Associação de sintomas psiquiátricos gerais com uso de drogas e sintomas alimentares em adolescentes brasileiros e suas implicações para os programas de prevenção escolares
Date
2022-12-01
Authors
Almeida, Mireille Coêlho de [UNIFESP]
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Sanchez, Zila van der Meer [UNIFESP]
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Tese de doutorado
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Abstract
Introdução. Na adolescência, observa-se um importante risco para o surgimento de sintomas psiquiátricos gerais, uso de álcool e outras drogas e sintomas alimentares. No Brasil, o Ministério da Saúde, em parceria com a Universidade Federal de São Paulo (UNIFESP), tem investido desde 2013 no desenvolvimento do Programa de Prevenção Escolar ao Uso de Drogas #Tamojunto 2.0. De base teórica psicossocial, o #Tamojunto 2.0 trabalha no fortalecimento de fatores de proteção globais, através do desenvolvimento de habilidades de vida. Dessa forma, apesar de não ter sido previsto em seu modelo teórico, ele também poderia ser um fator protetor para o surgimento de sintomas psiquiátricos gerais e sintomas alimentares nessa faixa etária. Considerando a frequente associação dos sintomas psiquiátricos gerais com uso de álcool e outras drogas e com sintomas alimentares, essa tese tem como objetivo principal avaliar os possíveis efeitos secundários do programa de Prevenção #Tamojunto 2.0 na redução de sintomas psiquiátricos em adolescentes de escolas públicas brasileiras, assim como investigar a associação desses sintomas com o uso de drogas e os sintomas alimentares apresentados. Metodologia. Através do ensaio controlado randomizado por cluster realizado para avaliar a efetividade do #Tamojunto 2.0, obtivemos os dados para análises apresentadas nesta tese. Participaram 5208 alunos de 8º ano do ensino fundamental de escolas públicas de três cidades brasileiras. 73 escolas foram randomizadas, para participação no Programa #Tamojunto 2.0, que foi implantado em 2019. A intervenção consistia em 12 aulas aplicadas pelo professor, previamente treinado. O grupo controle não recebeu nenhum programa preventivo no mesmo ano. O instrumento para coleta de dados era anônimo e de autopreenchimento, tendo sido aplicado em dois momentos: antes da intervenção, e 9 meses depois dela. Foram realizadas análises de predição, moderação e mediação, com produção de três artigos. Resultados. No primeiro artigo, observamos que os preditores do uso de drogas entre os adolescentes brasileiros foram: sexo feminino, idade maior, uso prévio de álcool e outras drogas, e a presença de sintomas psiquiátricos no baseline. Apesar disso, não encontramos evidências de efeito moderador dos sintomas psiquiátricos na resposta ao programa #Tamojunto 2.0. No segundo artigo, sugerimos que o SCOFF seja considerado um instrumento de rastreio útil para uso em adolescentes brasileiros, e identificamos uma alta prevalência de sintomas alimentares na população estudada, além de uma significativa associação desses sintomas com sintomas psiquiátricos gerais, especialmente as dificuldades emocionais. No terceiro artigo confirmamos que o #Tamojunto 2.0 não interferiu direta ou indiretamente na presença de sintomas alimentares dos adolescentes, porém evidenciamos o efeito mediador das seguintes variáveis: insatisfação corporal e sintomas psiquiátricos (aumentam o risco) e capacidade de tomada de decisões e habilidades de recusa (diminuem o risco). Conclusão. Dessa forma, entendemos que a necessidade de estratégias de saúde pública direcionadas aos adolescentes brasileiros é urgente. Sugerimos ainda que o foco dessas medidas seja o desenvolvimento de programas de prevenção escolares que abordem simultaneamente os sintomas psiquiátricos gerais, uso de álcool e outras drogas, e sintomas alimentares.
Introduction. Adolescence represents an important risk for the onset of general psychiatric symptoms, use of alcohol and other drugs and disordered eating. In Brazil, the Ministry of Health, in partnership with Universidade Federal de São Paulo (UNIFESP), has invested since 2013 in the development of the of the school-based drug use prevention program #Tamojunto 2.0. Based on psychosocial theory, #Tamojunto 2.0 works to strengthen global protective factors through the enhancement of life skills. Thus, despite not having been predicted in its theoretical model, it could also be a protective factor for the emergence of general psychiatric symptoms and disordered eating in this age group. Considering the common association of psychiatric symptoms, use of alcohol and other drugs, and disordered eating, the main objective of this thesis is to evaluate the secondary effects of the prevention program #Tamojunto 2.0 in the reduction of psychiatric symptoms of adolescents from Brazilian public schools, as well as to investigate the association of these symptoms with drug use and disordered eating. Methodology. Through the cluster randomized controlled trial carried out to evaluate the effectiveness of #Tamojunto 2.0, we obtained the data for the analyzes presented in this thesis. A total of 5208 8th grade students from public schools of three Brazilian cities participated. 73 schools were randomized to participate in #Tamojunto 2.0, which was implemented in 2019. Intervention consisted of 12 lessons administered by teachers, that were previously trained. Control group did not receive any prevention program in the same year. The instrument for data collection was anonymous and self-completed, having been applied in two moments: before intervention, and 9 months after it. Prediction, moderation and mediation analyzes were performed, with the elaboration of three papers. Results. In the first article, we found that predictors of drug use among Brazilian adolescents were: female sex, older age, previous use of alcohol and other drugs, and the presence of psychiatric symptoms at baseline. Despite that, we found no evidence of a moderating effect of psychiatric symptoms on the response to #Tamojunto 2.0 program. In the second article, we suggested that SCOFF be considered a useful screening tool for use in Brazilian adolescents, and we identified a high prevalence of disordered eating in the population of the study, mainly emotional difficulties. In the third article, we confirmed that #Tamojunto 2.0 did not interfere directly or indirectly in the presence of disordered eating, but we evidenced the mediating role of the following variables: body dissatisfaction and psychiatric symptoms (increasing the risk) and decision-making skills and refusal skills (reducing the risk). Conclusion. We realized that the need for public health strategies aimed at Brazilian adolescents is urgent. We also suggest that the focus of these measures be the development of school-based prevention programs that simultaneously address general psychiatric symptoms, use of alcohol and other drugs, and disordered eating.
Introduction. Adolescence represents an important risk for the onset of general psychiatric symptoms, use of alcohol and other drugs and disordered eating. In Brazil, the Ministry of Health, in partnership with Universidade Federal de São Paulo (UNIFESP), has invested since 2013 in the development of the of the school-based drug use prevention program #Tamojunto 2.0. Based on psychosocial theory, #Tamojunto 2.0 works to strengthen global protective factors through the enhancement of life skills. Thus, despite not having been predicted in its theoretical model, it could also be a protective factor for the emergence of general psychiatric symptoms and disordered eating in this age group. Considering the common association of psychiatric symptoms, use of alcohol and other drugs, and disordered eating, the main objective of this thesis is to evaluate the secondary effects of the prevention program #Tamojunto 2.0 in the reduction of psychiatric symptoms of adolescents from Brazilian public schools, as well as to investigate the association of these symptoms with drug use and disordered eating. Methodology. Through the cluster randomized controlled trial carried out to evaluate the effectiveness of #Tamojunto 2.0, we obtained the data for the analyzes presented in this thesis. A total of 5208 8th grade students from public schools of three Brazilian cities participated. 73 schools were randomized to participate in #Tamojunto 2.0, which was implemented in 2019. Intervention consisted of 12 lessons administered by teachers, that were previously trained. Control group did not receive any prevention program in the same year. The instrument for data collection was anonymous and self-completed, having been applied in two moments: before intervention, and 9 months after it. Prediction, moderation and mediation analyzes were performed, with the elaboration of three papers. Results. In the first article, we found that predictors of drug use among Brazilian adolescents were: female sex, older age, previous use of alcohol and other drugs, and the presence of psychiatric symptoms at baseline. Despite that, we found no evidence of a moderating effect of psychiatric symptoms on the response to #Tamojunto 2.0 program. In the second article, we suggested that SCOFF be considered a useful screening tool for use in Brazilian adolescents, and we identified a high prevalence of disordered eating in the population of the study, mainly emotional difficulties. In the third article, we confirmed that #Tamojunto 2.0 did not interfere directly or indirectly in the presence of disordered eating, but we evidenced the mediating role of the following variables: body dissatisfaction and psychiatric symptoms (increasing the risk) and decision-making skills and refusal skills (reducing the risk). Conclusion. We realized that the need for public health strategies aimed at Brazilian adolescents is urgent. We also suggest that the focus of these measures be the development of school-based prevention programs that simultaneously address general psychiatric symptoms, use of alcohol and other drugs, and disordered eating.