Effectiveness of Self-Help Plus in its digital version in reducing anxiety and post-traumatic symptomatology among nursing home workers during the COVID-19 pandemic: secondary analysis of randomised controlled trial data

Background: Healthcare workers (HCWs) face substantial daily work-related pressures, leading to frequent reports of depression, anxiety and post-traumatic stress disorder (PTSD) symptoms. Objective: To compare the effects of Self-Help Plus in its digital version Doing What Matters in Times of Stress (DWM) to an equally structured activity in reducing anxiety and/or PTSD symptoms among HCWs. Methods: We compared the proportion of participants with moderate-to-severe anxiety (General Anxiety Disorder Scale; GAD-7 ≥10) and/or PTSD symptoms (Impact of Event Scale-Revised (IES-R)) ≥26) between DWM and the alternative activity. We used an intention to treat analysis and performed χ2 tests at 1 and 14 weeks. We assessed compliance (≥five logins) and conducted per-protocol analyses. We also analysed GAD-7 and IES-R scores as continuous outcomes. Possible differential effectiveness was also assessed through login frequency. Findings: At 14 weeks, 14.5% of DWM and 27.6% of control participants showed at least moderate anxiety and/or PTSD symptoms (χ2=3.712, p=0.054). Among those with ≥five logins, DWM participants had fewer moderate symptoms (10.6% vs 31.4%, p=0.012), with reductions in anxiety (6.3% vs 19.6%, p=0.049) and PTSD symptoms (6.4% vs 27.5%, p=0.006). At 1 week, 30.6% of DWM and 28.2% of control participants reported moderate symptoms (χ2=0.113, p=0.736). Interaction analysis suggested compliance influenced outcomes (OR 4.560, p=0.096 at 14 weeks; OR 0.266, p=0.067 at 1 week). Conclusions: DWM is a promising strategy to reduce moderate-to-severe PTSD and/or anxiety symptoms in HCWs. Compliance is crucial to ensure efficacy. Clinical implications: DWM is a scalable digital tool that could be considered as an intermediate or complementary intervention for distressed HCWs.