Prevalence of externalizing behavior problems in Sri Lankan preschool children: birth, childhood, and sociodemographic risk factors

Socioeconomic and lifestyle factors associated with mental health problems among Mongolian elementary school children

PURPOSE

Lifestyle factors of children and adolescents' mental health problems are an emerging health issue in low- and middle-income countries (LMICs). However, there is a lack of studies on lifestyle factors in LMICs. This study examined the socioeconomic and lifestyle factors associated with mental health problems among school-age children in Mongolia.

METHODS

A population-based cross-sectional survey was conducted among 4th-year students at public elementary schools in one district in Ulaanbaatar. The Strengths and Difficulties Questionnaire (SDQ) and a self-administrated socioeconomic and lifestyle questionnaire were completed by participants' guardians. A multivariate logistic regression analysis was performed.

RESULTS

Of the 2301 children surveyed, 1694 without missing responses were included in the analysis. The multivariate logistic regression analysis showed that male gender [adjusted odds ratio (AOR) 1.64 (1.29-2.10)], low maternal education [AOR 1.89 (1.16-3.05)], short sleep [AOR 1.41 (1.10-1.80)], no physical activity [AOR 1.31 (1.03-1.67)], and long screen time (AOR 1.53 (1.20-1.94)) were associated with high risk of mental health problems. Low maternal education, low household income, no physical activity habit, and long screen time were associated with internalising problems. Meanwhile, male gender, low maternal education, and long screen time were associated with externalising problems.

CONCLUSION

The results are consistent with previous studies in high-income countries, indicating that there are globally common socioeconomic and lifestyle risk factors. The findings of this study may help develop a targeted preventive intervention for high-risk groups, such as socioeconomically disadvantaged groups, as well as a universal preventive intervention to foster a healthy lifestyle in Mongolia.

An epidemiological study of childhood development in an urban setting in Brazil

Objective:

Mental illness is an important public health concern, often starting early in life and particularly impacting children from low-and middle-income countries. Our aims were to 1) determine, in a representative sample of public preschool 4- to 5-year old children in Brazil, the prevalence of internalizing and externalizing disorders and socioemotional development delays; and 2) to identify modifiable risk factors associated with mental, behavioral, or developmental disorders (MBDD), such as microsystem (i.e., parent-child relationship), mesosystem (social support), and macrosystem contextual factors (neighborhood disadvantage).

Methods:

A random sample of public preschool children was recruited in the city of Embu das Artes (São Paulo metropolitan area) (n=1,292 from 30 public preschools). Six-month prevalence of MBDD was measured using the Child Behavior Checklist (CBCL) and the Ages and Stages Questionnaires: Social-Emotional (ASQ:SE).

Results:

Six-month prevalence estimates were 25.4% for internalizing disorders, 12.1% for externalizing disorders, and 30.3% for socioemotional development delays. MBDD prevalence estimates were higher in families with stressful relationships and parental depression or anxiety, and in families with lower social capital.

Conclusion:

At least 25% of preschool children living in an urban area in Brazil presented a mental health disorder. These mental disorder were associated with modifiable factors such as stressful family relationships and lower social capital. Prevention and intervention measures such as family therapy are needed to decrease such high prevalence.

The prevalence of psychiatric disorders among 3-4 year olds in an urban sample in Bangladesh

Preschool period is the most important stage of life when major development occurs that lays the foundation of later life. Nearly similar ranges of psychiatric disorders start during preschool age and they continue to childhood and adolescence. Early intervention can reduce risks of adverse psychosocial outcome and longitudinal continuity of disorders. Detailed assessment of psychiatric disorders among this population is increasingly of high importance. Present study was aimed to determine the prevalence of psychiatric disorders among 3-4 year olds and to find out possible baseline correlates. This was a quantitative, cross-sectional and descriptive study carried out from March to May 2018 in 160 random urban community samples of Dhaka city. Of these, 86 were boys and 74 were girls. Household Questionnaire and validated parent version of Bangla Strengths and Difficulties Questionnaire (SDQ) for screening psychopathology had been applied to the consented parents or caregivers of the respondents. Mean age of the subjects was 3.63 ± 0.49 years. Overall, predictive prevalence of psychiatric disorder was 11.9 %. Among them, 4.4 % was emotional disorder, 5.6 % was conduct disorder and 1.9 % was hyperactivity. Prevalence of predictive psychiatric disorders was roughly similar in 3 and 4 years age. Girls had an excess of emotional disorder and boys had more behavioral disorder. Comorbidity was found at a higher rate with significant overlapping among the broad types of psychiatric disorders. This study supports the other findings of psychiatric disorders among the preschool children that would ultimately help in applying suitable screening procedures and subsequent management of psychiatric conditions.

Prevalence and predictors of emotional and behavioral problems among institutionalized children in Kandy District, Sri Lanka

BACKGROUND

Child care institutions (CCIs) in Sri Lanka (SL) provide residence to over 14,000 children. These children have a high risk of developing psychological problems. However, there has been no prior scientific inquiry into mental health issues of institutionalized children in SL.

OBJECTIVE

To investigate the emotional and behavioral problems of children living in CCIs in Kandy District, and to explore associated factors.

PARTICIPANTS AND SETTING

Ten CCIs in Kandy District were selected and all children aged 6-18 years were recruited.

METHODS

Child Behavior Checklist (6-18) -Sinhala version (CBCL-S) was filled by the caregivers, and pertinent problem scores were derived. Relevant socio-demographic data were also collected.

RESULTS

A total of 259 children participated. Of them, 66.8 % were female. The mean age was 13.9 years. The average duration in care was 4.3 years. Clinical levels of behavioral problems were found in 14 % of children, whereas 7% were borderline. Externalizing problems like rule-breaking and aggression were more common (23.3 %) than internalizing problems (6.6 %). Male children exhibited more behavioral problems (p = 0.034). Present age, age on admission, duration in care, history of sexual abuse, institutional transfers and frequency of family contact were not associated with behavioral problems.

CONCLUSIONS

Institutionalized children showing high levels of externalizing problems may be a reflection of disturbed psychosocial development. However, internalizing problems may not be readily recognized, partly due to the shortage of trained caregivers in SL. Educating caregivers to detect and refer children with behavioral problems to psychiatric services is recommended.

Behavioral problems in preadolescence: Does gender matter?

Behavioral problems in children are increasingly acknowledged as a global issue in mental health. Preadolescence is the transitory phase of development that links childhood and adolescence, and the presence of behavioral problems in this phase could be detrimental to children's present and future. This study aimed to describe the epidemiology of "behavioral problems" in preadolescents aged 11 to 12 years and to examine their distribution by socioeconomic status and children's characteristics while developing an in-depth understanding of the role of gender as a risk factor for such problems. A school-based, cross-sectional study was conducted in Karachi, Pakistan. Participants were selected from a middle-class, coeducational school chain. Sociodemographic questionnaires and an officially adapted version of Youth Self Report Form, which is child- and adolescent-reported version of Child Behavior Checklist, were used to collect data from children. The prevalence of Overall Behavioral Problems was 28.6%. From Broadband Scales, the relative prevalence of internalizing problems was about 52% higher than that of externalizing problems. Among the Narrowband Scales, somatic complaints were the most prevalent (23.2%). Male children significantly had higher odds for being at risk of Overall Behavioral problems, internalizing problems, and co-occurring behavioral issues, as compared to female children. The study concludes that the prevalence of overall behavioral problems is at the higher end of the global range. Male children are more at risk for overall behavioral problems, and contrary to previous studies, they are significantly more at risk of internalizing problems. Our study is the first to report the risk of co-occurrence of multiple issues with respect to gender, and adds that male children are significantly at risk of multiple co-occurring behavioral problems. Our study highlights the need for an in-depth understanding of cultural, sociopolitical conditions for actionable and gender-sensitive interventions for preadolescents.

Simultaneous assessement of social skills and behavior problems: Education and gender

Abstract The aim was to compare the social skills of preschool and school-age children, considering groups differentiated by behavior problem indicators, according to the assessment performed by parents and teachers. Children of both genders participated in this study. Parents/primary caregivers assessed 194 children and 294 children were assessed by their teachers. The results indicated that, for the parents and teachers, the children without problems were more socially skilled. The gender of the children distinguished the repertoire of social skills, according to their parents, mainly the school-age children. For the teachers, considering both school periods, girls were more socially skilled and, for both parents and teachers, boys presented more behavior problems. These data have implications for assessment and intervention procedures.

Child mental health and maternal depression history in Pakistan

PURPOSE

We address the significant gaps in knowledge of prevalence and correlates of child mental health (CMH) problems outside of high income countries. We describe the prevalence of CMH problems and their correlates with a focus on the association with maternal depression in a sample of seven-year-old children in rural Pakistan.

METHODS

This study was nested in a long-term follow-up of a perinatal depression intervention together with a reference group of non-depressed women, yielding a population representative sample. The Total Difficulties (TD) and component scores of the Strength and Difficulties Questionnaire (SDQ) were used to measure emotional and behavioral difficulties.

RESULTS

The mean SDQ TD score was 10.6 (standard deviation = 8.3), with 12.5 % of children categorized as "abnormal" using standard cutoffs. Boys had a roughly 1 point higher (worse) SDQ TD score than girls (p value = 0.04). Children of mothers who were depressed prenatally as well as currently had SDQ TD scores 2.87 points higher than children whose mothers were not depressed at either time point (p value < 0.01). This association was stronger for boys. There was no evidence of elevated SDQ TD score among children whose mothers were depressed only prenatally or only currently. Some deviations from this pattern were observed with specific components of the SDQ.

CONCLUSIONS

In this low resource, South Asian setting, we found evidence of elevated levels of emotional and behavioral problems, highlighting the need for effective interventions. Given the strong association of CMH with maternal depression, any intervention efforts should give strong consideration to maternal mental health.

Prevalence and characteristics of victims and perpetrators of bullying

OBJECTIVE

To determine the prevalence of bullying (victims and perpetrators) in a representative sample of sixth graders from schools located in the city of Caxias do Sul, RS, Brazil and to determine possible associations with maternal education, socioeconomic level, sedentary habits, nutritional status, dissatisfaction with body image, gender, and age.

METHODS

This was a school-based epidemiological study. The target population consisted of sixth graders (11-14 years). A self-administered questionnaire and anthropometric measurements of weight and height were used for the assessment of nutritional status. Bullying was assessed through the Kidscape questionnaire, and body image through the Body Shape Questionnaire. Descriptive statistics and bivariate and multivariate analyses were used.

RESULTS

1,230 schoolchildren were evaluated, and the prevalences of victims and perpetrators of bullying were 10.2% and 7.1%, respectively. Those dissatisfied with their body image were three times more likely to be victims of bullying (PR=3.24; CI=1.99- 5.28), and almost twice as likely to be aggressors (PR=1.98; CI=1.53-3.73) than those who were satisfied. Schoolchildren with sedentary habits (more than three hours a day) were 55% more likely to be victims of bullying (PR=1.55; CI=1.01- 2.36) and more than twice as likely (PR=2.42; CI=1.47-3.97) to be aggressors. Boys were more than twice as likely (PR=2.45; CI=1.42-4.24) to be aggressors.

CONCLUSIONS

Body image and sedentary habits were associated with victims and perpetrators, and male gender was more prevalent among the perpetrators of bullying.

Early-life soy exposure and gender-role play behavior in children

BACKGROUND

Soy-based infant formula contains high levels of isoflavones. These estrogen-like compounds have been shown to induce changes in sexually dimorphic behaviors in animals exposed in early development.

OBJECTIVE

We examined gender-role play behavior in relation to soy-based and non-soy-based infant feeding methods among children in the Avon Longitudinal Study of Parents and Children.

METHODS

We studied 3,664 boys and 3,412 girls. Four exposure categories were created using data from questionnaires administered at 6 and 15 months postpartum: primarily breast, early formula (referent), early soy, and late soy. Gender-role play behavior was assessed using the Pre-School Activities Inventory (PSAI). Associations between infant feeding and PSAI scores at 42 months of age were assessed using linear regression. Post hoc analyses of PSAI scores at 30 and 57 months were also conducted.

RESULTS

Early-infancy soy use was reported for approximately 2% of participants. Mean [95% confidence interval (CI)] PSAI scores at 42 months were 62.3 (62.0, 62.6) and 36.9 (36.6, 37.2) for boys and girls, respectively. After adjustment, early soy (vs. early formula) feeding was associated with higher (less feminine) PSAI scores in girls (β = 2.66; 95% CI: 0.19, 5.12) but was not significantly associated with PSAI scores in boys. The association between soy exposure and PSAI scores in girls was substantially attenuated at 30 and 57 months.

CONCLUSIONS

Although not consistent throughout childhood, early-life soy exposure was associated with less female-typical play behavior in girls at 42 months of age. Soy exposure was not significantly associated with play behavior in boys.