title: Direct and indirect exposure to violence and psychological distress among civil servants in Rio de Janeiro, Brazil: a prospective cohort study.
abstract: BACKGROUND
  Important social and economic changes accompanying the recent fast rate of urbanization have been considered a major factor in triggering and sustaining urban violence in Brazil. The purpose of this paper is to investigate the effects of exposure to direct, indirect, and contextual violence on the risk of psychological distress.
  
  
  METHODS
  Prospective longitudinal study carried out among 3,058 civil servants working at university campuses in Rio de Janeiro. Psychological distress was measured using the General Health Questionnaire, and exposure to individual violence was assessed as direct (DV), indirect (IV), and both direct and indirect (DIV). Contextual violence was assessed through the geocoding of residential addresses of study participants and the rates of homicides in 2005 at the corresponding weighting area. Multiple logistic regression was used to evaluate individual and contextual correlates of psychological distress.
  
  
  RESULTS
  Exposure to DIV increased more than six times (95% CI 2.7-16.0) the odds of psychological distress occurrence at the six-year follow-up. Regarding persistence of psychological distress, the association with violence exposure was 1.6 (95% CI 1.0-2.4) for DV and 2.7 (95% CI 1.3-5.3) for IV. Contextual violence was not associated with psychological distress, and no interaction effect was found between exposure to individual and contextual violence in the occurrence/persistence of psychological distress.
  
  
  CONCLUSIONS
  Results of this study highlight the importance of assessing multiple forms of violence in research on the social determinants of mental disorders and support the view that individual exposure to different forms of violence increases the risk of psychological distress.
authors.affiliation: Department of Epidemiology, Institute of Social Medicine, State University of Rio de Janeiro, Rua São Francisco Xavier 524 / 7017D, 7° floor, Rio de Janeiro, CEP 20550-013, RJ, Brazil. cslopesims@gmail.com.
authors.forename: Claudia S
authors.initials: CS
authors.lastname: Lopes
authors.affiliation: Department of Epidemiology, Institute of Social Medicine, State University of Rio de Janeiro, Rua São Francisco Xavier 524 / 7017D, 7° floor, Rio de Janeiro, CEP 20550-013, RJ, Brazil. clmoraes@ims.uerj.br.
authors.forename: Claudia L
authors.initials: CL
authors.lastname: Moraes
authors.affiliation: Department of Epidemiology, Institute of Social Medicine, State University of Rio de Janeiro, Rua São Francisco Xavier 524 / 7017D, 7° floor, Rio de Janeiro, CEP 20550-013, RJ, Brazil. wjunger@ims.uerj.br.
authors.forename: Washington L
authors.initials: WL
authors.lastname: Junger
authors.affiliation: Department of Epidemiology, Institute of Social Medicine, State University of Rio de Janeiro, Rua São Francisco Xavier 524 / 7017D, 7° floor, Rio de Janeiro, CEP 20550-013, RJ, Brazil. gwerneck@ims.uerj.br.
authors.forename: Guilherme L
authors.initials: GL
authors.lastname: Werneck
authors.affiliation: Department of Epidemiology, Institute of Social Medicine, State University of Rio de Janeiro, Rua São Francisco Xavier 524 / 7017D, 7° floor, Rio de Janeiro, CEP 20550-013, RJ, Brazil. ponce@ims.uerj.br.|Department of Public Health Sciences, Division of Social Medicine, Karolinska Institutet, 171 77, Stockholm, Sweden. ponce@ims.uerj.br.
authors.forename: Antonio C
authors.initials: AC
authors.lastname: Ponce de Leon
authors.affiliation: Department of Epidemiology, Institute of Social Medicine, State University of Rio de Janeiro, Rua São Francisco Xavier 524 / 7017D, 7° floor, Rio de Janeiro, CEP 20550-013, RJ, Brazil. eduardof@ims.uerj.br.
authors.forename: Eduardo
authors.initials: E
authors.lastname: Faerstein
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001938:Brazil / Q000453:epidemiology; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D013315:Stress, Psychological / Q000453:epidemiology*; D014754:Violence / Q000706:statistics & numerical data*; D055815:Young Adult