Article Text

Download PDFPDF
Is there a bidirectional relationship between workplace bullying and the risk of sickness absence? Systematic review and meta-analysis of prospective studies
  1. Xinqi Liao1,
  2. Yuqiang Wang2,
  3. Qinglin Zeng3,
  4. Jinfeng Wang1,
  5. Xiangyu Yang1,
  6. Wen Yan4,
  7. Guofu Wang2,
  8. Yanli Zeng1
  1. 1 College of Nursing, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
  2. 2 Chengdu Fifth People's Hospital, Chengdu, Sichuan, China
  3. 3 Sichuan College of Traditional Chinese Medicine, Mianyang, Sichuan, China
  4. 4 State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases & Department of Prosthodontics, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan, China
  1. Correspondence to Dr Yanli Zeng, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan 610075, China; zengyanli{at}; Guofu Wang, Chengdu Fifth People's Hospital, No.33 Mashi Street, Chengdu, Wenjiang, 611137, China; wangguofu{at}


Exposure to workplace bullying increases the risk of sickness absence. However, the extent and direction of this relationship for different follow-up lengths are not well established. To provide evidence regarding the direction and extent of the relationship between workplace bullying and different durations of sickness absence. We searched nine databases from their inception to 29 November 2022. Multiple independent observers screened the literature, extracted the data and used the Risk Of Bias In Non-randomised Studies of Exposure to assess the methodological quality. The overall effect sizes of odds ratio, relative risk, hazard ratio and 95% confidence intervals were calculated. Our meta-analysis demonstrated a 26% increased risk of sick leave among workers exposed to workplace bullying for all follow-up lengths (95% CI 1.18 to 1.35), even after adjusting for confounding factors. Moreover, we found a significant association between long-term sickness absence and a higher likelihood of subsequent exposure to workplace bullying, with a pooled OR of 1.63 (95% CI 1.21 to 2.04). Our study established a bidirectional relationship between workplace bullying and long-term sickness absence, highlighting that it increases the risk of sickness absence at different follow-up lengths among employees who have been bullied. Hence, organisations should be mindful of workers who resume work after prolonged absences due to illness and adopt appropriate management strategies to prevent workplace bullying.

  • workplace bullying
  • sickness absence
  • bi-directional relationship
  • systematic review
  • meta-analysis

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.


  • XL, YW and QZ are joint first authors.

  • Contributors XL: conceptualisation; methodology; software; formal analysis; writing—original draft. YW: methodology; formal analysis; resources; writing—original draft. QZ: data curation; visualisation. JW: writing—review and editing; software. XY: software; data curation; visualisation. WY: formal analysis; supervision; validation. GW: conceptualisation; methodology; supervision; funding acquisition. YZ: writing—review and editing; project administration; funding acquisition; supervision.

  • Funding This work was supported by the 'XingLin Scholars' talent programme of Chengdu University of Traditional Chinese Medicine (grant numbers XSGG2019002 and ZRYY1904).

  • Competing interests None declared.

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

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.