Systematic review of first responder post-deployment or post-incident psychosocial interventions

Leona Tan; Katherine Petrie; Mark Deady; Richard A Bryant; Samuel B Harvey

doi:10.1093/occmed/kqab182

Systematic review of first responder post-deployment or post-incident psychosocial interventions

Occup Med (Lond). 2022 Apr 19;72(3):160-169. doi: 10.1093/occmed/kqab182.

Authors

Leona Tan^{1

2}, Katherine Petrie^{1

2}, Mark Deady¹, Richard A Bryant³, Samuel B Harvey¹

Affiliations

¹ Black Dog Institute, University of New South Wales, Randwick, NSW, Australia.
² School of Psychiatry, University of New South Wales, UNSW Sydney, Kensington, NSW, Australia.
³ School of Psychology, University of New South Wales, UNSW Sydney, Kensington, NSW, Australia.

PMID: 35020931
DOI: 10.1093/occmed/kqab182

Abstract

Background: First responder populations, such as emergency services and the military, report elevated levels of mental health problems. Although post-deployment or post-incident psychosocial support interventions are widely implemented within these services, its effectiveness in preventing the development of mental disorders is unclear.

Aims: To systematically assess which, if any, post-deployment or post-incident psychosocial interventions are effective at preventing the development of post-traumatic stress disorder (PTSD) and common mental disorders (CMD) amongst military and emergency service worker (ESW) settings.

Methods: A systematic review was conducted by searching four databases for any randomized controlled trials (RCTs) or controlled trials of post-deployment or post-incident interventions. The primary outcomes assessed were differences in symptoms of PTSD and CMD. Study quality was examined using the Downs and Black checklist. Pooled effect sizes and 95% CI were calculated using random-effects modelling for main meta-analyses, planned subgroup and sensitivity analyses.

Results: From 317 articles, seven RCTs were included in the final meta-analysis. Interventions identified included psychological debriefing, screening, stress education, team-based skills training and a peer-delivered risk assessment. A very small but significant effect was found for team-based skills training in reducing CMD symptoms. Some evidence was also found for team cohesion training in reducing both PTSD and CMD.

Conclusions: Limited evidence was found for post-deployment or post-incident psychosocial interventions within military and ESW populations. More high-quality studies, particularly among ESW settings, are urgently needed to determine how to better prevent the development of trauma related disorders after exposure.

Keywords: Emergency service worker; PTSD; mental disorder; military; occupational health; trauma.

Publication types

Meta-Analysis
Systematic Review

MeSH terms

Emergency Responders*
Humans
Military Personnel*
Psychosocial Intervention
Stress Disorders, Post-Traumatic* / prevention & control