Bullying in hospital settings : the nature of bullying, prevalence rates and occupational health outcomes

This thesis deals with the issue of bullying at work. The bullying concept refers to situations where a person is persistently and over time exposed to hostile and demeaning behaviours at work. Whether the bullying is deliberate or not, it is likely to cause humiliation, offence and distress in the target person. In the thesis, the focus is on two aspects of bullying at work - namely prevalence rates and occupational health outcomes. In recent years, attention has been paid to bullying and harassment among health care professionals. Findings from several countries suggest that health professionals are frequently exposed to various kinds of bullying behaviours or acts. Indeed, the two studies reported in this thesis point to high levels of bullying in the health sector.

The studies took place in two hospital trusts, one located in Scotland and the other in Iceland. Questionnaires were used to assess the prevalence and nature of bullying experiences in these trusts. The study samples were large and randomly generated. Two key methods were used to assess prevalence levels. The first method focused on persistent exposure to undesirable behaviour at work. The second method focused on subjective experiences of bullying at work. An interesting disparity in findings appeared, depending on the method used. Results from the first method consistently pointed to higher prevalence rates than results from the second method.

Apart from studying local prevalence rates, the project aimed at comparing the rates from the two countries. The results from this cross-cultural comparison pointed consistently to higher levels of bullying in Scotland than in Iceland. However, both studies showed that people were most likely to report work-related negative acts and personal derogation or isolation. This accords with the notion that rational-appearing aggression and other forms of covert aggression are more frequently used in the workplace than are overt forms of aggression.

In Scotland, cross-sectional data were used to assess the link between bullying and occupational health outcomes. Results showed that staff who had experienced one or more types of bullying acts in the past year were more likely than other staff to be dissatisfied in their job, to contemplate leaving and to have higher levels of anxiety and depression. They also reported poorer health and taking more days off work for sickness in the past year. In the Icelandic study, longitudinal data were used to assess the link between patterns of bullying experiences and health outcomes. In regression analyses, it was found that chronic exposure to bullying and recent onset predicted anxiety and depression levels. Moreover, three patterns of bullying (chronicity, remission and onset) predicted levels of psychosomatic complaints.

What mainly distinguishes the current project from other projects in the field is the methodology used to test the relationship between bullying and health outcomes. Specifically, the methodology used in the project enabled the author to study whether bullying at work is mainly a cause of adverse health outcomes or whether the relationship between bullying and health outcomes is more complex. Whilst most current knowledge suggests that bullying at work leads to outcomes such as increased levels of anxiety and depression, it is quite possible that other causal mechanisms (e.g. reverse causal mechanisms) are also at work. Indeed, the results reported in the thesis suggest that reverse causation is also possible. Specifically, that psychological distress (reflected in depressive symptoms) places people at more risk of being bullied at work. Whilst this finding is certainly important in its own right, it is also important in practical sense - for instance, when it comes to preventive actions. In order to effectively deal with the problem, it seems essential to look for ways to help and support vulnerable groups of employees. In particular, groups who suffer symptoms of depression.