Experiences and perceptions of family members of emergency first responders with post-traumatic stress disorder: a qualitative systematic review

Abstract

Objective: The objective of this review was to examine the perceptions and experiences of family members of emergency first responders (EFRs) with post-traumatic stress disorder (PTSD). Introduction: Research indicates that rates of PTSD in EFRs are approximately double civilian rates; however, little is known about the resultant effects on their family members. This review identifies the qualitative literature and data examining the perceptions and experiences of families with a current or former EFR family member with diagnosed or undiagnosed PTSD. Inclusion criteria: This review included all relevant articles, books, reports, and doctoral theses in English, globally, with no time limits, examining the experiences of family members of current or former EFRs family with diagnosed or undiagnosed PTSD. All possible familial configurations and family members were considered, including nuclear, separated, and blended families, of an EFR. There were no age restrictions on EFRs or their family members, or limitations on recency of service. EFRs included police, ambulance/paramedics, firefighters, and rescue personnel. Methods: The databases searched included MEDLINE (PubMed), PsycINFO (Ovid), Embase, CINAHL (EBSCOhost), and Scopus. Hand-searching of relevant journals was conducted across Australian Paramedic, Australasian Journal of Paramedicine, British Paramedic Journal, International Paramedic Practice, Irish Journal of Paramedicine, Journal of Paramedic Practice, Prehospital and Disaster Medicine, and Prehospital Emergency Care. Sources of unpublished studies and gray literature, such as dissertations, were searched via PTSDpubs (ProQuest) and OpenGrey (DANS EASY Data Archive). The search was updated in October 2021. Titles, abstracts, and full texts were screened by 2 independent reviewers against the inclusion criteria, and any conflicting views were resolved by discussion. Results were critically appraised for methodological quality. Post–data extraction results were synthesized and evaluated for credibility and dependability in accordance with the a priori protocol. Results: The search yielded 1264 records and 48 were deemed eligible for full-text review. Seven studies were critically appraised, and 5 studies were agreed upon for inclusion in the synthesis. From these 5 studies, 53 findings were extracted with associated illustrations and synthesized into 9 categories. Following meta-aggregation, 4 broad synthesized findings were developed: i) Changed family member roles, spousal relationships difficulties, and family functioning when living with an EFR with PTSD; ii) Spouses of an EFR with PTSD may experience vicarious trauma, secondary trauma, and/or overburden as a consequence of protecting the family unit; iii) Children of an EFR parent with PTSD may experience secondary trauma, vicarious trauma, and/or separation anxiety; and iv) Spouses’ help-seeking and support needs for their EFR partners with PTSD, their children, and themselves. The first 3 findings received a low ConQual score due to low dependability and moderate credibility. The final finding received a moderate ConQual score due to low dependability and high credibility. Conclusions: The findings of the 5 qualitative studies included in the review showed significant mental health and functional impacts for family members of EFR with PTSD. Most studies focused on spouses, with some limited data on children. Two of the 5 studies focused on the 9/11 World Trade Center terrorist attacks in the United States. The findings also indicate the need for targeted psychological and social services for EFR family members. Recommendations derived from the synthesized findings of this review include the need for further qualitative research, not only to deepen the understanding about the impacts and needs of EFR with PTSD on family members, but also to inform the design and provision of support services. Systematic review registration number: PROSPERO CRD42020196605

How a systematic review of the experiences of emergency first responder family members living with post-traumatic stress disorder can inform new models of care

“…2 The findings encapsulate the available qualitative data from spouses and children, and highlight both the mental health and functional impacts, as well as their support needs. 2 The findings also inform a set of recommendations for policy, research, and practice for a proposed new model of care. 2 EFRs, often called public safety personnel, can refer to vocations such as police, ambulance/paramedics, firefighters, and rescue personnel.…”

“…2 The findings also inform a set of recommendations for policy, research, and practice for a proposed new model of care. 2 EFRs, often called public safety personnel, can refer to vocations such as police, ambulance/paramedics, firefighters, and rescue personnel. There is an established evidence base on the high rates of PTSD in service populations compared with civilian populations.…”

“…The second synthesized finding brings together the findings from 2 categories, 1 for EFR spouses’ experiences of vicarious trauma and 1 for the experiences of secondary trauma, including the experiences of overburden as a carer of an EFR with PTSD 2. The third synthesized finding encompasses 4 categories of extracted findings from the included studies on children’s experiences of vicarious trauma, secondary trauma, and/or separation anxiety 2. The final synthesized finding collates 2 categories of findings on spouses’ help-seeking for their EFR partner with PTSD, as well as for themselves and their children, via the EFR organization and other external agencies 2…”

“…A systematic review in this issue of JBI Evidence Synthesis focuses on the experiences and perceptions of EFR family members, and shines a light on this phenomenon and the ripple effect of trauma in EFR service families 2. The findings encapsulate the available qualitative data from spouses and children, and highlight both the mental health and functional impacts, as well as their support needs 2. The findings also inform a set of recommendations for policy, research, and practice for a proposed new model of care 2…”

“…Despite the small number of included studies, the dependability of the extracted findings was high, with plentiful illustrations of the participants’ voices to support each finding 2. Most of the data addressed the experiences and perceptions of the service members’ spouses, with limited data from their children 2. The spouse’s change of role in the family to carer of the EFR with PTSD was a predominate experience, which involved both overburden and protecting the family unit 2.…”