MHM Magazine

the healthcare sector was reported to be more prevalent amongst junior staff and registrars, and in females more than males. A higher percentage of bullying was present in those who identified as Black, Asian, or Coloured. MENTAL HEALTH CONSEQUENCES The mental health of medical students is under threat, with 1 in 4 experiencing a Major Depressive Disorder, 1 in 5 experiencing an anxiety disorder, 1/3 at risk for MDD and ½ at risk for anxiety. What is concerning about this is that it means that junior doctors entering the workforce may be entering the space already struggling with their mental health, magnifying the consequences of workplace bullying. Bullying itself has been associated with altered hypothalamic-pituitary- adrenocortical (HPA) axis, a complex set of endocrine interactions eliciting cortisol responses. HPA-axis dysregulation has been associated with adverse health consequences such as depression, anxiety, sleep disorders, burnout, obesity, diabetes, and hypertension. A large meta-analysis found that of all psychological stressors the largest cortisol changes were associated with tasks containing uncontrollable or social-evaluative elements, which is particularly relevant within the medical workforce. Healthcare work is inherently socio-evaluative, with interpersonal interactions involving judgement from patients, family, and colleagues. Bullied healthcare workers may therefore be at particular risk of cortisol dysregulation and the associated health consequences. A review of the evidence found that workplace bullying was significantly associated with poor mental health, including conditions such as depression, burnout, anxiety, suicidal ideation and attempted suicide, and intense psychological distress. Physical health consequences of workplace bullying include insomnia, sleep changes, and sleep deficiencies, headaches, gastrointestinal problems, and nausea. These are independent or not necessarily as a result of the aforementioned mental health challenges that were reported. With regards to sick leave, there was reportedly a much higher rate of absenteeism and sick leave from both physical and mental health consequences, and lends itself to decreased productivity and decreased motivation. These consequences impact not only the individual, but the team and the system as a whole, creating adverse impacts on an already-strained healthcare system within our context. HELP AND HOPE Fortunately, there is help available. On an individual level, the Healthcare Workers Care Network (HWCN) is available to support all healthcare workers, with both a prevention and treatment option available. HWCN is available to reach 24/7 at 0800 21 21 21. Group support is also available through the HWCN, with a monthly group meeting available on the last Thursday of every month via Zoom. Details are available at healthcareworkerscarenetwork.org.za . Although there is a high prevalence of workplace bullying in South Africa, both experienced and witnessed, it shouldn’t fall on the individual to deal with these. There is a call for systemic changes in organisational culture, including policies legislated for management of negative workplace behaviours. There is hope on the horizon – there is a new code of Good Practice on the Prevention and Elimination of Harassment in the Workplace, which was effective as of 18 March 2022, and has placed a duty of care on employers to play their part in preventing and managing workplace bullying at a more organisational level. References available on request. Issue 6 | 2023 | MENTAL HEALTH MATTERS | 17 MHM