Restricted accessResearch articleFirst published online 2025-9
The impact of workplace violence on the risk of suicide among Chinese correctional personnel: A chain mediation model with insomnia and depression as mediating variables
Prison correctional personnel often experience increased workplace violence (WPV) and higher risk of suicide, but the link between the two is not yet clear. This study aims to explore the specific mediating variables and mediating paths between WPV and suicide.
Methods:
This is a cross-sectional study of 472 Chinese correctional personnel conducted through an online survey. We used the Workplace Violence Scale (WVS), the Athens Insomnia Scale (AIS), the Chinese version of the Depression Anxiety Stress Scale (DASS), and the revised Beck Suicidal Ideation scale (BSI) to quantify the WPV experienced by subjects and their mental health status. Data analysis, including mediation and network analysis, was performed using SPSS and R software.
Results:
Presence of insomnia and/or depression mediated the relationship between WPV and suicide risk, which accounted for 36.62% of the total effect. Insomnia alone accounted for 9.87%, depression alone accounted for 12.73%, whereas both put together accounted for 14.03%. Male personnel experienced more WPV than their female counterparts, and WPV in men had a stronger association with suicide risk. Network analysis indicated that daytime dysfunction and downheartedness were important nodes in mediating pathways.
Conclusions:
Experiencing WPV may lead to an increased risk of suicide among correctional personnel, particularly men, with insomnia and depression mediating the experienced risk. Correctional institutions should take measures to reduce the occurrence of WPV experienced by correctional personnel mitigate the impact of this occupational hazard, and prioritise the mental health of correctional personnel, particularly those already experiencing worrying symptoms.
BaglioniC.BattaglieseG.FeigeB.SpiegelhalderK.NissenC.VoderholzerU.LombardoC.RiemannD. (2011). Insomnia as a predictor of depression: A meta-analytic evaluation of longitudinal epidemiological studies. Journal of Affective Disorders, 135(1-3), 10–19.
2.
BeckA. T.KovacsM.WeissmanA. (1979). Assessment of suicidal intention: The scale for suicide ideation. Journal of Consulting and Clinical Psychology, 47(2), 343–352.
3.
BentleyK. H.FranklinJ. C.RibeiroJ. D.KleimanE. M.FoxK. R.NockM. K. (2016). Anxiety and its disorders as risk factors for suicidal thoughts and behaviors: A meta-analytic review. Clinical Psychology Review, 43, 30–46.
4.
BernertR. A.JoinerT. E. (2007). Sleep disturbances and suicide risk: A review of the literature. Neuropsychiatric Disease and Treatment, 3(6), 735–743.
5.
BezerraG. L.CarvalhoF. M.FernandesR. C. P.SantosK. O. B. (2022). Sleep disorders in correctional officers: Cross-sectional study. Sleep Science, 15(1), 34–40.
6.
BrådvikL. (2018). Suicide risk and mental disorders. International Journal of Environmental Research and Public Health, 15(9), 2028.
7.
BryanC. J.GonzalesJ.RuddM. D.BryanA. O.ClemansT. A.Ray-SannerudB.WertenbergerE.LeesonB.HeronE. A.MorrowC. E.EtienneN. (2015). Depression mediates the relation of insomnia severity with suicide risk in three clinical samples of U.S. military personnel. Depression and Anxiety, 32(9), 647–655.
BuysseD. J. (2013). Insomnia. Journal of the American Medical Association, 309(7), 706–716.
10.
CanettoS. S.SakinofskyI. (1998). The gender paradox in suicide. Suicide and Life-Threatening Behavior, 28(1), 1–23.
11.
CarletonR. N.AfifiT. O.TaillieuT.TurnerS.KrakauerR.AndersonG. S.MacPheeR. S.RicciardelliR.CrammH. A.GrollD.McCrearyD. R. (2019). Exposures to potentially traumatic events among public safety personnel in Canada. Canadian Journal of Behavioural Science, 51(1), 37–52.
12.
CarletonR. N.AfifiT. O.TurnerS.TaillieuT.DuranceauS.LeBouthillierD. M.SareenJ.RicciardelliR.MacPheeR. S.GrollD.HozempaK.BrunetA.WeekesJ. R.GriffithsC. T.AbramsK. J.JonesN. A.BeshaiS.CrammH. A.DobsonK. S.. . . AsmundsonG. J. G. (2017). Mental disorder symptoms among public safety personnel in Canada. Canadian Journal of Psychiatry, 63(1), 54–64.
13.
CarletonR. N.AfifiT. O.TurnerS.TaillieuT.DuranceauS.LeBouthillierD. M.SareenJ.RicciardelliR.MacPheeR. S.GrollD.HozempaK.BrunetA.WeekesJ. R.GriffithsC. T.AbramsK. J.JonesN. A.BeshaiS.CrammH. A.DobsonK. S.. . . AsmundsonG. J. G. (2018). Mental disorder symptoms among public safety personnel in Canada. Canadian Journal of Psychiatry, 63(1), 54–64.
14.
CarletonR. N.AfifiT. O.TurnerS.TaillieuT.LeBouthillierD. M.DuranceauS.SareenJ.RicciardelliR.MacPheeR. S.GrollD.HozempaK.BrunetA.WeekesJ. R.GriffithsC. T.AbramsK. J.JonesN. A.BeshaiS.CrammH. A.DobsonK. S.. . . AsmundsonG. J. G. (2018). Suicidal ideation, plans, and attempts among public safety personnel in Canada. Canadian Psychology, 59(3), 220–231.
15.
CarletonR. N.RicciardelliR.TaillieuT.MitchellM. M.AndresE.AfifiT. O. (2020). Provincial correctional service workers: The prevalence of mental disorders. International Journal of Environmental Research and Public Health, 17(7), 2203.
16.
CashmoreA. W.IndigD.HamptonS. E.HegneyD. G.JalaludinB. B. (2012). Workplace violence in a large correctional health service in New South Wales, Australia: A retrospective review of incident management records. BMC Health Services Research, 12(1), 245.
17.
CherekD. R.LaneS. D. (1999). Laboratory and psychometric measurements of impulsivity among violent and nonviolent female parolees. Biological Psychiatry, 46(2), 273–280.
18.
CherekD. R.MoellerF. G.DoughertyD. M.RhoadesH. (1997). Studies of violent and nonviolent male parolees: II. Laboratory and psychometric measurements of impulsivity. Biological Psychiatry, 41(5), 523–529.
19.
ConwayP. M.ErlangsenA.GrynderupM. B.ClausenT.RuguliesR.BjornerJ. B.BurrH.FrancioliL.GardeA. H.HansenÅ. M.HansonL. M.Kirchheiner-RasmussenJ.KristensenT. S.MikkelsenE. G.StenagerE.ThorsenS. V.VilladsenE.HøghA. (2022). Workplace bullying and risk of suicide and suicide attempts: A register-based prospective cohort study of 98 330 participants in Denmark. Scandinavian Journal of Work Environment & Health, 48(6), 425–434.
20.
EpskampS.BorsboomD.FriedE. I. (2018). Estimating psychological networks and their accuracy: A tutorial paper. Behavior Research Methods, 50(1), 195–212.
21.
FordD. E.KamerowD. B. (1989). Epidemiologic study of sleep disturbances and psychiatric disorders. An opportunity for prevention?Journal of the American Medical Association, 262(11), 1479–1484.
22.
FriedmanJ.HastieT.TibshiraniR. (2008). Sparse inverse covariance estimation with the graphical lasso. Biostatistics, 9(3), 432–441.
23.
GonçalvesS. G.MesasA. E.BravoD. S.BirolimM. M.GuidoniC. M.AndradeS. M.RodriguesR. (2023). Association between sleep quality and occupational factors in Brazilian correctional officers. Behavioral Sleep Medicine, 21(4), 397–410.
24.
HarwoodD.HawtonK.HopeT.JacobyR. (2001). Psychiatric disorder and personality factors associated with suicide in older people: A descriptive and case-control study. International Journal of Geriatric Psychiatry, 16(2), 155–165.
25.
HayesA. F. (2017). Introduction to mediation, moderation, and conditional process analysis: A regression-based approach. Guilford Publications.
26.
HenrikssonM. M.AroH. M.MarttunenM. J.HeikkinenM. E.IsometsäE. T.KuoppasalmiK. I.LönnqvistJ. K. (1993). Mental disorders and comorbidity in suicide. American Journal of Psychiatry, 150(6), 935–940.
27.
HineB.BatesE. A.WallaceS. (2022). “I have guys call me and say ‘I can’t be the victim of domestic abuse’”: Exploring the experiences of telephone support providers for male victims of domestic violence and abuse. Journal of Interpersonal Violence, 37(7-8), n5594–n5625.
28.
JamesL.TodakN.BestS. (2017). The negative impact of prison work on sleep health. American Journal of Industrial Medicine, 60(5), 449–456.
29.
John MannJ.MinaM.RizkM. D. (2020). A brain-centric model of suicidal behavior. American Journal of Psychiatry, 177(10), 902–916.
30.
KalmbachD. A.ChengP.AhmedaniB. K.PetersonE. L.ReffiA. N.SagongC.SeymourG. M.RuprichM. K.DrakeC. L. (2022). Cognitive-behavioral therapy for insomnia prevents and alleviates suicidal ideation: Insomnia remission is a suicidolytic mechanism. Sleep, 45(12), zsac251.
31.
KinmanG.ClementsA. J. (2022). Prison officers’ experiences of aggression: Implications for sleep and recovery. Occupational Medicine, 72(9), 604–608.
32.
KrakauerR. L.StelnickiA. M.CarletonR. N. (2020). Examining mental health knowledge, stigma, and service use intentions among public safety personnel. Frontiers in Psychology, 11, 949.
33.
LavigneJ. E.HurK.GibbonsJ. B.PigeonW. R. (2023). Associations between insomnia medications and risk of death by suicide. Sleep Medicine, 111, 199–206.
34.
LiL.WuC.GanY.QuX.LuZ. (2016). Insomnia and the risk of depression: A meta-analysis of prospective cohort studies. BMC Psychiatry, 16(1), 375.
35.
LuoZ.WangJ.ZhouY.MaoQ.LangB.XuS. (2023). Workplace bullying and suicidal ideation and behaviour: A systematic review and meta-analysis. Public Health, 222, 166–174.
36.
MagnavitaN.Di StasioE.CapitanelliI.LopsE. A.ChiricoF.GarbarinoS. (2019). Sleep problems and workplace violence: A systematic review and meta-analysis. Frontiers in Neuroscience, 13, 997.
37.
Magnusson HansonL. L.PenttiJ.NordentoftM.XuT.RuguliesR.MadsenI. E. H.ConwayP. M.WesterlundH.VahteraJ.ErvastiJ.BattyG. D.KivimäkiM. (2023). Association of workplace violence and bullying with later suicide risk: A multicohort study and meta-analysis of published data. Lancet Public Health, 8(7), e494–e503.
38.
MannJ. J. (2002). A current perspective of suicide and attempted suicide. Annals of Internal Medicine, 136(4), 302–311.
39.
MansuriZ.ReddyA.VadukapuramR.ThootkurM.TrivediC. (2022). Does insomnia increase the risk of suicide in hospitalized patients with major depressive disorder? A nationwide inpatient analysis from 2006 to 2015. Behavioral Sciences, 12(5), 117.
40.
Möller-LeimkühlerA. M. (2003). The gender gap in suicide and premature death or: why are men so vulnerable?European Archives of Psychiatry and Clinical Neuroscience, 253(1), 1–8.
41.
NadorffM. R.NazemS.FiskeA. (2013). Insomnia symptoms, nightmares, and suicide risk: Duration of sleep disturbance matters. Suicide and Life-Threatening Behavior, 43(2), 139–149.
42.
NybergA.KecklundG.HansonL. M.RajaleidK. (2021). Workplace violence and health in human service industries: A systematic review of prospective and longitudinal studies. Occupational and Environmental Medicine, 78(2), 69–81.
43.
O’ConnorR. C.KirtleyO. J. (2018). The integrated motivational-volitional model of suicidal behaviour. Philosophical Transactions of The Royal Society of London. Series B, Biological Sciences, 373(1754), 20170268.
44.
OhayonM. M. (2002). Epidemiology of insomnia: what we know and what we still need to learn. Sleep Medicine Reviews, 6(2), 97–111.
45.
OpsahlT.AgneessensF.SkvoretzJ. (2010). Node centrality in weighted networks: Generalizing degree and shortest paths. Social Networks, 32(3), 245–251.
46.
OsmanA.WongJ. L.BaggeC. L.FreedenthalS.GutierrezP. M.LozanoG. (2012). The Depression Anxiety Stress Scales-21 (DASS-21): Further examination of dimensions, scale reliability, and correlates. Journal of Clinical Psychology, 68(12), 1322–1338.
47.
ParkC. H. K.LeeJ. W.LeeS. Y.MoonJ.JeonD. W.ShimS. H.ChoS. J.KimS. G.LeeJ.PaikJ. W.KimM. H.YouS.JeonH. J.RheeS. J.KimM. J.KimJ.AhnY. M. (2020). Suicide risk factors across suicidal ideators, single suicide attempters, and multiple suicide attempters. Journal of Psychiatric Research, 131, 1–8.
48.
PodsakoffP. M.MacKenzieS. B.LeeJ.-Y.PodsakoffN. P. (2003). Common method biases in behavioral research: A critical review of the literature and recommended remedies. E-Journal of Applied Psychology, 88(5), 879–903.
49.
Polanco-RomanL.GomezJ.MirandaR.JeglicE. (2016). Stress-related symptoms and suicidal ideation: The roles of rumination and depressive symptoms vary by gender. Cognitive Therapy and Research, 40(5), 606–616.
50.
RibeiroJ. D.HuangX.FoxK. R.FranklinJ. C. (2018). Depression and hopelessness as risk factors for suicide ideation, attempts and death: Meta-analysis of longitudinal studies. British Journal of Psychiatry, 212(5), 279–286.
51.
RicciardelliR.CarletonR. N.GrollD.CrammH. (2018). Qualitatively unpacking Canadian public safety personnel experiences of trauma and their well-being. Canadian Journal of Criminology and Criminal Justice, 60(4), 566–577.
52.
RicciardelliR.CzarnuchS.AfifiT. O.TaillieuT.CarletonR. N. (2020). Public safety personnel’s interpretations of potentially traumatic events. Occupational Medicine, 70(3), 155–161.
53.
RichiardiL.BelloccoR.ZugnaD. (2013). Mediation analysis in epidemiology: Methods, interpretation and bias. International Journal of Epidemiology, 42(5), 1511–1519.
54.
SeidlerZ. E.DawesA. J.RiceS. M.OliffeJ. L.DhillonH. M. (2016). The role of masculinity in men’s help-seeking for depression: A systematic review. Clinical Psychology Review, 49, 106–118.
SnavelyC.RomeoM.CiardielloA.MojicaM. (2021). The pandemic of workplace violence: The gendered experience of emergency medicine trainees. AEM Education and Training, 5(3), e10630.
57.
SoldatosC. R.DikeosD. G.PaparrigopoulosT. J. (2000). Athens insomnia scale: Validation of an instrument based on ICD-10 criteria. Journal of Psychosomatic Research, 48(6), 555–560.
58.
SutarR.KumarA.YadavV. (2023). Suicide and prevalence of mental disorders: A systematic review and meta-analysis of world data on case-control psychological autopsy studies. Psychiatry Research, 329, 115492.
TiesmanH. M.HendricksS. A.WiegandD. M.Lopes-CardozoB.RaoC. Y.HorterL.RoseC. E.ByrkitR. (2023). Workplace violence and the mental health of public health workers during COVID-19. American Journal of Preventive Medicine, 64(3), 315–325.
61.
UherR.PayneJ. L.PavlovaB.PerlisR. H. (2014). Major Depressive Disorder in DSM-5: Implications for clinical practice and research of changes from DSM-IV. Depression and Anxiety, 31(6), 459–471.
62.
van Den BerghB.GathererA.FraserA.MollerL. (2011). Imprisonment and women’s health: Concerns about gender sensitivity, human rights and public health. Bulletin of the World Health Organization, 89(9), 689–694.
63.
WangP. X.WangM. Z.HuG. X.WangZ. M. (2006). [Study on the relationship between workplace violence and work ability among health care professionals in Shangqiu City]. Wei Sheng Yan Jiu = Journal of Hygiene Research, 35(4), 472–474.
64.
WiebengaJ. X.EikelenboomM.HeeringH. D.van OppenP.PenninxB. W. (2021). Suicide ideation versus suicide attempt: Examining overlapping and differential determinants in a large cohort of patients with depression and/or anxiety. Australian and New Zealand Journal of Psychiatry, 55(2), 167–179.
65.
WoznicaA. A.CarneyC. E.KuoJ. R.MossT. G. (2015). The insomnia and suicide link: Toward an enhanced understanding of this relationship. Sleep Medicine Reviews, 22, 37–46.
66.
WuT. T.ZouY. L.XuK. D.JiangX. R.ZhouM. M.ZhangS. B.SongC. H. (2023). Insomnia and multiple health outcomes: Umbrella review of meta-analyses of prospective cohort studies. Public Health, 215, 66–74.
67.
YosepI.MardhiyahA.HendrawatiH.HendrawatiS. (2023). Interventions for reducing negative impacts of workplace violence among health workers: A scoping review. Journal of Multidisciplinary Healthcare, 16, 1409–1421.
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