Hospitalização nos primeiros quatro anos de vida e transtorno mental aos seis anos: Coorte de nascimentos de 2004, Pelotas, RS

Abstract

Hospitalization is a common event during childhood. In Brazil, in 2008 the rate of hospitalization in children aged zero to four years was 8.9%. The main causes of hospitalization occur from respiratory diseases, diarrheal diseases and perinatal conditions. Hospitalization can lead the child to develop physical, emotional, cognitive and psychosocial problems. The period between six months and four years is considered the most vulnerable to the development of hospital-related problems. In the short term hospitalization may have consequences for the growth, development and children's mental health. Studies showed that during hospitalization, nutritional status may be affected due to infectious processes, difficulty or power failure, changes in everyday routine and familiar environment, among other factors. In addition, the child may experience behavioral and emotional changes due to stressful situations inherent to treatment, starting to exhibit behaviors regression, aggression, anxiety in general, as well as feeding problems and sleep. In 2010, all members of the 2004 Pelotas birth cohort were sought, of whom 3,721 were examined (90.2% of the original cohort). Valid data of children hospitalized at some point during the 48 months of life and psychiatric evaluation were collected from 3,132 participants. This thesis comprises three posts. First we carried out a systematic review of literature on the association between hospitalization in childhood and mental disorders. The findings suggest that hospitalization early in life favors the occurrence of behavioral problems in the medium term, especially those with longer duration and occurring before the age of five. Later, it was aimed to describe the characteristics associated with hospitalization in the first years of life and to analyze the early factors associated with the chance of hospitalization and the risk of multiple hospitalizations. The frequency of hospitalization was highest during the first year of life. The respiratory diseases were among the main causes of hospitalization, followed by Infectious and Parasitic Diseases. Biological factors of the mother and child as birth weight, gestational age, Apgar, sex and multiple pregnancy were inversely associated with hospitalization in the first two years of life, while environmental characteristics such as maternal smoking history during pregnancy, color of the mother and family income were associated with the number of hospitalizations. Finally, the association between hospitalization was investigated in the first four years of life and mental disorder at six and eleven. Children hospitalized in the first 48 months of life were more likely to develop any psychiatric disorder and internalizing problems at six and eleven years of age compared to children who never hospitalized, even after adjusting for maternal characteristics and child. Among children with multiple hospitalizations, the odds of presenting psychiatric disorder at six and eleven were twice as high as those who never hospitalized. The results confirmed the hypothesis that the hospital in the early stages of life has an effect on the mental health of children and adolescents.