The impacts of neighbourhood violence on mental health consultations among residents of low-income neighbourhoods in Rio de Janeiro: a retrospective cohort analysis
File(s)
Published version
Author(s)
Type
Journal Article
Abstract
Background
Violence is associated with poor mental health outcomes. However, longitudinal evidence from urban settings with endemic violence – particularly in low- and middle-income countries such as Brazil – remains limited. This study investigates the association between neighbourhood violence, including drug-gang conflicts and police operations, on mental health consultations in Rio de Janeiro.
Methods
A cohort of 1,358,943 individuals observed from January 2010 to December 2016 was analysed. Individuals were considered exposed to violence if a violent event occurred within 250 m of the primary healthcare clinic they attended. Using cross-sectional Poisson regression models, we examined which sociodemographic groups were more exposed to neighbourhood violence, and fixed effects panel Poisson regression assessed the association between neighbourhood violence and PHC consultations for mental health conditions.
Results
Over two thirds of the cohort (n = 913,125) were exposed to at least one neighbourhood violent event in the study period, most of which were police-related shootings (70.4%). Females, Black individuals, and younger adults were more likely to experience neighbourhood violence, particularly drug-gang violence. Exposure to two and three neighbourhood violent events in a month was associated with a 5% (IRR: 1.05; 95% CI: 1.02–1.07; p < 0.001) and 8% (IRR: 1.08; 95% CI: 1.04–1.12; p < 0.001) increase in mental health-relatedprimary healthcare consultations, respectively, while five or more events were linked to a 7% decrease (IRR: 0.93; 95% CI: 0.89–0.97; p < 0.001). Lagged analyses showed that exposure to 2–4 violent events per month was associated with increased mental health consultations, particularly 2–4 months after violence exposure. Increases in mental health consultations following high levels of violence exposure were observed among individuals aged 19–34 and 65 + years, but were lower among those with a high school education or higher.
Conclusions
Neighbourhood violence in Rio de Janeiro was associated with increased mental health-related primary healthcare consultations both immediately and two to four months following violence exposure.
Violence is associated with poor mental health outcomes. However, longitudinal evidence from urban settings with endemic violence – particularly in low- and middle-income countries such as Brazil – remains limited. This study investigates the association between neighbourhood violence, including drug-gang conflicts and police operations, on mental health consultations in Rio de Janeiro.
Methods
A cohort of 1,358,943 individuals observed from January 2010 to December 2016 was analysed. Individuals were considered exposed to violence if a violent event occurred within 250 m of the primary healthcare clinic they attended. Using cross-sectional Poisson regression models, we examined which sociodemographic groups were more exposed to neighbourhood violence, and fixed effects panel Poisson regression assessed the association between neighbourhood violence and PHC consultations for mental health conditions.
Results
Over two thirds of the cohort (n = 913,125) were exposed to at least one neighbourhood violent event in the study period, most of which were police-related shootings (70.4%). Females, Black individuals, and younger adults were more likely to experience neighbourhood violence, particularly drug-gang violence. Exposure to two and three neighbourhood violent events in a month was associated with a 5% (IRR: 1.05; 95% CI: 1.02–1.07; p < 0.001) and 8% (IRR: 1.08; 95% CI: 1.04–1.12; p < 0.001) increase in mental health-relatedprimary healthcare consultations, respectively, while five or more events were linked to a 7% decrease (IRR: 0.93; 95% CI: 0.89–0.97; p < 0.001). Lagged analyses showed that exposure to 2–4 violent events per month was associated with increased mental health consultations, particularly 2–4 months after violence exposure. Increases in mental health consultations following high levels of violence exposure were observed among individuals aged 19–34 and 65 + years, but were lower among those with a high school education or higher.
Conclusions
Neighbourhood violence in Rio de Janeiro was associated with increased mental health-related primary healthcare consultations both immediately and two to four months following violence exposure.
Date Issued
2026-12-01
Date Acceptance
2026-03-16
Citation
International Journal of Mental Health Systems, 2026, 20 (1)
ISSN
1752-4458
Publisher
BMC
Journal / Book Title
International Journal of Mental Health Systems
Volume
20
Issue
1
Copyright Statement
© The Author(s) 2026. This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.
License URL
Identifier
10.1186/s13033-026-00702-3
Publication Status
Published
Article Number
ARTN 12
Date Publish Online
2026-04-10