Associations among the workplace violence, burnout, depressive symptoms, suicidality, and turnover intention in training physicians: a network analysis of nationwide survey

Abstract

Depression and anxiety are the most common mental disorders among physicians, who have a greater risk of suicide than those in other professional occupations. Relationships among a demanding workload, workplace violence, burnout, and intention to turnover have also been reported. The current study examined the principal components and propagating patterns of mental health and working environment interactions in training physicians. A total of 1981 training physicians completed online self-report questionnaires during September–October (midpoint of the training year) 2020. Regularized partial correlations in a mixed graphical model (MGM) and joint probability distributions (directed acyclic graph; DAG) were estimated for four subtypes of workplace violence (verbal abuse/physical violence perpetrated by clients/hospital staff), three burnout subdomains (Maslach Burnout Inventory), thoughts about quitting, and nine depressive symptoms, including suicidality, comprising the DSM-5 diagnostic criteria for major depressive disorder (assessed using the Patient Health Questionnaire-9). Thoughts of death/self-harm showed directional dependencies on the joint probability distributions of psychomotor agitation/retardation, concentration difficulty, self-reproach, and sadness in the DAG. In the MGM, a partial correlation with psychomotor agitation/retardation (r = 0.196) accounted for 56.5% of the variance in thoughts of death/self-harm. Partial correlations with concentration difficulties (r = 0.294), self-reproach (r = 0.257), changes in appetite (r = 0.184), and worker-on-worker physical violence (r = 0.240) in the MGM accounted for 54.4% of the variance in psychomotor agitation/retardation. Thoughts about quitting were partially correlated with and dependent upon the joint probability distributions of emotional exhaustion (r = 0.222), fatigue (r = 0.142), anhedonia (r = 0.178), and sadness (r = 0.237). In contrast, worker-on-worker (r = 0.417) and client-on-physician (r = 0.167) verbal abuse had regularized partial correlations with directional dependencies on thoughts about quitting. Organization-level interventions aiming to reduce the worker-on-worker violence and individual-level approaches of clinical screening program and psychiatric counseling clinic are required. Follow-up studies to verify the effectiveness of these interventions for training physicians are needed.

Revealing the Confluences: Workplace Bullying and Suicidality Independent of Depression Presence

“…While depression independently increased the odds of suicidality by about 5-6 times 30 , as depression intensi es, the association between workplace bullying and suicide may weaken. Unlike previous research suggesting that workplace bullying might lead to suicidal thoughts and attempts via signi cant mood disorders 7,29 , this study indicates that workplace bullying itself might directly progress to suicide attempts. According to the Integrated Motivational-Volitional (IMV) model, after exposure to bullying, suicide attempts occur, which progress through three stages: phase 1-the premotivational phase of exposure to background factors and triggering events; phase 2-the motivational phase of repeated bullying leading to suicidal intent formation; and phase 3-the volitional phase of increased suicidal thoughts transitioning to attempts 49 .…”

“…Moreover, population-based studies utilizing national patient registers in countries like Australia, Denmark, Sweden, and Japan consistently indicated that exposure to workplace bullying heightened the risk of suicidal ideation 8-10,14,39 . In contrast, within Korea, studies exploring the connection between bullying and suicide predominantly focused on vulnerable groups like adolescents, the elderly, or speci c occupations such as nursing, or physicians-in-training [27][28][29] . This study, harnessing health examination data from a healthy cohort of Korean employees, not only represented the o ce workforce but also examined exposure frequency, a realm previously underexplored.…”

“…Despite its negative impact on South Korea as a whole, research on the relationship between workplace bullying and suicide remains limited. Studies on bullying in South Korea have so far been con ned to speci c groups such as in schools or among nurses and physicians-in-training [27][28][29] .…”

Suicidal ideation and their relationship with job satisfaction and job strain among Jordanian hospitals’ healthcare professionals: a cross-sectional study

“…Considering the increasing cases of violence and abuse against healthcare professionals, poor working conditions and environment, in conjunction with the poor economic situation, as well as increased anxiety and depression among working physicians and nurses, there is an increased possibility of heightened fear of the spread of suicidal ideation or suicide (41,42). Olwan and Alsawalqa (43) confirmed that the number of Jordanians who committed suicide over the study period was 1,119, and most cases occurred in the capital city, Amman.…”