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There is an urgent need to provide evidence-based well-being and mental health support for front-line clinical staff managing the COVID-19 pandemic who are at risk of moral injury and mental illness. We describe the evidence base for a tiered model of care, and practical steps on its implementation.

Hospital workers are at high risk for stress-related mental health issues and are considered a vulnerable workforce in most Western countries. Although multilevel interventions that address individual and organizational factors show promise, there is limited robust evidence of their effectiveness in hospital settings. This study evaluated the SEEGEN trial, a cluster-randomized controlled trial conducted in the German healthcare sector, to assess the effectiveness of a structured multilevel intervention designed to reduce psychosocial stress and to promote mental well-being among hospital employees. The intervention included five modules that targeted different hierarchical levels, sources of interpersonal and structural stress, and potentially vulnerable life stages. These modules were: (i) top management training, (ii) dilemma management - coping by taking responsibility, (iii) promoting stress-preventive relational leadership competence, (iv) reconciling work and family life, and (v) staying healthy at work. The study was conducted at three clinical centers in Germany and included 18 clusters with a total of N = 415 participants. The clusters were randomly assigned to either an intervention or a wait-list control group. The primary outcome was psychological strain (Irritation Scale; IRR), and the secondary outcomes were mental well-being (WHO-5) and perceived psychosocial safety climate, (PSC-12). Intervention effects were estimated using a two-level linear analysis of covariance. Changes from baseline to the 11-month follow-up were analyzed. The intervention had no statistically significant effect on the primary or secondary outcomes. The lack of significant effects may be attributed to low participation rates, an insufficient intervention dosage, and contextual factors, such as the SARS-CoV-2 pandemic and staffing shortages in the participating hospitals. Although the intervention cannot currently be recommended for widespread implementation, the study provides valuable insights into developing, delivering, and overcoming the challenges of multilevel workplace interventions in healthcare settings.

Background In an effort to combat burnout, a study investigates Mindfulness-Based Stress Reduction (MBSR) training for nurses. The goal is to reduce stress and improve job satisfaction, ultimately enhancing patient care. These findings may inspire the development of mindfulness-based support systems for healthcare professionals to promote overall well-being in the workplace. Materials and methods A single-blinded, randomized controlled trial with 60 emergency medical center nurses was conducted to assess the effectiveness of an eight-session MBSR program in reducing stress and burnout. The randomization process, utilizing sealed envelopes, ensured unbiased allocation to intervention or control groups. The training program included group sessions focused on meditation, yoga, and discussions, with participants receiving educational materials and CDs for home practice. Collected data included demographics, Maslach Burnout Inventory, and Occupational Stress Questionnaire results. Statistical analysis, utilizing SPSS version 21, featured Kolmogorov-Smirnov, Mann–Whitney U, and Wilcoxon tests to evaluate outcomes. Results Following MBSR Training, the intervention group displayed statistically significant differences in all occupational stress subscales compared to the control group (P < 0.05). Post-intervention, the intervention group also exhibited significant differences in burnout subscale scores (P < 0.001) compared to the control group. Conclusion MBSR can boost resilience and job satisfaction, enhancing patient care. Healthcare organizations should integrate MBSR programs for nursing staff well-being and combat stress and burnout. Research should probe long-term impacts and effective delivery methods for sustained stress relief in nursing. Trial registration This study has registered in Iranian Registry of Clinical Trials by the number of IRCT20131112015390N5 on Jun 2022.

Background Depression associated with occupational stress is highly prevalent, causing high rates of sick leave and thus posing significant societal and economic burden. Meta-analyses of the few studies on psychological and work-focused interventions for common mental disorders including depression report small effects on depressive symptomatology and occupational outcomes. There is an urgent need for more controlled studies on work-directed interventions assessing work outcomes. Methods This is an interventional, multicentre, active-controlled, cluster-randomised, observer-blinded clinical trial with two parallel groups conducted in 6 clinical centres throughout Germany over the course of 3 years. A sample of 144 outpatients with work stress related depression will be cluster-randomised to either a specific interpersonal group intervention for depression and work stress (IPT-Work) or a nonspecific supportive group psychotherapy (SP). Each group consists of 10 sessions over 8 weeks of 90 min duration with 4–6 participants. Patients will be assessed at baseline, post-treatment and at 3 months follow-up. The primary endpoint is the relative change in HRSD-24 score from baseline to follow-up 3 months after end of treatment. Secondary outcome measures include the Occupational Depression Inventory (ODI), the Work Ability Index (WAI), the Return to Work Attitude (RTW-SE), the Effort-Reward-Imbalance (ERI), the Job Content Questionnaire 2 (JCQ2), and the Connor-Davidson Resilience Scale (CD-RISC). In addition, Quality of Life (WHOQOL-BREF) and days of sick leave throughout the study period will be assessed. Effects of treatment will be analysed with a linear mixed model for repeated measures including randomised arm, time point and their interaction as well as HRSD-24 baseline scores and their interaction with time point as fixed effects. Discussion Results will provide a comparison of a nonwork-directed psychological intervention and a specific, work-directed approach with respect to symptom improvement and increase in work ability. The aim is to improve quality of mental health care for depressed employees to facilitate recovery, improve work ability, and reduce the risk of long-term occupational incapacity. Ultimately, findings will inform the practice of the efficiency of using psychological group treatment in depressed individuals with work stress. Trial registration German Clinical Trials Register (DRKS00035259); prospectively registered on 15th January 2025.

Health care workers (HCWs) frequently face multiple stressors at work, particularly those working night shifts. HCWs who have experienced distress may find it difficult to adopt stress management approaches, even if they are aware of the effects of stress and coping processes. Therefore, an individualized intervention may be required to assist distressed HCWs in bridging the \"knowledge-practice\" gap in stress management and effectively alleviating stress symptoms. The main objective of this research was to compare the effects of a complex interactive multimodal intervention (CIMI) to self-guided stress management interventions on stress symptoms of distressed HCWs, as measured by physiological (heart rate variability), psychological (perceived stress, mental distress, and subjective happiness), and sleep disorder (fatigue and sleepiness) indicators. We conducted a nonrandomized, controlled study in 2 Chinese general hospitals. The participants in this study were 245 HCWs who fulfilled at least 1 of the 3 dimensions on the Depression, Anxiety, and Stress Scale. All eligible individuals were required to complete a questionnaire and wear a 24-hour Holter device to determine the physiological signs of stress as indexed by heart rate variability at both baseline and after the intervention. The CIMI group received a 12-week online intervention with 4 components-mobile stress management instruction, a web-based WeChat social network, personalized feedback, and a nurse coach, whereas the control group simply received a self-guided intervention. After a 12-week intervention, the Perceived Stress Scale (PSS) scores reduced significantly in the CIMI group (mean difference [MD] -5.31, 95% CI -6.26 to -4.37; P<.001) compared to the baseline levels. The changes in PSS scores before and after the intervention exhibited a significant difference between the CIMI and control groups (d=-0.64; MD -4.03, 95% CI -5.91 to -2.14; P<.001), and the effect was medium. In terms of physiological measures, both the control group (MD -9.56, 95% CI -16.9 to -2.2; P=.01) and the CIMI group (MD -8.45, 95% CI -12.68 to -4.22; P<.001) demonstrated a significant decrease in the standard deviation of normal-to-normal intervals (SDNN) within the normal clinical range; however, there were no significant differences between the 2 groups (d=0.03; MD 1.11, 95% CI -7.38 to 9.59; P=.80). The CIMI was an effective intervention for improving sleep disorders, as well as parts of the psychological stress measures in distressed HCWs. The findings provide objective evidence for developing a mobile stress management intervention that is adaptable and accessible to distressed HCWs, but its long-term effects should be investigated in future research. ClinicalTrials.gov NCT05239065; https://clinicaltrials.gov/ct2/show/NCT05239065.

ObjectivesJob stressors are known determinants of common mental disorders. Over the past 10 years, there has been evidence that job stressors may also be risk factors for suicidality. The current paper sought to examine this topic through the first comprehensive systematic review and meta-analysis of the literature to date.MethodsWe used a three-tier search strategy of seven electronic databases. Studies were included if they reported on a job stressor or job-related stress as an exposure and suicide ideation, self-harm, suicide attempt or suicide as an outcome. Two researchers independently screened articles. All extracted effect estimates were converted to log-transformed ORs.ResultsThere were 22 studies that were included in meta-analysis. Overall, exposure to job stressors was associated with elevated risk of suicide ideation and behaviours. The OR for suicide ideation (14 studies) ranged from 1.45 (95% CI 1.01 to 2.08) for poor supervisor and colleague support to 1.91 (95% CI 1.22 to 2.99) for job insecurity. For suicide (six studies), exposure to lower supervisor and collegial support produced an OR of 1.16 (95% CI 0.98 to 1.38), while low job control resulted in an OR of 1.23 (95% CI 1.00 to 1.50). There were only two studies that examined suicide attempt, both of which suggested an adverse effect of exposure to job stressors.ConclusionsThis study provides some evidence that job stressors may be related to suicidal outcomes. However, as most studies in the area were cross-sectional and observational in design, there is a need for longitudinal research to assess the robustness of observed associations.

Strategies and measures for fighting occupational stress in China are inadequate. This study aimed to determine the level of occupational stress in coal miners and to assess the associations between occupational stress and job burn-out, depression and hypertension. The results could provide clues for preventive measures and strategies to improve the psychological well-being of this population. Cross-sectional study. Xinjiang Coal Administration Bureau. Four coal mines were selected randomly (computer-generated random number-based selection process) from the 21 coal mines of Xinjiang, and all miners with >1 year of employment were screened for participation. A general demographic questionnaire, the Self-rating Depression Scale, the Effort-Reward Imbalance (ERI) model and the Maslach Burn-out Inventory. A total of 1400 questionnaires were collected, including 1334 (95.3%) valid questionnaires. This survey indicated that 1107 (83.0%) participants with an ERI score >1 (high occupational stress) and 227 (12.8%) had ERI ≤1. Severe depression was found in 21.7% of the participants. Job burn-out was positively correlated with occupational stress, which was, in turn, associated with depression. Multivariable linear regression analysis showed that depression (β=0.006, p=0.012), sex (β=0.358, p<0.001) and occupational stress (β=0.702, p<0.001) were independently associated with job burn-out. Working years (β=-0.086, p 0.015) and job burn-out (β=0.022, p 0.001) were directly associated with depression. This study highlights that occupational stress may affect job burn-out, depression symptoms and hypertension. A higher degree of occupational stress was associated with poorer mental status and hypertension.

COVID-19 pandemic led to major life changes. We assessed the psychological impact of COVID-19 on dental academics globally and on changes in their behaviors. We invited dental academics to complete a cross-sectional, online survey from March to May 2020. The survey was based on the Theory of Planned Behavior (TPB). The survey collected data on participants' stress levels (using the Impact of Event Scale), attitude (fears, and worries because of COVID-19 extracted by Principal Component Analysis (PCA), perceived control (resulting from training on public health emergencies), norms (country-level COVID-19 fatality rate), and personal and professional backgrounds. We used multilevel regression models to assess the association between the study outcome variables (frequent handwashing and avoidance of crowded places) and explanatory variables (stress, attitude, perceived control and norms). 1862 academics from 28 countries participated in the survey (response rate = 11.3%). Of those, 53.4% were female, 32.9% were <46 years old and 9.9% had severe stress. PCA extracted three main factors: fear of infection, worries because of professional responsibilities, and worries because of restricted mobility. These factors had significant dose-dependent association with stress and were significantly associated with more frequent handwashing by dental academics (B = 0.56, 0.33, and 0.34) and avoiding crowded places (B = 0.55, 0.30, and 0.28). Low country fatality rates were significantly associated with more handwashing (B = -2.82) and avoiding crowded places (B = -6.61). Training on public health emergencies was not significantly associated with behavior change (B = -0.01 and -0.11). COVID-19 had a considerable psychological impact on dental academics. There was a direct, dose-dependent association between change in behaviors and worries but no association between these changes and training on public health emergencies. More change in behaviors was associated with lower country COVID-19 fatality rates. Fears and stresses were associated with greater adoption of preventive measures against the pandemic.

Background The teaching profession, while rewarding, presents numerous challenges that can adversely affect teachers’ psychological well-being and occupational stress. This cross-sectional study aimed to assess the psychological well-being and occupational stress among secondary school teachers in Beni Municipality, Nepal, and identify its associated factors. Methods A total of 231 secondary school teachers were included through a census approach. Data were collected via face-to-face interviews using structured questionnaires, including the General Health Questionnaire-12 (GHQ-12) and Teacher Stress Scale (TSS). Bivariate analyses and multivariable logistic regression were performed to identify factors associated with psychological well-being and stress at a 5% level of significance. Results The study found that 60.2% of the teachers experienced psychological distress, while 51.1% reported occupational stress. Factors significantly associated with better psychological well-being included designated teaching level at the secondary level (aOR = 2.30, 95% CI: 1.15–4.56), satisfaction with job description and responsibilities (aOR = 2.37, 95% CI: 1.33–4.24), and occupational stress (aOR = 2.09, 95% CI: 1.16–3.78). In regard to occupational stress, teachers aged 50 years and above (aOR = 3.04, 95% CI: 1.15–8.01), dissatisfaction with salary (aOR = 2.78, 95% CI: 1.10–7.02), and perceiving their job as highly demanding (aOR = 6.50, 95% CI: 2.14–19.76) were significantly associated with higher levels of occupational stress. Conclusion This study reveals that a significant proportion of secondary school teachers in public schools of Nepal experience psychological distress and occupational stress, with key factors including job satisfaction, salary dissatisfaction, and perceived job demands associated with them. The findings underscore the need for targeted interventions to improve teachers’ well-being, such as improving salary structures, clarifying job roles, offering professional development, providing access to mental health support, and fostering a supportive school environment.

Lockdowns to control the spread of the coronavirus disease 2019 (COVID-19) have had profound effects on everyday life worldwide, but their effect on mental health remains unclear because available meta-analyses and reviews rely mostly on cross-sectional studies. We conducted a rapid review and meta-analysis of longitudinal studies and natural experiments investigating the relationship between COVID-19 lockdowns and mental health. A total of 25 studies involving 72 004 participants and 58 effect sizes were analyzed. Using a random effects model, we found that lockdowns had small effects on mental health symptoms, g = 0.17, s.e. = 0.05, 95% CI (0.06–0.24), p = 0.001, but the effects on positive psychological functioning, g = −0.12, s.e. = 0.11, 95% CI (−0.33 to 0.09), p = 0.27, were not significant. Multivariate analysis of effect sizes revealed significant and relatively small effect sizes for anxiety and depression, while those for social support, loneliness, general distress, negative affect, and suicide risk were not significant. The results indicated substantial heterogeneity among studies, but meta-regression analyses found no significant moderation effects for mean age, gender, continent, COVID-19 death rate, days of lockdown, publication status or study design. The psychological impact of COVID-19 lockdowns is small in magnitude and highly heterogeneous, suggesting that lockdowns do not have uniformly detrimental effects on mental health and that most people are psychologically resilient to their effects.