The research, published in Lancet Regional Health: Europe, suggests that staff shortages and poor leadership are key driving factors behind increased distress, and stresses that targeted systemic and organisational reforms are are urgently needed for this to be tackled.
Europe faces a workforce shortage of approximately 1.2 million healthcare workers. As the current workforce continues to age and nears retirement, many countries report struggling to replace and retain graduate workers, reflecting concerns of low job satisfaction, absenteeism and presenteeism.
Researchers in this study conducted an umbrella review of the available literature to assess the prevalence of psychological distress in healthcare workers in Europe, as well as to evaluate the effectiveness of interventions targeting psychological distress.
When analysing the literature, researchers found overlapping and broad definitions of psychological distress that incorporated stress, burnout, fatigue, anxiety, low morale, and dissatisfaction. While not considered a mental disorder, burnout was by far the most frequently reported outcome as a result of chronic work-related stress.
Dr Sarah Ledden, a Research Associate at King’s IoPPN and one of the study’s joint first authors said, “The health of a nation depends on a healthy and viable healthcare workforce. Our review reinforces major concerns about the mental health of healthcare workers and the role this will have on sustaining healthcare systems into the future if this continues to impact staff entering and leaving healthcare. Increasing workloads, staff shortages, and chronic under-funding have contributed to a system where healthcare workers are feeling the strain.”
Researchers also identified moral distress as a key driver, as workers reported an inability to take what they view as ethically appropriate actions. One scoping review found that being forced to act against evidence, professional recommendations, or their ethical and moral values and beliefs to provide care during the COVID-19 pandemic led to increased levels of psychological distress amongst maternity staff.
Professor Neil Greenberg, an Occupational Psychiatrist at King’s IoPPN and one of the study’s senior author said, “Moral distress, or moral injury, is an increasingly recognised form of mental health difficulty that occurs when an individual acts, or if affected by the actions of others, in such a way that it goes against their moral code or understanding of how the world should work.
“As healthcare workers are consistently working in conditions in which they are overstretched, it is no surprise that we are seeing increasing reports of this.”
When assessing why healthcare workers are reporting distress at the rates that they are, the literature is clear that a combination of staff shortages and heavy workloads are the source. One UK survey found that only 34% of HCWs reported staffing levels were adequate for them to do their job properly.
Researchers also wanted to assess interventions seeking to address psychological distress. Many organisations have prioritised approaches that seek to help the individual be more resilient or better manage their stress. Although there was limited evidence supporting the effectiveness of these programmes, the researchers emphasised that responsibility for staff well-being should not be placed solely on individuals and that interventions must be accompanied by broader organisational efforts to support HCWs.
Researchers found that organisational level interventions that address the root causes of stress, and which facilitate strong social connections between colleagues and their supervisors, provided the strongest and longest lasting positive impact.
Professor Sharon Stevelink, Professor of Applied Epidemiology and Occupational Health at King’s IoPPN and one of the study’s authors said, “Problems like understaffing and workload issues are not easily solved, our study shows that organisations that take the time to unpick these organisational and systemic difficulties see much greater improvements in outcomes and staff wellbeing.”
Futureproofing the healthcare workforce in Europe: understanding and addressing psychological distress and occupational outcomes (DOI 10.1016/j.lanepe.2025.101463) (Pamela Almeida-Meza, Sarah Ledden, Brendan Dempsey, Alexandria Smith, Bethany Croak, Rupa Bhundia, Danielle Lamb, Aiysha Malik, Rosalind Raine, Cassie Redlich, Simon Wessely, Sharon Stevelink, Neil Greenberg) was published in Lancet Regional Health: Europe.
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