The effectiveness of psychological interventions for reducing PTSD and psychological distress in first responders: A systematic review and meta-analysis

Abstract

Background First responders are faced with stressful and traumatic events in their work that may affect their psychological health. The current review examined the effectiveness of psychological interventions to treat posttraumatic stress disorder (PTSD), anxiety, depression, stress and burnout in first responders. Methods Four databases were searched to identify controlled studies that examined the efficacy of psychological interventions to reduce PTSD symptoms (primary outcome) in first responders (including firefighters, police/law enforcement officers, search and rescue personnel, emergency and paramedics teams). Secondary outcomes were anxiety, depression, burnout, and stress. Results 15 studies were identified, including 10 studies that measured PTSD, 7 studies for anxiety, 10 studies for depression, 7 studies for stress and 1 for burnout. Interventions were associated with a significant reduction in PTSD (SDM = -0.86; 95% CI = -1.34 –- 0.39), depression (SDM = -0.63; 95% CI = -0.94 –-0.32), and anxiety (SDM = -0.38; 95% CI = -0.71 –-0.05) but not stress (SDM = -0.13; 95% CI = -0.51–0.25). CBT-based and clinician-delivered interventions were associated with significantly greater reductions in PTSD than other types of interventions and non-clinician interventions, but no differences were found for depression. There was evidence of moderate to high risk of bias across all studies. Conclusions Psychological interventions are effective in reducing PTSD, depression and anxiety symptoms but not stress in first responders. Further research is needed using high quality randomised designs over longer periods of follow-up.

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“…Recent literature has studied public safety personnel, especially emergency health workers, military personnel, firefighters, and law enforcement. Published literature has recorded a prevalence of any mental health condition from 6.4% to 57% for firefighters [9,10], 3.72% to 37.8% for military personnel [10][11][12], and 5.8% to 19.6% for police officers [9,13,14]. Prevalence is dynamic and these range of prevalence could be attributed to sample size, population, methodology, or time [10].…”

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“…Authors of a meta-analysis [ 33 ] of police stress reduction programs concluded that, “insufficient evidence exists to demonstrate the effectiveness of stress management interventions for reducing negative physiological, psychological or behavioral outcomes among police officers.” (p. 508). More recently, in a 2022 meta-analysis of behavioral health interventions [ 34 ], authors found collectively these interventions did not reduce stress across LEOs, firefighters, paramedics, and EMTs. Relatedly, LEOs face a number of barriers to seeking mental health services, including stigma and concerns regarding confidentiality, resulting in low use of these services [ 35 , 36 ].…”

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“…The re ghting community-including re ghters, paramedics, EMTs, and dispatch-have increased risk for traumatic exposure, but re service members are underrepresented in the traumatic stress literature [4,5,6,7,8,9]. In addition to high rates of PTSD, many may suffer from symptoms associated with PTSD without meeting full criteria for PTSD (i.e., partial or sub-threshold PTSD), highlighting the need to capture posttraumatic symptomatology in this population [10,11].…”