Workplace Violence and Staff Well-Being: Everyday Hassles and Acute Crises

Background: Workplace violence (WPV) in psychiatric settings has widespread implications for patients, staff, and institutions. WPV may be perpetrated by patients, visitors, or staff and encompasses assault and aggression.  Assault incorporates a range of physically violent acts while aggression consists of verbal threats, insults, and criticism.  Prior research has focused on risk factors for patient violence or staff conflict. The current study tests a more comprehensive model of WPV by (a) examining the relationships between different facets of WPV and staff's well-being, and (b) determining whether staff reactivity to social conflict (aggression) or distress over assault moderates those relationships.  

Methods: The sample included 328 staff at a large public mental hospital who completed a one-hour online survey about their occupational stressors and strains (26% response rate). WPV was estimated using measures of staff relationships (conflict and criticism from other staff), frequency and severity of patient-on-staff assaults, frequency of patient-on-staff aggression, and frequency that staff used patient containment procedures.  Reactions to social conflict, assault, and anger were estimated as distress and trauma indices. Outcome measures included estimates of well-being (physical health, mental health, safety). Hierarchical linear regressions were used to test whether the relationships between WPV factors and well-being are moderated by reactivity to social conflict or distress over assault. All analyses controlled for gender, position, and job experience.

Results: The sample was 67% female and 40% Caucasian. The majority of staff were psychiatric technicians (40.5%) or nurses (18.9%), 36.7% were clinical staff (e.g., psychologists, social workers), and 3.9% were supervisors (administrative, clinical). In the last year, 69.8% of staff reported at least one physical assault incident and 78.3% used patient containment procedures. Verbal aggression was common, as 98% reported verbal aggression from patients, 94.2% reported conflict and 93.5% reported criticism from other staff.

Physical Health. Poorer physical health was significantly related to more frequent patient aggression (β=.16, p=.04) and anger (β=.34, p<.001; model R²=26%). There were no main effects or moderation of WPV by distress indices.

Mental Health. Reactivity to social conflict moderated the association of staff conflict with mental health (β=.20, p< .01).  Specifically, among staff with high reactivity to social conflict, those who experienced frequent conflict reported poorer mental health, while those who experienced infrequent conflict reported better mental health. Among staff with low reactivity to social conflict, mental health was unaffected by conflict frequency.  Staff with more experience, frequent anger, and less frequent use of containment procedures reported poorer mental health (model R²=18.8%). 

Safety. WPV and controls accounted for 26.1% of the variance in perceived safety at work. Staff who reported more aggression from patients and other staff, and who were reactive to social conflict reported feeling unsafe.

Implications. WPV is a common stressor for psychiatric staff - but assault was not related to their well-being. Among psychiatric workers, who may be prepared for patient assaults, the greater challenges for their well-being are the everyday verbal aggressions from staff and patients, with important implications for interventions aimed at improving staff's well-being and, consequently, the functioning of hospitals.