The effectiveness of interventions aimed at improving wellbeing and resilience to stress in first responders: A systematic review

Journal article

First responders are routinely exposed to trauma and suffer higher rates of mental and physical ill health compared to the general population. Interventions which could improve resilience to stress may help to protect the health of this high risk population. We systematically reviewed such interventions for first responders to determine which ones work and why. We searched the Cochrane and Campbell Collaboration Library, EMBASE, IBSS, Medline, PILOTS, PubMed, PsycINFO, and SCOPUS from 1 January 1980 to 28 June 2018 for randomised and quasi-randomised controlled studies aiming to improve wellbeing, resilience or stress management for police, ambulance, fire, or search and rescue workers using non-pharmacological interventions. Data were extracted from published reports and obtained from authors. Within- and between-group effect sizes were calculated for mental and physical health outcomes. Risk of bias was assessed using the Cochrane Collaboration’s Risk of Bias Tool. The initial search identified 3,816 studies, 13 of which were eligible for analysis (n=634 cases, n=628 controls). Six studies demonstrated intervention-related improvements. However, risk of bias was mostly unclear or high. Within-group intervention effect sizes ranged from -0·82 (95% CI -1·48 – -0·17) to 2·71 (1·99 – 3·42) and between-group intervention effect sizes ranged from -0·73 (-1·25 – -0·21) to 1·47 (0·94 – 2·01), depending on the outcome. Largest effects were seen for interventions that targeted modifiable risk factors for trauma-related psychiatric disorders. Targeting modifiable predictors of trauma-related psychiatric disorders through training may protect the health of first responders who routinely face trauma in their line of work.

Authors: Wild, J; El-Salahi, S; Degli-Eposti, M

• Publication status: Published
• Peer review status: Peer reviewed
• Publisher: Hogrefe
• Journal: European Psychologist
• Volume: 25
• Issue: 4
• Pages: 252-271
• Publication date: 2020-07-28
• Acceptance date: 2020-01-17
• DOI: 10.1027/1016-9040/a000402
• EISSN: 1878-531X
• ISSN: 0705-5870
• Language: English
• Keywords: post-traumatic stress disorder; review; major depressive disorder; first responder; resilience