavioural problems in children who weigh 1,000 g or less at birth in four countries. Lancet 357:1641–1643

    PubMed  Article  CAS  Google Scholar 

  23. Hosmer DW, Lemeshow S (2000) Applied logistic regression. Wiley, New York

    Book  Google Scholar 

  24. GE IB (2004) Resultados da Amostra do Censo Demográfico 2000—Malha municipal digital do Brasil: situação em 2001. IBGE, Rio de Janeiro

    Google Scholar 

  25. Jansen PW, Raat H, Mackenbach JP, Jaddoe VW, Hofman A, Verhulst FC, Tiemeier H (2009) Socioeconomic inequalities in infant temperament: the generation R study. Soc Psychiatry Psychiatr Epidemiol 44:87–95

    PubMed  Article  Google Scholar 

  26. Johnson S (2007) Cognitive and behavioural outcomes following very preterm birth. Semin Fetal Neonatal Med 12:363–373

    PubMed  Article  Google Scholar 

  27. Kelly YJ, Nazroo JY, McMunn A, Boreham R, Marmot M (2001) Birthweight and behavioural problems in children: a modifiable effect? Int J Epidemiol 30:88–94

    PubMed  Article  CAS  Google Scholar 

  28. Kramer MS, Seguin L, Lydon J, Goulet L (2000) Socio-economic disparities in pregnancy outcome: why do the poor fare so poorly? Paediatr Perinat Epidemiol 14:194–210

    PubMed  Article  CAS  Google Scholar 

  29. Martins Mde F, da Costa JS, Saforcada ET, Cunha MD (2004) Quality of the environment and associated factors: a pediatric study in Pelotas, Rio Grande do Sul, Brazil. Cad Saude Publica 20:710–718

    PubMed  Article  Google Scholar 

  30. Mathews TJ, MacDorman MF (2008) Infant mortality statistics from the 2005 period linked birth/infant death data set. Natl Vital Stat Rep 57:1–32

    PubMed  CAS  Google Scholar 

  31. Mello M, Mello A, Kohn R (2007) Epidemiologia da saúde mental no Brasil. Artmed, Porto Alegre

    Google Scholar 

  32. Nomura Y, Rajendran K, Brooks-Gunn J, Newcorn JH (2008) Roles of perinatal problems on adolescent antisocial behaviours among children born after 33 completed weeks: a prospective investigation. J Child Psychol Psychiatry 49:1108–1117

    PubMed  Article  Google Scholar 

  33. Orlebeke JF, Knol DL, Verhulst FC (1999) Child behaviour problems increased by maternal smoking during pregnancy. Arch Environ Health 54:15–19

    PubMed  Article  CAS  Google Scholar 

  34. Paula CS, Duarte CS, Bordin IA (2007) Prevalence of mental health problems in children and adolescents from the outskirts of Sao Paulo city: treatment needs and service capacity evaluation. Rev Bras Psiquiatr 29:11–17

    PubMed  Article  Google Scholar 

  35. Prior M, Virasinghe S, Smart D (2005) Behavioural problems in Sri Lankan schoolchildren: associations with socio-economic status, age, gender, academic progress, ethnicity and religion. Soc Psychiatry Psychiatr Epidemiol 40:654–662

    PubMed  Article  Google Scholar 

  36. Ravens-Sieberer U, Wille N, Erhart M, Bettge S, Wittchen HU, Rothenberger A, Herpertz-Dahlmann B, Resch F, Holling H, Bullinger M, Barkmann C, Schulte-Markwort M, Dopfner M (2008) Prevalence of mental health problems among children and adolescents in Germany: results of the BELLA study within the National Health Interview and Examination Survey. Eur Child Adolesc Psychiatry 17(Suppl 1):22–33

    PubMed  Article  Google Scholar 

  37. Reijneveld SA, de Kleine MJ, van Baar AL, Kollee LA, Verhaak CM, Verhulst FC, Verloove-Vanhorick SP (2006) Behavioural and emotional problems in very preterm and very low birthweight infants at age 5 years. Arch Dis Child Fetal Neonatal Ed 91:F423–F428

    PubMed  Article  CAS  Google Scholar 

  38. Roberts G, Howard K, Spittle AJ, Brown NC, Anderson PJ, Doyle LW (2008) Rates of early intervention services in very preterm children with developmental disabilities at age 2 years. J Paediatr Child Health 44:276–280

    PubMed  Article  Google Scholar 

  39. Rothenberger A, Becker A, Erhart M, Wille N, Ravens-Sieberer U (2008) Psychometric properties of the parent Strengths and Difficulties Questionnaire in the general population of German children and adolescents: results of the BELLA study. Eur Child Adolesc Psychiatry 17(Suppl 1):99–105

    PubMed  Article  Google Scholar 

  40. Saha S, Barnett AG, Buka SL, McGrath JJ (2009) Maternal age and paternal age are associated with distinct childhood behavioural outcomes in a general population birth cohort. Schizophr Res 115(2–3):130–135

    PubMed  Article  Google Scholar 

  41. Samara M, Marlow N, Wolke D (2008) Pervasive behaviour problems at 6 years of age in a total-population sample of children born at </= 25 weeks of gestation. Pediatrics 122:562–573

    PubMed  Article  Google Scholar 

  42. Schmidt LA, Miskovic V, Boyle MH, Saigal S (2008) Shyness and timidity in young adults who were born at extremely low birth weight. Pediatrics 122:e181–e187

    PubMed  Article  Google Scholar 

  43. Schothorst PF, Swaab-Barneveld H, van Engeland H (2007) Psychiatric disorders and MND in non-handicapped preterm children. Prevalence and stability from school age into adolescence. Eur Child Adolesc Psychiatry 16:439–448

    PubMed  Article  CAS  Google Scholar 

  44. Silva AA, Bettiol H, Barbieri MA, Brito LG, Pereira MM, Aragao VM, Ribeiro VS (2006) Which factors could explain the low birth weight paradox? Rev Saude Publica 40:648–655

    PubMed  Google Scholar 

  45. Skovgaard AM, Olsen EM, Christiansen E, Houmann T, Landorph SL, Jorgensen T (2008) Predictors (0–10 months) of psychopathology at age 11/2 years—a general population study in The Copenhagen Child Cohort CCC 2000. J Child Psychol Psychiatry 49:553–562

    PubMed  Article  CAS  Google Scholar 

  46. Syed EU, Hussein SA, Mahmud S (2007) Screening for emotional and behavioural problems amongst 5–11-year-old school children in Karachi, Pakistan. Soc Psychiatry Psychiatr Epidemiol 42:421–427

    PubMed  Article  Google Scholar 

  47. Wang WL, Sung YT, Sung FC, Lu TH, Kuo SC, Li CY (2008) Low birth weight, prematurity, and paternal social status: impact on the basic competence test in Taiwanese adolescents. J Pediatr 153:333–338

    PubMed  Article  Google Scholar 

  48. Werner EE (1997) Vulnerable but invincible: high-risk children from birth to adulthood. Acta Paediatr Suppl 422:103–105

    PubMed  CAS  Google Scholar 

Download references

Acknowledgments

We are indebted to all the participants and schools which helped us to identify the children for our follow-up survey. The present study was financed by Fundação de Amparo a Pesquisa do Estado de São Paulo (FAPESP) and Conselho Nacional para o Desenvolvimento Científico e Tecnológico (CNPQ).

Author information

Affiliations

  1. Departamento de Saúde Pública, Universidade Federal do Maranhão, São Luís, Maranhão, Brazil

    Juliana D. M. Rodriguez & Antônio A. M. da Silva

  2. Departamento de Puericultura e Pediatria, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, São Paulo, Brazil

    Heloisa Bettiol & Marco A. Barbieri

  3. Department of Psychological Medicine, Weston Education Centre, King’s College London, London, SE5 9RJ, UK

    Roberto J. Rona

Authors
  1. Juliana D. M. Rodriguez
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Antônio A. M. da Silva
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Heloisa Bettiol
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Marco A. Barbieri
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Roberto J. Rona
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Juliana D. M. Rodriguez.

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Rodriguez, J.D.M., da Silva, A.A.M., Bettiol, H. et al. The impact of perinatal and socioeconomic factors on mental health problems of children from a poor Brazilian city: a longitudinal study. Soc Psychiatry Psychiatr Epidemiol 46, 381–391 (2011). https://doi.org/10.1007/s00127-010-0202-6

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00127-010-0202-6

Keywords

  • Birth weight
  • Preterm birth
  • Mental health problems
  • Perinatal factors
  • Socioeconomic and demographic factors