Increased COVID-19-related workplace bullying during its outbreak: a 2-month prospective cohort study of full-time employees in Japan

Abstract

Objectives: This 2-month cohort study aimed to investigate the changing prevalence and factors associated with COVID-19-related workplace bullying among the general workers in Japan. Methods: A baseline survey was conducted of 4,120 full-time workers at Time 1 (March 2020) and they were invited to a follow-up survey at Time 2 (May 2020) after the outbreak of COVID-19 in Japan. The prevalence of COVID-19-related workplace bullying was compared between Time 1 and Time 2 by using McNemar’s test. Multiple logistic regression analysis was conducted to investigate the associations between occupation (health care and non-health care workers), socioeconomic status, living in areas under the national emergency announcement, workplace measures against COVID-19, occupational class, chronic physical comorbidities, chronic mental comorbidities, and COVID-19-related workplace bullying at Time 2, adjusting for that at Time 1. Results: A total of 1,421 responded to the survey at Time 2. Data from 996 respondents after excluding 36 who retired during the follow-up were analyzed. The prevalence of COVID-19-related workplace bullying increased more than double from Time 1 (2.8%) to Time 2 (6.5%). Being a manual worker (OR=3.80), having higher education (OR=2.37), and having chronic physical comorbidity (OR=2.11) was significantly associated with the COVID-19-related workplace bullying at Time 2. Conclusions: COVID-19-related workplace bullying increased during the outbreak of COVID-19 in Japan. A lower-class occupation (manual workers) and having chronic physical comorbidity may be associated with greater victimization of COVID-19-related workplace bullying, while those with high educational attainment may be more sensitive to it.

Introduction

Workplace bullying and harassment are common problem in the workplace: the average prevalence of workplace bullying was reported as 14.6%, according to a meta-analysis¹⁾. Workplace bullying and harassment are known to have a huge impact on worker health, including mental health problems, such as depression and anxiety²⁾, and physical health problems, such as sleep problems³⁾ and cardiovascular disease^4,5). In addition, workplace bullying and harassment are a threat to and violation of the human rights and dignity of workers⁶⁾. In the global epidemic of the novel coronavirus (COVID-19) in 2020⁷⁾, some case reports and opinion papers have claimed that discrimination and stigma related to COVID-19 increased toward Asians, immigrants, and lower socioeconomic groups in the society^8,9). In the same manner, workplace bullying and harassment may also increase during the outbreak⁸⁾. For example, 43% of 1,497 discrimination cases related to COVID-19 reported from Asian Americans occurred in the workplace in the United States during the first 8 weeks of the COVID-19 outbreak^10,11). National officials, as well as international organizations, released messages to prevent workplace bullying and discrimination in the workplace^12,13).

To date, few studies have investigated the actual prevalence of workplace bullying related to COVID-19 in the working population during the outbreak. We previously reported that 2.3% of the general working population experienced COVID-19-related bullying in Japan as of mid-March 2020¹⁴⁾. However, the prevalence may be underestimated because the study was conducted before the first huge COVID-19 outbreak in Japan, which was April 2020 (i.e., a state of emergency was declared for Tokyo and six prefectures and was expanded to the rest of the country). Thus, the real impact of the COVID-19 outbreak on workplace bullying was unclear. Investigations have not been done to determine who are most vulnerable to COVID-19-related workplace bullying. Health care professionals are a possible high-risk group for bullying, which is well predicted by past experiences with outbreaks of severe acute respiratory syndrome (SARS), Middle East respiratory syndrome (MERS), and Ebola virus disease^15,16). However, the prevalence of workplace bullying in this group or relative magnitude of the problem compared to the general working population are unclear. Neither have investigations considered whether COVID-19-related workplace bullying is more prevalent among low socioeconomic status (SES), as a previous study of workplace bullying has reported¹⁷⁾. It is also important to know whether people with chronic physical comorbidities are also at risk of being bullied at work because they have been reported as a high-risk group of the severity of and mortality from COVID-19^18,19,20). Once high-risk groups of COVID-19-related workplace bullying are identified, more effective countermeasures could be developed and implemented to prevent COVID-19-related workplace bullying.

This 2-month cohort study aimed to reveal the changing prevalence of workplace bullying related to COVID-19 between just before and the end of a nationwide state of emergency during the 1^st wave of the COVID-19 outbreak (from March and May 2020) in a sample of the general working population in Japan. Also, we compared the prevalence among health care workers (HCWs) and non-health care workers (non-HCWs). In addition, we investigated factors at baseline associated with COVID-19-related workplace bullying at follow-up, including the occupation (HCWs or non-HCWs), SES (educational attainment and occupational class), and chronic physical comorbidities, as well as workplace preventive measures to COVID-19.

Methods

Study design and participants

This was a prospective cohort study using the data of the online survey. A total of 4,120 full-time workers living all over in Japan were recruited from more than 500,000 registered members of an Internet survey company in February 2019. The inclusion criteria for participants were (a) living in Japan, (b) aged 20–59 years old, and (c) currently employed. Participants whose workplaces were temporarily closed were excluded from the analyses. There were no specific exclusion criteria. Eligible members based on registration information who got an invitation e-mail from the company answered the questionnaire. The questionnaire was closed once the target sample was obtained, with an equal number of participants for each of the groups based on sex (male and female) and age (20–29, 30–39, 40–49, and 50 years or older). For these participants, a self-reported questionnaire survey through the Internet was conducted from March 19–22, 2020 (Time 1)^21,22). The questionnaire was closed when the target sample (up to 1,500 participants) was obtained. Overall, 1,448 workers (35.1%) completed the survey at Time 1. We excluded 27 respondents who were not employed at Time 1. Two months later (from May 22–26 2020), the Time 2 survey collected the data from Time 1 survey participants. We analyzed the data from participants who responded to both Time 1 and Time 2 survey. We excluded participants who did not work at Time 2.

This study was approved by the research ethics committee of the The Research Ethics Committee of the Graduate School of Medicine/Faculty of Medicine at the University of Tokyo approved this study [No. 10856- (3)].

Variables

Outcome variable: COVID-19-related workplace bullying

In this study, we defined COVID-19-related workplace bullying as the participants’ own perception of being mistreated or abused related to COVID-19 by employees in the same workplace. This definition was adopted from the definition of workplace bullying: a situation in which individuals perceive themselves as being on the receiving end of negative actions from supervisors or coworkers²³⁾. Thus, we did not include the bullying experiences by business partners or customers, who are not employees in the same workplace as victims. The scale was developed through a discussion among three occupational physicians (NS, RK, and NK) who engaged in responding to COVID-19 at the workplace and a professional of workplace bullying (KT) according to other bullying scales¹⁴⁾. Five items assessed whether workers had experienced COVID-19-related workplace bullying (e.g., being the target of sarcastic comments) (see eAppendix 1 for more detail). All items were rated “Yes” or “No.” Any COVID-19-related workplace bullying was defined as experiencing any of these items. Both the Time 1 and Time 2 surveys collected the data on the variables.

Exposure variables

Information about sociodemographic and occupational characteristics included gender, age, marital status, having a child, educational status, chronic physical comorbidities, chronic mental comorbidities, living area, company size, occupation (whether or not they were HCWs), occupational class, and their workplaces’ measures for preventing COVID-19. Gender was classified into male or female. Age was categorized as 20–29 years, 30–39 years, 40–49 years, and 50 years or older. Marital status was classified into “unmarried” or “married.” Having at least one child was classified “none” or “one or more.” Educational status was classified into “high school, vocational school, or junior college diploma or less” or “bachelor’s degree or higher.” Areas of living of the participants were dichotomized based on whether they lived in the places under the national emergency announcement on May 14. The participants were also asked whether their workplaces announced or implemented measures for the prevention of COVID-19. Company size was categorized in terms of the number of employees: over 1,000 employees, 300–999 employees, 50–299 employees, and fewer than 50 employees. We asked the respondents their occupations by using a list of major groups from the International Standard Classification of Occupations (ISCO)²⁴⁾. Occupation was categorized into HCWs and non-HCWs. Participants were asked whether they received treatment of any of eight chronic physical comorbidities (i.e., hypertension, diabetes, heart disease, stroke, respiratory disease, cancer, hepatic disease, and renal disease) at present or in the past; any physical comorbidity was defined as having any of these items. Chronic mental comorbidity was also assessed by the question asking whether they received treatment of any of depression, anxiety, and emotional disturbance at present or in the past; any chronic mental comorbidity was defined as having any of these comorbidities. Most of the exposure variables were retrieved from Time 1 data except for education, occupation (whether or not they were HCWs), and occupational class. The data of occupational class was collected at the cohort creation in February 2019, while education and occupation were collected at Time 2.

Statistical analysis

The prevalence of the participants who experienced COVID-19-related workplace bullying (Time 1 and Time 2) was tabulated for the total sample, and separately for HCWs and non-HCWs. McNemar’s test was used to compare the prevalence between Time 1 and Time 2. Multiple logistic regression analysis was conducted to investigate the associations of sociodemographic and occupational factors at Time 1 or February 2019 with COVID-19-related workplace bullying at Time 2, adjusting for that at Time 1. As a sensitivity analysis, a similar multiple logistic regression was conducted among participants who did not experience COVID-19-related workplace bullying at Time 1. Statistical significance was defined as a two-sided p<0.05. Statistical analyses were conducted by SPSS 24.0. Japanese version for Windows (IBM Corp, Armonk, NY, USA).

Results

Table 1 shows the sociodemographic and occupational characteristics of respondents. Among 1,421 participants who completed the Time 1 survey and were employed at the time, 389 respondents did not complete the Time 2 survey (follow-up rate=71.3%), and 36 respondents did not work at Time 2. The remaining 996 workers (valid response rate=24.2%) were included in this study. Most were non-manual workers (62.9%), non-HCWs (88.9%), and received some kind of workplace preventive announcements against COVID-19 (80.4%). The participants in the present sample were significantly more likely to work at larger companies (p=0.009) and be non-manual workers (p=0.036) than those lost to follow-up (eTable 1).

Table 1. Sociodemographic and occupational characteristics at Time 1 of full-time employees who completed surveys at Time 1 (March 2020) and Time 2 (May 2020) (N=996) during the COVID-19 outbreak in Japan

	n (%)	Mean (SD) [min–max]
Gender
Male	508 (51.0)
Female	488 (49.0)
Mean age		41.29 (10.6) [21–60]
Age, years
20–29	186 (18.7)
30–39	270 (27.1)
40–49	260 (26.1)
≥50	280 (28.1)
Marital status
Unmarried	500 (50.2)
Married	496 (49.8)
Having at least one child
None	593 (59.5)
One or more	403 (40.5)
Education†
High school, vocational school, or junior college diploma or less	477 (47.9)
Bachelor’s degree or higher	519 (52.1)
Living in areas under the national emergency announcement in May 2020 (yes)	692 (69.5)
Company size
>1,000 employees	323 (32.4)
300–999 employees	174 (17.5)
50–299 employees	267 (26.8)
<50 employees	204 (20.5)
Unknown	28 (2.8)
Occupational class
Manager	101 (10.1)
Non-manual	626 (62.9)
Manual	269 (27.0)
Occupation†
General worker	885 (88.9)
Health care worker	111 (11.1)
Workplace measure (announcement) about COVID-19 at Time 1 (yes)	801 (80.4)
Chronic physical condition (any)	170 (17.1)
Chronic mental condition (any)	36 (3.6)

SD, standard deviation.

†  The variable was measured at Time 2.

Table 2 shows the prevalence of COVID-19-related workplace bullying in Time 1 and Time 2. The proportion of respondents who experienced any COVID-19-related workplace bullying was 2.8% at Time 1 and 6.5% at Time 2 in the total sample, with a significant increase from Time 1 to Time 2 (p<0.001). The same trend was observed for non-HCWs (p<0.001), but was not significant for HCWs (p=0.388). For HCWs, the prevalence of any COVID-19-related workplace bullying was 6.3% at Time 1, significantly greater than for non-HCWs (2.4%, p=0.040). The prevalence was still greater for HCWs (9.9%) than for non-HCWs (6.1%) at Time 2, while the difference was non-significant (p=0.184). The most prevalent bullying items among HCWs was “being the target of sarcastic comments” (5.4%), while it was “being forced to self-isolate at home” among non-HCWs (3.2%) at Time 2. Among 36 respondents who were excluded from the analysis due to their quitting job, none reported any COVID-19-related workplace bullying at Time 1, and only one (2.8%) reported at Time 2 (data are not shown).

Table 2. Prevalence of COVID-19-related workplace bullying at Time 1 (March 2020) and Time 2 (May 2020) among full-time workers who were employed both at Time 1 and Time 2 during the COVID-19 outbreak in Japan (N=996)

	Total sample (N=996)			Non-health care workers (N=885)			Health care workers (N=111)
COVID-19-related workplace bullying	Time 1 n (%)	Time 2 n (%)	p value	Time 1 n (%)	Time 2 n (%)	p value	Time 1 n (%)	Time 2 n (%)	p value
Being the target of sarcastic comments	19 (1.9)	23 (2.3)	0.617	14 (1.6)	17 (1.9)	0.710	5 (4.5)	6 (5.4)	1.000
Being harassed	7 (0.7)	20 (2.0)	0.004*	6 (0.7)	19 (2.1)	0.002*	1 (0.9)	1 (0.9)	1.000
Being avoided	6 (0.6)	22 (2.2)	0.002*	4 (0.5)	19 (2.1)	0.001*	2 (1.8)	3 (2.7)	1.000
Being accused of poor  preparedness for the  prevention	8 (0.8)	24 (2.4)	0.002*	6 (0.7)	20 (2.3)	0.004*	2 (1.8)	4 (3.6)	0.500
Being forced to self-isolate at home	8 (0.8)	32 (3.2)	<0.001**	7 (0.8)	28 (3.2)	0.001*	1 (0.9)	4 (3.6)	0.375
Any of the above	28 (2.8)	65 (6.5)	<0.001**	21 (2.4)	54 (6.1)	<0.001**	7 (6.3)	11 (9.9)	0.388

* p<0.01. ** p<0.001, for the difference between Time 1 and Time 2 (McNemar’s test).

Table 3 shows the association between factors at Time 1 and any COVID-19-related workplace bullying at Time 2. COVID-19-related workplace bullying at Time 1 (odds ratio [OR] 6.68; 95% confidence interval [CI], 2.62–17.01), being a manual worker at Time 1 (OR 3.80; 95% CI, 1.12–12.92), having any physical comorbidity at Time 1 (OR 2.11; 95% CI, 1.14–3.93), and having a bachelor’s degree or higher (OR 2.37; 95% CI, 1.29–4.37) at Time 2 were significantly associated with COVID-19-related workplace bullying at Time 2. In the sensitivity analysis among participants who did not experience COVID-19-related workplace bullying at Time 1 (eTable 2), having a bachelor’s degree was still significantly associated with COVID-19-related workplace bullying at Time 2.

Table 3. Factors at Time 1 (March 2020) associated with any COVID-19-related workplace bullying at Time 2 (May 2020) among full-time employees in Japan (N=996): multiple logistic regression analysis

	Model 1		Model 2
	OR	95% CIs	OR	95% CIs	P value
COVID-19-related workplace bullying at Time 1
None	1		1
Any	6.393	2.699–15.145	6.683	2.620–17.048	<0.001**
Gender
Male	1		1
Female	0.724	0.435–1.206	0.843	0.469–1.517	0.570
Age, years
20–29	1		1
30–39	1.090	0.542–2.190	1.074	0.508–2.269	0.852
40–49	0.806	0.383–1.694	0.852	0.373–1.945	0.704
≥50	0.598	0.275–1.303	0.601	0.246–1.471	0.265
Marital status
Unmarried	1		1
Married	1.359	0.818–2.257	1.110	0.561–2.200	0.764
Having at least one child
None	1		1
One or more	1.282	0.774–2.125	1.435	0.723–2.848	0.301
Education†
High school diploma or less	1		1
Bachelor’s degree or higher	1.738	1.029–2.936	2.373	1.288–4.370	0.006*
Living in areas under the national emergency announcement in May 2020 (yes)
No	1		1
Yes	0.849	0.499–1.446	0.896	0.507–1.582	0.704
Workplace measure (announcement) about COVID-19
No	1		1
Yes	0.729	0.405–1.312	0.674	0.365–1.246	0.208
Occupation†
Non-health care worker	1		1
Health care worker	1.693	0.857–3.344	1.870	0.881–3.972	0.103
Occupational class
Manager	1		1
Non-manual	1.611	0.563–4.610	2.147	0.671–6.871	0.198
Manual	2.160	0.726–6.430	3.799	1.117–12.921	0.033*
Chronic physical condition
No	1		1
Any	1.963	1.110–3.472	2.113	1.138–3.925	0.018*
Chronic mental condition
No	1		1
Any	1.317	0.393–4.414	0.877	0.229–3.367	0.849

CI, confidence interval; OR, odds ratio.

* p<0.05. ** p<0.01. †The variables were measured at Time 2.

Model 1: Crude model.

Model 2: All variables were simultaneously entered in the model.

Discussion

The prevalence of any COVID-19-related workplace bullying substantially increased in a sample from the full-time employees in Japan during the outbreak of COVID-19 between March and May 2020 (2.8% and 6.5%, respectively). Having a bachelor’s degree or higher, being a manual worker, and having any physical comorbidity significantly predicted the exposure of COVID-19-related workplace bullying during the outbreak. At Time 1, HCWs had almost twice the prevalence of COVID-19-related workplace bullying compared to non-HCWs, but the increase for HCWs between Time 1 and Time 2 was not significant. The study first reported that a non-negligible proportion of workers experienced COVID-19-related workplace bullying during the outbreak, with prospective evidence that lower occupation positions (i.e., manual workers), higher education, and having chronic physical comorbidities were associated with the occurrence of COVID-19-related workplace bullying.

The overall prevalence of COVID-19-related workplace bullying at follow-up was 6.5%. This means about one of every 15 workers had experienced it at the end of the 2020 Spring outbreak of COVID-19 in Japan. The prevalence was much greater than in our previous, March 2020, report (2.3%) of a baseline sample of the same cohort¹⁴⁾. The most common bullying item was being forced to self-isolate at home, which could occur due to limited understanding of employers about COVID-19 and poor of communication between employers and employees.

HCWs had twice the prevalence of COVID-19-related workplace bullying compared to non-HCWs at follow-up, while the difference was not significant. An interesting difference between the occupations to be noted was that the prevalence of COVID-19-related workplace bullying among HCWs was already greater at baseline than for non-HCWs (6.3% vs. 2.4%, March 2020). The results were consistent with speculation and prediction in the COVID-19-related anecdotal reports and opinion papers^8,16) as well as the representative population study, which has reported people working with clients/patients (female-dominated occupations) reported higher prevalence of bullying²⁵⁾. In the current study, sarcastic comments were most prevalent among HCWs. Among HCWs working in the same hospital, perception of injustice may occur whether or not patients with COVID-19 were admitted to their wards. Such a perception of injustice might cause COVID-19-related workplace bullying, such as sarcastic comments, following to a previous finding that perception of injustice was a significant factor of general workplace bullying²⁶⁾. Also, HCWs may have worked in an unprecedented situation with the atmosphere of heightened fear and worry about the infection of COVID-19 since the early phases of the outbreak²⁷⁾. Such a stressful work environment may make COVID-19-related workplace bullying more prevalent, as well as general workplace bullying²⁸⁾. In our study, there was no significant association between being HCWs and COVID-19-related workplace bullying. This might be because this study did not assess COVID-19-related bullying from people outside the workplace, such as patients or patients’ family. Since high prevalence of workplace bullying and harassment was reported among HCWs during the COVID-19 pandemic²⁹⁾, the results in this study might underestimate the prevalence of COVID-19-related bullying among HCWs. Our study suggests that HCWs are one of the high-risk groups for COVID-19-related workplace bullying in an early phase of the outbreak. In addition to this finding, HCWs were reported to be bullied by patients and neighbors in the outbreak of COVID-19³⁰⁾. Thus, countermeasures to prevent bullying and discrimination targeted at HCWs are urgently required.

In this study, manual workers was significantly associated with COVID-19-related workplace bullying than managers at Time 2. Manual workers also showed a slightly increased risk of COVID-19-related workplace bullying than managers at Time 2, while the difference was non-significant. Manual workers are considered to have a lower frequency of remote work, and thus could have more frequent contact with their supervisors and colleagues, which may result in a more frequent experience of COVID-19-related workplace bullying. The other interpretation is that, as the linear trend of the prevalence of COVID-19-related workplace bullying across the three occupational classes^31,32), the pattern may reflect the association between low SES and COVID-19-related workplace bullying, just like that for workplace bullying in general³³⁾. Poor psychosocial working comorbidities, such as high demands, low social support, and low satisfaction with pay, which are proposed to explain victimization of workplace bullying in low SES groups³³⁾, may also explain the finding. Contrary to our expectation, we found that having a bachelor’s degree or higher was associated with COVID-19-related workplace bullying, which was inconsistent with the previous study of general workplace bullying in Japan¹⁷⁾. A possible explanation of the discrepancy is that the current study assessed workplace bullying specifically related to COVID-19, not general workplace bullying. People with higher educational attainment are reported to have access to more information and have a higher risk perception of COVID-19³⁴⁾. Too much access to information about COVID-19 through the television and web media was sometimes associated with greater fear and worry over COVID-19³⁵⁾. Supervisors and colleagues of workers with high education may also have high educational attainment. They may be more knowledgeable of COVID-19 and sensitive to conversations and behaviors among their colleagues at the workplace about COVID-19. In this study, being forced to self-isolate at home was most prevalent among participants who had a bachelor’s degree or higher, which may be because of increased sensitivity to COVID-19.

The present study also found that workers with a chronic physical comorbidity, who have been reported as a high-risk group for severity and mortality of COVID-19, were also a high-risk group for COVID-19-related workplace bullying at Time 2. The associations between having a chronic physical comorbidity and COVID-19-related workplace bullying at Time 2 was weakened and not significant among participants who did not experience COVID-19-related workplace bullying at Time 1. This may be because some participants with a chronic physical comorbidity had already been bullied at Time 1. Workers with chronic physical comorbidities are more likely to be targets of bullying because their employer and colleagues may take care of them either less or too much. For example, if employers and colleagues lack appropriate consideration for prevention, workers with choric illness may feel bullied because they may feel neglected and worried more to get infection. On the other hand, if employers and colleagues treat them too carefully, workers with chronic illness may also feel bullied because they may feel injustice. In addition, those workers may perceive responses and treatment given to them inappropriately or unreasonably because of too much worry about the infection.

These findings may indicate a need to develop separate policies and interventions specific to each of these high-risk groups and HCWs, even applying common organizational and individual-oriented approaches to prevent general workplace bullying³⁶⁾. However, we should note several limitations of the present study. First, since the reliability and validity of the measurements of COVID-19-related workplace bullying used in this study have been developed originally, the interpretation and comparison of their prevalence might be difficult. Also, although we clarified the perpetrator of bullying at Time 2, we did not ask at Time 1. Thus, bullying from not only supervisors or colleagues but also patients may have been included at Time 1. Second, this study used a self-report questionnaire to measure COVID-19-related workplace bullying. Thus, it is subject to a self-report bias. There may be other workplace bullying behaviors that could not be measured in the questionnaire. This could have led to an underestimation of the prevalence of workplace bullying. On the other hand, COVID-19-related workplace bullying was measured based on the perception of respondents, which may not be based on universally agreed to be a case of bullying. Some may even report that a reasonable request from their company, such as to appropriately quarantine themselves at home, was forced on them against their will if the respondents were not fully informed about the intent underlying the request from their companies. That might result in an overestimation of the prevalence of workplace bullying. Third, COVID-19-related workplace bullying may depend on the country, culture, and the spread of the pandemic. However, the reported prevalence of general workplace bullying in Japan was similar to its prevalence in other countries^1,37), so our core findings regarding the prevalence of workplace bullying might not be very different from the global prevalence rate. Fourth, while there might be other risk factors for getting an infection besides having chronic physical comorbidity, such as smoking, we did not investigate all of them. We should investigate them for future research. Fifth, the generalizability of the findings to the whole population of workers is limited. The study used a sample recruited from an Internet survey company, and the participants consisted only of full-time workers. Sixth, there may be selection bias since the response rate of participants was low (24.2%). However, the follow-up rate was relatively high (71.3%), and the prevalence of COVID-19-related workplace bullying was not so high (2.8%) among excluded respondents who had retired by Time 2, which may hold the bias to a minimum. Seventh, the number of predictor variables (n=15) in the multiple logistic regression analyses may be too large, while bullying cases at Time 2 was limited (n=65). We may have overlooked important predictors of COVID-19-related workplace bullying. The findings should be replicated with a larger sample and applying a more sophisticated statistical analysis, such as regression on propensity scores targeting a limited number of predictors under specific hypotheses.

Conclusion

The present study demonstrated that one in 15 workers reported COVID-19-related workplace bullying in a sample of the general working population, with the prevalence substantially increasing during the outbreak of COVID-19 in Japan. Manual workers, workers with a university or higher degree, and those having chronic physical comorbidities were identified as significant predictors of COVID-19-related workplace bullying. In addition, HCWs seem to face COVID-19-related workplace bullying from an early phase of the outbreak. These findings could be useful to develop interventions specific to each high risk-group to prevent COVID-19-related workplace bullying.

Acknowledgements

We appreciate to all of the participants who cooperated in the present study.

Funding sources

This work was supported by internal funds of the Department of Mental Health, Graduate School of Medicine, The University of Tokyo.

This work was partly supported by JSPS KAKENHI Grant Number 18H04072 (PI: Norito Kawakami).

Conflict of Interest

None declare.

Type of contribution

NK was in charge of this study, of supervising the process and of providing his expert opinion on the subject. NS and NK organized the study design. MI analyzed the data. NS, RK, and KT ensured that questions related to the accuracy or integrity of any part of the work were appropriately investigated and resolved. All authors contributed to the process of conducting the survey. MI and NK wrote the first draft of the manuscript, and all other authors revised the manuscript critically. All authors approved the final version of the manuscript.

Supplementary material

This article contains supplementary material (Appendix), which is available in the online version (doi: 10.1539/eohp.2021-0006-OA)

eTable 1. Difference in characteristics at Time 1 between the sample for the analysis and participants lost to follow-up at Time 2

	The sample for the analysis N=996		Lost to follow-up N=389
Variables at Time 1	N (%)	Mean (SD) [min–max]	N (%)	Mean (SD) [min–max]	P-value for difference
Gender					0.891
Male	508 (51.0)		200 (51.4)
Female	488 (49.0)		189 (48.6)
Mean age		41.29 (10.6) [21–60]		41.39 (10.4) [22–60]	0.865†
Age, years					0.984
20–29	186 (18.7)		70 (18.0)
30–39	270 (27.1)		105 (27.0)
40–49	260 (26.1)		105 (27.0)
≥50	280 (28.1)		109 (28.0)
Marital status
Unmarried	500 (50.2)		183 (47.0)
Married	496 (49.8)		206 (53.0)
Having at least one child					0.148
None	593 (59.5)		215 (55.3)
One or more	403 (40.5)		174 (44.7)
Living in areas under the national emergency announcement in May 2020					0.906
No	304 (30.5)		120 (30.8)
Yes	692 (69.5)		269 (69.1)
Company size					0.009
>1,000 employees	323 (32.4)		121 (31.1)
300–999 employees	174 (17.5)		48 (12.3)
50–299 employees	267 (26.8)		100 (25.7)
<50 employees	204 (20.5)		108 (27.8)
Missing	0 (0.0)		12 (3.1)
Occupational class					0.036
Manager	101 (10.1)		25 (6.4)
Non-manual	626 (62.9)		240 (61.7)
Manual	269 (27.0)		124 (31.9)
Workplace measure (announcement) about COVID-19					0.928
No	195 (19.6)		77 (19.8)
Yes	801 (80.4)		312 (80.2)
Chronic physical condition					0.873
No	826 (82.9)		324 (83.3)
Any	170 (17.1)		65 (16.7)
Chronic mental condition					0.080
No	960 (96.4)		382 (98.2)
Any	36 (3.6)		7 (1.8)

SD, standard deviation.

†  t-test; otherwise, chi-squared test.

eTable 2. Factors at Time 1 (March 2020) associated with any COVID-19-related workplace bullying at Time 2 (May 2020) among full-time employees in Japan who did not experience COVID-19-related workplace bullying at Time 1 (N=968): multiple logistic regression analysis

	Model 1		Model 2
	OR	95% CIs	OR	95% CIs	P value
Gender
Male	1		1
Female	0.693	0.402–1.195	0.864	0.469–1.593	0.639
Age, years
20–29	1		1
30–39	1.335	0.605–2.942	1.250	0.552–2.829	0.592
40–49	1.124	0.498–2.537	1.076	0.450–2.575	0.869
≥50	0.794	0.335–1.878	0.817	0.313–2.132	0.679
Marital status
Unmarried	1		1
Married	1.323	0.772–2.268	1.050	0.510–2.162	0.895
Having at least one child
None	1		1
One or more	1.340	0.784–2.292	1.383	0.675–2.834	0.375
Education†
High school diploma or less	1		1
Bachelor’s degree or higher	1.918	1.089–3.378	2.466	1.303–4.667	0.006*
Living in areas under the national emergency announcement in May 2020 (yes)
No	1		1
Yes	0.942	0.529–1.675	0.931	0.511–1.697	0.816
Workplace measure (announcement) about COVID-19
No	1		1
Yes	0.741	0.396–1.384	0.710	0.372–1.355	0.299
Occupation†
Non-health care worker	1		1
Health care worker	1.386	0.673–3.014	1.731	0.756–3.963	0.194
Occupational class
Manager	1		1
Non-manual	1.322	0.458–3.820	1.677	0.533–5.280	0.377
Manual	1.878	0.625–5.640	2.957	0.895–9.764	0.075
Chronic physical condition
No	1		1
Any	1.364	0.704–2.640	1.566	0.782–3.137	0.205
Chronic mental condition
No	1		1
Any	1.032	0.241–4.425	0.987	0.224–4.347	0.986

CI, confidence interval; OR, odds ratio.

* p<0.05. ** p<0.01. †The variables were measured at Time 2.

Model 1: Crude model.

Model 2: All variables were simultaneously entered in the model.

References

• 1.   Nielsen  MB,  Matthiesen  SB,  Einarsen  S. The impact of methodological moderators on prevalence rates of workplace bullying. A meta‐analysis. J Occup Organ Psychol. 2010; 83(4): 955-979.
• 2.   Verkuil  B,  Atasayi  S,  Molendijk  ML. Workplace Bullying and Mental Health: A Meta-Analysis on Cross-Sectional and Longitudinal Data. PLoS One. 2015; 10(8): e0135225.
• 3.   Lallukka  T,  Rahkonen  O,  Lahelma  E. Workplace bullying and subsequent sleep problems—the Helsinki Health Study. Scand J Work Environ Health. 2011; 37(3): 204-212.
• 4.   Kivimäki  M,  Virtanen  M,  Vartia  M,  Elovainio  M,  Vahtera  J,  Keltikangas-Järvinen  L. Workplace bullying and the risk of cardiovascular disease and depression. Occup Environ Med. 2003; 60(10): 779-783.
• 5.   Xu  T,  Magnusson Hanson  LL,  Lange  T, et al. Workplace bullying and workplace violence as risk factors for cardiovascular disease: a multi-cohort study. Eur Heart J. 2019; 40(14): 1124-1134.
• 6.   Carbo  J,  Hughes  A. Workplace bullying: Developing a human rights definition from the perspective and experiences of targets: CARBO and HUGHES: workplace bullying. Working USA. 2010; 13(3): 387-403.
• 7.   Del Rio  C,  Malani  PN. COVID-19-New Insights on a Rapidly Changing Epidemic. JAMA. 2020; 323(14): 1339-1340.
• 8.   Yahya  AS,  Khawaja  S,  Chukwuma  J. COVID-19 and a Potential Rise in Bullying Behaviors. Prim Care Companion CNS Disord. 2020; 22(3): 22.
• 9.   Devakumar  D,  Shannon  G,  Bhopal  SS,  Abubakar  I. Racism and discrimination in COVID-19 responses. Lancet. 2020; 395(10231): 1194.
• 10.   Kantamneni  N. The impact of the COVID-19 pandemic on marginalized populations in the United States: A research agenda. J Vocat Behav. 2020; 119: 103439.
• 11.   Cynthia  Choi,  Manjusha P.  Kulkarni. In one month, STOP AAPI HATE receives almost 1500 incident reports of verbal harassment, shunning, and physical assaults. April 24, 2020. http://www.asianpacificpolicyandplanningcouncil.org/wp-content/uploads/Press_Release_4_23_20.pdf. Accessed August 1, 2020.
• 12.  Message From EEOC Chair Janet Dhillon on National Origin and Race Discrimination During the COVID-19 Outbreak [U.S. Equal Employment Opportunity Commission] 2020. https://www.eeoc.gov/wysk/message-eeoc-chair-janet-dhillon-national-origin-and-race-discrimination-during-covid-19. Accessed August 1, 2020.
• 13.  Getting your workplace ready for COVID-19 [World Health Organization]. March 3, 2020. https://www.who.int/docs/default-source/coronaviruse/getting-workplace-ready-for-covid-19.pdf?sfvrsn=359a81e7_6. Accessed August 1, 2020.
• 14.   Sasaki  N,  Kuroda  R,  Tsuno  K,  Kawakami  N. Fear, worry and workplace harassment related to the COVID-19 epidemic among employees in Japan: prevalence and impact on mental and physical health. SSRN 3569887. 2020.
• 15.   Kisely  S,  Warren  N,  McMahon  L,  Dalais  C,  Henry  I,  Siskind  D. Occurrence, prevention, and management of the psychological effects of emerging virus outbreaks on healthcare workers: rapid review and meta-analysis. BMJ. 2020; 369: m1642.
• 16.   Shigemura  J,  Kurosawa  M. Mental health impact of the COVID-19 pandemic in Japan. Psychol Trauma. 2020; 12(5): 478-479.
• 17.   Tsuno  K,  Kawakami  N,  Tsutsumi  A, et al. Socioeconomic determinants of bullying in the workplace: a national representative sample in Japan. PLoS One. 2015; 10(3): e0119435.
• 18.   Zheng  Y-Y,  Ma  Y-T,  Zhang  J-Y,  Xie  X. COVID-19 and the cardiovascular system. Nat Rev Cardiol. 2020; 17(5): 259-260.
• 19.   Surveillances  V. The epidemiological characteristics of an outbreak of 2019 novel coronavirus diseases (COVID-19)—China, 2020. China CDC Weekly. 2020; 2(8): 113-122.
• 20.   Bialek  S,  Boundy  E,  Bowen  V, et al; CDC COVID-19 Response Team. Severe Outcomes Among Patients with Coronavirus Disease 2019 (COVID-19) - United States, February 12-March 16, 2020. MMWR Morb Mortal Wkly Rep. 2020; 69(12): 343-346.
• 21.   Sasaki  N,  Kuroda  R,  Tsuno  K,  Kawakami  N. Workplace responses to COVID-19 associated with mental health and work performance of employees in Japan. J Occup Health. 2020; 62(1): e12134.
• 22.   Sasaki  N,  Kuroda  R,  Tsuno  K,  Kawakami  N. Workplace responses to COVID-19 and their association with company size and industry in an early stage of the epidemic in Japan. Environmental and Occupational Health Practice. 2020; 2(1).
• 23.   Nielsen  MB,  Einarsen  S. Outcomes of exposure to workplace bullying: A meta-analytic review. Work Stress. 2012; 26(4): 309-332.
• 24.  International Standard Classification of Occupations. Welcome to the ISCO website. [International Labour Organization] 2010. https://www.ilo.org/public/english/bureau/stat/isco/. Accessed October 15, 2020.
• 25.   Ortega  A,  Høgh  A,  Pejtersen  JH,  Feveile  H,  Olsen  O. Prevalence of workplace bullying and risk groups: a representative population study. Int Arch Occup Environ Health. 2009; 82(3): 417-426.
• 26.   Abuseif  SF,  Abdullah  NAC. Perception of injustice, job insecurity and workplace bullying: the moderating role of self-control. Int J Acad Res Bus Soc Sci. 2015; 5: 2222-6990.
• 27.   Greenberg  N,  Docherty  M,  Gnanapragasam  S,  Wessely  S. Managing mental health challenges faced by healthcare workers during covid-19 pandemic. BMJ. 2020; 368: m1211.
• 28.   Johan Hauge  L,  Skogstad  A,  Einarsen  S. Relationships between stressful work environments and bullying: results of a large representative study. Work Stress. 2007; 21(3): 220-242.
• 29.   Dye  TD,  Alcantara  L,  Siddiqi  S, et al. Risk of COVID-19-related bullying, harassment and stigma among healthcare workers: an analytical cross-sectional global study. BMJ Open. 2020; 10(12): e046620.
• 30.   Makino  M,  Kanie  A,  Nakajima  A,  Takebayashi  Y. Mental health crisis of Japanese health care workers under COVID-19. Psychol Trauma. 2020; 12(S1): S136-S137.
• 31.   Fujishiro  K,  Xu  J,  Gong  F. What does “occupation” represent as an indicator of socioeconomic status?: exploring occupational prestige and health. Soc Sci Med. 2010; 71(12): 2100-2107.
• 32.   Tanaka  H,  Nusselder  WJ,  Bopp  M, et al. Mortality inequalities by occupational class among men in Japan, South Korea and eight European countries: a national register-based study, 1990-2015. J Epidemiol Community Health. 2019; 73(8): 750-758.
• 33.   Feijó  FR,  Gräf  DD,  Pearce  N,  Fassa  AG. Risk Factors for Workplace Bullying: A Systematic Review. Int J Environ Res Public Health. 2019; 16(11): E1945.
• 34.   Shoji  M,  Cato  S,  Iida  T,  Ishida  K,  Ito  A,  McElwain  K. COVID-19 and Social Distancing in the Absence of Legal Enforcement: Survey Evidence from Japan. 2020.
• 35.   Sasaki  N,  Kuroda  R,  Tsuno  K,  Kawakami  N. Exposure to media and fear and worry about COVID-19. Psychiatry Clin Neurosci. 2020; 74(9): 501-502.
• 36.   Gillen  PA,  Sinclair  M,  Kernohan  WG,  Begley  CM,  Luyben  AG. Interventions for prevention of bullying in the workplace. Cochrane Database Syst Rev. 2017; 1(1): CD009778.
• 37.   Naito  S. Workplace bullying in Japan. Workplace bullying and harassment. JILPT Report No. 12. 2013: 113.