Workplace violence against hospital personnel in Tunisia: prevalence, associated psychological and behavioral outcomes, and legal actions

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Background Workplace violence against hospital personnel is a significant occupational and public health concern that can compromise care quality and staff wellbeing. This study aimed to estimate its prevalence, describe its forms and outcomes, and identify associated factors, legal actions, and psychological outcomes. Methods A cross-sectional study was conducted over 4 months (August–November 2024) in the Hedi Chaker University Hospital and Habib Bourguiba University Hospital in Sfax. A representative sample of hospital personnel completed an anonymous self-administered questionnaire. Results A total of 406 hospital personnel were included. The sex ratio (M/F) was 0.24, and the median age was 36 years (IQR: 30–45). The prevalence of verbal, physical, and sexual violence was 63.1% ( n = 256), 17% ( n = 69), and 2% ( n = 8), respectively. Legal action was taken by 24 participants (9.6%). Multivariate analysis revealed that verbal violence was independently associated with overcrowded workplace (AOR = 0.12; p = 0.002) and poor medical services and a lack of hospital supplies (AOR = 7.3; p = 0.007), while physical violence was associated with patient death (AOR = 2.6; p = 0.003) and age ≥40 years (AOR = 1.7; p = 0.042). Taking legal action was more frequent after physical violence (COR = 8.08; p < 0.001) and among personnel working in intensive care units (COR = 14; p = 0.02), and less frequent among physicians (COR = 0.2; p = 0.042). Physical violence was significantly associated with insecurity, hypervigilance, mental health consultation for anxiety, depressive, and post-traumatic stress-related symptoms, social impairment, and sleep disorders (all p < 0.05). Conclusion Workplace violence in Sfax university hospitals was frequent and strongly associated with psychological outcomes, highlighting the need to strengthen prevention strategies, improve communication and training, and ensure adequate psychological support for hospital personnel.

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