Proactive psychological programs designed to mitigate posttraumatic stress injuries among at-risk workers: a systematic review and meta-analysis

Abstract

Background Public safety personnel and frontline healthcare professionals are at increased risk of exposure to potentially psychologically traumatic events (PPTE) and developing posttraumatic stress injuries (PTSI, e.g., depression, anxiety) by the nature of their work. PTSI are also linked to increased absenteeism, suicidality, and performance decrements, which compromise occupational and public health and safety in trauma-exposed workers. Evidence is lacking regarding the effectiveness of “prevention” programs designed to mitigate PTSI proactively. The purpose of this review is to measure the effectiveness of proactive PTSI mitigation programs among occupational groups exposed to PPTE on measures of PTSI symptoms, absenteeism, and psychological wellness. Methods Five electronic databases were searched per PRISMA guidelines for English or French peer-reviewed studies from 2008 to 2019 evaluating PTSI and psychological wellness in adults exposed to occupational PPTE. The risk of bias was assessed using the Newcastle-Ottawa Scale. Results We identified 42 studies evaluating 3182 public safety and frontline healthcare professionals, PPTE-exposed educational staff, and miners. Significant overlap was found across program themes that included mindfulness, psychoeducation, resilience promotion, and stress management strategies. Post-program effect sizes were small (SMD < 0.5) to moderate (SMD < 0.8) for reductions in PTSI symptoms and for promoting measures of well-being as indicated by a meta-analysis on 36 studies. There was no evidence for significant reductions in substance use, absenteeism, or biomarkers of distress except for heart rate. Subgroup analyses indicated that multimodal programs effectively improved general psychological health, while resilience programs improved measures of depression, burnout, coping, and resilience. Effect sizes for resilience, depression, and general psychological health improvements were greatest immediately or 1-month post-training, while improvements in PTSD symptoms and coping were larger at longer follow-up. Studies were of moderate quality and risk of bias. Conclusions The current results showcase modest evidence for time-limited reductions in PTSI following participation in holistic programs that promote resilience, stress, and emotion regulation among at-risk workers. Implications for organizational implementation of proactive PTSI mitigation programs and areas of future research are discussed. Systematic review registration PROSPERO (CRD42019133534)

A Qualitative Analysis of the Mental Health Training and Educational Needs of Firefighters, Paramedics, and Public Safety Communicators in Canada

“…This focus has also increased the demand for interventions designed to strengthen resilience [ 15 , 16 , 17 ]. While hundreds of interventions designed to protect PSPs’ mental health are available, research evidence regarding intervention effectiveness remains sparse [ 18 , 19 ]. The aim of this qualitative study was to increase the understanding of what topics PSP would like to learn about in psychoeducational training, what delivery methods of this education are preferred, and who in PSP organizations are in most need of receiving workplace mental health training.…”

Testing the Efficacy of a 1-Day Police Decision-Making and Autonomic Modulation Intervention: A Quasi-Random Pragmatic Controlled Trial

“…(27%) of officer's did not recover (i.e., return to resting baseline) during the observation period, indicating a significant need for stress modulation skills. Despite calls for reform to police UOF training and education practices (Iacobucci, 2014;Dubé, 2016;Huey, 2018;Bennell et al, 2021;CCJ, 2021) and growing need for effective occupational health interventions (Weiss, 2019;Anderson et al, 2020;Di Nota et al, 2021), the current findings demonstrate that utilizing abbreviated training to save costs is not effective for rewiring core physiological and cognitive processes aimed at modulating stress responses to reduce UOF errors.…”

“…Accordingly, the current study also addressed an urgent need to identify effective organizational programming that supports resilience and wellness capacity in public safety professionals (Beshai and Carleton, 2016;Weiss, 2019). Existing organizational training programs that aim to build resilience and mitigate the onset of PTSIs following PPTEs showed limited effectiveness, but with promising results for protocols integrating HRVBF including iPREP (Di Nota et al, 2021). A recent paper by expert police researchers and practitioners posits that training police officers to recognize and modify internal physiology during stressful encounters is one of the most urgent training approaches to address lethal force errors and promote physiological resilience (Bennell et al, 2021).…”

“…At the time the current study was conceptualized and delivered (2015)(2016)(2017), there was a strong organizational demand to reduce the duration of police training and skills-based practice based on an increasing number of government-mandated certification and policy initiatives. Subsequently, systematic reviews of 1-day organizational training protocols among first responders have shown limited improvements to resilience that are not sustained (Di Nota et al, 2021).…”

“…Numerous types of organizational training programs and interventions have been developed with the goal of reducing the impact of occupational stressors on operational performance and psychological functioning. However, empirical evaluations of these programs reveal limited effectiveness and significant practical challenges to implementing and evaluating training programs within organizational contexts (Beshai and Carleton, 2016;Di Nota and Huhta, 2019;Anderson et al, 2020;Di Nota et al, 2021). One effective approach that promotes both performance and health includes training police officers' awareness and adaptive management of internal physiological responses to stress (Bennell et al, 2021).…”