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Doctoral Thesis
DOI
https://doi.org/10.11606/T.5.2023.tde-24082023-123326
Document
Author
Full name
Livia Maria Lindoso Lima
E-mail
Institute/School/College
Knowledge Area
Date of Defense
Published
São Paulo, 2023
Supervisor
Committee
Silva, Clovis Artur Almeida da (President)
Azevedo, Ramiro Anthero de
Kozu, Katia Tomie
Toma, Ricardo Katsuya
Title in Portuguese
Impacto do isolamento social na saúde física e psíquica de adolescentes com condições crônicas imunossupressoras/imunomediadas preexistentes durante o enfrentamento da COVID-19
Keywords in Portuguese
Adolescentes
Condições crônicas
Pandemia da COVID19
Saúde mental
Abstract in Portuguese
INTRODUÇÃO: Durante o ano de 2020, o mundo vivenciou uma crise sanitária global devido a COVID-19. Nesse período medidas sanitárias, incluindo a quarentena para conter a propagação viral foram instituídas. Dentre essas medidas estavam o uso de máscara, distanciamento e isolamento social. A conexão social é primordial para o desenvolvimento adequado das funções psicossocial durante a adolescência. Dessa forma, a quarentena teve um efeito potencialmente negativo na saúde física e mental. Não há estudos sistematizados avaliando o impacto do isolamento social/quarentena na saúde física e psíquica de adolescentes com condições crônicas. OBJETIVOS: Comparar e correlacionar indicadores de saúde física e mental em adolescentes com condições crônicas e adolescentes saudáveis durante a quarentena da COVID-19. MÉTODOS: Estudo transversal analítico, que incluiu 355 adolescentes com condições crônicas e 111 adolescentes saudáveis entre 10 a 18 anos. Foram aplicados dois questionários online no período julho a setembro de 2020. O primeiro destes foi criado pela equipe médica do Instituto da Criança e do Adolescente da Faculdade de Medicina da Universidade de São Paulo para investigar características sociodemográficas, rotina de saúde e o impacto da quarentena na saúde física e mental. O segundo foi a versão autorrelatada e validada para língua e cultura brasileira do Questionário de Capacidades e Dificuldades (SDQ) para avaliar a saúde mental dos adolescentes. RESULTADOS: A mediana de idade em anos [14 (10-18) vs. 15 (10-18), p = 0,733] e frequências do sexo feminino (61% vs. 60%, p = 0,970) foram semelhantes entre adolescentes com condições crônicas e adolescentes saudáveis durante a quarentena da pandemia de COVID-19. As frequências de escore total de dificuldades anormais do SDQ foram semelhantes em pacientes e controles (30% vs. 31%, p = 0,775). A análise de regressão logística mostrou que sexo feminino (OR = 1,965; IC 95% = 1,091-3,541) e medo da atividade/complicação da doença de base (OR = 1,009; IC 95% = 1,001-1,018) foram associados à disfunção psicossocial em adolescentes com condições crônicas, enquanto tarefa de casa escolar (OR = 0,449; IC 95% = 0,206-0,981) e atividade física (OR = 0,990; IC 95% = 0,981-0,999) foram fatores de proteção. A análise mais aprofundada de pacientes com condições crônicas e diagnóstico prévio de transtornos mentais (9%) mostrou maior mediana do escore total de dificuldades total, emocional, conduta, problemas interpares e hiperatividade (p < 0,050) em comparação com pacientes sem diagnóstico. CONCLUSÕES: Esse estudo demonstrou que a atual pandemia e as restrições subsequentes impactaram negativamente tanto a saúde mental de adolescentes com condições crônicas como os saudáveis. Dessa forma, é importante o sistema de saúde garantir a continuidade dos adolescentes com condições crônicas de forma regular e iniciar programas voltados para a saúde mental de adolescentes saudáveis durante a pandemia
Title in English
Impact of social distancing on the physical and psychological health of adolescents with preexisting immunosuppressive/immunomediated chronic conditions during the confrontation of COVID-19
Keywords in English
Adolescents
Chronic conditions
COVID19 pandemic
Mental health
Abstract in English
INTRODUCTION: During the year 2020, the world experienced a global health crisis due to COVID-19. During this period, sanitary measures, including quarantine to contain the viral spread, were instituted. Among these measures were the use of mask, distancing and social isolation. Social connection is essential for the proper development of psychosocial functions during adolescence. In this way, quarantine had a potentially negative effect on physical and mental health. There are no systematic studies evaluating the impact of social isolation/quarantine on the physical and mental health of adolescents with chronic conditions. OBJECTIVES: To compare and correlate physical and mental health indicators in adolescents with chronic conditions and healthy adolescents during the COVID-19 quarantine. METHODS: Analytical crosssectional study, which included 355 adolescents with chronic conditions and 111 healthy adolescents, aged between 10 to 18 years. Two online questionnaires were applied from July to September 2020. The first of these was created by the medical staff of the Instituto da Criança e do Adolescente da Faculdade de Medicina da Universidade de São Paulo to investigate sociodemographic characteristics, health routine and the impact of the quarantine on physical and mental health. The second was the self-reported and validated version for the Brazilian language and culture of the Strengths and Difficulties Questionnaire (SDQ) to assess the mental health of adolescents. RESULTS: The median of age in years [14 (10-18) vs. 15 (10-18), p = 0.733] and female frequency (61% vs. 60%, p = 0.970) were similar between adolescents with chronic conditions and healthy adolescents during the quarantine of the COVID-19 pandemic. The abnormal total difficulties score of SDQ frequency was similar in both groups (30% vs. 31%, p = 0.775). Logistic regression analysis showed that female sex (OR = 1,965; 95% CI = 1,091-3,541), fear of underlying disease activity/complication (OR = 1,009; 95% CI = 1,001-1,018) were associated with psychosocial dysfunction in adolescents with chronic conditions, while school homework (OR = 0.449; 95% CI = 0.206-0.981) and physical activity (OR = 0.990; 95% CI = 0.981-0.999) were protective factors. Further analysis of patients with chronic conditions and a previous diagnosis of mental disorders (9%) showed a higher median total score for difficulties, emotional conduct, peer problems and hyperactivity (p < 0.050) compared with patients without a diagnosis. CONCLUSIONS: This study showed that the current pandemic and subsequent restrictions negatively impacted both the mental health of adolescents with chronic conditions and healthy adolescents. Thus, it is important for the health system to ensure the continuity of adolescents with chronic conditions on a regular basis and to initiate programs aimed at the mental health of healthy adolescents during the pandemic
 
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Publishing Date
2023-08-30
 
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