Psychometric properties and cut-off scores for the Swedish version of the Negative Acts Questionnaire: The full scale and short version

The present study investigates the psychometric properties and cut-off scores of a Swedish version of the Negative Acts Questionnaire, the most frequently used instrument to measure exposure to workplace bullying. Based on a probability sample of the Swedish workforce (n = 1853), we investigate the validity of both the full version (NAQ-R) and the short version (SNAQ). We suggest optimal cut-offs for the NAQ-R and SNAQ, and for the subscales measuring work- and person-related bullying. Based on the cut-off scores we provide estimates of prevalence in a Swedish context. The factor structure and psychometric properties are comparable to the Norwegian original and the English versions of the instrument. We also tested the criterion validity using 11 outcome and antecedent variables to bullying, and all provided support for its validity. The identified cut-off scores differentiate clearly when tested against the 11 variables used to test criterion validity in the study. The results showed that the Swedish version of the NAQ-R, including the SNAQ, is a valid measure of workplace bullying. To our knowledge, this study is the first study presenting statistical cut-offs for the NAQ-R subscales as well as investigating both the NAQ-R and the SNAQ simultaneously. The present study also provides some criticism against and suggestions for improving the NAQ-R, aiming to capture even more of the overall experience of exposure, ability to defend oneself, overall duration, and on- and offline exposure.

Does recall bias explain the association of mood disorders with workplace harassment?

Purpose

To determine the contribution of recall bias to the observed excess in mental ill-health in those reporting harassment at work.

Methods

A prospective cohort of 1885 workers in welding and electrical trades was contacted every six months for up to 5 years, asking whether they were currently anxious or depressed and whether this was made worse by work. Only at the end of the study did we ask about any workplace harassment they had experienced at work. We elicited sensitivity and specificity of self-reported bullying from published reliability studies and formulated priors that reflect the possibility of over-reporting of workplace harassment (exposure) by those whose anxiety or depression was reported to be made worse by work (cases). We applied the resulting misclassification models to probabilistic bias analysis (PBA) of relative risks.

Results

We observe that PBA implies that it is unlikely that biased misclassification due to the study subjects' states of mind could have caused the entire observed association. Indeed, the results demonstrated that doubling of risk of anxiety or depression following workplace harassment is plausible, with the unadjusted relative risk attenuated with understated uncertainty.

Conclusions

It seems unlikely that risk of anxiety or depression following workplace harassment can be explained by the form of recall bias that we proposed.

Prevalence and nature of workplace bullying and harassment and associations with mental health conditions in England: a cross-sectional probability sample survey

BACKGROUND

Evidence on workplace bullying and harassment (WBH) in the UK has not used probability-sample surveys with robust mental health assessments. This study aimed to profile the prevalence and nature of WBH in England, identify inequalities in exposure, and quantify adjusted associations with mental health.

METHODS

Data were from the 2014 Adult Psychiatric Morbidity Survey, a cross-sectional probability-sample survey of the household population in England. Criteria for inclusion in the secondary analysis were being aged 16-70 years and in paid work in the past month (n = 3838). Common mental disorders (CMDs) were assessed using the Clinical Interview Schedule-Revised and mental wellbeing using the Warwick-Edinburgh Mental Wellbeing Scale. Analyses were weighted. We examined associations between past-year WBH and current CMD using multivariable regression modelling, adjusting for sociodemographic factors. Interaction terms tested for gender differences in associations. The study received ethical approval (ETH21220-299).

RESULTS

One in ten employees (10.6%, n = 444/3838) reported past-year experience of WBH, with rates higher in women (12.2%, n = 284/2189), those of mixed, multiple, and other ethnicity (21.0%, n = 15/92), and people in debt (15.2%, n = 50/281) or living in cold homes (14.6%, n = 42/234). Most commonly identified perpetrators of WBH were line managers (53.6%, n = 244/444) or colleagues (42.8%, n = 194/444). Excessive criticism (49.3%, n = 212/444), verbal abuse (42.6%, n = 187/444), and humiliation (31.4%, n = 142/444) were the most common types. WBH was associated with all indicators of poor mental health, including CMD (adjusted odds ratio [aOR] 2.65, 95% CI 2.02-3.49), and 11 of 14 mental wellbeing indicators, including lower levels of confidence (aOR 0.57, 0.46-0.72) and closeness to others (aOR 0.57, 0.46-0.72). Patterns of association between WBH and mental health were similar in men and women.

CONCLUSIONS

These findings reinforce a need for more cohesive UK legislation against WBH; guidance on recognition of bullying behaviours for employees, managers, and human resources, focusing on prevention and early intervention, and increased awareness of the impact of WBH on mental health among health service practitioners. Limitations include reliance on cross-sectional data collected before pandemic-related and other changes in workplace practices. Longitudinal data are needed to improve evidence on causality and the longevity of mental health impacts.

The workplace culture, mental health and wellbeing of early- and mid-career health academics: a cross-sectional analysis

There are reports of poor working conditions for early and mid-career academics (EMCAs) in universities, however, empirical data using validated tools are scarce. We conducted an online, cross-sectional survey using validated tools to assess workplace satisfaction, exposure to workplace abuse, and mental health. Participants included employees of medical and health faculties of two of the largest Australian universities, surveyed between October 2020 and January 2021.Overall, 284 participants responded. Many reported job insecurity: half (50.7%) working on contracts with less than one remaining year. Workloads were considerable, with 89.5% of participants working overtime and 54.8% reporting burnout. Workplace abuse in the forms of bullying (46.6%), sexual harassment (25.3%), sexism (49.8%) and racism (22.5%) were commonly reported. Clinically significant symptoms of depression (28.0%), anxiety (21.7%) and suicidal ideation or self-harm (13.6%) were reported; with a higher prevalence among those working more overtime, and those exposed to workplace abuse. Priorities include providing a stable and safe workplace, increasing accountability and transparency in addressing workplace abuse, and supporting professional development.In summary, EMCAs in our study were commonly exposed to precarious employment conditions and workplace abuse. Our findings provide empirical evidence on where universities and funding bodies should direct resources and change organisational risk factors, to improve workplace culture.

When the Going Gets Tough and the Environment Is Rough: The Role of Departmental Level Hostile Work Climate in the Relationships between Job Stressors and Workplace Bullying

In line with the work environment hypothesis, the present study investigates whether department-level perceptions of hostile work climate moderate the relationship between psychosocial predictors of workplace bullying (i.e., role conflicts and workload) and exposure to bullying behaviours in the workplace. The data were collected among all employees in a Belgian university and constitutes of 1354 employees across 134 departments. As hypothesized, analyses showed positive main effects of role conflict and workload on exposure to bullying behaviours. In addition, the hypothesized strengthening effect of department-level hostile work climate on the relationship between individual-level job demands and individual exposure to bullying behaviours was significant for role conflict. Specifically, the positive relationship between role conflict and exposure to bullying behaviours was stronger among employees working in departments characterized by a pronounced hostile work climate. In contrast to our predictions, a positive relationship existed between workload and exposure to bullying behaviours, yet only among individuals in departments with low hostile work climate. These findings contribute to the bullying research field by showing that hostile work climate may strengthen the impact of role stress on bullying behaviours, most likely by posing as an additional distal stressor, which may fuel a bullying process. These findings have important theoretical as well as applied implications.

National Comparison of Program Director Perceptions vs. Resident Reports of the Learning Environment and Well-Being

OBJECTIVE

Our research objectives were to (1) assess the correlation between PD perceptions and their residents' reported experiences and (2) identify PD and program characteristics associated with alignment between PD perceptions and their residents' reports.

DESIGN, SETTING, PARTICIPANTS

A survey was administered to US general surgery residents following the 2019 American Board of Surgery In-Training Examination (ABSITE) to study wellness (burnout, thoughts of attrition, and suicidality) and mistreatment (gender discrimination, sexual harassment, racial/ethnic/religious discrimination, bullying). General surgery program directors (PDs) were surveyed about the degree to which they perceived mistreatment and wellness within their programs. Concordance between PDs' perceptions and their residents' reports was assessed using Spearman correlations. Multivariable logistic regression models examined factors associated with alignment between PDs and residents.

RESULTS

Of 6,126 residents training at SECOND Trial-enrolled programs, 5,240 (85.5%) responded to the ABSITE survey. All 212 PDs of programs enrolled in the SECOND Trial (100%) responded to the PD survey. Nationally, the proportion of PDs perceiving wellness issues was similar to the proportion of residents reporting them (e.g., 54.9% of PDs perceive that burnout is a problem vs. 40.1% of residents experience at least one burnout symptom weekly); however, the proportion of PDs perceiving mistreatment vastly underestimated the proportion of residents reporting it (e.g., 9.3% of all PDs perceive vs. 65.9% of all residents report bullying). Correlations between PDs' perceptions of problems within their program and their residents' reports were weak for racial/ethnic/religious discrimination (r = 0.176, p = 0.019), sexual harassment (r = 0.180, p = 0.019), burnout (r = 0.198, p = 0.007), and thoughts of attrition (r = 0.193, p = 0.007), and non-existent for gender discrimination, bullying, or suicidality. Multivariable regression models did not identify any program or PD characteristics that were consistently associated with improved resident-program director alignment.

CONCLUSIONS

Resident and PD perceptions were generally disparate regarding mistreatment, burnout, thoughts of attrition, and suicidality. Reconciling this discrepancy is critical to enacting meaningful change to improve the learning environment and resident well-being.

Prevalence and associated factors of bullying in medical residents: A systematic review and meta-analysis

OBJECTIVE

To assess the prevalence of bullying in medical residents and its associated factors.

METHODS

In this systematic review and meta-analysis, articles from MEDLINE, EMBASE, Scopus, PsycInfo, Cochrane databases, and Web of Science were searched. Published and unpublished cross-sectional studies were included. Cochrane's Q test and I2 statistics were used to assess the existence of heterogeneity. Subgroup analysis and sensitivity analysis were performed on evidence of heterogeneity. Egger's test and funnel plots were performed to investigate publication bias.

RESULTS

A total of 13 cross-sectional studies with a total of 44 566 study participants from different medical residencies were analyzed. The overall prevalence of bullying was 51% (95% CI 36-66). Furthermore, female residents and residents that belong to a minority group had higher odds of experiencing bullying compared to their peers.

CONCLUSION

A high prevalence of bullying in medical residents exists around the world. There is a need for education, dissemination, and more effective interventions among the residents and authorities about bullying to build and promote adequate behaviors and diminish bullying prevalence.

Burnout, Discrimination, Abuse and Mistreatment in Latin America Neurosurgical Training During the COVID-19 Pandemic

BACKGROUND

Discrimination, abuse and mistreatment are prevailing problems reported in neurosurgical-training programs globally. Moreover, the current COVID-19-pandemic may also display a negative impact on burnout levels in neurosurgery-residents. This study aims to evaluate burnout, discrimination and mistreatment in neurosurgical-residents training in Latin-America during the SARS-CoV-2 era.

METHODS

A 33-item electronic survey was sent to neurosurgery-residents from Latin-America from May-10 to May-25, 2021. Statistical analysis was made using IBM-SPSS-25.

RESULTS

111 neurosurgery residents responded the survey. Mean age was 29.39±2.37 years; 22.5% were female and 36% were training in Mexico. Residents who reported suffering from discrimination for testing positive to COVID-19 had the highest levels of depersonalization (66.7%, p=0.043) and emotional-exhaustion (75%, p= 0.023). Female respondents presented higher rates of gender discrimination (80%vs.1.2%, p=0.001), abuse (84%vs.58.1%, p<0.005) and sexual-harassment (24%vs.0%, p<0.001) than male respondents. Residents training in Mexico presented lower rates of emotional or verbal abuse (59.2%vs.32.5%, p=0.007) and bullying (p<0.005) than other countries in Latin-America. Older-age was a protective factor for high depersonalization scores (OR 0.133, 95%CI 0.035-0.500). Suffering from discrimination represented a risk factor for presenting high emotional-exhaustion scores (OR 3.019, 95%CI 1.057-8.629). High levels of depersonalization were associated with a 7-fold increased risk of presenting suicidal ideation (OR 7.869, 95%CI 1.266-48.88).

CONCLUSION

The COVID-19 pandemic has been a significant burden on several aspects of healthcare workers' lives. Our results provide a broad overview of its impact on burnout, discrimination and mistreatment as experienced by neurosurgery residents training in Latin-America, laying the groundwork for future studies and potential interventions.

Experiences of LGBTQ+ Residents in US General Surgery Training Programs

Importance

Previous studies have shown high rates of mistreatment among US general surgery residents, leading to poor well-being. Lesbian, gay, bisexual, transgender, queer, and other sexual and gender minority (LGBTQ+) residents represent a high-risk group for mistreatment; however, their experience in general surgery programs is largely unexplored.

Objective

To determine the national prevalence of mistreatment and poor well-being for LGBTQ+ surgery residents compared with their non-LGBTQ+ peers.

Design, Setting, and Participants

A voluntary, anonymous survey adapting validated survey instruments was administered to all clinically active general surgery residents training in Accreditation Council for Graduate Medical Education-accredited general surgery programs following the 2019 American Board of Surgery In-Training Examination.

Main Outcomes and Measures

Self-reported mistreatment, sources of mistreatment, perceptions of learning environment, career satisfaction, burnout, thoughts of attrition, and suicidality. The associations between LGBTQ+ status and (1) mistreatment, (2) burnout, (3) thoughts of attrition, and (4) suicidality were examined using multivariable regression models, accounting for interactions between gender and LGBTQ+ identity.

Results

A total of 6956 clinically active residents completed the survey (85.6% response rate). Of 6381 respondents included in this analysis, 305 respondents (4.8%) identified as LGBTQ+ and 6076 (95.2%) as non-LGBTQ+. Discrimination was reported among 161 LGBTQ+ respondents (59.2%) vs 2187 non-LGBTQ+ respondents (42.3%; P < .001); sexual harassment, 131 (47.5%) vs 1551 (29.3%; P < .001); and bullying, 220 (74.8%) vs 3730 (66.9%; P = .005); attending surgeons were the most common overall source. Compared with non-LGBTQ+ men, LGBTQ+ residents were more likely to report discrimination (men: odds ratio [OR], 2.57; 95% CI, 1.78-3.72; women: OR, 25.30; 95% CI, 16.51-38.79), sexual harassment (men: OR, 2.04; 95% CI, 1.39-2.99; women: OR, 5.72; 95% CI, 4.09-8.01), and bullying (men: OR, 1.51; 95% CI, 1.07-2.12; women: OR, 2.00; 95% CI, 1.37-2.91). LGBTQ+ residents reported similar perceptions of the learning environment, career satisfaction, and burnout (OR, 1.22; 95% CI, 0.97-1.52) but had more frequent considerations of leaving their program (OR, 2.04; 95% CI, 1.52-2.74) and suicide (OR, 1.95; 95% CI, 1.26-3.04). This increased risk of suicidality was eliminated after adjusting for mistreatment (OR, 1.47; 95% CI, 0.90-2.39).

Conclusions and Relevance

Mistreatment is a common experience for LGBTQ+ surgery residents, with attending surgeons being the most common overall source. Increased suicidality among LGBTQ+ surgery residents is associated with this mistreatment. Multifaceted interventions are necessary to develop safer and more inclusive learning environments.

Measuring workplace bullying in a U.S. nursing population with the Short Negative Acts Questionnaire

Efforts to decrease nurse-reported workplace bullying (WPB) is an interest among researchers, nursing leaders, and healthcare organizations. Varying conceptual definitions and measurement approaches of WPB, however, have created barriers for researchers to provide reliable and consistent information regarding WPB. In this paper, the authors aim to (1) evaluate the reliability and construct validity of the Short Negative Acts Questionnaire (SNAQ) in a sample of U.S. nurses working in hospitals located throughout Alabama, (2) determine targets and non-targets of WPB, and (3) evaluate the criterion validity of the SNAQ based on WPB classification. The internal consistency reliability and construct validity of the SNAQ in 943 Alabama registered nurses was evaluated using Cronbach's α and confirmatory factor analysis. An exploratory factor analysis was conducted to explore the underlying structure of the SNAQ. Targets and non-targets of WPB were identified using latent class analysis of the SNAQ and by the self-labeling item. Agreement between the two methods was evaluated with Cohen's κ. Using both methods, the association between WPB classification and outcomes empirically associated with nurse-reported WPB was evaluated with random effects multiple logistic regression to determine criterion validity. The results indicate that the SNAQ is a reliable and valid instrument to explore WPB in a sample of U.S. registered nurses working in hospitals throughout Alabama.

Associations between exposure to workplace bullying and insomnia: a cross-lagged prospective study of causal directions

Objective

Workplace bullying has been established as a significant correlate of sleep problems. However, little is known regarding the causal direction between bullying and sleep. The aim of this study was to examine temporal relationships between bullying and symptoms of insomnia.

Methods

Reciprocal and prospective associations between exposure to workplace bullying and symptoms of insomnia were investigated in a national probability sample comprising 1149 Norwegian employees. Data stemmed from a two-wave full panel survey study with a 6-month time interval between the baseline and follow-up assessments. Models with stabilities, forward-, reverse-, and reciprocal associations were tested and compared using Structural Equation Modelling. Analyses were adjusted for age, gender, and the stability in the outcome variables over time. Workplace bullying was assessed with the nine-item Short Negative Acts Questionnaire. Insomnia was assessed with a previously validated three item scale reflecting problems with sleep onset, sleep maintenance, and early morning awakening.

Results

The forward association model, which showed that exposure to workplace bullying prospectively increased levels of insomnia (b = 0.08; p < 0.001), had best fit with the data [CFI = 0.94; TLI = 0.93; RMSEA = 0.049 (0.046–0.052)]. The reverse association model where insomnia influences risk of being subjected to bullying was not supported.

Conclusion

Workplace bullying is a risk factor for later insomnia. There is a need for further studies on moderating and mediating variables that can explain how and when bullying influence sleep.

Prevalence, Types, and Sources of Bullying Reported by US General Surgery Residents in 2019

This survey study describes surgical trainees’ self-reported experiences of bullying and symptoms of burnout and suicidality assessed at the time of their board certification examination.

Job Demands as Risk Factors of Exposure to Bullying at Work: The Moderating Role of Team-Level Conflict Management Climate

Conflict management climate is an important organizational resource that is theorized to prevent interpersonal frustration from escalating into harsh interpersonal conflicts and even workplace bullying. The present study investigates whether team-level perceptions of conflict management climate moderate the relationship between previously investigated psychosocial predictors of workplace bullying (i.e., role conflicts, workload, cognitive demands) and perceived exposure to bullying behaviors in the workplace. We collected data from crews on ferries operating on the Norwegian coastline consisting of 462 employees across 147 teams. As hypothesized, multilevel analyses showed positive main effects of role conflict and cognitive demands (but not workload) on exposure to bullying behaviors. Also, the hypothesized moderation effect of team-level conflict management climate on the relationship between individual-level job demands and exposure to bullying behaviors was significant for role conflict and cognitive demands, but not for workload. Specifically, the positive relationships between the two job demands and exposure to bullying behaviors were stronger for employees working in teams with a weak (vs. a strong) conflict management climate. These findings contribute to the bullying research field by showing that conflict management climate may buffer the impact of stressors on bullying behaviors, most likely by preventing interpersonal frustration from escalating into bullying situations.

Individual and Organizational Characteristics Associated With Workplace Bullying of School Nurses in Virginia

The prevalence and contributing factors of workplace bullying (WPB) are unknown among school nurses (SNs) in kindergarten to 12th grade programs. The aim of this cross-sectional study was to examine individual and organizational characteristics of WPB in a sample of SNs in Virginia. Based on the Short-Negative Acts Questionnaire, 40% of nurses did not experience bullying behavior, 34.8% of nurses faced occasional bullying (now and then or monthly), and 25.3% of nurses were frequently bullied (weekly or daily). Backward stepwise regression demonstrated the predictor variables of being non-White, a licensed practical nurse, or not involved in student individual education plans were significantly associated with being bullied. Administrators/supervisors need to be aware of the existence of WPB.

A Scoping Review of Validated Tools to Measure Incivility in Healthcare Settings

OBJECTIVE

To identify and compare validated tools used to assess incivility in healthcare settings.

BACKGROUND

Incivility in the workforce is associated with poor quality outcomes, increased employee turnover, and decreased job satisfaction. Validated tools are essential for accurate measurement of incivility. The aim of this study was to compare characteristics of validated tools for use in a busy clinical setting.

METHODS

In a scoping review, English language research studies using incivility tools published in PubMed or CINAHL between March 1, 2013, and March 14, 2018, were assessed for sound psychometric properties and feasibility of use (eg, short, easy to administer).

RESULTS

After screening 869 articles and full text review of 244, 5 identified tools met the criteria; the Short Negative Acts Questionnaire seemed best suited for use in a busy healthcare setting.

CONCLUSION

Adoption of a standardized and validated incivility tool makes it possible to compare across clinical settings and track progress over time.

Workplace bullying among employees in Germany: prevalence estimates and the role of the perpetrator

OBJECTIVES

The aim of this study was to examine the prevalence of workplace bullying in Germany while also taking the perpetrator and severity level (measured by frequency) into account and considering the role of gender, age and socio-economic status.

METHODS

We used data from a large representative sample (N = 4143) of employees in Germany subject to social security contributions. Self-reported bullying was assessed for different combinations of perpetrators (co-workers, superiors) and according to severity, i.e., being exposed at all and to severe bullying (at least weekly).

RESULTS

Prevalence estimates varied from 2.9% for severe bullying by co-workers to 17.1% for overall bullying (i.e., without distinguishing by perpetrator, less severe bullying also included). Unskilled workers reported more bullying by both perpetrators than academics/managers. We also observed an age trend for severe bullying by superiors (i.e., bossing), with younger employees being more affected from bossing than elder. No gender differences were detected.

CONCLUSIONS

The findings indicate that it is crucial to consider type of perpetrator and severity of the behaviors when examining the prevalence of workplace bullying. The way bullying is defined and operationalized strongly contributes to the prevalence estimates. Differences between subgroups and associations or cause-effect relationships should be analyzed with these variations in mind.