Childhood psychiatric disorders usually persist through adolescence and adult life,¹1. Kieling C, Baker-Henningham H, Belfer M, Conti G, Ertem I, Omigbodun O, et al. Child and adolescent mental health worldwide: evidence for action. Lancet. 2011;378:1515-25. and have a deleterious impact and longstanding costs to individuals and society.²2. Merikangas KR, He JP, Brody D, Fisher PW, Bourdon K, Koretz DS. Prevalence and treatment of mental disorders among US children in the 2001-2004 NHANES. Pediatrics. 2010;125:75-81. Ninety percent of the world’s children and adolescents live in low- and middle-income countries, where methodologically sound data about the prevalence of child psychiatric disorders are still lacking to guide improvement in services planning.¹1. Kieling C, Baker-Henningham H, Belfer M, Conti G, Ertem I, Omigbodun O, et al. Child and adolescent mental health worldwide: evidence for action. Lancet. 2011;378:1515-25.

In Latin America, studies examining the prevalence of psychiatric disorders in children using diagnostic instruments are very scarce. In Brazil, only three prevalence studies involving children’s mental health and using diagnostic instruments have been conducted,³3. Paula CS, Miranda CT, Bordin IAS. Saúde mental na infância e adolescência: revisão dos estudos epidemiológicos brasileiros. In: Lauridsen-Ribeiro E, Tanaka OY, editors. Atenção em saúde mental para crianças e adolescentes no SUS. São Paulo: Hucitec;. 2010p. 75-92. none of which involved more than one region of the country. Thus, the purpose of the current study was to ascertain the prevalence of psychiatric disorders in schoolchildren from grades 2-6 living in four municipalities from four Brazilian regions (Southeast, Center, Northeast, and North), using probabilistic samples.

Considering that education is compulsory for all Brazilians aged 4 to 17 years and that 83.5% of this population is enrolled in public schools, this multicenter, cross-sectional study enrolled 1,676 6-to-16-year-olds (response rate: 81.1%). Trained psychologists administered the Brazilian version of the Schedule for Affective Disorders and Schizophrenia for School-Age Children/Present-and-Lifetime-Version (K-SADS-PL) to mothers/main caregivers to identify current child psychiatric disorders. The Universidade de São Paulo Research Ethics Committee approved the study protocol. Data collection lasted 15 months, and was completed by December 2011. A detailed description of the methodology is available elsewhere.⁴4. Paula CS, Bordin IA, Mari JJ, Velasque L, Rohde LA, Coutinho ES. The mental health care gap among children and adolescents: data from an epidemiological survey from four Brazilian regions. PloS One. 2014;9:e88241.

Prevalence rates were obtained for the overall sample and stratified by municipality/region, including any psychiatric disorder (excluding enuresis/encopresis), specific groups of disorders, and single disorders (Table 1). The observed overall prevalence of one or more psychiatric disorders (13.1%) was similar to most estimates reported for children around the world,²2. Merikangas KR, He JP, Brody D, Fisher PW, Bourdon K, Koretz DS. Prevalence and treatment of mental disorders among US children in the 2001-2004 NHANES. Pediatrics. 2010;125:75-81.,⁵5. Costello EJ, Egger H, Angold A. 10-year research update review: the epidemiology of child and adolescent psychiatric disorders: I. Methods and public health burden. J Am Acad Child Adolesc Psychiatry. 2005;44:972-86. including rates from Brazil.³3. Paula CS, Miranda CT, Bordin IAS. Saúde mental na infância e adolescência: revisão dos estudos epidemiológicos brasileiros. In: Lauridsen-Ribeiro E, Tanaka OY, editors. Atenção em saúde mental para crianças e adolescentes no SUS. São Paulo: Hucitec;. 2010p. 75-92. In comparison with one of the most important reviews in the field,⁵5. Costello EJ, Egger H, Angold A. 10-year research update review: the epidemiology of child and adolescent psychiatric disorders: I. Methods and public health burden. J Am Acad Child Adolesc Psychiatry. 2005;44:972-86. our estimates were similar in magnitude regarding any anxiety and any ADHD, somewhat smaller for any disruptive disorder, and smaller for any depressive and any oppositional conduct disorder.

Surprisingly, certain differences in prevalence rates by municipality/region were observed. The rate of any psychiatric disorder was lower in the Northeast municipality than in any of the other three sites. The rates of ADHD and disruptive disorders were higher in the Center of Brazil and lower in the Northeast, while oppositional/conduct disorder was more prevalent in the Center and less prevalent in the Northeast and North. These differences are difficult to interpret, as participating municipalities were similar in terms of population (having fewer than 50,000 inhabitants, as do 84.7% of Brazilian municipalities), were all located near a state capital, and had a Human Development Index near the countrywide average.

In conclusion, this was the first epidemiological study conducted in four Brazilian regions to investigate the prevalence of different types of psychiatric disorders among schoolchildren. Further studies are necessary to confirm or refute the differences observed by region. Because Brazil is a large and heterogeneous country in terms of socioeconomic status and availability of resources, local contexts must be examined to better capture differences in children’s mental health needs.

The next challenge is to translate evidence into action, scaling up services and human resources to deal appropriately with regional morbidity.

Disclosure

The authors report no conflicts of interest.

The study is part of the Instituto Nacional de Psiquiatria do Desenvolvimento para Infância e Adolescência (INPD), of the National Science and Technology Institute (Instituto Nacional de Ciência e Tecnologia, INCT). It was funded by Fundação de Amparo è Pesquisa do Estado de São Paulo (FAPESP; grant no. 2008/57896-8) and by Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq; grant no. 573974/2008; Edital n° 15/2008).

The authors are grateful to Marcos Tomanik Mercadante (in memoriam) for his assistance with study design.

References

Publication Dates

History