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Mental Health Expenditures

Association With Workplace Incivility and Bullying Among Hospital Patient Care Workers

Sabbath, Erika L. ScD; Williams, Jessica A.R. PhD; Boden, Leslie I. PhD; Tempesti, Tommaso PhD; Wagner, Gregory R. MD; Hopcia, Karen ScD; Hashimoto, Dean MD, JD; Sorensen, Glorian PhD

Journal of Occupational and Environmental Medicine: August 2018 - Volume 60 - Issue 8 - p 737–742
doi: 10.1097/JOM.0000000000001322

Objective: Bullied workers have poor self-reported mental health; monetary costs of bullying exposure are unknown. We tested associations between bullying and health plan claims for mental health diagnoses.

Methods: We used data from 793 hospital workers who answered questions about bullying in a survey and subscribed to the group health plan. We used two-part models to test associations between types of incivility/bullying and mental health expenditures.

Results: Workers experiencing incivility or bullying had greater odds of any mental health claims. Among claimants, unexposed workers spent $792, those experiencing one type of incivility or bullying spent $1557 (P for difference from unexposed = 0.016), those experiencing two types spent $928 (P = 0.503), and those experiencing three types spent $1446 (P = 0.040).

Conclusion: Workplace incivility and bullying may carry monetary costs to employers, which could be controlled through work environment modification.

Boston College School of Social Work, Chestnut Hill, Massachusetts (Dr Sabbath); University of Kansas School of Medicine, Kansas City, Kansas (Dr Williams); Boston University School of Public Health, Boston, Massachusetts (Dr Boden); University of Massachusetts Lowell, Lowell, Massachusetts (Dr Tempesti); Harvard T.H. Chan School of Public Health, Boston, Massachusetts (Wagner); Partners HealthCare System, Inc. , Boston, Massachusetts (Dr Hopcia); Partners HealthCare System, Inc., Boston College Law School, Boston, Massachusetts (Dr Hashimoto); Dana-Farber Cancer Institute Center for Community-based Research, Boston, Massachusetts (Dr Sorensen); and Harvard T.H. Chan School of Public Health, Boston, Massachusetts (Dr Sorensen).

Address correspondence to: Erika L. Sabbath, ScD, Boston College School of Social Work, McGuinn 202, 140 Commonwealth Ave, Chestnut Hill, MA 02467 (

Funding for this project was provided by the U.S. Centers for Disease Control and Prevention: 7K01 OH010673 (PI: Sabbath) and 5U19 OH008861 (PI: Sorensen). The funders had no role in the design or analysis of data.

The authors have no conflicts of interest to declare.

Copyright © 2018 by the American College of Occupational and Environmental Medicine