Public health workers face workplace violence that is ‘detrimental’ to mental health

One-third of public health workers have faced some sort of workplace violence that has affected their mental health, according to researchers.

Hope M. Tiesman, PhD, a research epidemiologist at the CDC’s National Institute for Occupational Safety and Health, and colleagues wrote that “during the COVID-19 pandemic, public health workers (PHWs) were at an increased risk for violence and harassment due to their public health work and experienced adverse mental health conditions.”

“PHWs play a pivotal role in public health emergencies, but there is little research on how these emergencies impact their mental health,” they wrote in the American Journal of Preventive Medicine.

The researchers conducted an online survey in April 2021 to better understand the prevalence of harassment, job-related threats and discrimination against PHWs during the pandemic and how they impacted mental health.

A nonprobability convenience sample of local, tribal and state PHWs completed the self-administered survey, answering questions about workplace violence (WPV) demographics, mental health symptoms and workplace factors.

Of the 26,174 PHWs who responded to the survey, Tiesman and colleagues found that 35% dealt with at least one form or a combination of forms of WPV. Further, “that violence was associated with a detrimental impact on PHWs’ mental health.”

More specifically, 26% (n = 5,962) experienced stigma due to their public health work, 24% (n = 5,350) were bullied or harassed and 12% (n = 2,688) received job-related threats, according to the researchers.

The more someone worked, the greater the likelihood that they would face WPV (< 20 hours,16%; 20-40 hours, 25%; 41-60 hours, 41%; 61-75 hours, 52%; >75 hours, 61%). The researchers noted that “this same trend was seen for degree of public interaction” (“little” interaction, 22%; “some,” 31%; “a lot,” 46%).

Even after adjusting for cofounders, the researchers found that facing any kind of WPV was significantly connected to a greater likelihood of reporting:

• depression symptoms (prevalence ratio [PR] = 1.95, 95% CI, 1.87-2.03);
• anxiety (PR = 1.87; 95% CI, 1.80-1.94);
• PTSD (PR = 2.0’ 95% CI, 1.93-2.07); and
• suicidal ideation (PR = 1.99; 95% CI, 1.83-2.18).

Additionally, Tiesman and colleagues noted that “a dose-response relationship was found between the number of WPV events experienced by a PHW and the likelihood of reporting mental health symptoms.”

For example, they wrote, “the proportion of PHWs reporting symptoms of depression was 1.7-fold greater if they experienced a single type of WPV, 2-fold for two types, and 2.4-fold greater if they experienced all three types of WPV.”

The researchers wrote that “ongoing training, workplace support, and increased communication following a WPV incident may be helpful” and that “efforts to strengthen public health capacities and support the public health workforce are also needed.”

“Any WPV directed at a PHW during a public health emergency is detrimental to them, as well as the communities they serve. WPV against PHWs is an alarming outcome of the COVID-19 pandemic,” they concluded. “Efforts should be made to protect and support the current public health workforce.”

Additionally, the researchers noted that “increased workplace communication following a WPV incident is also important and may protect the PHW from adverse mental health outcomes.”

If an incident occurs, they wrote, workers “should report the event to a designated official at their organization including the frequency of the violence and other details surrounding the event.” That way, “supervisors can make informed decisions about changes to work location, task, and shifts to reduce the probability of another WPV event.”

“Experiencing multiple WPV events has a cumulative effect on adverse mental health symptoms and can lead to increased turnover, burnout, and decreased job satisfaction,” Tiesman and colleages wrote. “Most important, supervisors and public health agencies need to contact law enforcement immediately if the PHWs’ life or family is threatened.”