Makarem Nisrine Nadim, Tavitian-Elmadjian Lucy R, Brome Dayana, Soubra Noura A
Department of Family Medicine, American University of Beirut Medical Center, Beirut, Lebanon
Department of Psychology, American University of Sharjah, Sharjah, UAE.
BMJ Open. 2025 Sep 22;15(9):e094758. doi: 10.1136/bmjopen-2024-094758.
Interest in workplace bullying (WPB) has been steadily growing with a focus on understanding its consequences as well as prevalence rates in different occupations and across different countries with varying cultural contexts. Research in the Middle East remains limited, especially in Lebanon. The scarcity of data from the Lebanese healthcare sector underscores the need to better understand WPB in this unique sociocultural and organisational environment.
The primary aim of this study is to investigate the prevalence of WPB among healthcare providers and hospital staff in Greater Beirut. The secondary aim is to investigate the relationship between WPB, psychological well-being, burnout and sick leaves in the Lebanese cultural context.
A cross-sectional study design was conducted.
Seven hospitals in Greater Beirut took part in the study, including six private hospitals and one public hospital.
A total of 958 participants aged 18-64 were recruited using stratified proportionate non-random sampling. Stratification by hospital size and department aimed to ensure broad representation of nursing and support staff across institutions. The participants included nursing and supporting staff, of which 26.3% were males and 73.7% were females. Those employed for less than 6 months were excluded.
The Arabic versions of each of the Negative Acts Questionnaire-Revised (NAQ-R), the General Health Questionnaire (GHQ-12) and the Copenhagen Burnout Inventory (CBI) were administered. These instruments were selected for their established reliability and widespread use in cross-cultural occupational health research. Surveys were administered via paper-and-pencil (six hospitals) and online (one hospital). Prevalence of bullying using the NAQ-R cut-off scores was first calculated and then their respective thresholds identified using receiver operating characteristic analysis. Pearson's correlation coefficient was used to evaluate the relationship between the NAQ-R and the GHQ-12, CBI and number of sick leaves.
Using the lower threshold as a cut-off on the NAQ-R, 35.1% of participants were classified as bullied. When applying the higher threshold as a cut-off, the percentage was slightly lower but remained comparable at 32.4%. Results showed that across the two outcomes, those who were bullied both when using a lower threshold and upper threshold were significantly more distressed and burnt out (p<0.05). Participants who reported being bullied had significantly poorer general health (M=2.39, SD=0.56) compared with those not bullied (M=2.05, SD=0.47), (df) = -8.43, p<0.001, with a large effect size (Cohen's d≈0.66). Similar differences were observed in work-related burnout (d≈0.37) and person-related burnout (d≈0.36). Results indicated that being bullied is significantly associated with differences along the categories of sick leave, such that it is associated with increased sick leaves taken up particularly in the range of 6-10 days. This was true when using the lower threshold cut-off as well as the higher threshold cut-off (Lower threshold: χ² (4, N=902) = 11.586, p=0.009, Standardised residual for 6-10 days=2>±1.96; Upper threshold: χ² (4, N=902)=9.963, p=0.019, Standardised residual for 6-10 days=2.2>±1.96).
Findings yielded lower prevalence rates of WPB among nurses and the entire sample as compared with research carried out in the Arab region. Our study further supports the impact of culture on the perpetuation of WPB and the uniqueness of Lebanon's culture on influencing this prevalence. Results indicated that participants who were bullied were significantly more distressed, more burnt out and reported taking up more sick leaves. These findings highlight the need to consider local workplace culture when addressing bullying and reinforce the significant psychological and occupational toll bullying takes on affected individuals. Healthcare institutions are encouraged to implement and reinforce clear antibullying policies, WPB prevention strategies and confidential reporting mechanisms. Future research should explore longitudinal patterns of bullying, obtain a more nationally representative sample and examine the effectiveness of targeted interventions to create safer, more supportive work environments.
对职场霸凌（WPB）的关注一直在稳步增长，重点在于了解其后果以及在不同职业和具有不同文化背景的不同国家中的发生率。中东地区的研究仍然有限，尤其是在黎巴嫩。黎巴嫩医疗保健部门的数据匮乏凸显了在这种独特的社会文化和组织环境中更好地了解职场霸凌的必要性。
本研究的主要目的是调查大贝鲁特地区医疗服务提供者和医院工作人员中职场霸凌的发生率。次要目的是在黎巴嫩文化背景下调查职场霸凌、心理健康、倦怠和病假之间的关系。
采用横断面研究设计。
大贝鲁特的七家医院参与了该研究，包括六家私立医院和一家公立医院。
使用分层比例非随机抽样招募了958名年龄在18 - 64岁之间的参与者。按医院规模和科室分层旨在确保各机构中护理和辅助人员的广泛代表性。参与者包括护理和辅助人员，其中男性占26.3%，女性占73.7%。工作不到6个月的人员被排除在外。
使用了修订后的负面行为问卷（NAQ - R）、一般健康问卷（GHQ - 12）和哥本哈根倦怠量表（CBI）的阿拉伯语版本。选择这些工具是因为它们在跨文化职业健康研究中具有既定的可靠性和广泛应用。调查通过纸笔方式（六家医院）和在线方式（一家医院）进行。首先使用NAQ - R的临界值计算霸凌的发生率，然后使用受试者工作特征分析确定各自的阈值。使用Pearson相关系数评估NAQ - R与GHQ - 12、CBI和病假天数之间的关系。
以NAQ - R的较低阈值作为临界值，35.1%的参与者被归类为受霸凌者。当使用较高阈值作为临界值时，该百分比略低，但仍相当，为32.4%。结果表明，在这两个结果中，无论使用较低阈值还是较高阈值都被霸凌的参与者明显更痛苦和倦怠（p < 0.05）。报告受霸凌的参与者的总体健康状况（M = 2.39，SD = 0.56）明显比未受霸凌的参与者（M = 2.05，SD = 0.47）差，（df） = - 8.43，p < 0.001，效应量较大（Cohen's d≈0.66）。在与工作相关的倦怠（d≈0.37）和与个人相关的倦怠（d≈0.36）方面也观察到类似差异。结果表明，受霸凌与病假类别差异显著相关，即与特别是6 - 10天范围内病假天数的增加相关。使用较低阈值临界值和较高阈值临界值时都是如此（较低阈值：χ²（4，N = 902） = 11.586，p = 0.009，6 - 10天的标准化残差 = 2 > ±1.96；较高阈值：χ²（4，N = 902） = 9.963，p = 0.019，6 - 10天的标准化残差 = 2.2 > ±1.96）。
与阿拉伯地区进行的研究相比，本研究结果显示护士和整个样本中职场霸凌的发生率较低。我们的研究进一步支持了文化对职场霸凌持续存在的影响以及黎巴嫩文化对这一发生率的独特影响。结果表明，受霸凌的参与者明显更痛苦、更倦怠，且报告的病假天数更多。这些发现突出了在应对霸凌时考虑当地职场文化的必要性，并强化了霸凌对受影响个人造成的重大心理和职业影响。鼓励医疗机构实施和加强明确的反霸凌政策、职场霸凌预防策略和保密报告机制。未来的研究应探索霸凌的纵向模式，获取更具全国代表性的样本，并检验有针对性干预措施的有效性，以创造更安全、更具支持性的工作环境。
