*2.2.2 Outcome variables*

*Occupational Wellbeing*

conducted in 2009 [7].

**2. Methods**

**2.2 Measurements**

*2.2.1 Data collection*

that it leads to submission or leave [1].

and doubly exposing them to harassment at work.

and residents before and after revolution.

The aims of the study were to:

**2.1 Study design and participants**

approved by the regional ethical committee.

immediate reaction rather than a long thoughtful answer.

to offend human dignity, intimidations aiming at terrorizing the targeted person so

Health care professionals are highly exposed to MHW and facing the pain and death of patients [5, 6]. Young doctors, interns and residents, are besides obliged to follow a highly demanding apprenticeship. In fact, they live in a state of chronic stress and are subjected to significant mental burden facing the challenge to learn, to work in a team, to become competent, responsible and empathic physicians and at the same time to provide medical services although the hostile atmosphere and in often unfavorable conditions. This kind of heavy occupational atmosphere, promoting the development of MHW, has been highlighted by a previous study

Tunisian jasmine revolution, initiated to face critical economic situation, frustration, hopelessness, injustice, corruption and political domination, conducted to a new approach of justice and dignity [8]. It was followed little by little, by the procession of freedom of expression that, sometimes exceeded rights limits. Otherwise, hospitals' working conditions, within the after revolution, have significantly worsened, due to family patients' violence and lack of equipment, leading to heavy work conditions affecting the medical practice of young doctors

• Compare the prevalence and the perception of workplace bullying in interns

This is a comparative cross-sectional study, practiced in two stages: 2009 and 2016.The cohort of participants included all interns and medical residents practicing within the teaching hospitals attached to the Faculty of Medicine of Monastir-Tunisia. This current study was based on data of 547 Participants in 2009 and 667 ones in 2016.It took place during approximately the same period in both stages: October and November2009 and then in October, November and December 2016. Incomplete forms were not included in the study and no participant was excluded. Moreover, even though both studies have been performed in the same places, no overlap between both cohorts was noticed, because 2009 cohort, whether interns or residents, have already finish their curriculum in 2016. Finally, the study was

Data on MHW were obtained through the administration of the same anonymous self-administered questionnaire distributed to the target population of 2009 and 2016.A unique investigator distributed the self-questionnaire to all the cohort of interns and residents in hospital departments. He guaranteed to each participant the anonymity and asked him/her to respond as sincerely as possible and trust his

• Assess the influence of workplace bullying on their quality of life.

**192**

a.Socio-professional data: gathering


b.Workplace bullying:

It was assessed through the Negative Acts Questionnaire Revised or NAQ-R, which is a standardized self-questionnaire, made of 22 items. None of them is directly referring to harassment. Many practical and scientific studies have concluded to its validity and reliability on evaluating this phenomenon. It has also been validated in several countries of the world as a standardized instrument for assessment of moral harassment at work [9–11].

Each kind of behavior is increasingly leveled from 1 to 5 depending on the repetition of this act in the last six months: never, sometimes, once a month, once a week, and daily.

Negative acts mentioned were gathered in two types of behaviors: People-related behaviors and Work-related behaviors.

A person is considered to be a victim of psychological harassment if he or she has been suffering of any of these acts at least once per week in the last six months.

This self-questionnaire also helps to identify the most widespread negative act in a workplace.

At the end of this self-questionnaire, there is a 23rd question preceded by a definition of "mobbing" at work. It is interested in harassment at work as generally perceived by the person. The term harassment has been replaced by the term "mobbing at work".

Mobbing at work was defined as "a situation where one or more people perceive themselves as the target of negative acts from one or more people over a long period of time and have difficulties in defending themselves against these people (a single incident is not regarded as "mobbing").

We chose to use the NAQ-R score as a dependent continuous variable.

c.The Quality of Life Impact:

The SF8 'health survey' scale is a standardized and valid self-questionnaire that explores health and well-being of persons [12, 13]. We got the license of the Quality Metric Office of Grants and Scholarly Research, number QM038831 [14].

It contains eight questions exploring the following dimensions: Health as perceived by the subject, repercussion of physical health on daily activities, pain, physical activity, vitality, social activity, psychic health, repercussions of mental health on daily activities.

It allows to calculate two scores using a specialized software: the overall physical score (PCS: physical component score), which is the average of the first four

sections; and the overall mental score (MCS: Mental component score) which is the average of the last four items.

These two scores range from 0 (the worst health state) to 100 (the more favorable state of health). The score 50 represents the average score or the standard of American population.

#### **2.3 The statistical study**

The results were analyzed with the SPSS software version 21. The univariate comparative study was conducted using cross-tabulations with the chi-square test for comparison of discontinuous variables and T-student test to establish the difference in averages between both populations. Verification of the normality of both quantitative variables PCS and MCS was made. The threshold of significance has been set at 0.05.

Multi-varied analysis was performed using binary logistic regression multivaried step-by-step to identify variables that are related significantly to harassment at work, regardless of the other variables respectively in 2009 and 2016, with a risk taken at 0.05. The criterion for including independent variables in the regression model was a threshold of significance <0.2.

Results of both cohorts were presented in chronological order (2009/2016).
