Cited by 499Stress and Burnout ResearchOccupational Health and BurnoutHealthcare professionals’ stress and burnout

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Preventing occupational stress in healthcare workers

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Marine, Albert, Ruotsalainen, Jani H, Serra, Consol, Verbeek, Jos H·2006·Cochrane Database of Systematic Reviews

DOI 10.1002/14651858.cd002892.pub2PMC PMC6718215

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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. SEARCH STRATEGY: 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: 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). 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.

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Authors: Marine, A., Ruotsalainen, J. H., Serra, C., & Verbeek, J. H.
Affiliations: Finnish Institute of Occupational Health (FI)
Universitat Pompeu Fabra (ES)
ORCID: Ruotsalainen, Jani H
Verbeek, Jos H
Venue: Cochrane Database of Systematic Reviews
Publisher: John Wiley & Sons, Ltd
Published: 2006-10-18
Issue: 4
Pages: CD002892-CD002892
ISSN: 1361-6137 (ISSN-L)
DOI: 10.1002/14651858.cd002892.pub2
PMC: PMC6718215
OpenAlex: W1912269944
Cited by: 499
References: 189
Citations by year: 2026: 4 · 2025: 11 · 2024: 36 · 2023: 32 · 2022: 48 · 2021: 58 · 2020: 57 · 2019: 42 · 2018: 24 · 2017: 31 · 2016: 30 · 2015: 20 · 2014: 22 · 2013: 12 · 2012: 17
Type: reference entry
Language: en
Open access: green
www.ncbi.nlm.nih.gov
Locations: Cochrane Database of Systematic Reviews (publishedVersion)
Europe PMC (PubMed Central) (publishedVersion)
PubMed Central (publishedVersion)
PubMed (publishedVersion)
Data Archiving and Networked Services (DANS) (submittedVersion)
Pure Amsterdam UMC (submittedVersion)
Topics: Social Sciences › Psychology › Social Psychology › Stress and Burnout Research
Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Occupational Health and Burnout
Health Sciences › Health Professions › General Health Professions › Healthcare professionals’ stress and burnout
Keywords: occupational stress, healthcare workers, burnout, stress prevention, relaxation training, organizational interventions, social support, work organization, quality of life, anxiety, intervention effectiveness, meta-analysis update, GRADE quality of evidence
MeSH terms: Health Personnel, Humans, Occupational Diseases, Stress, Psychological, Randomized Controlled Trials as Topic

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