Association between Workplace Violence and Depressive Symptoms among Nurses Mediated by Fear of Future Workplace Violence and Burnout: Cross-Sectional Questionnaire Study in Shandong, China (Preprint)

Abstract

The factors associated with depressive symptoms among nurses have been extensively documented; however, the mechanisms underlying the relationship between workplace violence and depressive symptoms in nurses have been less studied.

This study aims to examine the relationship between workplace violence and depressive symptoms and the mediating role of fear of future workplace violence and burnout in this relationship.

We conducted a cross-sectional web survey at 12 tertiary hospitals in Shandong province, China, in 2020. The Center for Epidemiologic Studies Depression Scale (CESD-10), the Chinese version of the Maslach Burnout Inventory-General Survey, and the Fear of Future Violence at Work scale were used to gather data. Descriptive statistics, independent sample t-test, one-way analysis of variance, Pearson’s correlation coefficient, and ordinary least squares regression with bootstrap resampling were used to analyze the data.

Among the nurses, the prevalence of depressive symptoms was 45.9% (868/1893). There were significant differences (P<.01) in the CESD-10 score for experience of workplace violence, burnout, and other control variables, with the exception of gender and marital status. Pearson’s correlation coefficient between depressive symptoms and fear of future workplace violence was 0.171 (P<.001). Overall, both significant direct (2.250, 95% bootstrap CI:1.583−2.917) and indirect effects (0.769, 95% bootstrap CI:0.543−1.012) were found. Specifically, the regression model showed that fear of future workplace violence and burnout mediated the relationship between experience of workplace violence and depressive symptoms. Indirect effects mediated by fear of future workplace violence and burnout were 0.203 (95% bootstrap CI:0.090−0.348) and 0.443 (95% bootstrap CI:0.262−0.642), respectively. Furthermore, the serial multiple mediation analyses indicated that the indirect effect mediated by fear of future workplace violence and burnout in sequential manner was 0.123 (95% bootstrap CI:0.070−0.189).

This study found a high prevalence of depressive symptoms among Chinese nurses, and identified the role of fear of future workplace violence and burnout as serial mediators in the relationship between experience of workplace violence and depressive symptoms. To improve the mental health of nurses, targeted interventions focusing on reducing workplace violence, fear of future workplace violence, and burnout should be developed by hospital managers.