Iná S. Santos

Bio: Iná S. Santos is an academic researcher from Universidade Federal de Pelotas. The author has contributed to research in topics: Population & Cohort. The author has an hindex of 10, co-authored 14 publications receiving 396 citations.

Validation of the Edinburgh postnatal depression scale (EPDS) for screening of major depressive episode among adults from the general population

Abstract: Standardized questionnaires designed for the identification of depression are useful for monitoring individual as well as population mental health. The Edinburgh Postnatal Depression Scale (EPDS) has originally been developed to assist primary care health professionals to detect postnatal depression, but several authors recommend its use outside of the postpartum period. In Brazil, the use of the EPDS for screening depression outside the postpartum period and among non-selected populations has not been validated. The present study aimed to assess the validity of the EPDS as a screening instrument for major depressive episode (MDE) among adults from the general population. This is a validation study that used a population-based sampling technique to select the participants. The study was conducted in the city of Pelotas, Brazil. Households were randomly selected by two stage conglomerates with probability proportional to size. EPDS was administered to 447 adults (≥20 years). Approximately 17 days later, participants were reinterviewed by psychiatrics and psychologists using a structured diagnostic interview (Mini International Neuropsychiatric Interview, MINI). We calculated the sensitivity and specificity of each cutoff point of EPDS, and values were plotted as a receiver operator characteristic curve. The best cutoff point for screening depression was ≥8, with 80.0% (64.4 - 90.9%) sensitivity and 87.0% (83.3 - 90.1%) specificity. Among women the best cutoff point was ≥8 too with values of sensitivity and specificity of 84.4% (67.2 – 94.7%) and 81.3% (75.5 – 86.1%), respectively. Among men, the best cutoff point was ≥7 (75% sensitivity and 89% specificity). The EPDS was shown to be suitable for screening MDE among adults in the community.

The association of maternal age with birthweight and gestational age: a cross-cohort comparison.

Abstract: Several studies have reported increased risks of low birthweight (LBW) among offspring of adolescent mothers1–9 (generally defined as women <20 years).1–7 More recently, the concern about adverse perinatal outcomes has also shifted towards older mothers as the number of births to women 35 years and older is increasing in both high-income countries (HIC) and middle-income countries (MIC).10–13 Several mechanisms have been suggested to explain these associations. With respect to adolescent mothers, it has been suggested that they are still developing and growing, and therefore, mother and offspring may compete for the supply of nutrients.14 At older ages, women are more likely to have pre-existing, possibly undiagnosed diseases or poor health, including reduced cardiovascular reserve, which could result in poor placentation and LBW.11,12,15,16 Furthermore, adverse perinatal outcomes in older mothers might be related to relative infertility, which could influence the likelihood of preterm births and LBW.16 At both ends of the age spectrum, the relationship between maternal age and adverse offspring outcomes may be strongly confounded by socio-economic position (SEP).17 However, this is likely to be in opposite directions, with the association between having a baby as a teenager and adverse perinatal outcomes possibly being explained by low SEP,17 and the generally higher SEP of older mothers concealing a biological effect of older maternal age on poor offspring outcomes.17 Given the difficulty of thoroughly controlling for all known confounders in observational studies, in particular regarding SEP, novel methods for exploring the association between maternal age and perinatal outcomes have been proposed.17,18 In the current paper, we have used an alternative method to explore the extent to which associations of maternal age with LBW and preterm birth might be confounded by SEP. We have focused on LBW and preterm birth because of the robust associations of both of these with infant morbidity and mortality19,20 and with lifelong adverse health outcomes,21 and also because these are the two commonest outcomes examined in previous studies of maternal age with adverse perinatal outcomes.8 We compared results across four cohorts in which we anticipate that SEP may relate differently to maternal age. The four cohorts are three birth cohorts from different time periods from Pelotas, Brazil (an MIC) and one pregnancy cohort from the South West of England (an HIC). Our assumption is that SEP will relate less strongly to maternal age at birth in the Brazilian compared with the English cohort, because young age at birth is more common in Brazil and carries less social stigma. Over the time period between the first (1982) and last (2004) of the Pelotas cohorts, Brazil has become more affluent, and with that, it adopted more Western attitudes and social behaviours. Therefore, there may be differences in the relationship of SEP to maternal age across these three Pelotas cohorts. If our assumptions are true that there are these differences in confounding structure between these four cohorts, for which some of our previous research provides evidence,22–24 then any consistency of association across the cohorts after adjusting for observed confounders is unlikely to be due to residual confounding. We are not aware of any previous studies that have used a cross-cohort comparison to explore maternal age and LBW or other perinatal outcomes.

Prevalence and comorbidity of psychiatric disorders among 6-year-old children: 2004 Pelotas Birth Cohort

Abstract: Purpose Most studies published on the prevalence of psychiatric disorders in children were conducted in high-income countries despite the fact that nearly 90 % of the world’s population aged under 18 live in low- and middle-income countries. The study aimed to assess the prevalence of psychiatric disorders among children of 6 years of age, to examine the distribution of psychiatric disorders by gender and socioeconomic status and to evaluate the occurrence of psychiatric comorbidities.

Genetic causes of intellectual disability in a birth cohort: A population-based study

Abstract: Intellectual disability affects approximately 1-3% of the population and can be caused by genetic and environmental factors. Although many studies have investigated the etiology of intellectual disability in different populations, few studies have been performed in middle-income countries. The present study estimated the prevalence of genetic causes related to intellectual disability in a cohort of children from a city in south Brazil who were followed from birth. Children who showed poor performance in development and intelligence tests at the ages of 2 and 4 were included. Out of 4,231 liveborns enrolled in the cohort, 214 children fulfilled the inclusion criteria. A diagnosis was established in approximately 90% of the children evaluated. Genetic causes were determined in 31 of the children and 19 cases remained unexplained even after extensive investigation. The overall prevalence of intellectual disability in this cohort due to genetic causes was 0.82%. Because this study was nested in a cohort, there were a large number of variables related to early childhood and the likelihood of information bias was minimized by collecting information with a short recall time. This study was not influenced by selection bias, allowing identification of intellectual disability and estimation of the prevalence of genetic causes in this population, thereby increasing the possibility of providing appropriate management and/or genetic counseling.

Gender differences in depression in representative national samples: Meta-analyses of diagnoses and symptoms.

Abstract: In 2 meta-analyses on gender differences in depression in nationally representative samples, we advance previous work by including studies of depression diagnoses and symptoms to (a) estimate the magnitude of the gender difference in depression across a wide array of nations and ages; (b) use a developmental perspective to elucidate patterns of gender differences across the life span; and (c) incorporate additional theory-driven moderators (e.g., gender equity). For major depression diagnoses and depression symptoms, respectively, we meta-analyzed data from 65 and 95 articles and their corresponding national data sets, representing data from 1,716,195 and 1,922,064 people in over 90 different nations. Overall, odds ratio (OR) = 1.95, 95% confidence interval (CI) [1.88, 2.03], and d = 0.27 [0.26, 0.29]. Age was the strongest predictor of effect size. The gender difference for diagnoses emerged earlier than previously thought, with OR = 2.37 at age 12. For both meta-analyses, the gender difference peaked in adolescence (OR = 3.02 for ages 13-15, and d = 0.47 for age 16) but then declined and remained stable in adulthood. Cross-national analyses indicated that larger gender differences were found in nations with greater gender equity, for major depression, but not depression symptoms. The gender difference in depression represents a health disparity, especially in adolescence, yet the magnitude of the difference indicates that depression in men should not be overlooked. (PsycINFO Database Record

Child and adolescent mental health worldwide: evidence for action

Abstract: This article suggests that while mental health problems affect 10—20% of children and adolescents worldwide, the mental health needs of children and adolescents are neglected, especially in low-income and middle-income countries. The authors review the evidence and the gaps in the published work in terms of prevalence, risk and protective factors, and interventions to prevent and treat childhood and adolescent mental health problems.

Annual Research Review: Secular trends in child and adolescent mental health

Abstract: Background Child and adolescent mental health problems are common, associated with wide-ranging functional impairments, and show substantial continuities into adult life. It is therefore important to understand the extent to which the prevalence of mental health problems has changed over time, and to identify reasons behind any trends in mental health. Scope and Methodology This review evaluates evidence on whether the population prevalence of child and adolescent mental health problems has changed. The primary focus of the review is on epidemiological cross-cohort comparisons identified by a systematic search of the literature (using the Web of Knowledge database). Findings Clinical diagnosis and treatment of child and adolescent psychiatric disorders increased over recent decades. Epidemiological comparisons of unselected population cohorts using equivalent assessments of mental health have found little evidence of an increased rate of ADHD, but cross-cohort comparisons of rates of ASD are lacking at this time. Findings do suggest substantial secular change in emotional problems and antisocial behaviour in high-income countries, including periods of increase and decrease in symptom prevalence. Evidence from low- and middle-income countries is very limited. Possible explanations for trends in child and adolescent mental health are discussed. The review also addresses how cross-cohort comparisons can provide valuable complementary information on the aetiology of mental illness.