Interventions aimed at reducing work-related stress for individual healthcare workers may lead to improvements in how people cope with stress up to a year later. Findings from a Cochrane review of the latest available evidence build on the conclusions of a previous review in 2015 that found low-quality evidence that interventions, such as cognitive behavioural training (CBT), mental and physical relaxation, were better than none.
The researchers included 117 studies of the effects of different interventions on stress alleviation in the current review, of which 89 studies were new. These 89 studies were published between 2013 and 2022. A total of 11,119 healthcare workers worldwide were randomised to different interventions, and stress was assessed by questionnaires measuring stress symptoms in the short term (up to three months after an intervention ended), in the medium term (between three and 12 months) and long-term (follow-up after more than a year).
The review from Cochrane, a collaboration of independent, international experts, looked at interventions at the level of the individual healthcare worker that focused attention either on the experience of stress, or away from the experience of stress. Strategies for focusing attention on the stress included CBT, and training on assertiveness, coping and communication skills. Interventions that focus attention away from the stress included relaxation, mindfulness meditation, exercise such as yoga and tai chi, massage, acupuncture, and listening to music. The researchers wanted to see whether different types of interventions were better than no intervention in reducing stress.
The healthcare workers in the studies were experiencing low to moderate levels of stress and burnout, which can lead to physical symptoms such as headaches, muscle tension or pain, but also mental symptoms, such as depression, anxiety, impaired concentration and emotional and relationship problems.
Sietske Tamminga, assistant professor in public and occupational health at Amsterdam University Medical Centre, Amsterdam, The Netherlands, who led the research said: “Healthcare workers often deal with stressful and emotional situations in patient care, human suffering, and pressure from relationships with patients, family members and employers, as well as high work demands and long working hours.
“We found that healthcare workers might be able to reduce their stress by means of individual-level interventions such as cognitive behaviour training, exercising or listening to music. This may be beneficial for the healthcare workers themselves and it may spill over to the patients they care for, and the organisations they work for. The effect may last for up to a year and a combination of interventions may be beneficial as well, at least in the short term. Employers should not hesitate to facilitate a range of stress interventions for their employees. The long-term effects of stress management interventions remain unknown.”
The researchers say that larger, better-quality studies are needed to look at both the short- and long-term effects of individual level interventions in order to increase the certainty of the evidence.
“We need more studies on interventions addressing work-related risk factors both at the individual and organisational level,” said Dr Tamminga. “It might be even more beneficial to improve working conditions themselves, instead of only helping individuals to deal better with heavy psychosocial burdens. For example, employers could address problems of understaffing, over-work and anti-social shift patterns. If you’re dedicated to change, you need to change the underlying risk factors rather than focusing on the symptoms.”
Limitations of the research include: the estimates of the effects of individual-level stress management interventions may be biased because of a lack of blinding of the participants in the included studies; many studies were small; and there were too few studies that focused on specific factors that can cause stress in the workplace.
Studies have reported that between 30% to 70% of physicians and nurses and 56% of anaesthesiologists experience burnout symptoms as a result of their work. Previous research has tended to focus on a particular type of intervention in specific groups of healthcare workers. The authors of this Cochrane review write: “To the best of our knowledge there are no up-to-date reviews that examine the effectiveness of various types of individual-level interventions aimed at reducing stress in various healthcare workers to provide a more complete overview.”
Dr Tamminga concluded: “There is already a shortage of healthcare workers due to high turnover rates, and effective prevention of stress and burnout may help to reduce this.”
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Tamminga SJ, Emal LM, Boschman JS, Levasseur A, Thota A, Ruotsalainen JH, Schelvis RMC, Nieuwenhuijsen K, van der Molen HF. IIndividual-level interventions for reducing occupational stress in healthcare workers. Cochrane Database of Systematic Reviews TBD, Issue TBD. Art. No.: CD002892. DOI: 10.1002/14651858.CD002892.pub6