The Prevalence And Influencing Factors Of Workplace Violence And Burnout Among Mental Health Professionals In China

Objective:Workplace violence(WPV)is defined as verbal abuse,threats or assaults against staff in work-related situations(including commuting)that pose explicit or implicit challenges to their safety,well-being or health.It cuts across different work settings and occupational groups and is one of the main sources of inequality,discrimination,stigma and conflict in the workplace.Workplace violence against health professionals is a global concern and affects workers in virtually all health care settings.A study showed that more than 60%of health professionals had experienced at least one form of workplace violence in the past 12 months.Workplace violence not only poses a direct threat to the physical health of healthcare workers,but also has a negative impact on individual mental health,and the productivity and safety of healthcare workers.In addition,exposure of workplace violence is associated with higher levels of burnout among medical staff.Mental health professionals are often at higher risk of violence due to the unique nature of their work environment and the population they serve.In this study,a cross-sectional,multicenter survey was conducted to investigate workplace violence and burnout among mental health professionals(psychiatrists,nurses,and psychologists)in provincial psychiatric institutions nationwide.Methods:This study was conducted as part of the 2020 National Hospital Performance Evaluation Survey with the mental health topic by National Health Commission between January 11 to March 15,2021.A total of 16,220 mental health professionals from 41 psychiatric hospitals in 29 provinces and autonomous regions invited to participate.General sociodemographic information was collected,including profession,gender,age,marital status,education level,professional title,region,monthly income,and working hours per week.The revised Chinese version of the Hospital Workplace Violence Questionnaire was used to assess the workplace experiences in the past 12 months;the Maslach Burnout Inventory-Human Service Survey(MBI-HSS)was used to assess burnout symptoms among mental health professionals.We compared the prevlence of workplace violence and burnout among professionals with different characteristics,analyzed the factors associated with workplace violence and burnout,respectively,and explored the relationship between them.Results:(1)A total of 14487 questionnaires were returned(response rate of 89.3%),and 568 were excluded using logical question setting.The data from 13,919 questionnaires(effective rate of 96.1%)was finally included in the statistical analysis,including 3877 psychiatrists(27.9%),9615 nurses(69.1%),and 427 psychologists(3.1%).Among them,26.2%were male and 73.8%were female;In terms of age,those aged 30-39 years accounted for the most(45.5%),and those in other age groups were<30 years old(24.3%),40-49 years old(18.6%)and?50 years old(11.7%)in order of their percentage.In terms of marital status,74.8%were married,21.1%were unmarried,and 4.1%were divorced/widowed.In terms of education level,67.1%have a bachelor's degree,21.1%have a college degree,10.1%have a master's degree,and 1.8%have a doctorate degree.(2)The prevalence of at least one type of workplace violence reported by mental health professionals in the past 12 months was 72.5%(95%confidence interval[CI]:71.7%-73.2%),and the prevalence of verbal violence,physical violence,and sexual violence was 69.5%(95%CI:68.7%-70.2%),46.3%(95%CI:45.5%-47.1%),and 21.0%(95%CI:20.3%-21.7%),respectively.Overall,psychiatric nurses had the highest risk of violence,followed by psychiatrists and psychologists;Males had a higher prevalence of violence than females,especially in terms of physical violence;In addition,middle professional title,location in eastern China,higher monthly income,and longer working hours per week were associated with a higher risk of violence.(3)The prevalence of emotional exhaustion,depersonalization,and low personal accomplishment was 14.9%(95%CI:14.3%-15.5%),23.2%(95%CI:22.5%-23.9%),and 57.3%(95%CI:56.5%-58.1%),respectively.Overall,psychiatric nurses reported the highest prevalence of burnout,followed by psychiatrists and psychologists;Being male,middle age(e.g.,30-39 years),unmarried,low monthly income,and longer working hours per week were associated with a higher risk of burnout.(4)Exposure to workplace violence among mental health professionals was significantly associated with an increased risk of burnout(emotional exhaustion and depersonalization),which remained significant after controlling for profession,gender,age,marital status,educational level,professional title,region,monthly income,and working hours per week.As the frequency of workplace violence increased,so did the risk of burnout.Mental health professionals with the most frequent exposure to violence(a few times a week vs never)had an 8-fold increased risk of emotional exhaustion(odd ratio[OR]=8.369,95%CI:7.031-9.963)and a 9-fold increased risk of depersonalization(OR=9.068,95%CI:7.840-10.489).And those with more frequent exposure to violence(a few times a month vs never)had a 4-fold increased risk of emotional exhaustion(OR=4.077,95%CI:3.439-4.835)and a 5-fold times increased risk of depersonalization(OR=4.756,95%CI:4.148-5.453).Conclusion:Workplace violence is frequently experienced by mental health professionals in China,especially physical and sexual violence.High risk of burnout is associated with exposure to workplace violence and increases with the frequency of exposure to workplace violence.Considering the direct and indirect harms of workplace violence to individuals,institutions,and society,policymakers and hospital administrators should take proactive steps to identify and address the distress of mental health professionals and ensure the safety of their work environment.Workplace violence against healthcare workers is a complex social and public problem whose prevention and control requires the involvement of patients,healthcare workers,institutions,the state,and society at large.Although it may not be possible to eliminate the occurrence of workplace violence in healthcare settings,reducing the frequency of the incident to some extent,or actively using measures to intervene after the incident,will greatly reduce the negative impact on healthcare professionals,improve the efficiency of healthcare services,and contribute to a safe,harmonious,and efficient healthcare environment.