Workplace violence against healthcare staff in Iran: a systematic review and proportional meta-analysis

Workplace violence against healthcare workers is a pervasive global crisis. While previous reviews have explored this issue in Iran, they were largely restricted to specific nursing populations and are now outdated given the rapid accumulation of recent literature. This study aims to address this knowledge gap by providing a comprehensive, updated proportional meta-analysis encompassing the broader Iranian healthcare workforce across four specific violence typologies (physical, verbal, sexual, and racial). A systematic search of PubMed, Scopus, Web of Science, Magiran, Science Information Database (SID), and IranDoc databases was conducted for records published up to March 2025. Methodological quality was evaluated using the Mixed Methods Appraisal Tool (MMAT). Data were extracted and synthesized using a random-effects proportional meta-analysis model to estimate the pooled prevalence of violence, alongside assessments for statistical heterogeneity and publication bias. A total of 95 papers (comprising 40,964 participants) were included in the present study. The overall proportion of violence experience was observed to be 83%. The overall pooled prevalence of workplace violence was 83% (95% CI: 76%–88%), characterized by substantial heterogeneity (I² = 94%). Verbal violence was the most common form at 76% (95% CI: 69%–82%; I² = 98%), followed by physical (27%, 95% CI: 21%–35%; I² = 97%), racial (11%, 95% CI: 7%–17%; I² = 94%), and sexual violence (4%, 95% CI: 3%–7%; I² = 94%). Based on a qualitative synthesis of the included studies, factors such as public unawareness of staff duties and critical staff shortages were frequently associated with these incidents, correlating with reported psychological distress and burnout among staff. Workplace violence, particularly verbal abuse, constitutes a significant crisis among Iranian healthcare professionals, profoundly affecting their occupational performance and mental health. To address this issue effectively, policymakers and hospital administrators should consider transcending passive oversight and adopt targeted, systemic interventions. Practical measures that may help include establishing optimal nurse-to-patient staffing ratios, enhancing physical security infrastructure in high-risk departments such as emergency wards, and initiating nationwide public awareness campaigns to better align patient expectations with clinical realities. CRD420261479604. Not applicable.