Reducing stress, anxiety and depression in undergraduate nursing students: Systematic review

Abstract

Objective: Undergraduate nursing students may experience high levels of stress, anxiety or depression. This can not only influence their personal wellbeing and academic performance, but also communication with patients during clinical placement and the quality and safety of the healthcare delivered. The objective of the review was to identify interventions that target stress, anxiety or depressed mood in undergraduate nursing students during their undergraduate course.

Review method: A quantitative systematic review, guided by the Joanna Briggs Institute methodology, was conducted. The review considered studies that included undergraduate nurses, and which evaluated interventions targeting stress, anxiety and depressed mood. The review included experimental studies published in English from 2008 to 2018. A tabulated and narrative summary was utilised to present the results.

Results: A total of 1579 studies were identified following a systematic search and 931 studies were screened by title and abstract. A total of 44 studies were critically appraised resulting in 22 studies for inclusion in the systematic review. The studies focused on stress (10 studies), anxiety (14 studies) and depression (7 studies). The majority of the studies (18 of 22) reported a statistically significant reduction in the stress, anxiety or depression experienced by nursing students who participated in interventions targeting these symptoms. Interventions that sought to improve coping management skills, such as mindfulness-based interventions, were most reported.

Conclusion: There are a range of effective interventions that target stress, anxiety or depressed mood among nursing students. The quality of the studies reporting these interventions was found to be variable and generally samples were small with limited follow-up. Studies of mindfulness interventions comprised the largest sample sizes, displayed the highest levels of evidence, and transcended stress, anxiety and depressed mood. Future research would benefit from a co-ordinated approach to build the strength of the body of evidence.

Keywords: Anxiety; Depression; Intervention; Nursing student; Program; Stress; Therapy.