Comparative effectiveness of resilience-related interventions on resilience and stress for healthcare professionals: A network meta-analysis of randomized controlled trials

Abstract

Background: Healthcare professionals face high workloads, emotional strain, and chronic stress, underscoring the need for effective strategies to enhance resilience. However, the comparative effectiveness of resilience-related interventions in this population remains unclear. This study aimed to evaluate and compare the effectiveness of various interventions in improving resilience and reducing stress among healthcare professionals.

Methods: A systematic search was conducted across eight databases (Cochrane Library, Embase, Ovid-MEDLINE, PubMed, Scopus, Web of Science, CINAHL, and ProQuest) on March 20, 2025, to identify randomized controlled trials of resilience-related interventions for healthcare professionals. Healthcare professionals included nurses, physicians, allied health professionals, and mixed clinical staff groups. A frequentist network meta-analysis was conducted in R using the netmeta package, applying random-effects models and standardized mean differences (SMDs). This method estimates relative effects by combining direct and indirect comparisons across interventions. Heterogeneity was assessed using Cochrane's Q, τ², and I². Subgroup analyses explored potential effect modifiers, and P-scores ranked the comparative effectiveness of interventions. Risk of bias was assessed using the Cochrane Risk of Bias 2.0 tool. The primary outcomes were resilience and stress, measured post-intervention, with resilience additionally assessed at a 3-month follow-up.

Results: Immediately after the intervention, positive psychology demonstrated the largest and significantly greater improvement in resilience (SMD = 0.57, 95 % CI: 0.36 to 0.78), followed by mindfulness (SMD = 0.50, 95 % CI: 0.24 to 0.76) and cognitive behavioral therapy (SMD = 0.47, 95 % CI: 0.23 to 0.71), all indicating moderate to large and statistically significant effects. At 3-month follow-up, positive psychology remained the most effective (SMD = 0.69, 95 % CI: 0.02 to 1.36), followed by mindfulness and cognitive behavioral therapy. For stress outcomes, positive psychology showed a significantly high effect (SMD = -0.69, 95 % CI: -1.08 to -0.29), as did cognitive behavioral therapy (SMD = -0.58, 95 % CI: -0.86 to -0.30) and mindfulness (SMD = -0.58, 95 % CI: -0.94 to -0.21). Sensitivity analyses confirmed the stability of the findings.

Conclusion: Positive psychology, mindfulness, and cognitive behavioral therapy were the most effective interventions for enhancing resilience and reducing stress among healthcare professionals, with some sustained effects at follow-up. These results support the implementation of structured, evidence-based resilience programs to improve mental well-being and job performance in healthcare settings.

Registration: PROSPERO (CRD42024518166).

Keywords: Healthcare professionals; Network meta-analysis; Resilience; Resilience-related interventions; Stress.