title: Improving mental health in health care practitioners: randomized controlled trial of a gratitude intervention.
abstract: OBJECTIVE
  Chronic occupational stress is common among health care practitioners, with potential impacts on personal mental health and staff turnover. This study investigated whether directing practitioners' attention to thankful events in work could reduce stress and depressive symptoms.
  
  
  METHODS
  A double-blind randomized controlled trial was conducted in 5 public hospitals with follow-up to 3 months posttreatment. One hundred two practitioners were randomly assigned into 3 conditions: gratitude, hassle, and nil-treatment. Those with scheduled long leaves were excluded. Participants in the gratitude and hassle group wrote work-related gratitude and hassle diaries respectively twice a week for 4 consecutive weeks. A no-diary group served as control. Depressive symptoms (primary outcome) and perceived stress (secondary outcome) were collected at baseline, posttreatment, and 3-month follow-up. Intent-to-treat analyses were performed with mixed-effects regression.
  
  
  RESULTS
  Significant Treatment × Time interaction effects were found for the gratitude intervention, whether it was compared with control or hassle; the general pattern was a decline in stress and depressive symptoms over time, but the rate of decline became less pronounced as time progressed. Hassle and control were basically indistinct from each other. Relative to control, the gratitude group reported lower depressive symptoms (-1.50 points; 95% CI [-2.98, -0.01]; d = -0.49) and perceived stress (-2.65 points; 95% CI [-4.00, -1.30]; d = -0.95) at follow-up. RESULTS for the comparison between gratitude and hassle were similar.
  
  
  CONCLUSIONS
  Taking stock of thankful events is an effective approach to reduce stress and depressive symptoms among health care practitioners.
authors.affiliation: Department of Health and Physical Education.
authors.forename: Sheung-Tak
authors.initials: ST
authors.lastname: Cheng
authors.affiliation: Department of Psychological Studies, Hong Kong Institute of Education.
authors.forename: Pui Ki
authors.initials: PK
authors.lastname: Tsui
authors.affiliation: Department of Psychological Studies, Hong Kong Institute of Education.
authors.forename: John H M
authors.initials: JH
authors.lastname: Lam
mesh_terms: D000328:Adult; D003866:Depressive Disorder / Q000523:psychology* / Q000628:therapy*; D004311:Double-Blind Method; D005260:Female; D005500:Follow-Up Studies; D006282:Health Personnel / Q000523:psychology*; D006801:Humans; D007588:Job Satisfaction; D008297:Male; D008603:Mental Health; D013315:Stress, Psychological / Q000523:psychology* / Q000628:therapy*; D016896:Treatment Outcome; D017132:Workplace / Q000523:psychology; D055815:Young Adult