Academic journal article Scandinavian Journal of Work, Environment & Health

Workplace Bullying and Sickness Absence: A Systematic Review and Metaanalysis of the Research Literature

Academic journal article Scandinavian Journal of Work, Environment & Health

Workplace Bullying and Sickness Absence: A Systematic Review and Metaanalysis of the Research Literature

Article excerpt

Sickness absence is clearly multifactorial, but exposures at the workplace are certainly an important part of health and illness among adults and correspondingly related to absence rates in contemporary work-life. To develop, improve and implement effective sick-leave prevention measures, we need to understand the risk factors. Previous research on the work environment and sickness absence has mainly focused on physical working conditions (1,2) and psychosocial factors such as job demands and control (3-5). Less is known about how and when workplace bullying is related to sickness absence, beyond cross-sectional studies demonstrating associations between the two. However, both primary studies (6, 7) and meta-analyses (8, 9) suggest exposure to bullying at the workplace increases the risk for mental and somatic health complaints prospectively. As an extension of these findings, it seems plausible that bullying should also be a risk factor for sickness absence. To contribute to the understanding of bullying and sickness absence, we first present a theoretical model to illustrate how bullying may be related to absence. Thereafter, we provide a systematic review and meta-analysis of existing peer-reviewed empirical studies on the relationship between bullying and absence. Finally, using our theoretical model as an outset, we discuss whether the existing knowledge base is adequate with regard to the development and implementation of well-informed interventions and preventive measures. The quality of evidence for an association between bullying and sickness absence will be evaluated on the basis of the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) guidelines (10).

Workplace bullying refers to situations at the workplace where an employee repeatedly and over a prolonged time period is exposed to harassing behavior from one or more colleagues (including subordinates and leaders) and where the targeted person is unable to defend him-/herself against this systematic mistreatment (11). Consequently, workplace bullying is not about single episodes of conflict or harassment at the workplace, but rather a form of persistent abuse where the exposed employee actually is (or perceives him/ herself to be) submissive to the perpetrator (12). Bullying is also not about negative actions and interpersonal conflicts that inevitably occur at workplaces and that are within the framework of the work contract or a legal and regulated framework.

Prevalence estimates suggest that about 15% of employees at a global basis perceive themselves as victims of workplace bullying at any given time (13). Employees exposed to bullying report more health complaints compared to non-bullied colleagues. In the early stages of a bullying process, targets commonly experience reactions such as worrying, distress, despair, and confusion (14). Psychological and psychosomatic reactions become more prominent and severe with persistent exposure. Illustrating these reactions, research shows that prolonged bullying is associated with subsequent reports of anxiety (8, 15), depression (8, 16), suicidal ideation (17, 18), headache (19), and sleep problems (20-22). In a meta-analysis it was found that exposure to bullying predicted subsequent mental health complaints [odds ratio (OR) 1.68, 95% confidence interval (95% CI) 1.35-2.09] and somatic complaints (OR 1.77, 95% CI 1.41-2.22) after adjusting for baseline health status (9). These same health complaints found among employees exposed to bullying are also commonly reported symptoms among sickness absentees (23). These associations with later health problems suggest that bullying could be an important risk factor and prominent precursor for sickness absence. In support of this assumption, a meta-analysis (15) found that exposure to workplace bullying was related to subsequent absence with an OR of 1.67 (95% CI 1.35-2.07). However, as this metaanalysis only included a limited number of studies without addressing the nature of the association, the existing synthesized evidence is restricted. …

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