Workplace incivility and bullying across healthcare professionals: patterns and correlates - a cross-sectional study

Abstract

Objectives To estimate the prevalence and frequency of workplace incivility and bullying across multiple healthcare roles; compare experiences among occupational groups; examine associations with psychological symptoms (stress, anxiety and depression); assess interrelations among mistreatment dimensions (experienced workplace incivility (EWI), witnessed workplace incivility (WWI), instigated workplace incivility (IWI and experienced workplace bullying (EWB)); and evaluate associations with demographic and contextual variables. Design Cross-sectional study. Setting Three teaching hospitals in Arak, Iran, between March and December 2023. Participants A stratified random sample of 550 healthcare workers was invited; 392 responded (response rate 71.3) and 359 with complete data were included, comprising nurses, interns, residents, general practitioners and administrative staff. Outcome measures Workplace incivility (Workplace Incivility Scale), workplace bullying (Negative Acts Questionnaire-Revised) and psychological symptoms (Depression, Anxiety and Stress Scale-21 Items). Results The sample (N=359) was 64 female with a mean age of 32 years. Significant differences were observed across occupational groups for WWI, IWI and EWB (all p<0.001). However, post hoc analyses indicated that most differences involved administrative staff, while clinical roles showed broadly comparable levels of exposure. Interns showed the highest prevalence of both EWI and EWB (38 and 69, respectively). All mistreatment dimensions were positively correlated with each other (rho=0.23-0.86) and with stress, anxiety and depression, particularly for EWI and EWB (rho=0.39-0.62, p<0.03). In adjusted analyses, EWI and EWB remained associated with higher stress, anxiety and depression after adjustment (all p <= 0.014), whereas WWI was associated only with stress (p=0.001) and IWI showed no independent associations. Demographic and contextual variables showed weak and inconsistent associations, except smoking, which was associated with higher mistreatment scores across all dimensions (p <= 0.001). Conclusions Workplace incivility and bullying are widespread across healthcare roles, with broadly comparable exposure across clinical staff. Direct experiences of mistreatment showed the most consistent associations with psychological distress, and mistreatment dimensions appeared to operate within interconnected patterns. Addressing these issues requires system-level interventions targeting structural and cultural drivers to promote psychologically safe clinical environments.