• Jani Ruotsalainen, Consol Serra, Albert Marine, and Jos Verbeek.
• Finnish Institute of Occupational Health, Cochrane Occupational Health Field, Neulaniementie 4, PO Box 93, FI-70701 Kuopio, Finland. jani.ruotsalainen@ttl.fi
• Scand J Work Environ Health. 2008 Jun 1; 34 (3): 169-78.

ObjectivesThis study evaluated the effectiveness of interventions in reducing stress at work among health care workers.MethodsA systematic search was conducted of the literature on reducing stress or burnout in health care workers. The quality of the studies found was then appraised and the results combined. A meta-analysis was performed when appropriate.ResultsAltogether 14 randomized controlled trials, three cluster-randomized trials, and two crossover trials, comprising 2812 participants, were included. Only two trials were of high quality. The following comparisons were possible: person-directed interventions versus no intervention, person-work interface interventions versus no intervention, and organizational interventions versus no intervention. Person-directed interventions can reduce stress [standardized mean difference (SMD) -0.85, 95% confidence interval (95% CI) -1.21 - -0.49] and burnout, measured as emotional exhaustion [weighted mean difference (WMD) -5.82, 95% CI -11.02 - -0.63) and lack of personal accomplishment (WMD -3.61; 95% CI -4.65 - -2.58). They also reduce anxiety, measured as state anxiety (WMD -9.42, 95% CI -16.92 - -1.93) and trait anxiety (WMD -6.91, 95% CI -12.80 - -1.01). Person-work interface interventions can reduce burnout, measured as depersonalization [mean difference (MD) -1.14, 95% CI -2.18 - -0.10]. Organizational interventions can also reduce stress symptoms (MD -0.34; 95% CI -0.62 - -0.06) and general symptoms (MD -2.90, 95% CI -5.16 - -0.64). No harmful effects were reported.ConclusionsLimited evidence is available for a small, but probably relevant reduction in stress levels from person-directed, person-work interface, and organizational interventions among health care workers. This finding should lead to a more-active stress management policy in health care institutions. Before large-scale implementation can be advised, larger and better quality trials are needed.

14 keywords...

hide…