Bullying at Work and Onset of a Major Depressive Episode among Danish Female Eldercare Workers

By Rugulies, Reiner; Madsen, Ida E. H. et al. | Scandinavian Journal of Work, Environment & Health, May 2012 | Go to article overview

Bullying at Work and Onset of a Major Depressive Episode among Danish Female Eldercare Workers


Rugulies, Reiner, Madsen, Ida E. H., Hjarsbech, Pernille U., Hogh, Annie, Borg, Vilhelm, Carneiro, Isabella C., Aust, Birgit, Scandinavian Journal of Work, Environment & Health


Objective The aim of this study was to analyze whether exposure to workplace bullying among 5701 female employees in the Danish eldercare sector increases the risk of onset of a major depressive episode (MDE).

Methods Participants received questionnaires in 2004-2005 and again in 2006-2007. MDE was assessed with the Major Depression Inventory. We examined baseline bullying as a predictor of onset of MDE at follow-up using multiple logistic regression. We further conducted a cross-sectional analysis at the tune of follow-up among participants who at baseline were free of bullying, MDE, and signs of reduced psychological health. Finally, we analyzed reciprocal effects, by using baseline bullying and baseline MDE as predictors for bullying and MDE at follow-up.

Results Onset rates of MDE in the groups of no, occasional, and frequent bullying were 1 .5%, 3.4%, and 1 1 .3%, respectively. Odds ratios (OR) for onset of MDE were 2.22 [95% confidence interval (95% CI) 1.31-3.76] for occasional bullying and OR 8.45 (95% CI 4.04-17.70) for frequent bullying, after adjustment for «»variâtes. In the cross-sectional analysis, OR were 6.29 (95% CI 2.52-15.68) for occasional bullying and 20.96 (95% CI 5.80-75.80) for frequent bullying. In the analyses on reciprocal effects, both baseline bullying [occasional: OR 2.12 (95% CI 1.29-3.48) and frequent: OR 6.39 (95% CI 3.10-13.17)] and baseline MDE [OR 7.18 (95% CI 3.60-14.30] predicted MDE at follow-up. However, only baseline bullying [occasional: OR 7.44 (95% CI 5.94-9.3 1) and frequent: OR 1 1 .91 (95% CI 7.56-18.77)] but not baseline MDE [OR 0.93 (95% CI 0.47-1.84)] predicted bullying at follow-up.

Conclusions Workplace bullying increased the risk of MDE among female eldercare workers. MDE did not predict risk of bullying. Eliminating bullying at work may be an important contribution to the prevention of MDE.

Key terms anxiety; depression; healthcare worker; longitudinal study; mental health; mobbing; negative act; occupational health; psychosocial factor; stress; workplace bullying.

The role of adverse psychosocial work environment exposures in the aetiology of major depressive episodes (MDE) has gained considerable interest over the last few years (1). Two recent comprehensive reviews reported that high psychological demands, low job control (only in one review), and low social support predicted onset of MDE and depressive symptoms in prospective studies (2, 3). A third review found further evidence for an effect of effort-reward imbalance (4). The reviews pointed out that psychosocial work environment factors other than those defined by the demand-control-support and the effort-reward imbalance models only rarely have been investigated and that there is a need for a broader research approach on the impact of the work environment on the onset of MDE.

Exposure to bullying at work could be a psychosocial working condition that increases the risk of MDE. In their seminal work on "social origins of depression", Brown & Harris have argued that a major cause for MDE is the "inability to hold good thoughts about ourselves" (5, p233). Humiliating experiences, such as becoming the target of bullying, will likely contribute to this inability, and humiliation has indeed predicted onset of MDE in the Virginia Twin Registry Study (6). Moreover, being bullied might evoke a feeling of helplessness, which has been discussed for a long time as an important social psychological contributor to MDE (7).

Against this background, it is remarkable that there is very little research on workplace bullying and MDE. Most of the research in this area is cross-sectional, with the well-known limitation of establishing temporality (8-10). Although several studies have investigated prospective associations between workplace bullying and psychological distress (11-14), to the best of our knowledge, only one prospective study (15) so far has analyzed the effect of workplace bullying on the onset of MDE. …

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