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Prevalence of workplace violence against healthcare workers: a systematic review and meta-analysis
  1. Jianxin Liu1,
  2. Yong Gan1,
  3. Heng Jiang2,3,
  4. Liqing Li4,
  5. Robyn Dwyer2,
  6. Kai Lu5,
  7. Shijiao Yan1,
  8. Opoku Sampson1,
  9. Hongbin Xu1,
  10. Chao Wang1,
  11. Yi Zhu1,
  12. Yuanyuan Chang1,
  13. Yudi Yang1,
  14. Tingting Yang6,
  15. Yawen Chen7,
  16. Fujian Song8,
  17. Zuxun Lu1
  1. 1 Department of Social Medicine and Health Management, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
  2. 2 Centre for Alcohol Policy Research, School of Psychology and Public Health, La Trobe University, Melbourne, Victoria, Australia
  3. 3 Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
  4. 4 Department of Management Science and Engineering, School of Economics and Management, Jiangxi Science and Technology Normal University, Nanchang, China
  5. 5 Office of Student Affairs, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
  6. 6 Department of Nutrition, Henan Provincial People’s Hospital, Zhengzhou, China
  7. 7 Wuhan Children’s Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
  8. 8 Norwich Medical School, Faculty of Medicine and Health Science, University of East Anglia, Norwich, UK
  1. Correspondence to Professor Zuxun Lu, Social Medicine and Health Management, Huazhong University of Science and Technology Tongji Medical College, Wuhan 430030, China; zuxunlu{at}; Professor Fujian Song, Norwich Medical School, Faculty of Medicine and Health Science, University of East Anglia, Norwich, United Kingdom;{at}


We aim to quantitatively synthesise available epidemiological evidence on the prevalence rates of workplace violence (WPV) by patients and visitors against healthcare workers. We systematically searched PubMed, Embase and Web of Science from their inception to October 2018, as well as the reference lists of all included studies. Two authors independently assessed studies for inclusion. Data were double-extracted and discrepancies were resolved by discussion. The overall percentage of healthcare worker encounters resulting in the experience of WPV was estimated using random-effects meta-analysis. The heterogeneity was assessed using the I 2 statistic. Differences by study-level characteristics were estimated using subgroup analysis and meta-regression. We included 253 eligible studies (with a total of 331 544 participants). Of these participants, 61.9% (95% CI 56.1% to 67.6%) reported exposure to any form of WPV, 42.5% (95% CI 38.9% to 46.0%) reported exposure to non-physical violence, and 24.4% (95% CI 22.4% to 26.4%) reported experiencing physical violence in the past year. Verbal abuse (57.6%; 95% CI 51.8% to 63.4%) was the most common form of non-physical violence, followed by threats (33.2%; 95% CI 27.5% to 38.9%) and sexual harassment (12.4%; 95% CI 10.6% to 14.2%). The proportion of WPV exposure differed greatly across countries, study location, practice settings, work schedules and occupation. In this systematic review, the prevalence of WPV against healthcare workers is high, especially in Asian and North American countries, psychiatric and emergency department settings, and among nurses and physicians. There is a need for governments, policymakers and health institutions to take actions to address WPV towards healthcare professionals globally.

  • violence
  • epidemiology
  • risk factors

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  • JL and YG contributed equally.

  • FS and ZL contributed equally.

  • Contributors YG, FS and ZL conceived the study. JL and YG searched the databases and checked them according to eligibility and exclusion criteria. HJ and LL helped develop the search strategies. JL and YG performed the data extraction and quality assessment. JL, YG, HJ and FS analysed the data. HJ, LL, RD and FS gave advice on meta-analysis methodology. YG wrote the draft of the paper. JL, YG, HJ, RD, OS, YZ, YaC, FS and ZL contributed to reviewing or revising the paper. All authors read and approved the final manuscript. FS and ZL are the guarantors of this work, and as such had full access to all the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.

  • Funding This study was supported by the Fundamental Research Funds for the Central Universities, Huazhong University of Science and Technology, Wuhan, China (2016YXMS215), the National Natural Science Foundation of China (71804049), and the China Postdoctoral Science Foundation funded project (2018M630870).

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.