A study reported in December in an article by European child and adolescent psychiatry shows an association between child poverty and an increased propensity to develop externalizing disorders in adolescence and early adulthood, particularly in girls. According to psychiatrists, externalizing disorders are characterized by poor impulse control, breaking rules, aggression, impulsiveness, attention deficit, and hyperactivity, among other forms of behavior.
The researchers who conducted the study concluded that multidimensional poverty and exposure to stressful life events, including frequent deaths and family conflict, were preventable risk factors that should be addressed in childhood. to reduce the impact of mental health problems in adulthood. The analysis took into account parental education, access to basic services, housing conditions and family infrastructure, among other variables.
For about seven years, 1,590 students enrolled in public schools in Porto Alegre and São Paulo (Brazil) were evaluated in three stages, the last in 2018-19. The students participate in the Brazilian High-Risk Childhood Psychiatric Disorders Cohort Study (BHRC), a large community-based survey involving 2,511 families with children aged 6 to 10 when it began in 2010.
Considered one of the most ambitious child mental health surveys ever conducted in Brazil, the BHRC, also known as the Project Connection – Minds of the Futureis run by the National Institute of Developmental Psychiatry (INPD), Which one is supported by FAPESP and the National Council for Scientific and Technological Development (CNPq). Its principal investigator is Euripede Constantino Miguel Filho, professor in the Department of Psychiatry of the Faculty of Medicine of the University of São Paulo (FM-USP). More than 80 university professors and researchers affiliated with 22 institutions in Brazil and elsewhere participate in its activities.
“It seems logical to say that poverty is correlated with the future development of mental health problems, but this is the first survey ever conducted in Brazil to analyze the mental health of children and young adults based on psychiatric assessments done multiple times. . We designed our study so that we could collect data on mental health in adolescence and early adulthood,” said Caroline Ziebold, first author of the article. Ziebold is a researcher at the Department of Psychiatry of the Federal University of São Paulo (UNIFESP).
Researchers used the Developmental Well-Being Assessment (DAWBA), a combination of interviews, questionnaires, and assessment techniques, to obtain psychiatric diagnoses in childhood (9-10), the adolescence (13-14) and early adulthood (18-19). They sought to detect internalizing disorders, such as depression and anxiety, as well as externalizing disorders, although the former did not account for a significant proportion of the overall results.
They used a specific questionnaire to assess the socio-economic status of families, concluding that 11.4% of the sample lived in conditions of poverty.
“The three-step psychiatric assessment produced consistent results by tracking changes over time. Children from poor families had lower levels of externalizing disorder than non-poor children at the first stage, but after a few years the curve reversed and the disorder steadily increased in poor children, with a likelihood of 63% develop disorders, while they decreased in poor children. the non-poor,” Ziebold said.
The stratification by sex shows that child poverty has particularly harmful consequences for women. “This finding was particularly striking and can be considered one of the most significant,” Ziebold said. “Externalizing disorders are generally more common in men. Our hypothesis is that mental health problems are less likely to be diagnosed early in poor girls, whether in the family or at school. Also, they tend to take on more responsibility for household chores from an early age, such as caring for younger siblings and sick family members. This added burden exposes them to more stressful life events, increasing the likelihood that they will develop mental health disorders in adulthood.
Externalizing disorders were particularly detrimental to women in terms of impact on educational attainment, leading to repeaters, dropouts and age distortions, as shown in a study by the group recently published in the journal Epidemiology. and Psychiatric Sciences.
Also using data from the BHRC, the study concluded that at least ten out of 100 girls older than the appropriate age for their grade level could have accompanied their age group if mental health problems, particularly disorders externalization, had been prevented or treated. If repeated, 5 girls out of 100 would not have failed (More than: agencia.fapesp.br/37741).
“Children and young adults with externalizing disorders may be more likely to fall behind in learning, social development, and the labor market, which increases the likelihood of poverty later in adult life,” Ziebold said.
In Brazil, the likelihood of children replicating their parents’ low level of education is twice the likelihood in the United States, for example, and well above the average of the 38 countries of the Organization for Cooperation and Development Economics (OECD). Nearly six in ten Brazilians (58.3%) whose parents did not complete high school also dropped out of school. In the United States and the OECD, the proportion is 29.2% and 33.4% respectively, according to the analysis of intergenerational mobility by the Institute for Mobility and Social Development (IMDS).
In the labor market, the likelihood of children finding skilled, well-paid jobs increases with the level of education of their parents. In the case of parents with a university degree, their children are 3.3 times more likely than average to hold high-skilled jobs and almost 9 times more likely than children of parents with little education (more in Portuguese on: imdsbrasil.org/doc/Imds_Sinopse%20de%20Indicadores01_Ago2021.pdf).
Because of the long-term impact of externalizing disorders on health and social outcomes in adult life, the researchers’ findings reinforce the importance of anti-poverty interventions in early childhood, according to Ziebold.
“When we highlight the need to reduce poverty in order to reduce the prevalence of mental health disorders, we are thinking about the issue in a multidimensional way,” she said. “There are no quick fixes. Immediate actions, such as abolishing school fees and providing cash transfers and income support for poor families, are important, but there is also a need to think about broader measures involving the promotion of social skills. -emotional, stress reduction, access to education and access to mental health services.
The proportion of the population living in poverty has increased alarmingly during the COVID-19 pandemic, she added. According to a report published by UNICEF, an additional 100 million children have fallen into multidimensional poverty worldwide, an increase of 10% since 2019.
The report also states that as of October 2020, the pandemic had interrupted or interrupted essential mental health services in 93% of countries and that more than 13% of girls and boys aged 10-19 live with a diagnosed mental disorder. . Even in the best-case scenario, he adds, it will take seven to eight years to recover and return to pre-pandemic levels of child poverty (More than: www.unicef.org/media/112841/file/UNICEF%2075%20report.pdf).
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European child and adolescent psychiatry
The title of the article
“Child poverty and mental health disorders in early adulthood: evidence from a Brazilian cohort study”
Publication date of articles