ABSTRACT
Introduction: In Colombia, children are frequently exposed to traumatic events; however, there are no data regarding the impact on depression, anxiety and somatic correlates of such exposure in children living in rural communities. Objective: To investigate the somatic complaints and symptoms of depression and anxiety among children exposed to traumatic events in a rural community of Colombia. Methods: Design: Cross-Sectional study. Participants: Two hundred and ninety-three Colombian children aged eight to 18 years. Main Outcome Measures: Standardized measures were administered to assess children's depression, anxiety, physical symptoms and exposure to traumatic events. Depression: CDI (Children's Depression Inventory); anxiety: SCARED (The Screen for Child Anxiety Related Emotional Disorders); somatic complaints: CBCL (Child Behavior Checklist, Somatic Complaints scale) and reporting traumatic events during the K-SADS-PL (Diagnostic Interview for Children and Adolescents). Results: Ninety-one of the 293 children (31.1%) reported somatic complaints. The most common somatic complaint was in the gastrointestinal category (35/91). One hundred and seventy eight children (60.5%) had observed traumatic events, including homicides during the last month. Two hundred five (69.9%) of the children showed depressive symptom profiles above established norms, and 239 (81.6%) exhibited anxiety symptoms according to their own reports. The correlation between depression and traumatic events, anxiety and somatic complaints, and between anxiety and depression were statistically significant (p<0.005). Conclusions: As the first study of its kind in children living in rural communities in Colombia, it demonstrates a clear impact of traumatic events on mental health. Information that somatic complaints are commonly an expression of underlying depression and anxiety may facilitate the treatment and thereby help avoid unnecessary medical workups and sequelae from traumatized children. It is important for physicians to probe for "hidden" symptoms in traumatized children.
Introducción: En Colombia, los niños están expuestos con frecuencia a eventos traumáticos, sin embargo, no hay datos sobre el impacto de la depresión, la ansiedad y la correlación somática de dicha exposición en niños que viven en comunidades rurales. Objetivo: investigar las alteraciones somáticas, síntomas de depresión y ansiedad en los niños expuestos a eventos traumáticos en una comunidad rural de Colombia. Metodología: Diseño: Estudio transversal; Participantes: Doscientos noventa y tres niños colombianos de ocho a 18 años. Principales medidas de resultado: se aplicaron medidas estandarizadas para evaluar la depresión infantil, ansiedad, síntomas físicos y la exposición a eventos traumáticos. Depresión:CDI (Children's Depression Inventory)). Ansiedad: SCARED (The Screen for Child Anxiety Related Emotional Disorders), Enfermedades somáticas: CBCL (Child Behavior Checklist, Somatic Complaints scale) e informar los eventos traumáticos durante el K -SADS -PL (Diagnostic Interview for Children and Adolescents). Resultados: Noventa y uno de los 293 niños ( 31,1 % ) informaron de síntomas somáticos. La queja somática más común estuvo en la categoría gastrointestinal (35/ 91). Ciento setenta y ocho niños ( 60,5 % ) habían observado los acontecimientos traumáticos, incluyendo homicidios durante el último mes. Doscientos cinco ( 69,9 % ) de los niños mostraron perfiles de síntomas depresivos por encima de las normas establecidas, y 239 ( 81,6 % ) presentaban síntomas de ansiedad según sus propios informes. La correlación entre la depresión y los eventos traumáticos, la ansiedad y quejas somáticas, y entre la ansiedad y la depresión fueron estadísticamente significativas ( p < 0,005 ). Conclusiones: como el primer estudio de su tipo en los niños que viven en comunidades rurales de Colombia , demuestra un claro impacto de eventos traumáticos en la salud mental. La afirmación que las quejas somáticas son comúnmente una expresión de la depresión y la ansiedad subyacente puede facilitar el tratamiento y de ese modo ayudar a evitar abordajes médicos innecesarios y secuelas en los niños traumatizados . Es importante para los médicos explorar los síntomas "ocultos" en los niños traumatizados.
ABSTRACT
OBJECTIVE: This multicenter study estimated the prevalence of bipolar disorder (BPD) among emergency department (ED) patients in Latin America. METHODS: To identify patients with BPD, a combination of DSM IV-criteria interview and the Mood Disorder Questionnaire (MDQ) was used. Data from 1,505 patients from hospitals in Argentina, Brazil, Chile, Colombia, and Mexico was analyzed. RESULTS: The prevalence ofBPD in this sample was 5.2% (95% CI = 4.5% to 6.9%). The mean age was 37 years (response rate of 83.0%). Compared to non-BPD patients, BPD patients were more likely to report asthma (16.7% vs. 9%), thyroid problems (12.8% vs. 5.8%), seizures (23.1% vs. 3.0%), obesity (39.7% vs. 26.9%), alcohol abuse (30.8% vs. 10.0%), attention deficit hyperactivity disorders (50.0% vs. 12.0%), depression (81.6% vs. 45.7%), obsessive compulsive disorder (20.1% vs. 3.0%), panic disorders (23.1% vs. 12.3%), phobic disorders (11.2% vs. 3.1%), and any anxiety disorder (82.1 % vs. 41.8%; all p < or = 0.05). Suicidal plans and attempts were also significant higher in the bipolar group (11.5% vs. 2.8% and 10.3% vs. 1.8% respectively). Multivariate analysis identified ADHD, depression, alcohol abuse, anxiety disorder, and last month suicide plans and attempts to be independently associated with BPD. CONCLUSION: Our study supports that BPD is prevalent in ED in Latin-American countries and that comorbidity is the rule, not the exception. Patients presenting at ED with irritability, anxiety, pressure speech, euphoria, with suicidal tendencies, involved in risky behaviors, alcohol abuse, dependence or those with history of mental health hospitalization in the past 12 months must be assessed for comorbid BPD.
