Estresse ocupacional e risco cardiovascular entre policiais militares: um estudo com enfoque biopsicossocial

Abstract

Non-communicable chronic diseases, particularly cardiovascular diseases (CVD), represent one of the major challenges in Public Health and are responsible for high morbidity and mortality in Brazil. Among the most vulnerable occupational groups are military police officers, whose work routine is characterized by continuous exposure to violence, extended working hours, high emotional demands, and limited job autonomy. Such conditions promote chronic activation of stress-related neuroendocrine mechanisms, contributing to physical and mental illness and increasing cardiovascular risk. This study examines the relationship between chronic occupational stress and the risk of CVD among military police officers in the state of Ceará, Brazil, considering the mediating role of mental illness and the moderating effect of age within the biopsychosocial work context. This is an observational, analytical, cross-sectional study with a quantitative approach, conducted among active-duty military police officers in the state of Ceará. The sample was obtained through multi-stage stratified sampling and comprised 1,762 participants. Data collection was carried out between 2019 and 2021 using a self-administered electronic questionnaire that included sociodemographic, behavioral, occupational, psychosocial, and health-related variables. The outcome variable was self-reported cardiovascular disease, constructed dichotomously based on reports of systemic arterial hypertension, myocardial infarction, heart disease, or stroke. Analyses included descriptive statistics and bivariate association tests, with calculation of risk ratios (RR) and 95% confidence intervals (95% CI), adopting a significance level of p<0.05. The analyses were organized according to the dimensions of the biopsychosocial theoretical model. The study was approved by the Research Ethics Committee under protocol number 2.237.838. The prevalence of CVD was 15.5% (95% CI: 13.7–17.4). Risk was significantly higher among men (18.5%) compared to women (7.8%) (RR=2.37; 95% CI: 1.58–3.54). An age gradient was observed, with a higher risk among officers aged 41 years or older (27.6%) (RR=4.10; 95% CI: 2.76–6.10) compared to those aged 30 years or younger (6.7%; RR=1.00). Lower educational attainment was associated with increased risk (20.5%; RR=1.55; 95% CI: 1.20–2.00). Mental health indicators showed strong associations with CVD, particularly psychological distress assessed by the SRQ20 (22.2%; RR=2.03; 95% CI: 1.60–2.58), depressive thoughts (24.6%; RR=2.08; 95% CI: 1.65–2.63), and sleep disorders (19.1%; RR=1.76; 95% CI: 1.36–2.27). Among lifestyle factors, physical inactivity (21.3%; RR=1.84; 95% CI: 1.45–2.34) and the need for intervention regarding alcohol use (21.5%; RR=2.38; 95% CI: 1.81–3.14) were prominent. Exposure to moral violence (25.8%; RR=2.06; 95% CI: 1.62–2.62) and psychological violence (23.2%; RR=1.73; 95% CI: 1.35–2.22) showed strong associations with CVD. Cardiovascular diseases among military police officers showed high prevalence and strong associations with occupational, psychosocial, and behavioral factors, particularly mental distress and workplace violence. These findings highlight the need for integrated occupational health surveillance policies, with a focus on mental health, reorganization of working conditions, and the promotion of healthy lifestyles within public security institutions.