Exposição à violência comunitária e intrafamiliar na ocorrência de alterações de comportamento externalizantes em pré-escolares no Equador.

Abstract

Introduction: Externalizing behavior problems are disruptive behaviors. Among the factors that contribute to the occurrence of behavioral problems in childhood, exposure to violence stands out as an important predictor, having already been observed ways in which exposure to community violence generates instabilities and conflicts familial context. This conflicts are responsible for the increase in occurrence of violent events against the child, which are responsible for damage to child development and associated with the occurrence of externalizing behavioral changes. Objective: To understand the relationship between exposure to community violence and the occurrence of externalizing behavior problems in preschool children living in the province of Esmeraldas, district of Quinindé, Ecuador, considering the mediating effect of exposure to intrafamilial violence. Methodology: this is a cross-sectional study associated with a cohort of the ECUAVIDA project, which includes 1673 residents in Ecuador. Exposure to community violence was assessed through a questionnaire produced for the collection of cohort data; the occurrence of intrafamily violence events using the Conflict Tactics Scale - Parent-Child (CTS-PC); the occurrence of externalizing behavior problems through the Child Behavior Checklist (CBCL), version 1.5-5 years; in addition to variables related to socio-demographic information from a standardized and pre-coded questionnaire. Descriptive analysis was performed on each of the variables, later logistic regression was performed regarding the relationships between the exposure, mediation, outcome and covariate variables. Finally, structural equation modeling was performed in order to analyze the possible mediation mechanisms of physical abuse in the relationship between exposure to community violence and the occurrence of externalizing behavior problems. For all analyses, STATA 14.0 software was used. Results: It was observed that 49.55% of respondents were direct victims of community violence, 88.40% witnessed 2 or more acts and 68.74% presented intermediate or high perceptions of violence. Among the intrafamilial variables, 24.03% of the children were exposed to psychological violence, 64.32% to corporal punishment and 26.02% to physical abuse. The prevalence of externalizing behavior problems was 6.52%. Through simple logistic regression, a statistically significant association was observed with the occurrence of externalizing behavior problems, direct victimization and high levels of perception of community violence; the occurrence of psychological violence, corporal punishment and 11 physical abuse in the intrafamilial environment; in addition to the child being male. Through mediation analysis, it was identified that the perception of violence is associated with the occurrence of externalizing behavior through the mediating role of the occurrence of physical abuse aimed at the child, with no statistically significant effect being observed in the direct action of the perception on the occurrence of behavior problems. It was also identified the way in which direct victimization is associated with the outcome through the mediating effect of the occurrence of physical abuse. In contrast, direct victimization is also associated with the occurrence of externalizing behavior problems directly. Conclusion: in both analyzed models, it was observed that community violence is associated with the occurrence of externalizing behavior problems through the mediation of intraafamilial physical abuse. Such results can contribute to the advancement of knowledge about the ways in which exposure to community violence and the experience of violent events in childhood perpetrated by the family affect children's mental health.