Maus-tratos infantis e uso de substâncias psicoativas na adolescência e início da vida adulta

Abstract

Child maltreatment refers to any act of abuse or neglect that can result in harm to the health, safety or dignity of a child, and can affect their emotional, physical and social health both in the short and long term. Within these harms, studies have described the association of child abuse with the use of psychoactive substances. However, there is a lack of investigations conducted in low- and middle-income countries, which often have social contexts that can both favor abuse and access and use of psychoactive substances. Furthermore, it is necessary to study the association of different types of abuse with a variety of types of psychoactive substances in the same population in order to identify individuals at greatest risk. Thus, this thesis aimed to investigate longitudinal associations between childhood abuse and use of psychoactive substances during adolescence and early adulthood using data from the 1993 Birth Cohort. Three articles compose the thesis together with the research project. The first article evaluated the association between four types of child maltreatment occurring up to the age of 15 with the use of tobacco, harmful use of alcohol and use of illicit drugs at three assessment points: at 15, 18 and 22 years. This article also explored differences in association by sex. In general, child maltreatment was associated with substance use and the strength of associations decreased over time. When differences by sex were present, associations were stronger among women. The second article comprised a systematic review of studies that explored the association between child maltreatment and use of psychoactive substances. In this review, associations were generally positive, with a stronger association observed when the abuse was of a sexual type and the illicit substance, although confidence intervals often overlapped. However, some methodological limitations in the included studies were identified and should be taken into consideration when interpreting the results. Almost half of the studies were cross sectional/retrospective, making it difficult to establish the temporal certainty of events and potentially leading to erroneous adjustment for a mediator and underestimating or even nullifying the measurement of the association effect. Finally, the third article evaluated the mediating role of mental disorder (at 18 years) in the association between child maltreatment (up to 15 years) and use of psychoactive substances (at 18 years), finding that mental suffering partially mediated this association.