"Healthcare systems across Europe face a workforce crisis characterised by staff shortages, high turnover, and psychological distress among healthcare workers (HCWs). To understand the true scope and extent of psychological distress and occupational outcomes among HCWs and key areas to target for actionable solutions to this, a comprehensive overview of the evidence is needed. In this Series paper, we have synthesised findings from existing systematic reviews and meta-analyses to assess the prevalence of psychological distress among HCWs in Europe, examine associated risk and protective factors, and evaluate the effectiveness of interventions targeting these. The Series paper shows that HCWs experience high levels of work-related psychological distress, particularly burnout. Organisational factors, such as staff shortages, high workloads, and poor leadership, are key contributors to HCWs psychological distress. Organisational-level, rather than individual-level, interventions showed greater promise in reducing psychological distress and improving occupational outcomes. Perhaps surprisingly, currently published reviews did not focus on diagnosable mental disorders, instead relying on self-report symptom-based measures, likely overestimating prevalence. Our findings show limited research available on psychological distress and occupational outcomes among non-clinical staff, HCWs from ethnic minorities, and countries outside Western Europe. We recommend long-term investment in fostering safe and supportive workplaces and implementing evidence based multi-level mental health initiatives that are co-produced with HCWs. We also advocate for high quality, longitudinal research and policies that prioritise protecting the mental health and occupational safety of HCWs in order to safeguard their wellbeing and futureproof healthcare system sustainability."

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