title: The frequency of patient-initiated violence and its psychological impact on physicians in china: a cross-sectional study.
abstract: BACKGROUND
  In China, the severity of medical disputes has greatly increased during the past two decades, which has caused various adverse outcomes for health professionals. Previous research on violence in healthcare settings has primarily examined the occurrence of patient-initiated violence and its effects on physicians, but few studies have focused on the impact of the extent of physicians' exposure to violence. This study examined the different frequency levels of specific types of violence and their relationships to physicians' psychological wellbeing, including emotional exhaustion (EE), job satisfaction (JS), and intention to leave (IL).
  
  
  METHODS
  Using a stratified random sampling method, the participants were drawn from 123 public hospitals in Shanghai, Hubei Province, and Gansu Province in China, and 1,656 completed questionnaires were collected. Chi-square test, analysis of variance, and mixed linear model were employed in the analysis.
  
  
  RESULTS
  The results showed that the rate of exposure to verbal abuse (VA) was the highest (92.75%), followed by threats of assault (TA, 88.10%) and physical assaults (PA, 81.04%). Physicians' reported high-frequency exposure to VA, TA, and PA was 35.14%, 27.72%, and 19.32%, respectively. The results indicated that exposure to violence significantly affected EE, JS, and IL, and the intensity of the harm of high-frequency exposure was several times stronger than that of low-frequency exposure. Interestingly, we found that VA produced a greater adverse impact on physicians' EE and satisfaction with work (JS-1) than did TA or PA. This finding may be attributed to the fact that physicians are more likely to be exposed to a high frequency of VA, and the effect of high-frequency exposure is much stronger.
  
  
  CONCLUSIONS
  The results indicated that decreasing violent incidents and creating a safer work environment for physicians should be a top priority for both government and society.
authors.affiliation: Key Lab of Health Technology Assessment, Ministry of Health (Fudan University); Collaborative Innovation Center of Social Risks Governance in Health; School of Public Health, Fudan University, Shanghai, 200032, P.R. China.
authors.forename: Jianwei
authors.initials: J
authors.lastname: Shi
authors.affiliation: School of Business, East China Normal University, Shanghai, 200241, P.R. China.
authors.forename: Sheng
authors.initials: S
authors.lastname: Wang
authors.affiliation: Key Lab of Health Technology Assessment, Ministry of Health (Fudan University); Collaborative Innovation Center of Social Risks Governance in Health; School of Public Health, Fudan University, Shanghai, 200032, P.R. China.
authors.forename: Ping
authors.initials: P
authors.lastname: Zhou
authors.affiliation: Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, 21205, United States of America.
authors.forename: Leiyu
authors.initials: L
authors.lastname: Shi
authors.affiliation: Health and Family Planning Commission of Hubei Province, Hubei, 430079, P.R. China.
authors.forename: Yu
authors.initials: Y
authors.lastname: Zhang
authors.affiliation: Health and Family Planning Commission of Gansu Province, Gansu, 730030, P.R. China.
authors.forename: Fei
authors.initials: F
authors.lastname: Bai
authors.affiliation: Key Lab of Health Technology Assessment, Ministry of Health (Fudan University); Collaborative Innovation Center of Social Risks Governance in Health; School of Public Health, Fudan University, Shanghai, 200032, P.R. China.
authors.forename: Di
authors.initials: D
authors.lastname: Xue
authors.affiliation: Shanghai Mental Health Center, Shanghai, 200030, P.R. China.
authors.forename: Xinkai
authors.initials: X
authors.lastname: Zhang
mesh_terms: D002681:China; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D008297:Male; D010361:Patients / Q000523:psychology*; D010820:Physicians / Q000523:psychology*; D014754:Violence