A1 Refereed original research article in a scientific journal
Onset of workplace bullying and violence and changes in health-related behaviors: a multi-cohort study; 
Authors: Xu, Tianwei; Nielsen, Morten Birkeland; Clark, Alice J.; Rugulies, Reiner; Pentti, Jaana; Sørensen, Jeppe Karl; Nordentoft, Mads; Westerlund, Hugo; Stenholm, Sari; Vahtera, Jussi; Madsen, E. H.; Hansen, Åse Marie; Virtanen, Marianna; Knardahl, Stein; Oksanen, Tuula; Kivimäki, Mika; Hanson, Linda L. Magnusson; Rod, Naja Hulvej
Publisher: Nordic Association of Occupational Safety and Health (NOROSH)
Publication year: 2026
Journal: Scandinavian Journal of Work, Environment and Health
ISSN: 0355-3140
eISSN: 1795-990X
DOI: https://doi.org/10.5271/sjweh.4302
Publication's open availability at the time of reporting: Open Access
Publication channel's open availability : Open Access publication channel
Web address : https://doi.org/10.5271/sjweh.4302
Self-archived copy’s web address: https://research.utu.fi/converis/portal/detail/Publication/526554426
Self-archived copy's licence: CC BY
Self-archived copy's version: Publisher`s PDF
Objectives
The aim of the study was to examine whether exposure to workplace bullying and violence is associated with changes in health-related behaviors over time.
Methods
This multi-cohort study included four cohorts from Sweden, Denmark, Finland, and Norway, comprising 78 624 participants aged 18–65 years at baseline between 2004 and 2016. The data were analyzed using an emulated trial design. The main analysis ascertained both onset of workplace bullying and violence (exposures) and changes in health-related behaviors (outcome) using data from time TX and TX+1 (concurrent analysis). To clarify temporality, changes in health-related behaviors were further calculated at time TX+1 to TX+2 (longitudinal analysis). We applied logistic regression with generalized estimating equations. Subgroup differences by sex were examined.
Results
Among 125 854 participant-observations across 2–3 study phases of the 78 624 participants, 6–8% experienced onset of workplace bullying and 9–14% reported onset of workplace violence over 1–2 years. The strongest association was observed between onset of violence and becoming obese, with an odds ratio (OR) of 1.13 [95% confidence interval (CI) 1.00–1.27] in the concurrent and 1.31 (95% CI 1.05–1.64) in the longitudinal analysis. In addition, onset of bullying (OR 1.23, 95% CI 1.06–1.44) and violence (OR 1.11, 95% CI 0.99–1.24) were concurrently associated with initiation of excessive alcohol use, with weaker associations in the longitudinal analysis. Exposure–response relationships were observed for all aforementioned associations and findings were consistent across cohorts. Men were more likely to initiate excessive alcohol use than women after experiencing violence (P=0.008).
Conclusion
Exposure to workplace bullying and violence was associated with adverse changes in health-related behaviors.
Key terms
stress; workplace violence.
Keywords:
Workplace Violence
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Funding information in the publication:
The study was funded by NordForsk, the Nordic Research Program on Health and Welfare (grant No. 75021), the Project on Psychosocial Work Environment and Healthy Ageing and Danish Working Environment Foundation (grant No. 09-2016-03) and the Swedish Research Council for Health, Working Life and Welfare (grant No. 2019-01318). TX is supported by Swedish Research Council for Health, Working Life and Welfare (grant No. 2020-00040). LLMH is supported by a grant from the Swedish Research Council for Health, Working Life and Welfare (grant No. 2019-01318). MK is supported by the Wellcome Trust (grant No. 221854/Z/20/Z), the UK Medical Research Council (grant No. MR/Y014154/1), and the Research Council of Finland (grant No. 350426). NHR acknowledge funding from TrygFonden to the Copenhagen Health Complexity Center. This work utilised data from SLOSH which is part of the REWHARD consortium supported by the Swedish Research Council (VR #2021-00154).
