Skip to main content
SpringerLink
Log in

Work-related threats and violence and post-traumatic symptoms in four high-risk occupations: short- and long-term symptoms

International Archives of Occupational and Environmental Health volume 92, pages 195–208 (2019)Cite this article

Abstract

Objectives

To examine the associations between exposure to work-related violence and threats and subsequent PTSD among males and females in four high-risk occupations in human service work. Furthermore, we examined the modifying effect of coping style and self-efficacy.

Methods

Questionnaire data were collected in 2011 and in 2015 from 2678 employees working in psychiatric wards, in the elder sector, in special schools and in the Prison and Probation Service (PPS). Exposure to work-related violence and threats was measured in 2011, while PTSD was measured in 2011 and 2015 by the Impact of Event Scale-Revised. To assess the associations, logistic regression was conducted, adjusted for bullying, sexual harassment, negative acts, conflicts at work, other private traumas and baseline PTSD.

Results

There was an association between work-related threats and PTSD in 2011 and 2015. Furthermore, there was an association between work-related violence and PTSD in 2011. The associations were strongest in the PPS. Male staff had a higher risk for PTSD. Neither coping style nor self-efficacy did modify the associations between exposure to work-related violence and threats and subsequent PTSD.

Conclusion

The prevention of PTSD following work-related violence and threats should first of all be based on reducing the risk of work-related violence. In addition, supervisors should be trained to detect symptoms of PTSD after exposure to traumatic events.

This is a preview of subscription content, access via your institution.

Access options

Buy single article

Instant access to the full article PDF.

USD 39.95

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

References

  • Abualrub RF, Al-Asmar AH (2011) Physical violence in the workplace among Jordanian hospital nurses. J Transcult Nurs 22(2):157–165

    Article  Google Scholar 

  • Andersen LP, Hogh A, Gadegaard C (2016) Risk factors for work-related threats and violence. Arbejdsmiljøforskningsfonden—The Danish Work Environment Fund, Copenhagen

    Google Scholar 

  • Andersen LP, Hogh A, Biering K, Gadegaard CA (2018) Work-related threats and violence in human service sectors: the importance of the psycho-social work environment examined in a multilevel prospective study. Work 59(1):141–154

    Article  Google Scholar 

  • Arnetz JE, Arnetz BB, Petterson IL (1996) Violence in the nursing profession: Occupational and lifestyle risk factors in Swedish nurses. Work Stress 10(2):119–127

    Article  Google Scholar 

  • Arnetz JE, Hamblin L, Russell J, Upfal MJ, Luborsky M, Janisse J et al (2017) Preventing patient-to-worker violence in hospitals: Outcome of a randomized controlled intervention. J Occup Environ Med 59(1):18–27

    Article  Google Scholar 

  • Asukai N, Kato H, Kawamura N, Kim Y, Yamamoto K, Kishimoto J et al (2002) Reliability and validity of the Japanese-language version of the impact of event scale-revised (IES-R-J): Four studies of different traumatic events. J Nerv Ment Dis 190(3):175–182

    Article  Google Scholar 

  • Benight CC, Bandura A (2004) Social cognitive theory of posttraumatic recovery: The role of perceived self-efficacy. Behav Res Ther 42(10):1129–1148

    Article  Google Scholar 

  • Bonde J, Utzon-Frank N, Bertelsen M, Borritz M, Eller N, Nordentoft M et al (2013) A scientific review addressing delayed onset posttraumatic stress disorder and posttraumatic depression. National Reseach Centre for Working Environment, København

    Google Scholar 

  • Breslau N, Davis GC (1992) Posttraumatic stress disorder in an urban population of young adults: risk factors for chronicity. Am J Psychiatry 149(5):671–675

    Article  CAS  Google Scholar 

  • Briere J, Agee E, Dietrich A (2016) Cumulative trauma and current posttraumatic stress disorder status in general population and inmate samples. Psychol Trauma Theory Res Pract Policy 8(4):439

    Article  Google Scholar 

  • Brown J, Mulhern G, Joseph S (2002) Incident-related stressors, locus of control, coping, and psychological distress among firefighters in northern Ireland. J Trauma Stress 15(2):161–168

    Article  Google Scholar 

  • Budd T (1999) Violence at work: findings from the British crime survey. Home Office, London

    Google Scholar 

  • Caldwell MF (1992) Incidence of PTSD among staff victims of patient violence. Hosp Commun Psychiatry 43(8):838–839

    CAS  Google Scholar 

  • Carlier IV, Lamberts RD, Gersons BP (1997) Risk factors for posttraumatic stress symptomatology in police officers: a prospective analysis. J Nerv Ment Dis 185(8):498–506

    Article  CAS  Google Scholar 

  • Carmel H, Hunter M (1989) Staff injuries from inpatient violence. Hosp Commun Psychiatry 40(1):41–46

    CAS  Google Scholar 

  • Carver CS (1997) You want to measure coping but your protocol’s too long: consider the brief COPE. Int J Behav Medi 4(1):92–100

    Article  CAS  Google Scholar 

  • Chen G, Gully SM, Eden D (2001) Validation of a new general self-efficacy scale. Organ Res Methods 4(1):62–83

    Article  CAS  Google Scholar 

  • Chen W, Hwu H, Kung S, Chiu H, Wang J (2008) Prevalence and determinants of workplace violence of health care workers in a psychiatric hospital in Taiwan. J Occup Health 50(3):288–293

    Article  Google Scholar 

  • Clausen T, Hogh A, Borg V (2012) Acts of offensive behaviour and risk of long-term sickness absence in the Danish elder-care services: a prospective analysis of register-based outcomes. Int Arch Occup Environ Health 85(4):381–387

    Article  Google Scholar 

  • Cohn A, Hodson S, Crane M (2010) Resilience training in the Australian defense force. InPsych Bull Austr Psychol Soc Ltd 32(2):16

    Google Scholar 

  • Creamer M, Bell R, Failla S (2003) Psychometric properties of the impact of event ScaleΓÇöRevised. Behav Res Ther 41(12):1489–1496

    Article  Google Scholar 

  • Dijkema MB, Grievink L, Stellato RK, Roorda J, Van der Velden PG (2005) Determinants of response in a longitudinal health study following the firework-disaster in Enschede, the Netherlands. Eur J Epidemiol 20(10):839–847

    Article  Google Scholar 

  • Einarsen S, Hoel H, Notelaers G (2009) Measuring exposure to bullying and harassment at work: validity, factor structure and psychometric properties of the negative acts questionnaire-revised. Work Stress 23(1):24–44

    Article  Google Scholar 

  • Engelhard IM, van den Hout MA, Kindt M (2003) The relationship between neuroticism, pre-traumatic stress, and post-traumatic stress: a prospective study. Personal Individ Differ 35(2):381–388

    Article  Google Scholar 

  • Evans J, Frank B (2003) Contradictions and tensions: exploring relations of masculinities in the numerically female-dominated nursing profession. J Men’s Stud 11(3):277

    Article  Google Scholar 

  • Fikretoglu D, Brunet A, Poundja J, Guay S, Pedlar D (2006) Validation of the deployment risk and resilience inventory in French-Canadian veterans: Findings on the relation between deployment experiences and post deployment health. Can J Psychiatry 51(12):755–763

    Article  Google Scholar 

  • Flannery RB, LeVitre V, Rego S, Walker AP (2011) Characteristics of staff victims of psychiatric patient assaults: 20-year analysis of the assaulted staff action program. Psychiatr Q 82(1):11–21

    Article  Google Scholar 

  • Folkman S (2013) Stress: appraisal and coping. Springer, New York

    Google Scholar 

  • Friborg O, Emaus N, Rosenvinge JH, Bilden U, Olsen JA, Pettersen G (2015) Violence affects physical and mental health differently: the general population based Tromsø study. PLoS One 10(8):e0136588

    Article  CAS  Google Scholar 

  • Friis K, Larsen FB, Lasgaard M (2017) Physical violence at work predicts health-related absence from the labor market: a 10-year population-based follow-up study. Psychol Violence. https://doi.org/10.1037/vio0000137

    Article  Google Scholar 

  • Gates DM, Ross CS, McQueen L (2006) Violence against emergency department workers. J Emerg Med 31(3):331–337

    Article  Google Scholar 

  • Gates DM, Gillespie GL, Succop P (2011) Violence against nurses and its impact on stress and productivity. Nurs Econ 29(2):59–67

    Google Scholar 

  • Gillespie GL, Gates DM, Miller M, Howard PK (2010) Violence against healthcare workers in a pediatric emergency department. Adv Emerg Nurs J 32(1):68–82

    Article  Google Scholar 

  • Gries CJ, Engelberg RA, Kross EK, Zatzick D, Nielsen EL, Downey L et al (2010) Predictors of symptoms of posttraumatic stress and depression in family members after patient death in the ICU. Chest J 137(2):280–287

    Article  Google Scholar 

  • Isenhardt A, Hostettler U (2016) Inmate violence and correctional staff burnout: The role of sense of security, gender, and job characteristics. J Interpers Violence. https://doi.org/10.1177/0886260516681156

    Article  Google Scholar 

  • Jacobowitz W (2013) PTSD in psychiatric nurses and other mental health providers: a review of the literature. Issues Ment Health Nurs 34(11):787–795

    Article  Google Scholar 

  • Kessler RC, Sonnega A, Bromet E, Hughes M, Nelson CB (1995) Posttraumatic stress disorder in the national comorbidity survey. Arch Gen Psychiatry 52(12):1048–1060

    Article  CAS  Google Scholar 

  • Kristensen TS, Hannerz H, Hogh A, Borg V (2005) The Copenhagen psychosocial questionnaire. A tool for the assessment and improvement of the psychosocial work environment. Scand J Work Environ Health 31(6):438–449

    Article  Google Scholar 

  • Lanctôt N, Guay S (2014) The aftermath of workplace violence among healthcare workers: a systematic literature review of the consequences. Aggress Violent Behav 19(5):492–501

    Article  Google Scholar 

  • Laposa JM, Alden LE, Fullerton LM (2003) Work stress and posttraumatic stress disorder in ED nurses/personnel (CE). J Emerg Nurs 29(1):23–28

    Article  Google Scholar 

  • Leather P, Lawrence C, Beale D, Cox T, Dickson R (1998) Exposure to occupational violence and the buffering effects of intra-organizational support. Work Stress 12(2):161–178

    Article  Google Scholar 

  • Littleton H, Horsley S, John S, Nelson DV (2007) Trauma coping strategies and psychological distress: a meta-analysis. J Trauma Stress 20(6):977–988

    Article  Google Scholar 

  • Luszczynska A, Benight CC, Cieslak R (2009) Self-efficacy and health-related outcomes of collective trauma. Eur Psychol 14(1):51–62

    Article  Google Scholar 

  • Matthiesen SB, Einarsen S (2004) Psychiatric distress and symptoms of PTSD among victims of bullying at work. Br J Guid Couns 32(3):335–356

    Article  Google Scholar 

  • Menckel E, Viitasara E (2002) Threats and violence in Swedish care and welfare. magnitude of the problem and impact on municipal personnel. Scand J Caring Sci 16(4):376–385

    Article  Google Scholar 

  • Nachreiner NM, Hansen HE, Okano A, Gerberich SG, Ryan AD, McGovern PM et al (2007) Difference in work-related violence by nurse license type. J Prof Nurs 23(5):290–300

    Article  Google Scholar 

  • Nielsen MB, Tangen T, Idsoe T, Matthiesen SB, Magerøy N (2015) Post-traumatic stress disorder as a consequence of bullying at work and at school. A literature review and meta-analysis. Aggress Violent Beh 21:17–24

    Article  Google Scholar 

  • Ozer EJ, Best SR, Lipsey TL, Weiss DS (2008) Predictors of posttraumatic stress disorder and symptoms in adults: a meta-analysis. Psychol Trauma Theory Res Pract Policy S(1):3–36

    Article  Google Scholar 

  • Pai H, Lee S (2011) Risk factors for workplace violence in clinical registered nurses in Taiwan. J Clin Nurs 20(9):1405–1412

    Article  Google Scholar 

  • Peñalba V, McGuire H, Leite JR (2008) Psychosocial interventions for prevention of psychological disorders in law enforcement officers. Cochrane Database of Syst Rev 2008(3):CD005601

    Google Scholar 

  • Perrin M, Vandeleur CL, Castelao E, Rothen S, Glaus J, Vollenweider P et al (2014) Determinants of the development of post-traumatic stress disorder, in the general population. Soc Psychiatry Psychiatr Epidemiol 49(3):447–457

    Article  Google Scholar 

  • Rash CJ, Coffey SF, Baschnagel JS, Drobes DJ, Saladin ME (2008) Psychometric properties of the IES-R in traumatized substance dependent individuals with and without PTSD. Addict Behav 33(8):1039–1047

    Article  Google Scholar 

  • Rasmussen CA, Hogh A, Andersen LP (2013) Threats and physical violence in the workplace: a comparative study of four areas of human service work. J Interpers Violence 28(13):2749–2769

    Article  Google Scholar 

  • Richter D, Berger K (2006) Post-traumatic stress disorder following patient assaults among staff members of mental health hospitals: a prospective longitudinal study. BMC Psychiatry 6(1):15

    Article  Google Scholar 

  • Rugulies R, Bultmann U, Aust B, Burr H (2006) Psychosocial work environment and incidence of severe depressive symptoms: prospective findings from a 5-year follow-up of the danish work environment cohort study. Am J Epidemiol 163(10):877–887

    Article  Google Scholar 

  • Saeki K, Okamoto N, Tomioka K, Obayashi K, Nishioka H, Ohara K et al (2011) Work-related aggression and violence committed by patients and its psychological influence on doctors. J Occup Health 53(5):356–364

    Article  Google Scholar 

  • Schat ACH, Kelloway EK (2003) Reducing the adverse consequences of workplace aggression and violence: the buffering effects of organizational support. J Occup Health Psychol 8(2):110–122

    Article  Google Scholar 

  • Schnider KR, Elhai JD, Gray MJ (2007) Coping style use predicts posttraumatic stress and complicated grief symptom severity among college students reporting a traumatic loss. J Counseling Psychol 54(3):344

    Article  Google Scholar 

  • Shin KM, Chang HY, Cho S, Kim NH, Kim KA, Chung YK (2015) Avoidance symptoms and delayed verbal memory are associated with post-traumatic stress symptoms in female victims of sexual violence. J Affect Disord 184:145–148

    Article  Google Scholar 

  • Skeffington PM, Rees CS, Mazzucchelli T (2017) Trauma exposure and post-traumatic stress disorder within fire and emergency services in western Australia. Austr J Psychol 69:20–28

    Article  Google Scholar 

  • Skogstad M, Skorstad M, Lie A, Conradi HS, Heir T, Weisæth L (2013) Work-related post-traumatic stress disorder. Occup Med 63(3):175–182

    Article  CAS  Google Scholar 

  • Somville FJ, De Gucht V, Maes S (2016) The impact of occupational hazards and traumatic events among belgian emergency physicians. Scand J Trauma Resusc Emerg Med 24(1):59

    Article  Google Scholar 

  • Spector PE, Zhou ZE, Che XX (2014) Nurse exposure to physical and nonphysical violence, bullying, and sexual harassment: a quantitative review. Int J Nurs Stud 51(1):72–84

    Article  Google Scholar 

  • Speroni KG, Fitch T, Dawson E, Dugan L, Atherton M (2014) Incidence and cost of nurse workplace violence perpetrated by hospital patients or patient visitors. J Emerg Nurs 40(3):218–228

    Article  Google Scholar 

  • Spinaris CG, Denhof MD, Kellaway JA (2012a) Posttraumatic stress disorder in united states corrections professionals: prevalence and impact on health and functioning. Desert Waters Correctional Outreach, Florence, pp 1–32

    Google Scholar 

  • Spinaris CG, Denhof MD, Kellaway JA (2012b) Posttraumatic stress disorder in united states corrections professionals: prevalence and impact on health and functioning (Retrieved from /z-wcorg/)

  • Spinaris C, Denhof M, Morton G (2013) Impact of traumatic exposure on corrections professionals. Desert Waters Correctional Outreach, Florence

    Google Scholar 

  • Tanielian T, Haycox LH, Schell TL, Marshall GN, Burnam MA, Eibner C et al (2008) Invisible wounds of war. Summary and recommendations for addressing psychological and cognitive injuries. Rand Cooperation, Santa Monica, CA, pp 1–67

    Book  Google Scholar 

  • Tolin DF, Foa EB (2006) Sex differences in trauma and posttraumatic stress disorder: a quantitative review of 25 years of research. Psychol Bull 132(6):959–992

    Article  Google Scholar 

  • Torkelson DJ, Seed MS (2011) Gender differences in the roles and functions of inpatient psychiatric nurses. J Psychosoc Nurs Ment Health Serv 49(3):34–41

    Google Scholar 

  • van der Ploeg E, Kleber RJ (2003) Acute and chronic job stressors among ambulance personnel: Predictors of health symptoms. Occup Environ Med 60(Suppl 1):i40–i46

    Article  Google Scholar 

  • Vidal-Martí C, Pérez-Testor C (2015) Patient assaults on professionals. type II workplace violence: a known phenomenon in barcelona nursing homes. Work 51(4):879–886

    Article  Google Scholar 

  • Vogt DS, Tanner LR (2007) Risk and resilience factors for posttraumatic stress symptomatology in gulf war I veterans. J Trauma Stress 20(1):27–38

    Article  Google Scholar 

  • Walsh BR, Clarke E (2003) Post-trauma symptoms in health workers following physical and verbal aggression. Work Stress 17(2):170–181

    Article  Google Scholar 

  • Weiss DS, Marmar CR (1997) The impact of event scale—revised. Guilford Press, New York, pp 399–411

    Google Scholar 

  • Willness CR, Steel P, Lee K (2007) A metaanalysis of the antecedents and consequences of workplace sexual harassment. Pers Psychol 60(1):127–162

    Article  Google Scholar 

  • Wohlfarth TD, van den Brink W, Winkel FW, & ter Smitten M (2003) Screening for posttraumatic stress disorder: an evaluation of two self-report scales among crime victims. Psychol Assess 15(1):101

    Article  Google Scholar 

  • Wykes T, Whittington R (1998) Prevalence and predictors of early traumatic stress reactions in assaulted psychiatric nurses. J Forensic Psychiatry 9(3):643–658

    Article  Google Scholar 

  • Wynne R, Clarkin N, Cox T, Griffeths A (1997) Guidance on the prevention of violence at work. European Commision, DG-V, Luxembourg

    Google Scholar 

  • Zlotnick C, Franklin CL, Zimmerman M (2002) Does “subthreshold” posttraumatic stress disorder have any clinical relevance? Compr Psychiatry 43(6):413–419

    Article  Google Scholar 

Download references

Funding

This work was supported by the Danish Environmental Research Fund (grant number 14-2014-03).

Author information

Authors and Affiliations

  1. Department of Occupational Medicine, Regional Hospital West Jutland, Herning, Denmark

    Lars Peter Andersen, Annie Hogh, Ask Elklit, Johan Hviid Andersen & Karin Biering

Authors
  1. Lars Peter Andersen
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Annie Hogh
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Ask Elklit
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Johan Hviid Andersen
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Karin Biering
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Lars Peter Andersen.

Ethics declarations

Conflict of interest

All authors declare that they have no conflict of interest.

Ethical approval

This article does not contain any studies with human participants or animals performed by any of the authors. This study was conducted based on approval from the Danish Data Protection Agency, journal # 2014-331-0925 and under their rules of data protection.

Rights and permissions

Reprints and Permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Andersen, L.P., Hogh, A., Elklit, A. et al. Work-related threats and violence and post-traumatic symptoms in four high-risk occupations: short- and long-term symptoms. Int Arch Occup Environ Health 92, 195–208 (2019). https://doi.org/10.1007/s00420-018-1369-5

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00420-018-1369-5

Keywords

Search

Navigation