Associations of workplace violence with depression and anxiety among health-care workers: the mediating role of perceived work stress

BACKGROUND: Workplace violence (WPV) is a pervasive occupational hazard in health-care settings and has increasingly been recognized as a major threat to health-care workers' mental health. Previous studies have consistently shown that WPV is associated with a range of adverse psychological outcomes, including depression and anxiety. However, despite the growing body of evidence documenting these associations, the underlying mechanisms through which WPV affects mental health remain insufficiently understood. OBJECTIVES: This study aims to examine the associations between WPV and depression and anxiety among health-care workers and to assess whether perceived work stress mediates these associations. METHODS: A cross-sectional survey was conducted among health-care workers in Xi'an, China, using a multistage stratified cluster sampling design. Logistic regression models were used to assess associations between WPV and mental health outcomes, and the Karlson-Holm-Breen method was applied to assess the mediating role of perceived work stress. RESULTS: A total of 39,773 participants were included in the final analysis, of whom 46.18% reported experiencing WPV. WPV was associated with higher odds of depression (OR = 3.79, 95% CI: 1.76-8.15) and anxiety (OR = 3.81, 95% CI: 2.11-6.90). Perceived work stress partially mediated these relationships, accounting for 18.90% of the association with depression and 15.63% with anxiety. CONCLUSIONS: WPV was significantly associated with depression and anxiety among health-care workers and perceived work stress may represent a potential pathway linking WPV to these outcomes. Interventions should focus on preventing WPV and strengthening mental health support for affected staff.