Preventing occupational stress in healthcare workers
Editorial Group: Cochrane Depression, Anxiety and Neurosis Group
Published Online: 18 OCT 2006
Assessed as up-to-date: 20 AUG 2006
Copyright © 2009 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.
How to Cite
Marine A, Ruotsalainen JH, Serra C, Verbeek JH. Preventing occupational stress in healthcare workers. Cochrane Database of Systematic Reviews 2006, Issue 4. Art. No.: CD002892. DOI: 10.1002/14651858.CD002892.pub2.
- Publication Status: Edited (no change to conclusions)
- Published Online: 18 OCT 2006
Healthcare workers can suffer from occupational stress which may lead to serious mental and physical health problems.
To evaluate the effectiveness of work and person-directed interventions in preventing stress at work in healthcare workers.
We searched the Cochrane Depression Anxiety and Neurosis Group trials Specialised Register, MEDLINE, PsychInfo and Cochrane Occupational Health Field database.
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.
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).
Limited evidence is available for the effectiveness of interventions to reduce stress levels in healthcare workers. Larger and better quality trials are needed.
Plain language summary
Preventing occupational stress in healthcare workers
Healthcare workers suffer from work-related or occupational stress often resulting from high expectations coupled with insufficient time, skills and/or social support at work. This can lead to severe distress, burnout or physical illness, and finally to a decrease in quality of life and service provision. The costs of stress and burnout are high due to increased absenteeism and turnover.
We conducted a systematic search of the literature on preventing stress or burnout in healthcare workers. We then appraised the quality of the studies found and combined their results.
Person-directed interventions that include a cognitive-behavioural approach (e.g. coping skills training), combined with relaxation techniques or not, can be effective in reducing burnout, anxiety, stress and general symptoms in healthcare workers when compared to no intervention. Work-directed interventions that include communication or nursing delivery change can also be effective in reducing burnout, stress and general symptoms in healthcare workers when compared to no intervention. At best, the results of stress or burnout reducing interventions may still be apparent from six months to two years after the end of the interventions.
Most of the studies are small and of poor quality, and it is not clear how large a change in a stress or burnout score is meaningful.
我們確定了14個隨機對照研究，三群隨機試驗和兩個交叉試驗研究，包括共1564名參與處遇組與1,248名控制組成員。有兩個試驗有高度的品質。處遇分為1)個人導向：認知行為，放鬆，製作音樂，有助於放鬆的按摩，和多方面;2)工作導向：改變態度和溝通，同事的支持，參與的問題解決與決策，並改變工作分配. 有限的證據顯示，個人導向的處遇措施可減少壓力(標準化平均差或SMD0.85; 95％CI −1.21，−0.49);耗竭：情緒耗盡(加權平均差或WMD −5.82; 95％CI −11.02，−0.63)和缺乏個人成就感(WMD −3.61; 95％CI −4.65，−2.58)和焦慮：焦慮狀態(WMD −9.42; 95％CI −16.92 ，−1.93)和特質焦慮(WMD −6.91; 95％CI12.80，−1.01)。有一個試驗顯示在處遇後一個月，壓力仍然偏低(WMD −6.10; 95％CI −8.44，−3.76)。另一項試驗顯示，在推動進修課程的處遇後減少了情緒耗盡(平均差或MD −2.69; 95％CI −4.20，−1.17)和缺乏個人成就感(MD −2.41; 95％CI −3.83，−0.99)，維持了兩年。兩份研究報告顯示，在減少焦慮狀態(WMD −8.31; 95％CI為−11.49，−5.13)和特質焦慮(WMD −4.09; 95％CI −7.60，−0.58)，持續達一個月。 有限制證據表明，工作導向的處遇措施可減少壓力症狀(平均差或MD −0.34; 95％CI −0.62，−0.06);失去自我感(MD −1.14; 95％CI −2.18，−0.10)，和一般症狀(MD 2.90; 95％CI −5.16，−0.64)。一項研究顯示，在6個月中，壓力症狀的程度上沒有顯著差異(MD −0.19; 95％CI −0.49，0.11)。
此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。