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. 2025 Oct 17;26(6):1769-1780.
doi: 10.5811/westjem.45138.

Prevalence and Impact of Violence Against Healthcare Workers in Brazilian Emergency Departments: A National Survey

Julia M Dorn de Carvalho  1 , Sarayna S McGuire  2 , Lucas L R Oliveira  1 , Fernanda Bellolio  2 , Otávio T Ranzani  3   4   5 , Bruno A M Pinheiro Besen  6   7 , Helio Penna Guimarães  1 , Maria Camila Lunardi  1 , Aidan F Mullan  8 , Ludhmila A Hajjar  1 , Ian Ward A Maia  1
Affiliations

Prevalence and Impact of Violence Against Healthcare Workers in Brazilian Emergency Departments: A National Survey

Julia M Dorn de Carvalho et al. West J Emerg Med. .

Abstract

Introduction: Workplace violence (WPV) is a significant occupational hazard in healthcare, with emergency departments (EDs) recognized as high-risk environments. Although globally significant, data from Latin America remain scarce. In this study we aimed to evaluate the prevalence and effects of WPV on healthcare workers in Brazilian EDs.

Methods: We conducted a cross-sectional survey of healthcare workers in Brazilian EDs. Respondents indicated verbal and physical violence experienced within the preceding six months, along with associated psychological and occupational impacts. Univariable models identified significant associated factors, followed by multivariable models to determine independent associated factors of WPV. We reported results as adjusted odds ratios (aOR) with 95% confidence intervals. Statistical analyses were performed in R v4.4.1, and significance was defined as P < .05.

Results: The response rate was 19.1% (1,255/6,570), Of those responses, 61.3% (769/1,255) met the inclusion criteria and were included in the analysis. Of all respondents, 84.0% were physicians. Respondents indicated 79.6% (612/769) occurrence of WPV, including verbal abuse (79.5%) and physical assault (12.1%). Physical assaults against co-workers were witnessed by 40.3% of respondents. Perpetrators included visitors (85.3%), patients (80.7%), and co-workers (35.8%). The absence of institutional preventive measures was associated with increased WPV (aOR, 2.47; 95% CI, 1.71-3.57; P < .001), while the presence of security staff reduced WPV (aOR, 0.61; 95% CI, 0.42-0.89; P = .01). Indicated impact included post-traumatic stress symptoms (88.4%), considering leaving their job (49.5%), impaired workplace performance (75.2%), and time off work (10%), including 11.5% permanently leaving.

Conclusion: Workplace violence is highly prevalent in Brazilian EDs, with substantial psychological and occupational consequences. The absence of protocols or preventive measures may increase WPV risk, emphasizing the urgent need for public policies to protect healthcare workers in emergency settings.

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Conflict of interest statement

Conflicts of Interest: By the WestJEM article submission agreement, all authors are required to disclose all affiliations, funding sources and financial or management relationships that could be perceived as potential sources of bias. No author has professional or financial relationships with any companies that are relevant to this study. There are no conflicts of interest or sources of funding to declare.

Figures

Figure 1
Figure 1
Frequency of each type of workplace violence experienced by Brazilian emergency department staff in the prior six months.
See this image and copyright information in PMC

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