Urgent action is needed to improve working conditions for doctors and nurses across Europe, which have become not only a major source of stress but also a serious threat to their mental health, according to a new survey released by the World Health Organization (WHO) Regional Office for Europe on World Mental Health Day.

The survey, titled “The Mental Health of Nurses and Doctors” (MeND), was conducted across all 27 member states of the EU, plus Iceland and Norway, with support from the European Commission. It is the largest study of its kind ever undertaken, analyzing responses from more than 90,000 healthcare professionals.

Over the past 12 months, about one third of doctors and one third of nurses reported experiencing bullying or threats of violence at work. 1 in 10 said they had been victims of physical violence or sexual harassment, and a similar proportion reported thoughts of self-harm or suicide within the 2 weeks preceding the survey — a rate twice as high as in the general population.

Unacceptable Burden

“The results of the MeND survey are a stark reminder that Europe’s health systems are only as strong as the people who power them,” said Hans Henri P. Kluge, WHO regional director for Europe. “1 in 3 doctors and nurses report depression or anxiety, and more than 1 in 10 have thought about ending their lives or hurting themselves. This is an unacceptable burden on those who care for us.”

Despite the mounting mental health challenges and difficult working conditions, most healthcare professionals — 3 in 4 doctors and 2 in 3 nurses — said they were generally satisfied with their jobs, though widespread fatigue remains a concern.

The findings underscore a worsening healthcare workforce crisis across Europe. A separate WHO Europe report published in 2022 warned that by 2030, the region could face a shortfall of nearly one million health professionals if current trends continue.

In some countries, up to 40% of doctors and nurses with depressive symptoms said they had taken sick leave in the past year. Between 11% and 34% said they had considered changing jobs — fueling a vicious cycle in which staff shortages lead to overwork, which in turn further undermines the well-being of those remaining on the front lines.

Urgent Policy Actions

The WHO report calls for urgent policy action to protect the mental health of healthcare professionals and strengthen Europe’s overstretched health systems. It outlines seven priority measures:

• Enforce zero tolerance for all forms of violence against healthcare staff
• Improve scheduling practices by making shift patterns more predictable and flexible
• Manage overtime fairly and foster a positive workplace culture
• Prevent excessive workloads that contribute to burnout
• Train healthcare leaders and hold them accountable for staff well-being
• Expand access to mental health support for healthcare workers
• Regularly monitor and report on workforce well-being indicators 

“We are physically and mentally exhausted, which unfortunately can sometimes lead to medical errors,” said Mélanie Debarreix, a radiology resident from France. “In France, among medical students, 66% have experienced a depressive episode and 21% have had suicidal thoughts over the past year — three times more than the general population. The way to protect our mental health and well-being would first and foremost include the strict enforcement of the law concerning working hours or mandatory rest after on-call shifts, as well as the allocation of sufficient financial resources to allow us to practice in line with our values. We chose a path of humanity, but that does not mean we stop being human ourselves.”

Pierino di Silverio, national secretary of ANAAO-ASSOMED, an autonomous Italian doctors’ union representing about 32,000 members, said working conditions for medical trainees are particularly concerning in Italy. “They receive inadequate scholarships that are no longer even tax-exempt. They are treated like students but should be classified as workers,” he explained to Univadis Italy, a Medscape Network platform.

Beyond the WHO’s recommendations, Di Silverio urged two additional reforms: “We need to adjust salaries, which are currently below the European average, partly due to taxation, and address professional liability, which currently pushes doctors into defensive medicine and exposes them to a high risk of being taken to court.”

More Stress, Fewer Absences

A survey published last summer by ANAAO-ASSOMED found that 1 in 3 Italian doctors had received a formal complaint — 43.6% of them criminal, 30.8% civil, and 25.6% both. Despite a low conviction rate of about 3%, the emotional toll is significant: at least 1 in 3 doctors said they had considered leaving the profession, and 1 in 2 avoided taking on higher-responsibility roles.

The WHO survey also highlights that temporary contracts are more common in Italy than the European average — particularly among nurses. For both doctors and nurses, work-life balance remains precarious: only 13% of Italian healthcare professionals report an optimal balance compared with 22% across Europe. Depression rates in Italy are higher than the EU27+2 average — 34% for doctors (vs 32%) and 26% for nurses (vs 24%) — while anxiety was reported by roughly one quarter of both groups compared with European averages of 28% and 24%.

However, absenteeism for mental-health reasons is lower than the continental average: only 4.2% of doctors and 7.6% of nurses in Italy took sick leave for psychological distress compared with 7.4% and 10.5%, respectively, in Europe. Conversely, exposure to workplace violence is higher — 84% of Italian healthcare workers reported experiencing at least one incident compared with the European average of 77.6%.

“In the last year, at least a fifth of my colleagues either left the profession or changed to a lower-stress setting,” said Cecilia, a nurse in northern Italy who has worked in the public health system since 2012. “About half of them were younger than me,” she added. “And as I can see with my own eyes, they’re leaving high-risk or emergency contexts such as the ICU [intensive care unit] and emergency room. These were the most engaging contexts a few years ago.”

“Across Europe, the pressures faced by doctors and nurses may look different — whether it’s long hours in one country or temporary contracts in another, or workplace violence in yet another — but the impact on mental health is universal,” said Natasha Azzopardi-Muscat, director of health systems at the WHO Regional Office for Europe. “We measure hospital capacity by counting beds and surgical outcomes in survival rates – yet too often we fail to measure the well-being of those delivering care. These findings show that mental health must be treated as a core performance measure, just like patient safety or hospital capacity. The resilience of our health and care systems is only as good as the resilience of the women and men who dedicate their lives to caring for others.”

This story was translated from Univadis Italy.