Comparative effectiveness of resilience-related interventions on resilience and stress for healthcare professionals: A network meta-analysis of randomized controlled trials

Abstract

Background

Healthcare professionals face high workloads, emotional strain, and chronic stress, underscoring the need for effective strategies to enhance resilience. However, the comparative effectiveness of resilience-related interventions in this population remains unclear. This study aimed to evaluate and compare the effectiveness of various interventions in improving resilience and reducing stress among healthcare professionals.

Methods

A systematic search was conducted across eight databases (Cochrane Library, Embase, Ovid-MEDLINE, PubMed, Scopus, Web of Science, CINAHL, and ProQuest) on March 20, 2025, to identify randomized controlled trials of resilience-related interventions for healthcare professionals. Healthcare professionals included nurses, physicians, allied health professionals, and mixed clinical staff groups. A frequentist network meta-analysis was conducted in R using the netmeta package, applying random-effects models and standardized mean differences (SMDs). This method estimates relative effects by combining direct and indirect comparisons across interventions. Heterogeneity was assessed using Cochrane's Q, τ², and I². Subgroup analyses explored potential effect modifiers, and P-scores ranked the comparative effectiveness of interventions. Risk of bias was assessed using the Cochrane Risk of Bias 2.0 tool. The primary outcomes were resilience and stress, measured post-intervention, with resilience additionally assessed at a 3-month follow-up.

Results

Immediately after the intervention, positive psychology demonstrated the largest and significantly greater improvement in resilience (SMD = 0.57, 95 % CI: 0.36 to 0.78), followed by mindfulness (SMD = 0.50, 95 % CI: 0.24 to 0.76) and cognitive behavioral therapy (SMD = 0.47, 95 % CI: 0.23 to 0.71), all indicating moderate to large and statistically significant effects. At 3-month follow-up, positive psychology remained the most effective (SMD = 0.69, 95 % CI: 0.02 to 1.36), followed by mindfulness and cognitive behavioral therapy. For stress outcomes, positive psychology showed a significantly high effect (SMD = − 0.69, 95 % CI: − 1.08 to − 0.29), as did cognitive behavioral therapy (SMD = − 0.58, 95 % CI: − 0.86 to − 0.30) and mindfulness (SMD = − 0.58, 95 % CI: − 0.94 to − 0.21). Sensitivity analyses confirmed the stability of the findings.

Conclusion

Positive psychology, mindfulness, and cognitive behavioral therapy were the most effective interventions for enhancing resilience and reducing stress among healthcare professionals, with some sustained effects at follow-up. These results support the implementation of structured, evidence-based resilience programs to improve mental well-being and job performance in healthcare settings.

Registration

PROSPERO (CRD42024518166).