Single-session intervention with and without video support to prevent the worsening of emotional distress among healthcare workers during the SARS-CoV-2 pandemic: a randomized clinical trial

SUMMARY BACKGROUND The SARS-CoV-2 pandemic was a major stressful event that significantly affected healthcare providers. This study aimed to compare the efficacy of a single-session intervention (SSI) with and without weekly personalized pre-recorded videos to prevent the worsening of emotional distress. METHODS Nationwide randomized clinical trial conducted in Brazil from May 19, 2020 to December 31, 2021. We included healthcare professionals with levels of anxiety, depression, or irritability below a T-score of 70, defined by the Patient-Reported Outcomes Measurement Information System. The exclusion criterion was suicide risk. Participants were randomized to SSI or SSI plus weekly personalized pre-recorded videos for four weeks (SSI-ET). The primary outcome was the proportion of participants with a significant escalation of symptoms (i.e., T-score above 70). The trial was registered with ClinicalTrials.gov ( NCT04632082 ). FINDINGS Of the 3328 volunteers assessed for eligibility, 1112 participants were allocated to either SSI (n=549) or SSI-ET (n=563). The cumulative proportion of incident cases at six months was 17.5% (95% CI 13.1% to 21.6%) for SSI and 15% (95% CI 10.9% to 18.8%) for SSI-ET, with no difference between groups (HR=0.81, 95% CI 0.83 to 1.79). Both groups presented significant symptom reduction in the one-month assessment and maintained over three and six-month follow-ups (Cohen’s d range = 0.68 - 1.08). CONCLUSIONS We found no benefit of adding asynchronous videos to SSIs; however, we found strong effects for the synchronous component for preventing symptom worsening. This component emphasizes core elements of mental health support, such as active listening, validation, and empathic care. Due to its simplicity and scalability, this intervention shows promise as a public health measure to be widely implemented. FUNDING Ministry of Health of Brazil, Coordenação de Aperfeiçoamento de Pessoal de Nível Superior, Conselho Nacional de Desenvolvimento Científico e Tecnológico, and Fundo de Incentivo à Pesquisa/Hospital de Clínicas de Porto Alegre.