Unhealed healers - Depression and suicidal tendencies of female nurses as barriers to providing assistance to individuals in suicidal crisis: a cross-sectional study

Abstract

Background/objectives

Studies from various countries indicate that nurses are a professional group at increased risk of depression and suicide. Hospital work involves managing life-and-death situations and coping with physical and emotional pain and suffering alongside patients and their families. The lack of adequate mental health and trauma support can adversely affect not only the mental state of nurses, but also their ability and competence to provide support to people experiencing mental crises, including suicidal thoughts. The aim of the study was to assess the epidemiology of depression and suicidal behavior in nursing staff and to examine their competence to talk about suicide.

Methods

The cross-sectional study comprised 400 nurses employed in various hospital wards across Poland. Researchers utilized a demographic-descriptive questionnaire, an original questionnaire assessing competence in discussing suicidal topics, and two standardized psychometric tools: the Suicidal Behavior Questionnaire (SBQ-R) and the Patient Health Questionnaire (PHQ-9). The survey was administered via an online questionnaire.

Results

The study revealed that nurses are a professional group at high risk of depression and suicide. 71% of the subjects (n = 284) struggled with depression symptoms of varying severity. The highest severity of symptoms was reported among those receiving psychological support (p < 0.001) and psychiatric treatment (p < 0.001). However, these individuals demonstrated greater competence in providing assistance to people in suicidal crises compared to those who did not receive such help (p < 0.05). The use of psychological and psychiatric help was a decisive factor in whether a nurse would become a wounded healer or an unhealed healer.

Conclusions

Given the magnitude of mental health and suicide risks among nurses, it is imperative to implement primary, secondary, and tertiary prevention measures for both nursing staff and students preparing to enter the profession.

Introduction

Each year, more than 720,000 people die by suicide worldwide, and up to 20 times more attempt it [1]. Men are more likely to die by suicide, while attempts are more common among younger women. This phenomenon is known as the gender paradox [2, 3]. The strongest risk factor remains a history of suicide attempts, followed by mood disorders such as depression, which are present in up to 90% of suicide victims [2, 4].

Global suicide rates are influenced by economic, social, and health-related factors and are rising among individuals with chronic illness or substance abuse [5]. Nurses, who often serve as the first point of patient contact, play a pivotal role in suicide prevention [6]. Studies indicate that nurses perceive suicide primarily as a response to overwhelming physical, mental, or social suffering, often triggered by illness, trauma, or cultural pressures [1]. However, non-mental health nurses may feel unprepared to address suicidality due to limited training, tending to prioritize physical care instead [6]. Educational interventions that shape compassionate attitudes and communication skills are thus essential from early stages of nursing education [7].

The role of nursing staff in suicide prevention

According to previous studies, nurses understood suicide as a search for relief from physical, mental and social suffering that was difficult or impossible to overcome [8–10]. Due to their close proximity to patients, nurses are uniquely positioned to detect signs of suicidal ideation [6]. Yet, research shows that many feel uncertain or fearful about raising the topic, often due to insufficient training. However, after receiving suicide risk assessment training, nurses report feeling more confident and capable of offering support [11].

In community psychiatric settings, structured training that incorporates the lived experiences of people who have survived mental health crises enhances nurses’ insight and ability to respond empathetically [12]. Key interpersonal competencies, such as openness, kindness, and non-judgment, are crucial in building trust and encouraging patients to disclose suicidal thoughts. In contrast, a lack of emotional availability may result in patient silence and avoidance of further help-seeking [10].

Risks to nurses’ mental health

Nursing involves constant exposure to distress, loss, and family suffering, requiring emotional resilience in high-pressure conditions [13]. Prolonged stress can lead to cardiovascular issues, disrupted sleep, and psychiatric disorders including depression and anxiety [14, 15].

Depression affects nearly one in four nurses globally [16], and Polish data show that only 24% of nurses report being symptom-free [17].

Night shifts and circadian rhythm disruption are particularly harmful to mental well-being [15], with shift work associated with a 33% increased risk of depressive symptoms [18]. Poor mental health impacts patient safety, staff retention, and care quality, contributing to absenteeism, presenteeism, and clinical errors [19, 20].

Compassion fatigue, defined as emotional exhaustion resulting from sustained caregiving, can diminish empathy and decision-making capacity [21, 22]. The COVID-19 pandemic further exacerbated these risks, with many nurses reporting burnout or leaving the profession due to prolonged stress and moral distress [23, 24]. Epidemiological data from the UK [25] and US show that nurses die by suicide at significantly higher rates than the general population and even physicians [23]. Occupational factors such as repeated exposure to suffering, emotional suppression, and access to lethal means may intensify this risk [26].

Nursing staff’s willingness to talk about suicide

Engaging in conversations about suicide is a vital component of suicide prevention, yet many nurses avoid such dialogue due to fear of saying the wrong thing or making matters worse [11]. Training in this area is consistently shown to improve confidence and readiness to intervene. In psychiatric care, programs that include first-person narratives from those with lived experience can help nurses better understand the emotional depth of suicidal crises [12].

Nurses with strong interpersonal skills - especially warmth, empathy, and non-judgment - are more likely to establish trust with patients in crisis, whereas a task-focused or emotionally detached approach may result in missed warning signs and disengaged patients who later avoid seeking help [10].

The concept of the wounded healer

In 1951, Carl Jung introduced the term wounded healer, a concept rooted in Greek mythology that describes individuals who, through their own suffering, develop empathy and understanding for others’ pain, enhancing their therapeutic effectiveness [27]. This identity arises from acknowledging one’s wounds and vulnerability, which becomes a tool in caring for others [28].

Conti-O’Hare adapted the concept to nursing, proposing the theory of the nurse as a wounded healer. She emphasized that nurses facing trauma (physical, psychological, emotional, or spiritual) adopt either effective or ineffective coping strategies. Those using ineffective mechanisms may function as walking wounded, projecting unresolved pain onto patients and colleagues, and demonstrating reduced empathy [29]. Such individuals often encounter difficulties in personal and professional relationships [30].

In this context, professionals who have not processed their own trauma or sought psychological help can be considered unhealed healers. They may deliver care with limited emotional insight or availability. In contrast, nurses who reflect on and integrate their experiences are capable of transforming personal suffering into healing power. The presence of a “scar” becomes a mark of growth, not damage. It is not only suffering, but awareness and willingness to confront it, that enables the wounded to become healers [31]. Building on Jung’s archetype of the wounded healer – a caregiver whose own suffering enables deeper empathy and insight – the term unhealed healer describes professionals who remain trapped in unresolved trauma, lacking the self-awareness or support necessary to transform pain into therapeutic presence. Unlike the wounded healer, they have not yet reached integration, and their suffering can unintentionally impair their caregiving.

The theory, though illuminating, has limitations: it focuses mainly on individual emotional processing, without considering external support systems available to nurses [30].

The aim of the study was to assess the prevalence and characteristics of depression and suicidal behavior among nursing staff, identify associated risk factors, and examine nurses’ ability to engage in suicide-related conversations through the lens of the wounded healer concept in a cross-sectional framework.

Materials and methods

Study design and setting

The research was conducted as a cross-sectional study. The criterion for inclusion was an active license to practice the profession of a nurse and work in the profession. On the other hand, the exclusion criterion was work in administrative positions, where nurses did not take care of the patient.

The aim of the study was to assess the epidemiology of depression and suicidal behavior in nursing staff and to examine their competence to talk about suicide.

Study population

The presented study involved 400 female nurses working in various hospital wards across Poland. The mean age of all participants was 36.815 years (SD = 10.385). Participants were selected using a random stratified sampling method conducted by an independent research institution, ensuring representativeness in terms of age, work experience, and sector of employment.

Outcome measure

The study used a demographic-descriptive questionnaire, an original questionnaire examining the competence to talk about suicidal topics, and two standardized psychometric methods: the Suicidal Behavior Questionnaire (SBQ-R) and the Patient Health Questionnaire (PHQ-9).

The demographic and descriptive questionnaire contained 11 metric items concerning gender, age, place of residence, marital status, children, education, seniority, place and systems of work, as well as the use of psychological and psychiatric help, in order to characterize the group of respondents.

The author’s original questionnaire, consisting of 13 single-choice items assessing readiness to talk about suicide, was developed with the support of Microsoft Copilot. The AI tool was used to identify key psychosocial and procedural competencies relevant to nurse–patient suicide-related communication. The preliminary items generated through this process were reviewed and refined in collaboration with mental health professionals. This approach enabled efficient content development grounded in interdisciplinary perspectives, while ensuring methodological rigor in subsequent psychometric analysis. Recognizing potential limitations of AI-generated content, such as subtle biases or lack of clinical sensitivity, the development process deliberatelyh incorporated expert validation to safeguard the tool’s reliability and contextual appropriateness.

As part of the statistical analyses, two factors were identified using exploratory factor analysis with Varimax rotation: interpersonal and emotional competences and technical and procedural competences. The first factor assessed self-confidence in a conversation about suicide, the ability to manage one’s own emotions, build trust in the relationship with the patient and ensure their safety, adapt to the patient’s individual needs and awareness of their own limitations. Questions concerning the second factor included training and experience in crisis intervention and suicide prevention, knowledge of procedures and protocols in the area of dealing with situations of mental crisis of the patient and warning signs of suicide, as well as access to support resources at work and outside it. Knowledge of active listening techniques is included in both factors. The respondents gave subjective answers using a 5-point Likert scale.

The Suicidal Behavior Questionnaire (SBQ-R) was used to assess suicidal risk. It consisted of three questions about suicidal thoughts and tendencies in the past and one about the likelihood of their occurrence in the future. The questions were single-choice, and the respondent answered on a 5, 6 or 7-point Likert scale. The points obtained for each answer added up, and the overall score ranged from 3 to 18 points. The higher the score, the greater the intensity of suicidal behavior [32, 33].

The Patient Health Questionnaire (PHQ-9) was used to diagnose the symptoms of depression and to make an initial assessment of its occurrence. The tool consists of nine items and one supplementary question. The subjects marked their answers on a 4-point Likert scale, assessing the frequency of depression symptoms in the last two weeks. The tenth question was addressed to people who recognized at least one of the symptoms mentioned earlier and referred to the degree of difficulties in everyday life due to their presence. Obtaining 5 points or more indicates the occurrence of depression with a further division according to its severity [34, 35].

Ethical considerations

The study was submitted to the Bioethics Committee of the Medical University of Warsaw, which took note of it and did not raise any objections to the methodology of the study (statement number AKBE/2/2025). Participation in the survey was equivalent to providing informed consent to participate in the study. The benefit for the study participants was not intended. No risks or inconveniences for the subjects were identified.

Data collection

The survey was conducted in February 2025 using a questionnaire made available to respondents online. The data collection process was carried out by an independent research and statistical institution specializing in conducting surveys and gathering data. The agency utilized a random stratified sampling approach to ensure that the sample was representative of the target population. Recruitment of participants followed established research protocols, and demographic quotas were applied where necessary to maintain the balance of key variables such as age, work experience, and sector of employment.

Prior to participation, all respondents provided informed consent, confirming their voluntary involvement in the study. The research firm adhered to ethical guidelines regarding data confidentiality and protection, ensuring that responses remained anonymous and that participation was free of coercion.

Data analysis

The analysis was performed using the IBM SPSS 26.0 package together with the Exact Tests module and the Statistica 13.3 package. All analyses were conducted with a significance threshold of p ≤ 0.05. Specific results are presented in the Results section.

The basic test that was used in statistical analyses was the Chi-square test for the independence of variables. To determine the strength of the compound, coefficients based on the aforementioned test were used: Phi and V Kramer. When the variables were ordinal, the following coefficients were used: Kendall’s tau-b for tables with the same number of columns and rows, and Kendall’s tau-c for tables with different numbers of columns and rows.

While the dependent variable was measured on a quantitative scale and the independent on a qualitative scale, and when the conditions for the use of parametric tests were not met, nonparametric U tests were used by Mann Whitney (for two samples) and Kruskal Wallis (for more than two samples).

Correlations between ordinal or quantitative variables (during the non-met conditions of using parametric tests) were performed using Spearman’s rho coefficient, which informs about the strength of the compound and its direction – positive or negative.

In the construction of the questionnaire to assess readiness to talk about suicide, the Varimax factor analysis using the principal axes method was used to isolate factors. Reliability was determined by calculating Cronbach’s alpha coefficient.

Results

Thanks to the data obtained from the demographic-descriptive questionnaire, the group of nurses participating in the study was characterized. Table 1 presents demographic characteristics and support services available to the study sample, including variables such as age, domicile, marital status, education, and professional background. The data are shown as frequencies and percentages.

Table 1.

Demographic characteristics and support services of the sample

Variable	Category	Frequency	Percent
Age	20–29 years old	117	29.3
	30–39 years old	124	31.0
	40–49 years old	104	26.0
	50 years and older	55	13.7
Domicile	Village	98	24.4
	A city of up to 50 thousand.	91	22.8
	The city from 50 thousand to 150 thousand.	67	16.8
	The city from 150 thousand to 500 thousand.	67	16.8
	City over 500 thousand	77	19.2
Marital status	Single/Unmarried	167	41.8
	Married	186	46.5
	Divorced	44	11.0
	Widow/widower	3	0.7
Children you have	Yes	213	53.2
	No	187	46.8
Education	Vocational secondary	80	20.0
	Bachelor of Nursing	116	29.0
	Master of Science in Nursing	204	51.0
Seniority	0–5 years	106	26.5
	6–10 years	97	24.3
	11–15 years	63	15.7
	16–20 years	55	13.7
	21 years and older	79	19.8
Facility status	Public	262	65.5
	Private	138	34.5
Employment Department	Internal medicine	96	24.0
	Surgical	80	20.0
	Paediatric	70	17.5
	Neurological	55	13.7
	Psychiatric	31	7.8
	Rehabilitation	68	17.0
Work system	Just a day	63	15.8
	Night Only	16	4.0
	Day and night	321	80.3
Psychological support	Never	207	51.8
	In the past	143	35.8
	Currently	50	12.4
Psychiatric treatment	Never	263	65.8
	In the past	84	21.0
	Currently	53	13.2

Depression and suicidality risk in nursing staff

The analysis of PHQ-9 results showed that 71% of the subjects (n = 284) struggled with depression symptoms of varying severity. Most participants suffered from mild depression (n = 120), while its absence was found in only 29% (n = 116). The percentage distribution of depression levels among the study participants is presented in Fig. 1.

Fig. 1.

Severity of depression in the study group based on PHQ-9

It has been confirmed that as the level of PHQ-9 depression increases, the results of SBQ-R suicidal behavior also increase (rho = 0.579, p < 0.001). Higher scores of the level of PHQ-9 depression and SBQ-R suicidal behavior were achieved by younger people (PHQ-9: Kendall’s tau-c = -0.153, p < 0.001; SBQ-R: Spearman’s rho = -0.127, p < 0.02) and those just beginning their nursing careers (PHQ-9: Kendall’s tau-c = -0.161, p < 0.001; SBQ-R: Spearman’s rho = -0.102, p < 0.05). The analysis did not reveal any significant associations between respondents’ residence or educational background and their depression or suicidality scores.

Other factors negatively affecting the level of both depression and suicidal behavior include lack of offspring (PHQ-9: U = 16544.000, p < 0.003; Cramér’s V = 0.177, p < 0.02; SBQ-R: U = 15378.000, p < 0.001) and exclusive night shift work (PHQ-9: H = 6.424, p < 0.05; SBQ-R: H = 17.849, p < 0.001), while single or unmarried marital status was associated only with higher levels of depression (PHQ-9: H = 9.092, p < 0.03; Cramér’s V = 0.135, p < 0.05).

The PHQ-9 and SBQ-R results were not significantly differentiated by the type of facility (public or private) where nursing staff are employed. The type of ward in which the respondents work also did not correlate with the level of depression on the PHQ-9 scale, but it was observed that people working in the psychiatric ward are characterized by a higher level of SBQ-R compared to the respondents from other wards (H = 15,158, df = 5, p < 0,02).

It was observed that respondents who had received psychological or psychiatric support in the past reported significantly higher levels of depression and suicidality compared to those who had never used such services (PHQ-9: U = 9243.00, Z = -5.972, p < 0.001; SBQ-R: U = 3141.00, Z = -6.785, p < 0.001 for psychological help; PHQ-9: U = 7546.00, Z = -4.372, p < 0.001; SBQ-R: U = 6388.00, Z = -5.818, p < 0.001 for psychiatric treatment). The highest scores were found among staff currently under the care of a psychologist (PHQ-9: U = 2954.50, Z = -4.706, p < 0.001; SBQ-R: U = 9276.00, Z = -5.989, p < 0.001) or psychiatrist (PHQ-9: U = 4278.00, Z = -4.434, p < 0.001; SBQ-R: U = 3244.00, Z = -6.137, p < 0.001). No statistically significant differences were found between those receiving psychological or psychiatric help currently and those who had accessed such support in the past. This may indicate that both groups experience a similarly elevated psychological burden.

The higher depression and suicidality scores observed in individuals who received psychological or psychiatric care may also reflect greater self-awareness and openness to acknowledging mental health symptoms [36].

Competence of nursing staff to talk to patients about suicide

Initial validation of a questionnaire examining the staff’s competence to talk to the patient about suicide

In order to conduct this study, a questionnaire was created to assess the competence of the examined staff in conducting conversations about suicide with the patient. The questionnaire contains 13 questions about both social and procedural skills. The survey allowed respondents to self-assess, allowing them to assess their strengths and weaknesses in selected categories.

In order to examine the psychometric properties of the questionnaire, an exploratory factor analysis was conducted using the principal axis factoring method with raw Varimax rotation. Two underlying factors were extracted from the items included in the questionnaire, as presented in Table 2.

Table 2.

Results of the varimax rotated factor analysis with factors extracted using the principal axis method

Question	Factor 1	Factor 2
1. Do you have adequate training in crisis intervention and suicide prevention?	-0.071	0.730
2. Do you feel comfortable talking to the patient about suicide?	0.423	0.054
3. Do you know the procedures and protocols for dealing with a patient’s mental crisis?	0.211	0.718
4. Can you recognize the warning signs of suicide?	0.396	0.511
5. Are you able to establish an empathetic and supportive relationship?	0.715	0.070
6. Do you have access to support resources within the institution where you work?	0.243	0.538
7. Do you have access to support resources outside the institution where you work?	0.348	0.400
8. Can you manage your own emotions, e.g. are you able to remain calm and professional, even in difficult situations?	0.544	0.187
9. Do you have experience in working with patients in mental crisis?	0.262	0.616
10. Do you know active listening techniques?	0.446	0.439
11. Can you adapt your approach to the individual needs of the patient?	0.709	0.233
12. Are you aware of your limitations, e.g. when you need support from other specialists?	0.538	0.166
13. Can you create a safe and supportive environment for the patient to feel safe and open up to difficult topics?	0.762	0.132
The eigenvalue	3.019	2.478
The variance explained	0.232	0.190

The loadings displayed in the table are greater than 0.4

The reliability of the questionnaire was assessed by the Cronbach’s alpha coefficient, which is a measure of the internal consistency of the questions. The value of the coefficient for factor I: 0.804, and for factor II: 0.812, which confirms the two-factor structure of the resulting tool.

Psychological help

The analysis showed that the differences between staff not receiving psychological help (group 1) and those currently receiving psychological assistance (group 3) indicate that in the case of important questions (1, 2, 4, 5, 7, 11) (p < 0.05), the latter obtained higher scores. Staff who have received psychological help in the past (group 2.) also scored higher on relevant questions (4, 7, 9, 10) compared to those who had never received such assistance. The difference between the group treated in the past and now was detected in two questions, where the latter scored higher.

The differences between group 1 and group 2 turned out to be statistically significant in the case of both factors, where higher scores were obtained by group 2 (factor 1: U = 12946,50, Z = -1.991, p < 0.05; factor 2: U = 11278.50, Z = -3.78, p < 0.001). Group 3 in comparison with group 1 also achieved higher results (factor 1: U = 3996.00, Z = -2.498, p < 0.02; factor 2: U = 4065.50, Z = -2.350, p < 0.02), while the results of groups 2 and 3 did not differ significantly.

Psychiatric treatment

Differences between nurses who has never received psychiatric treatment (group 1) and the group that underwent treatment in the past (group 2) indicated higher scores in the receiving group for six questions (1, 4, 6, 7, 9, 12) and factor 2 (U = 8286.00, Z = -3.44, p < 0.001). Differences between nurses who have never received treatment and those who are currently in treatment indicate higher scores for the latter in questions 1, 2, 4, 5, 7, 9, 11, and 12 and in factor 1 (U = 5333.50, Z = -2.82, p < 0.008) and 2 (U = 5257.50, Z = -2.82, p < 0.005). The differences between group 2 and group 3 were revealed only in the higher scores of group 3 in question 12 (U = 1660.000, Z = -2.49, p < 0.02).

Discussion

The present study reveals a strikingly high prevalence of depressive symptoms among nursing staff, with 71% of respondents affected - an alarming figure that echoes similar findings from previous research in Poland and internationally. For instance, Kubik et al. reported mild to moderate depressive symptoms in a substantial proportion of Polish nurses [37]. Comparable trends have also been observed globally: a study in India found that over 70% of nurses experienced varying degrees of anxiety and depression [14]; in France, nearly one-third of the nursing workforce reported depressive symptoms [16]; and in the United States, depression was identified in both clinical and self-reported terms among a significant proportion of nurses [38]. These findings underscore the global scope of mental health challenges in the nursing profession and highlight the need for deeper understanding of contributing factors and effective interventions.

Considering the impact of individual socio-demographic and occupational factors on depression and suicidal risk among nurses, several significant associations were identified. Younger age and shorter professional experience were linked to higher levels of both depressive symptoms and suicidality, which is consistent with studies showing increased vulnerability among early-career healthcare workers due to limited coping strategies and greater exposure to stressors [39]. Similarly, respondents without children had significantly higher scores on both mental health measures, aligning with previous findings that parenthood may serve as a protective factor by enhancing social connectedness and life purpose [26, 40]. Being single or unmarried was also associated with elevated depression levels, although it did not correlate with suicidality, which may reflect the buffering role of close relationships in mitigating depressive symptoms [41]. Elevated depression and suicidality were also observed among nurses working exclusively night shifts, a result supported by research highlighting the harmful effects of circadian rhythm disruption and sleep deprivation [15, 42].

A partially significant association emerged regarding clinical unit type. Although most departments did not differ in terms of psychological outcomes, nurses employed in psychiatric wards reported significantly higher suicidality scores. This may reflect the unique emotional burden and repeated exposure to patient crises inherent in psychiatric settings. Takahashi et al. reported that over half of psychiatric nurses had experienced a patient suicide, with 13.7% displaying symptoms of post-traumatic stress, and very few receiving mental health support. These findings underscore the urgent need for targeted interventions in high-risk specialties [43].

In contrast, no statistically significant associations were found between depression or suicidality and place of residence, education level, or whether the healthcare facility was public or private. While studies in general populations often point to the influence of socioeconomic and environmental variables [44–47], our results concern nurses in clinical roles, where workplace-related stressors may dominate. Notably, Zhang et al. similarly found no significant differences in suicidality based on educational attainment or workplace setting in a large cohort of healthcare professionals - instead identifying individual risk factors such as age, emotional distress and maladaptive coping [48].

Altogether, these findings suggest that in nursing populations, personal and occupational characteristics, rather than structural or demographic attributes, may play a more decisive role in shaping mental health outcomes. Prevention efforts should therefore prioritize vulnerable subgroups, promote early-career support, ensure healthy shift scheduling, and strengthen psychological support systems within clinical environments.

In this study, we distinguish between two profiles of nursing staff: wounded healers - nurses who, despite personal suffering, have sought psychological support and demonstrate higher competence in working with patients in suicidal crisis, and unhealed healers - individuals who have not sought such help and, although reporting fewer depressive symptoms, present lower levels of competence in crisis intervention. Our analysis showed that nurses who had received psychological or psychiatric support in the past or currently tended to report higher levels of depression and suicide risk, which likely reflects the severity of their initial mental burden. Importantly, this does not imply that psychological help was ineffective, but rather that those individuals faced more profound difficulties and, crucially, demonstrated greater readiness to confront them. At the same time, despite experiencing mental suffering in the form of low mood and a decrease in the will to live, the readiness and effectiveness of care for patients in crisis in this group was higher than among staff who did not use help and declared a better mental state.

These findings are consistent with the concept of the wounded healer, which refers to individuals who, through their personal struggles and vulnerabilities, develop a deep understanding and empathy for the suffering of others [27]. Participation in psychotherapy may reinforce this potential by fostering emotional competencies such as empathy, compassion, and mentalization [49–51].

As Missouridou et al. write, during the process of self-healing, wounded healers find the courage to accompany others in their suffering, while simultaneously undergoing a transformative journey themselves, a symbolic emergence from Plato’s cave. This transformation turns mute, paralyzing, and incomprehensible trauma into experience that can be understood, expressed, and given meaning. Such a process fosters both personal and professional development, as well as the formation of a deeply authentic identity [52, 53].

Conversely, individuals who had never received psychological or psychiatric help reported lower depression and suicidality levels on average. However, only 29% of them reported no symptoms at all. At the same time, they demonstrated lower competence in assisting individuals in mental crisis. This creates the image of the unhealed healer - a nurse who, despite appearing mentally well, may remain emotionally disengaged or overwhelmed by unresolved issues, which results in reduced professional effectiveness. Previous research supports this pattern, showing that poor mental well-being among nurses correlates with reduced work productivity, increased presenteeism, and impairment in daily functioning [54].

This contrast underscores that it is not the mere presence or absence of symptoms that determines therapeutic capacity, but whether personal suffering has been acknowledged and transformed into insight, emotional maturity, and a readiness to support others.

In conclusion, the study showed that nurses are a professional group with a high risk of depression and suicide, although in some respects heterogeneous. The highest severity of symptoms was reported by subjects receiving psychological and psychiatric help. This may be due to the fact that the use of specialist mental health help increases self-awareness of the difficulties experienced and fosters readiness to report emotional problems [55–57]. Additional differences were revealed in the provision of assistance to patients. Despite the fact that nurses receiving psychological and psychiatric help reported the highest levels of depression and suicidality, their competence in providing help to people in suicidal crisis was higher than that of those who did not receive such help. Given that the entire study population of nurses as a professional group showed a high risk of depression and suicide, the use of psychological and psychiatric help was a decisive factor in whether a nurse would become a wounded healer or an walking wounded unhealed healer. In other words, whether their own suffering will become a resource or merely a psychologically degrading factor.

This study has several limitations. Cross-sectional studies do not allow for determining the direction of relationships between variables, which makes it impossible to establish causality. Additionally, the sample may not be fully representative of the entire nursing population. While 400 participants constitute a significant sample, it may not account for the diversity of all nurses in Poland, much less nurses worldwide. The results of our study are limited to individuals assigned female at birth. We chose this sample due to the gender imbalance in the Polish nursing population, which would affect the quality of statistical analyses. According to a report prepared in 2023 at the request of the Supreme Chamber of Nurses and Midwives in Poland, women account for 97.1% of the nursing staff [58].

Another limitation of the study is the data collection method based on self-reporting. The topic of depression and suicide can be difficult for some individuals, potentially affecting their willingness to participate and the quality of their responses. Additionally, self-assessment of competence to talk about suicide is subjective and depends on the individual experiences and feelings of nurses, which can also be reflected in the results.

Considering these limitations, further research on a larger sample is planned, in the form of multicenter longitudinal studies, based on mixed measurement methods, including a combination of quantitative and qualitative methods (e.g., surveys supplemented by in-depth interviews).

Conclusions

Nursing staff is one of the professional groups most exposed to mental problems, including depressive disorders and suicidal behaviour. The percentage of nurses affected by these problems creates a disturbing picture showing the critical state of mental health of the largest group of employees in the field of health care. Due to the seriousness of the situation, it is necessary to take action for primary, secondary and tertiary prevention among both nursing staff and students preparing to practice this profession. The health care system is already struggling with staff shortages in the field of nursing care, and the abandonment of interventions consisting in providing systemic care will result in the deepening of mental disorders leading to burnout significantly reducing the quality of care provided, the need to resign from the profession, and finally to an increasing number of suicides among nursing staff. This is a great threat to the entire health care system, where the neglected mental health of nursing staff causes real damage to the staff themselves and patients, affecting the readiness to deal with the mental suffering of patients.

Abbreviations

PHQ-9

Patient Health Questionnaire-9

SBQ-R

Suicidal Behaviors Questionnaire-Revised

Author contributions

Conceptualization: M.P. and T.K.; methodology: M.P., T.K. and J.G.; software: M.P., T.K. and J.G.; validation: M.P., T.K. and J.G.; formal analysis: M.P., T.K. and A.S.; investigation: M.P., T.K. and J.G.; data curation: M.P, T.K. and J.G.; writing—original draft preparation: M.P. and T.K.; writing—review and editing: T.K., J.G. and A.S.; visualization: all authors; supervision: T.K. and A.S.; project administration: M.P.; funding acquisition: M.P. and T.K. All authors have read and agreed to the published version of the manuscript.

Funding

This research was funded by the Medical University of Warsaw, grant number 7/N/MG/N/24.

Data availability

No datasets were generated or analysed during the current study.

Declarations

Human ethics and consent to participate declarations

The study was conducted in accordance with the Declaration of Helsinki, and approved by the Ethics Committee of the Medical University of Warsaw (AKBE/2/2025). Informed consent was obtained from all subjects involved in the study. No risks or inconveniences were identified for the participants, and no direct benefits were intended.

Competing interests

The authors declare no competing interests.