A first-of-its-kind study provides an insight into the substantial mental health burden on nurses around the world, the research documenting the impact of three years of intense working conditions brought on by the Covid-19 pandemic.
Published in International Nursing Review, it describes how nurses are affected by stressors in their workplace and shows how the stress carries over into their home life.
“The personal losses from the pandemic complicate this picture as there could easily be lingering grief in a third of the workforce,” said Allison Squires, Professor at NYU Rory Meyers College of Nursing and the study’s lead author.
Stress and burnout among nurses working during the pandemic are well-documented, but most studies come from high-income countries. To address the gap in knowledge from other countries, Squires founded the Global Consortium of Nursing and Midwifery Studies.
The international research collaboration, which now includes nurses and other health professionals from 82 countries, is examining the long-term effects of the pandemic on the nursing workforce, reports News-Medical.net.
In the current study, the researchers surveyed 9 387 nurses from 35 countries between July 2022 and October 2023. They were asked about their mental health and other related factors, including loss, burnout, experiencing aggression from the public, access to mental health services, and self-care practices.
Widespread mental health challenges were uncovered, with rates of anxiety and depression ranging from 23% to 61%. The nurses consistently experienced more mental health symptoms at work than at home; the most common work-related issues were feeling tired (57%), anxiety (44%), and feeling overwhelmed (41%).
Rates of mental health issues varied widely among countries, probably reflecting cultural factors associated with psychological stressors or stigma related to mental illness, pointed out the authors. For instance, 69.9% of nurses in Brazil reported workplace-related anxiety, compared with 23.8% in Indonesia, while 80.9% of nurses in Turkey reported feeling overwhelmed at work, compared with 6.7% in Thailand.
Loss and public aggression were also identified as challenges to their mental health. Notably, 20% of them suffered the loss of a relative, 35% lost a friend, and 34% a co-worker to Covid-19.
“The staggering personal losses of friends, family, and co-workers and their effects on nurses’ mental health should not be under-estimated,” Squires and her co-authors write.
In addition, nearly half (48%) reported experiencing violence and aggression from the public due to their identity as a nurse, “an extremely concerning finding and ongoing health worker safety issue”, noted Squires.
Only 24% of nurses reported that their employers provided adequate mental health services, leaving many without support or relying on self-care strategies. Most of them reported more frequently engaging in self-care, including exercise, spiritual practices, and leaning on family and other relationships, compared with before the pandemic.
“The increased engagement in self-care practices suggests that nurses, given the intensity of the pandemic’s working conditions, may have turned to these activities to cope with adverse mental health symptoms experienced at work,” said Squires.
“However, promoting self-care will not address the scope of the problems we’ve identified; we need to develop targeted and accessible mental health support to foster a resilient nursing workforce.”
The researchers have urged policymakers and healthcare organisations to increase mental health services available to nurses worldwide and address issues in the clinical work environment in an effort to support the psychological safety of nurses and other frontline workers.
“Given our findings, it is not surprising we see nurses moving within the workforce to lower stress roles, leaving their positions or countries for better working conditions, or leaving the profession altogether,” observed Squires.
“This poses a threat to health system sustainability worldwide, and the impact is likely to affect the most vulnerable systems that were already stretched and stressed to their limits before the pandemic.”
Study details
A descriptive analysis of nurses’ self‐reported mental health symptoms during the Covid‐19 pandemic: An international study
Allison Squires, Hillary Dutton, Maria Guadalupe Casales-Hernandez et al.
Published in the International Nursing Review on 27 January 2025
Abstract
Aim
To describe the self-reported mental health of nurses from 35 countries who worked during the Covid-19 pandemic.
Background
There is little occupationally specific data about nurses’ mental health worldwide. Studies have documented the impact on nurses’ mental health of the pandemic, but few have baseline referents.
Methods
A descriptive, cross-sectional design structured the study. Data reflect a convenience sample of 9,387 participants who completed the opt-in survey between July 31, 2022, and October 31, 2023. Descriptive statistics were run to analyse the following variables associated with mental health: Self-reports of mental health symptoms, burnout, personal losses during the pandemic, access to mental health services, and self-care practices used to cope with pandemic-related stressors. Reporting of this study was steered by the STROBE guideline for quantitative studies.
Results
Anxiety or depression occurred at rates ranging from 23%–61%, with country-specific trends in reporting observed. Approximately 18% of the sample reported experiencing some symptoms of burnout. The majority of nurses’ employers did not provide mental health support in the workplace. Most reported more frequently engaging with self-care practices compared with before the pandemic. Notably, 20% of nurses suffered the loss of a family member, 35% lost a friend, and 34% a co-worker due to Covid-19. Nearly half (48%) reported experiencing public aggression due to their identity as a nurse.
Conclusions
The data obtained establish a basis for understanding the specific mental health needs of the nursing workforce globally, highlighting key areas for service development.
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