Table 4 Summary characteristics of eligible studies (n = 42). Studies not included in meta-analyses (n = 6) are marked with an asterisk (*)
Study (quality) | Sample size | Population (country) | Design | Program description | Program duration | Evaluation | Outcomes | Results |
|---|---|---|---|---|---|---|---|---|
Alexander et al., 2015 [55] (Moderate-Low) | 40 | Nurses (USA) | RCT | Mindfulness-based stress management (Yoga) vs. Nil training | 1 session (time not provided) × 8 weeks | Pre-training, post-training | HPLP-II; FMI; MBI EE, DP, PA subscales | Significant post-training improvements in self-care (HPLP-II), EE and DP |
Andersen et al., 2015 [35] (Moderate-Low) | 18 | Special forces (SWAT) police officers (Finland) | Prospective cohort study | Psycho-educational and physiological resilience promotion with HRV-BF (iPREP) | 5 days × 60 min sessions + 15 min daily breathing practice | Pre-training, post-training | HRmax; HRavg; respiratory achievement and coherence while listening to critical incident scenarios | Significant reductions in HRavg and improvement in respiratory achievement scores on Day 5 vs Day 1 of training, indicative of improved autonomic regulation under stress |
Andersen & Gustafsberg, 2016 [36] (Moderate-High) | 12 | Special forces (SWAT) police officers (Finland) | RCT | Psycho-educational and physiological resilience promotion with HRV-BF (iPREP) vs. TAU | 5 days total: 2 pre-post evaluation days, 3 training days | Pre-training, post-training | HRmax; HRRec to HRBase; BP; self-reported stress | At post-training evaluations, the iPREP group had significantly lower HRMax (scenario 1 only) |
Andersen et al., 2018 [40] (Moderate-low) | 57 | Police officers (Canada) | Prospective cohort study | Psycho-educational and physiological resilience promotion with HRV-BF (iPREP) | 4 days total: 1.5 days of pre and post-training evaluation, 2.5 days of training | Pre-training, post-training, 6, 12, and 18 months | HRMax and HRIndex during critical incident scenarios; HRRec | Significant reductions in HRIndex at 12 months follow-up, but not maintained at 18 months follow-up; HRRec faster at 12 and 18 months follow-up relative to pre- and post-training and 6 months follow-up |
Anderson, Vaughan & Mills, 2017 [33] (Moderate-Low) | 138 | Primary care paramedical students performing a duty practicum (Canada) | RCT | Web-based psychoeducational resilience promotion vs. TAU | 6-8 hours | Pre-training, post-training | RS global score and subscales | Resilience training significantly improved all measures except meaningfulness subscale following in-field practicum. SD values obtained from authors. |
Arble et al., 2017 [56] (Moderate-High) | 22 | Police officers (USA) | Prospective cohort study | Psychoeducational resilience promotion and coping skill building | 5 × 90 min group sessions | Pre-training, 12 months | COPE subscales; Sources of Support Scale; PCL; HADS; AUDIT | Following their first year in the field, officers appeared to report improved use of positive reframing and humor, and significant reductions in anxiety |
Arnetz et al., 2009 [57] (Low) | 18 | Police officers (Sweden) | RCT | Psycho-educational and physiological resilience promotion and coping skill building vs. TAU | 2 h × 10 weeks | 12 months | Serum antithrombin and cortisol; mean change in HR; self-reported stress; POMS vigor-activity subscale and negative mood composite | Following their first year in the field, trained officers appeared to report less negative mood, smaller changes in mean HR and self-reported stress, and greater changes in antithrombin following a simulated critical incident |
Arnetz et al., 2013 [58] (Moderate-High) | 75 | Police officers (Sweden) | RCT | Psycho-educational and physiological resilience promotion vs. TAU | 90 min × 10 weeks + homework 3× per week | Pre-training, 18 months | GHQ, serum cortisol; prolactin; DHEA | Statistically significant post-training improvement in GHQ only |
Bademci et al., 2016 [59] (Moderate-Low) | 42 | Correctional officers (Turkey) | Prospective cohort study | Psychosocial support program | 75-min sessions, 3 times a week × 11 weeks (41.25 hs total) | Pre-training, post-training | PANAS; MBI EE, DP, PA subscales; BDI; BAI | Significant post-training improvements on all measures |
Berger et al., 2016 [60] (Moderate-High) | 63 | Educational staff affected by the 2011 Christchurch earthquake (New Zealand) | RCT | Multimodal psychoeducational resilience promotion (EZ) vs. Critical incident management (METI) | 3 × 8 h sessions for both treatments | Pre-training, post-training, 8 months | PCL; ProQoL CF, burnout, CS subscales; CDRS | Resilience higher pre-training in EZ, significantly improved post-training for both groups. Greater improvements in PCL and ProQoL subscales for EZ compared with METI |
Berking et al., 2010 [61] (Moderate-Low) | 31 | Police officers (Switzerland) | Crossover RCT | Psycho-educational and physiological emotion regulation, cognitive therapy, coping skill building (iTEC) vs. WLC | 12 × 45 min sessions delivered on 3 days over 4 weeks + at least 3 brief and one longer daily homework | Pre-training, post-training | ERSQ; PANAS | Statistically significant post-training increase in ERSQ scores and near-significant increase in positive affect scores |
Bolier et al., 2014 [62] (Moderate-Low) | 366 | Allied health professionals (nurses, surgery assistants, physiotherapists, radiotherapists) (The Netherlands) | Cluster RCT | Web-based psychoeducation vs. Nil training | 4 to 8 weeks | Pre-training, 3 months, 6 months | MHC-SF global score + subscales; WHO-5 Well-being Scale; BSI depression and anxiety subscales | All measures except BSI depression improved post-training, 3 months and 6 months follow-up for both groups. Significant improvement in MHC-SF global and psychological well-being subscales for training group only. Very low uptake and compliance |
Brinkborg et al., 2011 [63] (High) | 106 | Social workers (Sweden) | RCT | Psychoeducational stress management and cognitive therapy (ACT-SMI) in high stress (PSS ≥ 25) vs. ACT-SMI in low stress (PSS ≤ 24) vs. high-stress WLC vs. low-stress WLC | 4 × 3 h biweekly group sessions + homework (physical exercise, mindfulness) | Pre-training, post-training | PSS; MBI global, EE, DP, PA subscales; GHQ; Pbse | Significant reductions in all measures except Pbse for all ACT-SMI participants compared with WLC. High stress groups: significant reductions in PSS, MBI. Low stress groups: significant reductions in PSS, MBI global + PA subscale only |
Brondolo et al., 2017 [64] (Moderate-Low) | 257 | ME’s, investigators, autopsy technicians, clerics/administrators, laboratory workers, clergy, legal staff, and facilities managers (USA) | Prospective cohort study | Web-based psychoeducation | 3 modules × 16 classes × 5-7 min each, mean completion = 10.69 classes (SD = 7.74, range 1-21) | 3 months and immediately pre-training, 1 month post-training | BDI; PDS | Of the 76 participants who completed at least 8 classes, post-training BDI scores were significantly lower than baseline or pre-training values, no changes in PDS values. Unadjusted M and SD values not reported in the text but provided by authors. |
Carleton et al., 2018 [38] (Moderate-Low) | 133 | Police officers (Canada) | Prospective cohort study | Psychoeducational resilience promotion, stress management, coping skill building (R2MR) | 4-h group seminar | Pre-training, 6 months, 12 months | BRS; DASS subscales; PCL; AUDIT | No statistically significant changes in mental health or resilience post-training or at follow-up, but small significant post-training reductions in stigma |
Cheng et al., 2015 [65] (Moderate-High) | 102 | Hospital workers (physicians, nurses, physiotherapists, and occupational therapists) (Hong Kong) | RCT | Emotion regulation | Gratitude journal (2 weekly entries × 4 weeks) vs. Hassle journal vs. Nil treatment | Pre-training, post-training, 3 months | CES-D, PSS | Significant post-training reductions for the gratitude group only, further improved (CES-D) or maintained (PSS) at follow-up. M and SD values extracted from reported regression analyses, author contacted for raw data |
Chongruksa et al., 2012 [66] (Moderate-High) | 42 | Police officers (Thailand) | Cluster RCT | Multimodal psychoeducation and counseling vs. Mental health psychoeducation control | 1.5–2 h/week × 12 weeks for both groups | Pre-training, mid-training, post-training, 1 month | BDI; GHQ global score + subscales; SCL-90 global score + subscales | Significant reductions in all measures mid- and post-training for the multimodal group only, and increased scores at 1-month follow-up |
Christopher et al., 2016 [67] (Low) | 43 | Police officers (USA) | Prospective cohort study | Mindfulness-based resilience promotion | 2 h × 8 weeks + 6 h final lesson + daily homework (20 h total) | Pre-training, mid-training, post-training | BRS; OLBI; PSQ; PSS; PROMIS Global Mental Health Subscale; cortisol AUC | Significant post-training improvements on all measures, and significant increase in cortisol AUC predicted by change in PROMIS mental health score |
Christopher et al., 2018 [68] (Moderate-Low) | 61 | Police officers (USA) | RCT | Mindfulness-based resilience promotion vs. Nil training | 2-h sessions × 8 weeks + 6-h session (20 h total) | Pre-training, post-training, 3 months | PROMIS subscales; Concise Health Risk Tracking Scale (suicidal ideation); PSQ; OLBI; CDRS; AUC cortisol | Significant post-training improvement in burnout and organizational stress only. Significant post-training reduction in cortisol AUC in males only. No differences at follow-up |
Craigie et al., 2016 [69] (Moderate-High) | 20 | Nurses (Australia) | Prospective cohort study | Mindfulness-based resilience promotion | 12 h total + daily mindfulness homework practice | Pre-training, post-training, 1 month | DASS subscales; ProQoL subscales; STAI; CDRS | Significant post-training reductions in DASS depression, ProQoL burnout, and STAI, only the latter two remained significant at follow-up. Significant improvements in DASS Stress and ProQoL compassion satisfaction from pre-training to follow-up |
Daigle et al., 2018 [70] (Moderate-Low) | 70 | Nurses (Canada) | RCT | Mindfulness-based stress management vs. WLC | 2.5 h × 8 weeks + full day retreat + recommended 45 min daily practice | Pre-training, post-training | POMS-TA | Significantly reduced POMS-TA post-training |
Duarte et al., 2017 [71] (Low)* | 48 | Oncology nurses (Portugal) | Prospective cohort study | Mindfulness-based stress management | 2-h group sessions × 6 weeks + 15 min daily homework | Post-training | DASS subscales; ProQoL BO, CF subscales, SLS | Significant post-training reductions in DASS Stress, ProQoL, and SLS. Direct effects of regression analyses reported only, author contacted for M and SD values |
Duchemin et al., 2015 [72] (Moderate-Low)* | 32 | SICU personnel (USA) | RCT | Multimodal mindfulness-based intervention vs. WLC | 9 × 1 h weekly sessions + recommended 20 min daily practice | Pre-training, post-training | PSS, DASS stress subscale, MBI EE, DP and PA subscales, ProQoL CS, BO STS subscales, self-report work stress | Significant post-training reduction in DASS stress and proportion of participants with high (> 26) EE scores. M and SDs for primary outcome measures not provided, authors contacted. |
Flarity et al., 2013 [73] (Moderate-Low) | 59 | Nurses (USA) | Prospective cohort study | Psychoeducational resilience promotion | 4-h group seminar | Pre-training, post-training | ProQoL CS, BO, STS subscales | Significant post-training improvements in all subscale scores and proportion in high/low cut-off ranges |
Hersch et al., 2016 [74] (Moderate-Low) | 104 | Nurses (USA) | RCT | Web-based stress management (BREATHE) vs. WLC | 7 online modules (average time = 43 min) | Pre-training, 3 months post-training | Nursing Stress Scale; Symptoms of Distress (emotional symptoms subscale); Coping with Stress Scale | Significant post-training improvement in Nursing Stress Scale only. Low rates of participation |
Joyce et al., 2018 [75] (Low) | 29 | Firefighters (Australia) | Prospective cohort study | Web-based, mindfulness-based resilience promotion (RAW) | 6 × 20–25 min sessions + optional practice | Pre-training, post-training | CDRS; CFQ; AAQ-II | Mean increase in resilience and reduction in cognitive fusion, psychological inflexibility, and avoidance, but not statistically significant |
Joyce et al., 2019 [76] (Moderate-High) | 143 | Primary Fire and Rescue and Hazmat (Australia) | Cluster RCT | Web-based, mindfulness-based resilience promotion (RAW) vs. Healthy Living Program (control) | 6 × 20–25 min sessions + optional practice vs. 6 × 20 min modules | Pre-training, 6 weeks and 6 months post-training | CDRS; BRS; FMI; AAQ-II; SCS; LOT-R; COPE active coping, emotional support, instrumental support subscales; LET | Significantly higher resilience and active coping in RAW participants at 6 months follow-up compared with control but coping not sustained at follow-up. Improved mindfulness sustained in full but not partial program completers. Authors contacted for CDRS and BRS SD values. |
Larijani et al., 2018 [77] (Low)* | 126 | Red Crescent Healthcare Centers (Iran) | Cluster RCT | Resilience promotion vs. Nil training | No description | Pre-training, post-training | GHQ physical symptoms, anxiety, social dysfunction, and depression subscales | Post-training improvements in physical symptoms, anxiety, and social dysfunction in experimental group only. Ranked data not useable for meta-analyses, authors contacted for unadjusted M and SD values. |
Lin et al., 2019 [78] (Moderate-Low) | 90 | Nurses (China) | RCT | Multimodal mindfulness-based cognitive therapy vs. WLC | 8 × 2 h weekly group mindfulness sessions + recommended practice vs. nil | Pre-training, post-training, 3 months | PSS; PANAS; CDRS | Significant post-training improvements in perceived stress, positive affect, and negative affect maintained at follow up, improved resilience at follow-up compared with baseline |
McCraty et al., 2009 [79] (Moderate-High) | 75 | Correctional officers (USA) | RCT | Psycho-educational and physiological stress management with HRV-BF (Power to Change Performance) vs. WLC | 2 days + 3mons recommended practice at work | Pre-training, 3 months post-training | Salivary cortisol and DHEA; BP; HRRest; HRV components (RMSSD, HF, LF, VLF, total power, LF/HF ratio); BSI subscales; POQA subscales | Significantly lower DHEA, BP, HR, anger and increased LF/HF HRV ratio post-training, no physiological changes, and increases in depressive symptoms in control group |
McCraty & Atkinson, 2012 [80] (Moderate-Low) | 59 | Police officers (USA) | RCT | Psycho-educational and physiological resilience promotion stress management with HRV-BF (Coherence Advantage Program) vs. WLC | 3 × 4 h sessions | Pre-training, post-training | POQA subscales; BP and IBI during critical incident scenarios (n = 23, 12 exp, 11 ctrl) | Depression declined by 13% among trained officers while it increased by 17% in the control group. Significantly greater decrease in IBI during the post-training scenario in experimental group only. Authors contacted for HR data (SDs) and POQA baseline scores |
Mealer et al., 2014 [81] (Moderate-Low)* | 27 | ICU nurses (USA) | RCT | Multimodal psychoeducation, mindfulness-based practice, emotional regulation vs. Nil training | 12 weeks total: 2-day workshop + 12 × 30 min weekly writing sessions + 15 min × 3/week mindfulness + 30–45min exercise × 3/week + 30–60 min counseling session | Pre-training, 1wk post-training | CDRS, PDS, HADS, MBI EE, DP, and PA subscales | Post-training reductions in depression symptoms in the experimental group. Both groups reported significant reductions in PTSD symptoms and improvements in resilience. |
Molek-Winiarska & Żołnierczyk-Zreda, 2018 [82] (Moderate-High) | 66 | Miners (Poland) | RCT | Mindfulness-based stress management vs. Nil training | 8-h sessions × 5 weeks (40 h total) + optional homework | Pre-training, 3 months post-training | GHQ global score and anxiety and depression subscales | Significant post-training reduction in anxiety and depression scores |
Oliver & Meier, 2009 [83] (Moderate-High) | 132 | Small-town and rural police officers and sheriffs (USA) | Prospective cohort study | Stress management | 8 h | Pre-training, post-training between 1-6mons, 7-12mons, or 13-18mons | Adult Manifest Anxiety Scale | No significant post-training reduction overall, but significant when analyzed according to post-test lag times (1-6mons, 7-12mons, 13-18mons) |
Poulsen et al., 2015 [84] (Moderate-Low) | 70 | Radiation therapists and oncology nurses (Australia) | RCT | Stress management workshop vs. Written educational materials only | 1 day | Pre-training, 6 weeks post-training | Recovery experiences questionnaire global score and subscales | Workshop group global scores increased post-training, and 3 of 4 subscales were higher than the control group |
Ramey et al., 2016 [85] (Moderate-Low) | 38 | Police officers (USA) | Prospective cohort study | Psycho-educational and physiological emotion regulation with HRV-BF | 2 × 2 h sessions held 2–3 weeks apart + 3mons practicing skills in the field | Pre-training, 3 months and 6 months post-training, but only a single post-training value is reported | BP; PSS; Impact of Events Scale total stress, intrusive and avoidance subscale scores; Response to Stressful Experience Scale; POQA subscales; on- and off-duty HR and HRV components (RMSSD, HF, LF, VLF, total power, LF/HF ratio), respiratory coherence on n = 26 | Below threshold (p > 0.05) improvements to anger and resentment but increases in intrusive and avoidance scores. Significant post-training changes to sympathetic (LF) and parasympathetic (HF) contributors of HRV on both work and off days, increased RMSSD on off days, and significantly increased respiratory coherence. Coherence values not reported and requested from the authors |
Ranta, 2009 [86] (Low)* | 80 | Police officers (India) | RCT | Multimodal psychophysiological stress management vs. Relaxation only | 3 × 1 h sessions + brief home assignments vs. 1 × 1 h session | Pre-training, post-training | PSQ and CBQ global scores | Significant post-training improvements in both outcomes for the multimodal group only. SDs not provided, authors contacted. |
Rø et al., 2010 [87] (Moderate-Low) | 153 | Nurses (Norway) | Prospective cohort study | Multimodal psychoeducational and psychophysiological retreat | 5 days | Pre-training, 12 months post-training | MBI EE, DP, and PA subscales; proportion on sick leave; preceding year number of weeks on sick leave; adverse life events | Significant reductions in MBI EE and DP 12-months post-training. Number of adverse life events not reported, authors contacted |
Rodrigues et al., 2018 [88] (Moderate-Low) | 33 | Nurses (USA) | Prospective cohort study | Stress management coping skill building | Single 90-min group session | Pre-training, 3 months post-training | MBI EE and DP subscales | Significant reduction in EE and DP 3 months post-training |
Steinberg et al., 2016 [89] (Moderate-Low)* | 32 | SICU personnel (USA) | RCT | Mindfulness-based intervention | 8 × 1 h weekly sessions + recommended 20-min practice × 5/week vs. Nil treatment | Pre-training, post-training | MBI EE, DP and PA subscales, ProQoL CS, BO, STS subscales, number of missed work days in past 2 months | Work satisfaction measures were significantly correlated with some mental health subscales, but were not reported or analyzed separately in the study. M and SDs for primary outcome measures not provided, authors contacted. |
Tveito & Eriksen, 2009 [90] (Moderate-Low) | 40 | Nursing home employees (Norway) | RCT | Multimodal stress management coping skill building (IHP) vs. WLC | 15 × 1 h weekly sessions and workplace assessment + 9 months physical exercise | Pre-training, post-training, 12 months | General Health Status Inventory SF-36 Mental Health subscale; Demand/Control Model subscales; number of days on sick leave; job stress (undefined) | No significant differences between groups post-training or 1-year follow-up |
Villani et al., 2013 [91] (Moderate-Low) | 30 | Oncology nurses (Italy) | RCT | Web-based stress management coping skill building (M-SIT) vs. Neutral stimuli control group | 15-min video clips, 2×/week, 4 weeks (8 sessions, 2 h total) | Pre-training, post-training | STAI; COPE Active coping and Denial subscales | Significant post-training improvement on all measures for M-SIT group only |