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Editorial: Workplace violence in healthcare: prevention strategies and mental health consequences

This editorial argues that workplace violence in healthcare has become a pervasive systemic issue with severe mental health consequences for staff. It highlights persistent high prevalence rates (60% of workers exposed) despite awareness efforts, emphasizing that normalization itself is psychologically harmful. Drawing on international studies, it shows widespread exposure across various roles and settings, leading to outcomes like depression, moral injury, and suicidal thoughts. The core argument is a paradigm shift: prevention must integrate mental health care strategies beyond mere safety measures, addressing the structural nature of WPV within healthcare environments.

By the NurseTrainer Evidence Studio

Frontiers in Psychiatry Published 2026 5 min read DOI 10.3389/fpsyt.2026.1886605
InternationalTrauma-Informed Care

In brief

This editorial argues that workplace violence in healthcare has become a pervasive systemic issue with severe mental health consequences for staff. It highlights persistent high prevalence rates (60% of workers exposed) despite awareness efforts, emphasizing that normalization itself is psychologically harmful.

What this article is about

Quick Answer

This editorial argues that workplace violence in healthcare has become a pervasive systemic issue with severe mental health consequences for staff. It highlights persistent high prevalence rates (60% of workers exposed) despite awareness efforts, emphasizing that normalization itself is psychologically harmful. Drawing on international studies, it shows widespread exposure across various roles and settings, leading to outcomes like depression, moral injury, and suicidal thoughts. The core argument is a paradigm shift: prevention must integrate mental health care strategies beyond mere safety measures, addressing the structural nature of WPV within healthcare environments.

Student takeaways

Key Takeaways

  • Workplace violence (WPV) in healthcare has transitioned from being considered a marginal occupational hazard to a defining feature of the work itself.
  • Prevalence studies show that 6 out of 10 healthcare workers are still exposed to any type of WPV, indicating limited progress over time despite awareness.
  • The normalization of WPV (e.g., describing it as 'part of the job') is identified as a form of psychological injury in its own right.
  • WPV has significant mental health consequences for healthcare workers, including sleep disruption, intrusive memories, depression, moral injury, and suicidal thoughts linked to both psychological and physical forms of violence.
  • The editorial argues that WPV is not merely an interaction between aggressor and target but a systemic property embedded within the healthcare environment.

Student summary

Why This Research Matters

This article, an editorial published in Frontiers in Psychiatry on July 2, 2026 (DOI: 10.3389/fpsyt.2026.1886605), delves into the critical issue of workplace violence (WPV) within healthcare settings and its profound mental health consequences for those who work in these environments. The authors, Christian Schulz, C.J. Cabilan, and Sanjeev Sockalingam, begin by posing a poignant question: when did we start accepting threats, physical assaults, or verbal abuse from patients as simply 'part of the job'? They argue that WPV has evolved beyond being a marginal occupational hazard; it is now a defining feature of healthcare work. This normalization itself can be seen as a psychological injury.

The editorial highlights historical context by mentioning Di Martino's (2002) pioneering work for ILO/WHO, which first brought global attention to the scale of WPV. More recent evidence from a meta-analysis of 253 studies involving over 330,000 participants indicates that this problem persists: approximately six out of ten healthcare workers still face any type of WPV from patients and visitors (Liu et al., 2019). The article emphasizes the human cost behind these statistics. Healthcare professionals often live with negative impacts such as sleep disruption, intrusive memories, depression, moral injury, and in severe cases, suicidal thoughts that can carry over into their next shift. Longitudinal evidence has consistently linked both psychological and physical forms of workplace violence to adverse mental health outcomes (Nyberg et al., 2021).

The core purpose of this editorial is to push the conversation beyond merely reporting how widespread WPV is, towards understanding its severe mental health consequences and exploring effective prevention strategies. It introduces a collection of eleven research contributions from diverse global settings: China, India, Italy, Switzerland, and Uganda. These studies collectively paint a coherent picture that WPV is not just an isolated incident but a structural occupational hazard. Its psychological effects ripple through individuals, teams, and the entire healthcare workforce.

The editorial then presents findings from several of these contributing studies to illustrate the breadth and depth of the problem: * In India, Vyas et al. found that 75% of doctors in public and private hospitals experience verbal abuse from patients' relatives. * A study by Liu, Zheng, and Liu in China surveyed a large cohort of nurses from 90 hospitals in Sichuan Province; their data showed that 18.4% of these nurses had experienced WPV in the previous year, with an additional 34% reporting they had witnessed colleagues being subjected to it. * Wang et al.'s research indicated a higher prevalence of WPV among nurses from secondary and tertiary hospitals in Lanzhou, at 69.9%. * Zhang et al. reported that an alarming 85% of emergency nurses experienced WPV in the previous year. The editorial notes that while many studies measure WPV prevalence from a staff safety perspective, Russotto et al.'s work in Italy offers a different lens, viewing WPV as both a staff and patient safety issue. Their study documented over 4,400 patient safety incidents within twelve months, with verbal aggression, physical assault, and death threats being the most common.

These studies collectively underscore that additional prevalence data alone is insufficient; the critical question now is what WPV does to those who survive it. The consequences are extensive, spanning the full spectrum of psychiatric morbidity. The editorial argues that WPV is not merely an interaction between an aggressor and a target but rather a systemic property embedded within healthcare environments.

The authors then pose a crucial challenge: if WPV has such profound mental health impacts, why do many prevention programs still treat it as a series of individual encounters? They contend that the field needs to recognize that prevention is not just about safety and security measures; it is also fundamentally about providing mental health care. This shift in perspective implies that interventions must address systemic issues within healthcare organizations rather than solely focusing on isolated incidents or individual coping mechanisms.

For nursing students, this article underscores several important points for critical appraisal: 1. **Problem Framing:** WPV is framed as a pervasive and deeply problematic issue with severe mental health ramifications, moving beyond simple 'safety' to encompass psychological well-being. 2. **Evidence Base:** The editorial relies on meta-analyses (Liu et al., 2019) and longitudinal studies (Nyberg et al., 2021), which provide strong evidence for the prevalence and consequences of WPV. 3. **Scope:** It highlights that WPV affects all levels of the healthcare workforce across various settings, from doctors to nurses in different types of hospitals and even emergency departments. 4. **Systemic Nature:** A key argument is that WPV is a structural occupational hazard, not just random acts. This suggests that solutions must be systemic rather than purely individual-focused. 5. **Prevention Paradigm Shift:** The article advocates for a significant shift in how prevention programs are designed and implemented, arguing they should integrate mental health care strategies more comprehensively.

Regarding source and rights cautions: the paper is published by Frontiers in Psychiatry (DOI: 10.3389/fpsyt.2026.1886605). The supplementary context indicates a provenance score of 84 from OpenAlex, with a 'source-linked' rights status and high authority level for the source metadata itself. While this suggests reliable sourcing information about the paper's origin, students should always verify access to full text through institutional subscriptions or open-access platforms if needed.

A nurse would reason from this evidence by understanding that WPV is not an inevitable part of their job but a serious occupational hazard with significant mental health impacts on both individuals and teams. This knowledge supports advocating for systemic changes within healthcare organizations, such as improved security measures, better training programs (including de-escalation techniques), robust reporting mechanisms, and crucially, access to psychological support services for staff who have experienced WPV. It also reinforces the need for a cultural shift in how healthcare environments are managed to prevent violence and protect mental health.

In summary, this editorial serves as a powerful call to action, urging the nursing profession and healthcare systems at large to re-evaluate their approach to workplace violence by integrating comprehensive mental health support into prevention strategies. It emphasizes that addressing WPV effectively requires understanding its deep-rooted systemic nature and its devastating psychological consequences.

Source abstract

Study Overview

When did we begin to accept that being threatened, struck, or sworn at by the people we care for is simply "part of the job"? Workplace violence (WPV) in healthcare is no longer a marginal occupational hazard -it is a defining feature of the work itself. Verbal abuse, threats, physical assault, and lateral aggression have become so routine that many colleagues describe them in those terms, and that normalization is itself a psychological injury. Di Martino's (2002) work for ILO/WHO first drew attention to the global scale of WPV. A more recent metaanalysis of 253 studies with 330,000 participants indicates that not much has changed -6 in 10 healthcare workers are still exposed to any type of WPV from patients and visitors (Liu et al., 2019). Behind the numbers are people living with the negative impacts -sleep disruption, intrusive memories, depression, moral injury, and, for some, suicidal thoughts into their next shift -a pattern that prospective and longitudinal evidence has now linked consistently to both psychological and physical workplace violence (Nyberg et al., 2021). This Research Topic was conceived to push the conversation beyond prevalence reporting and toward the mental health consequences of WPV and the prevention strategies that might meaningfully address them. The eleven contributions assembled here, drawn from China, India, Italy, Switzerland, and Uganda, offer a coherent picture:WPV is a structural occupational hazard whose psychological sequelae propagate through individuals, teams, and the entire workforce. Read together, they make an argument we believe the field is ready to hearprevention is much more than a safety and security measure; it is also mental health care.The contributions align with longstanding data that WPV occurs across different health settings and across all levels of the health workforce.In India, Vyas et al. reported that 75% of doctors in public and private hospitals experience verbal abuse from patients' relatives. In China, Liu, Zheng, and Liu surveyed a large cohort of nurses from 90 hospitals in Sichuan Province; their data showed that 18.4% of nurses had experienced WPV in the previous year, and 34% reported witnessing colleagues being subjected to it. Wang et al. reported a higher WPV prevalence of 69.9% among nurses from secondary and tertiary hospitals in Lanzhou. Further, Zhang et al. found that 85% of emergency nurses had experienced WPV in the previous year.In many studies, prevalence of WPV was measured from a staff safety perspective. In Italy, Russotto et al.offered an interesting lens -WPV as both a staff and patient safety issue. In their study they documented more than 4,400 patient safety incidents in twelve months, dominated by verbal aggression, physical assault, and death threats.These studies underscore the scale of WPV across diverse contexts and reframe injuries from WPV as both direct and indirect (vicarious). Additional prevalence studies are not needed. Prevalence, on its own, has stopped being informative; the question worth asking now is what WPV does to those who survive it.The consequences span the full spectrum of psychiatric morbidity. Together, these papers make visible what has been hiding in plain sight. WPV is not only an interaction between aggressor and target; it is a property of the system in which both are embedded. Why, then, do so many of our prevention programs still treat it as a series of individual encounters?

Study type: Journal article

Evidence appraisal

Main Findings

  • Workplace violence (WPV) in healthcare has transitioned from being considered a marginal occupational hazard to a defining feature of the work itself.
  • Prevalence studies show that 6 out of 10 healthcare workers are still exposed to any type of WPV, indicating limited progress over time despite awareness.
  • The normalization of WPV (e.g., describing it as 'part of the job') is identified as a form of psychological injury in its own right.
  • WPV has significant mental health consequences for healthcare workers, including sleep disruption, intrusive memories, depression, moral injury, and suicidal thoughts linked to both psychological and physical forms of violence.
  • The editorial argues that WPV is not merely an interaction between aggressor and target but a systemic property embedded within the healthcare environment.

Practice transfer

Clinical Relevance

  • Healthcare organizations must recognize WPV as a structural occupational hazard requiring comprehensive prevention strategies beyond basic safety measures.
  • Prevention programs should be reconceptualized to integrate mental health care, addressing both immediate safety concerns and long-term psychological well-being of staff.
  • There is an urgent need for improved security infrastructure (e.g., better lighting, panic buttons), de-escalation training, and robust reporting mechanisms that protect rather than penalize victims of WPV.
  • Healthcare institutions should prioritize providing accessible psychological support services (counseling, EAPs) to healthcare workers who have experienced WPV or witnessed it.
  • A cultural shift within healthcare organizations is necessary to challenge the normalization of WPV and foster environments where staff feel safe reporting incidents without fear.

Critical appraisal

Limitations

  • The editorial itself synthesizes findings from other studies; thus, its direct limitations are tied to the scope and potential biases of those contributing papers (e.g., self-reporting bias in prevalence data).
  • While it highlights a global scale through international contributions, specific contextual factors influencing WPV may vary significantly between countries not fully captured by aggregated data.
  • The editorial's focus on mental health consequences is crucial but might implicitly downplay or underemphasize the immediate physical injuries and safety risks associated with WPV.

Classroom use

Discussion Questions

  • How does your own experience or observations align with the assertion that WPV has become a 'defining feature' of healthcare work?
  • What are the potential ethical implications of normalizing WPV as 'part of the job'? How might this normalization affect patient care and staff retention?
  • The editorial cites high prevalence rates (e.g., 6 in 10 workers). What do you think are some of the primary drivers or contributing factors to such widespread exposure across different healthcare settings?
  • Considering the mental health consequences mentioned (depression, moral injury), how should healthcare organizations balance immediate safety interventions with long-term psychological support for staff who experience WPV?
  • The authors argue that prevention is 'mental health care.' What specific systemic changes within a hospital or clinic would you propose to implement this integrated approach?
  • How might cultural differences between the countries mentioned (China, India, Italy) influence the manifestation and reporting of WPV, as well as its mental health impacts on staff?
  • What role do leadership styles and organizational culture play in either mitigating or exacerbating WPV within healthcare settings?
  • The editorial highlights 'lateral aggression' among colleagues. How does this form of violence differ from patient-directed violence in terms of impact and prevention strategies?
  • Given the systemic nature of WPV, what policy-level changes (e.g., at national health departments) could be advocated for to support safer working environments for healthcare professionals?
  • How can nursing education better prepare future nurses to recognize, respond to, and advocate against WPV?

Knowledge check

Quiz

1. According to the abstract, what percentage of healthcare workers are still exposed to any type of workplace violence (WPV) from patients and visitors based on a meta-analysis by Liu et al. (2019)?

  1. 6 in 10
  2. 75%
  3. 85%
  4. 34%
Answer: 6 in 10
Rationale: The abstract states that the metaanalysis of 253 studies with 330,000 participants indicates 'that not much has changed -6 in 10 healthcare workers are still exposed to any type of WPV from patients and visitors (Liu et al., 2019).'

2. Which country's study reported that 75% of doctors in public and private hospitals experience verbal abuse from patients' relatives?

  1. China
  2. India
  3. Italy
  4. Uganda
Answer: India
Rationale: The abstract mentions, 'In India, Vyas et al. reported that 75% of doctors in public and private hospitals experience verbal abuse from patients' relatives.'

3. What percentage of nurses surveyed by Liu, Zheng, and Liu (from China) had experienced WPV in the previous year?

  1. 18.4%
  2. 34%
  3. 69.9%
  4. 75%
Answer: 18.4%
Rationale: The abstract states that 'In China, Liu, Zheng, and Liu surveyed a large cohort of nurses from 90 hospitals in Sichuan Province; their data showed that 18.4% of nurses had experienced WPV in the previous year...'

4. Which country's study documented over 4,400 patient safety incidents dominated by verbal aggression, physical assault, and death threats?

  1. China
  2. India
  3. Italy
  4. Switzerland
Answer: Italy
Rationale: The abstract states that 'In Italy, Russotto et al.offered an interesting lens -WPV as both a staff and patient safety issue. In their study they documented more than 4,400 patient safety incidents in twelve months...'

5. According to the editorial's argument, what is one of the main negative impacts of WPV on healthcare workers?

  1. Increased job satisfaction
  2. Improved teamwork
  3. Sleep disruption
  4. Enhanced communication skills
Answer: Sleep disruption
Rationale: The abstract mentions that 'Behind the numbers are people living with the negative impacts -sleep disruption, intrusive memories, depression, moral injury, and, for some, suicidal thoughts into their next shift...'

6. What does the editorial suggest is a more effective approach to WPV prevention than just safety measures?

  1. Individual counseling programs
  2. Mental health care integration
  3. Increased security personnel
  4. More frequent training sessions
Answer: Mental health care integration
Rationale: The abstract concludes that 'prevention is much more than a safety and security measure; it is also mental health care.'

7. What percentage of emergency nurses in Lanzhou experienced WPV in the previous year, as reported by Wang et al.?

  1. 18.4%
  2. 34%
  3. 69.9%
  4. 75%
Answer: 69.9%
Rationale: The abstract states that 'Wang et al. reported a higher WPV prevalence of 69.9% among nurses from secondary and tertiary hospitals in Lanzhou.'

8. What does the editorial imply about focusing solely on the prevalence of WPV?

  1. It is sufficient for understanding its impact.
  2. It has become less informative over time.
  3. It highlights successful prevention strategies.
  4. It primarily benefits patient safety.
Answer: It has become less informative over time.
Rationale: The abstract states, 'Prevalence, on its own, has stopped being informative; the question worth asking now is what WPV does to those who survive it.'

9. Which of the following is NOT listed as a consequence of WPV mentioned in the abstract?

  1. Sleep disruption
  2. Intrusive memories
  3. Increased job satisfaction
  4. Suicidal thoughts
Answer: Increased job satisfaction
Rationale: The abstract lists 'sleep disruption, intrusive memories, depression, moral injury, and, for some, suicidal thoughts' as negative impacts. Increased job satisfaction is not mentioned.

10. What does the editorial suggest about how WPV should be viewed in terms of prevention programs?

  1. As a series of individual encounters.
  2. As an interaction between aggressor and target only.
  3. As a property of the system in which both are embedded.
  4. As solely a patient safety issue.
Answer: As a property of the system in which both are embedded.
Rationale: The abstract states, 'WPV is not only an interaction between aggressor and target; it is a property of the system in which both are embedded. Why, then, do so many of our prevention programs still treat it as a series of individual encounters?'

Study cards

Flashcards

What does the editorial suggest about workplace violence (WPV) in healthcare?

The editorial suggests that WPV has evolved from a marginal occupational hazard to a defining feature of work, with normalization itself being a psychological injury.

According to Di Martino's 2002 work for ILO/WHO, what was the initial focus regarding workplace violence (WPV)?

Di Martino's 2002 work first drew attention to the global scale of WPV in healthcare.

What percentage of healthcare workers are exposed to any type of WPV from patients and visitors according to a meta-analysis by Liu et al. (2019) mentioned in the abstract?

According to Liu et al. (2019), 6 out of 10 (or 60%) healthcare workers are still exposed to any type of WPV.

What specific negative impacts on individuals' mental health does the editorial mention as a result of workplace violence (WPV)?

The editorial mentions sleep disruption, intrusive memories, depression, moral injury, and for some, suicidal thoughts into their next shift as negative impacts of WPV.

According to Nyberg et al. (2021), what has prospective and longitudinal evidence linked consistently to both psychological and physical workplace violence?

Prospective and longitudinal evidence has linked the pattern of living with these negative impacts (sleep disruption, intrusive memories, depression, moral injury, suicidal thoughts) consistently to both psychological and physical workplace violence.

What is one of the main goals stated for this Research Topic in the editorial?

One of the main goals is to push the conversation beyond prevalence reporting toward the mental health consequences of WPV and the prevention strategies that might meaningfully address them.

How many contributions are assembled in this Research Topic, as mentioned in the abstract?

Eleven contributions are assembled in this Research Topic.

From which countries were the eleven contributions to this Research Topic drawn, according to the abstract?

The eleven contributions were drawn from China, India, Italy, Switzerland, and Uganda.

What does the editorial argue is a key characteristic of workplace violence (WPV) in healthcare based on the assembled research?

The editorial argues that WPV is a structural occupational hazard whose psychological sequelae propagate through individuals, teams, and the entire workforce.

According to the abstract, what broader perspective do prevention programs need to adopt regarding workplace violence (WPV), as argued by the authors of this Research Topic?

Prevention programs need to treat WPV not just as a series of individual encounters but also as mental health care.

What percentage of doctors in public and private hospitals in India reported experiencing verbal abuse from patients' relatives, according to Vyas et al. (as cited in the abstract)?

According to Vyas et al., 75% of doctors experienced verbal abuse.

In a study by Liu, Zheng, and Liu (cited in the abstract), what percentage of nurses surveyed from 90 hospitals in Sichuan Province had personally experienced WPV in the previous year?

18.4% of nurses had experienced WPV in the previous year.

In a study by Wang et al., cited in the abstract, what was the reported prevalence of workplace violence (WPV) among nurses from secondary and tertiary hospitals in Lanzhou?

Wang et al. reported a higher WPV prevalence of 69.9% among these nurses.

According to Zhang et al., as mentioned in the abstract, what percentage of emergency nurses had experienced workplace violence (WPV) in the previous year?

Zhang et al. found that 85% of emergency nurses had experienced WPV.

What unique perspective on workplace violence (WPV) did Russotto et al.'s study from Italy offer, as described in the abstract?

Russotto et al. offered a lens viewing WPV as both a staff and patient safety issue.

In the Italian study by Russotto et al., cited in the abstract, what was documented over twelve months regarding patient safety incidents related to WPV?

More than 4,400 patient safety incidents were documented over twelve months.

What types of incidents dominated these 4,400+ patient safety incidents reported by Russotto et al. in their Italian study (as per the abstract)?

The incidents were dominated by verbal aggression, physical assault, and death threats.

According to the editorial's conclusion regarding prevalence studies on workplace violence (WPV), what has stopped being informative?

Prevalence of WPV, on its own, has stopped being informative.

What question does the editorial suggest is now more pertinent than simply reporting the prevalence of workplace violence (WPV)?

The question worth asking now is what WPV does to those who survive it.

How many concept cards are required for this flashcard set?

This flashcard set requires exactly 20 concept cards.

Search-ready answers

Frequently asked questions

What does the article suggest about the normalization of workplace violence (WPV) in healthcare?

The article suggests that WPV has become so routine in healthcare that many colleagues describe it as simply 'part of the job,' and this normalization itself is considered a psychological injury.

According to Liu et al. (2019), what percentage of healthcare workers are exposed to any type of workplace violence from patients and visitors?

Liu et al. (2019) indicate that 6 in 10 healthcare workers are still exposed to any type of WPV.

What is the main argument regarding prevention strategies for WPV presented by this Research Topic?

The article argues that prevention is much more than a safety and security measure; it is also mental health care, suggesting a shift from merely reporting prevalence to addressing psychological consequences through meaningful prevention.

In which country did Vyas et al. report that 75% of doctors in public and private hospitals experience verbal abuse?

Vyas et al. reported this finding for India.

What percentage of nurses surveyed by Liu, Zheng, and Liu (from China) had experienced WPV in the previous year?

18.4% of nurses surveyed by Liu, Zheng, and Liu from 90 hospitals in Sichuan Province had experienced WPV in the previous year.

According to Wang et al., what percentage of nurses from secondary and tertiary hospitals in Lanzhou reported experiencing workplace violence?

Wang et al. reported a higher WPV prevalence of 69.9% among nurses.

What unique perspective on WPV did Russotto et al. (from Italy) offer regarding patient safety incidents?

Russotto et al. documented more than 4,400 patient safety incidents in twelve months, reframing WPV as both a staff and patient safety issue, with incidents dominated by verbal aggression, physical assault, and death threats.

What are some of the negative mental health impacts mentioned for healthcare workers who experience workplace violence?

The article mentions that behind the numbers are people living with the negative impacts such as sleep disruption, intrusive memories, depression, moral injury, and, for some, suicidal thoughts into their next shift.

How does the article describe the nature of WPV in terms of its impact on individuals and teams?

The contributions assembled suggest that WPV is a structural occupational hazard whose psychological sequelae propagate through individuals, teams, and the entire workforce.

What question about prevention programs for WPV is raised by the article's conclusion?

The article raises the question: 'Why, then, do so many of our prevention programs still treat it as a series of individual encounters?'