Many US Healthcare Workers Experience Violence at Work

Doris Maugg, PhD

February 10, 2023

According to a recent US study, 32% of public healthcare workers have experienced at least one form of nonphysical violence in the workplace during the COVID-19 pandemic. The results of the study were published in the American Journal of Preventive Medicine.

These violent experiences were associated with negative effects on the workers' health. The more such experiences the workers had, the more they reported symptoms of depression, anxiety, posttraumatic stress disorder (PTSD), and suicidal thoughts.

"The negative effects of the COVID-19 pandemic on employees are documented, and research on the psychological effects is increasing," said study author Hope M. Tiesman, PhD, research epidemiologist in Division of Safety Research of the National Institute for Occupational Safety and Health (NIOSH) in Morgantown, West Virginia, in a press release.

Aggression in emergency rooms and toward emergency personnel is also on the rise in Germany. This is an "anxiety spiral" that resulted from the pandemic and was intensified due to the lack of personnel, explained Felix Walcher, MD, PhD, the new president of the German Interdisciplinary Association for Intensive Care and Emergency Medicine, to newspapers of the Funke Mediengruppe media company. In addition to increasing verbal attacks, the employees also reported an increased number of physical altercations.

Workplace Violence

Using an online questionnaire, the authors of the US study investigated the prevalence of nonphysical violence in the workplace toward public healthcare workers and its effects on their mental health. More than 26,000 employees working in the healthcare sector at the federal, state, and local levels took part in the survey.

The survey aimed to record respondents' experiences from the beginning of the pandemic in March 2020 to April 2021 and to include mental health issues from the 2 weeks prior to starting the survey. The survey included questions on demographics, the extent of violence in the workplace, and other factors surrounding the workplace.

Mental health was assessed using a standardized and validated tool for measuring mental problems such as depression, anxiety, PTSD, and suicidal thoughts.

Nonphysical Violence

The 26,174 participants reported the following experiences:

  • 26% experienced stigmatization due to their work in public healthcare (n = 5962)

  • 12% received job-related threats (n = 2688)

  • 24% were bullied or otherwise or harassed (n = 5350).

Overall, 32% of participants (n = 8244) experienced at least one form or a combination of forms of workplace violence.

As the number of hours worked per week increased, the chances of experiencing violence also increased. The prevalence of experience of violence for various workers was the following:

  • less than 20 hours of work per week: 16% experienced violence

  • 20-40 hours: 25% experienced violence

  • 41-60 hours: 41% experienced violence

  • 61-75 hours: 52% experienced violence

  • more than 75 hours: 61% experienced violence

The same trend for experiencing violence was also evident for interaction with the public sphere (little interaction: 22%, some interaction: 31%, a lot of interaction: 46%).

Depressive Symptoms

The researchers also found that violence in the workplace was associated with the following outcomes:

  • a 21% higher risk for depression or anxiety

  • a 31% higher risk for PTSD

  • a 26% higher risk for suicidal thoughts

Even after the researchers took health-influencing factors into account, such as COVID-19 infection, losing a family member to COVID-19, and other stress factors during the pandemic, the connection between experiencing violence and the effects on mental health were significant.

The more violence an employee experienced in the workplace, the greater the impact on their mental health. The researchers observed the following about the proportion of people who reported symptoms of depression:

  • It was around 1.7 times higher if respondents only experienced one kind of violence.

  • It was around twice as high if they experienced two kinds of violence.

  • It was around 2.4 times higher if they experienced all three kinds of violence.

No Causal Correlation

The authors recognized several limitations of this study, such as the random sampling of the online survey, which is why the results are not representative of all workers in the healthcare sector. A distortion of the results also cannot be ruled out. For example, it is possible that only employees who were particularly badly affected by violence took part in the survey or that, conversely, people who were particularly badly affected did not participate. Data regarding the reasons and the originators of the violence in this setting also could not be collected.

Since the study was cross-sectional, the authors were also unable to determine a causal correlation between the violence and mental health.

According to the authors of the study, there is an urgent need for treatment to establish new preventive approaches for workers in the public healthcare sector. Tiesman and her colleagues suggested preventive measures. "Since the public healthcare sector is repeatedly facing emergencies, we absolutely must ensure that our employees in the public healthcare sector are put in a position to neutralize the hostility, harassment, and threats that they face through training sessions, support at the workplace, and better communication after incidents."

It is also important to improve the health authorities' ability to prevent, react to, and follow up on incidents on site, said the authors. They also believe that further research is necessary to recognize and understand more precise relationships between the scope and consequences of violence at the workplace, including potential sociodemographic connections.

This article was translated from the Medscape German edition.


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