Advancing workplace mental health prevention is paramount, yet to date there are no effective, evidence-based strategies that can be widely recommended for prevention of occupational trauma-related symptoms. Because the conceptual framework of prevention following potentially psychologically traumatic exposure (PPTE) is to intervene prior to the development or worsening of trauma-related symptoms, an index of successful prevention is to observe no change or minimal change in baseline symptom levels. Considering common pitfalls of statistically interpreting an absence of change, in this review, we address the widespread problem of null findings in prevention science and discuss theoretical and analytical concepts to advance the quality and strength of inferences that can be drawn from statistical analysis in quantitative prevention science. Public safety personnel (PSP) comprise a unique set of occupational groups where frequent exposure to PPTEs is an inherent occupational hazard. Correspondingly, PSP demonstrate elevated prevalence rates of trauma-related disorders including PTSD, depression, anxiety, sleep problems, and substance use, and development of effective, evidence-based prevention is urgently needed. Using insights from research with PSP samples as a case study, we summarize current limitations constraining occupation-related prevention science and offer an overview of research design and analytical strategies to promote the development and testing of rigorous and effective prevention strategies to support occupational mental health.

Purpose Law enforcement personnel are often exposed to critical incidents and are at risk of post-traumatic psychopathologies. The purpose of this systematic review is to synthesize and evaluate recent empirical research about primary and secondary prevention strategies designed to reduce the risk of law enforcement officers developing post-traumatic disorders. Design/methodology/approach The study used a systematic review approach guided by the Institute of Medicine’s Standards for Systematic Reviews and Preferred Reporting Items for Systematic Reviews and Meta-Analyses. Findings In total, 13 articles were deemed relevant to the question of evidence for prevention programs intended to reduce the development of post-traumatic psychopathologies in law enforcement officers. Our review found these indicated a lack of evidence for the efficacy of prevention programs. Seven of the articles included in this review focused on Critical Incident Stress Debriefing (CISD), providing no evidence to support CISD as a secondary prevention strategy for law enforcement officers. The remaining six studies focused on diverse prevention approaches including resilience training, imagery and psychosocial support, with limited evidence available. Originality/value Interestingly, despite a plethora of literature in this area, our review indicates a lack of high-quality studies investigating effective prevention approaches for law enforcement personnel. Given the potentially significant impact of post-traumatic stress disorder and other conditions associated with work-related trauma for law enforcement organizations, there is a clear need to undertake high-quality research into preventative measures in this area.

Wildland fire is increasingly a consequence of the climate crisis, with growing impacts on communities and individuals. Wildland firefighters are critical to the successful management of wildland fire, yet very limited research has considered mental health in this population. Although a wealth of research in mental health risk and associated risk and protective factors exists for structural firefighters, unique demands of wildland firefighting such as the seasonal nature of work, the length and intensity of shifts, and the often geographically isolated working conditions, among other factors, require special consideration. The present review considers available literature on mental health in wildland firefighters, highlighting the importance of distinguishing occupation-related risks for firefighters from occupation-specific risks of wildland fire service work, and offers concrete evidence-based recommendations for future work in this high-priority research area.

Prevalence of mental health conditions such as depression and anxiety are known to vary widely in studies of public safety personnel (PSP), limiting reliable characterization of prevalence and risk/protective factors. Some of this variability likely arises from researchers' methodological choices (e.g., screening criteria). Delineating methodological variability from true individual and organizational variability in risk is critical to characterize prevalence and inform intervention. The present systematic review and metaregression examined methodological sources of variability in the prevalence of probable depression and anxiety in PSP using an international data set. The pooled global prevalence of probable depression across 78 studies was 10.3% [5.7%, 19.8%], adjusting for random effects of geographical region of study and measurement tool selection. Metaregression revealed that recruitment and screening factors such as type of potentially traumatic exposure (routine/disaster) and level of exposure of study sample (any exposure level/all trauma-exposed) were significantly associated with prevalence outcomes. Occupational group was also significantly associated with depression prevalence. The pooled global prevalence of probable anxiety in PSP across 37 studies was 10% [6.7%, 14.4%]. Preliminary bivariate metaregression analyses demonstrated similar associations with methodological recruitment/screening factors and occupational group. Converging evidence suggests that researchers' choices regarding participant recruitment and screening, alongside the selection of specific measurement tools to assess symptoms, contribute significantly to observed prevalence outcomes. Recommendations for future work, including suggestions for contextualizing methodological choices to enhance within-study reliability and validity, are discussed.

Firefighters demonstrate high rates of posttraumatic stress disorder, depression, and anxiety, but inconsistency in risk and protective factors across studies limits the development of effective occupational health promotion strategies. Psychological network modelling is an emerging statistical technique that facilitates exploratory analysis to help identify influential factors when accounting for numerous variables without strong a priori expectations. The present cross-sectional survey study evaluated the psychological network structure of commonly studied individual and organizational correlates of posttraumatic stress disorder, depression, and anxiety in Canadian firefighters to identify influential factors in occupational mental health. We provide a proof-of-principle demonstration of how psychological network modelling can be used to integrate theory and practice by generating insights and hypotheses to facilitate the design and testing of novel workplace interventions. The network model demonstrated good stability. Accounting for individual and organizational factors together with mental health outcomes, symptoms of intrusion and depression, alongside nontraumatic job stress, emerged as the most central nodes in the network. Hostility and coping self-efficacy were the most important individual-level nodes associated with mental health outcomes, while personality, empathy, years of service, physical job demands, and workplace social support were of low importance for understanding the overall landscape of mental health in firefighters. These results begin to highlight the potential for network theory to inform the design of evidence-based interventions spanning mental health and organizational climate. Concrete suggestions for testable intervention designs in the Canadian context are provided.

BACKGROUND:It is well documented that public safety personnel are exposed to potentially traumatic events (PTEs) at elevated frequency and demonstrate higher prevalence of trauma-related symptoms compared to the general population. Lesser studied to date are the organizational consequences of workplace PTE exposure and associated mental health outcomes such as acute/posttraumatic stress disorder (ASD/PTSD), depression, and anxiety. METHODS:The present review synthesizes international literature on work outcomes in public safety personnel (PSP) to explore whether and how PTE and trauma-related symptoms relate to workplace outcomes. A total of N = 55 eligible articles examining PTE or trauma-related symptoms in relation to work outcomes were systematically reviewed using best-evidence narrative synthesis. RESULTS:Three primary work outcomes emerged across the literature: absenteeism, productivity/performance, and costs to organization. Across n = 21 studies of absenteeism, there was strong evidence that PTE or trauma-related symptoms are associated with increased sickness absence. N = 27 studies on productivity/performance demonstrated overall strong evidence of negative impacts in the workplace. N = 7 studies on cost to organizations demonstrated weak evidence that PTE exposure or trauma-related mental health outcomes are associated with increased cost to organization. CONCLUSIONS:Based on available evidence, the experience of workplace PTE or trauma-related symptoms is associated with negative impact on PSP occupational functioning, though important potential confounds (e.g., organizational strain and individual risk factors) remain to be more extensively investigated.

External program review is often considered the “gold standard” approach to evaluating academic programs in higher education. Despite the importance of program review, skepticism persists regarding its ability to meaningfully engage faculty and have sustaining impact on program improvement. This paper builds on the academic Program Review Learning Community conceptual model and presents a process for applying a project management facilitation technique that leverages a course structure. The Program Review Course allows for multiple programs to be reviewed concurrently as part of an interdisciplinary cohort. Within the cohort, faculty teams gain access to templates, information sessions, workshops, and discussion forums, with opportunities for engagement both within and across multiple disciplines. Using learning modules, this approach is designed to create efficiency and collaboration in delivering program review tools and customized supports. Utilizing a course structure for program review fits well with a new way to think about program review because successful learning communities are often embedded within institutional structures. Use of this approach is expected to increase clarity and consistency, improve administrative feasibility, provide guidance for those new to program review, promote collegiality within and across programs, and involve team members in the creation of action planning. The authors propose that a course-based approach for conducting program review, with teams of disciplinary faculty joining an interdisciplinary cohort and supported by quality assurance practitioners and educational developers is a novel way to provide structure and academic development while meeting legislative requirements.

Public safety personnel (PSP) are known to experience difficult and demanding occupational environments, an environment that has been complicated by the COVID-19 pandemic. Firefighters, paramedics, and public safety communicators were among the front-line workers that continued to serve the public throughout the course of the pandemic. The present study considered the potential impacts of the COVID-19 pandemic on self-reported symptoms of mental health challenges in Canadian firefighters, paramedics, and public safety communicators. Participants were firefighters (n = 123), paramedics (n = 246), and public safety communicators (n = 48), who completed an online survey, including demographics, questions related to COVID-19 exposure and worry, the Patient Health Questionnaire-9, the Generalized Anxiety Disorder-7, the Social Interaction Phobia Scale, and the Posttraumatic Stress Disorder Checklist-5. Results revealed that risk factors for increased mental health symptom reporting were paramedic occupation, self-identified female, younger in age, COVID-19 personal contact, requirement to self-isolate, and self-perception of COVID-19 contraction (without confirmation through testing). The COVID-19 pandemic should be considered a risk factor for increased mental health symptom reporting in PSP.

The present project contributes to the literature on firefighters and spousal relationships through consideration of life satisfaction, marital satisfaction, and couple conflict for a sample of Canadian firefighters. Thirty four firefighter/spouse dyads completed measures of satisfaction, mental health, and conflict. Our results showed that firefighters self-reported more hostility than their spouses, but that there was no significant difference between firefighters and spouses with respect to life of marital satisfaction. Firefighters and spouses also differed in expression of dissatisfaction, in that firefighters were more likely to express dissatisfaction through physical or indirect expressions of aggression, and spouses were more likely to express dissatisfaction through anger. Understanding alternative presentations of dissatisfaction may be helpful to both the spousal couple, in terms of understanding one another, and also in therapeutic relationships where emotional expression may be interpreted.

BACKGROUND Although numerous studies have reported on PTSD prevalence in high-risk occupational samples, previous meta-analytic work has been severely limited by the extreme variability in prevalence outcomes. METHODS The present systematic review and meta-regression examined methodological sources of variability in PTSD outcomes across the literature on high-risk personnel with a specific focus on measurement tool selection. RESULTS The pooled global prevalence of PTSD in high-risk personnel was 12.1% [6.5%, 23.5%], and was similar to estimates obtained in other meta-analytic work. However, meta-regression revealed that PTSD prevalence differed significantly as a function of measurement tool selection, study inclusion criteria related to previous traumatic exposure, sample size, and study quality. PTSD prevalence estimates also differed significantly by occupational group and over time, as has also been reported in previous work, though exploratory examination of trends in measurement selection across these factors suggests that measurement strategy may partially explain some of these previously reported differences. CONCLUSIONS Our results highlight a pressing need to better understand the role of measurement strategies and other methodological choices in characterizing variable prevalence outcomes. Understanding the role of methodological variance will be critical for work attempting to reliably characterize prevalence as well as risk and protective factors for PTSD.

The present project was intended to provide an initial exploratory investigation into the relationship between hostility and world assumptions for a firefighting sample. Specifically, we hypothesized that increased hostility would be associated with more negative assumptions with respect to world benevolence, world justness, and self-worth, and that these variables would also be related to years of service and self-reported mental health. The current study was part of a larger study with firefighters from British Columbia, Canada, and included 186 paid-professional firefighters who completed a series of questionnaires. We demonstrated that, for our firefighting sample, hostility was related to both world benevolence and self-worth across multiple measures, even while controlling for the individual characteristic neuroticism. We did not find any significant relationship with years of service, but world benevolence and self-worth were also important in the prediction of mental health outcomes. These findings may have clinical or occupational intervention implications in therapeutic relationships with firefighters, in that the present project demonstrated a first indication that reduced hostility in combination with increased positivity in world assumptions may help achieve good mental health.

Previous research has suggested that high levels of hostility may result in negative outcomes such as aggression or disengagement and that this impact may be exasperated by the workplace environment. The current study contributes to knowledge regarding firefighters and the fire service work environment. Our purpose was to investigate relationships between work state, psychological well-being, general satisfaction and hostility for firefighters. Data analyses involved structural equation modeling and results indicated that positive work state is negatively related to satisfaction and positively related to psychological symptomatology. In particular, the present results suggest that positive working environment has significant impacts on many domains of firefighter life; consequently, creating a positive working environment should be considered a key area of intervention in assisting toward overall well-being for firefighters.

Background: Professionals working in the emergency department (ED) are regularly exposed to traumatic events. Rates of posttraumatic mental health conditions vary widely in the literature and there is no agreement that rates in ED staff are elevated relative to other populations. Objective: We conducted a systematic review of international literature reporting prevalence of posttraumatic stress disorder (PTSD), depression, and anxiety in ED personnel to determine whether prevalence is elevated compared to the general community, and to evaluate convergent evidence across the literature for predictive factors. To our knowledge, there is no comprehensive review on this topic in the literature at this time. Methods: Seven databases were searched for studies reporting rates of PTSD, depression, and anxiety in ED personnel. Two independent researchers screened studies and assessed quality using Munn's Prevalence Critical Appraisal Instrument. Best-evidence synthesis determined whether conditions demonstrated elevated prevalence compared to the general population of Canada, a conservative benchmark. Results: Twenty-four studies from 12 countries and a combined sample size of 4768 were included. PTSD rates ranged from 0% to 23.6% (mean 10.47%), depression ranged from 0.7% to 77.1% (mean 24.8%), and anxiety rates ranged from 2.4% to 14.6% (mean 9.29%). Each condition was elevated compared to the general population. Sociodemographic variables were not consistent predictors. Elevated PTSD seemed most strongly related to workplace exposure and maladaptive coping. Conclusions: ED professionals have an elevated risk of experiencing PTSD, depression, and anxiety. Identification of organizational and workplace predictors are needed to inform interventions that will reduce risk and provide optimal treatment and management of PTSD, depression, and anxiety in ED settings. (C) 2021 Elsevier Inc. All rights reserved.

PurposeHigher education institutions are required to evaluate program quality through cyclical program review processes. Despite often being considered the “gold standard” of academic review, there persists dissatisfaction with the lack of integration of program review findings into other planning processes, such as budgeting, assessment and strategic planning. As a result, the notion of program review action plans “collecting dust on the shelf” is so ubiquitous that the concept is normalized as an expected outcome. The purpose of this paper is to describe a conceptual model whereby teams of faculty members receive education and training from quality assurance practitioners and educational developers, access to institutional resources, opportunities for cross-departmental collaborations and collective advocacy to increase the capacity of faculty members to implement improvement goals resulting from program reviews.Design/methodology/approachThe authors theorize that a professional learning community is a meaningful approach to program review and present a conceptual model – the Academic Program Review Learning Community (PRLC) – as an antidote to hierarchical, fragmented, compliance-oriented processes. The authors suggest that the PRLC offers a reliable institutional framework for learning through formalized structures and nested support services, including peer learning and external coaching, which can enhance the catalytic capacity of reviews.FindingsThe authors argue that postsecondary institutions should create formal structures for incorporating learning communities because, without a reliable infrastructure for collective learning, decision-making may be fragmented oridiosyncratic because of shifting demands, priorities or disconnected faculty.Originality/valueA learning community model for program review fits well with a new way to think about program review because faculty are most engaged when they feel ownership over the process. Furthermore, few models exist for conducting program review; as a result, chairs and academics often struggle to conduct reviews without a coherent framework to draw upon.

Cesarean section is the most common surgical procedure performed on women of reproductive age [1]. Occasionally, the hysterotomy incision's healing leaves areas of myometrial loss of continuity creating pouchlike defects known as isthmocele. Such defects function as reservoir collecting menstrual blood generating postmenstrual spotting, pelvic pain, dyspareunia, and secondary infertility among other symptoms [2]. Saline infusion sonogram is an effective imaging modality [3]. Both surgical and nonsurgical options have been recommended for the treatment of patients with symptomatic isthmocele [4].

In addition to high-risk and high-stress events that police officers routinely encounter, many are also exposed to extreme traumatic exposures or disasters caused by nature (eg. Hurricanes) and human action (e.g., terrorist attacks or plane crashes). These exposures can result in a variety of adverse reactions including post-traumatic stress disorder (PTSD), acute stress disorder, major depressive disorder and anxiety disorders. Understanding and accurately measuring the burden of disease arising from involvement in extreme events, on policing organizations and individual police officers is critical for policy makers and those who plan and deliver services. This systematic review synthesizes existing research on large-scale disasters, in order to further our understanding of how extreme events impact the mental health of police officers. The results found variability in the reported rates of mental disorder; however, there are some clear trends. Overall, the rates of PTSD among police officers that are consistently lower than those of civilians affected by the same disaster, and are lower than other occupations. This undoubtedly speaks to the resilience and training of members of policing organizations that prepare them for this work. Studies also demonstrate that reported distress in terms of acute stress disorder, anxiety and depression, continues to rise in some groups as time-elapsed from the event lengthens; suggesting a need to ensure that mental health supports are provided at later stages after the event.

Objective Public transportation workers are exposed to higher levels of stress related to accidents, injuries, and person-under-train events when compared to other workers. This systematic review integrates the existing literature on mental health among high-risk public transportation workers to estimate the prevalence of post-traumatic stress disorder (PTSD), major depressive and anxiety symptoms following critical incidents while on duty. Methods This systematic review is part of a larger systematic review which examines mental health and work outcomes of individuals working in professions at high risk of critical incident exposure, i.e., high-risk professions. Articles were included if they measured the prevalence of PTSD, Major Depressive Disorder (MDD) and Anxiety Disorder (AD) in a transportation population following exposure to a major incident, for example, a person-under-a-train. Results Among the ten articles, all reported prevalence of PTSD which ranged from 0.73 to 29.9%. Four articles reported prevalence of depression among transportation workers exposed to a critical incident and prevalence outcomes ranged from 0.05 to 16.3%. Only two reported prevalence of anxiety from 1.3 to 13.9%. Conclusions This literature reports that transportation workers are prone to involvement in traumatic accidents leading to higher rates of PTSD compared to the general population. Strategies to reduce transportation accidents and to provide transportation workers follow-up mental health support is needed for this vulnerable population.