Prevalence and patterns of workplace violence among health workers in Bulgaria

Background

Workplace violence is a recognised occupational hazard for health workers and a growing public health concern, but national data from Bulgaria are scarce. This study estimates the prevalence and patterns of workplace violence among Bulgarian health workers and examines differences by sex, profession, and care setting.

Methods

In 2024, a cross-sectional online survey was conducted among 944 healthcare professionals across outpatient, hospital, and emergency care. A self-administered questionnaire collected demographic and occupational data and exposure to workplace violence in the preceding 12 months. Prevalence was estimated descriptively; associations were examined using chi-square tests with Cramer’s V.

Results

Over the preceding 12 months, 34.7% (95% CI: 31.7–37.9) of respondents experienced workplace violence, and 43.4% (40.2–46.7) had been a victim and/or witness of aggression. Verbal aggression was the most prevalent form (32.1%; 29.1–35.2), followed by physical aggression (6.8%; 5.3–8.6) and sexual harassment (3.5%; 2.4–4.9). Patients and their relatives were the primary perpetrators, with colleagues and managers as secondary sources. Violence exposure showed small but statistically significant associations with sex (p = 0.016, Cramer’s V = 0.078), with males reporting a higher burden; profession (p < .001, V = 0.137), with nurses and midwives disproportionately affected; and type of healthcare facility (p < .001, V = 0.178), with hospital and emergency care workers accounting for 58.2% of victims. Formal reporting procedures and anti-violence policies were available or known to fewer than 30% of respondents.

Conclusions

Workplace violence is common among Bulgarian health workers, with frontline staff more frequently exposed. The low awareness of protective mechanisms reflects a critical gap in institutional preparedness that requires coordinated prevention, reporting, and post-incident support measures at institutional and national levels.

Key messages

• Workplace violence is a pervasive occupational hazard in Bulgarian healthcare, with substantial exposure that disproportionately burdens frontline clinical staff.

• Effective prevention of violence against health workers demands coordinated institutional and national action, integrating primary prevention, reporting, and post-incident support.