Type of activity: Regional research study (cross-sectional, observational, descriptive-analytical)
Coordination: Health Workforce Unit (HSS/HW), in collaboration with the Mental Health and Substance Use Unit (NMH/MH), PAHO/WHO
Ethics approval: PAHO Ethics Review Committee (PAHOERC), Ref. No.: PAHOERC.0971.1
Coverage: 17 countries across the four subregions of the Region of the Americas: Barbados, Belize, Bolivia, Brazil, Chile, Colombia, Costa Rica, Ecuador, El Salvador, Guatemala, Guyana, Honduras, Mexico, Paraguay, Peru, Trinidad and Tobago, and Uruguay.
Target population: Nursing and medical professionals in direct clinical or care practice
Instrument: Adapted MeND questionnaire, online, anonymous, and self-administered (20–25 minutes), available in Spanish, English, and Portuguese
Data collection: September 21 to October 18, 2026
The COVID-19 pandemic exposed the profound vulnerability of health personnel in the Region of the Americas, with high rates of anxiety, depression, and burnout, in a context marked by a preexisting structural crisis of human resources for health: staffing deficits, precarious employment, high turnover, and limited psychosocial protection. The PAHO Policy on the Health Workforce 2030 (Document CD60/6), in its fifth strategic line, identifies working conditions and the well-being of health personnel as critical areas for advancing toward universal access to health and resilient health systems.
Despite the evidence accumulated during the pandemic, the information available on the mental health of health personnel in the Region is unevenly distributed: it is concentrated in a limited number of countries, combines heterogeneous populations and methodologies, and offers limited comparability across national contexts. This asymmetry constrains the identification of regional patterns and the formulation of differentiated, evidence-based policies.
To close these gaps, the study will simultaneously apply in 17 countries a regional adaptation of the instrument from the Mental Health of Nurses and Doctors (MeND) study, developed by the WHO Regional Office for Europe and applied in 27 countries of the European Union, Iceland, and Norway. The use of a common conceptual and methodological framework will make it possible to generate comparable regional evidence and will facilitate future transregional comparative analyses through harmonized indicators.
To describe mental health problems and well-being indicators among nursing and medical professionals in a representative group of countries of the Region of the Americas, and to analyze their association with sociodemographic variables and workplace stressors and protective factors. Specifically, the study seeks to:
- Estimate the proportion of professionals reporting symptoms consistent with depression, anxiety, and substance use, by country, type of institution, and sector.
- Describe subjective well-being, history of diagnosed mental health disorders, and use of mental health services and supports in the past 12 months.
- Describe the frequency of workplace stressors and protective factors in the work environment.
- Analyze the association between work-related variables and mental health, well-being, and substance use outcomes.
- Generate evidence comparable with the European study for a transregional analysis.
This is a cross-sectional, observational, non-interventional study, implemented through an online, anonymous, self-administered questionnaire, targeting licensed nursing and medical professionals in direct clinical or care practice. Data collection will use the adapted MeND instrument, which assesses sociodemographic characteristics, working conditions, mental health (anxiety, depression, and substance use, the latter through the ASSIST instrument), and well-being.
The study will be carried out in two phases: a pilot phase in five countries (Mexico, Brazil, Guatemala, Trinidad and Tobago, and Ecuador), aimed at validating the comprehension, usability, and operational performance of the instrument in the three languages, and a regional implementation phase in the 17 participating countries. The data collection stage is estimated to take place from September 21 to October 18, 2026.
Recruitment will be conducted through open dissemination via regional associations and professional councils of nursing and medicine, PAHO/WHO Collaborating Centres, ministries of health, and PAHO/WHO country offices in the participating countries.
- Barbados
- Belize
- Bolivia
- Brazil
- Chile
- Colombia
- Costa Rica
- Ecuador
- El Salvador
- Guatemala
- Guyana
- Honduras
- Mexico
- Paraguay
- Peru
- Trinidad and Tobago
Uruguay
The protocol was approved by the PAHO Ethics Review Committee (PAHOERC, Ref. No.: PAHOERC.0971.1) and is grounded in the CIOMS/WHO International Ethical Guidelines. Participation is voluntary and anonymous: no personally identifiable data will be collected, and the platform will be configured to prevent the recording of IP addresses and geolocation data. The study is considered minimal risk; online informed consent precedes access to the questionnaire, and participants will receive information on mental health resources and support lines available in each country, including the PAHO/WHO regional directory.
- Standardized, comparable regional evidence on the mental health, well-being, and working conditions of nursing and medical professionals in 17 countries.
- Identification of common challenges, risk factors, and protective factors in the work environment, disaggregated by country, subregion, profession, and sector.
- Technical inputs to guide national and regional policies, programs, and interventions aimed at protecting mental health and improving the working conditions of health personnel, in line with Document CD60/6.
- A basis for transregional comparative analysis with the MeND study of the European Region.
Contact: Yohana Díaz de Valle, Advisor, Health Workforce Unit, PAHO/WHO (diazdevalley@paho.org).