Workplace Violence and Turnover Intention Among Psychiatrists in a National Sample in China: The Mediating Effects of Mental Health

Yanhua Chen; Peicheng Wang; Lina Zhao; Yanrong He; Nuoya Chen; Huanzhong Liu; Yuanli Liu; Tingfang Liu; Yi-Lang Tang; Feng Jiang; Jiming Zhu

doi:10.3389/fpsyt.2022.855584

Workplace Violence and Turnover Intention Among Psychiatrists in a National Sample in China: The Mediating Effects of Mental Health

Front Psychiatry. 2022 Jun 15:13:855584. doi: 10.3389/fpsyt.2022.855584. eCollection 2022.

Authors

Yanhua Chen^{1

2}, Peicheng Wang², Lina Zhao³, Yanrong He¹, Nuoya Chen⁴, Huanzhong Liu^{5

6}, Yuanli Liu⁷, Tingfang Liu³, Yi-Lang Tang^{8

9}, Feng Jiang^{10

11}, Jiming Zhu^{1

12}

Affiliations

¹ Vanke School of Public Health, Tsinghua University, Beijing, China.
² School of Medicine, Tsinghua University, Beijing, China.
³ Institute for Hospital Management, Tsinghua University, Beijing, China.
⁴ Health Related Activity Recognition System Based on IoT Project, University of Macerata, Macerata, Italy.
⁵ Department of Psychiatry, Chaohu Hospital of Anhui Medical University, Hefei, China.
⁶ Anhui Psychiatric Center, Anhui Medical University, Hefei, China.
⁷ School of Health Policy and Management, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China.
⁸ Mental Health Service Line, Atlanta VA Medical Center, Decatur, GA, United States.
⁹ Addiction Psychiatry Fellowship Program, Department of Psychiatry and Behavioral Sciences, Emory University, Atlanta, GA, United States.
¹⁰ School of International and Public Affairs, Shanghai Jiao Tong University, Shanghai, China.
¹¹ Institute of Healthy Yangtze River Delta, Shanghai Jiao Tong University, Shanghai, China.
¹² Institute for Healthy China, Tsinghua University, Beijing, China.

Abstract

Background: Workplace violence (WPV) in healthcare has received much attention worldwide. However, scarce data are available on its impact on turnover intention among psychiatrists, and the possible mechanisms between WPV and turnover intention have not been explored in China.

Methods: A cross-sectional survey was conducted among psychiatrists in 41 tertiary psychiatric hospitals from 29 provinces and autonomous regions in China. A stress-strain-outcome (SSO) model was adopted to examine the effects of WPV on mental health and turnover intention. The association and mediation by burnout and stress were examined by multivariate logistic regression (MLR) and generalized structure equation modeling (GSEM).

Results: We invited 6,986 psychiatrists to participate, and 4,520 completed the survey (64.7% response rate). The prevalence of verbal and physical violence against psychiatrist in China was 78.0 and 30.7%, respectively. MLR analysis showed that psychiatrists who experienced verbal violence (OR = 1.15, 95% CI = 1.10-1.21) and physical violence (OR = 1.15, 95% CI = 1.07-1.24) were more likely to report turnover intention. GSEM analysis showed that burnout (β = 4.00, p < 0.001) and stress (β = 1.15, p < 0.001) mediated the association between verbal violence and turnover intention; similarly, burnout (β = 4.92, p < 0.001) and stress (β = 1.80, p < 0.001) also mediated the association between physical violence and turnover intention.

Conclusions: Experience of WPV is a significant contributor to turnover intention among psychiatrists. Mental health status, such as burnout and stress level significantly mediated the association. Policy makers and hospital administrators need to be aware of this association. Action is needed to promote mental health among the psychiatrists to improve morale and workforce sustainability.

Keywords: China; mental health; psychiatrists; turnover intention; workplace violence.