Revealing the Confluences: Workplace Bullying and Suicidality Independent of Depression Presence

doi:10.21203/rs.3.rs-4675051/v1

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Revealing the Confluences: Workplace Bullying and Suicidality Independent of Depression Presence

https://doi.org/10.21203/rs.3.rs-4675051/v1

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This cross-sectional study analyzed data from 12,541 employees aged 19–65 across 26 companies and public institutions who underwent workplace mental health screening. Workplace bullying, categorized into non-exposure, high-risk, and targeted groups, was self-reported. Depression was assessed using the Center for Epidemiological Studies Depression scale, and suicidality was measured via a self-reported questionnaire from the Korea National Health and Nutrition Examination Survey. Multivariable logistic regression revealed that 18.7% of women and 10.6% of men experienced bullying. High-risk and targeted bullying were significantly associated with increased odds of suicidal ideation (OR = 1.47, 95% CI = 1.27–1.69; OR = 1.81, 95% CI = 1.36–2.40) and suicide attempts (OR = 2.27, 95% CI = 1.34–3.85; OR = 4.43, 95% CI = 2.13–9.21). The association between bullying and suicidal ideation was significant for participants with and without depression (OR = 1.47, 95% CI = 1.28–1.69; OR = 1.86, 95% CI = 1.31–2.62). Men exhibited a stronger correlation (p for interaction < 0.001). Increased exposure to workplace bullying linked to higher suicidality risk, irrespective of depression status. The study highlights the need for companies to screen for bullying and provide mental health resources to prevent workplace-related suicides.

Biological sciences/Psychology

Health sciences/Health care

Health sciences/Health occupations

Health sciences/Risk factors

Workplace bullying

Suicidal Ideation

Suicide

Attempted

Depression

Mental Health

Occupational Stress

The 2022 World Health Organization guidelines emphasize workplace bullying as a significant issue of workplace harassment, affecting mental health, and potentially leading to severe outcomes such as suicide¹. Workplace bullying or mobbing involves sustained (at least 6 months) and repetitive (at least once a week) negative behaviors, mistreatment, or abuse directed at individuals or groups within an organization. A systemic analysis covering 220,000 employees globally estimated workplace bullying prevalence as ranging from 10–20% in European nations, 7–13% in the Americas, 7.0% in Australia, and 0.3–10.4% in Asia². In South Korea, a survey by workplace abuse 119, a non-governmental organization (NGO), found that 34.1% of employees reported experiencing workplace bullying in the previous year. This widespread occurrence demands serious attention for both employee health and organizational productivity worldwide.

In recent decades, with a growing global interest in workplace bullying, multiple studies have established its association with poor mental and physiological health including depression, anxiety, and insomnia as significant risk factors^3–8. Between workplace bullying and suicidality, studies in Scandinavia^9–11, Europe¹², the America¹³ and Australia¹⁴ have noted significant positive correlations. However, research in competitive East Asian work cultures remains limited¹⁵. Moreover, a substantial proportion of suicides occur in the general population without depression^16,17. Despite this fact, there is a scarcity of research evaluating the direct suicidality linked to workplace bullying.

South Korea is remarkable for its rapid economic development, having transitioned from an underdeveloped nation to a developed, high-income country within a few generations. This economic growth has been described as the Miracle on the Han River¹⁸. Amidst this rapid growth, corporations have thrived, serving as knights in shining armor in nurturing emerging industries and markets, expediting exports, and coming to the rescue in the economic landscape¹⁹. The placement of South Korea's working hours as being among the highest in OECD countries is not a matter of surprise²⁰. Despite this economic growth, suicide remains a severe societal issue in South Korea; here, suicide rates are the highest among the 42 OECD countries, with 24.1 suicides per 100,000 people in 2020²¹. Notably, suicide stands as the top cause of death among Koreans aged 10–30 and the second highest among those aged 40–60, making it the primary cause of death in the economically active population²². Given the unique characteristics of Korea's corporate-centered growth aligned with prevalent long working hours, the soaring suicide rates among the working population represent a noteworthy public health concern. A nurse's suicide at a university hospital due to 'taeum', a type of nursing bullying, sparked societal debates on workplace bullying and employee suicides²³. Subsequently, in 2021, ‘the Anti-bullying Legislation’, an amendment to the Labor Standards Act, was enacted²³. Despite the implementation of legislative measures, a comprehensive analysis of work-related disease certificates related to suicide, conducted by the Korea Workers' Compensation and Welfare Service in 2022, revealed that among the approved cases of 39 suicides, 'workplace bullying and harassment' was identified as the leading cause, accounting for 33%²⁴. Furthermore, in terms of the specific criteria of workplace bullying within the law, there is an argument that emphasize the need for a distinction between one-time and sustained, repetitive bullying⁵.

Previous global studies have confirmed that workplace bullying not only affects individuals’ mental health but also increases long-term sickness absences, job turnover, early retirement, and unemployment leading to substantial economic loss for both organizations and society ^11,25,26. Moreover, in the worst-case scenarios, workplace bullying precipitates a decline in the productive population through suicide.

Despite its negative impact on South Korea as a whole, research on the relationship between workplace bullying and suicide remains limited. Studies on bullying in South Korea have so far been confined to specific groups such as in schools or among nurses and physicians-in-training^27–29. Additionally, studies encompassing suicide attempts, not just ideations, are challenging to find. Furthermore, while depression is a well-known significant risk factor for suicide³⁰, whether the correlation between workplace bullying and suicide originates from depression remains unclear. Thus, this study, aims to 1) confirm the link between workplace bullying and suicide ideation and attempts, 2) determine how suicidality risk varies based on the frequency of bullying, and 3) explore correlation differences based on depression presence.

Characteristics of the participants

The characteristics of the participants are shown in Table 1. Among 12,541 participants, comprising 7,889 males (62.9%) and 4,652 females (37.1%), the CES-D and the burnout scores in both exhaustion and cynicism dimensions were higher among females. The prevalence of workplace bullying was 18.7% among females and 10.6% among males, signifying significantly more reported exposure to workplace bullying among females (p < 0.0001). The reported rates of suicidal ideation and attempts (all p < 0.001) were also significantly higher among females.

Table 1

Baseline characteristics of study subjects
Characteristics	Overall	Male	Female	P value
Number	12,541	7,889 (62.9)	4,652 (37.1)
Age (years)	36.70 ± 9.10	37.18 ± 9.15	35.88 ± 8.96	< 0.001
Age distribution				< 0.001
19–29	3,338 (26.6)	1,920 (24.3)	1,418 (30.5)
30–49	7,845 (62.6)	5,055 (64.1)	2,790 (60.0)
50–65	1,358 (10.8)	914 (7.3)	444 (9.5)
Education (graduate)				< 0.001
High school or below	1,305 (10.4)	1,032 (13.1)	273 (5.9)
College graduate	1,606 (12.8)	1,046 (13.3)	560 (12.0)
University graduate	7,743 (61.7)	4,608 (58.4)	3,135 (67.4)
Master’s degree	1,590 (12.7)	1,003 (12.7)	587 (12.6)
Doctorate degrees	297 (2.4)	200 (2.5)	97 (2.1)
Marital status				< 0.001
Married	5,437 (43.4)	3,127 (39.6)	2,310 (49.7)
Unmarried	6,858 (54.7)	4,645 (58.9)	2,213 (47.6)
Other	246 (2.0)	130 (1.5)	143 (2.8)
Type of Job				< 0.001
Government and public	8,460 (67.5)	6,160 (78.1)	2,300 (49.4)
Private	4,081 (32.5)	1,729 (21.9)	2,352 (50.6)
Years of service (years)	9.87 ± 8.77	10.29 ± 8.93	9.15 ± 8.44	< 0.001
Hours of work per week (hours)	46.97 ± 7.57	47.28 ± 7.44	46.43 ± 7.74	< 0.001
Monthly earned income (million won)				< 0.001
< 300	3,910 (31.2)	1,767 (22.4)	2,143 (46.1)
300–400	3,336 (26.6)	2,241 (28.4)	1,095 (23.5)
400–600	3,311 (26.4)	2,378 (30.1)	933 (20.1)
> 600	1,984 (15.8)	1,503 (19.1)	481 (3.8)
CES-D score	15.01 ± 10.12	13.42 ± 9.49	17.60 ± 10.61	< 0.001
Depression				< 0.001
No	7,574 (58.6)	5,092 (64.5)	2,262 (48.6)
Yes	5,187 (41.4)	2,797 (35.5)	2,390 (51.4)
Burnout (exhaustion)	2,324 (18.2)	977 (12.4)	1,347 (29.0)	< 0.001
Burnout (cynicism)	1,271 (10.1)	454 (5.8)	817 (17.6)	< 0.001
Workplace bullying				< 0.001
Non-exposed	10,837 (86.4)	7,055 (89.4)	3,782 (81.3)
High Risk	1,454 (11.6)	739 (9.4)	715 (15.4)
Targeted	250 (2.0)	95 (1.2)	155 (3.3)
Suicidal ideation				< 0.001
No	10,673 (85.1)	6,966 (88.3)	3,707 (79.7)
Yes	1,868 (14.9)	923 (11.7)	945 (20.3)
Suicide attempt				< 0.001
No	12,465 (99.4)	7,863 (99.7)	4,602 (98.9)
Yes	76 (0.6)	26 (0.3)	50 (1.0)
Data are presented as mean ± standard deviation, number (percentage) or median (interquartile range). Percentages are calculated based on column totals. P values are for between group difference by T-test in continuous variables or by Chi-square test in categorical variables. CES-D, Center for Epidemiological Studies Depression.

Increased Suicidal Ideation Linked to Workplace Bullying

The results presented in Table 2 show that participants experiencing workplace bullying were at higher odds of suicidal ideation compared to the non-bullied group. In the univariate model, the high-risk group had an odds ratio (OR) of 2.73 (95% confidence interval [CI] = 2.40–3.10, p < 0.001), and the targeted group had an OR of 4.65 ([CI] = 3.59–6.03, p < 0.001), indicating a significant increase in risk with increasing exposure to workplace bullying. In the multivariate model, the high-risk group had an OR of 1.47 ([CI] = 1.27–1.69, p < 0.001), and the targeted group had an OR of 1.81 ([CI] = 1.36–2.40, p < 0.001), indicating a consistent increase in risk for both groups. The odds decreased progressively with the addition of covariates, but the suicide risk for high-risk and targeted groups remained consistently higher than for the non-exposed group.

Table 2

Stepwise logistic regression analyses of associations between workplace bullying and suicidal ideation
Workplace bullying	Odds ratio (95% confidence interval)
Workplace bullying	Model 1	Model 2	Model 3	Model 4
Non-exposed	Ref	Ref	Ref	Ref
High Risk	2.73(2.40–3.10)	2.54(2.23–2.89)	2.48(2.18–2.83)	1.47(1.27–1.69)
Targeted	4.65(3.59–6.03)	3.89(2.99–5.07)	3.77(2.89–4.93)	1.81(1.36–2.40)
The analyses for total burnout and dimensions of burnout were performed separately. In analyses for dimensions of burnout, exhaustion and cynicism were entered in the models simultaneously. All odds ratios with p values less than 0.05 are presented in bold.
Model 1: Univariate models.
Model 2: Adjusted for Socio-demographic factors (age, gender, marital status, education)
Model 3: Model 2 + Job-related demographic factors (type of job, working hours, job duration, and monthly income)
Model 4: Model 3 + Clinical characteristics factors (depression, exhaustion, and cynicism)

Factors in Suicidal Ideation among the participants with and without depression

Table 3 presents the results of a multiple logistic regression analysis examining factors related to suicidal ideation among the total participants and groups with and without depression. Among all participants, being female, aged 30–49 years, having a high school education or lower, being unmarried, working in a private company, and the presence of burnout were all factors found to have higher odds of suicide ideation. The presence of depression increased the odds of suicidal ideation by 6.13 times ([OR] = 6.13 [5.36–7.02]). In the depression group, there were significant increases in the odds of suicidal ideation among both the high-risk group ([OR] = 1.41 [1.21–1.64]) and the targeted group ([OR] = 1.84 [1.37–2.47]), compared to the non-exposed group. However, among those without depression, the odds of suicidal ideation were significantly higher only in the high-risk group for workplace bullying ([OR] = 1.88 [1.31–2.69]).

Table 3

Logistic regression analyses of workplace bullying and suicidal ideation for depression and non-depression groups
	Total Participants				Depression				Non-depression
	B	OR	LCI	UCI	B	OR	LCI	UCI	B	OR	LCI	UCI
Female (Ref: Male)	0.145*	1.17	1.04	1.31	0.058	1.06	0.93	1.21	0.411*	1.60	1.27	2.01
Age (year, Ref: 19–29)
30–49	0.222*	1.25	1.07	1.46	0.187*	1.19	1.00	1.42	0.295	1.25	0.95	1.64
50–65	0.026	1.03	0.78	1.35	-0.229	0.79	0.57	1.09	0.630*	1.65	1.14	2.39
Education (Ref: High school or below)
College graduate	-0.443**	0.64	0.50	0.82	-0.489**	0.62	0.47	0.82	-0.404	0.67	0.39	1.13
University graduate	-0.167	0.85	0.69	1.03	-0.250*	0.79	0.62	0.99	0.26	1.03	0.69	1.53
Master’s degree	-0.190	0.83	0.64	1.07	-0.206	0.82	0.61	1.11	-0.208	0.81	0.49	1.35
Doctorate degree	-0.062	0.94	0.61	1.45	-0.138	0.88	0.52	1.50	0.089	1.09	0.52	2.32
Marital status (Ref: Unmarried)
Married	-0.190*	0.83	0.72	0.95	-0.229*	0.80	0.68	0.93	-0.41	0.96	0.71	1.29
Other	0.210	1.23	0.84	1.81	0.300	1.35	0.89	2.05	1.555	4.74	0.96	23.42
Type of Job (Ref: Government)
Private	0.371**	1.45	1.26	1.66	0.409**	1.52	1.30	1.78	0.206	1.23	0.92	1.65
Depression	1.814**	6.13	5.36	7.02
Burnout (exhaustion)	0.637**	1.89	1.65	2.17	0.581**	1.78	1.54	2.06	1.096**	3.05	2.17	4.27
Burnout (cynicism)	0.207*	1.23	1.05	1.44	0.256*	1.29	1.10	1.53	-0.075	0.93	0.50	1.71
Workplace bullying (Ref: Non-exposed)
High Risk	0.382**	1.47	1.27	1.69	0.339**	1.41	1.21	1.64	0.625**	1.88	1.31	2.69
Targeted	0.592**	1.81	1.36	2.40	0.600**	1.84	1.37	2.47	0.485	1.68	0.59	4.82
Models were adjusted for age, sex, education, marital status, type of job, years of service, working hours, income, depression, exhaustion, and cynicism.
B, estimate of the regression coefficient; OR, odds ratio; LCI, lower bound of 95% confidence interval; UCI, upper bound of 95% confidence interval; Ref, Reference.
* p < 0.05, ** p < 0.001. All odds ratios with p values less than 0.05 are presented in bold.

Subgroup Analysis of Workplace bullying exposure and Suicidal Ideation

Figure 1 explored the association between history of workplace bullying exposure and the prevalence of suicidal ideation in subgroups categorized by gender, age, income, and depression status. Both male and female employees who experienced bullying showed higher odds of having suicidal ideation compared to those who did not ([OR] for male employees, 1.78 [1.48–2.15]; for female employees, 1.29 [1.08–1.55]). Notably, male employees who experienced bullying had a significantly stronger association with suicidal ideation compared to female employees (p for interaction < 0.001). Additionally, workplace bullying showed a higher association with suicidal ideation among employees aged 19–29 years, 30–49 years, and those with a monthly income below 3 million won, between 3 and 4 million won, and between 4 and 6 million won. Although the association tended to decrease with increasing age, this did not reach statistical significance (p for interaction = 0.069). Finally, there was a tendency toward a stronger association with suicidal ideation among employees without depression ([OR] = 1.86 [1.31–2.62]) compared to those with depression ([OR] = 1.47 [1.28–1.69]), although not statistically significant (p for interaction = 0.082).

Factors in Suicide Attempts among the participants with and without depression

Table 4 displays the results of a multiple logistic regression analysis examining factors related to suicide attempts among all participants and groups with and without depression. Among all participants, being female, having a high school education or lower, working in a private company, and having shorter working hours were associated with higher odds of suicidal attempts. The presence of depression increased the odds of a suicide attempt by 5.07 times ([OR] = 5.07 [2.55–10.08]). The high-risk and the targeted groups had a 2.27-fold increase ([OR] = 2.27 [1.34–3.85] and a 4.43-fold increase ([OR] = 4.43 [2.13–9.21]) in the odds of suicide attempt compared with the non-exposure group. In the depression group, significant increases in suicide attempt odds were observed among the high-risk ([OR] = 2.15 [1.24–3.73]) and targeted groups ([OR] = 4.09 [1.92–8.71]). However, among those without depression, a significant increase in suicide attempt odds was observed only for the targeted group ([OR] = 13.30 [1.50–118.04]).

Table 4

Logistic regression analyses of associations between workplace bullying and suicidal behavior for depression and non-depression groups
	No. of Participants with suicidal behavior	Total Participants				Depression				Non-depression
	No. of Participants with suicidal behavior	B	OR	LCI	UCI	B	OR	LCI	UCI	B	OR	LCI	UCI
Female (Ref: Male)	50 (65.8)	0.639*	1.89	1.13	3.17	0.849*	2.34	1.32	4.12	-0.529	0.59	0.12	2.91
Education (Ref: High school or lower)
College graduate	11 (56.6)	-0.541	0.58	0.25	1.33	-0.332	0.72	0.27	1.88	-0.295	0.75	0.11	4.97
University graduate	13 (17.1)	-0.993*	0.41	0.21	0.81	-0.666	0.51	0.23	1.17	-0.744	0.48	0.09	2.49
Master’s degree	44 (57.9)	-0.976*	0.38	0.15	0.96	-0.460	0.63	0.21	1.86	-15.502	0.00	0.00	0.00
Doctorate degree	8 (10.5)	-16.542	0.00	0.00	0.00	-17.035	0.00	0.00	0.00	-15.541	0.00	0.00	0.00
Type of Job (Ref: Government)
Private	41 (53.9)	0.489*	1.63	1.01	2.64	0.603*	1.83	1.09	3.07	-1.109	1.23	0.92	1.65
Hours of work per week (hours)		-0.030*	0.97	0.95	1.00	-0.31*	0.97	0.94	1.00	-0.23	1.00	0.92	1.08
Depression	65 (85.5)	1.623**	5.07	2.55	10.08
Burnout (exhaustion)	36 (47.4)	0.424	1.58	0.96	2.60	0.374	1.45	0.81	2.62	0.642	1.90	0.21	16.97
Burnout (cynicism)	22 (28.9)	0.102	1.11	0.60	2.05	0.005	1.01	0.53	1.90	1.983*	7.26	1.46	36.10
Workplace bullying (Ref: Non-exposed)
High Risk	23 (30.3)	.822*	2.27	1.34	3.85	0.767*	2.15	1.24	3.73	1.243	3.47	0.72	16.68
Targeted	10 (13.2)	1.489**	4.43	2.13	9.21	1.409**	4.09	1.92	8.71	2.588*	13.30	1.50	118.04
Models were adjusted for age, sex, education, marital status, type of job, years of service, working hours, income, depression, exhaustion, and cynicism.
B, estimate of the regression coefficient; OR, odds ratio; LCI, lower bound of 95% confidence interval; UCI, upper bound of 95% confidence interval; Ref, Reference.
* p < 0.05, ** p < 0.001. All odds ratios with p values less than 0.05 are presented in bold.

This study brings to light a stark escalation in the risk of suicide among individuals subjected to workplace bullying. It substantiates a clear nexus between workplace bullying and suicidality, irrespective of depression status. The correlation between exposure to workplace bullying and suicide ideation was more pronounced among males, age 19–29, without depression. To the best of our knowledge, in South Korea, this pioneering study stands as the first to confirm this link and investigate the nuanced influence of depression.

Aligning with a comprehensive meta-analysis reporting a global prevalence of workplace bullying at 14.6%, this study unveiled alarming rates among females at 18.7% (High risk: 15.4%, Targeted: 3.3%) and males at 10.6% (High risk: 9.4%, Targeted: 1.2%). Reports of bullying exposure were notably more frequent among female employees. Female respondents indicated higher mean depression and burnout scores and suicidality than their male counterparts. These findings echo previous research highlighting a heightened tendency for females to report workplace bullying, regardless of their occupational field³⁶. They also correspond with previous studies reporting higher rates of mood disorders³⁷, suicidality among women³⁸. This appears to be attributed to gender differences associated with hormonal influences, stress from traditional female roles such as childbirth and childcare, coping mechanisms, and the extent of reporting to external sources^37,38.

This study found that, compared to individuals not exposed to workplace bullying, those in the high-risk group and the target group had respective suicide ideation odds of 1.47 and 1.81, and respective suicide attempt odds of 2.274 and 4.433. Even after adjusting for possible confounding variables, the odds showed a slight increase with the frequency of exposure. Prior research over the past two decades has hinted at a positive link between workplace bullying and suicide^{8–10,12,14,39}. However, most existing studies have been cross-sectional, complicating the establishment of causal relationships. Yet, a longitudinal cohort study in Norway encompassing 1,846 employees observed over the period from 2005 to 2010 found that exposure to workplace bullying nearly doubled the chances of contemplating suicide within two to five years (Adjusted Odds Ratio [AOR] = 2.05; CI = 1.08, 3.89; p < 0.05) (Nielsen et al., 2015). Moreover, population-based studies utilizing national patient registers in countries like Australia, Denmark, Sweden, and Japan consistently indicated that exposure to workplace bullying heightened the risk of suicidal ideation ^8–10,14,39. In contrast, within Korea, studies exploring the connection between bullying and suicide predominantly focused on vulnerable groups like adolescents, the elderly, or specific occupations such as nursing, or physicians-in-training^27–29. This study, harnessing health examination data from a healthy cohort of Korean employees, not only represented the office workforce but also examined exposure frequency, a realm previously underexplored.

The conceptualization of the association between workplace bullying and suicide can be drawn from various cases and theories. In an Italian prospective study, 48 targets of workplace bullying exhibited increased scores on the MMPI-2 scale's Hs, D, Hy, and Pa items 22 months later, along with high rates of suicidality⁷. Numerous studies have demonstrated that individuals exposed to workplace bullying have increased rates of mental health disorders such as depression, anxiety, leading to suicide^3,4,40–42. According to the Stress as Offense to Self (SOS) perspective, a theory within workplace bullying, self-worth comprises self-esteem and social esteem. Constructive social relations at work imply one's worth, capability, and value, whereas bullying undermines self-worth⁴³. Secondly, the Interpersonal Theory suggests that bullying, by deconstructing self-worth, leads to thwarted belongingness and perceived burdensomeness, ultimately escalating suicidal desires⁴⁴. Repeated exposure to workplace bullying continually exposes individuals to fear or distress through opponent processes and habituation, leading to create a ‘capability to die’. Intriguingly, individuals frequently exposed to workplace bullying have been found to exhibit higher salivary DHEA levels⁴⁵, lower cortisol levels¹⁰, and down-regulation of β2 adrenergic receptors (ADRB2)^46–48. These physiological changes observed in individuals experiencing workplace bullying suggest the presence of underlying mechanisms that may mediate the association between workplace bullying and suicidality.

An important outcome of this study is the robust association between workplace bullying and suicidal ideation regardless of depression status. The odds of suicidal thoughts due to workplace bullying were 1.47 for the depressed group and 1.86 for the non-depressed group, indicating a higher likelihood in the non-depressed group. While depression independently increased the odds of suicidality by about 5–6 times³⁰, as depression intensifies, the association between workplace bullying and suicide may weaken. Unlike previous research suggesting that workplace bullying might lead to suicidal thoughts and attempts via significant mood disorders^7,29, this study indicates that workplace bullying itself might directly progress to suicide attempts. According to the Integrated Motivational-Volitional (IMV) model, after exposure to bullying, suicide attempts occur, which progress through three stages: phase 1- the premotivational phase of exposure to background factors and triggering events; phase 2- the motivational phase of repeated bullying leading to suicidal intent formation; and phase 3- the volitional phase of increased suicidal thoughts transitioning to attempts⁴⁹. These mechanisms showcase how workplace bullying can instigate defeat and entrapment, leading to suicide attempts. This study is the first to propose the possibility of workplace bullying leading to suicide without presence of depression among working populations. It underscores a novel necessity to assess exposure to workplace bullying independently of the presence of depression for effective strategies in preventing workplace suicide.

This study confirmed an increase in suicidal ideation among both men and women exposed to workplace bullying, yet it identified men as more vulnerable than women in sub-analysis. Moreover, there was a trend indicating higher susceptibility among younger individuals (below 50 years) and those in the income bracket of less than 6 million KRW. Studies examining the gender association between workplace bullying and mental health have been inconsistent, but studies conducted in Italy and Korea have highlighted a higher correlation between deteriorated mental health due and workplace bullying in male employees. It might be because men's mental health appears to be focused within the workplace and the societal pressure for men (masculinity) to endure bullying may contribute to a higher reporting threshold^5,50. Additionally, lower-level middle managers may be at higher risk of deteriorating mental health due to workplace bullying as presumed from age and income perspectives. This might correlate with studies that suggest high vulnerability among less skilled apprentices exposed to workplace bullying, as they are unable to advocate for themselves within hierarchical structures⁵¹.

This study identified suicide-related risk factors, indicating that suicidal ideation risk was associated with female gender, age 30–49, high school-level education, being unmarried, working in the private sector, having depression and/or burnout, and being exposed to bullying. Similarly, suicidal attempt risk was associated with female gender, high school-level education, working in the private sector, having shorter working hours, being depressed, and being exposed to bullying. These findings align with those of a study across 17 countries in the Americas, Asia, Europe, Africa, and the Middle East, which showed a higher correlation between suicidal behavior and risk factors such as being female, unmarried, a high school graduate level education, experiencing depression, and experiencing burnout ³⁰. Moreover, this study found significantly higher suicidality in the private sector compared to in the public sector. Research in India indicated higher depression levels in the private sector⁵², and an analysis of US government reports found 222 out of 270 occupational suicides were in the private sector⁵³. In South Korea, the corporate culture in the private sector emphasizes profit maximization, cost-cutting and fostering competition⁵⁴, potentially heightening workplace tension and impacting employees' mental health due to job insecurity.

This study has several limitations. Firstly, due to its cross-sectional survey design, causal relationships between workplace bullying and suicidality cannot be verified. Further longitudinal studies are necessary to establish whether workplace bullying imposes suicide risks. Secondly, this study included data only from workers undergoing mental health check-ups in companies or institutions, predominantly analyzing employees from specific industry companies, potentially incurring selection biases. Subsequent studies with representative worker samples are required to validate generalizability. Thirdly, key variables such as workplace bullying, depression, and suicide were evaluated through self-reported surveys, which may expose response biases. Fourthly, the burnout questionnaire used in this study consists of a single item, making it challenging to assess various types such as harassment, gender discrimination, public humiliation, salary reduction, and personal tasking.

This study marks the first confirmation of the association between workplace bullying and suicide ideation or attempts among workers without depression. It underscores the importance of identifying bullying experiences, irrespective of depression, to assess suicide risks among employees and suggests a need for a more detailed evaluation among male employees. The implementation of organizational policies and occupational healthcare initiatives addressing workplace bullying is postulated to be instrumental in mitigating work-related suicides.

Study design, setting, and participants

We conducted a cross-sectional study including a diverse group of 13,620 employees, aged 19 to 65 years, who participated in workplace mental health screenings at the Workplace Mental Health Institute of Kangbuk Samsung Hospital, Seoul, Republic of Korea, between April 20, 2020 and November 23, 2022. Among the 13,620 respondents, we excluded a total of 1,079 participants due to incomplete information on sociodemographic data or workplace bullying. A total of 12,541 participants, comprising 7,889 men and 4,652 women, voluntarily agreed to participate in mental health examinations at the request of their respective companies. The participants were employees working in a total of 26 public institutions or large corporations, which encompass sectors such as finance, insurance, real estate, public administration, services, wholesale trade, and construction. All procedures were approved by the Institutional Review Board of Kangbuk Samsung Hospital (Approval number: KBSMC 2022-03-046) and adhered to the Declaration of Helsinki and Good Clinical Practice. Informed consent was waived as the study used de-identified routine health screening data.

Assessments

The dependent variable of interest was suicide ideation and attempts, and the independent variable was the presence of workplace bullying and its frequency.

Socio-demographic factors

Socio-demographic factors included age, gender, education level (high school graduate or below, university graduate, master’s degree, and doctorate degree), and marital status (married, unmarried, or other [divorced, widowed, or separated]).

Job-related demographic factors

Job-related demographic factors encompassed the type of job (government/public sector or private sector), the duration of employment at the current workplace (in years), weekly work hours, and monthly income quartiles (below 3 million KRW, 3 million KRW to under 4 million KRW, 4 million KRW to under 6 million KRW, and above 6 million KRW).

Clinical characteristic factors

Depressive symptoms in the past 7 days were assessed using the Korean version of the 20-item Center for Epidemiological Studies Depression (CES-D) scale^31,32, a self-reported questionnaire with a 4-point Likert scale. Higher scores indicate more severe depressive symptoms. The study's CES-D Cronbach’s alpha was 0.765. Traditionally, a CES-D score of 16 or higher has been used as a depression screening threshold (Roberts et al., 1990). Hence, individuals with a CES-D score of 16 or higher were identified as experiencing depression.

Workplace bullying was evaluated by asking participants about their experiences of intentional humiliation, harassment, verbal abuse, or social exclusion at work in the past 1 year. Responses were categorized as 'No,' 'Rarely or occasionally,' or 'Once a week or more often,' in order to classify workplace bullying into non-exposure, high-risk, and targeted groups based on exposure frequency.

Suicidal ideation and attempt were assessed separately using adapted two-item self-rated questionnaires from the Korea National Health and Nutrition Examination Survey³³. Participants were queried about serious thoughts of suicide and actual suicide attempts in the past year. Suicidal ideation and attempt were defined as any thoughts of suicide and attempted suicide within the preceding year, respectively.

Burnout was measured using the Oldenburg Burnout Inventory (OLBI), a 16-item self-rated questionnaire widely employed to assess burnout in various occupations³⁴. The OLBI evaluates two key burnout dimensions: exhaustion and cynicism, each comprising eight items scored on a five-point Likert scale. The presence of exhaustion and cynicism was determined based on OLBI scores higher than the mean plus one standard deviation among all participants ³⁵.

Statistical Analysis

The study groups’ baseline characteristics were compared using independent t-tests for continuous variables and the χ2 test for categorical variables. Stepwise logistic regression analyses were conducted to analyze the association between workplace bullying and suicidal ideation, in which the fist model was univariate, successively incorporating adjustments for sociodemographic factors (age, gender, marital status, education), occupational factors (type of job, working hours, job duration, and monthly income), and clinical characteristics (depression, exhaustion, and cynicism). Multiple logistic regression analyses were conducted, adjusting for potential confounding variables, to examine the relationship between workplace bullying experiences and suicidal ideation as well as suicidal attempts in the total participant and subgroups with and without depression. Subgroup analyses were performed to investigate if the multivariate-adjusted odds ratios for having suicidal ideation differ by gender, age, income, and depression among the participants who were exposed to workplace bullying. The interactions by gender, age, income, and depression differences were carried out using the likelihood ratio test. Statistical significance was set at a two-tailed p-value < 0.05. All analyses were conducted using IBM SPSS version 29.0 (IBM Co., Armonk, NY, USA). All procedures were approved by the Institutional Review Board of Kangbuk Samsung Hospital (Approval number: KBSMC 2022-03-046) and adhered to the Declaration of Helsinki and Good Clinical Practice. Informed consent was waived as the study used de-identified routine health screening data.

Competing interests

The authors declare no competing interests.

Author Contribution

E.S.K. conceptualized the study design, performed statistical analysis, and prepared the manuscript. Y.C.S., K.-S.O., and D.-W.S. assisted with the study conceptualization. E.S.K. also handled data curation and validation, with support from D.J.O., S.J.C., and S.-W.J. D.J.O., S.J.C., and S.-W.J. contributed to the formal analysis and methodology. J.K. participated in the investigation. E.S.K. handled visualization. J.K., S.J.C., and S.-W.J. reviewed and edited the manuscript. All authors reviewed the manuscript.

Acknowledgements

The authors received no external funding for this research. The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Data Availability

The datasets generated and analyzed in the current study are available from the corresponding author upon reasonable request.

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No competing interests reported.

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Revealing the Confluences: Workplace Bullying and Suicidality Independent of Depression Presence

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Abstract

Figures

Introduction

Results

Characteristics of the participants

Increased Suicidal Ideation Linked to Workplace Bullying

Factors in Suicidal Ideation among the participants with and without depression

Subgroup Analysis of Workplace bullying exposure and Suicidal Ideation

Factors in Suicide Attempts among the participants with and without depression

Discussion

Conclusion

Methods

Study design, setting, and participants

Assessments

Socio-demographic factors

Job-related demographic factors

Clinical characteristic factors

Statistical Analysis

Declarations

Competing interests

Author Contribution

Acknowledgements

Data Availability

References

Additional Declarations

Status:

Version 1