TY - JOUR
T1 - Individual-level interventions for reducing occupational stress in healthcare workers
AU - Tamminga, Sietske J.
AU - Emal, Lima M.
AU - Boschman, Julitta S.
AU - Levasseur, Alice
AU - Thota, Anilkrishna
AU - Ruotsalainen, Jani H.
AU - Schelvis, Roosmarijn M. C.
AU - Nieuwenhuijsen, Karen
AU - van der Molen, Henk F.
N1 - Funding Information: Sponsorship source: This study was supported by a Seed fund from Arizona State University to Luthar. Mayo Clinic funded and supported medical-care professionals’ time to participate in study activities Funding Information: • We are grateful for the funding provided for this project by the National Institute for Health Research (NIHR), UK. The views expressed are those of the authors and not necessarily those of the NIHR or the Department of Health and Social Care, UK. Funding Information: Sponsorship source: This project was supported by the Institute of Coaching at McLean Hospital, Harvard Medical School affiliate. Funding Information: Sponsorship source: The authors would like to thank the Vice-Chancellor for Research, Shiraz University of Medical Sciences, for financially supporting this study. Funding Information: Sponsorship source: "Portions of the project were funded by a Research AccelerationProgram grant from Carilion Clinic." Funding Information: Sponsorship source: The study was funded by the National Institute for Health Research Imperial Patient Safety Translational Research Centre and registered (ISRCTN11418903) Funding Information: Sponsorship source: This study was supported by the Nursing Research Project of The Second Xiangya Hospital, Central South University (2017-YHL-15). Funding Information: Sponsorship source: Funding: Funded in part by the OSU Harding Behavioral Health Stress, Trauma and Resilience program Funding Information: Sponsorship source: Funding: This study was supported by AFA insurance [Grant no 140007] Funding Information: Sponsorship source: Funding for this study was provided by the Mayo Clinic Department ofMedicine Program on Physician Well-Being and thePhysician Foundation Funding Information: Sponsorship source: This study was funded by a grant from the National Institutes of Health (grant number K24 HL-089223-07). Funding Information: Sponsorship source: This work has been partially financed by the Department of Health of the Government of Navarra, by obtaining the first prize in the II Contest of Ideas for Health Research in Primary Care. Funding Information: Sponsorship source: Funding for this study was provided by a grant RA12042 from Changhua Show Chwan Memorial Hospital and a grant MOST-103-2314-B-166-003 from the Minister of Science in Taiwan Funding Information: Sponsorship source: This work was supported by grants (grant numbers SFRH/BD/72460/2010 and RIPD/CIF/109464/2009) from the Foundation for Science and Technology (FCT) Funding Information: Sponsorship source: This study was supported by Research Grants Council of Hong Kong Strategic Public Policy Research Grant No. HKIEd1001-SPPR-08 awarded to Sheung-Tak Cheng. Funding Information: Sponsorship source: The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This research was supported by the Research and Creative Activities Fund of Texas Christian University. Funding Information: Sponsorship source: This study was funded by AFA Försäkring (150024) Funding Information: Sponsorship source: This project was supported by a research grant provided by the Ohio Bureau Workers Compensation Ohio Occupational Safety and Health Research Program. Funding Information: Sponsorship source: The study was funded by the Research Support Foundation of the State São Paulo (Process No 2017/19, 645-2) Funding Information: We are grateful for the funding provided for this project by the National Institute for Health Research (NIHR), UK. The views expressed are those of the authors and not necessarily those of the NIHR or the Department of Health and Social Care, UK. We thank Jos Verbeek, Albert Mariné, and Mariné A, Serra C for their work on the previous version of this review. We thank Vittoria Lutje for updating the searches and running the updated searches. We thank J Cohen-Katz, S Ketelaar/K Nieuwenhuijsen, K Moody, D Oman, P Dunne, J Kline, M Barattucci, T Pehlivan, M Sampson 2019, E Smoktunowicz, C West, A Sawyer, A Errazuriz, Jensen, B Yüceer for providing further information or data from their study. We thank our colleagues from Amsterdam UMC location Vrije Universiteit Amsterdam and University of Amsterdam, Public and Occupational health, Michiel Greidanus, Sanne Gommers, Donna Beerda, Donny Kreuger, Elmi Zwaan, Fenna van Ommen, Marije Hagendijk, and Judith Mollet for their help with extracting the outcomes as second data extractor. We thank the following students of the faculty of Medicine of the University of Amsterdam for their help with extracting the outcomes as second data extractor: Anniek Nauta, Boris Brojović, Bram Millenaar, Charlie Sent, Chiel Klein, Danny Kroon, Frederique Wekker, Guus Kerkvliet, Ida Blokland, Jens Nijzink, Jesse Warmerdam, Loran Mul, Lotte Bos Mertcan Göç, Mirte Dekkers, Nina Bijl, Nisrine Aynaou, Sabine de Beer, Sam Rozemuller. We thank the peer reviewers for their comments: Giuseppe La Torre, Department of Public Health and Infectious Diseases - Sapienza University of Rome; Amit Abraham, Weill Cornell Medicine-Qatar; and Afroditi Kanellopoulou, Statistician, Cochrane Central. We thank the Cochrane Work Review Group for supporting the authors in the development of this review. We are grateful for the funding provided for this project by the National Institute for Health Research (NIHR), UK. The views expressed are those of the authors and not necessarily those of the NIHR or the Department of Health and Social Care, UK. We thank Jos Verbeek, Albert Mariné, and Mariné A, Serra C for their work on the previous version of this review. We thank Vittoria Lutje for updating the searches and running the updated searches. We thank J Cohen-Katz, S Ketelaar/K Nieuwenhuijsen, K Moody, D Oman, P Dunne, J Kline, M Barattucci, T Pehlivan, M Sampson 2019, E Smoktunowicz, C West, A Sawyer, A Errazuriz, Jensen, B Yüceer for providing further information or data from their study. We thank our colleagues from Amsterdam UMC location Vrije Universiteit Amsterdam and University of Amsterdam, Public and Occupational health, Michiel Greidanus, Sanne Gommers, Donna Beerda, Donny Kreuger, Elmi Zwaan, Fenna van Ommen, Marije Hagendijk, and Judith Mollet for their help with extracting the outcomes as second data extractor. We thank the following students of the faculty of Medicine of the University of Amsterdam for their help with extracting the outcomes as second data extractor: Anniek Nauta, Boris Brojović, Bram Millenaar, Charlie Sent, Chiel Klein, Danny Kroon, Frederique Wekker, Guus Kerkvliet, Ida Blokland, Jens Nijzink, Jesse Warmerdam, Loran Mul, Lotte Bos Mertcan Göç, Mirte Dekkers, Nina Bijl, Nisrine Aynaou, Sabine de Beer, Sam Rozemuller. We thank the peer reviewers for their comments: Giuseppe La Torre, Department of Public Health and Infectious Diseases - Sapienza University of Rome; Amit Abraham, Weill Cornell Medicine-Qatar; and Afroditi Kanellopoulou, Statistician, Cochrane Central. We thank the Cochrane Work Review Group for supporting the authors in the development of this review. The following people conducted the editorial process for this article: Sign-off Editor (final editorial decision): Jan Hoving, Cochrane Work, Amsterdam UMC Contact Editor: Jos Verbeek, Cochrane Work, Amsterdam UMC Managing Editor (selected peer reviewers, collated peer-reviewer comments, provided editorial guidance to authors, edited the article): Jessica Thomas, Cochrane Work, Amsterdam UMC Information Specialist (searching support): Faridi van Etten, Amsterdam UMC Methods and Statistician review: Afriditi Kanellopoulou, Statistician at Cochrane Central Copy-editing (initial copy-edit and final proofread): Heather Maxwell, Copy-edit Group at Cochrane Central Sign-off Editor (final editorial decision): Jan Hoving, Cochrane Work, Amsterdam UMC Contact Editor: Jos Verbeek, Cochrane Work, Amsterdam UMC Managing Editor (selected peer reviewers, collated peer-reviewer comments, provided editorial guidance to authors, edited the article): Jessica Thomas, Cochrane Work, Amsterdam UMC Information Specialist (searching support): Faridi van Etten, Amsterdam UMC Methods and Statistician review: Afriditi Kanellopoulou, Statistician at Cochrane Central Copy-editing (initial copy-edit and final proofread): Heather Maxwell, Copy-edit Group at Cochrane Central Funding Information: Sponsorship source: This study was supported by a grant from the General Program of Science and Technology Plan for Health Care in Dongguan City of Guangdong Province. The funder played no role in the study design, data collection, data analysis, manuscript preparation, or decision to publish the report. Publisher Copyright: Copyright © 2023 The Authors. Cochrane Database of Systematic Reviews published by John Wiley & Sons, Ltd. on behalf of The Cochrane Collaboration.
PY - 2023/5/12
Y1 - 2023/5/12
N2 - Background: Healthcare workers can suffer from work-related stress as a result of an imbalance of demands, skills and social support at work. This may lead to stress, burnout and psychosomatic problems, and deterioration of service provision. This is an update of a Cochrane Review that was last updated in 2015, which has been split into this review and a review on organisational-level interventions. Objectives: To evaluate the effectiveness of stress-reduction interventions targeting individual healthcare workers compared to no intervention, wait list, placebo, no stress-reduction intervention or another type of stress-reduction intervention in reducing stress symptoms. Search methods: We used the previous version of the review as one source of studies (search date: November 2013). We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase, PsycINFO, CINAHL, Web of Science and a trials register from 2013 up to February 2022. Selection criteria: We included randomised controlled trials (RCT) evaluating the effectiveness of stress interventions directed at healthcare workers. We included only interventions targeted at individual healthcare workers aimed at reducing stress symptoms. Data collection and analysis: Review authors independently selected trials for inclusion, assessed risk of bias and extracted data. We used standard methodological procedures expected by Cochrane. We categorised interventions into ones that:. 1. focus one’s attention on the (modification of the) experience of stress (thoughts, feelings, behaviour);. 2. focus one’s attention away from the experience of stress by various means of psychological disengagement (e.g. relaxing, exercise);. 3. alter work-related risk factors on an individual level; and ones that. 4. combine two or more of the above. The crucial outcome measure was stress symptoms measured with various self-reported questionnaires such as the Maslach Burnout Inventory (MBI), measured at short term (up to and including three months after the intervention ended), medium term (> 3 to 12 months after the intervention ended), and long term follow-up (> 12 months after the intervention ended). Main results: This is the second update of the original Cochrane Review published in 2006, Issue 4. This review update includes 89 new studies, bringing the total number of studies in the current review to 117 with a total of 11,119 participants randomised. The number of participants per study arm was ≥ 50 in 32 studies. The most important risk of bias was the lack of blinding of participants. Focus on the experience of stress versus no intervention/wait list/placebo/no stress-reduction intervention. Fifty-two studies studied an intervention in which one's focus is on the experience of stress. Overall, such interventions may result in a reduction in stress symptoms in the short term (standardised mean difference (SMD) -0.37, 95% confidence interval (CI) -0.52 to -0.23; 41 RCTs; 3645 participants; low-certainty evidence) and medium term (SMD -0.43, 95% CI -0.71 to -0.14; 19 RCTs; 1851 participants; low-certainty evidence). The SMD of the short-term result translates back to 4.6 points fewer on the MBI-emotional exhaustion scale (MBI-EE, a scale from 0 to 54). The evidence is very uncertain (one RCT; 68 participants, very low-certainty evidence) about the long-term effect on stress symptoms of focusing one's attention on the experience of stress. Focus away from the experience of stress versus no intervention/wait list/placebo/no stress-reduction intervention. Forty-two studies studied an intervention in which one's focus is away from the experience of stress. Overall, such interventions may result in a reduction in stress symptoms in the short term (SMD -0.55, 95 CI -0.70 to -0.40; 35 RCTs; 2366 participants; low-certainty evidence) and medium term (SMD -0.41 95% CI -0.79 to -0.03; 6 RCTs; 427 participants; low-certainty evidence). The SMD on the short term translates back to 6.8 fewer points on the MBI-EE. No studies reported the long-term effect. Focus on work-related, individual-level factors versus no intervention/no stress-reduction intervention. Seven studies studied an intervention in which the focus is on altering work-related factors. The evidence is very uncertain about the short-term effects (no pooled effect estimate; three RCTs; 87 participants; very low-certainty evidence) and medium-term effects and long-term effects (no pooled effect estimate; two RCTs; 152 participants, and one RCT; 161 participants, very low-certainty evidence) of this type of stress management intervention. A combination of individual-level interventions versus no intervention/wait list/no stress-reduction intervention. Seventeen studies studied a combination of interventions. In the short-term, this type of intervention may result in a reduction in stress symptoms (SMD -0.67 95%, CI -0.95 to -0.39; 15 RCTs; 1003 participants; low-certainty evidence). The SMD translates back to 8.2 fewer points on the MBI-EE. On the medium term, a combination of individual-level interventions may result in a reduction in stress symptoms, but the evidence does not exclude no effect (SMD -0.48, 95% CI -0.95 to 0.00; 6 RCTs; 574 participants; low-certainty evidence). The evidence is very uncertain about the long term effects of a combination of interventions on stress symptoms (one RCT, 88 participants; very low-certainty evidence). Focus on stress versus other intervention type. Three studies compared focusing on stress versus focusing away from stress and one study a combination of interventions versus focusing on stress. The evidence is very uncertain about which type of intervention is better or if their effect is similar. Authors' conclusions: Our review shows that there may be an effect on stress reduction in healthcare workers from individual-level stress interventions, whether they focus one's attention on or away from the experience of stress. This effect may last up to a year after the end of the intervention. A combination of interventions may be beneficial as well, at least in the short term. Long-term effects of individual-level stress management interventions remain unknown. The same applies for interventions on (individual-level) work-related risk factors. The bias assessment of the studies in this review showed the need for methodologically better-designed and executed studies, as nearly all studies suffered from poor reporting of the randomisation procedures, lack of blinding of participants and lack of trial registration. Better-designed trials with larger sample sizes are required to increase the certainty of the evidence. Last, there is a need for more studies on interventions which focus on work-related risk factors.
AB - Background: Healthcare workers can suffer from work-related stress as a result of an imbalance of demands, skills and social support at work. This may lead to stress, burnout and psychosomatic problems, and deterioration of service provision. This is an update of a Cochrane Review that was last updated in 2015, which has been split into this review and a review on organisational-level interventions. Objectives: To evaluate the effectiveness of stress-reduction interventions targeting individual healthcare workers compared to no intervention, wait list, placebo, no stress-reduction intervention or another type of stress-reduction intervention in reducing stress symptoms. Search methods: We used the previous version of the review as one source of studies (search date: November 2013). We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase, PsycINFO, CINAHL, Web of Science and a trials register from 2013 up to February 2022. Selection criteria: We included randomised controlled trials (RCT) evaluating the effectiveness of stress interventions directed at healthcare workers. We included only interventions targeted at individual healthcare workers aimed at reducing stress symptoms. Data collection and analysis: Review authors independently selected trials for inclusion, assessed risk of bias and extracted data. We used standard methodological procedures expected by Cochrane. We categorised interventions into ones that:. 1. focus one’s attention on the (modification of the) experience of stress (thoughts, feelings, behaviour);. 2. focus one’s attention away from the experience of stress by various means of psychological disengagement (e.g. relaxing, exercise);. 3. alter work-related risk factors on an individual level; and ones that. 4. combine two or more of the above. The crucial outcome measure was stress symptoms measured with various self-reported questionnaires such as the Maslach Burnout Inventory (MBI), measured at short term (up to and including three months after the intervention ended), medium term (> 3 to 12 months after the intervention ended), and long term follow-up (> 12 months after the intervention ended). Main results: This is the second update of the original Cochrane Review published in 2006, Issue 4. This review update includes 89 new studies, bringing the total number of studies in the current review to 117 with a total of 11,119 participants randomised. The number of participants per study arm was ≥ 50 in 32 studies. The most important risk of bias was the lack of blinding of participants. Focus on the experience of stress versus no intervention/wait list/placebo/no stress-reduction intervention. Fifty-two studies studied an intervention in which one's focus is on the experience of stress. Overall, such interventions may result in a reduction in stress symptoms in the short term (standardised mean difference (SMD) -0.37, 95% confidence interval (CI) -0.52 to -0.23; 41 RCTs; 3645 participants; low-certainty evidence) and medium term (SMD -0.43, 95% CI -0.71 to -0.14; 19 RCTs; 1851 participants; low-certainty evidence). The SMD of the short-term result translates back to 4.6 points fewer on the MBI-emotional exhaustion scale (MBI-EE, a scale from 0 to 54). The evidence is very uncertain (one RCT; 68 participants, very low-certainty evidence) about the long-term effect on stress symptoms of focusing one's attention on the experience of stress. Focus away from the experience of stress versus no intervention/wait list/placebo/no stress-reduction intervention. Forty-two studies studied an intervention in which one's focus is away from the experience of stress. Overall, such interventions may result in a reduction in stress symptoms in the short term (SMD -0.55, 95 CI -0.70 to -0.40; 35 RCTs; 2366 participants; low-certainty evidence) and medium term (SMD -0.41 95% CI -0.79 to -0.03; 6 RCTs; 427 participants; low-certainty evidence). The SMD on the short term translates back to 6.8 fewer points on the MBI-EE. No studies reported the long-term effect. Focus on work-related, individual-level factors versus no intervention/no stress-reduction intervention. Seven studies studied an intervention in which the focus is on altering work-related factors. The evidence is very uncertain about the short-term effects (no pooled effect estimate; three RCTs; 87 participants; very low-certainty evidence) and medium-term effects and long-term effects (no pooled effect estimate; two RCTs; 152 participants, and one RCT; 161 participants, very low-certainty evidence) of this type of stress management intervention. A combination of individual-level interventions versus no intervention/wait list/no stress-reduction intervention. Seventeen studies studied a combination of interventions. In the short-term, this type of intervention may result in a reduction in stress symptoms (SMD -0.67 95%, CI -0.95 to -0.39; 15 RCTs; 1003 participants; low-certainty evidence). The SMD translates back to 8.2 fewer points on the MBI-EE. On the medium term, a combination of individual-level interventions may result in a reduction in stress symptoms, but the evidence does not exclude no effect (SMD -0.48, 95% CI -0.95 to 0.00; 6 RCTs; 574 participants; low-certainty evidence). The evidence is very uncertain about the long term effects of a combination of interventions on stress symptoms (one RCT, 88 participants; very low-certainty evidence). Focus on stress versus other intervention type. Three studies compared focusing on stress versus focusing away from stress and one study a combination of interventions versus focusing on stress. The evidence is very uncertain about which type of intervention is better or if their effect is similar. Authors' conclusions: Our review shows that there may be an effect on stress reduction in healthcare workers from individual-level stress interventions, whether they focus one's attention on or away from the experience of stress. This effect may last up to a year after the end of the intervention. A combination of interventions may be beneficial as well, at least in the short term. Long-term effects of individual-level stress management interventions remain unknown. The same applies for interventions on (individual-level) work-related risk factors. The bias assessment of the studies in this review showed the need for methodologically better-designed and executed studies, as nearly all studies suffered from poor reporting of the randomisation procedures, lack of blinding of participants and lack of trial registration. Better-designed trials with larger sample sizes are required to increase the certainty of the evidence. Last, there is a need for more studies on interventions which focus on work-related risk factors.
UR - http://www.scopus.com/inward/record.url?scp=85159225528&partnerID=8YFLogxK
U2 - https://doi.org/10.1002/14651858.CD002892.pub6
DO - https://doi.org/10.1002/14651858.CD002892.pub6
M3 - Review article
C2 - 37169364
SN - 1465-1858
VL - 2023
JO - Cochrane Database of Systematic Reviews
JF - Cochrane Database of Systematic Reviews
IS - 5
M1 - CD002892
ER -