Pesticide poisoning is one of the main factors, among others, associated with the risk of developing mental disorders among the rural population of the region of Atibaia (SP), shows statistical analysis carried out as part of the doctoral thesis “Assessment of quality of life and disorders mental disorders of residents in rural areas”, defended at the Faculty of Medical Sciences (FCM) at Unicamp.

The author of the thesis, Paulo Junior Paz de Lima, draws attention to the fact that his study dealt not only with rural workers, who directly manipulate agricultural pesticides, but with the population in general. “I got the rural community, not just the field workers,” he said in an interview with Journal of Unicamp. 

“Not everyone who lives in those communities works in agriculture. But even those who do not work in agriculture are exposed if the application of pesticides is carried out by air or by machine, without a specific time for it to occur. The pesticide reaches people’s homes, around plantations/crops,” he explained. The study areas include the neighborhoods of Laranjal, Pedreira, Ponte Alta and Rio Baixo, in the municipality of Atibaia.

The thesis reports that “in relation to contact and exposure to pesticides, whether in the work process or by living close to crops, 18,9% reported having contact (...) 25,2% mentioned living close to plantations, feeling the smell during the application of pesticides, pulling the hose for pesticide application by another, remaining close when pesticides are applied and washing clothes used during the application of these products”.

When the issue is pesticide poisoning, “13,3% mentioned having suffered poisoning. However, the number of those who reported feeling unwell during the application of this type of pesticide was higher, 16,6%.”

Parkinson

“There are people who cannot even go near the farm, who have an absurd allergic problem. These issues do not appear in the thesis, because the scope of the study is limited, but we see these problems”, said Paz de Lima. “Often, problems related to mental disorders appear and the local doctor does not associate them with pesticides.”

The researcher explains that intoxication can cause symptoms similar to those of Parkinson's disease, among others. “The person arrives with tremors, you’ll think it’s Parkinson’s. No, it's pesticide poisoning. He is intoxicated and the doctor didn’t even ask what the person works with,” he said. “And I’m not talking about people over 50, 60 years old and working in the field, I’m talking about kids, 18-year-olds.”

In the thesis, Paz de Lima writes that “poisoning and deaths from pesticides, in the Brazilian rural context, are public health problems that require greater attention from public authorities, in order to prevent them”. In 2009, the Ministry of Health recorded 171 deaths and 5.253 cases of poisoning by pesticides for agricultural use.

Sex and education

When the focus is expanded beyond workers who are victims of pesticide poisoning, the data collected in the thesis show that the frequency among rural residents with so-called common mental disorders is higher among females (81,9% of those affected), with aged between 21 and 40 years (55,4%), with a partner (73,5%), mixed race or black (51,8%), with low education, with a maximum of four years of study (42,2% ), unemployed (45,8%), with income below the minimum wage (34,9%), non-alcoholic (79,3%), non-smoker (80,5%), non-rural worker (73,2% ) and who mentioned having a health problem (60,3%).

Paz de Lima's work compares this data to surveys carried out in other parts of the country. “The prevalence of common mental disorders (CMD), as well as rates of alcoholism, smoking, morbidities and medication use were relatively high among the study population,” she writes. The prevalence of CMD in the population studied in the thesis, 23,4%, exceeded the proportion found in a study carried out among sugarcane cutters in Nova Andradina (MS), which was 12%, and also that found in the population of the city of São Paulo , where, in 2008, a proportion of 16,5% of people with common mental disorders were found among those over 16 years of age.

“The results showed that belonging to the white color/ethnicity, being younger, being male, not having health problems and having a higher level of education are factors that can contribute to reducing the chance of developing CMD”, writes the author.

Quality of Life

In addition to collecting data on mental health, Paz de Lima's thesis sought to evaluate the quality of life of the population studied. “The definition of quality of life is more comprehensive than health status and functional capacity, as it includes aspects of the environment that may or may not be affected by health”, writes the author.

“The discussion about the concepts of health and quality of life in the context and work in the field is important because it has assumed a secondary aspect, given the urgency of other priorities, as well as the guarantee of survival, even in degrading working conditions”, he says The thesis.

The instrument chosen to assess quality of life, more broadly, was a 26-question questionnaire developed by the World Health Organization (WHO), WHOQOL-Bref. Health-related quality of life was measured by another tool, the SF-36 questionnaire, originally created for the American think tank RAND Corporation to assess the cost-benefit of medical treatments. It is an instrument that “has been translated and adapted culturally and psychometrically by several countries, including Brazil”, says the thesis.

The author, however, draws attention to a difficulty: “When you create and validate an instrument in Brazil, whether it is to assess quality of life or to assess mental health, which population is this instrument validated for? For the urban population,” he told the reporter. “It is not validated for the rural population. It is complicated to evaluate the rural population using an instrument that was created for the urban population. It's another obstacle, because there's no instrument. Although there are instruments validated in rural communities outside of Brazil, in Brazil there are none, they have not been validated”.

The worst quality of life performance, in the WHO questionnaire (WHOQOL-Bref), appeared in the environmental domain – the instrument is divided into questions relating to four thematic domains: psychological, physical, social and environmental. 

“The results showed the variables age, sex, marital status, education, income, type of property ownership, complaints of health problems and use of medication as statistically associated with the quality of life domains”, says the thesis. “Factors such as advanced age, low education, as well as mental suffering, health problems and medication side effects contribute to a low level of quality of life.”

Negligence

Mental health is already neglected when it comes to studies on urban populations and, even more so, on the rural population, said Paz de Lima. “When you go to the rural population, you really don’t find this type of research in Brazil.” He also points out a great difficulty in publishing work in this area in national scientific journals.

“And so the question is: are there no articles on mental health and quality of life in rural areas because research is not done, or articles are not found because they are not published? Maybe people write theses and leave everything at colleges. But even in colleges you don’t find much,” he said. “You can find studies on sociology of rural areas, but on epidemiology, mental health, quality of life, there are almost none”.

He points out two hypotheses to explain this gap in available studies: the research lines of universities, already previously focused on the urban area, and the fact that the majority of those entering postgraduate programs also have urban origins and find it very difficult to research the rural environment. “It’s not easy to do research in rural areas,” he said. “And when you get to these places, you also have an obstacle, depending on the municipality and city hall, they don’t want to touch the issue of rural workers, because that’s where, among other issues, the issue of pesticides comes in, which they avoid.”

The text of the thesis states that “rural residents, specifically rural workers, generally fear participating in research and providing information about the work process. They suspect that the research is related to the investigation into the use of pesticides in agriculture, since many of these products, although prohibited in their countries of origin, are still used in Brazil”.

Paz de Lima recognizes that his results are specific to the area studied and cannot be, from a scientific point of view, considered valid for Brazil as a whole. But she considers that the work could be important to guide new studies on the topic in other rural communities.

Publication

Thesis: “Assessment of Quality of Life and Common Mental Disorders of Residents in Rural Areas”
Author Paulo Junior Paz de Lima
Advisor: Helenice Bosco de Oliveira
Unity: Faculty of Medical Sciences (FCM)