The benefits of interventions for work-related stress

Finding Similarities in Differences Between Autistic Adults: Two Replicated Subgroups

Autism is heterogeneous, which complicates providing tailored support and future prospects. We aim to identify subgroups in autistic adults with average to high intelligence, to clarify if certain subgroups might need support. We included 14 questionnaire variables related to aging and/or autism (e.g., demographic, psychological, and lifestyle). Community detection analysis was used for subgroup identification in an original sample of 114 autistic adults with an adulthood diagnosis (autism) and 58 non-autistic adults as comparison group (COMP), and a replication sample (NAutism = 261; NCOMP = 287), both aged 30-89 years. Next, we identified subgroups and assessed external validity (for cognitive and psychological difficulties, and quality of life [QoL]) in the autism samples. To test specificity, we repeated the analysis after adding 123 adults with ADHD, aged 30-80 years. As expected, the autism and COMP groups formed distinct subgroups. Among autistic adults, we identified three subgroups of which two were replicated. One of these subgroups seemed most vulnerable on the cluster variables; this subgroup also reported the most cognitive and psychological difficulties, and lowest QoL. Adding the ADHD group did not alter results. Within autistic adults, one subgroup could especially benefit from support and specialized care, although this must be tested in future studies.

Effectiveness of interventions on occupational stress, health and well-being, performance, and job satisfaction for midwives: A systematic mixed methods review

BACKGROUND

Work-related stress is high in midwifery with negative implications for midwives' health and performance. This systematic review therefore examined which stress management interventions (SMIs) are most effective at reducing occupational stress and improving midwives' health and well-being, performance, and job satisfaction.

METHODS

A systematic review included studies if they were: investigating midwives or student midwives; examining an individual- or organisation-level intervention; reporting the intervention effects on at least one outcome (e.g., job performance); peer-reviewed; and published in English. Methodological quality was assessed using the Mixed Methods Appraisal Tool. A narrative synthesis was conducted and data were presented by SMI level (i.e., individual vs. organisation) and modality type (e.g., mindfulness, care model). Sum codes were used to compare the effects of individual- and organisation-level SMIs on outcomes.

FINDINGS

From 2605 studies identified, 30 were eligible (18 individual- and 12 organisation-level SMIs). Eight studies were deemed low quality. While individual- and organisation-level SMIs were equally effective in improving job satisfaction and performance, there was a trend for organisation-level SMIs more effectively reducing work stress and improving health and well-being. Specific individual- (i.e., mindfulness, simulation training) and organisation-level (i.e., reflective groups, midwifery care models) SMIs were most beneficial.

CONCLUSION

It is recommended that health practitioners and policy makers implement interventions that target both individual- and organisation-levels to optimally support midwives' work stress, health, well-being, and performance. Notwithstanding these findings and implications, some studies had poor methodological quality; thus, future research should better follow intervention reporting guidelines.

Beneficial effects of a cognitive-behavioral occupational stress management group training: the mediating role of changing cognitions

Introduction

While the effectiveness of cognitive-behavioral stress management trainings (SMTs) is well-documented, the underlying mechanisms, especially in an occupational context, are not fully understood. We tested whether SMT-induced improvements in stress management skills, particularly in the mastery of changing cognitions, may explain beneficial SMT effects.

Methods

Our non-randomized controlled trial comprised 108 employees of a German health insurance company, with 65 of them participating in a cognitive-behavioral SMT and 43 participating in an alternative control training (AT). As outcome variables, we repeatedly assessed stress-related (functional stress management skills, relaxation, stress reactivity, exhaustion), work-related (job dissatisfaction), and specific-context-related (social support, trait anger) measures at baseline, 2 weeks, and 3 months after the trainings. Functional stress management skills and, in particular, a subscale assessing perceived mastery of changing cognitions ("cognitive-strategies-and-problem-solving") were tested as mediators of change.

Results

Repeated measures (M)AN(C)OVAs and complementary multigroup latent difference models confirmed improvements in all outcomes in the SMT-group compared to the AT-group (p's ≤ 0.015). Multivariate mediation path analyses revealed that, regarding mechanisms of change, the subscale cognitive-strategies-and-problem-solving was identified as the most important mediator for all outcomes (95% CIs for expected increases in SMT- vs. AT-group = [lower limits (LLs) ≥ 0.004]; 95% CIs for expected decreases in the SMT- vs. AT-group = [upper limits(ULs) ≤ -0.078]) except for job dissatisfaction.

Discussion

Our findings confirm that employees can effectively learn to master stress reduction techniques and consequently lower the resulting burden. Moreover, beneficial SMT effects seem to result from improvements in functional stress management skills, particularly in the ability to change cognitions. This points to the importance of training cognitive techniques.

Barriers and facilitators to implementing workplace interventions to promote mental health: qualitative evidence synthesis

BACKGROUND

Despite growing interest in workplace mental health interventions, evidence of their effectiveness is mixed. Implementation science offers a valuable lens to investigate the factors influencing successful implementation. However, evidence synthesis is lacking, especially for small-to-medium-sized enterprises (SMEs) and for specific work sectors. The objectives of this review are to establish the scope of research with explicit analysis of implementation aspects of workplace mental health interventions and to identify barriers and facilitators to implementation in general and within SMEs and selected sectors.

METHODS

A systematic scoping review and meta-synthesis of mixed methods process evaluation research from 11 databases, with the evaluation of methodological quality (MMAT) and confidence in findings (CERQual), was conducted. We selected information-rich studies and synthesised them using domains within the Nielsen and Randall implementation framework: context, intervention activities, implementation; and mental models.

RESULTS

We included 43 studies published between 2009 and 2022, of which 22 were rated as information-rich to be analysed for barriers and facilitators. Most studies were conducted in healthcare. Facilitators reflecting 'high confidence' included: relevant and tailored content, continuous and pro-active leadership buy-in and support, internal or external change agents/champions, assistance from managers and peers, resources, and senior-level experience and awareness of mental health issues. Healthcare sector-specific facilitators included: easy accessibility with time provided, fostering relationships, clear communication, and perceptions of the intervention. Stigma and confidentiality issues were reported as barriers overall. Due to the small number of studies within SMEs reported findings did not reach 'high confidence'. A lack of studies in construction and Information and Communication Technology meant separate analyses were not possible.

CONCLUSIONS

There is dependable evidence of key factors for the implementation of workplace mental health interventions which should be used to improve implementation. However, there is a lack of studies in SMEs and in a larger variety of sectors.

SYSTEMATIC REVIEW REGISTRATION

Research Registry ( reviewregistry897 ).

Decoding the impact of night/day shiftwork on well-being among healthcare workers

This study delved into the complex effects of work schedules on the well-being of healthcare professionals, spotlighting Nigeria's medical landscape. A diverse cohort of 387 participants, spanning doctors, nurses, pharmacists, and laboratory technicians or scientists, formed the research base, with the majority being women (67.7%), with a mean age of 34.67 years. Professionals self-reported their predominant schedules to gauge work patterns, classifying them as day or night shifts. The World Health Organization Quality of Life Brief Version (WHOQOL-BREF) tool assessed the quality of life across the physical, psychological, social relationship, and environmental domains. Psychological distress was measured using the Depression, Anxiety, and Stress Scales (DASS), and perceived social support was evaluated via the Multidimensional Scale of Perceived Social Support (MSPSS). A cross-sectional design was adopted, and the study employed moderated mediation analysis using SmartPLS 4.0. The results underscored the significant ramifications of night shifts on environmental and physical well-being. Psychological health and social relationships were better among day shift than night shift workers. There was a pronounced correlation between night shifts and heightened levels of anxiety, stress, and depression. The mediating role of psychological distress and the moderating influence of social support in these relationships were evident. This study offers invaluable insights into the role of work schedules in shaping the well-being of healthcare professionals, emphasising the protective role of social support and the unique challenges faced by migrant health workers.

Validation of the Indonesian version of the Recovery Experience Questionnaire

This study aimed to validate the Indonesian version of the Recovery Experience Questionnaire (REQ-I) to assess how individuals unwind and recuperate from work during their off-job times, specifically in terms of psychological detachment, relaxation, mastery, and control. The translated and back-translated REQ, which has gone through semantic and face validation processes, was administered through an internet survey using 740 Indonesian workers from various backgrounds. Furthermore, confirmatory Factor Analysis (CFA) was conducted to evaluate factorial validity. Construct validity was evaluated based on the correlation coefficients between recovery experience and potential consequences variables, while internal consistency and test-retest reliability were investigated to evaluate the reliability. The result of CFA showed that the hypothesized four-factor model was the most suitable for the data. Meanwhile, construct validity was supported by expected correlations of recovery experiences with possible consequences. Cronbach's α coefficient for each of the four subscales was sufficient at 0.85-0.92. Test-retest reliability of each of the four subscales with three months intervals was confirmed with sufficient intraclass correlation coefficients at 0.60-0.66. This current study confirmed that REQ-I was an adequate measure of recovery experiences used in the Indonesian context.

Interventions for mitigating occupational stress for professional dementia caregivers in residential aged care: A systematic review with meta-analysis

OBJECTIVE

Occupational stress in professional dementia caregivers in residential aged care facilities has adverse effects on care quality, caregivers' health, and workforce sustainability. The purpose of this study was to examine the evidence regarding interventions to mitigate occupational stress for this population.

METHODS

A systematic review of CINAHL, PsycINFO, PubMed and MEDLINE databases was conducted to identify original RCT research reporting on stress interventions, published in English between 1995 and March 2022. Search results were screened by two independent reviewers. Quality and risk of bias were appraised using the Downs and Black Checklist and Risk of Bias by two reviewers. Meta-analysis and subgroup analysis examined the pooled intervention effects on stress compared to control.

RESULTS

10 studies met the inclusion criteria, and these reported on 15 interventions and 28 outcomes from 92 facilities, involving 1,397 caregivers. We found a small and insignificant effect of interventions on caregiver stress (g = -.27, p = .16). Heterogeneity was partially explained by subgroup analysis. Interventions can mitigate stress and burden not attributed to client behaviour (n = 3) (g = -.85, p < .001), and improve caregivers' self-efficacy (n = 4) (g = -.35, p = .07). We were unable to determine the most effective type of intervention, although organisation focused interventions showed the greatest potential (g = -.58, p = .08).

CONCLUSION

Interventions that improve caregivers' personal and organisational resources can reduce non-client associated stress and burden and increase self-efficacy. Aged care providers are recommended to prioritise education with organisational support interventions. Research on longitudinal effects and high-risk caregivers is required. Limitations are discussed.

PROSPERO REGISTRATION NUMBER

CRD42022313715 (registered April 2022).

The effect of two facets of physicians' environmental stress on patients' compliance with COVID-19 guidelines: moderating roles of two types of ego network

Drawing upon the Conservation of Resources Theory, this study seeks to examine the association between two dimensions of environmental stress experienced by physicians and patients' adherence to COVID-19 guidelines, within the context of a social network framework. A third-wave longitudinal study was employed to gather 439 valid data points in China. Social network analysis and structural equation model were used to test the conceptual model. The results reveal the pivotal role of physicians' environmental stress related to their work and family contexts in influencing patients' adherence to COVID-19 guidelines through the mediation of physicians' information sharing. The ego networks of physicians, encompassing both advice-seeking and friendship ties, were observed to negatively moderate the relationship between stress and resource depletion. Broadly, our study shows the importance of understanding physicians' stress caused by the working and family environments, as these factorsnot only impact the psychological well-being of physicians but also significantly affect patients' compliance with COVID-19 guidelines. In addition, the work offers a framework for understanding the impact of the ego advice-seeking network and the ego friend network.

Sadness-Based Approach-Avoidance Modification Training for Subjective Stress in Adults: Pilot Randomized Controlled Trial

BACKGROUND

A key vulnerability factor in mental health problems is chronic stress. There is a need for easy-to-disseminate and effective interventions to advance the prevention of stress-related illnesses. App-based stress management trainings can fulfill this need. As subjectively experienced stress may be influenced by dysfunctional beliefs, modifying their evaluations might reduce subjective stress. Approach-avoidance modification trainings (AAMT) can be used to modify stimulus evaluations and are promising candidates for a mobile stress intervention. As the standard training reactions of the AAMT (swiping and joystick motion) have little valence, emotions could be incorporated as approach and avoidance reactions to enhance the effectiveness of AAMTs.

OBJECTIVE

We aimed to evaluate the feasibility of a mobile emotion-enhanced AAMT that engages users to display sadness to move stress-enhancing beliefs away and display positive emotions to move stress-reducing beliefs toward themselves (emotion-based AAMT using sadness and positive emotions [eAAMT-SP]). We explored the clinical efficacy of this novel intervention.

METHODS

We allocated 30 adult individuals with elevated stress randomly to 1 of 3 conditions (eAAMT-SP, a swipe control condition, and an inactive control condition). We evaluated the feasibility of the intervention (technical problems, adherence, usability, and acceptability). To explore the clinical efficacy of the intervention, we compared pretest-posttest differences in perceived stress (primary clinical outcome) and 3 secondary clinical outcomes (agreement with and perceived helpfulness of dysfunctional beliefs, emotion regulation, and depressive symptoms) among the conditions.

RESULTS

The predetermined benchmarks of 50% for intervention completion and 75% for feasibility of the study design (completion of the study design) were met, whereas the cutoff for technical feasibility of the study design (95% of trials without technical errors) was not met. Effect sizes for usability and acceptability were in favor of the eAAMT-SP condition (compared with the swipe control condition; intelligibility of the instructions: g=-0.86, distancing from dysfunctional beliefs: g=0.22, and approaching functional beliefs: g=0.55). Regarding clinical efficacy, the pretest-posttest effect sizes for changes in perceived stress were g=0.80 for the comparison between the eAAMT-SP and inactive control conditions and g=0.76 for the comparison between the eAAMT-SP and swipe control conditions. Effect sizes for the secondary clinical outcomes indicated greater pretest-posttest changes in the eAAMT-SP condition than in the inactive control condition and comparable changes in the swipe control condition.

CONCLUSIONS

The findings regarding the feasibility of the intervention were satisfactory except for the technical feasibility of the intervention, which should be improved. The effect sizes for the clinical outcomes provide preliminary evidence for the therapeutic potential of the intervention. The findings suggest that extending the AAMT paradigm through the use of emotions may increase its efficacy. Future research should evaluate the eAAMT-SP in sufficiently powered randomized controlled trials.

TRIAL REGISTRATION

German Clinical Trials Registry DRKS00023007; https://drks.de/search/en/trial/DRKS00023007.

Work-related causes of mental health conditions and interventions for their improvement in workplaces

Mental health problems and disorders are common among working people and are costly for the affected individuals, employers, and whole of society. This discussion paper provides an overview of the current state of knowledge on the relationship between work and mental health to inform research, policy, and practice. We synthesise available evidence, examining both the role of working conditions in the development of mental disorders, and what can be done to protect and promote mental health in the workplace. We show that exposure to some working conditions is associated with an increased risk of the onset of depressive disorders, the most studied mental disorders. The causality of the association, however, is still debated. Causal inference should be supported by more research with stronger linkage to theory, better exposure assessment, better understanding of biopsychosocial mechanisms, use of innovative analytical methods, a life-course perspective, and better understanding of the role of context, including the role of societal structures in the development of mental disorders. There is growing evidence for the effectiveness of interventions to protect and promote mental health and wellbeing in the workplace; however, there is a disproportionate focus on interventions directed towards individual workers and illnesses, compared with interventions for improving working conditions and enhancing mental health. Moreover, research on work and mental health is mainly done in high-income countries, and often does not address workers in lower socioeconomic positions. Flexible and innovative approaches tailored to local conditions are needed in implementation research on workplace mental health to complement experimental studies. Improvements in translating workplace mental health research to policy and practice, such as through workplace-oriented concrete guidance for interventions, and by national policies and programmes focusing on the people most in need, could capitalise on the growing interest in workplace mental health, possibly yielding important mental health gains in working populations.

Effects of an Internet Delivered Behavioral Activation Program on Improving Work Engagement Among Japanese Workers: A Pretest and Posttest Study

OBJECTIVE

The aim of the study is to examine the effect of a newly developed Internet-delivered behavioral activation (iBA) program on work engagement and well-being among Japanese workers with elevated psychological distress.

METHODS

Participants were recruited via an Internet survey company ( N = 3299). The eligibility criteria were as follows: (1) Japanese employees aged 20 to 59 years, (2) having psychological distress, and (3) not self-employed. This iBA program was a 3-week web-based training course using behavioral activation techniques. Work engagement, psychological distress, and eudemonic well-being at work were measured at baseline and postintervention period. A paired sample t test was conducted to assess the intervention effect.

RESULTS

Of the 568 eligible participants, 120 were randomly selected. A total of 108 participants completed the baseline survey and received the iBA program. Eighty respondents completed the postintervention survey and were included in analyses. The iBA program did not show a significant intervention effect on work engagement ( P = 0.22, Cohen d = 0.14), while psychological distress ( P < 0.01, d = -0.40) and role-oriented future prospects ( P = 0.02, Cohen d = 0.27) were significantly improved.

CONCLUSIONS

The effect of the iBA program on work engagement may be limited.

Strategies for coping with stress in mothers of children with atopic dermatitis - a cross-sectional study

Introduction

Our previous study showed that the severity of atopic dermatitis (AD) in children significantly correlates with the quality of life and perceived stress in their mothers.

Aim

To compare strategies for coping with stress in mothers of children with and without AD, as well as to investigate the relationship between coping strategies of mothers of affected children and AD variables, stress intensity, and quality of life.

Material and methods

The study included 88 mothers of children with AD and 57 mothers of children without AD as controls. The severity of skin lesions in children with AD was assessed by the Scoring Atopic Dermatitis (SCORAD) index, and skin itch was evaluated by the Numerical Rating Scale (NRS). All mothers completed the sociodemographic questionnaire (SD), the Perceived Stress Scale (PSS), and the Coping Orientations to Problems Experienced (COPE) scale. Additionally, mothers of children with AD filled out the Family Dermatology Life Quality Index (FDLQI).

Results

There were no statistically significant differences in coping strategies between the groups. However, there were significant correlations between the selected coping strategies and AD severity, perceived stress of mothers, and quality of life of the entire family of affected children.

Conclusions

Although mothers of children with AD experience higher levels of stress compared with mothers of children without AD, the disease does not change coping strategies. Psychological support for mothers of children with AD should be oriented toward strengthening cognitive coping strategies.

Self-Efficacy and Well-Being in Professionals Working in Intimate Partner Violence: Recovery Experiences and Burnout as Associated Variables

The negative consequences of intimate partner violence against women (IPVAW) are observed not only in the victims but also in the professionals who work in this field. Self-efficacy has been observed as a significant variable in the perception of work efficiency and general well-being, and in coping with work-related stress and burnout syndrome. Thus, we performed a correlational study (N = 200) to examine the mediating role of recovery experiences and emotional exhaustion in the relationship between self-efficacy and psychological well-being in these professionals. The mediating analyses revealed that self-efficacy was related to higher levels of well-being through its effects on the increase in recovery experiences and the decrease in burnout levels. These findings emphasize the need to develop intervention programs aimed at improving self-efficacy these professionals. This is necessary to improve their employment situations, increase their health, and optimize both institutional resources and the quality of the services offered.

Comparison between Standard Expository Cognitive Behavioral Therapy (CBT-E) and Immersive Virtual Reality CBT (CBT-VR) for Rehabilitation of Patients Affected by Occupational Stress Disorders: Study Protocol

Work-related stress presents a significant impact on work performance and physical health. It has been associated with the onset of a multitude of symptoms that can lead to occupational stress diseases, namely Adjustment Disorder and Post-Traumatic Stress Disorder. The literature has evidenced that "exposure therapy" of cognitive-behavioral training (CBT-E) seems to be the most effective technique to manage stress symptoms, including work stress diseases, and several studies have considered Virtual Reality (VR) as an adjuvant tool to exposure-based psychotherapy (CBT-VR) for the treatment of multiple psychiatric disorders. The aim of this study is to evaluate the effectiveness of CBT with exposure to stressful work scenarios in imaginative (CBT-E) and in immersive virtual reality (CBT-VR) scenarios in a group of workers affected by work-related stress disorders and compare the clinical and physiological outcomes between the two exposure techniques. A long-term goal would be to develop an evidence-based rehabilitation program as a treatment for the reintegration into work of patients affected by these psychiatric disorders.

Exploration of user needs and design requirements of a digital stress management intervention for software employees in Sri Lanka: a qualitative study

BACKGROUND

Digital stress management interventions are considered promising additions to the spectrum of the programs companies use to support the well-being of their employees. However, a series of constraints are identified that hinder the potential benefits of such interventions. These constraints include a lack of user engagement and personalisation, poor adherence and high attrition. Understanding the specific user needs and requirements is essential to increase the likelihood of success in implementing ICT (Information and Communication Technology)-supported stress management interventions. Thus, following the findings from a previous quantitative study, the proposed study aimed to further explore the user needs and requirements for designing digital stress management interventions for software employees in Sri Lanka.

METHODS

The study used a qualitative approach based on three focus groups with 22 software employees in Sri Lanka. The focus group discussions were conducted online and recorded digitally. Inductive thematic analysis was used to analyse the collected data. The consolidated criteria for reporting qualitative studies (COREQ)-32 items were followed for reporting this study.

RESULTS

The analysis revealed three major themes: self-help in a personal space, social support in a collaborative space, and general design considerations for achieving success. The first theme revealed the users' preference for having a personal space where they could engage in individual activities without support from an external party. The second theme elaborated on the importance of adding a collaborative platform to seek help from peers and professionals. The final theme explored the user-desired design features that could increase user engagement and adherence.

CONCLUSIONS

This study used a qualitative approach to further explore the findings of a previous quantitative study. The focus group discussions confirmed the results of the previous study and provided the opportunity to better understand user needs and yield new insights. Such insights revealed user preference for embedding personal and collaborative platforms in a single intervention, embedding gamified elements, the provision of passive content generation via sensory systems, and the need for personalisation. These empirical findings will feed into the design of ICT-supported interventions for occupational stress management among Sri Lankan software employees.

Job stress and university faculty members' life satisfaction: The mediating role of emotional burnout

As one of the leading work-related health problems arising from increasingly fierce competition, work-related stress has become a significant predictor of the reduced wellbeing of university faculty members, especially for non-tenured junior faculty members. In light of this and based on a survey, this research seeks to examine how and why work-related stress impacts the life satisfaction level of university junior faculty members. The results indicate that the three subdivisions of university faculty members' work-related stress, namely, research stress, teaching stress, and administrative stress, are all negatively related to their life satisfaction level. In addition, emotional burnout has been confirmed to function as the psychological mechanism for the aforementioned main effects. The research contributes to the literature mainly by offering a new insight in which the three subdivisions of work-related stress are regarded as independent variables affecting the life satisfaction level of university junior faculty members.

The Effect of Pythagorean Self-Awareness Intervention on Stress and Mental Health Characteristics of Civil Servants in Crete, Greece

Evidence is limited regarding the effects of holistic programs on work-related stress, anxiety, and depressive symptomatology. This study aimed to evaluate the effects of the Pythagorean Self-Awareness Intervention (PSAI) on stress and mental health characteristics of civil servants in Crete, Greece. This was a single arm interventional study with PSAI outcome evaluation. Validated, self-reported scales were used to assess stress and mental health characteristics (PSS, DASS, UCLA, RSE, and STAXI). Hair samples were obtained to measure cortisol concentrations as a biological stress marker. Paired-samples t-test or Wilcoxon tests were used to evaluate pre- and post-intervention measures. Overall, 48 civil servants (56.3% women, mean age 51 years) participated in the study. Statistically significant reductions were observed in all self-reported stress scales (p < 0.05). Although hair cortisol decreased, this difference was not statistically significant (p = 0.109). Statistically significant improvements were also observed on depressive symptomatology (p < 0.001), self-esteem (p < 0.001), loneliness (p < 0.001), self-efficacy (p = 0.002), and anger (p = 0.017). The PSAI appeared beneficial with respect to all self-reported outcomes. Larger studies including control groups and further follow-up evaluations are needed to ascertain these findings.

Investigating Employees’ Concerns and Wishes for Digital Stress Management Interventions with Value Sensitive Design: Mixed Methods Study (Preprint)

BACKGROUND

Work stress places a heavy economic and disease burden on society. Recent technological advances include digital health interventions for helping employees prevent and manage their stress at work effectively. Although such digital solutions come with an array of ethical risks, especially if they involve biomedical big data, the incorporation of employees' values in their design and deployment has been widely overlooked.

OBJECTIVE

To bridge this gap, we used the value sensitive design (VSD) framework to identify relevant values concerning a digital stress management intervention (dSMI) at the workplace, assess how users comprehend these values, and derive specific requirements for an ethics-informed design of dSMIs. VSD is a theoretically grounded framework that front-loads ethics by accounting for values throughout the design process of a technology.

METHODS

We conducted a literature search to identify relevant values of dSMIs at the workplace. To understand how potential users comprehend these values and derive design requirements, we conducted a web-based study that contained closed and open questions with employees of a Swiss company, allowing both quantitative and qualitative analyses.

RESULTS

The values health and well-being, privacy, autonomy, accountability, and identity were identified through our literature search. Statistical analysis of 170 responses from the web-based study revealed that the intention to use and perceived usefulness of a dSMI were moderate to high. Employees' moderate to high health and well-being concerns included worries that a dSMI would not be effective or would even amplify their stress levels. Privacy concerns were also rated on the higher end of the score range, whereas concerns regarding autonomy, accountability, and identity were rated lower. Moreover, a personalized dSMI with a monitoring system involving a machine learning-based analysis of data led to significantly higher privacy (P=.009) and accountability concerns (P=.04) than a dSMI without a monitoring system. In addition, integrability, user-friendliness, and digital independence emerged as novel values from the qualitative analysis of 85 text responses.

CONCLUSIONS

Although most surveyed employees were willing to use a dSMI at the workplace, there were considerable health and well-being concerns with regard to effectiveness and problem perpetuation. For a minority of employees who value digital independence, a nondigital offer might be more suitable. In terms of the type of dSMI, privacy and accountability concerns must be particularly well addressed if a machine learning-based monitoring component is included. To help mitigate these concerns, we propose specific requirements to support the VSD of a dSMI at the workplace. The results of this work and our research protocol will inform future research on VSD-based interventions and further advance the integration of ethics in digital health.

Burnout and Quality of Work Life among Municipal Workers: Do Motivating and Economic Factors Play a Mediating Role?

This study analyzes the relationship between burnout and quality of work life among municipal workers subjected to higher levels of stress and emotional exhaustion, impacting their occupational health in the context of the COVID-19 pandemic. With a sample of 459 municipal workers, the relationship between burnout and quality of work life is tested by considering the isolated mediating effect of the feeling of contributing to productivity and the combined effects of two mediators representing the feeling of contributing to productivity and receiving an appropriate salary. The main findings include a negative association between the three dimensions of burnout: emotional exhaustion, feelings of cynicism, and a sense of being less effective, and the mediators: contribution to productivity and appropriate salary. Also detected was an important mediating role associated with the effects of not feeling contributive at work, as well as not being well paid, on the relation between the burnout syndrome dimension of low effectiveness and quality of work life. For future action by public authorities and public managers, the need is highlighted to create innovative human resource management frameworks and flexible work organization, with remuneration plans based on productivity goals and aimed at an improved balance between personal life and work.

Effect of stress management based on cognitive-behavioural therapy on nurses as a universal prevention in the workplace: a systematic review and meta-analysis protocol

INTRODUCTION

The mental health status of nurses affects not only their well-being but also the organisational outcomes and the quality of patient care. Hence, stress management strategies are critical as a universal prevention measure that address an entire population and are not directed at a specific risk group to maintain nurses' mental health in the workplace. No systematic review or meta-analysis has been conducted to evaluate the effect of cognitive-behavioural therapy (CBT) that specifically focuses on universal prevention. Therefore, the aim of this study is to examine the effectiveness that is reported in published randomised controlled trial (RCT) studies.

METHODS AND ANALYSIS

This systematic review and meta-analysis will analyse published studies selected from electronic databases (ie, Cochrane Central Register of Controlled Trials, PubMed, Cumulative Index to Nursing and Allied Health Literature, PsycINFO, PsycARTICLES, Web of Science and the Japan Medical Abstracts Society). The inclusion criteria for studies are that they (1) were conducted to assess the effect of CBT on the mental health of nurses as a universal prevention, (2) used an RCT design and (3) provided sufficient results (sample sizes, means and SD) to estimate the pooled effect sizes with 95% CIs. Studies will be excluded if they only targeted nurses who had been screened as being at high risk in terms of their mental health and indicated that they required the prevention. The methodological quality of the included studies will be assessed using the Cochrane Collaboration's risk of bias tool.

ETHICS AND DISSEMINATION

Ethical approval is not required because this study is based on information obtained from previous studies. The results and findings of this study will be submitted for publication in a peer-reviewed international scientific journal. Results from this study will be helpful when implementing CBT strategies for nurses as a universal preventative measure in the workplace and for managing stress-related outcomes.

PROSPERO REGISTRATION NUMBER

CRD42020152837.

Internet-delivered cognitive behavioral interventions to reduce elevated stress: A systematic review and meta-analysis

Background

Face-to-face cognitive behavioral therapy (CBT) is the most promising treatment to reduce stress, but access to CBT is limited. Internet-delivered CBT (ICBT) enables large-scale dissemination at low costs. Evidence suggests that ICBT can reduce stress in subclinical and mixed diagnostic samples, but less is known about the effect of ICBT in targeted samples suffering from elevated perceived stress or stress-related disorders.

Objective

To investigate the efficacy of ICBT specifically aimed at reducing stress in adults with elevated perceived stress or stress-related disorders.

Methods

We searched for randomized controlled trials comparing ICBT with a control group in PubMed, Web of Science, and PsycInfo between 2010 and 2021. A meta-analysis of 14 comparisons (total N = 1831) was performed, and Cohen's d was calculated to assess the difference between intervention and control groups at posttest for the primary outcome self-rated stress. Effects on secondary outcomes of anxiety and depression were also investigated.

Results

The pooled mean effect size for self-rated stress at posttest was d = 0.78 [CI 95 % 0.66-0.90]. For anxiety and depression, the effects were d = 0.69 [95 % CI 0.52-0.86] and d = 0.65 [95 % CI 0.56-0.75] respectively. The heterogeneity of results between studies was overall low to moderate. Subgroup analyses were not conducted due to the limited number of studies eligible for inclusion.

Conclusions

Results provide evidence of the efficacy of ICBT to reduce stress, anxiety, and depressive symptoms in adults suffering from elevated stress or stress-related disorders. Findings have important implications for the development of safe and evidence-based treatment guidelines in the face of a rapid digital expansion.This study was preregistered at Open Science Framework (osf.io) with DOI 10.17605/OSF.IO/BQAZ3.

The association of work-related extended availability with recuperation, well-being, life domain balance and work: A meta-analysis

Work-related extended availability (WREA; the availability of employees for work-related matters in their leisure time) seems to be associated with decreases in well-being and life-domain balance, but to date there is no quantitative synthesis of the scattered evidence. We conducted a random-effects meta-analysis (113 articles with 121 studies relying on k = 117 independent samples with N = 131,872) on the associations between WREA and employee outcomes while examining potential moderators as well as differences between availability demands and behaviors. WREA was adversely associated with recuperation, well-being and private life, but favorably with some work-related criteria. There were no systematic differences in effect sizes between availability demands and behaviors; however, segmentation preferences were a moderator. Overall, these results suggest that WREA may pose a threat to employee recuperation, well-being and private lives, especially when employees prefer separating work and private life. However, positive potentials of WREA should not be overlooked. Plain Language Summary Work-related extended availability (WREA) refers to the availability of employees for work-related matters in their leisure time. Studies have shown that WREA may go along with primarily negative consequences for employees, but to date, there is no comprehensive overview of the literature statistically summarizing the current state of research, which was done in the study at hand. We assumed that WREA be related to problems with recovery, poorer well-being and difficulties to find a balance between work and private life. We also assessed in how far WREA goes along with attitudes towards work, absence from work and the intention to change jobs. Moreover, we considered differences between demands to be available and behaviors of actually taking care of work-related matters during leisure time. Finally, we investigated factors that may be associated with stronger consequences of WREA. We included 113 scientific papers with a total of 131,872 participants. WREA was related to problems with recovery, poorer well-being and difficulties to find a balance between work and private life, but also to more positive attitudes towards work. We did not find systematic differences between demands to be available and availability behaviors. However, we found that the relationship between WREA and work creating conflict with family life were stronger in samples with higher preferences to segment work and private life. Our findings suggest that WREA may pose a threat to employee recuperation, well-being and private lives, especially when employees prefer separating life domains. Still, positive potentials of WREA should not be overlooked.

The Advances of Immersive Virtual Reality Interventions for the Enhancement of Stress Management and Relaxation among Healthy Adults: A Systematic Review

The rapid changes in human contacts due to the COVID-19 crisis have not only posed a huge burden on the population’s health but may have also increased the demand for evidence-based psychological programs delivered through digital technology. A systematic review, following the “Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA)” guidelines, was therefore conducted to explore the advances in stress management interventions utilizing VR and suggest up-to-date directions for future practice. The relevant literature was screened and the search resulted in 22,312 records, of which 16 studies were considered for analysis. The Methodological Index for Non-Randomized Studies (MINORS) was also employed to assess the quality of the included studies. The results suggest that VR-based interventions can facilitate positive changes in subjective stress levels and stress-related biomarkers. However, special attention should be paid to the development of rigorous VR protocols that embrace natural elements and concepts deriving from traditional treatment approaches, such as cognitive behavioral therapy techniques. Overall, this review aims to empower future researchers to grasp the opportunity that the COVID-19 pandemic generated and utilize digital technologies for strengthening individuals’ mental health. Future projects need to conduct large-scale VR studies to evaluate their effectiveness compared to other mental health interventions.

Occupational violence and burnout among teachers: a narrative review

Occupational violence may favor the development of burnout syndrome. The objective of this study was to identify which characteristics are associated with burnout syndrome in teachers exposed to occupational violence and discuss measures aimed at reducing this type of violence. A narrative review with a theoretical-reflective approach was conducted on SciELO library and on PubMed, Web of Science, and Scopus databases. The violence experienced by teachers causes health-related problems and illnesses, especially in mental health, favoring the development of burnout syndrome. Occupational violence has affected teachers and influenced the onset of burnout syndrome. Thus, plans and actions involving teachers, students and their parents/legal guardians, employees, and especially managers are essential to promote safe and healthy work environments.

A Qualitative Analysis of the Mental Health Training and Educational Needs of Firefighters, Paramedics, and Public Safety Communicators in Canada

Background-Public safety personnel (PSP) are at heightened risk of developing mental health challenges due to exposures to diverse stressors including potentially psychologically traumatic experiences. An increased focus on protecting PSP mental health has prompted demand for interventions designed to enhance resilience. While hundreds of available interventions are aimed to improve resilience and protect PSPs' mental health, research evidence regarding intervention effectiveness remains sparse. Methods-Focus groups with PSP elicited a discussion of psychoeducational program content, preferred modes of program delivery, when such training should occur, and to whom it ought to be targeted. Results-The results of thematic analyses suggest that PSP participants feel that contemporary approaches to improving mental health and resilience are lacking. While welcomed, the provision of sporadic one-off mental health and resilience programs by organizations was seen as insufficient, and the available organizational mental health supports were perceived as being questionable. The available programs also left participants feeling insufficiently prepared to deal with personal mental health problems and in discussing mental health concerns with co-workers. Conclusions-Participants reported needing more engaging methods for delivering information, career-long mental health knowledge acquisition, and a systems approach to improve the workplace culture, particularly regarding mental health.

Nature and Mindfulness to Cope with Work-Related Stress: A Narrative Review

In recent years, work-related stress has grown exponentially and the negative impact that this condition has on people's health is considerable. The effects of work-related stress can be distinguished in those that affect workers (e.g., depression and anxiety) and those that affect the company (e.g., absenteeism and productivity). It is possible to distinguish two types of prevention interventions. Individual interventions aim at promoting coping and individual resilience strategies with the aim of modifying cognitive assessments of the potential stressor, thus reducing its negative impact on health. Mindfulness techniques have been found to be effective stress management tools that are also useful in dealing with stressful events in the workplace. Organizational interventions modify the risk factors connected to the context and content of the work. It was found that a restorative workplace (i.e., with natural elements) reduces stress and fatigue, improving work performance. Furthermore, practicing mindfulness in nature helps to improve the feeling of wellbeing and to relieve stress. In this paper, we review the role of mindfulness-based practices and of contact with nature in coping with stressful situations at work, and we propose a model of coping with work-related stress by using mindfulness in nature-based practices.

Improvement in social anxiety following a return-to-work intervention for patients with depression

PURPOSE

To retrospectively examine depression and social anxiety improvement in patients on sick leave due to depression who participated in a return-to-work intervention (RTW-I) program.

METHODS

Patients visited a psychiatric outpatient clinic simulating workplaces to learn recurrence prevention skills through RTW-Is, including group cognitive behavioral therapy, from April 1, 2013, to September 30, 2017. The Beck Depression Inventory-Second Edition (BDI-II), Social Adaptation Self-Evaluation Scale (SASS), and Liebowitz Social Anxiety Scale (LSAS) scores of 112 patients were analyzed before and after the intervention program. Missing postprogram data were substituted using the last observation carried forward scores. Next, 45 patients who responded to the work continuity survey 1 year after RTW-I were categorized into Group A (patients who continued working: 37) and Group B (those who did not continue: 8).

RESULTS

The mean BDI-II scores significantly decreased from preintervention 19.4 to postintervention 7.9 (t = 13.303, P < .001). The mean SASS scores significantly increased from preintervention 31.9 to postintervention 36.0 (t = -5.953, P < .001). The mean LSAS scores significantly decreased from preintervention 54.7 to postintervention 37.0 (t = 8.682, P < .001), and all scores demonstrated an improvement. Patients who continued working showed improved depressive and social anxiety symptoms. The BDI-II and SASS scores showed no significant differences between the groups, but the postintervention LSAS scores were significantly different (P = .041). LSAS score changes: Group A = -26.2; Group B = -9.8; estimated difference: -17.920, 95% CI: -32.181 to -3.659, P = .015.

CONCLUSIONS

The RTW-I program improved depressive and social anxiety symptoms. Patients with improved scores continued working for 1 year after the intervention.Trial registration: This trial was retrospectively registered with the UMIN Clinical Trial Registry (UMIN-CTR) (ID: UMIN000037662) on August 10, 2019.

Reducing Psychosocial Risk Factors and Improving Employee Well-Being in Emergency Departments: A Realist Evaluation

This study reports the findings of a 2.5 year intervention project to reduce psychosocial risks and increase employee well-being in 15 emergency departments in the Netherlands. The project uses the psychosocial risk management approach "PRIMA" which includes cycles of risk assessment, designing and implementing changes, evaluating changes and adapting the approach if necessary. In addition, principles of participative action research were used to empower the departments in designing and implementing their own actions during the project. Next to determining overall effects, the study aims to assess potential moderators including the level of intervening (organization-directed or multilevel), process variables (the number and fit of actions to risk factors, communication and employee participation) and partaking in a Psychosocial Safety Climate intervention offered during the second half of the project. The results of linear mixed-model analyses showed that all job factors improved with the exception of autonomy, which did increase halfway the project but not when considering the entire timeframe. In addition, work engagement decreased and symptoms of burnout remained stable. Emergency departments that implemented more fitting actions, communicated better and involved their employees more in the process, had more favorable changes in job factors and more stable well-being. More activity (based on the number of actions implemented) and a multilevel approach regarding stress management did not lead to greater improvements. The Psychosocial Safety Climate intervention was effective in improving Psychosocial Safety Climate, but a longer follow-up period seems required to evaluate its effect on job factors and well-being. Overall, the project resulted in positive changes in most job factors, and its findings emphasize the importance of process variables in stress management interventions. Longer follow-up and higher quality multilevel interventions (including professional support for employees with stress-related complaints) seem essential to also improve well-being.

Compensation, Benefits, and Total Rewards: A Bird's-Eye (Re)View

Research on compensation and employee benefits has enjoyed a long and rich history. Energized by a new generation of scholars, changes in the broader workplace context, and developments in adjacent areas of inquiry, many classic theoretical tensions and research questions have begun to evolve in novel directions, and exciting new areas of research are developing. In addition, there have been numerous calls for more academic research on both compensation and benefits and for greater alignment of that research with the needs and interests of practice, including the tendency of many practitioners (and employees) to view pay and benefits holistically as a package. In this review we highlight selected recent research on key components of core total rewards—compensation plus retirement, health, and work-life benefits. Extrapolating from our review, we identify evolving themes and trends and advance several recommendations for future research and suggestions for practice.

Implementation of an organizational intervention to improve low-wage food service workers' safety, health and wellbeing: findings from the Workplace Organizational Health Study

BACKGROUND

Many organizational interventions aim to improve working conditions to promote and protect worker safety, health, and well-being. The Workplace Organizational Health Study used process evaluation to examine factors influencing implementation of an organizational intervention. This paper examines the extent to which the intervention was implemented as planned, the dose of intervention implemented, and ways the organizational context hindered or facilitated the implementation of the intervention.

METHODS

This proof-of-concept trial was conducted with a large, multinational company that provides food service through contractual arrangements with corporate clients. The 13-month intervention was launched in five intervention sites in October 2018. We report findings on intervention implementation based on process tracking and qualitative data. Qualitative data from 25 post-intervention interviews and 89 process tracking documents were coded and thematically analyzed.

RESULTS

Over the 13-month intervention, research team representatives met with site managers monthly to provide consultation and technical assistance on safety and ergonomics, work intensity, and job enrichment. Approximately two-thirds of the planned in-person or phone contacts occurred. We tailored the intervention to each site as we learned more about context, work demands, and relationships. The research team additionally met regularly with senior leadership and district managers, who provided corporate resources and guidance. By assessing the context of the food service setting in which the intervention was situated, we explored factors hindering and facilitating the implementation of the intervention. The financial pressures, competing priorities and the fast-paced work environment placed constraints on site managers' availability and limited the full implementation of the intervention.

CONCLUSIONS

Despite strong support from corporate senior leadership, we encountered barriers in the implementation of the planned intervention at the worksite and district levels. These included financial demands that drove work intensity; turnover of site and district managers disrupting continuity in the implementation of the intervention; and staffing constraints that further increased the work load and pace. Findings underscore the need for ongoing commitment and support from both the parent employer and the host client.

TRIAL REGISTRATION

This study was retrospectively registered with the Clinical Trials. Gov Protocol and Results System on June 2, 2021 with assigned registration number NCT04913168 .

A Participatory Interior Design Approach for a Restorative Work Environment: A Research-Intervention

Exposure to environmental stressors has physical and psychological consequences. A demanding physical environment involves the allocation of additional attentional resources and an increase in psycho-physical stress. This study illustrates the process of a research-intervention aimed at designing a workplace, using a participatory design approach, and considering the beneficial effect of restorative environments in reducing stressful elements and improving well-being at work. Stressful situations occur daily, compromising proper functioning while causing the occurrence of physiological and/or psychological disorders. To be able to safeguard their psycho-physical well-being, people normally adopt coping strategies, i.e., remedies that allow them to cope and manage situations that generate stress. One of these strategies is the exposure to natural environments, which promotes recovery and sustains psycho-physical well-being. The restorative properties of natural environments have been scientifically proven. However, even built spaces can be thought of as restorative environments, in particular when certain conditions are granted. An applied science, known as biophilic design, provides useful indications from this perspective. This project involved 57 employees of the Italian site of an international non-governmental organization, in the transition from a site no longer adequate to a new site requiring renovation. In a first phase, a survey was conducted, to verify the perceived quality of the current workplace and to detect the unmet workers' needs, and to assess some other important psychological constructs connected with perception of restorativeness and well-being. In a second phase, the findings emerged from the survey was analyzed in depth through a participatory interior design process, together with an interdisciplinary team of architects, technicians of the organization and environmental psychology researchers. The team, together with some representatives of employees, worked together through possible scenarios, adopting a biophilic design approach, to design the new workplace. At the end, the same survey of the first phase was conducted, to detect differences in perceived quality in the new workplace compared to the previous one.

[Violence Against Staff in Delivery Rooms - Results of an Online-Survey and Structured Interviews in Obstetric Clinics in Berlin]

INTRODUCTION

Violence against medical staff is a known problem in emergency departments. Nevertheless, there is little empirical data about physical and verbal violence against staff members in delivery rooms in Germany.

METHODS

This study comprises both quantitative and qualitative analyses. For the quantitative part, midwives and doctors working in delivery rooms in Berlin were asked to fill out a questionnaire about their experiences with violence within the last 6 months; this survey was completed between 15 November 2019 and 15 February 2020. For the qualitative part, structured interviews were conducted to investigate individual experiences of violence in more detail.

RESULTS

Out of 173 participants in total, 148 (86%) reported to have experienced verbal violence and 82 (47%) reported to have experienced physical violence. Midwives and younger staff seem to be more often affected by violence. 70% of the participants did not feel sufficiently prepared for situations of violence. In a total of 36 interviews, the participants specifically named communicative problems, too high expectations of the pregnant women and their companion, as well as language barrier and cultural differences as reasons for furthering violence.

CONCLUSION

Violence against staff is a relevant problem in delivery rooms in Berlin. Participants would welcome training to deal with violence and professional help for coming to terms with experiences of violence. Improved information about pregnancy and delivery, institutionalized translation, and more staff could possibly help to decrease frequency of violence.

Einfluss einer achtsamkeitsbasierten Depressionsbehandlung in einer Tagesklinik auf arbeitsbezogene Bewältigungsmuster bei depressiven Patientinnen und Patienten mit berufsbezogenen Konflikten

<b><i>Hintergrund:</i></b> Ziel der Studie war es, den Einfluss einer achtsamkeitsbasierten Depressionsbehandlung in einer Tagesklinik auf arbeitsbezogene Bewältigungsmuster bei Patientinnen und Patienten mit einer akuten depressiven Episode und berufsbezogenen Konflikten zu untersuchen. <b><i>Methode:</i></b> In einer Pilotstudie wurden 81 Patientinnen und Patienten mit einer mittelgradigen oder schweren depressiven Episode und berufsbezogenen Konflikten entweder einer tagesklinischen achtsamkeitsbasierten Depressionsbehandlung (mit psychopharmakologischer Medikation bei Bedarf, <i>N</i> = 47) oder einer Kontrollbedingung mit psychopharmakologischer Beratung (<i>N</i> = 34) zugeordnet. Arbeitsbezogene Bewältigungsstile und -muster wurden mit dem Fragebogen für arbeitsbezogenes Erlebens- und Verhaltensmuster (AVEM) zu drei Messzeitpunkten (Beginn, Ende und 8-Monats-Katamnese) untersucht, um gesundheitsgefährdende Risikomuster zu untersuchen. Zudem wurde die psychopathologische Symptombelastung anhand des Beck-Depressions-Inventars (BDI-II) und des Brief-Symptom-Inventory (BSI) gemessen. <b><i>Ergebnisse:</i></b> Die achtsamkeitsbasierte Depressionsbehandlung reduzierte die psychopathologische Symptombelastung signifikant und bewirkte eine positive Veränderung umschriebener gesundheitsgefährdender arbeitsbezogener Bewältigungsstile und Risikomuster hin zu gesundheitsförderlichen Bewältigungsstilen. <b><i>Diskussion:</i></b> Wenngleich Risikomuster durch die achtsamkeitsbasierte Depressionsbehandlung nur zum Teil abgebaut werden konnten, sind die Ergebnisse vielversprechend in Bezug auf gesundheitsförderliche Veränderungen einzelner arbeitsbezogener Bewältigungsstile wie “Verausgabungsbereitschaft”, “Perfektionsstreben”, “Distanzierungsfähigkeit” und “Innere Ruhe/Ausgeglichenheit”. <b><i>Schlussfolgerung:</i></b> Die psychiatrische Versorgung von Patientinnen und Patienten mit einer Depression sollte arbeitsbedingte Stressfaktoren und Konflikte und deren Bewältigung berücksichtigen. Das Behandlungskonzept schließt eine Lücke in der psychiatrischen Versorgung.

Burnout Subtypes: Psychological Characteristics, Standardized Diagnoses and Symptoms Course to Identify Aftercare Needs

Background

To better understand individual differences between burnout inpatients and improve individually tailored treatments in a psychiatric hospital, cluster analysis based on a number of self-report measures was used to investigate psychosocial characteristics of 96 participants.

Method

Group membership was analyzed regarding associations with standardized measures of psychiatric and personality disorders. Moreover, symptom levels of burnout, depression, and general mental health were used to characterize the groups and to observe differential trajectories at admission, discharge, and follow-up.

Results

As in previous research, we identified four subtypes that differed in comorbidity, psychological characteristics and treatment outcome. This calls for tailored interventions for the more vulnerable patients.

Conclusion

The replicated and enriched characterization of burnout inpatients can help to optimally meet the differential needs of burnout patients.

Effort-Reward Imbalance at Work and Overcommitment in Patients with Acute Myocardial Infarction (AMI): Associations with Return to Work 6 Months After AMI

Purpose Stress-related factors influence the adaptation to life after acute myocardial infarction (AMI), including return to work. The goal of this study was to investigate the effect of work-related stress, (expressed by the effort-reward imbalance (ERI) model) on return to work after AMI. Methods A longitudinal study with AMI patients was conducted in order to assess associations between the independent variables effort, reward, ERI and overcommitment and the outcome return to work after AMI. Return to work was inquired at 6 months follow-up. Logistic regression models were applied in the analysis. The fully-adjusted model included demographic, clinical, social, stress-related and health-related quality of life (HRQOL) covariables. Results Of the 346 enrolled patients aged 31 to 82 years, 239 (69.1%) were included in the regression analysis. In the unadjusted model ERI presented an odds ratio (OR) of 1.72 (95% confidence interval (CI) 0.86-3.42). Associations for effort and overcommitment were 0.98 (95% CI 0.83-1.15) and 1.09 (95% CI 0.99-1.18). However, reward showed a significantly inverse association with return to work with an OR of 0.90 (95% CI 0.83-0.99). In the fully adjusted model the OR of ERI decreased to 1.20 (95% CI 0.49-2.96). Effort, reward and overcommitment also showed attenuated ORs without significant results in all models. Diabetes mellitus, current smoking, low physical and low mental HRQOL presented significantly negative relations with return to work. Conclusions Work-related stress appears less important than HRQOL and resilience in terms of return to work after AMI.

More Than Just "Stressful"? Testing the Mediating Role of Fatigue on the Relationship Between Job Stress and Occupational Crashes of Long-Haul Truck Drivers

Introduction

Recent evidence consistently highlights the adverse work environment of long-haul professional drivers, whose task structure typically involves the performance of extensive shifts, driving under stressful working conditions. In this regard, job stress and fatigue - that are highly prevalent in this workforce - seem to play a crucial role in explaining this group's negative traffic safety outcomes. The aim of this study was to assess whether work-related fatigue is a mechanism that mediates the relationship between job stress, health indicators and occupational traffic crashes of long-haul truck drivers (LHTD).

Methods

The data used in this study were collected from 521 Spanish long-haul truck drivers (97% males) from all 17 regions of Spain, with a mean age of 47 years.

Results

Utilizing structural equation models (SEM), it was found that work-traffic crashes of long-haul truck drivers could be explained through work-related fatigue that exerts a full mediation between job stress (job strain), health-related factors and traffic crashes suffered during the previous two years.

Discussion

Overall, the findings of this research support that a) stressful working conditions and health issues of drivers have significant effects on traffic crashes, and b) fatigue is a mechanism relating stress-related factors and work-traffic crashes of long-haul drivers. This study highlights the need of stress- and fatigue-management policies and interventions, in order to reduce the crash risk of long-haul truck drivers.

A three-armed randomised controlled trial investigating the comparative impact of guidance on the efficacy of a web-based stress management intervention and health impairing and promoting mechanisms of prevention

Background

Web-based stress management interventions (SMI) fit increasingly digital lifestyles, reduce barriers of uptake and are easily scalable. SMIs might lower levels of stress in employees and thereby contribute to the prevention of depressive symptomatology. Different guidance formats can impact the efficacy of SMIs, with higher intensity assumed to result in larger effects. However, head-to-head comparisons of guidance formats are rare. This is the first trial to examine the impact of adherence-focused guidance compared to self-help on the efficacy of an occupational SMI compared to a wait list control condition. Additionally, it will be investigated if the SMI enfolds its impact on preventing depressive symptomatology by different pathways through reducing health impairing and increasing promoting factors.

Methods

A three-armed randomised controlled trial (RCT) on an occupational SMI was conducted. 404 employees with elevated levels of perceived stress (PSS-10 ≥ 22) were randomly assigned to: adherence-focused guidance (AFG), self-help (SH) or a wait list control group (WLC). The primary outcome was perceived stress (PSS-10). Secondary outcomes included health- and work-related measures. A parallel mediation analysis with stress and resilience as mediators for the effect on depression (CES-D) was carried out. Data collection took place at baseline (T1), after 7 weeks (T2) and 6 months (T3).

Results

The SMI was effective for all groups on the primary and secondary outcomes. For stress, analyses of covariance (ANCOVA) revealed significant group effects at T2 (F_2,400 = 36.08, P < .001) and T3 (F_2,400 = 37.04, P < .001) with large effect sizes for AFG (T2: d = 0.83; T3: d = 0.85) and SH (T2: d = 0.88; T3: d = 0.91) compared to WLC. No significant group differences were found for the efficacy between AFG and SH on the outcomes. Adherence in terms of completed modules was significantly higher for AFG compared to SH. The SMI’s impact on depression was mediated by perceived stress: a₁b₁ = − 0.77, 95% CI [− 1.26, − 0.34] and resilience: a₂b₂ = − 0.62, 95% CI [− 1.05, − 0.26].

Conclusions

The SMI was effective for reducing stress and improving other health- and work-related outcomes, irrespective of the guidance format. Results did not demonstrate superiority of adherence-focused guidance for the efficacy but for adherence in terms of completed modules. Among other reasons, better communication strategies about offered guidance and awareness-raising measures are discussed. Results from mediation analysis suggest that preventive SMIs should be designed to reach two goals: reducing the risk factor of stress and simultaneously increasing health promoting factors such as resilience.

Trial registration

German Clinical Trial Registration (DRKS) DRKS00005687, 6/6/2014.

Effects of a tailored multidisciplinary counselling intervention to support the adjustment process after a traumatic injury: a randomized controlled trial

PURPOSE

To investigate the efficacy of a tailored counselling intervention for injured workers regarding different aspects of subjective well-being.

MATERIALS AND METHODS

Prospective randomized controlled trial with 192 mildly-to-moderately injured workers who were on sick leave for at least 18 weeks and showed a high-risk profile for a complicated rehabilitation process in a screening. Patients were assessed at baseline, 12 and 18 months post-injury. The outcome variables concerned five aspects of subjective well-being (negative feelings, life and job satisfaction, satisfaction related to family and health). Both the control and the experimental group received conventional case management. Participants in the intervention group additionally received tailored workplace interventions and/or mental health counselling sessions.

RESULTS

Participants in the intervention group received an average of 2.23 (SD = 6.94) counselling sessions. Both groups showed a significant reduction (mean (95% CI) of negative feelings control group 2.6 (2.3-3.4), intervention group 2.4 (1.6-3.4)), with a significant difference in negative feelings between the groups (p = 0.01).

CONCLUSIONS

Our results suggest that a tailored counselling intervention has a modest long-term effect (d = 0.74) on negative feelings for mildly-to-moderately injured workers. However, future studies should evaluate the feasibility of this study's treatment approach.Implications for rehabilitationAccidents and the resulting injuries often cause a wide range of burdens including psychosocial and emotional distress as well as long-time sick leaves.Tailored counselling led to significant reductions of negative feelings in mildly-to-moderately injured workers over time.By showing that even conventional case management can have a beneficial effect on subjective wellbeing, the results of this study reaffirm the holistic biopsychosocial nature of injury rehabilitation.

Perceptions of social and work functioning are related to social anxiety and executive function in autistic adults

LAY ABSTRACT

Many autistic adults have trouble in social situations and at work. Researchers do not know exactly why autistic people might find it difficult in these environments, and no studies to date have looked the way anxiety or other cognitive processes might affect autistic peoples' ability to socialise and succeed in getting and keeping jobs. Anxiety (how much you worry) and difficulty with getting stuff done or switching attention (known as executive function) can be concerns for autistic people and may contribute to social and work difficulties. This study looked at the relationships between the way autistic people perceived their anxiety and executive functioning and their ability to socialise and work. Sixty-two autistic participants completed questionnaires related to their ability to socialise and work, their social anxiety and their executive function. We found that participants who thought that they had poorer ability to work also found themselves to have more difficulties with executive function and they were more socially anxious. Our results showed that how autistic participants perceived their social anxiety and executive function were important in their perception of their social skills and work ability. This study supports the idea that anxiety and executive function could be targeted in interventions to support autistic people and their social and work outcomes.

Evaluating the Effectiveness of a One-Week Multimodal Prevention Program for Slowing down and Stress Reduction Performed in a German Health Resort: Results of a Randomized Controlled Trial

BACKGROUND

Effective concepts are required to overcome the negative impact of daily stressful overwhelming. We investigated the effectiveness of a 1-week multimodal program for stress reduction.

METHODS

We performed a randomized controlled trial including adults with above-average stress level. The intervention consisted of health coaching, relaxation, physical activity, and balneotherapeutic elements. Individuals were randomized either to the intervention group (IG) or to one of the two control groups B and C. The main outcome was change in stress (Perceived Stress Questionnaire [PSQ], Screening Scale of Chronic Stress of the Trier Inventory for Chronic Stress [TICS-SSCS]) at 6 months post intervention; further outcomes were well-being (World Health Organization 5-Item Well-Being Index [WHO-5]) and health status (EuroQol visual analog scale [EQ-5D VAS]). Data were collected pre/post intervention as well as after 1, 3, and 6 months.

RESULTS

Data of 96 individuals (mean age 48.0 years, 74% female) were available for analyses. The IG improved overtime with -13.45 points for the PSQ and -6.44 points for the TICS-SSCS after 6 months. At 6-month follow-up the IG did not significantly differ from group B (PSQ: p = 0.2332; TICS-SSCS: p = 0.0805) or group C (PSQ: p = 0.0950; TICS-SSCS: p = 0.0607) when controlling for baseline (ANCOVA). Compared to group C, ANCOVA revealed significant differences in WHO-5 (p = 0.0292) and EQ-5D VAS (p = 0.0177) post intervention. At the 3- and 6-month follow-up and compared to group B, no substantial differences could be found for WHO-5 and EQ-5D VAS.

CONCLUSION

The results indicate that even a short-term multimodal program for stress reduction appears to set a positive trend towards less perceived and chronic stress.

The effectiveness of spiritual interventions in the workplace for work-related health outcomes: A systematic review and meta-analysis

AIM

To investigate the effectiveness of spiritual interventions in the workplace for different health outcomes through the use of a meta-analysis of randomized controlled trials.

BACKGROUND

Most studies including spirituality in the workplace investigated it at the organisational/business level, while giving a secondary value to the well-being and quality of life of the workers.

METHODS

Systematic review and meta-analysis carried out on the following databases: SCOPUS, PubMed and Web of Science. Spiritual interventions investigating work-related health outcomes were included. Then, meta-analyses were conducted.

RESULTS

From a total of 2,832 studies, 7 articles were included in the systematic review and 6 in the meta-analysis. Spiritual interventions, as compared to controls, improved the health outcomes of the workers (standard mean difference (SMD), -1.42; 95% CI, -1.98, -0.86; p < .001; I²  = 96%). Subanalyses revealed that yoga was an effective intervention and that stress was reduced by these interventions.

CONCLUSION

Spiritual interventions in the workplace seem to be effective in improving workers' health. Nevertheless, the high heterogeneity and limited number of studies may hinder more robust conclusions at the moment.

IMPLICATIONS FOR NURSING MANAGEMENT

The use of spiritual interventions should be considered in workplaces in order to reduce the stress and other negative outcomes.

Co-designing Behavior Change Resources With Treatment-Seeking Smokers: Engagement Events' Findings

Background: Primary care organizations are well-suited to help patients change their unhealthy behaviors. Evidence shows that risk communication and self-monitoring of behavior are is an effective strategy practitioners can use to promote health behavior change with their patients. In order for this evidence to be actionable, it is important to understand how patients would like this information to be communicated and to operationalize the self-monitoring resources. The objective of this study was to co-create resources that encourage behavior change based on the scientific evidence and from patients with lived experiences.

Materials and Methods: Twenty-seven individuals who participated in a smoking cessation program and engaged in at least one other unhealthy behavior joined one of two engagement events. Each event was 3 h in duration and consisted of two exercises that provided support to participants in reaching a consensus about the types of messages they would like to receive from their practitioner as well as self-monitoring resources they would prefer to use. The first exercise followed an adapted version of the Consensus Methodology developed by the Institute of Cultural Affairs Canada, while the second exercise was in accordance to the Nominal Group Technique.

Results: Participants' preference was to have practitioners convey messages to promote health behavior change that include positive affirmation and to monitor all their health behaviors using a single self-reported tracking sheet.

Conclusions: This paper features the use of engagement events to reflect upon and identify potential resources that treatment seeking smokers prefer to receive while attempting to modify unhealthy behaviors. These resources can be used by health care providers in primary care settings to support health promotion interventions and assist their patients to increase their likelihood of adopting positive changes to risk behaviors.

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

OBJECTIVES

Work related stress is a major occupational health problem that is associated with adverse effects on physical and mental health. Healthcare workers are particularly vulnerable in the era of COVID-19. Physical methods of stress relief such as yoga and massage therapy may reduce occupational stress. The objective of this systematic review and network meta-analysis is to determine the effects of yoga, massage therapy, progressive muscle relaxation, and stretching on alleviating stress and improving physical and mental health in healthcare workers.

METHODS

Databases were searched for randomized controlled trials on the use of physical relaxation methods for occupational stress in healthcare workers with any duration of follow-up. Meta-analysis was performed for standard mean differences in stress measures from baseline between subjects undergoing relaxation vs non-intervention controls. Network meta-analysis was conducted to determine the best relaxation method.

RESULTS

Fifteen trials representing 688 healthcare workers were identified. Random-effects meta-analysis shows that physical relaxation methods overall reduced measures of occupational stress at the longest duration of follow-up vs baseline compared to non-intervention controls (SMD -0.53; 95% CI [-0.74 to -0.33]; p < .00001). On network meta-analysis, only yoga alone (SMD -0.71; 95% CI [-1.01 to -0.41]) and massage therapy alone (SMD -0.43; 95% CI [-0.72 to -0.14]) were more effective than control, with yoga identified as the best method (p-score = .89).

CONCLUSION

Physical relaxation may help reduce occupational stress in healthcare workers. Yoga is particularly effective and offers the convenience of online delivery. Employers should consider implementing these methods into workplace wellness programs.

A randomized controlled trial to improve psychological detachment from work and well-being among employees: a study protocol comparing online CBT-based and mindfulness interventions

BACKGROUND

The changing landscape of the work environment, which often encompasses expectations of employees being continuously available, makes it difficult to disengage from work and recover. This can have a negative impact on employees' well-being, resulting in burnout, depression and anxiety, among other difficulties. The current study will test the effectiveness of two different online interventions (i.e., cognitive behavioral therapy; CBT and mindfulness-based stress reduction; MBSR) on employees' psychological detachment, burnout and other variables related to general (e.g., life satisfaction) and work-specific (e.g., work engagement) well-being.

METHODS/DESIGN

The study is designed as a randomized control trial with two intervention groups (i.e., CBT, MBSR) and a waitlist control group. Participants will be full-time employees from a wide range of organizations from Slovenia, who report moderate difficulties with psychological detachment from work and burnout and are not receiving any other form of treatment. The online interventions will encompass 12 sessions over 6 weeks (2 sessions per week); each session will include 1) an active audio-guided session and 2) home assignments, accompanied by handouts and worksheets. The study outcomes (i.e., psychological detachment, burnout, general and work-specific well-being), potential mechanisms (i.e., work-related maladaptive thinking patterns, mindfulness) and moderators (e.g., supervisor support for recovery) will be assessed immediately before and after the interventions (pre and post measurement) and 3 months after intervention completion (follow-up). Additionally, participants will fill out questionnaires for the assessment of the central mechanisms and study outcomes each week.

DISCUSSION

We expect that the CBT-based intervention will lead to greater improvements in psychological detachment from work and burnout compared to the MBSR and the waitlist control group. Additionally, we expect that the CBT-based intervention will also lead to greater enhancement of both general and work-related well-being.

TRIAL REGISTRATION

https://doi.org/10.1186/ISRCTN98347361 [May 19, 2020].