Andréa Poyastro Pinheiro

Body dissatisfaction in Brazilian schoolchildren: prevalence and associated factors

OBJECTIVE To examine the prevalence of body dissatisfaction and associated factors in 8- to 11-year-old schoolchildren. METHODS A cross-sectional study including children aged 8- to 11-years enrolled in public and private schools in Porto Alegre, Southern Brazil, was carried out from August to December, 2001. A total of 901 subjects were selected through cluster sampling. Participants answered a questionnaire aimed at measuring body dissatisfaction and self-esteem and questions about family and social pressures on weight change. Height and weight were measured. The relationship between body dissatisfaction and the variables studied was measured by logistic regression. RESULTS The prevalence of body dissatisfaction was 82%. Fifty-five percent of the girls wanted a thinner body size, and 28% desired a larger one; the estimates for the boys were 43% and 38%, respectively. Children with the lowest self-esteem (OR = 1.80; 95% CI: 1.13-2.89) and who thought their parents (OR = 6.10; 95% CI: 2.95-12.60) and friends (OR = 1.81; 95% CI: 1.02-3.20) expected them to be thinner showed a higher chance of presenting body dissatisfaction. CONCLUSIONS Body dissatisfaction was highly prevalent among the evaluated schoolchildren, especially in those with lower self-esteem and who thought their parents and friends expected them to be thinner.

Transtornos mentais em uma amostra de gestantes da rede de atenção básica de saúde no Sul do Brasil

The aim of this study was to examine the prevalence of probable psychiatric disorders diagnosed during pregnancy and related sociodemographic causative factors among 712 women between the 16th and 36th week of pregnancy receiving prenatal care in 18 basic health units in Porto Alegre and Bento Goncalves in southern Brazil. PRIME-MD was used to assess mental disorders. The prevalence of probable mental disorder occurred in 41.7% of the women. The most prevalent diagnosis was major depressive disorder (21.6%), followed by generalized anxiety disorder (19.8%). A multivariate analysis showed that the factors most significantly associated with a probable psychiatric disorder were: the fact that the pregnant woman did not work or study: PR = 1.25 (95%CI: 1.04-1.51);the fact that the pregnant woman did not live with her spouse: PR = 1.24 (95%CI: 1.01-1.52);the fact that the pregnant woman had two or more children: PR = 1.21 (95%CI: 1.01-1.46). A high prevalence of probable mental disorder was observed. The increased search for health care by pregnant women provides an opportunity for screening, diagnosing and treating these disorders under the primary health care system.

Binge eating during pregnancy and birth outcomes: A cohort study in a disadvantaged population in Brazil

OBJECTIVE To assess the impact of binge eating behavior (BE) during pregnancy on birth outcomes among 697 Brazilian women who attended primary care. METHOD Pregnant women answered a questionnaire on sociodemographic data, obstetric history, and The Eating Disorder Examination Questionnaire (EDE-Q). Perinatal outcomes were obtained from birth records. Birth weight, prematurity, caesarean delivery, being small or large for gestational age were compared among women reporting BE (N = 119) and those without BE (N = 578). Poisson regression was used to estimate the association between BE during pregnancy and birth outcomes. RESULTS BE during pregnancy was not significantly associated with the birth outcomes analyzed. Gestational weight gain was significantly higher among those who reported BE. DISCUSSION Binge eating behavior during pregnancy may not influence birth outcomes as binge eating disorder does but affects gestational weight gain. Women reporting binge eating during pregnancy should undergo a diagnostic assessment for eating disorders.

Eating disorders symptoms in pregnancy and postpartum: A prospective study in a disadvantaged population in Brazil

OBJECTIVE To assess eating disorder symptoms (EDS) from prepregancy through postpartum. METHOD Seven hundred and twelve women with gestational age ranging from 16th to 36th week completed the eating disorder examination questionnaire (EDE-Q). A shortened version of the EDE-Q was used to assess, retrospectively, EDS during the last 28 days of the pregestational period. Follow up assessment occurred at the 4th-5th month postpartum (n = 427). Generalized structural equation models were used to estimate risk of EDS in pregestation, gestation, and postpartum. RESULTS Women who did not participate in follow up (n = 285) were not significantly different in sociodemographic characteristics. In postpartum, a higher number of women referred shape (RR = 1.65; 95% CI 1.19-2.30) and weight concerns (RR = 1.64; 95% CI 1.16-2.31) than in pregestation. Binge eating (BE) and self-induced vomiting diminished during pregnancy (RR = 0.70, 95% CI 0.57-0.85; RR = 0.21, 95% CI 0.10-0.44, respectively) and postpartum (RR = 0.62, 95% CI 0.48-0.80; RR = 0.38, 95% CI 0.19-0.76, respectively) compared with pregestation DISCUSSION Shape and weight concerns are highly prevalent in postpartum and may confer risk for the development of inappropriate eating behaviors. Health professionals should be trained on how to recognize these symptoms.

Common mental disorders and sociodemographic characteristics: baseline findings of the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil)

Objective: To assess the prevalence of common mental disorders (CMD) and the association of CMD with sociodemographic characteristics in the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil) cohort. Methods: We analyzed data from the cross-sectional baseline assessment of the ELSA-Brasil, a cohort study of 15,105 civil servants from six Brazilian cities. The Clinical Interview Schedule-Revised (CIS-R) was used to investigate the presence of CMD, with a score ≥ 12 indicating a current CMD (last week). Specific diagnostic algorithms for each disorder were based on the ICD-10 diagnostic criteria. Prevalence ratios (PR) of the association between CMD and sociodemographic characteristics were estimated by Poisson regression. Results: CMD (CIS-R score ≥ 12) was found in 26.8% (95% confidence intervals [95%CI] 26.1-27.5). The highest burden occurred among women (PR 1.9; 95%CI 1.8-2.0), the youngest (PR 1.7; 95%CI 1.5-1.9), non-white individuals, and those without a university degree. The most frequent diagnostic category was anxiety disorders (16.2%), followed by depressive episodes (4.2%). Conclusion: The burden of CMD was high, particularly among the more socially vulnerable groups. These findings highlight the need to strengthen public policies aimed to address health inequities related to mental disorders.

Association between dietary patterns and mental disorders in pregnant women in Southern Brazil

Objective: To evaluate the association between dietary patterns and mental disorders among pregnant women in southern Brazil. Methods: Cross-sectional study with 712 pregnant women recruited from the Study of Food Intake and Eating Behaviors in Pregnancy (ECCAGe). Food intake assessment was performed using the Food Frequency Questionnaire. Dietary patterns were identified by cluster analysis. The Primary Care Evaluation of Mental Disorders (PRIME-MD) was used to evaluate participants’ mental health. Poisson regression models with robust variance were fitted to estimate prevalence ratios (PR). Results: In the adjusted models, there was a high prevalence of major depressive disorder among women with low fruit intake (43%, PR 1.43, 95%CI 1.04-1.95) and high sweets and sugars intake (91%, PR 1.91, 95%CI 1.19-3.07). Women with a common-Brazilian dietary pattern had higher prevalence of major depressive disorder compared to those with a varied consumption pattern (PR 1.43, 95%CI 1.01-2.02). Low intake of beans was significantly associated with generalized anxiety disorder (PR 1.40, 95%CI 1.01-1.93). Conclusions: Low consumption of fruits and beans and intake of the common-Brazilian dietary pattern during pregnancy were associated with higher prevalence of mental disorders. These results reinforce the importance of an adequate dietary intake to ensure better mental health in pregnancy.

Association of binge eating behavior and psychiatric comorbidity in ELSA-Brasil study: Results from baseline data

OBJECTIVE To estimate the association of binge eating behavior (BE) with common mental disorders (CMD). METHOD Cross sectional investigation of 14,088 adults, aged 35-74years (ELSA-Brasil study). BE was assessed with Structured Clinical Interview for DSM Disorders (SCID - DSM IV) questions, and psychiatric morbidity with CIS-R (CIS R - Clinical Interview Schedule Revised). Poisson regression was used to estimate the association of BE and psychiatric morbidity. RESULTS Adjusted prevalence ratios (PR) for CMD and BE were: PR=1.60 (1.34-1.91) for a CIS R score 12-18 (presence of CMD with lower clinical severity); PR=2.40 (2.06-2.80) for a CIS R score≥18 (severe symptom profile likely to require treatment); for psychiatric diagnoses: PR=2.24 (1.84-2.73) for depressive episodes; PR=1.77 (1.53-2.04) for anxiety disorders, and PR=1.42 (1.20-1.67) for mixed depressive-anxiety disorder. CONCLUSION BE was associated with higher prevalence of common mental disorders. Our findings highlight the need to investigate mechanisms involved in the relationship of BE, obesity and psychopathology in low/middle income countries.

2660 – Suicidal ideation during pregnancy and risk factors for depressive symptoms in postpartum: a cohort study in a disadvantaged population in brazil

Objectives To estimate the prevalence of suicidal ideation during gestation and risk factors for depression in postpartum. Methods 712 pregnant women answered the PRIME MD, and reported sociodemographic data, obstetric history and history of violence; 427 women answered the PRIME MD at 4-5 th month postpartum. Poisson regression was used to estimate the association between suicidal ideation and sociodemographic, obstetric and violence variables, and to estimate the association between risk factors and depressive symptoms in postpartum. Results The prevalence of suicidal ideation during pregnancy was 10.3% (n=73). The prevalence of depression was 36.2% (n=258). Suicidal ideation was associated with: 0 to 4 years of schooling (PR=2.88, CI 95% 1.40-5.91), and 5 to 8 years of schooling (PR=2.63, CI 95% 1.45-4.77), being victim of violence in the current gestation (PR=4.35, CI 95% 2.81-6.74), and anxiety symptoms (PR= 5.49, CI 95% 3.58-8.40). The prevalence of depression in the postpartum was 28.3% (n=121); 45 were incident cases (37%). The following variables were significantly associated with depression in postpartum: Conclusion Gestation is not protective of suicidal ideation and common mental disorders. Treating common mental disorders during pregnancy is essential to prevent depression in post partum and to promote maternals and infants health.