Violência no trabalho e transtornos mentais comuns em trabalhadores/as da saúde em três municípios baianos

Abstract

During the COVID-19 pandemic, health workers have gained recognition for their importance to social well-being. However, along with this recognition, precariousness has also been revealed in the work environment, such as exposure to violence, whether from users of health services or among colleagues. The organization of work, with its exacerbation of occupational stressors and work overload, makes the work environment susceptible to violence, such as aggression and harassment. At the same time, Common Mental Disorders (CMD) have shown significant growth, especially among health workers in recent years, and are responsible for one of the main causes of absence from work and the granting of Social Security benefits. This context of health work, with stressors and situations of violence, is associated with a greater occurrence of mental health problems, such as CMDs, which may be aggravated in the Brazilian context during the COVID-19 pandemic. Objectives: This dissertation aimed to analyze the association between exposure to violence at work and CMD in primary and medium-complexity healthcare workers in three municipalities in northeastern Brazil. Methods: An analytical cross-sectional epidemiological study was carried out with a representative sample of health workers from three municipalities in the state of Bahia: Feira de Santana, São Gonçalo dos Campos and Cruz das Almas. The target population was made up of health workers from Primary Care and Medium Complexity. Data collection began in April 2021 and ended in April 2022. The outcome of common mental disorders was assessed using the Self-Reporting Questionnaire (SRQ-20), while exposure to violence was assessed using the question: have you suffered any aggression at work in the last 12 months? This question is part of block X, specifically on aggression and violence at work, of the structured questionnaire. The psychosocial aspects of work were assessed using the Effort-Reward Imbalance (ERI) scale. Results: The final sample of this study consisted of 1,011 participants who answered the questionnaires used and provided complete information on the variables of interest. The prevalence of CMD among primary care and medium-complexity health workers was 40.8%. Workers exposed to violent situations were 2.2 times more likely to have the outcome (OR = 12 2.28; 95% CI 1.44- 3.59), even after adjusting for confounding factors. Psychosocial work factors such as imbalance between effort and reward and excessive commitment were also positively associated with CMD. Conclusion: The findings confirm the hypothesis that violence at work in healthcare, in the post-COVID-19 pandemic context, is associated with CMDs, with violence being an independent health risk factor. The results are consistent with previous literature from other countries and other contexts. There was also a high prevalence of CMD among health workers in primary and medium-complex care, which points to the need for preventive and health promotion actions for this group of workers within the Unified Health System. Unlike sociodemographic and occupational profile factors, which were not associated with the outcome, psychosocial stressors at work, such as the imbalance between effort and rewards and overcommitment, also deserve attention, having shown measures of effect of great magnitude, which suggests that interventions to minimize violence at work and its possible effects on mental health should focus on the organization of work and the social determinants of health.