Efeito das experiências adversas na infância no comportamento de lactentes aos 18 meses

Abstract

Adverse Childhood Experiences (ACE) are negative, potentially traumatic events and/or circumstances experienced before age 18. The effects of ACEs on the behavior of infants are still poorly understood. Objective: To analyze the effect of ACEs on the behavior of 18-month-old infants born in a public maternity hospital that is a reference for high-risk deliveries. Methods: Data from a retrospective cohort composed of 95 infants followed up over 18 months at the Outpatient Clinic for Monitoring the Development of High-Risk Newborns at Sofia Feldman Hospital were analyzed. Data from sociodemographic and socioeconomic characteristics, perinatal conditions, parental stress, maternal depressive symptoms, marital conflicts, family exposure to substance abuse and violence in the neighborhood, obtained through standardized instruments, allowed the analysis of the effects of 10 ACE. Behavior was assessed at 18 months using the Preschool Pediatric Symptom Checklist (PPSC) questionnaire, part of the Survey of Well-being of Young Children (SWYC). The effect of ACE on behavior was analyzed by multiple linear regression, and Cohen's d evaluated the size effect of the association. The cumulative effect of ACE on behavior was evaluated using the Spearman correlation test. Results: Most infants were female (57%), premature (52.6%), and of low birth weight (62.1%). Less than 10% of mothers were teenagers, most studied for more than 8 years (57.4%), and lived in nuclear family arrangements (64.2%). The most prevalent ACE was violence in the neighborhood (59.1%), followed by maternal depressive symptoms (38.9%) and exposure to substance abuse (32.6%). About 10% of the families were screened positively for food insecurity, 14% were classified in the lowest socioeconomic level (D-E), and about 12% received Bolsa Família. On average, infants were exposed to 2.4 ACE, 42% were exposed to 3 or more ACE in the first 18 months of life. The final multivariate analysis model showed that among the 10 ACE analyzed, only the presence of maternal depressive symptoms was associated with a higher PPSC score (p<0.001). The final model explained 14% of the variation of results in PPSC (r2=0.14), with a large effect size (d=0.81). The Spearman test showed the correlation between the number of ACE and the PPSC score was positive (r=0.29) and significant (p=0.004). Conclusion: Maternal depressive symptoms negatively affected the behavior of infants evaluated at 18 months. In addition, a cumulative effect was observed between the number of ACEs and the behavior of infants.