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Meta-Analysis
. 2020 Jul 5;7(7):CD012527.
doi: 10.1002/14651858.CD012527.pub2.

Psychological interventions to foster resilience in healthcare professionals

Angela M Kunzler  1 , Isabella Helmreich  1 , Andrea Chmitorz  2   3 , Jochem König  4 , Harald Binder  5 , Michèle Wessa  1   6 , Klaus Lieb  1   3
Affiliations
Meta-Analysis

Psychological interventions to foster resilience in healthcare professionals

Angela M Kunzler et al. Cochrane Database Syst Rev. .

Abstract

Background: Resilience can be defined as the maintenance or quick recovery of mental health during or after periods of stressor exposure, which may result from a potentially traumatising event, challenging life circumstances, a critical life transition phase, or physical illness. Healthcare professionals, such as nurses, physicians, psychologists and social workers, are exposed to various work-related stressors (e.g. patient care, time pressure, administration) and are at increased risk of developing mental disorders. This population may benefit from resilience-promoting training programmes.

Objectives: To assess the effects of interventions to foster resilience in healthcare professionals, that is, healthcare staff delivering direct medical care (e.g. nurses, physicians, hospital personnel) and allied healthcare staff (e.g. social workers, psychologists).

Search methods: We searched CENTRAL, MEDLINE, Embase, 11 other databases and three trial registries from 1990 to June 2019. We checked reference lists and contacted researchers in the field. We updated this search in four key databases in June 2020, but we have not yet incorporated these results.

Selection criteria: Randomised controlled trials (RCTs) in adults aged 18 years and older who are employed as healthcare professionals, comparing any form of psychological intervention to foster resilience, hardiness or post-traumatic growth versus no intervention, wait-list, usual care, active or attention control. Primary outcomes were resilience, anxiety, depression, stress or stress perception and well-being or quality of life. Secondary outcomes were resilience factors.

Data collection and analysis: Two review authors independently selected studies, extracted data, assessed risks of bias, and rated the certainty of the evidence using the GRADE approach (at post-test only).

Main results: We included 44 RCTs (high-income countries: 36). Thirty-nine studies solely focused on healthcare professionals (6892 participants), including both healthcare staff delivering direct medical care and allied healthcare staff. Four studies investigated mixed samples (1000 participants) with healthcare professionals and participants working outside of the healthcare sector, and one study evaluated training for emergency personnel in general population volunteers (82 participants). The included studies were mainly conducted in a hospital setting and included physicians, nurses and different hospital personnel (37/44 studies). Participants mainly included women (68%) from young to middle adulthood (mean age range: 27 to 52.4 years). Most studies investigated group interventions (30 studies) of high training intensity (18 studies; > 12 hours/sessions), that were delivered face-to-face (29 studies). Of the included studies, 19 compared a resilience training based on combined theoretical foundation (e.g. mindfulness and cognitive-behavioural therapy) versus unspecific comparators (e.g. wait-list). The studies were funded by different sources (e.g. hospitals, universities), or a combination of different sources. Fifteen studies did not specify the source of their funding, and one study received no funding support. Risk of bias was high or unclear for most studies in performance, detection, and attrition bias domains. At post-intervention, very-low certainty evidence indicated that, compared to controls, healthcare professionals receiving resilience training may report higher levels of resilience (standardised mean difference (SMD) 0.45, 95% confidence interval (CI) 0.25 to 0.65; 12 studies, 690 participants), lower levels of depression (SMD -0.29, 95% CI -0.50 to -0.09; 14 studies, 788 participants), and lower levels of stress or stress perception (SMD -0.61, 95% CI -1.07 to -0.15; 17 studies, 997 participants). There was little or no evidence of any effect of resilience training on anxiety (SMD -0.06, 95% CI -0.35 to 0.23; 5 studies, 231 participants; very-low certainty evidence) or well-being or quality of life (SMD 0.14, 95% CI -0.01 to 0.30; 13 studies, 1494 participants; very-low certainty evidence). Effect sizes were small except for resilience and stress reduction (moderate). Data on adverse effects were available for three studies, with none reporting any adverse effects occurring during the study (very-low certainty evidence).

Authors' conclusions: For healthcare professionals, there is very-low certainty evidence that, compared to control, resilience training may result in higher levels of resilience, lower levels of depression, stress or stress perception, and higher levels of certain resilience factors at post-intervention. The paucity of medium- or long-term data, heterogeneous interventions and restricted geographical distribution limit the generalisability of our results. Conclusions should therefore be drawn cautiously. The findings suggest positive effects of resilience training for healthcare professionals, but the evidence is very uncertain. There is a clear need for high-quality replications and improved study designs.

Trial registration: ClinicalTrials.gov NCT03141190 NCT02540473 NCT02603133 NCT01643694 NCT02417051 NCT03753360 NCT03914898 NCT02151162 NCT03256682 NCT03613441 NCT03781336 NCT04368676 NCT04372303 NCT03518359 NCT03645512 NCT03759795.

PubMed Disclaimer

Conflict of interest statement

Angela Kunzler – none known. Isabella Helmreich is a board‐certified cognitive‐behaviour therapist. Andrea Chmitorz is a board‐certified cognitive‐behaviour therapist. Jochem König – none known. Harald Binder – none known. Michèle Wessa is a board‐certified cognitive‐behaviour therapist. Klaus Lieb is a board‐certified cognitive‐behaviour therapist with a special interest in schema therapy. Klaus Lieb is an Editor with Cochrane Developmental, Psychosocial and Learning Problems. Klaus Lieb received funding for this review from the Ministry of Science (MWWK) of the State Rhineland‐Palatinate, Germany.

Figures

1
1
Study flow diagram combining all searches. aDuchemin 2015; Mistretta 2018; Schroeder 2016. bVan Berkel 2014.
2
2
Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.
3
3
Risk of bias summary: review authors' judgements about each risk of bias item for each included study.
4
4
Study flow diagram for original searches (January 1990 to October 2016).
5
5
Study flow diagram for revised searches (October 2016 onwards). aDuchemin 2015; Mistretta 2018; Schroeder 2016. bVan Berkel 2014.
6
6
Figure A1. Contour‐enhanced funnel plot of comparison: comparison 1 Resilience intervention vs control, healthcare professionals, Resilience: post‐intervention.
7
7
Figure A2. Contour‐enhanced funnel plot of comparison: comparison 1 Resilience intervention vs control, healthcare professionals, Depression: post‐intervention.
8
8
Figure A3. Contour‐enhanced funnel plot of comparison: comparison 1 Resilience intervention vs control, healthcare professionals, Stress or stress perception: post‐intervention.
9
9
Figure A4. Contour‐enhanced funnel plot of comparison: comparison 1 Resilience intervention vs control, healthcare professionals, Well‐being or quality of life: post‐intervention.
1.1
1.1. Analysis
Comparison 1: Resilience intervention versus control condition for healthcare professionals: main analyses (primary and secondary outcomes), Outcome 1: Resilience: post‐intervention
1.2
1.2. Analysis
Comparison 1: Resilience intervention versus control condition for healthcare professionals: main analyses (primary and secondary outcomes), Outcome 2: Resilience: short‐term follow‐up (≤ 3 months)
1.3
1.3. Analysis
Comparison 1: Resilience intervention versus control condition for healthcare professionals: main analyses (primary and secondary outcomes), Outcome 3: Resilience: medium‐term follow‐up (> 3≤ 6 months)
1.4
1.4. Analysis
Comparison 1: Resilience intervention versus control condition for healthcare professionals: main analyses (primary and secondary outcomes), Outcome 4: Resilience: long‐term follow‐up (> 6 months)
1.5
1.5. Analysis
Comparison 1: Resilience intervention versus control condition for healthcare professionals: main analyses (primary and secondary outcomes), Outcome 5: Anxiety: post‐intervention
1.6
1.6. Analysis
Comparison 1: Resilience intervention versus control condition for healthcare professionals: main analyses (primary and secondary outcomes), Outcome 6: Anxiety: short‐term follow‐up (≤ 3 months)
1.7
1.7. Analysis
Comparison 1: Resilience intervention versus control condition for healthcare professionals: main analyses (primary and secondary outcomes), Outcome 7: Depression: post‐intervention
1.8
1.8. Analysis
Comparison 1: Resilience intervention versus control condition for healthcare professionals: main analyses (primary and secondary outcomes), Outcome 8: Depression: short‐term follow‐up (≤ 3 months)
1.9
1.9. Analysis
Comparison 1: Resilience intervention versus control condition for healthcare professionals: main analyses (primary and secondary outcomes), Outcome 9: Depression: medium‐term follow‐up (> 3 ≤ 6 months)
1.10
1.10. Analysis
Comparison 1: Resilience intervention versus control condition for healthcare professionals: main analyses (primary and secondary outcomes), Outcome 10: Depression: long‐term follow‐up (> 6 months)
1.11
1.11. Analysis
Comparison 1: Resilience intervention versus control condition for healthcare professionals: main analyses (primary and secondary outcomes), Outcome 11: Stress or stress perception: post‐intervention
1.12
1.12. Analysis
Comparison 1: Resilience intervention versus control condition for healthcare professionals: main analyses (primary and secondary outcomes), Outcome 12: Stress or stress perception: short‐term follow‐up (≤ 3 months)
1.13
1.13. Analysis
Comparison 1: Resilience intervention versus control condition for healthcare professionals: main analyses (primary and secondary outcomes), Outcome 13: Stress or stress perception: medium‐term follow‐up (> 3 ≤ 6 months)
1.14
1.14. Analysis
Comparison 1: Resilience intervention versus control condition for healthcare professionals: main analyses (primary and secondary outcomes), Outcome 14: Stress or stress perception: long‐term follow‐up (> 6 months)
1.15
1.15. Analysis
Comparison 1: Resilience intervention versus control condition for healthcare professionals: main analyses (primary and secondary outcomes), Outcome 15: Well‐being or quality of life: post‐intervention
1.16
1.16. Analysis
Comparison 1: Resilience intervention versus control condition for healthcare professionals: main analyses (primary and secondary outcomes), Outcome 16: Well‐being or quality of life: short‐term follow‐up (≤ 3 months)
1.17
1.17. Analysis
Comparison 1: Resilience intervention versus control condition for healthcare professionals: main analyses (primary and secondary outcomes), Outcome 17: Well‐being or quality of life: medium‐term follow‐up (> 3 ≤ 6 months)
1.18
1.18. Analysis
Comparison 1: Resilience intervention versus control condition for healthcare professionals: main analyses (primary and secondary outcomes), Outcome 18: Well‐being or quality of life: long‐term follow‐up (> 6 months)
1.19
1.19. Analysis
Comparison 1: Resilience intervention versus control condition for healthcare professionals: main analyses (primary and secondary outcomes), Outcome 19: Social support: short‐term follow‐up (≤ 3 months)
1.20
1.20. Analysis
Comparison 1: Resilience intervention versus control condition for healthcare professionals: main analyses (primary and secondary outcomes), Outcome 20: Social support: medium‐term follow‐up (> 3 ≤ 6 months)
1.21
1.21. Analysis
Comparison 1: Resilience intervention versus control condition for healthcare professionals: main analyses (primary and secondary outcomes), Outcome 21: Optimism: post‐intervention
1.22
1.22. Analysis
Comparison 1: Resilience intervention versus control condition for healthcare professionals: main analyses (primary and secondary outcomes), Outcome 22: Optimism: short‐term follow‐up (≤ 3 months)
1.23
1.23. Analysis
Comparison 1: Resilience intervention versus control condition for healthcare professionals: main analyses (primary and secondary outcomes), Outcome 23: Self‐efficacy: post‐intervention
1.24
1.24. Analysis
Comparison 1: Resilience intervention versus control condition for healthcare professionals: main analyses (primary and secondary outcomes), Outcome 24: Self‐efficacy: short‐term follow‐up (≤ 3 months)
1.25
1.25. Analysis
Comparison 1: Resilience intervention versus control condition for healthcare professionals: main analyses (primary and secondary outcomes), Outcome 25: Self‐efficacy: medium‐term follow‐up (> 3 ≤ 6 months)
1.26
1.26. Analysis
Comparison 1: Resilience intervention versus control condition for healthcare professionals: main analyses (primary and secondary outcomes), Outcome 26: Self‐efficacy: long‐term follow‐up (> 6 months)
1.27
1.27. Analysis
Comparison 1: Resilience intervention versus control condition for healthcare professionals: main analyses (primary and secondary outcomes), Outcome 27: Active coping: post‐intervention
1.28
1.28. Analysis
Comparison 1: Resilience intervention versus control condition for healthcare professionals: main analyses (primary and secondary outcomes), Outcome 28: Active coping: short‐term follow‐up (≤ 3 months)
1.29
1.29. Analysis
Comparison 1: Resilience intervention versus control condition for healthcare professionals: main analyses (primary and secondary outcomes), Outcome 29: Active coping: medium‐term follow‐up (> 3 ≤ 6 months)
1.30
1.30. Analysis
Comparison 1: Resilience intervention versus control condition for healthcare professionals: main analyses (primary and secondary outcomes), Outcome 30: Self‐esteem: short‐term follow‐up (≤ 3 months)
1.31
1.31. Analysis
Comparison 1: Resilience intervention versus control condition for healthcare professionals: main analyses (primary and secondary outcomes), Outcome 31: Hardiness: post‐intervention
1.32
1.32. Analysis
Comparison 1: Resilience intervention versus control condition for healthcare professionals: main analyses (primary and secondary outcomes), Outcome 32: Hardiness: medium‐term follow‐up (> 3 ≤ 6 months)
1.33
1.33. Analysis
Comparison 1: Resilience intervention versus control condition for healthcare professionals: main analyses (primary and secondary outcomes), Outcome 33: Positive emotions: post‐intervention
1.34
1.34. Analysis
Comparison 1: Resilience intervention versus control condition for healthcare professionals: main analyses (primary and secondary outcomes), Outcome 34: Positive emotions: short‐term follow‐up (≤ 3 months)
2.1
2.1. Analysis
Comparison 2: Resilience intervention versus control condition for healthcare professionals: subgroup analyses (primary outcomes), Outcome 1: Resilience: post‐intervention, subgroup analysis: setting
2.2
2.2. Analysis
Comparison 2: Resilience intervention versus control condition for healthcare professionals: subgroup analyses (primary outcomes), Outcome 2: Resilience: post‐intervention, subgroup analysis: delivery format
2.3
2.3. Analysis
Comparison 2: Resilience intervention versus control condition for healthcare professionals: subgroup analyses (primary outcomes), Outcome 3: Resilience: post‐intervention, subgroup analysis: intensity
2.4
2.4. Analysis
Comparison 2: Resilience intervention versus control condition for healthcare professionals: subgroup analyses (primary outcomes), Outcome 4: Resilience: post‐intervention, subgroup analysis: theoretical foundation
2.5
2.5. Analysis
Comparison 2: Resilience intervention versus control condition for healthcare professionals: subgroup analyses (primary outcomes), Outcome 5: Resilience: post‐intervention, subgroup analysis: comparator
2.6
2.6. Analysis
Comparison 2: Resilience intervention versus control condition for healthcare professionals: subgroup analyses (primary outcomes), Outcome 6: Resilience: short‐term follow‐up (≤ 3 months), subgroup analysis: setting
2.7
2.7. Analysis
Comparison 2: Resilience intervention versus control condition for healthcare professionals: subgroup analyses (primary outcomes), Outcome 7: Resilience: short‐term follow‐up (≤ 3 months), subgroup analysis: delivery format
2.8
2.8. Analysis
Comparison 2: Resilience intervention versus control condition for healthcare professionals: subgroup analyses (primary outcomes), Outcome 8: Resilience: short‐term follow‐up (≤ 3 months), subgroup analysis: intensity
2.9
2.9. Analysis
Comparison 2: Resilience intervention versus control condition for healthcare professionals: subgroup analyses (primary outcomes), Outcome 9: Resilience: short‐term follow‐up (≤ 3 months), subgroup analysis: theoretical foundation
2.10
2.10. Analysis
Comparison 2: Resilience intervention versus control condition for healthcare professionals: subgroup analyses (primary outcomes), Outcome 10: Resilience: short‐term follow‐up (≤ 3 months), subgroup analysis: comparator
2.11
2.11. Analysis
Comparison 2: Resilience intervention versus control condition for healthcare professionals: subgroup analyses (primary outcomes), Outcome 11: Depression: post‐intervention, subgroup analysis: setting
2.12
2.12. Analysis
Comparison 2: Resilience intervention versus control condition for healthcare professionals: subgroup analyses (primary outcomes), Outcome 12: Depression: post‐intervention, subgroup analysis: delivery format
2.13
2.13. Analysis
Comparison 2: Resilience intervention versus control condition for healthcare professionals: subgroup analyses (primary outcomes), Outcome 13: Depression: post‐intervention, subgroup analysis: intensity
2.14
2.14. Analysis
Comparison 2: Resilience intervention versus control condition for healthcare professionals: subgroup analyses (primary outcomes), Outcome 14: Depression: post‐intervention, subgroup analysis: theoretical foundation
2.15
2.15. Analysis
Comparison 2: Resilience intervention versus control condition for healthcare professionals: subgroup analyses (primary outcomes), Outcome 15: Depression: post‐intervention, subgroup analysis: comparator
2.16
2.16. Analysis
Comparison 2: Resilience intervention versus control condition for healthcare professionals: subgroup analyses (primary outcomes), Outcome 16: Stress or stress perception: post‐intervention, subgroup analysis: setting
2.17
2.17. Analysis
Comparison 2: Resilience intervention versus control condition for healthcare professionals: subgroup analyses (primary outcomes), Outcome 17: Stress or stress perception: post‐intervention, subgroup analysis: delivery format
2.18
2.18. Analysis
Comparison 2: Resilience intervention versus control condition for healthcare professionals: subgroup analyses (primary outcomes), Outcome 18: Stress or stress perception: post‐intervention, subgroup analysis: intensity
2.19
2.19. Analysis
Comparison 2: Resilience intervention versus control condition for healthcare professionals: subgroup analyses (primary outcomes), Outcome 19: Stress or stress perception: post‐intervention, subgroup analysis: theoretical foundation
2.20
2.20. Analysis
Comparison 2: Resilience intervention versus control condition for healthcare professionals: subgroup analyses (primary outcomes), Outcome 20: Stress or stress perception: post‐intervention, subgroup analysis: comparator
2.21
2.21. Analysis
Comparison 2: Resilience intervention versus control condition for healthcare professionals: subgroup analyses (primary outcomes), Outcome 21: Stress or stress perception: short‐term follow‐up (≤ 3 months), subgroup analysis: setting
2.22
2.22. Analysis
Comparison 2: Resilience intervention versus control condition for healthcare professionals: subgroup analyses (primary outcomes), Outcome 22: Stress or stress perception: short‐term follow‐up (≤ 3 months), subgroup analysis: delivery format
2.23
2.23. Analysis
Comparison 2: Resilience intervention versus control condition for healthcare professionals: subgroup analyses (primary outcomes), Outcome 23: Stress or stress perception: short‐term follow‐up (≤ 3 months), subgroup analysis: intensity
2.24
2.24. Analysis
Comparison 2: Resilience intervention versus control condition for healthcare professionals: subgroup analyses (primary outcomes), Outcome 24: Stress or stress perception: short‐term follow‐up (≤ 3 months), subgroup analysis: theoretical foundation
2.25
2.25. Analysis
Comparison 2: Resilience intervention versus control condition for healthcare professionals: subgroup analyses (primary outcomes), Outcome 25: Stress or stress perception: short‐term follow‐up (≤ 3 months), subgroup analysis: comparator
2.26
2.26. Analysis
Comparison 2: Resilience intervention versus control condition for healthcare professionals: subgroup analyses (primary outcomes), Outcome 26: Well‐being or quality of life: post‐intervention, subgroup analysis: setting
2.27
2.27. Analysis
Comparison 2: Resilience intervention versus control condition for healthcare professionals: subgroup analyses (primary outcomes), Outcome 27: Well‐being or quality of life: post‐intervention, subgroup analysis: delivery format
2.28
2.28. Analysis
Comparison 2: Resilience intervention versus control condition for healthcare professionals: subgroup analyses (primary outcomes), Outcome 28: Well‐being or quality of life: post‐intervention, subgroup analysis: intensity
2.29
2.29. Analysis
Comparison 2: Resilience intervention versus control condition for healthcare professionals: subgroup analyses (primary outcomes), Outcome 29: Well‐being or quality of life: post‐intervention, subgroup analysis: theoretical foundation
2.30
2.30. Analysis
Comparison 2: Resilience intervention versus control condition for healthcare professionals: subgroup analyses (primary outcomes), Outcome 30: Well‐being or quality of life: post‐intervention, subgroup analysis: comparator
2.31
2.31. Analysis
Comparison 2: Resilience intervention versus control condition for healthcare professionals: subgroup analyses (primary outcomes), Outcome 31: Well‐being or quality of life: short‐term follow‐up (≤ 3 months), subgroup analysis: setting
2.32
2.32. Analysis
Comparison 2: Resilience intervention versus control condition for healthcare professionals: subgroup analyses (primary outcomes), Outcome 32: Well‐being or quality of life: short‐term follow‐up (≤ 3 months), subgroup analysis: delivery format
2.33
2.33. Analysis
Comparison 2: Resilience intervention versus control condition for healthcare professionals: subgroup analyses (primary outcomes), Outcome 33: Well‐being or quality of life: short‐term follow‐up (≤ 3 months), subgroup analysis: intensity
2.34
2.34. Analysis
Comparison 2: Resilience intervention versus control condition for healthcare professionals: subgroup analyses (primary outcomes), Outcome 34: Well‐being or quality of life: short‐term follow‐up (≤ 3 months), subgroup analysis: theoretical foundation
2.35
2.35. Analysis
Comparison 2: Resilience intervention versus control condition for healthcare professionals: subgroup analyses (primary outcomes), Outcome 35: Well‐being or quality of life: short‐term follow‐up (≤ 3 months), subgroup analysis: comparator
3.1
3.1. Analysis
Comparison 3: Resilience intervention versus control condition for healthcare professionals: sensitivity analyses (primary outcomes), Outcome 1: Resilience: post‐intervention, sensitivity analysis for resilience scale (underlying state concept)
3.2
3.2. Analysis
Comparison 3: Resilience intervention versus control condition for healthcare professionals: sensitivity analyses (primary outcomes), Outcome 2: Resilience: post‐intervention, sensitivity analysis for attrition bias (low or unclear risk of bias) including subgroup analysis
3.3
3.3. Analysis
Comparison 3: Resilience intervention versus control condition for healthcare professionals: sensitivity analyses (primary outcomes), Outcome 3: Resilience: post‐intervention, sensitivity analysis for trial registration (registered trials)
3.4
3.4. Analysis
Comparison 3: Resilience intervention versus control condition for healthcare professionals: sensitivity analyses (primary outcomes), Outcome 4: Resilience: post‐intervention, sensitivity analysis for level of missing data (< 10% missing data)
3.5
3.5. Analysis
Comparison 3: Resilience intervention versus control condition for healthcare professionals: sensitivity analyses (primary outcomes), Outcome 5: Resilience: post‐intervention, sensitivity analysis for coping with missing data (< 10% missing data, imputation of missing data or accounting for missing data by model for longitudinal data)
3.6
3.6. Analysis
Comparison 3: Resilience intervention versus control condition for healthcare professionals: sensitivity analyses (primary outcomes), Outcome 6: Resilience: post‐intervention, sensitivity analysis (fixed‐effect analysis)
3.7
3.7. Analysis
Comparison 3: Resilience intervention versus control condition for healthcare professionals: sensitivity analyses (primary outcomes), Outcome 7: Resilience: short‐term follow‐up (≤ 3 months), sensitivity analysis for attrition bias (low risk of bias)
3.8
3.8. Analysis
Comparison 3: Resilience intervention versus control condition for healthcare professionals: sensitivity analyses (primary outcomes), Outcome 8: Resilience: short‐term follow‐up (≤ 3 months), sensitivity analysis for trial registration (registered trials)
3.9
3.9. Analysis
Comparison 3: Resilience intervention versus control condition for healthcare professionals: sensitivity analyses (primary outcomes), Outcome 9: Resilience: short‐term follow‐up (≤ 3 months), sensitivity analysis for level of missing data (< 10% missing data)
3.10
3.10. Analysis
Comparison 3: Resilience intervention versus control condition for healthcare professionals: sensitivity analyses (primary outcomes), Outcome 10: Resilience: short‐term follow‐up (≤ 3 months), sensitivity analysis for coping with missing data (< 10% missing data, imputation of missing data or accounting for missing data by model for longitudinal data)
3.11
3.11. Analysis
Comparison 3: Resilience intervention versus control condition for healthcare professionals: sensitivity analyses (primary outcomes), Outcome 11: Resilience: short‐term follow‐up (≤ 3 months), sensitivity analysis (fixed‐effect analysis)
3.12
3.12. Analysis
Comparison 3: Resilience intervention versus control condition for healthcare professionals: sensitivity analyses (primary outcomes), Outcome 12: Depression: post‐intervention, sensitivity analysis for attrition bias (low risk of bias)
3.13
3.13. Analysis
Comparison 3: Resilience intervention versus control condition for healthcare professionals: sensitivity analyses (primary outcomes), Outcome 13: Depression: post‐intervention, sensitivity analysis for reporting bias (low risk of reporting bias)
3.14
3.14. Analysis
Comparison 3: Resilience intervention versus control condition for healthcare professionals: sensitivity analyses (primary outcomes), Outcome 14: Depression: post‐intervention, sensitivity analysis for trial registration (registered trials)
3.15
3.15. Analysis
Comparison 3: Resilience intervention versus control condition for healthcare professionals: sensitivity analyses (primary outcomes), Outcome 15: Depression: post‐intervention, sensitivity analysis for level of missing data (< 10% missing data)
3.16
3.16. Analysis
Comparison 3: Resilience intervention versus control condition for healthcare professionals: sensitivity analyses (primary outcomes), Outcome 16: Depression: post‐intervention, sensitivity analysis for coping with missing data (<10% missing data, imputation of missing data or accounting for missing data by model for longitudinal data)
3.17
3.17. Analysis
Comparison 3: Resilience intervention versus control condition for healthcare professionals: sensitivity analyses (primary outcomes), Outcome 17: Depression: post‐intervention, sensitivity analysis (fixed‐effect analysis)
3.18
3.18. Analysis
Comparison 3: Resilience intervention versus control condition for healthcare professionals: sensitivity analyses (primary outcomes), Outcome 18: Stress or stress perception: post‐intervention, sensitivity analysis for attrition bias (low or unclear risk of bias) including subgroup analysis
3.19
3.19. Analysis
Comparison 3: Resilience intervention versus control condition for healthcare professionals: sensitivity analyses (primary outcomes), Outcome 19: Stress or stress perception: post‐intervention, sensitivity analysis for reporting bias (low risk of bias)
3.20
3.20. Analysis
Comparison 3: Resilience intervention versus control condition for healthcare professionals: sensitivity analyses (primary outcomes), Outcome 20: Stress or stress perception: post‐intervention, sensitivity analysis for trial registration (registered trials)
3.21
3.21. Analysis
Comparison 3: Resilience intervention versus control condition for healthcare professionals: sensitivity analyses (primary outcomes), Outcome 21: Stress or stress perception: post‐intervention, sensitivity analysis for level of missing data (< 10% missing data)
3.22
3.22. Analysis
Comparison 3: Resilience intervention versus control condition for healthcare professionals: sensitivity analyses (primary outcomes), Outcome 22: Stress or stress perception: post‐intervention, sensitivity analysis for coping with missing data (< 10% missing data, imputation of missing data or accounting for missing data by model for longitudinal data)
3.23
3.23. Analysis
Comparison 3: Resilience intervention versus control condition for healthcare professionals: sensitivity analyses (primary outcomes), Outcome 23: Stress or stress perception: post‐intervention, sensitivity analysis (fixed‐effect analysis)
3.24
3.24. Analysis
Comparison 3: Resilience intervention versus control condition for healthcare professionals: sensitivity analyses (primary outcomes), Outcome 24: Stress or stress perception: short‐term follow‐up (≤ 3 months), sensitivity analysis for attrition bias (low or unclear risk of bias) including subgroup analysis
3.25
3.25. Analysis
Comparison 3: Resilience intervention versus control condition for healthcare professionals: sensitivity analyses (primary outcomes), Outcome 25: Stress or stress perception: short‐term follow‐up (≤ 3 months), sensitivity analysis for reporting bias (low risk of bias)
3.26
3.26. Analysis
Comparison 3: Resilience intervention versus control condition for healthcare professionals: sensitivity analyses (primary outcomes), Outcome 26: Stress or stress perception: short‐term follow‐up (≤ 3 months), sensitivity analysis for trial registration (registered trials)
3.27
3.27. Analysis
Comparison 3: Resilience intervention versus control condition for healthcare professionals: sensitivity analyses (primary outcomes), Outcome 27: Stress or stress perception: short‐term follow‐up (≤ 3 months), sensitivity analysis for level of missing data (< 10% missing data)
3.28
3.28. Analysis
Comparison 3: Resilience intervention versus control condition for healthcare professionals: sensitivity analyses (primary outcomes), Outcome 28: Stress or stress perception: short‐term follow‐up (≤ 3 months), sensitivity analysis for coping with missing data (<10% missing data, imputation of missing data or accounting for missing data by model for longitudinal data)
3.29
3.29. Analysis
Comparison 3: Resilience intervention versus control condition for healthcare professionals: sensitivity analyses (primary outcomes), Outcome 29: Stress or stress perception: short‐term follow‐up (≤ 3 months), sensitivity analysis (fixed‐effect analysis)
3.30
3.30. Analysis
Comparison 3: Resilience intervention versus control condition for healthcare professionals: sensitivity analyses (primary outcomes), Outcome 30: Well‐being or quality of life: post‐intervention, sensitivity analysis for attrition bias (low or unclear risk of bias) including subgroup analysis
3.31
3.31. Analysis
Comparison 3: Resilience intervention versus control condition for healthcare professionals: sensitivity analyses (primary outcomes), Outcome 31: Well‐being or quality of life: post‐intervention, sensitivity analysis for reporting bias (low risk of bias)
3.32
3.32. Analysis
Comparison 3: Resilience intervention versus control condition for healthcare professionals: sensitivity analyses (primary outcomes), Outcome 32: Well‐being or quality of life: post‐intervention, sensitivity analysis for trial registration (registered trials)
3.33
3.33. Analysis
Comparison 3: Resilience intervention versus control condition for healthcare professionals: sensitivity analyses (primary outcomes), Outcome 33: Well‐being or quality of life: post‐intervention, sensitivity analysis for level of missing data (< 10% missing data)
3.34
3.34. Analysis
Comparison 3: Resilience intervention versus control condition for healthcare professionals: sensitivity analyses (primary outcomes), Outcome 34: Well‐being or quality of life: post‐intervention, sensitivity analysis for coping with missing data (<10% missing data, imputation of missing data or accounting for missing data by model for longitudinal data)
3.35
3.35. Analysis
Comparison 3: Resilience intervention versus control condition for healthcare professionals: sensitivity analyses (primary outcomes), Outcome 35: Well‐being or quality of life: post‐intervention, sensitivity analysis (fixed‐effect analysis)
3.36
3.36. Analysis
Comparison 3: Resilience intervention versus control condition for healthcare professionals: sensitivity analyses (primary outcomes), Outcome 36: Well‐being or quality of life: short‐term follow‐up (≤ 3 months), sensitivity analysis for attrition bias (low or unclear risk of bias) including subgroup analysis
3.37
3.37. Analysis
Comparison 3: Resilience intervention versus control condition for healthcare professionals: sensitivity analyses (primary outcomes), Outcome 37: Well‐being or quality of life: short‐term follow‐up (≤ 3 months), sensitivity analysis for reporting bias (low risk of bias)
3.38
3.38. Analysis
Comparison 3: Resilience intervention versus control condition for healthcare professionals: sensitivity analyses (primary outcomes), Outcome 38: Well‐being or quality of life: short‐term follow‐up (≤ 3 months), sensitivity analysis for trial registration (registered trials)
3.39
3.39. Analysis
Comparison 3: Resilience intervention versus control condition for healthcare professionals: sensitivity analyses (primary outcomes), Outcome 39: Well‐being or quality of life: short‐term follow‐up (≤ 3 months), sensitivity analysis for level of missing data (<10% missing data)
3.40
3.40. Analysis
Comparison 3: Resilience intervention versus control condition for healthcare professionals: sensitivity analyses (primary outcomes), Outcome 40: Well‐being or quality of life: short‐term follow‐up (≤ 3 months), sensitivity analysis for coping with missing data (<10% missing data, imputation of missing data or accounting for missing data by model for longitudinal data)
3.41
3.41. Analysis
Comparison 3: Resilience intervention versus control condition for healthcare professionals: sensitivity analyses (primary outcomes), Outcome 41: Well‐being or quality of life: short‐term follow‐up (≤ 3 months), sensitivity analysis (fixed‐effect analysis)
See this image and copyright information in PMC

Comment in

References

References to studies included in this review

Alexander 2015 {published data only}
    1. Alexander GR, Rollins K, Walker D, Wong L, Penings J. Yoga for self-care and burnout prevention among nurses. Workplace Health & Safety 2015;63(10):462-70. [DOI: 10.1177/2165079915596102] [PMID: ] - DOI - PubMed
Berger 2011 {published data only}
    1. Berger R, Gelkopf M. An intervention for reducing secondary traumatization and improving professional self-efficacy in well baby clinic nurses following war and terror: a random control group trial. International Journal of Nursing Studies 2011;48(5):601-10. [DOI: 10.1016/j.ijnurstu.2010.09.007] [PMID: ] - DOI - PubMed
Bernburg 2016 {published data only}
    1. Bernburg M, Baresi L, Groneberg D, Mache S. Does psychosocial competency training for junior physicians working in pediatric medicine improve individual skills and perceived job stress. European Journal of Pediatrics 2016;175(12):1905-12. [DOI: 10.1007/s00431-016-2777-8] [PMID: ] - DOI - PubMed
Bernburg 2019 {published data only}
    1. Bernburg M, Groneberg DA, Mache S. Mental health promotion intervention for nurses working in German psychiatric hospital departments: a pilot study. Issues in Mental Health Nursing 2019;40(8):706-11. [DOI: 10.1080/01612840.2019.1565878] [PMID: ] - DOI - PubMed
Calder Calisi 2017 {published data only}
    1. Calder Calisi C. The effects of the relaxation response on nurses' level of anxiety, depression, well-being, work-related stress, and confidence to teach patients. Journal of Holistic Nursing 2017;35(4):318-27. [DOI: 10.1177/0898010117719207] [PMID: ] - DOI - PubMed
Chesak 2015 {published data only}
    1. Chesak SS, Bhagra A, Schroeder DR, Foy DA, Cutshall SM, Sood A. Enhancing resilience among new nurses: feasibility and efficacy of a pilot intervention. Ochsner Journal 2015;15(1):38-44. [PMC4365845] [PMID: ] - PMC - PubMed
Cheung 2014 {published data only}
    1. Cheung YL. Psychological First Aid as a Public Health Disaster Response Preparedness Strategy for Responders in Critical Incidents and Disasters [PhD thesis]. Shatin (HK): Chinese University of Hong Kong, 2014.
Cieslak 2016 {published and unpublished data}
    1. Cieslak R, Benight CC, Rogala A, Smoktunowicz E, Kowalska M, Zukowska K, et al. Effects of internet-based self-efficacy intervention on secondary traumatic stress and secondary posttraumatic growth among health and human services professionals exposed to indirect trauma. Frontiers in Psychology 2016;7:1009. [DOI: 10.3389/fpsyg.2016.01009] [PMC4930928] [PMID: ] - DOI - PMC - PubMed
    1. Rogala A, Smoktunowicz E, Żukowska K, Kowalska M, Cieślak R. The helpers’ stress: effectiveness of a web-based intervention for professionals working with trauma survivors in reducing job burnout and improving work engagement [Stres pomagających – efektywność interwencji internetowej dla osób pracujących z ofiarami traumy w obniżaniu wypalenia zawodowego i wzmacniaunia zaangażowania w pracę]. Medycyna Pracy 2016;67(2):223-37. [DOI: 10.13075/mp.5893.00220] [PMID: ] - DOI - PubMed
Clemow 2018 {published data only}
    1. Clemow LP, Pickering TG, Davidson KW, Schwartz JE, Williams VP, Shaffer JA, et al. Stress management in the workplace for employees with hypertension: a randomized controlled trial. Translational Behavioral Medicine 2018;8(5):761-70. [DOI: 10.1093/tbm/iby018] [PMC6128963 ] [PMID: ] - DOI - PMC - PubMed
Duchemin 2015 {published and unpublished data}
    1. Duchemin AM, Steinberg BA, Marks DR, Vanover K, Klatt M. A small randomized pilot study of a workplace mindfulness-based intervention for surgical intensive care unit personnel: effects on salivary α-amylase levels. Journal of Occupational and Environmental Medicine 2015;57(4):393–9. [DOI: 10.1097/JOM.0000000000000371] [PMC4624325] [PMID: ] - DOI - PMC - PubMed
    1. Klatt M, Steinberg BA, Marks DR, Duchemin AM. Changes in physiological and psychological markers of stress in hospital personnel after a low-dose mindfulness-based worksite intervention. BMC Complementary and Alternative Medicine 2012;12(Suppl 1):O16. [DOI: 10.1186/1472-6882-12-S1-O16] [OA04.04] [PMC3373711] - DOI
    1. Steinberg BA, Klatt M, Duchemin AM. Feasibility of a mindfulness-based intervention for surgical intensive care unit personnel. American Journal of Critical Care 2016;26(1):10-8. [DOI: 10.4037/ajcc2017444] [PMID: ] - DOI - PubMed
Fei 2019 {published data only}
    1. Fei Y. Effects of emotional resilience training on nurses' perceived stress, positive and negative emotions and sleep quality [Efectos del entrenamiento de enfermeros en resiliencia emocional sobre el estrés percibido, las emociones positivas y negativas y la calidad del sueño]. Revista Argentina de Clínica Psicológica 2019;28(2):199-209. [DOI: 10.24205/03276716.2019.1106] - DOI
Gelkopf 2008 {published and unpublished data}
    1. Gelkopf M, Ryan P, Cotton SJ, Berger R. The impact of "training the trainers" course for helping tsunami-survivor children on Sri Lankan disaster volunteer workers. International Journal of Stress Management 2008;15(2):117-35. [DOI: 10.1037/1072-5245.15.2.117] - DOI
Hosseinnejad 2018 {published data only}
    1. Hosseinnejad F, Arsalani N, Rahgoui A, Biglarian A. Effectiveness of resiliency skills education on job satisfaction among nurses. Journal of Guilan University of Medical Sciences 2018;27(105):50-60. [No DOI available; magiran.com/p1814990]
Ireland 2017 {published data only}
    1. Ireland MJ, Clough B, Gill K, Langan F, O'Connor A, Spencer L. A randomized controlled trial of mindfulness to reduce stress and burnout among intern medical practitioners. Medical Teacher 2017;39(4):409-14. [DOI: 10.1080/0142159X.2017.1294749] [PMID: ] - DOI - PubMed
ISRCTN69644721 {published data only}
    1. ISRCTN69644721. An evaluation of a new resilience intervention for emergency workers [A randomised controlled trial to evaluate a new resilience intervention for emergency workers]. www.isrctn.com/ISRCTN69644721 (first received 25 October 2016).
Khoshnazary 2016 {published data only}
    1. Khoshnazary S, Hosseini MA, Fallahi Khoshknab M, Bakhshi E. The effect of emotional intelligence (EI) training on nurses' resiliency in Department of Psychiatry. Iranian Journal of Psychiatric Nursing 2016;3(4):29-37. [ijpn.ir/article-1-683-en.pdf]
Klatt 2015 {published and unpublished data}
    1. Klatt M, Steinberg BA, Duchemin AM. Mindfulness in motion (MIM): an onsite mindfulness based intervention (MBI) for chronically high stress work environments to increase resiliency and work engagement. Journal of Visualized Experiments 2015;101:e52359. [DOI: 10.3791/52359] [PMC4545050] [PMID: ] - DOI - PMC - PubMed
Lebares 2018 {published data only}
    1. Lebares CC, Guvva EV, Delucchi KL, Kayser AS, Ascher NL, Harris HW. Mindful surgeon: a pilot feasibility and efficacy trial of mindfulness-based stress resilience training in surgery. Journal of the American College of Surgeons 2018;227(4 Suppl 2):e21. [DOI: 10.1016/j.jamcollsurg.2018.08.051] - DOI
    1. Lebares CC, Guvva EV, Olaru M, Sugrue LP, Staffaroni AM, Delucchi KL, et al. Efficacy of mindfulness-based cognitive training in surgery: additional analysis of the mindful surgeon pilot randomized clinical trial. JAMA Network Open 2019;2(5):e194108. [DOI: 10.1001/jamanetworkopen.2019.4108] [PMC6632137 ] [PMID: ] - DOI - PMC - PubMed
    1. Lebares CC, Hershberger AO, Guvva EV, Desai A, Mitchell J, Shen W, et al. Feasibility of formal mindfulness-based stress-resilience training among surgery interns: a randomized clinical trial. JAMA Surgery 2018;153(10):e182734. [DOI: 10.1001/jamasurg.2018.2734] [PMC6233792 ] [PMID: ] - DOI - PMC - PubMed
    1. NCT03141190. Mindful mental training for surgeons to enhance resilience and performance under stress [Mindfulness training to improve mental health, stress and performance in physicians]. clinicaltrials.gov/ct2/show/NCT03141190 (first received 1 May 2017).
Lin 2019 {published data only}
    1. Lin L, He G, Yan J, Gu C, Xie J. The effects of a modified mindfulness-based stress reduction program for nurses: a randomized controlled trial. Workplace Health & Safety 2019;67(3):111-22. [DOI: 10.1177/2165079918801633] [PMID: ] - DOI - PubMed
Loiselle 2018 {published data only}
    1. Loiselle ME. Academic Physician Burnout and Transcendental Meditation: A Mixed Methods Randomized Controlled Trial [PhD thesis]. Fairfield (IA): Maharishi University of Management, 2018.
Luthar 2017 {published and unpublished data}
    1. Luthar SS, Curlee A, Tye SJ, Engelman JC, Stonnington CM. Fostering resilience among mothers under stress: "authentic connections groups" for medical professionals. Women's Health Issues 2017;27(3):382-90. [DOI: 10.1016/j.whi.2017.02.007] [PMID: ] - DOI - PubMed
Mache 2015a {published and unpublished data}
    1. Mache S, Danzer G, Klapp B, Groneberg DA. An evaluation of a multicomponent mental competency and stress management training for entrants in surgery medicine. Journal of Surgical Education 2015;72(6):1102-8. [DOI: 10.1016/j.jsurg.2015.06.018] [PMID: ] - DOI - PubMed
Mache 2015b {published and unpublished data}
    1. Mache S, Vitzthum K, Klapp BF, Groneberg DA. Evaluation of a multicomponent psychosocial skill training program for junior physicians in their first year at work: a pilot study. Family Medicine 2015;47(9):693-8. [PMID: ] - PubMed
Mache 2016 {published and unpublished data}
    1. Mache S, Bernburg M, Baresi L, Groneberg DA. Evaluation of self-care skills training and solution-focused counselling for health professionals in psychiatric medicine: a pilot study. International Journal of Psychiatry in Clinical Practice 2016;20(4):239-44. [DOI: 10.1080/13651501.2016.1207085] [PMID: ] - DOI - PubMed
Mache 2017 {published data only}
    1. Mache S, Baresi L, Bernburg M, Vitzthum K, Groneberg D. Being prepared to work in gynecology medicine: evaluation of an intervention to promote junior gynecologists professionalism, mental health and job satisfaction. Archives of Gynecology and Obstetrics 2017;295(1):153-62. [DOI: 10.1007/s00404-016-4223-6] [PMID: ] - DOI - PubMed
Mealer 2014 {published and unpublished data}
    1. Mealer M, Conrad D, Evans J, Jooste K, Solyntjes J, Rothbaum B, et al. Feasibility and acceptability of a resilience training program for intensive care unit nurses. American Journal of Critical Care 2014;23(6):e97-105. [DOI: 10.4037/ajcc2014747] [PMID: ] - DOI - PubMed
Medisauskaite 2019 {published data only}
    1. Medisauskaite A, Kamau C. Reducing burnout and anxiety among doctors: randomized controlled trial. Psychiatry Research 2019;274:383-90. [DOI: 10.1016/j.psychres.2019.02.075] [PMID: ] - DOI - PubMed
Mirzaeirad 2019 {published data only}
    1. Mirzaeirad SZ, Arsalani N, Dalvandi A, Rezasoltani P, Hoseini SD. The effect of resilience skills training on nursing stress of nursing staff in hospitals of Golestan province. Journal of Health Promotion Management 2019;8(2):41-8. [hpm.ir/article-1-881-en.html]
Mistretta 2018 {published data only}
    1. Mistretta EG, Davis MC, Temkit M, Lorenz C, Darby B, Stonnington CM. Resilience training for work-related stress among health care workers: results of a randomized clinical trial comparing in-person and smartphone-delivered interventions. Journal of Occupational and Environmental Medicine 2018;60(6):559-68. [DOI: 10.1097/JOM.0000000000001285] [PMID: ] - DOI - PubMed
    1. Mistretta EG, Davis MC, Temkit M, Lorenz C, Stonnington CM. Resilience training for work-related stress among healthcare workers: results of a randomized clinical trial comparing in-person and smartphone delivered interventions. Psychosomatic Medicine 2017;79(4):A13. [DOI: 10.1097/PSY.0000000000000473] - DOI - PubMed
NCT02603133 {published data only}
    1. NCT02603133. Web-based implementation for the science of enhancing resilience study (WISER). clinicaltrials.gov/ct2/show/NCT02603133 (first received 6 November 2015).
NCT03645798 {published data only}
    1. NCT03645798. The effects of "three good things" positive psychotherapy on nurses' burnout [The effects of "three good things" positive psychotherapy on burnout, turnover intention, job performance, job satisfaction, self-efficacy, coping styles, resilience and blood cortisol of Chinese nurses]. clinicaltrials.gov/ct2/show/NCT03645798 (first received 16 August 2018).
Poulsen 2015 {published data only}
    1. Poulsen AA, Sharpley CF, Baumann KC, Henderson J, Poulsen MG. Evaluation of the effect of a 1-day interventional workshop on recovery from job stress for radiation therapists and oncology nurses: a randomised trial. Journal of Medical Imaging and Radiation Oncology 2015;59(4):491-8. [DOI: 10.1111/1754-9485.12322] [PMID: ] - DOI - PubMed
Schroeder 2016 {published data only}
    1. Schroeder DA, Stephens E, Colgan D, Hunsinger M, Rubin D, Christopher MS. A brief mindfulness-based intervention for primary care physicians: a pilot randomized controlled trial. American Journal of Lifestyle Medicine 2016;12(1):83-91. [DOI: 10.1177/1559827616629121] [PMC6125016] [PMID: ] - DOI - PMC - PubMed
Smith 2019 {published data only}
    1. NCT03017469. Achieving resilience in acute care nurses (ARISE) [Achieving resilience in acute care nurses (ARISE): a randomized controlled trial of a multi-component intervention for nurses in critical care and trauma]. clinicaltrials.gov/ct2/show/NCT03017469 (first received 9 January 2017).
    1. Smith O, Faulkner K, Skiffington A, McShane J, Wan C, Krock M. A randomized controlled trial of an intervention to enhance resilience in acute care nurses (ARISE). Critical Care Medicine 2019;47(1):35. [DOI: 10.1097/01.ccm.0000550861.59004.b7] [104] - DOI
Sood 2011 {published data only}
    1. Sood A, Prasad K, Schroeder D, Varkey P. Stress management and resilience training among Department of Medicine faculty: a pilot randomized clinical trial. Journal of General Internal Medicine 2011;26(8):858-61. [DOI: 10.1007/s11606-011-1640-x] [PMC3138987] [PMID: ] - DOI - PMC - PubMed
Sood 2014 {published data only}
    1. Sood A, Sharma V, Schroeder DR, Gorman B. Stress management and resiliency training (SMART) program among Department of Radiology faculty: a pilot randomized clinical trial. Explore 2014;10(6):358-63. [DOI: 10.1016/j.explore.2014.08.002] [PMID: ] - DOI - PubMed
Stetz 2007 {published data only (unpublished sought but not used)}
    1. Stetz M, Long CP, Wiederhold B, Turner DD. Combat scenarios and relaxation training to harden medics against stress. Journal of CyberTherapy and Rehabilitation 2008;1(3):239-46. [GALE|A225437106]
    1. Stetz MC, Long CP, Schober WV Jr, Cardillo CG, Wildzunas RM. Stress assessment and management while medics take care of the VR wounded. Annual Review of Cybertherapy and Telemedicine 2007;5:165-71. [tinyurl.com/y2lth6bj]
Strijk 2011 {published and unpublished data}
    1. Strijk JE, Proper KI, Van Mechelen W, Van der Beek AJ. Effectiveness of a worksite lifestyle intervention on vitality, work engagement, productivity, and sick leave: results of a randomized controlled trial. Scandinavian Journal of Work, Environment & Health 2013;39(1):66-75. [DOI: 10.5271/sjweh.3311] [PMID: ] - DOI - PubMed
    1. Strijk JE, Proper KI, Van der Beek AJ, Van Mechelen W. A process evaluation of a worksite vitality intervention among ageing hospital workers. International Journal of Behavioral Nutrition and Physical Activity 2011;8:58. [DOI: 10.1186/1479-5868-8-58] [PMC3127968] [PMID: ] - DOI - PMC - PubMed
    1. Strijk JE, Proper KI, Van der Beek AJ, Van Mechelen W. A worksite vitality intervention to improve older workers’ lifestyle and vitality-related outcomes: results of a randomised controlled trial. Journal of Epidemiology and Community Health 2012;66(11):1071-8. [DOI: 10.1136/jech-2011-200626] [PMC3465836] [PMID: ] - DOI - PMC - PubMed
Tierney 1997 {published data only}
    1. Tierney MJ, Lavelle M. An investigation into modification of personality hardiness in staff nurses. Journal of Nursing Staff Development 1997;13(4):212-7. [PMID: ] - PubMed
Varker 2012 {published data only (unpublished sought but not used)}
    1. Varker T, Devilly GJ. An analogue trial of inoculation/resilience training for emergency services personnel: proof of concept. Journal of Anxiety Disorders 2012;26(6):696-701. [DOI: 10.1016/j.janxdis.2012.01.009] [PMID: ] - DOI - PubMed
Villani 2013 {published and unpublished data}
    1. Villani D, Grassi A, Cognetta C, Toniolo D, Cipresso P, Riva G. Self-help stress management training through mobile phones: an experience with oncology nurses. Psychological Services 2013;10(3):315-22. [DOI: 10.1037/a0026459] [PMID: ] - DOI - PubMed
West 2014 {published and unpublished data}
    1. West CP, Dyrbye LN, Rabatin JT, Call TG, Davidson JH, Multari A, et al. Intervention to promote physician well-being, job satisfaction, and professionalism: a randomized clinical trial. JAMA Internal Medicine 2014;174(4):527-33. [DOI: 10.1001/jamainternmed.2013.14387] [PMID: ] - DOI - PubMed
West 2015 {published and unpublished data}
    1. West CP, Dyrbye LN, Satele D, Shanafelt T. A randomized controlled trial evaluating the effect of COMPASS (colleagues meeting to promote and sustain satisfaction) small group sessions on physician well-being, meaning, and job satisfaction. Journal of General Internal Medicine 2015;30 Suppl 2:S89. [DOI: 10.1007/s11606-015-3271-0] - DOI
Wild 2016 {published data only (unpublished sought but not used)}
    1. Wild J. An Evaluation of Mind's Resilience Intervention for Emergency Workers; May 2016. www.mind.org.uk/media-a/4591/strand-3.pdf .

References to studies excluded from this review

Bian 2011 {published data only}
    1. Bian Y, Xiong H, Zhang L, Tang T, Liu Z, Xu R, et al. Change in coping strategies following intensive intervention for special-service military personnel as civil emergency responders. Journal of Occupational Health 2011;53(1):36-44. [DOI: 10.1539/joh.o10009] [PMID: ] - DOI - PubMed
Chang 2008 {published data only}
    1. Chang RR. Critical Incident Stress Debriefing and the Effect of Timing of Intervention on First Responders: A Preliminary Study [PhD thesis]. Lincoln (NE): University of Nebraska-Lincoln, 2008.
Dyrbye 2016 {published data only}
    1. Dyrbye LN, West CP, Richards ML, Ross HJ, Satele D, Shanafelt TD. A randomized, controlled study of an online intervention to promote job satisfaction and well-being among physicians. Burnout Research 2016;3(3):69-75. [DOI: 10.1016/j.burn.2016.06.002] - DOI
    1. NCT01643694. Individualized electronic intervention to promote work engagement [Randomized controlled trial evaluating the effect of an individualized electronic intervention to promote resilience, meaning, and engagement for physicians]. clinicaltrials.gov/ct2/show/NCT01643694 (first received 27 June 2012).
Imamura 2019 {published data only}
    1. Imamura K, Tran TT, Nguyen HT, Kuribayashi K, Sakuraya A, Nguyen AQ, et al. Effects of two types of smartphone-based stress management programmes on depressive and anxiety symptoms among hospital nurses in Vietnam: a protocol for three-arm randomised controlled trial. BMJ Open 2019;9(4):e025138. [DOI: 10.1136/bmjopen-2018-025138] [PMC6500319 ] [PMID: ] - DOI - PMC - PubMed
Lahn 2014 {published data only}
    1. Lahn MJ. Indices of Heart Rate Variability and Compassion in Healthcare Professionals Following Stress Resilience Training [PhD thesis]. Oakland (CA): Saybrook University, 2014.
Maunder 2010 {published data only}
    1. Maunder RG, Lancee WJ, Mae R, Vincent L, Peladeau N, Beduz MA, et al. Computer-assisted resilience training to prepare healthcare workers for pandemic influenza: a randomized trial of the optimal dose of training. BMC Health Services Research 2010;10:72. [DOI: 10.1186/1472-6963-10-72] [PMC2851711] [PMID: ] - DOI - PMC - PubMed
NCT02417051 {published data only}
    1. NCT02417051. The efficacy of a brief resilience training program for hurricane Sandy disaster responders. clinicaltrials.gov/ct2/show/NCT02417051 (first received 10 April 2015).
NCT03753360 {published data only}
    1. NCT03753360. Online mindfulness program for stress management (IGEM) [Immunological and genomic effects of an online mindfulness program for stress management]. clinicaltrials.gov/ct2/show/NCT03753360 (first received 20 November 2018).
NCT03914898 {published data only}
    1. NCT03914898. Effect of nurse-led intervention programme professional quality of life and psychological distress in nurses [Effect of nurse-led intervention programme on compassion fatigue, burnout, compassion]. clinicaltrials.gov/show/nct03914898 (first received 8 April 2019).
Rowe 1999 {published data only}
    1. Rowe MM. Four-year longitudinal study of behavioral changes in coping with stress. American Journal of Health Behavior 2006;30(6):602-12. [DOI: 10.5555/ajhb.2006.30.6.602] [PMID: ] - DOI - PubMed
    1. Rowe MM. Skills training in the long-term management of stress and occupational burnout. Current Psychology 2000;19(3):215–28. [DOI: 10.1007/s12144-000-1016-6] - DOI
    1. Rowe MM. Teaching health-care providers coping: results of a two-year study. Journal of Behavioral Medicine 1999;22(5):511-27. [DOI: 10.1023/a:1018661508593] [PMID: ] - DOI - PubMed
Speckens 2019 {published data only}
    1. Speckens A, Verweij H, Van Ravesteijn H, Lagro-Janssen T. Mindfulness for medical, surgical and psychiatric residents [Mindfulness voor artsen in opleidingtot medisch specialist]. Tijdschrift voor Psychiatrie 2019;61(3):188-93. [PMID: ] - PubMed
Strauss 2018 {published data only}ISRCTN11723441
    1. Strauss C, Gu J, Pitman N, Chapman C, Kuyken W, Whittington A. Evaluation of mindfulness-based cognitive therapy for life and a cognitive behavioural therapy stress-management workshop to improve healthcare staff stress: study protocol for two randomised controlled trials. Trials 2018;19(1):209. [DOI: 10.1186/s13063-018-2547-1] [PMC5879876] [PMID: ] - DOI - PMC - PubMed
Watanabe 2019 {published data only}
    1. Watanabe N, Horikoshi M, Shinmei I, Oe Y, Narisawa T, Kumachi M, et al. Brief mindfulness-based stress management program for a better mental state in working populations - Happy Nurse Project: a randomized controlled trial. Journal of Affective Disorders 2019;251:186-94. [DOI: 10.1016/j.jad.2019.03.067] [PMID: ] - DOI - PubMed

References to studies awaiting assessment

Almén 2020 {published data only}
    1. Almén N, Lisspers J, Öst LG, Sundin Ö. Behavioral stress recovery management intervention for people with high levels of perceived stress: a randomized controlled trial. International Journal of Stress Management 2020;27(2):183–94. [DOI: 10.1037/str0000140] - DOI
Aranda Auserón 2018 {published data only}
    1. Aranda Auserón G, Elcuaz Viscarret MR, Fuertes Goñi C, Güeto Rubio V, Pascual Pascual P, Sainz de Murieta García de Galdeano E. Evaluation of the effectiveness of a mindfulness and self-compassion program to reduce stress and prevent burnout in primary care health professionals [Evaluación de la efectividad de un programa de mindfulness y autocompasión para reducir el estrés y prevenir el burnout en profesionales sanitarios de atención primaria]. Atencion Primaria 2018;50(3):141-50. [DOI: 10.1016/j.aprim.2017.03.009] [PMC6836985] [PMID: ] - DOI - PMC - PubMed
Chesak 2019a {published data only}
    1. Chesak SS, Morin KH, Cutshall S, Carlson M, Joswiak ME, Ridgeway JL, et al. Stress Management and Resiliency Training in a nurse residency program: findings from participant focus groups. Journal for Nurses in Professional Development 2019;35(6):337-43. [DOI: 10.1097/NND.0000000000000589] [PMID: ] - DOI - PubMed
Dyrbye 2019 {published data only}
    1. Dyrbye LN, Shanafelt TD, Gill PR, Satele DV, West CP. Effect of a professional coaching intervention on the well-being and distress of physicians: a pilot randomized clinical trial. JAMA Intern Med 2019;179(10):1406-14. [DOI: 10.1001/jamainternmed.2019.2425] [PMC6686971] [PMID: ] - DOI - PMC - PubMed
Grabbe 2020 {published data only}
    1. Grabbe L, Higgins MK, Baird M, Craven PA, San Fratello S. The Community Resiliency Model® to promote nurse well-being. Nursing Outlook 2020;68(3):324-36. [DOI: 10.1016/j.outlook.2019.11.002] [PMID: ] - DOI - PubMed
Heath 2020 {published data only}
    1. Heath J, Walmsley LA, Aker RM, Ferrin S, Stone D, Norton JC. CPR to the Rescue! An interprofessional pilot program Cultivating Practices for Resilience (CPR) camp. Clinical Nurse Specialist 2020;34(2):63-9. [DOI: 10.1097/NUR.0000000000000506] [PMID: ] - DOI - PubMed
Kim 2018a {published data only}
    1. Kim JI, Yun JY, Park H, Park SY, Ahn Y, Lee H, et al. A mobile videoconference-based intervention on stress reduction and resilience enhancement in employees: randomized controlled trial. Journal of Medical Internet Research 2018;20(10):e10760. [DOI: 10.2196/10760] [PMC6234345] [PMID: ] - DOI - PMC - PubMed
    1. NCT03256682. The efficacy of mobile video counseling for employees with emotional labor [The efficacy of mobile video counseling targeted for stress reduction and resilience enhancement in employees with emotional labor]. clinicaltrials.gov/show/nct03256682 (first received 18 August 2017).
Mainwaring 2018 {published data only}
    1. Mainwaring J. Implementation of a mindfulness-based resilience practice for anesthesia providers. In: AANA (American Association of Nurse Anesthetists) 2018 Annual Congress; 2018 Sep 21-25; Boston (MA). 2018.
Moffatt‐Bruce 2019 {published data only}
    1. Moffatt-Bruce SD, Nguyen MC, Steinberg B, Holliday S, Klatt M. Interventions to reduce burnout and improve resilience: impact on a health system's outcomes. Clinical Obstetrics and Gynecology 2019;62(3):432-43. [DOI: 10.1097/GRF.0000000000000458] [PMID: ] - DOI - PubMed
NCT03613441 {published data only}
    1. NCT03613441. Impact of mindful awareness practices in pediatric residency training. clinicaltrials.gov/show/nct03613441 (first received 3 August 2018).
NCT03781336 {published data only}
    1. NCT03781336. Brief mindfulness meditation course to reduce stress in healthcare professionals [Brief mindfulness meditation course to reduce stress in healthcare professionals and trainees: a randomized clinical trial]. clinicaltrials.gov/ct2/show/NCT03781336 (first received 18 December 2018).
NCT04368676 {published data only}
    1. NCT04368676. Breath regulation and yogic exercise on online therapy for calm and happiness (BREATH). clinicaltrials.gov/show/nct04368676 (first received 30 April 2020).
NCT04372303 {published data only}
    1. NCT04372303. Effect of a compassion fatigue resiliency program. clinicaltrials.gov/show/nct04372303 (first received 4 May 2020).
NCT04373382 {published data only}
    1. NCT04373382. Peer champion support for hospital staff during and after the COVID-19 pandemic. clinicaltrials.gov/show/nct04373382 (first received 4 May 2020).
NCT04384861 {published data only}
    1. NCT04384861. Improving physician empathy, compassionate care and wellness. clinicaltrials.gov/show/nct04384861 (first received 12 May 2020).
Ouyang 2017 {published data only}
    1. Ouyang M, Yu Z, Hao Y. Effect of professional training combined with positive psychological intervention for reducing mental crisis of primary nurses [专业培训联合积极心理学干预减轻初责护士心理危机的效果]. Huli Yanjiu (Chinese Nursing Research) 2017;31(21):2585-8. [DOI: 10.3969/j.issn.1009-6493.2017.21.008] - DOI
Rodgers 2018 {published data only}
    1. Rodgers RK. Mental and emotional self-management: an examination of psychological and physiological outcomes [PhD thesis]. Claremont (CA): Claremont Graduate University, 2018.
Ruehl 2013 {published data only}
    1. Ruehl BD. The Psychological and Physical Health Effects of Written Emotional Expression in Pediatric Hematology/Oncology, Intensive Care, and Neonatal Intensive Care Nursing Staff [PhD thesis]. San Diego (CA): Alliant International University, 2013.
Van Berkel 2014 {published data only}
    1. Van Berkel J, Boot CR, Proper KI, Bongers PM, Van der Beek AJ. Effectiveness of a worksite mindfulness-based multi-component intervention on lifestyle behaviors. International Journal of Behavioral Nutrition and Physical Activity 2014;11:9. [DOI: 10.1186/1479-5868-11-9] [PMC3905927] [PMID: ] - DOI - PMC - PubMed
    1. Van Berkel J, Boot CR, Proper KI, Bongers PM, Van der Beek AJ. Effectiveness of a worksite mindfulness-related multi-component health promotion intervention on work engagement and mental health: results of a randomized controlled trial. PLoS ONE 2014;9(1):e84118. [DOI: 10.1371/journal.pone.0084118] [PMC3904825] [PMID: ] - DOI - PMC - PubMed
Yeo 2019 {published data only}
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References to ongoing studies

ACTRN12617000290392 {published data only}
    1. ACTRN12617000290392. Doctors Working Well: a study evaluating an online stress management program for doctors [A randomised controlled trial of an online intervention on resiliency, occupational stress, and burnout among junior medical doctors]. www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=372318 (first received 24 February 2017).
JPRN UMIN000031435 {published data only}
    1. JPRN-UMIN000031435. Mindfulness for health professionals building resilience and compassion (MHALO program) - randomized control trial. who.int/trialsearch/Trial2.aspx?TrialID=JPRN-UMIN000031435 (first received 23 February 2018).
NCT03518359 {published data only}
    1. NCT03518359. Enhanced stress resilience training for residents (ESRT-R) [Enhanced resilience training to improve mental health, stress and performance in resident physicians]. clinicaltrials.gov/ct2/show/NCT03518359 (first received 24 April 2018).
NCT03645512 {published data only}
    1. NCT03645512. Resilience intervention for critical care nurses [A randomized controlled trial of a resilience intervention for critical care nurses]. clinicaltrials.gov/ct2/show/NCT03645512 (first received 21 August 2018).
NCT03759795 {published data only}
    1. NCT03759795. Bournemouth University Resilience Training for Surgeons (BURTS) [Ameliorating the impact of complications and errors on surgeons: resilience training for surgeons]. clinicaltrials.gov/ct2/show/NCT03759795 (first received 13 November 2018).

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