**4. Discussion**

In our study, statistically significant differences occurred with respect to age and Sector. Regarding the age, medical residents of 25–35 years were subject to highest values of mobbing (mean = 58.5) in relation to ages groups 35–35 (mean = 51.0) and 45–55 (mean = 29.50). Regarding the Sector, the higher score was objected in the Surgery Sector (p = 0.0043), (mean = 62.55), and lowest in the Laboratory Sector (mean = 45.4).

The sample of the present study consisted of 92 individuals, all medical residents in the UGHP. Males and females were almost equal and regarding age most of the participants were 25–45 years old. As far as sector specialty was concerned, the majority of individuals worked at the Internal Medicine Sector, at the Surgical Sector, and at the Laboratory Sector. In respect of the level of education, most of the participants had a medical degree and worked as medical residents at UGHP for 0–5 years.

Generally, negative issues at work happened rarely to sometimes. Participants stated that they had been frequently ordered to do work below their level of competence as well as having key areas of responsibility removed or replaced with more trivial or unpleasant tasks. Negative incidents at work happened more frequently to young participants age 25–35 years old, individuals with specialty in Internal Medicine or Surgery, and those who worked 0–2 years as medical residents at UGHP.

Specifically, participants stated that labor-related intimidation happens sometimes while labor-related intimidation regarding the workers' personality or being a victim of mobbing in work rarely. Analyzing labor related intimidation, participants stated that they had been frequently ordered to do work below their level of competence as well as having key areas of responsibility removed or replaced with more trivial or unpleasant tasks.

In our study, very high levels of mobbing - very frequent and extreme aggressive behaviors emerged (score 56.3217.080 for NAQ-22). Regarding the Greek hospitals, these findings are consistent with the study of Gavrielatos [18] that referred to a sample of medical residents using the same tool (NAQ scale) [18]. Data from a crosssectional quantitative empirical study from University General Hospital from Heraklion, Crete, in Greece, revealed that among health care professionals 41.3% of the participants were subjects of serious mobbing and 31.3% of occasional mobbing, with doctors more vulnerable from nurses. Also the upper the more highly educated were victims of mobbing. This survey also used the Negative Acts Questionnaire-Revised [25]. In accordance with those results is a study conducted in Bosnia and Herzegovina; where over three-quarters of doctors declared they were exposed to moral harassment, and with surveys in Turkey and Portugal, where non-specialist doctors were exposed to moral harassment at a rate of 87.7% and 60% respectively [5, 21]. In a survey conducted among primary health care workers in Turkey, 31.1% of health workers declared having been victims of mobbing in the last one year with a frequency of 1–3 times per year [26]. Lower rates were observed in hospital doctors in the United Kingdom and Finland [5, 21]. With international evidence demonstrating that in the healthcare sector the phenomenon of moral harassment is reinforced, but on the other hand not properly evaluated by the victim due to the stress of survival amidst the economic crisis and daily exposure to illness and death, these percentages are particularly important [6, 21, 27, 28].

In another study from Turkey among healthcare professionals, half of the participants declared exposure to "mobbing behaviors for targeting reputation" and to "mobbing behaviors for targeting occupational status" [29]. A qualitative study from Greece among health professionals in a public hospital revealed that the mobbing phenomenon was tangible and the abuse was mainly verbal and behavioral [30].

As far as gender is concerned, findings in literature are controversial [6, 20, 26, 31, 32]. In the present study, there was no statistically significant difference in NAQ-22 related to gender. A statistically significant difference was observed only in questions referring to the individual's intimidation about his/her personality, such as question 2 (Being humiliated or ridiculed in connection with your work), question 5 (Spreading of gossip and rumors about you), question 7 (Having insulting or offensive remarks made about your person), and question 16 (Being given tasks with an unreasonable deadline). In the above-mentioned questions, women had a higher score than their male counterparts. Despite the fact that the present study does not present a statistically significant difference in the NAQ-22 between the two sexes, those responses of female medical residents should be taken under consideration and redefine the attitude towards female doctors. A survey conducted in Turkey also revealed high rates of mobbing in females doctors, participants with low income, and also workers from other provinces [33, 34]. On the other hand, a survey from Turkey in healthcare professionals from three different cities included workers from private hospitals, state hospitals, university hospitals, and other health centers revealed that the level of mobbing did not vary depending on gender, but on the marital status and age. Singles and younger employees were subjected to mobbing more than the married and older ones [35].

*Correlates of Mobbing among Medical Residents in a University General Hospital… DOI: http://dx.doi.org/10.5772/intechopen.104041*

In the international literature, there is a controversy about the relationship between age and the occurrence of the phenomenon of mobbing [20, 36]. In Uruguay 40.4% of hospital employees reported being the victim of mobbing at least once a week, with the majority being older and more highly educated [37]. In the current study, there appeared to be a particularly higher NAQ score in the youngest doctors (25–35-year-old). This pattern is in line with the study by Gavrielatos for physicians [18]. Possible explanations may include that older medical residents have learned how to handle similar incidents from their job experience or they are perpetrators themselves [38].

Regarding previous education, there was no statistically significant difference between medical residents with a medical degree, MSc degree, or PhD in our survey. A statistically significant difference occurred only in question 15 "Practical jokes carried out by people you don't get along with", with the maximum occurring in the case of people with an MSc degree. This finding is in part consistent with Gavrielatos's study, where doctors with an MSc or PhD seemed to be subject to higher mobbing rates [18]. Other studies also demonstrated that the selected victims were often more qualified than others [2, 39]. In Turkey healthcare professionals with a doctoral education level were exposed more to mobbing than their colleagues with lower education [40, 41].

In accordance, there is also a study conducted in Uruguay among hospital employees. In this study, there was more prevalent mobbing among the employees who had higher education [37].

According to the results of the present study, the highest rates of mobbing were observed in the Surgical Sector (62.55), whereas in the Laboratory sector the lowest (45.35). Issues of increased workload in connection with a lack of division of duties and responsibilities in connection with management deficiencies of the Surgical Sector are a possible explanation of these results. A strict hierarchical structure in an organization, combined with the ambiguity of tasks and lack of distinct responsibilities, may intensify and fuel the phenomenon as tensions are favored. Another potentially important parameter is the non-recognition of the efforts made by the employees, resulting in frustration and loss of confidence [2, 6, 19, 38, 42–44].

There was no statistically significant difference with respect to years of being a medical resident in this study. A difference was noted only in question 2 "Being humiliated or ridiculed in connection with your work" where people with 2–5 years of service (mean = 2.49) appeared to be more harassed than people with years of service 0–2 (mean= 2.11) and 6–10 (mean = 1.30). This is in contradiction with the findings of Gavrielatos [18] and Katsilaki [20], where those who accept very low levels of mobbing have more years of experience [18, 20, 45]. A cross-sectional study in a Malaysian Public University Hospital, using the validated Malay version of the 23-item Negative Acts Questionnaire—revised, revealed that workers in less than ten years were the victims [46].
