Spillover Effects of Violent Attacks and COVID-19 Exposure on Mental Health of Health Professionals: A Two-Phase Quasi-Natural Experiments Study in Northwest China

Background: The increasing violent attacks against health professionals have gained global concern in the pandemic era. However, most studies presented observational evidence for what happened in the COVID-19 context and paid great attention to health professionals who experienced violence and COVID-19. We quantify the spillover effects of violent attacks, COVID-19 exposure, and their interactions on health professionals’ mental health, and the role of organizational support in their relationships in China.Methods: A two-phase individual survey data (n=10,901) before and after the first outbreak of COVID-19 was integrated with regional macro data on the number of lawsuit cases of violent attacks and COVID-19 cases. Three studies were designed to isolate the general spillover impact of violent attacks on mental health of health professionals, how COVID-19 affects the mental health of health professionals, and whether organizational support moderates the relationship between violent attacks and mental health through econometric regressions.Findings: Violent attacks and COVID-19 are negatively associated with the mental health of health professionals, and the outbreak of COVID-19 adversely deteriorates the spillover effects of violent attacks. Physicians, not nurses, are the most affected group. Better perceived support from hospitals can significantly mitigate the adverse effects of COVID-19, violent attacks, and their interactions on mental health of health professionals.Interpretation: COVID-19 deteriorates the adverse effects of violent attacks on mental health of health professionals in the pandemic era, while better organizational support is helpful to mitigate these effects.Funding: This work was supported by MOE (Ministry of Education in China), Liberal arts and Social Sciences Foundation [21YJC630082].Declaration of Interest: The authors declare no conflict of interest.Ethical Approval: The study protocol was approved by the Ethics Committee, the First Hospital of Lanzhou University (LDYYLL2023-61). All participants gave informed consent after being informed about the aims of the survey and joined the study voluntarily. All methods were carried out in accordance with relevant guidelines and regulations.