{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,3]],"date-time":"2026-10-03T05:55:53Z","timestamp":1791006953613,"version":"4.1.0"},"reference-count":63,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2026,10,2]],"date-time":"2026-10-02T00:00:00Z","timestamp":1790899200000},"content-version":"vor","delay-in-days":274,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,1,1]],"date-time":"2026-01-01T00:00:00Z","timestamp":1767225600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/100008666","name":"Fundaci\u00f3 la Marat\u00f3 de TV3","doi-asserted-by":"publisher","award":["1114\/C\/2021"],"award-info":[{"award-number":["1114\/C\/2021"]}],"id":[{"id":"10.13039\/100008666","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100004587","name":"Instituto de Salud Carlos III","doi-asserted-by":"publisher","award":["FI23\/00015"],"award-info":[{"award-number":["FI23\/00015"]}],"id":[{"id":"10.13039\/501100004587","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Depression and Anxiety"],"published-print":{"date-parts":[[2026,1]]},"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Long\u2010term care workers (LTCWs), encompassing those in long\u2010term care facilities and home\u2010care settings, constitute a particularly vulnerable population to psychological distress. This study aimed to evaluate the effectiveness of a digital stepped\u2010care program, adapted from two World Health Organization (WHO) psychological interventions\u2014Doing What Matters in Times of Stress (DWM) and Problem Management Plus (PM+)\u2014in reducing anxiety and depressive symptoms among LTCWs.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A parallel\u2010group randomized controlled trial was conducted. Participants were LTCWs from Catalonia (Spain) experiencing psychological distress (Kessler Psychological Distress Scale, K10\u2009\u2265\u200916). All participants received Psychological First Aid (PFA), and those in the intervention group subsequently received the digital stepped\u2010care program: DWM as step 1, and if psychological distress persisted (K10\u2009\u2265\u200916), PM\u2009+\u2009as step 2. The primary outcome was the between\u2010group difference in self\u2010reported depressive and anxiety symptoms at week 21 (2\u2010month post\u2010program follow\u2010up), measured using the Patient Health Questionnaire\u2013Anxiety and Depression Scale (PHQ\u2010ADS). Secondary outcomes included depressive and anxiety symptoms measured separately, post\u2010traumatic stress disorder (PTSD) symptoms, and health\u2010related quality of life (HR\u2010QoL; measured using PHQ\u20109, 7\u2010item Generalized Anxiety Disorder [GAD\u20107] scale, PCL\u20105, and EuroQol 5\u2010dimensional descriptive system\u20135\u2010level [EQ\u20105D\u20105L], respectively).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Between October 2022 and May 2024, 165 participants were randomized (intervention:\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200983; control:\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200982). At week 21, depressive and anxiety symptoms were significantly lower in the intervention group, with moderate to large effect sizes (mean difference\u2009=\u20094.2, 95% CI: 1.1\u20137.3; Standardized effect size [SES]\u2009=\u20090.8, 95% CI: 0.1\u20131.4). Secondary outcomes also showed significantly greater improvement in the intervention group, except for HR\u2010QoL, for which no differences were found.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>This study provides evidence supporting the effectiveness of a digital and scalable stepped\u2010care program to support LTCWs\u2019 mental health. These robust findings may inform occupational and public health strategies for supporting LTCWs\u2019 experiencing psychological distress.<\/jats:p>\n                    <jats:p>\n                      <jats:bold>Trial Registration:<\/jats:bold>\n                      ClinicalTrials.gov identifier: NCT05526235\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1155\/da\/5875889","type":"journal-article","created":{"date-parts":[[2026,10,3]],"date-time":"2026-10-03T05:47:07Z","timestamp":1791006427000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["A Randomized Controlled Trial of a Digital Stepped\u2010Care Program to Reduce Anxiety and Depressive Symptoms Among Long\u2010Term Care Workers With Psychological Distress: The REPICAL 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