Department of Health Psychology and Applied Biological Psychology, Institute of Psychology, Leuphana University of Lueneburg, Lueneburg, Germany.
Department for Sport & Health Sciences, Technical University of Munich, Psychology & Digital Mental Health Care, Munich, Germany.
BMC Public Health. 2021 Aug 5;21(1):1511. doi: 10.1186/s12889-021-11504-2.
Web-based stress management interventions (SMI) fit increasingly digital lifestyles, reduce barriers of uptake and are easily scalable. SMIs might lower levels of stress in employees and thereby contribute to the prevention of depressive symptomatology. Different guidance formats can impact the efficacy of SMIs, with higher intensity assumed to result in larger effects. However, head-to-head comparisons of guidance formats are rare. This is the first trial to examine the impact of adherence-focused guidance compared to self-help on the efficacy of an occupational SMI compared to a wait list control condition. Additionally, it will be investigated if the SMI enfolds its impact on preventing depressive symptomatology by different pathways through reducing health impairing and increasing promoting factors.
A three-armed randomised controlled trial (RCT) on an occupational SMI was conducted. 404 employees with elevated levels of perceived stress (PSS-10 ≥ 22) were randomly assigned to: adherence-focused guidance (AFG), self-help (SH) or a wait list control group (WLC). The primary outcome was perceived stress (PSS-10). Secondary outcomes included health- and work-related measures. A parallel mediation analysis with stress and resilience as mediators for the effect on depression (CES-D) was carried out. Data collection took place at baseline (T1), after 7 weeks (T2) and 6 months (T3).
The SMI was effective for all groups on the primary and secondary outcomes. For stress, analyses of covariance (ANCOVA) revealed significant group effects at T2 (F = 36.08, P < .001) and T3 (F = 37.04, P < .001) with large effect sizes for AFG (T2: d = 0.83; T3: d = 0.85) and SH (T2: d = 0.88; T3: d = 0.91) compared to WLC. No significant group differences were found for the efficacy between AFG and SH on the outcomes. Adherence in terms of completed modules was significantly higher for AFG compared to SH. The SMI's impact on depression was mediated by perceived stress: ab = - 0.77, 95% CI [- 1.26, - 0.34] and resilience: ab = - 0.62, 95% CI [- 1.05, - 0.26].
The SMI was effective for reducing stress and improving other health- and work-related outcomes, irrespective of the guidance format. Results did not demonstrate superiority of adherence-focused guidance for the efficacy but for adherence in terms of completed modules. Among other reasons, better communication strategies about offered guidance and awareness-raising measures are discussed. Results from mediation analysis suggest that preventive SMIs should be designed to reach two goals: reducing the risk factor of stress and simultaneously increasing health promoting factors such as resilience.
German Clinical Trial Registration (DRKS) DRKS00005687 , 6/6/2014.
基于网络的压力管理干预（SMI）符合日益数字化的生活方式，减少了采用的障碍，并且易于扩展。SMI 可能会降低员工的压力水平，从而有助于预防抑郁症状。不同的指导形式可能会影响 SMI 的效果，高强度的指导被认为会产生更大的效果。然而，针对指导形式的头对头比较很少。这是第一项试验，旨在比较基于依从性的指导与自助指导对职业 SMI 的效果，与等待名单对照组相比。此外，还将研究 SMI 是否通过降低健康损害和增加促进因素来预防抑郁症状。
进行了一项基于网络的职业 SMI 的三臂随机对照试验（RCT）。404 名压力感知水平升高（PSS-10≥22）的员工被随机分配到以下三组：基于依从性的指导（AFG）、自助（SH）或等待名单对照组（WLC）。主要结果是感知压力（PSS-10）。次要结果包括健康和工作相关的措施。进行了平行中介分析，将压力和适应力作为对抑郁（CES-D）影响的中介。数据收集在基线（T1）、7 周后（T2）和 6 个月后（T3）进行。
对于所有组，SMI 在主要和次要结果上均有效。对于压力，协方差分析（ANCOVA）显示 T2（F=36.08，P<.001）和 T3（F=37.04，P<.001）时存在显著的组间效应，AFG（T2：d=0.83；T3：d=0.85）和 SH（T2：d=0.88；T3：d=0.91）的效果较大，与 WLC 相比。在主要和次要结果方面，AFG 和 SH 之间的效果没有显著的组间差异。就完成的模块而言，AFG 的依从性明显高于 SH。SMI 对抑郁的影响通过感知压力进行中介：ab=−0.77，95%CI[−1.26，−0.34]和适应力：ab=−0.62，95%CI[−1.05，−0.26]。
无论指导形式如何，SMI 均能有效降低压力，改善其他健康和工作相关的结果。结果并未表明基于依从性的指导在疗效上优于其他指导形式，而是在完成模块的依从性方面优于其他指导形式。此外，还讨论了关于提供指导的更好沟通策略和提高认识的措施等其他原因。中介分析的结果表明，预防 SMI 应设计为达到两个目标：降低压力这一风险因素，同时增加健康促进因素，如适应力。
德国临床试验注册（DRKS）DRKS00005687，2014 年 6 月 6 日。
