gms | German Medical Science

Background: Leadership-specific Stress Management Interventions (SMIs) have been proposed as an effective measure to enhance and sustain workforce health. While there is an influential systematic review on the effects of occupational stress management intervention programs, to date, no systematic review comprehensively summarizes and evaluates the effectiveness of leadership-specific SMI interventions.

Methods: We conducted a systematic literature search in four databases, supplemented by manual searches and trial registers. Our inclusion criteria encompassed any SMI designed for supervisors, irrespective of gender, management level, or the number of employees they supervised. As outcomes we specified psychological stress, mindfulness, mental health, and work- and leadership-related variables. Study designs encompassed randomized controlled trials (RCTs) or controlled before-after studies (CBAs) with passive, active, and waitlist control groups. Data were pooled in random effects models to compute standardized mean difference (SMD). To assess the robustness of results and explore potential sources of heterogeneity sensitivity analyses and moderator analyses were performed. Risk of bias (RoB) was assessed for each study (using ROBINS-I for CBAs and ROBINS-II for RCTs); the certainty of evidence was rated using the GRADE approach. Reporting followed the Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) statement and all analyses were performed in accordance with the Cochrane Handbook for Systematic Reviews. Trial registration: PROSPERO: CRD42023464101

Results: Of 3,905 non-duplicate records, 25 studies (n=2,466), performed between 1980 and 2023, met full inclusion criteria. Sample size in the included studies ranged from 9 to 269 participants, with a mean age of 43.2 years. Interventions varied widely in duration and delivery modes, ranging from one-day virtual group sessions to multi-week programs with individual follow-up sessions, daily homework exercises, and a combination of group or individual sessions and self-practice. Most interventions (n=11) were multimodal, combining cognitive-behavioral, relaxation and leadership-specific components. Meta-analyses revealed significant intervention effects for leadership-specific SMIs on mental health (SMD, -0.38 [95% CI, -0.69 to -0.08]), compared to waitlist, passive or active control groups. No significant intervention effects were found for psychological stress (SMD, -0.02 [95% CI, -0.43 to 0.39]), mindfulness (SMD, -0.03 [95% CI, -0.32 to 0.27]), work- (SMD, -0.68 [95% CI, -1.84 to 0.48]) and leadership-related outcomes (SMD, -1.16 [95% CI, -3.42 to 1.10]). For mental health, subgroup analyses provided significantly higher effect sizes for RCTs and interventions applying face-to-face trainings and mixed delivery approaches. The majority of studies (64%) were rated as having a ‘high’ RoB. The certainty of evidence was rated as ‘low’ for the primary variables of psychological stress, mindfulness and mental health, and ‘very low’ for the secondary variables of work- and leadership-related outcomes.

Conclusion: Our findings point to small-to-moderate intervention effects of SMIs on supervisors’ mental health. However, the results have to be interpretated with caution due to substantial heterogeneity, high risk of bias, small sample sizes and ‘low’ to ‘very low’ certainty of evidence ratings. Hence, there is a clear imperative for high-quality research on leadership-specific SMIs.

The authors declare that they have no competing interests.

The authors declare that an ethics committee vote is not required.