COVID-19-Related Workplace Bullying and Customer Harassment Among Healthcare Workers Over the Time of the COVID-19 Outbreak: A Eight-Month Panel Study of Full-Time Employees in Japan : Journal of Occupational and Environmental Medicine

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ORIGINAL ARTICLES

COVID-19-Related Workplace Bullying and Customer Harassment Among Healthcare Workers Over the Time of the COVID-19 Outbreak

A Eight-Month Panel Study of Full-Time Employees in Japan

Iida, Mako MSN; Sasaki, Natsu MD; Imamura, Kotaro PhD; Kuroda, Reiko MD; Tsuno, Kanami PhD; Kawakami, Norito MD

Author Information
Journal of Occupational and Environmental Medicine 64(5):p e300-e305, May 2022. | DOI: 10.1097/JOM.0000000000002511
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Workplace bullying and harassment (WBH) are negative and hostile behaviors in the workplace setting. WBH is quite common, with the global prevalence estimated as 14.6%1 WBH has been associated with mental health problems, such as depression, anxiety, and stress-related psychological complaints,2 and physical health problems, such as sleep problems3 and cardiovascular disease.4,5 WBH can occur not only among members of a workplace but also between a worker and his/her customers or clients,6,7 which has been called “customer harassment.”6

Workplace bullying and harrasment among the healthcare workers (HCWs) may increase in the COVID-19 outbreak.8 For instance, an anecdotal report described several typical targets of WBH during the outbreak9: a HCW who received a COVID-19 Reserve Transcription Polymerase Chain Reaction (RT-PCR) test, even although the result was negative, or a HCW who were in direct contact with the COVID-19 patients. A previous study showed that 18.1% of HCWs reported that HCWs and their family members had been harassed because of COVID-19, while only 7.1% of non- HCWs reported being harrased, across geographic regions including Africa, Asia, Europe, Northern America, Latin America, the Caribbean, and Oceania.10 HCWs have been reported as being exposed to WBH, as well as bullying from customers (ie, patients and their families), more frequently than non-HCWs even before the COVID- 19 pandemic.11 Thus, the COVID-19 pandemic has caused a greater psychological burden on HCWs through COVID-19-related WBH.8

However, previous studies for HCWs did not distinguish between discrimination from the community and WBH in the workplace, nor between WBH from supervisors or colleagues and harassment from customers (ie, patients and their families).10 The distinction of the settings (community or workplace) and types of perpetrators (from someone within the workplaces, such as supervisors/colleagues, or someone from outside of the organization, such as customers or patients) is important because the legal and ethical frameworks for developing countermeasures to prevent WBH are different depending on these characteristics of WBH.12 We previously reported that the prevalence of COVID-19-related WBH among HCWs was 6.3% and 9.9%, respectively, as measured early (March 2020) and in the middle (May 2020) of the first outbreak of COVID-19 in Japan, and that the prevalence for HCWs was greater than for non-HCWs.13 Another previous study reported the prevalence of COVID-19-related customer harassment experienced by HCWs was 10.8%.14 Furthermore, as the situation of COVID-19 infection changes, it is essential to monitor the time trend of the prevalence of COVID-19-related WBH among HCWs. Previous studies, including ours, addressed COVID-19-related WBH among HCWs only in an early phase of the COVID-19 outbreak (before May 2020).10,13 Further research is needed to investigate changing patterns of COVID-19-related WBH and customer harassment experienced by HCWs during later outbreaks.

The purpose of the present study was to investigate changes in prevalence of COVID-19-related WBH and customer harassment among HCWs, compared to non-HCWs, over the course of the second and third COVID-19 outbreaks in Japan (March to November 2020), expanding our previous report in the early phase of the outbreak.13

METHODS

Study Design and Participants

This was a prospective cohort study using the data from an online survey. The data were retrieved from the Employee Cohort Study in the Covid-19 pandemic in Japan (E-COCO-J). A total of 4120 full-time workers living all over Japan were recruited for the survey from more than 500,000 registered members of an Internet survey company in February 2019. Participant inclusion criteria were as follows: (a) reside in Japan, (b) be between the ages of 20 and 59, and (c) be currently employed. There were no exclusion criteria. Members who met the inclusion criteria received an e-mail invitation from the company and completed the questionnaire. The questionnaire was closed once the target sample (around 4000 participants) was obtained. Participants were asked to answer whether or not they were HCWs. A self-report questionnaire survey was conducted on March 2020 (T1), May 2020 (T2), August 2020 (T3), and November 2020 (T4), from early in the first wave to early in the third wave of the COVID-19 outbreak. We analyzed the data from participants currently employed and who responded to all four surveys. The Research Ethics Committee of the Graduate School of Medicine/Faculty of Medicine at the University of Tokyo approved this study [No. 10856- (2)(3)(4)(5)].

Variables

A scale of COVID-19-related WBH was developed according to other bullying scales,15 through a discussion among three occupational physicians (NS, RK, and NK) who engaged in responding to COVID-19 at the workplace, and a researcher of workplace bullying (KT).13 Five items assessed WBH related to COVID-19 (eg, being the target of sarcastic comments related to COVID-19). All items were rated “Yes” or “No.” Any WBH related to COVID-19 was defined as experiencing any of these items. Both the T1, T2, T3, and T4 surveys were used to collect the data on the variables. Reliability and validity have not been confirmed.

A scale of COVID-19-related customer harassment was also developed through a discussion among three occupational physicians and a professional in workplace bullying.14 Four items assessed customer harassment related to COVID-19 (eg, being the target of sarcastic comments related to COVID-19 from users or customers). All items were rated “Yes” or “No,” and any customer harassment related to COVID-19 was defined if participants endorsed any of these items. Only T2, T3, and T4 surveys collected the data on customer harassment variables. Reliability and validity have not been confirmed.

Information about sociodemographic and occupational characteristics included gender, age, marital status, having a child, educational status, and occupation (whether or not they were HCWs). Sex was classified as male or female. Age was categorized as 20 to 29 years, 30 to 39 years, 40 to 49 years, and over 50 years. Marital status was classified into “not married” or“married.” Having achild wasclassifiedas “none” or “one or more.” Educational status was classified into “high school, vocational school, or junior college diploma or less” or “bachelor's degree or higher.” Occupation was categorized into HCWs and non- HCWs. Sex, age, marital status, having a child were retrieved from T1, and education and occupation were collected at T2.

Analysis

First, descriptive statistics were compared between HCWs and non-HCWs by chi-squared test. The prevalence of COVID-19- related WBH at T1 to T4 and customer harassment at T2 to T4 were tabulated separately for HCWs and non-HCWs. McNemar's test was used to compare the difference from the baseline (T1 for WBH; T2 for customer harassment). The odds ratio of COVID-19-related WBH and customer harassment among HCWs compared to non- HCWs at each survey and overall were calculated by multiple logistic regression or a generalized linear model with repeated measures, adjusting for gender, age, marital status, and education. Time (T1 to T4) ∗ occupation (HCWs vs non-HCWs) interaction terms were also calculated. Statistical significance was defined as a two-sided P< 0.05. Statistical analyses were conducted by SPSS 27.0 Japanese version (IBM Corp., Armonk, NY) for Windows.

RESULTS

Figure 1 shows the participant flowchart. A total of 4120 fulltime workers were recruited for the survey, and 1448 completed the baseline questionnaire (response rate = 35.1%). After excluding 27 unemployed respondents, we followed the remaining 1421 respondents. A total of 1032 participants (response rate = 72.6%) completed the T2 survey, excluding 36 unemployed respondents. Among the remaining 996 participants, 938 respondents completed the T3 survey (response rate = 94.2%). After excluding 63 unemployed respondents, we followed the remaining 875 workers. A total of 869 respondents completed the T4 survey (response rate = 99.3%), excluding 69 respondents who did not work at T4. The remaining 800 workers completed all the surveys and were included in the further analyses.

F1
FIGURE 1:
Flowchart of participants.

Table 1 shows the sociodemographic and occupational characteristics of the respondents. Most were non-HCWs (90.0%). As a result of the Chi-squared test, HCWs were more likely to be women (P = 0.007) and had lower education (P = 0.010) than non-HCWs.

TABLE 1 - Sociodemographic and Occupational Characteristics at T1 of Full-time Employees who Completed Surveys at T1 (March 2020), T2 (May 2020), T3 (August 2020), and T4 (November 2020) During the COVID-19 Outbreak in Japan (N = 800)
HCWs (N = 80) n (%) Non-HCWs (N = 720) n (%) P for difference
Sex 0.007
 Male 31 (38.8) 393 (54.6)
 Female 49 (61.3) 327 (45.4)
Age, years old 0.833
 20–29 12 (15.0) 115 (16.0)
 30–39 25 (31.3) 191 (26.5)
 40–49 22 (27.5) 204 (28.3)
 50+ 21 (26.3) 210 (29.2)
Marital status 0.981
 Unmarried 40 (50.0) 361 (50.1)
 Married 40 (50.0) 359 (49.9)
Having at least one child 0.431
 None 43 (53.8) 420 (58.3)
 One or more 37 (46.3) 300 (41.7)
Educationa 0.010
Junior college diploma or less 48 (60.0) 323 (44.9)
Bachelor's degree or higher 32 (40.0) 397 (55.1)
SD, standard deviation.
aThe variable was measured at T2.
P< 0.05 as a result of chi-squared test.

Table 2 shows the prevalence of COVID-19-related WBH in T1 to T4, and customer harassment in T2 to T4 separately for HCWs and non-HCWs. The proportions of respondents who experienced any COVID-19-related WBH among HCWs vs non-HCWs were as follows: 5.0% vs 2.2% at T1,10.0% vs 5.1% at T2,10.0% vs 6.8% at T3, and 7.5% vs 5.6% at T4. The proportions of respondents who experienced any COVID-19-related customer harassment among HCWs vs non-HCWs were as follows: 10.0% vs 6.4% at T2, 12.5% vs 6.9% at T3, and 12.5% vs 5.0% at T4. As a result of McNemar's test, the prevalence of COVID-19-related WBH of T2 to T4 among non-HCWs was significantly higher than the prevalence of baseline (T1) (P = 0.004, P < 0.001, P = 0.001, respectively). The prevalence of COVID-19-related WBH among HCWs and customer harassment among HCWs and non-HCWs was not significantly changed from baseline (T1 for WBH and T2 for customer harassment).

TABLE 2 - Prevalence of COVID-19-related Workplace Bullying at T1-4 and Customer Harassment at T2-4 Among Currently Employed Full-time Workers During the COVID-19 Outbreak in Japan (N= 800)
P value for the difference from the baseline (T1 for workplace bullying; T2 for customer harassment)
T1 March 2020 n (%) T2 May 2020 n (%) T3 August 2020 n (%) T4 November 2020 n (%) T2 T3 T4
COVID-19-related workplace bullying:
 Healthcare workers 4 (5.0) 8 (10.0) 8 (10.0) 6 (7.5) 0.289 0.289 0.727
 Nonhealthcare workers 16 (2.2) 37 (5.1) 49 (6.8) 40 (5.6) 0.004 <0.001∗∗ 0.001
COVID-19-related customer harassment:
 Healthcare workers 8 (10.0) 10 (12.5) 10 (12.5) 0.754 0.754
 Nonhealthcare workers 46 (6.4) 50 (6.9) 36 (5.0) 0.703 0.519
P < 0.01.
∗∗P < 0.001, for the difference between T1, T2, T3, and T4 (McNemar's test).

Table 3 shows the odds ratio of COVID-19 related WBH and customer harassment among HCWs compared to non-HCWs at each survey and overall adjusting for sex, age, marital status, and education. Regarding COVID-19-related WBH, HCWs had a significantly higher risk than non-HCWs at T2 (odds ratio [OR], 2.31; 95% confidence interval [CI], 1.01 to 5.25). Regarding COVID-19- related customer harassment, HCWs had a significantly higher risk than non-HCWs at T4 (OR, 2.70, 95% CI, 1.26 to 5.82), and overall (OR, 2.08, 95% CI, 1.12 to 3.86). In addition, Time × occupation interaction terms were not significant for COVID-19-related WBH and customer harassment (P = 0.77, df = 3; P = 0.34, df = 2, respectively).

TABLE 3 - Odds Ratio of Covid-19 Related Workplace Bullying and Customer Harassment Among Health Care Workers (HCWS) Compared to Non-HCWS at Each Survey (Multiple Logistic Regression) and for Overall (Generalized Linear Model With Repeated Measures) Adjusting for Sex, Age, Marital Status, and Education Among Full-time Workers During the COVID- 19 Outbreak in Japan (N= 800)
T1 (March 2020) T2 (May 2020) T3 (August 2020) T4 (November 2020) Overalla
OR 95%CI P OR 95%CI P OR 95%CI P OR 95%CI P OR 95%CI P
COVID-19-related workplace bullying:
 Non-HCW 1 1 1 1 1
 HCW 2.42 0.77, 7.63 0.13 2.31 1.01,5.25 0.046 1.46 0.65, 3.25 0.36 1.31 0.53,3.23 0.56 1.72 0.88, 3.32 0.12
COVID-19-related customer harassment:
 Non-HCW 1 1 1 1
 HCW 1.67 0.75, 3.72 0.21 1.92 0.91, 4.04 0.09 2.70 1.26, 5.82 0.01 2.08 1.12, 3.86 0.02
aGeneralized linear model with repeated measures of each bullying outcome on time of survey and occupation (HCWs vs non-HCWs). Time × occupation interaction terms were not significant for workplace bullying and customer harassment (P = 0.768, df = 3; P = 0.341, df = 2, respectively).
P< 0.05.

DISCUSSION

The present study aimed to investigate changes in prevalence of COVID-19-related WBH and customer harassment among HCWs, over the course of the second and third COVID-19 outbreaks in Japan. Although significant increases in the prevalence of COVID-19-related WBH from March 2020 were observed only for non-HCWs, the prevalence tended to increase from March to May 2020 and stay high in August and November 2020 both among HCWs and non-HCWs. HCWs had a significantly higher risk of COVID-19-related WBH at T2 than non-HCWs even after adjusting for sex, age, marital status, and education. In addition, HCWs had significantly higher risks of COVID-19-related customer harassment than non-HCWs at T4 and overall. Time × occupation interaction was not significant for COVID-19-related WBH.

HCWs had a significantly higher prevalence of COVID-19- related WBH than non-HCWs at T2 (May 2020), as we already reported earlier.13 The present study additionally found that the prevalence of COVID-19-related WBH was non-significantly but consistently greater among HCWs than non-HCWs at T3 (August 2020) and T4 (November 2020). HCWs were at high risk of COVID- 19 infection,16 which increased worry about COVID-19 among HCWs.17 High levels of worry about COVID-19 may make HCWs more sensitive to the disease, and lead to COVID-19-related WBH, such as demanding colleagues to strictly follow preventive measures or discriminating against a colleague who had a sign of possible infection. In addition, HCWs experienced increased job demands to take care of their patients in unusual circumstances.18 High job demand is known as a factor of WBH in general.19 Increased job demands in the COVID-19 pandemic may also increase COVID-19- related WBH. These situations that HCWs faced may remain during the COVID-19 pandemic, despite the changing levels of the epidemic, and chronically increased COVID-19-related WBH among HCWs; therefore, psychosocial mechanisms of COVID-19-related WBH among HCWs should be investigated in future research.

HCWs had a significantly higher prevalence of COVID-19- related customer harassment than non-HCWs at T4 (November 2020) and overall. While it was non-significant, the prevalence was higher among HCWs than non-HCWs in other follow-up points as well. HCWs have been reported to have a higher prevalence of harassment and violence from patients/clients and their families than non-HCWs before the COVID-19 pandemic.20,21 Even limited to COVID-19 related customer harassment, this tendency may apply to HCWs under the COVID-19 pandemic. HCWs often have to take care of patients and their families face to face.10 They may also have to respond to phone calls or e-mails from patients and their families who are worried about the infection. Such difficult situations may have chronically continued over the COVID-19 pandemic despite the situation of infection. More attention should be given to COVID- 19 customer harassment of HCWs, and countermeasures should be used to mitigate harm to HCWs.

HCWs had a significantly higher risk than non-HCWs at T2 regarding COVID-19-related WBH, while they had a significantly higher risk at T4 and overall regarding COVID-19-related customer harassment. The high risk of COVID-19 infection and increased job demands related to the COVID-19 pandemic may threaten HCWs, especially in the early phase of the outbreak. It might be because there was little personal protective equipment and little information on preventing COVID-19.18 Such a specific situation for healthcare settings at T2 may make a significant difference in COVID-19- related WBH among HCWs. On the other hand, hospitals worldwide have imposed visitor restrictions to reduce the transmission of COVID-19.22 Patients and their family's worry were prolonged, leading to COVID-19-related customer harassment for HCWs at T4 and overall.

Among non-HCWs, the prevalence of COVID-19-related WBH also significantly increased from March to May 2020 and remained significantly higher in August and November 2020 (compared to March 2020). While the prevalence was lower than for HCWs, COVID-19-related WBH also seems to be an issue in the COVID-19 pandemic among non-HCWs. For example, 19.4% of general workers who experienced COVID-19-WBH reported that they had been verbally abused or had excessive pressure to take leave from their workplace because they had infected COVID-19 even after they had been cured.23 Providing accurate and timely information about COVID-19 has been proposed to minimize COVID-19-related WBH.24 The Government of Japan made an effort to do this since an early phase of the epidemic (January 2020)25; new legislation that mandated employers to establish a plan to prevent WBH at the workplace has been in effect since June 2020.26 However, the sustained pattern of COVID-19-related WBH indicates that this effort might not be successful to date. A booster countermeasure to prevent COVID- 19-related WBH is needed. On the other hand, the prevalence of COVID-19-related customer harassment among non-HCWs decreased from T3 to T4 in this study—even though non-HCWs could experience it (eg, drug store staffs have been yelled for missing items, such as masks, that were stockout due to COVID-19).27 The products and services temporarily missing by the rapid spread of infection gradually returned to normal at T4, and customers’ complaints may decrease. Also, this may be due to a decreased opportunity to meet customers face to face in the COVID-19 pandemic to keep social distancing. For instance, half of the companies in Tokyo adopted telework.28

The present study has several limitations. First, since the COVID-19-related WBH and customer harassment measurements used in this study have been developed originally, and the reliability and validity of the measurements were not demonstrated. Second, since we used a self-report questionnaire to measure COVID-19- related WBH and customer harassment, the findings could reflect self-report bias. Third, as several non-HCWs who did not interact with customers may be included in the analysis, the results of our study may be underestimated. Fourth, COVID-19-related WBH and customer harassment may vary by country, culture, and pandemic situation; however, the reported prevalence of this study was similar to the prevalence in other countries.10 Thus, our findings might not be very different from the general prevalence rate. Fifth, since we recruited our sample from an internet survey company and the participants consisted only of full-time workers, the generalizability of the findings to the whole population of workers is limited. Sixth, the low response rate (19.4%) may indicate selection bias, with a risk of underestimating the prevalence of WBH if potential respondents who had experienced WBH were less willing to participate in the study. Seventh, part-time workers and temporary workers may be more likely to be experienced COVID-19-related WBH than full-time workers. A previous study reported that temporary workers were at high risk of experiencing workplace bullying before the pandemic in Japan.29 Also, part-time workers among males and temporary/ contract workers among females had a higher risk of poor mental health than permanent workers in Japan.30 Since only full-time workers are included in our analyses, the results may be underestimated. Eighth, we did not ask whether the participants were infected with COVID-19 or not because the internet survey company did not allow us to due to ethical considerations for the survey participants. Because COVID-19 positive patients tend to be stigmatized,31 future studies should adjust the factor in the analyses. Ninth, the extent to which their occupation was affected by COVID-19 might be a confounder. We have to interpret the results carefully whether HCWs are likely to experience COVID-19-related WBH and customer harassment or any occupation (ie, not only HCWs) that was greatly affected by COVID-19 are likely to experience them.

CONCLUSION

This study found that as the spread of COVID-19 infection continued, HCWs were likely to experience COVID-19-related WBH and customer harassment from March to November 2020. Therefore, it is necessary to provide psychological care for HCWs and disseminate correct knowledge at the national level.

REFERENCES

1. Nielsen MB, Matthiesen SB, Einarsen S. The impact of methodological moderators on prevalence rates of workplace bullying. A meta-analysis. J Occup Organ Psychol 2010; 83:955–979.
2. Verkuil B, Atasayi S, Molendijk ML. Workplace bullying and mental health: A meta-analysis on cross-sectional and longitudinal data. PLoS One 2015; 10:e0135225.
3. Lallukka T, Rahkonen O, Lahelma E. Workplace bullying and subsequent sleep problems = The Helsinki Health Study. Scand J Work Environ Health 2011; 37:204–212.
4. Kivimaki M, Virtanen M, Vartia M, Elovainio M, Vahtera J, Keltikangas- Järvinen L. Workplace bullying and the risk of cardiovascular disease and depression. Occup Environ Med 2003; 60:779–783.
5. Xu T, Magnusson Hanson LL, Lange T, et al. Workplace bullying and workplace violence as risk factors for cardiovascular disease: A multi-cohort study. Eur Heart J 2019; 40:1124–1134.
6. Borchmann T, Pedersen BT. Employee representations of customer harassment and its causes in self-reported tales. Commun Lang Work 2020; 7:86–99.
7. LeBlanc MM, Kelloway EK. Predictors and outcomes of workplace violence and aggression. J Appl Psychol 2002; 87:444.
8. Yahya AS, Khawaja S, Chukwuma J. COVID-19 and a potential rise in bullying behaviors. Prim Care Companion CNS Disord 2020; 22:
9. Grover S, Singh P, Sahoo S, Mehra A. Stigma related to COVID-19 infection: Are the Health Care Workers stigmatizing their own colleagues? Asian J Psychiatr 2020; 53:102381.
10. Dye TD, Alcantara L, Siddiqi S, et al. Risk of COVID-19-related bullying, harassment and stigma among healthcare workers: An analytical crosssectional global study. BMJ Open 2020; 10:e046620.
11. Nyberg A, Kecklund G, Hanson LM, Rajaleid K. Workplace violence and health in human service industries: A systematic review of prospective and longitudinal studies. Occup Environ Med 2021; 78:69–81.
12. Related revised guidelines on harassment in the workplace. (In Japanese) [Ministry ofHealth, Labour andWelfare] 2020. Available at: https://www.mhlw.go.jp/content/11900000/000584512.pdf. Accessed October 4, 2021.
13. Iida M, Sasaki N, Kuroda R, Tsuno K, Kawakami N. Increased COVID-19- related workplace bullying during its outbreak: A 2-month prospective cohort study of full-time employees in Japan. Environ Occup Health Pract 2021; 3: doi: 10.1539/eohp.2021-0006-OA.
14. Asaoka H, Sasaki N, Kuroda R, Tsuno K, Kawakami N. Workplace bullying and patient aggression related to COVID-19 and its association with psychological distress among health care professionals during the COVID-19 pandemic in Japan. Tohoku J Exp Med 2021; 255:283–289.
15. Sasaki N, Kuroda R, Tsuno K, Kawakami N. Fear, worry and workplace harassment related to the COVID-19 epidemic among employees in Japan: Prevalence and impact on mental and physical health. 2020. Available at: https://dx.doi.org/10.2139/ssrn.3569887.
16. Nguyen LH, Drew DA, Graham MS, et al. Risk of COVID-19 among frontline health-care workers and the general community: A prospective cohort study. Lancet Public Health 2020; 5:e475–e483.
17. Puci MV, Nosari G, Loi F, Puci GV, Montomoli C, Ferraro OE. Risk perception and worries among health care workers in the covid-19 pandemic: Findings from an Italian survey. Healthcare 2020; 8:535Multidisciplinary Digital Publishing Institute.
18. Britt TW, Shuffler ML, Pegram RL, et al. Job demands and resources among healthcare professionals during virus pandemics: A review and examination of fluctuations in mental health strain during COVID-19. Appl Psychol 2021; 70:120–149.
19. Baillien E, De Cuyper N, De Witte H. Job autonomy and workload as antecedents of workplace bullying: A two-wave test of Karasek's Job Demand Control Model for targets and perpetrators. J Occup Organ Psychol 2011; 84:191–208.
20. Ghareeb NS, El-Shafei DA, Eladl AM. Workplace violence among healthcare workers during COVID-19 pandemic in a Jordanian governmental hospital: The tip of the iceberg. Environ Sci Pollut Res 2021; 28:61441–61449.
21. Khan MN, Haq ZU, Khan M, et al. Prevalence and determinants of violence against health care in the metropolitan city of Peshawar: A cross sectional study. BMC Public Health 2021; 21:1–11.
22. Infection Control Guidance. Centers for Disease Control and Prevention, 2021. Available at: https://www.cdc.gov/coronavirus/2019-ncov/hcp/infection-control-recommendations.html. Accessed January 10, 2022.
23. Survey on harassment in the workplace 2021. (In Japanese) Japanese Trade Union Confederation, 2021. Avairable at: https://www.jtuc-rengo.or.jp/info/chousa/data/20210625.pdf?4147. Accessed January 10, 2022.
24. Hamouche S. COVID-19 and employees’ mental health: Stressors, moderators and agenda for organizational actions. Emerald Open Res 2020; 2:15.
25. Update information for the COVID-19 [Ministry of Health, Labour and Welfare] 2020. Available at: https://www.mhlw.go.jp/stf/seisakunitsuite/bunya/topics_shingata_09444.html. Accessed September 14, 2021.
26. To prevent harassment in the workplace [Ministry of Health, Labour and Welfare] 2020. Available at: https://www.mhlw.go.jp/stf/seisakunitsuite/bunya/koyou_roudou/koyoukintou/seisaku06/index.html. Accessed September 14, 2021.
27. Joint meeting of relevant ministries and agencies for the promotion of measures to prevent significant dusruptive behavior from customers (in Japanese) [Ministry of Health, Labour and Welfare] 2021. Available at: https://www.mhlw.go.jp/content/11921000/000732126.pdf. Accessed January 10, 2022.
28. Tokyo Metropolitan Government. Results of a survey on telework adoption rates (in Japanese) [Tokyo Metropolitan Government web site]. January 22, 2021. Available at: https://www.metro.tokyo.lg.jp/tosei/hodohappyo/press/2021/01/22/17.html. Accessed February 23, 2021.
29. Tsuno K, Kawakami N, Tsutsumi A, et al. Socioeconomic determinants of bullying in the workplace: A national representative sample in Japan. PLoS One 2015; 10:e0119435.
30. Inoue A, Kawakami N, Tsuchiya M, Sakurai K, Hashimoto H. Association of occupation, employment contract, and company size with mental health in a national representative sample of employees in Japan. J Occup Health 2010; 52:227–240.
31. Goda K, Kenzaka T, Yahata S, Kumabe A, Katsurada M, Nishisaki H. Changes in patients’ outlook, behaviors, and attitudes toward COVID-19 after hospitalization and their experiences of discrimination and harassment. BMC Res Notes 2021; 14:1–6.
Keywords:

COVID-19; healthcare workers; infection; workplace bullying; workplace harassment

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