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Preventing occupational stress in healthcare workers

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Appendices

Appendix 1. Medline / Pubmed search strategy

25.11.2013

#1 "Health Personnel"[Majr] OR "health personnel"[tiab] OR "health care personnel"[tw] OR "healthcare personnel"[tw] OR "health care worker"[tw] OR "health care workers"[tw] OR "healthcare worker"[tw] OR "healthcare workers"[tw] OR "health worker"[tw] OR "health workers"[tw] OR "health professional"[tw] OR "health professionals"[tw] OR "health care professional"[tw] OR "health care professionals"[tw] OR "healthcare professional"[tw] OR "healthcare professionals"[tw] OR "medical care personnel"[tw] OR nurse[tiab] OR nurses[tiab] OR nursing[tw] OR physician[tiab] OR physicians[tiab]

#2 "Burnout, Professional"[Mesh] OR burnout[tiab] OR "psychological workload"[tw]

#3 "Stress, Psychological"[Mesh] OR "Anxiety"[Mesh:NoExp] OR "Depression"[Mesh] OR anxie*[tw] OR anxious*[tw] OR depress*[tw] OR stress*[tw] OR strain[tw] OR burden*[tw] OR "psychological load"[tw]

#4 work[tw] OR works*[tw] OR work'*[tw] OR worka*[tw] OR worke*[tw]OR workg*[tw] OR worki*[tw] OR workl*[tw] OR workp*[tw] OR occupation*[tw] OR job[tw] OR jobs [tw] OR employee*[tw]

#5 #3 AND #4

#6 (program* [tw] OR "prevention and control" [sh]) AND (occupational [tw] OR worker* [tw])

#7 (randomized controlled trial[pt] OR controlled clinical trial[pt] OR randomized controlled trials[mh] OR random allocation[mh] OR double‐blind method[mh] OR single‐blind method[mh] OR clinical trial[pt] OR clinical trials[mh] OR "clinical trial"[tw] OR ((singl*[tw] OR doubl*[tw] OR trebl*[tw] OR tripl*[tw]) AND (mask*[tw] OR blind*[tw])) OR "latin square"[tw] OR placebos[mh] OR placebo*[tw] OR random*[tw] OR research design[mh:noexp] OR comparative study[pt] OR evaluation studies as topic[mh] OR evaluation studies[pt] OR follow‐up studies[mh] OR prospective studies[mh] OR cross‐over studies[mh] OR control*[tw] OR prospectiv*[tw] OR volunteer*[tw]) NOT (animal[mh] NOT human[mh])

#8 "Costs and Cost Analysis"[Mesh] OR "economics"[MeSH Subheading] OR econom*[tiab] OR cost[tw] OR costs[tw]

#9 #1 AND (#2 OR #5) AND (#6 OR #7 OR #8)

Appendix 2. PsycINFO (ProQuest) search strategy

26.11.2013

#9 limit 8 to yr="2008 ‐Current"

#8 3 and 7

#7 4 or 5 or 6

#6 ((occupational or work or worker or workers or working or workplace or worksite or job) and (stress or strain or anxiety or anxious or depressive or depression or burden)).mp. [mp=title, abstract, heading word, table of contents, key concepts, original title, tests & measures]

#5 ("job stress" or burnout or "burn out").mp. [mp=title, abstract, heading word, table of contents, key concepts, original title, tests & measures]

#4 "Occupational Stress"/

#3 #1 or #2

#2 ("healthcare personnel" or "health care worker" or "health care workers" or "healthcare worker" or "healthcare workers" or "health worker" or "health workers" or "health professional" or "health professionals" or "healthcare professional" or "healthcare professionals" or nurses or nursing or physician or physicians or "medical care personnel").mp. [mp=title, abstract, heading word, table of contents, key concepts, original title, tests & measures]

#1 "Health Personnel"/ or "Allied Health Personnel"/ or "Medical Personnel"/ or "Mental Health Personnel"/

Appendix 3. NIOSHTIC‐2 search strategy

23.5.2012

DC{OUNIOS} AND GW{stress or burnout or strain or depress* or anxiety or anxious or burden or burn out} and GW{health care or healthcare* or health personnel or physician or physicians or nurse or nurses or nursing} and GW{random* or clinical or control* or double‐blind* or single‐blind* or placebo* or comparativ* or evaluat* or follow‐up* or cross‐over* or prospectiv*} and UD{> 201010}

2.12.2013

DC{OUNIOS} and GW{stress or burnout or strain or depress* or anxiety or anxious or burden or burn out} and GW{health care or healthcare* or health personnel or physician or physicians or nurse or nurses or nursing} and GW{random* or clinical or control* or double‐blind* or single‐blind* or placebo* or comparativ* or evaluat* or follow‐up* or cross‐over* or prospectiv*} and UD{> 201201}

Appendix 4. CENTRAL search strategy

2.12.2013

#1 burnout OR "burn out" OR "occupational stress" OR "job stress" OR "work stress" OR "work strain"

#2 (occupational stress) OR (job stress) OR (work stress) OR (work strain)

#3" health personnel" OR "healthcare personnel" OR "health care worker" OR "healthcare worker" OR "health worker" OR "health workers" OR "health professional" OR "health care professional"

#4 (nurse OR nurses OR nursing OR physician OR physicians):ti,ab,kw

#5 (#1 OR #2)

#6 (#3 OR #4)

#7 (#5 AND #6)

Appendix 5. CINAHL (EBSCO) search strategy

23.5.2012

#1 (MM "Health Personnel")

#2 TX "healthcare personnel" OR "health care worker" OR "health care workers" OR "healthcare worker" OR "healthcare workers" OR "health worker" OR "health workers" OR "health professional" OR "health professionals" OR "healthcare professional" OR "healthcare professionals"

#3 TI nurses OR nursing OR physician OR physicians OR "medical care personnel"

#4 AB nurses OR nursing OR physician OR physicians OR "medical care personnel"

#5 MH "Burnout, Professional"

#6 MH "Stress, Occupational"

#7 #1 or #2 OR #3 or #4

#8 "job stress" OR burnout OR "burn out"

#9 (occupational OR work OR worker OR workers OR working OR workplace OR worksite OR job) and (stress OR strain OR anxiety OR anxious OR depressive OR depression OR burden)

#10 #5 OR #6 OR #8 OR #9

#11 #7 AND #10

#12 random* OR clinical* OR control* OR double‐blind* OR single‐blind* OR placebo* OR comparativ* OR evaluat* OR follow‐up* OR cross‐over* OR prospectiv* OR volunteer*

#13 #11 AND #12

#14 #11 and #12 (Limiters ‐ Published Date from: 20101101‐20120531; Exclude MEDLINE records)

27.11.2013

#1 MM "Health Personnel"

#2 TX "healthcare personnel" OR "health care worker" OR "health care workers" OR "healthcare worker" OR "healthcare workers" OR "health worker" OR "health workers" OR "health professional" OR "health professionals" OR "healthcare professional" OR "healthcare professionals"

#3 TI nurses OR nursing OR physician OR physicians OR "medical care personnel"

#4 AB nurses OR nursing OR physician OR physicians OR "medical care personnel"

#5 MH "Burnout, Professional"

#6 MH "Stress, Occupational"

#7 S1 OR #2 OR #3 OR #4

#8 job stress OR burnout OR "burn out"

#9 (occupational OR work OR worker OR workers OR working OR workplace OR worksite OR job) and (stress OR strain OR anxiety OR anxious OR depressive OR depression OR burden)

#10 #5 OR #6 OR #8 OR #9

#11 #7 AND #10

#12 random* OR clinical* OR control* OR double‐blind* OR single‐blind* OR placebo* OR comparativ* OR evaluat* OR follow‐up* OR cross‐over* OR prospectiv* OR volunteer*

#13 #11 AND #12

#14 #11 AND #12 (Limiters ‐ Published Date: 20120101‐20131231; Exclude MEDLINE records)

Appendix 6. Web of Science search strategy

21.11.2013 (* = Databases=SCI‐EXPANDED, SSCI, A&HCI Timespan=All years)

#1 TS=("health personnel" OR "health care personnel" OR "healthcare personnel" OR "health care worker" OR "health care workers" OR "healthcare worker" OR "healthcare workers" OR "health worker" OR "health workers") *

#2 TS=("health professional" OR "health professionals" OR "health care professional" OR "health care professionals" OR "healthcare professional") *

#3 TS=("healthcare professionals" OR "medical care personnel") *

#4 #3 OR #2 OR #1 *

# 5 TS=(burnout OR "psychological workload") *

# 6 TS=(stress OR anxiety OR depression OR anxious OR depressive OR strain OR burden OR "psychological load") AND TS=(work OR works OR worker OR workers OR workplace OR worksite OR occupation OR occupational OR job OR jobs OR employee OR employees) *

#7 #6 OR #5 *

#8 #7 AND TS=(physician OR physicians OR nurse OR nurses OR nursing) *

#9 #7 AND #4 *

#10 #9 OR #8 *

#11 TS=(program* OR prevention OR control) AND TS=(occupational OR worker*) *

#12 #11 AND #10 *

#13 #10 AND TS=("randomized controlled trial" OR "controlled clinical trial" OR "randomized controlled trials" OR "random allocation" OR "double‐blind" OR "single‐blind" OR "clinical trial" OR "clinical trials" OR ((singl* OR doubl* OR trebl* OR tripl*) AND (mask* OR blind*)) OR "latin square" OR placebos OR placebo OR random* OR "comparative study" OR "evaluation studies" OR "follow‐up" OR "cross‐over" OR control* OR prospectiv* OR volunteer*) *

#14 #13 OR #12 *

#15 #14 (Databases=SCI‐EXPANDED, SSCI, A&HCI Timespan=2012‐2013)

Study flow diagram.
Figures and Tables -
Figure 1

Study flow diagram.

Risk of bias summary: review authors' judgements about each risk of bias item for each included study.
Figures and Tables -
Figure 2

Risk of bias summary: review authors' judgements about each risk of bias item for each included study.

Funnel plot of comparison: 1 Cognitive‐behavioural intervention vs no Intervention (SMD), outcome: 1.1 Any Stress‐related Outcome (follow‐up up to 1 month).
Figures and Tables -
Figure 3

Funnel plot of comparison: 1 Cognitive‐behavioural intervention vs no Intervention (SMD), outcome: 1.1 Any Stress‐related Outcome (follow‐up up to 1 month).

Funnel plot of comparison: 1 Cognitive‐behavioural intervention vs no Intervention (SMD), outcome: 1.2 Any Stress‐related Outcome (follow‐up 1 ‐ 6 months).
Figures and Tables -
Figure 4

Funnel plot of comparison: 1 Cognitive‐behavioural intervention vs no Intervention (SMD), outcome: 1.2 Any Stress‐related Outcome (follow‐up 1 ‐ 6 months).

Funnel plot of comparison: 3 Relaxation vs. no intervention (SMD), outcome: 3.2 Any stress outcome (follow‐up 1 ‐ 6 months).
Figures and Tables -
Figure 5

Funnel plot of comparison: 3 Relaxation vs. no intervention (SMD), outcome: 3.2 Any stress outcome (follow‐up 1 ‐ 6 months).

Comparison 1 Cognitive‐behavioural intervention vs no Intervention (SMD), Outcome 1 Any Stress‐related Outcome (follow‐up up to 1 month).
Figures and Tables -
Analysis 1.1

Comparison 1 Cognitive‐behavioural intervention vs no Intervention (SMD), Outcome 1 Any Stress‐related Outcome (follow‐up up to 1 month).

Comparison 1 Cognitive‐behavioural intervention vs no Intervention (SMD), Outcome 2 Any Stress‐related Outcome (follow‐up 1 ‐ 6 months).
Figures and Tables -
Analysis 1.2

Comparison 1 Cognitive‐behavioural intervention vs no Intervention (SMD), Outcome 2 Any Stress‐related Outcome (follow‐up 1 ‐ 6 months).

Comparison 1 Cognitive‐behavioural intervention vs no Intervention (SMD), Outcome 3 Any Stress‐related Outcome (follow‐up more than 6 months).
Figures and Tables -
Analysis 1.3

Comparison 1 Cognitive‐behavioural intervention vs no Intervention (SMD), Outcome 3 Any Stress‐related Outcome (follow‐up more than 6 months).

Comparison 1 Cognitive‐behavioural intervention vs no Intervention (SMD), Outcome 4 State‐Trait Anxiety Inventory (follow‐up up to 1 month).
Figures and Tables -
Analysis 1.4

Comparison 1 Cognitive‐behavioural intervention vs no Intervention (SMD), Outcome 4 State‐Trait Anxiety Inventory (follow‐up up to 1 month).

Comparison 1 Cognitive‐behavioural intervention vs no Intervention (SMD), Outcome 5 State‐Trait Anxiety Inventory (follow‐up 1 ‐ 6 months).
Figures and Tables -
Analysis 1.5

Comparison 1 Cognitive‐behavioural intervention vs no Intervention (SMD), Outcome 5 State‐Trait Anxiety Inventory (follow‐up 1 ‐ 6 months).

Comparison 1 Cognitive‐behavioural intervention vs no Intervention (SMD), Outcome 6 General Health Questionnaire (follow‐up up to 1 month).
Figures and Tables -
Analysis 1.6

Comparison 1 Cognitive‐behavioural intervention vs no Intervention (SMD), Outcome 6 General Health Questionnaire (follow‐up up to 1 month).

Comparison 2 Cognitive‐behavioural intervention vs. non‐stress management intervention (SMD), Outcome 1 Any stress scale (follow‐up 1 ‐ 6 months).
Figures and Tables -
Analysis 2.1

Comparison 2 Cognitive‐behavioural intervention vs. non‐stress management intervention (SMD), Outcome 1 Any stress scale (follow‐up 1 ‐ 6 months).

Comparison 2 Cognitive‐behavioural intervention vs. non‐stress management intervention (SMD), Outcome 2 Any stress scale (follow‐up more than 6 months).
Figures and Tables -
Analysis 2.2

Comparison 2 Cognitive‐behavioural intervention vs. non‐stress management intervention (SMD), Outcome 2 Any stress scale (follow‐up more than 6 months).

Comparison 2 Cognitive‐behavioural intervention vs. non‐stress management intervention (SMD), Outcome 3 Anxiety (follow‐up 1 ‐ 6 months).
Figures and Tables -
Analysis 2.3

Comparison 2 Cognitive‐behavioural intervention vs. non‐stress management intervention (SMD), Outcome 3 Anxiety (follow‐up 1 ‐ 6 months).

Comparison 3 Relaxation vs. no intervention (SMD), Outcome 1 Any stress outcome (follow‐up up to 1 month).
Figures and Tables -
Analysis 3.1

Comparison 3 Relaxation vs. no intervention (SMD), Outcome 1 Any stress outcome (follow‐up up to 1 month).

Comparison 3 Relaxation vs. no intervention (SMD), Outcome 2 Any stress outcome (follow‐up 1 ‐ 6 months).
Figures and Tables -
Analysis 3.2

Comparison 3 Relaxation vs. no intervention (SMD), Outcome 2 Any stress outcome (follow‐up 1 ‐ 6 months).

Comparison 3 Relaxation vs. no intervention (SMD), Outcome 3 Any stress outcome (follow‐up more than 6 months).
Figures and Tables -
Analysis 3.3

Comparison 3 Relaxation vs. no intervention (SMD), Outcome 3 Any stress outcome (follow‐up more than 6 months).

Comparison 3 Relaxation vs. no intervention (SMD), Outcome 4 State Anxiety (follow‐up 1 ‐ 6 months).
Figures and Tables -
Analysis 3.4

Comparison 3 Relaxation vs. no intervention (SMD), Outcome 4 State Anxiety (follow‐up 1 ‐ 6 months).

Comparison 3 Relaxation vs. no intervention (SMD), Outcome 5 Trait Anxiety (follow‐up 1 ‐ 6 months).
Figures and Tables -
Analysis 3.5

Comparison 3 Relaxation vs. no intervention (SMD), Outcome 5 Trait Anxiety (follow‐up 1 ‐ 6 months).

Comparison 3 Relaxation vs. no intervention (SMD), Outcome 6 General Health (follow‐up 1 ‐ 6 months).
Figures and Tables -
Analysis 3.6

Comparison 3 Relaxation vs. no intervention (SMD), Outcome 6 General Health (follow‐up 1 ‐ 6 months).

Comparison 4 Relaxation vs. other intervention (SMD), Outcome 1 Any stress outcome.
Figures and Tables -
Analysis 4.1

Comparison 4 Relaxation vs. other intervention (SMD), Outcome 1 Any stress outcome.

Comparison 4 Relaxation vs. other intervention (SMD), Outcome 2 Any anxiety outcome.
Figures and Tables -
Analysis 4.2

Comparison 4 Relaxation vs. other intervention (SMD), Outcome 2 Any anxiety outcome.

Comparison 4 Relaxation vs. other intervention (SMD), Outcome 3 General Health Questionnaire.
Figures and Tables -
Analysis 4.3

Comparison 4 Relaxation vs. other intervention (SMD), Outcome 3 General Health Questionnaire.

Comparison 5 Organisational intervention vs. no intervention (SMD), Outcome 1 Any stress‐related outcome (follow‐up up to 1 month).
Figures and Tables -
Analysis 5.1

Comparison 5 Organisational intervention vs. no intervention (SMD), Outcome 1 Any stress‐related outcome (follow‐up up to 1 month).

Comparison 5 Organisational intervention vs. no intervention (SMD), Outcome 2 Any stress‐related outcome RCTs (follow‐up 1 ‐ 6 months).
Figures and Tables -
Analysis 5.2

Comparison 5 Organisational intervention vs. no intervention (SMD), Outcome 2 Any stress‐related outcome RCTs (follow‐up 1 ‐ 6 months).

Comparison 5 Organisational intervention vs. no intervention (SMD), Outcome 3 Any stress‐related outcome (follow‐up more than 6 months).
Figures and Tables -
Analysis 5.3

Comparison 5 Organisational intervention vs. no intervention (SMD), Outcome 3 Any stress‐related outcome (follow‐up more than 6 months).

Comparison 5 Organisational intervention vs. no intervention (SMD), Outcome 4 General Health Questionnaire total score (follow‐up more than 6 months).
Figures and Tables -
Analysis 5.4

Comparison 5 Organisational intervention vs. no intervention (SMD), Outcome 4 General Health Questionnaire total score (follow‐up more than 6 months).

Comparison 6 Organisational intervention vs. other intervention (SMD), Outcome 1 Any stress‐related outcome (follow‐up up to 1 month).
Figures and Tables -
Analysis 6.1

Comparison 6 Organisational intervention vs. other intervention (SMD), Outcome 1 Any stress‐related outcome (follow‐up up to 1 month).

Comparison 6 Organisational intervention vs. other intervention (SMD), Outcome 2 Any stress‐related outcome (follow‐up 1 ‐ 6 months).
Figures and Tables -
Analysis 6.2

Comparison 6 Organisational intervention vs. other intervention (SMD), Outcome 2 Any stress‐related outcome (follow‐up 1 ‐ 6 months).

Comparison 6 Organisational intervention vs. other intervention (SMD), Outcome 3 Any stress‐related outcome (follow‐up more than 6 months).
Figures and Tables -
Analysis 6.3

Comparison 6 Organisational intervention vs. other intervention (SMD), Outcome 3 Any stress‐related outcome (follow‐up more than 6 months).

Comparison 6 Organisational intervention vs. other intervention (SMD), Outcome 4 General Health Questionnaire (total score).
Figures and Tables -
Analysis 6.4

Comparison 6 Organisational intervention vs. other intervention (SMD), Outcome 4 General Health Questionnaire (total score).

Comparison 7 Cognitive‐behavioural intervention vs. no intervention (MD), Outcome 1 Maslach Burnout Inventory (follow‐up up to 1 month).
Figures and Tables -
Analysis 7.1

Comparison 7 Cognitive‐behavioural intervention vs. no intervention (MD), Outcome 1 Maslach Burnout Inventory (follow‐up up to 1 month).

Comparison 7 Cognitive‐behavioural intervention vs. no intervention (MD), Outcome 2 Maslach Burnout Inventory (follow‐up 1 to 6 months).
Figures and Tables -
Analysis 7.2

Comparison 7 Cognitive‐behavioural intervention vs. no intervention (MD), Outcome 2 Maslach Burnout Inventory (follow‐up 1 to 6 months).

Comparison 8 Cognitive‐behavioural intervention and relaxation vs. no intervention (MD), Outcome 1 Maslach Burnout Inventory (follow‐up up to 1 month).
Figures and Tables -
Analysis 8.1

Comparison 8 Cognitive‐behavioural intervention and relaxation vs. no intervention (MD), Outcome 1 Maslach Burnout Inventory (follow‐up up to 1 month).

Comparison 9 Cognitive‐behavioural intervention vs. other intervention (MD), Outcome 1 Maslach Burnout Inventory (follow‐up more than 6 months).
Figures and Tables -
Analysis 9.1

Comparison 9 Cognitive‐behavioural intervention vs. other intervention (MD), Outcome 1 Maslach Burnout Inventory (follow‐up more than 6 months).

Comparison 10 Relaxation vs. no intervention (MD), Outcome 1 Maslach Burnout Inventory (follow‐up 1 ‐ 6 months).
Figures and Tables -
Analysis 10.1

Comparison 10 Relaxation vs. no intervention (MD), Outcome 1 Maslach Burnout Inventory (follow‐up 1 ‐ 6 months).

Comparison 11 Organisational intervention vs. no intervention (MD), Outcome 1 Maslach Burnout Inventory (follow‐up less than 1 month).
Figures and Tables -
Analysis 11.1

Comparison 11 Organisational intervention vs. no intervention (MD), Outcome 1 Maslach Burnout Inventory (follow‐up less than 1 month).

Comparison 11 Organisational intervention vs. no intervention (MD), Outcome 2 Maslach Burnout Inventory (follow‐up 1 ‐ 6 months).
Figures and Tables -
Analysis 11.2

Comparison 11 Organisational intervention vs. no intervention (MD), Outcome 2 Maslach Burnout Inventory (follow‐up 1 ‐ 6 months).

Comparison 11 Organisational intervention vs. no intervention (MD), Outcome 3 Maslach Burnout Inventory or Oldenburg Burnout Inventory (follow‐up more than 6 months).
Figures and Tables -
Analysis 11.3

Comparison 11 Organisational intervention vs. no intervention (MD), Outcome 3 Maslach Burnout Inventory or Oldenburg Burnout Inventory (follow‐up more than 6 months).

Comparison 12 Organisational intervention vs. other intervention (MD), Outcome 1 Maslach Burnout Inventory (follow‐up 1 ‐ 6 months).
Figures and Tables -
Analysis 12.1

Comparison 12 Organisational intervention vs. other intervention (MD), Outcome 1 Maslach Burnout Inventory (follow‐up 1 ‐ 6 months).

Comparison 13 Cognitive‐behavioural intervention vs. no Intervention (SUBGROUPS) (SMD), Outcome 1 Any Stress‐related Outcome (follow‐up up to 1 month).
Figures and Tables -
Analysis 13.1

Comparison 13 Cognitive‐behavioural intervention vs. no Intervention (SUBGROUPS) (SMD), Outcome 1 Any Stress‐related Outcome (follow‐up up to 1 month).

Comparison 13 Cognitive‐behavioural intervention vs. no Intervention (SUBGROUPS) (SMD), Outcome 2 Any Stress‐related Outcome (follow‐up 1 ‐ 6 months).
Figures and Tables -
Analysis 13.2

Comparison 13 Cognitive‐behavioural intervention vs. no Intervention (SUBGROUPS) (SMD), Outcome 2 Any Stress‐related Outcome (follow‐up 1 ‐ 6 months).

Comparison 14 Relaxation vs. no intervention (SUBGROUPS) (SMD), Outcome 1 Any stress outcome (follow‐up to 1 month).
Figures and Tables -
Analysis 14.1

Comparison 14 Relaxation vs. no intervention (SUBGROUPS) (SMD), Outcome 1 Any stress outcome (follow‐up to 1 month).

Comparison 14 Relaxation vs. no intervention (SUBGROUPS) (SMD), Outcome 2 Any stress outcome (follow‐up 1 ‐ 6 months).
Figures and Tables -
Analysis 14.2

Comparison 14 Relaxation vs. no intervention (SUBGROUPS) (SMD), Outcome 2 Any stress outcome (follow‐up 1 ‐ 6 months).

Summary of findings for the main comparison. Cognitive‐behavioural intervention compared to no Intervention for reducing stress

Cognitive‐behavioural intervention compared to no Intervention for reducing stress

Patient or population: Healthcare workers
Settings: Health Care
Intervention: Cognitive‐behavioural intervention
Comparison: No Intervention (SMD)

Outcomes

Illustrative comparative risks* (95% CI)

Relative effect
(95% CI)

No of Participants
(studies)

Quality of the evidence
(GRADE)

Comments

Assumed risk

Corresponding risk

No Intervention

Cognitive‐behavioural intervention

Stress 1 Month
Various Measurement Instruments
Follow‐up: 0 ‐ 1 month

The median stress level across all control groups across all follow‐up times was 24.33 points on the Emotional Exhaustion subscale of the Maslach Burnout Inventory¹

The mean stress level at 1 month in the intervention groups was 1.22 points lower (2.98 lower to 0.59 higher).

SMD ‐0.27 (‐0.66 to 0.13)

332
(6 studies)

⊕⊕⊝⊝
low²,³

This meta‐analysis was back transformed to the EE subscale of the MBI by using the median SD of the EE scale across control groups.

Stress 1 ‐ 6 months
Various Instruments. Scale from: 0 to 2.
Follow‐up: 1 ‐ 6 months

The median stress level across all control groups across all follow‐up times was 24.33 points on the Emotional Exhaustion subscale of the Maslach Burnout Inventory¹

The mean stress at 1 ‐ 6 months in the intervention groups was 1.83 points lower (0.77 to 2.85 lower).

SMD ‐0.38 (‐0.59 to ‐0.16)

549
(8 studies)

⊕⊕⊝⊝

low²,³

This meta‐analysis was back transformed to the EE subscale of the MBI by using the median SD of the EE scale across control groups.

Stress > 6 months
Various Instruments
Follow‐up: > 6 months

The median stress level across all control groups across all follow‐up times was 24.33 points on the Emotional Exhaustion subscale of the Maslach Burnout Inventory¹

The mean stress at more than 6 months in the intervention groups was 11.34 points lower (4.47 to 14.94 lower)

SMD ‐1.04 (‐1.37 to ‐0.70)

157
(2 studies)

⊕⊕⊝⊝

low²,³

This meta‐analysis was back transformed to the EE subscale of the MBI by using the median SD of the EE scale across control groups.

*The basis for the assumed risk (e.g. the median control group risk across studies) is provided in footnotes. The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI).
CI: Confidence interval

GRADE Working Group grades of evidence
High quality: Further research is very unlikely to change our confidence in the estimate of effect.
Moderate quality: Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate.
Low quality: Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate.
Very low quality: We are very uncertain about the estimate.

1 This was the median from the control groups of all studies that measured the effect of CBT vs. no intervention on Emotional Exhaustion with the same scale.
2 Most studies were at a high risk of bias
3 Publication bias detected with funnel plot

Figures and Tables -
Summary of findings for the main comparison. Cognitive‐behavioural intervention compared to no Intervention for reducing stress
Summary of findings 2. Relaxation compared to no intervention (SMD) for reducing stress

Relaxation compared to no intervention (SMD) for

Patient or population: Healthcare workers
Settings: Health care
Intervention: Relaxation
Comparison: No intervention (SMD)

Outcomes

Illustrative comparative risks* (95% CI)

Relative effect
(95% CI)

No of Participants
(studies)

Quality of the evidence
(GRADE)

Comments

Assumed risk

Corresponding risk

no intervention (SMD)

Relaxation

Stress 1 month

The median stress level across all control groups across all follow‐up times was 22.17 points on the Emotional Exhaustion subscale of the Maslach Burnout Inventory¹

The mean stress at 1 month in the intervention groups was 2.14 points lower (0.36 to 3.96 lower).

SMD ‐0.48 (‐0.89 to ‐0.08)

97
(4 studies)

⊕⊕⊝⊝

low

This meta‐analysis was back transformed to the EE subscale of the MBI by using the median SD of the EE scale across control groups.

Stress 1 ‐ 6 months

The median stress level across all control groups across all follow‐up times was 22.17 points on the Emotional Exhaustion subscale of the Maslach Burnout Inventory¹

The mean stress at 1 ‐ 6 months in the intervention groups was 4.84 points lower (2.37 to 6.92 lower).

SMD ‐0.49 (‐0.78 to ‐0.21)

521
(12 studies)

⊕⊕⊕⊝

moderate

This meta‐analysis was back transformed to the EE subscale of the MBI by using the median SD of the EE scale across control groups.

Stress > 6 months

The median stress level across all control groups across all follow‐up times was 22.17 points on the Emotional Exhaustion subscale of the Maslach Burnout Inventory¹

The mean stress at > 6 months in the intervention groups was 5.67 points lower (3.39 to 7.95 lower).

SMD ‐1.89 (‐2.65 to ‐1.13)

40
(1 study)

⊕⊕⊝⊝

low

This result was back transformed to the EE subscale of the MBI by using the median SD of the EE scale across control groups.

*The basis for the assumed risk (e.g. the median control group risk across studies) is provided in footnotes. The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI).
CI: Confidence interval;

GRADE Working Group grades of evidence
High quality: Further research is very unlikely to change our confidence in the estimate of effect.
Moderate quality: Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate.
Low quality: Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate.
Very low quality: We are very uncertain about the estimate.

1 This was the median from the control groups of all studies that measured the effect of relaxation vs. no intervention on Emotional Exhaustion with the same scale.

Figures and Tables -
Summary of findings 2. Relaxation compared to no intervention (SMD) for reducing stress
Table 1. GRADE assessment

Comparison

Risk of Bias

Inconsistency

Indirectness

Imprecision

Publication

Bias

Level of Evidence

CBT vs

no intervention

1 mo follow‐up

5 out of 6 studies

high risk of bias:

1 level down

I² = 64%:

no downgrading

No

332 participants

No downgrading

Yes in funnel

plot:

1 level down

Low Quality

CBT vs

no intervention

1 ‐ 6 mo follow‐up

5 out of 8 studies

high risk of bias:

1 level down

I² = 54%:

no downgrading

No

549 participants

No downgrading

Yes in funnel

plot:

1 level down

Low Quality

CBT vs

no intervention

> 6 months follow‐up

2 studies

high risk of bias:

1 level down

I² = 38%:

no downgrading

No

157 participants

1 level down

Not apparent

Low Quality

Relaxation

vs no intervention

1 mo follow‐up

3 out 4 studies

high risk of bias:

1 level down

I² = 0%:

no downgrading

No

97 participants

1 level down

Not apparent

Low Quality

Relaxation

vs no intervention

1 ‐ 6 mo follow‐up

10 out of 13 studies

high risk of bias:

1 level down

I² = 57%:

no downgrading

No

521 participants

no downgrading

Not apparent

Moderate Quality

Relaxation vs

no intervention

> 6 mo follow‐up

1 study:

no downgrading

N/A

No

40 participants

2 levels down

Not apparent

Low Quality

Figures and Tables -
Table 1. GRADE assessment
Comparison 1. Cognitive‐behavioural intervention vs no Intervention (SMD)

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Any Stress‐related Outcome (follow‐up up to 1 month) Show forest plot

7

332

Std. Mean Difference (IV, Random, 95% CI)

‐0.27 [‐0.66, 0.13]

1.1 Cognitive‐behavioural intervention only vs. no intervention

4

248

Std. Mean Difference (IV, Random, 95% CI)

‐0.25 [‐0.60, 0.11]

1.2 Cognitive‐behavioural intervention and relaxation vs. no intervention

3

84

Std. Mean Difference (IV, Random, 95% CI)

‐0.45 [‐1.61, 0.70]

2 Any Stress‐related Outcome (follow‐up 1 ‐ 6 months) Show forest plot

8

549

Std. Mean Difference (IV, Random, 95% CI)

‐0.38 [‐0.59, ‐0.16]

2.1 Cognitive‐behavioural intervention only vs. no intervention

6

439

Std. Mean Difference (IV, Random, 95% CI)

‐0.28 [‐0.47, ‐0.09]

2.2 Cognitive‐behavioural intervention and relaxation vs. no intervention

2

110

Std. Mean Difference (IV, Random, 95% CI)

‐0.78 [‐1.38, ‐0.18]

3 Any Stress‐related Outcome (follow‐up more than 6 months) Show forest plot

2

157

Std. Mean Difference (IV, Fixed, 95% CI)

‐1.04 [‐1.37, ‐0.70]

3.1 Cognitive‐behavioural intervention with or without relaxation vs. no intervention

2

157

Std. Mean Difference (IV, Fixed, 95% CI)

‐1.04 [‐1.37, ‐0.70]

4 State‐Trait Anxiety Inventory (follow‐up up to 1 month) Show forest plot

3

Mean Difference (IV, Random, 95% CI)

Subtotals only

4.1 CBT and relaxation vs. no intervention State Anxiety

3

135

Mean Difference (IV, Random, 95% CI)

‐11.07 [‐18.39, ‐3.75]

4.2 CBT and relaxation vs. no intervention Trait Anxiety

3

135

Mean Difference (IV, Random, 95% CI)

‐8.36 [‐10.02, ‐6.70]

5 State‐Trait Anxiety Inventory (follow‐up 1 ‐ 6 months) Show forest plot

1

Mean Difference (IV, Fixed, 95% CI)

Totals not selected

5.1 CBT and relaxation vs. no intervention State Anxiety

1

Mean Difference (IV, Fixed, 95% CI)

0.0 [0.0, 0.0]

5.2 CBT and relaxation vs. no intervention Trait Anxiety

1

Mean Difference (IV, Fixed, 95% CI)

0.0 [0.0, 0.0]

6 General Health Questionnaire (follow‐up up to 1 month) Show forest plot

1

Mean Difference (IV, Fixed, 95% CI)

Totals not selected

6.1 CBT and relaxation vs. no intervention

1

Mean Difference (IV, Fixed, 95% CI)

0.0 [0.0, 0.0]

Figures and Tables -
Comparison 1. Cognitive‐behavioural intervention vs no Intervention (SMD)
Comparison 2. Cognitive‐behavioural intervention vs. non‐stress management intervention (SMD)

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Any stress scale (follow‐up 1 ‐ 6 months) Show forest plot

2

83

Std. Mean Difference (IV, Random, 95% CI)

‐0.54 [‐1.16, 0.08]

2 Any stress scale (follow‐up more than 6 months) Show forest plot

1

Std. Mean Difference (IV, Random, 95% CI)

Totals not selected

3 Anxiety (follow‐up 1 ‐ 6 months) Show forest plot

1

Mean Difference (IV, Fixed, 95% CI)

Totals not selected

3.1 CBT vs. passive support by a psychologist

1

Mean Difference (IV, Fixed, 95% CI)

0.0 [0.0, 0.0]

Figures and Tables -
Comparison 2. Cognitive‐behavioural intervention vs. non‐stress management intervention (SMD)
Comparison 3. Relaxation vs. no intervention (SMD)

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Any stress outcome (follow‐up up to 1 month) Show forest plot

4

97

Std. Mean Difference (IV, Random, 95% CI)

‐0.48 [‐0.89, ‐0.08]

1.1 Physical relaxation (follow‐up up to 1 month)

4

97

Std. Mean Difference (IV, Random, 95% CI)

‐0.48 [‐0.89, ‐0.08]

2 Any stress outcome (follow‐up 1 ‐ 6 months) Show forest plot

12

521

Std. Mean Difference (IV, Random, 95% CI)

‐0.49 [‐0.78, ‐0.21]

2.1 Mental relaxation

6

205

Std. Mean Difference (IV, Random, 95% CI)

‐0.50 [‐1.15, 0.15]

2.2 Physical relaxation

6

316

Std. Mean Difference (IV, Random, 95% CI)

‐0.47 [‐0.70, ‐0.24]

3 Any stress outcome (follow‐up more than 6 months) Show forest plot

1

Std. Mean Difference (IV, Fixed, 95% CI)

Totals not selected

3.1 Mental relaxation

1

Std. Mean Difference (IV, Fixed, 95% CI)

0.0 [0.0, 0.0]

4 State Anxiety (follow‐up 1 ‐ 6 months) Show forest plot

1

66

Mean Difference (IV, Fixed, 95% CI)

‐7.79 [‐11.24, ‐4.34]

4.1 Mental relaxation vs. no intervention

1

33

Mean Difference (IV, Fixed, 95% CI)

‐8.74 [‐13.94, ‐3.54]

4.2 Physical relaxation vs. no intervention

1

33

Mean Difference (IV, Fixed, 95% CI)

‐7.04 [‐11.65, ‐2.43]

5 Trait Anxiety (follow‐up 1 ‐ 6 months) Show forest plot

1

66

Mean Difference (IV, Fixed, 95% CI)

‐1.09 [‐4.53, 2.36]

5.1 Mental relaxation vs. no intervention

1

33

Mean Difference (IV, Fixed, 95% CI)

‐2.41 [‐6.93, 2.11]

5.2 Physical relaxation vs. no intervention

1

33

Mean Difference (IV, Fixed, 95% CI)

0.75 [‐4.58, 6.08]

6 General Health (follow‐up 1 ‐ 6 months) Show forest plot

2

Mean Difference (IV, Fixed, 95% CI)

Subtotals only

6.1 Mental relaxation vs. no intervention

1

33

Mean Difference (IV, Fixed, 95% CI)

‐7.10 [‐11.39, ‐2.81]

6.2 Physical relaxation vs. no intervention

2

70

Mean Difference (IV, Fixed, 95% CI)

‐3.22 [‐6.53, 0.08]

Figures and Tables -
Comparison 3. Relaxation vs. no intervention (SMD)
Comparison 4. Relaxation vs. other intervention (SMD)

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Any stress outcome Show forest plot

4

Std. Mean Difference (IV, Fixed, 95% CI)

Totals not selected

1.1 Mental relaxation training vs. training on theory analysis (follow‐up 1 ‐ 6 months)

1

Std. Mean Difference (IV, Fixed, 95% CI)

0.0 [0.0, 0.0]

1.2 Mental relaxation vs. relaxing in a chair (follow‐up to 1 month)

1

Std. Mean Difference (IV, Fixed, 95% CI)

0.0 [0.0, 0.0]

1.3 Physical relaxation vs. break (follow‐up to 1 month)

2

Std. Mean Difference (IV, Fixed, 95% CI)

0.0 [0.0, 0.0]

2 Any anxiety outcome Show forest plot

1

Std. Mean Difference (IV, Random, 95% CI)

Totals not selected

2.1 AMMA touch therapy vs. touch therapy without intent (follow‐up to 1 month)

1

Std. Mean Difference (IV, Random, 95% CI)

0.0 [0.0, 0.0]

3 General Health Questionnaire Show forest plot

1

Std. Mean Difference (IV, Fixed, 95% CI)

Totals not selected

3.1 Physical relaxation training vs. training on theory analysis (follow‐up 1 ‐ 6 months)

1

Std. Mean Difference (IV, Fixed, 95% CI)

0.0 [0.0, 0.0]

Figures and Tables -
Comparison 4. Relaxation vs. other intervention (SMD)
Comparison 5. Organisational intervention vs. no intervention (SMD)

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Any stress‐related outcome (follow‐up up to 1 month) Show forest plot

3

Std. Mean Difference (IV, Fixed, 95% CI)

Totals not selected

1.1 Support

1

Std. Mean Difference (IV, Fixed, 95% CI)

0.0 [0.0, 0.0]

1.2 Communication skills

1

Std. Mean Difference (IV, Fixed, 95% CI)

0.0 [0.0, 0.0]

1.3 Special Care RCTs

1

Std. Mean Difference (IV, Fixed, 95% CI)

0.0 [0.0, 0.0]

2 Any stress‐related outcome RCTs (follow‐up 1 ‐ 6 months) Show forest plot

5

Std. Mean Difference (IV, Fixed, 95% CI)

Subtotals only

2.1 Working conditions RCTs

2

525

Std. Mean Difference (IV, Fixed, 95% CI)

‐0.12 [‐0.30, 0.05]

2.2 Special Care RCTs

1

71

Std. Mean Difference (IV, Fixed, 95% CI)

‐0.13 [‐0.60, 0.33]

2.3 Support RCTs

2

952

Std. Mean Difference (IV, Fixed, 95% CI)

0.07 [‐0.09, 0.23]

3 Any stress‐related outcome (follow‐up more than 6 months) Show forest plot

4

Std. Mean Difference (IV, Fixed, 95% CI)

Totals not selected

3.1 Working conditions RCTs

1

Std. Mean Difference (IV, Fixed, 95% CI)

0.0 [0.0, 0.0]

3.2 Working conditions CCTs

1

Std. Mean Difference (IV, Fixed, 95% CI)

0.0 [0.0, 0.0]

3.3 Special Care RCTs

1

Std. Mean Difference (IV, Fixed, 95% CI)

0.0 [0.0, 0.0]

3.4 Support RCTs

1

Std. Mean Difference (IV, Fixed, 95% CI)

0.0 [0.0, 0.0]

4 General Health Questionnaire total score (follow‐up more than 6 months) Show forest plot

1

Mean Difference (IV, Fixed, 95% CI)

Totals not selected

Figures and Tables -
Comparison 5. Organisational intervention vs. no intervention (SMD)
Comparison 6. Organisational intervention vs. other intervention (SMD)

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Any stress‐related outcome (follow‐up up to 1 month) Show forest plot

1

Std. Mean Difference (IV, Fixed, 95% CI)

Totals not selected

1.1 Special care vs. usual training and support RCTs

1

Std. Mean Difference (IV, Fixed, 95% CI)

0.0 [0.0, 0.0]

2 Any stress‐related outcome (follow‐up 1 ‐ 6 months) Show forest plot

1

Std. Mean Difference (IV, Fixed, 95% CI)

Totals not selected

2.1 Support vs. feedback only RCTs

1

Std. Mean Difference (IV, Fixed, 95% CI)

0.0 [0.0, 0.0]

3 Any stress‐related outcome (follow‐up more than 6 months) Show forest plot

2

Std. Mean Difference (IV, Fixed, 95% CI)

Subtotals only

3.1 Shorter vs longer working schedules RCTs

2

180

Std. Mean Difference (IV, Fixed, 95% CI)

‐0.55 [‐0.84, ‐0.25]

4 General Health Questionnaire (total score) Show forest plot

2

Mean Difference (IV, Fixed, 95% CI)

Totals not selected

4.1 Support vs. feedback RCTs (follow‐up 1 ‐ 6 months)

1

Mean Difference (IV, Fixed, 95% CI)

0.0 [0.0, 0.0]

4.2 Special care vs. general training RCTs (follow‐up more than 6 months)

1

Mean Difference (IV, Fixed, 95% CI)

0.0 [0.0, 0.0]

Figures and Tables -
Comparison 6. Organisational intervention vs. other intervention (SMD)
Comparison 7. Cognitive‐behavioural intervention vs. no intervention (MD)

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Maslach Burnout Inventory (follow‐up up to 1 month) Show forest plot

2

Mean Difference (IV, Fixed, 95% CI)

Subtotals only

1.1 Emotional exhaustion

2

158

Mean Difference (IV, Fixed, 95% CI)

‐2.01 [‐3.34, ‐0.68]

1.2 Depersonalisation

2

158

Mean Difference (IV, Fixed, 95% CI)

‐1.35 [‐2.33, ‐0.36]

1.3 Personal accomplishment (lack of)

2

158

Mean Difference (IV, Fixed, 95% CI)

0.16 [‐1.21, 1.54]

2 Maslach Burnout Inventory (follow‐up 1 to 6 months) Show forest plot

2

Mean Difference (IV, Fixed, 95% CI)

Subtotals only

2.1 Emotional exhaustion

2

128

Mean Difference (IV, Fixed, 95% CI)

‐2.13 [‐3.77, ‐0.49]

2.2 Depersonalisation

2

142

Mean Difference (IV, Fixed, 95% CI)

‐0.47 [‐1.53, 0.59]

2.3 Personal accomplishment (lack of)

2

143

Mean Difference (IV, Fixed, 95% CI)

‐0.62 [‐1.83, 0.59]

Figures and Tables -
Comparison 7. Cognitive‐behavioural intervention vs. no intervention (MD)
Comparison 8. Cognitive‐behavioural intervention and relaxation vs. no intervention (MD)

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Maslach Burnout Inventory (follow‐up up to 1 month) Show forest plot

2

Mean Difference (IV, Fixed, 95% CI)

Totals not selected

1.1 Emotional Exhaustion

2

Mean Difference (IV, Fixed, 95% CI)

0.0 [0.0, 0.0]

1.2 Personal Accomplishment (lack of)

2

Mean Difference (IV, Fixed, 95% CI)

0.0 [0.0, 0.0]

Figures and Tables -
Comparison 8. Cognitive‐behavioural intervention and relaxation vs. no intervention (MD)
Comparison 9. Cognitive‐behavioural intervention vs. other intervention (MD)

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Maslach Burnout Inventory (follow‐up more than 6 months) Show forest plot

1

Mean Difference (IV, Fixed, 95% CI)

Totals not selected

1.1 Emotional Exhaustion

1

Mean Difference (IV, Fixed, 95% CI)

0.0 [0.0, 0.0]

1.2 Depersonalisation

1

Mean Difference (IV, Fixed, 95% CI)

0.0 [0.0, 0.0]

1.3 Personal Accomplishment (lack of)

1

Mean Difference (IV, Fixed, 95% CI)

0.0 [0.0, 0.0]

Figures and Tables -
Comparison 9. Cognitive‐behavioural intervention vs. other intervention (MD)
Comparison 10. Relaxation vs. no intervention (MD)

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Maslach Burnout Inventory (follow‐up 1 ‐ 6 months) Show forest plot

4

Mean Difference (IV, Random, 95% CI)

Subtotals only

1.1 Emotional Exhaustion

4

137

Mean Difference (IV, Random, 95% CI)

‐1.06 [‐5.98, 3.87]

1.2 Depersonalisation

4

137

Mean Difference (IV, Random, 95% CI)

‐1.03 [‐2.70, 0.64]

1.3 Personal Accomplishment (lack of)

4

137

Mean Difference (IV, Random, 95% CI)

3.96 [0.70, 7.21]

Figures and Tables -
Comparison 10. Relaxation vs. no intervention (MD)
Comparison 11. Organisational intervention vs. no intervention (MD)

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Maslach Burnout Inventory (follow‐up less than 1 month) Show forest plot

1

Std. Mean Difference (IV, Fixed, 95% CI)

Totals not selected

1.1 Emotional exhaustion

1

Std. Mean Difference (IV, Fixed, 95% CI)

0.0 [0.0, 0.0]

1.2 Depersonalisation/ Disengagement

1

Std. Mean Difference (IV, Fixed, 95% CI)

0.0 [0.0, 0.0]

1.3 Personal Accomplishment (lack of)

1

Std. Mean Difference (IV, Fixed, 95% CI)

0.0 [0.0, 0.0]

2 Maslach Burnout Inventory (follow‐up 1 ‐ 6 months) Show forest plot

2

Std. Mean Difference (IV, Fixed, 95% CI)

Totals not selected

2.1 Emotional exhaustion

2

Std. Mean Difference (IV, Fixed, 95% CI)

0.0 [0.0, 0.0]

2.2 Depersonalisation

2

Std. Mean Difference (IV, Fixed, 95% CI)

0.0 [0.0, 0.0]

3 Maslach Burnout Inventory or Oldenburg Burnout Inventory (follow‐up more than 6 months) Show forest plot

3

Std. Mean Difference (IV, Fixed, 95% CI)

Subtotals only

3.1 Emotional exhaustion

3

313

Std. Mean Difference (IV, Fixed, 95% CI)

‐0.27 [‐0.50, ‐0.04]

3.2 Depersonalisation/ Disengagement

3

313

Std. Mean Difference (IV, Fixed, 95% CI)

‐0.33 [‐0.56, ‐0.10]

3.3 Personal Accomplishment (lack of)

2

182

Std. Mean Difference (IV, Fixed, 95% CI)

0.08 [‐0.22, 0.38]

Figures and Tables -
Comparison 11. Organisational intervention vs. no intervention (MD)
Comparison 12. Organisational intervention vs. other intervention (MD)

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Maslach Burnout Inventory (follow‐up 1 ‐ 6 months) Show forest plot

1

Mean Difference (IV, Fixed, 95% CI)

Totals not selected

1.1 Emotional Exhaustion

1

Mean Difference (IV, Fixed, 95% CI)

0.0 [0.0, 0.0]

1.2 Depersonalisation

1

Mean Difference (IV, Fixed, 95% CI)

0.0 [0.0, 0.0]

1.3 Personal Accomplishment (lack of)

1

Mean Difference (IV, Fixed, 95% CI)

0.0 [0.0, 0.0]

Figures and Tables -
Comparison 12. Organisational intervention vs. other intervention (MD)
Comparison 13. Cognitive‐behavioural intervention vs. no Intervention (SUBGROUPS) (SMD)

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Any Stress‐related Outcome (follow‐up up to 1 month) Show forest plot

7

332

Std. Mean Difference (IV, Random, 95% CI)

‐0.27 [‐0.66, 0.13]

1.1 Nurses

1

36

Std. Mean Difference (IV, Random, 95% CI)

‐0.18 [‐0.84, 0.48]

1.2 Physicians

2

106

Std. Mean Difference (IV, Random, 95% CI)

‐0.59 [‐1.00, ‐0.18]

1.3 All staff

3

178

Std. Mean Difference (IV, Random, 95% CI)

0.11 [‐0.57, 0.80]

1.4 Other professionals

1

12

Std. Mean Difference (IV, Random, 95% CI)

‐1.20 [‐2.47, 0.08]

2 Any Stress‐related Outcome (follow‐up 1 ‐ 6 months) Show forest plot

8

549

Std. Mean Difference (IV, Random, 95% CI)

‐0.38 [‐0.59, ‐0.16]

2.1 Nurses

6

403

Std. Mean Difference (IV, Random, 95% CI)

‐0.34 [‐0.64, ‐0.04]

2.2 All staff

2

146

Std. Mean Difference (IV, Random, 95% CI)

‐0.48 [‐0.81, ‐0.15]

Figures and Tables -
Comparison 13. Cognitive‐behavioural intervention vs. no Intervention (SUBGROUPS) (SMD)
Comparison 14. Relaxation vs. no intervention (SUBGROUPS) (SMD)

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Any stress outcome (follow‐up to 1 month) Show forest plot

4

97

Std. Mean Difference (IV, Fixed, 95% CI)

‐0.48 [‐0.89, ‐0.08]

1.1 Nurses

2

43

Std. Mean Difference (IV, Fixed, 95% CI)

‐0.70 [‐1.32, ‐0.07]

1.2 Physicians

1

38

Std. Mean Difference (IV, Fixed, 95% CI)

‐0.18 [‐0.81, 0.46]

1.3 Other Professionals

1

16

Std. Mean Difference (IV, Fixed, 95% CI)

‐0.70 [‐1.71, 0.32]

2 Any stress outcome (follow‐up 1 ‐ 6 months) Show forest plot

12

521

Std. Mean Difference (IV, Random, 95% CI)

‐0.49 [‐0.78, ‐0.21]

2.1 Nurses

7

288

Std. Mean Difference (IV, Random, 95% CI)

‐0.59 [‐1.02, ‐0.16]

2.2 Physicians

0

0

Std. Mean Difference (IV, Random, 95% CI)

0.0 [0.0, 0.0]

2.3 All Staff

5

233

Std. Mean Difference (IV, Random, 95% CI)

‐0.36 [‐0.71, ‐0.01]

2.4 Other Professionals

0

0

Std. Mean Difference (IV, Random, 95% CI)

0.0 [0.0, 0.0]

Figures and Tables -
Comparison 14. Relaxation vs. no intervention (SUBGROUPS) (SMD)