Lifetime prevalence and help seeking behavior in physical marital violence

OBJECTIVE: To estimate the lifetime prevalence of physical marital violence among women from a low-income urban community and to investigate help-seeking behavior among victims. METHODS: This is the Brazilian pilot cross-sectional study for an international multicenter study conducted in 1999, and is based on a probabilistic cluster sample from the municipality of Embu, São Paulo State. We considered as eligible women aged 15 to 49 years, living with children under age 18 years, who had lived with a husband or partner in lifetime. Information was collected using standardized questionnaires (n=86), administered by trained interviewers. We investigated three types of physical violence: severe (kicking, hitting with fist, beating, and/or use/threat to use weapon), non-severe (slapping in the absence of severe violence), and any type (severe and/or non-severe and/or other physical aggressions spontaneously referred), as well as the type of help sought by the victim (from people or institutions). We calculated frequency and 95% confidence intervals for each type of violence. RESULTS: Subjects reported slapping (32.6%), hitting with fist (17.5%), beating (15,2%), use/threat to use weapon (13.9%), and kicking (10.6%). Prevalence of marital violence was high: 22.1% (13.3-30.9) for severe violence, 10.5% (4.0-17.0) for non-severe violence, and 33.7% (32.7-34.7) for any type of violence. Victims of severe violence were more likely to seek help from the police (36.8%) or from traditional healers (21.1%) than from health care facilities (5.3%), despite the availability of these services in the area. CONCLUSIONS: Physical marital violence is frequent and severe among the population studied, and help was sought preferentially from the police or traditional healers rather than from health care services.OBJETIVO: Estimar a prevalência de violência conjugal física ao longo da vida em mulheres de comunidade urbana de baixa renda e identificar os tipos de ajuda procurados pelas vítimas. MÉTODOS: Trata-se de estudo-piloto brasileiro de corte transversal, vinculado a projeto multicêntrico internacional conduzido em 1999, com amostra probabilística de conglomerados no município de Embu, Estado de São Paulo. Foram considerados elegíveis os domicílios com mulheres de 15 a 49 anos, que residissem com filho/filha <18 anos e tivessem vivido com algum marido/companheiro ao longo da vida. Entrevistadoras treinadas aplicaram questionários padronizados (n=86). Três tipos de violência conjugal física sofrida ao longo da vida foram investigados: grave (chute, soco, espancamento e/ou uso/ameaça de uso de arma), não grave (tapa na ausência de violência grave) e algum tipo (grave e/ou não grave, além de outras formas de agressão física espontaneamente referidas) e os tipos de ajuda procurada (pessoas e instituições). Foram calculadas as freqüências dos tipos de violência e respectivos intervalos de confiança de 95%. RESULTADOS: As entrevistadas referiram tapa (32,6%), soco (17,5%), espancamento (15,2%), uso/ameaça de arma (13,9%) e chute (10,6%). Foram altas as taxas de prevalência de violência conjugal: grave 22,1% (13,3-30,9), não grave 10,5% (4,0-17,0) e algum tipo 33,7% (32,7-34,7). Vítimas de violência grave procuraram ajuda mais freqüentemente da polícia/delegacia (36,8%) ou de curandeiros/benzedeiras/pais de santo (21,1%) que de centros de saúde (5,3%), apesar da disponibilidade desses serviços na região. CONCLUSÕES: A violência conjugal física ao longo da vida é freqüente e grave na comunidade estudada, sendo que a procura de ajuda foi direcionada mais freqüentemente à polícia/delegacia ou a curandeiros/benzedeiras/pais de santo do que a centros de saúde.Universidade Federal de São Paulo (UNIFESP) Escola Paulista de Medicina Departamento de PsiquiatriaUniversidade Presbiteriana Mackenzie Faculdade de PsicologiaUNIFESP, EPM, Depto. de PsiquiatriaSciEL

Bayley-III Scales of Infant and Toddler Development: Transcultural Adaptation and Psychometric Properties

Escalas con evidencia de la validez/fiabilidad son importantes para la evaluación del desarrollo infantil. En Brasil, faltan instrumentos estandardizados/normalizados para la evaluación en la primera infancia. Este estudio investigó las propiedades psicométricas de las Bayley Scales of Infant and Toddler Development-III, traducida y adaptada al portugués. Se evaluaron 207 niños (12-42 meses). Evidencias de validez convergente se observaron entre Bayley-III con: Escala de Desarrollo Motor de Peabody 2, Escala de Inteligencia Internacional Leiter-R, Lista de Evaluación de Vocabulario y Prueba de Vocabulario Expresivo Imágenes Peabody. El análisis factorial exploratorio indicó un componente que explica el 86% de la varianza, corroborado por buenos índices de ajuste en el análisis factorial confirmatorio. Bayley-III mostró buena consistencia interna, con coeficientes alfa de 0,90. La adecuación de las propiedades psicométricas puede contribuir al avance de la investigación en el contexto nacional en el área de evaluación del desarrollo infantil.Escalas com evidências de validade e precisão são importantes para avaliação do desenvolvimento infantil. No Brasil, há escassez de instrumentos padronizados e normatizados para a primeira infância. Este estudo investigou as propriedades psicométricas da Bayley Scales of Infant and Toddler Development, terceira edição (Bayley-III) que foi traduzida, adaptada para o português e testada com 207 crianças (12-42 meses). Evidências de validade convergente foram observadas entre a Bayley-III e: Peabody Developmental Motor Scale-2, Escala Internacional de Inteligência Leiter-R, Lista de Avaliação de Vocabulário Expressivo e Teste de Vocabulário por Imagens-Peabody. Análise fatorial exploratória indicou componente que explica 86% da variância, corroborado por bons índices de ajustes na análise fatorial confirmatória. A Bayley-III apresentou boa consistência interna com coeficientes alfa a partir de 0,90 e boa estabilidade teste-reteste apenas para a escala motora fina. Estas adequadas propriedades psicométricas podem contribuir para o avanço nas pesquisas em contexto nacional na área de avaliação do desenvolvimento infantil.Scales with evidence of validity and reliability are important to evaluate child development. In Brazil, there is a lack of standardized instruments to evaluate young children. This study investigated the psychometric properties of the Bayley Scales of Infant Development, Third Edition (Bayley-III). It was translated into Brazilian Portuguese, culturally adapted and tested on 207 children (12-42 months of age). Evidence of convergent validity was obtained from correlations of the Bayley-III with the: Peabody Developmental Motor Scale 2, Leiter International Performance Scale-R, Expressive Vocabulary Assessment List and Peabody Picture Vocabulary Test. Exploratory factor analyses showed a single component explaining 86% of the variance, supported by goodness-of-fit indexes in confirmatory factor analysis. The Bailey-III demonstrated good internal consistency with alpha coefficients greater than or equal to .90 and stability for fine motor scale only. These robust psychometric properties support the use of this tool in future national studies on child development

Influence of psychosocial risk factors on the trajectory of mental health problems from childhood to adolescence: a longitudinal study

Background: Longitudinal epidemiological studies involving child/adolescent mental health problems are scarce in developing countries, particularly in regions characterized by adverse living conditions. We examined the influence of psychosocial factors on the trajectory of child/adolescent mental health problems (CAMHP) over time.Methods: A population-based sample of 6- to 13-year-olds with CAMHP was followed-up from 2002-2003 (Time 1/T1) to 2007-2008 (Time 2/T2), with 86 out of 124 eligible children/adolescents at T1 being reassessed at T2 (sample loss: 30.6%). Outcome: CAMHP at T2 according to the Child Behavior Checklist/CBCL's total problem scale. Psychosocial factors: T1 variables (child/adolescent's age, family socioeconomic status); trajectory of variables from T1 to T2 (child/adolescent exposure to severe physical punishment, mother exposure to severe physical marital violence, maternal anxiety/depression); and T2 variables (maternal education, child/adolescent's social support and pro-social activities).Results: Multivariate analysis identified two risk factors for child/adolescent MHP at T2: aggravation of child/adolescent physical punishment and aggravation of maternal anxiety/depression.Conclusions: the current study shows the importance of considering child/adolescent physical punishment and maternal anxiety/depression in intervention models and mental health care policies.Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)Mackpesquisa of the Mackenzie Presbyterian UniversityUniv São Paulo, Sch Med, Inst Psychiat, São Paulo, BrazilUniversidade Federal de São Paulo, Social Psychiat Div, São Paulo, BrazilUniv Prebiteriana Mackenzie, Dev Disorder Post Grad Program, São Paulo, BrazilUniversidade Federal de São Paulo, Social Psychiat Div, São Paulo, BrazilFAPESP: 00/14555-4Web of Scienc

Instrumento para rastreamento dos casos de transtorno invasivo do desenvolvimento : estudo preliminar de validação

OBJETIVO: Tradução, retro-versão, adaptação cultural e validação do Autism Screening Questionnaire para a língua portuguesa e para o seu uso no Brasil. MÉTODO: Foi selecionada uma amostra inicial de 120 pacientes, encaminhados de duas clínicas privadas e uma pública, divida em três grupos de 40 pacientes distintos: pacientes com diagnóstico clínico de transtornos globais do desenvolvimento ou transtornos invasivos do desenvolvimento; de síndrome de Down e de outros transtornos psiquiátricos. O questionário foi aplicado aos responsáveis legais dos pacientes seguindo os padrões de um questionário auto-aplicável. As medidas psicométricas do questionário traduzido, na sua versão final, foram testadas. RESULTADOS: Valores de sensibilidade de 92,5% e especificidade de 95,5% foram encontrados para uma pontuação de 15, como sendo um valor discriminativo para os sujeitos com características de transtornos globais do desenvolvimento/transtornos invasivos do desenvolvimento. A validade interna para o total das 40 questões foi de 0,895, com uma variação entre 0,6 a 0,8. Os valores de confiabilidade obtidos pelo teste e re-teste demonstraram que a maioria das questões obteve alta concordância. CONCLUSÕES: A versão final do instrumento de pesquisa, traduzido e adaptado à cultura brasileira, apresentou propriedades de medida satisfatórias, sugerindo adequadas propriedades preliminares de validação. É um instrumento de fácil aplicação e uma ferramenta útil para a realização de um screening diagnóstico em indivíduos com transtornos globais do desenvolvimento/transtornos invasivos do desenvolvimento.OBJECTIVE: To translate into Portuguese, back-translate, culturally adapt and validate a screening instrument for pervasive developmental disorder, the Autism Screening Questionnaire, for use in Brazil. METHOD: A sample of 120 patients was selected based on three groups of 40: patients with a clinical diagnosis of pervasive developmental disorder, Down syndrome, or other psychiatric disorders. The self-administered questionnaire was applied to the patients' legal guardians. Psychometric measures of the final version of the translated questionnaire were tested. RESULTS: The score of 15 had sensitivity of 92.5% and specificity of 95.5% as a cut-off point for the diagnosis of pervasive developmental disorder. Internal validity for a total of 40 questions was 0.895 for alpha and 0.896 for KR-20, ranging from 0.6 to 0.8 for both coefficients. Test and retest reliability values showed strong agreement for most questions. CONCLUSIONS: The final version of this instrument, translated into Portuguese and adapted to the Brazilian culture, had satisfactory measurement properties, suggesting preliminary validation proprieties. It was an easy-to-apply, useful tool for the diagnostic screening of individuals with pervasive developmental disorder

Impact of training in autism for primary care providers: a pilot study

Objective: To evaluate the impact of a training program on autism spectrum disorder (ASD) identification offered to Brazilian health professionals. Methods: Twenty-two primary care providers participated in five 3-hour weekly training sessions. Results: The trained providers significantly improved their ASD knowledge after training in comparison with pre-training (mean score, 6.73 vs. 9.18, p < 0.01). Clinical practice also changed: 4 months after the training program, the providers had referred six times as many suspected cases of ASD to a specialized mental health service in comparison with the previous 4 months. Conclusion: This pilot training model seems a promising, feasible, and inexpensive way to improve early identification of ASD in the primary care system.Universidade Federal de São Paulo (UNIFESP) Department of Psychiatry Child and Adolescent Psychiatry Unit (UPIA)Santa Casa de Misericórdia de São Paulo School of Medical Sciences Unit of Excellence in Autism Spectrum DisorderUniversidade Federal de São Paulo (UNIFESP) Department of PsychiatryFaculdade de Medicina de São José do Rio Preto Department of Psychiatry and Medical PsychologyUniversity of London King's College Institute of PsychiatryUniversidade Presbiteriana Mackenzie Graduate Program in Developmental DisordersUNIFESP, Department of Psychiatry Child and Adolescent Psychiatry Unit (UPIA)UNIFESP, Department of PsychiatrySciEL

Preliminary psychometric properties of the Brazilian Portuguese version of the emotional outburst questionnaire

This study focuses on the cross-cultural adaptation of the Emotional Outburst Questionnaire (EOQ) to Brazilian Portuguese and preliminarily assesses its predictive validity. The EOQ evaluates aspects of emotional outbursts (EO), including frequency, duration, intensity, types, associated behaviours, recovery time, triggers, and effectiveness of calming strategies. Two independent translators performed the translation, with subsequent synthesis and analysis revealing that only 33 items (24.81%) required revision. Among these, one item needed partial modification, and two needed total modification. The study demonstrated strong content validity and adaptation in terms of conceptual, idiomatic, and semantic aspects. The EOQ's predictive validity was assessed by analysing the interruption of mental health services in Brazil due to Covid-19 (T1) compared to when services resumed after social distancing measures were lifted (T2). Parents of 25 individuals with developmental disabilities (ASD, DS and ID), with a mean of 11 y/o, mostly male (76%), completed the EOQ. Service interruption during T1 led to increased frequency and duration of severe emotional outbursts reported by caregivers compared to T2 (frequency: p &lt; .001; duration: p = 0.05). This suggests that the EOQ exhibits predictive validity and sensitivity to changes influenced by individual contexts. These findings highlight the EOQ's potential as an outcome measure for intervention development

Age of diagnosis, service access, and rights of autistic individuals in Argentina: Caregivers reports of changes and similarities across time

Background: Many countries have developed health initiatives to protect those with disabilities and developmental concerns in the past few years. However, the needs of autistic individuals are still short of being fulfilled. Partially due to limited research expenditure, which would allow bridging the gap between evidence and practice, the long time it takes to implement passed laws, and the limited operationalization of inclusive policies. Objective: To quantitatively examine changes in the child\u27s age at the time of caregiver\u27s first developmental concerns and age of diagnosis of their autistic child across 5 years. Also, to address challenges experienced by caregivers (e.g., reported service barriers) and the work still needing to be done in Argentina based on caregivers\u27 reports of their priorities (e.g., ensuring their child receives better services). Methods: Two independent samples of caregivers of autistic individuals were surveyed by the Red Espectro Autista Latinoamerica (REAL) in 2015 (n = 763) and the World Health Organization (WHO) in 2020 (n = 422). Similar items in both surveys were compared through descriptive inferential analysis and chi-square tests for categorical variables. Results: Compared to the 2015 sample, for the 2020 sample, more caregivers reported an earlier age of first concerns and an earlier age of a professional diagnosis. In the 2020 sample, more children diagnosed before the age of three had a doctor or a teacher noticing the first developmental concern. Also, in this sample, fewer caregivers reported service barriers (e.g., limited availability, waitlist, costs, etc.) and a need for better social support and better health services. However, rates of caregivers indicating a need for more rights for autistic individuals and greater protection of existing rights increased. There was no change in the reported rate of family members who stopped working to care for the autistic individual. For both samples, there was statistically significant differences in individual (physician, teacher, caregiver) noticing first developmental concern and the age of diagnosis, with the majority having a caregiver noticing the first concern. Conclusion: The 5 years that separate both samples show an improvement in developmental concerns being noticed, a decrease in age of diagnosis, and an improvement in several service areas such as community awareness. Also, caregivers reported fewer barriers to service accessibility, thus suggesting a positive impact stemming from changes in public policies, non-profit organizations\u27 work through awareness campaigns, and advocates\u27 strives toward greater awareness. Nonetheless, a similar proportion of family members reported ceasing working to care for autistic individuals and perceived that the fundamental rights of their autistic children needed to be protected. These results imply that despite better care pathways in Argentina, there are still gaps when attempting to meet the needs of autistic individuals and their families. The present study provides a meaningful understanding of existing gaps and help exemplify the perceived improvements when non-profit agencies and advocates promote increased rights and community awareness in addition to the established laws focusing on ASD

Mental health and violence among sixth grade students from a city in the state of São Paulo

OBJECTIVE: To analyze risk and protective factors for mental health problems among adolescents. METHODS: Cross-sectional study with a random sample (N=327; attrition rate=6.9%) of sixth grade students from all public and private schools in the city of Barretos, Southeastern Brazil, conducted in 2004. The factors studied were: exposure to intrafamilial and urban violence, family socioeconomic level, sex, motherless household, participation in social activities (protective factor). All the independent risk and protective factors were included in the initial logistic regression model. Only the variable with a significance level of p<0.05 remained in the model. RESULTS: It was observed that exposure to violence was the only factor associated with mental health problems in the final logistic regression model (p=0.02, 95% CI: 1.12;4.22). In addition, adolescents exposed to intrafamilial violence were three times more likely to have problems than those exposed to urban violence (p=0.04; 95% CI: 1.03;7.55). CONCLUSIONS: Intrafamilial violence was associated with mental heath problems among adolescents studied and it could be more important than urban violence in medium-sized cities.OBJETIVO: Analisar fatores de proteção e de risco para problemas de saúde mental entre adolescentes. MÉTODOS: Estudo transversal realizado com amostra aleatória (N=327; perda=6,9%) de estudantes da sexta série de todas as escolas públicas e privadas de Barretos, SP, em 2004. Os fatores examinados foram: exposição à violência doméstica e urbana, nível socioeconômico familiar, sexo, morar sem a mãe, participar de atividades sociais (fator de proteção). As associações entre esses fatores e problemas de saúde mental foram analisadas por meio de modelos de regressão logística. Todos os fatores de risco e proteção independentes foram incluídos no modelo inicial de regressão logística, permanecendo no modelo final apenas a variável com nível de significância inferior a 0,05. RESULTADOS: Verificou-se que apenas exposição à violência permaneceu no modelo final como fator associado a problemas de saúde mental (p=0,02; IC 95%: 1,12;4,22). Crianças expostas à violência doméstica tinham três vezes mais chances de apresentarem estes problemas do que aquelas expostas à violência urbana (p=0,04; IC 95%: 1,03;7,55). CONCLUSÕES: A violência doméstica associou-se a problemas de saúde mental nos adolescentes do estudo, podendo ser mais importante que a violência urbana em cidades de médio porte.Universidade Presbiteriana Mackenzie Programa de Pós-graduação em Distúrbios do DesenvolvimentoUniversidade Federal de São Paulo (UNIFESP) Departamento de Psiquiatria Setor de Psiquiatria SocialUNIFESP Departamento de Psiquiatria Unidade de Psiquiatria da Infância e AdolescênciaUNIFESP, Depto. de Psiquiatria Setor de Psiquiatria SocialUNIFESP, Depto. de Psiquiatria Unidade de Psiquiatria da Infância e AdolescênciaSciEL