Included studies examining psychological violence as a predictor of mental health outcomes, sickness absence or physical health outcomes in employees in health care, social care or education
| Author | Year | Country | Industry/occupation | N (% Women) | Exposure | Outcome | Covariates | Follow-up time | Statistical methods | Risk estimate | Quality (score) | |
| Mental health outcomes | ||||||||||||
| 1 | Adriaenssens | 2015 | Belgium | Emergency nurses | 170 (54.7) | Social harassment, Leiden Quality of Work Questionnaire (LQWQ-N), Scale range 1 ‘totally disagree’ to 4 ‘totally agree’, a change score is used in which a higher score indicates a more favourable situation | Emotional exhaustion, Maslach Burnout Inventory, Scale range 0 ‘never’ to 6 ‘always’ | Age, gender, marital status, education, degree, years of service, working hours, shift work schedule | 18 months (mean) | Multiple linear regression analysis | β −0.14, p<0.05 | M (15) |
| Psychosomatic distress, sum score of symptoms of depression, anxiety and somatisation, Brief Symptom Inventory (BSI), Scale range 0 ‘not at all’ to 4 ‘very much’ | Age, gender, marital status, education, years of service, working hours, shift work schedule. | 18 months (mean) | Multiple linear regression analysis | β −0.17, p<0.01 | M (15) | |||||||
| 2 | Eriksen | 2006 | Norway | Nurses’ aids | 4076 (96.0) | Bullying, GPS-Nordic, 0 ‘no’, 1 ‘yes’ | Psychological distress (anxiety and depression) during the previous 14 days, SCL-5. Scale range from 1 ‘not at all’ to 4 ‘extremely’ | Work factors, change in work situation, age, gender, marital status, number of preschool children, pregnancy, care for relative, use of prescribed hypnotics, cigarette consumption, physical activity, chronic health problem, baseline psychological distress | 15 months | Multivariate linear regression analysis | n.s. | M (14) |
| 3 | Eriksen | 2008 | Norway | Nurses’ aids | 4771 (96.1) | Bullying, GPS-Nordic, 0 ‘no’, 1 ‘yes’ | Poor sleep, subjective sleep quality during the past 3 months, Basic Nordic Sleep Questionnaire, Scale range 1–5 with having slept ‘neither well not badly’ to ‘badly’ indicating poor sleep. | Age, gender, marital status, number of preschool children, care for relative, use of prescribed hypnotics, cigarette consumption, physical activity, chronic health problem | 3 months | Multivariate logistic regression analysis | OR 0.65 (95% CI 0.43 to 0.98) | M (14) |
| 4 | Kivimäki | 2003 | Finland | Hospital employees | 5432 (88.9) | Bullying, victims both surveys=‘bullied’, no bullying=‘not bullied’ | Depression, identified if respondent reported that a medical doctor had diagnosed him/her as having depression | Sex, age, occupation, income, BMI, smoking, alcohol consumption, job contract | 2 years | Logistic regression analysis | OR 4.2 (95% CI 2.0 to 8.6) | M (15) |
| 5 | Loerbroks | 2015 | Germany | Junior physicians | 507 (51.3) | Bullying, ‘no’ or ‘yes’ | Depressive symptoms, German Spielberger’s State-Trait Depression Scales, Scale range 1 ‘not at all’ to 4 ‘very much so’ | Age, sex, working hours, having a partner, alcohol consumption, physical activity, overweight/obesity, prevalent disease, and depression at baseline | 1 year, 3 years | Linear regression analysis | 1-year follow-up: β 0.10, p=0.01 3-year follow-up: β 0.11, p=0.01 | M (15) |
| 6 | Magnavita | 2013 | Italy | Physicians, nurses and other hospital employees | 627 (57.3) | Verbal (non-physical) aggression | Anxiety, Goldberg scales ranging from 0 to 9, dichotomised with cut-point at 5 | Age, gender, job, department | 2 years | Logistic regression analysis | OR 2.61 (95% CI 1.60 to 4.30) | M (13) |
| Depression, Goldberg scales ranging from 0 to 9, dichotomised with cut-point at 2 | Age, gender, job, department | 2 years | Logistic regression analysis | OR 2.66 (95% CI 1.61 to 4.39) | M (13) | |||||||
| 7 | Reknes | 2014 | Norway | Nurses | 1582 (90.2) | Bullying behaviours, measured by Negative Acts Questionnaire and analysed as a sum score ranging from 5 to 45 | Anxiety, Hospital Anxiety and Depression Scale, range 0–21 | Age, gender, night work, job demands, symptoms at baseline | 1 year | Hierarchical regression analysis | β 0.06 (p<0.01) | H (12) |
| Depression, Hospital Anxiety and Depression Scale, range 0–21 | Age, gender, night work, job demands, symptoms at baseline | 1 year | Hierarchical regression analysis | n.s. | H (12) | |||||||
| 8 | Rugulies | 2012 | Denmark | Female elder-care workers | 5640 (100) | Bullying, participants were presented a definition of bullying and indicated how often they had been exposed during 12 last months, with five response options from ‘no’ to ‘yes, daily or almost daily’; recoded into (i) ‘no’, (ii) ‘occasional bullying’ (‘now and then’ and ‘monthly’), (iii) frequent bullying (‘weekly’ and ‘daily/almost daily’) | Major depression, Major Depression Inventory, sum score 0–50, dichotomised into major depression or not according to an algorithm in accordance with the criteria of DSM-IV | Age, cohabiting, type of job, and seniority, length of follow-up | 14–26 months, mean 20 months | Logistic regression | OR for onset of major depression: 2.12 (95% CI 1.29 to 3.48) for occasional bullying and 6.39 (95% CI 3.10 to 13.17) for frequent bullying compared with no bullying | M (14) |
| 9 | Trépanier | 2014 | Canada | Nurses | 508 (90.5) | Bullying, measured by Negative Acts Questionnaire, mean scores of three subscales (person-related, work-related and physical intimidation) used as indicators of latent variable | Burnout, mean scores of the emotional exhaustion and cynicism subscales of the Maslach Burnout Inventory were used as latent indicators of burnout | Gender, age, job position, working shift were considered; only job position was included (due to significant associations) | 1 year | Structural equation modelling | Work place bullying predicted burnout (β=0.25, p≤0.05) | L (17) |
| 10 | Vedaa | 2016 | Norway | Nurses | 799 (90) | Bullying, Negative Acts Questionnaire | Insomnia, Bergen Insomnia Scale, analysed as continuous variable | Manifest: night shifts, caffeine, cigarettes; Latent: morningness-eveningness, flexibility, languidity, sleepiness, alcohol, anxiety, depression, work–family spillover | 2 years | Structural equation modelling | (β=0.08, p<0.05) | H (11) |
| Sickness absence | ||||||||||||
| 1 | Aagestad | 2014 | Norway | Health and social workers | 925 (100) | Bullying, Statistics Norway, ‘no’ or ‘yes’ | Doctor-certified sick leave 21 days or more | Age, educational level, occupation, chronic health complaint, disability, smoking, perceived mechanical workload, several work factors | 1 year | Logistic regression analysis | OR 1.67 (95% CI 1.14 to 2.45) | M (13) |
| 2 | Clausen | 2012 | Denmark | Employees in elder-care | 9520 (100) | Bullying during the past 12 months, 1 ‘never’, 2 ‘occasionally’, 3 ‘frequently’ | Register based long-term sickness absence, 8 or more consecutive weeks | Age, job function, tenure, BMI, smoking status, psychosocial working conditions | 1 year | Cox regression analysis | HR* 2.33 (95% CI 1.55 to 3.51) | M (14) |
| 3 | Kivimäki | 2000 | Finland | Hospital employees | 5655 (88.1) | Bullying, Statistics Finland, ‘yes’ or ‘no’ | Medically certified sickness absence, 4 days or more | Demographic data, occupational background, behaviour involving risks to health, baseline health status and sickness absence. | 1 year? | Poisson regression analysis | RR 1.26 (95% CI 1.10 to 1.44) | H (12) |
| Self-certified sickness absence, 3 days or fewer | Demographic data, occupational background, behaviour involving risks to health, baseline health status and sickness absence. | 1 year? | Poisson regression analysis | RR 1.16 (95% CI 1.05 to 1.29) | M (13) | |||||||
| 4 | Ortega | 2011 | Denmark | Elderly-care workers | 9749 (96.3) | Bullying, participants were presented a definition of bullying and indicated how often they had been exposed during 12 last months, categories (1) daily, (2) weekly, (3) monthly, (4) now and then, (5) never; recoded into (1) frequently (daily, weekly), (2) occasionally (monthly or less), (3) not bullied | Register-based long-term (>6 weeks) sickness absence, linkage to national register | Age, gender, occupational group, BMI, smoking habits, number of children at home, cohabiting status, psychosocial work factors | 1 year | Poisson regression analysis | RR 1.92 (95% CI 1.29 to 2.84) for frequently bullied, 1.11 (95% CI 0.87 to 1.41) for occasionally bullied compared with not bullied | M (13) |
| 5 | Roelen | 2018 | Norway | Nurses | 1533 (90) | Bullying behaviours, measured by Negative Acts Questionnaire and analysed as a sum score ranging from 5 to 45 (called it social harassment but other studies using the same instrument called it bullying behaviour) | Register-based long-term sickness absence 17 days or more; all-cause and mental-health related | Age, sex, marital status, children at home, workplace setting, years registered as nurse, work hours/week | 2 years | Cox regression | HR 1.06 (95% CI 1.01 to 1.19) for mental health related long-term sickness absence and HR 1.06 (95% CI 1.02 to 1.11) for all-cause long-term sickness absence | H (12) |
| Physical health outcomes | ||||||||||||
| 1 | Camerino | 2008 | Eight European countries† | Nurses | 34 107 (89.3) | Harassment from superiors, the NEXT study group, Scale range 1 ‘never’ to 5 ‘daily’ | Perceived health, SF-36, Scale range 1 ‘definitely false’ to 5 ‘definitely true’, higher score indicates better health | Country, gender, age, location of birth, occupational position, clinical setting, work shifts, work hours | 1 year | Multiple linear regression analysis | n.s. | M (16) |
| Harassment from colleagues, the NEXT study group, Scale range 1 ‘never’ to 5 ‘daily’ | Perceived health, SF-36, Scale range 1 ‘definitely false’ to 5 ‘definitely true’, higher score indicates better health | Country, gender, age, location of birth, occupational position, clinical setting, work shifts, work hours | 1 year | Multiple linear regression analysis | β −0.02, p<0.05 | M (16) | ||||||
| 2 | Kivimäki | 2003 | Finland | Hospital employees | 5432 (88.9) | Bullying, victims both surveys=‘bullied’, no bullying=‘not bullied’ | Self-reported CVD, identified if respondent reported that a medical doctor had diagnosed him/her with myocardial infarction, angina pectoris, cerebrovascular disease or hypertension | Sex, age, occupation, income, BMI, smoking, alcohol consumption, job contract | 2 years | Logistic regression analysis | n.s. | M (15) |
| 3 | Kivimäki | 2004 | Finland | Hospital employees | 4791 (88.7) | Bullying, ‘currently bullied‘ or ‘not bullied’ | Self-reported fibromyalgia, identified if respondent reported that a medical doctor had diagnosed him/her with with fibromyalgia | Age, sex, income, obesity, smoking | 2 years | Logistic regression analysis | OR 4.1 (95% CI 2.0 to 9.6) | M (15) |
| 4 | Trépanier | 2016 | Canada | Nurses | 508 (90.5) | Bullying, measured by Negative Acts Questionnaire, mean scores of three subscales (person-related, work-related and physical intimidation) used as indicators of latent variable | Psychosomatic complaints, measured by eight items (eg, headaches, chest pains), analysed as a latent construct | Gender, age, job position, working shift tested; no sign diff and none included | 1 year | Structural equation modelling | n.s. | L (16) |
*HR frequently exposed, reference never exposed.
†Belgium, Germany, Finland, France, Italy, The Netherlands, Poland, Slovakia.
β, standardised regression coefficient; BMI, body mass index; CVD, cardiovascular disease; DSM-IV, Diagnostic and Statistical Manual of Mental Disorders; Quality H, high; L, low; M, medium; n.s., statistically non-significant; RR, rate ratio.