A Randomized Controlled Trial of a Digital Stepped‐Care Program to Reduce Anxiety and Depressive Symptoms Among Long‐Term Care Workers With Psychological Distress: The REPICAL Study

Abstract

Background Long‐term care workers (LTCWs), encompassing those in long‐term care facilities and home‐care settings, constitute a particularly vulnerable population to psychological distress. This study aimed to evaluate the effectiveness of a digital stepped‐care program, adapted from two World Health Organization (WHO) psychological interventions—Doing What Matters in Times of Stress (DWM) and Problem Management Plus (PM+)—in reducing anxiety and depressive symptoms among LTCWs. Methods A parallel‐group randomized controlled trial was conducted. Participants were LTCWs from Catalonia (Spain) experiencing psychological distress (Kessler Psychological Distress Scale, K10 ≥ 16). All participants received Psychological First Aid (PFA), and those in the intervention group subsequently received the digital stepped‐care program: DWM as step 1, and if psychological distress persisted (K10 ≥ 16), PM + as step 2. The primary outcome was the between‐group difference in self‐reported depressive and anxiety symptoms at week 21 (2‐month post‐program follow‐up), measured using the Patient Health Questionnaire–Anxiety and Depression Scale (PHQ‐ADS). Secondary outcomes included depressive and anxiety symptoms measured separately, post‐traumatic stress disorder (PTSD) symptoms, and health‐related quality of life (HR‐QoL; measured using PHQ‐9, 7‐item Generalized Anxiety Disorder [GAD‐7] scale, PCL‐5, and EuroQol 5‐dimensional descriptive system–5‐level [EQ‐5D‐5L], respectively). Results Between October 2022 and May 2024, 165 participants were randomized (intervention: n = 83; control: n = 82). At week 21, depressive and anxiety symptoms were significantly lower in the intervention group, with moderate to large effect sizes (mean difference = 4.2, 95% CI: 1.1–7.3; Standardized effect size [SES] = 0.8, 95% CI: 0.1–1.4). Secondary outcomes also showed significantly greater improvement in the intervention group, except for HR‐QoL, for which no differences were found. Conclusions This study provides evidence supporting the effectiveness of a digital and scalable stepped‐care program to support LTCWs’ mental health. These robust findings may inform occupational and public health strategies for supporting LTCWs’ experiencing psychological distress. Trial Registration: ClinicalTrials.gov identifier: NCT05526235