RESUMO
Violence is a major public health problem globally, with the highest rates in low- and middle-income countries (LMICs) in the Americas and southern Africa. Parenting programmes in high-income countries can diminish risk for violence, by reducing risk factors such as child aggression and harsh parenting, and increasing protective factors such as child cognitive development and school readiness. However, there is critical need to identify low-cost programmes with replicable benefits that work in real-world LMICs contexts. A three-arm, randomised, single-blind trial evaluated effects of two low-cost, group-based parenting programmes recommended for LMICs (ACT: Raising Safe Kids; DBS: dialogic book-sharing) on child aggression (primary outcome), child development, parenting, maltreatment, and stress. Participants were 369 children with medium-high levels of aggression (mean age 3.1 years at baseline) in poor households. Interventions were implemented in city health and education services in southern Brazil. Maternal reports, filmed observations, child tasks, and hair cortisol were assessed at baseline, 1-month post-intervention, and 8-month follow-up. Intention-to-treat analyses compared each of ACT and DBS with a control group. Three hundred sixty-eight (99.7%) participants completed follow-up assessments 8 months after the interventions. There was no effect of ACT (standardised mean difference, SMD 0.11, 95% CI - 0.05, 0.27) or DBS (SMD 0.05, 95% CI - 0.11, 0.21) on the primary outcome of child aggression. ACT reduced harsh parenting behaviour post-intervention (SMD - 0.23; 95% CI - 0.46, - 0.01), but not at follow-up. DBS improved book-sharing practices at both time points (e.g., maternal sensitivity at follow-up SMD 0.33; 95% CI 0.08, 0.57). There were no benefits of either programme for other parenting, child development, or stress outcomes. Two parenting programmes in Brazil had small effects on parenting practices but did not reduce child aggression or several other important risk/protective factors for violence. Effective early interventions that reduce violence in real-world LMIC settings are highly desirable but may be challenging to achieve.
Assuntos
Agressão , Poder Familiar , Violência , Humanos , Brasil , Pré-Escolar , Feminino , Masculino , Violência/prevenção & controle , Método Simples-Cego , Criança , Fatores de RiscoAssuntos
COVID-19 , Humanos , Brasil/epidemiologia , Estudos de Coortes , Seguimentos , COVID-19/epidemiologiaRESUMO
BACKGROUND: The scale-up of parenting programmes to support early childhood development (ECD) is poorly understood. Little is known about how and when early interventions are most effective. Sustainability of ECD programming requires a better understanding of the mechanisms of real-world interventions. We examined the effects on caregiving practices of Primeira Infância Melhor (PIM), a state-wide home-visiting programme in Brazil. METHODS: This propensity score matched, longitudinal, quasiexperimental study uses data from the 2015 Pelotas Birth Cohort. We matched children who received PIM at any age with other cohort children on 25 key covariates. Sensitivity, guidance and responsiveness were assessed using video-recorded play tasks. Coerciveness and the parent-child relationship were assessed using the Parenting and Family Adjustment Scales. All parenting outcomes were examined at age 4 years. Separate moderation analyses were conducted for each effect modifier: family income, child age and duration of participation. RESULTS: Out of 4275 children in the cohort, 797 were enrolled in PIM up to age 4 years. 3018 children (70.6%) were included in the analytic sample, of whom 587 received PIM and 2431 were potential controls. We found a positive effect of PIM on responsiveness (ß=0.08, 95% CIs 0.002 to 0.16) and sensitivity (ß=0.10, 95% CIs 0.02 to 0.19). No effect was found for any secondary outcomes. Moderation analyses revealed a stronger positive effect on sensitivity for low-income parents (ß=0.18, 95% CIs 0.03 to 0.34). CONCLUSION: A state-wide, home-visiting programme in Brazil improved aspects of responsive caregiving. Effects were more pronounced for low-income families, suggesting benefits of purposeful targeting.
Assuntos
Desenvolvimento Infantil , Poder Familiar , Humanos , Pré-Escolar , Brasil , PobrezaRESUMO
Resumo Este estudo analisou o percurso de quatro famílias, destituídas do poder familiar, pelo Sistema de Garantia de Direitos da Criança e do Adolescente no Brasil. A análise do discurso de orientação psicanalítica foi empregada no corpus de informações de cada caso, compreendido por documentos relativos ao acompanhamento dos casos e entrevistas, realizadas com familiares e agentes institucionais. Os resultados apontam para formações discursivas que naturalizam ações judiciais punitivas de suspensão ou destituição do poder familiar, aplicadas hegemonicamente às famílias pobres, nas quais as mulheres são as principais culpabilizadas pelas falhas na gestão de cuidados. Verifica-se, também, a descontinuidade do acompanhamento, retomado quando há repetição da aplicação dessas medidas protetivas, assumindo a característica sintomática de falha. A escuta dos atores desses processos surge como uma estratégia de retificação subjetiva, ultrapassando práticas prescritivas e normativas, ratificadoras da exclusão e de criminalização da pobreza, particularmente das famílias negras.
Abstract This study analyzes the journey of four families, deprived of family power, by the Child and Adolescent Rights Guarantee System in Brazil. The psychoanalytically discourse analysis was used in the corpus of information of each case, comprised of documents relating to the accompaniment of the cases and interviews, carried out with family members and institutional agents. The results point to discursive formations that naturalizes punitive judicial actions of suspension or destitution of family power, hegemonically applied to poor families, in which women are considered as the main culprits for failures in care management. There is also discontinuity in follow-ups, resumed when the application of these protective measures is repeated, assuming the symptomatic characteristic of failure. Listening to the actors in these processes emerges as a subjective rectification strategy, going beyond prescriptive and normative practices, which ratify exclusion and the criminalization of poverty, particularly of black families.
Resumen Este estudio analizó la historia de cuatro familias, privadas de poder familiar por el Sistema de Garantía de los Derechos del Niño y del Adolescente de Brasil. El análisis del discurso de orientación psicoanalítica se utilizó en el corpus de datos de cada caso, compuesto por documentos relativos al seguimiento de los casos, y entrevistas, realizadas con familiares y agentes institucionales. Los resultados apuntan a formaciones discursivas que naturalizan acciones judiciales punitivas de suspensión o remoción del poder familiar, aplicadas hegemónicamente a familias pobres, en las que las mujeres son las principales culpabilizadas de los fallos en la gestión del cuidado. También existe discontinuidad en el seguimiento, que se reanuda cuando se repite la aplicación de estas medidas protectoras, asumiendo la característica sintomática de fallo. La escucha de los actores de estos procesos es una estrategia de rectificación subjetiva, superando las prácticas prescriptivas y normativas que ratifican la exclusión y criminalizan la pobreza, en especial de las familias negras.
Résumé Cette étude a analysé le parcours de quatre familles, privées de pouvoir familial, par le Système de Garantie des Droits de l'Enfant et de l'Adolescent au Brésil. L'analyse du discours d'orientation psychanalytique a été utilisée dans le corpus d'informations de chaque cas, composé de documents relatifs au suivi des cas et d'entretiens, réalisés avec des membres de la famille et des agents institutionnels. Les résultats indiquent des formations discursives qui naturalisent les actions judiciaires punitives de suspension ou de suppression du pouvoir familial, appliquées de manière hégémonique aux familles pauvres, dans lesquelles les femmes sont considérées les principales responsables des échecs de la gestion des soins. Il existe également une discontinuité dans le suivi, repris lors de la répétition de l'application de ces mesures de protection, assumant le caractère symptomatique de l'échec. L'écoute des acteurs de ces processus apparaît comme une stratégie de rectification subjective, dépassant les pratiques prescriptives et normatives, qui entérinent l'exclusion et la criminalisation de la pauvreté, notamment des familles noires.
Assuntos
Humanos , Feminino , Adulto , Política Pública , Maus-Tratos Infantis , Proteção da Criança , Poder Familiar , Criança Acolhida , Pobreza , Isolamento Social/psicologia , Defesa da Criança e do Adolescente , Decisões JudiciaisRESUMO
BACKGROUND: Intimate partner violence (IPV) is highly prevalent in low-income and middle-income countries and has been a major obstacle towards reaching global health targets for women and children. We aimed to investigate cross-sectional and longitudinal associations between IPV victimisation and maternal parenting practices of young children in a population-based birth cohort study in Brazil. METHODS: The 2015 Pelotas Birth Cohort is an ongoing, prospective cohort, including all hospital births occurring between Jan 1 and Dec 31, 2015, in the city of Pelotas, Brazil. When children were aged 4 years, mothers reported on emotional, physical, and sexual IPV victimisation in the past 12 months. Parenting outcomes were assessed through filming the mother and child in interactive tasks at age 4 years and maternal interviews at ages 4 years and 6-7 years. Interactive tasks were filmed at the Centre for Epidemiological Research facilities. Directly observed outcomes included negative (eg, coercive) and positive (eg, sensitivity and reciprocity) parenting interactions independently coded by a team of psychologists. Self-reported parenting was measured using the subscales on quality of parent-child relationship, positive encouragement, parental consistency, and coercive behaviour of the Parenting and Family Adjustment Scales questionnaire. Unadjusted and adjusted linear regression analyses were performed to assess the associations. FINDINGS: Of the 4275 livebirths enrolled in the cohort, 3730 mother-child dyads were included in our analytical sample at age 4 years and 3292 at age 6-7 years. After adjusting for all potential confounders, emotional IPV and physical or sexual IPV were associated with the following self-reported parenting outcomes: poor parent-child relationship quality (emotional IPV: p=0·011), lower parental consistency (emotional IPV: p<0·001, physical or sexual IPV: p=0·0053), and more coercive behaviour (emotional IPV: p<0·001, physical or sexual IPV: p=0·0071) at age 4 years. Associations were not observed for self-reported positive encouragement and filmed parenting outcomes in fully adjusted models. Longitudinally, IPV at age 4 years predicted similar outcomes when children were aged 6-7 years. INTERPRETATION: In this large cohort study, maternal IPV victimisation was consistently associated with poorer parent-child relationship, decreased parental consistency, and increased harsh parenting reported by mothers of young children. As well as initiatives to prevent IPV, parenting interventions focused on supporting the capacity of caregivers to provide nurturing care delivered at key stages early in the life course are crucial. FUNDING: Wellcome Trust. TRANSLATION: For the Portuguese translation of the abstract see Supplementary Materials section.
Assuntos
Coorte de Nascimento , Poder Familiar , Feminino , Humanos , Pré-Escolar , Criança , Estudos Prospectivos , Brasil , Estudos de Coortes , Estudos TransversaisRESUMO
This study aimed to evaluate social support and marital relationships in women with and without postpartum depression (PND), investigating the relationship between these constructs and the positive and negative impacts of each of them for the PND. A cross-sectional study was conducted with 67 women (32 with depression and 35 without depression) with children aged between 51 and 77 days. The results indicated that women with PND (assessed through the EPDS) had lower scores in perception of social support and identified their marital relationships as more conflicting. In the hierarchical model, demographic variables (baby's age and maternal education) and marital relationship explained part of the variance of symptoms of PND. Social support did not prove to be a significant predictor in the model. Among the factors evaluated, the quality of the marital relationship was the most important to minimize the risk of developing PND, being an aspect subject to interventions by health professionals. (AU)
O objetivo foi avaliar o apoio social e o relacionamento conjugal em mulheres com e sem depressão pós-parto (DPP), investigando a relação entre esses construtos e os impactos positivos e negativos de cada um deles para a DPP. Conduziu-se um estudo transversal com 67 mulheres (32 com depressão e 35 sem depressão) com filhos com idade entre 51 e 77 dias. Os resultados indicaram que mulheres com DPP (avaliadas por meio da EPDS) relataram menor percepção de apoio social e identificaram seus relacionamentos conjugais como mais conflituosos. No modelo hierárquico, variáveis demográficas (idade do bebê e escolaridade materna) e relacionamento conjugal explicaram em parte a variância dos sintomas de DPP. O apoio social não se revelou um preditor significativo no modelo. Entre os avaliados, a qualidade do relacionamento conjugal foi o mais importante para minimizar o risco de desenvolvimento de DPP, sendo um aspecto passível de intervenções por profissionais da saúde. (AU)
El objetivo fue evaluar el apoyo social y las relaciones maritales en mujeres con y sin depresión posparto (DPP), investigando la relación entre estos constructos y los impactos positivos y negativos de cada uno de ellos a la DPP. Se realizó un estudio transversal con 67 mujeres (32 con depresión y 35 sin depresión) con hijos de entre 51 y 77 días. Los resultados indicaron que las mujeres con DPP (evaluadas a través de la EPDS) presentaron una menor percepción de apoyo social e identificaron sus relaciones maritales como más conflictivas. En el modelo jerárquico, las variables demográficas (edad del bebé y educación materna) y la relación conyugal explicaron una parte de la varianza de los síntomas de la DPP. El apoyo social no resultó ser un predictor significativo en el modelo. Entre los factores evaluados, la calidad de la relación conyugal fue el más importante para minimizar el riesgo de desarrollar DPP, siendo un aspecto sujeto a intervenciones por parte de los profesionales de la salud. (AU)
Assuntos
Humanos , Masculino , Feminino , Adulto , Adulto Jovem , Saúde Mental , Conflito Familiar , Relações Interpessoais , Estudos Transversais , Análise Multivariada , Inquéritos e QuestionáriosRESUMO
Objective Studies evidence a high prevalence of mental disorders in pregnant women, which interfere in women's health, interpersonal relationships, baby care and, consequently, in child development. The research sought to identify risk and protective psychosocial factors of mental disorders during pregnancy. Method A total of 153 third trimester pregnant women participated in a quasi-experimental, quantitative and cross-sectional study. The instruments used were questionnaires and interviews. Frequency, descriptive and regression analysis were performed. Results The most significant risk factors for mental disorders during pregnancy were lack of confidence, childhood trauma, stressful life events, and previous depression. Protective factors included good marital relationship. The most prevalent mental disorders were depression and anxiety. Conclusion Preventive actions and interventions that cover the psychosocial factors involved in the development of mental disorders in pregnant women are important.
Objetivo Estudos mostram alta prevalência de transtornos mentais em gestantes, os quais interferem na saúde da mulher, nas relações interpessoais, nos cuidados com o bebê e, consequentemente, no desenvolvimento infantil. A pesquisa buscou identificar os fatores de risco e proteção psicossociais no desenvolvimento de transtornos mentais na gestação. Método Participaram do estudo 153 mulheres no terceiro trimestre de gestação, sendo uma pesquisa quase-experimental, quantitativa e transversal. Os instrumentos utilizados foram questionários e entrevistas, e análises de frequência, descritivas e de regressão foram realizadas. Resultados Os fatores de risco mais significativos para transtornos mentais na gestação foram falta de confiança, trauma na infância, eventos de vida produtores de estresse e depressão anterior. Entre os fatores de proteção, tem-se o bom ajustamento conjugal. Os transtornos mentais mais prevalentes foram depressão e ansiedade. Conclusão Cita-se a importância das ações preventivas e de intervenções que abarquem os fatores psicossociais envolvidos no desenvolvimento de transtornos mentais em gestantes.
Assuntos
Gravidez , Saúde Mental , Epidemiologia , Fatores de RiscoRESUMO
Treinar o reconhecimento de expressões faciais emocionais (REFE) pode auxiliar no incremento de outras habilidades socioemocionais, como teoria da mente (ToM). O objetivo foi desenvolver um treinamento de REFE para crianças e avaliar seus efeitos na acurácia desta habilidade e ToM. Participaram 61 crianças de 8 a 12 anos, alocadas aleatoriamente entre grupo intervenção (n = 32) e controle (n = 29), realizando tarefas pré e pós-intervenção de REFE e ToM (RMET-I). O grupo intervenção realizou o treinamento de REFE denominado Caçadores de Emoção. Todos os participantes aumentaram acurácia do reconhecimento de medo e nojo e reduziram da tristeza. Houve melhora em ambos os grupos na avaliação da ToM. Especificidades das tarefas utilizadas e do treinamento são apresentadas na discussão.
Training emotional facial expression recognition (EFER) can enhance other socio-emotional skills, such as the theory of mind (ToM). This study aimed develop an intervention for EFER for children and assess its effects on the accuracy of EFER and ToM. 61children aged eight to 12 years, randomly allocated between intervention (n = 32) and control group (n = 29), performed pre- and post-intervention tasks of EFER and ToM (RMET-I). The intervention group performed the REFE training named Hunters of Emotion. All participants increased the accuracy of recognizing the faces of fear and disgust and reduced of sadness. Finally, there was an improvement in both groups in the ToM assessment. Specificities of the tasks used and the training are presented in the discussion.
Entrenar el reconocimiento de expresiones faciales emocionales (REFE) puede ayudar a aumentar otras habilidades socioemocionales, como la teoría de la mente (ToM). El objetivo era desarrollar un entrenamiento REFE para niños y evaluar sus efectos sobre la precisión de REFE y ToM. Participaron 61 niños de 8 a 12 años, asignados aleatoriamente a un grupo de intervención (n = 32) y de control (n = 29), realizaron tareas de REFE y ToM (RMET-I) pré y posterior a la intervención. El grupo de intervención realizó el entrenamiento REFE denominado Buscadores de Emociones. Todos los participantes aumentaron la precisión para reconocer el miedo y el disgusto y redujeron la tristeza. Hubo una mejora en ambos grupos en la evaluación de ToM. Los detalles de las tareas utilizadas y el entrenamiento se presentan en la discusión.
Assuntos
Humanos , Criança , Percepção Social , Expressão Facial , Cognição SocialRESUMO
Background: Preventing interpersonal violence requires understanding the moral development and determinants of child aggression. Communication about moral values and concerns by parents is theoretically important in this process. We aimed to develop a coding system to measure mothers' communication about morality with young children and test its psychometric properties. Method: The cross-sectional study included a subsample (n = 200) of mothers and their four-year-old children in a population-based Brazilian birth cohort. Mothers and children were filmed while looking at a picture book together, containing events of aggression, taking away without asking, and several prosocial behaviours. Films were transcribed and a coding system, including 17 items, was developed to measure the maternal moral judgements and the explanations communicated to their children. Inter-rater reliability was estimated, and exploratory factor analysis performed. Results: Mothers judged acts of physical aggression as wrong more frequently than taking away material goods without asking; most mothers communicated about the emotional consequences of wrong behaviour with their child. Two latent factors of moral communication were identified, interpersonal moral concern and the expression of material moral concern. There was excellent inter-rater reliability between the two coders. Conclusions: Parent-child book-sharing provides a means to measure maternal communication about morality with their children. The coding system of this study measures both communication about interpersonal moral concern and material moral concern. Further studies with larger samples are suggested to investigate the importance of these dimensions of caregiver moral communication for children's moral development.
Assuntos
Comunicação , Princípios Morais , Livros , Pré-Escolar , Estudos Transversais , Feminino , Humanos , Mães/psicologia , Reprodutibilidade dos TestesRESUMO
The COVID-19 pandemic brought a series of restructurings necessary for research in Developmental Psychology. The aim of the manuscript is to discuss adaptations we made in our research in this context during the COVID-19 pandemic and to present strategies to adequate research protocols originally designed to occur in person. Although some contexts do not allow the continuity of studies, research at this time can bring essential contributions in this extreme period. This article explores the strategies for adapting recruitment procedures, suggesting dissemination platforms, and using social networks for this purpose. Guidelines are suggested for conducting non-face-to-face interviews with caregivers, ways of assessing the interaction of the mother-child pairs, and problematizing ethical issues. The procedures for returning the results, an ethical researcher commitment, may be improved by resources such as automatic reports. Besides, strategies for better dissemination of the results for the participants are suggested. (AU)
A pandemia COVID-19 trouxe uma série de reestruturações necessárias à pesquisa em Psicologia do Desenvolvimento. O objetivo deste artigo é discutir as adaptações que realizamos em pesquisas neste contexto durante a pandemia de COVID-19 e apresentar estratégias para adequação de protocolos de pesquisa originalmente planejados para ocorrer de forma presencial. Embora alguns contextos não permitam a continuidade dos estudos, pesquisas nesse momento podem trazer importantes contribuições sobre este período ímpar. No presente artigo são exploradas estratégias de adaptação dos procedimentos de recrutamento, sugeridas plataformas de divulgação e como melhor usar as redes sociais para esse fim. Também são descritos procedimentos para realização de entrevistas não presenciais com responsáveis, formas de avaliação da interação das duplas mãe-criança e problematizadas questões éticas. Os procedimentos de devolução dos resultados, um compromisso ético dos pesquisadores, podem ser facilitados por recursos como relatórios automáticos. Além disso, sugerimos estratégias para melhor divulgação dos resultados ao público participante. (AU)
La pandemia del COVID-19 trajo una serie de reestructuraciones necesarias para la investigación en Psicología del Desarrollo. El objetivo de este artículo es discutir las adaptaciones realizadas en las investigaciones en este contexto durante la pandemia de COVID-19 y presentar algunas estrategias para la adaptación de los protocolos de investigación originalmente planeados para ser presenciales. Si bien algunos contextos no permitan la continuidad de los estudios, la investigación en este momento puede aportar importantes avances sobre estos tiempos de crisis. Este artículo explora las estrategias para adaptar los procedimientos de contratación, sugiriendo algunas plataformas de difusión y la mejor manera de utilizar las redes sociales para este fin. También se describen los procedimientos para la realización de entrevistas no presenciales con padres o tutores legales, las formas de evaluar la interacción madre-hijo y las cuestiones éticas. Los procedimientos para la devolución de los resultados, un compromiso ético de los investigadores, pueden verse facilitados por funciones como informes automáticos. Además, se recomienda estrategias para una mejor difusión de los resultados al público participante. (AU)