Interventions for the prevention and management of occupational stress injury in first responders: a rapid overview of reviews

Abstract

Background: First responders are a high-risk population for occupational stress injuries as they often encounter prolonged stress within their line of work. The aim of this rapid overview of reviews is to summarize existing evidence on interventions for the prevention and management of occupational stress injury (OSI) in first responders. Methods: MEDLINE, EMBASE, PsycINFO, CINAHL, Web of Science, and Cochrane Library were searched for systematic reviews examining the impact of prevention, rehabilitation, and resilience-building strategies targeting frontline community safety personnel in February 2019. Pairs of reviewers screened titles and abstracts followed by full-text articles and conducted data abstraction and quality appraisal using the AMSTAR II tool. To ensure a rapid overview process, the search strategy was limited to the last 10 years, quality appraisal of reviews and abstraction of study-level data was completed by one person and verified by another, and the quality of the individual primary studies was not appraised. The findings were summarized descriptively. Results: A total of 14 reviews with 47 unique primary studies were found after screening 1393 records. A majority of studies targeted OSI in police officers (78.7%), followed by firefighters (17%) and correctional officers (4.3%). Of the 47 included primary studies, 24 targeted prevention of OSI (i.e., resilience training, stress management, suicide prevention, and other health promotions) and 23 targeted rehabilitation (i.e., drug therapy, psychotherapy, and other therapies). Prevention strategies including resilience training programs had positive outcomes, while suicide prevention and psychotherapy interventions reported mixed results.

The role of organizational supports in mitigating mental ill health in firefighters: A cohort study in Alberta, Canada

“…The need for evaluative studies of post‐disaster mental health interventions has been well documented, 3 and the difficulties in their design thoughtfully described 4,5 . Two systematic reviews, 6,7 including evidence from small randomized trials, 8–10 concluded that primary prevention strategies had some impact but that the effect of post‐event interventions was uncertain. Early attempts focused on post‐incident debriefing and early psychological interventions, which were found not to be useful in the secondary prevention of posttraumatic stress disorder (PTSD) 11,12 …”

A cluster RCT to improve workplace mental health in a policing context: Findings of a mixed‐methods implementation evaluation

“…While greater attention to operational stressors in police work is understandable given their dramatic nature and undeniable adverse impacts, there has been a relative neglect of organizational stressors in research, policy, and practice. In conclusion, we would argue that despite the challenges of getting police departments and their funders (in the context of this study, the state government) to earnestly address organizational stressors, this remains an essential priority for workplace mental health in policing contexts and deserves on‐going attention in research, policy, and practice 1,11 …”

“…A wide range of stress reduction interventions have been implemented and evaluated in policing/law enforcement contexts, as summarized in a recent umbrella review of interventions for the prevention and management of occupational stress injury in the first responders 11 . This review focused on mental health outcomes and detailed findings from 47 primary studies, categorized into prevention (24 primary studies, 21/24 in police settings) and rehabilitation interventions (23 primary studies, 16/23 in police settings).…”

“…This may partly be explained by the fact that policing interactions with the public tend to be very stressful, involving conflict, trauma, and violence, and these exposures are not—for the most part—directly under the control of police departments or organizations. Hence most “preventive” interventions in policing have tended to be symptom‐, health behavior‐, or illness‐directed (secondary‐ or tertiary‐level intervention) 11 . But there is growing recognition that generic or universal job stressors contribute as much to the burden of mental illness among police as operational stressors.…”

“…Accordingly, while acknowledging that all levels of intervention are needed (primary, secondary, and tertiary 12 ), there is a relative neglect of primary prevention to reduce job stressor exposures in the policing context, and efforts should be made to address this study, policy, and practice gap. In addition, there is a dearth of experimental studies with high causal inference in the evidence base to date, thus more trial‐based evidence is needed 1,11 …”