Andréa Tenório Correia da Silva1,2, Maria Fernanda Tourinho Peres3, Claudia de Souza Lopes4, Lilia Blima Schraiber3, Ezra Susser5, Paulo Rossi Menezes3,6. 1. Department of Preventive Medicine, Medical School of the University of São Paulo, Av. Dr. Arnaldo, 455, 2° andar, Cerqueira Cesar, São Paulo, SP, CEP 01246-903, Brazil. andreatenorio@usp.br. 2. Center for Research on Population Mental Health-NAPSaMP, Av. Dr. Arnaldo, 455 2° andar, Cerqueira César, São Paulo, SP, CEP 01246-903, Brazil. andreatenorio@usp.br. 3. Department of Preventive Medicine, Medical School of the University of São Paulo, Av. Dr. Arnaldo, 455, 2° andar, Cerqueira Cesar, São Paulo, SP, CEP 01246-903, Brazil. 4. Department of Epidemiology, Institute of Social Medicine, State University of Rio de Janeiro, Rua São Francisco Xavier 524, 7° andar, Rio de Janeiro, RJ, CEP 20559-900, Brazil. 5. Department of Epidemiology, Mailman School of Public Health, Columbia University, and New York State Psychiatric Institute, 722 West 168th St., Room 1030, New York, NY, 10032, USA. 6. Center for Research on Population Mental Health-NAPSaMP, Av. Dr. Arnaldo, 455 2° andar, Cerqueira César, São Paulo, SP, CEP 01246-903, Brazil.
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.
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.
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