医护人员的心理空间需求：一项多中心确定随机对照试验的研究结果，该试验评估了一种非指导性的数字正念自助应用程序对减少医护人员压力的效果。

Health Care Workers' Need for Headspace: Findings From a Multisite Definitive Randomized Controlled Trial of an Unguided Digital Mindfulness-Based Self-help App to Reduce Healthcare Worker Stress.

机构信息

School of Psychology, University of Sussex, Brighton, United Kingdom.

Sussex Partnership NHS Foundation Trust, Hove, United Kingdom.

出版信息

JMIR Mhealth Uhealth. 2022 Aug 25;10(8):e31744. doi: 10.2196/31744.

DOI:10.2196/31744

PMID:36006668

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC9459942/

Abstract

BACKGROUND

Health care workers experience high stress. Accessible, affordable, and effective approaches to reducing stress are lacking. In-person mindfulness-based interventions can reduce health care worker stress but are not widely available or accessible to busy health care workers. Unguided, digital, mindfulness-based self-help (MBSH) interventions show promise and can be flexibly engaged with. However, their effectiveness in reducing health care worker stress has not yet been explored in a definitive trial.

OBJECTIVE

This study aimed to investigate the effectiveness of an unguided digital MBSH app (Headspace) in reducing health care worker stress.

METHODS

This was a definitive superiority randomized controlled trial with 2182 National Health Service staff in England recruited on the web and allocated in a 1:1 ratio to fully automated Headspace (n=1095, 50.18%) or active control (Moodzone; n=1087, 49.82%) for 4.5 months. Outcomes were subscales of the Depression, Anxiety, and Stress (primary outcome) Scale short form; Short Warwick Edinburgh Mental Well-being Scale; Maslach Burnout Inventory; 15-item Five-Facet Mindfulness Questionnaire minus Observe items; Self-Compassion Scale-Short Form; Compassionate Love Scale; Penn State Worry Questionnaire; Brooding subscale of the Ruminative Response Scale; and sickness absence.

RESULTS

Intention-to-treat analyses found that Headspace led to greater reductions in stress over time than Moodzone (b=-0.31, 95% CI -0.47 to -0.14; P<.001), with small effects. Small effects of Headspace versus Moodzone were found for depression (b=-0.24, 95% CI -0.40 to -0.08; P=.003), anxiety (b=-0.19, 95% CI -0.32 to -0.06; P=.004), well-being (b=0.14, 95% CI 0.05-0.23; P=.002), mindfulness (b=0.22, 95% CI 0.09-0.34; P=.001), self-compassion (b=0.48, 95% CI 0.33-0.64; P<.001), compassion for others (b=0.02, 95% CI 0.00-0.04; P=.04), and worry (b=-0.30, 95% CI -0.51 to -0.09; P=.005) but not for burnout (b=-0.19, -0.04, and 0.13, all 95% CIs >0; P=.65, .67, and .35), ruminative brooding (b=-0.06, 95% CI -0.12 to 0.00; P=.06), or sickness absence (γ=0.09, 95% CI -0.18 to 0.34). Per-protocol effects of Headspace (454/1095, 41.46%) versus Moodzone (283/1087, 26.03%) over time were found for stress, self-compassion, and compassion for others but not for the other outcomes. Engagement (practice days per week) and improvements in self-compassion during the initial 1.5-month intervention period mediated pre- to postintervention improvements in stress. Improvements in mindfulness, rumination, and worry did not mediate pre- to postintervention improvements in stress. No serious adverse events were reported.

CONCLUSIONS

An unguided digital MBSH intervention (Headspace) can reduce health care workers' stress. Effect sizes were small but could have population-level benefits. Unguided digital MBSH interventions can be part of the solution to reducing health care worker stress alongside potentially costlier but potentially more effective in-person mindfulness-based interventions, nonmindfulness courses, and organizational-level interventions.

TRIAL REGISTRATION

International Standard Randomised Controlled Trial Number ISRCTN15424185; https://tinyurl.com/rv9en5kc.

摘要

背景

医护人员压力大。目前缺乏既实惠又有效的减压方法。面对面的正念干预可以减轻医护人员的压力，但对于忙碌的医护人员来说，这种方法并不普及或方便。自主的、数字化的、基于正念的自助干预措施有一定的效果，而且可以灵活应用。但是，它们在减轻医护人员压力方面的效果尚未在明确的试验中得到验证。

目的

本研究旨在调查自主的数字化正念自助应用程序（Headspace）在减轻医护人员压力方面的有效性。

方法

这是一项明确的优势随机对照试验，共有 2182 名英格兰国民保健署工作人员在网上招募，按照 1:1 的比例分为完全自动化的 Headspace（n=1095，50.18%）或主动对照组（Moodzone；n=1087，49.82%），接受 4.5 个月的干预。主要结局为抑郁、焦虑和压力量表短表（Depression, Anxiety, and Stress Scale short form）的亚量表；简短的沃特福德爱丁堡心理健康量表（Short Warwick Edinburgh Mental Well-being Scale）；马斯拉奇职业倦怠量表（Maslach Burnout Inventory）；五因素正念问卷减去观察项（15-item Five-Facet Mindfulness Questionnaire minus Observe items）；自我同情量表-短表（Self-Compassion Scale-Short Form）；关爱量表（Compassionate Love Scale）；宾夕法尼亚州担忧问卷（Penn State Worry Questionnaire）；沉思反应量表的沉思亚量表（Ruminative Response Scale）和病假缺勤。

结果

意向治疗分析发现，与 Moodzone 相比，Headspace 随着时间的推移能更大程度地减轻压力（b=-0.31，95%置信区间-0.47 至-0.14；P<.001），效果较小。与 Moodzone 相比，Headspace 对抑郁（b=-0.24，95%置信区间-0.40 至-0.08；P=.003）、焦虑（b=-0.19，95%置信区间-0.32 至-0.06；P=.004）、幸福感（b=0.14，95%置信区间 0.05-0.23；P=.002）、正念（b=0.22，95%置信区间 0.09-0.34；P=.001）、自我同情（b=0.48，95%置信区间 0.33-0.64；P<.001）、关爱他人（b=0.02，95%置信区间 0.00-0.04；P=.04）和担忧（b=-0.30，95%置信区间-0.51 至-0.09；P=.005）的影响有统计学意义，但对倦怠（b=-0.19，-0.04，和 0.13，所有 95%置信区间均>0；P=.65，.67，和.35）、沉思性沉思（b=-0.06，95%置信区间-0.12 至 0.00；P=.06）或病假缺勤（γ=0.09，95%置信区间-0.18 至 0.34）没有影响。与 Moodzone 相比，Headspace 在 4.5 个月的时间里对压力、自我同情和关爱他人有积极的效果（454/1095，41.46%），但其他结果没有。在最初的 1.5 个月的干预期间，自我同情和关爱他人的改善与压力的改善有关。正念、沉思和担忧的改善与压力的改善无关。没有报告严重的不良事件。