Skip to main content
SpringerLink
Log in

Workplace bullying and post-traumatic stress symptoms among family physicians in Lithuania: An occupation and region specific approach

  • Original Paper
  • Published:
International Journal of Occupational Medicine and Environmental Health

Abstract

Objectives

The study investigated associations between workplace bullying and post-traumatic stress symptoms as compared to and controlled for associations between the latter and other psychosocial stress factors at work and in everyday life. The study employed a representative sample of Lithuanian family physicians, hence investigated a particularly resourceful occupational group in a geographical region earlier found to have a high risk context for exposure to bullying at work.

Material and Methods

With a response rate of 89.2%, a total of 323 family physicians filled in an anonymous questionnaire on workplace bullying, post-traumatic symptomatology (IES-R), other psychosocial stressors at work and in everyday life, personal health resources (sense of coherence), behavioral characteristics and demographic variables. The statistical software SPSS 14.0, Windows was used in the analysis. Associations were tested using a multivariate logistic regression analysis.

Results

A high prevalence of bullying was found among family physicians in Lithuania, with 13% of them experiencing severe workplace bullying and 17.3% experiencing more occasional incidents of bullying. The prevalence of post-traumatic stress symptoms was also high with 15.8% scoring above the standardized cut-off thresholds for post-traumatic stress disorder. The odds ratio (OR) of severe bullying for post-traumatic stress after adjustment for age and gender was 8.05 (95% confidence intervals (CI): 3.80–17.04). In the fully adjusted model it increased to 13.88 (95% CI: 4.68–41.13) indicating cumulative effects of all the investigated stressors.

Conclusions

Workplace bullying is particularly prevalent among Lithuanian family physicians, as are the symptoms of post-traumatic distress. Strong associations between post-traumatic stress and exposure to severe bullying indicate that bullying is a significant source of mental health.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Matthiesen SB, Einarsen S. Psychiatric distress and symptoms of PTSD among victims of bullying at work. Br J Guid Counc. 2004;32(3):335–356, http://dx.doi.org/10.1080/03069880410001723558.

    Article  Google Scholar 

  2. Nielsen MB, Matthiesen SB, Einarsen S. Sense of coherence as a protective mechanism among targets of workplace bullying. J Occup Health Psychol. 2008;13(2):128–136, http://dx.doi.org/10.1037/1076-8998.13.2.128.

    Article  PubMed  Google Scholar 

  3. Caine RM, Ter-Bagdasarian L. Early identification and management of critical incident stress. Crit Care Nurse. 2003;23(1):59–65.

    PubMed  Google Scholar 

  4. Shalev AY. Post-traumatic stress disorder (PTSD) and stress related disorders. Psychiatr Clin North Am. 2009;32(3):687–704, http://dx.doi.org/10.1016/j.psc.2009.06.001.

    Article  PubMed Central  PubMed  Google Scholar 

  5. Mikkelsen EG, Einarsen S. Basic assumptions and symptoms of post-traumatic stress among victims of bullying at work. Eur J Work Organ Psychol. 2002;11(1):87–111, http://dx.doi.org/10.1080/13594320143000861.

    Article  Google Scholar 

  6. Nielsen MB, Hetland J, Matthiesen SB, Einarsen S. Longitudinal relationships between workplace bullying and psychological distress. Scand J Work Environ Health. 2012;38(1):38–46, http://dx.doi.org/10.5271/sjweh.3178.

    Article  PubMed  Google Scholar 

  7. van de Vliert E, Einarsen S, Nielsen MB. Are national levels of employee harassment cultural covariations of climato-economic conditions? Work Stress. 2013;27(1):106–122, http://dx.doi.org/10.1080/02678373.2013.760901.

    Article  Google Scholar 

  8. Hauge LJ, Skogstad A, Einarsen S. Relationship between stressful work environments and bullying: Results of a large representative study. Work Stress. 2007;21(3):220–242, http://dx.doi.org/10.1080/02678370701705810.

    Article  Google Scholar 

  9. Glasø L, Bele E, Nielsen MB, Einarsen S. Bus drivers’ exposure to bullying at work: An occupation-specific approach. Scand J Psychol. 2011;52(5):484–493, http://dx.doi.org/10.1111/j.1467-9450.2011.00895.x.

    Article  PubMed  Google Scholar 

  10. Malinauskiene V, Obelenis V, Sopagiene D. Psychological terror at work and cardiovascular diseases among teachers. Acta Med Lituanica. 2005;12(2):20–25.

    Google Scholar 

  11. Einarsen S, Hoel H, Zaph D, Cooper CL. The concept of bullying at work: The European tradition. In: Einarsen S, Hoel H, Zaph D, Cooper CL, editors. Bullying and harassment in the workplace. London: Taylor & Francis; 2011. p. 3–40.

    Google Scholar 

  12. Hoel H, Cooper CL, Faragher B. The experience of bullying in Great Britain: The impact of organizational status. Eur J Work Organ Psychol. 2001;10(4):443–465, http://dx.doi.org/10.1080/13594320143000780.

    Article  Google Scholar 

  13. Leymann H, Gustafsson A. Mobbing at work and the development of post-traumatic stress disorder. Eur J Work Organ Psychol. 1996;5(2):251–275, http://dx.doi.org/10.1080/13594329608414858.

    Article  Google Scholar 

  14. Berthelsen M, Skogstad A, Lau B, Einarsen S. Do they stay or do they go? A longitudinal study of intensions to leave and exclusion from working life among targets of workplace bullying. Int J Manpower. 2011;32(2):178–193, http://dx.doi.org/10.1108/01437721111130198.

    Article  Google Scholar 

  15. Johnson SL. International perspectives on workplace bullying among nurses: A review. Int Nurs Rev. 2009;56(1):34–40, http://dx.doi.org/10.1111/j.1466-7657.2008.00679.x.

    Article  CAS  PubMed  Google Scholar 

  16. Quine L. Workplace bullying in nurses. J Health Psychol. 2001;6(1):73–84, http://dx.doi.org/10.1177/135910530100600106.

    Article  CAS  PubMed  Google Scholar 

  17. Sterud T, Ekeberg Ø, Hem E. Health status in the ambulances services: A systematic review. BMC Health Serv Res. 2006;6:82, http://dx.doi.org/10.1186/1472-6963-6-82.

    Article  PubMed Central  PubMed  Google Scholar 

  18. Frank E, Carrera JS, Stratton T, Bickel J, Nora LM. Experiences of belittlement and harassment and their correlates among medical students in the United States: Longitudinal survey. BMJ. 2006;333:682, http://dx.doi.org/10.1136/bmj.38924.722037.7C.

    Article  PubMed Central  PubMed  Google Scholar 

  19. Martin WF. Is your hospital safe? Disruptive behavior and workplace bullying. Hosp Top. 2008;86(3):21–28, http://dx.doi.org/10.3200/HTPS.86.3.21-28.

    Article  PubMed  Google Scholar 

  20. Kowalenko T, Walters BL, Khare RK, Compton S. Workplace violence: A survey of emergency physicians in the state of Michigan. Ann Emerg Med. 2005;46(2):142–147, http://dx.doi.org/10.1016/j.annemergmed.2004.10.010.

    Article  PubMed  Google Scholar 

  21. Kansagra SM, Rao SR, Sullivan AF, Gordon JA, Magid DJ, Kaushal R, et al. A survey of workplace violence across 65 U.S. emergency departments. Acad Emerg Med. 2008;15(12):1268–1274, http://dx.doi.org/10.1111/j.1553-2712.2008.00282.x.

    Article  PubMed Central  PubMed  Google Scholar 

  22. Wood D. Bullying and harassment in medical schools. BMJ. 2006;333:664–665, http://dx.doi.org/10.1136/bmj.38954.568148.BE.

    Article  PubMed Central  PubMed  Google Scholar 

  23. Stebbing J, Mandalia S, Portsmouth S, Leonard P, Crane J. A questionnaire survey of stress and bullying in doctors undertaking research. Postgrad Med J. 2004;80:93–96, http://dx.doi.org/10.1136/pmj.2003.009001.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  24. Cheema S, Ahmad K, Giri SK, Kaliaperumal VK, Naqvi SA. Bullying of junior doctors prevails in Irish health system: A bitter reality. Ir Med J. 2005;98(9):274–275.

    CAS  PubMed  Google Scholar 

  25. Andersen GR, Aasland OG, Fridner A, Lovseth LT. Harassment among university hospital physicians in four European cities. Results from a cross-sectional study in Norway, Sweden, Iceland and Italy (the HOUOE study). Work. 2010;31(1):99–110.

    Google Scholar 

  26. Nagata-Kobayashi S, Maeno T, Yoshizu M, Shimbo T. Universal problems during residency: Abuse and harassment. Medical Education. 2009;(43):628–636, http://dx.doi.org/10.1111/j.1365-2923.2009.03388.x.

    Article  PubMed  Google Scholar 

  27. Miedema B, Easley J, Fortin P, Hamilton R, Tatemichi S. Disrespect, harassment, and abuse. Can Fam Physician. 2009;55:279–285.

    PubMed Central  PubMed  Google Scholar 

  28. Miedema B, Hamilton R, Lambert-Lanning A, Tatemichi S, Lemire F, Manca D, et al. Prevalence of abusive encounters in the workplace of family physicians: A minor, major, or severe problem? Can Fam Physician. 2010;56(3):e101–e108.

    PubMed Central  PubMed  Google Scholar 

  29. Sansone R, Sansone L, Wiederman M. Patient bullying: A survey of physicians in primary care. Prim Care Companion J Clin Psychiatry. 2007;9(1):56–58, http://dx.doi.org/10.4088/PCC.v09n0110.

    Article  PubMed Central  PubMed  Google Scholar 

  30. Koritsas S, Coles J, Boyle M, Stanley J. Prevalence and predictors of occupational violence and aggression towards GPs: A cross-sectional study. Br J Gen Pract. 2007;57(545): 967–970, http://dx.doi.org/10.3399/096016407782604848.

    Article  PubMed Central  PubMed  Google Scholar 

  31. Jankowiak B, Kowalczuk K, Krajewska-Kulak E, Sierakowska M, Lewko J, Klimaszewska K. Exposure the doctors to aggression in the workplace. Adv Med Sci. 2007;52Suppl 1:89–92.

    PubMed  Google Scholar 

  32. Nielsen MB, Matthiesen SB, Einarsen S. The impact of methodological moderators on prevalence rates of workplace bullying. A meta-analysis. J Occup Organ Psychol. 2010;83(4):955–979, http://dx.doi.org/10.1348/096317909X481256.

    Article  Google Scholar 

  33. Taylor KRF. Excessive work hours of physicians in training in El Salvador: Putting patients at risk. PloS Med. 2007;4(7):e205, http://dx.doi.org/10.1371/journal.pmed.0040205.

    Article  Google Scholar 

  34. Buddeberg-Fishcher B, Stamn M, Buddeberg C, Klaghofer R. Chronic stress experience in young physicians: Impact of person- and workplace-related factors. Int Arch Occup Environ Health. 2010;83:373–379, http://dx.doi.org/10.1007/s00420-009-0467-9.

    Article  Google Scholar 

  35. Buddeberg-Fishcher B, Klaghofer R, Stamm M, Siegrist J, Buddeberg C. Work stress and reduced health in young physicians: Prospective evidence from Swiss residents. Int Arch Occup Environ Health. 2008;82:31–38, http://dx.doi.org/10.1007/s00420-008-0303-7.

    Article  Google Scholar 

  36. Einav S, Shalev A, Ofek H, Freedman S, Matot I, Weiniger C. Differences in psychological effects in hospital doctors with and without post-traumatic stress disorder. Br J Psychiatry. 2008;193(2):165–166, http://dx.doi.org/10.1192/bjp.bp.108.051532.

    Article  PubMed  Google Scholar 

  37. Lubin G, Sids C, Vishne T, Shochat T, Osfiels Y, Shmushkevitz M. Acute stress disorder and post-traumatic stress disorder among medical personnel in Judea and Samaria areas in the years 2000–2003. Mil Med. 2007;172(4):376–378.

    PubMed  Google Scholar 

  38. Mills L, Mills T. Symptoms of post-traumatic stress disorder among emergency medicine residents. J Emerg Med. 2005;28(1):1–4, http://dx.doi.org/10.1016/j.jemermed.2004.05.009.

    Article  PubMed  Google Scholar 

  39. Wilberforce N, Wilberforce K, Bassler K. Post-traumatic stress disorder in physicians from an underserviced area. Family Practice. 2010;27:339–343, http://dx.doi.org/10.1093/fampra/cmq002.

    Article  PubMed  Google Scholar 

  40. Ahmer S, Yousafzai AW, Siddigi M, Faruqui R, Khan R, Zuberi S. Bullying of trainee psychiatrists in Pakistan: A cross-sectional questionnaire survey. Acad Psychiatry. 2009;33(4):335–339, http://dx.doi.org/10.1176/appi.ap.33.4.335.

    Article  PubMed  Google Scholar 

  41. Haoka T, Sasahara S, Tomotsune Y, Yoshino S, Maeno T, Matsuzaki I. The effect of stress-related factors on mental health status among resident doctors in Japan. Med Educ. 2010;44(8):826–834, http://dx.doi.org/10.1111/j.1365-2923.2010.03725.x.

    Article  PubMed  Google Scholar 

  42. Weiss DS, Marmar CR. The Impact of Event Scale-Revised. In: Wilson JP, Keane TM, editors. Assessing psychological trauma and PTSD. New York: Guildford Press; 1997. p. 399–411.

    Google Scholar 

  43. Creamer M, Bell R, Failla S. Psychometric properties of the impact of event scale-revised. Behav Res Ther. 2003;41(12):1489–1496, http://dx.doi.org/10.1016/j.brat.2003.07.010.

    Article  PubMed  Google Scholar 

  44. Einarsen S, Hoel H, Notelaers G. Measuring exposure to bullying and harassment at work: Validity, factor structure and psychometric properties of the Negative Acts Questionnaire-Revised. Work Stress. 2009;23(1):24–44, http://dx.doi.org/10.1080/02678370902815673.

    Article  Google Scholar 

  45. Malinauskiene V, Theorell T, Grazuleviciene R, Azaraviciene A, Obelenis V, Azelis V. Psychosocial factors at work and myocardial infarction among men in Kaunas, Lithuania. Scand J Work Environ Health. 2005;31(3):218–223, http://dx.doi.org/10.5271/sjweh.872.

    Article  PubMed  Google Scholar 

  46. Antonovsky A. Unraveling the mystery of health: How people manage stress and stay well. San Francisco, CA: Jossey-Bass; 1987.

    Google Scholar 

  47. Lundberg O, Nystrom Peck M. A simplified way of measuring sense of coherence. Eur J Public Health. 1995;5:56–59, http://dx.doi.org/10.1093/eurpub/5.1.56.

    Article  Google Scholar 

  48. Lauterbach D, Vora R, Rakow M. The relationship between posttraumatic stress disorder and self-reported health problems. Psychosom Med. 2005;67(6):939–947, http://dx.doi.org/10.1097/01.psy.0000188572.91553.a5.

    Article  PubMed  Google Scholar 

  49. Jonsson A, Segesten K, Mattsson B. Post-traumatic stress among Swedish ambulance personnel. Emerg Med J. 2003;20:79–84, http://dx.doi.org/10.1136/emj.20.1.79.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  50. Sareen J, Cox B, Stein M, Afifi T, Fleet C, Asmundson G. Physical and mental comorbidity, disability, and suicidal behavior associated with posttraumatic stress disorder in a large community sample. Psychosom Med. 2007;69:242–248, http://dx.doi.org/10.1097/PSY.0b013e31803146d8.

    Article  PubMed  Google Scholar 

  51. Mills KL, Teeson M, Ross J, Peters L. Trauma, PTSD, and substance use disorders: Findings from the Australian national survey of mental health and well-being. Am J Psychiatry. 2006;163:651–658, http://dx.doi.org/10.1176/appi.ajp.163.4.652.

    Article  Google Scholar 

  52. Nielsen M, Skogstad A, Matthiesen S, Glas L, Asland M, Notelaers G, et al. Prevalence of workplace bullying in Norway: Comparisons across time and estimation methods. Eur J Work Organ Psychol. 2009;18(1):81–101, http://dx.doi.org/10.1080/13594320801969707.

    Article  Google Scholar 

  53. Janson G, Hazler R. Trauma reactions of bystanders and victims to repetitive abuse experiences. Violence Vict. 2004;19(2):239–255.

    PubMed  Google Scholar 

  54. Kivimaki M, Elovainio M, Vahtera J. Workplace bullying and sickness absence in hospital staff. Occup Environ Med. 2000;57:656–660, http://dx.doi.org/10.1136/oem.57.10.656.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  55. Lutgen-Sandvik P, Tracy SJ, Alberts JK. Burned by bullying in the American workplace: Prevalence, perception, degree and impact. J Manag Stud. 2007;44(6):837–862, http://dx.doi.org/10.1111/j.1467-6486.2007.00715.x.

    Article  Google Scholar 

  56. Moayed FA, Daraiseh N, Shell R, Salem S. Workplace bullying: A systematic review of risk factors and outcomes. Theor Issues Ergon. 2006;7(3):311–327, http://dx.doi.org/10.1080/14639220500090604.

    Article  Google Scholar 

  57. de Boer J, Lok A, Van’t Verlaat E, Duivenvoorden HJ, Bakker AB, Smit BJ. Work-related critical incidents in hospital-based health care providers and the risk of post-traumatic stress symptoms, anxiety, and depression: A meta-analysis. Soc Sci Med. 2011;73(2):316–326, http://dx.doi.org/10.1016/j.socscimed.2011.05.009.

    Article  PubMed  Google Scholar 

  58. Brewin RC, Andrews B, Valentine JD. Meta-analysis of risk factors for posttraumatic stress disorder in trauma-exposed adults. J Consult Clin Psychol. 2000;68(5):748–766, http://dx.doi.org/10.1037/0022-006X.68.5.748.

    Article  CAS  PubMed  Google Scholar 

  59. Finne LB, Knardahl S, Lau B. Workplace bullying and mental distress - A prospective study of Norwegian employees. Scand J Work Environ Health. 2011;37(4):276–287, http://dx.doi.org/10.5271/sjweh.3156.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Occupational and Environmental Medicine, Laboratory of Population Studies, Lithuanian University of Health Sciences, Kaunas, Lithuania

    Vilija Malinauskiene

  2. Department of Health, Social and Physical Education, Lithuanian Sports University, Kaunas, Lithuania

    Vilija Malinauskiene

  3. Department of Psychosocial Science, University of Bergen, Bergen, Norway

    Staale Einarsen

Authors
  1. Vilija Malinauskiene
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Staale Einarsen
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Vilija Malinauskiene.

Additional information

The study has been partially supported by the Nordic Council of Ministers information office (project code DVP/13).

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Malinauskiene, V., Einarsen, S. Workplace bullying and post-traumatic stress symptoms among family physicians in Lithuania: An occupation and region specific approach. IJOMEH 27, 919–932 (2014). https://doi.org/10.2478/s13382-014-0328-y

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.2478/s13382-014-0328-y

Key words

Search

Navigation