A systematic review of the usefulness of pre-employment and pre-duty screening in predicting mental health outcomes amongst emergency workers

Ruth E Marshall; Josie S Milligan-Saville; Philip B Mitchell; Richard A Bryant; Samuel B Harvey

doi:10.1016/j.psychres.2017.03.047

A systematic review of the usefulness of pre-employment and pre-duty screening in predicting mental health outcomes amongst emergency workers

Psychiatry Res. 2017 Jul:253:129-137. doi: 10.1016/j.psychres.2017.03.047. Epub 2017 Mar 30.

Authors

Ruth E Marshall¹, Josie S Milligan-Saville², Philip B Mitchell², Richard A Bryant³, Samuel B Harvey⁴

Affiliations

¹ School of Psychiatry, University of New South Wales, Sydney, Australia.
² School of Psychiatry, University of New South Wales, Sydney, Australia; Black Dog Institute, Sydney, Australia.
³ School of Psychology, University of New South Wales, Sydney, Australia.
⁴ School of Psychiatry, University of New South Wales, Sydney, Australia; Black Dog Institute, Sydney, Australia; St George Hospital, Sydney, Australia. Electronic address: s.harvey@unsw.edu.au.

PMID: 28365535
DOI: 10.1016/j.psychres.2017.03.047

Abstract

Despite a lack of proven efficacy, pre-employment or pre-duty screening, which alleges to test for vulnerability to PTSD and other mental health disorders, remains common amongst emergency services. This systematic review aimed to determine the usefulness of different factors in predicting mental disorder amongst emergency workers and to inform practice regarding screening procedures. Systematic searches were conducted in MEDLINE, PsycINFO and EMBASE to identify cohort studies linking pre-employment or pre-duty measures in first responders with later mental health outcomes. Possible predictors of poor mental health were grouped into six categories and their overall level of evidence was assessed. Twenty-one prospective cohort studies were identified. Dynamic measures including physiological responses to simulated trauma and maladaptive coping styles (e.g. negative self-appraisal) had stronger evidence as predictors of vulnerability in first responders than more traditional static factors (e.g. pre-existing psychopathology). Personality factors (e.g. trait anger) had moderate evidence for predictive power. Based on the evidence reviewed, however, we are unable to provide emergency services with specific information to enhance their current personnel selection. The results indicate that pre-duty screening protocols that include personality assessments and dynamic measures of physiological and psychological coping strategies may be able to identify some personnel at increased risk of mental health problems. However, further longitudinal research is required in order to provide meaningful guidance to employers on the overall utility of either pre-employment or pre-duty screening. In particular, research examining the sensitivity, specificity and positive predictive values of various screening measures is urgently needed.

Keywords: Health screening; Mental health; Post-traumatic stress disorder; Psychiatry; Psychology.

Publication types

Review
Systematic Review

MeSH terms

Adaptation, Physiological
Adaptation, Psychological
Emergency Responders / psychology*
Employment / psychology*
Humans
Mental Disorders / diagnosis
Mental Disorders / psychology*
Occupational Diseases / psychology*
Personality Assessment*
Prospective Studies
Risk Assessment / methods