Suicide risk among nursing professionals: A cross-sectional study in university hospitals in the far south of Brazil

Abstract

Objective  To identify the prevalence of suicide risk and associated factors among nursing professionals in university hospitals in the far south of Brazil.

Methods  A cross-sectional study was conducted with nursing professionals from two federal university hospitals who responded to an online questionnaire containing sociodemographic, economic, health and behavioral questions, and the Mini International Neuropsychiatric Interview (MINI) to assess suicide risk. Multivariable analysis was conducted using Poisson regression.

Results  A total of 581 professionals participated, with 84.9% being female. The prevalence of suicide risk was 8.8%. The adjusted analysis showed an association of suicide risk with: smoking (PR: 1.95; 95% CI: 1.09;3.53), self-reported depression (PR: 3.42; 95% CI: 2.03;5.79), history of childhood abuse/violence (PR: 2.30; 95% CI: 1.37;3.85), and the desire to change professions (PR: 2.23; 95% CI: 1.22;4.04). As a protective factor, family income between R$ 5,001 and R$ 13,000 (PR: 0.44; 95% CI: 0.26:0.73).

Conclusion  The multi-factors for suicide risk stand out, including childhood situations, lower income, mental illness, limitations and suffering in the work process, and the need for actions to support and strengthen the health of nursing professionals.

Nursing Team; Hospitals; Suicide; Occupational Health; Cross-Sectional Studies

Resumo

Objetivo  Identificar a prevalência do risco de suicídio e os fatores associados em profissionais de enfermagem de hospitais universitários do extremo sul do Brasil.

Métodos  Estudo transversal, realizado com profissionais de enfermagem de dois hospitais universitários federais que responderam a um questionário on-line, contendo questões sociodemográficas, econômicas, de saúde e comportamento e ao Mini International Neuropsychiatric Interview (MINI) para avaliação do risco de suicídio. Foi realizada análise multivariável por meio de regressão de Poisson.

Resultados  Participaram 581 profissionais (84,9%) do sexo feminino. A prevalência do risco de suicídio foi de 8,8%. A análise ajustada evidenciou associação do risco de suicídio com: tabagismo (RP:1,95; IC95%: 1,09;3,53), depressão autorreferida (RP:3,42; IC95%: 2,03;5,79), vivência de situação de abuso/agressão na infância (RP:2,30; IC95%: 1,37;3,85) e desejo de trocar de profissão (RP:2,23; IC95%: 1,22;4,04). E como fator de proteção: renda familiar, entre R$ 5.001 e R$ 13.000 (RP: 0,44; IC95%: 0,26;0,73).

Conclusão  Destacam-se os multifatores para o risco de suicídio, sejam situações da infância, menor renda, adoecimento mental, limitações e sofrimentos no processo de trabalho, e a necessidade de haver ações de suporte e de fortalecimento à saúde dos profissionais de enfermagem.

Equipe de Enfermagem; Hospitais; Suicídio; Saúde do Trabalhador; Estudos Transversais

Introduction

According to the World Health Organization (WHO), nursing professionals represent 59% of the world’s health workforce and are in the first line of care, meeting the needs of individuals, families, and communities, and exposed to different working conditions¹. In hospital environments, they are in frequent contact with critically ill patients, with diverse workloads and exposed to infectious agents².

The manifestations of physical and psychosocial health problems occur at different times in the life of health workers³and can have an impact on the performance of their professional duties. Among the manifestations of mental illness are professional burnout, anxiety⁴,⁵, depression⁴,⁶, and the risk of suicide⁴.

Suicide is a real, complex, and multidetermined phenomenon, seen and treated as taboo by both health institutions and society in general because it is still a stigmatized topic⁴,⁷. Considered a serious public health problem, the number of cases is growing. One of the goals of the United Nations (UN) Sustainable Development Agenda is to reduce suicide mortality rates by a third between 2015 and 2030⁸.

Currently, research on the subject has been gaining prominence in scientific literature and in workplaces, especially due to its increasingly frequent nature and the serious implications and impacts on workers and the social environment⁴. A study carried out in Brazil in 2018, using the Mini International Neuropsychiatric Interview instrument to stratify suicide risk, highlights a higher lifetime prevalence of attempted suicide among professional nurses, when compared to doctors, in a university hospital⁴.

Two other studies carried out in 2017, in Nigeria and the United States, identified a higher frequency of suicide attempts among nurses compared to the general population⁹and a higher risk of suicidal ideation among nurses compared to other workers¹⁰.

Exposure to a psychologically poor work environment can cause a variety of mental health problems, as well as an increased risk of suicide¹¹. During the COVID-19 emergency, health professionals have become even more exposed to overload, stress, and various workloads, consequently increasing occupational risks and illness¹⁰,¹².

Studies carried out after the start of the pandemic have identified an association between suicidal ideation and depression, agitation, perceived overload, previous suicide attempts¹³and symptoms of post-traumatic stress¹⁴, the illness of family members or relatives due to COVID-19, poor marital status, poor self-rated health, current need for psychological intervention, high stress, and anxiety¹⁵.

It is essential to highlight the importance of research into the mental health of health professionals, especially nurses, due to the high workload and trauma experienced during the COVID-19 pandemic, thus exacerbating the pressure on the workforce of an already overburdened professional category¹⁶and subjected to psychological impact¹⁵.

Based on the above, the identification of factors associated with suicide risk is an assertive strategy for elucidating and addressing the issue with hospital institutions to support the development of actions that can make the work environment healthier, meet the needs of workers, and offer adequate support. This study stands out for including nurses, nursing technicians, and nursing assistants in its sample and aims to identify the prevalence of suicide risk and associated factors among nursing professionals at university hospitals in the far south of Brazil.

Methods

Study design and context

An observational, cross-sectional study was carried out, linked to the research consortium entitled “Processo de trabalho e condições de saúde dos trabalhadores de enfermagem dos hospitais públicos de ensino do extremo sul do Brasil (Work process and health conditions of nursing workers in public teaching hospitals in the extreme south of Brazil)”, coordinated by the Nursing Work Study Group in Southern Brazil (GETEnf Sul), of the Nursing Faculty of the Federal University of Pelotas.

The two Federal University Hospitals (FUH) are located in two municipalities in the far south of Brazil, represented in this study as FUH1 and FUH2. Both are public institutions that exclusively serve users of the Unified Health System (SUS) and are currently linked to the Brazilian Hospital Services Company (EBSERH). FUH1 has 175 beds and provides medium and highly complex outpatient and home care. FUH2 has 231 beds and is a reference in the treatment of high-risk pregnancies and highly complex orthopedic surgery.

The sample was nonrandom. The survey was conducted from September 3, 2021, to January 10, 2022. Data was collected using an online questionnaire due to the COVID-19 pandemic.

Participants

The target population was made up of nursing professionals (nurses, nursing technicians, and nursing assistants) working in the two hospitals. Nursing professionals who had been working at the institution for at least one month were eligible to take part, regardless of the type of employment relationship. Workers on leave of any kind at the time of data collection were excluded from the sample.

Study size

The total number of nursing professionals was 1,375, according to lists made available in 2021 by the participating institutions. However, it was subsequently not possible to monitor new hires and contract terminations, as well as the number of absences. All professionals were invited to take part in the study.

Recruitment process

The research was publicized and nursing professionals participated virtually. Dissemination was carried out via social media, through the research group’s official Instagram page, with the support of the general managers of the sectors of the institutions, who shared the invitation via smartphone apps, through work groups. In addition, the invitation was also posted on digital information panels located at the entrance to the hospitals. During the data collection period, the invitation to take part in the survey was sent weekly by institutional email to all nursing professionals, containing a link or QR code to access the questionnaire. Questionnaires identified as incomplete on the platform were forwarded individually by institutional email, with the corresponding link, with the aim of encouraging completion of participation and filling in the blanks.

Data collection

Data was collected using a self-administered questionnaire, online, using the REDCap^® - Research Electronic Data Capture software. The Informed Consent Form (IFC) was authorized virtually, when the participant advanced in the online form to answer the survey. The questionnaire was organized into eight blocks, totaling 217 questions. For this study, the variables relating to block six, on suicide risk, were used, configuring the outcome of interest, as well as others relating to socioeconomic and demographic factors (block one), work process (block two) and health and behavior (block three).

The REDCap software made it possible to create adaptable questions, with the option of skipping certain steps, as well as automatically saving each answer and the possibility of reviewing it before completing the questionnaire.

Variables and measurement

The dependent variable was suicide risk. To measure this, module C of version 5.0 of the Mini International Neuropsychiatric Interview (MINI) was used to classify suicide risk¹⁷. This version was translated for use in Brazil and showed good psychometric indicators¹⁸. The self-administered and virtual instrument, due to the state of the COVID-19 pandemic when the study took place, allowed participants more privacy to answer sensitive and private questions about their lives.

The MINI has six questions that assess suicidal behavior in the last 30 days and throughout life and allows for a dichotomous answer (yes or no), with a specific score for each “yes” answer according to the severity of the situation. The maximum total score of 33 points provides for stratification into low (1-5 points), moderate (6-9 points), and high risk (≥ 10 points). For analysis purposes, zero was considered the absence of suicide risk and values between 1 and 33 points were considered “suicide risk”¹⁸.

The other variables studied were divided into three blocks.

Block 1 included the following sociodemographic and economic variables: gender (male; female), age (22 to 40; 41 to 68), sexual orientation (heterosexual; LGBTQIA+), self-declared skin color (white; black/brown), marital status (with partner; without partner), education (high school/technical; higher education/post-graduate), religious belief (no; yes), children (no; yes), net family income in the last month (R$ 3.000 to R$ 5,000; R$ 5,001 to R$ 13,000), individual net income in the last month (R$ 3,000 to R$ 5,000; R$ 5,001 to R$ 13,000), and home (owned; financed/rented/loaned).

In block 2, the behavioral and health variables were: smoking (no/ex-smoker; yes), alcohol intake (no; yes), sleep quality (good/very good; bad/very bad), self-reported anxiety (no; yes), self-reported depression (no; yes), use of psychoactive drugs (no; yes), frequency of physical activity (do not exercise; 1 to 2 times a week; ≥ 3 times a week), experience of abuse and/or aggression in childhood (no; yes), family mental disorder (no; yes), self-perceived quality of life (poor/regular; good), and self-perceived health (poor/regular; good).

In the last block, the variables related to work process: position held (nursing assistant; nursing technician; nurse), weekly workload (30 h; ≥ 36 h), job satisfaction (no; yes), work overload (no; yes), assessment of supervision at work (poor/regular; good), quality of care provided (poor/regular; good), assessment of teamwork (poor/regular; good), stress at work (little/moderate; high), how much they believe in and have plans for their work (little/moderately; a lot), exposure to biological load (little/moderately; a lot), having suffered violence in the workplace (no; yes), whether they would like to change workplaces (no; yes), and whether they would like to change professions (no; yes).

Bias control

A pilot study was carried out with other professionals who were not part of the sample, to test the interface with the software used, correct possible problems, and finalize the instrument. At the end of the data collection process, quality control was carried out on 10% of the sample through telephone contact with timeless questions, to check the consistency of the answers. This was followed by cleaning, checking and correcting any possible inconsistencies.

In order to minimize losses and control biases, the research group made weekly contacts with the workers, using different means and approaches to raise awareness and emphasize the importance of participation, whether through emails or the preparation of information materials on workers’ health.

Data analysis

The data collected using the REDCap software^® was exported to Microsoft Excel^®. Questionnaires that remained incomplete in the database or belonged to professionals outside the sample of survey participants were excluded. In the case of incomplete questionnaires from participants in the sample, if there were duplicates, the questionnaire that had been fully filled in was kept in the database.

The analysis was carried out using Stata^® software (version 11.1, Stata Corp., College Station, United States). A crude analysis was carried out using Person’s chi-square test between the dependent variable “suicide risk” and the independent variables. A statistical significance level of 5% was adopted.

Poisson regression with robust variance was used for multivariable analysis, following a three-level hierarchical model. The first level included demographic and socioeconomic variables; the second included behavioral and health variables; and the third included work process variables. The independent variables with a p-value less than or equal to 0.2 (p≤ 0.20) in the crude analysis were included in the final model, and the same cut-off point was used to keep the variables in the model to control confounding factors. The backward method was used to build the final model, and the adjustment was carried out level by level.

Ethical considerations

The research protocol was approved by the Human Research Ethics Committee of the Federal University of Pelotas under opinion no. 4.805.388/2021, CAAE no. 48022221.3.000.5316, June 25, 2021, and respected the rights and duties of the participants¹⁹. All participants agreed to the Informed Consent Form. Although the risks of answering were minimal, contact was made available by e-mail and telephone for therapeutic listening and guidance in the event of discomfort when completing the survey.

The data corresponding to the research participants will be stored for a period of five years, after which it will be deleted. Access to the information and records of the data collection period is restricted to researchers linked to GETEnf Sul and takes place using a specific password.

Results

The prevalence of suicide risk among nursing professionals was 8.8%, with 6.0% being low risk, 0.5% moderate, and 2.3% high (Figure 1). Regarding the distribution of the relative frequency of the outcome among the categories studied, 6.6% occurred among nursing assistants, 10.0% among nursing technicians, and 7.8% among nurses.

Figure 1
Prevalence of suicide risk among nursing professionals in two university hospitals in the far south of Brazil, 2022 (n= 581)

Of the 1,375 nursing professionals invited to take part in the survey at the two hospitals, 761 (55.4%) did not answer the questionnaire, and of these, two workers informed us of their wish not to take part after accessing the ICF. Thirty-three were excluded (2.4%) due to incomplete completion. The participants who answered the block with questions relating to the outcome of this study corresponded to 581 workers (42.3%).

The sample consisted of 61 nursing assistants (10.5%), 290 nursing technicians (49.9%), and 230 nurses (39.6%). The mean age of the participants was 41.1 years (standard deviation ± 8.2), ranging from 22 to 68 years. Most participants were female (84.9%), heterosexual (92.8%), white-skinned (76.4%), had a partner (38%), had higher education or postgraduate degrees (70.4%), had a family income of more than R$5,000 and up to R$13,000 (57.6%), and owned their home (37.5%).

There was a higher prevalence of suicide risk among female respondents (8.9%), aged between 41 and 68 (10.3%), with LGBTQIA+ (gay, lesbian, bisexual, transsexual, queer, intersexual, asexual, pansexual, +) sexual orientation (16.7%), white skinned (9.7%), without a partner (10.4%), with a secondary or technical level of education (11%), without children (11%), with a family income of between R$3,000 and R$5,000 (13.4%), and with a rented or borrowed home (9.9%).

The complete description of the participants in relation to the outcome, according to sociodemographic, health, behavioral, and work process characteristics, can be seen in the tables.

Tables 1, 2, and 3 present crude and adjusted analyses of the suicide risk outcome with the selected exposure variables and according to the levels of the analysis model established.

Table 1
Prevalence, prevalence ratio, and factors associated with suicide risk, according to sociodemographic and economic variables, among nursing professionals in two university hospitals in the far south of Brazil, 2022 (n= 581)

Variable	n	%	Crude PR (95%CI)	Adjusted PR (95%CI)
Sex
Male	88	7.9	1	-
Female	493	8.9	1.12 (0.52;2.41)
Age
22 to 40 years old	290	7.2	1	1
41 to 68 years old	291	10.3	1.42 (0.83;2.43)	1.30 (0.71;2.38) µ
Sexual orientation
Heterosexual	539	8.2	1	1
LGBTQIA+**	42	16.7	2.04 (0.98;4.25)	1.21 (0.56;2.60) µ
Self-declared skin color
Black/Brown	137	5.8	1	1
White	444	9.7	1.29 (0.89;1.86)	1.26 (0.88;1.81) µ
Marital status
With a partner	360	7.8	1
No partner***	221	10.4	1.34 (0.79;2.26)
Education
High school and technical	172	11.0	1	-
Higher education/postgraduate****	409	7.8	0.71 (0.41;1.21)
Religious belief
No	130	5.4	1	1
Yes	451	9.7	1.81 (0.84;3.93)	1.56 (0.71;3.40) µ
Children
No	146	11.0	1	-
Yes	435	8.0	0.73 (0.42;1.29)
Individual income
3 to 5 thousand reais	319	10.7	1	-
> 5 to 13 thousand reais	262	6.5	0.61 (0.35;1.07)
Family income
3 to 5 thousand reais	246	13.4	1	1
> 5 to 13 thousand reais	335	5.4	0.40 (0.23;0.69)*	0.44 (0.26;0.73)*
House
Owned	218	6.9	1	1
Financed/rented/loaned	363	9.9	1.09 (0.95;1.26)	1.05 (0.92;1.21) µ

• %: Prevalence; PR: prevalence ratio; 95%CI: 95% confidence interval; *Statistically significant difference (p ≤ 0.05); **LGBTQIA+ (gay, lesbian, bisexual, transsexual, queer, intersexual, asexual, pansexual, +); ***no partner (single, separated, divorced, widowed); ****PG (Postgraduate); ^µ remained in the model as an adjustment variable.
• Source: own elaboration.

Table 2
Prevalence, prevalence ratio, and associated suicide risk factors, according to behavioral and health variables, among nursing professionals at two university hospitals in the far south of Brazil, 2022 (n= 581)

Variable	n	%	Gross PR (95%CI)	Adjusted PR (95%CI)
Smoking
No/ex-smoker	522	7.7	1	1
Yes	59	18.6	2.43 (1.32;4.48)*	1.95 (1.09;3.53)*
Drinking alcohol
No	330	9.1	1	-
Yes	251	8.4	0.92 (0.54;1.57)
Sleep quality
Good/very good	342	7.3	1	-
Bad/very bad	239	10.9	1.22 (0.94;1.58)
Self-reported anxiety
No	435	5.5	1	-
Yes	146	18.5	3.35 (1.99;5.62)*
Self-reported depression
No	508 73	5.3	1	1
Yes		32.9	6.19 (3.78;10.12)*	3.42 (2.03;5.79)*
Use of psychotropic drugs	503
No	78	6.0	1	-
Yes		26.9	4.51 (2.72;7.47)*
Frequency of physical activity	264
Do not exercise	140	10.6	1	-
1-2 times/week	177	10.7	1.01 (0.56;1.82)
≥ 3 times/week		4.5	0.43 (0.20;0.91)*
Childhood abuse and/or aggression	463
No	118	6.1	1	1
Yes		19.5	3.22 (1.93;5.39)*	2.30 (1.37;3.85)*
Family mental disorder case	362
No	219	7.2	1	-
Yes		11.4	1.59 (0.94;2.68)
Self-perception of quality of life	213
Poor/regular	368	14.6	1	1
Good/very good		5.4	0.61 (0.47;0.80)*	0.86 (0.63;1.16) µ
Self-perception of health	179
Poor/regular	402	16.2	1	-
Good/very good	402	5.5	0.34 (0.20;0.57)*

• %: Prevalence; PR: prevalence ratio; CI: confidence interval *Statistically significant difference (p ≤ 0.05); ^µ remained in the model as an adjustment variable.
• Source: own elaboration.

Table 3
Prevalence, prevalence ratio, and associated suicide risk factors among nursing professionals, according to work process variables. Far south of Brazil, RS, 2022 (n= 581)

Variable	n	%	Crude PR (95%CI)	Adjusted PR (95%CI)
Position held
Nursing assistant	61	6.6	1	-
Nursing technician	290	10.0	1.52 (0.55;4.18)
Nurse	230	7.8	1.19 (0.42;3.40)
Weekly workload (n= 568)
30 h	107	4.7	1	1
≥ 36 h	461	10.0	2.13 (0.87;5.24)	1.47 (0.56;3.90) µ
Job satisfaction
No	41	17.1	1	-
Yes	540	8.1	0.48 (0.22;0.99)*
Work overload
No	378	6.9	1	-
Yes	203	12.3	1.79 (1.06;3.01)*
Supervision at work
Poor/regular	196	11.2	1	-
Good	385	7.5	0.82 (0.63;1.07)
Quality of care
Poor/regular	91	13.2	1	1
Good	490	8.0	0.78 (0.57;1.05)	1.30 (0.95;1.77) µ
Evaluation of teamwork (n= 580)
Poor/regular	141	13.5	1	1
Good	439	7.3	0.74 (0.56;0.96)*	0.81 (0.60;1.08) µ
Stress at work (n= 580)
Little/moderate	315	5.4	1
High	265	12.8	1.54 (1.16;2.04)*
Having projects for work (n= 578)
Little/moderately	291	11.0	1	1
A lot	287	6.6	0.78 (0.59;1.02)	0.82(0.63;1.06)µ
Exposure to bioburden (n= 579)
Little/moderately	165	4.8	1	1
A lot	414	10.4	1.46 (1.01;2.11)*	1.31 (0.90;1.91) µ
Violence in the workplace
No	465	7.5	1	-
Yes	116	13.8	1.83 (1.05;3.19)*
Desire to change workplace
No	486	7.4	1	-
Yes	95	15.8	2.13 (1.21;3.74)*
Desire to change profession
No	324	4.9	1	1
Yes	257	13.6	2.76 (1.56;4.87)*	2.23 (1.22;4.04)*

• %: Prevalence; PR: prevalence ratio; 95%CI: 95% confidence interval; *Statistically significant difference (p ≤ 0.05); ^µ remained in the model as an adjustment variable.
• Source: own elaboration.

In the crude analysis, the variables at the first level showed a statistically significant association (p ≤ 0.05) with the suicide risk outcome: family income of R$ 5,001 to R$ 13,000. At the second level: smoking, self-reported anxiety, self-reported depression, use of psychoactive drugs, experience of abuse and/or aggression in childhood, physical activity greater than or equal to three times a week, good self-perception of quality of life, and good self-perception of health. In the third level: overload, high stress at work, high exposure to biological load, suffering violence in the workplace, desire to change workplace, desire to change profession, satisfaction with work, and good evaluation of teamwork.

The adjusted model showed a risk of suicide associated with: smoking (PR:1.95; 95%CI: 1.09;3.53), self-reported depression (PR:3.42; 95%CI: 2.03;5.79), experiencing abuse/aggression in childhood (PR:2.30; 95%CI: 1.37;3.85), and wanting to change profession (PR:2.23; 95%CI: 1.22;4.04). And as a protective factor: family income between R$5,001 and R$13,000 (PR: 0.44; 95%CI: 0.26;0.73).

Discussion

The prevalence of suicide risk among the study participants was 8.8%. An investigation using the same instrument and cut-off point found a prevalence of 21.18% in nurses and 12.21% in doctors at a public federal hospital prior to the pandemic⁴. It is important to consider that the difference in the result found may be related to a possible selection bias, as well as specific local characteristics of the study participants.

The association found between suicide risk and lower family income was not found in other studies with nursing professionals. A study carried out in the health care network with 890 nursing professionals from municipal and federal services in southern Brazil identified an inverse correlation between individual income of less than or equal to three minimum wages and suicidal ideation²⁰.

Individual income was not associated with suicide risk in this study, a factor that may be related to receiving better salaries when compared to remuneration in other workplaces and probably in the scenario investigated, the smaller discrepancy between jobs and functions does not allow the variable to be very sensitive to this measure. However, the family income variable was able to translate differences related to social classes, enabling its members to have a better lifestyle, with more access to resources and opportunities for well-being.

Tobacco use has remained associated as a marker for suicide risk. A study of university health students in Brazil found an association between suicidal ideation and the use of tobacco and other drugs²¹. A study in Brazil identified a 10.2% prevalence of smoking among hospital nursing professionals, which was associated with a personal history of depression and alcoholism²². In a study carried out in Mexico, increased nicotine dependence was associated with high levels of stress at work among health professionals²³.

Self-reported depression was strongly associated with suicide risk. A similar high magnitude association was found in Freire’s study, and it was also the variable with the highest prevalence ratio associated with the outcome⁴

Research conducted with nurses in China and Germany found an association between suicidal ideation and depression²⁴,¹³. A study on suicidal ideation and self-harm among hospital workers in China during the COVID-19 pandemic found a higher prevalence in nurses, followed by nursing technicians when compared to the other participants, remaining associated with depressive symptoms in the regression analysis¹⁵.

An American study found that nurses had a 38% higher prevalence of suicidal ideation compared to other workers in the general population and among participants with depressive symptoms, the chances of the outcome occurring increased 11-fold¹⁰. In Iran, nurses with secondary traumatic stress during the COVID-19 outbreak were associated with higher scores of depression, anxiety, and suicidal ideation¹⁴.

Another element exponentially associated with suicide risk is having experienced abuse/aggression in childhood. However, there is a scientific gap which makes it impossible to compare this finding specifically with the population investigated. It was possible to identify studies on childhood disorders in different populations around the world, showing an association with an increased risk of suicide, as well as other mental health problems in adults²⁵-²⁸.

Furthermore, the result found in this study, although cross-sectional, has an impact in pointing to a timeless and retrospective situation in the lives of nursing professionals when referring to situations experienced in childhood as a potential risk factor for mental illness. It is important to highlight the need for care and protection both in the family setting and in the effective implementation of public educational policies, as well as rigorously combating and punishing crimes against children and adolescents to suppress harmful acts that tend to increase these risk factors.

The association between the risk of suicide and the desire to change profession may be justified by the chronic stress established in the nursing work routine, which can make the activities performed a deleterious and negative experience, affecting the worker’s physical and mental health and quality of life⁴.

It should be borne in mind that this study was carried out during the COVID-19 pandemic, a period in which the health situation required a heavy workload and there was an inadequate number and preparation of nursing professionals. This context contributed to accentuating the situation of moral suffering, stress, psychological disorders, and exhaustion²⁹, in addition to physiological, psycho-affective, and socio-family changes³⁰, which, when somatized over time, can impact the desire for professional change.

This study presents information and discussions of great relevance, bringing innovative data involving the three categories of nursing, health professionals who work directly with the pain and illness of people and suffer from the limitations arising from the work process, and even more so for discussing the risk of suicide, a socially taboo subject and lacking in scientific research.

The findings contribute to pointing out aspects that can be mitigated or even modified within the workplace, whether through professional development, preventive health actions, monitoring programs, and complementary therapies. Future studies should delve deeper into the risk and protective factors found to be associated with the outcome, and thus better direct discussions, action planning, and programs to assist workers’ health.

Among the study’s limitations, we highlight the participants’ low adherence, which may have been due to their strenuous working hours, the excess of information, and the existence of other concurrent studies. The sample of volunteers may have introduced selection bias into the study. It is also important to highlight the impossibility of establishing temporal relationships between the outcome and the variables studied, due to the methodological design used. The study may also be subject to information bias, given that all the answers were self-reported by the participants in an online form. In internet surveys, participants do not have the opportunity to clarify their doubts about the questions. On the other hand, the virtual format allows respondents greater privacy. It should also be noted that there are restrictions when comparing the results of this study with previous studies, due to the use of different scales in research over this subject.

Conclusion

This study found an 8.8% prevalence of suicide risk among nursing professionals in the far south of Brazil. Smoking remained associated with the outcome as a risk marker; as risk factors, self-reported depression, experiencing abuse/aggression in childhood, and the desire to change profession; and as a protective factor, family income in the highest range.

It is worth highlighting the relevance of the results found, due to their robustness in investigating different individual, health, and work aspects of nursing professionals, who are essential in the care and treatment of patients and who are exposed at all times to the adversities of the work environment and the consequences of occupational risks. In short, the associations found have the potential to deepen discussions and plan actions to protect workers’ mental health and search for healthier workplaces, as well as reaffirming the need for further research on the subject in the three categories of Brazilian nursing.

References

• ¹ World Health Organization. State of the world's nursing 2020: investing in education, jobs and leadership. Geneva: World Health Organization; 2021.
• ² Hong S, Ai M, Xu X, Wang W, Chen J, Zhang Q, et al. Immediate psychological impact on nurses working at 42 government-designated hospitals during COVID-19 outbreak in China: a cross-sectional study. Nurs Outlook. 2021;69(1):6-12. https://doi.org/10.1016/j.outlook.2020.07.007
  » https://doi.org/10.1016/j.outlook.2020.07.007
• ³ Tostes MF, Silva AQ, Garçon TL, Maran E, Teston EF. Tostes MFP, Silva AQ, Garçon TL, Maran E, Teston EF. Dualidade entre satisfação e sofrimento no trabalho da equipe de enfermagem em centro cirúrgico. Rev SOBECC. 2017;22(1):3-9. https://doi.org/10.5327/Z1414-4425201700010002
  » https://doi.org/10.5327/Z1414-4425201700010002
• ⁴ Freire FO, Marcon SR, Espinosa MM, Santos HG, Kogien M, Lima NV, et al. Factors associated with suicide risk among nurses and physicians: a cross-section study. Rev Bras Enferm. 2020 Oct;73(73 Suppl 1):e20200352. https://doi.org/10.1590/0034-7167-2020-0352
  » https://doi.org/10.1590/0034-7167-2020-0352
• ⁵ Dal'Bosco EB, Floriano LS, Skupien SV, Arcaro G, Martins AR, Anselmo AC. Mental health of nursing in coping with COVID-19 at a regional university hospital. Rev Bras Enferm. 2020;73 Suppl 2:e20200434. https://doi.org/10.1590/0034-7167-2020-0434
  » https://doi.org/10.1590/0034-7167-2020-0434
• ⁶ Humerez DC, Ohl RI, Silva MC. Mental health of Brazilian nursing professionals in the context of the covid-19 pandemic: action of the Nursing Federal Council. Cogitare Enferm. 2020;25 e7411:1-9. Portuguese. https://doi.org/10.5380/ce.v25i0.74115
  » https://doi.org/10.5380/ce.v25i0.74115
• ⁷ World Health Organization. Suicide worldwide in 2019: global health estimates. Geneva: World Health Organization; 2021.
• ⁸ United Nations. The sustainable development goals report 2017. New York: United Nations; 2017.
• ⁹ Olibamoyo O, Coker O, Adewuya A, Ogunlesi O, Sodipo O. Frequency of suicide attempts and attitudes toward suicidal behaviour among doctors and nurses in Lagos, Nigeria. S Afr J Psychiatr. 2020 Jul;26:1402. https://doi.org/10.4102/sajpsychiatry.v26i0.1402
  » https://doi.org/10.4102/sajpsychiatry.v26i0.1402
• ¹⁰ Kelsey EA, West CP, Cipriano PF, Peterson C, Satele D, Shanafelt T, et al. Original research: suicidal ideation and attitudes toward help seeking in U.S. nurses relative to the general working population. Am J Nurs. 2021 Nov 1;121(11):24-36. Disponível em: https://doi.org/10.1097/01.NAJ.0000798056.73563.fa
  » https://doi.org/10.1097/01.NAJ.0000798056.73563.fa
• ¹¹ Chin WS, Chen YC, Ho JJ, Cheng NY, Wu HC, Shiao JS. Psychological Work Environment and Suicidal Ideation Among Nurses in Taiwan. J Nurs Scholarsh. 2019 Jan;51(1):106-13. https://doi.org/10.1111/jnu.12441
  » https://doi.org/10.1111/jnu.12441
• ¹² Duarte ML, Silva DG, Bagatini MM. Enfermagem e saúde mental: uma reflexão em meio à pandemia de coronavírus. Rev Gaucha Enferm. 2021;42(esp): e20200140. Disponível em: https://doi.org/10.1590/1983-1447.2021.20200140
  » https://doi.org/10.1590/1983-1447.2021.20200140
• ¹³ Höller I, Forkmann T. Ambivalent heroism? Psychological burden and suicidal ideation among nurses during the Covid-19 pandemic. Nurs Open. 2022 Jan;9(1):785-800. https://doi.org/10.1002/nop2.1130
  » https://doi.org/10.1002/nop2.1130
• ¹⁴ Ariapooran S, Ahadi B, Khezeli M. Depression, anxiety, and suicidal ideation in nurses with and without symptoms of secondary traumatic stress during the COVID-19 outbreak. Arch Psychiatr Nurs. 2022 Apr;37:76-81. https://doi.org/10.1016/j.apnu.2021.05.005
  » https://doi.org/10.1016/j.apnu.2021.05.005
• ¹⁵ Xu X, Wang W, Chen J, Ai M, Shi L, Wang L, et al. Suicidal and self-harm ideation among Chinese hospital staff during the COVID-19 pandemic: prevalence and correlates. Psychiatry Res. 2021 Feb;296:113654. https://doi.org/10.1016/j.psychres.2020.113654
  » https://doi.org/10.1016/j.psychres.2020.113654
• ¹⁶ Maben J, Conolly A, Abrams R, Rowland E, Harris R, Kelly D, et al. 'You can't walk through water without getting wet' UK nurses' distress and psychological health needs during the Covid-19 pandemic: A longitudinal interview study. Int J Nurs Stud. 2022 Jul;131:104242. https://doi.org/10.1016/j.ijnurstu.2022.104242
  » https://doi.org/10.1016/j.ijnurstu.2022.104242
• ¹⁷ Sheehan DV, Lecrubier Y, Sheehan KH, Amorim P, Janavs J, Weiller E, et al. The Mini-International Neuropsychiatric Interview (M.I.N.I.): the development and validation of a structured diagnostic psychiatric interview for DSM-IV and ICD-10. J Clin Psychiatry. 1998;59 Suppl 20:22-33.
• ¹⁸ Amorim P. Mini International Neuropsychiatric Interview (MINI): validação de entrevista breve para diagnóstico de transtornos mentais. Rev Bras Psiquiatr. 2000; 22(3):106-15, 2000. Disponível em: https://doi.org/10.1590/S1516-44462000000300003
  » https://doi.org/10.1590/S1516-44462000000300003
• ¹⁹ Ministério da Saúde (BR). Resolução n° 466, de 12 de dezembro de 2012. prova diretrizes e normas regulamentadoras de pesquisas envolvendo seres humanos. Diário Oficial União; 12 dez 2012.
• ²⁰ Oliveira MM, Treichel CA, Bakolis I, Alves PF, Coimbra VC, Cavada GP, et al. Mental health of nursing professionals during the COVID-19 pandemic: a cross-sectional study. Rev Saude Publica. 2022 Mar;56:8. https://doi.org/10.11606/s1518-8787.2022056004122
  » https://doi.org/10.11606/s1518-8787.2022056004122
• ²¹ Veloso LU, Lima CL, Sales JC, Monteiro CF, Gonçalves AM, Silva Júnior FJ. Suicidal ideation among health field undergraduates: prevalence and associated factors. Rev Gaucha Enferm. 2019 Oct;40:e20180144. https://doi.org/10.1590/1983-1447.2019.20180144
  » https://doi.org/10.1590/1983-1447.2019.20180144
• ²² Ayoub AC, Sousa MG. Prevalence of smoking in nursing professionals of a cardiovascular hospital. Rev Bras Enferm. 2019 Feb;72 suppl 1:173-80. https://doi.org/10.1590/0034-7167-2018-0145
  » https://doi.org/10.1590/0034-7167-2018-0145
• ²³ Gómez-Aranda C, García-Pérez A, González-Aragón ÁE, Reyes-Jiménez O. Asociación entre estrés laboral y dependencia nicotínica en trabajadores de la salud. Rev Med Inst Mex Seguro Soc. 2021 Nov;59(6):510-6.
• ²⁴ Wang J, Zhang X, Yang B, Li J, Li Y, Chen Q, et al. Suicidal ideation among nurses: unique and cumulative effects of different subtypes of sleep problems. J Affect Disord. 2020 Nov;276:600-7. https://doi.org/10.1016/j.jad.2020.07.095
  » https://doi.org/10.1016/j.jad.2020.07.095
• ²⁵ Jardim BG, Novelo M, Spanemberg L, Gunten A, Engroff P, Nogueira EL, et al. Influence of childhood abuse and neglect subtypes on late-life suicide risk beyond depression. Child Abuse Negl. 2018 Jun;80:249-56. https://doi.org/10.1016/j.chiabu.2018.03.029
  » https://doi.org/10.1016/j.chiabu.2018.03.029
• ²⁶ Ng QX, Yong BZ, Ho CY, Lim DY, Yeo WS. Early life sexual abuse is associated with increased suicide attempts: an update meta-analysis. J Psychiatr Res. 2018 Apr;99:129-41. https://doi.org/10.1016/j.jpsychires.2018.02.001
  » https://doi.org/10.1016/j.jpsychires.2018.02.001
• ²⁷ Angelakis I, Gillespie EL, Panagioti M. Childhood maltreatment and adult suicidality: a comprehensive systematic review with meta-analysis. Psychol Med. 2019 May;49(7):1057-78. https://doi.org/10.1017/S0033291718003823
  » https://doi.org/10.1017/S0033291718003823
• ²⁸ Lee J, Kim H, Chang SM, Hong JP, Lee DW, Hahm BJ, et al. The association of childhood maltreatment with adulthood mental disorders and suicidality in Korea: a Nationwide Community Study. J Korean Med Sci. 2021 Sep;36(37):e240. https://doi.org/10.3346/jkms.2021.36.e240
  » https://doi.org/10.3346/jkms.2021.36.e240
• ²⁹ Luz EM, Munhoz OL, Morais BX, Greco PB, Camponogara S, Magnago TS, et al. Repercussões da Covid-19 na saúde mental dos trabalhadores de enfermagem. Rev Enferm Centro Oeste Mineiro. 2020;10:e3824. https://doi.org/10.19175/recom.v10i0.3824
  » https://doi.org/10.19175/recom.v10i0.3824
• ³⁰ Carminati AES, Misura SMP, Denis YVG. Situación de carga física y mental en enfermería de Uruguay durante la pandemia Covid 19. Rev Uruguaya Enferm. 2022; 17(2): e2022v17n2a4. Disponível em: https://doi.org/10.33517/rue2022v17n2a4
  » https://doi.org/10.33517/rue2022v17n2a4

• Information about academic work:
  Work derived from the doctoral thesis “Risco de suicídio e depressão entre profissionais de enfermagem de hospitais universitários do sul do Brasil: estudo transversal (Risk of suicide and depression among nursing professionals at university hospitals in southern Brazil: a cross-sectional study)”, defended in 2023 at the Postgraduate Program in Nursing at the Federal University of Pelotas by the author Laíne Bertinetti Aldrighi and supervised by the author Vanda Maria da Rosa Jardim
• Data availability:
  The complete data set supporting the results of this study is available upon request to the corresponding author.
• Presentation at a scientific event:
  The authors declare that the study has not been presented at any scientific event.
• Funding:
  The authors declare that the study was not funded.

Edited by

• Editor-in-Chief:
  Eduardo Algranti

Data availability

The complete data set supporting the results of this study is available upon request to the corresponding author.

Publication Dates

• Publication in this collection
  25 Apr 2025
• Date of issue
  2025

History

• Received
  01 Apr 2024
• Reviewed
  10 Jan 2025
• Accepted
  13 Jan 2025