Características da violência sofrida por adolescentes escolares de uma capital brasileira Characteristics of violence suffered by high school adolescents in a Brazilian state capital

The aims of this cross-sectional study was to describe the characteristics of violence suffered by high school adolescent students of public schools in a Brazilian state capital. The data correspond to 456 adolescent victims of violence, collected by means of a questionnaire and processed by Epi-Info, in which analyses considered a value of p<0.05. Most of the adolescents were girls and the variables (gender, age, relationship with aggressor, frequency/length of time of abuse, place of occurrence and its interruption) varied according to the type of violence (bullying, physical, psychological, threat, sexual, witness, harassment, cyber-bullying, abandonment, neglect, child labor and parental alienation). The results represent the scene of violence suffered by adolescents, a reality that is poorly known and reported to official bodies, however, the descriptive data represent only part of the problem, highlighting the need to develop new studies to further investigate the various facets of the theme and to suggest new measures for facing violence in adolescence. Descriptors: Pediatric Nursing; Violence; Adolescent Health; Epidemiology. Martins CBG, Alencastro LCS. Rev. Eletr. Enf. [Internet]. 2015 jul./set.;17(3). Disponível em: http://dx.doi.org/10.5216/ree.v17i3.29684. 2


INTRODUCTION
Violence is present in the socio-historical context of humanity from its evolutionary process, and besides being associated with the social, economic and cultural aspects of a community, it is directly linked to human relationships (1) .
The World Health Organization (WHO) defines violence as "the intentional use of physical force or power, threatened or actual, against oneself, another person or against a group or community, which either results in or has a high likelihood of resulting in injury, death, psychological harm, maldevelopment, or deprivation" (2) .
Violence is classified as a public health problem, (2) not only because of its high mortality rates, but also the various damages and injuries that this grievance can cause to the well-being and quality of life of people, the calculable and incalculable costs as regards health and safety, as well as its broad potential to impact on the way of life of a society (3)(4) .When violence involves children and adolescents, the representation of this aggravation is even greater, particularly for the damage, sometimes irreparable, that this phenomenon can generate in the physical, mental and social development of this age group (4) .
Children and adolescents are considered vulnerable to violence as a reflection of the sociohistorical and cultural context that underlies the evolution of society and the appreciation thereof, as the story reveals that only in the twentieth century, children and adolescents have been recognized as members of humanity and concern for their safety and social value has become a major challenge for public officials (5) .
In Brazil, in 1990, the creation of the Children and Adolescent Statute (ECA, as per its acronym in Portuguese) was a milestone in the representation of children and adolescents in Brazilian society, because it determines the protection of this age group from "any form of neglect, discrimination, exploitation, violence, cruelty, and oppression, punishing by law any attempt on their fundamental rights" (6) .
Adolescence, in particular, being a transitional stage between childhood and adulthood, is a time when adolescents are faced with situations, questions, uncertainties and attitudes that can interfere directly in their formation process, which expose this age group to various situations of vulnerability, such as exposure to violence (7) .
Worldwide, the effects that situations of violence create are emphasized in life and the everyday lives of adolescents (8)(9) .The impact of violence in adolescence is directly reflected in the care from health services due to the physical and mental harm, in the death rate in this age group related to murders and especially the spread of violent acts that usually begin during this period and last until adult life, reflecting in an increase in crime, and also representing an important social factor (4)(5)(6)(7)(8) .
In view of this, the protection of adolescents in relation to the various situations that may interfere with their development process and social formation has been discussed, and since then, strategies and policies have been developed in order to reduce the occurrence, especially of violence, in this age group.In this sense, this study addresses the sub-agendas set for research in the areas of health and nursing, included in the National Agenda of Priorities in Health Research (10) , pointing to violence as a priority topic in the development of research.
In this scenario, the aim of this study was to describe the characteristics of violence suffered by high school students of public schools in a Brazilian state capital.

METHODS
This study presents some of the results of a master's degree dissertation originating from a subproject linked to the matrix project entitled "Violência Intencional entre adolescentes na capital de Mato Grosso".The classification of violence used in the instrument for data collection was based on the Ministry of Health Manual "Line of care for the comprehensive health care of children, adolescents and their families in situations of violence: guidance for managers and health professionals" from 2010 (11) .There was no time frame for the response of adolescents and, with a view to its refinement, a pilot test in classes that were not part of the study was conducted.
To conduct the study, the guidelines of the Brazilian

RESULTS
Of the 2,786 adolescents surveyed, 1,236 responded positively as regards exposure to violence, in the condition of victim only, aggressor only and in the condition of both victim and aggressor.Among those exposed to situations of violence, 36.9% (456 adolescents) were exclusively victims.
Thus, the analysis was focused on the characteristics of the violence suffered by 456 high-school students from a state capital in Brazil.
Among the adolescents who suffered violence, 139 (30.5%) were boys and 317 (69.5%) girls.By associating the type of violence suffered and sex of the adolescents, it was observed that, in both sexes, the first two most frequent types of violence were bullying and physical violence.However, the third and fourth type of violence differed between sexes, with threats and psychological violence for males and psychological followed by sexual violence for females (Table 1).
When listing the types of violence suffered with the age of the adolescents, it was observed that bullying was highlighted in the age group from 12 to 17 years and among older adolescents (18-19 years old), physical violence stood out (Table 2).With regard to the relationship to the aggressor associated with the type of violence suffered, the father, the mother and the boyfriend perpetrated the physical violence more often, whereas another family member (brother, uncles, grandparents, etc.) and friends of the family and/or neighbors were attackers, predominantly with sexual violence.Classmates carried out bullying more often.Members of a gang or a rival group, as well as strangers and others (stepfather, brother, teacher, etc.) exercised threats more frequently (Table 3).
It is noteworthy that there was no statistically significant association between the relationship of the aggressor and the sex of the victims (p=0.1302).With regard to the length of abuse, it is clear that threats, witnessing violence, abandonment and cyberbullying were the types of violence that had a higher proportion of duration -less than one month, while other manifestations of violence lasted longer.It is noteworthy that the blank answers may reveal the adolescents' resistance to state how often and how long they were the victim of situations of violence.
In the association between the types of violence suffered and the place where the violent act occurred, it was observed that: physical violence was perpetrated more often in the adolescent's residence; sexual violence predominated at their relatives house; bullying occurred more often at school; there were more threats on the street; both and physical violence occurred more often while in a place practicing sports; psychological violence, threats and witnessing violence were more common in bars and clubs; sexual violence occurred more often in other places (neighbor or friend's house, on the bus, work place, near school, etc.) (Table 5).By analyzing each type of violence according to their interruption or not (if it ceased or still persists) (p=0.0000), it was observed that most had ceased, with the exception of abandonment and neglect, as shown by the following results: In abandonment, 66.7% of situations still persist and for negligence, half persists.In bullying: 58.7% ceased, 12.7% persist and 28.6% of participants left the answer blank.In physical violence: 62.5% ceased, 14.4% persist and 23.1% left it In psychological: 63.4% ceased, 21.5% persist and 15.1% left it blank.In threats: 42.8% ceased, 12.5% persist and 44.7% left it blank.In sexual: 90.2% ceased, 2.4% persist and 2.7% left it blank.In witness of violence: 22.2% ceased, 11.1% persist and 66.7% left it blank.Harassment persists in 25.0% of the situations and 75.0%left blank.
In cyber-bullying: 50.0%ceased and 50.0%left it blank.In child labor, the adolescents did not answer whether it had ceased or still persists.All situations of parental alienation syndrome had ceased (100.0%).Among the adolescents who did not respond as to which type of violence they had suffered, 58.3% had ceased and 41.7% did not respond whether the violence had ceased or still persists.

DISCUSSION
National studies show an incidence of violence suffered by adolescents in which more than 40% of the adolescents surveyed reported having experienced some kind of violent act (12)(13) .International data also draw attention to the impact that involvement in situations of violence generates in adolescence (8)(9) , highlighting the need to implement measures to assist in the identification and reduction of these situations, with actions related to the treatment of the victims and the prevention of this event.
Girls, with the highest proportion, are shown as victims in violence among adolescents (14) .This result reflects the historical context of society, in which women have not been considered a being with rights and have to submit to the male sex (12,15) .In light of this, even though the female sex has won some rights in recent years, women still suffer stigmas that persist to the present day (16)(17) .Therefore, it is suggested that we enter into discussions with adolescents, in the school environment, on issues about questions of gender and the appreciation of women in society.
Bullying is the type of violence that stands out most among adolescent students (16)(17) .In Boston, in the United States, an investigation identified a percentage of 25.9% of involvement with bullying in the last 12 months (18) .In recent years, studies have highlighted bullying as a condition that is directly involved in the integration process of this age group with society with effects usually associated with the physical and depression, low selfesteem, suicidal thoughts, and losses in educational achievement and learning (19)(20) .
Psychological violence is also in the daily lives of adolescents as the fourth type of violence most suffered by them (21) .With regard to gender issues and the types of violence, girls still suffer more sexual violence than boys (14,21) , and boys suffer more threats than girls (22) .
The studies show, however, that adolescents are susceptible to violence in its different forms, which in turn may vary according to sex.Therefore, it is essential to promote actions to prevent violence, as already mentioned, but also to invest in services of care for this grievance and to guide adolescents on how to seek help and specific assistance in each case.
As for the age group of adolescents, a study conducted on adolescent students in Brazilian state capitals and the of the Federal District also pointed to the fact that suffering bullying is more frequent among younger adolescents (23) , while the incidence of physical violence increases with age in adolescence (24) .
This factor may be related to the profile of older teenagers, who, when feeling more confident, encouraged and with a further developed physique, become more intolerant and face disagreements in order to create opportunities for the violent act through physical aggression.This kind of violence often results in bodily injuries, which can leave irreversible sequelae, as well as demand costs with regard to health care services (4) .
Regarding the relationship with the aggressor, bullying is more exercised by classmates (19) , sexual violence by members and acquaintances of the family (15) , in physical violence, parents stand out as the main perpetrators of this type of violent act, demonstrating that they use physical violence as a punitive and educational means to resolve conflict situations with their children (12) .The companion of the victim (boyfriend) stands out as also being characterized as one of the attackers in the violence suffered by adolescents (12) .The frequency of the violent act (how many times) and the length of the abuse (period of exposure to violence) characterize the recurrence of violence suffered by the adolescents studied in this research.A study conducted in Recife, Pernambuco, found that 48.6% of the adolescents surveyed suffered aggression from one to five times and 33.3% more than 10 times (12) .
Given the aspect of the violence, in which exposure is repeated for long periods (12) , it is essential to establish simple and dynamic actions that help adolescents to report them, such complaint, dissemination of child protection agencies and services available for each situation, among other strategies that encourage victims to seek help so that the cycle of violence can be stopped, thus reducing the recurrence and persistence of violence in the everyday life of adolescents.
With regard to the place of occurrence of the violence suffered by adolescents, bullying occured more often in schools (19) .However, the very residence of the victim and intra-family environments stood out as places where teenagers suffer various forms of violence (25) .
Thus, identifying the risk factors for violence present in each environment in which it manifests itself may be the first step to better understanding this phenomenon and seeking viable solutions.
Although the study does not produce a time frame in relation to situations of violence referenced by the adolescents surveyed, the majority reported that the violence had ceased, similar to the study carried out in Recife, where 53.6% of the study population reported that the situation of violence had ceased (12) .However, one must consider the frequency and the length of the abuse that the adolescent suffered until the violence stopped.In this sense, we must recognize the damage caused by violence, considering the late disruption of the event.
The literature suggests that long and frequent exposure to the violence suffered by adolescents, despite having ceased, may impact the growth and development of this age group, and they are recognized in the physical, mental, sexual, behavioral, emotional and cognitive areas (4,(8)(9) .Thus, these can be expressed by means of dropping out of school, low performance in learning, difficulty sleeping and/or eating, running away from home, low self-esteem, ideation of suicidal behavior, involvement with gangs, alcohol and drugs, personal injury, unprotected sexual activity, and especially being able to generate a violent behavior, also affecting the perception and the way of seeing the world in which they live (4,(8)(9) .

CONCLUSION
According to the results, girls suffer more violence than boys and the types of violence that stood out were

*
Type of violence suffered: A = Bullying; B = Physical; C = Psychological; D = Threats; E = Sexual; F = Witness of violence; G = Bullying; H = Cyber-bullying; I = Abandonment; J = Neglect; K = Child labor; L = Parental Alienation; M = Blank.**In this analysis, 30 files were excluded, in which adolescents left the relationship with the aggressor blank.
violence suffered: A = Bullying; B = Physical; C = Psychological; D = Threats; E = Sexual; F = Witness of violence; G = Bullying; H = Cyberbullying; I = Abandonment; J = Neglect; K = Child labor; L = Parental Alienation; M = Blank.**In this analysis, 50 files were excluded, in which adolescents left the place where the violence occurred blank.

Faced
with this context, one can observe that the perpetrators of violent acts are characterized, in general, by acquaintances, from the family nucleus and/or close family, or with an emotional bond with the victim, such as boy/girlfriends.Therefore, it becomes necessary to invest in family and social relationships, in order to work with parents on strategies to assist in the education of their children with behavior based on dialog, understanding, conviviality and respect, and thus devaluing the cultural formation of conflict resolution through punitive methods with the use of violence.In addition, it is essential that parents participate and know the routines of their children and the people who are around them, to identify a possible situation of violence.
bullying and physical violence, where the younger adolescents suffered the first one more often and the older ones, the second.The aggressors, the frequency of the violent act, the length of the abuse and the place of occurrence varied according to the type of violence suffered and most situations of violence ceased, except for situations of abandonment and neglect.This study revealed the occurrence and characteristics of violence experienced by adolescents, situations often not communicated to specific services addressing violence and, although a possible limitation was not stipulating a cut-off time for the response of adolescents in relation to situations of violence, the study investigated a significant number of subjects, with results that represent the actual situation of the scene of violence suffered by the adolescents from a state capital in Brazil, therefore, it deals with a reality that is poorly known and largely unreported to official agencies.It is noteworthy that the study shows significant descriptive data, which represent only part of the problem, highlighting the need to develop new studies to further investigate the various facets of the theme and to suggest new coping measures for violence in adolescence, through actions that aid in the prevention of this grievance and in seeking help and reporting of cases, thus contributing to the quality of life in this age group.

Table 1 :
Distribution of adolescent victims of violence, according to the type of violence and sex of the victims (p=0.0027).Cuiabá, MT, Brazil, 2012.

Table 2 :
Distribution of adolescent victims of violence, according to the type of violence and age of the victims (p=0.0000).Cuiabá, MT, Brazil, 2012.

Table 4
shows the types of violence suffered, according to the frequency of the violent act and the length of abuse.Bullying, psychological violence, cyber-bullying, neglect, child labor and parental alienation were manifestations of violent acts, most frequent, occurring more often, more than once or maintained continuously.Whereas, physical violence, sexual violence, threats, witness of violence and abandonment, occurred more frequently once.Harassment had its frequency distributed uniformly for once, two to four times and always.

Table 3 :
Distribution of adolescent victims of violence, according to the type of violence suffered and the relationship with the aggressor (p=0.0000).Cuiabá, MT, Brazil, 2012.

Table 4 :
Distribution of adolescent victims of violence, according to the type of violence suffered, frequency of the violent act (p=0.0175) and length of abuse (p=0.0046).Cuiabá, MT, Brazil, 2012.

Table 5 :
Distribution of adolescent victims of violence, according to the type of violence and the place where it occurred (p=0.0000).Cuiabá, Mato Grosso, Brazil, 2012.