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Workplace bullying, violence increase type 2 diabetes risk

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November 14, 2017

Tianwei Xu
Tianwei Xu

Adults who experience incidents of workplace bullying or violence are more likely to develop type 2 diabetes vs. those who do not report such experiences, according to findings published in Diabetologia.

“Workplace bullying is prevalent at work, with one in ten exposed,” Tianwei Xu, a doctoral student in the department of public health at the University of Copenhagen, Denmark, told Endocrine Today. “Workplace violence is prevalent especially among occupations with frequent client contact.”

Xu and colleagues analyzed data from 45,905 men and women aged 40 to 65 years and without diabetes, who participated in four prospective studies, including the Swedish Work Environment Study, the Swedish Longitudinal Occupational Survey of Health, the Finnish Public Sector Survey and the Danish Work Environment Cohort Study (26,625 women). Participants self-reported incidents of workplace bullying and violence at baseline via questionnaires with similar wording in all cohorts. Workplace bullying was defined as having been bullied in the workplace at least once during the past 12 months. Workplace violence was defined as having been the target of violent actions or threats of violence in the past 12 months at work (the Finnish study did not assess workplace violence). Researchers assessed incident diabetes during follow-up through national health and medication records and used marginal structural Cox models to examine associations between workplace bullying and violence and type 2 diabetes.

Within the cohort, 9% reported workplace bullying, and 12% reported being exposed to workplace violence or threats of violence. Between 2% and 4% of participants reported exposure to workplace bullying and violence, although there was little statistical agreement between the two measures across studies, according to researchers. During a mean follow-up time of 11.7 years, 1,223 participants developed type 2 diabetes.

Researchers found that participants who reported workplace bullying had a 1.46 times higher risk for developing incident type 2 diabetes vs. those who did not report workplace bullying (95% CI, 1.23-1.74). After additional adjustment for BMI (available in three of the four included studies), the HR fell slightly, from 1.55 (95% CI, 1.25-1.92) to 1.37 (95% CI, 1.11-1.69). Additional adjustments for alcohol consumption, mental illness and limiting the analysis to the first 4 years of follow-up did not change the results, according to researchers.

During a mean follow-up of 11.4 years, researchers identified 930 cases of type 2 diabetes in the three cohorts used for analysis on workplace violence. Participants who reported being exposed to workplace violence or threats of violence were 1.26 times more likely to develop type 2 diabetes (95% CI, 1.02-1.56) vs. those who did not report workplace violence, with results persisting after adjustment for age, sex, educational level, marital status and country of birth. Further adjustment for BMI only slightly attenuated the risk, according to researchers, and further adjustment for alcohol consumption and mental illness did not change the findings.

“Clinicians should be informed about these potential risk factors,” Xu said. “If patients are being exposed to workplace bullying or violence, they should be advised to consult their company physician, if available, or union representative, in order to cope with the stressful situation.”

Xu said research on bullying and violence prevention policies with workplaces as the target are warranted, to determine whether such policies could be an effective means of reducing the incidence of type 2 diabetes.

“Further study of possible pathways, for example through weight gain, negative emotions and the physiological stress response, will be crucial in providing an understanding of the causal mechanisms, as well as developing more cost-effective interventions with surrogate outcomes,” the researchers wrote. – by Regina Schaffer

For more information:

Tianwei Xu can be reached at the University of Copenhagen, Department of Public Health, Section of Social Medicine, Gothersgade 160, 1014 Copenhagen, Denmark; email:

Disclosures: The authors report no relevant financial disclosures.