Public health workers face workplace violence ‘harmful’ to mental health

November 21, 2022

3 minutes of reading


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A third of public health workers have experienced some form of workplace violence that has affected their mental health, according to researchers.

Hope M. Theisman, Ph.D., research epidemiologist at the CDC’s National Institute for Occupational Safety and Health and colleagues wrote that “during the COVID-19 pandemic, public health workers (PHWs) have been at increased risk of violence and harassment because of their field work of public health and have experienced adverse mental health conditions.”


Data retrieved from: Tiesman HM, et al. Am J Prev Med. 2022;10.1016/j.amepre.2022.10.004.

“PHWs play a key role in public health emergencies, but there is little research on how these emergencies affect their mental health,” they wrote in American Journal of Preventive Medicine.

Researchers conducted an online survey in April 2021 to better understand the prevalence of harassment, work-related threats, and discrimination against PHWs during the pandemic and how they affected mental health.

A non-probability convenience sample of local, tribal, and state PHWs completed a self-administered survey answering questions about workplace violence (WPV) demographics, mental health symptoms, and workplace factors.

Of the 26,174 PHWs who responded to the survey, Tiesman and colleagues found that 35% engaged in at least one form or combination of forms of WPV. Additionally, “this violence is associated with a detrimental impact on the mental health of PHWs.”

Specifically, 26% (n = 5,962) had experienced stigma because of their work in public health, 24% (n = 5,350) had been abused or harassed, and 12% (n = 2,688) had received threats related to work, according to the researchers.

The more someone works, the more likely they are to encounter WPV (< 20 часа, 16 %; 20-40 часа, 25 %; 41-60 часа, 41 %; 61-75 часа, 52 %; > 75 hours, 61%). The researchers note that “the same trend was observed for the degree of social interaction” (“a little” interaction, 22%; “somewhat,” 31%; “a lot,” 46%).

Even after adjusting for confounders, the researchers found that exposure to any type of WPV was significantly associated with a greater likelihood of reporting:

  • symptoms of depression (prevalence rate [PR] = 1.95, 95% CI, 1.87-2.03);
  • anxiety (PR = 1.87; 95% CI, 1.80-1.94);
  • PTSD (PR = 2.0′ 95% CI, 1.93–2.07); and
  • suicidal ideation (PR = 1.99; 95% CI, 1.83-2.18).

Additionally, Tiesman and colleagues noted that “a dose-response relationship was found between the number of WPV events experienced by PHWs and the likelihood of reporting mental health symptoms.”

For example, they write, “the proportion of PHW reporting depressive symptoms was 1.7 times greater if they experienced one type of WPV, 2 times greater for two types, and 2.4 times greater if they experienced both the three types of WPV. “

The researchers wrote that “ongoing training, workplace support, and increased communication after a WPV incident may be helpful” and that “efforts to strengthen public health capacity and support the public health workforce are also needed.”

“Any WPV targeting PHWs during a public health emergency is harmful to them as well as the communities they serve. WPV against PHWs is an alarming outcome of the COVID-19 pandemic,” they concluded. “Efforts must be made to protect and support the current public health workforce.”

Additionally, the researchers note that “increased workplace communication after a WPV incident is also important and may protect PHWs from adverse mental health outcomes.”

If an incident occurs, they wrote, workers “should report the event to a designated official within their organization, including the frequency of the violence and other details surrounding the event.” In this way, “supervisors can make informed decisions about workplace, task, and shift changes to reduce the likelihood of another WPV event.”

“Experiencing multiple WPV events has a cumulative effect on adverse psychological symptoms and may lead to increased turnover, burnout, and decreased job satisfaction,” Tiesman and colleagues wrote. “Most importantly, supervisors and public health agencies should contact law enforcement immediately if a PHW’s life or family is in danger.”

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