Maternidade e paternidade na esquizofrenia: o impacto da doença na vida de pacientes e seus filhos
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Data
2006
Autores
Terzian, Angela Cristina Cesar [UNIFESP]
Orientadores
Mari, Jair de Jesus [UNIFESP]
Tipo
Tese de doutorado
Título da Revista
ISSN da Revista
Título de Volume
Resumo
Objetivos: Determinar e analisar as taxas de reprodução de pacientes com
esquizofrenia, comparando com as taxas encontradas na população geral.
Identificar o ajustamento social de filhos de pacientes com esquizofrenia, com idade
de 18 anos ou mais e comparar com os dados referentes à população geral.
Métodos: Pacientes com diagnóstico de esquizofrenia, atendidos no
PROESQ/UNIFESP (São Paulo) e nos serviços públicos ambulatoriais de saúde
mental de Cuiabá (Mato Grosso), responderam um questionário padronizado. Três
taxas de reprodução foram estudadas: taxa de casamento (calculada pela proporção
de pacientes alguma vez casados entre todos os pacientes), fertilidade (definida
como a habilidade de produzir filhos vivos) e fecundidade (média do número de
filhos entre os indivíduos que tiveram filhos). No segundo estudo, os pacientes
forneceram informações referentes a seus filhos através de um questionário
estruturado. O ajustamento social de filhos de pacientes foi avaliado pelas variáveis:
defasagem escolar, inserção no mercado de trabalho e situação conjugal. As
estimativas populacionais foram obtidas através dos dados do Censo Brasileiro.
Resultados: No primeiro estudo foram identificados 167 pacientes dos quais 33
(19.8%) foram alguma vez casados. A fertilidade foi de 15.8% para homens e 25%
para mulheres (p=0.14) e a fecundidade foi de 1.75 para homens e 1.69 para
mulheres (p=0.85). Análise de regressão logística identificou associação entre idade
de início da doença mais tardio com maior taxa de casamento (p=0.003). Pacientes
mostraram menores taxas de reprodução em comparação a população geral. A taxa
de casamento foi de 17.6% para pacientes do sexo masculino e 68.0% para
população masculina e de 23.1% para pacientes do sexo feminino e 71.0% para a
população feminina geral (IC95% 10.21 – 24.99; IC95% 12.85 – 33.35,
respectivamente). A taxa de fertilidade foi de 31.6% (IC95% 16.82 – 46.38) para
pacientes do sexo feminino com idade entre 25-44 anos e de 73.1% para a
população feminina e de 28.6% (IC95% 4.9 – 52.3) para pacientes com 45 anos ou
mais e de 87.3% para a população feminina na mesma faixa etária. A fecundidade
foi de 1.69 (IC95% 1.02 – 2.35) para pacientes e de 2.71 para a população feminina
geral. No segundo estudo, 489 pacientes com diagnóstico de esquizofrenia foram
identificados; 232 (47.4%) eram homens. Média de idade atual foi de 41.5 anos
(DP=11.6) e 290 pacientes (59.3%) eram ou tinham sido alguma vez casados.
Noventa e dois pacientes do sexo masculino (39.7%) foram pais e 202 pacientes do
sexo feminino (78.6%) eram mães (p<0.001). A fecundidade foi de 3.2 para
pacientes do sexo masculino e 3.4 para pacientes do sexo feminino. Um total de 828
filhos foi identificado e foram selecionados para o estudo, os dados de 431 filhos
com 18 anos ou mais. A porcentagem de defasagem escolar foi de 59.2% (IC95%
45.4 – 73.0) para filhos de pacientes, nas idades de 18 e 19 anos, e de 71.1% na
população, não havendo diferença estatisticamente significante. Filhos de pacientes
mostraram menor inserção no mercado de trabalho quando comparados à
população geral (66.7% e 75.6% respectivamente; IC95% 62.1 – 71.3). Filhos do sexo
masculino foram menos casados do que a população masculina geral (54.7% e
66.0% respectivamente; IC95% 48.2 – 61.2). Conclusões: Pacientes com
esquizofrenia apresentaram diferentes taxas de reprodução entre os estudos.
Contudo, muitos pacientes com esquizofrenia tiveram filhos e uma parcela
significativa destes filhos, durante a vida adulta, apresentaram prejuízo no
ajustamento social, com menor inserção no mercado de trabalho e menor
probabilidade de terem sido casados. Estes resultados apontam para a necessidade
de serem desenvolvidas, em nosso país, políticas de ações preventivas para
pacientes com esquizofrenia e seus filhos e a criação de serviços de saúde que
atendam as necessidades destes indivíduos.
Objectives: To determine and analyze the reproduction rates of patients with schizophrenia and comparing findings with population rates. To identify the social adjustment of these patients’ adult offspring. Methods: Patients diagnosed with schizophrenia, attending the PROESQ/UNIFESP (Sao Paulo) and the public mental health clinics in the city of Cuiaba (Mato Grosso State), responded to a standardized questionnaire. Three outcomes were investigated: marital rate (proportion of subjects ever married), fertility (ability to procreate), and fecundity (number of offspring produced by a fertile individual). In a second study, patients provided information about their children by way of a structured questionnaire. Data about offspring education, employment and marital status were collected. Brazilian census data was used for comparison. Results: In the first study, of the 167 participating patients 33 (19.8%) had been married at some point. Their fertility rate was: 15.8% for men and 25.0% for women (p=0.14) and fecundity was: 1.75 for men and 1.69 for women (p=0.85). A logistic regression analysis identified an association between a later age at onset of illness and a higher rate of marriage (p=0.003). Patients showed lower reproductive rates when compared to the expect findings in the São Paulo city population. The marital rate was 17.6% for male patients and 68.0% for male population, and 23.1% for female patients and 71.0% for female population (CI95% 10.21 – 24.99; CI95% 12.85 – 33.35, respectively). The fertility rate for female patients was 31.6% (CI95% 16.82 – 46.38) and 73.1% for the female population in the age range 25-44 years and 28.6% for patients (CI95% 4.9 – 52.3) and 87.3% for the population in the age range 45 years and over. The fecundity for women in sample was 1.69 (CI95% 1.02 – 2.35) and 2.71 for the female population. In the second study, 489 patients with a DSM-IV diagnosis of schizophrenia were identified; 232 (47.4%) were men. Mean current age was 41.5 years (SD=11.6), and 290 (59.3%) had been married at least once. Ninety-two (39.7%) of the male patients were fathers and 202 (78.6%) of the female patients had at least one liveborn infant, and this difference was statistically significant (p<0.001). Fecundity was 3.2 for men and 3.4 for women. A total of 828 children were identified; 431 were 18 years or older and were thus included in the study. The percentage of age-grade discrepancy was 59.2% (CI95% 45.4 – 73.0) for the patients’ offspring at the ages of 18 and 19 years, and of 71.1% in the general population, there being no statistically significant difference. The patients’ offspring had lower employment situation when compared with the general population (66.7% and 75.6% respectively; CI95% 62.1 – 71.3). Sons were less married than the general male population (54.7% and 66.0% respectively; CI95% 48.2 – 61.2). Conclusion: Patients with schizophrenia demonstrated different reproduction rates between the two studies. Nevertheless, many patients with schizophrenia had children and one significant sector of these children, during their adult life, showed impairment in their social adjustment. These results point to the need, within the country, to develop health policies that cover this reality and attend to the needs of these individuals.
Objectives: To determine and analyze the reproduction rates of patients with schizophrenia and comparing findings with population rates. To identify the social adjustment of these patients’ adult offspring. Methods: Patients diagnosed with schizophrenia, attending the PROESQ/UNIFESP (Sao Paulo) and the public mental health clinics in the city of Cuiaba (Mato Grosso State), responded to a standardized questionnaire. Three outcomes were investigated: marital rate (proportion of subjects ever married), fertility (ability to procreate), and fecundity (number of offspring produced by a fertile individual). In a second study, patients provided information about their children by way of a structured questionnaire. Data about offspring education, employment and marital status were collected. Brazilian census data was used for comparison. Results: In the first study, of the 167 participating patients 33 (19.8%) had been married at some point. Their fertility rate was: 15.8% for men and 25.0% for women (p=0.14) and fecundity was: 1.75 for men and 1.69 for women (p=0.85). A logistic regression analysis identified an association between a later age at onset of illness and a higher rate of marriage (p=0.003). Patients showed lower reproductive rates when compared to the expect findings in the São Paulo city population. The marital rate was 17.6% for male patients and 68.0% for male population, and 23.1% for female patients and 71.0% for female population (CI95% 10.21 – 24.99; CI95% 12.85 – 33.35, respectively). The fertility rate for female patients was 31.6% (CI95% 16.82 – 46.38) and 73.1% for the female population in the age range 25-44 years and 28.6% for patients (CI95% 4.9 – 52.3) and 87.3% for the population in the age range 45 years and over. The fecundity for women in sample was 1.69 (CI95% 1.02 – 2.35) and 2.71 for the female population. In the second study, 489 patients with a DSM-IV diagnosis of schizophrenia were identified; 232 (47.4%) were men. Mean current age was 41.5 years (SD=11.6), and 290 (59.3%) had been married at least once. Ninety-two (39.7%) of the male patients were fathers and 202 (78.6%) of the female patients had at least one liveborn infant, and this difference was statistically significant (p<0.001). Fecundity was 3.2 for men and 3.4 for women. A total of 828 children were identified; 431 were 18 years or older and were thus included in the study. The percentage of age-grade discrepancy was 59.2% (CI95% 45.4 – 73.0) for the patients’ offspring at the ages of 18 and 19 years, and of 71.1% in the general population, there being no statistically significant difference. The patients’ offspring had lower employment situation when compared with the general population (66.7% and 75.6% respectively; CI95% 62.1 – 71.3). Sons were less married than the general male population (54.7% and 66.0% respectively; CI95% 48.2 – 61.2). Conclusion: Patients with schizophrenia demonstrated different reproduction rates between the two studies. Nevertheless, many patients with schizophrenia had children and one significant sector of these children, during their adult life, showed impairment in their social adjustment. These results point to the need, within the country, to develop health policies that cover this reality and attend to the needs of these individuals.
Descrição
Citação
TERZIAN, A CC. Maternidade e paternidade na esquizofrenia: o impacto da doença na vida de pacientes e seus filhos. São Paulo, 2006. 98 f. Tese (Doutorado em Psiquiatria) - Escola Paulista de medicina (EPM), Universidade Federal de São Paulo (UNIFESP), São Paulo, 2006.