Bridging the adherence gap in internet interventions: A randomized controlled trial study protocol investigating context-specific self-efficacy.

Low adherence in self-guided internet interventions is linked to poorer outcomes. Although some predictors of adherence have been identified, few are modifiable for widespread application. One personal variable with the potential to increase adherence in internet interventions is context-specific self-efficacy. This protocol outlines a randomized controlled trial design, divided into two phases. In Phase 1 (students, N = 216), participants will complete a self-efficacy-enhancing exercise, which will be compared to a waitlist control group to test its effectiveness in increasing internet intervention adherence self-efficacy. Phase 2 will be the main two-arm trial, where all participants (medical students, N = 952) will undergo an internet intervention called Med-Stress Student. In the experimental group, the program will be preceded by the self-efficacy-enhancing exercise developed in Phase 1. We anticipate that participants in the experimental group will show higher adherence (primary outcome) to the intervention and greater improvement in intervention outcomes (secondary outcomes i.e., lower stress and higher work engagement) at posttest, as well as at six-month and one-year follow-ups. If effective, enhancing context-specific self-efficacy could be recommended before any internet intervention as a relatively simple way to boost participants' adherence.

Crossover of the dimensions of work-family and family-work conflict in couples: Protocol for a qualitative study.

Conflict between work and non-work is a bidirectional and a multidimensional construct that has garnered much attention from researchers and practitioners alike. Previously, studies with a dyadic design demonstrated that interrole conflict can cross over between partners in romantic relationships. The aim of the present study is to explore-from an individual and dyadic perspective-how partners perceive dimensions of interrole conflict (that is: time, strain, behaviour, and possibly others) and whether crossover between partners is dimension-dependent. This protocol outlines a qualitative interview study. Participants (N = 40) will be dual-earner couples that meet two inclusion criteria: both partners need to be professionally active, and the couples need to have lived together for at least a year. Interviews will be conducted separately with each partner. To analyse the data at the individual level we will use reflexive thematic analysis. To analyse the data at the dyadic level we will apply an adapted version of the framework method. We anticipate that findings of this study will have the potential to advance theoretical models depicting crossover processes and, more generally, the interface between work and family lives. Moreover, insights into how couples experience dimension-based interrole conflict will be important for the development of targeted interventions.

Low-effort internet intervention to reduce students' stress delivered with Meta's Messenger chatbot (Stressbot): A randomized controlled trial.

In order to be more accessible and overcome the challenges of low adherence and high dropout, self-guided internet interventions need to seek new delivery formats. In this study, we tested whether a widely-adopted social media app - Meta's (Facebook) Messenger - would be a suitable conveyor of such an internet intervention. Specifically, we verified the efficacy of Stressbot: a Messenger chatbot-delivered intervention focused on enhancing coping self-efficacy to reduce stress and improve quality of life in university students. Participants (N = 372) were randomly assigned to two conditions: (1) an experimental group with access to the Stressbot intervention, and (2) a waitlist control group. Three outcomes, namely coping self-efficacy, stress, and quality of life, were assessed at three time points: a baseline, post-test, and one-month follow-up. Linear Mixed Effects Models were used to analyze the data. At post-test, we found improvements in the Stressbot condition compared to the control condition for stress (d = -0.33) and coping self-efficacy (d = 0.50), but not for quality of life. A sensitivity analysis revealed that the positive short-term intervention effects were robust. At the follow-up, there were no differences between groups, indicating that the intervention was effective only in the short term. In sum, the results suggest that the Messenger app is a viable means to deliver a self-guided internet intervention. However, modifications such as a more engaging design or boosters are required for the effects to persist.

Effect of Sleep Disturbance Symptoms on Treatment Outcome in Blended Cognitive Behavioral Therapy for Depression (E-COMPARED Study): Secondary Analysis.

BACKGROUND: Sleep disturbance symptoms are common in major depressive disorder (MDD) and have been found to hamper the treatment effect of conventional face-to-face psychological treatments such as cognitive behavioral therapy. To increase the dissemination of evidence-based treatment, blended cognitive behavioral therapy (bCBT) consisting of web-based and face-to-face treatment is on the rise for patients with MDD. To date, no study has examined whether sleep disturbance symptoms have an impact on bCBT treatment outcomes and whether it affects bCBT and treatment-as-usual (TAU) equally. OBJECTIVE: The objectives of this study are to investigate whether baseline sleep disturbance symptoms have an impact on treatment outcomes independent of treatment modality and whether sleep disturbance symptoms impact bCBT and TAU in routine care equally. METHODS: The study was based on data from the E-COMPARED (European Comparative Effectiveness Research on Blended Depression Treatment Versus Treatment-as-Usual) study, a 2-arm, multisite, parallel randomized controlled, noninferiority trial. A total of 943 outpatients with MDD were randomized to either bCBT (476/943, 50.5%) or TAU consisting of routine clinical MDD treatment (467/943, 49.5%). The primary outcome of this study was the change in depression symptom severity at the 12-month follow-up. The secondary outcomes were the change in depression symptom severity at the 3- and 6-month follow-up and MDD diagnoses at the 12-month follow-up, assessed using the Patient Health Questionnaire-9 and Mini-International Neuropsychiatric Interview, respectively. Mixed effects models were used to examine the association of sleep disturbance symptoms with treatment outcome and treatment modality over time. RESULTS: Of the 943 patients recruited for the study, 558 (59.2%) completed the 12-month follow-up assessment. In the total sample, baseline sleep disturbance symptoms did not significantly affect change in depressive symptom severity at the 12-month follow-up (ß=.16, 95% CI -0.04 to 0.36). However, baseline sleep disturbance symptoms were negatively associated with treatment outcome for bCBT (ß=.49, 95% CI 0.22-0.76) but not for TAU (ß=-.23, 95% CI -0.50 to 0.05) at the 12-month follow-up, even when adjusting for baseline depression symptom severity. The same result was seen for the effect of sleep disturbance symptoms on the presence of depression measured with Mini-International Neuropsychiatric Interview at the 12-month follow-up. However, for both treatment formats, baseline sleep disturbance symptoms were not associated with depression symptom severity at either the 3- (ß=.06, 95% CI -0.11 to 0.23) or 6-month (ß=.09, 95% CI -0.10 to 0.28) follow-up. CONCLUSIONS: Baseline sleep disturbance symptoms may have a negative impact on long-term treatment outcomes in bCBT for MDD. This effect was not observed for TAU. These findings suggest that special attention to sleep disturbance symptoms might be warranted when MDD is treated with bCBT. Future studies should investigate the effect of implementing modules specifically targeting sleep disturbance symptoms in bCBT for MDD to improve long-term prognosis.

Other- (vs. self-) oriented meaning interventions enhance momentary work engagement through changes in work meaningfulness.

We tested whether a short, online meaning intervention boosts momentary work engagement (MWE) through an increase in perceived work meaningfulness. In Study 1 (N = 227), employees who were asked to write why their work was meaningful subsequently experienced higher work meaningfulness and higher MWE compared to a control group. Work meaningfulness mediated the relationship between the intervention and MWE. Study 2, conducted among employees (N = 254), found that writing about how one's work serves a greater good (vs. how it advances personal career, vs. control) led to an increase in work meaningfulness, which consequently predicted MWE. The research examines a new tool to enhance work meaningfulness that can be easily and widely applied and that provides insight into how sources of meaningful work are related to work meaningfulness and to important occupational outcomes. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Beyond the individual: A systematic review of the effects of unit-level demands and resources on employee productivity, health, and well-being.

Creating sustainable employment-that is, a condition in which employees remain productive but also enjoy good health and well-being-is a challenge for many organizations. Work environment factors are major contributors to these employee outcomes. The job demands-resources model categorizes work environment factors into demands versus resources, which are, respectively, detrimental versus beneficial to employee outcomes. Although conceptualized as workplace factors, these job characteristics have been studied mostly at an individual level. Therefore, their roles at the supraindividual level (i.e., any work-unit level above an individual, such as group or organization) for employee productivity, health, and well-being remains unclear. The aim of this systematic review is to synthesize evidence concerning job resources and job demands at the supraindividual level and their relationships to productivity, health, and work-related well-being. The review covers articles published through December 2018. In total, 202 papers met the inclusion criteria. We found stronger support for the beneficial roles of supraindividual job resources than for the detrimental roles of job demands for productivity and work-related well-being. Regarding health, most of the relationships were found to be nonsignificant. To conclude, this review demonstrates that, at the supraindividual level, the motivational path has received more support than the health impairment path. Based on these findings, we provide recommendations for further research and practice. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Examining the Theoretical Framework of Behavioral Activation for Major Depressive Disorder: Smartphone-Based Ecological Momentary Assessment Study.

BACKGROUND: Behavioral activation (BA), either as a stand-alone treatment or as part of cognitive behavioral therapy, has been shown to be effective for treating depression. The theoretical underpinnings of BA derive from Lewinsohn et al's theory of depression. The central premise of BA is that having patients engage in more pleasant activities leads to them experiencing more pleasure and elevates their mood, which, in turn, leads to further (behavioral) activation. However, there is a dearth of empirical evidence about the theoretical framework of BA. OBJECTIVE: This study aims to examine the assumed (temporal) associations of the 3 constructs in the theoretical framework of BA. METHODS: Data were collected as part of the "European Comparative Effectiveness Research on Internet-based Depression Treatment versus treatment-as-usual" trial among patients who were randomly assigned to receive blended cognitive behavioral therapy (bCBT). As part of bCBT, patients completed weekly assessments of their level of engagement in pleasant activities, the pleasure they experienced as a result of these activities, and their mood over the course of the treatment using a smartphone-based ecological momentary assessment (EMA) application. Longitudinal cross-lagged and cross-sectional associations of 240 patients were examined using random intercept cross-lagged panel models. RESULTS: The analyses did not reveal any statistically significant cross-lagged coefficients (all P>.05). Statistically significant cross-sectional positive associations between activities, pleasure, and mood levels were identified. Moreover, the levels of engagement in activities, pleasure, and mood slightly increased over the duration of the treatment. In addition, mood seemed to carry over, over time, while both levels of engagement in activities and pleasurable experiences did not. CONCLUSIONS: The results were partially in accordance with the theoretical framework of BA, insofar as the analyses revealed cross-sectional relationships between levels of engagement in activities, pleasurable experiences deriving from these activities, and enhanced mood. However, given that no statistically significant temporal relationships were revealed, no conclusions could be drawn about potential causality. A shorter measurement interval (eg, daily rather than weekly EMA reports) might be more attuned to detecting potential underlying temporal pathways. Future research should use an EMA methodology to further investigate temporal associations, based on theory and how treatments are presented to patients. TRIAL REGISTRATION: ClinicalTrials.gov, NCT02542891, https://clinicaltrials.gov/ct2/show/NCT02542891; German Clinical Trials Register, DRKS00006866, https://tinyurl.com/ybja3xz7; Netherlands Trials Register, NTR4962, https://www.trialregister.nl/trial/4838; ClinicalTrials.Gov, NCT02389660, https://clinicaltrials.gov/ct2/show/NCT02389660; ClinicalTrials.gov, NCT02361684, https://clinicaltrials.gov/ct2/show/NCT02361684; ClinicalTrials.gov, NCT02449447, https://clinicaltrials.gov/ct2/show/NCT02449447; ClinicalTrials.gov, NCT02410616, https://clinicaltrials.gov/ct2/show/NCT02410616; ISRCTN registry, ISRCTN12388725, https://www.isrctn.com/ISRCTN12388725.

Resource-Based Internet Intervention (Med-Stress) to Improve Well-Being Among Medical Professionals: Randomized Controlled Trial.

BACKGROUND: Medical professionals are exposed to multiple and often excessive demands in their work environment. Low-intensity internet interventions allow them to benefit from psychological support even when institutional help is not available. Focusing on enhancing psychological resources-self-efficacy and perceived social support-makes an intervention relevant for various occupations within the medical profession. Previously, these resources were found to operate both individually or sequentially with self-efficacy either preceding social support (cultivation process) or following it (enabling process). OBJECTIVE: The objective of this randomized controlled trial is to compare the efficacy of 4 variants of Med-Stress, a self-guided internet intervention that aims to improve the multifaceted well-being of medical professionals. METHODS: This study was conducted before the COVID-19 pandemic. Participants (N=1240) were recruited mainly via media campaigns and social media targeted ads. They were assigned to 1 of the following 4 groups: experimental condition reflecting the cultivation process, experimental condition reflecting the enabling process, active comparator enhancing only self-efficacy, and active comparator enhancing only perceived social support. Outcomes included 5 facets of well-being: job stress, job burnout, work engagement, depression, and job-related traumatic stress. Measurements were taken on the web at baseline (time 1), immediately after intervention (time 2), and at a 6-month follow-up (time 3). To analyze the data, linear mixed effects models were used on the intention-to-treat sample. The trial was partially blinded as the information about the duration of the trial, which was different for experimental and control conditions, was public. RESULTS: At time 2, job stress was lower in the condition reflecting the cultivation process than in the one enhancing social support only (d=-0.21), and at time 3, participants in that experimental condition reported the lowest job stress when compared with all 3 remaining study groups (ds between -0.24 and -0.41). For job-related traumatic stress, we found a significant difference between study groups only at time 3: stress was lower in the experimental condition in which self-efficacy was enhanced first than in the active comparator enhancing solely social support (d=-0.24). The same result was found for work engagement (d=-0.20), which means that it was lower in exactly the same condition that was found beneficial for stress relief. There were no differences between study conditions for burnout and depression neither at time 2 nor at time 3. There was a high dropout in the study (1023/1240, 82.50% at posttest), reflecting the pragmatic nature of this trial. CONCLUSIONS: The Med-Stress internet intervention improves some components of well-being-most notably job stress-when activities are completed in a specific sequence. The decrease in work engagement could support the notion of dark side of this phenomenon, but further research is needed. TRIAL REGISTRATION: ClinicalTrials.gov NCT03475290; https://clinicaltrials.gov/ct2/show/NCT03475290. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): RR2-10.1186/s13063-019-3401-9.

Consensus statement on the problem of terminology in psychological interventions using the internet or digital components.

Since the emergence of psychological interventions delivered via the Internet they have differed in numerous ways. The wealth of formats, methods, and technological solutions has led to increased availability and cost-effectiveness of clinical care, however, it has simultaneously generated a multitude of terms. With this paper, we first aim to establish whether a terminology issue exists in the field of Internet-delivered psychological interventions. If so, we aim to determine its implications for research, education, and practice. Furthermore, we intend to discuss solutions to mitigate the problem; in particular, we propose the concept of a common glossary. We invited 23 experts in the field of Internet-delivered interventions to respond to four questions, and employed the Delphi method to facilitate a discussion. We found that experts overwhelmingly agreed that there were terminological challenges, and that it had significant consequences for conducting research, treating patients, educating students, and informing the general public about Internet-delivered interventions. A cautious agreement has been reached that formulating a common glossary would be beneficial for the field to address the terminology issue. We end with recommendations for the possible formats of the glossary and means to disseminate it in a way that maximizes the probability of broad acceptance for a variety of stakeholders.

Efficacy of an Internet-based intervention for job stress and burnout among medical professionals: study protocol for a randomized controlled trial.

BACKGROUND: Medical professionals are at high risk of job stress and burnout. Research shows that work-related stress can be reduced through enhancing psychological resources, in particular, self-efficacy and perceived social support. These psychological resources can operate either individually or sequentially: in line with the cultivation hypothesis, self-efficacy precedes and cultivates perceived social support, whereas according to the enabling hypothesis it is perceived social support that comes first and enables self-efficacy. Based on this theoretical framework we developed an internet-based intervention, Med-Stress, dedicated to healthcare providers and aimed at reducing job stress and burnout. Med-Stress contains two modules that enhance self-efficacy and perceived social support, which are tested in four variants reflected in four study conditions. We expect that sequential enhancement of resources: self-efficacy and social support or social support and self-efficacy will yield larger posttest results than individual enhancement. METHODS: In this four-arm randomized controlled trial we will test four variants of the Med-Stress intervention. The trial is open for professionally active medical providers aged at least 18 years (N = 1200) with access to an Internet-connected device. We will compare the effects of two experimental conditions reflecting cultivation and enabling effects of self-efficacy and perceived social support (sequential enhancement of resources), and two active controls strengthening self-efficacy or perceived social support. Job stress and job burnout will be the primary outcomes, whereas depression, job-related traumatic stress, and work engagement will be secondary ones. Additionally, we will measure perceived social support, self-efficacy to manage job stress and burnout, and the ability to obtain social support, exposure to traumatic events, and users' expectancy and credibility of the intervention. All assessments will be applied before the intervention, at posttest (at 3 or 6 weeks depending on the study condition), and at 6-month and 12-month follow up. In the case of experimental groups, additional measurements will be taken after enhancing each resource. DISCUSSION: Resource-based interventions are relatively context-free and could potentially benefit medical professionals across the field. If Med-Stress is successful, its most effective variant could be implemented in the healthcare system as a standalone, supportive tool for employees. TRIAL REGISTRATION: ClinicalTrials.gov, NCT03475290 Registered on 23 March 2018.

How job and family demands impact change in perceived stress: A dyadic study.

OBJECTIVES: The aim of this two-wave study has been to test the spillover and crossover of job and family demands on changes in perceived stress at work and in the family. Specifically, we proposed that demands from one domain (work or family) spilled over to another domain through interrrole conflict (work-family/family-work conflict) and context-specific self-efficacy. Additionally, we hypothesized that changes in perceived stress were impacted not only by a person's own demands through interrole conflict but also by the demands of one's significant other, in the process of crossover. MATERIAL AND METHODS: The study was of dyadic design and it was conducted online, among 130 heterosexual couples, at 2 time points separated by 3 months interval. Hypotheses were verified by means of the path analysis. RESULTS: No support was found for the spillover of job and family demands on changes in perceived stress through interrole conflict and self-efficacy, neither for women nor for men. With regard to the crossover, no support was found for the actor effects, i.e., a person's demands did not impact changes in one's own work- and family-related perceived stress but partial support was found for the partner effects, i.e., women's job demands were associated with men's changes in work and family-related stress through women's work-family conflict, and men's family demands were associated with women's change in family-related perceived stress through men's family-work conflict. CONCLUSIONS: The study is a longitudinal test of the Spillover-Crossover model and Work-Home Resources model demonstrating that job and family demands are transmitted across domains and across partners in the intimate relationships through the interrole conflict but the nature of this crossover is different for men and women. Int J Occup Med Environ Health 2018;31(2)199-215.

Interrole conflict and self-efficacy to manage work and family demands mediate the relationships of job and family demands with stress in the job and family domains.

BACKGROUND AND OBJECTIVES: This study derives from Work-Home Resources model (ten Brummelhuis, L. L., & Bakker, A. B. (2012). A resource perspective on the work-home interface: The work-home resources model. American Psychologist, 67(7), 545-556. doi: 10.1037/a0027974 ) and Social Cognitive Theory (Bandura, A. (1986). Social foundations of thought and action: A social cognitive theory. Englewood Cliffs, NJ, US: Prentice-Hall, Inc.) to investigate mechanisms responsible for the effect of job and family demands on work- and family-related perceived stress. We hypothesized that interrole conflict and self-efficacy to manage work and family demands operate either independently or sequentially transmitting the effects of demands on perceived stress. DESIGN: A sample of 100 employees of various occupations participated in the study conducted online in two waves: Time 1 (T1) and Time 2 (T2) with a three-month interval. METHOD: Regression analysis with bootstrapping was applied. RESULTS: Interrole conflict (T1) did not mediate the relationships between demands (T1) and perceived stress (T2), whereas self-efficacy (T1) mediated only those between family demands (T1) and stress (T2). However, data supported the sequential mediation hypotheses: Demands (T1) were associated with increased interrole conflict (T1) which in turn decreased self-efficacy (T1) and ultimately resulted in the elevated perceived stress at work and in the family (T2). CONCLUSIONS: Demands originating in one domain can impact stress both in the same and other life areas through the sequence of interrole conflict and context-specific self-efficacy.

Attitudes towards digital treatment for depression: A European stakeholder survey.

BACKGROUND: The integration of digital treatments into national mental health services is on the agenda in the European Union. The E-COMPARED consortium conducted a survey aimed at exploring stakeholders' knowledge, acceptance and expectations of digital treatments for depression, and at identifying factors that might influence their opinions when considering the implementation of these approaches. METHOD: An online survey was conducted in eight European countries: France, Germany, Netherlands, Poland, Spain, Sweden, Switzerland and The United Kingdom. Organisations representing government bodies, care providers, service-users, funding/insurance bodies, technical developers and researchers were invited to participate in the survey. The participating countries and organisations reflect the diversity in health care infrastructures and e-health implementation across Europe. RESULTS: A total of 764 organisations were invited to the survey during the period March-June 2014, with 175 of these organisations participating in our survey. The participating stakeholders reported moderate knowledge of digital treatments and considered cost-effectiveness to be the primary incentive for integration into care services. Low feasibility of delivery within existing care services was considered to be a primary barrier. Digital treatments were regarded more suitable for milder forms of depression. Stakeholders showed greater acceptability towards blended treatment (the integration of face-to-face and internet sessions within the same treatment protocol) compared to standalone internet treatments. Organisations in countries with developed e-health solutions reported greater knowledge and acceptability of digital treatments. CONCLUSION: Mental health stakeholders in Europe are aware of the potential benefits of digital interventions. However, there are variations between countries and stakeholders in terms of level of knowledge about such interventions and their feasibility within routine care services. The high acceptance of blended treatments is an interesting finding that indicates a gradual integration of technology into clinical practice may fit the attitudes and needs of stakeholders. The potential of the blended treatment approach, in terms of enhancing acceptance of digital treatment while retaining the benefit of cost-effectiveness in delivery, should be further explored. FUNDING: The E-COMPARED project has received funding from the European Union Seventh Framework Programme (FP7/2007-2013) under grant agreement no. 603098.

Effects of Internet-Based Self-Efficacy Intervention on Secondary Traumatic Stress and Secondary Posttraumatic Growth among Health and Human Services Professionals Exposed to Indirect Trauma.

BACKGROUND: Although the evidence for the associations among self-efficacy, secondary traumatic stress (STS) and secondary posttraumatic growth (SPTG) is mounting, there is a lack of the experimental evidence for the influence of self-efficacy on positive and negative mental health outcomes among professionals indirectly exposed to trauma. PURPOSE: This study investigated the effects of an internet-based self-efficacy intervention (the experimental condition), compared to an education (the active control condition) on STS and SPTG among workers exposed to traumatic events indirectly, through their clients. We hypothesized that the group assignment (experimental vs. control) would affect STS and SPTG indirectly, with a mediating role of self-efficacy beliefs. METHODS: Participants were 168 health and human services professionals (78% women), exposed indirectly to a traumatic event at work. They were randomly assigned to either a 4-session internet-based self-efficacy intervention (n = 87) or an education control group (n = 81) which received information about coping resources and consequences of stressors at work or at home. STS, SPTG, and self-efficacy were measured at the baseline (Time 1), 1-month follow-up (Time 2) and 2-month follow-up (Time 3). RESULTS: Analysis of covariance showed that the group assignment had a significant effect on STS (Time 2) and self-efficacy (Time 2), with lower STS and higher self-efficacy reported by the self-efficacy intervention participants. Compared to the experimental group, the active control (education) group participants reported higher SPTG at Time 2. Mediation analyses indicated that the group assignment had indirect effects on STS and SPTG at Time 3. Workers who experienced increases in self-efficacy (Time 2) through the intervention were more likely to report lower STS and higher SPTG at Time 3. CONCLUSION: Elucidating the mediating processes that explain why an intervention for secondary trauma works is essential in order to develop more effective support systems that promote improved mental health outcomes among health and human services professionals. Prevention programs for workers exposed indirectly to traumatic events may target self-efficacy enhancement and education.

[The helpers' stress: Effectiveness of a web-based intervention for professionals working with trauma survivors in reducing job burnout and improving work engagement]. / Stres pomagajacych - efektywnosc interwencji internetowej dla osób pracujacych z ofiarami traumy w obnizaniu wypalenia zawodowego i wzmacnianiu zaangazowania w prace.

BACKGROUND: The study aimed at evaluating effectiveness of the web-based intervention, "The Helpers' Stress," in reducing job burnout and enhancing work engagement among professionals working with trauma survivors. MATERIAL AND METHODS: Participants were randomly allocated to 1 of the 3 intervention modules: 1 - the self-efficacy enhancement (N = 87), 2 - the social support enhancement (N = 85), or to 3 - the educational module (comparison group, N = 81). Participants completed the online questionnaires before the intervention (T1), immediately after (T2), and 4 weeks after the intervention (T3). RESULTS: Due to high drop-out rate at T2 and T3 in social support enhancement module, we excluded from analysis participants assigned to this condition. Participants assigned to the self-efficacy enhancement module presented higher levels of self-efficacy (at T2 and T3), compared to those assigned to the educational module. Job burnout decreased significantly between T1 and T2, and between T2 and T3, and work engagement increased significantly between T1 and T2, and between T1 and T3, among participants assigned to both modules mentioned above. Self-efficacy (T2) mediated the relationship between the group assignment (educational module vs. self-efficacy enhancement module) and respectively job burnout (T3) or work engagement (T3). CONCLUSIONS: The results of our study highlight the role of self-efficacy in reducing job burnout and increasing work engagement. Med Pr 2016;67(2):223-237.

Associations between job burnout and self-efficacy: a meta-analysis.

BACKGROUND AND OBJECTIVES: This study aimed at systematically reviewing and meta-analyzing the strength of associations between self-efficacy and job burnout (the global index and its components). We investigated whether these associations would be moderated by: (a) the type of measurement of burnout and self-efficacy, (b) the type of occupation, (c) the number of years of work experience and age, and (d) culture. DESIGN AND METHODS: We systematically reviewed and analyzed 57 original studies (N = 22,773) conducted among teachers (k = 29), health-care providers (k = 17), and other professionals (k = 11). RESULTS: The average effect size estimate for the association between self-efficacy and burnout was of medium size (-.33). Regarding the three burnout components, the largest estimate of the average effect (-.49) was found for the lack of accomplishment. The estimates of the average effect were similar, regardless of the type of measures of burnout and self-efficacy measurement (general vs. context-specific). Significantly larger estimates of the average effects were found among teachers (compared to health-care providers), older workers, and those with longer work experience. CONCLUSIONS: Significant self-efficacy-burnout relationships were observed across countries, although the strength of associations varied across burnout components, participants' profession, and their age.

What Comes First, Job Burnout or Secondary Traumatic Stress? Findings from Two Longitudinal Studies from the U.S. and Poland.

This longitudinal research examined the directions of the relationships between job burnout and secondary traumatic stress (STS) among human services workers. In particular, using cross-lagged panel design, we investigated whether job burnout predicts STS at 6-month follow up or whether the level of STS symptoms explains job burnout at 6-month follow-up. Participants in Study 1 were behavioral or mental healthcare providers (N = 135) working with U.S. military personnel suffering from trauma. Participants in Study 2 were healthcare providers, social workers, and other human services professions (N = 194) providing various types of services for civilian trauma survivors in Poland. The cross-lagged analyses showed consistent results for both longitudinal studies; job burnout measured at Time 1 led to STS at Time 2, but STS assessed at Time 1 did not lead to job burnout at Time 2. These results contribute to a discussion on the origins of STS and job burnout among human services personnel working in highly demanding context of work-related secondary exposure to traumatic events and confirm that job burnout contributes to the development of STS.