Abstract
Workplace violence (WPV) against healthcare workers has become a growing problem, which seriously affects the medical service market and is the focus of global concern. This study aimed to evaluate the prevalence of WPV among doctors in tertiary general hospitals in Northeast China, and to analyze the influencing factors of WPV, so as to provide a reference for the development of targeted and effective prevention strategies and measures of WPV. A cross-sectional survey was conducted at two tertiary general hospitals in Dalian, Liaoning Province, Northeast China, from February to March 2024. Data were collected using a structured questionnaire covering WPV situations, sociodemographic characteristics, work situations, and psychosocial factors. A binary logistic regression model was employed to assess the independent influencing factors of WPV. A total of 503 doctors were included in this study, of whom 31.8% reported experiencing WPV. Binary logistic regression analysis identified that years of work experience of 6–15 years (OR: 1.984, 95% CI: 1.201–3.277, P = 0.007) and > 15 years (OR: 2.608, 95% CI: 1.482–4.588, P = 0.001), number of night shifts per month > 3 times (OR: 1.656, 95% CI: 1.094–2.506, P = 0.017), anxiety symptoms (OR: 1.752, 95% CI: 1.070–2.868, P = 0.026), and poor doctor-patient relationship (OR: 1.645, 95% CI: 1.060–2.553, P = 0.026) were risk factors for WPV. However, good self-rated quality of life (OR: 0.533, 95% CI: 0.335–0.850, P = 0.008) was a protective factor for WPV. Due to the cross-sectional design, the possibility of inferences of causal relationships between study variables was limited. The incidence of WPV was high among doctors in tertiary general hospitals in Northeast China, and it was affected by many factors. Therefore, it is urgent to develop effective interventions to alleviate the WPV suffered by doctors, and more attention should be paid to doctors with risk factors.
Similar content being viewed by others
Data availability
The raw data supporting the conclusions of this article will be made available by the corresponding author, without undue reservation.
References
Di, M. V. Workplace violence in the health sector - Country case studies. (2002).
Ramacciati, N., Ceccagnoli, A. & Addey, B. Violence against nurses in the triage area: an Italian qualitative study. Int. Emerg. Nurs. 23 (4), 274–280 (2015).
Pol, A., Carter, M. & Bouchoucha, S. Violence and aggression in the intensive care unit: what is the impact of Australian National emergency access target? Australian Crit. Care: Official J. Confederation Australian Crit. Care Nurses. 32 (6), 502–508 (2019).
Liu, J. et al. Prevalence of workplace violence against healthcare workers: a systematic review and meta-analysis. Occup. Environ. Med. 76 (12), 927–937 (2019).
Afshari, A., Barati, M., Darabi, F. & Khazaei, A. Violent encounters on the front line: sequential explanatory mixed-methods investigation of physical violence factors in the prehospital setting. BMC Emerg. Med. 24 (1), 162 (2024).
Lu, L. et al. Prevalence of workplace violence against Health-Care professionals in china: A comprehensive Meta-Analysis of observational surveys. Trauma. Violence Abuse. 21 (3), 498–509 (2020).
Sun, T. et al. Workplace violence, psychological stress, sleep quality and subjective health in Chinese doctors: a large cross-sectional study. BMJ open. 7 (12), e017182 (2017).
O’Brien, C. J., van Zundert, A. A. J. & Barach, P. R. The growing burden of workplace violence against healthcare workers: trends in prevalence, risk factors, consequences, and prevention - a narrative review. EClinicalMedicine 72, 102641 (2024).
Franz, S., Zeh, A., Schablon, A., Kuhnert, S. & Nienhaus, A. Aggression and violence against health care workers in Germany–a cross sectional retrospective survey. BMC Health Serv. Res. 10, 51 (2010).
Yang, Y. et al. How workplace violence correlates turnover intention among Chinese health care workers in COVID-19 context: the mediating role of perceived social support and mental health. J. Nurs. Adm. Manag. 30 (6), 1407–1414 (2022).
Najafi, F., Fallahi-Khoshknab, M., Ahmadi, F., Dalvandi, A. & Rahgozar, M. Antecedents and consequences of workplace violence against nurses: A qualitative study. J. Clin. Nurs. 27 (1–2), e116–e28 (2018).
Eala, M. A. B. et al. Violence against health-care workers in the Philippines. Lancet (London England). 399 (10340), 2012–2013 (2022).
Zhong, X. F. & Shorey, S. Experiences of workplace violence among healthcare workers in home care settings: A qualitative systematic review. Int. Nurs. Rev. 70 (4), 596–605 (2023).
Bhusal, A., Adhikari, A. & Singh Pradhan, P. M. Workplace violence and its associated factors among health care workers of a tertiary hospital in Kathmandu, Nepal. PloS One. 18 (7), e0288680 (2023).
Pich, J., Hazelton, M., Sundin, D. & Kable, A. Patient-related violence at triage: A qualitative descriptive study. Int. Emerg. Nurs. 19 (1), 12–19 (2011).
Angland, S., Dowling, M. & Casey, D. Nurses’ perceptions of the factors which cause violence and aggression in the emergency department: a qualitative study. Int. Emerg. Nurs. 22 (3), 134–139 (2014).
Torabi, M., Afshari, A., Salimi, R. & Khazaei, A. Leveling of triggers: a comprehensive summative content analysis of factors contributing to physical violence in emergency medical services. BMC Emerg. Med. 25 (1), 22 (2025).
Sun, P. et al. Workplace violence against health care workers in North Chinese hospitals: A Cross-Sectional survey. International J. Environ. Res. public. Health ; 14(1). (2017).
Pinar, T. et al. Workplace violence in the health sector in turkey: A National study. J. interpers. Viol.. 32 (15), 2345–2365 (2017).
Otachi, J. K., Robertson, H. & Okoli, C. T. C. Factors associated with workplace violence among healthcare workers in an academic medical center. Perspect. Psychiatr. Care. 58 (4), 2383–2393 (2022).
Wang, P. X., Wang, M. Z., Hu, G. X. & Wang, Z. M. Study on the relationship between workplace violence and work ability among health care professionals in Shangqiu City. J. Hygiene Res. 35 (4), 472–474 (2006).
Qiu, T. et al. The mediating role of psychological capital on the association between workplace violence and professional identity among Chinese doctors: a cross-sectional study. Psychol. Res. Behav. Manage. 12, 209–217 (2019).
Tian, Y. et al. Workplace violence against hospital healthcare workers in china: a National WeChat-based survey. BMC public. Health. 20 (1), 582 (2020).
Cohen, S., Kamarck, T. & Mermelstein, R. A global measure of perceived stress. J. Health Soc. Behav. 24 (4), 385–396 (1983).
Messineo, L. & Tosto, C. Evaluation of the psychometric properties of the Italian version of the 10-item perceived stress scale in a sample of teachers. Front. Psychol. 14, 1330789 (2023).
Andreou, E. et al. Perceived stress scale: reliability and validity study in Greece. Int. J. Environ. Res. Public Health. 8 (8), 3287–3298 (2011).
Spitzer, R. L., Kroenke, K., Williams, J. B. & Löwe, B. A brief measure for assessing generalized anxiety disorder: the GAD-7. Arch. Intern. Med. 166 (10), 1092–1097 (2006).
Gong, Y. et al. Validation of the 7-item generalized anxiety disorder scale (GAD-7) as a screening tool for anxiety among pregnant Chinese women. J. Affect. Disord. 282, 98–103 (2021).
Wu, F. et al. Association between intimate partner violence and prenatal anxiety and depression in pregnant women: a cross-sectional survey during the COVID-19 epidemic in Shenzhen, China. BMJ open. 12 (5), e055333 (2022).
Smilkstein, G. The family APGAR: a proposal for a family function test and its use by physicians. J. Fam. Pract. 6 (6), 1231–1239 (1978).
Chen, M. et al. Association of family function and suicide risk in teenagers with a history of self-harm behaviors: mediating role of subjective wellbeing and depression. Front. public. Health. 11, 1164999 (2023).
Sun, L. et al. Correlations between psychological symptoms and social relationships among medical undergraduates in Anhui Province of China. Int. J. Psychiatry Med. 42 (1), 29–47 (2011).
Tamura, H. et al. Association between physician empathy and difficult patient encounters: a Cross-Sectional study. J. Gen. Intern. Med. 38 (8), 1843–1847 (2023).
Molla, A., Mekuriaw, B. & Kerebih, H. Depression and associated factors among patients with tuberculosis in ethiopia: a cross-sectional study. Neuropsychiatr. Dis. Treat. 15, 1887–1893 (2019).
Du, J. et al. The validity and IRT psychometric analysis of Chinese version of difficult Doctor-Patient relationship questionnaire (DDPRQ-10). BMC Psychiatry. 23 (1), 900 (2023).
Liu, R. et al. Workplace violence against frontline clinicians in emergency departments during the COVID-19 pandemic. PeerJ 9, e12459 (2021).
Alfuqaha, O. A. et al. Workplace violence among healthcare providers during the COVID-19 health emergency: A Cross-Sectional study. Behavioral Sci. (Basel Switzerland) ; 12(4). (2022).
Bekelepi, N. & Martin, P. Self-reported incidents of violence towards nurses working in acute psychiatric units. Curationis 46 (1), e1–e8 (2023).
Janatolmakan, M., Abdi, A., Rezaeian, S., Framarzi Nasab, N. & Khatony, A. Violence against Emergency Nurses in Kermanshah-Iran: Prevalence and Associated Factors. Nursing Res. Pract. 9362977. (2023).
Hulsegge, G. et al. Shift work, sleep disturbances and social jetlag in healthcare workers. J. Sleep Res. 28 (4), e12802 (2019).
Ganesan, S. et al. The impact of shift work on Sleep, alertness and performance in healthcare workers. Sci. Rep. 9 (1), 4635 (2019).
Vallejo-Andrada, A., Caravaca-Sánzhez, F., Sarasola-Sánchez-Serrano, J. L. & Barrera-Algarín, E. Violence toward social workers in Spain and its association with Burnout, job satisfaction and anxiety. Social Work public. Health. 40 (3), 89–101 (2025).
Cheng, F. F. et al. Anxiety in Chinese pediatric medical staff during the outbreak of coronavirus disease 2019: a cross-sectional study. Transl. Pediatr. 9 (3), 231–236 (2020).
Zhang, L. et al. Anxiety and depression in healthcare workers 2 years after COVID-19 infection and scale validation. Sci. Rep. 15 (1), 13893 (2025).
Zhou, Y. et al. General perception of Doctor-Patient relationship from patients during the COVID-19 pandemic in china: A Cross-Sectional study. Front. public. Health. 9, 646486 (2021).
Yang, J. S. & Hao, D. J. Dilemmas for nurses in China. Lancet (London England). 392 (10141), 30 (2018).
de Waard, C. S. et al. Perceived doctor-patient relationship and satisfaction with general practitioner care in older persons in residential homes. Scand. J. Prim. Health Care. 36 (2), 189–197 (2018).
Han, C., Wu, Q., Liu, C. & Wang, P. Patient’s perceived empathy can predict doctor-patient relationship in medical interaction. BMC Med. Educ. 25 (1), 741 (2025).
Tang, C., Guan, C. & Liu, C. Quality of working life of medical Doctors and associated risk factors: a cross-sectional survey in public hospitals in China. BMJ open. 12 (11), e063320 (2022).
Lin, W. Q. et al. Workplace violence and job performance among community healthcare workers in china: the mediator role of quality of life. Int. J. Environ. Res. Public Health. 12 (11), 14872–14886 (2015).
Marzo, R. R. et al. Demographic and work-related factors associated with burnout, resilience, and quality of life among healthcare workers during the COVID-19 pandemic: A cross sectional study from Malaysia. Front. public. Health. 10, 1021495 (2022).
Acknowledgements
We would like to thank the data collectors for their efforts for this study. Finally, we would also like to thank the study participants.
Author information
Authors and Affiliations
Contributions
BW, YNZ, JQ, DMY, and XC designed and advanced the study. BW, YNZ, and XC analyzed the data and wrote the manuscript. All authors read, revised, and approved the final manuscript and agree to be accountable for all aspects of the work.
Corresponding authors
Ethics declarations
Competing interests
The authors declare no competing interests.
Ethics approval
The Ethics Committee of the First Affiliated Hospital of Dalian Medical University approved the study (Number: PJ-KS-KY-2024-219). Written informed consent was obtained from all study subjects. All methods in our study were conducted in accordance with the Declaration of Helsinki.
Additional information
Publisher’s note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
Open Access This article is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License, which permits any non-commercial use, sharing, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if you modified the licensed material. You do not have permission under this licence to share adapted material derived from this article or parts of it. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by-nc-nd/4.0/.
About this article
Cite this article
Chen, X., Zhang, Y., Qin, J. et al. Prevalence and influencing factors of workplace violence among doctors in Northeast China: a cross-sectional study. Sci Rep (2026). https://doi.org/10.1038/s41598-025-34701-0
Received:
Accepted:
Published:
DOI: https://doi.org/10.1038/s41598-025-34701-0
