Williams • Mental Health Conditions, Nurse Mental Health • 01 Aug 2025

Addressing Health Care Workers’ Mental
Health: A Systematic Review of Evidence-
Based Interventions and Current Resources

Mental health issues among health care workers, such as nurses and physicians, have become a critical concern, particularly since the onset of the COVID-19 pandemic. In any given year, mental health issues create an economic burden in the United States of $225 billion attributable to costs associated with medical care and lost productivity. In the general workforce, mental health issues (e.g., distress, burnout) and mental illnesses (e.g., anxiety, depression) are associated with increased absenteeism and presenteeism (i.e., lost productivity or reduced performance), turnover, and increased rates of short- and long-term disability.

Within the health care sector, the consequences of poor worker mental health have never been more troubling. Before COVID-19, more than 50% of clinicians reported experiencing some level of burnout because of challenges associated with short staffing, long hours, high job demands, and compassion fatigue. This number rose to 76% within the first year of the pandemic. Benefits surrounding mental illness (i.e., diagnosable psychological disorders classified within the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders [DSM-5; Washington, DC: American Psychiatric Association; 2013]) have grown substantially, with many organizations now offering funding for psychological services. Those who invest in mental health support and intervention see an estimated return on investment (ROI) of $4 per dollar invested.

Since 2020, mental health in the workplace has ranked among the most critical areas of research and practice by major organizations worldwide. This article summarizes a systematic review by W. Kent Anger, PhD, Jennifer K. Dimoff, PhD, and Lindsey Alley, MS, published in the American Journal of Public Health (2024;114(S2):S213–S226), which evaluates evidence-based interventions aimed at improving mental health outcomes for health care workers.

Background and Objectives

Mental health is declining in health care workers. The objectives of this systematic review were to provide a comprehensive assessment of intervention literature focused on the support and treatment of mental health within the health care workforce. The target audience includes academicians, practitioners in public health, health care administrators, leaders, and safety and human resources professionals.

Methods

Search Methods

For this review, we considered all relevant peer-reviewed and gray literature describing workplace mental health interventions targeting health care workers. We searched online databases, including Ovid MEDLINE ALL, PsycINFO, PubMed, National Institute for Health and Care Excellence, Agency for Healthcare Research and Quality Project Database, Patient-Centered Outcomes Research Institute Project Database, National Institute for Occupational Safety and Health Project Database, Effective Healthcare Program, Google Scholar, and DuckDuckGo. The initial search placed no restrictions on language, location, or time, searching all literature up to March 2022.

Key search terms were defined as follows (* indicates truncation for broader inclusion):

• Target population: physician, nurse, doctor, surgeon, provider, clinician, resident, “first responder,” “health care worker,” “healthcare worker,” “care provider,” “home care worker,” “home health aide,” “hospice worker,” “health aide”
• Mental health: depress*, burnout, anx*, fatigue, stress, distress, strain, satisfaction, “quality of life,” wellbeing/well-being/well being*/wellbeing*, “mental health”
• Intervention: intervention, program, training, computer-based, online, resource, app, program, “peer support,” “support group,” “social support,” “supervisor support,” policy, redesign, “work redesign,” “organization level,” “individual level,” “system level”

Selection Criteria

We selected manuscripts published before March 2022 that evaluated the target population (e.g., nurses), mental health outcomes (e.g., burnout, depression), and intervention category (e.g., mindfulness). Articles were gathered and initially screened for relevance by a senior research associate with advanced expertise in systematic review methodology (LA). We considered all studies employing either a pre-post or post-only design, including randomized controlled trials, quasi-experimental studies, qualitative post hoc evaluations, case studies, and program descriptions with a data collection component. We mined systematic reviews and meta-analyses in health care mental health for additional references.

Data Collection and Analysis

All relevant literature was imported into Zotero and Covidence (systematic review software). Articles were rated by at least two senior researchers (WKA, JD, LA). In the first screening phase, articles were rated for inclusion or exclusion based on titles and abstracts (scale: Yes, No, Maybe). A full-text review was conducted for articles rated as “Yes” or “Maybe.”

Inclusion criteria were: (1) recruited health care workers (broadly defined), (2) measured one or more mental health-related outcomes, and (3) introduced a mental health-focused intervention (e.g., resource, tool, exercise, policy, program, training).

Exclusion criteria were: (1) the intervention was not specific to mental health (e.g., job performance, patient care skills training), (2) the sample did not include at least one type of medical personnel, and (3) the full publication was not available in English.

Study quality was assessed using a slightly adapted version of the validated Downs and Black (D&B) measure, consisting of 25 items to rate study quality, external validity, internal validity-bias, internal validity-confounding, and power.

A final item assessed raters’ confidence (1 = not at all confident; 4 = very confident) that the true intervention effect lies close to the authors’ estimate, derived from the GRADE rating protocol. Interrater reliability (Cohen’s κ) was calculated, with initial values of 0.79 (abstract review), 0.76 (full-text review), and 0.42 for D&B quality ratings (revised D&B IRR = 0.84 after consensus).

Results

The search yielded 5158 publications (4951 peer-reviewed) for preliminary screening. After removing duplicates and irrelevant publications, 628 abstracts were screened, and 211 articles underwent full-text review. One hundred twenty-two publications (describing 118 interventions) met inclusion criteria, all peer-reviewed.

Study Quality

Study quality, assessed by D&B criteria (maximum 25 points), showed the three highest-rated studies received 22 points. Seventeen publications (14%) earned ratings between 20 and 21, 48 (41%) between 15 and 19, and 42% rated 14 or below. Thirteen articles (11%) received the highest confidence rating (4), and 19 (16%) received 3.5.

Study Design

Most interventions employed a randomized controlled trial (n=52; 44%) or quasi-experimental design (n=50; 42%), defined as either a single-group study with two data collection timepoints or a multigroup study with a single post-intervention timepoint.

Setting

Evaluations were conducted in hospitals (n=85; 72%), online (n=15; 13%), nonhospital facilities (n=10; 8%), or miscellaneous settings (e.g., multiple, telephone, mail, unspecified; n=8; 7%). Programs were typically implemented during work hours. Studies spanned 25 countries, with most in the United States (n=45; 38%), Italy, and Canada (n=9 each; 8%).

Sample Sizes

Participant numbers ranged from 11 to 1575. Forty-six interventions (38%) had fewer than 50 participants, 27 (23%) had 51–100, 27 (23%) had 101–249, and 18 (15%) had 250 or more, including four with 1000 or more.

Health Care Worker Occupation

Nurses were recruited most frequently (n=78; 66%), followed by physicians (n=41; 35%). Twenty-two interventions (19%) did not provide specific job title demographics.

Intervention Categories

Seven intervention categories emerged:

1. Coping skills development (e.g., resilience-building, help-seeking, responding to stressors)
2. Mindfulness (e.g., mindfulness, directed meditation)
3. Health literacy and anti-stigma (e.g., mental health awareness, stigma reduction)
4. Peer support (e.g., team focus, relationship building, coworker support)
5. Organizational and system level (e.g., policies, cultural change, large-scale resources)
6. Reflection and relaxation (e.g., writing, artistic exercises, gratitude)
7. Medical (e.g., pharmaceutical treatment)

Thirty-one interventions (26%) fit multiple categories. Table 2 details category distribution:

Intervention Category	No. of Interventions (%)
Coping skills development	38 (32%)
Health literacy and anti-stigma	25 (21%)
Mindfulness	33 (28%)
Peer support	16 (14%)
Organizational and system level	11 (9%)
Reflection and relaxation	25 (21%)
Medical	4 (4%)

Prevention Categories

Interventions were categorized as primary (preventing illness before occurrence), secondary (early interventions to treat existing illness), or tertiary (managing long-term health problems). Twenty interventions were primary, 40 secondary, one tertiary, with some hybrid formats (e.g., primary/secondary: 44; secondary/tertiary: 13).

Prevention Category	No. of Interventions (%)
Primary	20 (17%)
Primary/secondary	44 (37%)
Secondary	40 (33%)
Secondary/tertiary	13 (11%)
Tertiary	1 (1%)

Individual vs. Organizational Interventions

Interventions were coded as individual (e.g., coping education; n=98; 83%), organizational (e.g., work environment changes; n=8; 7%), or both (n=12; 10%).

Mental Health Outcomes

The most common outcomes measured were stress (n=48; 41%), burnout (n=40; 34%), anxiety, depression, and emotional exhaustion or compassion fatigue (each n=31; 26%). Table 3 summarizes outcomes:

Outcomes	No. of Interventions	No. With Significant Changes	No. With Effect Sizes	Effect Size (Large/Medium/Small)
General health and well-being
Sleep/exhaustion	12	7	3	0/2/1
Mental health	14	5	4	2/1/1
General health	12	8	4	2/1/1
Affect	10	7	6	2/4/0
Well-being	13	10	7	4/1/2
Quality of life	11	8	7	4/2/1
Somatization	3	2	0	0/0/0
Stress and strain
Stress	48	29	14	5/6/3
Distress	14	9	4	3/0/1
Posttraumatic stress disorder	6	2	1	1/0/0
Strain	5	3	2	1/0/1
Depression	31	15	8	4/3/1
Anxiety	32	20	12	6/2/4
Burnout and compassion fatigue
Burnout	40	15	6	2/3/1
Emotional exhaustion or compassion fatigue	30	16	11	4/2/5
Emotions and attitudes
Psychosocial functioning	5	2	1	1/0/0
Happiness	2	1	0	0/0/0
Anger	2	1	0	0/0/0
Mental health stigma	2	2	0	0/0/0
Resilience and coping
Social support	15	8	2	1/0/1
Coping	10	1	1	0/1/0
Demands	6	1	1	0/1/0
Support seeking	5	2	0	0/0/0
Drinking behaviors	6	3	0	0/0/0
Work-life balance	7	3	2	0/1/1
Resilience	7	6	4	1/2/1
Mindfulness
Mindfulness	13	8	6	2/3/1
Self-compassion	7	5	4	0/2/2
Psychological flexibility	4	2	1	0/1/0
Awareness	2	2	0	0/0/0
Self-efficacy and self-esteem
Confidence	10	7	3	1/1/1
Self-efficacy	8	5	2	1/1/0
Inadequacy	1	1	0	0/0/0
Civility and relationships
Trust	1	1	1	1/0/0
Civility/incivility	5	5	2	1/0/1
Empathy	2	2	2	0/2/0
Respect	2	2	1	1/0/0

Statistically Significant Changes and Effect Sizes

Ninety interventions (76%) reported statistically significant improvements. Forty-six (39%) reported or calculated effect sizes (Cohen’s d: small=0.2, medium=0.5, large=0.8; η²/partial η²: small=0.01, medium=0.06, large=0.14; R²: small=0.00, medium=0.03, large=0.14; delta: small=0.2, medium=0.5, large=0.8). Significant changes included stress (n=29; 24%), anxiety (n=20; 17%), emotional exhaustion or compassion fatigue (n=16; 14%), burnout (n=15; 13%), and depression (n=15; 13%). Large effect sizes were noted in 27 interventions (23%), particularly for stress (5 large), anxiety (6 large), depression (4 large), emotional exhaustion (4 large), and burnout (2 large).

Time Commitment for Participants

Ninety publications (76%) noted participant time commitment, ranging from 0 (outside work) to 50 hours. Fifty-five interventions (47%) required 10 or fewer hours.

Discussion

The 118 interventions (122 publications) focused on general mental health, well-being, and specific issues like depression, anxiety, stress, burnout, and compassion fatigue. Findings suggest that targeted, well-designed interventions can significantly improve mental health outcomes among health care workers.

Interventions That Improved Outcome Measures

Of the 118 interventions, 97 were associated with significant reductions in key outcomes: stress (n=29), anxiety (n=20), emotional exhaustion or compassion fatigue (n=16), burnout (n=16), and depression (n=15). Randomized controlled trials showed improvements in stress (n=17), emotional exhaustion (n=10), depression (n=9), anxiety (n=9), and burnout (n=7). Nearly one-fourth (n=27; 23%) of improvements had large effect sizes, with 12 of 40 high-quality interventions (D&B ≥18) producing large effect sizes in key outcomes, indicating meaningful real-world impact.

Interventions incorporating mindfulness and coping skills development (e.g., acceptance and commitment therapy [ACT], cognitive behavioral therapy [CBT]) yielded the most significant changes. Relaxation and reflection interventions (e.g., art therapy, expressive writing, yoga) also showed positive outcomes. Multifocused interventions combining health literacy, coping skills, reflection, and peer support improved mental health measures. Medical interventions (e.g., cannabidiol therapy, transcranial magnetic stimulation) showed promise in reducing anxiety and depression.

Notable interventions included:

• Civility, Respect, and Engagement at Work (CREW): 7 outcomes improved
• Stress Management and Resiliency Training (SMART): 5 outcomes, 5 large effect sizes
• MINDBODYSTRONG and Brief Mindfulness-Based Stress Reduction (MBSR): 4 outcomes each
• Mindfulness-Based Resilience Training (MBRT), Acupressure and Emotional Freedom Techniques (EFT), expressive writing, enhancing resilience: 3 outcomes each

High-quality studies (D&B ≥18) showed coping skills development and mindfulness interventions as most effective, with SMART (7 outcomes, 5 large effect sizes) and Acupressure and EFT (3 outcomes, all large) leading in coping skills, and Mindfulness-Based Cognitive Therapy for Life (6 outcomes, 1 large) and ACT+CBT (4 outcomes, 2 large) in mindfulness. Peer support and organizational interventions had mixed results unless combined with individual strategies.

Statistically significant improvements may not always translate to universal health improvements, as effectiveness varies by individual and baseline mental health status.

Study Quality

Most evaluations had high study quality: 20 (17%) scored >19 on D&B, and 48 (41%) scored 15–19, indicating strong design and implementation. Fifty-two (44%) were randomized controlled trials, and 50 (42%) were quasi-experimental. Thirty-two (27%) earned confidence ratings ≥3.5. Lower-quality studies faced challenges like small sample sizes (62% ≤100 participants), lack of control groups, or inadequate power, making it unclear whether nonsignificant outcomes resulted from ineffective interventions or methodological limitations.

Availability and Cost

Cost-related data or ROI calculations were rare. Four of six interventions with ROI measures showed improved attendance. Thirty-two percent of interventions were described in sufficient detail for implementation or available from authors. Thirty-seven interventions had publicly available resources (see Table A at https://ajph.org). Organizations should select interventions based on specific outcomes, mechanisms, and target beneficiaries, with ongoing post-intervention measurement to assess long-term impact.

Limitations and Future Directions

This review included articles up to March 2022, potentially missing recent COVID-19-related research. It focused solely on health care, excluding effective interventions from other sectors. Small sample sizes and insufficient evaluation methods limited efficacy determination for many programs. Most interventions were individual-focused, highlighting a gap in organizational-level research. Despite these limitations, the growing literature and prioritization of mental health at organizational and policy levels are promising.

Plain-Language Summary

We searched research publications to locate interventions that aimed to improve mental health among health care workers, such as nurses and medical doctors. The interventions were designed to offer support, such as training or counseling, to health care workers who were having symptoms of poor mental health, such as burnout, stress, or anxiety. We screened 5158 science journal articles and found 118 different interventions that had been offered to health care workers. Each article was evaluated to rate the degree to which they used accepted scientific methods of research. Most studies used strong research designs and contained valuable information about methods to improve mental health among health care workers. More than one third of the interventions were conducted in the United States, and most of the others were conducted in Canada or Europe. Several interventions were successful in improving symptoms of stress, burnout, anxiety, and depression among health care workers.

Authors’ Conclusions

Targeted, well-designed mental health interventions can improve outcomes among health care workers.

Public Health Implications

Targeted health care-focused interventions to address workers’ mental health could improve outcomes within this important and vulnerable workforce.

About the Authors

W. Kent Anger and Lindsey Alley are with Oregon Health & Science University (OHSU), Oregon Institute of Occupational Health Sciences, Portland, OR 97233. Jennifer Dimoff is with University of Ottawa, Telfer School of Management, Ottawa, Ontario, Canada.

Correspondence

Correspondence should be sent to W. Kent Anger, PhD, Oregon Health & Science University, L606, Portland, OR 97233 (e-mail: anger@ohsu.edu). Reprints can be ordered at https://ajph.org by clicking the “Reprints” link.

Publication Information

Full Citation: Anger WK, Dimoff JK, Alley L. Addressing health care workers’ mental health: a systematic review of evidence-based interventions and current resources. Am J Public Health. 2024;114(S2):S213–S226.
Acceptance Date: December 2, 2023.
DOI: https://doi.org/10.2105/AJPH.2023.307556

Contributors

W. K. Anger had overall responsibility for accuracy, distributed manuscript responsibilities, reviewed titles and abstracts and full articles, organized the article, assessed intervention availability, was the primary author of the Results section, completed most tables and both supplementary tables, and contributed to the Discussion section. J. K. Dimoff reviewed titles, abstracts, and full articles, contributed to the Results section, consulted on the assessment and interpretation of mental health issues, established the organization of mental health outcomes, and was the primary author of the Discussion section. L. Alley reviewed titles, abstracts, and full articles, performed the systematic search, extracted relevant statistics and information for tables, wrote the Methods section, and contributed to the Introduction and Discussion sections.