Nurses are increasingly facing mental health struggles but not receiving the support they need. (© Leonid – stock.adobe.com)

Lack of support threatens global healthcare systems, study warns

NEW YORK — Every day, millions of nurses worldwide shoulder not just the physical demands of healthcare, but an invisible mental burden that’s only now coming to light. A landmark study from New York University reveals alarming rates of anxiety, depression, and burnout among nursing professionals, challenging healthcare systems to address a crisis that threatens both worker well-being and patient care.

These healthcare professionals, who make up the largest segment of the medical workforce worldwide, faced extraordinary challenges while caring for patients during the pandemic, the most difficult period in modern healthcare history. This research reveals the effects, with rates of anxiety and depression ranging from 23% to 61% among those working through the crisis.

This study, published in the International Nursing Review, analyzed data from 9,387 nurses across 35 countries, spanning low, middle, and high-income nations. The research was conducted between July 2022 and October 2023 and emerged from the Global Consortium of Nursing and Midwifery Studies, an international collaboration now spanning 82 countries examining the pandemic’s long-term effects on the nursing workforce. While previous studies have documented nurses’ mental health challenges during COVID-19, most focused on wealthy nations, leaving a significant knowledge gap about the experiences of nurses in other parts of the world.

“Our study describes how nurses are affected by stressors in their workplace and shows how the stress carries over into their home life,” says lead author Allison Squires, a professor at NYU Rory Meyers College of Nursing, in a statement.

This spillover effect became particularly evident in the study’s findings about mental health symptoms both at work and at home. At work, 44% of nurses experienced anxiety, 21% reported depression, and 57% felt persistently exhausted. These challenges followed many home, where 34% continued experiencing anxiety, and 19% battled depression in their personal lives.

The prevalence of symptoms varied dramatically by country. In Brazil, 69.9% of nurses reported workplace anxiety, compared to 23.8% in Indonesia. In Turkey, 80.9% of nurses felt overwhelmed at work, versus just 6.7% in Thailand. These stark differences likely reflect varying cultural attitudes toward mental health, different healthcare system structures, and diverse approaches to managing workplace stress across countries.

During the pandemic, not only were nurses overwhelmed by being on the front lines, but one in five nurses lost a family member to COVID-19, while 35% lost a friend and 34% lost a coworker. Many nurses also had to continue working while processing their grief, creating an additional layer of emotional burden.

“The staggering personal losses of friends, family, and coworkers and their effects on nurses’ mental health should not be underestimated,” Squires and her coauthors write.

Beyond personal losses, nurses faced unprecedented social challenges. Nearly half experienced aggression from the public simply for being healthcare workers—what Squires calls “an extremely concerning finding and ongoing health worker safety issue.” This hostility often stemmed from pandemic-related tensions and misinformation, adding another layer of stress to an already demanding profession.

While only 2% of nurses described themselves as completely “burned out,” an additional 16% reported experiencing burnout symptoms. This relatively low self-reported rate may reflect economic realities in many countries, where nurses must continue working regardless of stress levels to support their families. It might also indicate cultural differences in how burnout is perceived and reported across different regions.

Healthcare organizations largely failed to provide adequate support during this crisis. Only 24% of nurses felt their employers offered sufficient mental health services during the pandemic. Many facilities lacked the resources or infrastructure to provide mental health support, while others may not have recognized the severity of the need.

“Promoting self-care will not address the scope of the problems we’ve identified; we need to develop targeted and accessible mental health support in order to foster a resilient nursing workforce,” said Squires.

Despite these institutional shortcomings, nurses actively worked to protect their mental health through increased self-care practices. Many reported exercising more frequently, paying greater attention to nutrition, engaging in spiritual practices, and strengthening personal support networks. Some nurses are moving to lower-stress roles, leaving their positions for better working conditions in other countries, or abandoning the profession entirely.

Still, individual coping strategies alone cannot address the systemic issues revealed by the study.

“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 prior to the pandemic,” adds Squires.

The situation has caught the attention of international nursing organizations. The International Council of Nurses warns that combined with an aging workforce, stress-related departures from nursing will worsen an already severe global shortage. This shortage could particularly impact developing nations, where healthcare systems often operate with minimal staff and resources.

As healthcare evolves, the mental well-being of nurses can no longer be treated as an afterthought. This research provides a roadmap for change, highlighting the need for accessible mental health services, improved working conditions, and systematic support for nursing professionals worldwide.