Physical relaxation for occupational stress in healthcare workers: A systematic review and network meta-analysis of randomized controlled trials

The interaction of occupational stress and job burnout on depressive symptoms in railway workers in Fuzhou city

BACKGROUND

To explore the relationship between occupational stress, burnout and depressive symptoms among railroad workers in Fuzhou, and to analyze the interaction of burnout and occupational stress on depressive symptoms.

METHODS

In this study, 861 railway employees of Fuzhou railway bureau were randomly selected from January to April, 2022. Occupational stress inventory revised edition (OSI-R), China job burnout inventory (CMBI) and Symptom Checklist-90 (SCL-90) were used to investigate the occupational stress, job burnout and depressive symptoms of railway workers. Interactions associated with depressive symptoms were assessed by linear hierarchical regression analysis and SPSS macros (PROCESS).

RESULTS

Occupational stress, job burnout and depressive symptoms accounted for 50.58%, 93.47%, and 11.19% of the study population, respectively. There were intergroup differences between age, marriage status, and length of service (P < 0.05). Occupational stress and job burnout are the main risk factors for depressive symptoms (OR: 2.01, 95% CI: 1.17-3.45; 1.94, 1.69-2.23, respectively). More importantly, further analysis of the interaction between occupational stress and job burnout showed that those with high levels of job burnout had a high-risk effect on depressive symptoms at high levels of occupational stress.

CONCLUSION

Occupational stress and job burnout are risk factors for depressive symptoms among railroad workers in Fuzhou City. The interaction of job burnout and occupational stress increases the risk of depressive symptoms.

Exploring the concept and management strategies of caring stress among clinical nurses: a scoping review

Objective

The concept of caring stress and its specific management has received less attention than other dimensions of stress in nurses. Therefore, to clarify the concept of caring stress, a scoping review study was designed. This scoping review aimed to investigate the concept of caring stress among clinical nurses and examine the strategies used for its management.

Methods

This review employed a scoping review methodology to comprehensively map the essential concepts and attributes of the phenomenon by drawing on a wide range of sources. International databases including PubMed, Scopus, Web of Science, Google Scholar, and Scientific Information Database (SID) were searched to gather relevant studies published until October 1, 2023. MESH terms included "caring stress", "care", "stress", "nurse", and "stress management" were used. Two reviewers independently collected data from full-text papers, ensuring that each paper underwent assessment by at least two reviewers.

Results

Out of 104,094 articles initially searched, 22 articles were included in this study. High workloads, transmitting the infection, stressful thoughts, stressful emotions, and stressful communications were the significant concepts and factors of caring stress among nurses. Also, rest breaks during patient care shifts, playing music in the ward, and denial of critical situations were examples of positive and negative coping and management ways to reduce caring stress.

Conclusion

Effective stress management strategies can lead to better patient care and safety. Stressed nurses are more likely to make errors or become less vigilant in their duties, impacting patient outcomes. By addressing caring stress, clinical practice can prioritize patient well-being. Further research is required to delve deeper into this critical issue concerning nurses in the future.

Professional burnout among expert physicians, patient-focused care, and trust in top management: Moving forward

INTRODUCTION

Professional burnout in physicians is perceived as an inevitable occupational hazard inhibiting patient-focused care, the preferred approach of care, which enhances satisfaction of physicians with their work and improves clinical outcomes. Burnout jeopardizes the physical, mental, and emotional health of physicians, inhibiting high-quality care. Most individual-driven interventions and job-level interventions to reduce burnout proved inefficient or reduced burnout for only a short term. The potential of organizational processes to reduce burnout was acknowledged but is yet to be empirically tested. Drawing on social exchange theory, this study investigates the role of an organizational phenomenon, organizational trust among physicians in top management, on burnout.

METHODS

Data were collected across specialties in 10 out of 20 Israeli public general hospitals. The sample comprised 798 senior expert physicians. Measures were all previously published. Structural equation modeling was performed.

RESULTS

Response rates ranged from 17% to 77% across the 10 hospitals. Mean burnout was 4.7 (SD = 0.68), mean patient-focused care was 3.9 (SD = 0.79), and mean organizational trust was 3.7 (SD = 0.84). Mean burnout for women was 5.6 and for physicians from internal medicine was 5.5. The structural equation modeling supported the proposed study model, which explained 45% of burnout. Organizational trust reduced burnout by 14%.

DISCUSSION

Efforts to reduce burnout should integrate effective individual-level and job-level interventions with building trust among physicians in top management through implementing the paramount professional value of patient-focused care.

CONCLUSIONS

Perceiving management, among physicians, as facilitating the value of patient-focused care led to organizational trust in top management, which was negatively associated with burnout.

Changes in harm reduction service providers professional quality of life during dual public health emergencies in Canada

BACKGROUND

Harm reduction (HR) is a critical response to the pronounced toxicity deaths being experienced in Canada. HR providers report many benefits of their jobs, but also encounter chronic stress from structural inequities and exposure to trauma and death. This research study sought to quantify the emotional toll the toxicity emergency placed on HR providers (Cycle One; 2019). Study objectives were later expanded to determine the impact of the ongoing toxicity as well as the pandemic's impact on well-being (Cycle Two; 2021).

METHODS

Standardized measures of job satisfaction, burnout, secondary traumatic stress, and vulnerability to grief were used in an online national survey. Open-ended questions addressed resources and supports. HR partners across Canada validated the findings and contributed to alternative interpretations and implications.

RESULTS

651 respondents in Cycle One and 1,360 in Cycle Two reported moderately high levels of job satisfaction; they reported finding great meaning in their work. Yet, mean levels of burnout and secondary traumatic stress were moderate, with the latter significantly increasing in Cycle Two. Reported vulnerability to grief was moderate but increased significantly during COVID. When available, supports lacked the quality necessary to respond to the complexities of HR workers' experiences, or an insufficient number of sessions were covered through benefits. Respondents shared that their professional quality of life was affected more by policy failures and gaps in the healthcare system than it was by the demands of their jobs.

CONCLUSION

Both the benefits and the strain of providing harm reduction services cannot be underestimated. For HR providers, these impacts are compounded by the drug toxicity emergency, making the service gaps experienced by them all the more critical to address. Implications highlight the need for integration of HR into the healthcare system, sustainable and reliable funding, sufficient counselling supports, and equitable staffing models. Support for this essential workforce is critical to ensuring the well-being of themselves, the individuals they serve, and the health of the broader healthcare system.

Prevalence and factors for anxiety and depression among secondary school teachers from Sfax city of Tunisia in times of the coronavirus disease 2019 pandemic: a cross-sectional study

Introduction

teachers have to adapt during the coronavirus disease 2019 (COVID-19) pandemic to many changes that could potentially make them more vulnerable to psychological distress. We aimed to assess anxiety and depression in Tunisian secondary school teachers during the COVID-19 pandemic and to explore their associated factors.

Methods

we conducted a cross-sectional survey concerning Tunisian secondary school teachers between May 1st, 2021, and June 30th, 2021, using an online survey platform via Google Forms. Participants were asked to fill in a form including two psychometric tests: the General Anxiety Disorder 7 (GAD-7) and the Patient Health Questionnaire 9 (PHQ-9). We performed both univariable and multivariable logistic regression analyses.

Results

a total of 170 secondary school teachers were included, of whom 22.4% (n=38) were males and 77.6% (n=132) were females. The median age was 45.5 years (Q1=39, Q3=49). The overall anxiety prevalence was 34.7% (n=59) while it was 41.7% (n=71) for depression. In multivariable analysis, anxiety was strongly associated with sleep disturbances (aOR: 5.1; 95% CI: 1.80-14.45; p=0.002) and depression (aOR: 33.91; 95% CI: 12.32-93.33; p<0.001) while depression was strongly associated with dissatisfaction with working conditions (aOR: 3.99; 95% CI: 1.49-10.65; p=0.006), the irregular wearing of protective masks (aOR: 3.94; 95% CI: 1.33-11.66; p=0.013) and anxiety (aOR=51.63; 95% CI: 17.74-150.25; p<0.001).

Conclusion

secondary school teachers in Tunisia are characterized by a high rate of anxiety and depressive disorders which are related to personal and professional factors on which we can act by supplying of educational institutions by protective masks, the implementation of programs for adjusting working conditions and the practice of non-pharmacological interventions for insomnia management.

Evaluation and Comparison of Relaxation-Related Workplace Interventions Among Office Workers at an Insurance Institution: An Intervention Study

Relaxation-related workplace interventions can be counterstrategies for stress due to office work and should be evaluated for success after implementation. This study reports on the evaluation and comparison of 3 relaxation techniques introduced as an intervention for health promotion. A Germany-wide multicenter evaluation of a 3-month relaxation intervention (30 min, once a week) including autogenic training, progressive muscle relaxation (PMR) or Tai Chi was conducted at 14 locations as an intervention study. Anonymous questionnaires (n = 244) were used to collect self-reports of perceived stress after the courses. Status before the courses (pre) and after completion (post) were reported at the end of the intervention. All 3 relaxation techniques were able to improve the subjective perception of stress (SPS) score. Autogenic training was reported to improve all singular items with large effects, whereas only 2 items showed change for Tai Chi and none for PMR. Singular items were also influenced by the location of the courses. All 3 methods were able to improve stress-related outcomes in terms of stress perception and individual aspects of stress management. For this specific intervention autogenic training yielded the largest and wide-ranging effects. Tai Chi was also effective, but additional effect due to an associated increase in physical activity were not found. For a workplace intervention PMR could not be recommended based on this study. The literature on workplace interventions is surprisingly scarce, and future studies should focus on the selection of appropriate participants while avoiding potential bias.

Effect of stachys lavandulifolia on occupational stress in emergency medical technicians

OBJECTIVE

According to studies, occupational stress is quite prevalent among Emergency Medical Technicians (EMTs). On the other hand, it has been shown that Stachys lavandulifolia, also known as the Mountain Tea in Iran, has anxiolytic properties. Considering the current increasing trend of using remedies based on alternative medicine for stress management, the present clinical trial intended to investigate the effect of Stachys lavandulifolia on occupational stress in EMTs METHODS: The present study included 60 EMTs working in Arak, Markazi province, Iran, who were randomly divided into study and control groups. The study group was treated with tea made of Stachys lavandulifolia (2 g daily) for 2 months, while the control group was treated with black tea. Moreover, the level of occupational stress in the study participants was assessed using the Hospital Stress Scale (HSS-35) before and after the intervention. Data analysis was performed using the SPSS software version 22.

RESULTS

According to our results, the mean occupational stress score was significantly decreased in the study group after the intervention (p < 0.05). Moreover, the post-intervention scores were significantly lower in the study group compared to the control group (p < 0.05). However, there was no significant change in occupational stress in the control group after the intervention (p > 0.05).

CONCLUSION

In combination with other stress-relieving options, the tea made of Stachys lavandulifolia can be used as a complementary therapy for alleviating occupational stress in EMTs.

An ophthalmologist with myocardial bridging developed takotsubo cardiomyopathy while operating; A case report and literature review

Key Clinical Message

Healthcare workers are prone to very high level of physical as well as emotional stress that lead to devastating health-related consequences which include but not limited to cardiovascular events that may lead to death. Recognizing the risk of Takotsubo Cardiomyopathy among healthcare worker is the main aim of this report.

Abstract

Takotsubo Cardiomyopathy (TC) is a reversible left ventricular wall motion abnormality that could not be explained by coronary artery disease and is typically precipitated by either emotional or physical stress. There is no sufficient data regarding the incidence of TC among healthcare workers and people with myocardial bridging. Here we are describing a case of an ophthalmologist with myocardial bridging who developed TC while in the operation theater.

A Multimodal Prevention Program for Stress Reduction

BACKGROUND

Stress-reducing preventive measures and the elements of which they are made up have been inadequately studied to date. In this trial, we studied the stress experienced over the twelve months from the beginning of the intervention by subjects who underwent a two-week-long multimodal prevention program for stress reduction with a psycho-educative component, with a refresher at six months, compared to that experienced by subjects in two control groups (CG-B: prevention program without psychoeducation, CG-C: no intervention).

METHODS

Adults with an elevated stress exposure who were at risk of stressinduced health impairment were the subjects of a prospective, three-armed, randomized controlled trial. The subjects who participated in the two preventive programs (IG [intervention group], CG-B) traveled to a health resort. They were blinded with respect to their group assignment and the content of their intervention. The primary outcomes were subjectively experienced stress (Perceived Stress Questionnaire, PSQ) and chronic stress experience (Screening scale of the Trier Inventory for Chronic Stress, TICS-SSCS), assessed one, three, six, and twelve months after the start of the intervention. The groups were compared with univariate and multivariate analyses. Trial registry number: DRKS00011290.

RESULTS

Among 120 candidates who expressed interest in participation and were randomly allotted to one of the three groups, 87 persons (67.8% female) with a mean age of 50.5 years (SD 8.8 years) were included in the study. Subjects in the IG with psychoeducation had a lower degree of perceived stress at twelve months than those in either one of the control groups, with controlling for baseline values, as measured by both of the instruments used: PSQ (ANCOVA: F[2, 77] = 11.77; p < 0.001, strong effect: ηp² = 0.234) and TICS-SSCS (ANCOVA: F[2, 78] = 3.93; p = 0.024, moderate effect: ηp² = 0.091).

CONCLUSION

This exploratory trial reveals a lessening of subjectively experienced stress after participation in a two-part prevention program for stress reduction with a specific psychoeducative component.

Identifying the communication of burnout syndrome on the Twitter platform from the individual, organizational, and environmental perspective

Addressing the escalating prevalence of burnout syndrome, which affects individuals across various professions and domains, is becoming increasingly imperative due to its profound impact on personal and professional aspects of employees' lives. This paper explores the intersection of burnout syndrome and human resource management, recognizing employees as the primary assets of organizations. It emphasizes the growing importance of nurturing employee well-being, care, and work-life balance from a human resource management standpoint. Employing social media analysis, this study delves into Twitter-based discourse on burnout syndrome, categorizing communication into three distinct dimensions: individual, organizational, and environmental. This innovative approach provides fresh insights into interpreting burnout syndrome discourse through big data analysis within social network analysis. The methodology deployed in this study was predicated upon the enhanced Social Media Analysis based on Hashtag Research framework and frequency, topic and visual analysis were conducted. The investigation encompasses Twitter communication from January 1st, 2019, to July 31st, 2022, comprising a dataset of 190,770 tweets. Notably, the study identifies the most frequently used hashtags related to burnout syndrome, with #stress and #mentalhealth leading the discussion, followed closely by #selfcare, #wellbeing, and #healthcare. Moreover, a comprehensive analysis unveils seven predominant topics within the discourse on burnout syndrome: organization, healthcare, communication, stress and therapy, time, symptoms, and leadership. This study underscores the evolving landscape of burnout syndrome communication and its multifaceted implications for individuals, organizations, and the broader environment, shedding light on the pressing need for proactive interventions. In organizations at all levels of management, the concept of burnout should be included in the value philosophy of organizations and should focus on organizational aspects, working hours and work-life balance for a healthier working environment and well-being of employees at all levels of management.

Psychosocial status and risk perception among Iranian healthcare workers during the fifth wave of the COVID-19 pandemic

BACKGROUND

Healthcare workers (HCWs) are essential resources, and their health and wellbeing are key not only for offering constant and useful care facilities to clients, but also for maintaining the safety of the workforce and patients. The risk of severe mental health problems among HCWs may have increased during large outbreaks of COVID-19. To evaluate the psychosocial status and risk perception of HCWs who participated in treating COVID-19 patients in Northern Iran, we performed a web-based cross-sectional study.

METHODS

The web-based cross-sectional design was applied between June 27 and September 2, 2021. Using convenience sampling, 637 HCWs were recruited from hospitals in Northern Iran (Mazandaran). The HCWs completed self-report questionnaires that included a sociodemographic information form, the 12-item General Health Questionnaire, Impact of the Event Scale-Revised, Risk Perception Questionnaire, and Anxiety Stress Scale-21. The data were analyzed via descriptive and inferential statistics and univariate/multivariate logistic regression to assess the risk factors linked to each psychosocial consequence.

RESULTS

The results reveal that the COVID-19 pandemic had an adverse psychosocial influence on HCWs, which was already apparent 1.5 years after the crisis began. Based on the results, 71.6%, 55.6%, and 32.3% of HCWs reported having anxiety, depression, and stress symptoms, respectively, since the outbreak of this disease. The logistic regression models displayed that marital status, having children, and working hours with patients were all risk factors of psychosocial impairment.

CONCLUSIONS

The outbreak of COVID-19 can be considered an important experience of a bio-disaster resulting in a significant rate of psychiatric problems in HCWs. There is a need for designing and promoting supportive programs to help HCWs cope and to improve their psychosocial state, and the present study has detected for whom psychosocial support may be effective and practical 1.5 years after the primary outbreak. Moreover, detecting and managing concerns and reducing infection-related embarrassment/stigma are essential for improving HCWs' mental health.

Effect of Nature-Themed Recharge Room on Healthcare Workers' Level of Stress and Anxiety

OBJECTIVE

To determine if there is a difference in stress and anxiety before and after the use of the nature-themed recharge room.

BACKGROUND

Psychological support measures have been noted to be relevant to nurses; however, the effect of the pandemic on the healthcare workers' emotional and psychological well-being led to urgent calls to implement psychological support measures more widely.

METHODS

The study utilized a 1-group pretest and posttest design. One hundred sixty hospital employees utilized the recharge room, with 131 completed questionnaires counted in the data analysis. Data were collected using the demographic form, Perceived Stress Scale, and State-Trait Anxiety Inventory.

RESULTS

Most participants were between 25 and 35 years old, female, worked the morning shift, had 3 to 5 years of experience, preferred a water feature theme, and used the room for 10 minutes. The mean stress preintervention score was 7.44, and postintervention score was 7.17, with the difference not statistically significant. The mean anxiety preintervention score was 14.17, and postintervention score was 8.48, with the difference statistically significant at a P < 0.05. Females working in the hospital for 1 to 5 years were physicians/residents, nursing support staff, and leaders with the highest mean stress (4-item Perceived Stress Scale) and anxiety (6-item State-Trait Anxiety Inventory) preintervention scores. Comparing the preintervention and postintervention anxiety levels, the highest reduction was noted among females working in the hospital for 1 to 3 years and nursing support staff who have used the room for 5 to 15 minutes with 2 or fewer people.

CONCLUSION

Organizational leaders should offer psychological support programs, such as the nature-themed recharge room, to help reduce the healthcare workers' stress and anxiety.

Understanding and Fostering Mental Health and Well-Being among University Faculty: A Narrative Review

In recent years, there has been increasing recognition of mental health concerns in academia, with stress, burnout, anxiety, and depression being reported among faculty members. The demanding work environment, the need to balance personal and professional duties, and the constant pressure of productivity while navigating multiple tasks of teaching, research, mentorship, professional development, and service all impact the mental health and overall well-being of faculty. Higher education institutions have structurally changed as has the research landscape. These changes as well as faculty-specific and student-specific factors coupled to the effect of the COVID-19 pandemic have led to profound effects on the mental health of academics. This paper is a narrative review of the pertinent literature describing faculty mental health and well-being. It summarizes the available evidence on factors influencing faculty mental health and shows the prevalence of anxiety, depression, stress, and burnout among faculty from various academic fields and along the whole academic ladder. Using a suggested framework that collates the efforts of leaders and faculty, the paper concludes by exploring strategies that promote work-life balance among academics and suggesting effective interventions to improve their mental health outcomes.

Socialization, Relaxation, and Leisure across the Day by Social Determinants of Health: Results from the American Time Use Survey, 2014-2016

This study used the American Time Use Survey (ATUS) to examine socialization, relaxation, and leisure activities throughout the day as related to social determinants of health (SDOH). The study population was adults aged 25 years and older who participated in the ATUS in 2014-2016, the most recent years for collecting SDOH. Descriptive analyses provide characteristics of the study population. Graphical analyses display socialization by SDOH across the hours of the day based on adjusted regression models. Quasi-binomial models analyzed the association between the numbers of minutes of various activities and SDOH. Associations between SDOH and sleeplessness (yes or no) were explored using logistic regression. For much of the day, being female, having less education, living in poverty, and having food insecurity were associated with more time socializing and relaxing. The major activities under socializing and relaxation are watching television and movies. Having a college degree was strongly associated with increased minutes of sports activity, whereas living in poverty and food insecurity were associated with fewer minutes. Less education, living in poverty, and having food insecurity were associated with sleeplessness. A possible mechanism of the effects of SODH on health is by its altering of the patterns of daily life.

Occupational stress of physicians and nurses in emergency departments after contracting COVID-19 and its influencing factors: a cross-sectional study

Background

Occupational stress is one of the major occupational health hazards globally. This study investigated the current situation of and factors influencing the occupational stress of physicians and nurses in emergency departments (EDs) after contracting coronavirus disease (COVID-19).

Methods

An online questionnaire survey was conducted among physicians and nurses in EDs in China between January 5 and 8, 2023. A general descriptive analysis of variables was conducted, the differences in the occupational stress of physicians and nurses in EDs with different characteristics were analyzed using the chi-square test, and factors influencing occupational stress were investigated using generalized ordinal logistic regression.

Results

Of the 1924 physicians and nurses in EDs who contracted COVID-19, 64.71% considered their occupational stress high or very high, with overly intense work as the primary stressor. Those with ≥ 10 years of work tenure, working in tertiary hospitals and with higher professional titles were more stressed, while females, nurses, those with a master's degree or higher, and those who continued to work after contracting COVID-19 were less stressed. There were differences in the predictors of occupational stress between physicians and nurses.

Conclusion

China's physicians and nurses in EDs had high occupational stress after contracting COVID-19. Attention should be given to the occupational mental health of physicians and nurses in EDs, and training on the prevention and treatment of COVID-19 infection should be strengthened.

Individual-level interventions for reducing occupational stress in healthcare workers

BACKGROUND

Healthcare workers can suffer from work-related stress as a result of an imbalance of demands, skills and social support at work. This may lead to stress, burnout and psychosomatic problems, and deterioration of service provision. This is an update of a Cochrane Review that was last updated in 2015, which has been split into this review and a review on organisational-level interventions.  OBJECTIVES: To evaluate the effectiveness of stress-reduction interventions targeting individual healthcare workers compared to no intervention, wait list, placebo, no stress-reduction intervention or another type of stress-reduction intervention in reducing stress symptoms.  SEARCH METHODS: We used the previous version of the review as one source of studies (search date: November 2013). We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase, PsycINFO, CINAHL, Web of Science and a trials register from 2013 up to February 2022.

SELECTION CRITERIA

We included randomised controlled trials (RCT) evaluating the effectiveness of stress interventions directed at healthcare workers. We included only interventions targeted at individual healthcare workers aimed at reducing stress symptoms.  DATA COLLECTION AND ANALYSIS: Review authors independently selected trials for inclusion, assessed risk of bias and extracted data. We used standard methodological procedures expected by Cochrane. We categorised interventions into ones that: 1. focus one's attention on the (modification of the) experience of stress (thoughts, feelings, behaviour);  2. focus one's attention away from the experience of stress by various means of psychological disengagement (e.g. relaxing, exercise);  3. alter work-related risk factors on an individual level; and ones that 4. combine two or more of the above.  The crucial outcome measure was stress symptoms measured with various self-reported questionnaires such as the Maslach Burnout Inventory (MBI), measured at short term (up to and including three months after the intervention ended), medium term (> 3 to 12 months after the intervention ended), and long term follow-up (> 12 months after the intervention ended).  MAIN RESULTS: This is the second update of the original Cochrane Review published in 2006, Issue 4. This review update includes 89 new studies, bringing the total number of studies in the current review to 117 with a total of 11,119 participants randomised.  The number of participants per study arm was ≥ 50 in 32 studies. The most important risk of bias was the lack of blinding of participants.  Focus on the experience of stress versus no intervention/wait list/placebo/no stress-reduction intervention Fifty-two studies studied an intervention in which one's focus is on the experience of stress. Overall, such interventions may result in a reduction in stress symptoms in the short term (standardised mean difference (SMD) -0.37, 95% confidence interval (CI) -0.52 to -0.23; 41 RCTs; 3645 participants; low-certainty evidence) and medium term (SMD -0.43, 95% CI -0.71 to -0.14; 19 RCTs; 1851 participants; low-certainty evidence). The SMD of the short-term result translates back to 4.6 points fewer on the MBI-emotional exhaustion scale (MBI-EE, a scale from 0 to 54). The evidence is very uncertain (one RCT; 68 participants, very low-certainty evidence) about the long-term effect on stress symptoms of focusing one's attention on the experience of stress. Focus away from the experience of stress versus no intervention/wait list/placebo/no stress-reduction intervention  Forty-two studies studied an intervention in which one's focus is away from the experience of stress. Overall, such interventions may result in a reduction in stress symptoms in the short term (SMD -0.55, 95 CI -0.70 to -0.40; 35 RCTs; 2366 participants; low-certainty evidence) and medium term (SMD -0.41 95% CI -0.79 to -0.03; 6 RCTs; 427 participants; low-certainty evidence). The SMD on the short term translates back to 6.8 fewer points on the MBI-EE. No studies reported the long-term effect. Focus on work-related, individual-level factors versus no intervention/no stress-reduction intervention Seven studies studied an intervention in which the focus is on altering work-related factors. The evidence is very uncertain about the short-term effects (no pooled effect estimate; three RCTs; 87 participants; very low-certainty evidence) and medium-term effects and long-term effects (no pooled effect estimate; two RCTs; 152 participants, and one RCT; 161 participants, very low-certainty evidence) of this type of stress management intervention.  A combination of individual-level interventions versus no intervention/wait list/no stress-reduction intervention Seventeen studies studied a combination of interventions. In the short-term, this type of intervention may result in a reduction in stress symptoms (SMD -0.67 95%, CI -0.95 to -0.39; 15 RCTs; 1003 participants; low-certainty evidence). The SMD translates back to 8.2 fewer points on the MBI-EE. On the medium term, a combination of individual-level interventions may result in a reduction in stress symptoms, but the evidence does not exclude no effect (SMD -0.48, 95% CI -0.95 to 0.00; 6 RCTs; 574 participants; low-certainty evidence). The evidence is very uncertain about the long term effects of a combination of interventions on stress symptoms (one RCT, 88 participants; very low-certainty evidence). Focus on stress versus other intervention type  Three studies compared focusing on stress versus focusing away from stress and one study a combination of interventions versus focusing on stress. The evidence is very uncertain about which type of intervention is better or if their effect is similar.

AUTHORS' CONCLUSIONS

Our review shows that there may be an effect on stress reduction in healthcare workers from individual-level stress interventions, whether they focus one's attention on or away from the experience of stress. This effect may last up to a year after the end of the intervention. A combination of interventions may be beneficial as well, at least in the short term. Long-term effects of individual-level stress management interventions remain unknown. The same applies for interventions on (individual-level) work-related risk factors. The bias assessment of the studies in this review showed the need for methodologically better-designed and executed studies, as nearly all studies suffered from poor reporting of the randomisation procedures, lack of blinding of participants and lack of trial registration. Better-designed trials with larger sample sizes are required to increase the certainty of the evidence. Last, there is a need for more studies on interventions which focus on work-related risk factors.

Yoga for Preventive Health: A Holistic Approach

Yoga has been prevalent for over 5000 years; it originated in India and has become an essential lifestyle ingredient for achieving optimal health. The goal of this article in lifestyle modification is to increase awareness about the benefits of yoga and how its practice can reduce the overall risk of chronic diseases. Yoga has been proven to be therapeutic for enhancing immunity and support management of chronic diseases such as cardiovascular, respiratory, endocrine disorders, obesity, cancer, and metabolic syndrome. Yoga techniques called asanas, such as pranayama for breathing regulation and dhyana for meditation, boost innate immune response, interrupt inflammation, and thereby prevent the manifestation of chronic diseases. Yoga also provides symptomatic relief for chronic arthritis by increasing joint flexibility and microcirculation. Yoga and meditation regulate neurotransmitters, neuropeptides, hormones, and cytokines that mediate interactions between the central nervous system and the immune system. These techniques reduce the psychological and physiological effects of chronic stress. Serotonin, oxytocin, and melatonin released directly due to practicing yoga have been shown to better manage anxiety and fear, especially during the pandemic. We believe the current trends of chronic disease management will become more effective with the implementation of lifestyle changes using yoga.

A comparative study of well-being, resilience, mindfulness, negative emotions, stress, and burnout among nurses after an online mind–body based intervention during the first COVID-19 pandemic crisis

Background

To mitigate against the possible adverse effects of stress among nurses due to the COVID-19 outbreak, we designed a 12-week mind–body based online intervention program to promote well-being and prevent stress-related disorders such as burnout. Our study aimed to compare the impact of the intervention on perception of stress, negative emotions, burnout, mindfulness, resilience, and well-being at pretest and 6 months post-intervention and to compare the effect among nurses working at two different hospitals.

Methods

We conducted an uncontrolled trial using a convenience sample of nurses working at two hospitals in Mexico: one designated to treat confirmed COVID-19 patients (COVID-hospital) and the other whose patients had a negative COVID-19 test on admission (Non COVID-hospital). The 12 week online intervention consisted of 36 mind–body based micropractices, with subjective well-being as the primary outcome. Secondary outcomes were health perception, resilience, mindfulness, negative emotions, stress, and burnout.

Results

A pretest survey was completed by 643 nurses. Of the remaining valid responses, 82% were women, with a mean age of 34.8 (SD = 8.95) years old. For the analysis two groups of nurses were sampled by cluster: a COVID-hospital group of 429 (67%) nurses, and a non-COVID Hospital group of 214 (33%) nurses. The proportion lost to follow-up was 71% at postest (n = 188) and 42% at 6 months follow-up (n = 371). At pretest, non-COVID hospital nurses had lower subjective well-being and higher burnout than their COVID hospital counterparts. At postest, non-COVID hospital nurses displayed more negative emotions than their COVID hospital peers. At 6 months post-intervention, nurses experienced improved mindfulness, reduced negative emotions and stress, but a decrease in subjective well-being and resilience. Nurses working at the non-COVID hospital had significantly higher mean scores for burnout than those working at the COVID hospital.

Conclusion

The results of our study suggest that our online mind–body interventions can help to reduce stress and negative emotions, yet the effects on subjective well-being and resilience are uncertain. Further research is needed to gain a better understanding of their potential mechanisms and the associated efforts of such online interventions.

Clinical Trial Registration

ClinicalTrials.gov, NCT05515172.

A Multicenter Survey of Pediatric-Neonatal Transport Teams in the United States to Assess the Impact of the Coronavirus Disease 2019 Pandemic on Staffing

Objective

The coronavirus disease 2019 pandemic has resulted in unprecedented burnout in frontline health care providers. However, the impact of the pandemic on interfacility pediatric and neonatal transport team members has not been studied. The current study uses a survey design to document the impact of the pandemic on pediatric and neonatal transport team members with a focus on staffing and resilience promotion strategies.

Methods

Data for this study came from a short cross-sectional survey distributed to members of the American Academy of Pediatrics Section on Transport Medicine.

Results

Sixty-six teams responded (around 45%). Forty-one respondents (62%) reported vacancies on their transport teams, with 35 (53.8%) reporting more vacancies during the pandemic. Forty percent of highly trained registered nurses and respiratory therapists from specialty teams left their positions for those with better compensation during the pandemic. Forty-two percent of respondents were not trained to recognize burnout, stress, or compassion fatigue.

Conclusion

Our study shows that half of the respondents had more vacancies during the pandemic than in previous years and reported difficulty in filling those positions. We were unable to link the vacancies to the pandemic and burnout because hospitalizations and transports in the pediatric facilities decreased during the pandemic; however, we do report that coronavirus disease 2019 exposure before the vaccine was a source of stress for team members. There are opportunities to improve the identification of burnout and to foster resilience and boost retention of this highly skilled niche workforce.

Yoga for COVID-19: An ancient practice for a new condition - A literature review

A substantial proportion of people with acute COVID-19 develop post-COVID-19 condition (previously known as long-COVID) characterized by symptoms that persist for months after the initial infection, including neuropsychological sequelae. Post-COVID-19 condition frequency varies greatly according to different studies, with values ranging from 4 to 80% of the COVID-19 patients. Yoga is a psycho-somatic approach that increases physical, mental, emotional and spiritual strength, and connection. Yoga practice enhances innate immunity and mental health, so it can be used as complementary therapy in the COVID-19 treatment, namely the post-COVID-19 condition. In this article, we conducted a literature review on yoga and COVID-19, finding that an intervention comprising asana, pranayama, and meditation may be a strategy of choice for these patients' recovery. However, further studies are needed to show its effectiveness in this, still unknown, context.

Recovery and stress of control center dispatchers in the first waves of the SARS-CoV-2 pandemic

Control center dispatchers (CCDs) are exposed to high levels of work-related mental stress, which are exacerbated by the current severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic. The aim of this study was to comparatively analyze the recovery and stress state of CCDs during the first and second waves of the SARS-CoV‑2 pandemic. A total of 490 CCDs (n = 440, t1 and n = 50, t2) with a mean age of 42.26 ± 8.79 years participated directly at the end of the first wave from June to August 2020 (t1) and during the second wave between January and February 2021 (t2) of the SARS-CoV‑2 pandemic. The short form (EBF-24/A; test form S2) of the Kallus recovery-stress questionnaire (EBF) was applied. Over the course of the two survey phases, the dimensions strain significantly increased (t1: 2.47 ± 1.08 vs. t2: 3.12 ± 0.93 points, p < 0.001) and recovery significantly decreased (t1: 3.03 ± 0.94 vs. t2: 2.50 ± 0.81 points, p < 0.001). Significant to highly significant differences were present in the EBF dimensions of the two waves in the majority of cases, even when taking the waves into account. For the variable "recovery in the social field", a medium effect was noticeable in the corrected model (η² = 0.064). The SARS-CoV‑2 pandemic illustrates that the stress experience increased from the first to the second waves, and the recovery of CCDs decreased. These data provide a directional trend as the pandemic is ongoing, and stress and strain situations in control centers may continue to worsen. Immediate health promotion and prevention measures are essential.

Effects of mindfulness decompression therapy on mental health and job burnout among nurses working in the frontline of the novel coronavirus pandemic: A retrospective study

OBJECTIVES

As the coronavirus disease 2019 (COVID-19) pandemic continues to spread worldwide, nucleic acid detection is a key step in controlling it. Psychological issues and job burnout of nurses working in nucleic acid sampling roles for long periods have become apparent. This study aimed to explore the effects of mindfulness decompression therapy on mental health and job burnout in front-line nurses working in nucleic acid sampling during the pandemic.

METHODS

Nucleic acid sampling frontline nurses who were positive for burnout on both the Symptom Checklist-90 (SCL-90) and the Maslach Burnout Inventory-General Scale (MBI-GS) were selected as the participants. Frontline nurses in the nucleic acid testing area who received routine psychological nursing intervention from June 2020 to April 2021 were used as the control group. Nurses who received both routine psychological nursing and mindfulness decompression therapy from May 2021 to December 2021 formed the "mindfulness" subject group. We compared the two groups' primary outcome measures of SCL-90 and MBI-GS scores.

RESULTS

Before the intervention, there were no significant differences between the two groups in general data, SCL-90 scores, and MBI-GS scores. After the mindfulness decompression therapy, according to SCL-90 and MBI-GS scales, psychological distress and job burnout of nurses in the mindfulness group were significantly better than those in the control group.

CONCLUSION

Mindfulness decompression therapy can effectively improve mental health and relieve job burnout in frontline nurses in nucleic acid sampling areas, which is worthy of clinical application. Randomized controlled trials are still needed, however, to fully confirm the effects of mindfulness decompression therapy.

Quality of Life and Stress Management in Healthcare Professionals of a Dental Care Setting at a Teaching Hospital in Rome: Results of a Randomized Controlled Clinical Trial

In the healthcare environment, more and more people experience work-related stress. The Faculty of Medicine and Dentistry of Sapienza University of Rome, having observed the need to take care of healthcare professionals, has set itself the objective of providing useful tools such as additional and necessary personal protective equipment for healthcare professionals.

OBJECTIVE

To promote health through better management, skills, and the use of strategies and solutions to identify, decompress, and neutralize those responsible for work-related stress mechanisms in order to take care of those who care (CURARE CURANTES).

MATERIALS AND METHODS

A randomized controlled clinical trial was conducted. The participants were enrolled by three departments of the Department of Dental and Maxillofacial Sciences of Rome; in consideration of emotional involvement of health professionals who work there. A motivational program was offered.

RESULTS

There were 17 and 16 healthcare professionals in the intervention and control groups, respectively. Levels of the mental composite score (MCS) varied both in the pre-post phase of the intervention group (p = 0.002), and between the intervention group and control group in the post phase (p = 0.006). No significant differences were observed for the physical composite score (PCS). Similarly, there were no significant differences regarding the positivity scale (PS) and the two dimensions of work-related stress (job demand and decision latitude).

CONCLUSION

This study demonstrates the efficacy of yoga training practiced directly in the workplace and wearing work clothes, entering the work context, not weighing further on the healthcare workload, and being a way to carry out physical activity even in those cases in which professionals do not have the time to do it in their free time.

Effectiveness of Digital Interventions for Deficit-Oriented and Asset-Oriented Psychological Outcomes in the Workplace: A Systematic Review and Narrative Synthesis

BACKGROUND

Digital psychological interventions can target deficit-oriented and asset-oriented psychological outcomes in the workplace. This review examined: (a) the effectiveness of digital interventions for psychological well-being at work, (b) associations with workplace outcomes, and (c) associations between interventions' effectiveness and their theory-base.

METHODS

six electronic databases were searched for randomised controlled trials (RCT) and quasi-experimental studies. The methodological quality of studies that used randomisation was conducted with the "Cochrane Collaboration's Risk of Bias" tool, while the "JBI Critical Appraisal Checklist" was used for non-randomised studies. Studies' theory-base was evaluated using an adaptation of the "theory coding scheme" (TSC). Due to heterogeneity, narrative synthesis was performed.

RESULTS

51 studies were included in a synthesis describing four clusters of digital interventions: (a) cognitive behavioural therapy, (b) stress-management interventions and workplace well-being promotion, (c) meditation training and mindfulness-based interventions, and (d) self-help interventions. Studies demonstrated a high risk of contamination effects and high attrition bias. Theory-informed interventions demonstrated greater effectiveness. Cognitive behavioural therapy demonstrated the most robust evidence for reducing depression symptoms among healthy employees. With the exception of the Headspace application, there was weak evidence for meditation training apps, while relaxation training was a key component of effective stress-management interventions.

Analysis of occupational stress and its correlation with oxidative-antioxidant levels among employees of a power grid enterprise in Guangdong

BACKGROUND

Occupational stress and its health effects on occupational populations have attracted extensive attention from researchers in public health. The stressors faced by employees of power grid enterprises are increasing progressively, which is easy to cause occupational stress. The balance of the body's oxidative-antioxidant levels plays an essential role in maintaining the body's health status. This study aims to explore occupational stress and its correlation with oxidative-antioxidant levels in employees of a power grid enterprise.

METHODS

A cluster random sampling method was used to investigate the basic information of 528 employees in a power grid enterprise and investigate the two occupational stress models of employees by using the Job Content Questionnaire based on the job demand-control-support (JDC) model, and the Effort-Reward Imbalance Questionnaire based on the effort-reward imbalance (ERI) model, respectively. Peripheral blood samples were collected from the employees to measure the levels of malondialdehyde (MDA), total antioxidant capacity (TAC), and superoxide dismutase (SOD). The correlation between different models of occupational stress level and the body's oxidation-antioxidation level was further explored.

RESULTS

The detection rate of high JDC model occupational stress was 50.6% and the detection rate of high ERI model occupational stress was 50.9%. The JDC model occupational stress was significantly associated with high-temperature and high-altitude operation, visual display terminal operation, monthly income, and exercise (all P < 0.05). The ERI model occupational stress was significantly associated with visual display terminal operation (all P < 0.05). The results of the generalized additive model showed that SOD levels had a non-linear relationship with the D/C ratio as well as the E/R ratio. With the D/C ratio close to 1, SOD levels raised rapidly. When the E/R ratio exceeded 1, the SOD level raised rapidly (all P<0.05) . TAC levels were negatively associated with the E/R ratio (P < 0.05).

CONCLUSION

The detection rates of occupational stress in both models among employees in a power grid enterprise are higher. ERI model occupational stress was associated with body TAC and SOD levels, and JDC model occupational stress was associated with body SOD levels.

Psychopathological states among Congolese health workers during the first wave of COVID-19 pandemic: links with emotion regulation and social support

Background: The COVID-19 pandemic is an unprecedented stressor for frontline healthcare workers, notably increasing acute stress disorder and depression rates. Emotion regulation and social support could be major protective factors against such psychopathological states, but their role has not been explored outside Western contexts. Objective: To assess the association between emotion regulation, social support, acute stress disorder, and depression among healthcare workers directly confronted with the first wave of COVID-19 pandemic in the eastern Democratic Republic of the Congo. Method: A cross-sectional study assessed acute stress disorder, depression, adaptive (i.e. acceptance, positive refocusing, …) and maladaptive (i.e. self-blame, rumination, catastrophizing, …) emotion regulation strategies, social support (instrumental, emotional, and informational levels), as well as self-reported situations and feelings related to COVID-19, in a population of 252 frontline healthcare workers (121 women; 131 men; mean age: 39 ± 11 years old) at the Referral General Hospital of Bukavu. We also explored the relations between these variables through bivariate and multivariate logistic regression. Results: Forty percent of participants presented symptoms of depression, and 16% presented acute stress disorder. In bivariate logistic regression, these psychiatric outcomes were associated with the availability of a COVID-19 protection kit [OR = 0.24 (0.12-0.98)], hostility toward health workers [OR = 3.21 (1.23-4.21)], putting into perspective [OR = 0.91 (0.43-0.98)], self-blame [OR = 1.44 (1.11-2.39)], catastrophizing [OR = 1.85 (1.01-4.28)], blaming others [OR = 1.77 (1.04-3.32)], emotional support [OR = 0.83 (0.49-0.98)], instrumental support [OR = 0.74 (0.28-0.94)], and informational support [OR = 0.73 (0.43-0.98)]. In multivariate logistic regression, hostility [OR = 2.21 (1.54-3.78)], self-blame [OR = 1.57 (1.02-2.11)], rumination [OR = 1.49 (1.11-3.13)] and emotional support [OR = 0.94 (0.65-0.98)] remained significantly associated with psychiatric outcomes. Conclusion: Depression and acute stress disorder were highly prevalent among Congolese healthcare workers during the first wave of the COVID-19 health pandemic. Hostility, self-blame, rumination, and social support were associated with depression and/or acute stress disorder and should be targeted by interventions aiming to support health workers' wellbeing.

HIGHLIGHTS

Frontline health workers presented high prevalence of acute stress disorder (16%) and depression (40%) during the first wave of COVID-19 pandemic in the Eastern Democratic Republic of the Congo, as they were working in hostile environment without enough protection kits.Acute stress disorder and depression were negatively associated with adaptive emotion regulation and social support; and positively with maladaptive emotion regulation.Intervention aiming to support health workers in pandemics should target emotion regulation and social support.

Utility of the Stress and Anxiety to Viral Epidemic-3 Items as a Tool for Assessing Work-Related Stress, and Relationship With Insomnia and Burnout of Healthcare Workers During the COVID-19 Pandemic

Background and Objective The aim of this study is to explore the usefulness of the Stress and Anxiety to Viral Epidemic-3 items (SAVE-3) scale as a tool for assessing work-related stress in healthcare workers.Methods There were 389 participants and all remained anonymous. The SAVE-9, the Patient Health Questionnaire-4, the Maslach Burnout Inventory-Human Services Survey for Medical Personnel (MBI-HSS-MP), the perceived stress scale (PSS), and single item insomnia measure were used. After checking whether the SAVE-3 scale is clustered into a sole factor from SAVE-9 scale based on principal component analysis with promax rotation, confirmatory factor analysis (CFA) was done on the 3 items of the SAVE-3 to examine the factorial validity for a unidimensional structure.Results The SAVE-3 was clustered with factor loadings from 0.664–0.752, and a CFA revealed that 3 items of the SAVE-3 cohered together into a unidimensional construct with fit for all of indices (comparative fit index = 1.00; Tucker Lewis index = 1.031; standardized root-mean-square residual = 0.001; root-mean-square-error of approximation = 0.00). The SAVE-3 scale showed acceptable reliability (Cronbach’s α = 0.56 and McDonald’s ω = 0.57) in this sample. A high SAVE-3 score correlated significantly with younger age (r = -0.12, p = 0.02), a high PSS score (r = 0.24, p < 0.001), a high total score for the MBI-HSS-MP (r = 0.35, p < 0.001) and all of its subscales (emotional exhaustion, r = 0.40, p < 0.001; personal accomplishment, r = -0.14, p < 0.005; depersonalization, r = 0.39, p < 0.001), and poor sleep quality (r = 0.15, p < 0.001).Conclusions Taken together, the data suggest that SAVE-3 is a reliable, valid, and usable scale for measuring work-related stress in healthcare workers during the COVID-19 epidemic.

Burnout Among Healthcare Workers in the COVID 19 Era: A Review of the Existing Literature

In the current period of global public health crisis due to the COVID-19, healthcare workers are more exposed to physical and mental exhaustion - burnout - for the torment of difficult decisions, the pain of losing patients and colleagues, and the risk of infection, for themselves and their families. The very high number of cases and deaths, and the probable future "waves" raise awareness of these challenging working conditions and the need to address burnout by identifying possible solutions. Measures have been suggested to prevent or reduce burnout at individual level (physical activity, balanced diet, good sleep hygiene, family support, meaningful relationships, reflective practices and small group discussions), organizational level (blame-free environments for sharing experiences and advices, broad involvement in management decisions, multi-disciplinary psychosocial support teams, safe areas to withdraw quickly from stressful situations, adequate time planning, social support), and cultural level (involvement of healthcare workers in the development, implementation, testing, and evaluation of measures against burnout). Although some progress has been made in removing the barrier to psychological support to cope with work-related stress, a cultural change is still needed for the stigma associated with mental illness. The key recommendation is to address the challenges that the emergency poses and to aggregate health, well-being and behavioral science expertise through long term researches with rigorous planning and reporting to drive the necessary cultural change and the improvement of public health systems.

Reducing Work-related Stress in Nursing Personnel: Applying an Intervention

Objective: To compare the levels of ex-post-facto stress between nursing personnel who participated in an educational intervention with nursing personnel on work duties, within the hospital work environment. Materials and method: This was an observational and cross-sectional study. The final sample was composed of 30 nursing personnel, with 15 of them composing the group exposed to the intervention and 15 being selected by simple random sampling to compose the unexposed group. The intervention consisted of a program focused on the employees, structured in four sessions, applied in a course format twice a week, and lasted two months. The Student’s t-test for independent samples and the Mann-Whitney U-test were used to compare the groups. Results: Using the Mann-Whitney U-test, the stress levels could be compared between the groups, and a statistical difference in stress levels was observed between the control group (3.34 ± 0.71 a.u.) and the intervention group (2.52 ± 0.59 a.u.) (p = 0.002; d = 1.26). Conclusions: Comparing the general stress levels between the groups, it was found that the intervention significantly decreased the stress levels in the participants; it was also possible to identify the mental stressors faced by the participants using the Scale of Stress in Professionals.