Workplace bullying and suicide risk: A register-based study of 78,972 participants in Denmark

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Background and aims

Workplace bullying means harassing, offending, socially excluding someone or negatively affecting someone’s work repeatedly and regularly over an extended period of time. Nowadays, workplace bullying affects approx. 12% of the Danish working population. The available studies show that workplace bullying has an adverse impact on the mental health of those targeted (Nielsen et al., 2014; Verkuil et al., 2015). However, empirical evidence linking workplace bullying to the risk of attempted suicide and death by suicide is scarce. One cross-sectional study examined the association between exposure to bullying behaviors and suicidal potential (attempted suicide and suicidal ideation; Balducci et al., 2009), while two prospective studies investigated the impact of workplace bullying and bullying behaviors on suicidal ideation (Nielsen et al., 2015; Nielsen et al., 2016). We aim to bridge this gap with a prospective register-based study investigating the impact of being exposed to workplace bullying on attempted suicide and death by suicide in a Danish large-size sample. The results of this study will be presented at the conference.


Sample: The study adopts a register-based cohort design and is based on a pooled dataset of 78,972 individuals (69% women, n=54,490) from 9 Danish questionnaire-based surveys undertaken between 2002 and 2012 (18 measurement waves in all). The pooled dataset includes numerous occupational groups in both the private and the public sector and is linked to nation-wide register data on suicide attempt and death by suicide.

Measures: In all the surveys included in the pooled dataset, the exposure variable, i.e., workplace bullying, was measured by first providing a definition of bullying and then asking the participants: “Have you been subjected to bullying at work within the past 12 months?”, to be answered on a Likert-type scale with 5 response options, 1 = never, 2 = now and then, 3 = monthly, 4 = weekly, and 5 = daily. Based on the answers, the following sub-groups will be generated: a) employees exposed to frequent workplace
bullying (response options 4 and 5); b) employees exposed to occasional workplace bullying (response options 2 and 3); and c) employees not exposed to workplace bullying (response option 1; reference category). The two register-based outcomes are suicide attempt (presentation to a psychiatric or a somatic hospital), and death by suicide, identified as primary cause of death.

Statistical analysis: We will fit two separate multivariate Cox proportional hazard models to estimate Hazard Ratios (HR) and their 95% confidence intervals for the prospective association of being occasionally and frequent bullied at baseline (vs. never been bullied) on the risk of both suicide attempt and death by suicide. The analyses will be adjusted for gender, age group and other covariates. For each participant, baseline will be defined as the first time exposure status to workplace bullying was assessed in the
surveys included in the pooled dataset. Suicide attempt and death by suicide will be followed in the registers starting from the baseline point of each survey until December 31, 2015. People migrated out of the country or who died during the study because of causes other than suicide will be censored at the respective date of these events.

Ethical issues: The permission to conduct the study was granted by the Danish Data Protection Agency (DDPA). The present study will be carried out according to the security regulations of Statistics Denmark and DDPA.

Study impact

The study findings will provide new evidence about the prospective association of workplace bullying with suicide attempt and death by suicide. If a significant association between bullying and suicide is established, the new evidence can be employed to further emphasize the importance of promoting organizational policies and practices aimed at eliminating bullying in work organizations.


Balducci C, Alfano V, Fraccaroli F (2009). Relationships between mobbing at work and MMPI-2 personality profile, posttraumatic stress symptoms, and suicidal ideation and behavior. Violence Vict. 24:52-67.
Nielsen MB, Einarsen S, Notelaers G, Nielsen GH (2016). Does exposure to bullying behaviors at the workplace contribute to later suicidal ideation? A three-wave longitudinal study. Scand J Work Environ Heath. 42:246-250.
Nielsen MB, Magerøy N, Gjerstad J, Einarsen S (2014). Workplace bullying and subsequent health problems. Tidsskr Nor Laegeforen. 134:1233-1238.
Nielsen MB, Nielsen GH, Notelaers G, Einarsen S. (2015 ). Workplace bullying and suicidal ideation: A 3-wave longitudinal Norwegian study. Am J Public Health. 105:e23-8.
Verkuil B, Atasayi S, Molendijk ML (2015). Workplace Bullying and Mental Health: A Meta- Analysis on Cross-Sectional and Longitudinal Data. PLoS ONE. 10:e013522.
Original languageEnglish
Publication date2017
Number of pages1
Publication statusPublished - 2017

ID: 173711435