Skip to main content
NCBI home page
NIHPA Author Manuscripts logoLink to NIHPA Author Manuscripts
. Author manuscript; available in PMC: 2025 Aug 7.
Published in final edited form as: Nurs Res. 2025 Jul 11;74(6):454–459. doi: 10.1097/NNR.0000000000000852

Perceived Need and Utilization of Mental Health Services by Registered Nurses

Shira Winter 1, Robert H Pietrzak 2,3,4, Celestine He 1, Jonathan M DePierro 1, Bevin Cohen 1,5, Chi Chan 1,6, Sydney Starkweather 7, Cara Faherty 1, Emma Benn 1, Uraina Clark 1, Nihal Mohamed 1, Lauren Peccoralo 1, Jonathan Ripp 1
PMCID: PMC12329662  NIHMSID: NIHMS2099204  PMID: 40680286

Abstract

Background:

Nurses experience high rates of mental health stressors. Mental health support services can mitigate the burden of these stressors and mental health sequelae, but nurses may not access them due to stigma, unavailability, or concerns regarding professional standing.

Objective:

To examine the association between nurse characteristics and perceived need for and utilization of mental health services and identify barriers to nurses accessing mental health services.

Methods:

Cross-sectional survey data were analyzed from 367 nurses in one large urban health system. Descriptive statistics and multinomial logistic regression were used to examine demographic, workplace, and mental health characteristics that were independently associated with perceived need for and utilization of mental health services.

Results:

Nurses who reported experiences of verbal abuse, anxiety, or burnout and who were younger and partnered were more likely to have utilized mental health services and have perceived they would benefit from these services. The most prevalent barriers to care included not knowing how to find a provider, inconvenient hours, and embarrassment or concerns about judgment from others.

Discussion:

Several barriers prevent nurses who perceive a need for mental health services from accessing them. Interventions targeting these barriers may help mitigate the burden of mental health conditions in this population.

Keywords: mental health services, registered nurses, burnout, workplace violence, Covid-19 pandemic, health care utilization

There are over 3 million nurses in the United States, constituting a major portion of our health care labor force (U.S. Bureau of Labor Statistics, 2025). The American Nurses Foundation (ANF, 2022) found that after the COVID-19 pandemic, 60% of nurses reported feeling burnt out, with 52% saying that they would leave or consider leaving their current position, and around half of those reporting that they would leave or consider leaving because work negatively affected their well-being (ANF, 2022). Another national sample of nurses found that about one third who left their jobs did so because of burnout (Shah et al., 2021).

Burnout, defined as a state of emotional, physical, and mental exhaustion caused by prologued and excessive stress—particularly in the workplace (Maslach & Leiter, 2016)—can co-occur with other job-mediated mental health disorders, with stress contributing to both outcomes. It is, therefore, not surprising that the COVID-19 pandemic ushered high rates of anxiety, depression, posttraumatic stress, and insomnia among frontline health care workers (Feingold et al., 2021; García-Vivar et al., 2023). In one health system, approximately one third of nurses screened positive for major depressive disorder, posttraumatic stress disorder, and/or generalized anxiety disorder, and presence of these disorders was associated with burnout (Cohen et al., 2022). There are several interventions that can mitigate the effect of these issues and have been shown to help promote nurse retention, such as mental health content in nurse residency programs, as well as didactic sessions and workshops that incorporate multimodal techniques for addressing mental health challenges (Foster et al., 2024; Sampson et al., 2020). Collectively, these findings suggest that preventing and treating burnout and mental health conditions stemming from work-related stressors may facilitate retention and promote well-being of the nursing workforce.

There are several evidence-based methods for preventing stress and burnout in nurses, including adequate staffing, occupational safety, managerial and peer support, and greater autonomy and flexibility in work (Aiken et al., 2023; Velando-Soriano et al., 2020). In addition to structural and organizational interventions that focus on prevention, individual mental health services may be appropriate for health care workers who experience clinically significant depressive and anxiety symptoms, which are strongly linked to burnout and may benefit from therapeutic treatment. In fact, access to psychological services was associated with improved mental health outcomes among health care workers during COVID-19 (Umbetkulova et al., 2024). Connecting nurses with mental health professionals who can help them cope with stress within and outside the workplace might mitigate risk of burnout and other mental health disorders (Clough et al., 2017).

Unfortunately, access to mental health services is limited by appointment availability, cost, stigma, concerns about perceptions of professional competence, and an overall dearth of services designed and marketed expressly to this workforce (Knaak et al., 2017; Krupa et al., 2009; Ross & Goldner, 2009). Moreover, there is insufficient understanding of the factors associated with nurses’ perceived need for and utilization of mental health services, as well as a nuanced understanding of the barriers to pursuing mental health services and how to overcome them. Such information can inform efforts to help nurses recognize when they might benefit from mental health services and reduce barriers to access.

The Andersen Healthcare Utilization Model formed the conceptual basis for this analysis. The model posits that predisposing, enabling, and need factors contribute to health care utilization (Anderson, 2008). This model has previously been applied to better understand help-seeking in multiple populations, including military veterans, migrants, and World Trade Center first responders (Diab et al., 2020; Gabrielian et al., 2014; Krzyż et al., 2023). Basing the analysis of this theoretical model, we focused on predisposing (e.g., demographic and workplace characteristics) and need-based (e.g., screening positive for anxiety and depression) factors associated with perceived need for and utilization of mental health services (Figure 1). We subsequently identified barriers to accessing mental health services among nurses who perceived that they would benefit from mental health services but did not access them.

Figure 1:

Figure 1:

Open in a new tab

Anderson’s Model of Health Services Utilization applied to factors related to nurses’ perceived benefit from and access of mental health services

The objectives of this study were to (a) characterize predisposing (e.g., demographic characteristics) and need-based factors (e.g., psychological and mental health factors and stressors) associated with perceived need for and utilization of mental health services among nurses and (b) identify prominent barriers to accessing mental health services among nurses who thought they could benefit from mental health services but did not access them.

Methods

Study Design, Setting, and Participants

A secondary data analysis was conducted using data from a single institution, multisite, cross-sectional anonymous survey administered between September and October 2022 to a diverse sample of health care workers at a large urban academic tertiary/quaternary hospital in New York City. This survey was sent to a subset of institutional email addresses, with periodic email reminders and an opportunity to be entered into a raffle to win various prizes as incentive for survey completion (DePierro et al., 2024). The survey was sent to a total of 4,998 hospital staff and obtained a 28% response rate across all staff, including nurses (n = 1,398; DePierro et al., 2024). This paper reports results for only nurse respondents, excluding advanced practice nurses. This study was reviewed by the medical center’s institutional review board, which issued an exempt determination. Participants were provided with an information sheet describing the study prior to completing the survey.

Survey Instrument and Variables

The survey assessed variables from the following domains: demographics, work location, team dynamics, managerial support, workplace climate vis-a-vis diversity, exposure to workplace violence (e.g. frequency of exposure to physical violence and verbal abuse from a patient or patient’s visitor), intent to leave (both current position and health care altogether), coping mechanisms (e.g., support from others, substance use, and cognitive patterns such as denial), personal and financial strain (e.g., caregiver responsibilities), accessing mental health services, nature of work during the COVID-19 pandemic, and several validated scales that were analyzed using previously validated cut scores, including the Patient Health Questionnaire–2 (PHQ–2) for depression (sensitivity = .89, specificity = .76, Cronbach’s alpha = .65–.81; Caro-Fuentes & Sanabria-Mazo, 2024; Kroenke et al., 2003; Mitchell et. al, 2016), the Generalized Anxiety Disorder–2 (GAD–2) for anxiety (sensitivity = .76, specificity = .81, Cronbach’s alpha = .74-.84; Caro-Fuentes &Sanabria-Mazo, 2024; Kroenke et al., 2007; Plummer et al., 2016), World Health Organization–Five (WHO–5) Well-Being Index (sensitivity = .86, specificity = .81 when used in the context of depression; Topp et al., 2015), and the two-item Maslach Burnout Inventory (MBI; varying sensitivity and specificity by population, with two-item MBI demonstrating sensitivity of .936 and specificity of .73 in medical residents; Li-Sauerwine et al., 2020).

The dependent variable regarding perceived need for and access to mental health services was assessed using the following question, “Over the past year, has there been a time when you thought you might benefit from mental health services (e.g., talk therapy, counseling, psychiatry)?” Participants could select one of four responses: “Yes, and I have utilized mental health services during this time,” “Yes, and I have NOT utilized mental health services during this time,” “No,” or “I don’t remember/prefer not to answer.” We refer to these first three responses hereafter as perceived benefit and accessed care, perceived benefit but did not access care, and did not think they would benefit. Those who selected “I don’t remember/prefer not to answer” were not included in the analysis (n = 21). Nurses who answered they thought they might benefit from mental health services but had not utilized them were then asked, “Why not?” and were given the opportunity to select one or more reasons from a list that included options related to access (e.g., hours, wait times, cost), stigma (e.g., privacy concerns, embarrassment), and others (Figure 2).

Figure 2:

Figure 2:

Open in a new tab

Predicted Probabilities of Mental Health Care Utilization as a Function of Burnout Screening Status and Verbal Abuse

Data Analysis

First, we computed descriptive statistics and chi-square tests for all independent variables to identify bivariate differences between nurses who perceived benefit and accessed care, perceived benefit but did not access care, and those who did not think they would benefit. Then, we conducted a multinomial logistic regression to examine demographic, workplace, and mental health characteristics that were independently associated with perceived need for and utilization of mental health services. Interaction terms of significant independent variables were subsequently incorporated into this regression model to identify possible combinations of variables linked to perceived need for and utilization of mental health services. Lastly, among respondents who said that they thought they would benefit from mental health services but did not access them, we calculated the prevalence of barriers to accessing mental health services. All analyses were performed using IBM SPSS Statistics (Version 28).

Results

Sample Characteristics

A total of 367 nurses completed the survey. Respondents who did not answer or responded “I don’t remember” to the main outcome variable were not included, leaving a total of 319 responses. Table 1 shows descriptive characteristics of nurses who perceived benefit and accessed care (n = 68, 21%), perceived benefit but did not access care (n = 106, 33%), and did not think they would benefit (n = 145, 45%). Group differences were observed for age, partner status, exposure to verbal abuse, well-being, anxiety, depression, and burnout. There were no statistical differences with respect to race/ethnicity and work setting.

Table 1.

Sample characteristics for nurses who accessed care, perceived benefit but did not access care, and did not access or perceive benefit of care

Accessed Care n (%) Perceived Benefit But Did Not Access Care n (%)N, % No Access or Perceived Benefit of Care n (%) p
Age <.001
20–29 20 (32.3) 22 (22.0) 20 (15.3)
30–39 24 (38.7) 31 (31.0) 22 (16.8)
40+ 18 (29.0) 47 (47.1) 89 (67.9)
Race
White 25 (40.3) 31 (30.1) 31 (23.0) .239
Asian 15 (24.2) 33 (32.0) 59 (43.7)
Black 8 (12.9) 14 (13.6 17 (12.6)
Latinx 4 (6.5) 7 (6.8) 10 (7.4)
Other/no answer 10 (16.1) 19 (17.5) 18 (13.3)
Partner status .003
Single 28 (51.9) 45 (47.4) 36 (29.0)
Married 26 (48.1) 50 (52.6) 88 (71.0)
Work Setting .687
Inpatient 59 (86.8) 91 (85.8) 120 (82.8)
Outpatient 9 (13.2) 15 (14.2) 25 (17.2)
Physical Violence .019
5 or fewer times 33 (51.6) 66 (63.5) 99 (71.7)
6+ times 31 (48.4) 38 (36.5) 39 (28.3)
Verbal abuse .006
5 or fewer times 16 (25) 31 (29.8) 63 (45.3)
6+ times 48 (75) 73 (70.2) 76 (54.7)
Well-being <.001
No 23 (35.4) 24 (23.5) 15 (11.6)
Yes 42 (64.6) 78 (76.5) 122 (88.4)
Anxiety <.001
No 36 (55.4) 72 (69.2) 127 (90.7)
Yes 29 (44.6) 32 (30.8) 13 (9.3)
Depression <.001
No 45 (69.2) 79 (76.0) 134 (95.7)
Yes 20 (30.8) 25 (24.0) 6 (4.3)
Burnout <.001
No 22 (33.8) 41 (39.0) 96 (69.1)
Yes 43 (66.2) 64 (61.0) 43 (30.9)
Open in a new tab

Note. Wellbeing measured by the World Health Organization (WHO)-5 Wellbeing Index, Anxiety by the Generalized Anxiety Disorder (GAD)-2, Depression by the Patient Health Questionnaire (PHQ)-2, and burnout by the Maslow Burnout Inventory (MBI).

Multivariable Regression Results

Table 2 shows results of a multinomial regression analysis that evaluated the association between predisposing and need factors and perceived need for and utilization of mental health services. After excluding missing responses across all variables, 260 responses were included in the analysis. Compared to nurses who did not think they would benefit, those who perceived benefit and accessed care had fourfold higher odds of anxiety and twofold higher odds of burnout and were younger and less likely to be partnered. Compared to nurses who did not think they would benefit, those who perceived benefit but did not access care had higher odds of anxiety, burnout, and instances of verbal abuse and were younger and less likely to be partnered. No statistically significant differences were found between respondents who perceived benefit and accessed care and those who perceived benefit but did not access care. A significant interaction between burnout and verbal abuse was also observed; Figure 2 shows predicted probabilities for this interaction, which revealed that among nurses who screened positive for burnout, those who reported six or more instances of past-year verbal abuse were more than twice as likely to have utilized mental health services relative to those who reported five or fewer instances of verbal abuse. Those who experienced both burnout and verbal abuse had a 37% probability of accessing mental health services, whereas those who experienced only six or greater instances of verbal abuse or screened positive for burnout both had a 15% probability. Among nurses who did not screen positive for burnout, mental health care was accessed at similar rates for both those who experienced greater than six or five or fewer instances of verbal abuse.

Table 2.

Results of multinomial regression of the association between predisposing and need factors, and perceived need for and utilization of mental health services

Variable Perceived Benefit and Accessed Care versus Did Not Think They Would Benefit Perceived Benefit and Did Not Access Care versus Did Not Think They Would Benefit Perceived Benefit and Accessed Care versus Perceived Benefit and Did Not Access Care
OR [95%CI] OR [95%CI] OR [95%CI]
Physical Violence 1.39 [0.54–3.56] 0.78 [0.36–1.71] 1.77 [0.76–4.12]
Verbal Abuse 2.26 [0.88–5.78] *2.31 [1.12–4.78] 0.98 [0.40–2.41]
Wellbeing 0.66 [0.25 – 1.78] 0.93 [0.39–2.24] 0.71 [0.30–1.68]
Anxiety **4.57 [1.63–12.86] *2.86 [1.13–7.24] 1.60 [0.7–3.79]
Depression 2.66 [0.70–10.14] 2.91 [0.88–9.65] 0.92 [0.33–2.51]
Burnout *2.48 [1.10–5.59] *2.52 [1.31–4.84] 0.98 [0.45–2.13]
Age *0.54 [0.33–0.90] *0.83* [0.55–1.26] 0.65 [0.40–1.06]
Race 1.27 [0.98–1.63] 1.06 [0.87–1.30] 1.19 [0.93–1.52]
Partnered *0.38 [0.17–0.85] *0.43 [0.23–0.83] 0.87 [0.40–1.89]
Work Setting 0.59 [0.20–1.71] 1.14 [0.48–2.74] 0.51 [0.18–1.45]
Open in a new tab

Note. OR=odds ratio; CI=confidence interval.

*

p<.05

**

p<.01.

Reasons for Not Accessing Care

Figure 3 shows the prevalence of reasons why nurses who perceived benefit of mental health care did not access it (n = 106). Forty-four percent (n = 47) of respondents stated they did not try to access services. Respondents cited practical barriers, including being unaware of available service (n = 23, 22%), not knowing how to find a provider (n = 31, 29%), inconvenient hours (n = 30, 28%), wait times (n = 7, 7%), cost (n = 22, 21%), and insurance issues (n = 4, 4%). Respondents also reported concerns related to stigma and mistrust of mental health services, including embarrassment or concern about judgment from others (n = 24, 23%), privacy concerns (n = 17, 16%), concerns about the effects of a mental health diagnosis on licensure or credentialing (n = 15, 14%), and concerns about the efficacy or trustworthiness of professional mental health services (n = 3, 3%). Ten percent (n = 11) of respondents also indicated a reason other than those included on the list, though the survey did not collect details about what these were.

Figure 3:

Figure 3:

Open in a new tab

Reasons for not accessing mental health services among nurses who perceived they would benefit from mental health services

Discussion

Results of this study indicate that there are predisposing and need-based factors relating to demographics, work environment, and mental health characteristics that are associated with perceived need for and utilization of mental health services among nurses. These factors are younger age, being single, exposure to verbal abuse, burnout, and high anxiety levels. Taken together, these findings may help tailor interventions for nurses who are suffering from mental health issues and may benefit from professional assistance.

There are several possible explanations for the significant association between younger age and perceived need for and utilization of mental health services, including tendency for greater resilience with age, differences in generational perceptions of mental health services, and the inverse association between work-related stress and years of experience in nursing (Elshaikh et al., 2023; Martin et al., 2023). Evidence suggests that the stress of the COVID-19 pandemic had a more deleterious effect on the mental health of younger generations compared with its effect on older generations (Grelle et al., 2023). Consistent with the results of this study, the ANF 2022 survey found that 46% of nurses under 25 reported that they do not feel emotionally healthy, compared with 19% of nurses over 55 (ANF, 2022). Nurses who have been in the profession for longer periods of time may have developed coping mechanisms to manage the stresses of the job, or their increased levels of experience may lead them to be less affected by certain situations that novice nurses may consider to be stressful, such as acute deterioration in patient condition or excessive workload demands. More generally, these results are consistent with other studies, which have explored lower rates of mental health utilization among older adults (Karlin & Norris, 2006; Lavingia et al., 2020). As awareness of the importance of mental health in the workplace becomes more widespread, there may be less stigma surrounding the utilization of mental health services in younger generations of employees.

Verbal abuse was also found to be significantly associated with perceived benefit from mental health services. Nurses are frequently subjected to physical and verbal abuse from both patients and colleagues, which have negative effects not only on the mental health of nurses but also on patient outcomes (Edward et al., 2014; Woon, 2023). Furthermore, nurses who reported being subjected to both more frequent verbal abuse and screened positive for burnout had a higher probability of accessing mental health services. This finding underscores the need to implement evidence-based solutions for reducing workplace violence against nurses, such as education in de-escalation through simulation and universal precautions (Kumari et al., 2022), and develop effective ways to support nursing staff who are subject to workplace violence and verbal abuse to promote resilience.

It is not surprising that the two need-based psychological factors most associated with utilizing mental health services were burnout and anxiety, even when controlling for depression, well-being, and other factors. Compared to depression and well-being, burnout and anxiety often have a more immediate effect on an individual’s ability to function—particularly in professional settings such as the workplace. Burnout directly affects work performance and motivation, while anxiety can lead to chronic worry, making them more likely to seek support than those experiencing lower levels (Hoffman & Smits, 2008; Maslach et al., 2001).

While nursing is inherently a high-stress profession, there are proven workplace modifications and techniques that can mitigate burnout, such as adequate staffing, managerial and social support, and job flexibility and autonomy (Aiken et al., 2023; Velando-Soriano et al., 2020). Our findings suggest that interventions to facilitate greater utilization of individual mental health services may also be warranted. For example, increasing education and screening opportunities can help nurses who are possibly suffering in silence to identify their mental health needs earlier and help them overcome barriers to accessing services. Improving nurses’ mental health requires a two-pronged approach to access to mental health services, as well as structural changes that promote well-being at work.

Notably, there were no statistically significant differences in characteristics between respondents who reported they would benefit from mental health services but did not utilize them and those who reported they would benefit from mental health services and did utilize them. This finding may indicate that what determines utilization is less related to predisposing or need-based factors and more related to enabling factors; however, this hypothesis should be further explored with a larger sample. Commonly endorsed barriers to care included practical and stigma-related concerns, which may be modifiable with efforts to reduce stigma and improve ease of access to mental health services, such as nurse leaders engaging in open dialogue about the importance of mental wellness, easily accessible behavioral health programs, and marketing of available resources (Bergman & Rushton, 2023). In addition, material support and structural changes that facilitate access among nurses who wish to seek mental health care, such as information about finding providers, greater availability of appointments, and reduced costs, could all contribute to ensuring that nurses who think they might benefit from mental health services get the help they need. Some health care systems have already responded to this need by creating programs geared toward making mental health services more accessible and available to employees (Bellehsen et al., 2024; DePierro et al., 2020). Further research is needed to identify the effectiveness of such programs in addressing barriers to care, mitigating burnout and related mental health concerns, and improving nurse well-being.

Limitations

There are several limitations to note. Because data were collected via a self-report survey, this analysis may be subject to both response and recall bias. Additionally, this survey was administered at a single institution in one city, which limited both the sample size and generalizability of the findings to other locations. The overall low response rate to the survey across providers—as well as participation bias—further limit the results of this study. Finally, respondents may have used resources other than formal mental health services (e.g., mobile mental health apps, meditation, yoga), which were not captured in this analysis.

Conclusion

The profession of nursing is challenged by burnout and stress in the workplace that may exacerbate mental health conditions, pointing to a critical and urgent need to preserve the mental health of the nursing workforce. This is a moral imperative for employers who bear ethical and legal responsibility for protecting the mental and physical health of employees, a practical imperative for the national health care system struggling to retain nurses in the profession, and a financial imperative for individual hospitals that are struggling to recruit nurses and prevent turnover. Attention to demographic and modifiable factors that affect mental health and access to mental health resources may promote good mental health and work satisfaction among nurses, enabling them to continue to deliver the highest quality care to their patients.

Acknowledgments

This work was supported in part through the computational and data resources and staff expertise provided by Scientific Computing and Data at the Icahn School of Medicine at Mount Sinai and supported by the Clinical and Translational Science Award (Grant No. UL1TR004419) from the National Center for Advancing Translational Sciences and by HRSA (Grant No. U3NHP45498).

Footnotes

The authors have no conflicts of interest to report.

This study was reviewed by the Mount Sinai Institutional Review Board, which issued an exempt determination (STUDY-21-00144).

References

  1. Aiken LH, Lasater KB, Sloane DM, Pogue CA, Rosenbaum KEF, Muir KJ, & McHugh MD (2023). Physician and nurse well-being and preferred interventions to address burnout in hospital practice: Factors associated with turnover, outcomes, and patient safety. JAMA Health Forum, 4, e231809. 10.1001/jamahealthforum.2023.1809 [DOI] [PMC free article] [PubMed] [Google Scholar]
  2. American Nurses Foundation. (2022). Pulse on the nation’s nurses survey series: COVID-19 two year impact assessment survey. [Google Scholar]
  3. Anderson RM (2008). National health surveys and the behavioral model of health services use. Medical Care, 46, 647–653. 10.1097/MLR.0b013e31817a835d [DOI] [PubMed] [Google Scholar]
  4. Bergman A, & Rushton CH (2023). Overcoming stigma: Asking for and receiving mental health support. AACN Advanced Critical Care, 34, 67–71. 10.4037/aacnacc2023684 [DOI] [PMC free article] [PubMed] [Google Scholar]
  5. Bellehsen MH, Cook HM, Shaam P, Burns D, D’Amico P, Goldberg A, McManus MB, Sapra M, Thomas L, Wacha-Montes A, Zenzerovich G, Watson P, Westphal RJ, & Schwartz RM (2024). Adapting the stress first aid model for frontline healthcare workers during COVID-19. International Journal of Environmental Research and Public Health, 21, 171. 10.3390/ijerph21020171 [DOI] [PMC free article] [PubMed] [Google Scholar]
  6. Caro-Fuentes S, & Sanabria-Mazo JP (2024). A systematic review of the psychometric properties of the Patient Health Questionnaire-4 in clinical and nonclinical populations. Journal of the Academy of Consultation-Liaison Psychiatry, 65, 178–194. 10.1016/j.jaclp.2023.11.685 [DOI] [PubMed] [Google Scholar]
  7. Clough BA, March S, Chan RJ, Casey LM, Phillips R, & Ireland MJ (2017). Psychosocial interventions for managing occupational stress and burnout among medical doctors: A systematic review. Systematic Reviews, 6, 144. 10.1186/s13643-017-0526-3 [DOI] [PMC free article] [PubMed] [Google Scholar]
  8. Cohen B, DePierro J, Chan CC, Tolan E, Deshpande R, Feder A, Feingold JH, Peccoralo L, Pietrzak RH, & Ripp J (2022). Factors associated with burnout among nurses providing direct patient care during the COVID-19 pandemic. JONA: Journal of Nursing Administration, 52, 598–607. 10.1097/NNA.0000000000001216 [DOI] [PMC free article] [PubMed] [Google Scholar]
  9. DePierro JM, Chan CC, Mohamed N, Starkweather S, Ripp J, & Peccoralo LA (2024). Determinants of staff intent to leave health care during the COVID-19 pandemic. American Journal of Public Health, 114, 200–203. 10.2105/AJPH.2024.307574 [DOI] [PMC free article] [PubMed] [Google Scholar]
  10. DePierro J, Katz CL, Marin D, Feder A, Bevilacqua L, Sharma V, Hurtado A, Ripp J, Lim S, & Charney D (2020). Mount Sinai’s Center for Stress, Resilience and Personal Growth as a model for responding to the impact of COVID-19 on health care workers. Psychiatry Research, 293, 113426. 10.1016/j.psychres.2020.113426 [DOI] [PMC free article] [PubMed] [Google Scholar]
  11. Diab O, DePierro J, Cancelmo L, Schaffer J, Schechter C, Dasaro CR, Todd A, Crane M, Udasin I, Harrison D, Moline J, Luft B, Southwick SM, Feder A, & Pietrzak RH (2020). Mental healthcare needs in World Trade Center responders: Results from a large, population-based health monitoring cohort. Administration and Policy in Mental Health and Mental Health Services Research, 47, 427–434. 10.1007/s10488-019-00998-z [DOI] [PMC free article] [PubMed] [Google Scholar]
  12. Edward K-L, Ousey K, Warelow P, & Lui S (2014). Nursing and aggression in the workplace: A systematic review. British Journal of Nursing, 23, 653–659. 10.12968/bjon.2014.23.12.653 [DOI] [PubMed] [Google Scholar]
  13. Elshaikh U, Sheik R, Saeed RKM, Chivese T, & Alsayed Hassan D (2023). Barriers and facilitators of older adults for professional mental health help-seeking: A systematic review. BMC Geriatrics, 23, 516. 10.1186/s12877-023-04229-x [DOI] [PMC free article] [PubMed] [Google Scholar]
  14. Feingold JH, Peccoralo L, Chan CC, Kaplan CA, Kaye-Kauderer H, Charney D, Verity J, Hurtado A, Burka L, Syed SA, & Murrough JW (2021). Psychological impact of the COVID-19 pandemic on frontline health care workers during the pandemic surge in New York City. Chronic Stress, 5, 2470547020977891. 10.1177/2470547020977891 [DOI] [PMC free article] [PubMed] [Google Scholar]
  15. Foster K, Shochet I, Shakespeare-Finch J, Maybery D, Bui MV, Gordon I, Bagot KL, & Roche M (2024). Promoting resilience in mental health nurses: A partially clustered randomised controlled trial. International Journal of Nursing Studies, 159, 104865. 10.1016/j.ijnurstu.2024.104865 [DOI] [PubMed] [Google Scholar]
  16. Gabrielian S, Yuan AH, Andersen RM, Rubenstein LV, & Gelberg L (2014). VA health service utilization for homeless and low-income Veterans: A spotlight on the VA Supportive Housing (VASH) program in greater Los Angeles. Medical Care, 52, 454–461. 10.1097/MLR.0000000000000112 [DOI] [PMC free article] [PubMed] [Google Scholar]
  17. García-Vivar C, Rodríguez-Matesanz I, San Martín-Rodríguez L, Soto-Ruiz N, Ferraz-Torres M, & Escalada-Hernández P (2023). Analysis of mental health effects among nurses working during the COVID-19 pandemic: A systematic review. Journal of Psychiatric and Mental Health Nursing, 30, 326–340. 10.1111/jpm.12880 [DOI] [PMC free article] [PubMed] [Google Scholar]
  18. Grelle K, Shrestha N, Ximenes M, Perrotte J, Cordaro M, Deason RG, & Howard K (2023). The generation gap revisited: Generational differences in mental health, maladaptive coping behaviors, and pandemic-related concerns during the initial COVID-19 pandemic. Journal of Adult Development, 30, 381–392. 10.1007/s10804-023-09442-x [DOI] [PMC free article] [PubMed] [Google Scholar]
  19. Hoffman SG & Smits JAJ (2008). Cognitive-behavioral therapy for adult anxiety disorders: A meta-analysis of randomized placebo-controlled trials. Journal of Clinical Psychiatry, 69, 621–632. 10.4088/jcp.v69n0415 [DOI] [PMC free article] [PubMed] [Google Scholar]
  20. Karlin BE, & Norris MP (2006). Public mental health care utilization by older adults. Administration and Policy in Mental Health and Mental Health Services Research, 33, 730–736. 10.1007/s10488-005-0003-5 [DOI] [PubMed] [Google Scholar]
  21. Knaak S, Mantler E, & Szeto A (2017). Mental illness-related stigma in healthcare: Barriers to access and care and evidence-based solutions. Healthcare Management Forum, 30, 111–116. 10.1177/0840470416679413 [DOI] [PMC free article] [PubMed] [Google Scholar]
  22. Kroenke K, Spitzer RL, & Williams JBW (2003). The Patient Health Questionnaire-2: Validity of a two-item depression screener. Medical Care, 41, 1284–1292. 10.1097/01.MLR.0000093487.78664.3C [DOI] [PubMed] [Google Scholar]
  23. Kroenke K, Spitzer RL, Williams JBW, Monahan PO, & Löwe B (2007). Anxiety disorders in primary care: Prevalence, impairment, comorbidity, and detection. Annals of Internal Medicine, 146, 317–325. 10.7326/0003-4819-146-5-200703060-00004 [DOI] [PubMed] [Google Scholar]
  24. Krupa T, Kirsh B, Cockburn L, & Gewurtz R (2009). Understanding the stigma of mental illness in employment. Work, 33, 413–425. 10.3233/WOR-2009-0890 [DOI] [PubMed] [Google Scholar]
  25. Krzyż EZ, Antunez Martinez OF, & Lin H-R (2023). Uses of Andersen health services utilization framework to determine healthcare utilization for mental health among migrants—A scoping review. Frontiers in Public Health, 11, 1284784. 10.3389/fpubh.2023.1284784 [DOI] [PMC free article] [PubMed] [Google Scholar]
  26. Kumari A, Sarkar S, Ranjan P, Chopra S, Kaur T, Baitha U, Chakrawarty A, & Klanidhi KB (2022). Interventions for workplace violence against health-care professionals: A systematic review. Work, 73, 415–427. 10.3233/WOR-210046 [DOI] [PubMed] [Google Scholar]
  27. Lavingia R, Jones K, & Asghar-Ali AA (2020). A systematic review of barriers faced by older adults in seeking and accessing mental health care. Journal of Psychiatric Practice, 26, 367–382. 10.1097/PRA.0000000000000491 [DOI] [PubMed] [Google Scholar]
  28. Li-Sauerwine S, Rebillot K, Melamed M, Addo N, & Lin M (2020). A 2-question summative score correlates with the Maslach Burnout Inventory. Western Journal of Emergency Medicine, 21, 610–617. 10.5811/westjem.2020.2.45139 [DOI] [PMC free article] [PubMed] [Google Scholar]
  29. Martin B, Kaminski-Ozturk N, O’Hara C, & Smiley R (2023). Examining the impact of the COVID-19 pandemic on burnout and stress among U.S. nurses. Journal of Nursing Regulation, 14, 4–12. 10.1016/S2155-8256(23)00063-7 [DOI] [PMC free article] [PubMed] [Google Scholar]
  30. Maslach C, & Leiter MP (2016). Understanding the burnout experience: Recent research and its implications for psychiatry. World Psychiatry, 15, 103–111. 10.1002/wps.20311 [DOI] [PMC free article] [PubMed] [Google Scholar]
  31. Maslach C, Shaufeli WB, & Leiter MP (2001). Job burnout. Annual Review of Psychology, 52, 397–422. 10.1146/annurev.psych.52.1.397 [DOI] [PubMed] [Google Scholar]
  32. Mitchell AJ, Yadegarfar M, Gill J, & Stubbs B (2016). Case finding and screening clinical utility of the Patient Health Questionnaire (PHQ-9 and PHQ-2) for depression in primary care: A diagnostic meta-analysis of 40 studies. BJPsych Open, 2, 127–138. 10.1192/bjpo.bp.115.001685 [DOI] [PMC free article] [PubMed] [Google Scholar]
  33. Plummer F, Manea L, Trepel D, & McMillan D (2016). Screening for anxiety disorders with the GAD-7 and GAD-2: A systematic review and diagnostic metaanalysis. General Hospital Psychiatry, 39, 24–31. 10.1016/j.genhosppsych.2015.11.005 [DOI] [PubMed] [Google Scholar]
  34. Ross CA, & Goldner EM (2009). Stigma, negative attitudes and discrimination towards mental illness within the nursing profession: A review of the literature. Journal of Psychiatric and Mental Health Nursing, 16, 558–567. 10.1111/j.1365-2850.2009.01399.x [DOI] [PubMed] [Google Scholar]
  35. Sampson M, Melnyk BM, & Hoying J (2020). The MINDBODYSTRONG intervention for new nurse residents: 6-month effects on mental health outcomes, healthy lifestyle behaviors, and job satisfaction. Worldviews on Evidence-Based Nursing, 17, 16–23. 10.1111/wvn.12411 [DOI] [PubMed] [Google Scholar]
  36. Shah MK, Gandrakota N, Cimiotti JP, Ghose N, Moore M, & Ali MK (2021). Prevalence of and factors associated with nurse burnout in the US. JAMA Network Open, 4, e2036469. 10.1001/jamanetworkopen.2020.36469 [DOI] [PMC free article] [PubMed] [Google Scholar]
  37. Topp CW, Østergaard SD, Søndergaard S, & Bech P (2015). The WHO-5 Well-Being Index: A systematic review of the literature. Psychotherapy and Psychosomatics, 84, 167–176. 10.1159/000376585 [DOI] [PubMed] [Google Scholar]
  38. Umbetkulova S, Kanderzhanova A, Foster F, Stolyarova V, & Cobb-Zygadlo D (2024). Mental health changes in healthcare workers during COVID-19 pandemic: A systematic review of longitudinal studies. Evaluation & the Health Professions, 47, 11–20. 10.1177/01632787231165076 [DOI] [PMC free article] [PubMed] [Google Scholar]
  39. U.S. Bureau of Labor Statistics. (2025). Occupational employment and wage statistics, May 2023. 29–1141 Registered nurses. Retrieved April 24, 2024, from https://www.bls.gov/oes/2023/may/oes291141.htm
  40. Velando-Soriano A, Ortega-Campos E, Gómez-Urquiza JL, Ramírez-Baena L, De La Fuente EI, & Cañadas-De La Fuente GA (2020). Impact of social support in preventing burnout syndrome in nurses: A systematic review. Japan Journal of Nursing Science, 17, e12269. 10.1111/jjns.12269 [DOI] [PubMed] [Google Scholar]
  41. West CP, Dyrbye LN, Sloan JA, & Shanafelt TD (2009). Single item measures of emotional exhaustion and depersonalization are useful for assessing burnout in medical professionals. Journal of General Internal Medicine, 24(12), 1318–1321. 10.1007/s11606-009-1129-z [DOI] [PMC free article] [PubMed] [Google Scholar]
  42. Woon C (2023). A literature review: Violence and aggression in neuroscience nursing. Journal of Neuroscience Nursing, 55, 60–64. 10.1097/JNN.0000000000000692 [DOI] [PubMed] [Google Scholar]

RESOURCES