Public Health Sciences Thesis Sheds New Light on the Consequences of Workplace Bullying

The thesis breaks new ground by distinguishing between concurrent, prospective and reverse associations between workplace bullying and mental health.

“The link between workplace bullying and mental ill health is already well established. However, fewer studies have taken into account that the relationship may be reciprocal and followed the same individuals over several years to better understand the direction of these associations. This is important because it affects which interventions are likely to make a real difference,” says Rebecka Holmgren, a doctoral student in Public Health Sciences at the Department of Public Health Sciences, Stockholm University.

When Holmgren conducted analyses focusing on changes within individuals over time, the picture became more nuanced. The data showed that bullying triggered short-term increases in anxiety, though not necessarily long-term changes. Interestingly, anxiety itself did not appear to increase the likelihood of future bullying once these individual changes were taken into account.

Bullying Linked to Sick Leave and Medication

In addition to mental health symptoms, Holmgren also examined more concrete outcomes that may reflect more severe distress. Employees exposed to workplace bullying had a higher risk of taking sick leave due to depression or anxiety diagnoses during the following two years. The findings strengthen the evidence that bullying has tangible consequences not only for individuals, but also for workplaces and society at large.

One of the studies in the thesis focused on treatment with psychotropic medication. The results showed that individuals exposed to workplace bullying were more likely to begin treatment with such medication — particularly antidepressants — within two years. This raises further concerns that workplace bullying may contribute to clinically significant deterioration in mental health.

“We already know that workplace bullying increases the risk of mental health problems, but these studies also show that the consequences may be more far-reaching. Some individuals seek medical treatment because their mental health worsens, while others are unable to continue working,” Holmgren says. “It is also important to note that these associations remained even after accounting for individuals’ mental health before the bullying occurred. This challenges the notion that only already vulnerable individuals are affected. The findings suggest that workplace bullying can have serious consequences for anyone.”

Implications for Prevention

One surprising finding was the lack of evidence that good leadership could buffer the effects of bullying on anxiety. Although leadership quality is often highlighted as a key factor in healthy workplaces, the research suggests that it may not be enough to counteract the psychological effects of repeated negative behaviour from colleagues or managers.

Overall, the findings clearly indicate that workplace bullying is a risk factor for both depression and anxiety, even after accounting for prior mental health, demographic factors and other workplace conditions.

“The conclusions are clear. Preventing workplace bullying is not only a matter of workplace culture, but also of public health. Early interventions and rapid support for affected employees may play a crucial role in reducing mental ill health in working life,” Holmgren says.

As awareness of mental health in the workplace continues to grow, the research adds further weight to calls for organisations to move from awareness to concrete anti-bullying measures before the consequences become long-term.

“Mental ill health among working adults has many causes, but our findings suggest that workplace bullying may be one of them. Despite clear anti-bullying legislation in Sweden, an estimated one in ten employees is still affected,” Holmgren says. “While this thesis focuses on the consequences of workplace bullying, other research shows that the main risk factors are organisational. Measures such as clear policies, supportive leadership and structured work processes are therefore likely to be crucial in reducing bullying and, in turn, the risk of mental ill health.”

Håkan Soold

Facts

On 21 May, Rebecka Holmgren defended her doctoral thesis, Workplace bullying and mental health conditions: Disentangling concurrent, prospective, and reverse associations in the Swedish and Danish workforce, at the Department of Public Health Sciences, Stockholm University.

The thesis consists of four studies:

Study I examined the theoretical and psychometric properties of a single-item measure of workplace bullying. The findings showed that the measure captured experiences consistent with the theoretical understanding of workplace bullying and overlapped satisfactorily with established bullying measures, supporting its reliability for use in subsequent studies.

Assessing the validity of a single-item measure of exposure to workplace bullying: A mixed-methods study among Swedish workers (not published yet, currently under peer review).

Study II investigated the relationship between workplace bullying and anxiety symptoms, and whether leadership quality could mitigate anxiety following bullying exposure. Analyses comparing exposed and non-exposed individuals suggested a bidirectional relationship. However, analyses comparing individuals with themselves over time found only short-term increases in anxiety following bullying exposure and no evidence of reverse associations. No moderating effect of leadership quality was found.

Workplace bullying, symptoms of anxiety and the interaction with leadership quality – a longitudinal study using dynamic panel models with fixed effects (Scandinavian Journal of Work, Environment & Health).

Study III explored the association between workplace bullying and sickness absence due to depression or anxiety disorders. Individuals exposed to bullying had an increased risk of sickness absence during the following two years compared with non-exposed individuals. No clear evidence was found that sickness absence increased the risk of later bullying.

Bidirectional associations between workplace bullying and sickness absence due to common mental disorders – a propensity-score matched cohort study (BMC Public Health)

Study IV examined whether workplace bullying was associated with an increased risk of treatment with psychotropic medication. The analysis included individuals without prior bullying exposure or recent psychotropic medication use. Exposed individuals had an elevated risk of initiating psychotropic medication treatment within two years, particularly antidepressants.

Onset of exposure to workplace bullying and incident treatment with psycho-tropic medication – an emulated target trial with 25,309 Swedish and Danish employees (Epidemiology and Psychiatric Sciences).