Unhealed healers. Depression and Suicidal Tendencies of Female Nurses as Barriers to Providing Assistance to Individuals in Suicidal Crisis: A Cross-sectional Study

Unhealed healers. Depression and Suicidal Tendencies of Female Nurses as Barriers to Providing Assistance to Individuals in Suicidal Crisis: A Cross-sectional Study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Unhealed healers. Depression and Suicidal Tendencies of Female Nurses as Barriers to Providing Assistance to Individuals in Suicidal Crisis: A Cross-sectional Study Martyna Pękacka, Tytus Koweszko, Jacek Gierus, Andrzej Silczuk This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6400185/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 12 You are reading this latest preprint version 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 “walking wounded 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. nurses suicide depression wounded healers Figures Figure 1 1. Introduction Suicidal behavior is a major public health problem worldwide because of its frequency and the destructive effects of the individual on the general population [1]. Every year, more than 720,000 people die from suicide worldwide, and about 10–20 times more attempt suicide [2]. In most countries, the risk of suicide is higher in adult men, while the risk of suicide attempt is higher in young women [3]. This type of phenomenon is referred to as the gender paradox and is explained mostly by the aggressiveness and impulsiveness of men, resulting in the use of more lethal methods [4]. Literature review by Motillon-Toudic et al. et al. (2022) showed that among the associations of suicide risk factors, the strongest association is between suicide and previous suicide attempts. Another significant association revealed in the aforementioned study is the association of suicide with mood disorders, including depression [5]. Mental disorders are also considered to be another important risk factor, which occur in up to 90% of suicide victims [3]. Data from 194 countries suggest that suicide rates vary depending on economic, social, cultural and environmental factors, as well as age and gender. In addition, suicides are on the rise globally in people with chronic physical and mental illnesses, including alcohol and substance abuse, as well as in people who have already attempted suicide. Much less information is available on the specifics and epidemiology of suicide attempts, but it is assumed that in some regions they may exceed the number of suicides by up to 30 times [6]. 1.1. The role of nursing staff in suicide prevention Nursing staff provide primary care, are closest to the patient, and have a better chance of assessing and identifying warning signs of a suicidal crisis. Therefore, it plays a key role in suicide prevention [7]. 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. They associated taking their own lives with serious illness, traumatic life situations or inability to meet family expectations, especially in patients from communities deeply rooted in cultural and religious traditions [2]. It has also been noted that non-mental health nurses are unable to understand and criticize cases of suicide attempts or self-harm, indicating that they are mostly focused on physical care [7]. Understanding appropriate attitudes toward people with suicidal thoughts is a fundamental step in a nursing student's education program that can influence the course and experience of clinical internship and shape future nursing practice [1]. 1.2. Risks to Nurses' Mental Health Nursing is a demanding profession that puts a significant strain on staff physically and mentally. Nurses are expected to be humane, compassionate, competent and conscientious in a demanding work environment. On a daily basis, nurses deal with the deteriorating condition of patients, frequent cases of death and bereavement of families, and at the same time they must provide professional and appropriate support to patients and their relatives [8]. Chronic stress at work adversely affects the mental health of this group of specialists. Over time, stress can lead to serious health problems such as heart disease, increased blood pressure, diabetes, and mental disorders, mi.in. depression and anxiety [9]. A study by Fond et al. showed that about 25% of nurses suffer from depression [10]. On the other hand, according to research by Pękacka et al., in Poland only 24% of the nurses surveyed do not show any symptoms of depression, 32% experience mild depression, 20% moderate depression, 16% moderately severe, and 8% severe [11]. Disturbed circadian rhythms and insufficient quality and quantity of sleep are considered to be the two most important factors in the long-term impact of night work on the mental health of nurses [12]. Rosenberg et al. found that mental health problems were more common in shift workers than in those in the permanent work system, and shift work was associated with a 33% increase in the risk of depressive symptoms [13]. Depression and burnout not only affect nurses' well-being, but also have a negative impact on the workforce and the quality of healthcare provided, including layoffs, an increase in medical errors, and a decline in patient satisfaction [14]. Major depression affects employee performance as well as organizational productivity. It is associated with an increase in absenteeism at work, short-term disability and reduced productivity and presenteeism, defined as the phenomenon of ineffective attendance at work as a result of poor health. Depressed workers can have impaired judgment of clinical situations, and errors in judgment can lead to serious consequences for both patients and staff [15]. Joinson ( 1992 ) first used the term compassion fatigue to describe the loss of a nurse's ability to care in an emergency department setting. Specialists' sense of apathy and aloofness was associated with many environmental stressors, complex patient needs, trauma, and emotional distress. This term defines the negative feelings that nurses feel when they care for those who are suffering. Compassion fatigue from a nurse affects her quality of life and the people she cares for. It results in a decrease in compassion and empathy and an impairment of the ability to make decisions about patient care [16,17]. The COVID-19 pandemic has also taken its toll and exposed nurses to chronic traumatic stress, a strong mental health risk factor [18]. As the pandemic continued, healthcare workers, particularly frontline nurses, experienced burnout, and many nurses in public health practices quit or temporarily left their jobs due to accumulated fatigue and mental distress [19]. Studies from different countries show that nurses may be at increased risk of suicide. According to data from the Office for National Statistics in the United Kingdom and the U.S. National Violent Death Reporting System, nurses have a higher suicide rate than women in the general population [20]. It was shown that nurses were almost twice as likely to die by suicide as the general population and 70% more likely than women doctors [18]. In addition to suicide-related factors, widely described in the general population, some of them may be due to the function and workplace of health care workers. Working in a hospital involves situations that require certain skills, such as dealing with life and death management, physical and emotional pain and suffering experienced together with patients and their families. Such an environment can predispose to mental disorders such as stress, anxiety, depression and substance use, which can make it even more difficult for this group of specialists to seek specialist help. In addition, easy access to lethal drugs and knowledge how to use them are factors that increase the risk of committing suicide [21]. 1.3. Nursing staff's willingness to talk about suicide In the context of nurses' readiness to talk to patients about suicide, it is worth emphasizing the importance of training for nursing staff in the field of suicide risk assessment. As Bolsner et al. Due to the lack of proper training, nurses are afraid to talk to patients about suicide. Research suggests that after receiving risk assessment training, nurses realize that this area is not significantly different from any other disease and, as a result, are better able to help people with suicidal tendencies [22]. For interventions with patients after a suicide attempt, which are complex and challenging clinical situations, nurses need structured training that takes into account their specifics. In community psychiatric care, this type of training can use not only specialist and theoretical knowledge, but also the experience of people who have experienced a serious mental crisis themselves. Their knowledge and experiences can be particularly valuable, providing unique perspectives and practical tips that help nurses better understand and support patients in similar situations [23]. Omerov and Bullington, on the other hand, draw attention to the importance of interpersonal competence in the assessment and care of patients in suicidal crisis. Qualities such as kindness, non-judgmental attitude, openness, and respect are beneficial in alleviating patient suffering, effectively assessing risk, and delivering appropriate care. On the other hand, the lack of a caring approach may result in patients hiding their needs, using escape strategies, or giving up seeking help in the event of subsequent suicidal crises [24]. 1.4. The concept of the "wounded healer" In 1951, Carl Jung first used the term " wounded healer ". The concept derives from Greek mythology and refers to individuals who, through their struggles and weaknesses, develop a deep understanding and empathy for the pain of others, which fosters effective therapeutic interventions [25]. The identity of the wounded healer stems from awareness and attention to one's own pain and fear, which in turn affects the care of others. Awareness of fracture and mortality becomes a powerful tool when caring for another person's pain [26]. Conti-O'Hare introduced the concept of the "wounded healer" into the nursing discipline and developed the theory of "nurse as a wounded healer ". She emphasized that when faced with physical, emotional, psychological, or spiritual trauma, nurses can adopt effective or ineffective coping strategies. People who use ineffective strategies may behave like " walking wounded" and project their own struggles onto patients and colleagues, showing less empathy [27]. Such people experience problems in social, intimate and professional relationships [28]. In contrast, people who successfully manage trauma are able to recognize, overcome, and transform their pain into healing. Although the "scar" remains, personal traumas that have been the subject of deep reflection can turn nurses into "wounded healers," improving their ability to build therapeutic relationships with patients. It is not only their suffering that transforms them into healers, but also the awareness of the hurt and their willingness to accept and overcome it [29]. The theory has some limitations, focusing mainly on healthcare professionals and how their emotions affect the provision of nursing care. The theory does not mention any support that the nurse receives from those around her, but focuses on how she deals with her own internal struggles and what coping strategies she uses to overcome difficulties [28]. The aim of the study was to assess the prevalence and characteristics of depression and suicidal behavior among nursing staff, and to investigate their ability to engage in suicide-related conversations through the lens of the wounded healer concept in a cross-sectional framework. 2. Materials and Methods 2.1. 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. 2.2. Study population The presented study involved 400 female at-born nurses working in various hospital wards across Poland. The mean age of all participants was 36.815 years (SD = 10.385). 2.3. 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. Author's questionnaire examining readiness to talk about suicide consisting of 13 single-choice items. The method items were generated by AI (Microsoft Copilot). The AI was asked to identify key areas to assess nurses' readiness to talk to a patient about suicide. As part of the statistical analyses, two factors were identified: 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 [30,31]. 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 [32,33]. 2.4. 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. 2.5. Data collection The survey was conducted in February 2025 using a questionnaire made available to the respondents online. Informed consent was obtained from all subjects involved in the study. 2.6. 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 relationships, correlations and differences were statistically significant at p ≤ 0.05. 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 2 samples) and Kruskal Wallis (for more than 2 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. 3. Results Thanks to the data obtained from the demographic-descriptive questionnaire, the group of nurses participating in the study was characterized. Table 1 presents the characteristics of the study group. Table 1 Demographic characteristics and support services of the sample. 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 13,8 Domicile Village 98 24,5 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 19,3 Marital status Emerald/Kawal 167 41,8 Married 186 46,5 Divorced 44 11,0 Widow/widower 3 0,8 Children you have Yes 213 53,3 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 15,8 16–20 years 55 13,8 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 13,8 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 12,5 Psychiatric treatment Never 263 65,8 In the past 84 21,0 Currently 53 13,3 3.1. 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 . 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: Tau-c Kendalla=-0,153, p < 0,001; SBQ-R: rho=-0,127, p < 0,02) and those just beginning their nursing careers starting to become nurses (PHQ-9: Kendall’s Tau-b=-0,161, p < 0,001; SBQ-R: rho=-0,102, p < 0,05). Other factors negatively affecting the level of depression and suicidal behavior include lack of offspring, work only on night duty and marital status of a single or unmarried. The PHQ-9 and SBQ-R results are not significantly differentiated by the type of facility 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 the group of respondents who had used psychological help or psychiatric treatment in the past achieved higher scores of depression and suicidality compared to the group that had never used psychological help (PHQ-9: U = 9243,00, Z=-5,972, p < 0,001; SBQ-R: U = 3141,00, Z=-6,785, p < 0,001) or psychiatric treatment (PHQ-9: U = 7546,000, Z=-4,372, p < 0,001; SBQ-R: U = 6388,00, Z=-5,818, p < 0,001), while the highest results were shown in the staff group that is 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 = 4278,000, Z=-4,434, p < 0,001; SBQ-R: U = 3244,00, Z=-6,137, p < 0,001). No statistically significant differences were found between the group receiving psychological help or psychiatric treatment in the past and now. It has not been shown that age, place of residence or degree of education have a statistically significant impact on the level of depression and suicidal behavior. 3.1. Competence of nursing staff to talk to patients about suicide 3.2.1. 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, a factor analysis was carried out using the main axes method, extracting two factors from the items included in the questionnaire, the results of which are presented in Table 2 . Table 2 Results of the Varimax Rotated Factor Analysis with factors extracted using the principal axis method. The loadings displayed in the table are greater than 0.4. Question Factor 1 Factor 2 1. Do you have adequate training in crisis intervention and suicide prevention? -0,071044 0,730644 2. Do you feel comfortable talking to the patient about suicide? 0,423042 0,054308 3. Do you know the procedures and protocols for dealing with a patient's mental crisis? 0,211478 0,718050 4. Can you recognize the warning signs of suicide? 0,396974 0,511985 5. Are you able to establish an empathetic and supportive relationship? 0,715803 0,070241 6. Do you have access to support resources within the institution where you work? 0,243083 0,538603 7. Do you have access to support resources outside the institution where you work? 0,348814 0,400851 8. Can you manage your own emotions, e.g. are you able to remain calm and professional, even in difficult situations? 0,544357 0,187817 9. Do you have experience in working with patients in mental crisis? 0,262679 0,616925 10. Do you know active listening techniques? 0,446887 0,439365 11. Can you adapt your approach to the individual needs of the patient? 0,709889 0,233611 12. Are you aware of your limitations, e.g. when you need support from other specialists? 0,538530 0,166805 13. Can you create a safe and supportive environment for the patient to feel safe and open up to difficult topics? 0,762422 0,132058 The eigenvalue 3,019734 2,478974 The variance explained 0,232287 0,190690 The reliability of the questionnaire was assessed by the Cronbach Alpha coefficient, which is a measure of the internal consistency of the questions. The value of the coefficient for factor I: 0.804213952, and for factor II: 0.812203491, which confirms the one-factor structure of the resulting tool. 3.2.2. 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. 3.2.3. Psychiatric treatment Differences between nurses that 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). 4. Discussion In the course of statistical analyses, an alarming percentage of nursing staff affected by depressive disorders was revealed, which amounted to 71%, and is similar to the results of other studies conducted so far in Poland. Kubik et al. showed a slight exacerbation of depressive symptoms in 41.81% of nurses, moderate in 17.68%, and moderate to severe in 4.76% [34]. According to a study conducted in India, 74% experience varying degrees of anxiety, and 70.8% suffer from mild to very severe depression [9]. In France, 29.3% of the nursing staff suffer from depression [10], while in the United States, among nurses who were diagnosed with symptoms of depression, 32% were clinically depressed and 58% said they suffered from depression in the ordinary sense [35]. Considering the impact of individual socio-demographic data on the level of depression and suicidal risk, it was noted that the lack of offspring, night work only and marital unmarried status were associated with an increase in depression and suicidal risk among nursing staff. Other studies are consistent with our results. The lack of a partner and offspring are important predictors of the risk of self-harm. Having children can reduce feelings of loneliness and give a sense of purpose in a parent's life. In addition, children, like a life partner, can be an important source of emotional and social support [21,36]. In contrast, disturbed circadian rhythms and insufficient quality and quantity of sleep were identified as the two most important factors in the long-term impact of night shift work on the mental health of nurses [37]. In our study, the place of employment, the status and the level of education did not affect the mental state of the respondents in the evaluated aspects. This is not consistent with the available literature, as a number of studies describe the significance of the above data in the context of depressive disorders and suicidal risk. According to the study by Kumar et al. in the general population, higher education was a protective factor, due to the associated higher earnings, while older age was a risk factor [38]. On the other hand, research shows that younger people in the professional group of nurses are more likely to suffer from depression and suicide risk, which is associated with less professional experience and greater susceptibility to stress in crisis situations [39,40]. Gruebner et al. showed in their study that the risk of mental disorders, including depression and anxiety, is higher in people living in large cities, but the cause has not been clearly established [41]. Similar conclusions were also formulated in the study by Sampson et al. [42]. However, other conclusions were drawn from studies conducted in China, where urbanization was a factor positively affecting the treatment of depression due to increased access to therapeutic resources [43]. Analysis of the results showed that nurses who received psychological or psychiatric help in the past or currently were characterized by higher levels of depression and suicide risk. 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. Our results are consistent with the concept of "wounded healer" , which refers to people who, through their struggles and weaknesses, develop a deep understanding and empathy for the pain of others [25]. In addition, participation in psychotherapy can foster the quality of help by developing emotional competences such as empathy, compassion or mentalization [44–46]. On the other hand, people who had never received psychological or psychiatric help reported lower depression and suicidality as a group, but only 29% of the study population did not show any symptoms of depression. At the same time, these people were less competent in providing assistance to people in mental crisis. This creates an image of " unhealed healers ", i.e. nurses who, immersed in their problems, are characterized by reduced efficiency at work, which is revealed by the lower quality of care and readiness to provide it. Previous research confirms that poor mental well-being of nurses correlates with reduced work productivity, manifested by higher rates of presenteeism, impairment of daily activities, and overall loss of productivity [47]. 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 [48–50]. 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 psychological 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 [51]. 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). 5. 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 The following abbreviations are used in this manuscript: PHQ-9 - Patient Health Questionnaire-9 SBQ-R - Suicidal Behaviors Questionnaire-Revised Declarations Funding: This research was funded by the Medical University of Warsaw, grant number 7/N/MG/N/24. 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. Data Availability Statement: The datasets generated and/or analyzed during the current study are not publicly available due to data privacy, but are available from the corresponding author uponreasonable request. Conflicts of Interest: The authors declare no conflicts of interest. References Ferrara P, et al. Nursing students' attitudes towards suicide and suicidal patients: A multicentre cross-sectional survey. Nurse Educ Today. 2022;109:105258. 10.1016/j.nedt.2021.105258 . World Health Organization. Suicide worldwide in 2019: global health estimates. 2021. Available from: https://www.who.int/publications/i/item/9789240026643 Clua-García R, et al. Suicide care from the nursing perspective: A meta-synthesis of qualitative studies. J Adv Nurs. 2021;77(7):2995–3007. 10.1111/jan.14789 . Griffin L, Hosking W, Gill PR, Shearson K, Ivey G, Sharples J. The Gender Paradox: Understanding the Role of Masculinity in Suicidal Ideation. Am J Men's Health. 2022;16(5):15579883221123853. 10.1177/15579883221123853 . Motillon-Toudic Chloé, et al. Social isolation and suicide risk: Literature review and perspectives. Eur Psychiatry: J Association Eur Psychiatrists. 2022;65(1):e65. 10.1192/j.eurpsy.2022.2320 . Bachmann S. Epidemiology of Suicide and the Psychiatric Perspective. Int J Environ Res Public Health. 2018;15(7):1425. 10.3390/ijerph15071425 . Huang K, Chin, et al. Survey of knowledge, self-efficacy, and attitudes toward suicide prevention among nursing staff. BMC Med Educ. 2023;23(1):692. 10.1186/s12909-023-04685-4 . Alyahya KI, et al. The Prevalence and Correlation of Suicidal Ideation Among Nurses in King Saud University Medical City. Cureus. 2023;15(9):e44859. 10.7759/cureus.44859 . Kaushik A, et al. Depression, Anxiety, Stress and Workplace Stressors among Nurses in Tertiary Health Care Settings. Indian J Occup Environ Med. 2021;25(1):27–32. 10.4103/ijoem.IJOEM_123_20 . Fond G, Fernandes S, Lucas G, Greenberg N, Boyer L. Depression in healthcare workers: Results from the nationwide AMADEUS survey. Int J Nurs Stud. 2022. 10.1016/j.ijnurstu.2022.105258 . Pękacka M, Koweszko T, Gierus J, Silczuk A. Ryzyko samobójcze i nasilenie depresji u personelu pielęgniarskiego. V Ogólnopolska Konferencja Naukowa „Problemy zdrowia człowieka – przyczyny, stan obecny, sposoby na przyszłość. Wydawnictwo Tygiel; 2024. pp. 103–13. 10.1016/j.nedt.2021.105258 . Okechukwu CE, Colaprico C, Di Mario S, et al. The Relationship between Working Night Shifts and Depression among Nurses: A Systematic Review and Meta-Analysis. 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Daneault S. The wounded healer: can this idea be of use to family physicians? Can Fam Physician. 2008;54(9):1218–25. Corso VM. Oncology nurse as wounded healer: developing a compassion identity. Clin J Oncol Nurs. 2012;16(5):448–50. 10.1188/12.CJON.448-450 . Foodani MN, Zakerimoghadam M, Ghiyasvandian S, et al. Wounded healer nurses: a qualitative content analysis of the positive traits of nurses affected by chronic cardiovascular disease. BMC Nurs. 2024;23:465. 10.1186/s12912-024-02124-3 . Conti-O'Hare M. The Nurse as Wounded Healer: From Trauma to Transcendence. Jones & Bartlett Learning; 2002. Piredda M, Fiorini J, Marchetti A, et al. The Wounded Healer: A Phenomenological Study on Hospital Nurses Who Contracted COVID-19. Front Public Health. 2022;10:867826. 10.3389/fpubh.2022.867826 . Chodkiewicz J, Gruszczyńska E. Polska adaptacja Zrewidowanego Kwestionariusza Zachowań Samobójczych A. Osmana i współpracowników. Psychiatr Pol. 2020. Osman A, Bagge CL, Gutierrez PM, Konick LC, Kopper BA, Barrios FX. (2001). Suicidal Behaviors Questionnaire—Revised (SBQ-R) [Database record]. APA PsycTests . Kokoszka A, Jastrzębski A, Obrębski M. Ocena psychometrycznych właściwości polskiej wersji Kwestionariusza Zdrowia Pacjenta-9 dla osób dorosłych. Psychiatria. 2016. Levis B, Benedetti A, Thombs BD. DEPRESsion Screening Data (DEPRESSD) Collaboration. Accuracy of Patient Health Questionnaire-9 (PHQ-9) for screening to detect major depression: individual participant data meta-analysis [published correction appears in BMJ. 2019;365:l1781. 10.1136/bmj.l1781] . BMJ . 2019;365:l1476. doi:10.1136/bmj.l1476. Kubik B, Jurkiewicz B, Kołpa M, Stępień K. Nurses’ health in the context of depressive symptoms. Med Studies/Studia Medyczne. 2018;34(2):147–52. 10.5114/ms.2018.76876 . Statista. (2024). Percentage of U.S. nurse practitioners (NP) who felt depressed in 2024. Retrieved from https://www.statista.com/statistics/1537126/nurses-depression-levels-united-states/ , accessed 18.12.2024. Dehara M, Wells MB, Sjöqvist H, Kosidou K, Dalman C, Sörberg Wallin A. Parenthood is associated with lower suicide risk: a register-based cohort study of 1.5 million Swedes. Acta Psychiatr Scand. 2021;143(3):206–15. 10.1111/acps.13240 . Okechukwu CE, Colaprico C, Di Mario S, et al. The Relationship between Working Night Shifts and Depression among Nurses: A Systematic Review and Meta-Analysis. Healthc (Basel). 2023;11(7):937. 10.3390/healthcare11070937 . Kumar A, Bartoli B, Lichand G, Wolf S. Sociodemographic predictors of depression and anxiety symptomatology among parents in rural Côte d'Ivoire. J Affect Disord. 2023;338:1–9. 10.1016/j.jad.2023.05.060 . Cheung T, Yip PS. Lifestyle and Depression among Hong Kong Nurses. Int J Environ Res Public Health. 2016. 10.3390/ijerph13030318 . Awan S, Diwan MN, Aamir A, et al. Suicide in Healthcare Workers: Determinants, Challenges, and the Impact of COVID-19. Front Psychiatry. 2022. 10.3389/fpsyt.2022.812875 . Gruebner O, Rapp MA, Adli M, Kluge U, Galea S, Heinz A. Cities and Mental Health. Dtsch Arztebl Int. 2017;114(8):121–7. 10.3238/arztebl.2017.0121 . Sampson L, Ettman CK, Galea S. Urbanization, urbanicity, and depression: a review of the recent global literature. Curr Opin Psychiatry. 2020;33(3):233–44. 10.1097/YCO.0000000000000588 . He S, Song D, Jian WY. The Association between Urbanization and Depression among the Middle-Aged and Elderly: A Longitudinal Study in China. Inquiry. 2020;57:46958020965470. 10.1177/0046958020965470 . Watson JC. The role of empathy in psychotherapy: Theory, research, and practice. In: Cain DJ, Keenan K, Rubin S, editors. Humanistic psychotherapies: Handbook of research and practice. 2nd ed. Washington, DC: American Psychological Association; 2016. pp. 115–45. McIntyre SL, Samstag LW. An Integrative Review of Therapeutic Empathy. Soc Advancement Psychother. 2020. Decety J, Lamm C. Empathy and mentalizing: The neurobiological underpinnings of understanding others. Psychol Sci. 2009;18(8):708–14. Hussein AHM, Abou Hashish EA, Younes BM. The Relationship Between Nurses' Psychological Well-Being and Their Work Productivity Loss: A Descriptive Correlational Study. SAGE Open Nurs. 2024;10:23779608241285400. 10.1177/23779608241285400 . Gulliver A, Griffiths KM, Christensen H. Perceived barriers and facilitators to mental health help-seeking in young people: a systematic review. BMC Psychiatry. 2010;10:113. 10.1186/1471-244X-10-113 . Tang P, Pavlopoulou G, Kostyrka-Allchorne K, Phillips-Owen J, Sonuga-Barke E. Links between mental health problems and future thinking from the perspective of adolescents with experience of depression and anxiety: a qualitative study. Child Adolesc Psychiatry Mental Health. 2023;17(1):143. 10.1186/s13034-023-00679-8 . Vaingankar JA, Sambasivam R, Chang S, et al. A qualitative study exploring psychotherapy recipients’ perspectives on positive mental health. Curr Psychol. 2024;43:18042–55. 10.1007/s12144-023-05603-z . MedMedia S. z o.o. (2023). Stan pielęgniarstwa i położnictwa w Polsce . MedMedia Sp. z o.o. Available from: https://www.termedia.pl/pobierz/f81dbcfd36b46ad990519fbd8a21ac93 Additional Declarations No competing interests reported. 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Depression and Suicidal Tendencies of Female Nurses as Barriers to Providing Assistance to Individuals in Suicidal Crisis: A Cross-sectional Study","fulltext":[{"header":"1. Introduction","content":"\u003cp\u003eSuicidal behavior is a major public health problem worldwide because of its frequency and the destructive effects of the individual on the general population [1]. Every year, more than 720,000 people die from suicide worldwide, and about 10\u0026ndash;20 times more attempt suicide [2]. In most countries, the risk of suicide is higher in adult men, while the risk of suicide attempt is higher in young women [3]. This type of phenomenon is referred to as the gender paradox and is explained mostly by the aggressiveness and impulsiveness of men, resulting in the use of more lethal methods [4].\u003c/p\u003e \u003cp\u003eLiterature review by Motillon-Toudic et al. et al. (2022) showed that among the associations of suicide risk factors, the strongest association is between suicide and previous suicide attempts. Another significant association revealed in the aforementioned study is the association of suicide with mood disorders, including depression [5]. Mental disorders are also considered to be another important risk factor, which occur in up to 90% of suicide victims [3].\u003c/p\u003e \u003cp\u003eData from 194 countries suggest that suicide rates vary depending on economic, social, cultural and environmental factors, as well as age and gender. In addition, suicides are on the rise globally in people with chronic physical and mental illnesses, including alcohol and substance abuse, as well as in people who have already attempted suicide. Much less information is available on the specifics and epidemiology of suicide attempts, but it is assumed that in some regions they may exceed the number of suicides by up to 30 times [6].\u003c/p\u003e \u003cdiv id=\"Sec2\" class=\"Section2\"\u003e \u003ch2\u003e1.1. The role of nursing staff in suicide prevention\u003c/h2\u003e \u003cp\u003eNursing staff provide primary care, are closest to the patient, and have a better chance of assessing and identifying warning signs of a suicidal crisis. Therefore, it plays a key role in suicide prevention [7]. 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. They associated taking their own lives with serious illness, traumatic life situations or inability to meet family expectations, especially in patients from communities deeply rooted in cultural and religious traditions [2]. It has also been noted that non-mental health nurses are unable to understand and criticize cases of suicide attempts or self-harm, indicating that they are mostly focused on physical care [7]. Understanding appropriate attitudes toward people with suicidal thoughts is a fundamental step in a nursing student's education program that can influence the course and experience of clinical internship and shape future nursing practice [1].\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003e1.2. Risks to Nurses' Mental Health\u003c/h2\u003e \u003cp\u003eNursing is a demanding profession that puts a significant strain on staff physically and mentally. Nurses are expected to be humane, compassionate, competent and conscientious in a demanding work environment. On a daily basis, nurses deal with the deteriorating condition of patients, frequent cases of death and bereavement of families, and at the same time they must provide professional and appropriate support to patients and their relatives [8]. Chronic stress at work adversely affects the mental health of this group of specialists. Over time, stress can lead to serious health problems such as heart disease, increased blood pressure, diabetes, and mental disorders, mi.in. depression and anxiety [9]. A study by Fond et al. showed that about 25% of nurses suffer from depression [10]. On the other hand, according to research by Pękacka et al., in Poland only 24% of the nurses surveyed do not show any symptoms of depression, 32% experience mild depression, 20% moderate depression, 16% moderately severe, and 8% severe [11]. Disturbed circadian rhythms and insufficient quality and quantity of sleep are considered to be the two most important factors in the long-term impact of night work on the mental health of nurses [12]. Rosenberg et al. found that mental health problems were more common in shift workers than in those in the permanent work system, and shift work was associated with a 33% increase in the risk of depressive symptoms [13].\u003c/p\u003e \u003cp\u003eDepression and burnout not only affect nurses' well-being, but also have a negative impact on the workforce and the quality of healthcare provided, including layoffs, an increase in medical errors, and a decline in patient satisfaction [14]. Major depression affects employee performance as well as organizational productivity. It is associated with an increase in absenteeism at work, short-term disability and reduced productivity and presenteeism, defined as the phenomenon of ineffective attendance at work as a result of poor health. Depressed workers can have impaired judgment of clinical situations, and errors in judgment can lead to serious consequences for both patients and staff [15]. Joinson (\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e1992\u003c/span\u003e) first used the term compassion fatigue to describe the loss of a nurse's ability to care in an emergency department setting. Specialists' sense of apathy and aloofness was associated with many environmental stressors, complex patient needs, trauma, and emotional distress. This term defines the negative feelings that nurses feel when they care for those who are suffering. Compassion fatigue from a nurse affects her quality of life and the people she cares for. It results in a decrease in compassion and empathy and an impairment of the ability to make decisions about patient care [16,17].\u003c/p\u003e \u003cp\u003eThe COVID-19 pandemic has also taken its toll and exposed nurses to chronic traumatic stress, a strong mental health risk factor [18]. As the pandemic continued, healthcare workers, particularly frontline nurses, experienced burnout, and many nurses in public health practices quit or temporarily left their jobs due to accumulated fatigue and mental distress [19].\u003c/p\u003e \u003cp\u003eStudies from different countries show that nurses may be at increased risk of suicide. According to data from the Office for National Statistics in the United Kingdom and the U.S. National Violent Death Reporting System, nurses have a higher suicide rate than women in the general population [20]. It was shown that nurses were almost twice as likely to die by suicide as the general population and 70% more likely than women doctors [18].\u003c/p\u003e \u003cp\u003eIn addition to suicide-related factors, widely described in the general population, some of them may be due to the function and workplace of health care workers. Working in a hospital involves situations that require certain skills, such as dealing with life and death management, physical and emotional pain and suffering experienced together with patients and their families. Such an environment can predispose to mental disorders such as stress, anxiety, depression and substance use, which can make it even more difficult for this group of specialists to seek specialist help. In addition, easy access to lethal drugs and knowledge how to use them are factors that increase the risk of committing suicide [21].\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003e1.3. Nursing staff's willingness to talk about suicide\u003c/h2\u003e \u003cp\u003eIn the context of nurses' readiness to talk to patients about suicide, it is worth emphasizing the importance of training for nursing staff in the field of suicide risk assessment. As Bolsner et al. Due to the lack of proper training, nurses are afraid to talk to patients about suicide. Research suggests that after receiving risk assessment training, nurses realize that this area is not significantly different from any other disease and, as a result, are better able to help people with suicidal tendencies [22].\u003c/p\u003e \u003cp\u003eFor interventions with patients after a suicide attempt, which are complex and challenging clinical situations, nurses need structured training that takes into account their specifics. In community psychiatric care, this type of training can use not only specialist and theoretical knowledge, but also the experience of people who have experienced a serious mental crisis themselves. Their knowledge and experiences can be particularly valuable, providing unique perspectives and practical tips that help nurses better understand and support patients in similar situations [23].\u003c/p\u003e \u003cp\u003eOmerov and Bullington, on the other hand, draw attention to the importance of interpersonal competence in the assessment and care of patients in suicidal crisis. Qualities such as kindness, non-judgmental attitude, openness, and respect are beneficial in alleviating patient suffering, effectively assessing risk, and delivering appropriate care. On the other hand, the lack of a caring approach may result in patients hiding their needs, using escape strategies, or giving up seeking help in the event of subsequent suicidal crises [24].\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003e1.4. The concept of the \"wounded healer\"\u003c/h2\u003e \u003cp\u003eIn 1951, Carl Jung first used the term \" \u003cem\u003ewounded healer\u003c/em\u003e\". The concept derives from Greek mythology and refers to individuals who, through their struggles and weaknesses, develop a deep understanding and empathy for the pain of others, which fosters effective therapeutic interventions [25]. The identity of the wounded healer stems from awareness and attention to one's own pain and fear, which in turn affects the care of others. Awareness of fracture and mortality becomes a powerful tool when caring for another person's pain [26]. Conti-O'Hare introduced the concept of the \"wounded healer\" into the nursing discipline and developed the theory of \"nurse as a wounded healer\u003cem\u003e\".\u003c/em\u003e She emphasized that when faced with physical, emotional, psychological, or spiritual trauma, nurses can adopt effective or ineffective coping strategies. People who use ineffective strategies may behave like \"\u003cem\u003ewalking wounded\"\u003c/em\u003e and project their own struggles onto patients and colleagues, showing less empathy [27]. Such people experience problems in social, intimate and professional relationships [28]. In contrast, people who successfully manage trauma are able to recognize, overcome, and transform their pain into healing. Although the \"scar\" remains, personal traumas that have been the subject of deep reflection can turn nurses into \"wounded healers,\" improving their ability to build therapeutic relationships with patients. It is not only their suffering that transforms them into healers, but also the awareness of the hurt and their willingness to accept and overcome it [29]. The theory has some limitations, focusing mainly on healthcare professionals and how their emotions affect the provision of nursing care. The theory does not mention any support that the nurse receives from those around her, but focuses on how she deals with her own internal struggles and what coping strategies she uses to overcome difficulties [28].\u003c/p\u003e \u003cp\u003eThe aim of the study was to assess the prevalence and characteristics of depression and suicidal behavior among nursing staff, and to investigate their ability to engage in suicide-related conversations through the lens of the wounded healer concept in a cross-sectional framework.\u003c/p\u003e \u003c/div\u003e"},{"header":"2. Materials and Methods","content":"\u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003e2.1. Study design and Setting\u003c/h2\u003e \u003cp\u003eThe 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.\u003c/p\u003e \u003cp\u003eThe 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.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003e2.2. Study population\u003c/h2\u003e \u003cp\u003eThe presented study involved 400 female at-born nurses working in various hospital wards across Poland. The mean age of all participants was 36.815 years (SD\u0026thinsp;=\u0026thinsp;10.385).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec9\" class=\"Section2\"\u003e \u003ch2\u003e2.3. Outcome measure\u003c/h2\u003e \u003cp\u003eThe 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).\u003c/p\u003e \u003cp\u003eThe 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.\u003c/p\u003e \u003cp\u003eAuthor's questionnaire examining readiness to talk about suicide consisting of 13 single-choice items. The method items were generated by AI (Microsoft Copilot). The AI was asked to identify key areas to assess nurses' readiness to talk to a patient about suicide. As part of the statistical analyses, two factors were identified: 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.\u003c/p\u003e \u003cp\u003eThe 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 [30,31].\u003c/p\u003e \u003cp\u003eThe 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 [32,33].\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec10\" class=\"Section2\"\u003e \u003ch2\u003e2.4. Ethical Considerations\u003c/h2\u003e \u003cp\u003e 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.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003e2.5. Data collection\u003c/h2\u003e \u003cp\u003eThe survey was conducted in February 2025 using a questionnaire made available to the respondents online. Informed consent was obtained from all subjects involved in the study.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003e2.6. Data Analysis\u003c/h2\u003e \u003cp\u003eThe analysis was performed using the IBM SPSS 26.0 package together with the Exact Tests module and the Statistica 13.3 package. All relationships, correlations and differences were statistically significant at p\u0026thinsp;\u0026le;\u0026thinsp;0.05.\u003c/p\u003e \u003cp\u003eThe 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.\u003c/p\u003e \u003cp\u003eWhile 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 2 samples) and Kruskal Wallis (for more than 2 samples).\u003c/p\u003e \u003cp\u003eCorrelations 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 \u0026ndash; positive or negative.\u003c/p\u003e \u003cp\u003eIn 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.\u003c/p\u003e \u003c/div\u003e"},{"header":"3. Results","content":"\u003cp\u003eThanks to the data obtained from the demographic-descriptive questionnaire, the group of nurses participating in the study was characterized. Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e presents the characteristics of the study group.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eDemographic characteristics and support services of the sample.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eFrequency\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003ePercent\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003e\u003cb\u003eAge\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e20\u0026ndash;29 years old\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e117\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e29,3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e30\u0026ndash;39 years old\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e124\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e31,0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e40\u0026ndash;49 years old\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e104\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e26,0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e50 years and older\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e55\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e13,8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"4\" rowspan=\"5\"\u003e \u003cp\u003e\u003cb\u003eDomicile\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eVillage\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e98\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e24,5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eA city of up to 50 thousand.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e91\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e22,8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eThe city from 50 thousand to 150 thousand.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e67\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e16,8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eThe city from 150 thousand to 500 thousand.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e67\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e16,8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCity over 500 thousand\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e77\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e19,3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003e\u003cb\u003eMarital status\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eEmerald/Kawal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e167\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e41,8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMarried\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e186\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e46,5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDivorced\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e44\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e11,0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eWidow/widower\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0,8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cb\u003eChildren you have\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e213\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e53,3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e187\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e46,8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e\u003cb\u003eEducation\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eVocational secondary\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e80\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e20,0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eBachelor of Nursing\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e116\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e29,0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMaster of Science in Nursing\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e204\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e51,0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"4\" rowspan=\"5\"\u003e \u003cp\u003e\u003cb\u003eSeniority\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0\u0026ndash;5 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e106\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e26,5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6\u0026ndash;10 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e97\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e24,3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e11\u0026ndash;15 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e63\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e15,8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e16\u0026ndash;20 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e55\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e13,8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e21 years and older\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e79\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e19,8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cb\u003eFacility status\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePublic\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e262\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e65,5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePrivate\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e138\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e34,5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"5\" rowspan=\"6\"\u003e \u003cp\u003e\u003cb\u003eEmployment Department\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eInternal medicine\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e96\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e24,0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSurgical\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e80\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e20,0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePaediatric\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e70\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e17,5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNeurological\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e55\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e13,8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePsychiatric\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e31\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e7,8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRehabilitation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e68\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e17,0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e\u003cb\u003eWork system\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eJust a day\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e63\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e15,8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNight Only\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e4,0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDay and night\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e321\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e80,3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e\u003cb\u003ePsychological support\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNever\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e207\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e51,8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eIn the past\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e143\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e35,8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCurrently\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e12,5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e\u003cb\u003ePsychiatric treatment\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNever\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e263\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e65,8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eIn the past\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e84\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e21,0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCurrently\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e53\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e13,3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cdiv id=\"Sec14\" class=\"Section2\"\u003e \u003ch2\u003e3.1. Depression and suicidality risk in nursing staff\u003c/h2\u003e \u003cp\u003eThe analysis of PHQ-9 results showed that 71% of the subjects (N\u0026thinsp;=\u0026thinsp;284) struggled with depression symptoms of varying severity. Most participants suffered from mild depression (N\u0026thinsp;=\u0026thinsp;120), while its absence was found in only 29% (N\u0026thinsp;=\u0026thinsp;116). The percentage distribution of depression levels among the study participants is presented in Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eIt has been confirmed that as the level of PHQ-9 depression increases, the results of SBQ-R suicidal behavior also increase (rho\u0026thinsp;=\u0026thinsp;0,579, p\u0026thinsp;\u0026lt;\u0026thinsp;0,001). Higher scores of the level of PHQ-9 depression and SBQ-R suicidal behavior were achieved by younger people (PHQ-9: Tau-c Kendalla=-0,153, p\u0026thinsp;\u0026lt;\u0026thinsp;0,001; SBQ-R: rho=-0,127, p\u0026thinsp;\u0026lt;\u0026thinsp;0,02) and those just beginning their nursing careers starting to become nurses (PHQ-9: Kendall\u0026rsquo;s Tau-b=-0,161, p\u0026thinsp;\u0026lt;\u0026thinsp;0,001; SBQ-R: rho=-0,102, p\u0026thinsp;\u0026lt;\u0026thinsp;0,05). Other factors negatively affecting the level of depression and suicidal behavior include lack of offspring, work only on night duty and marital status of a single or unmarried.\u003c/p\u003e \u003cp\u003eThe PHQ-9 and SBQ-R results are not significantly differentiated by the type of facility 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\u0026thinsp;=\u0026thinsp;15,158, df\u0026thinsp;=\u0026thinsp;5, p\u0026thinsp;\u0026lt;\u0026thinsp;0,02).\u003c/p\u003e \u003cp\u003eIt was observed that the group of respondents who had used psychological help or psychiatric treatment in the past achieved higher scores of depression and suicidality compared to the group that had never used psychological help (PHQ-9: U\u0026thinsp;=\u0026thinsp;9243,00, Z=-5,972, p\u0026thinsp;\u0026lt;\u0026thinsp;0,001; SBQ-R: U\u0026thinsp;=\u0026thinsp;3141,00, Z=-6,785, p\u0026thinsp;\u0026lt;\u0026thinsp;0,001) or psychiatric treatment (PHQ-9: U\u0026thinsp;=\u0026thinsp;7546,000, Z=-4,372, p\u0026thinsp;\u0026lt;\u0026thinsp;0,001; SBQ-R: U\u0026thinsp;=\u0026thinsp;6388,00, Z=-5,818, p\u0026thinsp;\u0026lt;\u0026thinsp;0,001), while the highest results were shown in the staff group that is currently under the care of a psychologist (PHQ-9: U\u0026thinsp;=\u0026thinsp;2954,50, Z=-4,706, p\u0026thinsp;\u0026lt;\u0026thinsp;0,001; SBQ-R: U\u0026thinsp;=\u0026thinsp;9276,00, Z=-5,989, p\u0026thinsp;\u0026lt;\u0026thinsp;0,001) or psychiatrist (PHQ-9: U\u0026thinsp;=\u0026thinsp;4278,000, Z=-4,434, p\u0026thinsp;\u0026lt;\u0026thinsp;0,001; SBQ-R: U\u0026thinsp;=\u0026thinsp;3244,00, Z=-6,137, p\u0026thinsp;\u0026lt;\u0026thinsp;0,001). No statistically significant differences were found between the group receiving psychological help or psychiatric treatment in the past and now.\u003c/p\u003e \u003cp\u003eIt has not been shown that age, place of residence or degree of education have a statistically significant impact on the level of depression and suicidal behavior.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec15\" class=\"Section2\"\u003e \u003ch2\u003e3.1. Competence of nursing staff to talk to patients about suicide\u003c/h2\u003e \u003cp\u003e \u003cem\u003e3.2.1. Initial validation of a questionnaire examining the staff's competence to talk to the patient about suicide\u003c/em\u003e \u003c/p\u003e \u003cp\u003eIn 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.\u003c/p\u003e \u003cp\u003eIn order to examine the psychometric properties of the questionnaire, a factor analysis was carried out using the main axes method, extracting two factors from the items included in the questionnaire, the results of which are presented in Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eResults of the Varimax Rotated Factor Analysis with factors extracted using the principal axis method. The loadings displayed in the table are greater than 0.4.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eQuestion\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFactor 1\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eFactor 2\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1. Do you have adequate training in crisis intervention and suicide prevention?\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-0,071044\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e0,730644\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2. Do you feel comfortable talking to the patient about suicide?\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e0,423042\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0,054308\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e3. Do you know the procedures and protocols for dealing with a patient's mental crisis?\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0,211478\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e0,718050\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e4. Can you recognize the warning signs of suicide?\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0,396974\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e0,511985\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e5. Are you able to establish an empathetic and supportive relationship?\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e0,715803\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0,070241\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e6. Do you have access to support resources within the institution where you work?\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0,243083\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e0,538603\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e7. Do you have access to support resources outside the institution where you work?\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0,348814\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e0,400851\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e8. Can you manage your own emotions, e.g. are you able to remain calm and professional, even in difficult situations?\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e0,544357\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0,187817\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e9. Do you have experience in working with patients in mental crisis?\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0,262679\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e0,616925\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e10. Do you know active listening techniques?\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e0,446887\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e0,439365\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e11. Can you adapt your approach to the individual needs of the patient?\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e0,709889\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0,233611\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e12. Are you aware of your limitations, e.g. when you need support from other specialists?\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e0,538530\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0,166805\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e13. Can you create a safe and supportive environment for the patient to feel safe and open up to difficult topics?\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e0,762422\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0,132058\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eThe eigenvalue\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3,019734\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2,478974\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eThe variance explained\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0,232287\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0,190690\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eThe reliability of the questionnaire was assessed by the Cronbach Alpha coefficient, which is a measure of the internal consistency of the questions. The value of the coefficient for factor I: 0.804213952, and for factor II: 0.812203491, which confirms the one-factor structure of the resulting tool.\u003c/p\u003e \u003cdiv id=\"Sec16\" class=\"Section3\"\u003e \u003ch2\u003e3.2.2. Psychological help\u003c/h2\u003e \u003cp\u003eThe analysis showed that the differences between staff not receiving psychological help (\u003cem\u003egroup 1\u003c/em\u003e) and those currently receiving \u003cem\u003epsychological assistance (group 3\u003c/em\u003e) indicate that in the case of important questions (1, 2, 4, 5, 7, 11) (p\u0026thinsp;\u0026lt;\u0026thinsp;0,05), the latter obtained higher scores. Staff who have received psychological help in the past (\u003cem\u003egroup 2.\u003c/em\u003e) 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.\u003c/p\u003e \u003cp\u003eThe 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\u0026thinsp;=\u0026thinsp;12946,50, Z=-1,991, p\u0026thinsp;\u0026lt;\u0026thinsp;0,05; factor 2: U\u0026thinsp;=\u0026thinsp;11278,50, Z=-3,78, p\u0026thinsp;\u0026lt;\u0026thinsp;0,001). Group 3 in comparison with group 1 also achieved higher results (factor 1: U\u0026thinsp;=\u0026thinsp;3996,00, Z=-2,498, p\u0026thinsp;\u0026lt;\u0026thinsp;0,02; factor 2: U\u0026thinsp;=\u0026thinsp;4065,50, Z=-2,350, p\u0026thinsp;\u0026lt;\u0026thinsp;0,02), while the results of groups 2 and 3 did not differ significantly.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec17\" class=\"Section3\"\u003e \u003ch2\u003e3.2.3. Psychiatric treatment\u003c/h2\u003e \u003cp\u003eDifferences between nurses that 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\u0026thinsp;=\u0026thinsp;8286,00, Z=-3,44, p\u0026thinsp;\u0026lt;\u0026thinsp;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\u0026thinsp;=\u0026thinsp;5333,50, Z=-2,82, p\u0026thinsp;\u0026lt;\u0026thinsp;0,008) and 2 (U\u0026thinsp;=\u0026thinsp;5257,50, Z=-2,82, p\u0026thinsp;\u0026lt;\u0026thinsp;0,005). The differences between group 2 and group 3 were revealed only in the higher scores of group 3 in question 12 (U\u0026thinsp;=\u0026thinsp;1660,000, Z=-2,49, p\u0026thinsp;\u0026lt;\u0026thinsp;0,02).\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e"},{"header":"4. Discussion","content":"\u003cp\u003eIn the course of statistical analyses, an alarming percentage of nursing staff affected by depressive disorders was revealed, which amounted to 71%, and is similar to the results of other studies conducted so far in Poland. Kubik et al. showed a slight exacerbation of depressive symptoms in 41.81% of nurses, moderate in 17.68%, and moderate to severe in 4.76% [34]. According to a study conducted in India, 74% experience varying degrees of anxiety, and 70.8% suffer from mild to very severe depression [9]. In France, 29.3% of the nursing staff suffer from depression [10], while in the United States, among nurses who were diagnosed with symptoms of depression, 32% were clinically depressed and 58% said they suffered from depression in the ordinary sense [35].\u003c/p\u003e \u003cp\u003eConsidering the impact of individual socio-demographic data on the level of depression and suicidal risk, it was noted that the lack of offspring, night work only and marital unmarried status were associated with an increase in depression and suicidal risk among nursing staff. Other studies are consistent with our results. The lack of a partner and offspring are important predictors of the risk of self-harm. Having children can reduce feelings of loneliness and give a sense of purpose in a parent's life. In addition, children, like a life partner, can be an important source of emotional and social support [21,36]. In contrast, disturbed circadian rhythms and insufficient quality and quantity of sleep were identified as the two most important factors in the long-term impact of night shift work on the mental health of nurses [37].\u003c/p\u003e \u003cp\u003eIn our study, the place of employment, the status and the level of education did not affect the mental state of the respondents in the evaluated aspects. This is not consistent with the available literature, as a number of studies describe the significance of the above data in the context of depressive disorders and suicidal risk. According to the study by Kumar et al. in the general population, higher education was a protective factor, due to the associated higher earnings, while older age was a risk factor [38]. On the other hand, research shows that younger people in the professional group of nurses are more likely to suffer from depression and suicide risk, which is associated with less professional experience and greater susceptibility to stress in crisis situations [39,40]. Gruebner et al. showed in their study that the risk of mental disorders, including depression and anxiety, is higher in people living in large cities, but the cause has not been clearly established [41]. Similar conclusions were also formulated in the study by Sampson et al. [42]. However, other conclusions were drawn from studies conducted in China, where urbanization was a factor positively affecting the treatment of depression due to increased access to therapeutic resources [43].\u003c/p\u003e \u003cp\u003eAnalysis of the results showed that nurses who received psychological or psychiatric help in the past or currently were characterized by higher levels of depression and suicide risk. 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. Our results are consistent with the concept of \u003cem\u003e\"wounded healer\"\u003c/em\u003e, which refers to people who, through their struggles and weaknesses, develop a deep understanding and empathy for the pain of others [25]. In addition, participation in psychotherapy can foster the quality of help by developing emotional competences such as empathy, compassion or mentalization [44\u0026ndash;46]. On the other hand, people who had never received psychological or psychiatric help reported lower depression and suicidality as a group, but only 29% of the study population did not show any symptoms of depression. At the same time, these people were less competent in providing assistance to people in mental crisis. This creates an image of \"\u003cem\u003eunhealed healers\u003c/em\u003e\", i.e. nurses who, immersed in their problems, are characterized by reduced efficiency at work, which is revealed by the lower quality of care and readiness to provide it. Previous research confirms that poor mental well-being of nurses correlates with reduced work productivity, manifested by higher rates of presenteeism, impairment of daily activities, and overall loss of productivity [47].\u003c/p\u003e \u003cp\u003eIn 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 [48\u0026ndash;50]. 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 \u0026ldquo;walking wounded unhealed healer\". In other words, whether their own suffering will become a resource or merely a psychological degrading factor.\u003c/p\u003e \u003cp\u003eThis 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 [51].\u003c/p\u003e \u003cp\u003eAnother 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.\u003c/p\u003e \u003cp\u003eConsidering 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).\u003c/p\u003e"},{"header":"5. Conclusions","content":"\u003cp\u003eNursing 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.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eThe following abbreviations are used in this manuscript:\u003c/p\u003e\u003cp\u003ePHQ-9 - Patient Health Questionnaire-9\u003c/p\u003e\u003cp\u003eSBQ-R - Suicidal Behaviors Questionnaire-Revised\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eFunding:\u003c/strong\u003e This research was funded by the Medical University of Warsaw, grant number 7/N/MG/N/24.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eHuman Ethics and Consent to Participate Declarations:\u0026nbsp;\u003c/strong\u003eThe 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.\u0026nbsp;No risks or inconveniences were identified for the participants, and no direct benefits were intended.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData Availability Statement:\u003c/strong\u003e The datasets generated and/or analyzed during the current study are not publicly available due to data privacy, but are available from the corresponding author uponreasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConflicts of Interest:\u003c/strong\u003e The authors declare no conflicts of interest.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eFerrara P, et al. 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Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.termedia.pl/pobierz/f81dbcfd36b46ad990519fbd8a21ac93\u003c/span\u003e\u003cspan address=\"https://www.termedia.pl/pobierz/f81dbcfd36b46ad990519fbd8a21ac93\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-nursing","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"nurs","sideBox":"Learn more about [BMC Nursing](http://bmcnurs.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/nurs/default.aspx","title":"BMC Nursing","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"nurses, suicide, depression, wounded healers","lastPublishedDoi":"10.21203/rs.3.rs-6400185/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6400185/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground/Objectives: \u003c/strong\u003eStudies 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.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods:\u003c/strong\u003e 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.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults:\u003c/strong\u003eThe 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\u0026lt;0,001) and psychiatric treatment(p\u0026lt;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\u0026lt;0,05). 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\".\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusions:\u003c/strong\u003e 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.\u003c/p\u003e","manuscriptTitle":"Unhealed healers. Depression and Suicidal Tendencies of Female Nurses as Barriers to Providing Assistance to Individuals in Suicidal Crisis: A Cross-sectional Study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-05-09 11:13:45","doi":"10.21203/rs.3.rs-6400185/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-06-13T20:08:55+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-06-09T20:01:51+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"1061355828991034104386148878902462813","date":"2025-06-06T18:28:43+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"320607765898017538486579089047756350989","date":"2025-06-04T06:55:24+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-05-08T01:51:38+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"19727401169685985412222075530828116370","date":"2025-05-08T00:43:34+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"19867494550566589614385357018554501935","date":"2025-05-07T12:17:22+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"103224881767532384636432176718714633744","date":"2025-05-05T11:58:35+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-05-05T10:58:56+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-05-05T10:49:46+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-05-05T06:16:06+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Nursing","date":"2025-04-23T18:57:28+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-nursing","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"nurs","sideBox":"Learn more about [BMC Nursing](http://bmcnurs.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/nurs/default.aspx","title":"BMC Nursing","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"793e8638-dc41-4611-b947-08a89f813f88","owner":[],"postedDate":"May 9th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2025-08-07T07:44:51+00:00","versionOfRecord":[],"versionCreatedAt":"2025-05-09 11:13:45","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-6400185","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6400185","identity":"rs-6400185","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}