title: Preventing occupational stress in healthcare workers.
abstract: BACKGROUND
  Healthcare workers can suffer from occupational stress which may lead to serious mental and physical health problems.
  
  
  OBJECTIVE
  To evaluate the effectiveness of work and person-directed interventions in preventing stress at work in healthcare workers.
  
  
  METHODS
  We searched the Cochrane Depression Anxiety and Neurosis Group trials Specialised Register, MEDLINE, PsychInfo and Cochrane Occupational Health Field database.
  
  
  METHODS
  Randomised controlled clinical trials (RCT) of interventions aimed at preventing psychological stress in healthcare workers. For work-directed interventions interrupted time series and prospective cohort were also eligible.
  
  
  METHODS
  Two authors independently extracted data and assessed trial quality. Meta-analysis and qualitative synthesis were performed where appropriate.
  
  
  RESULTS
  We identified 14 RCTs, three cluster-randomised trials and two crossover trials, including a total of 1,564 participants in intervention groups and 1,248 controls. Two trials were of high quality. Interventions were grouped into 1) person-directed: cognitive-behavioural, relaxation, music-making, therapeutic massage and multicomponent; and 2) work-directed: attitude change and communication, support from colleagues and participatory problem solving and decision-making, and changes in work organisation. There is limited evidence that person-directed interventions can reduce stress (standardised mean difference or SMD -0.85; 95% CI -1.21, -0.49); burnout: Emotional Exhaustion (weighted mean difference or WMD -5.82; 95% CI -11.02, -0.63) and lack of Personal Accomplishment (WMD -3.61; 95% CI -4.65, -2.58); and anxiety: state anxiety (WMD -9.42; 95% CI -16.92, -1.93) and trait anxiety (WMD -6.91; 95% CI -12.80, -1.01). One trial showed that stress remained low a month after intervention (WMD -6.10; 95% CI -8.44, -3.76). Another trial showed a reduction in Emotional Exhaustion (Mean Difference or MD -2.69; 95% CI -4.20, -1.17) and in lack of Personal Accomplishment (MD -2.41; 95% CI -3.83, -0.99) maintained up to two years when the intervention was boosted with refresher sessions. Two studies showed a reduction that was maintained up to a month in state anxiety (WMD -8.31; 95% CI -11.49, -5.13) and trait anxiety (WMD -4.09; 95% CI -7.60, -0.58). There is limited evidence that work-directed interventions can reduce stress symptoms (Mean Difference or MD -0.34; 95% CI -0.62, -0.06); Depersonalization (MD -1.14; 95% CI -2.18, -0.10), and general symptoms (MD -2.90; 95% CI -5.16, -0.64). One study showed that the difference in stress symptom level was nonsignificant at six months (MD -0.19; 95% CI -0.49, 0.11).
  
  
  CONCLUSIONS
  Limited evidence is available for the effectiveness of interventions to reduce stress levels in healthcare workers. Larger and better quality trials are needed.
authors.affiliation: Corporacio Sanitaria Parc Tauli de Sabadell, Prevention Service, Parc Tauli s/n, Sabadell, Catalonia, Spain. amarine@cspt.es
authors.forename: A
authors.initials: A
authors.lastname: Marine
authors.forename: J
authors.initials: J
authors.lastname: Ruotsalainen
authors.forename: C
authors.initials: C
authors.lastname: Serra
authors.forename: J
authors.initials: J
authors.lastname: Verbeek
mesh_terms: D006282:Health Personnel / Q000523:psychology*; D006801:Humans; D009784:Occupational Diseases / Q000517:prevention & control* / Q000523:psychology; D016032:Randomized Controlled Trials as Topic; D013315:Stress, Psychological / Q000517:prevention & control*