Prevalence of cardiometabolic risk and health factors among Puerto Rican young adults in the Boricua Youth Study - Health Assessment.

We describe and compare the prevalence of cardiometabolic risk factors and ideal cardiovascular health (CVH) among Puerto Rican young adults in the San Juan metro area in Puerto Rico and the South Bronx, NY. As part of the Boricua Youth Study - Health Assessment, (mean age 23 ± 0.1 years) objective anthropometric, blood pressure and blood samples were collected. Information on diet, physical activity and sleep were collected via surveys. Life's Essential 8 metrics were characterized as continuous with higher scores indicating more optimal CVH and categorically (80-100 scores for ideal CVH). Mean CVH score among NY participants was lower (61.9) than in PR (68.9). No participant had all ideal health metrics, 36% of participants in PR had 5 or more ideal CVH; while only 16% in NY met this criterion. The prevalence of cardiometabolic risk factors was high for obesity (35% in NY, 19% in PR) and diabetes (17% NY, 20% PR). In this ethnically homogenous population, we found low levels of ideal CVH that varied across study site, suggesting differences by sociocultural context. Interventions to maintain and improve CVH across the life course, tailored to sociocultural environments, are necessary for the prevention of cardiovascular disease.

Developing a National-Scale Exposure Index for Combined Environmental Hazards and Social Stressors and Applications to the Environmental Influences on Child Health Outcomes (ECHO) Cohort.

Tools for assessing multiple exposures across several domains (e.g., physical, chemical, and social) are of growing importance in social and environmental epidemiology because of their value in uncovering disparities and their impact on health outcomes. Here we describe work done within the Environmental influences on Child Health Outcomes (ECHO)-wide Cohort Study to build a combined exposure index. Our index considered both environmental hazards and social stressors simultaneously with national coverage for a 10-year period. Our goal was to build this index and demonstrate its utility for assessing differences in exposure for pregnancies enrolled in the ECHO-wide Cohort Study. Our unitless combined exposure index, which collapses census-tract level data into a single relative measure of exposure ranging from 0-1 (where higher values indicate higher exposure to hazards), includes indicators for major air pollutants and air toxics, features of the built environment, traffic exposures, and social determinants of health (e.g., lower educational attainment) drawn from existing data sources. We observed temporal and geographic variations in index values, with exposures being highest among participants living in the West and Northeast regions. Pregnant people who identified as Black or Hispanic (of any race) were at higher risk of living in a "high" exposure census tract (defined as an index value above 0.5) relative to those who identified as White or non-Hispanic. Index values were also higher for pregnant people with lower educational attainment. Several recommendations follow from our work, including that environmental and social stressor datasets with higher spatial and temporal resolutions are needed to ensure index-based tools fully capture the total environmental context.

Espiritismo and Santeria: a gateway to child mental health services among Puerto Rican families?

BACKGROUND: Barriers to mental health care access among Latinx children contribute to mental health disparities. It is unclear whether traditional spiritual guides in Latinx communities may function more as gateway providers or in some instances as deterrents to mental health treatment. This study assesses whether family involvement in Espiritismo and/or Santeria, two forefront non-Christian spiritual traditions among Latinx families, is associated with mental health care utilization among Puerto Rican children in two contexts. METHODS: Data are from Waves 1-3 (2000-2004) of the Boricua Youth Study, a population-based longitudinal cohort study of Puerto Rican children from San Juan and Caguas, Puerto Rico (PR), and the South Bronx, New York (SBx), 5 to 17 years of age (N = 2491). RESULTS: At baseline, 5.02% (n = 58) of the families reported involvement with Espiritismo and/or Santeria in the SBx and 3.64% (n = 52) in PR. Logistic regression models predicting mental health service use found, after adjusting for multiple risk and protective factors, that families involved with Espiritismo and/or Santeria were 2.41 times more likely (p = 0.0034) to use mental health services over the course of 3 years than children with no family involvement in these practices in the SBx. The same association was not found in PR. CONCLUSIONS: The findings among PR families in the SBx lend support to the gateway provider model in which spiritual guides open doors to mental health treatment. Forming community connections between mental health providers and traditional spiritual groups may be a culturally considerate, fruitful approach to reducing barriers to mental health treatment among Latinx families.

Association of Childhood Adversities With Suicide Ideation and Attempts in Puerto Rican Young Adults.

Importance: Racial/ethnic and sex disparities in suicide ideation and attempts are well established, with higher risk of suicide ideation and attempt among US racial/ethnic minority school-aged youths (than their White peers) and girls and women (than boys and men). The suicide-related risk of racial/ethnic minority young adults, especially young women, may be strongly influenced by adverse childhood experiences, known early determinants of suicide ideation and attempts. Objectives: To assess lifetime and past-year prevalence estimates of suicide ideation and suicide attempt and to examine sex differences in the role of adverse childhood experiences as a prospective risk factor for Puerto Rican young adults from 2 sociocultural contexts. Design, Setting, and Participants: Data in this longitudinal cohort study are from 4 waves of the Boricua Youth Study, a population-based cohort study of Puerto Rican children from San Juan and Caguas, Puerto Rico, and the South Bronx, New York, 5 to 17 years of age (N = 2491; waves 1-3: 2000-2004) and 15 to 29 years of age (wave 4: 2013-2017). Data analysis was performed from February 26, 2019, to October 16, 2020. Exposures: Adverse childhood experiences were assessed by interview in childhood and early adolescence (waves 1-3) and included child maltreatment (physical, sexual, and emotional abuse and neglect), exposure to violence, parental loss (separation, divorce, and death), and parental maladjustment (mental health problems, substance or alcohol abuse, intimate partner violence, and incarceration). Main Outcomes and Measures: Lifetime and past-year suicide ideation and attempt were assessed in young adulthood (wave 4) using the World Health Organization Composite International Diagnostic Interview. Results: Among 2004 Puerto Rican young adults (80.4% of the original cohort; mean [SD] age, 22.9 [2.8] years; 1019 [50.8%] male), young women compared with young men had a higher prevalence of lifetime suicide attempt (9.5% vs 3.6%) and lifetime suicide ideation (16.4% vs 11.5%), whereas past-year suicide ideation (4.4% vs 2.4%) was not statistically different. Logistic regression models, adjusting for demographics and lifetime psychiatric disorders, found that young women but not young men with more adverse childhood experiences had higher odds of suicide ideation (lifetime; odds ratio [OR], 2.44; 95% CI, 1.54-3.87; past year: OR, 2.56; 95% CI, 1.18-5.55). More adverse childhood experiences were also prospectively associated with lifetime suicide attempt (OR, 1.16; 95% CI, 1.04-1.29), irrespective of sex. Conclusions and Relevance: The findings of this cohort study suggest that, among Puerto Rican young adults from 2 different sociocultural contexts, adverse childhood experiences were relevant to understanding suicide attempt and suicide ideation, the latter specifically among young women. The prevention of cumulative adverse childhood experiences could reduce later risk of suicide attempts and, among young women, for suicide ideation.

Developmental Psychopathology and Ethnicity I: The Young Adulthood Assessment of the Boricua Youth Study.

OBJECTIVE: Developmental psychopathology processes pertinent to underserved ethnically diverse youths may not always coincide with those relevant to youths from nondisadvantaged groups. This article reports on the young adulthood assessment (fourth wave; April 2013 to August 2017) of the Boricua Youth Study, which includes 2 population-based samples of children of Puerto Rican background (N = 2,491) aged 5-13 years (recruited in 2000), in the South Bronx, New York, and San Juan, Puerto Rico. METHOD: Study procedures included intensive participant tracking and in-person interviews of young adults and, when possible, their parents. Study participation rates, measures, and weights are described. RESULTS: At Boricua Youth Study wave 4 (on average 11.3 years since last wave of participation), we reassessed 2,004 young adults (mean age = 22.9 years, range = 15-29 years; 51% women; retention rate adjusted for ineligibility = 82.7%) and available parents (n = 1,180). Nonparticipation was due to inability to locate/contact participants (8.6%); refusal (4.7%); and ineligible status (2.8%) owing to cognitive impairment, incarceration, or death. Among participants originally from Puerto Rico, 91% stayed in Puerto Rico during young adulthood. Of participants from the South Bronx, 52.4% remained in the area (85.8% within 100 miles). Most study measures had good internal consistency (Cronbach α ≥ .70). CONCLUSION: Our results support the viability of retaining a population-based cohort of children from the same ethnic group across 2 contexts during a life stage when individuals are likely to move. Longitudinal samples that are generalizable to underserved populations can elucidate developmental processes of relevance for curtailing the risk of psychopathology in disadvantaged contexts.

Transition Cliffs for Young Adults with Anxiety and Depression: Is Integrated Mental Health Care a Solution?

Young adulthood is a major transition period, particularly challenging for those with mental disorders. Though the prevalence of depressive and anxiety disorders is especially high, young adults are less likely to receive mental health treatment than younger and older individuals. Reasons for this mental health treatment gap are multifold and range from individual- to system-level factors that must be taken into consideration when addressing young adult mental health needs. Studies in adults and adolescents have shown that integrated care in primary care settings is an effective model of treatment of mental disorders. After providing an overview of the mental health treatment gap in this developmental period, the argument is made for research focused on integrated care models specifically tailored for young adults that takes into consideration the various needs and challenges that they face and addresses the mental health treatment gap in young adulthood.

Research Review: Intergenerational transmission of disadvantage: epigenetics and parents' childhoods as the first exposure.

BACKGROUND: For decades, economists and sociologists have documented intergenerational transmission of socioeconomic disadvantage, demonstrating that economic, political, and social factors contribute to 'inherited hardship'. Drawing on biological factors, the developmental origins of adult health and disease model posits that fetal exposure to maternal prenatal distress associated with socioeconomic disadvantage compromises offspring's neurodevelopment, affecting short- and long-term physical and mental health, and thereby psychosocial standing and resources. Increasing evidence suggests that mother-to-child influence occurs prenatally, in part via maternal and offspring atypical HPA axis regulation, with negative effects on the maturation of prefrontal and subcortical neural circuits in the offspring. However, even this in utero timeframe may be insufficient to understand biological aspects of the transmission of factors contributing to disadvantage across generations. METHODS: We review animal studies and emerging human research indicating that parents' childhood experiences may transfer epigenetic marks that could impact the development of their offspring independently of and in interaction with their offspring's perinatal and early childhood direct exposures to stress stemming from socioeconomic disadvantage and adversity. RESULTS: Animal models point to epigenetic mechanisms by which traits that could contribute to disadvantage may be transmitted across generations. However, epigenetic pathways of parental childhood experiences influencing child outcomes in the next generation are only beginning to be studied in humans. With a focus on translational research, we point to design features and methodological considerations for human cohort studies to be able to test the intergenerational transmission hypothesis, and we illustrate this with existing longitudinal studies. CONCLUSIONS: Epigenetic intergenerational transmission, if at play in human populations, could have policy implications in terms of reducing the continuation of disadvantage across generations. Further research is needed to address this gap in the understanding of the perpetuation of compromised lives across generations.

Correlations between caregiver psychiatric symptoms and offspring psychopathology in a low-resource setting

Objective: Associations between parental/caregiver depression and adverse child outcomes are well established and have been described through one or more mechanisms: child psychopathology following exposure to a depressed caregiver, child psychopathology exacerbating a caregiver's depression, and caregiver and offspring depression sharing the same etiology. Data from low and middle-income countries is scarce. We examined correlations between common symptoms of mental disorders in caregivers and their offspring's psychopathology in a Brazilian sample. Methods: In this cross-sectional study, adult caregivers were screened for depression during routine home visits by community health workers as part of the Brazilian Family Health Strategy. Caregivers with suspected depression were assessed using the Zung Self-Rating Depression Scale and the Self-Reporting Questionnaire (SRQ-20). Children's symptoms were evaluated using the Strengths and Difficulties Questionnaire (SDQ). Results: The sample included 68 primary caregivers and 110 children aged 6 to 15 years. Higher caregiver scores on the SRQ-20 correlated significantly with psychiatric symptoms in offspring. Conclusion: These results substantiate our hypothesis that child psychopathology correlates with caregivers' psychiatric symptoms. This paper adds to the growing literature on community mental health assessment and can help guide future strategies for reducing the burden of common mental disorders in caregivers and children alike in low and middle-income countries.

Correlations between caregiver psychiatric symptoms and offspring psychopathology in a low-resource setting.

OBJECTIVE: Associations between parental/caregiver depression and adverse child outcomes are well established and have been described through one or more mechanisms: child psychopathology following exposure to a depressed caregiver, child psychopathology exacerbating a caregiver's depression, and caregiver and offspring depression sharing the same etiology. Data from low and middle-income countries is scarce. We examined correlations between common symptoms of mental disorders in caregivers and their offspring's psychopathology in a Brazilian sample. METHODS: In this cross-sectional study, adult caregivers were screened for depression during routine home visits by community health workers as part of the Brazilian Family Health Strategy. Caregivers with suspected depression were assessed using the Zung Self-Rating Depression Scale and the Self-Reporting Questionnaire (SRQ-20). Children's symptoms were evaluated using the Strengths and Difficulties Questionnaire (SDQ). RESULTS: The sample included 68 primary caregivers and 110 children aged 6 to 15 years. Higher caregiver scores on the SRQ-20 correlated significantly with psychiatric symptoms in offspring. CONCLUSION: These results substantiate our hypothesis that child psychopathology correlates with caregivers' psychiatric symptoms. This paper adds to the growing literature on community mental health assessment and can help guide future strategies for reducing the burden of common mental disorders in caregivers and children alike in low and middle-income countries.

Mental health of children who work on the streets in Brazil after enrollment in a psychosocial program.

PURPOSE: To evaluate the mental health status of children working on the streets in Sao Paulo City, Brazil, two years after their participation in a psychosocial program, and to identify factors associated with their mental health status. METHODS: From a total sample of 126 children working on the streets, 107 (85%) were re-evaluated two years after the initiation of a psychosocial program which aimed to cease their work on the streets. The focus was the presence of mental health problems, defined based on a screening instrument (Strengths and Difficulties Questionnaire). Logistic regression models tested factors related to the probability that a child would not present mental health problems at follow-up. RESULTS: The likelihood of a child presenting mental health problems was higher at baseline compared to the two-year follow-up (67.5 and 56.1%, respectively). Absence of mental health problems two years after a psychosocial intervention was significantly correlated with the following baseline factors: lower level of caregiver's psychiatric symptoms as measured by the SRQ (Self-Report Questionnaire) (AOR = 0.84, p = 0.0065), absence of child physical neglect (AOR = 0.38, p = 0.0705) and parental Protestant religion affiliation, compared to other religions (AOR = 4.06; p = 0.0107). CONCLUSIONS: Different factors are related to the absence of mental health problems of children working on the streets after enrollment in a two-year psychosocial program. Our findings suggest that interventions that aim to improve child mental health should consider the detection of psychiatric symptoms in caregivers, provide treatment when it is needed, and also assess other problems such as neglect in the family setting.

Closing the mental health gap in low-income settings by building research capacity: perspectives from Mozambique.

BACKGROUND: Neuropsychiatric disorders are the leading cause of disability worldwide, accounting for 22.7% of all years lived with disability. Despite this global burden, fewer than 25% of affected individuals ever access mental health treatment; in low-income settings, access is much lower, although nonallopathic interventions through traditional healers are common in many venues. Three main barriers to reducing the gap between individuals who need mental health treatment and those who have access to it include stigma and lack of awareness, limited material and human resources, and insufficient research capacity. We argue that investment in dissemination and implementation research is critical to face these barriers. Dissemination and implementation research can improve mental health care in low-income settings by facilitating the adaptation of effective treatment interventions to new settings, particularly when adapting specialist-led interventions developed in high-resource countries to settings with few, if any, mental health professionals. Emerging evidence from other low-income settings suggests that lay providers can be trained to detect mental disorders and deliver basic psychotherapeutic and psychopharmacological interventions when supervised by an expert. OBJECTIVES: We describe a new North-South and South-South research partnership between Universidade Eduardo Mondlane (Mozambique), Columbia University (United States), Vanderbilt University (United States), and Universidade Federal de São Paulo (Brazil), to build research capacity in Mozambique and other Portuguese-speaking African countries. CONCLUSIONS: Mozambique has both the political commitment and available resources for mental health, but inadequate research capacity and workforce limits the country's ability to assess local needs, adapt and test interventions, and identify implementation strategies that can be used to effectively bring evidence-based mental health interventions to scale within the public sector. Global training and research partnerships are critical to building capacity, promoting bilateral learning between and among low- and high-income settings, ultimately reducing the mental health treatment gap worldwide.

Physical characteristics of the environment and BMI of young urban children and their mothers.

The study examined whether characteristics of the urban physical environment are associated with child and maternal body mass index (BMI) in a sample of 3 year-old children and their mothers from 18 US cities (N=1997 dyads). BMI was determined based on measured height and weight. Characteristics of the interior and exterior physical environment, assessed and rated by trained interviewers, were related to child BMI at age 3 and to their mother's BMI. Negative aspects of the physical environment were more strongly related to maternal BMI among whites than among African-Americans or Hispanics.

A saúde mental infantil na Saúde Pública brasileira: situação atual e desafios / Child mental health and Public Health in Brazil: current situation and challenges

OBJETIVO: Descrever e analisar a situação atual de desenvolvimento da política pública brasileira de saúde mental infantil e juvenil, com foco nos Centros de Atenção Psicossocial Infanto-juvenil e na rede intersetorial potencial de atenção à saúde mental infantil e juvenil que engloba outras políticas relacionadas à criança e ao adolescente em âmbito nacional. MÉTODO: Análise de publicações e dados oficiais do governo brasileiro sobre a implantação e/ou distribuição de serviços públicos nacionais relacionados à criança e ao adolescente. RESULTADOS: A política brasileira de saúde mental infantil e juvenil tem como ação central a implementação de Centros de Atenção Psicossocial Infanto-Juvenil para atendimento dos casos de transtornos mentais que envolvem prejuízos funcionais severos e persistentes. Existe uma rede intersetorial potencial de cuidado que pode se efetivar com a articulação das ações específicas de saúde mental infantil e juvenil nos setores da saúde geral/atenção básica, educação, assistência social e justiça/direitos. Esta articulação será de grande importância para o atendimento de problemas mais freqüentes, que envolvem prejuízos mais pontuais. DISCUSSÃO: No Brasil, o incremento do sistema de cuidados depende da expansão da rede de serviços de saúde mental infantil e juvenil, dos mais aos menos especializados, e de sua articulação efetiva com outros setores públicos dedicados ao cuidado da infância e adolescência.

OBJECTIVE: To describe and analyze current developments in the Brazilian child and adolescent mental health public policy, focusing on the Centers for Psychosocial Care for Children and Adolescents and in a potential child and adolescent mental health care system, derived from other child and adolescent public policies in the national context. METHOD: Examination of publications and official data produced by the Brazilian government about the implementation and/or distribution of public services for children and adolescents in the country. RESULTS: The Brazilian child and adolescent mental health policy has as one of its main strategies the implementation of Centers for Psychosocial Care for Children and Adolescents to cover persistent child psychiatric disorders with severe levels of impairment. In addition, there is a potential intersectorial system which would become effective once specific child mental health actions are articulated with the sectors of general health, education, child welfare and justice/rights. This articulation will play an important role in responding to psychiatric disorders which are frequent with impairment of very specific areas of functioning. DISCUSSION: In Brazil, improvement of the child and adolescent mental health care system relies upon the expansion of the mental health specialty sector as well as in its articulation with other public sectors responding to child and adolescent needs.

Worldwide child and adolescent mental health begins with awareness: a preliminary assessment in nine countries.

To temper untoward mental health outcomes in children and adolescents, the World Psychiatric Association's Presidential Global Child Mental Health Programme, in collaboration with the WHO and the International Association of Child and Adolescent Psychiatry and Allied Professionals, established a Child Mental Health Awareness Task Force headed by Sam Tyano. Its task was to develop methodologies to increase awareness among policy-makers, community leaders, health professionals, teachers, parents, and children. Based on a prior comprehensive international search for effective techniques for information dissemination, an awareness manual was written for use by health professionals in diverse communities so as to guide the design and implementation of location specific awareness campaigns. We assessed the children, parents and teachers both before and after the campaign to determine changes in knowledge, attitudes and understanding of mental health. The school-based studies were conducted in selected communities in nine countries on five different continents distinguished by their different languages, cultures and their differing levels of economic development: Armenia, Azerbaijan, Brazil, China, Egypt, Georgia, Israel, Russia, and Uganda. In the six sites that completed all assessments, indicators of positive change in awareness of child mental health were identified, and results demonstrated an increased willingness to discuss emotional problems freely. These data support the utility of collaborating with schools so as to foster better child mental health in such under-resourced communities.

[Child mental health and Public Health in Brazil: current situation and challenges]. / A saúde mental infantil na Saúde Pública brasileira: situação atual e desafios.

OBJECTIVE: To describe and analyze current developments in the Brazilian child and adolescent mental health public policy, focusing on the Centers for Psychosocial Care for Children and Adolescents and in a potential child and adolescent mental health care system, derived from other child and adolescent public policies in the national context. METHOD: Examination of publications and official data produced by the Brazilian government about the implementation and/or distribution of public services for children and adolescents in the country. RESULTS: The Brazilian child and adolescent mental health policy has as one of its main strategies the implementation of Centers for Psychosocial Care for Children and Adolescents to cover persistent child psychiatric disorders with severe levels of impairment. In addition, there is a potential intersectorial system which would become effective once specific child mental health actions are articulated with the sectors of general health, education, child welfare and justice/rights. This articulation will play an important role in responding to psychiatric disorders which are frequent with impairment of very specific areas of functioning. DISCUSSION: In Brazil, improvement of the child and adolescent mental health care system relies upon the expansion of the mental health specialty sector as well as in its articulation with other public sectors responding to child and adolescent needs.

Prevalence of mental health problems in children and adolescents from the outskirts of Sao Paulo City: treatment needs and service capacity evaluation.

OBJECTIVE: To estimate the prevalence of mental health problems in children and adolescents, with or without considering global impairment, within a low-income urban community; to estimate the public service delivery capacity in terms of mental healthcare; and to determine the relationship between delivery capacity and treatment demand. METHOD: Cross-sectional study. Probabilistic sample of clusters including all eligible households (low-income community - Embu, Southeastern Brazil). PARTICIPANTS: 479 children and adolescents (aged 6-17 years; attrition rate: 18.8%). MEASUREMENT: 1) Clinical mental health problems in children and adolescents using the Child Behavior Checklist and/or Youth Self-Report total problem scales; 2) Global impairment: positive score in the Brief Impairment Scale (total score > 15.5); 3) Care service capacity: total number of cases annually seen by psychologists/psychiatrists in the health, education, juvenile justice, and child welfare sectors. RESULTS: Prevalence of mental health problems in children and adolescents: 24.6% (20.7-28.5) without considering global impairment; 7.3% (5.0-9.6) with global impairment (cases in need of treatment). Current annual service capacity can only provide care for 14.0% of impaired cases; approximately seven years would be necessary for all to be treated. CONCLUSIONS: Mental health problems in children and adolescents are frequent in the studied community, and the current structure of the community's public service system is not prepared to treat impaired cases in an adequate timeframe.

Prevalence of mental health problems in children and adolescents from the outskirts of Sao Paulo City: treatment needs and service capacity evaluation

OBJECTIVE: To estimate the prevalence of mental health problems in children and adolescents, with or without considering global impairment, within a low-income urban community; to estimate the public service delivery capacity in terms of mental healthcare; and to determine the relationship between delivery capacity and treatment demand. METHOD: Cross-sectional study. Probabilistic sample of clusters including all eligible households (low-income community - Embu, Southeastern Brazil). Participants: 479 children and adolescents (aged 6-17 years; attrition rate: 18.8 percent). Measurement: 1) Clinical mental health problems in children and adolescents using the Child Behavior Checklist and/or Youth Self-Report total problem scales; 2) Global impairment: positive score in the Brief Impairment Scale (total score > 15.5); 3) Care service capacity: total number of cases annually seen by psychologists/psychiatrists in the health, education, juvenile justice, and child welfare sectors. RESULTS: Prevalence of mental health problems in children and adolescents: 24.6 percent (20.7-28.5) without considering global impairment; 7.3 percent (5.0-9.6) with global impairment (cases in need of treatment). Current annual service capacity can only provide care for 14.0 percent of impaired cases; approximately seven years would be necessary for all to be treated. CONCLUSIONS: Mental health problems in children and adolescents are frequent in the studied community, and the current structure of the community's public service system is not prepared to treat impaired cases in an adequate timeframe.

OBJETIVO: Estimar a prevalência de problemas de saúde mental em crianças e adolescentes, com e sem prejuízo funcional global, em comunidade urbana de baixa renda; estimar a capacidade de assistência da rede pública de serviços do município; e relacionar a capacidade de assistência à necessidade de tratamento em saúde mental da infância/adolescência. MÉTODO: Estudo transversal. Amostra probabilística de conglomerados incluindo todos os domicílios elegíveis (bairro de baixa renda, Embu-SP). Participantes: 479 crianças/adolescentes (6-17 anos; perda amostral: 18,8 por cento). Medidas: 1) problemas de saúde mental em crianças e adolescentes em nível clínico pela escala de total de problemas do Child Behavior-Checklist e/ou Youth Self-Report; 2) prejuízo funcional global: escore total > 15,5 na Brief Impairment Scale; 3) Capacidade de assistência: total de casos atendidos anualmente por psicólogos/psiquiatras nos setores de saúde, educação, justiça e cidadania/assistência social. RESULTADOS: Prevalência de problemas de saúde mental em crianças e adolescentes: 24,6 por cento (20,7-28,5) desconsiderando prejuízo funcional global; 7,3 por cento (5,0-9,6) com prejuízo funcional global (casos que necessitam tratamento). A capacidade anual de assistência dos casos com prejuízo funcional global é de 14,0 por cento; sendo necessários cerca de sete anos para que todos possam ser tratados. CONCLUSÕES: Problemas de saúde mental em crianças e adolescentes são freqüentes na comunidade estudada e a infra-estrutura atual da rede pública de serviços do município não está preparada para atender em tempo hábil os casos que necessitam tratamento.