Workplace violence (WPV) is a situation in which a person is harassed, threatened, or attacked at work (1). According to the World Health Organization (WHO), WPV includes physical and psychological violence (2). WPV is a major issue in healthcare settings in both hospital and pre-hospital settings (3). Unfortunately, WPV is on the rise in all health care settings (4). Many factors such as night work, high stress, lack of resources, disproportionate gender representation, and inadequate workplace security can lead to WPV (5).

Health care workers (HCWs) are at high risk for exposure to WPV (6, 7). According to studies, 50–88% of HCWs have been exposed to WPV (3). Depending on the type and setting of the health care environments, the rates can be higher. For example, up to 90% of emergency medicine HCWs report some degree of WPV (4). Similarly, 83% of pre-hospital emergency medical technicians experience WPV at least once a year (8).

WPV for HCWs may be associated with negative consequences such as low job satisfaction, change of profession, and work absenteeism (9, 10). Additionally, the experience of WPV is associated with decreased self-esteem, increased anxiety, and stress (11–13). Furthermore, WPV toward HCWs can lead to reduced quality of patient care (14).

Numerous systematic review and meta-analysis studies of WPV against HCWs have been conducted, but a comprehensive evaluation summarizing the results is lacking. This umbrella review serves as a data reference for policymakers in the field of health care. The aim was to assess the prevalence of WPV against HCWs in hospital and pre-hospital settings.

This study was conducted based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines (15). The protocol of this study was registered in the International Prospective Register of Systematic Reviews (PROSPERO) with code CRD42022296244.

The prevalence of overall WPV, physical violence, verbal violence, and sexual harassment against HCWs are 58.7, 20.8, 66.8, and 10.5%, respectively. A 2020 meta-analysis study by Byon et al. showed that the prevalence of physical and non-physical violence against home health workers was 36.4 and 41.8%, respectively (33). Another meta-analysis showed that the prevalence of sexual violence among home health workers is 6% (34). We surmise that critical medical conditions, delirium, personality disorders, and lack of long-term relationships in hospital and pre-hospital settings lead to this higher prevalence of violence against HCWs than home health workers. Negative factors such as lack of information, inadequate personnel, and equipment increase the risk of WPV in health care services (35). Furthermore, in health care settings, factors such as work stress, poor co-worker relationships, and poor social support can lead to WPV (36).

The prevalence of violence, especially verbal violence against HCWs in hospital and pre-hospital settings is high. Sun et al. showed that the prevalence of verbal WPV against doctors in China was 76.2% (37). Magnavita et al. showed that WPV has a direct relationship with sleep problems (38). Other review studies have shown that WPV reduces the quality of work, increases mental health problems, and can lead to HCWs quitting their jobs (39). Additionally, workplace violence is directly related to burnout, lower job satisfaction, less patient safety, and an increase in medical mistakes (40–42). Therefore, health care policymakers should constantly screen for WPV and establish regulations and enact programs to minimize its occurrence.

The prevalence of WPV against HCWs is high. WPV has negative physical, psychological, and occupational consequences for HCWs and their patients. Therefore, the health system managers should screen HCWs for the occurrence and impacts of WPV and establish regulations to minimize them.

In most of the included studies, the prevalence of WPV in men and women was not reported separately, so it was not possible to report the prevalence of WPV by gender. Another limitation of this study was the high degree of heterogeneity between the studies. Finally, the studies selected were in the English language and primarily from Asian continent sources. Thus, the results may not be generalizable to worldwide communities.

The authors used a systematic review and meta-analysis approach in this study for two reasons. First, an umbrella review of meta-analyses provides a higher level of evidence than other studies that review and evaluate original studies. Second, this is the first study in this field with this title. Numerous systematic reviews and meta-analyses have been conducted on the mental health outcomes, among health care workers (HCWs). Still, no single study has combined these results to identify overarching trends or conclusions. Therefore, the present umbrella review of meta-analyses aims to serve as the first and most comprehensive study in this regard. This umbrella review assesses all meta-analyses conducted on the prevalence of workplace violence against health care workers in hospital and pre-hospital settings among HCWs worldwide to estimate the prevalence of workplace violence against in this population. This study's results can serve as a resource for policy-makers or health managers to implement appropriate plans to improve the mental health of HCWs around the world.

The datasets presented in this study can be found in online repositories. The names of the repository/repositories and accession number(s) can be found in the article/supplementary material.

This article was approved by the Ethical Committee of Karmen University of Medical Sciences with Reg. No. 401000012. The Ethic Approval Code is IR.KMU.REC.1401.074.

AS, MG, SM, MT, and HS designed the review, developed the inclusion criteria, screened titles and abstracts, appraised the quality of included papers, and drafted the manuscript, reviewed the study protocol and inclusion criteria and provided substantial input to the manuscript, and reviewed the study protocol. AS and MG read and screened articles for inclusion. All authors critically reviewed drafts and approved the final manuscript.

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

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