Fatores de risco para incidência e persistência de transtornos internalizantes: estudo longitudinal da infância ao início da vida adulta
Data
2024-07-18
Autores
Ribeiro, Sahâmia Martins 
Orientadores
Pan Neto, Pedro Mário
Tipo
Dissertação de mestrado
Título da Revista
ISSN da Revista
Título de Volume
Resumo
Introdução: Transtornos internalizantes são condições de saúde mental comuns, angustiantes e incapacitantes ao longo do tempo. Estudos longitudinais prospectivos têm demonstrado a associação de vários fatores com problemas internalizantes. No entanto, poucos desses estudos investigaram os múltiplos preditores e suas contribuições relativas na distinção das trajetórias de curso e na influência da persistência desses transtornos em coortes não clínicas.
Objetivos: Descrever o curso dos transtornos internalizantes em uma amostra comunitária de crianças e adolescentes e investigar quais fatores de risco estão associados à incidência e persistência desses transtornos.
Métodos: Este estudo é parte de um grande estudo prospectivo de base comunitária, o Estudo de Coorte de Alto Risco Brasileiro para Condições Mentais. A maioria dos participantes não atenderam aos critérios para um transtorno internalizante na linha de base (n=1.438; 74,2%). Por outro lado, dos participantes que preenchiam os critérios para um transtorno internalizante na linha de base (n=309; 13,8%), foram formados dois grupos: o grupo remitente (n=199; 64,4%) e o grupo persistente (n=110; 35,6%). Os diagnósticos do DSM-IV foram determinados por psiquiatras clínicos usando uma entrevista estruturada (Development and Well-Being Assessment, DAWBA). O transtorno mental parental foi avaliado pelo MINI (Mini International Neuropsychiatric Interview). A psicopatologia dimensional foi avaliada usando o Strengths and Difficulties Questionnaire (SDQ), tanto o relato dos pais quanto pelos próprios participantes. Modelos de regressão logística foram usados para analisar associações entre variáveis de linha de base e as trajetórias de curso.
Resultados: Sexo feminino, transtornos internalizantes nos pais e gravidade dos sintomas, particularmente os auto-relatados, foram associados tanto com as trajetórias incidentes quanto persistentes de transtornos internalizantes durante a adolescência. Níveis mais elevados de maus-tratos durante a infância foram relacionados apenas com a incidência dessas condições.
Conclusão: Sexo feminino, status de saúde mental dos pais e gravidade dos sintomas, particularmente auto-relatados pela criança, estão associados tanto com as trajetórias incidentes quanto persistentes de transtornos internalizantes em jovens. Esses achados podem promover estratégias de intervenção precoce visando grupos específicos com maior risco para trajetórias mais deletérias.
Introduction: Internalizing disorders are common, distressing, and impairing mental health conditions over time. Prospective longitudinal studies have demonstrated the association of several factors with internalizing problems. However, few of these studies investigated the multiple predictors and their relative contribution in distinguishing course trajectories and influencing the persistence of these disorders in non-clinical cohorts. Aims: To describe the course of internalizing disorders in a community sample of children and adolescents and to investigate which risk factors are associated with the incidence and persistence of these disorders. Methods: This study is part of a large community-based prospective study, the Brazilian High-Risk Cohort Study for Mental Conditions. Most participants did not meet the criteria for an internalizing disorder at baseline (n=1,438; 74.2%). Conversely, among the participants who met the criteria for an internalizing disorder at baseline (n=309; 13.8%), two groups were formed: the remittent group (n=199; 64.4%) and the persistent group (n=110; 35.6%). DSM-IV diagnoses were determined by clinical psychiatrists using a structured interview (Development and Well-Being Assessment, DAWBA). Parental mental disorder was assessed using the MINI (Mini International Neuropsychiatric Interview). Dimensional psychopathology was evaluated using the Strengths and Difficulties Questionnaire (SDQ) both reports by parents and participants. Logistic regression models were used to analyze associations between baseline variables and course trajectories. Results: Female sex, parental internalizing disorders, and symptom severity, particularly self-reported symptoms, were associated with both incident and persistent trajectories of internalizing disorders during adolescence. Higher levels of childhood maltreatment were associated only with the incidence of these conditions. Conclusion: Female sex, parental mental health status, and symptom severity, particularly self-reported by the child, are associated with both incident and persistente trajectories of internalizing disorders in youth. These findings may inform early intervention strategies targeting specific groups at higher risk for more deleterious trajectories.
Introduction: Internalizing disorders are common, distressing, and impairing mental health conditions over time. Prospective longitudinal studies have demonstrated the association of several factors with internalizing problems. However, few of these studies investigated the multiple predictors and their relative contribution in distinguishing course trajectories and influencing the persistence of these disorders in non-clinical cohorts. Aims: To describe the course of internalizing disorders in a community sample of children and adolescents and to investigate which risk factors are associated with the incidence and persistence of these disorders. Methods: This study is part of a large community-based prospective study, the Brazilian High-Risk Cohort Study for Mental Conditions. Most participants did not meet the criteria for an internalizing disorder at baseline (n=1,438; 74.2%). Conversely, among the participants who met the criteria for an internalizing disorder at baseline (n=309; 13.8%), two groups were formed: the remittent group (n=199; 64.4%) and the persistent group (n=110; 35.6%). DSM-IV diagnoses were determined by clinical psychiatrists using a structured interview (Development and Well-Being Assessment, DAWBA). Parental mental disorder was assessed using the MINI (Mini International Neuropsychiatric Interview). Dimensional psychopathology was evaluated using the Strengths and Difficulties Questionnaire (SDQ) both reports by parents and participants. Logistic regression models were used to analyze associations between baseline variables and course trajectories. Results: Female sex, parental internalizing disorders, and symptom severity, particularly self-reported symptoms, were associated with both incident and persistent trajectories of internalizing disorders during adolescence. Higher levels of childhood maltreatment were associated only with the incidence of these conditions. Conclusion: Female sex, parental mental health status, and symptom severity, particularly self-reported by the child, are associated with both incident and persistente trajectories of internalizing disorders in youth. These findings may inform early intervention strategies targeting specific groups at higher risk for more deleterious trajectories.
Descrição
Citação
RIBEIRO, Sahâmia Martins. Fatores de risco para incidência e persistência de transtornos internalizantes: estudo longitudinal da infância ao início da vida adulta. 2024. 91f. Dissertação (Mestrado em Psiquiatria e Psicologia Médica) - Escola Paulista de Medicina, Universidade de São Paulo (UNIFESP), São Paulo, 2024.