Workplace Bullying Linked to Use of Antidepressants

Photo: Przemek Klos/Mostphotos

The study, led by Rebecka Holmgren, PhD student at the Department of Public Health Sciences at Stockholm University, was recently published in the journal Epidemiology and Psychiatric Sciences. It adds some of the strongest evidence to date that workplace bullying may play a role in the development of common mental disorders.

“Our findings show that workplace bullying is not only associated with self-reported mental health symptoms, but also with an increased need for medical treatment,” Holmgren says. “This highlights bullying as a serious workplace hazard and underscores the responsibility of employers to prevent it, while also pointing to its broader consequences for public health.”

A widespread problem

Common mental disorders – such as depression and anxiety – are a growing concern in today’s workforce. Alongside the personal suffering they cause, they also come with major costs for employers and society, including sick leave, reduced productivity, and healthcare expenses. At the same time, the use of psychotropic medication among adults has been rising in Sweden, alongside many other European countries.

One risk factor that has increasingly drawn attention is the psychosocial work environment. Workplace bullying – defined as repeated, persistent exposure to negative social acts where there is a power imbalance – is estimated to affect around 7–9 % of the workforce in Sweden.

Previous studies have linked bullying to poor mental health, sickness absence, and even suicidal behaviour. But whether bullying actually causes mental health problems is still not known.

Mimicking a clinical trial

To address this, the researchers used an innovative approach known as an “emulated target trial.” Instead of running an actual experiment – which would be unethical in this case – the research team carefully designed their observational study to resemble a clinical trial as closely as possible.

The team analysed data from 25,309 employees in Sweden and Denmark, drawing on two long-running cohort studies: the Swedish Longitudinal Occupational Survey of Health (SLOSH) and the Work Environment and Health in Denmark Survey (WEHD). Survey responses collected between 2012 and 2018 were linked to national registers tracking purchases of psychotropic medication.

Importantly, the study focused only on employees who, at the start of the study period, were not exposed to workplace bullying and were not using psychotropic medication. This allowed the researchers to examine what happened after the onset of bullying.

Bullying onset followed by medication use

1,490 participants (5.9%) reported that they had begun experiencing workplace bullying. During the following 2 years, these individuals were more likely than their non-bullied colleagues to start treatment with psychotropic medication.

The association weakened somewhat after accounting for factors such as age, gender, depressive symptoms, and other psychosocial working conditions – but it did not disappear. When the researchers looked specifically at antidepressant use, the link was even clearer.

The study also found that the more frequently individuals were bullied, the higher their risk of starting psychotropic medication. This also makes sense from a theoretical perspective. Being repeatedly targeted by negative acts at work can undermine a person’s sense of social value, in turn can put a strain on self-esteem and mental health over time.

“What stood out to us was how clear the associations were, also in a relatively healthy working population at start. Moreover, because not everyone who experiences mental health problems will receive or seek medical treatment, it’s possible that our results actually underestimate the true impact of bullying on mental health,” Holmgren says. “At the same time, psychotropic medications are prescribed for a range of conditions, some of them not mental disorders, which means the findings should be interpreted with appropriate caution.”

Workplace bullying a public health concern

According to the researchers, this is the first study to show that the onset of workplace bullying can contribute to mental health conditions severe enough to require medical treatment.

The findings suggest that workplace bullying is not just a social or organizational issue – it is a public health concern. Preventing bullying could help reduce the number of workers who go on to develop depression and other mental disorders, potentially lowering both personal suffering and societal costs.

As Holmgren and her colleagues conclude, the results underline the importance of early and effective preventive interventions in the workplace. Creating safer, more respectful work environments may be a powerful tool for protecting workers’ mental health.

“Other research shows that risk factors for bullying are primarily organizational, so efforts like clear policies, supportive leadership, and structured work processes are likely key to reducing bullying.”

Håkan Soold