Department of Community Medicine, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka.
Health Systems Analysis and Evidence, WHO Country Office for Sri Lanka, Colombo, Sri Lanka.
Arch Environ Occup Health. 2022;77(7):530-544. doi: 10.1080/19338244.2021.1958738. Epub 2021 Aug 2.
Teachers are largely affected by OS, during their most productive years, leading to catastrophic physical, psychological, and economic burden on themselves, families and society by large. Teachers are responsible for producing the workforce of any nation, and thus have a major impact indirectly on the economy and health of a nation. There are several individual-level interventions conducted to reduce occupational stress (OS) among teachers. This study was conducted to systematically review and conduct a meta-analysis of the effectiveness of individual-level interventions to reduce occupational stress among teachers. This review was registered in the International Prospective Register of Systematic Reviews (PROSPERO; Registration ID: CRD42020149277) and followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. PubMed, Scopus, Cochrane, PsycInfo, and Web of Science databases were searched using predefined search strategies covering the eligibility criteria. Studies were selected in four rounds. Risk of bias assessments were conducted with GRADE recommendations and ROBINS-I criteria for randomized and non-randomized interventions, respectively. Study selection, data extraction and bias assessments were performed independ ently by two reviewers with a third reviewer to resolve conflicts. Narrative synthesis of the findings were also performed. Clinical, methodological, and statistical heterogeneity assessments were conduct ed. Meta-analyses were performed with Review Manager 5.3 software using the "generic inverse variance method" with mean difference as the pooled estimate. Sensitivity analyses of the findings was also performed. At the initial search, 293 articles were identified and 29 subsequently selected for synthesis of findings. The findings of the meta-analysis indicated that Cognitive Behavioral Therapy (CBT) and relaxation interventions significantly reduced OS among teachers with an effect size of 6.2 ( < 0.001). Effect size was highest for combined CBT and relaxation interventions which was 6.57 ( < 0.001). Relaxation interventions only and CBT interventions only had effect sizes of 3.35 ( < 0.001) and 3.12 ( = 0.002) respectively. In sensitivity analysis, after removing low-quality studies, CBT interventions only, combined CBT and relaxation interventions and overall effect size were 6.31 ( < 0.00001), 17.36 ( < 0.00001), and 14.55 ( < 0.00001), respectively, ie, substantially greater than with low-quality studies included. Inconclusion, CBT and relaxation interventions reduce OS among teachers and it's most effective when those individual-level interventions are conducted together.
教师在其最富有成效的年份中受到职业紧张（OS）的影响很大，这给他们自己、家庭和社会带来了灾难性的身体、心理和经济负担。教师负责培养任何国家的劳动力，因此间接地对国家的经济和健康产生重大影响。已经进行了一些针对教师职业紧张的个体干预措施。本研究旨在系统地综述和进行荟萃分析，以评估个体干预措施对减少教师职业紧张的效果。该综述在国际前瞻性系统评价注册库（PROSPERO；注册号：CRD42020149277）中进行，并遵循系统评价和荟萃分析的首选报告项目（PRISMA）指南。使用预定义的搜索策略，在 PubMed、Scopus、Cochrane、PsycInfo 和 Web of Science 数据库中进行了搜索，涵盖了纳入标准。研究经过四轮筛选。使用 GRADE 建议和针对随机和非随机干预的 ROBINS-I 标准对偏倚风险进行评估。研究选择、数据提取和偏倚评估由两名独立的评审员进行，如有分歧则由第三名评审员解决。还进行了发现的叙述性综合。对临床、方法学和统计学异质性进行了评估。使用 Review Manager 5.3 软件进行荟萃分析，采用“通用倒数方差法”，以均值差作为汇总估计值。还对发现进行了敏感性分析。在最初的搜索中，确定了 293 篇文章，随后有 29 篇文章被纳入结果综合分析。荟萃分析的结果表明，认知行为疗法（CBT）和放松干预措施显著降低了教师的职业紧张程度，效应量为 6.2（<0.001）。CBT 和放松联合干预的效应量最高，为 6.57（<0.001）。仅放松干预和 CBT 干预的效应量分别为 3.35（<0.001）和 3.12（=0.002）。在敏感性分析中，在去除低质量研究后，CBT 干预仅、CBT 和放松联合干预以及整体效应量分别为 6.31（<0.00001）、17.36（<0.00001）和 14.55（<0.00001），即包含低质量研究时的效应量显著更大。综上所述，CBT 和放松干预措施可降低教师的职业紧张程度，当这些个体干预措施一起实施时效果最佳。
