One in three US public health workers reports feeling threatened by the public while on the job during the COVID-19 pandemic

A new studyopens in new tab/window in the American Journal of Preventive Medicineopens in new tab/window, published by Elsevier, documents the record levels of nonphysical violence directed at public health workers on the frontlines of the COVID-19 response and the impact of the public anger and aggression on these workers’ mental health. While the pandemic’s effects on healthcare and other frontline workers are well documented, this study is one of the first to explore its impact on the public health workforce, an occupation that has not historically been at risk for workplace violence. Researchers found that one out of three public health workers surveyed experienced at least one form of workplace violence.

“The negative effects of the COVID-19 pandemic on workers have been documented and the research on psychological impacts is building,” said Hope Tiesman, PhD, Research Epidemiologist with the Division of Safety Research at the National Institute for Occupational Safety and Health (NIOSH), Morgantown, WV, USA, and lead author of the study. “Public health workers do the important work of disseminating information and services to the public; making sure their health and well-being are addressed in the face of workplace violence is important for their mental health and for the health of the nation in future public health crises.”

Dr. Tiesman was part of a team of researchers at the US Centers for Disease Control and Prevention (CDC) that developed, conducted, and analyzed an online survey to understand the prevalence of nonphysical workplace violence against public health workers from March 2020 to April 2021, and assessed the impact on their mental health. More than 26,000 state, tribal, local, and territorial public health workers responded to the survey, which included questions on demographics, level of workplace violence, other workplace factors, and mental health issues such as depression, anxiety, post-traumatic stress disorder (PTSD), and suicidal ideation.

The findings of this novel project show that nearly one in three of these essential public health workers experienced at least one form of workplace violence -- including receiving job threats or being bullied, harassed, or stigmatized -- in the course of their work to inform and protect the public. This unprecedented workplace violence took its toll on the workers’ mental health.

The investigators found that workplace violence was associated with a 21% greater risk of reporting depression or anxiety, a 31% greater risk of reporting PTSD, and a 26% greater risk of reporting suicidal thoughts, even after controlling for illness including COVID-19, losing a family member to COVID-19, and other stress-producing factors during this crisis. The more workplace violence they experienced, the greater the impact on their mental health, which is detrimental to both the individuals and the communities they serve.

Several work factors were associated with increasing workplace violence, such as increasing hours worked per week and increasing interaction with the public.

Addressing the need to develop mitigation approaches to the growing problem, Dr. Tiesman said, “As successive public health emergencies unfold, it is crucial that we ensure that our public health workforce has been empowered to defuse the hostility, harassment, and threats they encounter through training, workplace support, and greater communication after incidents occur. It is also important to increase the capacity of public health departments to prevent, respond to, and follow up on incidents experienced out in the field. A better understanding is needed of the scope and consequences of workplace violence, as well as differences across the types of public health agencies, geographic locations, and sociodemographic groups.”

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Notes for editors

The article is “Workplace Violence and the Mental Health of Public Health Workers During COVID-19,” by Hope M. Tiesman, PhD, Scott A. Hendricks, MS, Douglas M. Wiegand, PhD, Barbara Lopes-Cardozo, MD, Carol Y. Rao, ScD, Libby Horter, MPH, Charles E. Rose, PhD, and Ramona Byrkit, MPH (https://doi.org/10.1016/j.amepre.2022.10.004opens in new tab/window). It appears online in advance of the American Journal of Preventive Medicine, volume 64, issue 3 (March 2023), published by Elsevier.

The article is openly available at https://www.ajpmonline.org/article/S0749-3797(22)00507-4/fulltextopens in new tab/window.

Full text of this article is also available to credentialed journalists upon request; contact Jillian B. Morgan at +1 734 936 1590 or [email protected]opens in new tab/window. Journalists wishing to interview the authors should contact Nura Sadeghpour, MPH, Health Communication Specialist, CDC-NIOSH OD, at +1 202 245 0673 or [email protected]opens in new tab/window.

Elsevier’s Novel Coronavirus Information Center provides expert-curated information for researchers, healthcare professionals and public health officials, including clinical guidance and a portal to access all of Elsevier’s COVID-19 research. All resources are freely available. We also have dedicated hubs for healthcare professionals; health educators and students; librarians; and R&D professionals. You can find these in our Coronavirus Resource Directory.

About the American Journal of Preventive Medicine

The American Journal of Preventive Medicineopens in new tab/window is the official journal of the American College of Preventive Medicineopens in new tab/window and the Association for Prevention Teaching and Researchopens in new tab/window. It publishes articles in the areas of prevention research, teaching, practice and policy. Original research is published on interventions aimed at the prevention of chronic and acute disease and the promotion of individual and community health. The journal features papers that address the primary and secondary prevention of important clinical, behavioral and public health issues such as injury and violence, infectious disease, women's health, smoking, sedentary behaviors and physical activity, nutrition, diabetes, obesity, and alcohol and drug abuse. Papers also address educational initiatives aimed at improving the ability of health professionals to provide effective clinical prevention and public health services. The journal also publishes official policy statements from the two co-sponsoring organizations, health services research pertinent to prevention and public health, review articles, media reviews, and editorials. www.ajpmonline.orgopens in new tab/window

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