Associating socioeconomic position and maternal depression with the health of children: an evaluation of the 2008 Brazilian household survey

Leivas, Pedro Henrique Soares; Tejada, Cesar Augusto Oviedo; Bertoldi, Andréa Dâmaso; Santos, Anderson Moreira Aristides dos; Jacinto, Paulo de Andrade

doi:10.1590/1413-81232018235.23162015

Acessibilidade / Reportar erro

Brasil

Español English

sumário « anterior atual seguinte »

Sumário

Free Themes • Ciênc. saúde colet. 23 (5) • May 2018 • https://doi.org/10.1590/1413-81232018235.23162015 copy

Associating socioeconomic position and maternal depression with the health of children: an evaluation of the 2008 Brazilian household survey

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

The study analyzed the association between socioeconomic position (income), maternal depression and the health of children in Brazil, using information from the 2008 National Household Survey (PNAD/IBGE). The analysis considered the sampling design for the research and included 46,874 individuals up to the age of nine. The Poisson models were estimated for three health outcomes for children: health as reported by the parents or the responsible person, restrictions on habitual activities for health reasons and periods when they were confined to bed two weeks before the interviews in the study. The results showed an association between the mothers' depression and the three health outcomes, even after taking into account the following: socioeconomic position, maternal characteristics (health self-referral, age, level of education and smoking), age, gender, the child's race, geographical region, the situation as noted in the census and the number of residents in a household. It was found that there still exists an association between maternal depression and children's health irrespective of socioeconomic position. Therefore public policies that aim to reduce the adverse effects of maternal depression on the health of children need to also take into account the higher income segments of society.

Key words
Children's health; Maternal depression; Socioeconomic position; Poisson regression

Variables			N	%	IC 95%
Children's characteristics
	Age (in years)
		0 to 3	16.362	34.7	34.3-35.2
		4 to 6	14.125	30.1	29.7-30.5
		7 to 9	16.387	35.2	34.7-35.6
	Sex (male)		23.922	50.7	50.3-51.2
	Race
		Native Indian	101	0.2	0.1-0.4
		White	21.179	48.2	47.3-49.1
		Black	2.071	4.1	3.8-4.4
		Asian	151	0.4	0.3-0.5
		Mixed-race	23.372	47.2	46.3-48.0
	Health Self-Referral
		Very good	15.730	34.9	33.9-35.9
		Good	26.223	56.2	55.2-57.2
		Regular	3.906	8.2	7.9-8.7
		Bad or very bad	326	0.65	0.6-0.8
	She/He was confined to bed in the last 14 days		1.758	3.6	3.4-3.9
	Restrictions in the habitual activities for health reasons in the last 14 days		3.975	8.4	8.0-8.7
Maternal Characteristics
	Age (in years)
		15 to 29	20.328	42.68	41.9-43.4
		30 to 39	20.018	42.9	42.2-43.6
		≥ 40	6.528	14.4	13.9-14.8
	Level of Education
		0	3.261	7.0	6.7-7.6
		1 to 3	4.547	9.8	9.3-10.3
		4 to 7	13.524	28.8	28.1-29.5
		8 to 10	9.106	19.2	18.7-19.8
		11 years of study or more	16.436	35.1	34.3-35.9
	Very good health or good health		35.691	76.7	76.1-77.4
	Suffering from depression		2.495	5.5	5.2-5.8
	Smoking daily		5.696	12.6	12.1-13.1

Variables			Prevalence of health, regular or poor for children (%)	Prevalence ratio
Variables			Prevalence of health, regular or poor for children (%)	Gross	CI 95%	p value^# # Value p refers to the Wald test under the null theory of equality between the PRs. Aside from the socioeconomic position and the maternal characteristics shown in the table, the prevalence ratios were adjusted by: age, sex, race of child, geographical region, situation as mentioned in the census and the number of residents in a household. Where	Adjusted	CI 95%	^p value^# # Value p refers to the Wald test under the null theory of equality between the PRs. Aside from the socioeconomic position and the maternal characteristics shown in the table, the prevalence ratios were adjusted by: age, sex, race of child, geographical region, situation as mentioned in the census and the number of residents in a household. Where
Income (quintile)
	1st (least)		13.0	3,26^ p < 0.01,	(2.84 - 3.75)	< 0.001	1.97^ p < 0.01,	(1.68 - 2.31)	< 0.001
	2nd		10.9	2.74^ p < 0.01,	(2.39 - 3.14)		1.68^ p < 0.01,	(1.45 - 1.95)
	3rd		9.8	2.45^ p < 0.01,	(2.14 - 2.81)		1.69^ p < 0.01,	(1.47 - 1.95)
	4th		7.2	1.81^ p < 0.01,	(1.57 - 2.09)		1.42^ p < 0.01,	(1.24 - 1.64)
	5th (greater)		4.0	1.00			1.00
Maternal Characteristics
	Maternal Depression
		No	8.6	1.00		< 0.001	1.00		0.011
		Yes	13.9	1.61^ p < 0.01,	(1.43 - 1.82)		1.18^* * p < 0.05.	(1.04 - 1.33)
	Health Self-Referral
		Regular/bad/really bad	19.2	1.00		< 0.001	1.00		< 0.001
		Very good/good	5.8	0.30^ p < 0.01,	(0.28 - 0.33)		0.35^ p < 0.01,	(0.32 - 0.38)
	Age (years)
		15 to 29	10.1	1.00		< 0.001	1.00		< 0.001
		30 to 39	7.9	0.78^ p < 0.01,	(0.72 - 0.85)		0.85^ p < 0.01,	(0.79 - 0.92)
		≥ 40	8.7	0.86^ p < 0.01,	(0.78 - 0.96)		0.85^ p < 0.01,	(0.76 - 0.94)
	level of education (years)
		0	11.6	1.00		< 0.001	1.00		< 0.001
		1 to 3	13.2	1.14	(0.99 - 1.31)		1.09	(0.95 - 1.25)
		4 to 7	10.5	0.91	(0.80 - 1.02)		0.97	(0.85 - 1.09)
		8 to 10	9.6	0.82^ p < 0.01,	(0.73 - 0.94)		0.96	(0.84 - 1.10)
		≥ 11	5.5	0.47^ p < 0.01,	(0.42 - 0.54)		0.77^ p < 0.01,	(0.66 - 0.89)
	Daily Smoking
		No	8.8	1.00		0.023	1.00		0.781
		Yes	9.9	1.12^* * p < 0.05.	(1.02 - 1.24)		0.99	(0.89 - 1.09)

Variables			Prevalence of restrictions in habitual activities (%)	Prevalence ratio
Variables			Prevalence of restrictions in habitual activities (%)	Gross	CI 95%	p value^# # Value p refers to the Wald test under the null theory of equality between the PRs. PR adjusted by (aside from household income and maternal characteristics): age, sex, race of child, geographical region, situation as mentioned in the census and the number of residents in a household. Where	Adjusted	CI 95%	p value^# # Value p refers to the Wald test under the null theory of equality between the PRs. PR adjusted by (aside from household income and maternal characteristics): age, sex, race of child, geographical region, situation as mentioned in the census and the number of residents in a household. Where
Income (quintile)
	1st (least)		8.2	0.98	(0.87 - 1.09)		1.03	(0.90 - 1.18)
	2nd		8.1	0.96	(0.86 - 1.08)		0.94	(0.82 - 1.07)
	3rd		8.8	1.04	(0.94 - 1.16)	0.706	1.01	(0.90 - 1.14)	0.467
	4th		8.3	0.99	(0.89 - 1.09)		0.96	(0.86 - 1.06)
	5th (greater)		8.4	1.00			1.00
Maternal Characteristics
	Maternal Depression
		No	8.1	1.00		< 0.001	1.00		< 0.001
		Yes	12.7	1.56^ p < 0.01,	(1.38 - 1.77)		1.35^ p < 0.01,	(1.19 - 1.54)
	Health Self-Referral
		Regular/bad/really bad	12.0	1.00		< 0.001	1.00		< 0.001
		Very good/good	7.3	0.61^ p < 0.01,	(0.56 - 0.65)		0.59^ p < 0.01,	(0.54 - 0.64)
	Age (years)
		15 to 29	9.0	1.00			1.00
		30 to 39	8.0	0.88^ p < 0.01,	(0.82 - 0.95)	< 0.001	0.91^* * p < 0.05.	(0.84 - 0.98)	0.005
		≥ 40	7.5	0.83^ p < 0.01,	(0.75 - 0.93)		0.85^ p < 0.01,	(0.76 - 0.95)
	level of education (years)
		0	7.2	1.00			1.00
		1 to 3	7.9	1.10	(0.92 - 1.30)		1.03	(0.86 - 1.22)
		4 to 7	8.1	1.12	(0.96 - 1.32)	0.067	1.04	(0.88 - 1.22)	0.387
		8 to 10	8.7	1.21^* * p < 0.05.	(1.03 - 1.43)		1.09	(0.92 - 1.30)
		≥ 11	8.7	1.21^* * p < 0.05.	(1.03 - 1.41)		1.14	(0.96 - 1.37)
	Daily Smoking
		No	8.3	1.00		0.345	1.00		0.145
		Yes	8.7	1.05	(0.95 - 1.16)		1.08	(0.97 - 1.20)

Variables			Prevalence of periods spent in a hospital bed (%)	Prevalence ratio
Variables			Prevalence of periods spent in a hospital bed (%)	Gross	CI 95%	p value^# # Value p refers to the Wald test under the null theory of equality between the PRs. PR adjusted by (aside from household income and maternal characteristics): age, sex, race of child, geographical region, situation as mentioned in the census and the number of residents in a household. Where	Adjusted	CI 95%	p value^# # Value p refers to the Wald test under the null theory of equality between the PRs. PR adjusted by (aside from household income and maternal characteristics): age, sex, race of child, geographical region, situation as mentioned in the census and the number of residents in a household. Where
Income (quintile)
	1st (least)		4.1	1.32^ p < 0.01,	(1.11 - 1.58)		1.29^* * p < 0.05.	(1.04 - 1.61)
	2nd		3.8	1.22^* * p < 0.05.	(1.02 - 1.47)		1.10	(0.89 - 1.35)
	3rd		3.8	1.21^* * p < 0.05.	(1.01 - 1.44)	0.0214	1.09	(0.90 - 1.32)	0.088
	4th		3.4	1.08	(0.90 - 1.29)		1.00	(0.83 - 1.20)
	5th (greater)		3.1	1.00			1.00
Maternal Characteristics
	Maternal Depression
		No	3.5	1.00		< 0.001	1.00		< 0.001
		Yes	6.7	1.95^ p < 0.01,	(1.62 - 2.34)		1.54^ p < 0.01,	(1.27 - 1.86)
	Health Self-Referral
		Regular/bad/really bad	6.3	1.00		< 0.001	1.00		< 0.001
		Very good/good	2.8	0.45^ p < 0.01,	(0.41 - 0.51)		0.47^ p < 0.01,	(0.42 - 0.53)
	Age (years)
		15 to 29	4.0	1.00			1.00
		30 to 39	3.3	0.82^ p < 0.01,	(0.73 - 0.92)	0.002	0.84^ p < 0.01,	(0.74 - 0.95)	0.017
		≥ 40	3.5	0.88	(0.75 - 1.04)		0.87	(0.73 - 1.03)
	level of education (years)
		0	3.7	1.00			1.00
		1 to 3	3.8	1.02	(0.80 - 1.29)		0.94	(0.75 - 1.19)
		4 to 7	3.8	1.03	(0.83 - 1.27)	0.514	0.97	(0.79 - 1.21)	0.845
		8 to 10	3.6	0.97	(0.77 - 1.22)		0.92	(0.73 - 1.18)
		≥ 11	3.4	0.91	(0.73 - 1.14)		1.01	(0.77 - 1.31)
	Daily Smoking
		No	3.6	1.00		0.029	1.00		0.131
		Yes	4.2	1.19^* * p < 0.05.	(1.02 - 1.38)		1.13	(0.96 - 1.32)

		Gross PR	CI 95%	Difference	Value p^# # Value p refers to the Wald test under the null theory of equality between the RPs. The prevalence ratios were adjusted by: age, sex, race of child, geographical region, level of education, whether the mother smoked, situation as mentioned on the census and the number of residents in a household. Where	Adjusted PR	CI 95%	Difference	Value p^# # Value p refers to the Wald test under the null theory of equality between the RPs. The prevalence ratios were adjusted by: age, sex, race of child, geographical region, level of education, whether the mother smoked, situation as mentioned on the census and the number of residents in a household. Where
1° Q. x Without depression		3.36^ p < 0.01,	(2.90 - 3.89)	2.179	< 0.001	2.33^ p < 0.01,	(1.97 - 2.76)	1.601	< 0.001
	1° Q. x With depression	5.54^ p < 0.01,	(4.21 - 7.27)			3.93^ p < 0.01,	(2.92 - 5.30)
2° Q. x Without depression		2.89^ p < 0.01,	(2.50 - 3.33)	0.275	0.496	2.06^ p < 0.01,	(1.75 - 2.42)	0.465	0.126
	2° Q. x With depression	3.16^ p < 0.01,	(2.38 - 4.19)			2.52^ p < 0.01,	(1.90 - 3.35)
3° Q. x Without depression		2.48^ p < 0.01,	(2.14 - 2.87)	2.078	< 0.001	1.91^ p < 0.01,	(1.64 - 2.23)	1.729	< 0.001
	3° Q. x With depression	4.56^ p < 0.01,	(3.56 - 5.83)			3.64^ p < 0.01,	(2.83 - 4.69)
4° Q. x Without depression		1.83^ p < 0.01,	(1.57 - 2.13)	1.575	< 0.001	1.55^ p < 0.01,	(1.33 - 1.81)	1.401	< 0.001
	4° Q. x With depression	3.40^ p < 0.01,	(2.58 - 4.49)			2,95^ p < 0.01,	(2.23 - 3.92)
5° Q. x Without depression		1.00		1.137	< 0.001	1.00		1.091	< 0.001
5° Q. x Without depression		2.14^ p < 0.01,	(1.45 - 3.15)			2.09^ p < 0.01,	(1.42 - 3.08)

ABRASCO - Associação Brasileira de Saúde Coletiva Av. Brasil, 4036 - sala 700 Manguinhos, 21040-361 Rio de Janeiro RJ - Brazil, Tel.: +55 21 3882-9153 / 3882-9151 - Rio de Janeiro - RJ - Brazil
E-mail: cienciasaudecoletiva@fiocruz.br

Acompanhe os números deste periódico no seu leitor de RSS

[1] Collaborations

PHS Leivas, CAO Tejada, AH Dâmaso, AMA Santos and PA Jacinto contributed equally in the elaboration of the project, writing the article, reviewing the relevant literature and reviewing the intellectual content, analyzing and interpreting the results and approving the final version for publication.