Relação entre traumas na Infância e depressão em idosos cadastrados na Estratégia de Saúde da Família

Abstract

Introduction: Depression is a highly prevalent disease in the elderly, warranting further investigation of the factors associated with its occurrence. In addition, exposure to adverse conditions, especially in childhood, would appear to have an important influence on the manifestation of this disease. Objective: A cross-sectional study aimed to examine the relationship between maltreatment in childhood with depression in the elderly, based on data originating from the research, Epidemiological and Clinical Study of the Elderly, enrolled in the health strategy of Porto Alegre (EMI-SUS). Methods: A random sample comprised of 449 elderly participants, living in low socioeconomic conditions, and enrolled in the Family Health Strategy (FHS) program in the city of Porto Alegre. The prevalence of adverse childhood experiences was estimated, as reported by the elderly and measured using the Childhood Trauma Questionnaire (CTQ), with the aim of examining associations with sociodemographic factors and current geriatric depression, obtained from the 15-item Geriatric Depression Scale (GDS-15). Results: The sample was predominantly white/Caucasian (67.2%), female (64.1%), and aged 65-75 years (46.1%). The majority had a personal income of less than one minimum salary (57.7%) or had no income (8%), and had a very low formal education level of 4 years or less (35.4%), with a significant number being illiterate (25.8%). Depression was more prevalent in the elderly of a more advanced age (31.6%), divorced (33.2%), black (33.9%), illiterate (39.7%), and with no income (44.1%). Many participants reported experiences of maltreatment during childhood, having suffered some form of abuse or neglect (35.7%). Higher frequencies of emotional neglect (47.3%) and emotional abuse (43.5%) were observed in the reports. The odds ratios with 95% confidence intervals for the maltreatment subtypes were: Emotional Neglect [2.822 (1.698-4.692)], Emotional Abuse [2.252 (1.351-3.754)], Physical Neglect [1.912 (1.179-3.103)], and Physical Abuse [1.754 (1.076-2.861)], all of which were independently associated with current geriatric depression. Severe depression was significantly associated with Emotional Abuse [4.193 (1.752-10.036)], Emotional Neglect [3.543 (1.489-8.429)], and Physical Abuse [3.014 (1.245-7.296)]. In the adjusted model considering the overlapping of maltreatment, a rising odds ratio was found for current geriatric depression in which it was significantly associated with two [3.298 (1.600-6.796)], three 3.108 (1.359-7.111), four [3.813 (1.643-8.933)] and five [4.394 (1.300-14.853)] types of maltreatment experience. Conclusion: The main findings revealed that individuals presenting current geriatric depression more frequently reported having suffered physical and emotional abuse and/or neglect. Moreover, there is evidence that emotional abuse and neglect, coupled with an overlapping experience of maltreatment, contributed to the severity of depression. It is important to note that these elements were found within the context of a low-income, low-education level, homogeneous and multiethnic population.