Why was the study done?
Public safety personnel (PSP) and frontline healthcare workers (FHW) are frequently exposed to potentially psychologically traumatic events. As a result of this exposure, they are more likely to develop a posttraumatic stress injury (PTSI). These injuries can vary in severity and type but commonly involve symptoms of mental health disorders like depression, anxiety, and posttraumatic stress disorder (PTSD). Given the high rates of PTSI in at-risk populations like PSP and FHW, many programs have been developed and offered by organizations to proactively protect workers from developing PTSI. These programs are specifically designed to prevent PTSI, and not offer treatment for already existing conditions and work-related PTSI.
The current study reviewed the literature on proactive PTSI interventions specifically designed for PSP and FHW. The authors evaluated the effectiveness of these types of programs by statistically analyzing numerical (i.e., quantitative) data before and after each type of intervention.
What was done in the study?
The authors reviewed published research from September 2008–December 2019 for studies that looked specifically at proactive PTSI prevention programs among PSP, FHW, and any other trauma-exposed occupational group. Of the thousands of studies surveyed, 36 research articles were included in the current analysis because they had the right study population and data on all required variables. The numerical data from the studies were combined and analyzed to give results on the effectiveness of these programs on improving various types of PTSI, substance use, absenteeism, and biological indicators of health (e.g., heart rate, blood pressure). Program effectiveness was rated on a scale from small to large based on statistical analysis.
What did we find out?
- The programs reviewed fell into ten broad categories that overlapped significantly: mindfulness, psychoeducation, psychophysiology, resilience promotion, stress management, building coping skills, emotion regulation, cognitive behavioural therapy, psychological support or counselling, and multi-modal (those programs that combine approaches and topics).
- There was a huge variety in the content and duration of programs, how they were offered (e.g., group settings, online), and how their effectiveness was evaluated, including measured outcomes, follow-up durations, and extent of participant drop-out at follow-up
- All program types resulted in small to moderate decreases in PTSI after training, especially depression, burnout, PTSD, stress, and anxiety, but were often for a limited time.
- Across program types, no improvements were made to rates of absenteeism or suicidality (i.e., thoughts, plans, attempts).
- Reductions in alcohol or substance use were of small effects.
- Resilience promotion programs were most effective in reducing symptoms of depression and burnout, and improving coping and resilience.
- There were large reductions seen in general mental health disorder symptoms when a multi-modal program was provided.
- Initial improvements to mental health disorder symptoms were large immediately after training and at one month post-training, and were small for resilience measures. However, these improvements were reduced when evaluated 18 months post-training.
- There was little evidence for improvement in biological stress functions like blood pressure or stress hormones. However, there was a significant improvement in overall and average heart rate.
Where do we go from here?
In reviewing the literature on proactive PTSI programs, the authors of this study could find no clear front runner for the best program or program type. Resilience promotion and multi-modal programs appeared to produce consistent modest reductions in PTSI symptoms and development. However, the improvements seem to be time-limited, with much of the change disappearing after an 18-month follow-up. Researchers need to continue to study the effectiveness of proactive PTSI programs, and use a consistent standard set of outcome measures to compare improvements to past studies. Still, this review clearly shows that any PTSI prevention program should be offered regularly to ensure that the benefits are longer lasting.
The original wording of the study was changed and condensed for the current research summary.
Di Nota, P.M., Bahji, A., Groll, D., Carleton, R.N., & Anderson, G.S. (2021). Proactive psychological programs designed to mitigate posttraumatic stress injuries among at-risk workers: A systematic review and meta-analysis. Systematic Reviews 10:126. https://doi.org/10.1186/s13643-021-01677-7
Summary Prepared by Kossick, E. Reviewed & Edited by Barootes, B. & Anderson,G.