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INTRODUCTION AND OBJECTIVE: Burnout is a pervasive issue in healthcare, with urology trainees reporting burnout rates as high as 63.8%. Resilience training is a proven tool to prevent burnout and improve performance in high stress working environments, with demonstrated efficacy in surgical residency programs. Enhanced Stress Resilience Training (ESRT) is a mindfulness-based cognitive skills training developed and validated by Dr. Carter Lebares and the UCSF Center for Mindfulness in Surgery. ESRT offers tools to reframe thoughts and promote emotional regulation. The primary goal of this study is to assess feasibility and to introduce a curriculum to expand a pre-existing program focused on wellness and individual skill development. METHODS: Through consultation with Dr. Lebares, we customized course structure to include a didactics presentation and five ESRT sessions taught over Zoom by a certified ESRT instructor, a retired surgeon. We conducted the sessions in place of standard departmental conferences to mitigate personal time used for the training. Baseline descriptive pre and post course data was collected using validated surveys, including the Mental Health Continuum Short Form, Physician Wellbeing Index, and the Connor Davidson Resilience Index, with a subsequent focus group to gain qualitative data on overall course perception. Using two-sample t-tests, we compared differences between and pre and post course responses. RESULTS: There were 33 participants in the course, with 20 residents, 7 faculty, and 6 others (student/APP). Surveys were completed by 30 participants pre course and 15 participants post course, with 15 sets of paired data. There were no statistically significant differences in self-reported wellbeing or stress response after course participation; however, participants were significantly more likely to use meditation as a stress coping mechanism after the course (p=0.008). Qualitative descriptive results demonstrated a 15% increase in participants’ understanding of the impact mindfulness practices have on work performance. CONCLUSIONS: Our program successfully implemented ESRT via a novel remote delivery format. Although our analysis was limited by small sample size, our pilot study highlights feasibility in implementation. This curriculum also showed resident skill development in stress regulation through mindfulness practices. Next steps would include repeat delivery within the program to promote durability, and possible expansion beyond our single program.

INTRODUCTION AND OBJECTIVE: Urology residents have reported greater levels of professional burnout compared to other specialties. Recently, increased awareness of risk factors for burnout and interventions to enhance trainee well-being may have contributed to changes in the prevalence of resident burnout. We aimed to measure burnout and career choice regret in a national sample of urology residents. METHODS: We analyzed residents’ responses to the AUA Census in 2019, 2020, and 2021. We compared urology residents’ responses to the 22-item Maslach Burnout Inventory in 2019 vs 2021, including overall professional burnout and the emotional exhaustion and depersonalization subscales. We also assessed responses to questions about career and specialty choice regret in 2019 vs 2020-2021. RESULTS: Among 415 respondents in 2019 and 166 respondents in 2021, the prevalence of professional burnout was 47% and 48%, respectively. 7% and 10% of residents met criteria for emotional exhaustion, while 47% and 48% of residents met criteria for depersonalization. Burnout symptoms were highest among second-year residents in both cohorts (65% and 69%). In 2019, among the 53% of residents who had ever reconsidered career or specialty choice, a majority (54%) experienced this most frequently during the second year of residency. Similarly, in 2020-2021, among the 51% who had reconsidered career or specialty choice, 57% said it was most frequent during the second year. There was no significant difference between the cohorts in terms of the prevalence of burnout, emotional exhaustion, or depersonalization, or in terms of the frequency of career and specialty choice regret (all p>0.05). Finally, there was no significant gender disparity in either cohort regarding the prevalence of career and specialty choice regret: 58% women vs 50% men in 2019, and 56% women vs 49% men in 2020-2021 (all p>0.05). CONCLUSIONS: In a national sample of urology residents, the prevalence of professional burnout has remained unchanged between 2019 and 2021. Second-year residents appear to be at greatest risk for career and specialty choice regret. Interventions targeting early-career residents may reduce the psychosocial burden of residency on trainees.

In turbulent times like these, it’s natural for people to hold back and avoid taking risks at work. This can mean a reluctance to report mistakes, ask questions, offer new ideas, or challenge a plan. People, whether they’re aware of it or not, try to protect their reputations and jobs. Unfortunately, the same behaviors that feel risky to individual employees are precisely what their companies need in order to thrive in this uncertain economic climate. To solve this dilemma, we encourage leaders to adopt a “winning formula” for achieving a more psychologically safe workplace and the benefits it provides.

This resource is found in our Actionable Strategies for Health Organizations: Empowering Worker & Learner Voice (Psychological Safety).

Reach new levels of organizational productivity and achievement by redefining the phrase “workplace health” In Make Work Healthy, a team of distinguished organizational transformation professionals delivers an insightful how-to manual for improving organizational performance with a new approach to workforce management. The book offers organizations, leaders, and managers with the knowledge, data, frameworks, and methodologies they need to radically transform how they approach day-to-day operations into a sustainable and resilient business success model. The authors focus on workplace health—in a broad sense—as a way of focusing organizational attention on culture, building work capacity, productivity, and sustainability. They explain the tangible business value that comes from focusing on wellbeing as well as the symbiotic relationship between organizational health and employee health. Make Work Healthy includes: Strategies for moving beyond typical “wellness” initiatives such as just addressing illness and absence reduction to a more holistic understanding of “healthy work” Ways to locate, attract, recruit, and retain talent over the long-term by aligning organizational goals with employee health Tactics to help managers of dispersed, hybrid, and remote teams manage feelings of pressure and isolationAn indispensable, effective, and holistic new take on organizational and employee health, Make Work Healthy will earn a place in the hands of managers, executives, board members, and other business and human resources leaders who seek impressive gains in company productivity and fulfilment.

OUTCOMES: 1. Describe the components of CASE, a US Department of Veterans Affairs clinical ethics consultation tool and opportunities to resolve ethical dilemmas near end of life. 2. Identify resources and collaborative opportunities for inpatient palliative care and ethics consultation teams caring for dying patients and distressed families and healthcare providers. BACKGROUND: Ethical dilemmas commonly complicate care and comfort near end of life. Family members and providers may especially experience ethical dilemmas when surrogates are required for patients without capacity or known wishes. The US Department of Veterans Affairs (VA) aims to improving ethical quality through its implementation of a standardized approach to ethics consultation based on consistent and systematic use of widely accepted ethical standards and norms and by recruiting consultants from the interdisciplinary team. CASE DESCRIPTION: An 87-year-old hospitalized veteran with low blood pressure and hypoactive delirium was identified as seriously ill and at high risk for imminent death. The cosurrogate daughters reported their mother shared no prior preferences for care near her end of life. Despite early palliative care team involvement, the daughters could not reach treatment decisions and reported their own moral distress. After 10 days, concerned nurses called for an ethics team consultation to “help with patient suffering and family disagreement.” The palliative care team and the ethics team together applied the novel VA ethics consultation model and collaboratively addressed the ethical dilemma, aligned care to maximize comfort, and alleviated staff moral injury. DISCUSSION: We will describe the structure and application of the VA Ethics Consultation Program's CASE approach (clarify, assemble, synthetize, explain, support) as a tool with which palliative care teams may effectively resolve surrogate conflict near a loved one's end of life when no prior preferences are known. Through CASE methodology, including review of substituted judgment/best interest standards and specific negotiating techniques, the ethics and palliative care teams supported successful quality outcomes for the patient, family, staff, and the healthcare system. CONCLUSION: A systematic approach of ethical reasoning, such as CASE, can support interdisciplinary palliative care teams to resolve ethical dilemmas while improving quality outcomes when death is expected and imminent.

INTRODUCTION: A New York State initiative requests that Emergency Department (ED) providers document in the electronic health record (EHR) each admitted patient’s employment status and, if applicable, their mode of commute. This initiative diverts them from their primary duties and increases the likelihood they will either disregard the request or input incorrect information to complete the data fields as fast as possible. This study intends to understand how well providers adhere to this regulation, which, while important for society as a whole, has little clinical relevance, especially in the ED, where the focus is to identify and treat emergent conditions. We hypothesized that clinician-collected employment data would contain many more "N/A" responses than registration-collected employment data (the "gold standard"). METHODS: We took a randomly selected convenience sample of 100 patients admitted from the ED and compared each patient’s provider-entered response to the employment data field to the registration-recorded response. The EHR operates such that the "Employment" field must be completed in order to complete the admission electronically. Data fields collected were: last name, first name, date of birth, medical record number, date and time of arrival, date and time of admission, attending physician, resident physician (if there was one), mid-level provider (if there was one), provider-entered employment status, registration-entered employment status, admitting service (eg, Medicine, Surgery, OB/Gyn), and disposition level (eg, ICU). We assessed the percent of employment data that was concordant between the provider's entry and the registration clerk's entry. We also assessed for the potential confounding variable of how busy the ED was at time of admission, as providers may not take ask about employment or enter such data during particularly busy times. Finally, we interviewed providers to elicit reasons they did not enter accurate data. Statistical significance was set a priori at p <0.05. RESULTS: One hundred six patients were screened; six were excluded because one of the authors (MR) was their attending physician. For 92 of the remaining 100 patients, providers recorded employment as “N/A," and for eight patients they recorded “retired." For seven of these eight patients, provider entry matched registration entry (87.5% concordance). To adjust for whether how busy the ED was may have impacted the accuracy of data entry, admissions were categorized according to what time of day the patient was admitted. There was no statistically significant correlation between how busy the ED was and accuracy of data entry. The majority of providers stated they responded "NA" because the employment information was unrelated to the ED visit. CONCLUSION: In New York, for each patient admitted from the ED, the ED provider is requested to enter the patient's job information and, if they commute to work, the method they use. However, this takes providers' attention away from what they should be doing most: diagnosing and treating patients. This study highlights the unintended consequence of requesting data fields that are not clinically relevant and, from the patient and provider perspective, are not good investments of time and energy and distract from the clinical visit. Persons interpreting such clinically irrelevant data should do so with caution, as the results are unlikely to reflect the truth of what the questions intend to determine.

BACKGROUND: Troubled conscience among nurses and other healthcare workers represents a significant contributor to healthcare worker moral distress, burnout and attrition. While research in this area has examined critical care in hospitals, less knowledge has been obtained from long-term care contexts such as nursing homes, despite widely recognised challenges with regard to vulnerable patients, increasing workload and maintaining workforce sustainability among nurses. OBJECTIVE: The aim of this study was to illuminate and interpret the meaning of the lived experience of troubled conscience among registered nurses (RNs) working in nursing homes. RESEARCH DESIGN: This qualitative research employed narrative interviews with eight nurses to obtain essential meanings of their lived experiences of troubled conscience. The interview texts were analysed using a phenomenological hermeneutic approach. ETHICAL CONSIDERATIONS: Participation was voluntary, informed and was conducted with written consent. The Norwegian Centre for Research Data approved the data processing of personal data. FINDINGS: The analysis uncovered two themes: (1) troubled conscience means abandoning ideals, with the subthemes: failing dependent patients; being disloyal to colleagues; being inadequate in the performance of work tasks and (2) troubled conscience means facing realities, with the subthemes: accepting being part of the system; responding to barriers. DISCUSSION: Troubled conscience meant experiencing continuous and simmering tension between one's ideals and realities and feeling a drive to preserve accountability and one's moral integrity. Endangered ideals were often under cross-pressure and included humanistic values, professional values, working life values and the values of the organisation. CONCLUSION: Nurses' troubled conscience refers to a struggle, but also a force that plays out at various levels and arenas in long-term care. Openness and dialogue about how professional values and the welfare state's intentions can be realised within the given framework are important for individual nurses' occupational health as well as the quality of care provided to patients.

INTRODUCTION: EHRs are associated with improved patient outcomes, but the inefficiency of time spent on EHR may contribute to healthcare provider stress, exhaustion and burnout. EHR use associates with higher prevalence of burnout in Neonatal Intensive Care Units (NICUs), but the relationship between EHR use and burnout in other inpatient settings remains unclear. This study sought to identify subjective and objective markers of EHR use associated with provider burnout in the pediatric inpatient setting. METHODS: Attendings, fellows, hospitalists, and nurse practitioners from a quaternary children’s hospital who work primarily in the inpatient setting were included in our study. We collected five months (June-October 2020) of EHR-use and schedule data for these providers. This data was then linked to 2020 annual wellness survey (September-October) data which included a 4-item EHR experience score and the Stanford Professional Fulfillment Index. We evaluated associations using Pearson correlation, lasso regression for variable selection, and mixed effect linear regression. RESULTS: Of 246 eligible providers, 179 (73%) responded to the survey. Average EHR experience score was 2.2±0.8, range 0-4, and average burnout score was 1.1±0.7, range 0-4, with burnout prevalence of 32%. Average number of notes/orders placed was independently associated with the EHR experience scores (coefficient -0.013, p=.04). EHR experience scores were negatively correlated with provider burnout scores (r -0.18, p=.03), but not independently associated after adjustment for work setting and role. EHR task count per patient, division, and role were selected as important predictor variables for burnout via lasso regression. Among these, the Pediatric Intensive Care Unit (PICU) division was independently associated with higher burnout scores (coefficient 0.36, p=.016). None of the EHR use measures were independently associated with burnout. CONCLUSIONS: Burnout is prevalent among inpatient providers, and being a PICU provider was independently associated with burnout. Although routinely collected EHR use measures may associate with negative EHR experience, we did not identify independent associations with burnout among this sample of inpatient pediatric providers. Larger studies are needed to investigate this relationship further.

[This is an excerpt.] Moral distress is indeed distressing for those who experience it and whose sense of integrity can be shaken by exposure to events or situations that test their core values and ethical belief systems. But the meaning of this term—both from a conceptual and an empirical perspective—continues to be a source of contention. [To read more, click View Resource.]

Medicaid is characterized by low rates of provider participation, often attributed to reimbursement rates below those of commercial insurance or Medicare. Understanding the extent to which Medicaid reimbursement for mental health services varies across states may help illuminate one lever for increasing Medicaid participation among psychiatrists. We used publicly available Medicaid fee-for-service schedules from state Medicaid agency websites in 2022 to construct two indices for a common set of mental health services provided by psychiatrists: a Medicaid-to-Medicare index to benchmark each state’s Medicaid reimbursement with that of Medicare for the same set of services, and a state-to-national Medicaid index comparing each state’s Medicaid reimbursement with an enrollment-weighted national average. On average, Medicaid paid psychiatrists at 81.0 percent of Medicare rates, and a majority of states had a Medicaid-to-Medicare index that was less than 1.0 (median, 0.76). State-to-national Medicaid indices for psychiatrists’ mental health services ranged from 0.46 (Pennsylvania) to 2.34 (Nebraska) but did not correlate with the supply of Medicaid-participating psychiatrists. As policy makers look to reimbursement rates as one strategy to address ongoing mental health workforce shortages, comparing Medicaid payment across states may help benchmark ongoing state and federal proposals.

INTRODUCTION: Medical education research often focuses on measuring negative mental states like burnout, rather than focusing on positive states like well-being. Flourishing – a state that includes domains of happiness and mental health - is a way of thinking about well-being that may be relevant to education and research. The purpose of this prospective, observational study was to compare the relationship among flourishing, other well-being measures, and burnout in medical students via a survey administered at two time points. METHODS: We surveyed medical students at one U.S. institution about their flourishing, satisfaction with work-life balance, quality of life, empathic concern, and burnout (emotional exhaustion and depersonalization) before and after the onset of the COVID-19 pandemic. Flourishing was measured using two scores, the Flourish Index (FI) and Secure Flourish Index (SFI), with higher scores indicating greater flourishing. Pre- and post-scores for both measures were compared. RESULTS: 107/585 (18%) medical students responded to the survey and 78/107 (73%) participated in the post survey. At the first time point, respondents reported both a mean FI and SFI 6.7 (SD=1.3); higher levels of flourishing correlated with higher satisfaction with work-life balance (p<.001), higher quality of life (p<.001), and lower levels of burnout (emotional exhaustion p<.001; depersonalization p=.021). SFI scores were higher at the second time point (M=7.1, SD=1.2) than the first (M=6.7, SD=1.3, p=.026). FI, satisfaction with work-life balance, quality of life, empathic concern, and burnout were unchanged at the second time point. DISCUSSION: Like past findings in medical residents, we found medical students’ flourishing—as measured by FI and SFI scores—correlated with greater satisfaction with work-life balance, higher quality of life, and lower burnout. In this limited sample, we found flourishing remained largely unchanged after the COVID-19 pandemic onset.

Healthcare workers (HCWs) witnessed firsthand the detrimental effects of the COVID-19 pandemic as they worked tirelessly to slow the spread of disease and protect communities. Those on the frontline were confronted with a high risk for infection, lack of appropriate protective equipment and medical supplies, unprecedented exposure to death, inadequate emotional support, isolation from their families because of fear of viral transmission, and an unrelenting workload. Thus, it is unsurprising that COVID-19 jeopardized the mental health of HCWs beyond that of the general public across the globe. A plethora of data showed that more than one in five HCWs reported high levels of depression, anxiety, or traumatic stress/posttraumatic stress disorder, while at least two in five experienced significant sleep disturbances. Of particular concern, burnout levels, substance misuse, and suicidal behavior also increased among the workforce compared with prepandemic levels. In addition, a variety of sociodemographic, occupational, and circumstantial risk factors, such as younger age, female sex, risk for infection, mental health history, and low social support intensified these adverse psychological outcomes. By identifying trends and variables that exacerbated the impact on the mental health of HCWs, interventions and strategies can be developed at the local, regional, national, and international level.

Student mental health concerns can manifest in several forms. Medical students juggling a multitude of trials (i.e., intense academic rigor, financial debt, sleep deprivation, lack of control, continual exposure to sickness and death, and training mistreatment) can help explain the higher prevalence of psychological disorders within this population. Furthermore, these mental health difficulties are not static; certain challenges move into the forefront as students face key transition points in schooling. Primary examples include the entry year of medical school, the shift from preclinical curriculum to clinical training, and the final moments prior to beginning residency. Given the existing mental health trends among medical students at baseline, it can be concluded that the COVID-19 pandemic has exacerbated the stress, anxiety, and depression associated with medical education. Solutions do indeed exist to address the moral injury medical students face, from expanded crisis management training and implementation of peer support networks to destigmatization of and improved access to professional mental health resources. It is up to the curators of the medical education system to make these solutions the new status quo.

The COVID-19 pandemic has imposed substantial burdens on clinicians and there is a need to better understand the impact on mental health and well-being. This scoping review investigates the prevalence of mental health concerns in anaesthetists, risk and protective factors for mental well-being, and anaesthetists' pandemic-related concerns and support. We searched online databases for articles published between January 2020 and May 2022, using search terms related to: anaesthesia; burnout, well-being, mental health or stress; and COVID-19. We identified 20 articles comprising 19 different populations of anaesthetists (n = 8680) from 14 countries. Studies identified the prevalence of the following condition in anaesthetists: burnout (14–59%); stress (50–71%); anxiety (11–74%); depression (12–67%); post-traumatic stress (17–25%); psychological distress (52%); and insomnia (17–61%). Significant risk factors for poorer mental health included: direct COVID-19-related issues (fear of self and family exposure to infection; requirement for quarantine); practitioner health factors (insomnia; comorbidities); psychosocial factors (loneliness; isolation; perceived lack of support at home and work); demographic factors (female gender; non-white ethnicity; LGBTQIA+); and workplace factors (redeployment outside area of clinical practice; increased work effort; personal protective equipment shortages). Protective factors identified included: job satisfaction; perceived organisational justice; older age; and male sex. Anaesthetists' self-reported concerns related to: personal protective equipment; resource allocation; fear of infection; fear of financial loss; increased workload; and effective communication of protocols for patient treatment. Support from family, colleagues and hospital management was identified as an important coping mechanism. Findings from this review may support the design of interventions to enhance anaesthetists' psychological health during pandemic conditions and beyond. Future research should include consistent psychological outcome measures and rigorous experimental design beyond cross-sectional studies.

The APAF Center for Workplace Mental Health (CWMH) provides employers with high-impact tools and resources to effectively address the mental health and well-being of employees and their families and provide actionable steps in creating a mentally healthy workplace. Through the Brave of Heart Fund, the Center was able to create Frontline Connect: Mental Health for the Healthcare Workforce. Frontline Connect is focused on improving access to mental health care for frontline healthcare workers. The high-impact video toolkit highlights effective strategies for healthcare leaders to improve access to timely and effective mental health care and to eradicate stigma and other barriers.

INTRODUCTION: Mentorship is an important aspect of medical education in providing students guidance and connections to new opportunities, ultimately leading to increased productivity and career satisfaction. The purpose of this study was to design and implement a formal mentoring program between medical students participating in their orthopedic surgery rotation and orthopedic residents to determine if this relationship improved students’ experiences during their rotation compared to students who were not mentored. DESIGN: Third- and fourth-year medical students rotating in orthopedic surgery and PGY2-PGY5 orthopedic residents at one institution were eligible to participate in a voluntary mentoring program between the months of July and February during 2016 to 2019. Students were either randomly paired with a resident mentor (experimental group) or not (unmentored control group). Anonymous surveys were distributed to participants at weeks 1 and 4 of their rotation. There were no minimum number of meetings required between mentors and mentees. RESULTS: Twenty-seven students (18 mentored, 9 unmentored) and 12 residents completed surveys during week 1. Fifteen students (11 mentored, 4 unmentored) and 8 residents completed surveys during week 4. While both mentored and unmentored students experienced an increase in enjoyment, satisfaction, and level of comfort at week 4 compared to week 1, the unmentored group demonstrated a greater overall increase. However, from the perspective of the residents, excitement for the mentoring program and the perceived value of mentoring decreased and 1 (12.5%) resident felt that it detracted from their clinical responsibilities. CONCLUSION: While formal mentoring enhanced the experience of medical students on orthopedic surgery rotations, it did not substantially improve medical student perceptions when compared to students who did not receive formal mentoring. The greater satisfaction and enjoyment observed in the unmentored group may be explained by informal mentoring that naturally occurs among students and residents with similar interests and goals.

BACKGROUND: Mentorship during residency training is correlated with improved outcomes. Many residency programs have implemented formal mentorship programs; however, reported data for these programs have not been previously synthesized. Thus, existing programs may fall short on delivering effective mentorship. Objective: To synthesize current literature on formal mentorship programs in residency training in Canada and the United States, including program structure, outcomes, and evaluation. METHODS: In December 2019, the authors performed a scoping review of the literature in Ovid MEDLINE and Embase. The search strategy included keywords relevant to mentorship and residency training. Eligibility criteria included any study describing a formal mentorship program for resident physicians within Canada or the United States. Data from each study were extracted in parallel by 2 team members and reconciled. RESULTS: A total of 6567 articles were identified through the database search, and 55 studies met inclusion criteria and underwent data extraction and analysis. Though reported program characteristics were heterogenous, programs most commonly assigned a staff physician mentor to a resident mentee with meetings occurring every 3 to 6 months. The most common evaluation strategy was a satisfaction survey at a single time point. Few studies performed qualitative evaluations or used evaluation tools appropriate to the stated objectives. Analysis of data from qualitative studies allowed us to identify key barriers and facilitators for successful mentorship programs. CONCLUSIONS: While most programs did not utilize rigorous evaluation strategies, data from qualitative studies provided insights into barriers and facilitators of successful mentorship programs, which can inform program design and improvement.

BACKGROUND: After-hours documentation burden among US clinicians is often uncompensated work and has been associated with burnout, leading health systems to identify root causes and seek interventions to reduce this. A few studies have suggested quality programme participation (e.g., Merit-Based Incentive Payment System [MIPS]) was associated with a higher administrative burden. However, the association between MIPS participation and after-hours documentation has not been fully explored. Thus, this study aims to assess whether participation in the MIPS programme was independently associated with after-hours documentation burden. METHODS: We used 2021 data from the National Electronic Health Records Survey. We used a multivariable ordinal logistic regression model to assess whether MIPS participation was associated with the amount of after-hours documentation burden when controlling for other factors. We controlled for physician age, specialty, sex, number of practice locations, number of physicians, practice ownership, whether team support (e.g., scribes) is used for documentation tasks, and whether the practice accepts Medicaid patients. RESULTS: We included 1801 office-based US physician respondents with complete data for variables of interest. After controlling for other factors, MIPS participation was associated with greater odds of spending a greater number of hours on after-hours documentation (odds ratio?=?1.44, 95% confidence interval 1.06-1.95). CONCLUSIONS: MIPS participation may increase after-hours documentation burden among US office-based physicians, suggesting that physicians may require additional resources to more efficiently report data.

Law enforcement officers are frequently subjected to highly stressful and traumatic situations with increased negative physical and mental health outcomes. Mindfulness is proposed as a means of improving self-reported physical or mental health outcomes, including depression, anxiety, burnout, and sleep disturbances. This meta-analysis aims to pool the results from studies evaluating mindfulness for police officers, providing an overall effect size for each outcome of interest. Through systematic review, four studies were identified for meta-analysis. Fixed and random inverse variance effects were used. Results indicate that mindfulness-based intervention programs likely decrease depression and may result in reductions of anxiety and burnout.

The current systematic review and meta-analysis focused on the effectiveness of mindfulness interventions for the mental resilience of police officers. The aim was to determine whether mindfulness can contribute to the increase of mental resilience of police officers by reducing stress-related complaints and/or psychological problems. Through an extensive literature search 651 potential relevant studies were found on EBSCO-host, PubMed and Web of Science. After selection, nine studies with at least a pre-post-intervention design were included in the systematic review and meta-analysis. Moderate effects were found for the effect of mindfulness interventions for police officers on reducing burnout, stress, depression and anxiety, and enhancing psychological health between pre- and post-measurements. The effects were less clear between pre- and follow-up measurements. For resilience the effects were not significant. In addition, no moderation effects were found for the type of mindfulness intervention, after how many weeks the follow-up measurement took place and the length of the mindfulness intervention. Mindfulness interventions seem effective for reducing burnout, stress, depression and anxiety, and for improving the psychological health of police officers in the short term. Mindfulness interventions do not seem effective in improving resilience due to problems with operationalization of the construct. Follow-up research is required so mindfulness interventions can be used more effectively within the target group.