Abstract
BACKGROUND: Healthcare workers are frequently exposed to high emotional demands through encounters with patient suffering, death, worries, and aggressive reactions. Such demands have been linked to an elevated risk of mental health problems, particularly depression. Despite growing recognition of these challenges, evidence on the effectiveness of workplace interventions remains limited. This study evaluates the impact of a multilevel intervention implemented in a Danish hospital to prevent and reduce the adverse consequences of emotional demands. METHODS: We used nationwide register data and a difference-in-differences design to estimate the effect of the intervention, which was introduced on 1 January 2021 and lasted three years. The study population comprised all employees at the intervention hospital and comparable control hospitals from 1 January 2018 to 31 December 2023. The outcomes were healthcare costs related to general practitioner services and a composite measure capturing costs related to mental healthcare in primary care and redeemed prescriptions for antidepressant and anxiolytic medications. Marginal effects of the intervention were obtained from two-part models combining probit or logistic regression to estimate the probability of incurring any healthcare costs and generalised estimating equations to model costs conditional on positive values. RESULTS: Our findings show no overall effect of the intervention on healthcare costs. However, subgroup analyses suggest heterogeneous effects across groups of healthcare employees, including indications of cost-reducing effects on minor mental healthcare costs among nurses and on general practitioner-related costs among doctors. CONCLUSION: The intervention produced no measurable overall effects on healthcare costs; however, the limited statistical power to detect small overall effects means that modest intervention impacts cannot be ruled out. These findings highlight the need for further research on strategies to prevent and manage emotional demands at work.