Violência comunitária e saúde mental de adolescentes

Abstract

This thesis assesses the association between community violence (CV) and internalizing mental disorders (IMD) in adolescents and youngs. The first two manuscripts refer to a systematic review which objective was to investigate if: (i) higher exposure to VC is associated with greater risk of TMI, (ii) different degrees of proximity with VC are distinctly associated with symptoms of depression, anxiety and post-traumatic stress disorder (PTSD), (iii) gender, age and race influence this relationship. The stages of selection, extraction and quality assessment were carried out by pair of researchers and according to the Preferred Reporting Items for Systematic Reviews and meta-Analysis Protocols (PRISMA-P). The search resulted in 2987 works, after applying the selection criteria, 42 studies were included in the review. The results showed that there is an association between CV and IMD, that victims are at greater risk than witnesses for the development of depression, anxiety and PTSD and that girls are more vulnerable when exposed to the same level of VC when compared to boys. Age and race did not appear as effect modifiers, but studies that tested these factors were scarse. The third manuscript present the results of a cross-sectional survey conducted with individuals that participated in the Study of Cardiovascular Risk in Adolescents (ERICA) which objective was to assess the association between different types of crimes with the presence of common mental disorders (CMD) in adolescents living in the city of Rio de Janeiro. Crime indicators were constructed based on records of police reports from the Civil Police of Rio de Janeiro, dividing them into crimes against property and crimes against life, lethal and non-lethal. The data were submitted to geospatial analysis and tested in logistic regression models. The results showed that the OR for the occurrence of CMD were higher among adolescents living in more violent regions when considering the three types of crimes, the ORs and respective 95% confidence intervals being: 2,97 (1,97 – 4,50) for crimes against property; 2,46 (1,54 – 3,93) for non-lethal crimes; and 2,35 (1,65 – 3,34) for lethal crimes. The ORs were higher among girls compared to boys, older adolescents compared to younger ones, and in black compared to non-blacks, also for the three types of crimes. This thesis contributes to the advancement of scientific knowledge in the area of violence and mental health of adolescents, both phenomena subject to preventive intervention. It brings as innovation the systematic updating of knowledge in the field and the observation that girls, younger adolescents and blacks are more vulnerable than their peers when exposed to CV.