Peer Support and Crisis-Focused Psychological Interventions Designed to Mitigate Post-Traumatic Stress Injuries among Public Safety and Frontline Healthcare Personnel: A Systematic Review

Abstract

Public safety personnel (PSP) and frontline healthcare professionals (FHP) are frequently exposed to potentially psychologically traumatic events (PPTEs), and report increased rates of post-traumatic stress injuries (PTSIs). Despite widespread implementation and repeated calls for research, effectiveness evidence for organizational post-exposure PTSI mitigation services remains lacking. The current systematic review synthesized and appraised recent (2008–December 2019) empirical research from 22 electronic databases following a population–intervention–comparison–outcome framework. Eligible studies investigated the effectiveness of organizational peer support and crisis-focused psychological interventions designed to mitigate PTSIs among PSP, FHP, and other PPTE-exposed workers. The review included 14 eligible studies (n = 18,849 participants) that were synthesized with qualitative narrative analyses. The absence of pre–post-evaluations and the use of inconsistent outcome measures precluded quantitative meta-analysis. Thematic services included diverse programming for critical incident stress debriefing, critical incident stress management, peer support, psychological first aid, and trauma risk management. Designs included randomized control trials, retrospective cohort studies, and cross-sectional studies. Outcome measures included PPTE impacts, absenteeism, substance use, suicide rates, psychiatric symptoms, risk assessments, stigma, and global assessments of functioning. Quality assessment indicated limited strength of evidence and failures to control for pre-existing PTSIs, which would significantly bias program effectiveness evaluations for reducing PTSIs post-PPTE.

Why Are Workplace Social Support Programs Not Improving the Mental Health of Canadian Correctional Officers? An Examination of the Theoretical Concepts Underpinning Support

“…The authors also determined that there are no validated mental health interventions being implemented in this population and workplaces typically do not evaluate their programing using accepted methods, therefore, evidence for effectiveness of individual and interpersonal mental health programming is lacking [ 13 ]. This finding is supported by a recent systematic review focused on peer support and crisis-focused interventions implemented among PSP and healthcare personnel [ 14 ]. The authors found that the majority of the studies included in their review did not conduct pre-post evaluations and used inconsistent outcome measures which resulted in poor quality of evidence of the effectiveness of such interventions [ 14 ].…”

“…This finding is supported by a recent systematic review focused on peer support and crisis-focused interventions implemented among PSP and healthcare personnel [ 14 ]. The authors found that the majority of the studies included in their review did not conduct pre-post evaluations and used inconsistent outcome measures which resulted in poor quality of evidence of the effectiveness of such interventions [ 14 ].…”

“…As a response to high demand and low job control with frequent exposure to violence, aggression, and traumatic experiences, increasing the social support offered to correctional officers has become one of the primary preventative methods used in an attempt to decrease the incidence of occupational stress injuries [ 13 ]. Workplace support interventions such as peer-support programs, critical incident debriefs, and mentorship training programs have been implemented to fill this need [ 13 , 14 ].…”

“…Based on the current offerings of programs, the authors surveyed 134 workplace personnel with knowledge about peer support programs and found that 31% of them agreed that running the program resulted in an increased workload for peer supporters and that the stigma associated with mental health often prevented participation in the program [ 6 ]. A recent study that examined the availability and perceived use of mental health supports among PSP and found, although most PSP had access to professional, non-professional (e.g., Employee Family Assistance Programs), and peer support, many would only access professional or organizational support as a last resort, instead preferring to access support from a spouse or friend [ 14 ]. This suggests that PSP still perceived workplace stigma related to mental health and may be unwilling to seek support from peers and leaders even if that support is available.…”

“…Given the range of operational stressors and their link to an increased risk of adverse mental health outcomes, organizational programs have been developed to provide correctional officers with supports aimed at promoting mental well-being and providing mental health interventions that incorporate recovery and reduction of relapse risk [ 11 , 12 , 13 ]. However, research has shown minimal support for the effectiveness of such individualistic workplace mental health programs [ 13 , 14 ]. A recent international scoping review that examined prevention and early intervention programs for veterans and first responders (including correctional officers) found that the mental health interventions that have been implemented typically focus on building individual-level resilience and interpersonal support programs [ 13 ].…”