ELECTRICIDAD, ILUMINACIÓN Y SEÑAL DIGITAL 1.- Materiales

This review was registered with the international prospective register of systematic reviews, Prospero (https://www.crd.york.ac.uk/PROSPERO/), reference number CRD42016027349. PRISMA guidelines (Moher, Liberati, Tetzlaff, & Altman, 2009) will be followed in the reporting of the review.

2.2.1 Inclusion criteria

The inclusion criteria for the population of interest were that studies used participants who were involved in delivering patient care working in mental health settings. ‘Mental health settings’ refers to typical adult mental health care, i.e. those services providing care for people aged 18+ (i.e. the working aged population) who are experiencing mental ill-health, including community, inpatient, NHS, and voluntary sector settings. Studies included were quantitative, or mixed methods studies with at least some quantitative data, and were either peer-reviewed journal articles, book chapters, or dissertations. To be included, studies needed to have measured at least one psychological wellbeing outcome (e.g. burnout, stress, depression, job satisfaction etc.) and at least one psychological construct (e.g. a personality trait such as

neuroticism), and have reported the association between them. Studies from any time period and any country were included, although only studies available in English were included.

2.2.2 Exclusion criteria

Studies using participants not working in adult mental health were excluded, including those working in: Child and Adolescent Mental Health Services (CAMHS);

prison/forensic services; the armed forces; learning disability care; hospice care; cancer care; residential care homes for the elderly, non-psychiatric hospital nursing (or where ‘nurses’ was given with no indication as to specialism). Studies investigating only demographic (e.g. age, gender, education level) and/or organisational/job role factors associated with psychological wellbeing (e.g. workplace characteristics, role

conflict/ambiguity, CPD opportunities, social support, length of time in post, teamwork, attitude towards patients, aggression/safety management, salary, caseload/workload, amount of supervision, level of professional knowledge/skills, autonomy/decision latitude/workplace empowerment) were also excluded.

2.2.3 Search strategy

The databases used were: Medline; PsycINFO; Embase; Social Policy and Practice; Cumulative Index of Nursing and Allied Health Literature (CINAHL); PubMed: Cochrane: Web of Science (including Social Sciences Citation Index).

The search terms used are given below in Table 1.

Table 1

Search terms used

1 Terms to capture the population of interest

“mental health staff” OR “mental health worker*” OR “mental health professional*” OR “mental health personnel” OR “mental health nurse*” OR “mental health workforce” OR “psychiatric staff” OR “psychiatric worker*” OR “psychiatric professional*” OR “psychiatric personnel” OR “psychiatric nurse*” OR “psychiatric workforce”

2a Terms to capture the outcomes of interest

burnout OR “Burnout, Professional” (MeSH term)

2b stress OR “Stress, Psychological” (MeSH term)

2c anxiety OR depression OR burden OR strain OR

“psychological load”

2e wellbeing OR well-being 3 Terms to capture the

type of study of interest

correl* OR predict* OR associat* OR longitudinal OR cross-sectional OR “cross sectional"

The search terms were combined in the following way: ((1 AND 2a) OR (1 AND 2b) OR (1 AND 2c) OR (1 AND 2d) OR (1 AND 2e)) AND 3.

2.2.4 Additional search methods

In addition to the database searches, backward and forward citation tracking of

included studies was carried out (i.e. checking backwards through the reference lists of all papers identified by the database searches for any additional relevant studies, and checking forwards for any paper citing the database-identified papers), and experts were consulted.

2.2.5 Data collection

The primary reviewer screened all titles (and abstracts where necessary) to produce an initial short list of potentially relevant papers, then carried out a secondary screening of full papers to produce a final list of papers meeting the inclusion criteria. An additional reviewer (KF) screened a randomly selected 20 papers included in the final list and 20 papers excluded from the final list, and disputes regarding inclusion were resolved via discussion with a third reviewer (BLE). Where papers met the inclusion criteria, full- text versions were imported to reference management software (Zotero:

https://www.zotero.org/) and data was extracted. A data extraction template was developed (see Appendix 1 for the fully populated tables of this template), and the following information was recorded for each included study: 1st Author, Date, Paper type, Country, Setting, Study design, Hypotheses, Time period, Data collection,

Response rate : Follow up rate, Inclusion criteria, Exclusion criteria, Sampling method, Sample size, Sample composition, Sample age, Sample gender, Sample other,

Wellbeing construct, Wellbeing measure, Psych factor construct, Psych factor measure, Exclusions from analysis, Results, Confounders controlled for, Quality Assessment.

2.2.5.2 Quality assessment tool

There is no definitive quality assessment tool recommended for use in systematic reviews of observational research. The Cochrane Collaboration provides a handbook for systematic reviews of interventions (Higgins & Green, 2011), but no equivalent guidance for systematic reviews of observational studies. A systematic review of tools for assessing quality in epidemiological observational studies was carried out in 2007 (Sanderson, Tatt, & Higgins, 2007) and identified 86 different tools. The authors advise against tools that use numerical summary scores due to the weighting of component items, and instead recommend a checklist approach that considers the few most important potential sources of bias in a study’s findings (with a higher number of items met indicating higher quality) (Sanderson et al., 2007).

Two potential critical appraisal tools (CATs) were identified for the purposes of this review (Loney, Chambers, Bennett, Roberts, & Stratford, 2000; Munn, Moola, Riitano, & Lisy, 2014). The tools are broadly similar, but one (Loney et al., 2000) lacked items regarding representativeness of the sample and confounding factors, and one (Munn et al., 2014) lacked an item about the appropriateness of the study design and sampling method. In addition, both used language not quite in keeping with the focus of the current review (e.g. ‘condition’ and ‘health outcome’). For these reasons, the two tools have been combined and the language standardised (see Table 66 in Appendix 2). The Loney CAT uses a scoring system of 1 point for each item met, with a maximum of 8 points available, but no weighting of items, and a higher score indicating higher quality. The Munn CAT does not explicitly award points for met items, but simply categorises them as met (‘yes’), unmet (‘no’), ‘unclear’, or ‘not applicable’. Both tools therefore meet the requirement of (Sanderson et al., 2007) of not using weighted

scores. For the purposes of this review the combined tool uses the Munn categories and the Loney system of unweighted points per met item, with the addition (adopted from tools recommended by the Cochrane Collaboration, e.g. Thomas, Ciliska, Dobbins, & Micucci, 2004) of a summary of each paper as being either low, moderate, or high quality. The combined tool resulted in nine items, so the scores were allocated to the categories as follows: 0-3 items met = low quality; 4-6 items met = moderate quality; 7- 9 items met = high quality.

The two sets of guidance for using the CATs have been combined for the purposes of this review. Where the guidance was very similar the Munn (2014) wording has been used as it contains more generalisable wording, whereas the Loney (2000) guidance is tailored more specifically to dementia studies. The full scales are provided in Appendix 3, the guidance for each individual scale is in Appendix 4, and the combined guidance developed for this review is available in Appendix 5.

2.2.6 Analysis

Due to the expected heterogeneity of the papers in this review, particularly with regard to the constructs assessed and measures used to do so, a systematic review with narrative synthesis was planned. This review involved the same systematic search and quality appraisal process of a meta-analysis, but synthesises evidence found by way of textual ‘story telling’ rather than the manipulation of statistical data (Popay et al., 2006; Ryan, 2013). In line with the recommendations of the Cochrane Collaboration (Ryan, 2013), the analysis consists of three main stages. The first stage is primarily descriptive, with a preliminary synthesis built from descriptions of included studies (including methodological quality), summarising different study designs, and describing similarities and differences between findings. The second stage explores relationships in the data, both within studies and between them (separately for cross-sectional and longitudinal studies if applicable), looking at patterns in the data, considering

heterogeneity, and developing conceptual models. The third stage involves assessing the robustness of the synthesis by considering the overall completeness and

applicability of evidence, the quality assessment of studies, and any potential biases in the review process (Ryan, 2013).