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Am J Public Health. 2016 Nov;106(11):1990-1997. Epub 2016 Sep 15.

Work-Related Depression in Primary Care Teams in Brazil.

Author information

Andréa Tenório Correia da Silva and Paulo Rossi Menezes are with the Department of Preventive Medicine, Medical School of the University of São Paulo, Brazil, and Center for Research on Population Mental Health, São Paulo. Claudia de Souza Lopes is with Department of Epidemiology, Institute of Social Medicine, State University of Rio de Janeiro, Brazil. Ezra Susser is with Department of Epidemiology, Mailman School of Public Health, Columbia University, and the New York State Psychiatric Institute, New York.



To identify work-related factors associated with depressive symptoms and probable major depression in primary care teams.


Cross-sectional study among primary care teams (community health workers, nursing assistants, nurses, and physicians) in the city of São Paulo, Brazil (2011-2012; n = 2940), to assess depressive symptoms and probable major depression and their associations with job strain and other work-related conditions.


Community health workers presented higher prevalence of probable major depression (18%) than other primary care workers. Higher odds ratios for depressive symptoms or probable major depression were associated with longer duration of employment in primary care; having a passive, active, or high-strain job; lack of supervisor feedback regarding performance; and low social support from colleagues and supervisors.


Observed levels of job-related depression can endanger the sustainability of primary care programs. Public Health implications. Strategies are needed to deliver care to primary care workers with depression, facilitating diagnosis and access to treatment, particularly in low- and middle-income countries. Preventive interventions can include training managers to provide feedback and creating strategies to increase job autonomy and social support at work.

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