Working conditions and mental health among doctors and nurses in the European Union, Iceland, and Norway: a cross-sectional survey

Abstract

Background Europe faces persistent challenges in retaining and recruiting healthcare workers. Poor working conditions and deteriorating wellbeing may contribute to attrition and turnover intentions, yet large-scale studies examining associations between working conditions and mental health in Europe after the COVID-19 pandemic remain scarce. Methods We conducted a cross-sectional online survey between October 2024 and April 2025 among a non-probabilistic sample of doctors and nurses in the 27 EU countries, Iceland, and Norway. Working conditions included job demands, hazards, resources, and organisational support structures. Mental health outcomes were symptoms of depression and anxiety, probable alcohol dependence, and suicidal thoughts. Associations were estimated using adjusted Poisson regression models with random intercepts for countries. Findings We recruited 90,171 respondents, of whom 51,702 (58%) were nurses and 70,249 (78%) were females. Depressive symptoms affected almost one in three respondents (26,837, 30%), probable anxiety 18,677 (23%), probable alcohol dependence 2756 (2–4%), and suicidal thoughts 11,671 (13%). Physical violence affected 3673 doctors (10%) and 9545 nurses (18%). More than one in four doctors worked >50 h per week (10,441, 28%), and 13,262 doctors (35%) and 20,458 nurses (39%) worked more than one night shift per week. Adverse working conditions were strongly associated with poor mental health (adjusted prevalence ratios 0·98–1·94), while job resources and organisational support were associated with better outcomes (adjusted PRs 1·06–0·56). Dose–response and weighted analyses confirmed robustness. Interpretation Mental health problems are highly prevalent among European doctors and nurses and are systematically associated with working conditions. Improving working conditions and well-being may help address the ongoing healthcare workforce crisis. Funding European Commission.