The hidden epidemic: Workplace violence and its psychological impact on healthcare workers

Dear Editor, The article by Kumar et al.,[1] titled “Workplace Violence in the Healthcare Setting and its Psychological Impact on Healthcare Workers,” found a high prevalence of 43.7% workplace violence (WPV) in healthcare, significantly impacting workers’ mental health. A meta-analysis of 47 observational studies revealed that the overall prevalence of WPV against healthcare professionals was 62.4%, with verbal abuse accounting for the highest majority (61.2%), followed by psychological violence (50.8%), threats (39.5%), physical violence (PV) (13.7%), and sexual harassment (6.3%).[2] The prevalence of WPV in healthcare workers ranges from 40.8% to 78% in Indian studies.[3-11] Kumar et al.’s[1] study, involving 268 participants, found that 42.5% encountered verbal violence (VV) and 3.4% suffered PV. WPV incidents were frequently underreported. The patients are the perpetrators of PV in almost half (44%) of the incidents. In comparison, the main perpetrators of VV were the patients’ attendants (65.8%), followed by the patients themselves (10.5%) and coworkers or seniors (20%). Psychological distress was notably higher among those who experienced both VV and PV, with those subjected to PV reporting poorer sleep quality. Two-thirds of participants believed the incidents could have been prevented. Prevention strategies such as improved patient counseling, better communication, enhanced security, and stricter laws could help reduce violence. This paper highlights an important malady that is increasingly afflicting our healthcare settings. Violence against healthcare workers in any situation is inexcusable. However, it has become so common that it no longer makes headlines but often goes unnoticed despite its profound impact on doctors, healthcare staff, and patient care. A study found that healthcare workers face emotional, verbal, and PV more frequently in government facilities. Verbal abuse was the most common, with property damage by patients, relatives, and mobs, especially at night. Most workers tried to resolve conflicts peacefully, though some had to confront the aggressors.[12] WPV in healthcare arises from systemic and interpersonal factors such as staff shortages, patient noncompliance, long waits, and communication issues. Key causes include a lack of morality and literacy, especially in government settings, with trust issues and delayed treatment fueling violence. In private hospitals, overpriced services contribute similarly. Differences in views between patients’ relatives and healthcare workers highlight challenges in addressing violence effectively.[12,13] A recent review outlined three major contributors to WPV in healthcare: (i) emotional and behavioral responses of patients and their companions; (ii) factors related to healthcare staff, such as inexperience, anxiety, poor coping skills, and lack of training; and (iii) systemic issues like overcrowding, lengthy wait times, rigid visiting rules, lack of clear communication, and cultural or language barriers.[14] WPV in healthcare can lead to various psychological effects, with victims often facing demoralization, depression, diminished self-esteem, and feelings of ineptitude. They may also experience symptoms of post-traumatic stress disorder, such as sleep disturbances, irritability, trouble concentrating, flashbacks, and emotional distress. This widespread violence not only affects individual healthcare workers but also undermines overall healthcare delivery. It leads to increased absenteeism, a decline in care quality, and even career abandonment by affected professionals.[14] Deficiencies in healthcare infrastructure, such as inadequate security and poor communication with patients and their relatives, contribute significantly to WPV. Addressing these issues through enhanced security measures, transparent and empathetic communication, accessible counseling services, and better-equipped staff—both in numbers and training—can help reduce violence. Such improvements foster a safer environment for healthcare workers and allow them to focus on patient care without the constant concern for personal safety, ultimately enhancing the quality of care provided. Author contributions DM, SC: Concept and design of paper. DM, SC: Drafting the article and revising it critically. DM, SS: Final editing and approval of the version to be published. All authors have read and approved the manuscript. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.