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.

Stress Management Interventions to Facilitate Psychological and Physiological Adaptation and Optimal Health Outcomes in Cancer Patients and Survivors.

Cancer diagnosis and treatment constitute profoundly stressful experiences involving unique and common challenges that generate uncertainty, fear, and emotional distress. Individuals with cancer must cope with multiple stressors, from the point of diagnosis through surgical and adjuvant treatments and into survivorship, that require substantial psychological and physiological adaptation. This can take a toll on quality of life and well-being and may also promote cellular and molecular changes that can exacerbate physical symptoms and facilitate tumor growth and metastasis, thereby contributing to negative long-term health outcomes. Since modifying responses tostressors might improve psychological and physiological adaptation, quality of life, and clinical health outcomes, several randomized controlled trials have tested interventions that aim to facilitate stress management. We review evidence for the effects of stress management interventions on psychological and physiological adaptation and health outcomes in cancer patients and survivors and summarize emerging research in the field to address unanswered questions.

Effectiveness and Moderators of an Internet-Based Mobile-Supported Stress Management Intervention as a Universal Prevention Approach: Randomized Controlled Trial.

BACKGROUND: Emerging evidence indicates the effectiveness of internet-based mobile-supported stress management interventions (iSMIs) in highly stressed employees. It is yet unclear, however, whether iSMIs are also effective without a preselection process in a universal prevention approach, which more closely resembles routine occupational health care. Moreover, evidence for whom iSMIs might be suitable and for whom not is scarce. OBJECTIVE: The aim of this study was to evaluate the iSMI GET.ON Stress in a universal prevention approach without baseline inclusion criteria and to examine the moderators of the intervention effects. METHODS: A total of 396 employees were randomly assigned to the intervention group or the 6-month waiting list control group. The iSMI consisted of 7 sessions and 1 booster session and offered no therapeutic guidance. Self-report data were assessed at baseline, 7 weeks, and at 6 months following randomization. The primary outcome was perceived stress. Several a priori defined moderators were explored as potential effect modifiers. RESULTS: Participants in the intervention group reported significantly lower perceived stress at posttreatment (d=0.71, 95% CI 0.51-0.91) and at 6-month follow-up (d=0.61, 95% CI 0.41-0.81) compared to those in the waiting list control group. Significant differences with medium-to-large effect sizes were found for all mental health and most work-related outcomes. Resilience (at 7 weeks, P=.04; at 6 months, P=.01), agreeableness (at 7 weeks, P=.01), psychological strain (at 6 months, P=.04), and self-regulation (at 6 months, P=.04) moderated the intervention effects. CONCLUSIONS: This study indicates that iSMIs can be effective in a broad range of employees with no need for preselection to achieve substantial effects. The subgroups that might not profit had extreme values on the respective measures and represented only a very small proportion of the investigated sample, thereby indicating the broad applicability of GET.ON Stress. TRIAL REGISTRATION: German Clinical Trials Register DRKS00005699; https://www.drks.de/DRKS00005699.

Delivery of a psychological intervention to assess and reduce workplace stress among intensive care staff.

INTRODUCTION: Intensive care staff have high levels of stress. We conducted a service improvement initiative to assess workplace stress levels among staff in one adult general intensive care unit and deliver a stress management intervention. METHODS: A psychological intervention of four stress management sessions, and fortnightly staff support drop-in groups, was developed and delivered within a year. Pre- and post-intervention, workplace stress in the unit was assessed using a Health and Safety Executive tool. RESULTS: Pre-intervention assessment of 76 (47.2%) staff indicated that improvement was needed in all domains of workplace stress. 125 staff (77.6%) participated in the intervention and gave positive ratings for content, relevance, practicality and personal value (median 4 (1-5); interquartile range 3.8-4.6). Post-intervention assessment of 71 staff (41.3%) demonstrated improvements in all workplace stress domains. CONCLUSION: A reduction in workplace stress was observed following a service improvement intervention in one intensive care unit although no causality can be assumed. Similar interventions should be evaluated using robust study designs.

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.

The Evaluation of a Mind-Body Intervention (MBT-T) for Stress Reduction in Academic Settings: A Pilot Study.

This study is aimed at evaluating the outcomes of mind-body transformation therapy (MBT-T), previously known as the creative psychosocial genomic healing experience© (CPGHE). The intervention was aimed at reducing the perceived level of stress in two non-clinical groups of students with different educational levels and different expertise in the domain of well-being. Whereas participants from the first group were first-year university students, participants from the second group were students attending a post-graduate program in psychotherapy. All participants (n = 159) were exposed to a single session of MBT-T, each group in a separate session. The results of two paired-samples t-tests, conducted separately on the two samples, showed that there was a statistically significant reduction in the participants' perceived level of stress between pre- and post-intervention states in both samples (t88 = 5.39, p < 0.001; t53 = 4.56, p < 0.001 respectively). The results, therefore, showed that a single session of MBT-T was beneficial in reducing the perceived level of stress in both first-year university students and students attending a post-graduate program in psychotherapy, regardless of educational level and expertise in the domain of well-being.

Efficacy of a Stress Management Intervention for Mothers of Children with Cancer.

OBJECTIVE: Mothers of children with cancer confront life stress that can impact their psychological and physical health and, in turn, the health of the family. Recommendations advocate preemptive stress-management interventions; however, few studies have investigated their efficacy. Here, we report results of a parallel randomized pilot trial examining health benefits of a stress management intervention designed to teach coping skills. METHODS: One hundred twenty mothers (age 36 ± 8 years) of children newly diagnosed with cancer were randomized to a 12-session stress management intervention (n = 60) or usual care (n = 60). Sessions took place in the inpatient or outpatient setting of a children's hospital. Primary outcome variables included psychological function and physical health assessed preintervention and postintervention and at 6-month follow-up (∼12 months postdiagnosis). RESULTS: Enrollment, retention, and satisfaction data supported feasibility and acceptability. Latent change score models showed the intervention reduced perceived stress (d = -0.37, p = 0.03), anxiety symptoms (ds = -0.38 and -0.56, ps < .03) and, a nonsignificant effect for depressive symptoms (d = -0.29, p = .11) across the 6 months following diagnosis. Intervention participants also endorsed fewer depressive symptoms than controls ∼12 months after diagnosis. The intervention improved stress management skills, which associated with the psychological benefits of participation. There were no intervention-related changes in perceived health or markers of inflammation. CONCLUSION: Intervention-related improvements in stress management skills may result in better psychological health in the face of caring for a child with cancer. TRIAL REGISTRATION: ClinicalTrials.gov identifier: NCT02022449.

Cognitive Behavioral Stress Management intervention in Mexican colorectal cancer patients: Pilot study.

OBJECTIVE: Determine the feasibility and the preliminary effects of brief cognitive behavioral stress management (CBSM) intervention, compared with psychoeducation (PE) group in posttraumatic stress, distress, optimism, and quality of life in patients with colorectal cancer. METHODS: Ninety-four patients were randomized: 40 in CBSM intervention and 54 in PE. They answered psychological questionnaires before and after the intervention and 3 months later for follow-up. RESULTS: Of the included participants, 23.40% (22) completed the sessions (11 in each group). A significant effect was obtained in the variable of optimism F2,28  = 4.0, P = 0.03, ƞ2p  = 0.22 and a significant interaction effect between the groups in the avoidance behavior F2,28  = 6.0, P = 0.01, ƞ2p  = 0.30 and hyperactivation F2,30  = 3.91, P = 0.03, ƞ2p  = 0.20, with a large effect size in both. A significant interaction effect was found in the quality of life symptoms subscale for patients with colorectal cancer with a stoma F3,20  = 21.8, P = 0.00, ƞ2p  = 0.68. CONCLUSIONS: The CBSM intervention and PE are feasible therapies, albeit with some modifications. Preliminary effects are observed in the dimensions of posttraumatic stress and symptoms of quality of life.

Smart Stress Care: Usability, Feasibility and Preliminary Efficacy of Fully Automated Stress Management Application for Employees.

OBJECTIVE: We developed a fully automated smartphone-based stress management application and explored its usability, potential feasibility, and preliminary efficacy for stress management in Korean employees. METHODS: Healthy employees working in large public enterprises were enrolled. Participants used our automated stress management application for four weeks. With the application, they monitored their stress level and life style factors. Personalized stress management techniques, including psychoeducation and cognitive behavioral technique, were also provided based on their stress level and lifestyle pattern. In 2014, additional relaxation techniques were incorporated. Participants' mental health status and lifestyle pattern were self-assessed at baseline and at 4 weeks after using the application. RESULTS: A total of 68 subjects were recruited. The application generally received high satisfaction rating. After the intervention, perceived stress level was significantly decreased, both in 2013 and 2014 (BEPSI-K score pre. vs. post. 14.27 vs. 11.00, F=12.49, p=0.001 in 2013; 12.05 vs. 10.00, F=17.18, p<0.001). In 2014, depression symptom severity was also significantly decreased (CES-D score pre- vs. Post-, 17.66 vs. 11.95, F=9.76, p=0.004). The effects were more significant in females and in those <35 years. CONCLUSION: Our fully automated stress management application is acceptable and usable, showing preliminary efficacy for reducing employees' stress levels.

Recovery from work-related stress: a randomized controlled trial of a stress management intervention in a clinical sample.

PURPOSE: Randomized controlled trials (RCTs) of interventions aimed at reducing work-related stress indicate that cognitive behavioural therapy (CBT) is more effective than other interventions. However, definitions of study populations are often unclear and there is a lack of interventions targeting both the individual and the workplace. The aim of this study was to determine whether a stress management intervention combining individual CBT and a workplace focus is superior to no treatment in the reduction of perceived stress and stress symptoms and time to lasting return to work (RTW) in a clinical sample. METHODS: Patients with work-related stress reactions or adjustment disorders were randomly assigned to an intervention group (n = 57, 84.2% female) or a control group (n = 80, 83.8% female). Subjects were followed via questionnaires and register data. The intervention contained individual CBT and the offer of a workplace meeting. We examined intervention effects by analysing group differences in score changes on the Perceived Stress Scale (PSS-10) and the General Health Questionnaire (GHQ-30). We also tested if intervention led to faster lasting RTW. RESULTS: Mean baseline values of PSS were 24.79 in the intervention group and 23.26 in the control group while the corresponding values for GHQ were 21.3 and 20.27, respectively. There was a significant effect of time. 10 months after baseline, both groups reported less perceived stress and improved mental health. 4 months after baseline, we found significant treatment effects for both perceived stress and mental health. The difference in mean change in PSS after 4 months was - 3.09 (- 5.47, - 0.72), while for GHQ it was - 3.91 (- 7.15, - 0.68). There were no group differences in RTW. CONCLUSIONS: The intervention led to faster reductions in perceived stress and stress symptoms amongst patients with work-related stress reactions and adjustment disorders. 6 months after the intervention ended there were no longer differences between the groups.

Long-Term Effectiveness of Stress Management at Work: Effects of the Changes in Perceived Stress Reactivity on Mental Health and Sleep Problems Seven Years Later.

The reduction of stress reactivity resulting from stress management interventions prevents disorders and improves mental health, however, its long-term sustainability has been little examined. The objective of this study was, therefore, to determine the effectiveness of a stress management intervention, designed to improve stress reactivity, for mental health and sleep problems seven years later, using longitudinal data from 101 male industrial workers. Linear regressions estimated the adjusted effects of the changes in stress reactivity in general as well as in its six subdimensions (work overload, social conflict, social stress, failure at work, and anticipatory and prolonged reactivity) on depression, anxiety, and sleep problems seven years later. The improvement of the prolonged reactivity had positive effects on depression, anxiety, and sleep problems (unstandardized regression coefficients [Bs] ≥ 0.35, all p-values ≤ 0.01). Depression and sleep problems were further improved by a reduction of the reactivity to social conflicts (Bs ≥ 0.29, p-values < 0.05), and an improvement in the overall reactivity score positively influenced sleep problems (B = 0.07, p = 0.017). In conclusion, the improvement of stress reactivity resulting from a work stress intervention was effective and generally long-lasting in preventing mental health and sleep problems. The reduction of the prolonged reactivity seems of particular importance and efficient in inhibiting negative stress manifestations.

Smart Stress Care: Usability, Feasibility and Preliminary Efficacy of Fully Automated Stress Management Application for Employees

OBJECTIVE: We developed a fully automated smartphone-based stress management application and explored its usability, potential feasibility, and preliminary efficacy for stress management in Korean employees. METHODS: Healthy employees working in large public enterprises were enrolled. Participants used our automated stress management application for four weeks. With the application, they monitored their stress level and life style factors. Personalized stress management techniques, including psychoeducation and cognitive behavioral technique, were also provided based on their stress level and lifestyle pattern. In 2014, additional relaxation techniques were incorporated. Participants’ mental health status and lifestyle pattern were self-assessed at baseline and at 4 weeks after using the application. RESULTS: A total of 68 subjects were recruited. The application generally received high satisfaction rating. After the intervention, perceived stress level was significantly decreased, both in 2013 and 2014 (BEPSI-K score pre. vs. post. 14.27 vs. 11.00, F=12.49, p=0.001 in 2013; 12.05 vs. 10.00, F=17.18, p < 0.001). In 2014, depression symptom severity was also significantly decreased (CES-D score pre- vs. Post-, 17.66 vs. 11.95, F=9.76, p=0.004). The effects were more significant in females and in those < 35 years. CONCLUSION: Our fully automated stress management application is acceptable and usable, showing preliminary efficacy for reducing employees’ stress levels.

The effects of stress management intervention for companions of patients with AIDS on psychological status and anti-viral treatment of patients with AIDS / 中华护理杂志

Objective To explore the effects of stress management intervention for companions of patients with AIDS on psychological status,quality of life and anti-viral treatment of patients with AIDS.Methods Totally 92 patients with AIDS and their companions were randomly divided into the experimental group and the control group,each with 46 cases.Both groups received routine nursing,the experimental group received stress management intervention for 4 months.Before and after intervention was complete,the GHQ-12 was used to assess the psychological status of companions in both groups.Morisky questionnaire,SF-12 and stigma scale were used to evaluate anti-viral treatment compliance,quality of life and stigma of patients in both groups.Results The differences in general health scores of two groups after 4 months were statistically significant.There were significant differences in scores of stigma,quality of life scores,anti-viral treatment adherence and anti-viral treatment between AIDS patients in two groups.Conclusion Stress management intervention for companions of patients with AIDS can significantly improve psychological status of companions,reduce the stigma of AIDS patients,improve the quality of life and anti-viral treatment adherence and the effects of anti-viral treatment for patients.

Web-based stress management for newly diagnosed cancer patients (STREAM-1): a randomized, wait-list controlled intervention study.

BACKGROUND: Being diagnosed with cancer causes major psychological distress, yet the majority of newly diagnosed cancer patients lack psychological support. Internet interventions overcome many barriers for seeking face-to-face support and allow for independence in time and place. We assess efficacy and feasibility of the first web-based stress management intervention (STREAM: STREss-Aktiv-Mindern) for newly diagnosed, German-speaking cancer patients. METHODS/DESIGN: In a prospective, wait-list controlled trial 120 newly diagnosed cancer patients will be included within 12 weeks of starting anti-cancer treatment and randomized between an immediate (intervention group) or delayed (control group) 8-week, web-based intervention. The intervention consists of eight modules with weekly written feedback by a psychologist ("minimal-contact") based on well-established stress management manuals including downloadable audio-files and exercises. The aim of this study is to evaluate efficacy in terms of improvement in quality of life (FACT-F), as well as decrease in anxiety and depression (HADS), as compared to patients in the wait-list control group. A sample size of 120 patients allows demonstrating a clinically relevant difference of nine points in the FACT score after the intervention (T2) with a two-sided alpha of 0.05 and 80 % power. As this is the first online stress management intervention for German-speaking cancer patients, more descriptive outcomes are equally important to further refine the group of patients with the largest potential for benefit who then will be targeted more specifically in future trials. These descriptive endpoints include: patients' characteristics (type of cancer, type of treatment, socio-demographic factors), dropout rate and dropout reasons, adherence and satisfaction with the program. DISCUSSION: New technologies open new opportunities: minimal-contact psychological interventions are becoming standard of care in several psychological disorders, where their efficacy is often comparable to face-to-face interventions. With our study we open this field to the population of newly diagnosed cancer patients. We will not only assess clinical efficacy but also further refine the target population who has the most potential to benefit. An internet-based minimal-contact stress management program might be an attractive, time- and cost-effective way to effectively deliver psychological support to newly diagnosed cancer patients and an opportunity to include those who currently are not reached by conventional support. TRIAL REGISTRATION: ClinicalTrials.gov NCT02289014 .