Occupational stress and professional burnout among the Millennial generation: A scoping review.

Toward an understanding of healthcare professionals' burnout in telehealth: Two literature reviews and an organizing framework.

Effects of mindfulness-based stress reduction on ICU nurses' resilience and well-being.

Continuous stress, emotional tension, the pace of work, and constant contact with sick people exposes nurses and midwives to professional burnout. Until now, the level of burnout among nurses has been assessed, but research among midwives with an analysis of sociodemographic determinants, including attitudes toward work and life, is still limited. The aim of the study was to assess factors influencing the level of professional burnout among midwives, taking into account job satisfaction, life satisfaction, and dispositional optimism. This cross-sectional observational study was conducted on a group of 98 midwives. Standardized research tools were used to assess professional burnout (Maslach Burnout Inventory, MBI), dispositional optimism (Life Orientation Test, LOT-R), life satisfaction (Satisfaction with Life Scale, SWLS), and job satisfaction (Job Satisfaction Scale, JSS). Depersonalization was significantly higher in individuals with 21 years or more of work experience than in midwives with 0-5 years of seniority (p = 0.023). Lack of job satisfaction was significantly higher among individuals with low life satisfaction than among those with medium and high levels of life satisfaction (p < 0.001), among pessimists compared with neutral individuals (p < 0.001), among those working in a shift system (p = 0.045), and among individuals with less than 21h of free time per week (p = 0.013). Independent predictors of lower emotional exhaustion burnout were employment in two workplaces (17.98 points). Independent predictors of lower reduced personal accomplishment were job satisfaction (1.638 points) and life satisfaction (24.385 points). An optimistic outlook on life reduced the overall level of professional burnout (13.449 points). The study found that the overall level of professional burnout among midwives was moderate. Professional burnout was associated with individual, interpersonal, and organizational factors. Higher levels of burnout were observed among midwives with a pessimistic outlook.

INTRODUCTION: The pervasive influence of social media has transformed communication and traditional social work practice, presenting both opportunities and ethical challenges. This article critically examines the effective and ethical integration of social media in social work, addressing gaps in policy and practice. METHODS: This article used elements of the PRISMA criteria to map existing literature on social media integration in social work. A qualitative thematic analysis was employed to interpret selected literature, ensuring both methodological rigor and interpretive depth. The search strategy involved electronic databases, backward searching of references, and forward searching for citations, with strict inclusion and exclusion criteria applied. FINDINGS: The findings indicate that social media offers significant avenues for communication, advocacy, professional networking, and service delivery. This helps to enhance accessibility for diverse service users groups. However, its integration comes with challenges, including privacy and confidentiality concerns, blurred professional boundaries, the digital divide, the spread of disinformation, and the risk of professional burnout due to constant connectivity. Existing frameworks often lag behind technological advancements, leading to uncertainty for social workers. CONCLUSIONS: Effective and ethical social media integration demands enhanced e-professionalism, continuous digital literacy, and robust policy development. This article provides essential insights for practitioners, educators, and policymakers to navigate the evolving digital landscape and uphold professional ethics. These insights also aim to improve service-user outcomes by addressing the challenges and opportunities of social media in social work practice.

The presented paper examines human resource management strategies in the context of hospital administration. This study aims to identify the key challenges and opportunities that arise in managing personnel within administrative processes. Special attention is given to strategic approaches such as staff motivation, prevention of professional burnout, and the integration of technological innovations into human resource management. These strategies contribute to improving the administrative efficiency of hospitals and enhancing the quality of patient-centered care. The study highlights the crucial role of strategic human resource management in achieving organizational objectives and provides recommendations for attracting and retaining staff, enhancing motivation, and mitigating professional burnout, all of which ultimately contribute to the operational productivity and sustainability of healthcare organizations.

Burnout is a work-related syndrome recognised by the World Health Organization and included in the International Classification of Diseases 11th revision (ICD-11) as resulting from chronic workplace stress that has not been successfully managed. Characterised by emotional exhaustion, depersonalisation, and a reduced sense of professional accomplishment, it predominantly affects healthcare professionals exposed to sustained emotional and organisational demands at the workplace. Global evidence indicates that nearly half of practising clinicians experience burnout, with higher prevalence in emergency medicine, anaesthesiology, surgical subspecialities, radiology, internal medicine, family medicine and primary healthcare, as well as among registrars and students. Burnout is a syndrome that is closely associated with other mental health conditions, such as depression, anxiety, substance use, and increased suicide risk, while compromising patient safety through elevated rates of diagnostic and medication errors. Contributing factors include excessive workloads, administrative burden, limited autonomy, poor work-life balance, and misalignment of personal and institutional values. Effective management requires a dual focus: individual strategies such as mindfulness, exercise, and stress-management programmes, and organisational reforms including workload optimisation, streamlining electronic documentation, leadership development, and value alignment. When recognised early and addressed comprehensively, burnout is reversible with improved clinician well-being and enhanced patient outcomes. A coordinated response from healthcare institutions, professional councils, and policymakers is essential to safeguard the workforce and sustain high-quality health services. This article aims to provide readers with evidence-based strategies to help themselves or to support a colleague who may be experiencing burnout.

Burnout and lack of professional fulfilment are prevalent among perioperative personnel, often exacerbated by a culture that lacks positive reinforcement. Microaffirmations-small, intentional acts of recognition-may offer a scalable strategy to improve workplace culture and well-being. The primary objective was to evaluate the impact of a microaffirmation-based intervention, the Microaffirmations in Perioperative Personnel Project (MAPP Project), on professional fulfilment and burnout. The secondary objective was to evaluate changes in perceived and experienced microaggressions among perioperative staff. A toolkit of microaffirmation examples was disseminated to perioperative members, and volunteer peer MAPP coaches modelled affirming behaviours. Surveys were administered at baseline before start of the intervention and at 3 and 6 months after the end of the intervention. The primary outcomes of professional fulfilment and burnout were measured using the validated Professional Fulfillment Index. Secondary outcomes including perceived and experienced microaggressions were assessed via a custom Microaggressions Impact Questionnaire. A total of 388 responses were collected across the three time points. Mean fulfilment scores increased from 2.53 at baseline to 2.67 at 6 months (P=0.222), whereas burnout scores decreased from 1.06 to 0.87 (P=0.029). Perceived microaggressions and their reported impact also declined. Among 67 participants who completed all three surveys, trends were consistent but not statistically significant. Survey response rates were 63%, 40%, and 41% at each time point, respectively. The MAPP Project was associated with improved fulfilment, reduced burnout, and decreased perceived microaggressions among perioperative staff. These findings suggest that microaffirmation-based interventions may be a feasible and effective strategy to enhance workplace culture in health care settings.

The article examines the specific features of professional burnout and stress levels among employees in the oil and gas industry. The aim of the study is to identify the relationship between employees’ psycho-emotional states and their working conditions in a high-risk production environment. The diagnostic tools included the Copenhagen Burnout Inventory (CBI), A.O. Prokhorov’s «Stress Level Assessment» methodology, and author-designed questionnaires. The study identified groups of employees with high levels of emotional exhaustion and pronounced stress reactions. An inverse relationship between stress levels and the degree of professional burnout was revealed: high stress is more often associated with low burnout levels, while low stress is characteristic of employees with high levels of burnout. This dynamic reflects a transition from an acute stress response to chronic resource depletion. Young specialists with limited work experience were found to be the most vulnerable group. The practical significance of the study lies in the need for early diagnosis and the implementation of preventive measures aimed at maintaining the psycho-emotional resilience of personnel.

Pharmaceutical care can be improved via mobile health (mHealth) applications (apps); however, the engagement of these apps depends on healthcare providers' acceptance. Thus, identifying barriers and facilitators to utilizing mHealth apps is needed to develop and facilitate their use. The objective of this research was to investigate the various elements that influence the acceptability and utilization of mHealth apps in the delivery of pharmaceutical care services, as perceived by pharmacists working in the government health sector of Kuwait. A cross-sectional survey was conducted, and the results were used in the mobile health technology acceptance model (m-TAM) to measure the behavioral intentions of pharmacists with regard to the acceptance and use of mHealth apps. Multiple elements influence the behavioral intention of pharmacists to use mHealth apps, including Compatibility (CO), Performance Expectancy (PE), Personal Innovativeness (PI) and Effort Expectancy (EE) were statistically significant predictors. The mediating role of PE was found to be statistically significant in the link between CO and BI and in the association between EE and BI. The substantial mediation effects of Effort Expectancy (EE) and Performance Expectancy (PE) were seen in the three associations between job-related mental demands (MA) and burnout (BI), professional identity (PI) and burnout (BI), and perceived social support at work (PSA) and Behavioural Intention (BI). The results further demonstrate that EE substantially mediates the connections between MA and PE, MSE and PE, PI and PE, and PSA and PE. These results suggest that the acceptance of mHealth apps by pharmacists in Kuwait is multifaceted and requires evaluating a chain of effects. As a result, developing apps that provide pharmaceutical care requires consideration of each one of these factors. Results can direct policymakers and stakeholders in their efforts to implement mHealth in Kuwait.

Police work takes place in highly demanding contexts, characterised by frequent exposure to critical events, time pressure, physical risk and high emotional demands. These factors increase the risk of chronic stress, operational fatigue and professional burnout. Despite growing interest in police wellbeing, there is still a lack of an integrated framework that articulates the main protective factors and guides preventive policies. This article aims to synthesise recent literature on mental health in police forces and propose an operational model for promoting wellbeing tailored to the needs of this group. A narrative review of the literature was conducted through a selective search in PubMed, PsycINFO, Scopus, and Dialnet (2010-2025). Studies focusing on police resilience, organisational support, emotional competencies, operational stress, leadership, and organisational climate were included. The studies analysed identify five key protective factors for police mental health: (1) individual and collective resilience; (2) social and organisational support; (3) emotional literacy and affective regulation; (4) sense of purpose and professional identity; and (5) psychosocial climate and healthy leadership. Based on these axes, the Integrated Model of Police Mental Health (IPMHM) is proposed, which articulates interventions at the individual, group and organisational levels. The results suggest that promoting mental health in police forces requires systemic approaches that integrate personal competencies with safe organisational environments and professional cultures oriented towards well-being, highlighting the role of leadership, continuous training and peer support.

Background: Professional burnout, characterized by three distinct psychological dimensions—emotional exhaustion, depersonalization, and reduced personal achievement—threatens elementary teachers’ well-being and educational quality. Limited research examines burnout patterns in elementary education contexts experiencing economic crisis, particularly the interplay between workplace stress and societal stressors. Notably, the bidirectional relationship between workplace burnout and economic crisis burden, a distinctive contribution of this study, remains underexplored. Methods: A cross-sectional study surveyed 128 Greek elementary education teachers (response rate: 87.7%) during October 2024 using the Maslach Burnout Inventory-Educators Survey (MBI-ES) and demographic questionnaires. Statistical analysis examined relationships among burnout dimensions, demographic factors, and the psychological impact of the economic crisis. Results: Teachers demonstrated moderate emotional exhaustion (M = 25.09, SD = 11.05), with 35.9% experiencing high levels. Personal accomplishment was largely preserved, with 64.1% maintaining at least moderate levels, while depersonalization remained low, with 51.6% scoring in the low range and only 20.3% exhibiting high levels. Substitute teachers showed significantly higher depersonalization than permanent staff (7.92 vs. 4.73, p &lt; 0.001). Male teachers reported nearly twice the level of depersonalization as females (9.66 vs. 5.36, p = 0.050). Emotional exhaustion strongly predicted the psychological impact of the economic crisis (β = 0.416, p &lt; 0.001), explaining 27.4% of the variance. Most notably, this study establishes a bidirectional relationship between burnout and economic crisis burden—a distinctive contribution to the literature—revealing that emotional exhaustion predicts economic crisis psychological impact (β = 0.416, p &lt; 0.001) while economic stress equally predicts emotional exhaustion (β = 0.413, p &lt; 0.001), creating a reciprocal vulnerability cycle between occupational and societal stressors. The asymmetrical burnout pattern—moderate emotional exhaustion alongside preserved personal accomplishment (64.1% at least moderate) and low depersonalization (51.6% low)—suggests Greek teachers maintain professional efficacy despite emotional depletion. Conclusions: Emotional exhaustion, explaining 27.4% of the variance in economic crisis psychological burden (β = 0.416, p &lt; 0.001), emerges as the central vulnerability linking workplace stress to broader societal stressors. Crucially, bidirectional analyses revealed that economic stress equally predicts emotional exhaustion (β = 0.413, p &lt; 0.001), establishing a reciprocal vulnerability cycle between occupational and societal stressors. The asymmetrical burnout pattern—moderate emotional exhaustion alongside preserved personal accomplishment and low depersonalization—suggests Greek teachers maintain professional efficacy despite emotional depletion. These findings support targeted interventions prioritizing emotional recovery, employment security for substitute teachers, and gender-specific support in primary education.

Abstract Background Occupational burnout is increasingly common among college teachers, manifested by emotional exhaustion, dehumanization and a reduced sense of personal accomplishment, which seriously endangers their professional and mental health. Existing research mostly focuses on causes such as work stress and insufficient support, but there is still a lack of empirical research using positive psychology for targeted intervention. Positive psychology focuses on cultivating positive emotions, engagement, meaning and relationships, and has the potential to improve psychological resilience. The purpose of this study is to use a structured positive psychology intervention program to test its effect on alleviating professional burnout and improving self-efficacy and work engagement of college teachers, with a view to providing empirical evidence for the psychological support system for college teachers. Methods The study adopted a randomized controlled design, recruiting 240 college teachers who met the burnout criteria, and randomly assigned them to the intervention group and the control group, with 120 students each. The intervention group received a 12-week, 90-minute weekly positive psychology group intervention, which covered positive emotion cultivation, strengths identification, gratitude exercises, meaning reconstruction and goal setting, and was led by a trained psychological counselor. The control group received no intervention. The study used burnout, well-being, self-efficacy and student interaction satisfaction scales to evaluate before the intervention, at the end of the intervention and 3 months after the intervention. Data analysis used repeated measures analysis of variance and multiple regression, controlling covariates such as teaching years, professional titles, and gender to test the intervention effect and its mechanism. Results The total burnout score of the intervention group at the end of the intervention was significantly lower than that of the control group, with emotional exhaustion reduced by 26.8%, dehumanization reduced by 18.4%, and personal accomplishment increased by 22.1%. Repeated measures analysis showed that the interaction between time and group was significant, indicating that the intervention effect was sustained, and the total burnout score of the intervention group was still lower than the baseline at follow-up. The intervention group's happiness increased by 19.7%, self-efficacy increased by 15.3%, and student interaction satisfaction increased by 13.6%. Mediation analysis showed that self-efficacy plays a partial mediating role in the relationship between burnout and interaction satisfaction. Regression analysis showed that teachers with higher emotional exhaustion before the intervention benefited more significantly. Discussion Research shows that structured positive psychology intervention can effectively alleviate the burnout of college teachers and improve their sense of well-being, self-efficacy and the quality of teacher-student interaction. The results support the practicality of positive psychology in occupational health promotion and suggest that systematic psychological training can enhance teachers' psychological resources to cope with stress. The intervention effect is sustained and particularly effective for individuals with high burnout, providing an empirical basis for colleges and universities to promote targeted psychological support. In the future, online hybrid intervention models can be explored and their impact on teaching effectiveness and organizational behavior can be tracked over the long term. It is recommended that colleges and universities incorporate such interventions into teacher development systems as normalized burnout prevention and mitigation measures.

Background/aimPharmacists and pharmacy technicians employed in community pharmacies face a considerable risk of workplace violence, which can negatively influence their job satisfaction, productivity, and mental well-being. This study examined the prevalence and consequences of workplace violence in community pharmacies in Ankara through a mixed-methods design integrating cross-sectional survey data with qualitative insights.Materials and methodsThe target population included pharmacists and pharmacy technicians. We examined demographic factors, psychological outcomes, and the nature of violent incidents. Data were obtained from a random sample of 355 community pharmacies using a 39-item survey and the depression anxiety stress scales (DASS-21), complemented by qualitative interviews with 12 pharmacists.ResultsA total of 242 participants took part in the study: 174 pharmacists (71.9%; median age 46.0 years) and 68 pharmacy technicians (28.1%; median age 35.0 years). Overall, 63.2% reported at least one violent incident (58.0% of pharmacists; 76.5% of pharmacy technicians). Verbal violence emerged as the most prevalent form, with pharmacy technicians reporting significantly higher exposure than pharmacists. Perpetrators were most often patients or their relatives, while broader societal violence and deficiencies within the health system were frequently cited as contributing factors. Many participants refrained from taking legal action, attributing this to professional burnout and the perception of violence as an inherent aspect of their occupation. Findings from the DASS-21 revealed higher anxiety scores among pharmacy technicians compared to pharmacists. Among pharmacists, exposure to workplace violence was paradoxically associated with lower stress and depression scores, a pattern not observed among technicians.ConclusionWorkplace violence in community pharmacies is prevalent—particularly verbal abuse—and disproportionately impacts pharmacy technicians. Addressing this issue necessitates enhanced training, institutional support, and strengthened security measures, alongside extending white code legal protections to community pharmacies to improve safety and service quality.

This research explored a cross-country comparison of qualitative and quantitative data assessing the experiences of prenatal genomic healthcare professionals (HCP) in Australia and the Netherlands. The interview script included open-ended questions on work experience, validated scales on compassion fatigue and stress, and demographic details. Content analysis with an inductive coding approach was used for the coding and analysis of qualitative data. Quantitative data were compared between professions and countries, using a one-way ANCOVA. Quantitative data were obtained from 93 participants and qualitative data from a subset of 63 participants, recruited from the departments of clinical genetics, maternal-fetal medicine and genomic laboratories. The following themes were constructed: (1) Advancements in prenatal genomics increase diagnostic rates but cause increased workloads; (2) Benefits and drawbacks of the current healthcare system; (3) The burden of equivocality: high stakes and ambiguous findings; and (4) Multidisciplinary teamwork, support and supervision may improve working conditions. There were no significant differences in compassion fatigue between professions, but Australian HCPs experienced significantly more symptoms of burnout and secondary traumatic stress than Dutch HCPs. Although participants had overall positive views and experiences, with high levels of job satisfaction and low levels of compassion fatigue, additional resources are required to minimize professional burnout while dealing with increasing demands.

Teachers in remote schools often experience psychological stress and professional burnout due to limited resources, heavy workloads, and lack of psychosocial support, which negatively affect both teacher well-being and learning quality. This community service program aims to enhance teachers’ mental well-being and professionalism through a Tech-Based Psychosocial Mentoring Innovation, supporting SDGs 3, 4, and 8, as well as University Key Performance Indicators (IKU) 3 and 7 by empowering educators in low-resource settings. The program was implemented in three stages: preparation (needs assessment, development of the “Healthy Teacher” psychosocial module, and creation of a Google Site–based Learning Management System), implementation (three-day training on stress management, emotional regulation, and reflective mentoring), and evaluation (using the WHO-5 Wellbeing Index, daily reflections, and focus group discussions). Results showed a significant improvement in teachers’ well-being, with WHO-5 scores increasing from moderate to good levels. Teachers also reported improved stress management, higher motivation, and stronger collegial support. The program produced ten psychoeducational videos, a digital LMS, and a sustainable reflective teacher community supported by two internal mentors. Overall, this innovation effectively enhanced teachers’ psychological well-being and professionalism in remote schools and can be replicated in other rural or low-resource educational settings to promote sustainable teacher well-being and school quality improvement.

(1) Background: Professional burnout threatens secondary school principals’ well-being and educational quality worldwide. This study investigated burnout prevalence and gender differences among Greek secondary school principals, addressing gaps in understanding gendered manifestations of burnout in educational leadership. (2) Methods: A census survey was conducted with 54 secondary school principals (68.5% male, 31.5% female) from Fokida Prefecture, Greece. The Maslach Burnout Inventory-Educators Survey assessed three burnout dimensions. Mann–Whitney U tests examined gender differences, with effect sizes calculated for practical significance. (3) Results: Emotional exhaustion was prevalent among principals regardless of gender. Significant gender differences emerged in depersonalization, with male principals showing higher emotional distancing (small-to-medium effects). Female principals demonstrated significantly higher personal achievement, maintaining professional efficacy despite equivalent exhaustion. (4) Conclusions: These preliminary findings suggest that while workplace stressors create universal emotional exhaustion, gender shapes burnout manifestation through different coping pathways. Male principals appear more prone to emotional distancing, while female principals sustain achievement through maintained engagement. Pending replication in larger samples, findings support the need for gender-sensitive interventions alongside systemic organizational reforms.

This pilot study examines the impact of guided imagery hypnotherapy (GIH) on symptoms of job-related burnout in medical professionals. Nine adults (eight female) involved in direct medical care in the region of San Diego, California participated in eight consecutive weekly GIH sessions. Subjective measures of burn-out, compassion, and self-compassion were recorded roughly one week before the start of the hypnotherapy series (baseline session zero) and after the first, fourth, and final GIH sessions. Resting state electroencephalographic data (EEG) was also recorded at each of these measurement times. Additionally, EEG was recorded for the duration of the hypnotherapy protocol during sessions one, four, and eight. Two sets of frontal alpha asymmetry (FAA) scores were computed for each participant. First, for each session, FAA was derived from the cleaned, preprocessed EEG recorded for the full duration of the GIH protocol. Additionally, FAA was computed from segments of EEG centered on eleven key events associated with hypnosis and visualization during the protocol. Linear mixed model analysis revealed a reliable increase in self-compassion and a decrease in emotional exhaustion across the four measurement times. Further, a reliable shift toward left over right hemispheric dominance, indicated by increases in FAA, was observed both across and within sessions, suggesting an evolution toward approach-related self-regulation at short and longer time scales. These outcomes indicate the promising potential of GIH for alleviating symptoms of job-related burnout and improving self-regulation in response to challenging work situations.

In Italy, people with severe mental disorders (SMDs) are often residents in mental health supported accommodations (SAs). SMDs are associated with persistent symptoms, functional impairment, and social exclusion. Although the goal of SAs is to promote personal recovery, defined as living life to the fullest potential, the adoption of such approaches remains challenging. The study aims to assess the effectiveness of personal recovery-oriented compared with standard treatment in enhancing patients' functioning, integrating the assessment with biological markers and innovative digital technologies. In addition, the study investigates whether such interventions can reduce the burden experienced by caregivers and mental health professionals. EMPOWER-RES is a non-randomized multicenter clinical trial comparing patients in SAs receiving personal recovery-oriented treatment (n=36) and standard treatment (n=36). Patients will be matched by sex, age, and diagnosis. The personal recovery-oriented treatment will use the Mental Health Recovery Star, a tool that represents ten life dimensions and monitors the stages of change. Standardized assessments will be administered to patients, caregivers, and professionals baseline and after six months. A mobile application will collect real-time data on patients' daily experiences, mood and social interactions, while accelerometers will monitor their physical activity and sleep-wake rhythms. Not yet available. The hypothesis is that personal recovery will significantly increase Personal and Social Functioning (PSP score ≥5 points at 6 months), reduce caregiver burden and professional burnout. The study will provide new insights to optimize mental health services and personalized therapeutic options for patients with SMDs living in SAs.

Previous reviews have investigated the relationship between empathy and burnout. However, these are now out of date, did not capture the effect of the pandemic, did not include healthcare professionals other than doctors and nurses or medical students, did not assess the impact of differences in profession and did not pool the data, which made estimating the strength of the association unclear. We therefore aim to address these shortcomings in an up-to-date, rigorous, systematic review and meta-analysis. Findings will be reported in accordance with the Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines and flowchart.We will search American Psychological Association (APA) PsycINFO, APA PsycArticles, Cumulative Index to Nursing and Allied Health Literature (CINAHL), The Cochrane Library, PubMed and Scopus. We will also search ResearchSquare and Social Science Research Network (SSRN) for preprints; ProQuest Dissertations and Theses and Electronic Theses Online Service for relevant theses. Forward and backward citation searches will identify additional studies. Two independent reviewers will screen titles, abstracts and full texts and extract data. Two independent reviewers will assess risk of bias using Risk of Bias 2 (RoB 2) for randomised controlled trials, Risk of Bias in Non-randomised Studies of Interventions (ROBINS-I) for non-randomised interventional studies and Risk of Bias in Non-randomised Studies of Exposures (ROBINS-E) for observational studies.For all included studies, we will summarise the study characteristics, including number of participants; health profession, specialty and career stage; country and gender. If data are suitable, we will pool results and conduct subgroup analyses (including by health profession, career stage and clinical specialty). We will also explore the relationships between subscales of empathy and burnout. We will use metaregression to explore the impact of theoretically derived factors (such as study design and profession) on the strength of the association. Sensitivity analyses will assess the impact of low-quality research. In our discussion, we will summarise results, the limitations and provide a general interpretation of the results and implications. Ethical approval is not required for this review, as primary data will not be collected. The review will be disseminated through peer-reviewed publication and presentation at conferences. CRD420251075618.