Patient-related aggression distress and emotional exhaustion in Swiss psychiatric nurses: a sequential mediation model involving posttraumatic stress and depersonalization

Background Psychiatric nurses frequently encounter workplace violence, increasing their risk for psychological distress. This study examines how general workplace stressors relate to patient-related aggression (PRA) distress and clarifies the psychological pathway through which PRA-distress translates into emotional exhaustion via post-traumatic stress symptoms (PTSS) and depersonalization. Methods An online survey was conducted with 317 psychiatric nurses across six Swiss hospitals. Instruments assessed PRA distress (adaptation of the POPAS), workplace stressors, self-efficacy (GSE), posttraumatic stress symptoms (PTSS-10), and subscales of burnout (MBI). Bivariate correlations examined the association between workplace stressors and PRA-distress, and a sequential mediation analysis (PROCESS Model 6, 5,000 bootstrap resamples, N = 278) tested whether PTSS and depersonalization sequentially mediated the effect of PRA-distress on emotional exhaustion, controlling for age, employment percentage, and self-efficacy. Results Workplace stressors were strongly associated with PRA-distress ( r = .63, p <.001), indicating that aggression-related distress is embedded within broader organizational strain. In the mediation model ( R ² = .589), PRA-distress predicted PTSS ( b = 0.29, p <.001), which predicted depersonalization ( b = 0.24, p <.001) alongside a direct effect of PRA-distress on depersonalization ( b = 0.10, p = .042). Both PTSS ( b = 0.80) and depersonalization ( b = 0.74, both p <.001) strongly predicted emotional exhaustion, and the total indirect effect was significant ( b = 0.36, 95% CI [0.20, 0.51]). The direct effect of PRA-distress on exhaustion remained significant ( b = 0.19, p = .022), indicating partial mediation. Self-efficacy and age were protective, associated with lower PTSS/exhaustion and depersonalization/exhaustion, respectively. Conclusion Patient-related aggression distress was associated with emotional exhaustion both directly and through a sequential pathway of traumatic stress and depersonalization, while remaining embedded in broader organizational strain. These findings point to immediate, post-incident trauma support, self-efficacy-building interventions, and systemic efforts to reduce structural workplace stressors as promising directions for future intervention research, rather than as established recommendations given the cross-sectional design.