Workplace Violence as a Predictor of Depression and Anxiety in Nurses: Insights from a Groundbreaking Longitudinal Study in China
In the fast-paced and demanding healthcare environment, nurses face numerous occupational hazards, but few are as insidious and damaging as workplace violence (WPV). A recent multi-center longitudinal study conducted across China has brought to light the profound psychological consequences of WPV for nursing professionals. The comprehensive research reveals a compelling association between experiences of violence at work and the development of depression and anxiety, shedding definitive light on a chronic yet often overlooked threat to mental health in healthcare settings.
The scope and scale of this study are remarkable, encompassing data from over 63,000 nurses drawn from multiple healthcare centers nationwide. This extensive cohort was analyzed under rigorous methodologies, including Cox regression models, propensity score matching, and subgroup analyses that together provide robust evidence of WPV’s detrimental impact. Embedded within the theoretical framework of the Job Demands–Resources (JDR) model, the research situates WPV amidst various occupational stressors and resources, clarifying how this form of violence exacerbates psychological strain among nursing staff.
A particularly innovative aspect of the study is the utilization of cross-lagged panel network analysis (CLPN), an advanced statistical technique allowing for the exploration of symptom-level interactions over time. The analysis uncovered bidirectional relationships between specific facets of workplace violence—such as emotional abuse—and mental health symptoms like irritability and fatigue. This nuanced mapping reveals how certain symptoms interplay dynamically in the aftermath of violent encounters, offering key insights into the symptom clusters that may predict escalating psychological distress.
Statistical findings from the study are compelling in both their clarity and effect size. Nurses exposed to workplace violence exhibited a 38% increased risk of developing depression and a 31% heightened risk of anxiety compared to their non-exposed counterparts. The researchers observed a clear dose–response relationship tied to the frequency and type of violence experienced, underscoring the cumulative psychological toll that repeated WPV episodes impose on healthcare workers.
Explorations into demographic and professional characteristics further nuanced these results. Male nurses, older staff members, individuals with lower seniority, and those working in high-pressure departments were found to be more vulnerable to the psychological repercussions of workplace violence. This differential risk highlights the complex interplay of personal and environmental factors in determining mental health outcomes and suggests tailored intervention strategies might be necessary to address these sub-populations effectively.
The network of symptoms connecting depression and anxiety within this nursing population is particularly telling. Core symptoms such as feelings of worthlessness and anticipatory fear function as critical bridges linking these two pervasive mental health conditions. The identification of such bridging symptoms is vital, as it accentuates potential targets for clinical interventions designed not only to treat existing conditions but also to interrupt the progression from acute stress reactions to full-blown psychiatric disorders.
Theoretical underpinnings grounded in the Job Demands–Resources (JDR) model provide a compelling conceptual lens through which to understand these findings. The model posits that high job demands, such as dealing with workplace violence, exhaust psychological and physical resources, leading to burnout and depressive symptoms. Conversely, job resources potentially buffer these effects but seem insufficient in many cases for nurses combating ongoing incidents of violence, as this study suggests.
The implications of these findings extend beyond individual nurses to implicate systemic healthcare infrastructure weaknesses. Mental health distress linked to WPV not only diminishes nurses’ well-being but also threatens healthcare delivery quality and system resilience. Psychological exhaustion among nurses may precipitate increased absenteeism, reduced patient care quality, and higher staff turnover, compounding the strain on already burdened healthcare facilities.
Importantly, the study advocates for the development of targeted, theory-driven interventions grounded in its empirical data. These interventions could range from organizational policies aimed at reducing the incidence of workplace violence, to psychological support programs tailored to the identified symptom pathways. Integrating these approaches could hold promise for mitigating psychological exhaustion and fortifying nurses’ mental health resilience.
Workplace violence remains an alarmingly prevalent issue in healthcare settings worldwide, but this longitudinal study offers a rare and data-rich demonstration of its predictive power regarding mental health outcomes. By illuminating the pathways and key psychological symptoms influenced by violence, this Chinese cohort study contributes significantly to the global discourse on occupational health safety, nurse well-being, and mental health preventative strategies.
The study published in BMC Psychiatry stands as a call to action for healthcare administrators, policymakers, and mental health practitioners alike. As healthcare systems grapple with increasing demands and workforce shortages, protecting the mental health of nurses is not just a moral imperative but a strategic necessity. Addressing workplace violence robustly may serve as a cornerstone of these efforts, ultimately enhancing the sustainability of healthcare provision.
In sum, the researchers—Zhang, Xu, Yang, and colleagues—have produced a landmark study that not only details the hazardous psychological sequelae of workplace violence but also provides practical frameworks for intervention. Through comprehensive data analysis, including symptom-level network mapping and stratified risk assessments, this work charts a course for future research and meaningful, evidence-based workplace reforms.
Subject of Research: The impact of workplace violence on depression and anxiety symptoms among nurses.
Article Title: Workplace violence predicts depression and anxiety in nurses: a multi-center longitudinal study in China.
Article References:
Zhang, Z., Xu, H., Yang, J. et al. Workplace violence predicts depression and anxiety in nurses: a multi-center longitudinal study in China. BMC Psychiatry 25, 1099 (2025). https://doi.org/10.1186/s12888-025-07530-8
Image Credits: AI Generated
DOI: 10.1186/s12888-025-07530-8 (Published 18 November 2025)
