title: Workplace violence and occupational stress in healthcare workers: a chicken-and-egg situation-results of a 6-year follow-up study.
abstract: OBJECTIVE
  Violence at work (WV) is an important occupational hazard for health care workers (HCWs). A number of surveys addressing the causes and effects of WV have shown that it is associated with work-related stress. However, it is not clear what direction this relationship takes, that is, whether job strain facilitates aggression against HCWs or WV is the cause of job strain.
  
  
  METHODS
  From 2003 to 2009, HCWs from a public health care unit were asked to self-assess their level of work-related stress and to report aggression that occurred in the 12-month period preceding their routine medical examination. In 2009, physical and mental health and job satisfaction were also assessed. A total of 698 out of 723 HCWs (96.5%) completed the study.
  
  
  RESULTS
  Job strain and lack of social support were predictors of the occurrence of nonphysical aggression during the ensuing year. HCWs who experienced WV reported high strain and low support at work in the following year. The experience of nonphysical violence and a prolonged state of strain and social isolation were significant predictors of psychological problems and bad health at follow-up.
  
  
  CONCLUSIONS
  The relationship between work-related distress and WV is bidirectional. The monitoring of workers through questionnaires distributed before their periodic examination is a simple and effective way of studying WV and monitoring distress.
  
  
  CONCLUSIONS
  The findings of the present study may facilitate the subsequent design of participatory intervention for the prevention of violence in healthcare facilities. This should always be accompanied by measures designed to reduce strain and improve social support.
authors.affiliation: Aggregate Professor, Department of Public Health, Università Cattolica del Sacro Cuore, Rome, Italy.
authors.forename: Nicola
authors.initials: N
authors.lastname: Magnavita
mesh_terms: D000328:Adult; D004651:Employment / Q000523:psychology*; D005260:Female; D005500:Follow-Up Studies; D006282:Health Personnel / Q000523:psychology* / Q000706:statistics & numerical data; D006304:Health Status; D006801:Humans; D007588:Job Satisfaction; D008297:Male; D008875:Middle Aged; D012944:Social Support; D013315:Stress, Psychological / Q000209:etiology*; D011795:Surveys and Questionnaires; D064450:Workplace Violence / Q000523:psychology*
keywords: Cause-effect; job strain; mental health; occupational exposure; psychosocial factors; violence; workplace