Bullying presents considerable methodological problems for researchers. A central difficulty is that of definition as no clear consensus exists on what constitutes adult bullying. Although physical bullying is rarely reported, the workplace presents opportunities for a wide range of intimidating tactics. Rayner and Hoel provide five categories of bullying behaviour.⁷ These are threat to professional status (for example, belittling opinion, public professional humiliation, accusation of lack of effort); threat to personal standing (for example, name calling, insults, teasing); isolation (for example, preventing access to opportunities such as training, withholding information); overwork (for example, undue pressure to produce work, impossible deadlines, unnecessary disruptions); and destabilisation (for example, failure to give credit when due, meaningless tasks, removal of responsibility, shifting of goal posts).

Most definitions of workplace bullying share three elements that are influenced by case law definitions in the related areas of racial and sexual harassment. Firstly, bullying is defined in terms of its effect on the recipient not the intention of the bully. Thus it is subject to variations in personal perceptions. Secondly, there must be a negative effect on the victim.^7,8 Lyons and colleagues use the following definition: “persistent, offensive, abusive, intimidating, malicious or insulting behaviour, abuse of power or unfair penal sanctions, which makes the recipient feel upset, threatened, humiliated or vulnerable, which undermines their self-confidence and which may cause them to suffer stress.” ¹³ Thirdly, the bullying behaviour must be persistent.¹²

There have been three main approaches to research into workplace bullying. The first has been qualitative and individualistic in perspective, identifying a role for the individual in terms of vulnerability to bullying or a propensity to bully^5,14,15 and elucidating the dynamics of bully-victim relationships. The second approach is descriptive and epidemiological and is usually based on self report.^6,9,10 These studies document the prevalence of workplace bullying, the types experienced, age and sex differences, who is told, what action is taken, etc. The third approach is influenced by theories and constructs in organisational psychology and has focused on the interaction between the individual and the organisation and how aspects of the organisational structure and climate of the workplace may encourage the development of a bullying culture.^11,12

We sent a questionnaire to all 1580 trust employees, together with a covering letter explaining the purpose of the research and a prepaid envelope. The questionnaire was anonymous to encourage participation. A reminder was sent after three weeks, a second questionnaire after a further three weeks, and then a final reminder. The data were then entered on to computer and analysed with spss for Unix.

Table ​Table22 shows the proportion of staff reporting each type and category of bullying. Overall, 421 (38%) people reported experiencing one or more types of bullying and 241 (22%) described an incident in the past three months; 460 (42%) had witnessed the bullying of others.

Table ​Table33 shows the differences in occupational group, sex, age, and hours between those who reported bullying and those who did not, and table ​table44 shows the percentage of staff in each occupational group reporting each category of bullying. Of those reporting an incident in the past three months, 161 (67%) had tried to take action about the bullying when it occurred, but most (119 (74%)) were not satisfied with the outcome. Only 14/241 (6%) people had used the staff stress counselling service, which was comparatively new.

The most common bully was a senior manager or line manager (128/239 (54%)), although in 80 (34%) cases it was someone of the same level of seniority as the victim and in 31 (12%) it was someone less senior. In 137 (57%) cases the bully was the same sex as the victim, and in 54 (8%) cases it was someone of the opposite sex. In 59 (27%) cases the bully was male and in 144 (65%) female; both sexes were involved in the remaining cases. Of the 205 cases for which information was given on age, in 100 (49%) the bully was older than the victim, in 57 (28%) both parties were of similar age, and in 48 (23%) the bully was younger.

Relations between bullying and occupational health outcomes were examined by t test or χ² test where appropriate. Staff who had experienced bullying in the past year reported significantly lower levels of job satisfaction than other workers (mean 10.5 (SD 2.7) v 12.2 (2.3), t (1, 1098)=10.7, P<0.001). Additionally they had significantly higher levels of job induced stress (22.5 (6.1) v 16.9 (5.8), t (1, 1098)=14.4, P<0.001) and higher scores on the propensity to leave scale (8.5 (2.9) v 7.0 (2.7), t (1, 1098)=8.72, P<0.001) than those who had not been bullied. They were significantly more likely to suffer clinical levels of anxiety (30% (125) v 9% (60), df=1, χ²=79.3, P<0.001) and depression (8% (33) v 1% (7), df=1, χ²=32.5, P<0.001). Sixty one people who had experienced bullying reported that their health had been affected and 20 had taken time off work. Altogether 335 days were reported lost. Forty four per cent (56/122) of smokers who had experienced bullying reported an increase in their smoking in the previous year, and 20% (70/373) of drinkers reported an increase in their alcohol consumption.

Staff who had experienced bullying reported lower levels of job satisfaction and higher levels of job induced stress. They were more likely to be clinically anxious and depressed and were more likely to report wanting to leave. Three explanations could account for these associations. Firstly, being bullied leads to psychological ill health and reduced job satisfaction. Secondly, certain staff may be more likely to report being bullied than others. These may be people who are more pessimistic in outlook. Such people might also report higher levels of job dissatisfaction, propensity to leave, etc than other workers. Thirdly, being depressed, stressed, or anxious may cause a person to be bullied by unscrupulous workers who choose weaker people as their victims. Anxiety and depression may also weaken a person’s ability to cope with stressors such as bullying or make them more likely to perceive other people’s behaviour as hostile and critical. Longitudinal data are required to try to disentangle these effects.

Despite these difficulties, the finding that 42% of staff had witnessed the bullying of others, including many who did not report being bullied themselves, confirms that it is not purely a subjective phenomenon. Similarly, the finding that higher proportions of unqualified residential care staff and younger staff report being bullied suggests a role for aspects of the organisational climate.