Workplace Violence and Self-Reported Physical and Mental Health: A National Cross-Sectional Study in Lebanon

Abstract Background Workplace violence (WPV) is any physical or psychological violence experienced in the workplace. Studies that investigate the prevalence of WPV in the Middle East North Africa (MENA) region are scarce. This study aimed to examine the determinants of WPV and its association with self-reported physical and mental health among employed adults residing in Lebanon. Methods This was a national cross-sectional study that recruited working age residents of Lebanon through Random Digital Dialing. Data were collected by trained data collectors through SurveyCTO software from January till July 2024. The main exposure of this study was physical and verbal WPV. Three outcomes depressive symptoms, anxiety symptoms, and physical health were measured using the PHQ-9, GAD-7, and PROMIS GBH scales, respectively. Adjusted logistic regression models estimated the association between WPV and each outcome, respectively. Findings The study included 3,076 employed participants. Median age (IQR) of study sample was 37 (28-46) years old, 889 (30%) completed college and further education, 1,111 (25%) were non-Lebanese. A total of 518 (16%) participants experienced at least one form of WPV. Moreover, 1,080 (33·4%) experienced depressive symptoms, 825 (25·5%) experienced anxiety symptoms, and 2,374 (75·5%) reported poor physical health. Being exposed to WPV increased the odds of depressive symptoms [adjusted odds ratio (aOR):3·00 (95%CI:2·40-3·70)], anxiety symptoms (aOR:3·01 (95%CI:2·41-3·72)), and poor physical health (aOR:2·82 (95%CI:2·04-3·98)). Interpretation The study highlights the extent of WPV among workers in Lebanon and the urgent need to address the matter. Findings offer a basis for targeting interventions to vulnerable workers. Funding International Development Research Centre (IDRC)- Canada Research in context Evidence before this study A literature search was conducted on workplace violence (WPV) exposure and mental and physical health outcomes using the following databases: PubMed, Web of Science, Science Direct, and Google Scholar. Articles published in English until September 1, 2024 were searched using the search terms “workplace violence”, “occupational violence”, “workplace physical violence”, “workplace sexual violence”, “workplace sexual harassment”, and “mental health”, “depression”, “anxiety”, “trauma”, “isolation”, “social phobia”, “physical health”, “non-communicable diseases, “cancer”, “cardiovascular disease”, “diabetes”, “hypertension”, “respiratory disease”, “anemia”, “musculoskeletal disease”, “chronic renal failure”, “neurological disease”, “sleep problems”, “sick leave”, “sickness”, and “population-based study”. The Lancet 2023 Series “Work and Health” highlighted the elevated risk of experiencing anxiety symptoms, depressive symptoms, and overall fatigue for workers experiencing WPV. The series accentuated the scarcity of studies examining the impact of WPV on mental and physical health in low-middle income countries (LMIC). Studies that aim to investigate the magnitude of WPV in Lebanon and in the Middle East and North Africa (MENA) region were only conducted within the healthcare sector focusing on healthcare workers. Added value of this study This study adds significant value as one of the largest national studies in the MENA region to examine the association of WPV with mental and physical health among adults in all work sectors. This is the first study that investigates association of WPV with depressive symptoms, anxiety symptoms, and self-reported physical health among Lebanese and non-Lebanese working in the formal and informal sector and residing in Lebanon, a LMIC. Results reveal a relatively high prevalence of WPV in both work sectors. Study results also show a significantly higher odds of WPV among uneducated, non-Lebanese including refugees and immigrants, and freelance informal sector workers. Furthermore, WPV was strongly associated with depressive symptoms, anxiety symptoms, and reporting poor physical health. Implications of all the available evidence This large national study highlights the adverse mental and physical health outcomes of WPV on employed adults in Lebanon particularly among non-nationals including immigrants and refugees, uneducated, and informal freelance workers. These findings accentuate detrimental health, social, and financial implications of WPV on institutions and organisations. The findings suggest potential benefit from enhancing labour law enforcement by the government and providing targeted interventions that promote respect and tolerance within formal and informal work sectors regardless of worker’s nationality.

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