Research on a Moderated Mediation Model of the Psychological Impact of Workplace Violence Against Health Workers

Background Workplace violence against healthcare workers is a common occupational hazard with serious psychological consequences. However, the organizational and cultural pathways through which workplace violence against health workers affects mental health remain insufficiently understood. This study examined whether perceived forbearance culture mediates the association between WPV and mental health, and whether job demands moderate this effect. Methods A cross-sectional survey was conducted among 2,976 healthcare workers from multiple levels of healthcare facilities across eastern, central, and western China. WPV was assessed with a dichotomous item, forbearance culture with a single Likert-type item, and job demands with multidimensional indicators. Psychological outcomes were measured using the GAD-7 and PHQ-9 scales. Moderated mediation analyses were performed using PROCESS Model 14, controlling for demographic and occupational covariates. Results WPV was reported by 20.1% of participants and was associated with higher anxiety (β ₁  = 2.09, p < 0.001) and depression (β ₄  = 2.66, p < 0.001). Forbearance culture partially mediated these associations, with significant indirect effects for anxiety (Effect = 0.55, 95% CI: 0.42–0.70) and depression (Effect = 0.69, 95% CI: 0.53–0.87). Job demands amplified the adverse effects of forbearance culture, with the moderating effect being stronger for depressive symptoms. Conclusion WPV harms healthcare workers’ mental health both directly and indirectly through a workplace culture that discourages reporting and normalizes violence. Interventions aimed at improving organizational culture and managing workload are essential for mitigating psychological harm and promoting safer clinical environments.