Workplace violence predicts the co-occurrence of musculoskeletal pain and depression symptoms among healthcare workers

Introduction
Musculoskeletal pain and depression often co-occur and tend to have synergistic effects on work disability and lost work days. Little is known of the workplace risk factors for such co-occurrence. We investigated the effects of exposure to workplace violence on co-occurring musculoskeletal pain and symptoms of depression over a 2-year follow-up.

Methods
Nursing home workers with complete data from 3 consecutive annual surveys formed the study cohort (n=344). The outcome was the combination of musculoskeletal pain with at least moderate intensity (any body site) and feelings of depression. Exposure to physical assault at work and pain were inquired about using a recall period of 3 months and depression of 1 month. Risks were assessed with log-binomial regression and adjusted for individual and work-related factors. 

Results
Baseline exposure to violence almost doubled the risk of having both pain and feelings of depression one year later. Persistent exposure over the 2 years considerably increased the risk of the co-occurrence at the end of the 2-year follow-up (adjusted RR 3.6, 95% CI 1.7-7.9). The risks were higher when those with baseline co-occurrence were excluded. 

Discussion
Workplace violence should be recognized as a notable risk factor for musculoskeletal symptoms with co-occurring depression. More effective prevention is needed to improve workplace safety and support good musculoskeletal and mental health among healthcare workers.