Overwork, bullying and violence: depression and thoughts of suicide also in Italy for doctors and nurses

"The results of the MeND survey remind us that Europe's healthcare systems are only as strong as the people who feed them," commented Hans Henri Kluge, WHO Regional Director for Europe. "One in 3 doctors and nurses report depression or anxiety and more than 1 in 10 have thought about ending their own life or harming themselves. This is an unacceptable burden on those who care for us. It must not be this way.

In Italia il malessere si traduce in intenzioni di lasciare la professione superiori in media a quelle espresse nell’Europa a 27: riguardano rispettivamente il 9,7% dei medici (rispetto a una media del 9,1%) e ben il 16,7% degli infermieri, superiore di oltre un punto percentuale al 15,4% europeo. Istanze di “mollare” che derivano anche da una condizione di benessere complessivo inferiore o uguale alla media europea, già bassa: su una scala da zero a 100, i nostri infermieri si fermano a 48 (la media Ue27 è 50) mentre i dottori nostrani si sovrappongono con un 51% alla media Ue27. Ma di cosa soffrono i nostri sanitari quando si guarda alla salute mentale? I medici per lo più di ansia (25%) e depressione (25%) e per un 14% di pensieri suicidari, mentre gli infermieri stanno peggio: per il 34% denunciano depressione (la media Ue27 è al 32%), per il 26% ansia (media Ue 24%) e per il 14% di pensieri suicidari (media Ue 13%).

Non mancano le strategie possibili, da anni evidenziate anche da sindacati e società scientifiche italiani. Kluge le sintetizza così, inviando una lettera ideale agli Stati: «Possiamo intraprendere azioni concrete in questo momento, come imporre la tolleranza zero per la violenza e le molestie nei luoghi di lavoro sanitari; riformare i modelli di turni e gli straordinari per porre fine alla cultura del lavoro fino allo sfinimento; ridurre i carichi di lavoro eccessivi investendo in assunzioni più intelligenti e flussi di lavoro semplificati, anche sfruttando la potenza delle tecnologie digitali come l’intelligenza artificiale; e garantire che ogni operatore sanitario abbia accesso a un supporto per la salute mentale confidenziale e privo di stigma. Allo stesso tempo - avvisa - dobbiamo ritenere i leader sanitari responsabili della creazione di luoghi di lavoro sicuri e solidali. In definitiva, la crisi della salute mentale tra i nostri operatori sanitari è una crisi di sicurezza sanitaria, che minaccia

Despite the poor mental health and working conditions, 3 out of 4 doctors and 2 out of 3 nurses expressed a strong sense of purpose and meaning in their work and are mostly satisfied with their work. This suggests that health workers are passionate and motivated by their work, but need tailor-made support to do their job and care for their patients effectively.

"We are physically and mentally exhausted, which unfortunately can sometimes lead to medical errors," Mélanie Debarreix, a radiology registrar from France, testifies in the Report. "These working conditions have a huge impact on our mental health and well-being. In France, among medical students, 66% have experienced a depressive episode and 21% have had suicidal thoughts in the last year, three times more than in the general population. The way to protect our mental health and well-being should include first of all strictly enforcing the law on working hours or mandatory rest after on-call shifts, and allocating sufficient financial resources to allow us to practice in line with our values. We have chosen a path of humanity, but this does not mean that we stop being human ourselves.

Unsafe and unsupported working conditions are linked to stress, anxiety and depression among health workers, and this affects not only them, but also patients and society. Depending on the country, up to 40 per cent of doctors and nurses with symptoms of depression reported taking sick leave in the last year. Between 11 and 34 per cent of health workers said they were thinking of quitting their jobs. This loss of capacity can mean that patients face longer waits, reduced quality of care and health systems lose vital staff. In the end, everyone pays the price.

"Across Europe, the pressures faced by doctors and nurses may look different, whether it is long working hours in one country or temporary contracts in another, or workplace violence in yet another, but the impact on mental health is universal," says Natasha Azzopardi-Muscat, director of health systems WHO/Europe. "We measure hospital capacity by counting beds and surgical outcomes in survival rates, but too often we fail to measure the wellbeing of those who provide care. These results show that mental health needs to be treated as a core measure of performance, 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.

These findings add further weight to the 2022 WHO/Europe Report "It's time to act", according to which recruitment of health and care workers is not keeping pace with increasing demand, putting unbearable pressure on our health systems and health workers. Without action, Europe faces a projected shortage of 940,000 health workers by 2030.

Improved working conditions would help reduce sick leave and discourage staff from leaving the profession altogether, while at the same time attracting more doctors and nurses to the profession. And it would adapt European healthcare systems to current and future demographic changes and the needs of the population, as well as being better able to cope with future health emergencies.

The WHO outlines seven urgent policy actions that countries must take to improve working conditions and change organisational cultures, all of which can be achieved by reusing existing resources:

1. Zero tolerance for violence of any kind;

2. Improving the predictability and flexibility of shifts;

3. Managing overtime fairly and building a positive workplace culture;

4. Dealing with excessive workloads;

5. Training and empowering leaders;

6. Expanding access to mental health support; and

7. Conduct regular monitoring and reporting on the welfare of health workers.

"With Europe facing a shortage of nearly one million health workers by 2030, we cannot afford to lose them to burnout, despair or violence. Their well-being is not only a moral obligation, but is the foundation of safe, high-quality care for every patient," Kluge concludes. Let this survey be a much-needed wake-up call for action.