1. Mobbing Psychiatric impacts and psycho-social outcomes Professor Philippe Corten Van Driette Y., Dewell P., From L., Friedrich A., Tiv Ph., Pelc I. Clinique du Stress - 2005

2. Mobbing: Background Mobbing was described byMobbing was described by –H. Leymann –M-F. Hirigoyen –Ch. Dejours As a moral ill-treatment at work Mobbing (Bullying) definition: –Repetitive and abusive attitudes at work (=harassment) –The behaviors separately considered are insignificants –H. Leymann process: To isolate the victim To prevent her to ask help or to express oneself To bring her into disrepute toward colleagues or hierarchy To hit the victim in his dignity (humiliations) To compromise the health of the victim –Goal: Destruction of the moral integrity

3. Mobbing: Aim and hypothesis Has mobbing severe psychiatric consequences?Has mobbing severe psychiatric consequences? Has mobbing severe psycho-social outcomes?Has mobbing severe psycho-social outcomes? What are the characteristics of the victims?What are the characteristics of the victims?

4. Mobbing: Methodology Design: retrospective studyDesign: retrospective study Sample:Sample: –Source: outpatients of the “clinique du stress” CHU-Brugmann, Brussels since September 2002 to august 2005. –Inclusive criteria: Step 1:Step 1: All patients who met the definition of a pathological chronic stress were assessed (N= 395) –Definition of a chronic pathological stress: A persistent state of tension negatively perceived Where someone is or feels unable to answer adequately to the task Where this inability may have significant consequences With psychological, physical and/or functional impact

5. Mobbing: Methodology –Inclusive criteria Step 2:Step 2: Only patients who attribute the main source of stress to the job were maintained in the sample (N= 341) Step 3:Step 3: Following the H. Leymann criteria the sample was divided in 2 subgroups –Perceived mobbing N= 101 –Stressed patients without perceived mobbing N=228

6. Mobbing: Methodology ToolsTools Clinical assessment:Clinical assessment: –GHQ-28 of D. Goldberg (General Health Questionnaire) with 4 subscales AnxietyAnxiety DepressionDepression SummarizationsSummarizations DisabilityDisability –Beck Depression Inventory –Perceived stress of Cohen and Williamson –Stress at work of Legeron –Maslach Burn Out Inventory Attitudes and behaviors toward stress –Locus of control –Copings –Assertivity –Alexythymia (TAS-20) Clinical interview and follow-up by psychologists and/or psychiatrists –Anamnesis data –Sociologic data –Treatment Drugs Psychotherapy Medical disablement to work

7. Mobbing: results 1- Has mobbing severe psychiatric consequences?

12. Mobbing: results 2- What are the outcomes? Length of follow-up: NSLength of follow-up: NS –Mobbing: 10,09 months sd 8,91 –Stress: 9,03 months sd 8,12

13. Mobbing: results 2- What are the outcomes?

15. Mobbing: results 3- Characteristics a) Attitudes toward stress Locus of controlLocus of control –Internality (0 to 6) Mobbing: Mean 2,52 sd 1,54Mobbing: Mean 2,52 sd 1,54 Stress: Mean 3,09 sd 1,65Stress: Mean 3,09 sd 1,65 Anova p=.0038Anova p=.0038 –Externality (0 to 6) Mobbing: Mean 1,95 sd 1,4Mobbing: Mean 1,95 sd 1,4 Stress: Mean 1,71 sd 1,45Stress: Mean 1,71 sd 1,45 Anova NSAnova NS => Less internality Copings => Nearly same or better

16. Mobbing: results 3- Characteristics a) Attitudes toward stress EmotionsEmotions –Bad perceptions (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 verbalizations (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 emotions (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 verbalizations but similar or better than stressed patients without mobbing Assertivity => similar

17. Mobbing: results 3- Characteristics b) Sociological data Age : NS mean 42 years sd 8,55Age : NS mean 42 years sd 8,55 Gender: mobbing 60% female vs 48% stressed (Chi Square p=.0351)Gender: mobbing 60% female vs 48% stressed (Chi Square p=.0351) Life milieu: NS 65% founded homeLife milieu: NS 65% founded home Civil status: mobbing 21% divorced vs 7% (Chi Square p=.0111)Civil status: mobbing 21% divorced vs 7% (Chi Square p=.0111) Education: NS 56% University or High SchoolEducation: NS 56% University or High School

18. Mobbing: results 3- Characteristics c) complaints

19. Mobbing: discussion Legal prosecution In Belgium two procedures are recognized to prosecute an harassing peopleIn Belgium two procedures are recognized to prosecute an harassing people –Internal procedure inside the company –Justice procedure

20. Mobbing: discussion Post Traumatic Stress Disorder (PTSD) ? ReviviscenceAvoidanceHyper arousal Symptoms:

21. Mobbing: discussion 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: NO –From the victim: YES Spontaneously they compare mobbing to the most life frightful situationsSpontaneously they compare mobbing to the most life frightful situations “The XYZ company, it is Guantanamo in Brussels” “When I gona better, I saw my inner city and what I look was Hiroshima” “For me to be victim of mobbing is like to be a concentration camp survival: the same difficulties to speak about, the same incredible story, the same silence …” Should we include in the definition of life threatening situation, the destruction of the moral integrity also?Should we include in the definition of life threatening situation, the destruction of the moral integrity also?

22. Mobbing: Conclusions Mobbing has severe psychiatric consequences (GHQ-28 = 21)Mobbing has severe psychiatric consequences (GHQ-28 = 21) OutcomesOutcomes –Long time disablement (mean 9 months for 76% of them) –2/3 anti depressive drugs, 60% supportive therapy, ½ specified psychotherapy – only 27% return to the same job after treatment, 33% are sacked CharacteristicsCharacteristics –Similar or better attitude toward stress –More female and divorced –Neck tensions, decrease of libido, loose of weight, diarrhea, bruxism + Tiredness & early wake up ProsecutionsProsecutions –2/3 with no prosecution PTSDPTSD –43% have all the symptoms => extension of the life threatening definition?