Objectives: Children of depressed mothers are at risk of developing mental health problems. We sought to determine whether treatment for maternal depression by community-based health workers would decrease behavioral/emotional symptoms in their children. Interventions for maternal depressive symptoms in a low/middle-income country can have a high global impact. Methods: Community-based health workers were trained to deliver a psychosocial intervention for mothers with depression in a primary care setting. A total of 49 mothers and 60 children were assessed pre-intervention, post-intervention, and at 6 months follow-up. Child behavioral/emotional symptoms were evaluated according to type of change in maternal depressive symptoms: response or remission. Results: An overall decrease in maternal depressive symptoms from baseline to post-intervention and 6 months follow-up were found. Response or remission was associated with better outcomes in child behavioral/emotional symptoms at 6 months follow-up (p = 0.0247, Cohen’s d: 0.76; p = 0.0224, Cohen’s f: 0.44) but not at post-intervention (p = 0.1636, Cohen’s d: 0.48; p = 0.0720, Cohen’s f: 0.33). Conclusions: Improvement in maternal depression was related to decreased behavioral/emotional symptoms in their children. Our results suggest that providing interventions for maternal depression in primary care is a viable strategy to prevent behavioral/emotional symptoms in the next generation. Clinical Trial registration: Brazilian Clinical Trials, number RBR-5qhmb5.

Objective: Associations between parental/caregiver depression and adverse child outcomes are well established and have been described through one or more mechanisms: child psychopathology following exposure to a depressed caregiver, child psychopathology exacerbating a caregiver’s depression, and caregiver and offspring depression sharing the same etiology. Data from low and middle-income countries is scarce. We examined correlations between common symptoms of mental disorders in caregivers and their offspring’s psychopathology in a Brazilian sample. Methods: In this cross-sectional study, adult caregivers were screened for depression during routine home visits by community health workers as part of the Brazilian Family Health Strategy. Caregivers with suspected depression were assessed using the Zung Self-Rating Depression Scale and the Self-Reporting Questionnaire (SRQ-20). Children’s symptoms were evaluated using the Strengths and Difficulties Questionnaire (SDQ). Results: The sample included 68 primary caregivers and 110 children aged 6 to 15 years. Higher caregiver scores on the SRQ-20 correlated significantly with psychiatric symptoms in offspring. Conclusion: These results substantiate our hypothesis that child psychopathology correlates with caregivers’ psychiatric symptoms. This paper adds to the growing literature on community mental health assessment and can help guide future strategies for reducing the burden of common mental disorders in caregivers and children alike in low and middle-income countries.

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: Descrever e analisar a situação atual de desenvolvimento da política pública brasileira de saúde mental infantil e juvenil, com foco nos Centros de Atenção Psicossocial Infanto-juvenil e na rede intersetorial potencial de atenção à saúde mental infantil e juvenil que engloba outras políticas relacionadas à criança e ao adolescente em âmbito nacional. MÉTODO: Análise de publicações e dados oficiais do governo brasileiro sobre a implantação e/ou distribuição de serviços públicos nacionais relacionados à criança e ao adolescente. RESULTADOS: A política brasileira de saúde mental infantil e juvenil tem como ação central a implementação de Centros de Atenção Psicossocial Infanto-Juvenil para atendimento dos casos de transtornos mentais que envolvem prejuízos funcionais severos e persistentes. Existe uma rede intersetorial potencial de cuidado que pode se efetivar com a articulação das ações específicas de saúde mental infantil e juvenil nos setores da saúde geral/atenção básica, educação, assistência social e justiça/direitos. Esta articulação será de grande importância para o atendimento de problemas mais freqüentes, que envolvem prejuízos mais pontuais. DISCUSSÃO: No Brasil, o incremento do sistema de cuidados depende da expansão da rede de serviços de saúde mental infantil e juvenil, dos mais aos menos especializados, e de sua articulação efetiva com outros setores públicos dedicados ao cuidado da infância e adolescência.

OBJECTIVE: To describe and analyze current developments in the Brazilian child and adolescent mental health public policy, focusing on the Centers for Psychosocial Care for Children and Adolescents and in a potential child and adolescent mental health care system, derived from other child and adolescent public policies in the national context. METHOD: Examination of publications and official data produced by the Brazilian government about the implementation and/or distribution of public services for children and adolescents in the country. RESULTS: The Brazilian child and adolescent mental health policy has as one of its main strategies the implementation of Centers for Psychosocial Care for Children and Adolescents to cover persistent child psychiatric disorders with severe levels of impairment. In addition, there is a potential intersectorial system which would become effective once specific child mental health actions are articulated with the sectors of general health, education, child welfare and justice/rights. This articulation will play an important role in responding to psychiatric disorders which are frequent with impairment of very specific areas of functioning. DISCUSSION: In Brazil, improvement of the child and adolescent mental health care system relies upon the expansion of the mental health specialty sector as well as in its articulation with other public sectors responding to child and adolescent needs.

OBJETIVO: Estimar a prevalência de problemas de saúde mental em crianças e adolescentes, com e sem prejuízo funcional global, em comunidade urbana de baixa renda; estimar a capacidade de assistência da rede pública de serviços do município; e relacionar a capacidade de assistência à necessidade de tratamento em saúde mental da infância/adolescência. MÉTODO: Estudo transversal. Amostra probabilística de conglomerados incluindo todos os domicílios elegíveis (bairro de baixa renda, Embu-SP). Participantes: 479 crianças/adolescentes (6-17 anos; perda amostral: 18,8%). Medidas: 1) problemas de saúde mental em crianças e adolescentes em nível clínico pela escala de total de problemas do Child Behavior-Checklist e/ou Youth Self-Report; 2) prejuízo funcional global: escore total > 15,5 na Brief Impairment Scale; 3) Capacidade de assistência: total de casos atendidos anualmente por psicólogos/psiquiatras nos setores de saúde, educação, justiça e cidadania/assistência social. RESULTADOS: Prevalência de problemas de saúde mental em crianças e adolescentes: 24,6% (20,7-28,5) desconsiderando prejuízo funcional global; 7,3% (5,0-9,6) com prejuízo funcional global (casos que necessitam tratamento). A capacidade anual de assistência dos casos com prejuízo funcional global é de 14,0%; sendo necessários cerca de sete anos para que todos possam ser tratados. CONCLUSÕES: Problemas de saúde mental em crianças e adolescentes são freqüentes na comunidade estudada e a infra-estrutura atual da rede pública de serviços do município não está preparada para atender em tempo hábil os casos que necessitam tratamento.

OBJECTIVE: To estimate the prevalence of mental health problems in children and adolescents, with or without considering global impairment, within a low-income urban community; to estimate the public service delivery capacity in terms of mental healthcare; and to determine the relationship between delivery capacity and treatment demand. METHOD: Cross-sectional study. Probabilistic sample of clusters including all eligible households (low-income community - Embu, Southeastern Brazil). Participants: 479 children and adolescents (aged 6-17 years; attrition rate: 18.8%). Measurement: 1) Clinical mental health problems in children and adolescents using the Child Behavior Checklist and/or Youth Self-Report total problem scales; 2) Global impairment: positive score in the Brief Impairment Scale (total score > 15.5); 3) Care service capacity: total number of cases annually seen by psychologists/psychiatrists in the health, education, juvenile justice, and child welfare sectors. RESULTS: Prevalence of mental health problems in children and adolescents: 24.6% (20.7-28.5) without considering global impairment; 7.3% (5.0-9.6) with global impairment (cases in need of treatment). Current annual service capacity can only provide care for 14.0% of impaired cases; approximately seven years would be necessary for all to be treated. CONCLUSIONS: Mental health problems in children and adolescents are frequent in the studied community, and the current structure of the community's public service system is not prepared to treat impaired cases in an adequate timeframe.