Resumen: Exposure to psychosocial risks and workplace violence is associated with a higher prevalence of workers' mental health problems. The purpose of the present study was to examine the mediating role of workplace violence between psychosocial risks (ISOSTRAIN, effort-reward imbalance), organizational background (tyrannical leadership) and mental health problems (distress) among 1023 workers in three high complexity public hospitals in three regions of Chile. It was hypothesized that exposure to psychosocial risks and some organizational features (tyrannical leadership) is associated with lower levels of mental health and that part of this effect is mediated by exposure to workplace violence. A questionnaire was applied including the Negative Act Questionnaire Revised (NAQ-R), the Psychological Distress Screening, the Destructive Leadership Scale, the Effort-Reward Imbalance Questionnaire and the Job Content Questionnaire. Path analysis showed that exposure to psychosocial risks, tyrannical leadership and workplace violence increase levels of workers' distress. Part of the effect of psychosocial risks and tyrannical leadership on mental health is mediated by exposure to workplace violence.