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Early vulnerabilities for psychiatric disorders in elementary schoolchildren from four Brazilian regions

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Abstract

Purpose

The purpose of the study is to identify early vulnerabilities for psychiatric disorders among Brazilian elementary school children, controlling for familial and community adversities.

Methods

This is a cross-sectional study examining the association between child psychiatric disorders and potential early vulnerabilities (disability, low intellectual quotient, and negative dimensions of the temperament trait self-directedness (low resourcefulness, low purposefulness, low enlightened second nature), controlling for the potential confounders: familial and community adversities. Sample: Four probabilistic samples of second-to-sixth grade students from public schools in four towns from different Brazilian regions (N = 1620). The following instruments were applied: the K-SADS-PL (to assess child/adolescent psychiatric disorders); the Ten-Question Screen (to measure child disability); three structured questions used as proxy of self-directedness; and the reduced version of the WISC-III to measure IQ. To evaluate familial/community adversities: Self-Report Questionnaire—SRQ-20 (to assess maternal/primary caretaker anxiety/depression); questions derived from structured questionnaires (to measure child abuse, marital physical violence, neighborhood violence); Brazilian Association of Research Companies questionnaire (to evaluate poverty/socioeconomic status). Trained psychologists interviewed mothers/primary caretakers and evaluated children/adolescents individually.

Results

A final logistic regression model showed that children/adolescents with low resourcefulness, low purposefulness, low enlightened second nature, lower IQ and disability were more likely to present any child psychiatric disorders.

Conclusion

Early vulnerabilities such as low IQ, presence of disability, and dimensions of temperament were associated with psychiatric disorders among Brazilian elementary school children, after controlling for familial and ecological confounders. These early vulnerabilities should be considered in mental health prevention/intervention programs in low-middle-income countries like Brazil.

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Acknowledgements

This study was funded by the State of São Paulo Funding Agency—FAPESP “INPD—Psiquiatria do Desenvolvimento para Infância e Adolescência” Instituto Nacional de Ciência e Tecnologia (INCT). Grant Number: [2008/57896-8], and by the National Research Council—CNPQ,—“Instituto Nacional de Ciência e Tecnologia de Psiquiatria do Desenvolvimento para Infância e Adolescência” Sigla: INPD—Edital nº 15/2008. Grant number [573974/2008]. CSP, JJM, ECM, LAR and ESFC are researchers from the National Research Council (CNPQ).

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Authors and Affiliations

  1. Development Disorders Program, Mackenzie University, Rua da Consolação 930, Edifício 28, 01302-907, Sao Paulo, SP, Brazil

    Cristiane S. Paula

  2. Department of Psychiatry, Federal University of Sao Paulo (UNIFESP), Rua Borges Lagoa 570, 1° andar, 04023-061, Sao Paulo, SP, Brazil

    Cristiane S. Paula, Jair J. Mari, Isabel Altenfelder Santos Bordin & Natalia Barroso

  3. Department of Psychiatry, University of Sao Paulo, Medical School (USP), Rua Dr. Ovídio Pires de Campos, 785, 1° andar, 05403-010, Sao Paulo, SP, Brazil

    Euripedes C. Miguel

  4. National Institute of Developmental Psychiatry for Children and Adolescents, University of Sao Paulo, Medical School (USP), Sao Paulo, SP, Brazil

    Isabela Fortes

  5. Núcleo de Intervenção Precoce (NIP), Av. das Américas 1155, sala 2010, 22631-000, Rio de Janeiro, Brazil

    Isabela Fortes

  6. Department of Psychiatry, Hospital de Clínicas de Porto Alegre, Federal University of Rio Grande do Sul, 4° andar, Rua Ramiro Barcelos 2350, 90035-003, Porto Alegre, Brazil

    Luis Augusto Rohde

  7. Department of Epidemiology, Oswaldo Cruz Foundation, Fiocruz, Rua Leopoldo Bulões, 1480/8° andar, 21041-210, Rio de Janeiro, RJ, Brazil

    Evandro Silva Freire Coutinho

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  1. Cristiane S. Paula
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Correspondence to Cristiane S. Paula.

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Conflict of interest

The 7th author (LAR) has been a member of the speakers’ bureau/advisory board and/or acted as a consultant for Eli-Lilly, Janssen-Cilag, Medice, Novartis, and Shire in the last 3 years. He receives authorship royalties from Oxford Press and ArtMed. The ADHD and Juvenile Bipolar Disorder Outpatient Programs chaired by him received unrestricted educational and research support from the following pharmaceutical companies in the last 3 years: Eli-Lilly, Janssen-Cilag, Novartis, and Shire. He also receives research support from Brazilian governmental institutions (CNPq, FAPERGS, HCPA, and CAPES). On behalf of the other authors, the corresponding author states that there is no conflict of interest. All authors declare that the submitted work has not been published before (neither in English nor in any other language) and that the work is not under consideration for publication elsewhere. A single study is not split up into several parts to increase the quantity of submissions and submitted to various journals or to one journal over time (e.g., “salami-publishing”). No data have been fabricated or manipulated to support our conclusions. No data, text, or theories by others are presented as if they were the author’s own (“plagiarism”). All authors gave consent to submit this manuscript before the submission and all eight authors have contributed sufficiently to the scientific work and therefore share collective responsibility and accountability for the results. The dataset and any additional data related to this manuscript will be provided by the first author upon request.

Ethical standards

All procedures performed in this study involving human participants were in accordance with the ethical standards of the University of São Paulo institutional research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Informed consent was obtained from all individual participants included in the study.

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Paula, C.S., Mari, J.J., Bordin, I.A.S. et al. Early vulnerabilities for psychiatric disorders in elementary schoolchildren from four Brazilian regions. Soc Psychiatry Psychiatr Epidemiol 53, 477–486 (2018). https://doi.org/10.1007/s00127-018-1503-4

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