Workplace Incivility and Bullying Across Healthcare Professionals: Patterns and Correlates – a Cross-Sectional Study Publisher Pubmed

Summary: How common is bullying in hospitals? A study of 359 Iranian health workers found mistreatment linked to anxiety, stress and depression, especially among interns. #Healthcare #MentalHealth

Yousefian S ; Shayganfard M ; Safari M ; Javaheri J ; Sadeghi B
Source: BMJ Open Published:2026

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 (ρ=0.23–0.86) and with stress, anxiety and depression, particularly for EWI and EWB (ρ=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. © Author(s) (or their employer(s)) 2026. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ Group. This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: https://creativecommons.org/licenses/by-nc/4.0/.