Background: The high levels of sustained stress that health professionals often experience are a significant risk factor for developing mental health problems, such as anxiety, depression, and somatic symptoms, that not only affect their well-being but also have major social and organizational consequences. Different interventions, including those based on third-wave psychotherapy principles (ie, mindfulness, compassion, and acceptance), have proven to be effective in reducing stress in this population. Among them, those delivered on the web constitute a promising alternative with notable advantages in accessibility and flexibility, but some adherence inconveniences may limit their efficacy. Objective: This study aimed to evaluate the effectiveness of the MINDxYOU program, a web-based self-guided intervention based on third-wave psychotherapy principles, to reduce perceived stress and promote mental health in a sample of health professionals. Methods: In a stepped-wedge cluster randomized design, 357 health professionals from health centers in Aragon and Málaga, Spain, were recruited. They were divided into 6 clusters—3 per region—and randomly assigned to 1 of the 3 sequences, each starting with a control phase and then transitioning to the intervention phase (the MINDxYOU program) after 8, 16, or 24 weeks. This self-guided, web-based program, designed to be completed over 8 weeks, included weekly contact (via WhatsApp, call, or email) from the research team to promote adherence. Participants were assessed on the web every 8 weeks for 5 assessments. Perceived stress was the study’s primary outcome, with additional measures of clinical factors (anxiety, depression, and somatization) and process variables (resilience, mindfulness, compassion, and acceptance). Results: The program was initiated by 229 participants, 112 (48.9%) of whom were completers (ie, completed at least 3 of the 4 modules). Perceived stress demonstrated a significant reduction both when considering the entire sample (β=–1.08, SE 0.51; P=.03) and the sample of completers (β=–1.84, SE 0.62; P=.003). The proportion of participants reflecting “low stress” increased after the treatment (n=90, 46.6% vs n=100, 28.8% at baseline). Intracluster analysis revealed that pre- versus postintervention moderate effects were present in 2 clusters (Cohen d=0.46 and 0.62), and these were maintained in subsequent assessments. The linear mixed-effects models also showed that depression, anxiety, and somatization, as well as resilience, self-compassion, and some mindfulness facets, experienced significant improvements (P<.05) when comparing the intervention and control phases. Conclusions: The MINDxYOU program was effective in reducing perceived stress and promoting mental health, as well as increasing resilience, mindfulness facets, and self-compassion. These effects suggest that participants experienced a tangible improvement that could potentially enhance their well-being. Adherence to the intervention was moderate, while program use was notable compared to similar interventions. Finding ways to promote adherence to the intervention would contribute to increasing the effectiveness of this program. Trial Registration: ClinicalTrials.gov NCT05436717; https://clinicaltrials.gov/study/NCT05436717 International Registered Report Identifier (IRRID): RR2-10.1186/s12912-022-01089-5

Background: The mechanisms through which mindfulness and third wave–based digital programs exert their effects on stress reduction remain poorly understood. Identifying these mediators is essential to optimize their implementation, particularly in health care settings. This approach is particularly relevant for health care professionals, who are constantly exposed to high levels of emotional demands, work overload, and risk of burnout, especially in the aftermath of the COVID-19 pandemic. Despite the growing need for scalable and accessible mental health support in this population, such digital programs remain scarce and underused. Objective: The primary aim of this study was to analyze the psychological mechanisms through which the MINDxYOU online program may contribute to stress reduction among health care professionals, focusing on a mediation model. Specifically, we explored if variables such as resilience and facets of mindfulness, compassion, and acceptance mediated the effects of the intervention on perceived stress. Methods: In a stepped-wedge cluster randomized design, 357 health professionals from health centers in Aragon and Málaga, Spain, were recruited. They were divided into 6 clusters, 3 per region, and randomly assigned to one of the 3 sequences, each starting with a control phase and then transitioning to the intervention phase (the MINDxYOU program) after 8, 16, or 24 weeks. This self-guided, web-based program, designed to be completed over 8 weeks, included weekly contact (via WhatsApp, call, or email) from the research team to promote adherence. Participants were assessed on the web every 8 weeks for 5 assessments. Perceived stress was the study’s primary outcome, with additional measures of clinical factors (anxiety, depression, and somatization) and process variables (resilience, mindfulness, compassion, and acceptance). Mediation models using mixed-effects regressions and bootstrap resampling (1000 iterations) were applied to analyze the direct and indirect effects of the treatment on psychological outcomes. Results: Resilience emerged as the most consistent and significant mediator, exerting a relevant indirect effect on reducing stress (β=−1.41; P =.02), anxiety (β=−0.88; P =.03), and depression (β=−0.97; P =.01), even in multivariate models. Mindfulness facets such as observing, describing, and nonreacting also showed significant, albeit less consistent, mediating effects. In contrast, compassion and acceptance were weakly associated and did not play a significant mediating role. Conclusions: These results demonstrate resilience as the key psychological mediator. Strengthening resilience through online interventions appears to be a crucial pathway for reducing stress and emotional symptoms in this population. Specific mindfulness skills may also contribute to the intervention’s therapeutic effect, although with less robust evidence.

Early readmission to psychiatric units poses a significant challenge for both patients and healthcare institutions. It hampers patient progress and prognosis, and the professional approach taken during discharge can greatly influence the recovery process. This paper proposes a multicomponent discharge transition intervention to mitigate the risk of early readmission to a mental health hospitalization unit (MHHU). The present proposal consists of two distinct phases with two clearly differentiated main objectives. On the one hand, following an observational design, the development of a measurement instrument to assess patients’ risk of early readmission, allowing for stratification into the high-, medium-, and low-risk categories. On the other hand, according to a quasi-experimental design, the implementation and evaluation of the intervention program, with a focus on tailored interventions to ensure adherence and continuity of care post-discharge, with a more intensive approach for high-risk patients. A post-discharge psychotherapeutic group will also be introduced for high-risk cases to support recovery. The program’s effectiveness will be evaluated by comparing the early readmission rates at the Regional Hospital of Malaga’s MHHU to those of the previous year. Two other hospitals in the province, where the intervention is not applied, will serve as control groups. Success will also be measured through pre- and post-assessments of the recovery, functionality, subjective well-being, social support, and treatment satisfaction of those participating in the psychotherapeutic group. This proposal aims to address the issue of early readmission by enhancing predictability and understanding intervention strategies to reduce readmission rates.

Depression and cognitive impairment frequently co-occur in older adults, but their temporal relationship remains unclear. While depression is often considered a risk factor for cognitive decline, evidence is mixed, particularly in individuals with mild cognitive impairment or early dementia (MCI/ED). This study analyzed longitudinal data from 1086 participants (M = 74.49, SD = 7.24) in the SMART4MD clinical trial, conducted in Spain and Sweden over 18 months, with assessments every six months. Cognitive impairment was measured using the Mini-Mental State Examination, and depression was assessed with the Geriatric Depression Scale-15. Findings revealed a concurrent association between depressive symptoms and cognitive impairment. In regression mixed analysis, depression levels predicted increased cognitive decline over time, but no evidence was found for cognitive impairment predicting future depression. These associations were confirmed using a bivariate latent growth curve model with cross-lagged paths, which revealed early but attenuating bidirectional effects between depression and cognition. These results highlight depression as a medium-term risk factor for cognitive decline, emphasizing the importance of addressing depressive symptoms to mitigate cognitive deterioration in MCI/ED populations.

Background: Health care professionals are exposed to high levels of occupational stress, emotional exhaustion, and anxiety-depressive symptoms. Digital interventions using mindfulness- and acceptance-based approaches have shown promising results in improving psychological well-being in this population. The MINDxYOU program is a self-guided digital intervention designed to reduce perceived stress and enhance emotional regulation, resilience, and psychological flexibility. Although its effectiveness has been demonstrated, treatment response may vary substantially between individuals. Objective: The aims of this study are to explore the sociodemographic, occupational, and psychological moderators of the effectiveness of the digital MINDxYOU program on perceived stress among health care professionals and to identify differential response profiles. Methods: This study is a secondary analysis of a stepped-wedge cluster randomized trial including 347 health care professionals from 6 clusters allocated to 3 intervention start sequences. The intervention (MINDxYOU) is a self-guided, web-based program designed to be completed over 8 weeks, grounded in third-wave psychological approaches and incorporating mindfulness-, compassion-, and acceptance-based components. Weekly support was provided via WhatsApp Messenger (Meta Platforms Inc), phone calls, or email to promote adherence. Assessments were conducted every 8 weeks across 5 measurement waves. Linear mixed-effects models were used to evaluate moderation effects by testing condition × moderator interactions, accounting for repeated measures within participants and clustering effects. Results: Moderation analyses showed greater reductions in perceived stress among participants with higher baseline depressive symptom scores (9-item Patient Health Questionnaire [PHQ-9]; B=−0.22, SE 0.08; P =.004) and those with higher scores in the observing facet of mindfulness (15-item Five Facet Mindfulness Questionnaire [FFMQ-15]; B=−0.86, SE 0.41; P =.04). In addition, nursing staff exhibited greater reductions in perceived stress compared with physicians (B=1.92, SE 0.81; P =.02) and other health care professionals (B=1.80, SE 0.90; P =.04). Conclusions: The results suggest that baseline psychological and occupational characteristics may contribute to differences in the effectiveness of the MINDxYOU program in reducing perceived stress. These findings provide preliminary evidence regarding potential response profiles in digital mental health interventions and support the development of more personalized and targeted approaches to stress management in health care settings.

BACKGROUND The high levels of sustained stress that health professionals often experience are a significant risk factor for developing mental health problems, such as anxiety, depression, and somatic symptoms, that not only affect their well-being but also have major social and organizational consequences. Different interventions, including those based on third-wave psychotherapy principles (ie, mindfulness, compassion, and acceptance), have proven to be effective in reducing stress in this population. Among them, those delivered on the web constitute a promising alternative with notable advantages in accessibility and flexibility, but some adherence inconveniences may limit their efficacy. OBJECTIVE This study aimed to evaluate the effectiveness of the MINDxYOU program, a web-based self-guided intervention based on third-wave psychotherapy principles, to reduce perceived stress and promote mental health in a sample of health professionals. METHODS In a stepped-wedge cluster randomized design, 357 health professionals from health centers in Aragon and Málaga, Spain, were recruited. They were divided into 6 clusters—3 per region—and randomly assigned to 1 of the 3 sequences, each starting with a control phase and then transitioning to the intervention phase (the MINDxYOU program) after 8, 16, or 24 weeks. This self-guided, web-based program, designed to be completed over 8 weeks, included weekly contact (via WhatsApp, call, or email) from the research team to promote adherence. Participants were assessed on the web every 8 weeks for 5 assessments. Perceived stress was the study’s primary outcome, with additional measures of clinical factors (anxiety, depression, and somatization) and process variables (resilience, mindfulness, compassion, and acceptance). RESULTS The program was initiated by 229 participants, 112 (48.9%) of whom were completers (ie, completed at least 3 of the 4 modules). Perceived stress demonstrated a significant reduction both when considering the entire sample (β=–1.08, SE 0.51; P=.03) and the sample of completers (β=–1.84, SE 0.62; P=.003). The proportion of participants reflecting “low stress” increased after the treatment (n=90, 46.6% vs n=100, 28.8% at baseline). Intracluster analysis revealed that pre- versus postintervention moderate effects were present in 2 clusters (Cohen d=0.46 and 0.62), and these were maintained in subsequent assessments. The linear mixed-effects models also showed that depression, anxiety, and somatization, as well as resilience, self-compassion, and some mindfulness facets, experienced significant improvements (P<.05) when comparing the intervention and control phases. CONCLUSIONS The MINDxYOU program was effective in reducing perceived stress and promoting mental health, as well as increasing resilience, mindfulness facets, and self-compassion. These effects suggest that participants experienced a tangible improvement that could potentially enhance their well-being. Adherence to the intervention was moderate, while program use was notable compared to similar interventions. Finding ways to promote adherence to the intervention would contribute to increasing the effectiveness of this program. CLINICALTRIAL ClinicalTrials.gov NCT05436717; https://clinicaltrials.gov/study/NCT05436717 INTERNATIONAL REGISTERED REPORT RR2-10.1186/s12912-022-01089-5