The study, conducted by a team led by Mingxue Ma, Yuanheng Li, and Yazhou Wang of Harbin Medical University together with collaborators at I.M. Sechenov First Moscow State Medical University, was published in BMC Public Health. It surveyed 3,408 healthcare workers across 35 tertiary public hospitals in nine cities of Heilongjiang Province between March and May 2025. Participants were asked whether they had experienced digital, physical, or psychological violence during the preceding twelve months, and the researchers used logistic regression models to identify the factors associated with digital violence and to probe its links with cognitive, behavioral, and occupational outcomes.

The headline figure is stark: 22.4 percent of respondents reported experiencing digital violence within the previous year. Among those exposed, the abuse was not always confined to the digital realm. Only 41.6 percent of victims experienced digital violence alone, while 58.4 percent also reported physical and/or psychological workplace violence during the same period. That overlap is scientifically important. It indicates that digital violence frequently shares risk environments with traditional workplace violence, likely arising from the same underlying conflicts between patients, families, and the healthcare system, yet it also occurs on its own in a meaningful minority of cases, meaning it cannot simply be treated as a shadow of in-person aggression.

The concept of digital violence in healthcare reflects a structural shift in how medicine is delivered and discussed. Digitalization has extended patient–healthcare worker interactions far beyond the consultation room, into online appointment platforms, review sites, social media, and messaging applications. Every public-facing digital touchpoint creates a surface on which dissatisfaction can be expressed anonymously, at scale, and with a permanence that a corridor argument never has. A defamatory post about a physician can circulate indefinitely, shaping the perceptions of thousands of prospective patients and remaining attached to the clinician’s name in search results. The study’s authors argue that this transformation has created genuine opportunities for violence in digital environments, and that evidence on the phenomenon and its relationship to conventional workplace violence has, until now, remained limited.

The demographic and occupational patterns the researchers uncovered are among the most thought-provoking elements of the work. Higher odds of digital violence were observed among male healthcare workers, those employed in general hospitals, those holding administrative positions, and those working in low-resource cities. By contrast, holding an associate senior or senior professional title was associated with lower odds of exposure. Each of these associations invites interpretation. The male excess runs counter to some patterns seen in in-person workplace violence research and may reflect differences in public visibility or in the roles men occupy within hospitals. The elevated risk for administrative staff suggests that the front line of digital conflict is not exclusively clinical; managers who handle complaints, scheduling, and billing disputes may absorb a disproportionate share of online hostility. The urban gradient points toward structural inequities, with healthcare workers in cities with fewer resources facing conditions that generate more friction with patients and their families.

The protective association with senior professional titles is equally revealing. Clinicians who have reached associate senior or senior rank may carry greater institutional authority, enjoy stronger reputational buffers online, or interact with patients through channels less exposed to public commentary. Alternatively, senior staff may have had more time to develop strategies for managing difficult encounters before they escalate into public attacks. Whatever the mechanism, the finding implies that early-career and mid-career healthcare workers, who lack both the title and the accumulated social capital, may be the most digitally vulnerable members of the workforce.

Beyond mapping who gets targeted, the study examined what digital violence does to the people on the receiving end, and here the results take on a psychological texture. Digital violence was associated with the overall distributions of worry, monitoring of online evaluations, and reduced online expression. In practical terms, healthcare workers who had been attacked online were more likely to be anxious about their digital presence, to habitually check what patients and the public were saying about them on review platforms and social media, and to withdraw from online spaces altogether, self-censoring their professional and personal expression. These are classic signatures of a chilling effect. The digital commons that hospitals increasingly rely upon for outreach, education, and reputation management becomes a source of vigilance and fear rather than an instrument of practice.

Perhaps the most sobering finding concerns the profession’s future. Digital violence was associated with altered attitudes toward whether respondents would want their children to enter the same profession. When abuse follows clinicians home through their phones and lingers in public search results, it does not merely wound the individual; it transmits a message to the next generation about the costs of the career. Notably, however, the study found no significant association between digital violence and two other outcomes: willingness to choose the profession again and turnover intention. This dissociation is analytically interesting. It suggests that online abuse erodes the affective and reputational dimensions of occupational identity, the pride and the willingness to recommend the career to one’s own children, without necessarily pushing people out of their jobs in the short term. The damage, in other words, may be cumulative and intergenerational rather than immediately visible in staffing statistics.

Methodologically, the study has both strengths and constraints that readers should keep in view. Its scale is a genuine asset: 3,408 respondents across 35 tertiary hospitals in nine cities gives the prevalence estimates considerable weight within the population sampled. The use of logistic regression allowed the team to adjust for multiple factors simultaneously and to separate the correlates of digital violence from those of physical and psychological aggression, confirming that both traditional forms were independently and significantly associated with the digital form. At the same time, the cross-sectional design captures a single moment in time, so the associations reported cannot establish causal direction. It remains possible, for instance, that healthcare workers who are already worried or withdrawn experience or recall digital abuse differently, rather than the abuse producing the worry. The sample was also restricted to tertiary public hospitals in a single Chinese province, which limits generalization to primary care settings, private institutions, and other health systems. The authors themselves frame digital violence as a partially distinct yet interconnected form of occupational violence, a formulation that carefully preserves both the overlap with and the independence from traditional workplace aggression.

The policy implications are straightforward and, arguably, overdue. The authors conclude that digital violence is common among healthcare workers and that the findings support incorporating it into workplace violence surveillance and prevention frameworks in healthcare settings. Most hospital violence-prevention programs were designed around physical security: guards, panic buttons, restricted access, and de-escalation training for front-line staff. None of that machinery detects a defamatory thread on a review platform or a coordinated harassment campaign on social media. Building digital violence into surveillance would mean routinely asking about online abuse in occupational health assessments, tracking it alongside physical and psychological incidents, and developing institutional responses, from platform reporting mechanisms to legal support for targeted staff. The study was supported by the National Natural Science Foundation of China, and its publication in an open-access journal means that hospital administrators, occupational health researchers, and policymakers worldwide can examine the full evidence base. As healthcare systems everywhere deepen their digital transformation, the experience of Heilongjiang’s healthcare workers offers a warning worth heeding: the waiting room is no longer the only place where violence finds them, and any serious effort to protect the health workforce must now extend into the digital spaces where their professional lives increasingly unfold.

Subject of Research: Prevalence and associated factors of digital violence against healthcare workers in Chinese tertiary public hospitals

Article Title: Digital violence against healthcare workers in Heilongjiang Province of China: prevalence and associated factors

Article References: Digital violence against healthcare workers in Heilongjiang Province of China: prevalence and associated factors. (n.d.). https://doi.org/10.1186/s12889-026-29524-1

Image Credits: AI Generated

DOI: 10.1186/s12889-026-29524-1

Keywords: digital violence, healthcare workers, workplace violence, online harassment, occupational health, cyberpsychology, China, public health, tertiary hospitals, cross-sectional survey, e-health, Harbin Medical University