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Research Summaries

Assessing the perceptions and impacts of Critical Incident Stress Management

Keywords: Anxiety, Critical Incident Stress Management (CISM), Depression, Posttraumatic Stress Disorder (PTSD), Stressors

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Why was the study done?

Public Safety Personnel (PSP) work consists of unique stressors and demands, including exposures to potentially traumatic events (PPTEs). PSP screen positive for mental health disorders much more often than the general population.

Many programs have been developed to support PSP mental health, including peer support programs like Critical Incident Stress Management (CISM) as delivered by the International Critical Incident Stress Foundation (ICISF). Some peer support programs have been associated with decreased odds of screening positive for Posttraumatic Stress Disorder (PTSD), Major Depressive Disorder (MDD), Generalized Anxiety Disorder (GAD), and Social Anxiety Disorder (SAD).

Many people and organizations promote the value of peer support; however, there is still very little evidence on the impact of peer support programs. CISM is a widely used programs that involves peer support. The ICISF CISM is designed to incorporate tools for managing psychological injury and stress, emphasize the value of the peer relationship, and foster connectedness. ICISF has an instructor candidate training program for providing CISM and requires that instructors agree to offer the training at a high level of fidelity. Each instructor commits to no more than 10% deviation from the training program.

The current study looked at:

  • if the prevalence of various mental health disorders among ICSIF CISM peer support participants varied by individual differences (gender, age, years of service);
  • if perceptions of ICSIF CISM varied by individual differences or the presence of a positive mental health disorder screen; and
  • if positive mental health disorder screens varied by ICSIF CISM training experience (high fidelity, unknown fidelity, no ICSIF CISM).

What was done in the study?

There were 91 participants recruited for the experimental high fidelity ICSIF CISM training group from four integrated fire departments in Alberta. The term Integrated means that each participant was trained as a firefighter and certified as a primary or advanced care paramedic. Researchers took the data for the control groups having unknown fidelity CISM training (64 participants) and no CISM training (60 participants) from an existing sample of integrated PSP.

Each participant in the experimental group completed a demographics questionnaire, the Peer Support Survey (PSS), and mental health screening tools for PTSD, MDD, GAD, SAD, Panic Disorder (PD), and Alcohol Use Disorder (AUD). The control group participants completed the same measures, except for the PSS.

What did we find out?

Experimental group only:

  • 7% of participants screened positive for at least one mental health disorder.
  • Younger participants were more likely to screen positive for AUD than older participants, but there were no differences based on gender or years of service.
  • There were no individual differences in other mental health disorder screens.
  • Participants described the ICISF CISM peer support as beneficial.
  • Perceived skills acquired via ICISF CISM, perceived use of coping strategies, and perceived value of CISM were similar across gender, age, and years of service.
  • Participants who screened positive for PTSD reported having fewer CISM skills, but the same coping strategies, and still described CISM as valuable.
  • No relationships were found between perceived skills acquired via CISM, coping strategies, the value of CISM, and mental health disorders other than PTSD.

Comparing groups:

  • Participants who received high fidelity ICISF CISM training were less likely to screen positive for AUD or GAD than participants with no CISM experience.
  • Rates of MDD, PD, PTSD, and SAD were comparable between the three groups.

Where do we go from here?

Participants in this study perceived the ICISF CISM training as beneficial, providing valuable tools that included skills and coping strategies for assisting peers. The results showed some benefits for participants who had received high fidelity ICISF CISM. Participants in the high fidelity training had a similar rate of positive screens when compared to other firefighter populations. The study does have limitations given that the control and experimental groups were collected at separate times, that primarily men were participating, and that participants were from a single geography and sector. Despite the limitations, the study offers new information about the benefits of CISM peer support and highlights new directions for research on peer support.


The original wording of the study was changed and condensed for the current research summary.

Original Study

Price, J.A.B., Landry, C.A., Sych, J., McNeill, M., Stelnicki, A.M., Asmundson, A.J.N., & Carleton, R.N. (2022). Assessing the perceptions and impact of critical incident stress management peer support among firefighters and paramedics in Canada. International Journal of Environmental Research and Public Health 19, 4976.

Summary prepared by Kossick, E. Reviewed and edited by Barootes, B. & Carleton, R.N.

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