mobbing psychiatric impacts and psycho-social outcomes professor philippe corten van driette y.,...

MobbingMobbing Psychiatric impacts Psychiatric impacts

and psycho-social and psycho-social outcomesoutcomes

Professor Philippe CortenProfessor Philippe CortenVan Driette Y., Dewell P., From L., Friedrich Van Driette Y., Dewell P., From L., Friedrich

A., Tiv Ph., Pelc I.A., Tiv Ph., Pelc I.

Clinique du Stress - 2005Clinique du Stress - 2005

Mobbing: BackgroundMobbing: Background• Mobbing was described byMobbing was described by

– H. LeymannH. Leymann– M-F. HirigoyenM-F. Hirigoyen– Ch. DejoursCh. Dejours

As a moral ill-treatment at As a moral ill-treatment at workwork

• Mobbing (Bullying) Mobbing (Bullying) definition:definition:– Repetitive and abusive Repetitive and abusive

attitudes at work attitudes at work (=harassment)(=harassment)

– The behaviors separately The behaviors separately considered are insignificantsconsidered are insignificants

– H. Leymann process:H. Leymann process:• To isolate the victimTo isolate the victim• To prevent her to ask help or To prevent her to ask help or

to express oneselfto express oneself• To bring her into disrepute To bring her into disrepute

toward colleagues or toward colleagues or hierarchyhierarchy

• To hit the victim in his To hit the victim in his dignity (humiliations)dignity (humiliations)

• To compromise the health of To compromise the health of the victimthe victim

– Goal: Goal: • Destruction of the moral Destruction of the moral

integrityintegrity

Mobbing:Mobbing:Aim and hypothesisAim and hypothesis

• Has mobbing severe psychiatric Has mobbing severe psychiatric consequences?consequences?

• Has mobbing severe psycho-social Has mobbing severe psycho-social outcomes?outcomes?

• What are the characteristics of the What are the characteristics of the victims?victims?

Mobbing: MethodologyMobbing: Methodology• Design: retrospective Design: retrospective

studystudy• Sample:Sample:

– Source: Source: outpatients of the outpatients of the “clinique du stress” CHU-“clinique du stress” CHU-Brugmann, Brussels since Brugmann, Brussels since September 2002 to September 2002 to august 2005.august 2005.

– Inclusive criteria:Inclusive criteria:• Step 1:Step 1:

All patients who met the All patients who met the definition of a definition of a pathological chronic pathological chronic stress were assessed stress were assessed (N= 395)(N= 395)

– Definition of a Definition of a chronic pathological chronic pathological stress:stress:• A persistent state of A persistent state of

tension negatively tension negatively perceivedperceived

• Where someone is or Where someone is or feels unable to feels unable to answer adequately to answer adequately to the taskthe task

• Where this inability Where this inability may have significant may have significant consequencesconsequences

• With psychological, With psychological, physical and/or physical and/or functional impactfunctional impact

Mobbing: MethodologyMobbing: Methodology

– Inclusive criteriaInclusive criteria• Step 2:Step 2:

Only patients who attribute Only patients who attribute the main source of stress to the main source of stress to the job were maintained in the job were maintained in the sample (N= 341)the sample (N= 341)

• Step 3:Step 3:

Following the H. Leymann Following the H. Leymann criteria the sample was criteria the sample was divided in 2 subgroupsdivided in 2 subgroups

– Perceived mobbing N= 101Perceived mobbing N= 101– Stressed patients without Stressed patients without

perceived mobbing N=228perceived mobbing N=228

Mobbing: MethodologyMobbing: Methodology

• ToolsTools• Clinical assessment:Clinical assessment:

– GHQ-28 of D. Goldberg GHQ-28 of D. Goldberg (General Health (General Health Questionnaire) with 4 Questionnaire) with 4 subscalessubscales

• AnxietyAnxiety• DepressionDepression• SummarizationsSummarizations• DisabilityDisability

– Beck Depression Beck Depression InventoryInventory

– Perceived stress of Cohen Perceived stress of Cohen and Williamsonand Williamson

– Stress at work of LegeronStress at work of Legeron– Maslach Burn Out Maslach Burn Out

InventoryInventory

• Attitudes and behaviors Attitudes and behaviors toward stresstoward stress– Locus of controlLocus of control– CopingsCopings– AssertivityAssertivity– Alexythymia (TAS-20)Alexythymia (TAS-20)

• Clinical interview and Clinical interview and follow-up by psychologists follow-up by psychologists and/or psychiatristsand/or psychiatrists– Anamnesis dataAnamnesis data– Sociologic dataSociologic data– TreatmentTreatment

• DrugsDrugs• PsychotherapyPsychotherapy• Medical disablement to Medical disablement to

workwork

Mobbing: resultsMobbing: results1- Has mobbing severe psychiatric 1- Has mobbing severe psychiatric

consequences?consequences?

20,88

16,79

0 7 14 21 28

Score GHQ

Mobbing

Stress

GHQ-28 Anova p<.0001



5,783,65

7,475,93

10,178,41

8,446,19

0 2 4 6 8 10 12 14

GHQ Score

Somatization****

Anxiety****

Functionalimpact***

Depression****

GHQ-28 Anova ***p<.001 ****p<.0001

Mobbing

Stress



14,66

11,88

0 4 8 12 16 20 24 28 32 36

Beck Score

Mobbing

Stress

Beck Depression Inventory Anova p=.0019



49,73

47,3

14 21 28 35 42 49 56 63 70

Cohen & Williamson score

Mobbing

Stress

Perceived stress Anova p=.0117



6,18

5,44

0 2 4 6 8

Mobbing

Stress

Burn Out Level (MBI) Anova p=.0105

Mobbing: resultsMobbing: results2- What are the outcomes?2- What are the outcomes?

• Length of follow-Length of follow-up: up: NSNS– Mobbing: 10,09 Mobbing: 10,09

months sd 8,91months sd 8,91– Stress: 9,03 months Stress: 9,03 months

sd 8,12sd 8,12

Work disablement Chi Square p=.0001

76%

51%

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

Mobbing

Stress

Work disablement: lenght in months Anova NS

9,36

6,88

0 1 2 3 4 5 6 7 8 9 10

Mobbing

Stress

Months


Treatment Chi Square *p<.05

65%

37%

20%

71%

52%

60%

65%

35%

25%

69%

55%

47%

0% 20% 40% 60% 80% 100%

Antidepressivedrugs

Anxiolytics

Hypnotics

Relaxation

SpecifiedPsychotherapy

SupportivePsychotherapy*

Mobbing

Stress


Work outcomes Chi Square ****p<.0001 others NS

96%

27%

27%

33%

9%

97%

64%

19%

7%

11%

0% 20% 40% 60% 80% 100%

Return to labormarket

Same job****

Mutation

Sacked****

Resign

Mobbing

Stress

Mobbing: resultsMobbing: results3- Characteristics3- Characteristics

a) Attitudes toward stressa) Attitudes toward stress• Locus of controlLocus of control

– Internality (0 to 6)Internality (0 to 6)• Mobbing: Mean 2,52 sd Mobbing: Mean 2,52 sd

1,541,54• Stress: Mean 3,09 sd Stress: Mean 3,09 sd

1,651,65• Anova p=.0038Anova p=.0038

– Externality (0 to 6)Externality (0 to 6)• Mobbing: Mean 1,95 sd Mobbing: Mean 1,95 sd

1,41,4• Stress: Mean 1,71 sd Stress: Mean 1,71 sd

1,451,45• Anova NSAnova NS

=> Less internality=> Less internality

• CopingsCopings=> Nearly same or => Nearly same or

betterbetter

4,053,73

6,836,53

6,125,37

5,34,91

0 3 6 9 12 15

Emotions

Limits*

Plan & help

Withdrawal

Coping Anova *p<.05 others NS

Mobbing

Stress


a) Attitudes toward stressa) Attitudes toward stress• EmotionsEmotions

– Bad perceptionsBad perceptions(0 to 35, cutting point 14)(0 to 35, cutting point 14)

• Mobbing: 19,8 sd 6,35Mobbing: 19,8 sd 6,35• Stress: 21,49 sd 6,65Stress: 21,49 sd 6,65• Anova NSAnova NS

– Bad verbalizationsBad verbalizations(0 to 25, cutting point 10)(0 to 25, cutting point 10)

• Mobbing: 13,76 sd 4,66Mobbing: 13,76 sd 4,66• Stress: 16,05 sd 4,94Stress: 16,05 sd 4,94• Anova p=.0014Anova p=.0014

– Avoidance of emotionsAvoidance of emotions(0 to 40, cutting point 16)(0 to 40, cutting point 16)

• Mobbing: 14,39 sd 4,81Mobbing: 14,39 sd 4,81• Stress: 15,38 sd 4,78Stress: 15,38 sd 4,78

=> => Bad perceptions and Bad perceptions and verbalizations but similar verbalizations but similar or better than stressed or better than stressed patients without mobbingpatients without mobbing

• AssertivityAssertivity=> => similarsimilar

6,23

6,61

8,03

8,45

11,23

10,76

0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15

Assertive

Passive

Agressive

Assertivity Anova NS

Mobbing

Stress


b) Sociological datab) Sociological data

• Age : NS mean 42 years sd 8,55Age : NS mean 42 years sd 8,55• Gender: mobbing Gender: mobbing 60% female60% female vs vs

48% stressed (Chi Square p=.0351)48% stressed (Chi Square p=.0351)• Life milieu: NS 65% founded homeLife milieu: NS 65% founded home• Civil status: mobbing Civil status: mobbing 21% divorced21% divorced

vs 7% (Chi Square p=.0111)vs 7% (Chi Square p=.0111)• Education: NS 56% University or Education: NS 56% University or

High SchoolHigh School


c) complaintsc) complaints

83%79%

67%60%

67%

52%

64%

38%41%

25%29%

16%

29%

15%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%Ti

redn

ess

Early

wak

e up

Neck

tens

ions

*Li

bido

- **

Diarrh

oea*

*

Loos

e of

wei

ght**

Bruxi

sm**

Complaints Chi square *p<.05 **p<.01 others NS

Mobbing

Stress

Mobbing: discussionMobbing: discussionLegal prosecutionLegal prosecution

• In Belgium two procedures are recognized to prosecute an harassing In Belgium two procedures are recognized to prosecute an harassing peoplepeople– Internal procedure inside the companyInternal procedure inside the company– Justice procedureJustice procedure

20%

16%

64%

0% 20% 40% 60% 80% 100%

Internal procedure

Justice

No Procedure

Prosecutions

Mobbing: discussionMobbing: discussionPost Traumatic Stress Post Traumatic Stress

Disorder (PTSD) ?Disorder (PTSD) ?

Reviviscence Avoidance Hyper arousal

Symptoms:

Mobbing: discussionMobbing: discussionPTSD ?PTSD ?

• 43% of the victims have all the symptoms43% of the victims have all the symptoms

• Is mobbing a life threatening situation?Is mobbing a life threatening situation?– From the witnesses: From the witnesses: NONO – From the victim: From the victim: YESYES

• Spontaneously they compare mobbing to the most life Spontaneously they compare mobbing to the most life frightful situations frightful situations

““The XYZ company, it is Guantanamo in Brussels”The XYZ company, it is Guantanamo in Brussels”““When I gona better, I saw my inner city and what I look was When I gona better, I saw my inner city and what I look was Hiroshima”Hiroshima”““For me to be victim of mobbing is like to be a concentration For me to be victim of mobbing is like to be a concentration camp survival: the same difficulties to speak about, the same camp survival: the same difficulties to speak about, the same incredible story, the same silence …”incredible story, the same silence …”

• Should we include in the definition of life threatening Should we include in the definition of life threatening situation, the destruction of the moral integrity also?situation, the destruction of the moral integrity also?

Mobbing: ConclusionsMobbing: Conclusions• Mobbing has severe psychiatric consequencesMobbing has severe psychiatric consequences (GHQ-28 = 21) (GHQ-28 = 21)• OutcomesOutcomes

– Long time disablement (mean 9 months for 76% of them)Long time disablement (mean 9 months for 76% of them)– 2/3 anti depressive drugs, 60% supportive therapy, ½ specified 2/3 anti depressive drugs, 60% supportive therapy, ½ specified

psychotherapypsychotherapy– only 27% return to the same job after treatment, 33% are only 27% return to the same job after treatment, 33% are

sackedsacked• CharacteristicsCharacteristics

– Similar or better attitude toward stressSimilar or better attitude toward stress– More female and divorcedMore female and divorced– Neck tensions, decrease of libido, loose of weight, diarrhea, Neck tensions, decrease of libido, loose of weight, diarrhea,

bruxism + Tiredness & early wake upbruxism + Tiredness & early wake up• ProsecutionsProsecutions

– 2/3 with no prosecution2/3 with no prosecution• PTSDPTSD

– 43% have all the symptoms => extension of the life threatening 43% have all the symptoms => extension of the life threatening definition?definition?

mobbing psychiatric impacts and psycho-social outcomes professor philippe corten van driette y.,...

Documents

ns mobbing

background mobbing

perceived mobbing n

mobbing psychiatric

williamson stress

moral integrity slide

pathological chronic

chronic pathological