Included studies examining physical violence as a predictor of mental health outcomes, sickness absence and 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 method | Risk estimate | Quality (score) | |
| Mental health outcomes | ||||||||||||
| 1 | Dement | 2014 | USA | Hospital employees | 9884 (not given) | Physical violence by patients, reported event | Psychotropic drug claims Days of drug supply | Gender, age, race | 6 years | Multivariate Poisson regression analysis | Claim RR 1.45 (95% CI 1.01 to 2.33) Days of supply RR 1.33 (95% CI 0.95 to 1.87) | M (15) |
| Mental health claims | Gender, age, race | 6 years | Multivariate Poisson regression analysis | n.s. | M (15) | |||||||
| 2 | Eriksen | 2006 | Norway | Nurses’ aids | 4076 (96.0) | Threats and violence, General Nordic Questionnaire for Psychological and Social Factors at Work (GPS-Nordic). Scale range from 1 ‘never or very seldom’ to 5 ‘very often or always’ | Psychological distress (anxiety and depression) during the previous 14 days, Hopkins Symptom Checklist (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 hypnotics, cigarette consumption, physical activity, chronic health problem, baseline psychological distress | 15 months | Multivariate linear regression analysis | b, unstandardised regression coefficient, 0.020, SE 0.007, p<0.01 | M (14) |
| 3 | Eriksen | 2008 | Norway | Nurses’ aids | 4771 (96.1) | Threats and violence, GPS-Nordic. Scale range from 1 ‘never or very seldom’ to 5 ‘very often or always’ | Poor sleep during the previous 3 months, Basic Nordic Sleep Questionnaire. Scale range from 1 ‘well’ to 5 ‘badly’. Dichotomised, the worst three response alt indicating poor sleep | Age, gender, marital status, number of preschool children, care for relative, cigarette consumption, physical activity, long-term health problem, work schedule, physical work factors, several psychosocial work factors, use of hypnotics and sleep quality 3 months before baseline. | 3 months | Multivariate logistic regression analysis | Rather often: OR 1.77 (95% CI 1.27 to 2.46) Very often or always: OR 1.60 (95% CI 0.86 to 2.98) compared with never or very seldom | M (14) |
| 4 | Gluschkoff | 2017 | Finland | Teachers | 4988 (77) | Threats and violence during the preceding year, ‘no’ or ‘yes’ | Disturbed sleep during the previous 4 weeks, Jenkins Sleep Problem Scale. Scale range from 1 ‘never’ to 6 ‘nearly every night’. Dichotomised with symptoms at least two to four times a week indicating disturbed sleep. | Age, gender | Three measures with 2-year intervals | Log-binomial regression analysis using generalised estimating equations | RR 1.26 (95% CI 1.07 to 1.48) | M (16) |
| 5 | Kind | 2018 | Switzerland | Caregivers (social education workers) in residential youth welfare institutions | 121 (62) | Verbal threats during the past 3 months, categorised into ‘verbal aggression’ vs ‘no aggression’ | Symptoms of burnout during the previous 3 weeks, Burnout Screening Scales, BOSS. Dichotomised, T-score ≥60. | Age, sex, work experience (years), employment in current institution (years), private stressors | 10.5 months (mean) | Cox proportional hazards analysis | HR 1.67 (95% CI 1.09 to 2.58) | L (17) |
| 6 | Magnavita | 2013 | Italy | Physicians, nurses and other hospital employees | 627 (57.3) | Physical aggression, Violent Incident Form, dichotomised (not described how) | Anxiety, Goldberg scales ranging 0 to 9, dichotomised with cut-point at 5 | Age, gender, job, department | 2 years | Logistic regression analysis | OR 5.00 (95% CI 2.27 to 11.0) | M (13) |
| Depression, Goldberg scales ranging 0 to 9, dichotomised with cut-point at 2 | Age, gender, job, department | Logistic regression analysis | OR 4.04 (95% CI 1.89 to 8.62) | M (13) | ||||||||
| 7 | Pihl-Thingvad | 2019 | Denmark | Social educators working with disabled adults | 1823 | Patient-initiated threats of physical violence, physical violence, severe assaults within the previous month, categorised into no, low and high exposure | Burnout symptoms, Copenhagen Burnout Inventory (CBI), 0=never to 4=always | Age, gender, somatic health, mental health, lifestyle factors, work-related factors, support, coping strategies | 1 year | Difference in burnout at baseline and follow-up measured with ANOVA, within and between subject design, general linear models for repeated measures | Low exposed 0.9 (0.3–2.6) High exposed 3.0 (0.5–3.5) Both exposed groups differ significantly from the non-exposed group | H (12) |
| 8 | Pihl-Thingvad | 2019 | Denmark | Social educators working with disabled adults | 1763 | Patient-initiated threats of physical violence, physical violence, severe assaults within the previous month, frequency and severity | Post-traumatic stress disorder (PTSD), The International Trauma Questionnaire, 0=non-clinical 1=subclinical and clinical PTSD | Gender, age, BMI, alcohol, years of experience, critical incidents outside work, PTSD at baseline, trauma coping self-efficacy, workplace social capital, training, mutual adjustment frequency/severity | 1 year | Binary logistic regression |
Frequency
Low OR 4 (CI 1.0 to 16.3) Medium OR 5.9 (CI 1.4 to 24.2) High OR 6.5 (CI 1.6 to 25.6) Severity Mild violence OR 3.8 (CI 0.3 to 46.2) Threats OR 5.4 (CI 1.2 to 24.2) Moderate OR 2.6 (CI 0.6 to 10.8) Severe OR 6.5 (CI 1.6 to 26.0) | M (13) |
| 9 | Sundin | 2011 | Sweden | Nurses | 775 (94.3) | Threats and violence, 3 items, ie, aggressive and threatening patients, being exposed to violence | Burnout, Maslach Burnout Inventory, emotional exhaustion and depersonalisation, both dimensions scored on a scale from 0 (never/low burnout) to 6 (every day/ high burnout score) and dichotomised according to normative values in a medical sample | Age, gender, marital status, number of years in profession, number of years in current work place | 1 year | Logistic regression analysis | n.s. | L (17) |
| Sickness absence | ||||||||||||
| 1 | Aagestad | 2014 | Norway | Health and social workers | 925 (100) | Threats and violence during the past 12 months, Statistics Norway, dichotomised ‘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, sick leave at baseline | 1 year | Logistic regression analysis | n.s. | M (13) |
| 2 | Clausen | 2012 | Denmark | Employees in elder-care | 9520 (100) | Threats during the past 12 months. 1 ‘never exposed’, 2 ‘occasionally exposed’, 3 ‘frequently exposed’ | Registerbased long-term sickness absence, 8 or more consecutive weeks | Age, job function, tenure, BMI, smoking status, psychosocial working conditions | 1 year | Cox proportional hazards analysis | HR 1.52* (95% CI 1.11 to 2.07) | M (14) |
| Violence during the past 12 months. 1 ‘never exposed’, 2 ‘occasionally exposed’, 3 ‘frequently exposed’ | Register-based long-term sickness absence, 8 or more consecutive weeks | Age, job function, tenure, BMI, smoking status, psychosocial working conditions | 1 year | Cox proportional hazards analysis | HR 1.54 (95% CI 1.06 to 2.25) | M (14) | ||||||
| 3 | Rugulies | 2007 | Denmark | Human service workers (healthcare and social workers) | 890 (84) | Violence and threats of violence from clients during the past 12 months. Dichotomised into ‘no incidence’ and ‘at least one incidence’ | Self-reported days of sickness absence during the past 12 months | Age, gender, organisation, family status, children below the age of 7 at home, smoking, alcohol consumption, leisure time physical activity, BMI, socioeconomic status, baseline sickness absence | 3 years | Poisson regression analysis | RR 1.56 (95% CI 1.29 to 1.90) | M (15) |
| Physical health outcomes | ||||||||||||
| 1 | Camerino | 2008 | Eight European countries | Nurses | 34 107 (89.3) | Violence by patients/relatives, generally. Dichotomised into ‘no frequent violence’ and ‘frequent violence’ | Perceived health, SF-36. Scale range 1 ‘definitely false’ to 5 ‘definitely true’ | Country, gender, age, location of birth, occupational position, clinical setting, work shifts, work hours | 1 year | Hierarchical linear regression analysis | n.s. | M (16) |
| 2 | Miranda | 2014 | USA | Clinical staff in nursing homes | 344 (94) | Physical assault (in the past 3 months, having been hit, kicked, grabbed, shoved, pushed or scratched by a patient, patient’s visitor or family member while at work); analysed as (a) 0=no, 1=1–2 times, 2=3 or more times; (b) cumulative exposure over 2-year follow-up 1=none, 2=occasional, 3=frequent, 4=persistent | Musculoskeletal pain, self-reported wrt the preceding 3 months (a) in any of four specified body areas, (b) widespread pain, (c) pain intensity, (d) pain interfering with work, (e) pain interfering with sleep, (f) pain co-occurring with depressive symptoms | Age, gender, ethnic background, education, organisational unit, job demands, control, supervisor support, physically demanding, work–family interference | 2 years (three measurement points at 0, 12 and 24 months) | Log-binomial regression modelling | Physical assault at baseline increased the risk of all pain outcomes at 1-year follow-up, highest PR for widespread pain (PR 2.5 (95% CI 1.3 to 4.7) for 1–2 times and PR 2.4 (95% CI 1.3 to 4.4) for 3+ times compared with 0 times). Cumulative exposure to physical assault predicted most pain outcomes, highest PRs for widespread pain (PR 2.8 (95% CI 1.2 to 6.7) for occasional, PR 3.2 (95% CI 1.4 to 7.3) for frequent and PR 2.0 (95% CI 0.8 to 5.0) for persistent exposure to violence compared with none) | M (14) |
*HRs of frequently exposed compared with never exposed.
ANOVA, analysis of variance; BMI, body mass index; L, low; M, medium; n.s., statistically non-significant; PR, prevalence ratio; Quality H, high; RR, rate ratio.