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Workplace Bullying, Psychological Distress, and Job Satisfaction in Junior Doctors

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Workplace bullying has been recognized as a major occupational stressor since the mid 1980s. A number of different terms have been used to describe it, including employee abuse, emotional abuse, mistreatment and neglect at work, mobbing, and harassment. In the United Kingdom, a number of reports from trades unions illustrating the pain, psychological distress, physical illness, and career damage suffered by the victims of bullying first drew attention to the issue. However, academic interest in the issue began only recently, and there are still few empirical studies. The most systematic research comes from Scandinavia, where there is strong public awareness and antibullying legislation.
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Special Section:
Praxis: Ethical Issues in Medical Education and Training
Workplace Bullying, Psychological Distress,
and Job Satisfaction in Junior Doctors
LYN QUINE
Workplace bullying has been recognized as a major occupational stressor since
the mid 1980s.
1,2,3
A number of different terms have been used to describe it,
including employee abuse,
4
emotional abuse,
5
mistreatment and neglect at
work,
6
mobbing,
7,8
and harassment.
9
In the United Kingdom, a number of
reports from trades unions illustrating the pain, psychological distress, physical
illness, and career damage suffered by the victims of bullying first drew
attention to the issue.
10,11,12
However, academic interest in the issue began only
recently, and there are still few empirical studies. The most systematic research
comes from Scandinavia, where there is strong public awareness and antibul-
lying legislation.
13,14
In the school-based literature, bullying is defined as a subset of aggressive
behaviors involving three criteria: it is intentional harm-doing, involves an
imbalance of power between the victim and the bully, and is carried out
repeatedly and over time.
15
Three main types are identified: direct physical
bullying, verbal bullying, and indirect bullying. Definition of workplace bully-
ing presents the researcher with significantly more difficulties, for there is no
clear agreement on what constitutes adult bullying, whether it refers to a range
of behaviors or can be expressed in a single definition. Physical bullying is
rarely reported,
16
but the workplace presents unique opportunities for a wide
range of aggressive and intimidating behaviors. Most existing definitions incor-
porate three elements. First, in line with case-law definitions in the related
areas of racial and sexual harassment, the perceptions of the behavior by the
victim, not the intention of the perpetrator, determines whether bullying has
occurred. Thus it is subject to differences in personal perceptions. Second, there
must be a negative effect on the victim.
17
See for example, one of the most
widely used definitions, that of the U.K. Manufacturing, Science, and Finance
Union (MSF):
persistent, offensive, abusive, intimidating, malicious or insulting behav-
iour, abuse of power or unfair penal sanctions, which makes the
recipient feel upset, threatened, humiliated or vulnerable, which under-
mines their self-confidence and which may cause them to suffer stress.
(p. 3)
18
Thirdly, the bullying must be persistent. The rule of thumb used in Sweden, for
example, is one occurrence per week over the last six months.
19
Five categories of bullying behavior have been identified in the literature:
20
Cambridge Quarterly of Healthcare Ethics (2003), 12,91
101. Printed in the USA.
Copyright © 2003 Cambridge University Press 0963-1801/03 $12.50
91
threat to professional status
belittling you in public, professional humil-
iation, accusation of lack of effort
threat to personal standing
spreading rumors, gossiping about you, name
calling, and teasing
isolation
ignoring you, withholding information from you, preventing
access to opportunities such as leave or training
enforced overwork
undue pressure to produce work, setting impossible
deadlines, unnecessary disruptions
destabilization
failure to give credit when due, being given meaningless
tasks, removal of responsibility, shifting of goalposts, repeated reminders
of error
Bullying is most frequently associated with an abuse of power, by a line
manager or supervisor over junior staff. However, other power relationships
may lead to bullying by colleagues or a group of people who may target one
individual.
In the United States, a parallel literature has indicated that medical students
and trainee doctors also report experiencing high levels of mistreatment or
bullying behaviors. In 1982, a U.S. physician, Henry Silver, drew attention to a
transformation in attitude and behavior that took place among students over
the course of medical school training, from “eager and enthusiastic” to “cyni-
cal, depressed, and filled with frustration,” and suggested that these changes
could be the result of abuse or mistreatment that was unrecognized or ignored.
In a later paper, Silver and Glicken reported the results of the first empirical
study of the incidence and severity of abuse in one medical school.
21
A number
of other studies quickly followed describing the types of mistreatment suf-
fered.
22,23,24,25,26,27,28,29,30,31,32
A survey of ten U.S. medical schools in 1991, for
example, found that 96% of medical students had suffered abuse: 87% reported
public belittlement and humiliation, 81% being shouted or yelled at, 55% sexual
harassment, 36% being given extra tasks for punishment, 34% being threatened
with unfair grades, 19% racial harassment, and 18% being hit or pushed.
33
It is
now recognized that high levels of mistreatment occur, which increase with
progression through medical school, continue during the early postgraduate
years,
34
are a significant source of stress, and may be an important cause of
dropout.
35,36
The literature suggests that such treatment is often justified in
terms of its “educational” value. Kassebaum and Cutler observe that the most
common forms of mistreatment
public belittlement and humiliation
appear
to be “misguided attempts to reinforce learning.”
37
Both mistreatment of medical students and workplace bullying have been
linked to a host of adverse effects on the health and well-being of those who
experience it, including depression, anxiety, lowered job satisfaction, greater
sickness absence, higher propensity to leave, and reduced effectiveness at
work.
38,39,40,41,42,43
Increased smoking and escape drinking have also been
reported.
44,45,46,47
One issue that makes the study of bullying difficult is inherent in the way it
is defined. Because bullying or mistreatment are normally assessed by self-
report, the question inevitably arises as to whether some people’s perceptions
may be biased due to dispositional traits, leading them to be more likely to
report benign behavior as bullying. In previous work, I drew attention to a
likely source of bias
negative affectivity
48
defined by Watson and Clarke as
Lyn Quine
92
a mood dispositional dimension that reflects stable and pervasive individual
differences in negative emotionality and self-concept. In an influential review,
these authors concluded that individuals high in negative affectivity “are more
likely to report distress, discomfort, and dissatisfaction over time and regard-
less of the situation.” Such individuals also tend to dwell on their failures and
shortcomings and to focus more on the negative aspects of other people and
the world in general. “Consequently they have a less favourable view of self
and other people and are less satisfied with themselves and life” (p. 483).
49
Findings from this and further reviews
50,51
suggest that it would be appropriate
to take account of negative affectivity when investigating reports of bullying.
Though there has been considerable research on the mistreatment or abuse of
medical students in the United States, there is little research on trainee doctors
either in the United States or the United Kingdom. Additionally, the influence
of negative affectivity on reports of bullying and on relationships between
bullying and occupational health outcomes has not been investigated. This
study aimed to bridge that gap. The study arose after the issue of bullying was
raised with the author by a Dean Director of Postgraduate Medical Training in
the United Kingdom, following publication of a paper in the British Medical
Journal on bullying among health professionals.
52
The aims were to investigate
the prevalence of bullying among junior doctors, to determine the association
between workplace bullying and demographic variables such as age, gender,
and ethnic group, and to examine the relationship between bullying and two
occupational health outcomes, job satisfaction and psychological distress after
partialing out the effects of negative affectivity.
Methods
An anonymous questionnaire was sent out with the BMA News Review to a
sample of 1,000 junior hospital doctors with job grades from house officer to
senior registrar, randomly generated electronically from the British Medical
Association members’ mailing list. The News Review is sent out regularly to all
registered doctors. Because of the method of contacting participants, it was not
possible to send reminders. After 2 months, the data were entered onto
computer and analyzed using SPSS for UNIX.
Questionnaire
The questionnaire was in three sections. The first collected information about
the participant’s age, gender, job grade (house officer, registrar, etc), and ethnic
group. The second section contained two widely used scales to measure
occupational health outcomes, psychological distress (GHQ-12),
53
job satisfac-
tion,
54
and a measure of negative affectivity.
55
The GHQ-12 is a self-
administered questionnaire for detecting psychiatric disorder in a British
population. It is a shortened 12-item version of the General Health Question-
naire designed by Goldberg.
56
The job satisfaction scale is an 18-item measure
produced by Brayfield and Rothe to measure facet-free job satisfaction.
57
The
Negative Affectivity Scale provides a 21-item measure of negative affectivity.
All three scales are widely reported to have satisfactory reliability and validity.
The third section of the questionnaire contained questions about junior
doctors’ experiences of bullying. The Lyons et al. definition of bullying, which
Workplace Bullying in Junior Doctors
93
has been endorsed by trades unions, was presented.
58
Participants were then
asked to indicate whether they had been subjected to workplace bullying in the
last 12 months and whether they had witnessed others being bullied. Partici-
pants also completed a 21-item bullying scale developed for our earlier work,
which asked about experience of 21 bullying behaviors from peers, senior staff,
or managers in the past 12 months.
59
Results
We received 594 completed questionnaires, and 48 were returned undelivered
by the postal service, which represented a response rate of 62%. As a first step,
scores were computed for job satisfaction, GHQ-12, and negative affectivity.
Each scale was found to have good internal reliability, with Cronbach’s alphas
of 0.92 for job satisfaction, 0.90 for GHQ-12, and 0.81 for negative affectivity.
Table 1 shows the participants’ job grade, gender, and ethnic group. Fifty-five
percent of the respondents were house officers or senior house officers, whereas
39% were registrars, 3% were senior registrars, and 3% held other junior
grades. The sample was equally divided between men and women. Seventy
percent were white, and 30% were from other ethnic groups.
Prevalence of Bullying
Overall, 37% (220) junior doctors reported having been bullied in the past 12
months. Sixty-nine percent (407) had witnessed the bullying of others. Fifty-
three percent (107/211) reported being bullied by colleagues in their own work
group, 46% (91/199) by people outside their own work group, 60% (123/205)
by their immediate team leader, 34% (66/194) by a senior manager, and 30%
(46/154) by some other person. Ninety-six percent (212/220) of doctors reported
being bullied by more than one person.
Associations between Bullying and Demographic Variables
To investigate differences in reports of bullying by gender, ethnic group, job
grade, and age, analyses by chi-square test were conducted. The results showed
that doctors from minority ethnic groups were more likely to report being
Table 1. Profile of Participants
Job grade (n 5 589)
House officer/senior house officer 321 (55%)
Registrar/specialist registrar 230 (39%)
Senior registrar 18 (3%)
Other 20 (3%)
Gender (n 5 590)
Male 294 (50%)
Female 296 (50%)
Ethnic group (n 5 587)
White 413 (70%)
Other ethnic group 174 (30%)
Lyn Quine
94
bullied than white doctors (45% [78] compared to 34% [139]; df 1, x
2
5 5.9, p ,
0.05; CI 1.11
2.28), and women were more likely to report being bullied than
men (43% [126] compared to 32% [92] of male doctors; df 1, x
2
5 7.2, p , 0.01;
CI 1.14
2.26). There were no differences in reports of bullying by age or job
grade. There were no significant differences in negative affectivity between
men and women or between white doctors and those from minority ethnic
groups, showing that variations in negative affectivity could not account for the
significant findings. Overall, negative affectivity accounted for only 6% of the
variance in reports of bullying (R2 5 0.059, F(1,556) 5 36.0; p , 0.001).
Prevalence of Bullying Behaviors
Table 2 shows the proportion of junior doctors reporting each type and
frequency of bullying behavior and the proportion of doctors from minority
ethnic groups compared to white doctors. Eighty-four percent of doctors (486)
had experienced at least one type of mistreatment. Table 3 presents the differ-
ences in gender between those who reported each type of bullying behavior
and those who did not.
Associations between Bullying and Occupational Health Variables
To examine whether doctors who reported being bullied suffered lower levels
of job satisfaction and greater psychological distress than other doctors and to
ensure that these relationships were unrelated to negative affectivity, analyses
of covariance were conducted. Two separate analyses, one for job satisfaction
and one for psychological distress, were conducted using negative affectivity as
a covariate. The results showed that even when negative affectivity was
partialed out, doctors who reported being bullied had significantly lower levels
of job satisfaction (adjusted mean 61.5 versus 64.9, t(1, 523) 5 8.1, p , 0.001;
95% CI 20.23
0.38) and higher levels of psychological distress (adjusted mean
4.0 versus 2.7, t(1, 551) 5 10.6, p , 0.001; 95% CI 0.15
0.10) than those who did
not report it.
Discussion
Thirty-seven percent (220) of junior doctors in this study reported being bullied
in the previous year. Negative affectivity accounted for only 6% of the variation
in such reports. These rates compare with 18% reporting being bullied in the
last 6 months in a recent UNISON survey of trade union members and 38% in
the previous 12 months in a study of 1,100 staff in a community National
Health Service Trust.
60,61
Both of these studies were carried out in the United
Kingdom. Though a little over a third of doctors identified themselves as
having been bullied, 84% of doctors had actually experienced at least one type
of bullying behavior. These most often took the form of destructive innuendo
and sarcasm (43%), persistent attempts to belittle and undermine an individu-
al’s work (40%), or undue pressure to produce work (39%), although persistent
and unjustified criticism of work (37%), public humiliation (34%), and shifting
the goalposts (32%) were frequently reported.
Estimates of harassment, abuse, and discrimination among both medical
students and junior doctors in the United States are generally somewhat higher,
Workplace Bullying in Junior Doctors
95
Table 2. Overall Rates of Bullying Behaviors and Differences by Ethnic Group
All White
Other
ethnic groups x
2
Threat to professional status
Persistent attempts to belittle and undermine your work 232 (40%) 149 (37%) 78 (45%) 3.5*
Persistent unjustified criticism and monitoring of your work 213 (37%) 151 (38%) 57 (33%) 1.1 NS
Persistent attempts to humiliate you in front of colleagues 198 (34%) 131 (33%) 63 (37%) 0.8 NS
Intimidatory use of discipline/competence procedures 101 (17%) 66 (16%) 33 (19%) 0.7 NS
Threat to personal standing
Undermining your personal integrity 174 (30%) 120 (30%) 51 (30%) 0.0 NS
Destructive innuendo and sarcasm 250 (43%) 170 (42%) 77 (45%) 0.3 NS
Verbal and nonverbal threats 107 (18%) 66 (16%) 39 (23%) 3.2 NS
Making inappropriate jokes about you 166 (28%) 99 (25%) 59 (34%) 5.7 **
Persistent teasing 122 (21%) 89 (22%) 31 (18%) 1.2 NS
Physical violence 2 (0%) 0 (0%) 0 (0%)
——
Violence to property 10 (2%) 6 (2%) 4 (2%) 0.5 NS
Discrimination on grounds of race or gender 88 (15%) 35 (9%) 50 (29%) 39.4 ***
Isolation
Withholding necessary information from you 114 (20%) 71 (18%) 42 (24%) 3.4 NS
Freezing out/ignoring/excluding 179 (31%) 115 (29%) 61 (36%) 2.7 NS
Unreasonable refusal of applications for leave, training, or promotion 142 (24%) 83 (21%) 56 (33%) 9.4 **
Overwork
Undue pressure to produce work 356 (39%) 138 (34%) 81 (47%) 8.2 **
Setting of impossible deadlines 179 (31%) 119 (30%) 58 (34%) 0.9 NS
Destabilization
Shifting goalposts without telling you 188 (32%) 131 (33%) 53 (31%) 0.2 NS
Constant undervaluing of your efforts 164 (28%) 110 (27%) 49 (29%) 0.1 NS
Persistent attempts to demoralize you 96 (17%) 61 (15%) 33 (19%) 1.4 NS
Removal of areas of responsibility without consultation 73 (13%) 54 (13%) 19 (11. ) 0.5 NS
NS 5 Not significant
*p , 0.05
**p , 0.01
***p , 0.001
96
Table 3. Differences in Reported Bullying Behaviors by Gender
Males Females x
2
Threat to professional status
Persistent attempts to belittle and undermine your work 100 (32%) 128 (44%) 5.4 *
Persistent unjustified criticism and monitoring of your work 95 (33%) 114 (40%) 2.7 NS
Persistent attempts to humiliate you in front of colleagues 79 (27%) 115 (40%) 10.0 ***
Intimidatory use of discipline/competence procedures 42 (15%) 57 (20%) 2.6 NS
Threat to personal standing
Undermining your personal integrity 63 (22%) 109 (38%) 17.1 ***
Destructive innuendo and sarcasm 107 (37%) 141 (49%) 7.6 **
Verbal and nonverbal threats 47 (16%) 58 (20%) 1.3 NS
Making inappropriate jokes about you 66 (23%) 92 (32%) 5.6 **
Persistent teasing 60 (21%) 60 (21%) 0.0 NS
Physical violence 2 (1%) 0 (0%) 2.0 NS
Violence to property 8 (3%) 2 (1%) 3.7 NS
Discrimination on grounds of race or gender 44 (15%) 40 (14%) 0.1 NS
Isolation
Withholding necessary information from you 60 (21%) 54 (19%) 0.4 NS
Freezing out/ignoring/excluding 86 (30%) 91 (32%) 0.8 NS
Unreasonable refusal of applications for leave, training, or promotion 72 (25%) 68 (23%) 0.2 NS
Overwork
Undue pressure to produce work 111 (39%) 109 (38%) 0.0 NS
Setting of impossible deadlines 86 (30%) 91 (31%) 0.1 NS
Destabilization
Shifting goalposts without telling you 89 (31%) 95 (33%) 0.2 NS
Constant undervaluing of your efforts 64 (22%) 96 (33%) 8.5 **
Persistent attempts to demoralize you 34 (12%) 60 (21%) 8.2 **
Removal of areas of responsibility without consultation 40 (14%) 33 (12%) 0.8 NS
NS 5 Not significant
*p , 0.05
**p , 0.01
***p , 0.001
97
though measured over a longer time period. For example, Richman et al. found
that 89% of graduates reported experiencing some form of harassment during
their time at medical school, whereas Baldwin et al. reported a figure of 96%,
and Wolf et al. 99%.
62,63,64
Daugherty et al., in a survey of bullying in the first
postgraduate year, found a figure of 93%.
65
Junior doctors from minority ethnic
groups were more likely to be bullied and reported five bullying behaviors
significantly more frequently than white doctors. These findings are consistent
with findings in the United States.
66,67
Although this should be a cause for
concern, it should not come as a surprise. Racial discrimination has been shown
to occur at all levels in the U.K. medical profession, from application to medical
school
68,69,70
to examination success,
71
job application,
72,73,74,75
and even the
allocation of distinction awards to consultants.
76
Women doctors were more
likely than men to be bullied and reported seven of the 21 bullying behaviors
significantly more frequently. These findings are in accord with those from a
study of university employees, which found that women experience work
harassment more often and more severely than men.
77
Junior doctors were
most likely to have been bullied by their immediate team leader, which is
consistent with the idea that it is an ill-conceived attempt to reinforce learning.
78
Those who had experienced bullying reported decreased job satisfaction and
increased psychological distress, even when negative affectivity had been
covaried out, which suggests that negative affectivity does not play any
significant role in these relationships and should not be used as an explanation
by those seeking to deny the existence of bullying. The reports of other doctors
who have witnessed bullying, though have not themselves been bullied, also
suggests that bullying is not simply in the eye of the beholder. The notion that
those who report bullying are simply those who view the world through
gloomier spectacles places the victims in double jeopardy, because it both
denies their own perceptions of their experience and precludes any discussion
of the health consequences that bullying may have.
The interpretation of these findings should be guarded. Like all the U.S.
studies, this one relied on self-reports of bullying, which are by definition
subjective and may not entirely correspond to the actual occurrence of mis-
treatment. People’s perceptions about what constitutes bullying or their per-
sonal sensitivity and vulnerability to mistreatment or abuse may differ.
Nevertheless, the literature on stress emphasises that it is people’s appraisals of
stressful events that are important rather than the events per se (pp. 22
94).
79
We have tried to minimize the effects of bias by providing a clear definition of
bullying, asking about individual bullying behaviors and controlling for neg-
ative affectivity in some analyses. A second reason for caution is that the data
are cross-sectional, which limits the conclusions that can be drawn about cause
and effect relationships. Prospective longitudinal data that would monitor
reports of bullying and subsequent negative effects are now needed. A final
limitation is the nonresponse rate. Although a higher rate would have been
desirable, the study achieved an acceptable response rate of 62%, which is
similar to many other studies of mistreatment (Baldwin et al. 59%; Wolf et al.
61%; Mangus et al. 55%; Komaromy et al. 62%).
80,81,82,83
Despite these limitations, the data presented here strongly suggest that
disturbingly high levels of bullying and mistreatment during training are a part
of many junior doctors’ perceptions and experience. The price of ignoring it
may be dropout from medical school, high levels of anxiety and depression
Lyn Quine
98
among trainee doctors, ignoring the needs of patients, and future mistreatment
of others by those who have been mistreated
the so-called transgenerational
legacy.
84,85,86
The development and implementation of antibullying policies that
include a statement on expected standards of behavior, education to raise
awareness of bullying, the introduction of procedures for dealing with allega-
tions of bullying, and protection of the accusers from retaliation would seem to
be important steps forward. These are beginning to be implemented in the
United Kingdom,
87
although they seem to have had little effect in the United
States, where, after two articles had aroused national attention,
88,89
the Amer-
ican Medical Association recommended that all medical schools should imple-
ment measures to combat bullying.
90
According to Kassebaum and Cutler,
however, despite these measures, the pattern of student abuse is largely
unabated.
91
It appears that alongside changes in policy, what is required is a
change in attitudes and in the mistaken conviction that negative rather than
positive reinforcement best promotes learning.
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... Mobbing can lead to significant social, psychological, and psychosomatic consequences such as tiredness, stress, insomnia, depression, joint suicide, decreased job satisfaction, lack of motivation, a decreased retention rate of staying in the profession, absence from duties, and resignations (18)(19)(20)(21)(22). For instance, Nielsen et al. indicate that there is a relationship between mobbing and psychological distress: there is a vicious spiral in which mobbing and distress amplify one other's harmful consequences (23). ...
... For instance, Nielsen et al. indicate that there is a relationship between mobbing and psychological distress: there is a vicious spiral in which mobbing and distress amplify one other's harmful consequences (23). Quine conducted a study with 594 young doctors and reported that those who were mobbed had lower job satisfaction and more psychological distress (18). According to the Seafarer's Mental Health Study, there is a positive correlation between depression, anxiety, and suicidal thoughts, and exposure to or threat of violence in seafarers (11). ...
Article
The aim of this study is to determine whether oceangoing officer candidates encounter mobbing “psychological terror in the workplace” during their onboard training period and analyze whether there is a dimensional difference between the mobbing behaviors experienced by the deck cadets. The attendees of the study are a total 212 oceangoing officer candidates who have sea experience and are studying for a BSc degree in maritime transportation engineering. The demographic information of cadets, along with the details about the internship process and the Leymann Inventory of Psychological Terror (LIPT) items was analyzed using statistical tests by SPSS and association rule mining methods with the SPSS modeler. The study results demonstrate that, regardless of the ship type or internship duration, the cadets were subjected to mobbing in the sub-dimension of Self-expression and communication and Occupational situation and quality of life. The cadets who reported experiencing occupational stress indicated that their career expectations changed after the internship. The presence of “only one cadet on board” was identified as a significant antecedent factor affecting not only Self-expression and communication and Occupational situation and quality of life but also occupational stress and changes in work expectations after internship.
... A 2024 national survey of trainee doctors in Australia found that 20% of IMG trainees and 38% of Aboriginal and/or Torres Strait Islander trainees had personally experienced bullying, harassment, discrimination and/or racism in the previous year, and that almost half (42% and 51% respectively) attributed the source as senior medical staff [38]. Our results support other international studies which report psychological distress and poorer job satisfaction in black and ethnic minority (BAME) doctors reporting bullying [34,35,39]. Other effects of bullying include burnout and increased accidents at work [40]. ...
Article
Full-text available
Background International medical graduates (IMGs) are an essential workforce for many high-income countries worldwide and are often recruited to fill workforce shortages. Studies identify workplace discrimination as a major challenge for IMGs. However, little detailed exploration has been undertaken on this issue. Methods We designed a sequential explanatory mixed methods study to explore details of inequitable treatment perceived by IMGs in Australia. An online survey was distributed to IMGs across Australia. We analysed data descriptively and tested for significant demographic differences against the primary discrimination variable using tests of association (t-test and chi-squared tests). Following analysis, individual interviews were undertaken by telephone, teleconference or face-to-face. Thematic analysis was conducted on qualitative study components. All data was triangulated to assess areas of congruence and difference and to gain fuller understanding of the data. Results We surveyed and interviewed 286 and 36 IMGs respectively. Most survey respondents reported that IMGs were disadvantaged when compared to Australian graduates, primarily due to registration and bureaucratic processes. Institutions/organisations and senior staff were implicated as major perpetrators of discrimination. Subtle experiences of interpersonal discrimination were reported by > 75% of those reporting discrimination in the last five years. Statistically significant associations (p < 0.05) were identified between the primary discrimination variable and ethnicity, native language, country of primary medical qualification and employment status. Negative sequelae of discrimination on IMG health and career progress were reported. Four themes were identified: i) Disadvantage as an independent construct to discrimination; ii) Structural and institutional discrimination facilitates exploitation; iii) Workplace bullying is a manifestation of inequitable treatment; iv) Inequitable treatment has physical and mental health implications for IMGs. High congruence was detected on triangulation of the quantitative and qualitative results. Conclusions IMGs describe various aspects of discrimination and disadvantage in Australia, warranting further investigation and action. Institutions are responsible for supporting a more equitable and inclusive environment for IMGs.
... It is reported that approximately 1.5 million people in Europe have sought treatment due to illnesses related to mobbing (Cicerali 2011). Quine (2003) noted that individuals who do not report mobbing have higher levels of psychological distress. Finally, according to Leymann's estimates, 10% of suicides in his country are attributed to work-related trauma (Namie 2003). ...
Article
Full-text available
This article aims to review the literature to explore whether trauma is among the symptoms experienced by individuals exposed to mobbing. Mobbing, defined as repeated psychological harassment in the workplace, is a prolonged process rather than a single incident. Those subjected to mobbing often exhibit various physical and psychological symptoms. Numerous studies in the literature indicate that mobbing can lead to the development of post-traumatic stress disorder (PTSD). Trauma, characterized by its sudden onset and life-threatening impact, significantly harms individuals. This review focuses on the psychological issues arising from PTSD due to mobbing, highlighting conditions such as depressive disorders, anxiety disorders, adjustment disorders, and PTSD itself. The loss of self-confidence and self-esteem observed in mobbing victims can exacerbate these issues, potentially leading to suicidal tendencies. Research findings indicate alarmingly high rates of these outcomes, underscoring the severe impact of mobbing on mental health.
... In some studies of bullying of junior doctors generally (not the studies in our review, which focused on psychiatric trainees), a mood dispositional dimension called negative affectivity has been controlled for, as people who are high in this item are more likely to report distress and grievances. 12,33 However, this was not performed in the studies in our review. As cross-sectional surveys inviting voluntary participation from trainees, all studies in this review are subject to self-selection bias. ...
Article
Full-text available
Aims and method We aimed to systematically review primary studies exploring workplace bullying of psychiatric trainees, including rates, forms of bullying, perpetrators and help-seeking. We searched Ovid MEDLINE, PubMed, CINAHL, PsycINFO and Embase using PRISMA guidelines. The inclusion criterion was primary research papers surveying or interviewing psychiatry trainees with respect to perceived workplace bullying by staff members. Exclusion criteria were secondary research papers and papers whose only focus was bullying by patients or carers. Results Substantial levels of bullying were reported in all five included studies. Perpetrators were often reported to be consultants, managers or peers. Most trainees did not obtain help for bullying and harassment. All of the studies had methodological limitations. Clinical implications Concerning levels of workplace bullying have been reported by psychiatric trainees in the UK and abroad. Further methodologically robust studies are required to evaluate the current levels and nature of this bullying, and strategies to prevent and manage it.
... 44 Despite the literature including some longitudinal studies on workplace discrimination and mental health, 20,30,31,35 there is limited focus on workplace discrimination and psychological distress, with only one cross-sectional study focusing on these concepts specifically. 45 Instead, psychological distress has been explored with similar concepts not explicitly defined as "workplace discrimination" (ie, "workplace bullying" or "workplace harassment"), [46][47][48] or workplace discrimination has been explored with a focus on depressive symptoms as a mental health outcome. Thus, there is the opportunity to explore the longterm relationship between workplace discrimination and psychological distress among US workers. ...
Article
Objective To explore the relationship between workplace discrimination and psychological distress across nine years using data from the Midlife in the Unites States (MIDUS) study. Methods Workplace discrimination was measured with a validated 6-item scale at baseline with three categories (low, intermediate, and high), and psychological distress was measured with the Kessler-6 scale at baseline and follow-up. In total, 1,546 workers were analyzed by linear regression. Results High levels of workplace discrimination were significantly associated with increased psychological distress at follow-up (crude β = 0.633, 95% CI = 0.307, 0.959). After adjusting for demographic factors, socioeconomic status, and health-related behaviors, associations were slightly attenuated (fully adjusted β = 0.447, 95% CI = 0.115, 0.780). Conclusions High workplace discrimination was longitudinally associated with higher levels of psychological distress. Organizations should actively prevent discrimination which may improve workers’ mental health consequently.
... Bullying based on performance is typically perpetrated by superiors, as in the case of excessive workloads with short deadlines. One of the criteria to be fulfilled to measure workplace bullying is that it has to be repeated, prolonged and persistent behaviour for a minimum of 6 months to be labelled as bullying (Quine, 2003). ...
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Workplace Bullying is a negative interpersonal behaviour observed among employees. Studies show that it harms employees' health and wellness, which may affect how they perform for the organization. This study aims to determine the prevalence of workplace bullying and evaluate industry workers' perspectives with those of employees in academia. A cross-sectional study was conducted using the Negative Act Questionnaire-Revised (NAQ-R), a valid tool. Using SPSS, the data were processed, descriptive statistics were produced with graphs and Cronbach's alpha was created. The study's findings revealed that just 48 per cent of businesses reported workplace bullying, compared to 58 per cent of academic institutions. The reliability tests results showed they were extremely reliable. According to descriptive statistics, workplace bullying occurs more frequently in academia than in industry. When comparing the effects of different types of bullying on employee productivity across sectors, there is little difference between person-related and work-related bullying; however, findings suggest that most of the responses reported person-related bullying more than work-related bullying from both sectors. Hence, the results of this study show that bullying practices do occur in both academic and non-academic settings.
... This study further highlights the pervasive issue of mistreatment of residents [57][58][59][60][61]. Experiencing or witnessing this behaviour negatively impacts on health and wellbeing, with reports of psychological distress, posttraumatic stress disorder, professional demotivation, burnout, dissatisfaction with the job and with training, and thoughts of leaving [57,59,60,[62][63][64][65][66][67]. ...
Article
Full-text available
Context The challenging nature of the transition from medical student to doctor is highlighted by the associated negative consequences to new doctors’ mental health and wellbeing. Enhanced understanding of the lived experience of recent medical graduates as they move through the stages of transition over the first year of practice can inform interventions to ease the difficulties encountered. Methods Using interpretative phenomenological analysis (IPA), a novel approach to this topic, we explored the lived experience of transition from student to doctor over the first year of practice after graduation. Twelve new graduates were purposively recruited. We conducted semi-structured interviews at the end of their first year of practice with respect to their experience over the first year. Results The experience of transition was characterised by overlapping temporal stages. Participants’ initial adjustment period was characterised by shock, coping and stabilisation. A phase of development followed, with growth in confidence and a focus on self-care. Adversity was experienced in the form of interprofessional tensions, overwork, isolation and mistreatment. Finally, a period of reflection and rationalisation marked the end of the first year. Discussion Following initial anxiety regarding competence and performance, participants’ experience of transition was predominantly influenced by cultural, relational and contextual aspects of clinical practice. Solutions to ease this challenging time include stage-specific transitional interventions, curricular change at both undergraduate and postgraduate levels and a re-evaluation of the clinical learning environment to mitigate the difficulties endured.
Article
Objectives This study explored the association between emotional labour and workplace violence with health-related productivity loss (HRPL). Methods We used the initial dataset from a survey known as the Korean Work, Sleep, and Health Study, an ongoing nationwide panel study initiated in 2022. To assess emotional labour, the study included 2386 workers who worked in customer service. The Korean Workplace Violence Scale-13 and the Korean Emotional Labour Scale-11 were used to assess the level of exposure to workplace violence, and the intensity of emotional labour, respectively. The Work Productivity and Activity Impairment Questionnaire was used to measure HRPL, including absenteeism and presenteeism. We examined differences in HRPL based on workplace violence and emotional labour using generalised linear regression models. Results HRPL increased with an increase in workplace violence and emotional labour scores. Notably, the mean HRPL was highest in high-risk group of both workplace violence and emotional labour. The mean HRPL increased as the number of 'high-risk' components for workplace violence and emotional labour increased. All the workplace violence and emotional labour components exhibited higher HRPL in the 'high-risk' groups compared to the 'low-risk' groups. Conclusions Our study showed that both emotional labour and workplace violence are associated with reduced productivity.
Article
İşyerinde karşılaşılan en önemli sorunlardan biri olan mobbing, son yıllarda önem kazanmaya başlamıştır. Mobbing, fiziksel ve ruhsal sağlık sorunlarına neden olabilir. Mobbing sonucu sıkıntı, kaygı, depresyon, intihar düşüncesi ve iş doyumunda azalma ortaya çıkabilir. Bu çalışmanın amacı mobbing maruziyeti açısından sağlık sektöründe çalışan hekim, hemşire ve tıbbi sekreterlerdeki mobbing maruziyeti düzeylerini karşılaştırmaktır. Araştırmaya 44 hekim, 78 hemşire, 62 tıbbi sekreter katıldı. Araştırmada katılımcılara Mobbing Ölçeği, Genel Sağlık Anketi-12 (GSA-12), İntihar Düşünce Ölçeği ve Minnesota İş Doyumu Ölçeği uygulandı. Toplam mobbing maruziyeti düzeyi kadın hekimlerde kadın hemşire ve kadın tıbbi sekreterlere göre fazla bulunurken, erkek hekimlerde erkek hemşirelere göre fazla bulundu. GSA-12 ile yapılan psikolojik sıkıntı incelemesinde, hekimlerde %81,8, tıbbi sekreterlerde %58,1, hemşirelerde %59 oranında psikolojik sıkıntı varlığı görüldü. Hekimlerde psikolojik sıkıntı varlığı anlamlı olarak daha fazlaydı. Mobbing maruziyeti ile psikolojik sıkıntı ve suisid düşüncesi arasında pozitif ilişki, mobbing maruziyeti ile iş doyumu arasında negatif ilişki vardı. Mobbing maruziyeti hekimlerde fazladır. Sağlık çalışanlarında mobbing maruziyeti genel olarak yüksek psikolojik sıkıntı, düşük iş doyumu ve suisid düşüncesi ile ilişkili görünmektedir.
Article
This study examines the association between workplace abuse experienced by care workers at the hands of care recipients and their turnover intentions, as well as the mediating effects of work-related stress and job satisfaction. Compared to care recipients’ experiences of abuse, care workers’ experiences have been relatively underexplored. Using data from the Korean National Long-Term Care Survey in 2019, the path from workplace abuse to care workers’ turnover intentions was examined. Results showed significant mediating effects of work-related stress and job satisfaction in the relationship between workplace abuse and turnover intentions. Findings have policy implications for improving long-term care workers’ social awareness and working conditions.
Article
Objective. —To assess the prevalence, correlates, and mental health consequences of reported medical training—related abuses.Design. —A longitudinal cohort study of 137 students surveyed from medical school entrance (time 1) through the winter of the fourth training year (time 4).Setting. —A state college of medicine.Outcome Measures. —Reported training-related abuses (measured at time 4) and mental health status measured at times 1 and 4 (depressive and anxiety symptoms, hostility, problem drinking, escapist drinking, alcohol consumption levels, and gender role orientations).Results. —Seventy-two percent of students reported at least one abusive experience during medical training. Females were significantly more likely than males to report gender discrimination, exclusion from informal settings, discomfort from sexual humor, and unwanted sexual advances. Abuse was significantly related to most psychopathological outcomes, controlling for pre-existing psychopathology. Males low in masculinity and females low in femininity were most likely to report abuse.Conclusions. —The data provide further support for the assumption that a high proportion of medical students not only experience the training process as abusive in nature but also suffer measurable psychopathological consequences. Efforts should be made to reform medical education, with a prominent focus on gender role—related issues.(JAMA. 1992;267:692-694)
Article
In this article the concept of mobbing is introduced. Mobbing means harassing, ganging up on someone, or psychologically terrorizing others at work. Although mobbing is a very old phenomenon, it was not described and systematically researched until the early 1980s. The article begins with a case example, some historical notes, and a definition of mobbing, and then regards mobbing in the context of medical and psychological stress research. Several stages in the development of mobbing are described, based on about 800 case studies. Some epidemiological findings from a representative sample of the Swedish work population are reported. Causes and consequences of mobbing are discussed, and conclusions for prevention and intervention are drawn.