Effectiveness of a mental health stepped-care programme for healthcare workers with psychological distress in crisis settings: a multicentre randomised controlled trial

Abstract

Background: Evidence-based mental health interventions to support healthcare workers (HCWs) in crisis settings are scarce.

Objective: To evaluate the capacity of a mental health intervention in reducing anxiety and depression symptoms in HCWs, relative to enhanced care as usual (eCAU), amidst the COVID-19 pandemic.

Methods: We conducted an analyst-blind, parallel, multicentre, randomised controlled trial. We recruited HCWs with psychological distress from Madrid and Catalonia (Spain). The intervention arm received a stepped-care programme consisting of two WHO-developed interventions adapted for HCWs: Doing What Matters in Times of Stress (DWM) and Problem Management Plus (PM+). Each intervention lasted 5 weeks and was delivered remotely by non-specialist mental health providers. HCWs reporting psychological distress after DWM completion were invited to continue to PM+. The primary endpoint was self-reported anxiety/depression symptoms (Patient Health Questionnaire-Anxiety and Depression Scale) at week 21.

Findings: Between 3 November 2021 and 31 March 2022, 115 participants were randomised to stepped care and 117 to eCAU (86% women, mean age 37.5). The intervention showed a greater decrease in anxiety/depression symptoms compared with eCAU at the primary endpoint (baseline-adjusted difference 4.4, 95% CI 2.1 to 6.7; standardised effect size 0.8, 95% CI 0.4 to 1.2). No serious adverse events occurred.

Conclusions: Brief stepped-care psychological interventions reduce anxiety and depression during a period of stress among HCWs.

Clinical implications: Our results can inform policies and actions to protect the mental health of HCWs during major health crises and are potentially rapidly replicable in other settings where workers are affected by global emergencies.

Trial registration number: NCT04980326.

Keywords: COVID-19; adult psychiatry; anxiety disorders; depression & mood disorders.

Figure 1

Trial overview. DWM, Doing What Matters in Times of Stress; eCAU, enhanced care as usual; HCWs, healthcare workers; ICF, informed consent form; PM+, Problem Management Plus.

Figure 2

Standardised effect sizes across outcomes and endpoints. All models include participants as random effect and outcomes measured at baseline as fixed effect. The residual SDs of the models were 5.49 for the PHQ-ADS, 3.06 for the PHQ-9, 2.98 for the GAD-7 and 4.24 for the PCL-5. All CIs were calculated using robust SEs. *Primary endpoint. **Primary outcome. DWM, Doing What Matters in Times of Stress; GAD-7, seven-item Generalised Anxiety Disorder; PCL-5, Post-Traumatic Stress Disorder Checklist for the DSM-5 (Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition); PHQ-9, Patient Health Questionnaire; PHQ-ADS, Patient Health Questionnaire-Anxiety and Depression Scale; PM+, Problem Management Plus; SES, standardised effect size.