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



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).


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.


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).


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.


Depression Primary care Workplace violence Health personnel Stressful events Brazil 



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.


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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

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