Vitimização e maus-tratos na infância e adolescência e problemas de saúde mental aos 18 anos: estudo de coorte de nascimentos de 1993

Abstract

Violence against children and adolescents, whatever its form, is an important concern for world organizations and one of the main global issues to be resolved, due to the impact it has on the number of victims and the magnitude of the organic and emotional consequences it produces. throughout an individual's life. Exposure to violence in childhood has been associated with the development of mental health problems in adolescence and adulthood. However, there is little evidence available from prospective studies in low- or middle-income countries, and the differences by sex in the association between maltreatment in childhood and adolescence with the subsequent development of depression or anxiety are not well understood. The objectives of this thesis were: 1) to study the various factors associated with exposure to violence in childhood and adolescence among members of the 1993 birth cohort study in the city of Pelotas-RS, Brazil, 2) to study the relationship between treatment in childhood and adolescence with the subsequent development of a major depressive episode at the age of 18-19, in this same cohort study, and 3) summarize the evidence in the literature on differences by sex in the association between childhood maltreatment and depression or anxiety in childhood. adulthood. The main findings are described below for each article:Article 1. Through official records, it was observed that victimization events in childhood and adolescence are present in 22% of cohort members up to the age of 18. The highest incidences were found among females, and among members whose mothers were teenagers, poorer, less educated and without a partner at the time of the child's birth. The most frequent violent victimization was for crimes of bodily harm, robbery and crimes against individual freedom. The rate of violence in the community registered in official bodies is much higher than violence within the family. Article 2. Women in the cohort who reported exposure to emotional abuse (OR = 2.7; 95% CI = 1.9 - 3.8) and domestic violence (OR = 1.9; 95% CI = 1.2 - 2.9) in childhood, were at increased risk for depression, even after adjusting for confounders and other types of maltreatment. Women exposed to two or more forms of maltreatment had a higher risk of depression (OR = 4.1; 95% CI = 2.8 - 6.1) compared to unexposed girls. In the adjusted analysis, maltreatment was not associated with depression among men. Review article. A significant association (p<0.05) was observed between exposure to physical and sexual abuse with the subsequent development of depression and/or anxiety, both for males and females, with the exception of sexual abuse and anxiety for males. The effects studied were greater for females when compared to males, but there were no significant differences between them (p>0.05). Violence against children and adolescents is an important risk factor for the development of major depressive episodes and /or anxiety. Early interventions to prevent all forms of violence in childhood are necessary in order to reduce the consequences on adult mental health, especially among girls exposed to poly-maltreatment. Studies like the present one would make it possible to identify risk and protective factors throughout an individual's life, highlighting the importance of implementing surveillance and violence control measures.