What's the Violence-Depression Connection?

Health care workers, including nurses, are particularly vulnerable to bullying and verbal abuse, which can lead to devastating emotional trauma and depression.

According to recent nursing graduate Callie Vincent ’09, however, this psychological workplace violence doesn’t necessarily cause the depression. Instead, depression experienced by nurses may actually be a predictor of such violence.

“Health care professionals are one of the professions most affected by [workplace violence],” said Jacquelyn Campbell, PhD, RN, FAAN, Vincent’s advisor for the study. “So we need to think about how we go about preventing that.”

Vincent’s research was funded by her Provost’s Undergraduate Research Award, given twice a year to allow Johns Hopkins undergraduates a chance to develop research skills. She was among 51 recipients in 2008, joining the ranks of other past School of Nursing students who have also conducted research funded by this award.

Using data from an ongoing Safe At Work study, led by Campbell, Vincent analyzed questionnaires taken in summer 2007 from 1,623 nursing staff at The Johns Hopkins Hospital, Johns Hopkins Bayview Medical Center, and Howard County General Hospital. The questionnaires examined the type of violence experienced and measured depression using the Center for Epidemiologic Studies Short Depression scale.

The results were surprising.

Vincent initially expected depression would be an outcome of the violence, but instead found it was a predictor for the violence.

Nursing staff who were depressed when they were first interviewed were nine times more likely to be depressed at a follow up sur-vey. Of the 20 people who were depressed at the time of the follow up questionnaire, 65 percent had reported depression in the first survey.

“So many of the people who experience workplace violence started out depressed,” Vincent said. “They could be more at risk [for violence].”

The findings could mean that depressed staff may be more of a target for psychological violence, or that those who are depressed view certain situations more negatively, Vincent said.

Vincent’s study also examined other variables that could contribute to depression, such as experiences with interpersonal violence or child abuse. These data are important to know when developing mental health services for nurses, Campbell said.

“She got a lot of interesting results, important results, that need to be looked at further and communicated with the field,” she said.

The PURA program not only allowed Vincent to make a significant contribution to this area of research, but it also gave Vincent a chance to experience the challenges and joys of research—which Campbell hopes will compel Vincent to pursue her doctoral degree.

With more research, these findings could lead to a greater focus on overall mental health services, Vincent said.

“The point of intervention may not necessarily be at the final step of workplace violence occurring,” she said. “We may need to focus on making sure employees have good mental health to begin with.”