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Research / Funded grants

2022 Focus Grant

HEAR Plus MINDBODYSTRONG: A Mental Health Resiliency Intervention for Nurses

2 research findings from this AFSP-funded study.

Research finding · July 2026

Nurses identified workplace stressors shaping mental health and suicide prevention needs

Nurses regularly work in emotionally demanding environments shaped by long hours, chronic understaffing, repeated exposure to trauma, and high levels of responsibility for patient care. Over time, these pressures can contribute to burnout, depression, anxiety, and suicide risk, particularly when workplace cultures make it difficult for healthcare workers to prioritize their own well-being or seek support. Research has also shown that many healthcare workers avoid mental health services because of perceived negative attitudes (stigma), time constraints, or fears about professional consequences. Understanding how nurses themselves describe these stressors, and what they believe would meaningfully improve their well-being, is critical for developing suicide prevention efforts that are responsive to the realities of healthcare work.

With her AFSP-funded work, Dr. Bernadette Mazurek Melnyk analyzed responses from 464 nurses identified as being at moderate-to-high risk for mental distress, including suicidal thoughts and behaviors. Nurses described a wide range of overlapping stressors, including deteriorating mental and physical health, suboptimal work environments, financial insecurity, and strain within personal and family relationships. A central theme that emerged was what the Dr. Melnyk described as “the price of caring,” where the identity and expectations associated with being a nurse blurred the boundaries between professional obligation and personal well-being. Participants frequently described feeling unable to fully disconnect from caregiving demands, leading to exhaustion, guilt, and emotional depletion. Nurses identified several changes they believed could improve mental health and reduce distress, including stronger workplace support, adequate staffing, flexible scheduling, protection from workplace violence, increased pay, opportunities for career transition, and access to mental health services and evidence-based coping programs. Some also emphasized the importance of rest, therapy, social support, mindfulness, exercise, and reclaiming time outside of work. Overall, the findings highlight the importance of suicide prevention efforts that address both individual mental health needs and the broader workplace and systemic conditions shaping nurse well-being.

Citation: Hsieh, A. P., Cooper, A., Mayfield, C., Bauernsmith, I., Brown, K., Tucker, S., Melnyk, B. M., & Davidson, J. E. (2026). Nurses At-Risk for Mental Health Distress and Suicidality Describe Stressors and Strategies for Healthcare System Change: A Thematic Analysis. The Journal of nursing administration, 56(3), 127–134. https://doi.org/10.1097/NNA.0000000000001696

This finding comes from an AFSP-funded study — see the grant below ↓

Research finding · July 2025

A range of variables impacted nurses’ experience of burnout and suicidal ideation

Nurses in the United States face alarmingly high rates of burnout, depression, and suicidal ideation, outpacing many other occupational groups. Despite increasing awareness, many nurses struggling with mental health concerns do not receive support or treatment, often due to negative attitudes (stigma), workplace culture, or fear of professional consequences. Suicide prevention in the nursing workforce requires more than individual coping strategies. It demands a systemic understanding of which work-related and personal factors contribute to risk, and which can offer protection. As health systems confront ongoing staffing shortages and workforce distress, identifying modifiable contributors to suicidal ideation is critical for both employee well-being and patient safety.

Dr. Bernadette Mazurek Melnyk examined data from 499 U.S. nurses identified as moderate-to-high-risk for mental health concerns, including suicidal ideation. Dr. Melnyk analyzed associations between suicidal ideation and a range of variables: burnout, depression, anxiety, PTSD, shift length, job satisfaction, workplace mattering, and more. She found that suicidal ideation was significantly associated with burnout, depression, anxiety, PTSD, working 12-hour shifts, and intent to leave the job. Protective factors included resilience, healthy lifestyle beliefs and behaviors, job satisfaction, and especially a sense of mattering in the workplace. Nurses who felt they mattered to their organization had 40% lower odds of suicidal ideation. This study highlights the urgent need for health care systems to address structural causes of burnout, invest in evidence-based mental health supports, and create cultures where nurses are valued –– not only to reduce distress, but potentially to save lives.

Citation: Melnyk, B. M., Davidson, J. E., Tucker, S., Tan, A., Hsieh, A. P., Cooper, A., Mayfield, C., & Hoying, J. (2025). Burnout, Mental Health, and Workplace Characteristics: Contributors and Protective Factors Associated With Suicidal Ideation in High-Risk Nurses. Worldviews on evidence-based nursing, 22(3), e70042. https://doi.org/10.1111/wvn.70042

This finding comes from an AFSP-funded study — see the grant below ↓

The grant behind this work · 2022 Focus Grant

HEAR Plus MINDBODYSTRONG: A Mental Health Resiliency Intervention for Nurses

Bernadette Mazurek Melnyk, PhD

Bernadette Mazurek Melnyk, Ph.D., APRN-CNP, FAANP, FNAP, FAAN

Ohio State University

Judy Davidson, DNP, R.N.

Judy Davidson, DNP, R.N.

University of California San Diego

Amount awarded
$1,498,914 Focus area
Clinical Treatment

Inside the Research

Nurses have a higher suicide rate than the general population. They also experience high rates of burnout and depression that adversely impact health care quality and safety. This study will test a combination of an interactive, anonymous suicide screening program developed by AFSP along with a digitized version of a cognitive behavioral skills-building program previously shown to reduce emotional distress in clinicians. If effective, this intervention could be used to reduce depression and suicide risk throughout the nursing profession and serve as a model for other health care professions.

Full scientific abstract

Background: Nurses have a higher suicide rate than the general population and experience high rates of burnout and depression, which have escalated further since the COVID-19 pandemic. Studies support that nurses' mental health adversely impacts healthcare quality and safety. Suicide prevention strategies, designed specifically for nurses, are urgent public health imperatives.

Research Aims: 1) Assess acceptability and usability of a digitalized on-line interactive version of the MINDBODYSTRONG© cognitive-behavioral skills building program with 10 nurses, and  2) conduct a rigorous randomized controlled trial (RCT) to determine the effects of the Healer Education Assessment and Referral (HEAR) program's adaptation of the American Foundation for Suicide Prevention's (AFSP) Interactive Screening program (ISP) combined with the on-line version of the MINDBODYSTRONG© program versus the HEAR program alone on depression, suicidal ideation, burnout, anxiety, post-traumatic stress, healthy lifestyle beliefs, healthy lifestyle behaviors, and job satisfaction in 364 U.S. nurses 

Design: First, acceptability and usability of a new digitalized version of MINDBODYSTRONG© will be created and feedback obtained with 10 nurses. Second, a two arm RCT will be conducted in which nurses who screen positive for moderate to high suicide risk will receive either the HEAR program plus the on-line MINDBODYSTRONG© program or the HEAR program alone with follow-up immediately post-intervention and at three, six and 12 months.

Sample: Ten nurses from Ohio State's Wexner Medical Center will test the acceptability and usability of the digitalized version of MINDBODYSTRONG©. The RCT sample will include 364 nurses (182 per arm) recruited through the American Nurses Association.

Measures: Valid and reliable measures will assess depression, suicidal intent, anxiety, burnout, post-traumatic stress, healthy lifestyle beliefs, healthy lifestyle behaviors and job satisfaction. A short evaluation questionnaire also will gain feedback on the helpfulness of the intervention and obtain data regarding type of treatment (e.g., therapy, medication) the nurses have received.

Procedures: Ten nurses will answer questions on acceptability and usability of the digitalized version of MINDBODYSTRONG©. Feedback will be used to refine the program for the full-scale RCT. Nurses from the ANA who consent will be screened with the HEAR Screening Program. Participants will be randomly assigned to the intervention or control group. Those who score moderate- to high-risk for suicide will be contacted by a mental health counselor who will engage them through an encrypted interface online. The counselor will offer support online or by phone. Those who screen moderate- to high-risk and who are randomized to the intervention group will be offered the on-line version of MINDBODYSTRONG©. Reminders will be sent weekly to complete the next MINDBODYSTRONG© session and a MINDBODYSTRONG© coach will check in with participants at weeks 3 and 5. Data will be collected at baseline and post-intervention as well as at three, six- and 12-months post-intervention through an on-line confidential survey.

Impact: If effective, this suicide prevention package could be readily scaled to reduce depression and suicide risk throughout the nursing profession.

Next Steps: Plans include refining the intervention and replicating this study with other health professionals experiencing high rates of burnout, depression, and suicide.

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