Association between community-based and workplace violence and the sleep quality of health professionals: a cross-sectional study

Silveira, Fabrícia Bezerra de Castro Alves; Lira Neto, José Claudio Garcia; Weiss, Carleara; Araújo, Márcio Flávio Moura de

doi:10.1590/1413-81232021265.04522021

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ARTICLE • Ciênc. saúde coletiva 26 (5) • May 2021 • https://doi.org/10.1590/1413-81232021265.04522021 copy

Association between community-based and workplace violence and the sleep quality of health professionals: a cross-sectional study

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Community-based and workplace violence against health professionals has caused feelings of vulnerability, emotional exhaustion, and psychological changes, reflecting on sleep quality disorders. Thus, we aimed to analyze the association between community and workplace violence and the sleep quality of health professionals working in primary health care. The study was conducted with 286 health professionals who worked in PHC in one of the largest cities in Brazil. The primary outcome was sleep quality as assessed by the Pittsburgh Sleep Quality Index. Most of the participants (69.2%/p=0.074) were classified as “bad sleepers”, and nurses (73.3%/p=0.049) showed the worst sleep quality. Additionally, most professionals suffered some type of violence at work (p<0.001), which impaired professional activities (p=0.010), forcing them to change their behavior (p<0.001) and consider changing the workplace location (p=0.051). The results showed that professionals have been experiencing moments of fear, anxiety, and stress associated with workplace and community violence. This highlights the need for public policies geared to occupational health.

Key words:
Workplace Violence; Sleep; Health Personnel; Primary Health Care

Region	Number of doctors	Sample of doctors	Number of nurses	Sample of nurses	Number of dental surgeons	Sample of dental surgeons	Total sample
1	55	14	68	18	34	9	41
2	44	11	47	12	43	11	34
3	60	16	78	20	43	11	47
4	36	9	48	13	35	9	31
5	65	17	97	25	46	12	54
6	95	25	125	32	86	22	79
Total	355	92	463	120	287	74	286

Region	Mortality rate due to homicide per 100 thousand inhabitants
1	55.32
2	40.59
3	51.72
4	43.48
5	91.13
6	61.98
Fortaleza	60.15

Variables		Bad sleeper (n=188)		Good sleeper (n=98)		PR (95%CI)	p-value
Variables		n	%	n	%	PR (95%CI)	p-value
Gender						0,0741	0,074¹ 1 Chi-square test;
	Male	43	57.3	32	42.7	1
	Female	145	68.7	66	31.3	1.2 (0.97-1.49)
Age group (years)						0.9892	0,989² 2 Fisher's exact test;
	23-29	28	68.3	13	31.7	1.07 (0.74-1.53)
	30-39	64	66.7	32	33.3	1.04 (0.75-1.44)
	40-49	75	64.7	41	35.3	1.01 (0.73-1.40)
	50-59	16	64.0	9	36.0	1
	≥60	5	71.4	2	28.6	1.12 (0.64-1.94)
Professional category						0.0491	0,049¹ 1 Chi-square test;
	Doctor	58	63.0	34	37.0	1.11 (0.86-1.43)
	Nurse	88	73.3	32	26.7	1.29 (1.03-1.62)
	Dental surgeon	42	56.8	32	43.2	1
Region of the city where the primary health care unit is located						0.5181	0,518¹ 1 Chi-square test;
	Region 1	26	63.4	15	36.6	1.10 (0.80-1.53)
	Region 2	24	70.6	10	29.4	1.23 (0.90-1.69)
	Region 3	34	72.3	13	27.7	1.26 (0.94-1.68)
	Region 4	23	74.2	8	25.8	1.29 (0.95-1.76)
	Region 5	31	57.4	23	42.6	1
	Region 6	50	63.3	29	36.7	1.1 (0.83-1.47)
Seniority in the primary health care unit		72.0 (22.0-156.0)		72.0 (16.0-144.0)		-	0.957³ 3 Mann-Whitney test.

Variables		Bad sleeper (n=188)		Good sleeper (n=98)		PR (95%CI)	p-value
Variables		n	%	n	%	PR (95%CI)	p-value
You consider the work territory				0.1572			0,157² 2 Fisher's exact test.
	I do not consider it a violent area	3	42.9	4	57.1	1
	I consider it a non-violent area	64	61.0	41	39.0	1.42 (0.6-3.39)
	I consider it a very violent area	121	69.5	53	30.5	1.62 (0.69-3.84)
Territorial violence hindered professional activities				0.0101			0,010¹ 1 Chi-square test;
	Not once	24	48.0	26	52.0	1
	Once or twice	71	67.0	35	33.0	1.4 (1.02-1.92)
	≥3 times	92	71.9	36	28.1	1.5 (1.1-2.04)
Territorial violence forced a change of conduct				<0.0011			<0,001¹ 1 Chi-square test;
	Not once	36	43.9	46	56.1	1
	Once or twice	72	69.9	31	30.1	1.59 (1.21-2.1)
	≥3 times	80	79.2	21	20.8	1.8 (1.39-2.35)
Was a victim of violence during work activities within the service				<0.0011			<0,001¹ 1 Chi-square test;
	Not once	25	44.6	31	55.4	1
	Once or twice	70	62.5	42	37.5	1.4 (1.01-1.94)
	≥3 times	92	78.6	25	21.4	1.76 (1.3-2.39)
Was a victim of violence during work activities within the community				0.0071			0,007¹ 1 Chi-square test;
	Not once	110	59.5	75	40.5	1
	Once or twice	45	72.6	17	27.4	1.22 (1.01-1.48)
	≥3 times	31	83.8	6	16.2	1.41 (1.17-1.7)
Felt fear, anxiety, or stress due to violence in the territory				0.0012			0,001² 2 Fisher's exact test.
	Not once	22	45.8	26	54.2	1
	I do not consider the territory violent	1	100.0	0	0.0	2.18 (1.6-2.97)
	Once or twice	71	62.8	42	37.2	1.37 (0.98-1.92)
	≥3 times	93	76.2	29	23.8	1.66 (1.2-2.3)
It took a long time to sleep when thinking about territorial violence				<0.0011			<0,001¹ 1 Chi-square test;
	Not once	78	51.3	74	48.7	1
	Once or twice	67	78.8	18	21.2	1.54 (1.27-1.86)
	≥3 times	43	89.6	5	10.4	1.75 (1.45-2.1)
Had nightmares related to violence in the service/territory				<0.0011			<0,001¹ 1 Chi-square test;
	Not once	125	59.2	86	40.8	1
	Once or twice	42	85.7	7	14.3	1.45 (1.23-1.7)
	≥3 times	21	80.8	5	19.2	1.36 (1.1-1.7)
Woke up unmotivated to go to work due to violence in the service/territory				<0.0011			<0,001¹ 1 Chi-square test;
	Not once	62	52.5	56	47.5	1
	Once or twice	57	72.2	22	27.8	1.37 (1.1-1.71)
	≥3 times	69	78.4	19	21.6	1.49 (1.22-1.83)
Considered changing the workplace due to violence in the service/territory				0.0511			0,051¹ 1 Chi-square test;
	Not once	106	63.5	61	36.5	1
	Once or twice	39	60.0	26	40.0	0.95 (0.75-1.19)
	≥3 times	43	79.6	11	20.4	1.25 (1.05-1.5)

Variables		PR (95%CI)	p-value
Did violence in the community force professionals to change their behavior?
	Not once	1
	Once or twice	1.42 (1.07-1.89)	0.014
	≥3 times	1.42 (1.06-1.89)	0.019
Did the professional take too long to sleep when thinking about violence in the community?
	Not once	1
	Once or twice	1.38 (1.13-1.69)	0.002
	≥3 times	1.55 (1.25-1.91)	<0.001

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E-mail: cienciasaudecoletiva@fiocruz.br

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[1] Collaborations

FBCA Silveira and MFM Araújo contributed to the conception and design, analysis, and interpretation of the data. FBCA Silveira, MFM Araújo, JCG Lira Neto and C Weiss drafted the paper and critically reviewed it. JCG Lira Neto, C Weiss and MFM Araújo contributed to the approval of the version to be published.