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.

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.

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.

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.

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.

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.

Purpose The purpose of this systematic review is to evaluate the extant literature on depression and anxiety disorders in police using a multinational data set to determine whether the prevalence of these trauma-related disorders (TRMDs) is elevated in comparison to the general population. Design/methodology/approach Systematic review was employed in combination with best-evidence narrative synthesis to evaluate these hypotheses. Findings Despite wide variability in prevalence outcomes across the literature, strong evidence supports the hypothesis that the prevalence of depression is elevated in police, whereas moderate evidence supports the same hypothesis regarding anxiety. Preliminary evaluation of commonly examined predictive factors for each disorder demonstrated weak and inconsistent associations between these TRMDs and sociodemographic factors. No studies evaluated the relationship between incident-related factors (e.g. severity or frequency of exposure) and TRMDs, thus, at present, the literature on police is almost entirely unable to address the question of whether the prevalence of these disorders in police is influenced by exposure to work-related trauma. Research limitations/implications The findings highlight a critical need for future work to address incident-related factors in predicting symptoms of depression and anxiety in police samples to determine whether these disorders bear a unique relationship to work-related traumatic exposure. Such work will significantly benefit the design and implementation of successful prevention and intervention strategies in the workplace. Originality/value The present review provides a comprehensive synthesis of a highly variable literature, highlighting critical gaps in our current knowledge of TRMDs in police and suggesting numerous avenues for future study.

We conducted a systematic review of the empirical literature examining the effectiveness of psychological interventions for post-traumatic symptomatology in police, firefighters, and paramedic personnel. The review process was guided by the PRISMA statement (Moher et al. [2009]. Preferred reporting items for systematic reviews and meta-analyses: The PRISMA statement. PLoS Medicine, 6(7), e1000097. https://doi.org/10.1371/journal.pmed.1000097) and Institute of Medicine's Standards for Systematic Reviews (IOM [2011]. Finding what works in health care: Standards for systematic reviews. ). An inter-disciplinary, multi-national research team with expertise in mental health trauma and occupational stress in high risk professions was engaged at each stage of the review. Two team members rated each study in terms of quality and contribution to the research question. Twenty-one studies were identified: 9 case studies, 2 single-group studies, 8 randomised controlled trials, and 2 studies examining work leave. Most of the studies were limited by small sample sizes and absence of active control conditions. Research limitations reduce the ability to draw definitive best practices recommendations; however, the increase in randomised controlled trials provides encouraging signs that trauma-focused psychotherapies can be effective for first responders.

BACKGROUND:The prevalence of PTSD in police officers has been the subject of a large and highly variable empirical literature. The present systematic review evaluates the extant literature on PTSD in police officers using an international dataset.METHODS:We employed best-evidence narrative synthesis to evaluate whether PTSD prevalence in police is elevated in comparison to the general population of Canada (8%), which itself has a higher lifetime PTSD prevalence than many other regions and thus serves as a conservative standard of comparison.RESULTS:PTSD prevalence in police varied considerably across studies from 0% - 44% (M = 14.87%, Median = 9.2%). Despite this variability, strong evidence exists to suggest PTSD prevalence is elevated in police officers. Examination of possible sources of variability in prevalence outcomes highlighted substantial variability in outcomes due to the selection of measurement tool for assessing PTSD (e.g., DSM vs. IES). Examination of commonly-assessed predictive factors for PTSD risk across the literature showed that individual-difference factors (e.g., age, years of service) bear weak-to-nonexistent relationships with PTSD risk, while incident-specific factors (e.g., severity of exposure) are more strongly and consistently associated with PTSD prevalence. Organizational factors (e.g., low support from supervisor) are at present understudied but important possible contributors to PTSD risk.CONCLUSIONS:PTSD prevalence is elevated in police officers and appears most strongly related to workplace exposure. Measurement variability remains a critical source of inconsistencies across the literature with drastic implications for accurate detection of officers in need of mental health intervention.

Firefighting service is known to involve high rates of exposure to potentially traumatic situations, and research on mental health in firefighting populations is of critical importance in understanding the impact of occupational exposure. To date, the literature concerning prevalence of trauma-related mental disorders such as posttraumatic stress disorder (PTSD) has not distinguished between symptomology associated routine duty-related exposure and exposure to large-scale disaster. The present systematic review synthesizes a heterogeneous cross-national literature on large-scale disaster exposure in firefighters and provides support for the hypothesis that the prevalence of PTSD, major depressive disorder, and anxiety disorders are elevated in firefighters compared with rates observed in the general population. In addition, we conducted narrative synthesis concerning several commonly assessed predictive factors for disorder and found that sociodemographic factors appear to bear a weak relationship to mental disorder, while incident-related factors, such as severity and duration of disaster exposure, bear a stronger and more consistent relationship to the development of PTSD and depression in cross-national samples. Future work should expand on these preliminary findings to better understand the impact of disaster exposure in firefighting personnel.

Due to high rates of potentially traumatic exposure (PTE) within the firefighting profession, a large body of literature concerning firefighters' mental health has developed over recent decades. However, given variable prevalence outcomes and the largely descriptive nature of most studies, it is unclear whether the prevalence of trauma-related mental disorders in firefighters is elevated in comparison with the general population. The present systematic review examined literature on prevalence of posttraumatic stress disorder, depression, and anxiety in firefighters exposed to routine, duty-related PTEs to synthesize prevalence outcomes across the literature. Systematic search of 6 databases was conducted to review eligible articles published between 1980 and 2017 in any language. In all, 40 articles concerned firefighters exposed to routine work-related PTE. We report that strong evidence exists to suggest that the prevalence of posttraumatic stress disorder and depression is elevated in firefighters compared with the general population of Canada, whereas moderate evidence exists for the elevated prevalence of anxiety disorders. However, measurement tool is a substantial source of variability in prevalence estimates across the literature, and few predictive factors bear consistent relationships to posttraumatic stress disorder across samples. Future work should focus on measurement variance and examine possible interactions between commonly assessed predictive factors for disorder risk in firefighters.

Ambulance personnel, including paramedics, emergency medical technicians, and others, are exposed to potentially distressing situations frequently as a function of their duties. The present systematic review evaluated the prevalence of trauma-related mental disorders, including posttraumatic stress disorder (PTSD), depression, and anxiety in ambulance personnel with best-evidence narrative synthesis across an international dataset of 24 eligible studies to determine whether prevalence is elevated in this occupational group relative to the general population. In addition, we integrate and synthesize findings related to predictive factors for the prevalence of these disorders across the literature, broadly grouping predictive factors into three categories: individual-difference factors (e.g., sociodemographics), exposure-related factors (e.g., frequency), and organizational factors (e.g., support from supervisors). The relationship between exposure-related factors and depression/anxiety symptoms is of special interest because both disorders may occur outside the context of traumatic stress but are also highly comorbid with PTSD. We report strong evidence that prevalence rates of probable PTSD, depression, and anxiety disorder are elevated in ambulance personnel. The strongest predictive associations for PTSD symptoms concerned exposure-related and organizational factors, whereas individual-difference factors bore weak or inconsistent associations with symptoms. Importantly, there is a concerning lack of data regarding the impact of workplace traumatic exposure on depression and anxiety in ambulance personnel, and as such it is not possible at present to differentiate between manifestation of symptoms following exposure compared with ongoing symptoms unrelated to the workplace. Addressing this gap in the literature is of critical importance for guiding organizational response to these disorders in ambulance service. (PsycInfo Database Record (c) 2020 APA, all rights reserved)

In addition to the daily stressors of the job, correctional officers are exposed to violence, direct threat to themselves, and ultimately workplace injury at rates considerably higher than that of other workers. Yet, while the mental health aftermath of such exposures have been frequently studied in other public safety professions, the consequences for correctional officers are relatively unknown. The current systematic review examines the existing literature on correctional officers to provide prevalence estimates of PTSD, acute stress disorder, major depression and anxiety disorder. The literature on this topic is very limited, but nevertheless provides evidence of high prevalence of PTSD, depression and anxiety when compared to other occupational groups and the general population. PTSD is most strongly associated with physical violence and injury encountered on the job. Depression and anxiety are most strongly associated with low levels of perceived support from the organization, low job satisfaction, and low-perceived social valuing of the roles these officers perform. These findings have implications for future research and for occupational health and safety interventions in support of these key members of the public safety workforce.

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.

The EnRiCH Project was formed to address challenges with disaster management for high risk populations. The theoretical foundation is based on salutogenesis, systems theory and community resilience, with emphasis on community assets, social capital, citizen participation, and collaborative practice, which support adaptive capacity to respond and recover from adverse events. We present results from the process evaluation of the use of the structured interview matrix (SIM) facilitation technique as a first step in asset-mapping for a community resilience intervention. Nine SIM sessions were conducted across five geographic communities (n=143) with professionals and volunteers from emergency management, health and social services, community organisations and citizens who represent high risk populations. Open-ended questionnaires were completed by (n=139) participants to document experiences of partaking in the session. Content analysis suggests that the SIM is an effective technique to enhance connectedness, common ground, collaborative action, and awareness of existing services and supports in each community. Copyright (c) 2014 John Wiley & Sons, Ltd.

Collaborative teamwork is becoming more common in several domains including healthcare and disaster management. While collaborative teamwork can benefit from information system (IS) support, designing IS models to support collaboration is a significant challenge owing to the variations in tasks and people that must be supported, and the different contexts within which collaboration takes place. Collaborative teamwork can vary greatly because of context, which is the integration of diverse, dynamic, and heterogeneous needs for groups to achieve a specific goal. However in the literature there has been limited emphasis on how contextual underpinnings can be incorporated into IS design. This paper uses a case study of the design of a user-driven prototype disaster management IS. We used the think aloud method to capture participant thoughts while interacting with the IS prototype. The think aloud data was analyzed and used to develop an ontology of contextual considerations to support IS design.