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Gomes NMDO, Caldas ED. Street and drug use experiences among sheltered children and adolescents in the Federal District of Brazil. JOURNAL OF CHILD AND ADOLESCENT PSYCHIATRIC NURSING 2022; 36:105-113. [PMID: 36453194 DOI: 10.1111/jcap.12403] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Revised: 11/06/2022] [Accepted: 11/20/2022] [Indexed: 12/05/2022]
Abstract
PROBLEM The use of drugs by street children and adolescents is a problem found in most large cities around the world. METHODS This is a cross-sectional study of street children and adolescents living in shelters in the Federal District, Brazil. An objective questionnaire was applied to 84 individuals from September 2016 to October 2017; 14 of them participated in the qualitative study. FINDINGS Most participants were adolescents (84.5%) and males (64.3%), with a history of abandonment, domestic violence, and family drug abuse. All spent some time on the street; boys had a higher chance of being behind the school level and using drugs than girls. Over 60% had used drugs in the previous year, mainly alcohol and marijuana. Over 70% understand the health consequences of this behavior, but most have never tried or failed to stop. About 40% consider themselves dependent on drugs. CONCLUSIONS The results showed that street-life experience, peer pressure, and exposure to drugs within the family had an important impact on respondent's drug use behavior, reinforcing the importance of education programs that focus on the family.
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Affiliation(s)
| | - Eloisa Dutra Caldas
- Laboratory of Toxicology, Department of Pharmacy, Faculty of Health Sciences University of Brasilia Brasilia Federal District Brazil
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Gouveia L, Massanganhe H, Mandlate F, Mabunda D, Fumo W, Mocumbi AO, de Jesus Mari J. Family reintegration of homeless in Maputo and Matola: a descriptive study. Int J Ment Health Syst 2017; 11:25. [PMID: 28413439 PMCID: PMC5387388 DOI: 10.1186/s13033-017-0133-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2016] [Accepted: 04/01/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Homelessness is a global and local social problem with underestimated prevalence. It has been shown to increase the risk of mental illness, raising concerns from mental health providers about the need for effective interventions targeting this population. OBJECTIVES The aim of this paper is to describe the mental health status of the homeless people in two urban setting in a low-income country, through using standardised clinical and socio-demographic assessments as well assessing potential predictors of family integration versus non-family integration among a group of homeless individuals receiving psychiatric and psychosocial treatment. METHODS A descriptive study was performed in Maputo and Matola cities between 2008 and 2010. Homeless people with apparent mental illness were mapped and recruited. The participants were referred from community to hospital, using a multidisciplinary treatment model, according to their clinical condition and later entered a family reintegration process. RESULTS Seventy-one homeless people were recruited (93.0% male; 80.3% unemployed). The most common diagnosis was schizophrenia and other psychosis (46; 64.8%), followed by mental and behaviour disorder related to substance misuse (21; 29.6%), and intellectual disability (4; 5.6%). Family reintegration was achieved for 53.5% (38 patients). Patients with intellectual disability were less reintegrated and those with disorders related to substance use had better reinsertion in their families (Chi square (2) = 6.1; p = 0.047). CONCLUSIONS Family reintegration was achieved in more than half of participants after hospitalization. Integration was higher in cases of substance misuse, with those with associated intellectual disability being more difficult to reintegrate. Trial registration Trial Registration Number: NCT02936141, date of registration: 14/10/2016, retrospectively registered.
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Affiliation(s)
- Lídia Gouveia
- Department of Mental Health, Ministry of Health-Mozambique, Av. Eduardo Mondlane/Av. Salvador Allende, P.O.Box 1613, Maputo, Mozambique
- Faculty of Medicine, University Eduardo Mondlane, Maputo, Mozambique
- Department of Psychiatry, Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil
| | - Honório Massanganhe
- Department of Mental Health, Ministry of Health-Mozambique, Av. Eduardo Mondlane/Av. Salvador Allende, P.O.Box 1613, Maputo, Mozambique
| | - Flávio Mandlate
- Department of Mental Health, Ministry of Health-Mozambique, Av. Eduardo Mondlane/Av. Salvador Allende, P.O.Box 1613, Maputo, Mozambique
- Faculty of Medicine, University Eduardo Mondlane, Maputo, Mozambique
| | - Dirceu Mabunda
- Department of Mental Health, Ministry of Health-Mozambique, Av. Eduardo Mondlane/Av. Salvador Allende, P.O.Box 1613, Maputo, Mozambique
- Faculty of Medicine, University Eduardo Mondlane, Maputo, Mozambique
| | - Wilza Fumo
- Department of Mental Health, Ministry of Health-Mozambique, Av. Eduardo Mondlane/Av. Salvador Allende, P.O.Box 1613, Maputo, Mozambique
- Faculty of Medicine, University Eduardo Mondlane, Maputo, Mozambique
| | - Ana Olga Mocumbi
- Faculty of Medicine, University Eduardo Mondlane, Maputo, Mozambique
- National Health Institute, Ministry of Health-Mozambique, Maputo, Mozambique
| | - Jair de Jesus Mari
- Department of Psychiatry, Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil
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Hoffmann EV, Duarte CS, Fossaluza V, Milani ACC, Maciel MR, Mello MF, Mello AF. Mental health of children who work on the streets in Brazil after enrollment in a psychosocial program. Soc Psychiatry Psychiatr Epidemiol 2017; 52:55-63. [PMID: 27866219 DOI: 10.1007/s00127-016-1316-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2016] [Accepted: 11/15/2016] [Indexed: 11/25/2022]
Abstract
PURPOSE To evaluate the mental health status of children working on the streets in Sao Paulo City, Brazil, two years after their participation in a psychosocial program, and to identify factors associated with their mental health status. METHODS From a total sample of 126 children working on the streets, 107 (85%) were re-evaluated two years after the initiation of a psychosocial program which aimed to cease their work on the streets. The focus was the presence of mental health problems, defined based on a screening instrument (Strengths and Difficulties Questionnaire). Logistic regression models tested factors related to the probability that a child would not present mental health problems at follow-up. RESULTS The likelihood of a child presenting mental health problems was higher at baseline compared to the two-year follow-up (67.5 and 56.1%, respectively). Absence of mental health problems two years after a psychosocial intervention was significantly correlated with the following baseline factors: lower level of caregiver's psychiatric symptoms as measured by the SRQ (Self-Report Questionnaire) (AOR = 0.84, p = 0.0065), absence of child physical neglect (AOR = 0.38, p = 0.0705) and parental Protestant religion affiliation, compared to other religions (AOR = 4.06; p = 0.0107). CONCLUSIONS Different factors are related to the absence of mental health problems of children working on the streets after enrollment in a two-year psychosocial program. Our findings suggest that interventions that aim to improve child mental health should consider the detection of psychiatric symptoms in caregivers, provide treatment when it is needed, and also assess other problems such as neglect in the family setting.
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Affiliation(s)
- Elis Viviane Hoffmann
- Programa de Atendimento e Pesquisa em Violência (PROVE), Department of Psychiatry, Universidade Federal de São Paulo, Rua: Borges Lagoa, 570-10° andar, Vila Clementino, São Paulo, SP, Cep: 04038-000, Brazil.
| | - Cristiane S Duarte
- Division of Child and Adolescent Psychiatry, Columbia University-NYSPI, New York, NY, USA
| | - Victor Fossaluza
- Department of Mathematics and Statistics, University of Sao Paulo (USP), Sao Paulo, SP, Brazil
| | - Ana Carolina C Milani
- Programa de Atendimento e Pesquisa em Violência (PROVE), Department of Psychiatry, Universidade Federal de São Paulo, Rua: Borges Lagoa, 570-10° andar, Vila Clementino, São Paulo, SP, Cep: 04038-000, Brazil
| | - Mariana R Maciel
- Programa de Atendimento e Pesquisa em Violência (PROVE), Department of Psychiatry, Universidade Federal de São Paulo, Rua: Borges Lagoa, 570-10° andar, Vila Clementino, São Paulo, SP, Cep: 04038-000, Brazil
| | - Marcelo F Mello
- Programa de Atendimento e Pesquisa em Violência (PROVE), Department of Psychiatry, Universidade Federal de São Paulo, Rua: Borges Lagoa, 570-10° andar, Vila Clementino, São Paulo, SP, Cep: 04038-000, Brazil
| | - Andrea F Mello
- Programa de Atendimento e Pesquisa em Violência (PROVE), Department of Psychiatry, Universidade Federal de São Paulo, Rua: Borges Lagoa, 570-10° andar, Vila Clementino, São Paulo, SP, Cep: 04038-000, Brazil
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Abstract
Children have rights, as enumerated in the Declaration of the Rights of the Child, and need protection from violence, exploitation, and abuse. Global threats to child safety exist. These threats include lack of basic needs (food, clean water, sanitation), maltreatment, abandonment, child labor, child marriage, female genital mutilation, child trafficking, disasters, and armed conflicts/wars. Recent disasters and armed conflicts have led to a record number of displaced people especially children and their families. Strategies and specific programs can be developed and implemented for eliminating threats to the safety of children.
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Affiliation(s)
- Sharon E Mace
- Department of Emergency Medicine, Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, Cleveland Clinic, 9500 Euclid Avenue, E-19, Cleveland, OH 44195, USA; Observation Unit, Emergency Services Institute, Cleveland Clinic, 9500 Euclid Avenue, E-19, Cleveland, OH 44195, USA.
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Mello AF, Juruena MF, Maciel MR, Cavalcante-Nobrega LP, Cividanes GC, Fossaluza V, Calsavara V, Mello MF, Cleare AJ, Mari JDJ. Factors related to the cortisol awakening response of children working on the streets and siblings, before and after 2 years of a psychosocial intervention. Psychiatry Res 2015; 225:625-30. [PMID: 25500347 DOI: 10.1016/j.psychres.2014.11.034] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2014] [Revised: 10/27/2014] [Accepted: 11/08/2014] [Indexed: 02/08/2023]
Abstract
The study objective was to observe the cortisol awakening response (CAR) pattern before and after a psychosocial intervention with children from dysfunctional families who had at least one child working on the streets, and to verify factors related to it. Two hundred and eleven children between 7 and 14 years old were selected and 191 were included, 178 were re-evaluated 2 years after, of whom 113 had cortisol measures completed. Besides cortisol, they were evaluated at baseline and at end point regarding: abuse/neglect, mental health symptoms, exposure to urban violence and family environment. There was no significant difference between the CAR area under the curve (AUC) before and after the intervention. Two regression analysis models were built to evaluate factors related to the CAR before and after intervention. Before the intervention, working on the streets (vs. not) was related to a greater cortisol increase after awakening, at follow-up, having suffered physical punishment (vs. not) was related to a flattened cortisol response. The intervention was not associated with changes in the magnitude of the CAR AUC, though the CAR was associated with psychosocial stressors pre- and post-intervention. Effective interventions for children at risk that might shape a physiological cortisol response are still needed.
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Affiliation(s)
- Andrea Feijo Mello
- Department of Psychiatry, Paulista Medical School, Federal University of Sao Paulo, Sao Paulo, Brazil.
| | - Mario Francisco Juruena
- Department of Neurosciences and Behaviour, Faculty of Medicine Ribeirao Preto, University of Sao Paulo, Sao Paulo, Brazil; King׳s College London, Institute of Psychiatry, Department of Psychological Medicine, London, UK
| | - Mariana Rangel Maciel
- Department of Psychiatry, Paulista Medical School, Federal University of Sao Paulo, Sao Paulo, Brazil
| | | | | | - Victor Fossaluza
- Mathematics and Statistics Institute, University of Sao Paulo, Sao Paulo, Brazil
| | - Vinicius Calsavara
- Mathematics and Statistics Institute, University of Sao Paulo, Sao Paulo, Brazil
| | - Marcelo Feijo Mello
- Department of Psychiatry, Paulista Medical School, Federal University of Sao Paulo, Sao Paulo, Brazil
| | - Anthony James Cleare
- King׳s College London, Institute of Psychiatry, Department of Psychological Medicine, London, UK
| | - Jair de Jesus Mari
- Department of Psychiatry, Paulista Medical School, Federal University of Sao Paulo, Sao Paulo, Brazil
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