Physical violence against patients with mental disorders in Brazil: sex differences in a cross-sectional study

Objectives: Patients with mental illness are more exposed to violence than the general population. This study assessed factors associated with lifetime physical violence against these patients stratified by sex in Brazil. Methods: This is a National cross-sectional multicenter study with a representative sample of 2,475 patients randomly selected from 26 public mental health services. Logistic regression was used to evaluate factors associated with physical violence and crude (OR) and adjusted odds ratios (aOR) with 95% confidence interval were estimated. Statistical level considered was 0.05. Results: The prevalence of lifetime physical violence against mental patients was similar for women (57.6%) and men (57.8%). Physical violence against women was independently associated with: previous psychiatric hospitalizations (aOR = 2.09), lifetime STD (aOR = 1.75), lifetime alcohol consumption (aOR = 1.59), age of sexual debut (< 16 y.o.) (aOR = 1.40), lifetime sex under alcohol/drugs use (aOR = 2.08), having received/offered money for sex (aOR = 1.73) and lifetime incarceration (aOR = 1.69). Among men, associated factors were: age (18-40 y.o.) (aOR = 1.90), history of homelessness (aOR = 1.71), previous psychiatric hospitalization (aOR = 1.39), lifetime STD (aOR = 1.52), lifetime alcohol consumption (aOR = 1.41), lifetime use of marijuana or cocaine (aOR = 1.54), having received/offered money for sex (aOR = 1.47), lifetime history of incarceration (aOR = 2.07). Discussion: The prevalence of physical violence in this population was high for both sexes. Although there were similar factors independently associated with physical violence among men and women, there are important differences, such as age of sexual debut and lifetime sex under alcohol/drugs use for women, but not for men, while younger age, history of homelessness, and lifetime use of marijuana or cocaine were associated factors for men only. Screening for history of violence upon admission and early interventions to decrease vulnerability are needed in mental health public services in Brazil.