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Effectiveness of interventions on the stress management of schoolteachers: a systematic review and meta-analysis
  1. Netra Raj Paudel1,
  2. Bidhya Acharya Adhikari1,
  3. K C Prakash1,2,3,
  4. Saila Kyrönlahti1,4,
  5. Clas-Håkan Nygård1,4,
  6. Subas Neupane1,4,5
  1. 1 Unit of Health Sciences, Faculty of Social Sciences, Tampere University, Tampere, Finland
  2. 2 Department of Public Health, University of Turku, Turku, Finland
  3. 3 Department of Psychology, Stress Research Institute, Stockholm University, Stockholm, Sweden
  4. 4 Gerontology Research Center, Tampere University, Tampere, Finland
  5. 5 Tampere University Hospital, Tampere, Finland
  1. Correspondence to Netra Raj Paudel, Tampere University, Tampere, Finland; netra.paudel{at}


Background This systematic review aimed to analyse the effectiveness of interventions on the stress management of schoolteachers.

Methods We searched the Medline, PsycINFO, CINAHL and Education Research Complete until 30 November 2021, to identify relevant studies using relevant key words. Job or occupational stress was used as the outcome measure. Stress was defined as Perceived Stress Scale, Teacher Stress Inventory, Maslach Burnout Inventory, Teacher’s Distress, Brief Symptoms Inventory or Global Severity Index. Study selection, data extraction, risk of bias assessment was performed by two independent reviewers. The pooled estimate of the effect by the type of outcome measurement tool and by type of interventions used was calculated using random effects meta-analysis. We used Grades of Recommendations, Assessment, Development and Evaluation to assess the overall quality of the evidence.

Results We reviewed 26 studies, of which 24 were randomised trials and 2 pre-test/post-test studies. Based on meta-analysis, a positive effect of intervention (pooled estimate −1.13, 95% CI −1.52 to −0.73) with high heterogeneity among studies (χ2=426.88, p<0.001, I2=94%) was found by type of interventions used. Cognitive–behavioural therapy had the strongest positive effect, followed by meditation among the types of interventions studied. We identified evidence of a moderate quality for interventions aiming to manage the stress level of schoolteachers.

Conclusions The meta-analysis showed a positive effect of interventions, suggesting that interventions might reduce the stress level among teachers. The quality of the evidence was moderate.

PROSPERO registration number CRD42021225098

  • public health
  • occupational health

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  • Contributors Concept and design: SN and NRP. Acquisition, analysis or interpretation of data: NRP, BAA, SN and KCP. Drafting of the manuscript: NRP, BAA, KCP and SN. Critical revision of the manuscript: SN, SK, C-HN and KCP. Statistical analysis: SN. Administrative, technical or material support: SN and C-HN. Supervision: SN and C-HN.

  • Funding This work was supported by Juho Vainio Foundation Finland (grant number: 202100245 to KCP).

  • Disclaimer The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.