• Almas Iqbal Shalamar Medical College and Teaching Hospital- Lahore
  • Afshan Khattak Ministry of Health, United Arab Emirates & Chairperson of Society for Undergraduate Medical Research (SUMR) Peshawar, Pakistan
  • Farhat R Malik Peshawar Medical College, Warsak Road, Peshawar. Riphah International University, Islamabad. Pakistan.


Background Bullying is a well-recognized negative behaviour, involving a perpetrator and a victim, with negative physical and/or psychological consequences. Bullying, as a multifaceted form of mistreatment, came to the attention of academic and administrative teams in schools and the workplace, more than three decades ago. Workplace bullying is well recognized to lead to anxiety, depression, feeling of helplessness, higher risks of cardiovascular disease and suicidal ideation among its victims. Healthcare teams face high odds and challenging roles in intensive care units and operating theatres. The objective of the study was to determine the prevalence of bullying behaviour through (Revised), Negative Attitudes Questionnaire (NAQ-R), among healthcare team members in an operating theatre of a Tertiary Care hospital in Lahore Methods A cross-sectional pilot study was conducted, through a validated tool, Negative Attitude Questionnaire-Revised (NAQ-R). An online survey was posted through Survey Monkey. Data analysed through SPSS Version- 19 by computing descriptive statistics as frequency and percentages with graph construction. Results One hundred thirty-one complete responses received out of 139 with a response rate of 94.24%. Responses were from both government (53%) and private sector (47%) hospitals. Norway cut off values used for analysis. Overall, 32% were not bullied whereas 68% were bullied, 47.6% were victims of bullying frequently and rest occasionally. Bullying behaviour across gender confirmed higher frequency in women as compared to men (83% vs 58%) with frequent bullying also more common in women when compared with males (51% versus 18%). Conclusion Bullying occurs in both genders although, predominantly more among womenKeywords: Bullying; Behaviour; Gender; Pilot Study; Anxiety; Depression; Prevalence; Aggression; Female; NAQ- R

Author Biographies

Almas Iqbal, Shalamar Medical College and Teaching Hospital- Lahore

Department of Anesthesia / Assistant Professor

Afshan Khattak, Ministry of Health, United Arab Emirates & Chairperson of Society for Undergraduate Medical Research (SUMR) Peshawar, Pakistan

Pediatrics / Senior Consultant

Farhat R Malik, Peshawar Medical College, Warsak Road, Peshawar. Riphah International University, Islamabad. Pakistan.

Community Health Sciences/ Associate Professor


Olweus D. Norway. In: Smith PK, Morita Y, Junger-Tas J, Olweus D, Catalano R, Slee Pl, editors. The nature of school bullying: a cross-national perspective, 1st ed. London: Routledge, 1999; p.31.

Einarsen S, Hoel H, Zapf D, Cooper CL. The concept of bullying at work. In: Einarsen S, Hoel H, Zapf D, Cooper CL, editors. Bullying and emotional abuse in the workplace: international perspectives in research and practice, 1st ed. London: Taylor and Francis, 2003; p.6.

European working conditions survey. Violence, harassment and discrimination in the workplace. Dublin: European Foundation for the Improvement of Living and Working Conditions; 2005 [Internet] Fourth European Working Conditions Survey [cited 2018 Sep 20th]. Available from: http://www.eurofound.europa.eu/docs/ewco/4EWCS/ef0698/chapter4.pdf

Due P, Holstein BE, Soc MS. Bullying victimization among 13 to 15-year-old school children: results from two comparative studies in 66 countries and regions. Int J Adolesc Med Health 2008; 20:209–21.

Srabstein J, Leventhal B. Prevention of bullying-related morbidity and mortality: A call of public health policies. Bull World Health Organ 2010; 88:403.

Kivimaki M, Virtanen M, Vartia M, Elovainio M, Vahtera J, Keltikangas-Jarvinen L. Workplace bullying and the risk of cardiovascular disease and depression. Occup Environ Med 2003;60(10):779–83.

Gullander M, Hogh A, Hansen AM, Persson R, Rugulies R, Kolstad HA, et al. Exposure to workplace bullying and risk of depression. J Occup Environ Med 2014;56(12):1258–65.

Nielsen MB, Nielsen GH, Notelaers G, Einarsen S. Workplace Bullying and Suicidal Ideation: A 3-Wave Longitudinal Norwegian Study. Am J Public Health 2015;105(11): e23–8.

Kivimäki M, Elovainio M, Vahtera J. Workplace bullying and sickness absence in hospital staff. Occup Environ Med 2000;57(10):656–60.

Paice E, Smith D. Bullying of trainee doctors is a patient safety issue. Clin Teach 2009;6 (1):13–7.

Report of the Mid Staffordshire NHS Foundation Trust Public Inquiry. February 2013 Executive Summary. Published by The Stationery Office (TSO) [Internet] [cited 2019 Jan 3rd]. Available from: https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/279124/0947.pdf

Halligan A. The Francis report: what you permit, you promote. J R Soc Med 2013;106(4):116–7.

Riskin A, Erez A, Foulk TA, Kugelman A, Gover A, et al. The Impact of Rudeness on Medical Team Performance: A Randomized Trial. Pediatrics 2015;136(3):487–95.

Crebbin W, Campbell G, Hillis DA, Watters DA. Prevalence of bullying, discrimination and sexual harassment in surgery in Australasia. ANZ J Surg 2015;85(12):905–9.

Nielsen MB, Hetland J, Matthiesen SB, Einarsen S. Longitudinal relationships between workplace bullying and psychological distress. Scand J Work Environ Health 2012;38(1):38–46.

Notelaers G, Einarsen S. The world turns at 33 and 45: Defining simple cutoff scores for the Negative Acts Questionnaire-Revised in a representative sample. Eur J Work Organ Psychol 2013;22(6):670–82.

Gupta R, Bakhshi A, Einarsen S. Investigating Workplace Bullying in India: Psychometric Properties, Validity, and Cutoff Scores of Negative Acts Questionnaire-Revised. SAGE Open 2017;7(2):2158244017715674.

Leymann H. Mobbing and psychological terror at workplaces. Violence Vict 1990;5(2):119–26.

Wise J. Significant numbers of consultant obstetricians and gynecologists report bullying. BMJ 2016; 353: i3576.

Drosdeck JM, Osayi SN, Peterson LA, Yu L, Ellison EC, Muscarella P. Surgeon and nonsurgeon personalities at different career points. J Surg Res 2015;196(1):60–6.

Whitaker M. The surgical personality: does it exist? Ann R Coll Surg Engl 2018;100(1):72–7.

Ariza-Montes JA, Muniz R NM, Leal-Rodríguez AL, Leal-Millán AG. Workplace bullying among managers: a multifactorial perspective and understanding. Int J Environ Res Public Health 2014;11(3):2657–82.

Villafranca A, Hamlin C, Enns S, Jacobsohn E. Disruptive behaviour in the perioperative setting: a contemporary review. Can J Anaesth 2017;64(2):128–40.