Prevalence and risk factors for intimate partner violence among ICU nurses

Intimate partner violence (IPV) is a significant global public health issue, with far-reaching consequences for both physical and mental health [1]. Approximately one-third of women worldwide have experienced IPV in intimate relationships [2, 3]. IPV victims are at increased risk of physical harm, mental health disorders such as depression and anxiety, and long-term psychological trauma [4]. Moreover, IPV has broader societal impacts, including disrupted family dynamics, impaired child development, and greater demands on social welfare and healthcare systems [5]. In China, the lifetime prevalence of IPV among women is 19% [6], with regional variations influenced by cultural norms, legal frameworks, and healthcare practices [2]. While much IPV research in healthcare focuses on clinicians’ capacity to identify and manage IPV in patients [7, 8], little attention has been paid to the vulnerability of healthcare workers themselves. A study of 471 female healthcare professionals in Australia found that nearly half had experienced IPV, underscoring the prevalence of IPV within the healthcare sector [9]. This issue is further exacerbated by the fact that nursing is widely regarded as a highly stressful profession, where work-related stress poses a continuous challenge to nurses’ emotional well-being and overall health, thereby significantly affecting their ability to balance personal and professional responsibilities [10, 11].

ICU nurses face distinct occupational pressures compared to nurses in other departments [12]. They are required to respond to critical and urgent situations, make high-risk decisions quickly, and work under severe time constraints [13]. These high-intensity demands, combined with structural stressors such as long shifts and irregular schedules, contribute to increased emotional exhaustion and family conflict [14, 15]. A cross-sectional study with a total of 616 Chinese nurses in ICU indicates that 48.2% of ICU nurses experience burnout, and 64.1% report depressive symptoms, highlighting the significant impact of these stressors on their mental health [16]. Additionally, the frequent occurrence of work-family conflicts, due to extended overtime and rotating shifts, is a common issue among ICU nurses. This stress pattern has been observed in medical systems in Belgium and Jordan as well [17, 18].

ICU nurses experience significantly higher levels of occupational stress compared to their counterparts in other departments. Factors such as long working hours, high-acuity patient care, and emotional exhaustion increase their vulnerability to IPV [14, 15, 19]. The high-stress work environment, coupled with limited social support, exacerbates this vulnerability, as workplace stress often spills over into personal relationships, further increasing the risk of IPV [12, 13]. In addition to professional demands, ICU nurses are exposed to verbal and physical violence in the workplace [20]. A study of 139,533 healthcare workers across 32 countries found that up to 97% experienced verbal violence, and 82% experienced physical violence. ICU workers were shown to have a significantly higher risk, with increased risk ratios of up to 2.3 or odds ratios as high as 22.9 compared to healthcare workers in other departments [21]. These traumatic experiences further compound emotional strain, creating a dual erosion of both career and family life. When work demands occupy time for personal communication and family interaction, work-family conflict becomes a vicious cycle [14]. Yang et al. [22] found that ICU nurses experience more work-family conflict than nurses in other settings, which is strongly associated with increased anxiety and depressive symptoms, highlighting its effect on emotional well-being. This conflict not only exacerbates emotional distress but also negatively impacts professional performance and overall quality of life [23, 24]. The resulting work-family conflict significantly heightens the likelihood of anxiety and depression, thereby increasing the risk of IPV among ICU nurses [25, 26].

Research has shown that strong social support can help mitigate the psychological effects of work-related stress, reducing the likelihood of IPV, while insufficient support can exacerbate emotional distress and increase the risk of IPV [27, 28]. However, the prevalence and specific risk factors for IPV among ICU nurses remain largely underexplored. This study aims to address this gap by investigating the prevalence of IPV among Chinese ICU nurses, providing valuable insights for the development of targeted interventions.

This study examined the prevalence and risk factors of IPV among ICU nurses in China, revealing an overall IPV prevalence of 58.1%, which reflects a notably high level of IPV within this group. This rate is lower than the 74.26% reported in a study of female nurses in Chinese public hospitals [41], potentially due to the inclusion of male nurses, whose intimate relationship dynamics may differ. Additional influences, such as work-related stress, social support, cultural norms, and family responsibilities, may also affect IPV prevalence [2]. Traditional gender roles in Chinese society, where men are often perceived as primary financial providers and authority figures, may contribute to power imbalances that heighten IPV risk [42, 43]. Further research is needed to explore these sociocultural influences. In contrast to studies in Australia [9], which reported lower IPV rates among healthcare workers, the higher prevalence of IPV among ICU nurses in China may be partly attributed to the high-stress ICU work environment. Such an environment can strain family relationships and increase IPV risk, particularly in the context of cultural and social factors unique to China [19].

Our study also found that psychological aggression (61.3%) and negotiation disputes (67.6%) were the most prevalent forms of IPV, surpassing physical assault (41.4%), injury (18.9%), and sexual coercion (8.1%). ICU nurses face significant emotional demands, such as emotional exhaustion and empathic fatigue, which can impair emotional regulation and conflict resolution skills, making them more susceptible to psychological aggression and negotiation disputes [14, 15]. Furthermore, exposure to workplace violence can deplete emotional resources, increasing the risk of IPV [20]. While physical and sexual violence were less common, these forms of IPV may be underreported due to gender power imbalances and cultural stigma, particularly regarding sexual coercion. When comparing ICU nurses to surgeons [44], differences in the types of IPV were noted, with ICU nurses experiencing more psychological aggression and surgeons reporting higher rates of emotional abuse and controlling behaviors. These disparities may be influenced by differences in workplace culture, gender distribution, and IPV measurement methods. Nevertheless, these findings highlight how work-related stress can negatively impact family relationships and dynamics. Prolonged verbal insults and emotional neglect not only affect personal well-being but also contribute to anxiety, depression, and a decline in the quality of care provided by nurses [45].

Several risk factors for IPV among ICU nurses were identified in this study. Notably, being an only child, the partner’s age, and occupation were significant predictors. In China’s distinct family structure, only children often face significant family expectations and pressure, which can lead to conflicts and violence within the family, thereby raising the risk of IPV [46]. Additionally, younger partners were associated with a lower risk of IPV among ICU nurses, while older partners, influenced by traditional gender roles, often expect wives to assume household and caregiving responsibilities [47]. The disconnect between these traditional expectations and the demanding nature of ICU nursing can heighten the risk of conflict and IPV. Furthermore, older partners may experience midlife crises, leading to increased psychological stress [48]. These findings highlight how both work-related and family-related factors contribute to the elevated risk of IPV among ICU nurses.

Another important finding is that IPV risk was lower when the partner was employed, likely due to the financial stability that employment provides, reducing economic stress [49]. Financial independence allows both partners to share the economic burden more equally, which can lead to a more balanced relationship and fewer conflicts arising from financial issues. Furthermore, studies have shown that unemployed individuals often experience poor social engagement and low self-esteem, while employed partners can gain social support, a sense of achievement, and a stable social network, all of which contribute to better stress management and a healthier marital relationship [50]. Therefore, employment status plays a key role in moderating the risk of IPV, suggesting that a stable financial and social environment may reduce the likelihood of violence.

The study also uncovered significant differences in dyadic coping, social support, and psychological symptoms between ICU nurses who experienced IPV and those who did not. Studies indicate that higher levels of supportive coping are associated with a reduced likelihood of physical victimization, while negative coping strategies are linked to an increased risk of physical violence [51]. In terms of social support, ICU nurses who experienced IPV scored significantly lower on the social relationships levels compared to those who did not. These findings are consistent with a multicenter study involving 3,496 adults from six European countries, which found that individuals reporting physical assault victimization had lower levels of social support [52]. This suggests that a lack of social support can exacerbate the risk of IPV.

Interestingly, while there were no significant differences in depression symptoms between ICU nurses who had experienced IPV and those who had not, anxiety symptoms were significantly higher in the IPV group. Depression can be influenced by various factors, such as genetics, life experiences, and psychosocial stressors, making it difficult to attribute changes solely to IPV [53, 54]. This is consistent with a study in Nepal during the COVID-19 pandemic, which found no significant differences in depression among ICU nurses, regardless of whether they worked in COVID or non-COVID units [55]. However, our study highlights the significant difference in anxiety symptoms, suggesting that IPV may trigger more immediate psychological responses, such as anxiety, which are linked to prolonged stress and fear from intimate relationships [56]. The significant impact of anxiety underscores the importance of providing targeted psychological support for nurses experiencing IPV, particularly in improving dyadic coping skills and enhancing mental health. Addressing the psychological well-being of IPV victims in the workplace can significantly improve their overall health and ability to cope with both work and personal stressors.

This study found that 58.1% of ICU nurses reported experiencing IPV, with negotiation being the most commonly reported form and sexual coercion the least. Factors such as being an only child, the partner’s age, and the partner’s occupation were identified as significant contributors to IPV risk. Given the high prevalence of IPV among ICU nurses, enhancing psychological support in the workplace and implementing a robust work scheduling system could alleviate work-related stress, potentially reducing the risk of IPV.