Prevalence, risk factors, consequences, and prevention and management of patient aggression and violence against physicians in hospitals: A systematic review

Most reviews have examined workplace violence rather heterogeneously without explicit regard to a professional group or particular source of violence (from colleagues/leaders vs. from patients and their relatives/friends). This study reviews the literature regarding the prevalence, risk factors, consequences, and prevention and management of aggression and violence by patients (and their relatives/friends) against physicians in hospitals. A total of 104 studies were included by searching five databases. The prevalence of aggression and violence was higher in developing countries and against younger physicians. The risk factors for the occurrence of aggression and violence were present at multiple levels (i.e., patients, patient-physician interactions, hospitals, and society). However, knowledge on how risk factors at different levels interact is absent. Although research on risk factors acknowledged multiple levels, research on consequences was mainly focused on the individual level (i.e., work functioning, psychological well-being and health) with less attention to the team and organizational level. While some prevention models took into account the risk factors of aggression and violence in different contexts, there is still limited knowledge on how to establish a well-aligned and comprehensive intervention strategy that considers risk factors and consequences at different levels.