Relação intergeracional entre a saúde mental de avós e pais, problemas de comportamento e estado nutricional dos filhos em uma coorte de nascimentos

Abstract

In the last decades there has been a notable increase in the symptoms of depression and anxiety worldwide, with higher prevalence in low and middleincome countries. In 2017, about 6% of the population in Brazil suffered from depressive disorders and 9% from anxiety disorders, and a significant increase in these rates is estimated as a result of the current COVID-19 pandemic. Common mental disorders, characterized by symptoms of anxiety, depression and unspecified somatic complaints, can cause countless losses to the lives of individuals and their surroundings, and are a major contributor to the global burden of disease and years of life lived with disability. One of the most common forms of mental disorders that can have important consequences throughout life is maternal depression. Studies have shown that women who manifest such isorders during the perinatal period and during their children's childhood are at greater risk of developing problems related to mother-child interaction, with negative repercussions on their physical and mental health. With the exponential increase in the rates of overweight and childhood obesity, there was a need to investigate its causes, including the relationship with the parents' mental disorders. Studies on maternal mental disorders and the children's nutritional status showed heterogeneous results, presenting methodological and social context variation between them. Regarding the genealogical influence of mental disorders, the repercussion of maternal mental health on that of children is well established in the literature, but little is known about the paternal and grandparent implications on the mental health of their descendants, particularly in low and middle-income. This thesis, therefore, aimed to study, in the population followed by the 1993 Birth Cohort (C93), the relationship between common mental disorders (CMD) of mothers, fathers and grandparents about overweight, emotional and behavioral problems in children during their childhood. For this, a research project and three articles evaluating these associations were developed. The first article was a systematic review, in which the existing evidence between maternal CMDs, especially depression and anxiety, and the overweight of their children were analyzed. Few studies were found on this topic, mostly in high-income countries. A significant association was shown in half of them, pointing out the quality of mother-child interactions and maternal care as mediators, in addition to indicating the chronicity of maternal depressive symptoms as a possible contributor to the overweight in the offspring. The second article investigated the association between the CMD in mothers belonging to C93 at 18 and 22 years old and the Body Mass Index (BMI) of their children between zero and ten years old. The prevalence of maternal CMD at 18 and 22 years of age was 39.9% and 25.2%, respectively, and overweight in children was 15.8%. Statistical analyzes showed a lower BMI in the children when the mother presented one or two episodes of CMD in relation to the non-symptomatic ones, however these results were not significant after adjusting for confounding factors. The third article that makes up this thesis evaluated the intergenerationality of mental health between three generations: CMD in the mothers of the C93 members (G1); CMD in C93 members who were parents at 22 (G2) and their 12 children's emotional and behavioral problems (G3). The study found CMD revalence of 39.4% in G1 and 22.6% in G2, while children had 39.9% of internalization problems and 29.8% of externalization problems. Adjusted analyzes showed a significant association both for maternal grandmothers (G1) and grandchildren (G3) as well as for mothers (G2) and children (G3), with the CMDs of mothers G2 acting as possible mediators of the relationship between G1 and G3. The CMDs of both paternal grandmothers and fathers were not associated with the internalization and externalization problems of G3. The role of grandmothers and mothers as caregivers may partly explain the observed associations, especially in the context of the place studied.