Psychological violence, subjective well-being, and burnout among healthcare workers: The roles of sleep disturbance and perceived occupational infection risk.

BACKGROUND: Psychological violence (PCV), which includes verbal abuse, bullying, intimidation, sexual harassment and ethnic discrimination, is the most frequently reported form of workplace violence in health care and a well-documented correlate of burnout. Healthcare workers (HCWs) in infectious disease services face this psychosocial hazard alongside two further, structurally persistent conditions: impaired recovery through disturbed sleep, and the appraised risk of acquiring infection at work. How these demands combine with workers' personal psychological resources is not well understood.

OBJECTIVE: To examine (i) whether PCV exposure is associated with burnout, (ii) whether subjective well-being (SWB) functions as an intervening variable in that association, (iii) whether sleep disturbance is associated with burnout independently of SWB, and (iv) whether the strength of the SWB-burnout association depends on the level of perceived occupational infection risk.

METHODS: Cross-sectional survey of 675 HCWs (76.3% women) at a public tertiary infectious disease hospital in southern China (December 2022 - January 2023), a designated centre for HIV/AIDS, tuberculosis, hepatitis and, at the time of data collection, COVID-19. PCV exposure over the preceding 12 months was assessed with the ILO/ICN/WHO/PSI instrument; SWB with the WHO-5; burnout with the two-item abbreviated Maslach Burnout Inventory screen; sleep disturbance with three binary epidemiological items; and perceived occupational infection risk with a single validated item indexing appraised infection hazard in the respondent's own workplace. Conditional process analysis (ordinary least squares path analysis, 5000 bootstrap resamples) was adjusted for gender, age band, education, occupation, employment type, department and reported concern about workplace violence.

RESULTS: PCV was reported by 34.1% of participants and sleep disturbance by 53.3%. PCV exposure was positively associated with burnout (adjusted direct association b = 0.53, 95% CI 0.11 to 0.96, P = .015; total association b = 0.72, 95% CI 0.27 to 1.19). SWB was negatively associated with burnout (b = -0.13, P < .001) and accounted for an indirect association of 0.19 (95% CI 0.05 to 0.34), approximately 26% of the total. Sleep disturbance was independently associated with burnout after adjustment for SWB and all covariates (b = 0.46 per additional sleep symptom, 95% CI 0.25 to 0.68, P < .001). Perceived occupational infection risk moderated the SWB-burnout association (interaction b = -0.038, 95% CI -0.060 to -0.016, P < .001): the association between SWB and burnout was steeper at higher perceived risk (b = -0.085 at -1 SD; -0.133 at the mean; -0.181 at +1 SD), and the conditional indirect association rose correspondingly (0.12 to 0.26; index of moderated mediation 0.054, 95% CI 0.012 to 0.112).

CONCLUSIONS: In a workforce facing sustained occupational infection risk, PCV exposure, low SWB and disturbed sleep were each associated with greater burnout, and SWB differentiated burnout most sharply among workers appraising their workplace as most hazardous. Because the design is cross-sectional, the direction of the PCV-SWB-burnout sequence cannot be established, and reciprocal influence is likely. The findings support treating violence prevention, recovery-protective scheduling and infection-risk communication as complementary components of occupational mental health provision rather than as separate programmes.