There’s no question that the Covid-19 pandemic has had a tremendous impact on the mental health of nurses, PAs, and other healthcare providers. Of course, burnout has been among the most significant challenges. Still, moral injury, empathy fatigue, and sheer exhaustion, on top of dealing with all the ways the pandemic has changed providers’ personal lives, all play a role in higher rates of depression and anxiety.

But many don’t realize that nurses’ mental health was already in jeopardy before the pandemic began. New research from the Mayo Clinic reveals just how much. The study, published in the American Journal of Nursing and led by Elizabeth A. Kelsey, DNP, APRN, CNP, an assistant professor at Mayo Clinic Minnesota in Rochester, focused on how frequently nurses thought about suicide and how they felt about seeking help when they did.

The researchers sent a survey to 86,858 nurses who were members of the American Nurses Association and 5,198 US workers in other fields. The survey asked whether respondents had thoughts about suicide and questions related to burnout. For example, the suicide question read, “During the past 12 months, have you had thoughts of taking your own life?” To learn more about burnout, the researchers used the 22 questions from an established burnout assessment tool which measures people’s emotional exhaustion, depersonalization, and low sense of personal accomplishment.

Other questions on the survey dealt with symptoms of depression, the respondents’ personal and professional characteristics, and participants’ willingness to seek help if they experienced serious emotional difficulty. Personal characteristics collected included age, gender, race/ethnicity, and relationship and parental status, and professional questions asked how many hours the respondent worked per week, their highest level of education, their various medical-related certifications and degrees, their years of nursing experience, their practice setting, and the number of mandatory or unplanned overtime shifts they had worked in the past month.

The response rate among nurses was 8.5%, with 7,378 nurses filling out the questionnaire. From this group, 5.5% reported having thoughts of suicide in the past year, compared to 4.3% of workers in other professions who reported suicidal thoughts. Fortunately, the vast majority of nurses (84%) said they would “probably or definitely” seek professional help for a serious emotional problem, something that only 63% of workers in other fields said they would do. However, a substantially smaller percentage of the nurses who had thoughts of suicide (73%) said they would be willing to seek help compared to those who had not experienced suicidal thoughts (85%).

“Previous studies of nurses suggest that barriers to accessing mental health services also include concerns about the potential negative impact on one’s career, concerns about confidentiality, difficulties in getting time off work for treatment, and challenges with scheduling an appointment,” the authors wrote.” In addition, the fact that some states include questions about mental health on nursing licensure applications may also be a factor,” they wrote while calling for more research into barriers to mental health care for nurses.

Next, the researchers compared characteristics among the nurses and between the nurses and other workers, adjusting their analysis to take different personal and professional differences into account. After adjusting for symptoms of depression and personal and professional characteristics, the researchers found that burnout was strongly linked with having thoughts of suicide. Together, nurses and other workers were almost three times more likely to have thoughts of suicide if they had burnout, though, for nurses alone, the risk of suicidal thoughts was twice as likely for those with burnout.

However, even when the researchers accounted for burnout—as well as age, gender, hours worked per week, and relationship status—nurses remained 38% more likely to have suicidal thoughts than workers in other professions. Suicidal thoughts were more common among younger and single people than those older and either married, partnered, or widowed.

“Collectively, this evidence convincingly builds the case that health care organizations must address systems-level causes of burnout, for the good of both patients and health care workers,” the authors wrote. However, they added that these system-wide interventions also need to take into account the differences between various healthcare roles.” Given the increased stress nurses are experiencing during the Covid-19 pandemic,” the researchers wrote, “the need to act has never been more acute.”

NOTE:

If you’re having thoughts of harming yourself, it’s important to tell someone and get help. The National Suicide Hotline is 1-800-273-8255, or you can text message the Crisis Text Line at 741741. For those with a hearing impairment, you can call 1-800-799-4889, and those who prefer to speak to someone in Spanish can call 1-800-628-9454.

For those who are members of LGBTQ groups, the Trevor line for LGBTQ youth and young adults is 1-866-488-7386, and a transgender suicide hotline staffed only by transgender people is 1-877-565-8860 in the US and 1-877-330-6366 in Canada.