**5. Conclusion**

*Occupational Wellbeing*

the standard average of 50.

102 out of 155 countries) [77].

problems [62, 73].

investigations.

As for the impact of bullying on participants' quality of life, it significantly influenced the quality of mental life regardless of the study cohort, but no significant difference was found between 2009 and 2016 and most of scores were below

Despite the decline in the rate of MHW in 2016, the quality of mental life did not change after the revolution. This may be related to other factors than the MHW upon which social or managerial factors, working conditions, work-family interface

In the latest study conducted by 'Word Happiness' in 2017 regarding the satisfaction of life and happiness based on certain criteria such as health, social support, freedom and corruption, Tunisia was among the lowest ranked countries (rank of

The alteration of interns and resident mental quality of life can be also attributed

The influence of MHW on the mental quality of life has been demonstrated in literature both in the general population [77, 78] and in the health caregivers [78, 79] and some authors assert that mental disorders are also predictors of harassment [79–81]. If we consider, the influence of MHW on the quality of physical life, the latter significantly altered the physical quality of life in both cohorts without significant difference between them and scores were below the American standard of 50. In the literature, MHW has deleterious effects on physical health. It increased cardiovascular risk and caused musculoskeletal pain in addition to other medical

The new scheme of residency ship, consisting in pending months from June to December with long periods of preparation, leads to inactivity, and spending most of the day on screen and desk could explain the lack of improvement in the quality of physical life despite the significant increase in leisure time and the regression of

Considering the limits of our study, despite the decrease in the participation rate in 2016, the sample of the studied population remains representative of the general population. Some factors could influence the participation rate in both cohorts: some of the interns and residents were unmotivated, others could not answer our questionnaire due to lack of time and excessive workload. Many of them also found that the questionnaire was too long. The lower participation rate of residents compared to interns' one can be explained by their heavier workloads. Finally, the abstention of some participants can also be explained by the perception of MHW as a taboo subject or lack of conviction of the usefulness of such

The rate of participation in workplace bullying investigations among young

Regarding the used tools, the NAQ and the SF8 are both validated and frequently used in different professional sectors and in various languages. But, due to the absence of a validated version in Tunisian dialect or in Arabic, we opted for the use of the French validated version which is commonly understandable by our study population because all medical studies are performed in French in

However, the disadvantage of the NAQ-R is that it asks a direct question at the end, about the self-perception of moral harassment. The respondents tend to deny this suffering, either out of shame or lack of motivation or unconscious denial of

physicians in literature varied between 22.1 and 72% [40, 41, 55, 63, 82].

reality. This could be the cause of underestimation of results.

to the fact that the internship is a period of chronic stress for young doctors who face the challenge of learning to work as a team, to become competent, responsible and empathic doctors and at the same time ensuring the best medical benefits in a

quality, social support, marital status and income … [75, 76].

sometimes competitive and even hostile climate.

the MHW in 2016 comparatively to 2009.

**202**

Tunisia.

Health care professions, especially in young doctors, are at high-risk of moral harassment, due to required interactions with patients and their parents, requested performance of learning and the advent of violence against healthcare professionals after Tunisian revolution. The present study showed that MHW had significantly decreased in2016 according to the objective assessment by NAQ-R score. No significant difference between both cohorts perception of MHW was shown which can be explained by the lack of awareness of this phenomenon and by the absence of Tunisian legislation against harassment.

The determinants of the MHW in 2009 were the job position, gender, and seniority, choice of medicine satisfaction, serious family problems and leisure activities; while in 2016, they were the job position, the specialty nature, the choice of medical studies and the satisfaction of the exercise of Medicine. Finally, MHW negatively influenced the quality of mental and physical life in a comparable way in the two steps of investigation.

The promulgation of a law penalizing the MHW has become urgent especially after the revisions of the post revolution law texts. Politicians should focus on this major issue because MHW has many bad effects on the personal, social and organizational level. It is also important to set up training and awareness programs about MHW to prevent its emergence and reduce its deleterious effects.
