Objective: To describe the service use profile of Child and Adolescent Psychosocial Care Centers (Centro de Atenção Psicossocial Infanto-Juvenil [CAPSi]) in Brazil regarding diagnostic categories, sociodemographic aspects, and care modalities between 2008 and 2012. Methods: A descriptive, ecological study was performed using data from the Unified Health System regarding high-complexity procedure authorizations (Autorização de Procedimentos de Alta Complexidade [APAC]) for the period from 2008-2012. The variables sex, age, diagnosis (F00-F99 of ICD-10), and type of care provided were examined. The data were processed using TabWin and STATA version 12. Results: A total of 837,068 records were examined, each representing one visit to CAPSi. Most visits were by male users (68.8%). The most common diagnoses were hyperkinetic disorders (13%), pervasive developmental disorders (12.4%), and conduct disorders (8.4%). Conclusions: Behavioral and emotional disorders that usually appear during childhood or adolescence and psychological development disorders were frequent, with more than 50% of the latter comprising autism spectrum disorders. Regional differences were observed, with a higher presence of this diagnosis in the Southeast, while the North and Northeast had a high percentage of visits due to mental retardation.

Objective: To develop, implement, and verify the impact of a training program for health care providers working with children with autism spectrum disorder (ASD) in psychosocial care centers for children and adolescents (Centro de Atenção Psicossocial à Infância e à Adolescência – CAPSi) in São Paulo, Brazil. Methods: This quasi-experimental study was conducted with 14 professionals from four CAPSi units. The training program consisted of six phases: 1) pre-intervention observation; 2) meeting with staff to assess the main needs of the training program; 3) developing materials for training and evaluation; 4) meetings to discuss program implementation; 5) a final meeting for case discussion and evaluation; and 6) distance supervision. Three measures were used to evaluate the training program: i) the Knowledge, Attitudes, and Practices (KAP) questionnaire; ii) videos containing questions designed to assess program comprehension; and iii) a satisfaction survey. Results: Thirteen videos were produced to as visual aids for use during the training program, and a further 26 videos were developed to evaluate it. The program was well evaluated by the participants. The video responses and KAP questionnaire scores suggest that staff knowledge and attitudes improved after training. Conclusion: The positive findings of this study suggest that the tested training program is feasible for use with multidisciplinary teams working in the CAPSi environment.

Objective: Parents of children with autism spectrum disorders (ASD) seem to perceive that their child’s development is not following the normal pattern as early as the first year of life. However, ASD children may not receive a diagnosis until they are of preschool age, especially in low- and middle-income countries. The objective of this study was to evaluate the pathway between initial parental concerns about atypical child development and ASD diagnosis in Brazil. Methods: Nineteen mothers whose children had been diagnosed with ASD participated and were interviewed. The ASD group consisted of two girls and 17 boys, with a mean age of 93.0 months (SD 48.4 months; range 39-197 months). Results: Mothers had their first concerns regarding ASD when children were 23.6±11.6 months old, but formal diagnosis occurred at a mean ± SD age of 59.6±40.5 months, corresponding to a 3-year delay. Most mothers felt discouraged to address their concerns due to negative experiences with health professionals. Conclusion: In Brazil, mothers perceived the first signs of ASD in their children at an age similar to that reported in other countries, but the diagnosis of ASD seemed to be delayed. Consistent with the literature, mothers reported negative experiences with health professionals during the pathway to achieving ASD diagnosis.

Objective: To evaluate the impact of a training program on autism spectrum disorder (ASD) identification offered to Brazilian health professionals. Methods: Twenty-two primary care providers participated in five 3-hour weekly training sessions. Results: The trained providers significantly improved their ASD knowledge after training in comparison with pre-training (mean score, 6.73 vs. 9.18, p < 0.01). Clinical practice also changed: 4 months after the training program, the providers had referred six times as many suspected cases of ASD to a specialized mental health service in comparison with the previous 4 months. Conclusion: This pilot training model seems a promising, feasible, and inexpensive way to improve early identification of ASD in the primary care system.

Objective: To quantitatively study the exposure to childhood maltreatment and urban violence in children from families with at least one child working on the streets and to investigate the relationship between these factors and street work. Methods: Families who participated in a nongovernmental organization (NGO) program to eliminate child labor were included. Data concerning sociodemographic characteristics, punishment methods used in the family environment against the children, five types of abuse and neglect perpetrated by the caregivers, urban violence exposure and family functioning were collected. Results: The sample included 126 children who were working on the streets and 65 siblings who were not working on the streets. Caregivers reported high levels of severe physical punishment. The children reported high levels of abuse and neglect, and high levels of urban violence exposure. The families showed a predominance of dysfunctional and unsatisfactory relationships. A multiple logistic regression model showed that age older than 12 years and severe physical punishment at home were associated with street work. Conclusion: Interventions to decrease the risk of child street work should be family-focused and should aim to reduce violence in the family environment.

O Sistema de Avaliação de Base Empírica de Achenbach para crianças/adolescentes em idade escolar inclui três instrumentos para avaliar problemas emocionais e/ou comportamentais: Child Behavior Checklist (CBCL) [pais], Youth Self-Report (YSR) [adolescentes] e Teacher's Report Form (TRF) [professores]. Este artigo de revisão fornece informações detalhadas sobre o desenvolvimento desses instrumentos nos Estados Unidos e no Brasil, descrevendo as principais alterações em itens, escalas e pontos de corte na pontuação, ocorridas nas versões originais de 1991 a 2001, e o processo de tradução, retrotradução e adaptação cultural dos questionários originais para desenvolver as atuais versões brasileiras oficiais do CBCL, YSR e TRF. A utilidade desses instrumentos em pesquisa e na prática clínica é salientada, mencionando estudos epidemiológicos e de avaliação de intervenções conduzidos no Brasil. Pesquisadores e clínicos são instruídos a respeito do uso correto das atuais versões brasileiras oficiais, dando exemplos de perguntas frequentes, relevantes para o contexto brasileiro.

The Achenbach System of Empirically Based Assessment (ASEBA) for school-age children includes three instruments for assessing emotional and/or behavioral problems: Child Behavior Checklist (CBCL), completed by parents, Youth Self-Report (YSR), completed by adolescents and Teacher's Report Form (TRF), completed by teachers. This review article gives detailed information on the development of these forms in the United States and Brazil, describing the main changes to the items, scales and score cut-off points in original versions between 1991 and 2001, as well as the process involved in the translation, back-translation and cultural adaptation of the original questionnaires to develop the current official Brazilian versions of the CBCL, YSR and TRF. The utility of these tools for research and clinical practice is highlighted, mentioning epidemiological studies and evaluation of interventions conducted in Brazil. Researchers' and clinicians' doubts regarding the correct use of the current official Brazilian versions are answered, giving examples of frequently asked questions relevant to the Brazilian context.

El sistema de evaluación de base empírica de Achenbach para niños/adolescentes en edad escolar incluye tres instrumentos para evaluar problemas emocionales y/o de comportamiento: Child Behavior Checklist (CBCL) [padres], Youth Self-Report (YSR) [adolescentes] y Teacher's Report Form (TRF) [profesores]. Este artículo de revisión proporciona información detallada sobre el desarrollo de estos instrumentos en los Estados Unidos y en Brasil, describiendo las principales alteraciones en ítems, escalas y puntos de corte en la puntuación, que se realizaron en las versiones originales de 1991 a 2001, y el proceso de traducción, retrotraducción y adaptación cultural de los cuestionarios originales, con el fin de desarrollar las actuales versiones brasileñas oficiales del CBCL, YSR y TRF. La utilidad de estos instrumentos en investigación y en la práctica clínica se resalta mencionando estudios epidemiológicos y de evaluación de intervenciones, llevados a cabo en Brasil. Investigadores y personal clínico son instruidos en lo que se refiere al uso correcto de las actuales versiones brasileñas oficiales, dando ejemplos de preguntas frecuentes y relevantes para el contexto brasileño.

O Sistema de Avaliação de Base Empírica de Achenbach para crianças/adolescentes em idade escolar inclui três instrumentos para avaliar problemas emocionais e/ou comportamentais: Child Behavior Checklist (CBCL) [pais], Youth Self-Report (YSR) [adolescentes] e Teacher's Report Form (TRF) [professores]. Este artigo de revisão fornece informações detalhadas sobre o desenvolvimento desses instrumentos nos Estados Unidos e no Brasil, descrevendo as principais alterações em itens, escalas e pontos de corte na pontuação, ocorridas nas versões originais de 1991 a 2001, e o processo de tradução, retrotradução e adaptação cultural dos questionários originais para desenvolver as atuais versões brasileiras oficiais do CBCL, YSR e TRF. A utilidade desses instrumentos em pesquisa e na prática clínica é salientada, mencionando estudos epidemiológicos e de avaliação de intervenções conduzidos no Brasil. Pesquisadores e clínicos são instruídos a respeito do uso correto das atuais versões brasileiras oficiais, dando exemplos de perguntas frequentes, relevantes para o contexto brasileiro.

The Achenbach System of Empirically Based Assessment (ASEBA) for school-age children includes three instruments for assessing emotional and/or behavioral problems: Child Behavior Checklist (CBCL), completed by parents, Youth Self-Report (YSR), completed by adolescents and Teacher's Report Form (TRF), completed by teachers. This review article gives detailed information on the development of these forms in the United States and Brazil, describing the main changes to the items, scales and score cut-off points in original versions between 1991 and 2001, as well as the process involved in the translation, back-translation and cultural adaptation of the original questionnaires to develop the current official Brazilian versions of the CBCL, YSR and TRF. The utility of these tools for research and clinical practice is highlighted, mentioning epidemiological studies and evaluation of interventions conducted in Brazil. Researchers' and clinicians' doubts regarding the correct use of the current official Brazilian versions are answered, giving examples of frequently asked questions relevant to the Brazilian context.

El sistema de evaluación de base empírica de Achenbach para niños/adolescentes en edad escolar incluye tres instrumentos para evaluar problemas emocionales y/o de comportamiento: Child Behavior Checklist (CBCL) [padres], Youth Self-Report (YSR) [adolescentes] y Teacher's Report Form (TRF) [profesores]. Este artículo de revisión proporciona información detallada sobre el desarrollo de estos instrumentos en los Estados Unidos y en Brasil, describiendo las principales alteraciones en ítems, escalas y puntos de corte en la puntuación, que se realizaron en las versiones originales de 1991 a 2001, y el proceso de traducción, retrotraducción y adaptación cultural de los cuestionarios originales, con el fin de desarrollar las actuales versiones brasileñas oficiales del CBCL, YSR y TRF. La utilidad de estos instrumentos en investigación y en la práctica clínica se resalta mencionando estudios epidemiológicos y de evaluación de intervenciones, llevados a cabo en Brasil. Investigadores y personal clínico son instruidos en lo que se refiere al uso correcto de las actuales versiones brasileñas oficiales, dando ejemplos de preguntas frecuentes y relevantes para el contexto brasileño.

INTRODUÇÃO: Problemas de saúde mental na infância/adolescência (SMIA) trazem diversos prejuízos e geram altos custos. A assistência precoce pode ser custo efetiva, levando a melhor qualidade de vida a longo prazo. OBJETIVOS/MÉTODO: Analisando os artigos mais relevantes, documentos do governo, base de dados e a política nacional, este artigo discute como melhor administrar a atual falta de serviços na área da SMIA e propõe estratégias para maximizar os serviços já existentes. RESULTADOS: Dados apontam evidente falta de serviços e de profissionais para tratar dos problemas de SMIA. Serviços especializados, como o CAPSi (Centro de Atenção Psicossocial Infanto-Juvenil) estão estruturados para assistir casos severos, mas são insuficientes e desigualmente distribuídos. A maioria da população já tem bom acesso às unidades básicas de saúde e um melhor planejamento ajudaria a prepará-las para melhor assistir indivíduos com problemas de SMIA. Psiquiatras são escassos no sistema público, enquanto psicólogos e pediatras estão mais disponíveis; para estes recomenda-se capacitação mais especializada em SMIA. Incentivos financeiros e de carreira motivariam profissionais a procurarem emprego no sistema público de saúde. CONCLUSÕES: Apesar de estratégias complexas e de longo prazo serem necessárias para lidar com as atuais barreiras no campo da SMIA, a implantação de certas propostas simples já poderiam trazer impacto imediato e positivo neste cenário.

INTRODUCTION: Child/adolescent mental health (CAMH) problems are associated with high burden and high costs across the patient's lifetime. Addressing mental health needs early on can be cost effective and improve the future quality of life. OBJECTIVE/METHODS: Analyzing most relevant papers databases and policies, this paper discusses how to best address current gaps in CAMH services and presents strategies for improving access to quality care using existing resources. RESULTS: The data suggest a notable scarcity of health services and providers to treat CAMH problems. Specialized services such as CAPSi (from Portuguese: Psychosocial Community Care Center for Children and Adolescents) are designed to assist severe cases; however, such services are insufficient in number and are unequally distributed. The majority of the population already has good access to primary care and further planning would allow them to become better equipped to address CAMH problems. Psychiatrists are scarce in the public health system, while psychologists and pediatricians are more available; but, additional specialized training in CAMH is recommended to optimize capabilities. Financial and career development incentives could be important drivers to motivate employment-seeking in the public health system. CONCLUSIONS: Although a long-term, comprehensive strategy addressing barriers to quality CAMH care is still necessary, implementation of these strategies could make.

Estudo de corte transversal conduzido em comunidade urbana de baixa renda do município de Embu-SP com objetivo de identificar fatores associados a problemas de saúde mental em crianças/adolescentes (PSMCA) em amostra probabilística (N=67, faixa etária 4-17 anos). Foram aplicados instrumentos estruturados às mães: Child Behavior Checklist (PSMCA); WorldSAFE Core Questionnaire (dados sociodemográficos; violência doméstica; embriaguez do pai/padrasto); Self-Report Questionnaire (problemas de saúde mental maternos, ideação suicida materna). Os resultados do estudo apontaram fatores estatisticamente associados aos PSMCA: criança/adolescente ser do sexo masculino e sofrer punição física grave; ideação suicida da mãe e violência conjugal física grave contra a mãe; embriaguez do pai/padrasto. Concluindo, grupos vulneráveis com características individuais/familiares identificadas neste estudo devem ser considerados prioritários em propostas de prevenção/tratamento.

Across-sectional study was conducted in an urban low-income community in the municipality of Embu-SP with the objective of identifying factors associated with mental health problems of children and adolescents (MHPCA) in a probabilistic sample (N=67, aged 4-17 years). Standardized instruments were applied to mothers: Child Behavior Checklist; WorldSAFE Core Questionnaire (demographics, domestic violence, father/stepfather drunkenness); Self-Report Questionnaire (maternal mental health problems and suicide ideation). The results of this study identified factors statistically related to MPHCA: child/adolescent of male gender and severe physical punishment; maternal suicide ideation and severe physical marital violence; father/stepfather drunkenness. As a result, vulnerable groups with individual/family characteristics identified in this study should have priority in prevention/treatment programs.

OBJECTIVE: To examine the relationship between specific types of child mental health problems and severe physical punishment, in combination with other important known risk factors. METHODS: We conducted a cross-sectional study in Embu, São Paulo, Brazil, as the Brazilian component of a multicountry survey on abuse in the family environment. From a probabilistic sample of clusters that included all eligible households (women aged 15-49 years with a son or daughter < 18 years of age), we randomly selected one mother-child pair per household (n = 813; attrition rate: 17.6%). This study focused on children aged 6-17 years (n = 480). Child Behaviour Checklist CBCL/6-18 was used to identify children with internalizing problems only, externalizing problems only, and both internalizing and externalizing problems (comorbidity). Severe physical punishment was defined as being hit with an object, being kicked, choked, smothered, burnt, scalded, branded, beaten or threatened with a weapon. We examined other potential correlates from four domains: child (gender, age, ever witnessing marital violence); mother (education, unemployment, anxiety or depression, marital violence); father (absence, drunkenness); and family (socioeconomic status). The WHO Self-Reporting Questionnaire (SRQ-20) was used to identify maternal anxiety or depression (score > 7). Backward logistic regression analysis identified independent correlates and significant interactions. FINDINGS: Multivariate modelling showed that severe punishment was an independent correlate of comorbid internalizing and externalizing problems but was not associated with internalizing problems only. It increased the risk of externalizing problems alone only for children and adolescents not exposed to maternal anxiety or depression. Maternal anxiety or depression increased the risk only for children or adolescents not exposed to severe punishment. CONCLUSION: Severe punishment may be related to child mental health problems, with the mechanism depending on the type of problem. Its influence persists in the presence of family stressors such as the father's absence and maternal anxiety or depression.

OBJETIVO: Examinar la relación existente entre tipos concretos de problemas de salud mental infantil y los castigos físicos severos, teniendo en cuenta otros factores de riesgo importantes. MÉTODOS: Realizamos un estudio transversal en Embu (São Paulo, Brasil)como parte de una encuesta multipaís sobre el maltrato en el entorno familiar. A partir de una muestra probabilística de conglomerados que incluyó a todos los hogares elegibles (mujeres de 15 a 49 años con hijos menores de 18 años), seleccionamos aleatoriamente a una pareja madre-hijo por hogar (n = 813; tasa de abandonos: 17,6%). El presente estudio se centró en los niños de 6 a 17 años (n = 480). Para identificar a los niños con problemas únicamente de internalización, únicamente de externalización o simultáneamente de internalización y externalización (comorbilidad) se utilizó la Lista de Comportamientos Infantiles (CBCL/6-18). El castigo físico severo se definió como golpes con objetos, patadas, estrangulación, asfixia, quemaduras, escaldaduras, marcas, palizas o amenazas con armas. Además, examinamos otros correlatos pertenecientes a cuatro dominios: características del niño (sexo, edad, haber sido testigo de violencia conyugal), la madre (nivel educativo, desempleo, ansiedad o depresión, violencia conyugal), el padre (ausencia, embriaguez) y la familia (nivel socioeconómico). Para identificar la ansiedad y la depresión maternas (puntuación > 7) se utilizó el Cuestionario de Autoinformación de la OMS (SRQ-20). Los correlatos independientes y las interacciones significativas se identificaron mediante análisis de regresión logística retrógrada. RESULTADOS: Los modelos multivariados revelaron que el castigo severo se correlacionó de forma independiente con problemas comórbidos de internalización y externalización, pero no con problemas únicamente de internalización. Asimismo, aumentó el riesgo de problemas únicamente de externalización, pero sólo en niños y adolescentes no expuestos a ansiedad ni depresión maternas. La ansiedad o depresión maternas aumentaron el riesgo sólo en niños o adolescentes no expuestos a castigos severos. CONCLUSIÓN: Los castigos severos pueden estar relacionados con problemas de salud mental infantil, y el mecanismo depende del tipo de problema. Su influencia es persistente en presencia de factores causantes de estrés familiar, tales como ausencia del padre y la depresión o ansiedad de la madre.

OBJECTIF: Examiner la relation entre certains types de troubles mentaux chez l'enfant et les châtiments corporels sévères, en association avec d'autres facteurs de risque importants connus. MÉTHODES: Nous avons mené une étude transversale à Embu dans l'Etat de São Paulo au Brésil, en tant que composante brésilienne d'une enquête multipays sur les mauvais traitements dans le cadre familial. A partir d'un échantillonnage probabiliste en grappes couvrant tous les foyers admissibles dans l'étude (femmes de 15 à 49 ans ayant un fils ou une fille de moins de 18 ans), nous avons sélectionné au hasard un couple mère-enfant par foyer (n = 813 ; taux d'attrition : 17,6 %). L'étude s'est focalisée sur les enfants de 6 à 17 ans (n = 480). La Child Behaviour Checklist (CBCL/6-18) a été utilisée pour identifier les enfants présentant des troubles internalisés seulement, des troubles externalisés seulement ou à la fois des troubles internalisés et externalisés (comorbidité). A été défini comme un châtiment corporel sévère infligé à un enfant le fait de le frapper avec un objet, de lui donner des coups de pied, de l'étrangler, de l'étouffer, de le brûler, de l'ébouillanter, de le marquer avec un objet brûlant, de le battre ou de le menacer avec une arme. Nous avons examiné d'autres possibilités de corrélations dans les quatre domaines suivants : l'enfant (sexe, âge, témoin régulier de violences conjugales) ; la mère (éducation, chômage, anxiété ou dépression, violence conjugale), le père (absence, ébriété) et la famille (statut socioéconomique). Le Self-Reporting Questionnaire de l'OMS (SRQ-20) a été utilisé pour reconnaître l'anxiété ou la dépression chez la mère (score > 7). Une analyse par régression logistique rétrograde a permis d'identifier les corrélats indépendants et les interactions significatives. RÉSULTATS: Une modélisation multivariée a montré que les châtiments sévères étaient un corrélat indépendant de la comorbidité troubles internalisés/troubles externalisés, mais ne présentaient pas d'association avec les troubles internalisés seuls. Ces châtiments n'augmentaient le risque de troubles externalisés seuls que chez les enfants et les adolescents non exposés à l'anxiété ou à la dépression maternelle. La présence d'une anxiété ou d'une dépression chez la mère ne majorait ce risque que chez les enfants et les adolescents ne subissant pas des châtiments sévères. CONCLUSION: Il peut exister une relation entre châtiments sévères et troubles mentaux chez l'enfant, le mécanisme impliqué dépendant du type de trouble. Cette influence persiste en présence de stresseurs familiaux comme l'absence du père ou l'anxiété ou la dépression maternelle.

OBJETIVO: Analisar fatores de proteção e de risco para problemas de saúde mental entre adolescentes. MÉTODOS: Estudo transversal realizado com amostra aleatória (N=327; perda=6,9%) de estudantes da sexta série de todas as escolas públicas e privadas de Barretos, SP, em 2004. Os fatores examinados foram: exposição à violência doméstica e urbana, nível socioeconômico familiar, sexo, morar sem a mãe, participar de atividades sociais (fator de proteção). As associações entre esses fatores e problemas de saúde mental foram analisadas por meio de modelos de regressão logística. Todos os fatores de risco e proteção independentes foram incluídos no modelo inicial de regressão logística, permanecendo no modelo final apenas a variável com nível de significância inferior a 0,05. RESULTADOS: Verificou-se que apenas exposição à violência permaneceu no modelo final como fator associado a problemas de saúde mental (p=0,02; IC 95%: 1,12;4,22). Crianças expostas à violência doméstica tinham três vezes mais chances de apresentarem estes problemas do que aquelas expostas à violência urbana (p=0,04; IC 95%: 1,03;7,55). CONCLUSÕES: A violência doméstica associou-se a problemas de saúde mental nos adolescentes do estudo, podendo ser mais importante que a violência urbana em cidades de médio porte.

OBJECTIVE: To analyze risk and protective factors for mental health problems among adolescents. METHODS: Cross-sectional study with a random sample (N=327; attrition rate=6.9%) of sixth grade students from all public and private schools in the city of Barretos, Southeastern Brazil, conducted in 2004. The factors studied were: exposure to intrafamilial and urban violence, family socioeconomic level, sex, motherless household, participation in social activities (protective factor). All the independent risk and protective factors were included in the initial logistic regression model. Only the variable with a significance level of p<0.05 remained in the model. RESULTS: It was observed that exposure to violence was the only factor associated with mental health problems in the final logistic regression model (p=0.02, 95% CI: 1.12;4.22). In addition, adolescents exposed to intrafamilial violence were three times more likely to have problems than those exposed to urban violence (p=0.04; 95% CI: 1.03;7.55). CONCLUSIONS: Intrafamilial violence was associated with mental heath problems among adolescents studied and it could be more important than urban violence in medium-sized cities.

OBJETIVO: Analisar fatores de proteção e de risco para problemas de saúde mental entre adolescentes. MÉTODOS: Estudo transversal realizado com amostra aleatória (N=327; perda=6,9%) de estudantes da sexta série de todas as escolas públicas e privadas de Barretos, SP, em 2004. Os fatores examinados foram: exposição à violência doméstica e urbana, nível socioeconômico familiar, sexo, morar sem a mãe, participar de atividades sociais (fator de proteção). As associações entre esses fatores e problemas de saúde mental foram analisadas por meio de modelos de regressão logística. Todos os fatores de risco e proteção independentes foram incluídos no modelo inicial de regressão logística, permanecendo no modelo final apenas a variável com nível de significância inferior a 0,05. RESULTADOS: Verificou-se que apenas exposição à violência permaneceu no modelo final como fator associado a problemas de saúde mental (p=0,02; IC 95%: 1,12;4,22). Crianças expostas à violência doméstica tinham três vezes mais chances de apresentarem estes problemas do que aquelas expostas à violência urbana (p=0,04; IC 95%: 1,03;7,55). CONCLUSÕES: A violência doméstica associou-se a problemas de saúde mental nos adolescentes do estudo, podendo ser mais importante que a violência urbana em cidades de médio porte.

OBJECTIVE: To analyze risk and protective factors for mental health problems among adolescents. METHODS: Cross-sectional study with a random sample (N=327; attrition rate=6.9%) of sixth grade students from all public and private schools in the city of Barretos, Southeastern Brazil, conducted in 2004. The factors studied were: exposure to intrafamilial and urban violence, family socioeconomic level, sex, motherless household, participation in social activities (protective factor). All the independent risk and protective factors were included in the initial logistic regression model. Only the variable with a significance level of p<0.05 remained in the model. RESULTS: It was observed that exposure to violence was the only factor associated with mental health problems in the final logistic regression model (p=0.02, 95% CI: 1.12;4.22). In addition, adolescents exposed to intrafamilial violence were three times more likely to have problems than those exposed to urban violence (p=0.04; 95% CI: 1.03;7.55). CONCLUSIONS: Intrafamilial violence was associated with mental heath problems among adolescents studied and it could be more important than urban violence in medium-sized cities.