title: Violence at work and depressive symptoms in primary health care teams: a cross-sectional study in Brazil.
abstract: OBJECTIVE
  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).
  
  
  CONCLUSIONS
  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.
authors.affiliation: 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.|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.
authors.forename: Andréa Tenório Correia
authors.initials: AT
authors.lastname: da Silva
authors.affiliation: 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.
authors.forename: Maria Fernanda Tourinho
authors.initials: MF
authors.lastname: Peres
authors.affiliation: 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.
authors.forename: Claudia de Souza
authors.initials: Cde S
authors.lastname: Lopes
authors.affiliation: 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.
authors.forename: Lilia Blima
authors.initials: LB
authors.lastname: Schraiber
authors.affiliation: 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.
authors.forename: Ezra
authors.initials: E
authors.lastname: Susser
authors.affiliation: 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.|Center for Research on Population Mental Health-NAPSaMP, Av. Dr. Arnaldo, 455 2° andar, Cerqueira César, São Paulo, SP, CEP 01246-903, Brazil.
authors.forename: Paulo Rossi
authors.initials: PR
authors.lastname: Menezes
mesh_terms: D000293:Adolescent; D000328:Adult; D000374:Aggression; D001938:Brazil / Q000453:epidemiology; D003430:Cross-Sectional Studies; D003863:Depression / Q000453:epidemiology*; D003865:Major Depressive Disorder / Q000453:epidemiology*; D005260:Female; D006282:Health Personnel / Q000523:psychology* / Q000706:statistics & numerical data; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D010348:Patient Care Team; D011320:Primary Health Care; D011795:Surveys and Questionnaires; D064450:Workplace Violence / Q000523:psychology* / Q000706:statistics & numerical data*; D055815:Young Adult
keywords: Brazil; Depression; Health personnel; Primary care; Stressful events; Workplace violence