Behavioral Dysphonia and Depression in Elementary School Teachers *Luise Marques da Rocha, †Mara Behlau, and *Luciano Dias de Mattos Souza, *Pelotas, Rio Grande do Sul, and yS~ ao Paulo, S~ ao Paulo, Brasil Summary: Objective/Hypothesis. To verify the relationship between behavioral dysphonia and current depres- sive episodes in municipal elementary school teachers. We hypothesize that teachers with behavioral dysphonia will be more susceptible to psychiatric disorders. Design. Cross-sectional study, quantitative, conducted across municipal schools in both rural and urban regions of Pelotas. Method. Five-hundred seventy-five teachers from urban and rural areas of the same Brazilian state were included. The full version of the Voice Handicap Index validated into Brazilian Portuguese was used to determine the presence of behavioral dysphonia. A profile of vocal behaviors was also used to quantify the number of phonotraumatic events. In addition, the Mini-International Neuropsychiatric Interview was used to determine current episodes of depression. Data were analyzed via correlative studies using chi-square and Poisson regression analyses. Results. Across all teachers, the prevalence of dysphonia was 33.9% and 55% reported that they had already taken a leave because of their voice. Those teachers with a current depressive episode had a higher rate of dysphonia compared with those without depression (prevalence ratio [PR] 1.66; P < 0.000). Teachers who presented with a risk of serious vocal problems had a prevalence ratio of 2.58, indicating a greater proportion of dysphonia, whereas teachers classified as champions of abuse were five times more likely compared with those teachers with behaved or candidates for voice problems. Conclusions. There is an association between behavioral dysphonia and current depressive episodes in elementary school teachers. Key Words: Dysphonia–Depression–Faculty. INTRODUCTION Teachers are inherently more likely to present with voice problems. 1–4 A myriad of factors related to work and voice use contribute to the overall vocal health of this challenging population. The voice is essential for communication, one of the main ways to transfer ideas and thoughts, and for teachers, it is a vital tool of the trade. A seminal study from the United States showed a high incidence of voice disorders in teachers when compared with the general population. 5 Similar findings were reported in a recent study of teachers in 27 Brazilian states; 63% of teachers reported that they have had a voice problem compared with 35% of the general population. 1 Several risk factors may contribute to the increased likeli- hood of voice disorders in teachers. These factors include (1) physical factors such as inadequate acoustics and increased class size, (2) chemical factors such as dust and smoke expo- sure, and (3) ergonomics such as continuous voice use at increased intensity. 1,6 Furthermore, increased occupational demands, unsatisfactory teaching environments, 7 poor work organization, daily stresses, few opportunities for vocal rest, 8 and decreased social status and remuneration leading to profes- sional frustration 9 may contribute to dysphonia 9,10 as well as issues related to overall psychological well-being in teachers 11 In this population, dysphonia may lead to absence from work resulting in financial and social losses. 13 Vocal complaints in this population are likely related to difficulty in producing natural voice. 12 Specifically, altered vocal quality (hoarseness, instability, or as vocal fatigue or effort), difficulties in breathing control, tension, reduced vocal projection, and discomfort during speech have been reported. 1,9,10,12,14,15 Absenteeism can be the result of worsening symptoms. 1,3,7,16,17 The current literature suggests an emotional component to dysphonia. 2,10,14,16 Although emotional issues with regard to voice production and specifically with regard to employment, has been discussed, these aspects have not received adequate attention through a structured approach with teachers from multiple locations. A recent finish study suggested that stress arising from work conditions may increase vocal symptoms in teachers and have a negative influence on emotional aspects of their occupation. 3 Similarly, major depressive episodes and generalized anxiety disorders were more prevalent in teachers with vocal disorders. 2 A recent review indicated a strong association between functional dysphonia and psycho- social symptoms as those present in depressive episodes. 18 Therefore, the aim of the present study was to investigate the relationship between behavioral dysphonia and depression in primary school teachers. METHODS The present study was approved by the Ethics Committee of the Catholic University of Pelotas under the protocol number Accepted for publication October 22, 2014. From the *Programa de P os-Graduac ¸~ ao em Sa ude e Comportamento, Universidade Cat olica de Pelotas, Pelotas, Rio Grande do Sul, Brasil; and the yPrograma de P os- Graduac ¸~ ao em Dist urbios da Comunicac ¸~ ao Humana, Universidade Federal de S~ ao Paulo, S~ ao Paulo, S~ ao Paulo, Brasil. Address correspondence and reprint requests to Luciano Dias de Mattos Souza, Pro- grama de P os-Graduac ¸~ ao em Sa ude e Comportamento, Universidade Cat olica de Pelotas, Rua Gonc ¸alves Chaves, 373, sala 418C, Centro, Pelotas, RS 96015-560, Brasil. E-mail: luciano.dms@gmail.com Journal of Voice, Vol. -, No. -, pp. 1-6 0892-1997/$36.00 Ó 2014 The Voice Foundation http://dx.doi.org/10.1016/j.jvoice.2014.10.011