Workplace Mental Health Programs for Healthcare Workers: A Systematic Review.

Burnout and psychological distress among healthcare workers (HCWs) have become a major workforce challenge, raising an important question: should responsibility for worker wellbeing rest primarily with individuals or with the organization of work itself? This systematic review evaluated workplace mental health programs for HCWs, comparing individual-level psychological interventions with organizational-level approaches. Following PRISMA 2020 guidelines, 54 studies (2016-2026) from more than 18 countries were identified from approximately 7144 records through a PubMed/MEDLINE search. The included studies comprised 29 individually randomized controlled trials (RCTs), 11 cluster-randomized or stepped-wedge trials, and 14 additional non-randomized or contextual studies. ROBINS-I was applied only to the five eligible non-randomized intervention studies-the remaining non-randomized studies contributed contextual evidence and were not included in the ROBINS-I assessment. Here, 41 studies contributed effectiveness evidence, of which 34 (83%) reported a statistically significant improvement in at least 1 primary or key outcome, while 13 studies provided contextual, feasibility, or implementation evidence. Individual-level interventions dominated the evidence base (39/54; 72%). In contrast, organizational interventions were less frequently evaluated, rarely randomized, and showed mixed findings. Observational studies consistently identified workload, organizational trust, and other structural stressors as factors associated with burnout, although causal inferences remain limited. Risk of bias was substantial, with only 7 of 40 randomized trials (17.5%) rated as low risk. All five non-randomized intervention studies assessed using ROBINS-I were judged to have serious risk of bias. Overall, individual-level interventions were evaluated more frequently than organizational interventions and generally reported improvements in mental health outcomes. However, the evidence base was limited by the single-database search, variability in study quality, and methodological limitations. Further well-designed and adequately powered studies, particularly of organizational interventions, are needed to strengthen the evidence base.