Psychiatrists Hardest Hit by Workplace Violence

Megan Brooks

November 01, 2019

Workplace violence among mental health professionals is common, but psychiatrists seem to be hit the hardest compared to their peers, new research shows.

Results of a cross-sectional survey that included psychiatrists, psychiatry residents, nurses, and other mental health care professionals showed that 90% of study participants experienced verbal aggression or aggression with objects during their career.

"Workplace aggression was extremely common among mental health professionals in our sample, in line with the findings of other authors. The findings highlight the importance of training mental health workers on how to manage workplace violence," investigators led by Andrea Aguglia, MD, PhD, University of Genoa, Italy, write.

The study was published online October 23 in Psychiatric Services.

Impact on Burnout

Prior studies show high levels of burnout among mental health practitioners, but few have examined whether it is associated with workplace violence.

To investigate, the researchers surveyed 183 mental health providers who worked in emergency psychiatric wards and mental health care centers in Italy in 2018.

The cohort included 39 psychiatrists (19 women), 58 psychiatric residents (30 women), 56 nurses (34 women) and 30 other professionals (rehabilitation technicians, psychologists and educators; 20 women).

The researchers developed a questionnaire that asked about the frequency and modality of exposure to violent behaviors from patients or patients' family members. It included questions on verbal threats, verbal aggression, physical aggression, and aggression using objects. They also queried respondents about psychiatric symptoms experienced following the worst experience of patient violence. These symptoms included insomnia, anorexia, flashbacks, and discomfort.

Burnout was assessed using the Maslach Burnout Inventory (MBI).

The vast majority of professionals (90%) reported experiencing verbal aggression from patients or patients' relatives. There were no differences among the professional groups studied.

Psychiatrists reported a significantly higher rate of patient aggression than any other group of mental health professionals. For instance, 97% reported verbal aggression, 74% reported verbal threats, 97% reported patient aggression involving objects, and 62% reported physical patient aggression.

Overall, more than half (53%) the study group reported verbal threats, and 82% reported aggression with objects. In addition, half of mental health professionals reported physical aggression.

Mental health providers who suffered verbal or object aggression in the prior year had significantly higher burnout scores on the MBI compared to their peers who did not.

In particular, acts of verbal aggression in the past year were strongly associated with higher levels of burnout among women, but the association was not significant among men.

There were no differences in MBI scores regarding past-year exposure to physical aggression.

Among the study cohort, 90% of psychiatrists reported receiving some type of workplace violence training, compared with only 48% of residents, 66% of nurses, and 50% of the other providers.

Risky Profession

Commenting on the study for Medscape Medical News, David Ballard, PsyD, MBA, senior director for applied psychology at the American Psychological Association (APA) and head of the APA's Psychologically Healthy Workplace Program, said he was not surprised by the findings.

"We know that healthcare workers have a higher rate of exposure to violence and aggression in the workplace than many other occupations do," he said.

Ballard said this study "highlights the importance of not only preparing healthcare workers and mental health professionals to assess the risk for violence and manage it effectively but also for the organizations that they work in to have systems and policies in place to mitigate the risk."

The healthcare field is "notorious" for having high levels of burnout, added Ballard, "because people often put in long hours in difficult circumstances and are exposed to many different stressors."

Ballard said the fact that the World Health Organization's new International Classification of Diseases (ICD-11) specifically references burnout as a syndrome resulting from chronic workplace stress that has not been successfully managed is "a step in the right direction and brings burnout much more in line with what the research shows."

The study had no specific funding. The authors and Ballard report no relevant financial relationships.

Psychiatr Serv. Published online October 23, 2019. Abstract

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