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. OBJECTIVES: To evaluate the effectiveness of work and person-directed interventions in preventing stress at work in healthcare workers. METHODS:Search methods: We searched the Cochrane Depression Anxiety and Neurosis Group trials Specialised Register, MEDLINE, PsychInfo and Cochrane Occupational Health Field database. Selection criteria: 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. Data collection and analysis: Two authors independently extracted data and assessed trial quality. Meta-analysis and qualitative synthesis were performed where appropriate. MAIN 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: cognitivebehavioural, 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 ) and trait anxiety (WMD -4.09; 95% CI -7.60, -0.58). There is limited evidence that workdirected 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).AUTHORS' CONCLUSIONS: Limited evidence is available for the effectiveness of interventions to reduce stress levels in healthcare workers. Larger and better quality trials are needed.

Occupational Burnout in Healthcare Workers

“…People who work in the service sector are more affected (i.e., teachers, lawyers, engineers, police, guards, etc.) (5,7). It is possible to include healthcare workers, particularly family physicians, in this group (8,9).…”

“…It is mostly expressed as psychological distress and a psychosocial problem (3,5). Schaufeli et al (3) have proposed the term "engagement" to save the concept of burnout from the negative burden.…”

Impact of Occupational Stress on Job Performance: Moderating Role of Social and Supervisor‟s Support

“…(Jani et al, 2014) It is also evident from study of Jani and others in 2014 that stress can be reduced by altering work schedule. Organizational need to be more focused on identifying factors that leads toward stress (Jani et al, 2014).…”

Using the Job Burden-Capital Model of Occupational Stress to Predict Depression and Well-being among Electronic Manufacturing Service Employees in China

“…Some studies have shown that occupational stress influences depression and well-being through various working conditions, i.e., effort-reward imbalance is closely associated with depression; job demands (e.g., high work pressure, emotional needs, role ambiguity) might lead to sleep disorders [7], anhedonia [8], and so on, which serve as the main component of depression. Well-being and protective factors, specifically, social support [9], self-esteem [10] and autonomy [11] might alleviate occupational factors' negative effects through increasing employee learning opportunities [12,13] and improving a sense of integration in the work [14].…”

“…At present, most research on this topic has been conducted on health hazards and thereby achieved great success [11][12][13]. However, to predict and evaluate occupational stress and its outcomes, most studies are based on occupational stressors, or, in recent years [12,[15][16][17], they have used two internationally recognized models, i.e., the job demands-control (JDC) model [15] and the effort-reward imbalance (ERI) model [16].…”