Workplace violence predicts depression and anxiety in nurses: a multi-center longitudinal study in China

Workplace violence (WPV) is a growing occupational threat to nurses' mental health, particularly under the strain of high-demand healthcare systems. Yet, longitudinal evidence on its psychological impact remains limited.

This prospective cohort study drew on data from the Chinese Nurses' Mental Health Study (NMHS), including 63,295 nurses across multiple centers. Cox regression models, propensity score matching, and subgroup analyses were conducted to assess the effects of WPV on depression and anxiety symptoms. The Job Demands-Resources (JDR) model served as the theoretical framework, and cross-lagged panel network analysis (CLPN) was used to explore symptom-level pathways and key bridging nodes over time.

WPV was associated with increased risks of depression (HR = 1.38, 95% CI: 1.29-1.48) and anxiety (HR = 1.31, 95% CI: 1.16-1.46), showing a dose-response relationship by frequency and type. CLPN identified bidirectional links between emotional abuse and symptoms such as irritability and fatigue. Depression and anxiety were connected through core symptoms like worthlessness and anticipatory fear. Stronger associations were observed among male nurses, older staff, those with lower seniority, and nurses working in high-pressure departments.

WPV contributes to differential psychological burdens and symptom-specific risks among nurses. These findings underscore the need for targeted, theory-driven interventions to address violence-related distress, reduce psychological exhaustion, and enhance healthcare system resilience.