Advertisement

Social Psychiatry and Psychiatric Epidemiology

, Volume 50, Issue 9, pp 1347–1355 | Cite as

Violence at work and depressive symptoms in primary health care teams: a cross-sectional study in Brazil

  • Andréa Tenório Correia da SilvaEmail author
  • Maria Fernanda Tourinho Peres
  • Claudia de Souza Lopes
  • Lilia Blima Schraiber
  • Ezra Susser
  • Paulo Rossi Menezes
Original Paper

Abstract

Purpose

Implementation of primary care has long been a priority in low- and middle-income countries. Violence at work may hamper progress in this field. Hence, we examined the associations between violence at work and depressive symptoms/major depression in primary care teams (physicians, nurses, nursing assistants, and community health workers).

Methods

A cross-sectional study was undertaken in the city of Sao Paulo, Brazil. We assessed a random sample of Family Health Program teams. We investigated depressive symptoms and major depression using the nine-item Patient Health Questionnaire (PHQ-9), and exposure to violence at work in the previous 12 months using a standardized questionnaire. Associations between exposure to violence and depressive symptoms/major depression were analyzed using multinomial logistic regression.

Results

Of 3141 eligible workers, 2940 (93 %) completed the interview. Of these, 36.3 % (95 % CI 34.6–38.1) presented intermediate depressive symptoms, and 16 % (95 % CI 14.6–17.2), probable major depression. The frequencies of exposure to the different types of violence at work were: insults (44.9 %), threats (24.8 %), physical aggression (2.3 %), and witnessing violence (29.5 %). These exposures were strongly and progressively associated with depressive symptoms (adjusted odds ratio 1.67 for exposure to one type of violence; and 5.10 for all four types), and probable major depression (adjusted odds ratio 1.84 for one type; and 14.34 for all four types).

Conclusion

Primary care workers presenting depressive symptoms and those who have experienced violence at work should be assisted. Policy makers should prioritize strategies to prevent these problems, since they can threaten primary care sustainability.

Keywords

Depression Primary care Workplace violence Health personnel Stressful events Brazil 

Notes

Acknowledgments

Our study was funded by the São Paulo Research Foundation (FAPESP—2010/07180-6). The sponsor had no role in study design, data collection and processing, interpretation, or writing of the manuscript. PRM was partially funded by CNPq-Brazil. ATCS was partially funded by the NAPSaMP-USP.

Conflict of interest

On behalf of all authors, the corresponding author states that there is no conflict of interest.

References

  1. 1.
    Rohde J, Cousens S (2008) 30 years after Alma-Ata: has primary health care worked in countries? Lancet 372(9642):950–961CrossRefPubMedGoogle Scholar
  2. 2.
    Rasella D, Harhay MO, Pamponet ML, Aquino R, Barreto ML (2014) Impact of primary health care on mortality from heart and cerebrovascular diseases in Brazil: a nationwide analysis of longitudinal data. BMJ 348:g4014CrossRefGoogle Scholar
  3. 3.
    Mayosi BM, Lawn JE, van Niekerk A, Bradshaw D, Abdool Karim SS, Coovadia HM (2012) Health in South Africa: changes and challenges since 2009. Lancet 380(9858):2029–2043CrossRefPubMedGoogle Scholar
  4. 4.
    Pallas SW, Minhas D, Pérez-Escamilla R, Taylor L, Curry L, Bradley EH (2013) Community health workers in low- and middle-income countries: what do we know about scaling up and sustainability? Am J Public Health 103(7):e74–e82PubMedCentralCrossRefPubMedGoogle Scholar
  5. 5.
    Nelson R (2014) Tackling violence against health-care workers. Lancet 383(9926):1373–1374CrossRefPubMedGoogle Scholar
  6. 6.
    Tak SW, Sweeney MH, Alterman T et al (2010) Workplace assaults on nursing assistants in US nursing homes: a multilevel analysis. Am J Public Health 100(10):1938–1945PubMedCentralCrossRefPubMedGoogle Scholar
  7. 7.
    Gerberich SG, Church TR, McGovern PM et al (2004) An epidemiological study of the magnitude and consequences of work related violence: the Minnesota Nurses’ Study. Occup Environ Med 61:495–503PubMedCentralCrossRefPubMedGoogle Scholar
  8. 8.
    Geiger-Brown J, Muntaner C, McPhaul K, Lipscomb J, Trinkoff A (2007) Abuse and violence during home care work as predictor of worker depression. Home Health Care Serv Q 26:59–77CrossRefPubMedGoogle Scholar
  9. 9.
    Di Martino V (2003) Workplace violence in the health sector: Country case studies. World Health Organization. http://www.who.int/violence_injury_prevention/injury/en/WVsynthesisreport.pdf. Accessed 5 May 2014
  10. 10.
    Magin PJ, Adams J, Sibbritt DW, Joy E, Ireland MC (2005) Experiences of occupational violence in Australian urban general practice: a cross-sectional study of GPs. Med J Aust 183:352–356PubMedGoogle Scholar
  11. 11.
    Hobbs FDR (1991) Violence in general practice: a survey of general practitioners’ views. BMJ 302(6772):329–332PubMedCentralCrossRefPubMedGoogle Scholar
  12. 12.
    Ministério da Saúde. Histórico da cobertura da estratégia saúde da família. Ministério da Saúde. http://dab.saude.gov.br/portaldab/ape_esf.php. Accessed 22 Aug 2014
  13. 13.
    Secretaria Municipal de Saúde (2012) Estratégia Saúde da Família. Prefeitura de São Paulo. http://www.prefeitura.sp.gov.br/cidade/secretarias/saude/atencao_basica/esf/index.php?p=17783. Accessed 21 Apr 2014
  14. 14.
    Santos IS, Tavares BF, Munhoz TN et al (2013) Sensitivity and specificity of the Patient Health Questionnaire-9 (PHQ-9) among adults from the general population. Cad Saude Publica 29:1533–1543CrossRefPubMedGoogle Scholar
  15. 15.
    Krug EG, Dahlberg LL, Mercy JA, Zwi AB, Lozano R (2002) World report on violence and health. World Health Organization. http://whqlibdoc.who.int/publications/2002/9241545615_eng.pdf?ua=1. Accessed 16 Jun 2014
  16. 16.
    Schraiber LB, Latorre M do RDO, França I, Segri NJ, D’Oliveira AFPL (2010) Validity of the WHO VAW study instrument for estimating gender-based violence against women. Rev Saude Publica 44:658–666CrossRefPubMedGoogle Scholar
  17. 17.
    OpenDataKit Web site (2008). http://opendatakit.org. Accessed 18 Oct 2014
  18. 18.
    Lopes CS, Faerstein E, Chor D (2003) Stressful life events and common mental disorders: results of the Pro-Saude Study. Cad Saude Publica 19:1713–1720CrossRefPubMedGoogle Scholar
  19. 19.
    Goldberg RJ, Steury S (2001) Depression in the workplace: costs and barriers to treatment. Psychiatr Serv 52:1639–1643CrossRefPubMedGoogle Scholar
  20. 20.
    Andrade LH, Wang Y-P, Andreoni S et al (2012) Mental disorders in megacities: findings from the Sao Paulo megacity mental health survey. Brazil. PLoS One 7:e31879CrossRefPubMedGoogle Scholar
  21. 21.
    Tracy M, Morgenstern H, Zivin K, Aiello AE, Galea S (2014) Traumatic event exposure and depression severity over time: results from a prospective cohort study in an urban area. Soc Psychiatry Psychiatr Epidemiol 49:1769–1782CrossRefPubMedGoogle Scholar
  22. 22.
    Suliman S, Mkabile SG, Fincham DS et al (2009) Cumulative effect of multiple trauma on symptoms of posttraumatic stress disorder, anxiety, and depression in adolescents. Compr Psychiatry 50:121–127CrossRefPubMedGoogle Scholar
  23. 23.
    Moshiro C, Heuch I, Astrøm AN, Setel P, Kvåle G (2005) Effect of recall on estimation of non-fatal injury rates: a community based study in Tanzania. Inj Prev 11:48–52PubMedCentralCrossRefPubMedGoogle Scholar
  24. 24.
    Ellsberg M, Caldera T, Herrera A, Winkvist A, Kullgren G (1999) Domestic violence and emotional distress among Nicaraguan women: results from a population-based study. Am Psychol 54:30–36CrossRefGoogle Scholar
  25. 25.
    Campbell JC (2002) Health consequences of intimate partner violence. Lancet 359:1331–1336CrossRefPubMedGoogle Scholar
  26. 26.
    Devries K, Watts C, Yoshihama M et al (2011) Violence against women is strongly associated with suicide attempts: evidence from the WHO multi-country study on women’s health and domestic violence against women. Soc Sci Med 73:79–86CrossRefPubMedGoogle Scholar
  27. 27.
    D’Oliveira AFP, Diniz SG, Schraiber LB (2002) Violence against women in health-care institutions: an emerging problem. Lancet 359(9318):1681–1685CrossRefPubMedGoogle Scholar
  28. 28.
    Chambers R, Campbell I (1996) Anxiety and depression in general practitioners: associations with type of practice, fundholding, gender and other personal characteristics. Fam Pract 13:170–173CrossRefGoogle Scholar
  29. 29.
    Goldberg RJ, Steury S (2001) Depression in the workplace: costs and barriers to treatment. Psychiatr Serv 52:1639–1643CrossRefPubMedGoogle Scholar
  30. 30.
    Kõlves K, De Leo D (2013) Suicide in medical doctors and nurses: an analysis of the Queensland Suicide Register. J Nerv Ment Dis 201(11):987–990CrossRefPubMedGoogle Scholar
  31. 31.
    Wieclaw J, Agerbo E, Bo Mortensen P, Burr H, Tüchsen F, Bonde JP (2006) Work related violence and threats and the risk of depression and stress disorders. J Epidemiol Community Health 60(9):771–775PubMedCentralCrossRefPubMedGoogle Scholar
  32. 32.
    Büssing A, Höge T (2004) Aggression and violence against home care workers. J Occup Health Psychol 9:206–219CrossRefPubMedGoogle Scholar
  33. 33.
    Marchand A, Durand P, Haines V, Harvey S (2014) The multilevel determinants of workers’ mental health: results from the SALVEO study. Soc Psychiatry Psychiatr Epidemiol 50(3):445–459CrossRefPubMedGoogle Scholar
  34. 34.
    Starfield B (1994) Is primary care essential? Lancet 344:1129–1133CrossRefPubMedGoogle Scholar
  35. 35.
    World Health Organization (2006) The World Health Report 2006: Working together for health. World Health Organization website http://www.who.int/whr/2006. Accessed 10 May 2014
  36. 36.
    World Health Organization (2003) Workforce crisis a major obstacle in global tuberculosis control. Bull World Health Organ 81(11):85Google Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2015

Authors and Affiliations

  • Andréa Tenório Correia da Silva
    • 1
    • 2
    Email author
  • Maria Fernanda Tourinho Peres
    • 1
  • Claudia de Souza Lopes
    • 3
  • Lilia Blima Schraiber
    • 1
  • Ezra Susser
    • 4
  • Paulo Rossi Menezes
    • 1
    • 2
  1. 1.Department of Preventive MedicineMedical School of the University of São PauloSão PauloBrazil
  2. 2.Center for Research on Population Mental Health-NAPSaMPSão PauloBrazil
  3. 3.Department of Epidemiology, Institute of Social MedicineState University of Rio de JaneiroRio de JaneiroBrazil
  4. 4.Department of Epidemiology, Mailman School of Public HealthColumbia University, and New York State Psychiatric InstituteNew YorkUSA

Personalised recommendations