Interrelationships of Anxiety, Burnout, Depression, and Insomnia Among Chinese Healthcare Workers Exposed to Workplace Violence: A Network Analysis

Workplace violence (WPV) against healthcare workers (HCWs) is a global public health concern. In China, HCWs face similar challenges; however, the impacts of WPV exposure on their mental health and occupational functioning remain unclear. This study aims to investigate the symptom network of anxiety, burnout, depression, and insomnia (ABDI) and adverse outcomes in Chinese HCWs exposed to WPV. From November 2023 to June 2024, 3361 HCWs with confirmed experiences of WPV were recruited across China through snowball sampling. WPV and ABDI were assessed using the Workplace Violence Scale, Generalized Anxiety Disorder Scale-7 (GAD-7), Oldenburg Burnout Inventory (OLBI), Patient Health Questionnaire-9 (PHQ-9), and Insomnia Severity Index (ISI), respectively. Data on adverse personal outcomes (low quality of life [QOL] and suicidal ideation [SI]) and occupational outcomes (turnover intention [TI]) were collected. We constructed and visualized networks, calculating strength and bridge strength (BS) indices to identify central and bridge symptoms. In the ABDI network of WPV-exposed HCWs, exhaustion (EX) emerged as the most central and bridge symptom. Uncontrollable worry (GAD2) and difficulty staying asleep (ISI2) were also central symptoms, while fatigue (PHQ4) and restlessness (GAD5) were identified as secondary bridge symptoms. Disengagement (DEM) strongly predicted TI; EX and sleep dissatisfaction (ISI4) predicted low QOL; and SI was most strongly linked to worthless (PHQ6), motor disturbance (PHQ8), and feeling afraid (GAD7). This study highlights that EX may serve as a priority target for preventing and intervening in psychological distress among WPV-exposed HCWs, as well as for improving their QOL. Burnout extends beyond workplace-related issues and is broadly associated with mental health problems and adverse outcomes. Implementing early detection and intervention measures is crucial for preventing and alleviating adverse effects in HCWs exposed to WPV.