Impact of the COVID-19 pandemic on the mental health of frontline healthcare workers in a highly affected region in Brazil.

BACKGROUND: The COVID-19 pandemic had a major impact on the mental health of healthcare workers (HCWs), especially in low and middle-income countries, which had to face additional political, social, and economic challenges. We thus aimed to assess the prevalence of mental health outcomes and the associated factors in HCWs treating COVID-19 patients in one of the most affected regions in Brazil. METHODS: We used the Respondent-Driven Sampling method to assess the risks of COVID-19 infection and symptoms of mental disorders in nurses, nursing technicians, and physicians who worked on the frontline in the metropolitan region of Recife. 865 healthcare workers completed a survey regarding sociodemographic data, work-related risks, and symptoms of mental disorders - SRQ-20 for common mental disorders (CMD); AUDIT-C for problematic alcohol use; GAD-7 for anxiety; PHQ-9 for depression; PCL-5 for post-traumatic stress disorder (PTSD). Gile's successive sampling estimator was used to produce the weighted estimates by professional category. A Poisson regression model with robust variance was used to analyze factors associated with a positive screening for CMD. We will present the results of a cross-sectional analysis of the mental health outcomes after the first peak of COVID-19 - from August 2020 to February 2021. RESULTS: The prevalence ratios for a positive screening for CMD were 34.9% (95% CI: 27.8-41.9) in nurses, 28.6% (95% CI: 21.3-36.0) in physicians, and 26.6% (95% CI: 16.8-36.5) in nursing technicians. Nurses presented a higher prevalence of depressive symptoms (23%). Positive screening for problematic alcohol use (10.5 to14.0%), anxiety (10.4 to 13.3%), and PTSD (3.3 to 4.4%) were similar between the professional categories. The main factors associated with CMD in nurses and physicians were related to an intrinsic susceptibility to mental illness, such as previous or family history of psychiatric disorder, and female sex. Among nurse technicians, work-related factors, such as accidents with biological material, presented the strongest association with CMD. CONCLUSION: The mental health of HCWs fighting COVID-19 in Recife was severely affected. It is crucial that healthcare services provide adequate working conditions and psychological support, investing in programs to promote and protect HCWs mental health.

The effect of common mental disorders on suicidal attempts by women, during pregnancy and six to nine years after birth. / Efeito dos transtornos mentais comuns na gestação e seis a nove anos pós-parto para a tentativa de suicídio em mulheres.

There is scarcity of global data on suicide attempts (SA). The higher frequency of mental disorders places women at a higher risk for SA. Mental disorders (MD) are ranked first in the Global Burden of Diseases (GBD) in terms of years lived with disability (YLD) and common mental disorders (CMD) affect women the most. IN this light, the present study aimed to investigate the impact of CMD during pregnancy, as well as 6 to 9 years after birth, on SA in women who were registered in the Family Health Strategy from the town of Recife, Pernambuco, Brazil. This study consisted of two stages of a prospective cohort. 643 adult women were included. The prevalence of CMD in stage I (pregnancy) and in stage III (six to nine years after birth) were, respectively, 19.3% and 12.6%. The incidence of SA was 10.9%. The multivariate analysis demonstrated a cumulative effect of CMD for SA: only during pregnancy (OR 5.4; 95%CI 2.2-13.3); only in the third stage (OR 5.8; 95%CI 2.3-14.9); and in both stages (OR 6.0; 95%CI 2.5-14.4). The increase of CMD in women increases the chances of SA, hence the importance of implementing public policies for women's health, especially for those with a history of mental disorders and unhealthy habits, and those who suffer violence.

Há escassez de dados globais sobre as tentativas de suicídio (TS). A maior frequência de adoecimento mental coloca as mulheres em maior risco de TS. Os transtornos mentais (TM) estão em primeiro lugar na carga global de doenças em termos de anos vividos com incapacidade (AVI). Entre os problemas de saúde mental que mais acometem mulheres estão os transtornos mentais comuns (TMC). O objetivo desta pesquisa foi investigar o impacto dos TMC na gravidez e seis a nove anos após o parto para a TS em mulheres cadastradas na Estratégia de Saúde da Família no Recife, Pernambuco, Brasil. O estudo engloba duas etapas de uma coorte prospectiva. Foram incluídas 643 mulheres adultas. A prevalência de TMC na etapa I (gestação) e sua incidência na etapa III (seis a nove anos após o parto) foram, respectivamente, 19,3% e 12,6%. A incidência da TS foi de 10,9%. A análise multivariada demonstrou efeito cumulativo dos TMC para a TS: TMC só na gestação (OR 5,4; IC95% 2,2-13,3); só na terceira etapa (OR 5,8; IC95% 2,3-14,9); e em ambas (OR 6,0; IC95% 2,5-14,4). O acúmulo dos TMC em mulheres aumenta a chance de TS, sendo importante a implementação de políticas públicas para a saúde das mulheres, principalmente com histórico de doença mental, hábitos não saudáveis e que sofrem violência.

Maternal educational practices and mental health disorders of school-age children.

OBJECTIVE: To investigate the association between emotional and behavioral difficulties in schoolchildren and maternal educational practices. METHODS: Participants and Setting: 631 mother-child pairs were evaluated in a poor urban district in Recife, northeastern Brazil. Cross-sectional study carried out between 2013 and 2014. It integrates a prospective cohort study designed to investigate the consequences of intimate partner violence that occurred during pregnancy, postpartum, and seven years after birth for the physical and mental health of women and their children. Maternal educational practices were assessed using the Parent-Child Conflict Tactics Scale (CTSPC - mother-child version) and the child's behavioral and emotional disorders through the Strengths and Difficulties Questionnaire (SDQ) mother-version. The association was estimated through crude and adjusted prevalence ratios, using Poisson regression considering the 95% confidence interval. RESULTS: The prevalence of violent maternal educational practices was 91.8% (572/631) being 89.7% (566/631) of psychological aggression and 75.6% of physical aggression, subdivided into corporal punishment (73.5%), physical maltreatment (35.8%) and severe physical maltreatment (1.7%). Corporal punishment (Adjusted PR 1.5; CI 95%: 1.1-2.1; p = 0.010) and severe physical maltreatment (Adjusted PR 1.9; CI 95%: 1.3-2.8; p = 0.002) were associated with emotional and behavioral difficulties in schoolchildren. CONCLUSION: The high prevalence of violent maternal educational practices, especially corporal punishment and severe physical maltreatment is associated with emotional and behavioral disorders in children. Therefore, it is necessary to interventions that promote parental support and effective use of non-violent discipline in conducting the educational process to establish healthier family relationships and to prevent/mitigate the impact of emotional and behavioral problems in children.

Could children exposed to intimate partner violence against their mother have more functional gastrointestinal disorders?

OBJECTIVE: To analyze the association between child exposure to intimate partner violence (CEIPV) committed against their mother and functional gastrointestinal disorders (FGIDs) in school-age children. METHODS: A prospective cohort study was carried out that evaluated 626 mother-child pairs living in a poor urban area in the Northeast of Brazil. The mothers were asked about their children's exposure to intimate partner violence. Holden's classification was used, which investigates ten types of CEIPV from prenatal care. The number of exposures, age of onset, and the perpetrator of the exposure were also verified. The FGIDs in children were identified from the mother's responses to the questionnaire about pediatric gastrointestinal symptoms, Roma III version parent-report, translated and cross-culturally adapted into Brazilian Portuguese. RESULTS: FGIDs were more frequent among children exposed to violence than those not exposed (OR: 1.64; 95% CI: 1.04-2.58; p = 0.03). Likewise, in children who suffered four or more types of exposure (OR: 1.81; 95% CI: 1.10-2.96; p  = 0.01), in which the exposure started in the first two years of life (OR: 1.93; 95% CI: 1.08-3.47; p = 0.02) and in those whose biological father was the perpetrator of the violence (OR; 1.62; 95% CI: 1, 05-2.48; p = 0.02). CONCLUSION: Corroborating the proposal of the biopsychosocial model, CEIPV increases the chance of occurrence of FGIDs in school-age children. Therefore, early identification and proposals for appropriate interventions are suggested both for the prevention of CEIPV and for the prevention and follow-up of FGIDs.

Prevalence and factors associated with dating violence among public school adolescents.

OBJECTIVE: Identify the prevalence and factors associated with dating violence among school adolescents. METHOD: Quantitative, descriptive, cross-sectional study, conducted in a state public school in Recife, Pernambuco, in August 2018, with 270 adolescents, aged between 12 and 19 years, from middle and high school. A form was applied with questions about the characterization of the adolescents, the experience of dating relationships, and the Conflict in Adolescent Dating Relationships Inventory. Pearson's chi-square test or Fisher's exact test was used for statistical analysis. RESULTS: The prevalence of physical, sexual, and psychological victimization was 31.9%, 36.4% and 81.8%, respectively. An association was identified between religious affiliation (p = 0.002), sexual orientation of the participants (p = 0.027), and parents' education (p = 0.015) and physical victimization during dating. CONCLUSION: Individual and contextual aspects related to dating violence among adolescents imply the need for the involvement of the school nurse in intersectoral and interdisciplinary health interventions.

Violence against women by their intimate partner during pregnancy and postnatal depression: a prospective cohort study.

BACKGROUND: Partner violence against women is common during pregnancy and might have an adverse effect on the mental health of women after delivery. We aimed to investigate the association of postnatal depression with psychological, physical, and sexual violence against women by their intimate partners during pregnancy. METHODS: In a prospective cohort study undertaken in Recife, northeastern Brazil, between July, 2005, and December, 2006, we enrolled pregnant women (aged 18-49 years) in their third trimester of pregnancy who were attending primary health-care clinics. The women were interviewed during pregnancy and after delivery. The form of partner violence in pregnancy was assessed with a validated questionnaire, and the Edinburgh postnatal depression scale was used to measure postnatal depression. Associations were estimated with odds ratios (ORs), adjusted for confounding factors contributing to the association between postnatal depression and intimate partner violence. FINDINGS: 1133 pregnant women were eligible for inclusion in the study, of whom 1045 had complete data for all variables and were included in the analysis. 270 women (25.8%, 95% CI 23.2-28.6) had postnatal depression. The most common form of partner violence was psychological (294 [28.1%, 25.4-31.0]). Frequency of psychological violence during pregnancy was positively associated with occurrence of postnatal depression, and although this association was attenuated after adjustment, women reporting the highest frequency of psychological violence were more likely to have postnatal depression even after adjustment (adjusted OR 2.29, 95% CI 1.15-4.57). Women who reported physical or sexual violence in pregnancy were more likely to develop postnatal depression (OR 3.28, 2.29-4.70), but this association was substantially reduced after adjustment for psychological violence and confounding factors. INTERPRETATION: Psychological violence during pregnancy by an intimate partner is strongly associated with postnatal depression, independently of physical or sexual violence. This finding has important policy implications since most social policies focus on prevention and treatment of physical violence. FUNDING: Departamento de Ciência e Tecnologia da Secretaria de Ciência, Tecnologia, e Insumos Estratégicos, and Conselho Nacional de Desenvolvimento Científico e Tecnológico (Brazil).

Postnatal depression in women after unsuccessful attempted abortion.

A population-based cohort study investigated postnatal depression in Brazilian women who attempted an abortion. Participants' views and actions on abortion were assessed during pregnancy and postnatal depression was evaluated with the Edinburgh Postnatal Depression Scale. An unsuccessful abortion attempt was associated with postnatal depression (adjusted OR = 1.6, 95% CI 1.0-2.5). In Brazil abortion is illegal under most circumstances.

Depression in childhood: The role of children's exposure to intimate partner violence and maternal mental disorders.

BACKGROUND: Intimate partner violence (IPV) is a global problem with high prevalence rates, and is linked to maternal mental disorders (MMD). Children's exposure to IPV (CEIPV) can have impacts on their physical and mental health, including depression. OBJECTIVE: To analyze the associations between exposure to both CEIPV and MMD and depression in schoolchildren. PARTICIPANTS AND SETTING: 630 mother-child pairs were evaluated in a poor urban district in Recife, Northeast Brazil. METHODS: A cohort study investigated the effects of IPV during pregnancy, postpartum and six to nine years after delivery. Women were asked about their experience of IPV, their own mental health, and the exposure of their child to violence. The child's mood was reported by the mother, using the Short Mood and Feelings Questionnaire (SMFQ). Ten types of CEIPV, and the age of onset of exposure, were compared with the child's subsequent risk of depression. RESULTS: IPV was associated with MMD in 31.9% of the women at some period of time. Depressive symptoms were reported in 15.7% of school-age children. All types of CEIPV were associated with depression at school age. Multivariable analyses of exposure to IPV and MMD at different ages showed that exposure to both IPV and MMD in the first year of life had the strongest association with childhood depression (OR = 9.1; 95% CI: 2.4-33.9). CONCLUSIONS: The frequency of CEIPV and MMD, and the high prevalence of depression at school age, shows the importance of assessing MMD and identifying exposure to IPV in pregnancy and the early years.

Suicide attempt, Post-traumatic stress disorder and associated factors in women of Recife. / Tentativa de suicídio, transtorno de estresse pós-traumático e fatores associados em mulheres do Recife.

OBJECTIVE: To investigate the association of suicide attempt (SA) with Post-Traumatic Stress Disorder (PSTD), Intimate Partner Violence (IPV) and variables related to socioeconomic and demographic aspects in a cohort of women enrolled in the Family Health Strategy in Recife. METHODS: A cross-sectional study was carried out, nested in a prospective cohort study with 644 women aged 18 to 49 enrolled in the Family Health Strategy of the Sanitary District II of Recife, PE, between July 2013 and December 2014. The SA was evaluated by the question "Have you ever tried to end your life?" PTSD was diagnosed through the Post-traumatic Stress Disorder Checklist - Civilian Version (PCL-C). A hierarchical modeling was performed, applying the χ2 test and Standardized Waste Analysis. The association of the independent variables with SA was estimated through simple and adjusted Logistic Regression. RESULTS: The prevalence of SA was 10.9%, and the frequency of PSTD was 16%. Women who had PTSD and those who did not have a religion showed higher risk for suicide (odds ratio - OR = 5.11, 95%CI 2.9 - 8.7, OR = 1.76, 95%CI 1.0 - 2.9 respectively). CONCLUSIONS: There was a higher risk of SA in women who had PTSD and low adherence to a religion. Thus, it was understood that coping with PTSD comes from preventing, treating and promoting greater knowledge about this disorder, in addition to aggregating and social protective effect promoted by religiosity, which can be a strategy for the reduction and prevention of SA.

OBJETIVO: Investigar a associação da tentativa de suicídio (TS) com o transtorno de estresse pós-traumático (TEPT), a violência por parceiro íntimo (VPI) e variáveis relacionadas aos aspectos socioeconômicos e demográficos em uma coorte de mulheres cadastradas na Estratégia Saúde da Família do Recife. MÉTODOS: Foi realizado um estudo transversal, aninhado em um estudo de coorte prospectivo, com 644 mulheres de 18 a 49 anos, cadastradas na Estratégia Saúde da Família do Distrito Sanitário II da cidade do Recife (PE), entre julho de 2013 e dezembro de 2014. A TS foi avaliada pela pergunta "Já tentou pôr fim à sua vida?", e o TEPT, diagnosticado por meio do Post-traumatic Stress Disorder Checklist - Civilian Version (PCL-C). Foram realizadas uma modelagem hierarquizada, a aplicação do teste χ2 e a análise de resíduos padronizados. A associação das variáveis independentes com a TS foi estimada por meio de regressão logística simples e ajustada. RESULTADOS: A prevalência da TS foi de 10,9%, e a frequência de TEPT, de 16%. As mulheres que tinham TEPT e também as que não possuíam religião tiveram maior chance de tentar o suicídio (odds ratio - OR = 5,11, intervalo de confiança de 95% - IC95% 2,9 - 8,7; OR = 1,76, IC95% 1,0 - 2,9, respectivamente). CONCLUSÕES: Houve maior risco de TS nas mulheres que tiveram TEPT e baixa adesão a uma religião. Sendo assim, compreendeu-se que o enfrentamento do TEPT se dá prevenindo esse transtorno, tratando dele e promovendo mais conhecimentos sobre ele, além do efeito agregador e protetor social que a religiosidade promove, que também podem ser estratégias de redução e prevenção da TS.

Efeito dos transtornos mentais comuns na gestação e seis a nove anos pós-parto para a tentativa de suicídio em mulheres / The effect of common mental disorders on suicidal attempts by women, during pregnancy and six to nine years after birth

Resumo Há escassez de dados globais sobre as tentativas de suicídio (TS). A maior frequência de adoecimento mental coloca as mulheres em maior risco de TS. Os transtornos mentais (TM) estão em primeiro lugar na carga global de doenças em termos de anos vividos com incapacidade (AVI). Entre os problemas de saúde mental que mais acometem mulheres estão os transtornos mentais comuns (TMC). O objetivo desta pesquisa foi investigar o impacto dos TMC na gravidez e seis a nove anos após o parto para a TS em mulheres cadastradas na Estratégia de Saúde da Família no Recife, Pernambuco, Brasil. O estudo engloba duas etapas de uma coorte prospectiva. Foram incluídas 643 mulheres adultas. A prevalência de TMC na etapa I (gestação) e sua incidência na etapa III (seis a nove anos após o parto) foram, respectivamente, 19,3% e 12,6%. A incidência da TS foi de 10,9%. A análise multivariada demonstrou efeito cumulativo dos TMC para a TS: TMC só na gestação (OR 5,4; IC95% 2,2-13,3); só na terceira etapa (OR 5,8; IC95% 2,3-14,9); e em ambas (OR 6,0; IC95% 2,5-14,4). O acúmulo dos TMC em mulheres aumenta a chance de TS, sendo importante a implementação de políticas públicas para a saúde das mulheres, principalmente com histórico de doença mental, hábitos não saudáveis e que sofrem violência.

Abstract There is scarcity of global data on suicide attempts (SA). The higher frequency of mental disorders places women at a higher risk for SA. Mental disorders (MD) are ranked first in the Global Burden of Diseases (GBD) in terms of years lived with disability (YLD) and common mental disorders (CMD) affect women the most. IN this light, the present study aimed to investigate the impact of CMD during pregnancy, as well as 6 to 9 years after birth, on SA in women who were registered in the Family Health Strategy from the town of Recife, Pernambuco, Brazil. This study consisted of two stages of a prospective cohort. 643 adult women were included. The prevalence of CMD in stage I (pregnancy) and in stage III (six to nine years after birth) were, respectively, 19.3% and 12.6%. The incidence of SA was 10.9%. The multivariate analysis demonstrated a cumulative effect of CMD for SA: only during pregnancy (OR 5.4; 95%CI 2.2-13.3); only in the third stage (OR 5.8; 95%CI 2.3-14.9); and in both stages (OR 6.0; 95%CI 2.5-14.4). The increase of CMD in women increases the chances of SA, hence the importance of implementing public policies for women's health, especially for those with a history of mental disorders and unhealthy habits, and those who suffer violence.

Mental health of children exposed to intimate partner violence against their mother: A longitudinal study from Brazil.

BACKGROUND: Exposure to intimate partner violence (IPV) is an important adverse childhood experience, but there are few longitudinal studies in low and middle-income countries. OBJECTIVE: To investigate the consequences of exposure to IPV for a child's mental health. PARTICIPANTS AND SETTING: 614 mother-child pairs were evaluated in a poor urban district in Recife, northeastern Brazil. METHODS: Women were interviewed in pregnancy, postpartum and six to nine years after delivery, and asked about their experience of IPV, and the exposure of their child to violence. The Strengths and Difficulties Questionnaire (SDQ) was completed by child's mother and teacher. Ten types of child experience of IPV and the age of onset of exposure were compared with the child's behavioral profile at school age. RESULTS: The mothers reported that 372/614 (60.6%) children had been exposed to IPV. The commonest types of child exposure to IPV were "prenatally", "overheard", "eyewitnessed", and 10.0% of children were physically or verbally involved in the IPV. Mothers reported high SDQ Total Difficulties scores in 71.7% of all children exposed to IPV and teachers in 59.8%. Multivariate logistic regression analysis demonstrated the strongest association with behavioral difficulties was with exposure to IPV in the age group 1-2 years (OR 2.5 [95% CI: 1.3-4.8]). CONCLUSION: Young children are sensitive to the age of first exposure to IPV and to the type of IPV. Interventions to reduce IPV should be targeted on vulnerable women from poor urban communities during their pregnancies and in the first two years of their child's life.

Violence against women by their intimate partner and common mental disorders.

The World Health Organization considers gender violence a cause of anxiety, depression and suicidal thoughts among women. This study investigated the association between violence committed against women by their intimate partners, defined by psychologically, physically and sexually abusive acts, and common mental disorders, assessed by using the Self Reporting Questionnaire (SRQ-20). A population-based household survey was carried out among women aged 15-49 years in two sites: São Paulo, the largest Brazilian city, and Zona da Mata of Pernambuco, a region with both urban and rural areas in the Northeast of the country. A large proportion of women reported violence (50.7%). The most frequent forms were psychological violence alone (18.8%) or accompanied by physical violence (16.0%). The prevalence of mental disorders was 49.0% among women who reported any type of violence and 19.6% among those who did not report violence (p<0.0001). After adjustment for demographic and socioeconomic characteristics, the nature of the relationship, stressful life events and social support, all the forms of violence studied, with the exception of sexual violence alone or accompanied by either physical or psychological violence (p=0.09), were significantly associated with mental disorders: physical violence alone (OR1.91; CI 95%1.2-3.0), psychological violence alone (OR 2.00; CI 95% 1.5-2.6), sexual violence alone or accompanied by either physical or psychological violence (OR1.80; CI95% 0.9-3.6), both psychological and physical violence (OR 2.56; CI 95% 1.9-3.5) and all three forms of violence (OR 2.68; CI 95% 1.8-4.0). This is the first population-based study on the association between intimate partner violence and mental health in Brazil. It contributes to the existing body of research and confirms that violence, frequently experienced by women in the country, is associated with mental disorders. Policies and strategies aimed at reducing gender-based violence are necessary for preventing and reducing anxiety and depression among women.

Maternal educational practices and mental health disorders of school-age children

Abstract Objective: To investigate the association between emotional and behavioral difficulties in schoolchildren and maternal educational practices. Methods: Participants and Setting: 631 mother-child pairs were evaluated in a poor urban district in Recife, northeastern Brazil. Cross-sectional study carried out between 2013 and 2014. It integrates a prospective cohort study designed to investigate the consequences of intimate partner violence that occurred during pregnancy, postpartum, and seven years after birth for the physical and mental health of women and their children. Maternal educational practices were assessed using the Parent-Child Conflict Tactics Scale (CTSPC - mother-child version) and the child's behavioral and emotional disorders through the Strengths and Difficulties Questionnaire (SDQ) mother-version. The association was estimated through crude and adjusted prevalence ratios, using Poisson regression considering the 95% confidence interval. Results: The prevalence of violent maternal educational practices was 91.8% (572/631) being 89.7% (566/631) of psychological aggression and 75.6% of physical aggression, subdivided into corporal punishment (73.5%), physical maltreatment (35.8%) and severe physical maltreatment (1.7%). Corporal punishment (Adjusted PR 1.5; CI 95%: 1.1-2.1; p = 0.010) and severe physical maltreatment (Adjusted PR 1.9; CI 95%: 1.3-2.8; p = 0.002) were associated with emotional and behavioral difficulties in schoolchildren. Conclusion: The high prevalence of violent maternal educational practices, especially corporal punishment and severe physical maltreatment is associated with emotional and behavioral disorders in children. Therefore, it is necessary to interventions that promote parental support and effective use of non-violent discipline in conducting the educational process to establish healthier family relationships and to prevent/mitigate the impact of emotional and behavioral problems in children. © 2022 Sociedade Brasileira de Pediatria. Published by Elsevier Editora Ltda. This is an open access article under the CC BY-NC-ND license (https://creativecommons.org/licenses/by-nc-nd/4.0/).

Could children exposed to intimate partner violence against their mother have more functional gastrointestinal disorders?

Abstract Objective: To analyze the association between child exposure to intimate partner violence (CEIPV) committed against their mother and functional gastrointestinal disorders (FGIDs) in school-age children. Methods: A prospective cohort study was carried out that evaluated 626 mother-child pairs living in a poor urban area in the Northeast of Brazil. The mothers were asked about their children's exposure to intimate partner violence. Holden's classification was used, which investigates ten types of CEIPV from prenatal care. The number of exposures, age of onset, and the perpetrator of the exposure were also verified. The FGIDs in children were identified from the mother's responses to the questionnaire about pediatric gastrointestinal symptoms, Roma III version parent-report, translated and cross-culturally adapted into Brazilian Portuguese. Results: FGIDs were more frequent among children exposed to violence than those not exposed (OR: 1.64; 95% CI: 1.04-2.58; p = 0.03). Likewise, in children who suffered four or more types of exposure (OR: 1.81; 95% CI: 1.10-2.96; p = 0.01), in which the exposure started in the first two years of life (OR: 1.93; 95% CI: 1.08-3.47; p = 0.02) and in those whose biological father was the perpetrator of the violence (OR; 1.62; 95% CI: 1, 05-2.48; p = 0.02). Conclusion: Corroborating the proposal of the biopsychosocial model, CEIPV increases the chance of occurrence of FGIDs in school-age children. Therefore, early identification and proposals for appropriate interventions are suggested both for the prevention of CEIPV and for the prevention and follow-up of FGIDs.

[Prevalence of intimate partner violence against women in regions of Brazil]. / Prevalência da violência contra a mulher por parceiro íntimo em regiões do Brasil.

OBJECTIVE: To analyze the results from the "WHO Multi-country Study on Women's Health and Domestic Violence", on the prevalence of intimate partner violence against women found in Brazil. METHODS: This cross-sectional study was part of the "WHO Multi-country Study on Women's Health and Domestic Violence against women", which was carried out in ten countries between 2000 and 2003. All the countries used a standardized structured questionnaire, devised for this study. In order to obtain data from contrasting settings within each country, the biggest city and a rural region were investigated whenever feasible. A representative sample of women aged 15 to 49 years was selected from the city of São Paulo and 15 municipalities in a rural region of the northeast, the Zona da Mata de Pernambuco. The study included 940 women from São Paulo and 1,188 from Zona da Mata de Pernambuco who had had an intimate partner at some time in their lives. Violence was classified as psychological, physical and sexual types, and was analyzed in relation to overlapping, recurrence of episodes, severity and when it occurred. RESULTS: The women in São Paulo and Pernambuco respectively reported the following at least once in their lifetimes: psychological (N=383; 41.8% and N=580; 48.9%); physical (N=266; 27.2% and N=401; 33.7%); sexual (N=95; 10.1% and N=170; 14.3%) violence. There was significant overlapping among the types of violence, which seemed to be associated with the most severe types of violence. The greatest single type was psychological violence, in São Paulo and Pernambuco (N=164; 17.5% and N=206; 17.3%), and the smallest was sexual violence (N=2; 0.2% and N=12; 1.0%). CONCLUSIONS: The results show that violence is a very common phenomenon. The findings reiterate previous international studies results with regard to high magnitude and overlapping of types of intimate partner violence.

Intimate partner violence and incidence of common mental disorder.

OBJECTIVE: To investigate the association of intimate partner violence against women reported in the last 12 months and seven years with the incidence of common mental disorders. METHODS: A prospective cohort study with 390 women from 18 to 49 years, registered in the Family Health Program of the city of Recife, State of Pernambuco; from July 2013 to December 2014. The Self Reporting Questionnaire-20 (SRQ-20) assessed mental health. Intimate partner violence consists of concrete acts of psychological, physical or sexual violence that the partner inflicts on the woman. Poisson regression was used to estimate crude and adjusted relative risks (RR) of the association between common mental disorders and intimate partner violence. RESULTS: The incidence of common mental disorders was 44.6% among women who reported intimate partner violence in the last 12 months and 43.4% among those who reported in the past seven years. Mental disorders remained associated with psychological violence (RR = 3.0; 95%CI 1.9-4.7 and RR = 1.8; 95%CI 1.0-3.7 in the last 12 months, and seven years, respectively), even in the absence of physical or sexual violence. When psychological violence were related to physical or sexual violence, the risk of common mental disorders was even higher, both in the last 12 months (RR = 3.1; 95%CI 2.1-4.7) and in the last seven years (RR = 2.5; 95%CI 1.7-3.8). CONCLUSIONS: Intimate partner violence is associated with the incidence of common mental disorders in women. The treatment of the consequences of IPV and support for women in seeking protection for themselves for public services is essential. OBJETIVO: Investigar a associação da violência por parceiros íntimos relatada contra as mulheres nos últimos 12 meses e últimos sete anos com a incidência dos transtornos mentais comuns. MÉTODOS: Estudo de coorte prospectivo com 390 mulheres de 18 a 49 anos, cadastradas no Programa Saúde da Família da cidade do Recife, PE, entre julho de 2013 e dezembro de 2014. A saúde mental foi avaliada pelo Self Reporting Questionnaire-20 (SRQ-20). A violência por parceiro íntimo foi definida por atos concretos de violência psicológica, física ou sexual infligidos à mulher pelo parceiro. A regressão de Poisson foi utilizada para estimar os riscos relativos (RR) brutos e ajustados da associação entre transtorno mental comum e violência por parceiro íntimo. RESULTADOS: A incidência dos transtornos mentais comuns foi de 44,6% entre as mulheres que relataram violência nos últimos 12 meses e de 43,4% nas que relataram violência nos últimos sete anos. Os transtornos mentais mantiveram-se associados à violência psicológica (RR = 3,0; IC95% 1,9-4,7 e RR = 1,8; IC95% 1,0-3,7 nos últimos 12 meses, e sete anos, respectivamente), mesmo na ausência de violência física ou sexual. Quando a violência psicológica esteve combinada com violência física ou sexual, o risco dos transtornos mentais comuns foi ainda mais elevado, tanto nos últimos 12 meses (RR = 3,1; IC95% 2,1-4,7) quanto nos últimos sete anos (RR = 2,5; IC95% 1,7-3,8). CONCLUSÕES: A violência por parceiro íntimo está associada à incidência de transtornos mentais comuns nas mulheres. É fundamental o tratamento das consequências da VPI e o apoio às mulheres na busca de proteção para si pelos serviços públicos.

Intimate partner violence and maternal educational practice.

OBJECTIVE: The objective of this study is to analyze the association between intimate partner violence against women and maternal educational practice directed to children at the beginning of formal education. METHODS: This is a cross-sectional study, carried out between 2013 and 2014, with 631 mother/child pairs, registered in the Family Health Strategy of the Health District II of the city of Recife, State of Pernambuco, Brazil. It integrates a prospective cohort study designed to investigate the consequences of exposure to intimate partner violence in relation to the child who was born between 2005 and 2006. The maternal educational practice has been assessed by the Parent-Child Conflict Tactics Scale and the intimate partner violence by a questionnaire adapted from the Multi-Country Study on Women's Health and Domestic Violence of the World Health Organization. Intimate partner violence referred to the last 12 months and was defined by specific acts of psychological, physical, and sexual violence inflicted to women by the partner. The crude and adjusted prevalence ratios were estimated for the association studied, using log-binomial regression. RESULTS: The prevalence of intimate partner violence was 24.4%, and violent maternal educational practice was 93.8%. The use of non-violent discipline was mentioned by 97.6% of the women, coexisting with violent strategies of discipline. Children whose mothers reported intimate partner violence presented a higher chance of suffering psychological aggression (PR = 2.2; 95%CI 1.0-4.7). CONCLUSIONS: The violence suffered by the mother interferes in the parental education. The findings show high prevalence of violent maternal educational practice, pointing to the need for interventions that minimize the damage of violence in women and children. OBJETIVO: Analisar a associação entre a violência pelo parceiro íntimo contra a mulher e a prática educativa materna direcionada às crianças no início da escolaridade formal. MÉTODOS: Estudo transversal, realizado entre 2013 e 2014, com 631 pares mãe/criança, cadastradas na Estratégia de Saúde da Família do Distrito Sanitário II da cidade do Recife, Pernambuco. Integra o estudo de coorte prospectivo delineado para investigar as consequências da exposição à violência pelo parceiro íntimo para a criança que nasceu da gestação que ocorreu entre 2005 e 2006. A prática educativa materna foi avaliada pela escala de conflitos Parent-Child Conflict Tactics Scale e a violência pelo parceiro íntimo por um questionário adaptado do Estudo Multipaíses sobre a Saúde da Mulher e Violência Doméstica da Organização Mundial da Saúde. A violência pelo parceiro íntimo referiu-se aos últimos 12 meses e foi definida por atos concretos de violência psicológica, física e sexual infligidos à mulher pelo parceiro. Foram estimadas as razões de prevalência brutas e ajustadas para a associação estudada, utilizando-se a regressão log-binominal. RESULTADOS: A prevalência da violência pelo parceiro íntimo foi de 24,4%, e da prática educativa materna violenta de 93,8%. O uso de disciplina não violenta foi referido por 97,6% das mulheres, coexistindo com estratégias violentas de disciplinamento. As crianças cujas mães relataram violência pelo parceiro íntimo apresentaram maior chance de sofrer agressão psicológica (RP = 2,2; IC95% 1,0-4,7). CONCLUSÕES: A violência sofrida pela mãe interfere na educação parental. Os achados demonstram alta prevalência de prática educativa materna que perpassa pela violência, o que aponta para a necessidade de intervenções que minimizem os prejuízos da violência na mulher e na criança.

Previous experience of family violence and intimate partner violence in pregnancy.

OBJECTIVE: To estimate differential associations between the exposure to violence in the family of origin and victimization and perpetration of intimate partner violence in pregnancy. METHODS: A nested case-control study was carried out within a cohort study with 1,120 pregnant women aged 18-49 years old, who were registered in the Family Health Strategy of the city of Recife, State of Pernambuco, Brazil, between 2005 and 2006. The cases were the 233 women who reported intimate partner violence in pregnancy and the controls were the 499 women who did not report it. Partner violence in pregnancy and previous experiences of violence committed by parents or other family members were assessed with a standardized questionnaire. Multivariate logistic regression analyses were modeled to identify differential associations between the exposure to violence in the family of origin and victimization and perpetration of intimate partner violence in pregnancy. RESULTS: Having seen the mother suffer intimate partner violence was associated with physical violence in childhood (OR = 2.62; 95%CI 1.89-3.63) and in adolescence (OR = 1.47; 95%CI 1.01-2.13), sexual violence in childhood (OR = 3.28; 95%CI 1.68-6.38) and intimate partner violence during pregnancy (OR = 1.47; 95% CI 1.01 - 2.12). The intimate partner violence during pregnancy was frequent in women who reported more episodes of physical violence in childhood (OR = 2.08; 95%CI 1.43-3.02) and adolescence (OR = 1.63; 95%CI 1.07-2.47), who suffered sexual violence in childhood (OR = 3.92; 95%CI 1.86-8.27), and who perpetrated violence against the partner (OR = 8.67; 95%CI 4.57-16.45). CONCLUSIONS: Experiences of violence committed by parents or other family members emerge as strong risk factors for intimate partner violence in pregnancy. Identifying and understanding protective and risk factors for the emergence of intimate partner violence in pregnancy and its maintenance may help policymakers and health service managers to develop intervention strategies.

Prevalence and factors associated with dating violence among public school adolescents / Prevalencia y factores asociados con la violencia en el noviazgo entre adolescentes de escuelas públicas / Prevalência e fatores associados à violência no namoro entre adolescentes de escola pública

ABSTRACT Objective Identify the prevalence and factors associated with dating violence among school adolescents. Method Quantitative, descriptive, cross-sectional study, conducted in a state public school in Recife, Pernambuco, in August 2018, with 270 adolescents, aged between 12 and 19 years, from middle and high school. A form was applied with questions about the characterization of the adolescents, the experience of dating relationships, and the Conflict in Adolescent Dating Relationships Inventory. Pearson's chi-square test or Fisher's exact test was used for statistical analysis. Results The prevalence of physical, sexual, and psychological victimization was 31.9%, 36.4% and 81.8%, respectively. An association was identified between religious affiliation (p = 0.002), sexual orientation of the participants (p = 0.027), and parents' education (p = 0.015) and physical victimization during dating. Conclusion Individual and contextual aspects related to dating violence among adolescents imply the need for the involvement of the school nurse in intersectoral and interdisciplinary health interventions.

RESUMEN Objetivo Identificar prevalencia y factores asociados a la violencia en el noviazgo entre adolescentes escolares. Método Estudio cuantitativo, descriptivo, transversal, realizado en una escuela pública estatal, en Recife, Pernambuco, en agosto de 2018, con 270 adolescentes, con edades comprendidas entre 12 y 19 años, de primaria y secundaria. Se aplicó un formulario con preguntas sobre la caracterización de los adolescentes, la experiencia de las relaciones amorosas y el Inventario de conflictos en las relaciones íntimas de los adolescentes. Para el análisis estadístico se utilizó la prueba de chi-cuadrado de Pearson o la prueba exacta de Fisher. Resultados La prevalencia de victimización física, sexual y psicológica fue de 31,9%; 36,4% y 81,8%, respectivamente. Se identificó una asociación entre afiliación religiosa (p = 0,002), orientación sexual de los participantes (p = 0,027) y educación de los padres (p = 0,015) con la victimización física durante el noviazgo. Conclusión Los aspectos individuales y contextuales relacionados con la violencia en el noviazgo entre adolescentes implican la necesidad de la participación de la enfermera escolar en intervenciones de salud intersectoriales e interdisciplinarias.

RESUMO Objetivo: identificar a prevalência e fatores associados à violência no namoro entre adolescentes escolares. Método: estudo quantitativo, descritivo, transversal, realizado em uma escola pública estadual, no Recife, Pernambuco, em agosto de 2018, com 270 adolescentes, entre 12 e 9 anos, do ensino fundamental e médio. Aplicou-se formulário com questões sobre a caracterização dos adolescentes e vivência de relações no namoro, como também o Inventário de Conflitos nos Relacionamentos Íntimos de Adolescentes. Utilizou-se o teste Qui-quadrado de Pearson ou o teste exato de Fisher para análise estatística. Resultados: as prevalências de vitimização física, sexual e psicológica foram 31,9%, 36,4% e 81,8%, respectivamente. Identificou-se associação entre a filiação religiosa (p=0,002), orientação sexual dos participantes (p=0,027), escolaridade dos pais (p=0,015) e a vitimização física no namoro. Conclusão: aspectos individuais e contextuais relacionados à violência no namoro entre adolescentes implicam na necessidade do envolvimento da enfermeira escolar em intervenções intersetoriais e interdisciplinares em saúde.

Physical violence by an intimate partner and the inappropriate use of prenatal care services among women in Northeastern Brazil. / Violência física pelo parceiro íntimo e uso inadequado do pré-natal entre mulheres do Nordeste do Brasil.

OBJECTIVE: To analyze the association between physical violence by an intimate partner (PVIP) and the inappropriate use of prenatal care services. METHODS: A nested cross-sectional study was conducted with 1,026 women, based on data from a prospective cohort study designed to investigate intimate partner violence among pregnant women enrolled in the Family Health Program (PSF) in Recife, Northeastern Brazil. The use of prenatal care services was assessed with basis on the guidelines from the Program for Humanization of Prenatal Care and Childbirth (Brazilian Ministry of Health) and considered the time of the first prenatal care visit and the total number of visits during the pregnancy. Data were collected through two face-to-face interviews (one in the last pregnancy trimester and the other in the postpartum period), using standardized questionnaires and data on Pregnancy Card records. An unconditional logistic regression was performed to estimate the odds ratio (OR) and the 95% confidence intervals to measure the association between an PVIP and the inappropriate use of prenatal care services, using the stepwise method. RESULTS: The prevalence of the inappropriate use of prenatal care services was 44.1% and of an PVIP, 25.6%. In the logistic regression analysis, an intimatePVIP was associated with inappropriate prenatal care (OR = 1.37; 95%CI 1.01 - 1.85; p = 0.04) after adjustment by variables confirmed as confounders (parity, alcohol use in pregnancy, and education level). CONCLUSION: Women who are victims of an PVIP have more chance of receiving inappropriate prenatal care due to late onset of prenatal care, fewer prenatal care visits, or both.