Abstract

Intimate partner violence is an important cause of morbidity and mortality among women. Although there are no official statistics, data reveal a high prevalence worldwide. This study aimed to estimate the prevalence and factors associated with intimate partner violence among women in a community in Recife, Pernambuco. A cross-sectional cohort study was conducted with 245 women in the 15 to 49-year age bracket. A questionnaire with sociodemographic variables was used, together with the WHO Violence Against Women (VAW) study tools and the Self-Reporting Questionnaire (SRQ-20). The participants all signed an informed consent form. The prevalence of intimate partner violence was classified by type of violence: emotional - 52.7%; physical - 46.1 %; and sexual - 13.6%. Bivariate analysis revealed an association between experiencing violence with not having a partner (p = 0.001) and drug use (p ≤ 0.001). In multivariate analysis, the variables were strongly associated with the outcome: sexual intercourse for fear (OR 5.58); depressive-anxious mood (OR 2.69); drug use (OR 2.57). A high prevalence of intimate partner violence in the community, especially emotional violence, emerges as an important finding, indicating the need for care in prevention and the overall health of this population.

Violence against women; Domestic violence; Cross-sectional studies

Introduction

Gender-based violence is an important cause of illness and death in women all over the world¹1. Krug EG, Dahlberg L, Mercy JA, Zwi AB, Lozano R, editores. World report on violence and health. Geneva, World Health Organization; 2002.. It occurs very frequently in the domestic environment, with the male partner as the aggressor, and is referred to as Intimate Partner Violence (IPV)²2. Waiselfisz JJ. Mapa da violência contra a mulher 2012. Os novos padrões da violência homicida no Brasil. São Paulo: Instituto Sangari; 2012.

3. d’Oliveira AFPL, Schraiber LB, França-Junior I, Ludermir AB, Portella AP, Diniz CS. Fatores associados à violência por parceiro íntimo em mulheres brasileiras. Rev Saude Publica 2009; 43(2):299-311.

4. Garcia Moreno C, Jansen HAFM, Ellsberg M, Heise L, Watts CH. Prevalence of intimate partner violence: findings from the WHO multi-country study on women’s health and domestic violence. The Lancet 2006; 368(9543):1260-1269^-55. Brasil. Presidência da República (PR). Secretaria Nacional de Enfrentamento à Violência contra as Mulheres. Secretaria de Políticas para as Mulheres. Política Nacional de Enfrentamento à Violência Contra as Mulheres. Brasília: PR; 2011.. Although there are no official statistics that reveal the real magnitude of the problem, data presented by the World Health Organization (WHO) show high prevalence – reporting 36% of all women in the Americas having suffered some type of IPV⁶6. Garcia L, Freitas L, Silva G. Violência contra a mulher: feminicídios no Brasil. Rio de Janeiro: Ipea; 2013..

In Brazil, over the three-year period 2009-11, the Mortality Information System (SIM) reported 13,071 homicides of women, referred to as femicides. It is estimated that in this period there were 16,993 femicides, equivalent to an annual mortality rate of 5.82/100,000 women⁶6. Garcia L, Freitas L, Silva G. Violência contra a mulher: feminicídios no Brasil. Rio de Janeiro: Ipea; 2013.. In Brazil the Northeastern Region showed the highest rate in 2013, of 6.90/100,000, followed by the Center-West and North Regions. Among the Federal Units of Brazil (26 States and the Federal District), Pernambuco was in fifth position, with a rate higher than the national average: 7.81 homicides⁶6. Garcia L, Freitas L, Silva G. Violência contra a mulher: feminicídios no Brasil. Rio de Janeiro: Ipea; 2013..

However, the rate of femicides only portrays the extreme of physical violence. A larger number of women are exposed daily to other forms of violence that are socially more hidden, with episodes that can be serious and repetitive, having significant repercussions on physical and mental health⁷7. Organización Panamericana de la Salud (OPS). Comprender y abordar la violencia contra las mujeres. Violencia infligida por la pareja. Washington: OPS; 2013.

Women in a situation of IPV have a higher risk for: common mental disorders (‘CMDs’); post-traumatic stress disorder; chronic pain syndrome; socialization difficulties; abuse of alcohol and other drugs; reproductive health problems; sexually transmitted diseases; and suicidal ideation, among other co-morbidities⁷7. Organización Panamericana de la Salud (OPS). Comprender y abordar la violencia contra las mujeres. Violencia infligida por la pareja. Washington: OPS; 2013

8. Mozzambani ACF, Ribeiro RL, Fuso SF, Fiks JP, Mello MF. Gravidade Psicopatológica em mulheres vítimas de violência doméstica. Rev Psiquiatr Rio Gd Sul 2011; 33(1):43-47.

9. Zilberman ML, Blume SB. Violência doméstica, abuso de álcool e substâncias psicoativas. Rev Bras Psiquiatr 2005; 27(Supl. II):S51-S55.^-1010. Silva EP, Ludermir AB, Araújo TVB, Valongueiro SA. Frequência e padrão de violência por parceiro íntimo antes, durante e depois da gravidez. Rev Saude Publica 2011; 45(6):1044-1053..

Considering the damages to the woman’s health and consequent repercussions on her capacity in the workplace, and in the family and social relationship, prevention and combating of IPV calls for articulation of various sectors, such as the courts, public safety, health and education – among others⁵5. Brasil. Presidência da República (PR). Secretaria Nacional de Enfrentamento à Violência contra as Mulheres. Secretaria de Políticas para as Mulheres. Política Nacional de Enfrentamento à Violência Contra as Mulheres. Brasília: PR; 2011..

In spite of the incentives and support for research on this subject, it is found that few surveys have been made in Brazil’s Northeast Region. It is known that the cultural context exercises an influence on violence, and regional variations have been observed¹¹11. Vieira E, Perdona G, Santos M. Fatores associados a violência física por parceiro íntimo em usuárias de serviço de saúde. Rev Saude Publica 2011; 45(4):730-737.. With this in mind, the objective of the present study was to investigate the prevalence of IPV, and associated factors, in women of a community in the city of Recife, in the state of Pernambuco, in the Northeast of Brazil.

Method

This is a cross-sectional study, structured on the basis of a non-probabilistic sample, comprising women aged 15 to 49, over the period February to April 2014.

The community where the study was made, in which one of the 61 Zones of Special Social Interest (Zonas Especiais de Interesse Social – ZEISs) of the city of Recife is located, has an urbanized area with a high percentage of people living in flooding areas, in shantytowns, and in homes built over water on precarious stakes¹²12. Prefeitura da Cidade do Recife. Perfil dos bairros. [acessado 2014 ago 8]. Disponível em: http://www2.recife.pe.gov.br/a-cidade/perfil-dos-bairros/rpa1/coelhos/
http://www2.recife.pe.gov.br/a-cidade/pe... . It has a population of 7,636 (2010 demographic census), of which 53.36% are women. The average number of residents per household (per domicile population) is 3.6, and the average nominal monthly family income is R$ 898.41.The proportion of women responsible for a household is 53.63% of the population¹²12. Prefeitura da Cidade do Recife. Perfil dos bairros. [acessado 2014 ago 8]. Disponível em: http://www2.recife.pe.gov.br/a-cidade/perfil-dos-bairros/rpa1/coelhos/
http://www2.recife.pe.gov.br/a-cidade/pe... . The community has been classified in the statement as having low quality of life, and has an accumulated mortality coefficient (MC) per homicide of 259.7 in a census-based ecological exploratory group study carried out in the city¹³13. Barbosa ANMF, Ferreira LOC, Barros MDA. Homicídios e condição de vida: a situação na cidade do Recife, Pernambuco. Epidemial. Serv. Saúde 2011; 20(2):141-150.. The MC was calculated from the number of homicides taking place over three years. Dividing by the number of residents of the location in the period, in this study Recife presented an MC of 203.3/100,000 inhabitants¹³13. Barbosa ANMF, Ferreira LOC, Barros MDA. Homicídios e condição de vida: a situação na cidade do Recife, Pernambuco. Epidemial. Serv. Saúde 2011; 20(2):141-150..

To calculate the sample size, the public-domain program OpenEpi, version 3.01, was used¹⁴14. Dean AG, Sullivan KM, Soe MM. OpenEpi: Open Source Epidemiologic Statistics for Public Health. [acessado 2014 ago 8]. Disponível em: https://www.OpenEpi.com
https://www.OpenEpi.com... . The calculation was based on a prevalence of 27% for violence against women (VAW) who were users of the Single Health System (Sistema Único de Saúde) in the region¹⁵15. Silva MA, Falbo Neto GH, Figueiroa JN, Cabral Filho JE. Violence against women: Prevalence and associated factor Sin patients attending a public healthcare service in the Northeast of Brazil. Cad Saude Publica 2010; 26(2):264-272.. Taking into account that 70% of the cases of VAW are perpetrated by a personal partner¹⁶16. Schraiber LB, D’ Oliveira AFPL, Portella AP, Menicucci E. Violência de gênero no campo da Saúde Coletiva: conquistas e desafios. Cien Saude Colet 2009; 14(4):1019-1027., IPV was estimated at 20% for the study. Considering a population of 2,672 women, an alpha error of 0.05 and a beta error of 0.15 (IC = 95%), a sample of 226 women was found. To account for possible losses, the final size of the sample was decided at 245.

The study included women aged 15 to 49, resident in the district referred to. The cutoff point of age was established based on an instrument specified by the WHO for estimating prevalence of IPV and used in this study¹⁷17. Schraiber LB, Dias MR, França-Junior I, Segri NJ, D’Oliveira AFPL, Pires Lucas AF, D’Oliveira AFPL. Validade do instrumento WHO VAW STUDY para estimar violência de gênero contra a mulher. Rev Saude Publica 2010; 44(4):658-666. The criterion for exclusion was any reduction in capacity for understanding that might make it impossible to comprehend the Free Consent Form and the items of the questionnaire.

The principal investigator and five academics from the Psychology course, previously trained for this purpose, took part in the collection of data. Taking into account the risk of working in certain areas, it was decided that the questionnaires, with an average duration of 15 minutes, would be applied in the Basic Health Unit (UBS) of the district and in households where this was possible. The investigators attended the community from Monday to Friday and accompanied the visits of Community Health Agents (ACSs).Confidentiality and secrecy of information was guaranteed. The data were collected individually, without the presence of the ACSs.

The instrument used to collect the data was a questionnaire with structured questions, including aspects of socioeconomic situation, relationship and behavior. The independent variables analyzed were: Socioeconomic (age, skin color, number of years’ schooling, number of children, and whether employed); relationship (whether having a partner or not; partner in the last 12 months; cohabiting with partner); and behavioral (religious practice, and its frequency; use of alcohol, and its frequency; use of other drugs).

The questionnaire was augmented by two instruments: The WHO VAW Study (WVS)¹⁷17. Schraiber LB, Dias MR, França-Junior I, Segri NJ, D’Oliveira AFPL, Pires Lucas AF, D’Oliveira AFPL. Validade do instrumento WHO VAW STUDY para estimar violência de gênero contra a mulher. Rev Saude Publica 2010; 44(4):658-666. This was developed by the OMS and, validated in Brazil, is recommended for estimating prevalence of IPV of the types: emotional, physical, and sexual. For tracking of signs of Common Mental Disorders (‘CMDs’), the SRQ-20 Self-Reporting Questionnaire¹⁸18. Santos KOB, Araújo TM, Oliveira NF. Estrutura fatorial e consistência interna do Self-Reporting Questionnaire (SRQ-20)em uma população urbana. Cad Saude Publica 2009; 25(3):47-58., prepared by the WHO and validated transculturally, recommended for studies in communities, was used. The groups of symptoms investigated in the SRQ-20refer to a mood of depressive-anxious mood, reduction of vital energy, somatic symptoms and depressive thoughts¹⁸18. Santos KOB, Araújo TM, Oliveira NF. Estrutura fatorial e consistência interna do Self-Reporting Questionnaire (SRQ-20)em uma população urbana. Cad Saude Publica 2009; 25(3):47-58.^,1919. Santos EG, Siqueira MM. Prevalência dos transtornos mentais na população adulta brasileira: uma revisão sistemática de 1997 a 2009. Jornal Bras. Psiquiatr 2010; 59(3):238-246..

All the women of adult age who agreed to participate signed the Free and Informed Consent Form (Termo de Consentimento Livre e Esclarecido, or TCLE).The adolescents signed the Free and Informed Assent Form (Termo de Assentimento Livre e Esclarecido, or TALE), after permission from their legal representative through signature on the appropriate TCLE. When a woman reported violence, she was supported and oriented about her rights, receiving information and referral for help from a VAW referral service.

The study met the ethical criteria of Resolution 466/2012²⁰20. Conselho Nacional de Saúde. Resolução 466, de 12 de dezembro de 2012. Diário Oficial da União 2013; 13 jun. of the National Health Council, had the consent of the Health Department of the Prefecture of the City of Recife, and was approved by the Research Ethics Committee of the Professor Fernando Figueira Integrative Medicine Institute (IMIP).

The data were double-entered digitally and validated through the EpiInfo 3.5.3 program²¹21. Epiinfo [acessado 3 maio 2014]. Disponível em: http://wwwn.cdc.gov/epiinfo/
http://wwwn.cdc.gov/epiinfo/... . The Stata²²22. Stata. Data Analysis and Statistical Software. [acessado 3 jul 2014]. Disponível em: www.stata.com
www.stata.com... software was used in the statistical treatment. Initially, frequency distribution tables²¹21. Epiinfo [acessado 3 maio 2014]. Disponível em: http://wwwn.cdc.gov/epiinfo/
http://wwwn.cdc.gov/epiinfo/... were obtained for the category variables, and measures of central tendency and dispersion were calculated for the numeric variables. The basal characteristics of each group were compared using the Chi-squared association test (Pearson).For determination of the strength of association between dependent variable and independent variables, the Odds Ratio (OR) was calculated as an estimate of relative risk with its confidence interval (CI 95%)²²22. Stata. Data Analysis and Statistical Software. [acessado 3 jul 2014]. Disponível em: www.stata.com
www.stata.com... . To compose the model, the variables that obtained significance < 0.20 in the bivariate analysis were considered; the logistic progression model was carried out by the Backward LR method.

Results

The frequencies found in this study for IPV, by type of violence suffered, were: 52.7%, emotional; 46.1% physical; 13.6% sexual. The prevalence of IPV at least one time in life was 33.3%.

As to the individual characteristics, the majority of women were in the age group 25 to 49 (75.7%).They reported themselves as being black or mixed-race (79.8%), having less than eight years’ schooling (66.4%), not being in work (58.4%), having a partner at the time of the study (77.0%),or in the last 12 months (93.0%), having children (85.5%),or following a religious practice (72.4%).The use of alcohol and one or more unlawful drugs, such as marijuana, crack or cocaine was reported by 31.3% of the women (Table 1).

The results of theSRQ-20 showed the following frequencies of signs of CMDs, in the four groups of symptoms: 78.6% depressive-anxious mood; 77.8% somatic symptoms; 73.7% reduction in vital energy; and 51.0% depressive thoughts (Table 2).

The prevalence of IPV was shown to be higher among younger women (37.3%), black or mixed-race women (33.5%), those with eight or more years’ schooling (40.0%),those without a partner at the time of the data collection (51.8%) and in the last 12 months (47.1%), without children (40.0%), without work (36.6%) and who declared they did not follow a religious practice (35.8%).Half of these women (50.7%) stated that they had made use of drugs at least once, and more than one-third (36.8%) reported use of alcohol (Table 3).

The frequency of signals of CMD among the women who reported IPV were: 38.2% depressive-anxious mood; 36.0% somatic symptoms; 36.3% reduction of vital energy, and 41.1% depressive thoughts.

When association of all the variables, categorized in binaries, was investigated, the results of the bivariate analysis showed associations of the variable having suffered some type of violence with the variables not having a partner (p = 0.001) and use of drugs (p< 0.001). In the association with the groups of symptoms of the SRQ-20 there were significant associations between IPV and depressive-anxious mood (p = 0.003), and depressive thoughts (0.013). The individual and relationship variables: age, skin color, schooling, partner in the last 12 months, cohabitation, children, number of children, work, and religious practice did not show significant association with the outcome.

The results of the Multivariate Logistic Regression showed that: use of drugs, having had sexual relations due to fear, and depressive thoughts were factors that remained associated with the outcome, with respective p-values of: 0.002; 0.001 and 0.020 (Table 4).

Discussion

The findings of this study identified a high prevalence of IPV in the population studied, showing themselves to be similar to other Brazilian studies and corroborating the pertinent literature on this subject¹⁷17. Schraiber LB, Dias MR, França-Junior I, Segri NJ, D’Oliveira AFPL, Pires Lucas AF, D’Oliveira AFPL. Validade do instrumento WHO VAW STUDY para estimar violência de gênero contra a mulher. Rev Saude Publica 2010; 44(4):658-666^,2323. Ribeiro WS, Andreoli SB, Ferri CP, Prince M, Mari JJ. Exposição à violência e problemas de saúde mental em países em desenvolvimento: uma revisão da literatura. Rev Brasileira de Psiquiatria 2009; 31(Supl. 2):S49-S57.

24. Moura LBA, Gandolfi L, Vasconcelos AMN, Pratesi R. Violência contra mulheres por parceiro íntimo em área urbana economicamente vulnerável, Brasília, DF. Rev Saude Publica 2009; 43(6):944-953.

25. Guedes A, García-Moreno C, Bott S. Violencia contra las mujeres en Latinoamérica y el Caribe. Foreign Affairs Latinoamérica 2014; 14(1):41-48.^-2626. Organização Mundial da Saúde (OMS). Prevenção da violência sexual e da violência pelo parceiro íntimo contra a mulher: ação e produção de evidência. Washington: OMS; 2010.. As to the type of violence suffered, emotional violence had the highest frequency, followed by physical, and sexual. For sexual violence, although the frequency is the lowest among the types of violence investigated, it is above the prevalences found in other studies in Brazil¹⁷17. Schraiber LB, Dias MR, França-Junior I, Segri NJ, D’Oliveira AFPL, Pires Lucas AF, D’Oliveira AFPL. Validade do instrumento WHO VAW STUDY para estimar violência de gênero contra a mulher. Rev Saude Publica 2010; 44(4):658-666^,2424. Moura LBA, Gandolfi L, Vasconcelos AMN, Pratesi R. Violência contra mulheres por parceiro íntimo em área urbana economicamente vulnerável, Brasília, DF. Rev Saude Publica 2009; 43(6):944-953.. In a study on IPV in the municipality of São Paulo, physical violence was 34.5%,and among users of the primary health network of São Paulo State, emotional violence was similar (53.8%), but there was a lower frequency of physical violence (32.2%)¹¹11. Vieira E, Perdona G, Santos M. Fatores associados a violência física por parceiro íntimo em usuárias de serviço de saúde. Rev Saude Publica 2011; 45(4):730-737.^,2727. Botti NCL, Castro CG, Silva AK, Silva MF, Oliveira LC, Castro AC, Fonseca LLK. Avaliação da ocorrência de transtornos mentais comuns entre a população de rua de Belo Horizonte. Barbaroi 2010; (33):178-193..

Among those interviewed, 33.3% answered yes to the question “have you at some time suffered some type of violence?” However, during the application of the WHO VAW Study, when asked about violence practiced by a partner or former partner, 52.7% responded in the affirmative for emotional violence. This finding could indicate, as described in other studies, that when women are stimulated by reference to different types of aggression, the frequency of violence reported increases⁵5. Brasil. Presidência da República (PR). Secretaria Nacional de Enfrentamento à Violência contra as Mulheres. Secretaria de Políticas para as Mulheres. Política Nacional de Enfrentamento à Violência Contra as Mulheres. Brasília: PR; 2011., perhaps showing that, in some contexts, it needs to be named to be recognized.

In a survey carried out in the Federal District²⁴24. Moura LBA, Gandolfi L, Vasconcelos AMN, Pratesi R. Violência contra mulheres por parceiro íntimo em área urbana economicamente vulnerável, Brasília, DF. Rev Saude Publica 2009; 43(6):944-953., with women of the same age group, the frequency of emotional violence was also high: 80.2%.This type of violence is perhaps more easily reported, due to factors that could involve the fear of more aggressions or the shame of talking about abuses that have taken place in the conjugal relationship²⁶26. Organização Mundial da Saúde (OMS). Prevenção da violência sexual e da violência pelo parceiro íntimo contra a mulher: ação e produção de evidência. Washington: OMS; 2010..

As to the individual, relationship and behavior aspects, the majority of the women who reported IPV were young, stated themselves to be mixed-race or black, had eight or more years’ study, were without a partner at the time of the data collection, had no children, did not work, did not have a religious practice and had used drugs. These results are similar to those of a study by the WHP of prevalences of IPV, referred to as the WHO Multi-country Study¹⁷17. Schraiber LB, Dias MR, França-Junior I, Segri NJ, D’Oliveira AFPL, Pires Lucas AF, D’Oliveira AFPL. Validade do instrumento WHO VAW STUDY para estimar violência de gênero contra a mulher. Rev Saude Publica 2010; 44(4):658-666, which in Brazil included the city of São Paulo and the Northern Zona da Mata region of Pernambuco State. The individual characteristics considered by the WHO as risk factors for IPV, and cited in the ecological model that is used to understand this form of violence¹1. Krug EG, Dahlberg L, Mercy JA, Zwi AB, Lozano R, editores. World report on violence and health. Geneva, World Health Organization; 2002., include: youth, being separated/divorced, and abuse of drugs.

The four groups of symptoms detected by theSRQ-20 suggest, among women who reported IPV once in their life, signs of physical suffering, and significant suspicion for Common Mental Disorders²⁸28. Araújo TM, Pinho OS, Almeida MMG. Prevalência de transtornos mentais comuns em mulheres e sua relação com as características sociodemográficas e o trabalho doméstico. Rev Bras. de Saúde Materno Infantil 2005; 5(3):337-348.. Women in a situation of IPV have an increased risk for various physic morbidities, including dangerous use of drugs (lawful and unlawful), depression, anxiety and phobias²⁹29. Rocha SV, Almeida MMG, Araújo TM, Júnior JSV. Prevalência de transtornos mentais comuns entre residentes em áreas urbanas de Feira de Santana, Bahia. Rev Bras. de Epidemiologia 2010; 13(4):630-640.. Post-traumatic stress disorders, food disorders and sleep disorders, damage to self-esteem, self-aggression and sexual risk behavior show themselves to be more frequent in women who have suffered violence from their male partners⁵5. Brasil. Presidência da República (PR). Secretaria Nacional de Enfrentamento à Violência contra as Mulheres. Secretaria de Políticas para as Mulheres. Política Nacional de Enfrentamento à Violência Contra as Mulheres. Brasília: PR; 2011.. Physical and sexual violence increase the chances of suicidal ideation and behavior⁵5. Brasil. Presidência da República (PR). Secretaria Nacional de Enfrentamento à Violência contra as Mulheres. Secretaria de Políticas para as Mulheres. Política Nacional de Enfrentamento à Violência Contra as Mulheres. Brasília: PR; 2011..

The results of the multivariate logistic regression showed the following factors strongly associated with IPV having similar chances, with increases of more than a factor of 2: having had sex out of fear, increasing the chance of IPV by a factor of more than 5 (OR 5.58); use of drugs (OR 2.57); and depressive-anxious mood (OR 2.69).

Considering that, in some relationships, IPV tends to start from verbal aggression, evolving to other forms of violence, such as physical, and possibly culminating in femicide, it is important to appreciate that there is a need for action to enable health professionals to recognize and talk with women about emotional violence. As well as interrupting a situation that generates intense suffering, and preventing and/or treating the morbidities arising from this type of violence, early intervention could help to reduce feminine mortality, whether by homicide, suicide, or as a result of other complications of IPV.

The high prevalences of IPV found are possibly compatible with the position of the city of Recife in the Brazilian ranking for violence⁴4. Garcia Moreno C, Jansen HAFM, Ellsberg M, Heise L, Watts CH. Prevalence of intimate partner violence: findings from the WHO multi-country study on women’s health and domestic violence. The Lancet 2006; 368(9543):1260-1269. In spite of the improvements that have taken place in the last decade with developments such as: the creation of the Department for Women; centers of referral and assistance to women who are victims of violence; and specialized police stations, the findings are an indication of the need for financial investments and development of more efficacious programs.

This investigation has the limitations that are inherent to descriptive observational studies, and other variables could have been included, such as the use of alcohol and other drugs by the partner, which are factors associated with IPV. In methodological terms, determining the prevalence of IPV is a challenge, due to the factors that can contribute to its underestimation, such as: complexity of the subject, emotional condition of the women in situation of violence, skill of the investigator and the instrument used, to which is added the difficulty of researching populations in locations of high vulnerability and high risk for violence in general, such as this present study. However, the identification of high prevalence of IPV in this community, especially emotional violence, associated with tracking of signals of CMDs, stands out as an important finding, indicating this population’s pressing need for care in prevention and general health.

The high frequencies of signs of CMDs merit attention, considering that they are little diagnosed and consequently not adequately treated. Studies indicate that CMDs can cause significant mental and bodily suffering, social isolation, reduction in yield from schooling and work, abuse of drugs, aggressive behavior, damage to quality of life and risk of suicide²⁹29. Rocha SV, Almeida MMG, Araújo TM, Júnior JSV. Prevalência de transtornos mentais comuns entre residentes em áreas urbanas de Feira de Santana, Bahia. Rev Bras. de Epidemiologia 2010; 13(4):630-640.. The data of this study show that greater investments in the Mental Health of this population are a primordial need.

These findings also indicate the need for further studies, in similar populations, that can deepen the knowledge of these morbidities, because they indicate that vulnerable populations have higher chances of these negative health events, than those that have been found in studies presented in the pertinent literature. It is possible that the collection of data largely in the home, and at the time of the visit of the ACS, has acted to produce better information, because the survey assistants were presented as persons known personally to the agent – and users of the SUS are accustomed to providing information on their illnesses and difficulties to those agents.

There is a lack of confrontation of IPV, among the various sectors of society, whether public, private, organized civil society or the citizen. Further, prevention needs to go beyond the victims, and be inclusive. It is understood that there is an urgent need for deconstruction of the ‘naturalization’ of violence, inequality of gender and other inequalities that favor its recrudescence, and for these ideas to be included in school curricula from primary to graduation. Studies have already confirmed a need for greater financial investment, professional training, and other sectors that serve this population, to give them skills in recognition of signs and symptoms of physic suffering arising from a situation of violence³⁰30. Kind L, Orsini MLP, Nepomuceno V, Gonçalves L, Souza GA, Ferreira MFF. Subnotificação e (in)visibilidade de violência contra mulheres na atenção primária à saúde. Cad Saude Publica 2013; 29(3):1805-1815..

IPV, as a public health problem, has not been reduced, and in spite of being present day-to-day in the routine of the health services, lack of awareness of this problem, and of facing it, on the part of sector professionals contributes to the under-reporting. The information on how to present and confront IPV is still limited. It is possible that, in the actions of prevention and care, there is a need for greater integration of the sectors involved – with the implication that there is a need for inclusive and wide-ranging action to be taken.

References

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History