Introduction
Methods
The study population
Survey instruments
Workplace violence
Correlates of workplace violence
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Age in years, categorized into tertiles (≤ 42, 43–52, ≥ 53)
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Sex categorized into female and non-female (i.e. male or non-binary)
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Partnership status was defined as being single versus in a partnership
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The highest educational level was operationalized according to the German school system as low (secondary modern school qualification [‘Haupt-/Volksschulabschluss’]), intermediate (secondary school level I certificate ([‘Mittlere Reife’]) or high (general qualification for university entrance [‘Abitur’] or entrance qualification limited to universities of applied sciences [‘Fachhochschulreife’])
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Gross income grouped into four categories (≤ 1999€, 2000–2499€, 2500–2999€, ≥ 3000€)
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Migration background—categorized into “yes” and “no”- was considered to be present if one of the following conditions was met: I) both parents born abroad or II) participant born abroad and at least one parent born abroad or III) mother tongue is not German [29]
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Total number of years worked as a MA since completion of MA vocational training (“years in job”), categorized into three roughly equalized sized groups (≤ 18, 19–29, ≥ 30)
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Number of mean working hours per week including overtime, categorized into three roughly equalized sized groups (≤ 30, 31–39, ≥ 40)
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Type of employer (general practitioner [GP] practice, specialist practice, medical care center, hospital/clinic, others)
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Employment status according to one’s contract (“full-time” generally refers to around 35–42 h per week vs “part time/mini-job” lower number of hours than the full-time contract)
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Leadership position (“yes”/“no”)
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Number of MAs employed in the respective practice (categorized into three roughly equalized sized groups: 1–3 MAs, 4–6 MAs, ≥ 7 MAs)
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Number of physicians in the respective practice (categorization into tertiles was not feasible based on the distribution. Therefore, this variable was categorized into four roughly equalized sized groups: 1 physician, 2 physicians, 3–4 physicians, ≥ 5 physicians)
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Practice location based on the following definitions: rural area (< 20,000 inhabitants), small city (20,000 to 100,000 inhabitants), or large city (> 100,000 inhabitants)
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Anxiety was assessed using the established short version of the Generalized Anxiety Disorder questionnaire (GAD-2) [30] which has been shown to be a reliable screening tool for generalized anxiety disorder [31]. The GAD-2 inquires after the frequency of symptoms with a 4-point Likert scale varying between “not at all” (0) and “almost every day” (3). The score can range from 0 to 6 and the cut-off for anxiety was set at ≥ 3 [30]. The internal consistency in our sample was 0.86 (Spearman-Brown coefficient).
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Depressive symptoms were assessed by the short version of the Patient Health Questionnaire (PHQ-2) [30], which has been validated in previous studies and shows good psychometric properties and convergent validity with other established measures such as the Hospital Anxiety and Depression Scale [32]. Responses are given on a 4-point Likert scale assessing the frequency of symptoms from “not at all” (0) to “almost every day” (3). The score can range from 0 to 6 and the cut-off for depression is 3 and above [30]. The internal consistency in our sample for PHQ-2 scale was 0.79 (Spearman-Brown coefficient).
Statistical analysis
Results
Sample population
Characteristic | ||
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n | (%) | |
Age, mean (M), standard deviation (SD), (min–max) | 46.8 | (10.4), (25–70) |
≤ 42 | 144 | (34.0) |
43—52 | 130 | (30.7) |
≥ 53 | 150 | (35.4) |
Sex | ||
Female (vs. non-femalea) | 418 | (98.6) |
Partnership | ||
Yes (vs. no) | 374 | (88.2) |
Highest school degreeb | ||
Low | 25 | (5.9) |
Intermediate | 315 | (74.3) |
High | 84 | (19.8) |
Gross salary (€) | ||
≤ 1999 | 121 | (29.7) |
2000–2499 | 101 | (24.8) |
2500–2999 | 89 | (21.8) |
≥ 3000 | 97 | (23.8) |
Did not want to disclose | 16 | (3.8) |
Migration background | ||
Yes (vs. no) | 20 | (4.7) |
Years in job, M (SD), (min–max) | 23.9 | (11.3), (3–53) |
≤ 18 | 145 | (34.2) |
19 – 29 | 135 | (31.8) |
≥ 30 | 144 | (34.0) |
Average weekly working hours, M (SD), (min–max) | 33.4 | (8.7), (3–60) |
≤ 30 | 158 | (37.3) |
31 – 39 | 135 | (31.8) |
≥ 40 | 131 | (30.9) |
Current employer c | ||
General practitioner practice | 162 | (38.3) |
Specialist practice | 158 | (37.4) |
Medical care center | 44 | (10.4) |
Hospital/clinic | 33 | (7.8) |
Others | 26 | (6.1) |
Employment status d | ||
Full-time | 208 | (50.0) |
Part time/Mini-job | 208 | (50.0) |
Leadership position | ||
Yes | 206 | (48.6) |
Number of medical assistants in the practice, M (SD) e | 8.3 | (15.6) |
1–3 | 114 | (28.9) |
4–6 | 147 | (37.2) |
≥ 7 | 134 | (33.9) |
Number of physicians in the practice, M (SD) f | 3.7 | (3.8) |
1 | 104 | (26.5) |
2 | 100 | (25.4) |
3–4 | 95 | (24.2) |
≥ 5 | 94 | (23.9) |
Practice location c | ||
Large city (> 100,000 inhabitants) | 181 | (42.8) |
Small city (> 20,000 inhabitants) | 156 | (36.9) |
Rural area (< 20,000 inhabitants) | 86 | (20.3) |
Anxiety (According to GAD-2)g | ||
Yes | 84 | (19.8) |
Depression (According to PHQ-2)h | ||
Yes | 88 | (20.8) |
Descriptive analysis
Verbal violence | Physical violence | Sexual harassment | Any WPVa | |||||
---|---|---|---|---|---|---|---|---|
n | (%) | n | (%) | n | (%) | n | (%) | |
Twelve-month prevalence | 252 | (59.4) | 25 | (5.9) | 16 | (3.8) | 255 | (60.1) |
Frequency of WPV | ||||||||
Once in a year | 29 | (11.5) | 15 | (60.0) | 1 | (6.3) | ||
Once in a quarter | 87 | (34.5) | 8 | (32.0) | 7 | (43.8) | ||
Monthly | 63 | (25.0) | 0 | 7 | (43.8) | |||
Weekly | 53 | (21.0) | 1 | (4.0) | 1 | (6.3) | ||
(Almost) daily | 20 | (7.9) | 1 | (4.0) | 0 | |||
Perpetratorb | ||||||||
Patients | 208 | (82.5) | 21 | (84.0) | 15 | (93.8) | ||
Relatives of patients | 118 | (46.8) | 5 | (20.0) | 1 | (6.3) | ||
Colleagues | 49 | (19.4) | 1 | (4.0) | 1 | (6.3) | ||
Supervisors | 48 | (19.0) | 1 | (4.0) | 0 | |||
Others | 6 | (2.4) | 2 | (8.0) | 0 |
Association analyses
Characteristic | Any WPVa | |||
---|---|---|---|---|
Model Ib | Model IIc | |||
PR | 95% CI | PR | 95% CI | |
Age | ||||
≥ 53 | 1.0 | ref | 1.0 | ref |
43—52 | 0.98 | 0.79-1.22 | 0.97 | 0.79-1.21 |
≤ 42 | 1.28 | 1.07-1.53 | 1.27 | 1.06-1.52 |
Partnership | ||||
Yes | 1.0 | ref | 1.0 | ref |
No | 1.34 | 1.12-1.60 | 1.31 | 1.10-1.57 |
Highest school degreed | ||||
Low | 1.0 | ref | 1.0 | ref |
Intermediate | 1.01 | 0.71-1.44 | 1.01 | 0.72-1.41 |
High | 1.08 | 0.74-1.58 | 1.04 | 0.72-1.49 |
Gross salary (€) | ||||
≤ 1999 | 1.0 | ref | 1.0 | ref |
2000–2499 | 1.06 | 0.86-1.31 | 0.98 | 0.79-1.21 |
2500–2999 | 1.04 | 0.83-1.29 | 0.89 | 0.70-1.13 |
≥ 3000 | 0.93 | 0.74-1.17 | 0.81 | 0.62-1.06 |
Migration background | ||||
No | 1.0 | ref | 1.0 | ref |
Yes | 1.21 | 0.91-1.60 | 1.13 | 0.87-1.49 |
Characteristic | Any WPVa | |||
---|---|---|---|---|
Model Ib | Model IIc | |||
PR | 95% CI | PR | 95% CI | |
Years in job | ||||
≥ 30 | 1.0 | ref | 1.0 | ref |
19 – 29 | 0.95 | 0.77-1.17 | 0.96e | 0.78-1.12 |
≤ 18 | 1.13 | 0.94-1.36 | 1.13e | 0.95-1.36 |
Average weekly working hours | ||||
≥ 40 | 1.0 | ref | 1.0 | ref |
31 – 39 | 1.11 | 0.92-1.33 | 1.11 | 0.92-1.33 |
≤ 30 | 0.87 | 0.71-1.07 | 0.87 | 0.71-1.07 |
Current employer | ||||
General practitioner practice | 1.0 | ref | 1.0 | ref |
Specialist practice | 1.04 | 0.86-1.26 | 1.06 | 0.88-1.28 |
Medical care center | 1.38 | 1.12-1.71 | 1.36 | 1.10-1.68 |
Hospital/clinic | 1.25 | 0.96-1.62 | 1.22 | 0.94-1.58 |
Others | 0.86 | 0.56-1.32 | 0.85 | 0.54-1.32 |
Employment status | ||||
Full-time | 1.0 | ref | 1.0 | ref |
Part time/mini-job | 1.05 | 0.90-1.24 | 1.23 | 0.95-1.59 |
Leadership position | ||||
No | 1.0 | ref | 1.0 | ref |
Yes | 1.12 | 0.96-1.31 | 1.10 | 0.94-1.29 |
Number of medical assistants in the employing practice | ||||
≥ 7 | 1.0 | ref | 1.0 | ref |
4–6 (vs. ≥ 7) | 1.01 | 0.82-1.24 | 0.98 | 0.80-1.20 |
1–3 (vs. ≥ 7) | 0.96 | 0.78-1.17 | 0.96 | 0.78-1.17 |
Number of practitioners in the employing practice | ||||
≥ 5 | 1.0 | ref | 1.0 | ref |
3–4 (vs. ≥ 5) | 1.13 | 0.89-1.43 | 1.09 | 0.86-1.38 |
2 (vs. ≥ 5) | 1.22 | 0.97-1.53 | 1.16 | 0.93-1.45 |
1 (vs. ≥ 5) | 0.96 | 0.74-1.24 | 0.95 | 0.74-1.22 |
Practice locationd | ||||
Large city | 1.0 | ref | 1.0 | ref |
Small city | 0.86 | 0.72-1.03 | 0.87 | 0.73-1.04 |
Rural area | 0.93 | 0.75-1.14 | 0.95 | 0.77-1.16 |
Characteristic | Anxietyb | Depressionc | |||
---|---|---|---|---|---|
PR | 95% CI | PR | 95% CI | ||
Any WPVa | Model Id | 1.95 | 1.24-3.08 | 1.84 | 1.19-2.85 |
Model IIe | 1.85 | 1.16-2.95 | 1.72 | 1.11-2.67 |