Academic journal article Bulletin of the World Health Organization

Severe Physical Punishment: Risk of Mental Health Problems for Poor Urban Children in Brazil/Chatiments Corporels Severes: Risques Pour la Sante Mentale Des Enfants Pauvres Dans Les Villes Bresiliennes/Castigos Fisicos Severos: Riesgo De Problemas De Salud Mental En Ninos Brasilenos De Entornos Urbanos

Academic journal article Bulletin of the World Health Organization

Severe Physical Punishment: Risk of Mental Health Problems for Poor Urban Children in Brazil/Chatiments Corporels Severes: Risques Pour la Sante Mentale Des Enfants Pauvres Dans Les Villes Bresiliennes/Castigos Fisicos Severos: Riesgo De Problemas De Salud Mental En Ninos Brasilenos De Entornos Urbanos

Article excerpt

Introduction

Few epidemiological surveys have focused on child mental health in developing countries. A literature review (1980-1999) on population studies in Latin America (1) identified 10 studies in which prevalence rates of mental health problems of 15% to 21% were found. Only nine studies in Brazil that used more rigorous methods can be found in the literature (1980-2006); all of them used probabilistic sampling and standardized instruments specifically developed to identify mental problems or disorders in children and/or adolescents. (2) Based on screening instruments, prevalence rates varied according to informant, from 8.3% for teachers to 35.2% for parents; based on diagnostic interviews, such rates varied from 7.0% to 12.7%.

Several types of factors may increase a child's vulnerability to mental health problems: biological factors (central nervous system abnormalities due to injury, infections or malnutrition), genetic factors (family history of depression), psychosocial factors (marital discord, maternal psychopathology or paternal criminality), stressful life events (parental death or separation from parents) and exposure to physical or sexual abuse. (3) The cumulative effect of multiple factors is more important in determining a child's emotional or behavioural problems than the presence of an isolated stressor, regardless of its magnitude. (4) In Brazil, the negative impact of different stressors has been shown to affect child mental health; stressors include witnessing marital violence, (5) living with a mentally disturbed mother (5,6) and suffering physical aggression at home. (5-7) However, Brazil lacks a comprehensive examination of the relationship between factors that can be prevented (e.g. corporal or physical punishment) and child mental health problems.

Corporal punishment is associated with mental health problems during childhood and adolescence (antisocial behaviour, depression) and in adult life (aggressive or criminal acts, antisocial behaviour, alcoholism, depression). (8) This phenomenon occurs worldwide, but most studies on child maltreatment have been conducted in developed countries. (9) According to the Pan American Health Organization's Team on Violence and Injury Prevention, (10) corporal punishment is more prominent in Latin America, whereas sexual abuse and exploitation are more common in the Caribbean. Nevertheless, methodologically sound data on child abuse in Latin America and the Caribbean are lacking, so that the magnitude of the problem remains poorly defined.

The United Nations Secretary General's Study on Violence against Children (2006) (11) recommended the development of a national research agenda on violence against children across settings where violence occurs. This study is part of WorldSAFE (World Studies of Abuse in the Family Environment), a project involving researchers from six countries. (12) In our pilot study (7) we found high rates of child mental health problems (22.4% in children aged 4-17 years) and severe physical punishment (10.1% in children aged 0-17 years), which confirms the need to explore the potential association between these factors. This study represents the first use of a comprehensive approach for examining--in a probabilistic household sample of children from a developing country (Brazil) living in an impoverished and violent area--whether and in what way severe physical punishment may be related to different types of mental health problems in children.

Methods

Study design and sampling

We conducted a cross-sectional study in south-eastern Brazil, in a typical urban poor neighbourhood of the city of Embu. The city has 238 891 inhabitants and is located in the boundaries of Sao Paulo city in the great Sao Paulo area, where more than 10% (19 million) of the Brazilian population lives. Embu is totally urban, and 38.1% of its inhabitants are under 20 years of age. It is characterized by neighbourhoods of small households and slums and was considered one of the most violent cities in the country at the time the data were collected (April 2002 to February 2003). …

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