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Group interventions to promote mental health in health professional education: a systematic review and meta-analysis of randomised controlled trials

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Abstract

Effects of interventions for improving mental health of health professional students has not been established. This review analysed interventions to support mental health of health professional students and their effects. The full holdings of Medline, PsycINFO, EBM Reviews, Cinahl Plus, ERIC and EMBASE were searched until 15th April 2016. Inclusion criteria were randomised controlled trials of undergraduate and post graduate health professional students, group interventions to support mental health compared to alternative education, usual curriculum or no intervention; and post-intervention measurements for intervention and control participants of mindfulness, anxiety, depression, stress/distress or burnout. Studies were limited to English and short term effects. Studies were appraised using the PEDro scale. Data were synthesised using meta-analysis. Four comparisons were identified: psychoeducation or cognitive-behavioural interventions compared to alternative education, and mindfulness or relaxation compared to control conditions. Cognitive-behavioural interventions reduced anxiety (−0.26; −0.5 to −0.02), depression (−0.29; −0.52 to −0.05) and stress (0.37; −0.61 to −0.13). Mindfulness strategies reduced stress (−0.60; −0.97 to −0.22) but not anxiety (95% CI −0.21 to 0.18), depression (95% CI −0.36 to 0.03) or burnout (95% CI −0.36 to 0.10). Relaxation strategies reduced anxiety (SMD −0.80; 95% CI −1.03 to −0.58), depression (−0.49; −0.88 to −0.11) and stress (−0.34; −0.67 to −0.01). Method quality was generally poor. Evidence suggests that cognitive-behavioural, relaxation and mindfulness interventions may support health professional student mental health. Further high quality research is warranted.

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Acknowledgements

We acknowledge the Traditional Custodians of our land and pay our respects to their Elders, past and present. Thank you to Tonya Jones for her assistance in data extraction.

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Correspondence to Kristin Lo.

Appendix

Appendix

Medline search strategy (Ovid 1946–2016), April 2016

  1. 1.

    student$.mp.

  2. 2.

    mindful$.mp.

  3. 3.

    resilien$.mp.

  4. 4.

    burnout.mp.

  5. 5.

    (wellness or wellbeing).mp.

  6. 6.

    exp Mental Health/

  7. 7.

    calm.mp.

  8. 8.

    exp Performance Anxiety

  9. 9.

    exp “Quality of Life”

  10. 10.

    2 or 3 or 4 or 5 or 6 or 7 or 8 or 9 or 10

  11. 11.

    1 and 11

[mp = title, abstract, original title, name of substance word, subject heading word, keyword heading word, protocol supplementary concept, rare disease supplementary concept, unique identifier]

PsycINFO (Ovid 1987–2016),

  1. 1.

    student$.mp.

  2. 2.

    mindful$.mp.

  3. 3.

    resilien$.mp.

  4. 4.

    burnout.mp.

  5. 5.

    exp Mental Health

  6. 6.

    (distress or stress).mp.

  7. 7.

    calm.mp.

  8. 8.

    exp Performance Anxiety

  9. 9.

    exp “Quality of Life”

  10. 10.

    2 or 3 or 4 or 5 or 6 or 7 or 8 or 9 or 10

  11. 11.

    1 and 11

ALL EBM Reviews (1st Quarter 2016)

  1. 1.

    student$.mp.

  2. 2.

    mindful$.mp.

  3. 3.

    resilien$.mp.

  4. 4.

    burnout.mp.

  5. 5.

    (wellness or wellbeing).mp.

  6. 6.

    exp Mental Health

  7. 7.

    (distress or stress).mp

  8. 8.

    calm.mp.

  9. 9.

    exp Performance Anxiety

  10. 10.

    exp “Quality of Life”

  11. 11.

    2 or 3 or 4 or 5 or 6 or 7 or 8 or 9 or 10

  12. 12.

    1 and 11

[mp = ti, ab, tx, kw, ct, ot, sh, hw]

CINAHL Plus (Ebsco 1937–2016)

  1. 1.

    mindful*

  2. 2.

    distress

  3. 3.

    stress

  4. 4.

    wellness

  5. 5.

    wellbeing

  6. 6.

    calm

  7. 7.

    “mental health”

  8. 8.

    resilien*

  9. 9.

    burnout

  10. 10.

    “performance anxiety”

  11. 11.

    “quality of life”

  12. 12.

    1 or 2 or 3 or 4 or 5 or 6 or 7 or 8 or 9 or 10 or 11

  13. 13.

    student*

  14. 14.

    11 and 12

  15. 15.

    limit to RCT

ERIC (ProQuest 1945–2016),

  1. 1

    (mindful* OR stress OR distress OR wellness OR wellbeing OR calm OR “mental health” OR resilien* OR burnout OR “performance anxiety” OR “quality of life”)

    AND student*

    Limit to research OR numerical/quantitative data

EMBASE (Elsevier 1957–2016).

  • #18.1 mindful*

  • #18.2 ‘distress’/exp OR distress OR ‘stress’/exp OR stress

  • #18.3 ‘wellness’/exp OR wellness OR ‘wellbeing’/exp OR wellbeing

  • #18.4 calm

  • #18.5 ‘mental health’/exp OR ‘mental health’

  • #18.6 resilien*

  • #18.7 ‘burnout’/exp OR burnout

  • #18.8 ‘quality of life’/exp OR ‘quality of life’

  • #18.9 ‘performance anxiety’/exp OR ‘performance anxiety’

  • #18.10 (#18.1 OR #18.2 OR #18.3 OR #18.4 OR #18.5 OR #18.6 OR #18.7 OR #18.8 OR #18.9)

  • #18.11 student*

  • #18.12 (#18.10 AND #18.11) AND ‘randomized controlled trial’

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Lo, K., Waterland, J., Todd, P. et al. Group interventions to promote mental health in health professional education: a systematic review and meta-analysis of randomised controlled trials. Adv in Health Sci Educ 23, 413–447 (2018). https://doi.org/10.1007/s10459-017-9770-5

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