Objective: Mental illness is an important public health concern, often starting early in life and particularly impacting children from low-and middle-income countries. Our aims were to 1) determine, in a representative sample of public preschool 4- to 5-year old children in Brazil, the prevalence of internalizing and externalizing disorders and socioemotional development delays; and 2) to identify modifiable risk factors associated with mental, behavioral, or developmental disorders (MBDD), such as microsystem (i.e., parent-child relationship), mesosystem (social support), and macrosystem contextual factors (neighborhood disadvantage). Methods: A random sample of public preschool children was recruited in the city of Embu das Artes (São Paulo metropolitan area) (n=1,292 from 30 public preschools). Six-month prevalence of MBDD was measured using the Child Behavior Checklist (CBCL) and the Ages and Stages Questionnaires: Social-Emotional (ASQ:SE). Results: Six-month prevalence estimates were 25.4% for internalizing disorders, 12.1% for externalizing disorders, and 30.3% for socioemotional development delays. MBDD prevalence estimates were higher in families with stressful relationships and parental depression or anxiety, and in families with lower social capital. Conclusion: At least 25% of preschool children living in an urban area in Brazil presented a mental health disorder. These mental disorder were associated with modifiable factors such as stressful family relationships and lower social capital. Prevention and intervention measures such as family therapy are needed to decrease such high prevalence.

Abstract Objective Construct validity for the Motor Development Scale (MDS) has not been established. The aim of this study was to examine whether the unidimensional model of MDS would be appropriate for children aged 4 to 6 years-old and provide construct validity for the items concerning this age group in Brazil. Methods A total of 938 children participated in the study (214 4-year-olds, 643 5-year-olds, and 81 6-year-olds). Confirmatory factor analysis (CFA) was used to evaluate construct validity of the MDS using a unidimensional model. Results The CFA for the unidimensional model showed excellent adequacy indices for age 4: χ2(2) = 0.581, p = 0.748, comparative fit index (CFI) = 1.000, Tucker-Lewis index (TLI) = 1.090, root mean square error of approximation (RMSEA) = 0.000 (90% confidence interval [90%CI] = 0.000 to 0.093, close fit [Cfit] = 0.841); age 5: χ2(2) = 2.669, p = 0.263, CFI = 0.993, TLI = 0.980, RMSEA = 0.023 (90%CI = 0.000 to 0.085, Cfit = 0.682), weighted root mean square residual (WRMR) = 0.407; and age 6: χ2(9) = 8.275, p = 0.506, CFI = 1.000, TLI = 1.010, RMSEA = 0.000 (90%CI = 0.000 to 0.118, Cfit = 0.653), WRMR = 0.495. Reliability was good: ω = 0.87 (95%CI = 0.81 to 0.92). Conclusion The proposed unidimensional solution for the MDS provides a concise, parsimonious and reliable way to assess motor development in children aged 4 to 6 years.

ABSTRACT OBJECTIVE: To investigate how stressful life events and social support relate to central adiposity in Southern Brazil. METHODS: Data included information from 802 participants in the 1982 Pelotas Birth Cohort that was collect in 2004-2005 and 2006. Stratifying by sex, we studied self-reported stressful life events during the year before 2004-2005 in relation to change in waist circumference between 2004-2005 and 2006 and waist-to-hip ratio in 2006, using both bivariate and multivariate linear regression models. RESULTS: In adjusted models, the experience of stressful life events during the year before 2004-2005 predicted a change in waist circumference in 2006 in men and a change in both waist-to-hip ratio in 2006 and waist circumference between 2004-2005 and 2006 in women. Men who experienced two or more stressful events had on average a one centimeter increase in their waist circumference between 2004-2005 and 2006 (β = 0.97, 95%CI 0.02-1.92), compared to those reporting no stressful events. For women, those who had one and those who had two or more stressful life events had over a 1 cm increase in their waist circumference from 2004-2005 to 2006 (β = 1.37, 95%CI 0.17-2.54; β = 1.26, 95%CI 0.11-2.40, respectively), compared to those who did not experience any stressful event. For both sexes, social support level was not significantly related to either waist-to-hip ratio or change in waist circumference, and it did not modify the association between stress and central adiposity. CONCLUSIONS: The experience of more than one stressful life event was associated with distinct indicators of central adiposity for men versus women.

ABSTRACT OBJECTIVE: To investigate how stressful life events and social support relate to central adiposity in Southern Brazil. METHODS: Data included information from 802 participants in the 1982 Pelotas Birth Cohort that was collect in 2004-2005 and 2006. Stratifying by sex, we studied self-reported stressful life events during the year before 2004-2005 in relation to change in waist circumference between 2004-2005 and 2006 and waist-to-hip ratio in 2006, using both bivariate and multivariate linear regression models. RESULTS: In adjusted models, the experience of stressful life events during the year before 2004-2005 predicted a change in waist circumference in 2006 in men and a change in both waist-to-hip ratio in 2006 and waist circumference between 2004-2005 and 2006 in women. Men who experienced two or more stressful events had on average a one centimeter increase in their waist circumference between 2004-2005 and 2006 (β = 0.97, 95%CI 0.02-1.92), compared to those reporting no stressful events. For women, those who had one and those who had two or more stressful life events had over a 1 cm increase in their waist circumference from 2004-2005 to 2006 (β = 1.37, 95%CI 0.17-2.54; β = 1.26, 95%CI 0.11-2.40, respectively), compared to those who did not experience any stressful event. For both sexes, social support level was not significantly related to either waist-to-hip ratio or change in waist circumference, and it did not modify the association between stress and central adiposity. CONCLUSIONS: The experience of more than one stressful life event was associated with distinct indicators of central adiposity for men versus women.

Resumo: O objetivo do estudo foi de investigar o papel da violência entre parceiros íntimos na interrupção precoce do aleitamento materno exclusivo nos três primeiros meses de vida. Usamos dados de uma coorte prospectiva de 564 crianças atendidas em quatro unidades de atenção primária no Rio de Janeiro, Brasil. A interrupção do aleitamento exclusivo foi definida como a ingestão pela criança de qualquer forma de líquido ou sólido, independente da ingestão de leite materno, nas 24 horas anteriores. Violência entre parceiros íntimos foi avaliada com a versão em português das Conflict Tactics Scales (CTS-1). As associações foram expressas como razões de prevalência e riscos relativos e os respectivos intervalos de 95% de confiança. Os filhos de mulheres que haviam vivenciado violência grave apresentavam uma probabilidade 30% maior de interrupção precoce do aleitamento exclusivo no segundo mês de vida, comparados com aqueles cujas mães não haviam vivenciado esse tipo de violência. Estratégias dos serviços de saúde para promover o aleitamento materno exclusivo devem levar em conta a identificação e enfrentamento da violência familiar.

Abstract: The aim of this study was to investigate the role of intimate partner violence in the early interruption of exclusive breastfeeding in the first three months of life. We used data from a prospective cohort of 564 children attending four primary health clinics in Rio de Janeiro, Brazil. Interruption of exclusive breastfeeding was defined as a child receiving any kind of liquid or solid, regardless of breast milk intake, measured by a 24 hour recall. The Portuguese version of the Conflict Tactics Scales (CTS-1) was used to assess intimate partner violence. Associations were expressed as prevalence ratios and relative risks and their respective 95% confidence intervals. Children of mothers who experienced severe violence had 30% greater likelihood of early interruption of exclusive breastfeeding in the second month of life as compared to those who did not experience this type of violence. Strategies in health services for promoting exclusive breastfeeding should consider identifying and addressing family violence.

Resumen: El objetivo del estudio era investigar el papel de la violencia en la pareja en la interrupción precoz de la lactancia materna exclusiva durante los tres primeros meses de vida. Usamos datos de una cohorte prospectiva de 564 niños, atendidos en cuatro unidades de atención primaria en Río de Janeiro, Brasil. La interrupción de la lactancia materna exclusiva fue definida como la ingestión por parte del bebé de cualquier forma de líquido o sólido, independientemente de la ingestión de leche materna, durante las 24 horas anteriores. La violencia en la pareja fue evaluada con la versión en portugués de las Conflict Tactics Scales (CTS-1). Las asociaciones fueron expresadas como razones de prevalencia y riesgos relativos con sus respectivos intervalos de confianza de un 95%. Los hijos de mujeres que habían experimentado violencia grave presentaban una probabilidad un 30% mayor de interrupción precoz de la lactancia materna exclusiva durante el segundo mes de vida, comparado con aquellos cuyas madres no habían experimentado ese tipo de violencia. Las estrategias de los servicios de salud para promover la lactancia materna exclusiva deben tener en cuenta la identificación y combate a la violencia familiar.

Resumo: O objetivo do estudo foi de investigar o papel da violência entre parceiros íntimos na interrupção precoce do aleitamento materno exclusivo nos três primeiros meses de vida. Usamos dados de uma coorte prospectiva de 564 crianças atendidas em quatro unidades de atenção primária no Rio de Janeiro, Brasil. A interrupção do aleitamento exclusivo foi definida como a ingestão pela criança de qualquer forma de líquido ou sólido, independente da ingestão de leite materno, nas 24 horas anteriores. Violência entre parceiros íntimos foi avaliada com a versão em português das Conflict Tactics Scales (CTS-1). As associações foram expressas como razões de prevalência e riscos relativos e os respectivos intervalos de 95% de confiança. Os filhos de mulheres que haviam vivenciado violência grave apresentavam uma probabilidade 30% maior de interrupção precoce do aleitamento exclusivo no segundo mês de vida, comparados com aqueles cujas mães não haviam vivenciado esse tipo de violência. Estratégias dos serviços de saúde para promover o aleitamento materno exclusivo devem levar em conta a identificação e enfrentamento da violência familiar.

Abstract: The aim of this study was to investigate the role of intimate partner violence in the early interruption of exclusive breastfeeding in the first three months of life. We used data from a prospective cohort of 564 children attending four primary health clinics in Rio de Janeiro, Brazil. Interruption of exclusive breastfeeding was defined as a child receiving any kind of liquid or solid, regardless of breast milk intake, measured by a 24 hour recall. The Portuguese version of the Conflict Tactics Scales (CTS-1) was used to assess intimate partner violence. Associations were expressed as prevalence ratios and relative risks and their respective 95% confidence intervals. Children of mothers who experienced severe violence had 30% greater likelihood of early interruption of exclusive breastfeeding in the second month of life as compared to those who did not experience this type of violence. Strategies in health services for promoting exclusive breastfeeding should consider identifying and addressing family violence.

Resumen: El objetivo del estudio era investigar el papel de la violencia en la pareja en la interrupción precoz de la lactancia materna exclusiva durante los tres primeros meses de vida. Usamos datos de una cohorte prospectiva de 564 niños, atendidos en cuatro unidades de atención primaria en Río de Janeiro, Brasil. La interrupción de la lactancia materna exclusiva fue definida como la ingestión por parte del bebé de cualquier forma de líquido o sólido, independientemente de la ingestión de leche materna, durante las 24 horas anteriores. La violencia en la pareja fue evaluada con la versión en portugués de las Conflict Tactics Scales (CTS-1). Las asociaciones fueron expresadas como razones de prevalencia y riesgos relativos con sus respectivos intervalos de confianza de un 95%. Los hijos de mujeres que habían experimentado violencia grave presentaban una probabilidad un 30% mayor de interrupción precoz de la lactancia materna exclusiva durante el segundo mes de vida, comparado con aquellos cuyas madres no habían experimentado ese tipo de violencia. Las estrategias de los servicios de salud para promover la lactancia materna exclusiva deben tener en cuenta la identificación y combate a la violencia familiar.

OBJECTIVE: To investigate the relationship between maternal depression and child growth in developing countries through a systematic literature review and meta-analysis. METHODS: Six databases were searched for studies from developing countries on maternal depression and child growth published up until 2010. Standard meta-analytical methods were followed and pooled odds ratios (ORs) for underweight and stunting in the children of depressed mothers were calculated using random effects models for all studies and for subsets of studies that met strict criteria on study design, exposure to maternal depression and outcome variables. The population attributable risk (PAR) was estimated for selected studies. FINDINGS: Seventeen studies including a total of 13 923 mother and child pairs from 11 countries met inclusion criteria. The children of mothers with depression or depressive symptoms were more likely to be underweight (OR: 1.5; 95% confidence interval, CI: 1.2-1.8) or stunted (OR: 1.4; 95% CI: 1.2-1.7). Subanalysis of three longitudinal studies showed a stronger effect: the OR for underweight was 2.2 (95% CI: 1.5-3.2) and for stunting, 2.0 (95% CI: 1.0-3.9). The PAR for selected studies indicated that if the infant population were entirely unexposed to maternal depressive symptoms 23% to 29% fewer children would be underweight or stunted. CONCLUSION: Maternal depression was associated with early childhood underweight and stunting. Rigorous prospective studies are needed to identify mechanisms and causes. Early identification, treatment and prevention of maternal depression may help reduce child stunting and underweight in developing countries.

OBJETIVO: Investigar la relación entre la depresión materna y el crecimiento infantil en países en vías de desarrollo a través de una revisión bibliográfica sistemática y un metaanálisis. MÉTODOS: Se realizó una búsqueda en seis bases de datos para hallar estudios realizados en países en vías de desarrollo sobre la depresión materna y el crecimiento infantil que hubieran sido publicados antes de 2010. Se emplearon métodos metanalíticos y se calculó el conjunto de oportunidades relativas (OR) del bajo peso y el retraso del crecimiento infantil en los hijos de madres con depresión, empleando modelos de efectos aleatorios para todos los estudios y subconjuntos de estudios que cumplieron los estrictos criterios de diseño de estudio, exposición a la depresión materna y variables de resultados. Se calculó el riesgo atribuible a la población (RAP) en los estudios seleccionados. RESULTADOS: Los criterios de inclusión se cumplieron en 17 estudios que incluyeron a un total de 13 923 parejas de madres e hijos procedentes de 11 países. Los hijos de madres con depresión o síntomas depresivos resultaron ser más proclives a tener peso bajo (OR: 1,5; intervalo de confianza del 95%, IC: 1,2-1,8) o un retraso del crecimiento infantil (OR: 1,4; IC del 95 %: 1,2-1,7). El subanálisis de tres estudios longitudinales evidenció un efecto más contundente: la OR del peso insuficiente fue de 2,2 (IC del 95%: 1,5-3,2) y para el retraso en el crecimiento infantil, 2,0 (IC del 95%: 1,0-3,9). El RAP para los estudios seleccionados mostró que si se mantuviera la población infantil completamente al margen de los síntomas de depresión de las madres, entre un 23% y un 29% menos de niños tendría bajo peso o retraso en el crecimiento infantil. CONCLUSIÓN: La depresión materna se asoció al bajo peso y al retraso en el crecimiento en la primera infancia. Es necesario realizar estudios prospectivos rigurosos para identificar los diversos mecanismos y causas. La detección temprana, el tratamiento y la prevención de la depresión materna podrían ayudar a reducir el retraso en el crecimiento infantil y el peso insuficiente en los niños de los países en vías de desarrollo.

OBJECTIF: Étudier la relation entre dépression maternelle et croissance infantile dans les pays en développement par un examen systématique de la documentation et une méta-analyse. MÉTHODES: Six bases de données ont été consultées pour les études sur la dépression maternelle et la croissance des enfants dans les pays en développement, publiées jusqu'en 2010. Les méthodes standard de méta-analyse ont été suivies et les odds ratios (OR, rapports des chances) mis en commun pour l'insuffisance pondérale et le retard de croissance des enfants de mères déprimées ont été calculés en utilisant des modèles à effets aléatoires pour toutes les études et pour les sous-ensembles d'études qui répondaient aux critères stricts de conception d'étude, d'exposition à la dépression maternelle et de variables de résultat. Le risque attribuable dans la population (RAP) a été estimé pour des études sélectionnées. RÉSULTATS: Dix-sept études, incluant un total de 13 923 paires de mère et enfant de 11 pays, remplissaient les critères d'inclusion. Les enfants de mères souffrant de dépression ou de symptômes dépressifs étaient plus susceptibles de présenter une insuffisance pondérale (IP: 1,5; intervalle de confiance, IC, de 95%: 1,2-1,8) ou un retard de croissance (IP: 1,4; IC de 95%: 1,2-1,7). La sous-analyse de trois études longitudinales a montré un effet plus important: l'OR pour insuffisance pondérale était de 2,2 (IC de 95%: 1,5-3,2) et pour retard de croissance, de 2,0 (IC de 95%: 1,0-3,9). Le RAP des études sélectionnées a indiqué que si la population infantile était entièrement non-exposée à des symptômes dépressifs maternels, 23 à 29% d'enfants en moins souffriraient d'insuffisance pondérale ou de retard de croissance. CONCLUSION: La dépression maternelle est associée à l'insuffisance pondérale et au retard de croissance de la petite enfance. De rigoureuses études prospectives sont nécessaires pour en identifier les mécanismes et les causes. L'identification précoce, le traitement et la prévention de la dépression maternelle peuvent aider à réduire le retard de croissance et l'insuffisance pondérale des enfants dans les pays en développement.