Introduction

Sequential cases of violent attacks in Brazilian daycare centers, preschools, and schools in the first quarter of 2023 caused the national and international media to advertise an “epidemic” of violence in schools ¹1. Gual JR. The violence 'epidemic' in Brazil's schools: more than 1,200 cases under investigation. El País 2023; 19 apr. https://english.elpais.com/international/2023-04-19/the-violence-epidemic-in-brazils-schools-more-than-1200-cases-under-investigation.html.
https://english.elpais.com/international... .

Between 2002 and 2022, 16 violent attacks with fatal victims were reported in schools in Brazil ²2. Cara DT. Relatório. O extremismo de direita entre adolescentes e jovens no Brasil: ataques às escolas e alternativas para a ação governamental. https://campanha.org.br/acervo/relatorio-ao-governo-de-transicao-o-ultraconservadorismo-e-extremismo-de-direita-entre-adolescentes-e-jovens-no-brasil-ataques-as-instituicoes-de-ensino-e-alternativas-para-a-acao-governamental/ (accessed on 05/Aug/2023).
https://campanha.org.br/acervo/relatorio... . In 2023, new attacks occurred, affecting the lives of education professionals, students, and their families, including the “Blumenau Massacre” in a daycare center in Santa Catarina State, when four children aged 4 to 7 years died ³3. Borges C, Pacheco J. Quatro crianças são mortas em ataque a creche em Blumenau; homem foi preso. G1 2024; 5 apr. https://g1.globo.com/sc/santa-catarina/noticia/2023/04/05/ataque-creche-blumenau.ghtml.
https://g1.globo.com/sc/santa-catarina/n... .

In addition to violent attacks by aggressors from outside the school, violent actions by students against teachers ⁴4. Estudante de 13 anos mata professora e fere mais quatro pessoas em escola estadual de São Paulo. Jornal Nacional 2023; 27 mar. https://g1.globo.com/jornal-nacional/noticia/2023/03/27/estudante-de-13-anos-mata-professora-e-fere-mais-quatro-pessoas-em-escola-estadual-de-sao-paulo.ghtml.
https://g1.globo.com/jornal-nacional/not... and by teachers against students have also been reported recently in the country, such as the case in which a childcare center director was reported for acts of torture against a 5-year-old child in São Paulo ⁵5. Depoimentos de pais e funcionários levaram escola infantil a ser investigada por tortura em São Paulo. Fantástico 2023; 2 jul. https://g1.globo.com/fantastico/noticia/2023/07/02/depoimentos-de-pais-e-funcionarios-levaram-escola-infantil-a-ser-investigada-por-tortura-em-sao-paulo-video.ghtml.
https://g1.globo.com/fantastico/noticia/... .

For the World Health Organization (WHO), violence is the intentional use of physical force or power, threatened or actual, against oneself, another person, or against a group or community, that either results in or has a high likelihood of resulting in injury, death, psychological harm, maldevelopment, or deprivation ⁶6. Krug EG. Relatório mundial sobre violência e saúde. Geneva: Organização Mundial da Saúde; 2002. of a physical, psychological, or sexual nature, or through negligence and abandonment ⁶6. Krug EG. Relatório mundial sobre violência e saúde. Geneva: Organização Mundial da Saúde; 2002.^,77. Ministério da Saúde. Política nacional de redução da morbimortalidade por acidentes e violências. Brasília: Ministério da Saúde; 2001.. From the perspective of students as victims, these violent events constitute explicit forms of adverse childhood experiences, which can cause irreversible impacts on their lives ⁸8. Assis SG, Constantino P, Avanci JQ, Njaine K. Impactos da violência na escola: um diálogo com professores. Rio de Janeiro: Editora Fiocruz; 2023.^,99. Charlot B. A violência na escola: como os sociólogos franceses abordam essa questão. Sociologias 2002; (8):432-43.^,1010. Felitti VJ, Anda RF, Nordenberg D, Williamson DF, Spitz AM, Edwards V, et al. Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults. The Adverse Childhood Experiences (ACE) Study. Am J Prev Med 1998; 14:245-58..

Despite the spread of news regarding the attacks followed by physical injuries and/or deaths in Brazilian schools, little is discussed about the effects these episodes may have on the lives and health of schoolchildren who suffered or witnessed these attacks. Using adverse childhood experiences concepts, this study aims to discuss the impact of violent attacks in schools on the health of surviving students and reflect on preventive approaches for these events.

Adverse childhood experiences and the impact on health over the years

Adverse childhood experiences refer to traumatic events or situations a person experienced during childhood and adolescence. Brazilian studies have reported a high prevalence of at least one adverse childhood experience among children, adolescents, and young adults ¹¹11. Andrade CR, Avanci JQ, Oliveira RVC. Experiências adversas na infância, características sociodemográficas e sintomas de depressão em adolescentes de um município do Rio de Janeiro, Brasil. Cad Saúde Pública 2022; 38:e00269921.^,1212. Risso PA, Jural LA, Santos IC, Cunha A. Prevalence and associated factors of adverse childhood experiences (ACE) in a sample of Brazilian university students. Child Abuse Negl 2023; 19:106030.. These traumatic events in an individual’s childhood and adolescence include bullying and violence within the community - where school is inserted ¹³13. Pereira FG, Viana MC. Cross-cultural adaptation of the Adverse Childhood Experiences International Questionnaire. Rev Saúde Pública 2021; 55:79..

In addition to being associated with early mortality and an increase in chronic diseases ¹⁴14. Mersky JP, Topitzes J, Reynolds AJ. Impacts of adverse childhood experiences on health, mental health, and substance use in early adulthood: a cohort study of an urban, minority sample in the U.S. Child Abuse Negl 2013; 37:917-25., adverse childhood experiences can lead to toxic stress and mental health problems, impairing the development of victims, from childhood to adulthood. Depending on the magnitude of the event, adverse childhood experiences can help trigger depression and suicidal ideations among adolescents and adults ¹⁵15. Muwanguzi M, Kaggwa MM, Najjuka SM, Mamun MA, Arinaitwe I, Kajjimu J, et al. Exploring adverse childhood experiences (ACEs) among Ugandan university students: its associations with academic performance, depression, and suicidal ideations. BMC Psychol 2023; 11:11..

Adverse childhood experiences have several consequences on the health of survivors of violent events and can generate unhealthy habits and aggravate other pathological processes ¹⁶16. Ramírez Labbé S, Santelices MP, Hamilton J, Velasco C. Adverse childhood experiences: mental health consequences and risk behaviors in women and men in Chile. Children (Basel) 2022; 9:1841.^,1717. Brown NM, Brown SN, Briggs RD, Germán M, Belamarich PF, Oyeku SO. Associations between adverse childhood experiences and ADHD diagnosis and severity. Acad Pediatr 2017; 17:349-55.. Associations are also observed between adverse childhood experiences and attention deficit hyperactivity disorder in children and adolescents, also when community violence was investigated separately ¹⁸18. Marie-Mitchell A, O'Connor TG. Adverse childhood experiences: translating knowledge into identification of children at risk for poor outcomes. Acad Pediatr 2013; 13:14-9.. Also, children who had traumatic events from 4 to 5 years of age are more likely to develop behavioral and developmental disorders ¹⁹19. Robles A, Gjelsvik A, Hirway P, Vivier PM, High P. Adverse childhood experiences and protective factors with school engagement. Pediatrics 2019; 144:e20182945., serving as a warning, especially in cases such as the Blumenau Massacre.

Reintegration of victims into the school environment should be widely discussed, considering the strong effect on physical and mental health and academic performance ²⁰20. Bronfenbrenner U. A ecologia do desenvolvimento humano: experimentos naturais e planejados. Porto Alegre: Artes Médicas; 1996.. Despite the scarcity of studies investigating adverse childhood experiences in schools and, in particular, adverse childhood experiences involving violent events, the provision of medical and psychological support should be considered, with pedagogical adaptations and changes in the physical area of the school. Also, healthy home environment and community can also avoid problems in school performance, as these are protective factors for children who experience adverse childhood experiences ²⁰20. Bronfenbrenner U. A ecologia do desenvolvimento humano: experimentos naturais e planejados. Porto Alegre: Artes Médicas; 1996.. This would create a support network working toward giving a new meaning to the environment where children, adolescents, and teachers had experienced violence.

Prevention strategies based on the multidimensional origin of attacks

Identifying the origins and determinants of violent attacks in schools is a big challenge, especially when observing the multiple types of aggressors in the cases mentioned above, i.e., external agents ³3. Borges C, Pacheco J. Quatro crianças são mortas em ataque a creche em Blumenau; homem foi preso. G1 2024; 5 apr. https://g1.globo.com/sc/santa-catarina/noticia/2023/04/05/ataque-creche-blumenau.ghtml.
https://g1.globo.com/sc/santa-catarina/n... , students ⁴4. Estudante de 13 anos mata professora e fere mais quatro pessoas em escola estadual de São Paulo. Jornal Nacional 2023; 27 mar. https://g1.globo.com/jornal-nacional/noticia/2023/03/27/estudante-de-13-anos-mata-professora-e-fere-mais-quatro-pessoas-em-escola-estadual-de-sao-paulo.ghtml.
https://g1.globo.com/jornal-nacional/not... , and teachers ⁵5. Depoimentos de pais e funcionários levaram escola infantil a ser investigada por tortura em São Paulo. Fantástico 2023; 2 jul. https://g1.globo.com/fantastico/noticia/2023/07/02/depoimentos-de-pais-e-funcionarios-levaram-escola-infantil-a-ser-investigada-por-tortura-em-sao-paulo-video.ghtml.
https://g1.globo.com/fantastico/noticia/... . In view of these facts, reflecting, proposing, and adopting measures to prevent and mitigate this “epidemic” involves public policies for the creation of multiprofessional centers to understand and act on the root of such violence, as well as providing continuous training for professionals of the education system (including teachers, directors, inspectors, and others) on how to apply preventive approaches and identify and reduce damage caused by violence in school in its different forms, including violence of smaller magnitude.

Several authors have analyzed school violence based on Bronfenbrenner’s bioecological theory, considering the influences of the environment, interpersonal relationships, and social factors to which an individual is exposed, and how these aspects can increase the risk of victimization or perpetration of violence ⁸8. Assis SG, Constantino P, Avanci JQ, Njaine K. Impactos da violência na escola: um diálogo com professores. Rio de Janeiro: Editora Fiocruz; 2023.^,2020. Bronfenbrenner U. A ecologia do desenvolvimento humano: experimentos naturais e planejados. Porto Alegre: Artes Médicas; 1996.. In this model, violence develops from ecological systems that act simultaneously ⁸8. Assis SG, Constantino P, Avanci JQ, Njaine K. Impactos da violência na escola: um diálogo com professores. Rio de Janeiro: Editora Fiocruz; 2023., including home, school, community environments, considering that interactions in these environments can impact one’s development. Therefore, healthier and more favorable ecosystems contribute to better development, while more adverse and dysfunctional environments lead to higher chances of violent and harmful behavior for oneself and others.

In response to the attacks, the Executive Branch in Brazil announced some measures to reduce the cases of violence in schools, including the creation of a monitoring system with a hotline so people can report cases of school violence and incentive toward investigations and epidemiological studies based on these events ²¹21. Lula sanciona a criação de sistema de monitoramento da violência escolar, com disque-denúncia. Carta Capital 2023; 3 aug. https://www.cartacapital.com.br/cartaexpressa/lula-sanciona-a-criacao-de-sistema-de-monitoramento-da-violencia-escolar-com-disque-denuncia/.
https://www.cartacapital.com.br/cartaexp... . Also, an amendment to Law n. 8,072, of July 25, 1990, which addresses heinous crimes, has been proposed to include cases of very serious violence with physical injury followed by death occurring in schools ²²22. Lo Re I, Ferreira P. Governo Lula quer que ataques a escolas sejam punidos como crimes hediondos. CNN Brasil 2023; 21 jul. https://www.cnnbrasil.com.br/nacional/ataque-a-escolas-governo-lula-quer-que-casos-sejam-punidos-como-crime-hediondo/.
https://www.cnnbrasil.com.br/nacional/at... .

Given the complexity of the problem, a broader discussion is required, promoting reflections on the school space and how it is inserted in the aggressor’s ecosystem, as well as the reasons for making it a place of violence in the present or future - in the present, as in the case of students and teachers who committed violent acts in the school due to their school experiences as a student or worker, and in the future, when a violent attack is potentially associated with prior experiences, as in the Realengo Massacre in 2011, when a former student of a municipal school in Rio de Janeiro invaded and murdered 12 teenagers. As explained by the aggressor’s family and close friends, he was a victim of bullying and physical attacks at school ten years before the attack ²³23. Lopes AJ. Considerações sobre o massacre de Realengo. Estudos de Psicanálise 2012; (37):25-44.. According to an American study, in shooting attacks in schools, 72% of the aggressors had at least one adverse childhood experience, such as exposure to violence, and 60% were victims of bullying ²⁴24. Dowdell EB, Freitas E, Owens A, Greenle MM. School shooters: patterns of adverse childhood experiences, bullying, and social media. J Pediatr Health Care 2022; 36:339-46., highlighting that such violent acts may be connected to the accumulation of experiences in the childhood.

Final considerations

Despite the growing number of evidence about the cumulative impact of adverse childhood experiences on the health of individuals, emphasis should be placed on the production of scientific knowledge about specific impacts of violent events in the school environment, especially when considering the important role of school in the child and adolescent development.

In this perspective, schools can influence the behavior of students and other actors using different approaches, including the identification of vulnerable children/adolescents or chronically exposed to risk situations, violence, bullying, and mistreatment. Also, schools can encourage the exchange of information, inspiring students to talk and think about their own experiences, and can identify and refer students to health services, and develop health promotion actions. It is also important to highlight the role of state and municipal departments, in particular health and education departments, in providing continuing training for professionals involved in this process as well as human and financial resources for the implementation of articulated measures. These strategies may involve, for example, practices that simulate real cases frequently experienced in everyday life in school and how to handle these cases, aiming to ensure the integrity of all actors involved in the educational complex. Reflection on the culture of school violence should not focus exclusively on aggressors and victims, but also include everyone that is vulnerable and at risk, teaching people how to recognize, report, and not feel intimidated. Home, community, and school must be positive environments so students can feel safe.

Understanding the etiological diversity and ecological development of violence becomes a sine qua non condition to avoid, in the long run, new cases of the “violence pandemic” in schools. Moreover, primary health care in or out of schools should include screening for adverse childhood experiences ²⁵25. Estrada-Darley I, Chen P, McBain R, Alvarado G, Engel C, Malika N, et al. Patient and caregiver perspectives on implementation of ACE screening in pediatric care settings: a qualitative evaluation. J Pediatr Health Care 2023; 37:616-25. to protect children and adolescents and support the development and strengthening of adverse childhood experiences monitoring, contingency, and prevention programs for schoolchildren, addressing adverse childhood experiences that occur in the school environment or not, since social, interpersonal, and environmental relationships can also occur in this space and, consequently, encourage the development of violent attitudes and its outcomes.

Finally, it is necessary to address the challenge of reinserting children and adolescents who survived these attacks into the school environment, understanding the potential impact on their overall development over the years. In addition to the multiprofessional support mentioned above, joint strategies must be developed that show the real meaning of school to these individuals.

Acknowlegments

To Brazilian Coordination for the Improvement of Higher Education Personnel (CAPES; DS - 01) and Brazilian National Research Council (CNPq; 310225/2020-5).

References

Publication Dates

History