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.

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: Mechanical restraint remains a common coercive practice in acute psychiatric wards and is particularly concerning in older adults due to greater physical and cognitive vulnerability. Methods: We conducted a retrospective observational study using routinely collected registry data from all recorded mechanical restraint episodes in 20 acute adult mental health inpatient units in the Andalusian public health system over 30 months. Among 2,435 restrained individuals with documented age, 19.4% (n=473) were ≥55. Age was modelled as a continuous predictor of (i) repeated restraint (any subsequent episode) and (ii) multiple restraints (≥3 episodes) using mixed-effects logistic regression with random intercepts for unit and adjustment for sociodemographic, diagnostic, and episode-related factors. Results: Compared with younger users, older restrained users were more often female and Spanish, more frequently had bipolar disorder and organic/intellectual disability diagnoses, and less often had substance use or personality disorders. They experienced a longer time from admission to the first restraint. Restraint was more often recorded as “required for another therapeutic activity” and less often due to “aggressive behavior”. During restraint, older users more frequently displayed confusion, and episodes more often began at night. Repeated restraint occurred in 27.2% of subjects; younger age was significant in univariable analysis but not after adjustment (aOR 1.004). Multiple restraint occurred in 23.0%; after adjustment, older age was associated with lower odds (aOR 0.992). Conclusions: Older adults showed a distinct restraint profile, supporting age-sensitive restraint-reduction strategies focused on frailty/confusional states in older individuals and preventing repeated episodes in younger users.

BACKGROUND Healthcare professionals are exposed to high levels of occupational stress, emotional exhaustion, and anxiety-depressive symptoms. Digital interventions based on 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 To analyze the moderating factors influencing the effectiveness of the digital MINDxYOU program on perceived stress among healthcare professionals and identify differential response profiles. METHODS This study is a secondary analysis of a stepped-wedge cluster randomized trial including 347 healthcare professionals from six clusters allocated to three 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, phone calls, or email to promote adherence. Assessments were conducted every eight weeks across five 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 that the program was more effective among participants with higher baseline depressive symptoms (PHQ-9; B= -0.22; p= 0.004) and those with higher scores in the “Observing” facet of mindfulness (FFMQ-15; B= -0.86; p= 0.039). In addition, nursing exhibited greater reductions in perceived stress compared with physicians (B= 1.92; p= 0.019) and other healthcare professionals (B= 1.80, p= 0.044). CONCLUSIONS The effectiveness of the MINDxYOU program in reducing perceived stress is influenced by baseline psychological and occupational characteristics. These findings highlight the relevance of identifying individual response profiles in digital mental health interventions and support the development of more personalized and targeted approaches to stress management in healthcare settings. CLINICALTRIAL Clinical Trial registration. ClinicalTrials.gov NCT05436717; https://clinicaltrials.gov/ct2/show/NCT05436717 INTERNATIONAL REGISTERED REPORT RR2-10.1186/s12912-022-01089-5