Severe physical punishment: risk of mental health problems for poor urban children in Brazil

Abstract

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.Une traduction en français de ce résumé figure à la fin de l'article. Al final del artículo se facilita una traducción al español. ‫املقالة.‬ ‫لهذه‬ ‫الكامل‬ ‫النص‬ ‫نهاية‬ ‫يف‬ ‫الخالصة‬ ‫لهذه‬ ‫العربية‬ ‫الرتجمة‬

Exposure to maltreatment and urban violence in children working on the streets in São Paulo, Brazil: factors associated with street work

“…This may be related to their high level of violence against their own children, as previously shown in a Brazilian study using a similarly impoverished sample of children and families. 8 This same pattern was observed in a qualitative study with blended families of homeless youth from Melbourne, Australia. It was reported that particular issues usually arise from a sense of displacement, either of the new member or of the young person.…”

“…The previous study found that the prevalence of severe physical punishment was 20.0%. 8 Indeed, the present study's rates were also higher than those reported from 19 communities in six countries evaluated by the WorldSAFE study (n=14,239). Importantly, the WorldSAFE study used the same instrument and definition of severe physical punishment as the present investigation.…”

“…2 A Brazilian study of an impoverished sample of children and families from an area of favelas near the city of Sã o Paulo showed that single motherhood was related to increased aggression toward their children. 8 Further studies have reported that one reason for street children leaving their homes is the number of boyfriends/partners of their mothers that come through the house, which increases levels of abuse. These studies also reported that stepfathers often commit child abuse at higher rates compared to birth fathers.…”

Mental healthcare in Brazil: modest advances and major challenges

“…A cross-sectional study was conducted in Embu, a deprived city on the outskirts of São Paulo, to study mental health and risk factors in children aged 6-17 years. It found that 20% of children had suffered severe physical punishment, defined as being hit with an object, being kicked, choked, smothered, burnt, scalded, branded, beaten or threatened with a weapon, in the previous year (Bordin 2009). Physical punishment and maternal minor affective disorders were associated with both internalising and externalising problems in this age group.…”

Childhood maltreatment and psychological adjustment: a systematic review

“…However, in Brazil, studies about the relationship between these variables are scarce. National studies have focused on aspects such as the prevalence and consequences of abuse, especially sexual abuse, in certain situations and their related factors (Amazarray & Koller, 1998;Drezett et al, 2001), the risk of developing mental illness in individuals exposed to maltreatment (Bordin et al, 2009;Borges & Dell'Aglio, 2008;Vitolo, Fleitlich-Bilyk, Goodman, & Bordin, 2005) and the development of group interventions for victims of sexual abuse (Habigzang et al, 2009). Furthermore, most of these published studies did not compare groups with the presence and absence of childhood maltreatment.…”