Individual‐level interventions for reducing occupational stress in healthcare workers
The Cochrane Database of Systematic Reviews · 9 authors, 6 centres
AI SUMMARY
FIDELITY 100%
POPULATIONHealthcare workers (nurses, physicians, and other clinical staff) in various healthcare settings who had not actively sought help for burnout, depression, or anxiety.
INTERVENTIONIndividual-level stress-reduction interventions categorized as: (1) focusing attention on the experience of stress (e.g., CBT, coping skills training); (2) focusing attention away from stress (e.g., relaxation, yoga, massage, mindfulness meditation); (3) altering work-related risk factors on an individual level; or (4) a combination of the above.
COMPARISONNo intervention, wait list, placebo, no stress-reduction intervention, or another type of stress-reduction intervention.
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This Cochrane systematic review of 117 RCTs (11,119 participants) found that individual-level stress interventions for healthcare workers—whether focusing attention on stress (e.g., CBT) or away from it (e.g., relaxation, yoga)—may reduce stress symptoms for up to one year, though the certainty of evidence is low due to risk of bias and lack of blinding. A combination of interventions may also be beneficial in the short term. The evidence is very uncertain for long-term effects (>12 months) and for interventions targeting work-related risk factors, highlighting the need for better-designed trials.
Full summary
4,045 CHARS
**Background:** Healthcare workers are at high risk of work-related stress due to an imbalance of demands, skills, and social support, which can lead to burnout, psychosomatic disorders, and reduced quality of patient care. This is an update of a Cochrane Review last updated in 2015, now split into this review on individual-level interventions and a companion review on organisational-level interventions. The objective was to evaluate the effectiveness of individual-level stress-reduction interventions for healthcare workers.
**Methods:** The authors searched CENTRAL, MEDLINE, Embase, PsycINFO, CINAHL, Web of Science, and a trials register from November 2013 to February 2022, plus included studies from the previous review. They included only RCTs evaluating individual-level stress interventions for healthcare workers engaged in clinical work. Interventions were categorised into four types: (1) focus on the experience of stress (thoughts, feelings, behaviour); (2) focus away from stress (relaxation, exercise, mindfulness meditation); (3) alter work-related risk factors on an individual level; and (4) combinations. The primary outcome was stress symptoms measured by validated self-report questionnaires. Review authors independently selected trials, assessed risk of bias using the Cochrane tool, and extracted data. Meta-analyses used random-effects models, and certainty of evidence was assessed using GRADE.
**Key Results:** This update includes 117 studies (11,119 participants randomised), adding 89 new studies since the previous update. Fifty-two studies examined interventions focusing on the experience of stress. Compared to no intervention, these may reduce stress symptoms in the short term (SMD -0.37, 95% CI -0.52 to -0.23; 41 RCTs; 3645 participants; low-certainty evidence), translating to 4.6 fewer points on the MBI-emotional exhaustion scale (0-54). Medium-term effects were similar (SMD -0.43, 95% CI -0.71 to -0.14; 19 RCTs; 1851 participants; low-certainty evidence). Long-term evidence was very uncertain (1 RCT; 68 participants). Forty-two studies examined interventions focusing away from stress. These may reduce stress symptoms in the short term (SMD -0.55, 95% CI -0.70 to -0.40; 35 RCTs; 2366 participants; low-certainty evidence), translating to 6.8 fewer points on the MBI-EE, and medium term (SMD -0.41, 95% CI -0.79 to -0.03; 6 RCTs; 427 participants; low-certainty evidence). No studies reported long-term effects. Seven studies examined altering work-related risk factors; the evidence was very uncertain for all time points (very low-certainty evidence). Seventeen studies examined combined interventions, which may reduce stress in the short term (SMD -0.67, 95% CI -0.95 to -0.39; 15 RCTs; 1003 participants; low-certainty evidence), translating to 8.2 fewer points on the MBI-EE. Medium-term effects did not exclude no effect (SMD -0.48, 95% CI -0.95 to 0.00; 6 RCTs; 574 participants; low-certainty evidence). Long-term evidence was very uncertain (1 RCT; 88 participants). Three studies comparing different intervention types showed very uncertain evidence about which is superior.
**Clinical Implications:** Individual-level stress interventions for healthcare workers—whether cognitive-behavioural or relaxation-based—may reduce stress symptoms for up to one year, though the low certainty of evidence means true effects may be substantially different (potentially smaller due to placebo effects). Combined interventions may offer additional short-term benefit. The lack of evidence for interventions targeting work-related risk factors is a notable gap, as these address root causes. The authors recommend better-designed trials with larger samples, blinding where possible, and longer follow-up (>12 months). They also call for more research on work-related risk factor interventions and suggest future studies should have at least 116 participants per arm (for focus-on-stress interventions) or 53 per arm (for focus-away-from-stress interventions) based on observed effect sizes.
PICO
PPOPULATION
Healthcare workers (nurses, physicians, and other clinical staff) in various healthcare settings who had not actively sought help for burnout, depression, or anxiety.
IINTERVENTION
Individual-level stress-reduction interventions categorized as: (1) focusing attention on the experience of stress (e.g., CBT, coping skills training); (2) focusing attention away from stress (e.g., relaxation, yoga, massage, mindfulness meditation); (3) altering work-related risk factors on an individual level; or (4) a combination of the above.
OOUTCOME
Stress symptoms measured by validated self-report questionnaires (e.g., Maslach Burnout Inventory, Perceived Stress Scale) at short-term (≤3 months), medium-term (>3 to 12 months), and long-term (>12 months) follow-up.