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McGuinness SL, Johnson J, Eades O, Cameron PA, Forbes A, Fisher J, Grantham K, Hodgson C, Hunter P, Kasza J, Kelsall HL, Kirkman M, Russell G, Russo PL, Sim MR, Singh KP, Skouteris H, Smith KL, Stuart RL, Teede HJ, Trauer JM, Udy A, Zoungas S, Leder K. Mental Health Outcomes in Australian Healthcare and Aged-Care Workers during the Second Year of the COVID-19 Pandemic. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19094951. [PMID: 35564351 PMCID: PMC9103405 DOI: 10.3390/ijerph19094951] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Revised: 04/14/2022] [Accepted: 04/15/2022] [Indexed: 01/27/2023]
Abstract
Objective: the COVID-19 pandemic has incurred psychological risks for healthcare workers (HCWs). We established a Victorian HCW cohort (the Coronavirus in Victorian Healthcare and Aged-Care Workers (COVIC-HA) cohort study) to examine COVID-19 impacts on HCWs and assess organisational responses over time. Methods: mixed-methods cohort study, with baseline data collected via an online survey (7 May–18 July 2021) across four healthcare settings: ambulance, hospitals, primary care, and residential aged-care. Outcomes included self-reported symptoms of depression, anxiety, post-traumatic stress (PTS), wellbeing, burnout, and resilience, measured using validated tools. Work and home-related COVID-19 impacts and perceptions of workplace responses were also captured. Results: among 984 HCWs, symptoms of clinically significant depression, anxiety, and PTS were reported by 22.5%, 14.0%, and 20.4%, respectively, highest among paramedics and nurses. Emotional exhaustion reflecting moderate–severe burnout was reported by 65.1%. Concerns about contracting COVID-19 at work and transmitting COVID-19 were common, but 91.2% felt well-informed on workplace changes and 78.3% reported that support services were available. Conclusions: Australian HCWs employed during 2021 experienced adverse mental health outcomes, with prevalence differences observed according to occupation. Longitudinal evidence is needed to inform workplace strategies that support the physical and mental wellbeing of HCWs at organisational and state policy levels.
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Affiliation(s)
- Sarah L. McGuinness
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC 3800, Australia; (J.J.); (O.E.); (P.A.C.); (A.F.); (J.F.); (K.G.); (C.H.); (P.H.); (J.K.); (H.L.K.); (M.K.); (G.R.); (M.R.S.); (H.S.); (K.L.S.); (R.L.S.); (H.J.T.); (J.M.T.); (A.U.); (S.Z.); (K.L.)
- Alfred Health, Melbourne, VIC 3004, Australia
- Correspondence:
| | - Josphin Johnson
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC 3800, Australia; (J.J.); (O.E.); (P.A.C.); (A.F.); (J.F.); (K.G.); (C.H.); (P.H.); (J.K.); (H.L.K.); (M.K.); (G.R.); (M.R.S.); (H.S.); (K.L.S.); (R.L.S.); (H.J.T.); (J.M.T.); (A.U.); (S.Z.); (K.L.)
- Alfred Health, Melbourne, VIC 3004, Australia
| | - Owen Eades
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC 3800, Australia; (J.J.); (O.E.); (P.A.C.); (A.F.); (J.F.); (K.G.); (C.H.); (P.H.); (J.K.); (H.L.K.); (M.K.); (G.R.); (M.R.S.); (H.S.); (K.L.S.); (R.L.S.); (H.J.T.); (J.M.T.); (A.U.); (S.Z.); (K.L.)
- Alfred Health, Melbourne, VIC 3004, Australia
| | - Peter A. Cameron
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC 3800, Australia; (J.J.); (O.E.); (P.A.C.); (A.F.); (J.F.); (K.G.); (C.H.); (P.H.); (J.K.); (H.L.K.); (M.K.); (G.R.); (M.R.S.); (H.S.); (K.L.S.); (R.L.S.); (H.J.T.); (J.M.T.); (A.U.); (S.Z.); (K.L.)
- Alfred Health, Melbourne, VIC 3004, Australia
| | - Andrew Forbes
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC 3800, Australia; (J.J.); (O.E.); (P.A.C.); (A.F.); (J.F.); (K.G.); (C.H.); (P.H.); (J.K.); (H.L.K.); (M.K.); (G.R.); (M.R.S.); (H.S.); (K.L.S.); (R.L.S.); (H.J.T.); (J.M.T.); (A.U.); (S.Z.); (K.L.)
| | - Jane Fisher
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC 3800, Australia; (J.J.); (O.E.); (P.A.C.); (A.F.); (J.F.); (K.G.); (C.H.); (P.H.); (J.K.); (H.L.K.); (M.K.); (G.R.); (M.R.S.); (H.S.); (K.L.S.); (R.L.S.); (H.J.T.); (J.M.T.); (A.U.); (S.Z.); (K.L.)
| | - Kelsey Grantham
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC 3800, Australia; (J.J.); (O.E.); (P.A.C.); (A.F.); (J.F.); (K.G.); (C.H.); (P.H.); (J.K.); (H.L.K.); (M.K.); (G.R.); (M.R.S.); (H.S.); (K.L.S.); (R.L.S.); (H.J.T.); (J.M.T.); (A.U.); (S.Z.); (K.L.)
| | - Carol Hodgson
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC 3800, Australia; (J.J.); (O.E.); (P.A.C.); (A.F.); (J.F.); (K.G.); (C.H.); (P.H.); (J.K.); (H.L.K.); (M.K.); (G.R.); (M.R.S.); (H.S.); (K.L.S.); (R.L.S.); (H.J.T.); (J.M.T.); (A.U.); (S.Z.); (K.L.)
- Alfred Health, Melbourne, VIC 3004, Australia
| | - Peter Hunter
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC 3800, Australia; (J.J.); (O.E.); (P.A.C.); (A.F.); (J.F.); (K.G.); (C.H.); (P.H.); (J.K.); (H.L.K.); (M.K.); (G.R.); (M.R.S.); (H.S.); (K.L.S.); (R.L.S.); (H.J.T.); (J.M.T.); (A.U.); (S.Z.); (K.L.)
- Alfred Health, Melbourne, VIC 3004, Australia
| | - Jessica Kasza
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC 3800, Australia; (J.J.); (O.E.); (P.A.C.); (A.F.); (J.F.); (K.G.); (C.H.); (P.H.); (J.K.); (H.L.K.); (M.K.); (G.R.); (M.R.S.); (H.S.); (K.L.S.); (R.L.S.); (H.J.T.); (J.M.T.); (A.U.); (S.Z.); (K.L.)
| | - Helen L. Kelsall
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC 3800, Australia; (J.J.); (O.E.); (P.A.C.); (A.F.); (J.F.); (K.G.); (C.H.); (P.H.); (J.K.); (H.L.K.); (M.K.); (G.R.); (M.R.S.); (H.S.); (K.L.S.); (R.L.S.); (H.J.T.); (J.M.T.); (A.U.); (S.Z.); (K.L.)
| | - Maggie Kirkman
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC 3800, Australia; (J.J.); (O.E.); (P.A.C.); (A.F.); (J.F.); (K.G.); (C.H.); (P.H.); (J.K.); (H.L.K.); (M.K.); (G.R.); (M.R.S.); (H.S.); (K.L.S.); (R.L.S.); (H.J.T.); (J.M.T.); (A.U.); (S.Z.); (K.L.)
| | - Grant Russell
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC 3800, Australia; (J.J.); (O.E.); (P.A.C.); (A.F.); (J.F.); (K.G.); (C.H.); (P.H.); (J.K.); (H.L.K.); (M.K.); (G.R.); (M.R.S.); (H.S.); (K.L.S.); (R.L.S.); (H.J.T.); (J.M.T.); (A.U.); (S.Z.); (K.L.)
| | - Philip L. Russo
- School of Nursing and Midwifery, Monash University, Melbourne, VIC 3800, Australia;
- Cabrini Health, Melbourne, VIC 3144, Australia
| | - Malcolm R. Sim
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC 3800, Australia; (J.J.); (O.E.); (P.A.C.); (A.F.); (J.F.); (K.G.); (C.H.); (P.H.); (J.K.); (H.L.K.); (M.K.); (G.R.); (M.R.S.); (H.S.); (K.L.S.); (R.L.S.); (H.J.T.); (J.M.T.); (A.U.); (S.Z.); (K.L.)
| | - Kasha P. Singh
- Peninsula Health, Melbourne, VIC 3199, Australia;
- The Peter Doherty Institute for Infection and Immunity, The University of Melbourne, Melbourne, VIC 3000, Australia
| | - Helen Skouteris
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC 3800, Australia; (J.J.); (O.E.); (P.A.C.); (A.F.); (J.F.); (K.G.); (C.H.); (P.H.); (J.K.); (H.L.K.); (M.K.); (G.R.); (M.R.S.); (H.S.); (K.L.S.); (R.L.S.); (H.J.T.); (J.M.T.); (A.U.); (S.Z.); (K.L.)
| | - Karen L. Smith
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC 3800, Australia; (J.J.); (O.E.); (P.A.C.); (A.F.); (J.F.); (K.G.); (C.H.); (P.H.); (J.K.); (H.L.K.); (M.K.); (G.R.); (M.R.S.); (H.S.); (K.L.S.); (R.L.S.); (H.J.T.); (J.M.T.); (A.U.); (S.Z.); (K.L.)
- Ambulance Victoria, Melbourne, VIC 3108, Australia
| | - Rhonda L. Stuart
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC 3800, Australia; (J.J.); (O.E.); (P.A.C.); (A.F.); (J.F.); (K.G.); (C.H.); (P.H.); (J.K.); (H.L.K.); (M.K.); (G.R.); (M.R.S.); (H.S.); (K.L.S.); (R.L.S.); (H.J.T.); (J.M.T.); (A.U.); (S.Z.); (K.L.)
- Monash Health, Melbourne, VIC 3168, Australia
| | - Helena J. Teede
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC 3800, Australia; (J.J.); (O.E.); (P.A.C.); (A.F.); (J.F.); (K.G.); (C.H.); (P.H.); (J.K.); (H.L.K.); (M.K.); (G.R.); (M.R.S.); (H.S.); (K.L.S.); (R.L.S.); (H.J.T.); (J.M.T.); (A.U.); (S.Z.); (K.L.)
- Monash Health, Melbourne, VIC 3168, Australia
| | - James M. Trauer
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC 3800, Australia; (J.J.); (O.E.); (P.A.C.); (A.F.); (J.F.); (K.G.); (C.H.); (P.H.); (J.K.); (H.L.K.); (M.K.); (G.R.); (M.R.S.); (H.S.); (K.L.S.); (R.L.S.); (H.J.T.); (J.M.T.); (A.U.); (S.Z.); (K.L.)
| | - Andrew Udy
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC 3800, Australia; (J.J.); (O.E.); (P.A.C.); (A.F.); (J.F.); (K.G.); (C.H.); (P.H.); (J.K.); (H.L.K.); (M.K.); (G.R.); (M.R.S.); (H.S.); (K.L.S.); (R.L.S.); (H.J.T.); (J.M.T.); (A.U.); (S.Z.); (K.L.)
- Alfred Health, Melbourne, VIC 3004, Australia
| | - Sophia Zoungas
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC 3800, Australia; (J.J.); (O.E.); (P.A.C.); (A.F.); (J.F.); (K.G.); (C.H.); (P.H.); (J.K.); (H.L.K.); (M.K.); (G.R.); (M.R.S.); (H.S.); (K.L.S.); (R.L.S.); (H.J.T.); (J.M.T.); (A.U.); (S.Z.); (K.L.)
- Alfred Health, Melbourne, VIC 3004, Australia
| | - Karin Leder
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC 3800, Australia; (J.J.); (O.E.); (P.A.C.); (A.F.); (J.F.); (K.G.); (C.H.); (P.H.); (J.K.); (H.L.K.); (M.K.); (G.R.); (M.R.S.); (H.S.); (K.L.S.); (R.L.S.); (H.J.T.); (J.M.T.); (A.U.); (S.Z.); (K.L.)
- Royal Melbourne Hospital, Melbourne, VIC 3050, Australia
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Stiawa M, Peters M, Mulfinger N, Krumm S, Worringer B, Maatouk I, Küllenberg J, Junne F, Genrich M, Gündel H, Puschner B. ["Stress Occurs Every Day" - Reasons for Work-Related Burden in Hospitals and Coping of Staff. A Qualitative Study]. PSYCHIATRISCHE PRAXIS 2021; 49:128-137. [PMID: 34015853 DOI: 10.1055/a-1477-6000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVE Workplace exposures are considered to be high in hospital staff. Workplace interventions might be an appropriate way to reduce workplace exposures. Therefore, views of hospital staff on reasons and implications of workplace exposures were assessed and consequences for workplace interventions were considered. METHODS Six focus groups and seven semi-structured interviews were conducted with 34 members of hospital staff in total. Qualitative Content Analysis was performed. RESULTS Stress occurs due to a lack of personnel, high workload, missing common-rooms for breaks and lunch, missing communication, a lack of clarity in work processes, team conflicts and a lack of appreciation. Social support, work breaks, reduction of working hours, physical activity and empowerment were mentioned as factors leading to stress reduction. CONCLUSION Possible stress reduction by means of problem-related coping and emotional coping depending on hospital structure and culture.
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Affiliation(s)
- Maja Stiawa
- Klinik für Psychiatrie und Psychotherapie II der Universität Ulm
| | - Martin Peters
- Klinik für Psychiatrie und Psychotherapie II der Universität Ulm
| | - Nadine Mulfinger
- Klinik für Psychosomatische Medizin und Psychotherapie, Universitätsklinikum Ulm
| | - Silvia Krumm
- Klinik für Psychiatrie und Psychotherapie II der Universität Ulm
| | - Britta Worringer
- Institut für Arbeits-, Sozial- und Umweltmedizin der Universität Düsseldorf
| | - Imad Maatouk
- Klinik für Allgemeine Innere Medizin und Psychosomatik der Universität Heidelberg
| | - Janna Küllenberg
- Klinik für Allgemeine Innere Medizin und Psychosomatik der Universität Heidelberg
| | - Florian Junne
- Abteilung für Psychosomatische Medizin und Psychotherapie, Medizinische Universitätsklinik Tübingen, Universität Tübingen.,Universitätsklinik für Psychosomatische Medizin und Psychotherapie, Otto-von-Guericke-Universität Magdeburg
| | - Melanie Genrich
- Fakultät für Bildungswissenschaften, Arbeits- und Organisationspsychologie der Universität Duisburg-Essen
| | - Harald Gündel
- Klinik für Psychosomatische Medizin und Psychotherapie, Universitätsklinikum Ulm
| | - Bernd Puschner
- Klinik für Psychiatrie und Psychotherapie II der Universität Ulm
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Stuber F, Seifried-Dübon T, Rieger MA, Gündel H, Ruhle S, Zipfel S, Junne F. The effectiveness of health-oriented leadership interventions for the improvement of mental health of employees in the health care sector: a systematic review. Int Arch Occup Environ Health 2021; 94:203-220. [PMID: 33011902 PMCID: PMC7532985 DOI: 10.1007/s00420-020-01583-w] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Accepted: 09/10/2020] [Indexed: 11/16/2022]
Abstract
PURPOSE An increasing prevalence of work-related stress and employees' mental health impairments in the health care sector calls for preventive actions. A significant factor in the workplace that is thought to influence employees' mental health is leadership behavior. Hence, effective leadership interventions to foster employees' (leaders' and staff members') mental health might be an important measure to address this pressing issue. METHODS We conducted a systematic review according to the PRISMA statement (Liberati et al. 2009) and systematically searched the following databases: PubMed (PMC), Web of Science, PsycINFO (EBSCOhost), EconLit (EBSCOhost), and Business Source Premier (EBSCOhost). In addition, we performed a hand search of the reference lists of relevant articles. We included studies investigating leadership interventions in the health care sector that aimed to maintain/foster employees' mental health. RESULTS The systematic search produced 11,221 initial search hits in relevant databases. After the screening process and additional literature search, seven studies were deemed eligible according to the inclusion criteria. All studies showed at least a moderate global validity and four of the included studies showed statistically significant improvements of mental health as a result of the leadership interventions. CONCLUSIONS Based on the findings, leadership interventions with reflective and interactive parts in group settings at several seminar days seem to be the most promising strategy to address mental health in health care employees. As the available evidence is limited, efforts to design and scientifically evaluate such interventions should be extended.
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Affiliation(s)
- Felicitas Stuber
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tuebingen, Tuebingen, Germany.
| | - Tanja Seifried-Dübon
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tuebingen, Tuebingen, Germany
| | - Monika A Rieger
- Institute of Occupational Medicine, Social Medicine and Health Services Research, University Hospital Tuebingen, Tuebingen, Germany
| | - Harald Gündel
- Department of Psychosomatic Medicine and Psychotherapy, Ulm University Medical Center, Ulm, Germany
| | - Sascha Ruhle
- Department of Business Administration, in particular, Work Human Resource Management and Organization Studies, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - Stephan Zipfel
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tuebingen, Tuebingen, Germany
| | - Florian Junne
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tuebingen, Tuebingen, Germany
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Rogoža D, Strumila R, Klivickaitė E, Diržius E, Čėnaitė N. Depressive Symptoms, Help-Seeking, and Barriers to Mental Healthcare Among Healthcare Professionals in Lithuania. Acta Med Litu 2021; 28:59-76. [PMID: 34393629 PMCID: PMC8311845 DOI: 10.15388/amed.2020.28.1.3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Revised: 01/04/2021] [Accepted: 01/05/2021] [Indexed: 11/22/2022] Open
Abstract
Summary. Background: Previous research suggests that healthcare professionals (HCPs) experience high levels of work-related psychological distress, including depressive symptoms. Due to the stigma of mental health problems and other barriers, HCPs are likely to be hesitant to seek appropriate mental healthcare. We aimed to explore these phenomena among HCPs in Lithuania. Methods: A web survey inquiring about depressive symptoms, help-seeking, and barriers to mental health-care was conducted. Depressive symptoms were measured using the Patient Health Questionnaire-9 (PHQ-9). 601 complete questionnaires were included in the analyses. The barriers to help-seeking were identified using the inductive content analysis approach. Descriptive, non-parametric, and robust statistical analysis was performed using SPSS software. Results: Most of the respondents have reported depression-like symptoms over the lifetime, although only about a third of them sought professional help. Of those, roughly half preferred a private specialist. The stigma and neglect of mental health problems were the most common barriers to help-seeking. Around half of the HCPs believed that seeking mental healthcare can imperil their occupational license. About a quarter of the HCPs screened positive for clinically relevant depressive symptoms. Statistically significant differences in the PHQ-9 score were found between categories of healthcare specialty, marital status, religious beliefs, workplace, and years of work as a HCP. Fewer years of work and younger age were associated with the higher PHQ-9 score. Conclusions: Our findings suggest that HCPs in Lithuania may be inclined not to seek appropriate mental healthcare and experience poor mental health, although stronger evidence is needed to verify these findings.
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Affiliation(s)
- Daniel Rogoža
- Vilnius University, Faculty of Medicine, Vilnius, Lithuania
| | - Robertas Strumila
- Vilnius University, Faculty of Medicine, Institute of Clinical Medicine, Clinic of Psychiatry, Vilnius, Lithuania
| | - Eglė Klivickaitė
- Vilnius University, Faculty of Medicine, Institute of Clinical Medicine, Clinic of Psychiatry, Vilnius, Lithuania
| | - Edgaras Diržius
- Lithuanian University of Health Sciences, Clinic of Psychiatry, Kaunas, Lithuania Lithuanian University of Health Sciences, Institute of Biological Systems and Genetic Research, Kaunas, Lithuania Lithuanian University of Health Sciences, Centre for Evidence-Based Medicine, Kaunas, Lithuania
| | - Neringa Čėnaitė
- Vilnius University, Faculty of Medicine, Institute of Clinical Medicine, Clinic of Psychiatry, Vilnius, Lithuania
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Interventions to reduce symptoms of common mental disorders and suicidal ideation in physicians: a systematic review and meta-analysis. Lancet Psychiatry 2019; 6:225-234. [PMID: 30744997 DOI: 10.1016/s2215-0366(18)30509-1] [Citation(s) in RCA: 89] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2018] [Revised: 12/07/2018] [Accepted: 12/07/2018] [Indexed: 12/28/2022]
Abstract
BACKGROUND An increased prevalence of common mental disorders and suicide has been reported among physicians worldwide. We aimed to assess which, if any, interventions are effective at reducing or preventing symptoms of common mental health disorders or suicidality in physicians. METHODS For this systematic review and meta-analysis MEDLINE, EMBASE, PsycINFO, and Cochrane CENTRAL (database inception to March 26, 2018), reference lists of included studies, and additional sources were systematically searched and screened by two independent reviewers. We included randomised controlled studies or controlled before-after studies of interventions to reduce depression, anxiety, or suicidality in physicians, as assessed by a validated outcome measure. Both organisation-level and physician-directed interventions were considered. Our primary outcome was differences in symptoms of common mental health disorders following intervention. We used random-effects modelling for the main meta-analyses and planned subgroup and sensitivity analyses. The study protocol is registered with PROSPERO, number CRD42018091646. FINDINGS We identified 2992 articles for screening, of which eight were included in the systematic review (n=1023 physicians) and seven in the meta-analysis. Results indicated a moderate effect in favour of the physician-directed interventions for reduction in symptoms of common mental health disorders (standardised mean difference 0·62; 95% CI 0·40-0·83; p<0·0001). Separate analyses showed physician-directed interventions resulted in reductions of symptoms of depression, anxiety, and suicidality. No evidence of significant heterogeneity was found (Q=3·78; p=0·44). INTERPRETATION Physician-directed interventions are associated with small reductions in symptoms of common mental health disorders among physicians. Research regarding organisational interventions aimed at improving physicians' mental health via modification of the work environment is urgently needed. FUNDING Health Workforce Programme, Commonwealth Department of Health, Australian Government, iCare Foundation, and NSW Health.
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