Relationships between workplace violence, psychological symptoms, and adverse events: a nationwide cohort study of Chinese nurses

Abstract

Background: Nurses in China are disproportionately exposed to workplace violence. Rates of psychological symptoms and adverse events among Chinese nurses have increased in recent years. To evaluate whether workplace violence is associated with psychological symptoms and adverse events among nurses.

Methods: This study is a cross-sectional analysis using baseline data from the Nurses' Mental Health Study (NMHS), conducted across 67 tertiary hospitals in 31 regions of China to assess the mental health of nurses. Workplace violence (WPV) from patients and their relatives was assessed using the Workplace Violence Scale (WVS). Outcomes included depressive symptoms (PHQ-9), anxiety (GAD-7), obsessive-compulsive symptoms (SCL-90-R), burnout, insomnia, and adverse events. To reduce selection bias, propensity score matching was applied, followed by multivariable logistic regression to examine associations between WPV, psychological symptoms, and adverse events.

Results: A total of 105,614 nurses participated, with 93.1 % female and 66.0 % married. WPV was reported by 30.3 % (n = 32,027). Before matching, the prevalence of depression, anxiety, obsessive-compulsive symptoms, burnout, and insomnia was 53.0 %, 36.5 %, 74.2 %, 42.4 %, and 22.1 %, respectively. Adverse events were reported by 32.3 % of nurses. Nurses exposed to WPV were significantly more likely to report psychological symptoms and adverse events than those who were not.

Conclusions: WPV from patients and their relatives was significantly associated with increased psychological symptoms and adverse events among Chinese nurses. Reducing WPV in healthcare settings may improve both nurse well-being and patient safety.

Keywords: Adverse events; China; Nurse; Psychological symptoms; Workplace violence.