Abstract / Summary
Background: Long-term care workers (LTCWs), encompassing those in long-term care facilities and home-care settings, constitute a particularly vulnerable population to psychological distress. This study aimed to evaluate the effectiveness of a digital stepped-care program, adapted from two World Health Organization (WHO) psychological interventions-Doing What Matters in Times of Stress (DWM) and Problem Management Plus (PM+)-in reducing anxiety and depressive symptoms among LTCWs.
Methods: A parallel-group randomized controlled trial was conducted. Participants were LTCWs from Catalonia (Spain) experiencing psychological distress (Kessler Psychological Distress Scale, K10 ≥ 16). All participants received Psychological First Aid (PFA), and those in the intervention group subsequently received the digital stepped-care program: DWM as step 1, and if psychological distress persisted (K10 ≥ 16), PM + as step 2. The primary outcome was the between-group difference in self-reported depressive and anxiety symptoms at week 21 (2-month post-program follow-up), measured using the Patient Health Questionnaire-Anxiety and Depression Scale (PHQ-ADS). Secondary outcomes included depressive and anxiety symptoms measured separately, post-traumatic stress disorder (PTSD) symptoms, and health-related quality of life (HR-QoL; measured using PHQ-9, 7-item Generalized Anxiety Disorder [GAD-7] scale, PCL-5, and EuroQol 5-dimensional descriptive system-5-level [EQ-5D-5L], respectively).
Results: Between October 2022 and May 2024, 165 participants were randomized (intervention: n = 83; control: n = 82). At week 21, depressive and anxiety symptoms were significantly lower in the intervention group, with moderate to large effect sizes (mean difference = 4.2, 95% CI: 1.1-7.3; Standardized effect size [SES] = 0.8, 95% CI: 0.1-1.4). Secondary outcomes also showed significantly greater improvement in the intervention group, except for HR-QoL, for which no differences were found.
Conclusions: This study provides evidence supporting the effectiveness of a digital and scalable stepped-care program to support LTCWs' mental health. These robust findings may inform occupational and public health strategies for supporting LTCWs' experiencing psychological distress. Trial Registration: ClinicalTrials.gov identifier: NCT05526235.