Background
Methods
Protocol registration
Eligibility criteria
Population
Interventions
Comparators
Outcomes
Study design(s)
Others
Study selection
Data abstraction
Quality appraisal
Data synthesis
Results
Literature search
Review characteristics
Characteristics | N (%) |
---|---|
No. of included reviews | 14 |
Date of publication | |
2009–2012 | 4 (28.6%) |
2013–2016 | 5 (35.7%) |
2017–2019 | 5 (35.7%) |
Country of publication | |
Australia | 6 (42.9%) |
Canada | 2 (14.3%) |
Netherlands | 1 (7.1%) |
UK | 1 (7.1%) |
USA | 4 (28.6%) |
No. of included primary studies | 47 |
Study design | |
Randomized controlled trials | 19 (40.4%) |
Non-randomized controlled trials | 6 (12.8%) |
Quasi-experimental | 7 (14.9%) |
Observational | 9 (19.2%) |
Case report | 5 (10.6%) |
Descriptive | 1 (2.1%) |
Population | |
Police | 37 (78.7%) |
Firefighters | 8 (17.0%) |
Correctional services | 2 (4.3%) |
Coroner/forensic pathologists | 0 (0.0%) |
Intervention | |
Prevention | 24 (51.1%) |
Rehabilitation | 23 (48.9%) |
Summary of included reviews
Review author (year) | Review country | Review objective(s) | Total no. of studies included in review (no. of relevant studies) | Citations of relevant studies (author, year) | Population(s) included in relevant studies | AMSTAR 2 score |
---|---|---|---|---|---|---|
Lees, T (2019) [17] | Australia | To review the most recent information regarding anxiety, PTSD, sleepiness, and fatigue and to identify interventions and treatments proposed to overcome work-related stressors and associated mental illnesses inflicting law enforcement officers. | 43 (6) | Arble, 2017; Chongruksa, 2012; Christopher, 2016; Oliver, 2009; Peres, 2011; Plat, 2013 | Police | Critically low |
Barger, LK (2018) [18] | USA | To critically review and synthesize existing literature on the impact of fatigue training on fatigue-related outcomes for emergency medical services (EMS) personnel and similar shift worker groups. | 18 (4) | Christopher, 2016; Holbrook, 1994; Kuehl, 2016; Sullivan, 2016 | Police, firefighter | Moderate |
Torchalla, I (2018) [19] | Canada | To summarize the evidence base for interventions targeting individuals with work-related post-traumatic stress disorder (PTSD), to make recommendations for clinicians and administrative decision-makers involved in their rehabilitation, and to guide future research in this area. Particular attention was given to studies that were conducted in naturalistic clinical settings or in a workers’ compensation claim context. | 11 (2) | Gersons, 2000; Lansing, 2005 | Police | Critically low |
MacMillan, F (2017) [20] | Australia | To systematically review studies of health promotion interventions in the police force. | 21 (7) | Jeter, 2013; Kuehl, 2016; Norris, 1990; Norvell, 1993; Richmond, 1999; Short, 1984; Tanigoshi, 2008 | Police | Low |
Witt, K (2017) [21] | Australia | To summarize the international literature on the effectiveness of suicide prevention programs for protective and emergency services employees. | 13 (4) | Finney, 2015; Levenson, 2010; Mishara, 2012; Welch, 1998 | Police, firefighter | Critically low |
Rose, FR (2016) [22] | USA | To conduct a systematic review and meta-analysis with regards to the effectiveness of psychological debriefing. | 27 (8) | Bohl, 1991; Bohl, 1995; Carlier, 2000; Harris, 2002; Leonard, 1999; Regehr, 2001; Ruck, 2013; Tuckey, 2014 | Police, firefighter, correctional services | Critically low |
Whybrow, D (2015) [23] | UK | To summarize current knowledge about TRiM and make recommendations for further research. | 13 (2) | Hunt, 2013; Watson, 2014 | Police | Critically low |
Milner, A (2014) [24] | Australia | To provide a systematic assessment of workplace suicide prevention activities, including short-term training activities, as well as suicide prevention strategies designed for occupational groups at risk of suicide. | 13 (1) | Mishara, 2012 | Police | Critically low |
Patterson, GT (2014) [25] | USA | To conduct a systematic review examining the effects of stress management interventions on outcomes among police officers and recruits. | 12 (12) | Ackerly, 1986; Coulson, 1987; Digliani, 1994; Gersons, 2000; Ireland, 2007; McCraty, 1999; Norvell, 1993; Richmond, 1999; Shipley, 2002; Short, 1984; Tanigoshi, 2008; Wilson, 2001 | Police | Critically low |
Skeffington, PM (2013) [26] | Australia | To conduct a systematic review in order to identify and synthesize all programs aimed at the primary prevention of PTSD to date. | 7 (3) | Arnetz, 2009; Sarason, 1979; Sijaric-Voloder, 2008 | Police | Critically low |
Haugen, PT (2012) [27] | USA | To conduct a systematic review of the PTSD treatment literature (English and non-English) in order to evaluate such treatment proposals based on what is known about treating PTSD in first responders. This review especially sought to identify RCTs whose primary outcome was PTSD. | 17 (8) | Cornelius, 2007; Coupland, 2009; Ford, 1996; Gersons, 2000; Kitchiner, 2004; Lansing, 2005; Tolin, 1999; Wilson, 2001 | Police, firefighter | Critically low |
Plat, MJ (2011) [28] | Netherlands | To conduct a systematic review describing (1) the existing job-specific workers’ health surveillance (WHS) activities, and (2) the effectiveness of job-specific WHS interventions with respect to work functioning, for selected jobs. | 31 (2) | Arnetz, 2009; Elliot, 2007 | Police, firefighter | Low |
Stergiopoulos, E (2011) [29] | Canada | To identify interventions targeting work-related PTSD in order to get workers back to the workplace. | 7 (1) | Gersons, 2000 | Police | Moderate |
Martin, A (2009) [30] | Australia | To investigate whether different types of health promotion intervention in the workplace reduce depression and anxiety symptoms. | 22 (1) | McCraty, 2003 | Correctional services | Critically low |
Quality appraisal of included reviews
Data synthesis
Police
Firefighters
Correctional services
Interventions and outcomes examined
Intervention coding | Intervention name | Intervention duration + frequency | Intervention description | Study author (year) | Study Design | Population |
---|---|---|---|---|---|---|
Resilience training | Trauma prevention training program | 90-min sessions over 5 days | Program was designed to strengthen resilience during stressful encounters and teach methods of coping after exposure, thereby preventing the emergence of maladaptive symptoms and behaviors with adverse effects on professionalism. | Arble, E (2017) [31] | Quasi-experimental | Police |
Police trauma resilience training | 2-h training once/week for 10 weeks | An initial psycho-educational session, followed by ten small group sessions consisting of relaxation and imagery training with mental skill rehearsal. Twelve months later, psychophysiological stress and police work performance were assessed during a live critical incident simulation. | Arnetz, BB (2009) [32] | RCT | Police | |
Mindfulness-based resilience training | 2-h class once/week for 8 weeks | A curriculum designed to train participants in a number of experiential exercises evoking qualities of mindfulness: mental focus, sustained attention, and a broad sense of personal and situational awareness. These exercises include versions of the body scan (body awareness exercise), sitting meditation, mindful movement, walking meditation, eating meditation, mindful martial arts exercises, and other elements of mindfulness-based stress reduction (MBSR). During class, there are periods of discussion exploring the experience of these exercises, as well as daily homework practice of the experiential mindfulness exercises, supplemented with several readings and journaling. | Christopher, MS (2016) [33] | Longitudinal cohort study | Police | |
Visuo-motor behavior rehearsal | 10 and 20 min consecutively | Progressive relaxation portion and an imagery/mental rehearsal portion prior to undergoing a highly stressful, critical event training scenario involving “live fire.” | Shipley, P (2002) [34] | RCT | Police | |
Stress management | Stress management program | 4 h/week for 6 weeks | The program included physiological and psychological interventions, such as relaxation training, physical exercise, dietary advice, rational emotive modeling, assertiveness/communication training. | Ackerley, DG (1986) [35] | RCT | Police |
Stress reduction program | 2.5 h × 4 sessions | The program utilized a cognitive-behavioral approach to training to teach stress awareness and stress control, including an assessment of current factors present in the policeman’s life which are stressful to him, a presentation of general information commonly used in stress management, and didactic interchange with class participants utilizing specific stressors listed by those participants. | Coulson, JE (1987) [36] | Quasi-experimental | Police | |
HeartMath® stress and emotional self-management training | 4–6 h × 3 sessions over 1 month | Program provided practical techniques designed to reduce stress in the moment, improve physiological and emotional balance, increase mental clarity, and enhance performance and quality of life. | McCraty, R (1999) [37] | RCT | Police | |
Stress management training | 8-h session | Stress awareness training and stress management training. | Oliver, WM (2009) [38] | Observational | Police | |
Stress management training | 2-h sessions × 6 | Stress awareness training and stress management training, with key components including self-monitoring in stressful situations, muscle relaxation, and development of adaptive self-statements. | Sarason, IG (1979) [39] | RCT | Police | |
Stress inoculation training | 2-h sessions × 5 over 7 weeks | Three major components which generally followed the phases of (1) conceptualization, (2) skills acquisition and rehearsal, and (3) application and follow-through. | Digliani, JA (1994) [40] | RCT | Police | |
Cognitive-behavioral stress management | 4 weekly sessions over 1 month | Key components include stress and trauma education, relaxation techniques, problem-solving, and communication skills. In the therapeutic part of the program, CBT techniques were used, while in the educational part of the program, stress and trauma-related issues were the focus. | Sijaric-Voloder, S (2008) [41] | RCT | Police | |
Suicide prevention | Suicide prevention program | 6 months of presentations and online course | The program included (1) suicide awareness training, (2) suicide prevention training, and (3) education training for crisis management. | Finney, EJ (2015) [42] | Quasi-experimental | Firefighters |
Badge of life psychological survival for police officers program/emotional self-care training program | NR | Suicide prevention program including awareness training, further awareness training materials available online to facilitate face-to-face delivery where preferred, annualized mental health “check-ups” with mental health professionals, and peer support programming. | Levenson, RL Jr (2010) [43]* | Descriptive | Police | |
Together for life program | NR | The program involved training for all officers, supervisors, and union representatives as well as establishing a volunteer helpline and a publicity campaign. | Mishara, BL (2012) [44] | Quasi-experimental | Police | |
Suicide prevention program | NR | This program included awareness training, gatekeeper training, a 24-h crisis telephone hotline, life skills and stress management workshops, a crisis intervention team, suicide postvention services, and changes to media reporting guidelines following the suicide of an officer. | Welch, J (1998) [45] | Quasi-experimental | Police | |
Other health promotions | Power to change performance program | 5 modules over 2 days (positive emotion techniques); daily physiological readings | The program focused on stress and health risk reduction, including a positive-emotion refocusing technique with physiological feedback training (heart rhythms). | McCraty, R (2003) [46] | RCT | Correctional |
Health assessment and promotion program | 5–15 min each | Health assessment and motivational interviewing intervention, plus self-help materials for alcohol, smoking, and stress, an advice booklet, and audio cassette. | Richmond, RL (1999) [47] | RCT | Police | |
Safety & Health Improvement: Enhancing Law Enforcement Departments (SHIELD) wellness intervention | 30-min sessions once/week for 12 weeks | Team-based intervention that fosters social support and accountability; each member of the team would discuss weekly goals and there was a scripted set of questions to answer out loud regarding successful strategies identified by subjects to reach the weekly goal. | Kuehl, KS (2016) [48] | RCT | Police | |
Health promotion through fitness training | 30–40 min/session, 3×/week for 10 weeks | Aerobic (i.e., running) and anaerobic (i.e., weight training) structured group sessions. Intervention groups were encouraged to do unsupervised sessions at home when they missed sessions. | Norris, R (1990) [49] | NRCT | Police | |
Circuit weight training program | 20 min/session, 3×/week for 16 weeks, | Circuit weight training, exercises, and sets of reps. Proper technique and individualized training guide provided. | Norvell, N (1993) [50] | RCT | Police | |
Education and aerobic conditioning | 90-min sessions over 8 weeks (education); 3× 45-min sessions/week for 8 weeks (aerobic conditioning) | Exercise/fitness education and aerobic conditioning sessions. | Short, MA (1984) [51] | RCT | Police | |
Yoga program | 75-min classes 6×/week for 4 non-continuous weeks | Classes involved Kripalu yoga (focusing on mindfulness, deep relaxation, yoga postures, meditation, and breathing). | Jeter, PE (2013) [52] | Quasi-experimental | Police | |
Educational sessions with sleep screening | 30-min (mandatory educational sessions) | The program included (1) mandatory educational sessions for sleep, (2) voluntary sleep disorders screening, and (3) sleep disorders diagnosis and treatment for those who screened at risk for a sleep disorder. | Sullivan, JP (2017) [53] | RCT | Firefighters | |
Sleep hygiene training | NR | Workshop on self-management techniques for controlling insomnia, with the intention of heightening subjects’ awareness and increasing their knowledge of sleep hygiene. | Holbrook, MI (1994) [54] | Quasi-experimental | Police |
Intervention coding | Intervention name | Intervention duration/frequency | Intervention description | Study author (year) | Study design | Population |
---|---|---|---|---|---|---|
Drug therapy | Carbemazepine and sodium valproate | 500 mg 2× daily (sodium valproate) | The patient first received carbemazepine added to the other medications, then withdrew due to side effects. The patient was re-admitted to the hospital and sodium valproate was commenced. After the symptoms improved, the patient was discharged and followed up as an outpatient. | Ford, N (1996) [55] | Case report | Police |
Prazosin | 1 mg once/day for 1 week, then increase by 1 mg every 3-4 days thereafter, to up to 6 mg after 4 weeks | Prazosin administered to the patient with increasing dosages. | Coupland, NJ (2009) [56] | Case report | Firefighters | |
Psychotherapy | Brief eclectic psychotherapy (BEP) | 60-min sessions once/week for 16 weeks | Combines cognitive-behavioral and psychodynamic approaches (including 5 essential elements: psycho-education, imaginary guidance, writing assignments and mementos, domain of meaning or integration, and a farewell ritual) over sessions of individual psychotherapy. | Gersons, BPR (2000) [57] | RCT | Police |
Brief eclectic psychotherapy (BEP) | 16 weekly sessions | Combines cognitive-behavioral and psychodynamic approaches (including 5 essential elements: psycho-education, imaginary guidance, writing assignments and mementos, domain of meaning or integration, and a farewell ritual) over sessions of individual psychotherapy. | Plat, MCJ (2013) [58] | Observational | Police | |
Brief psychological intervention | 1.5-h session | A group intervention was given within 24 h after a critical incident. Briefly, participants described what they had done, expressed what they felt at the time of the incident, and talked about any symptoms. The therapist explained typical reactions and the normality of feeling anger, guilt, and having nightmares. Participants related past experience to the current incident. The therapist then summed up what the participants had expressed. | Bohl, N (1991) [59] | NRCT | Police | |
Brief psychological intervention | 1.5-h session | A group intervention was given within 24 h after a critical incident. Briefly, participants described what they had done, expressed what they felt at the time of the incident, and talked about any symptoms. The therapist explained typical reactions and the normality of feeling anger, guilt, and having nightmares. Participants related past experience to the current incident. The therapist then summed up what the participants had expressed. | Bohl, N (1995) [60] | NRCT | Firefighters | |
Cognitive-behavioral treatment | 60-min sessions × 15 over 7 months | The treatment included building rapport, development of alternate and adaptive mechanisms for coping, progressive muscle relaxation, introducing of assimilation and rational thinking as coping mechanisms, gradual exposure to the traumatic events with discussions of trauma, as well as relapse prevention and review of progress. | Cornelius, TL (2007) [61] | Case report | Police | |
Individual wellness counseling sessions | 60 min every other week × 5 (cognitive-behavioral personalized wellness counseling) 5 sessions every other week over 10 weeks (individual counseling) | Cognitive-behavioral counseling personalized wellness sessions every other week. Referral to mental health services as required. | Tanigoshi, H (2008) [62] | RCT | Police | |
Critical incident stress debriefing | NR | A peer counseling group procedure with psychoeducational components that provide information on various stress reactions following exposure to a critical incident. The strategy in this group meeting is to begin with materials that the participants are comfortable in discussing, leading to more emotionally intense exchanges, and concluding with a psychoeducational component intended to bring closure to the group. Strategy uses 7 stages: (a) introduction, (b) fact, (c) thought, (d) reaction, (e) symptoms, (f) teaching, and (g) reentry. | Harris, MB (2002) [63] | Observational/cohort | Firefighters | |
Critical incident stress debriefing (CISD) | Within 72-hr after a critical incident | A peer counseling group procedure with psychoeducational components that provide information on various stress reactions following exposure to a critical incident. The strategy in this group meeting is to begin with materials that the participants are comfortable in discussing, leading to more emotionally intense exchanges, and concluding with a psychoeducational component intended to bring closure to the group. Strategy uses 7 stages: (a) introduction, (b) fact, (c) thought, (d) reaction, (e) symptoms, (f) teaching, and (g) reentry. | Leonard, R (1999) [64] | Observational | Police | |
Critical incident debriefs | NR | Group-based debriefing sessions. | Ruck, S (2013) [65] | NRCT | Correctional | |
Critical incident stress debriefing (CISD) | ~ 90 min, within 72-h after a critical incident | A peer counseling group procedure with psychoeducational components that provide information on various stress reactions following exposure to a critical incident. The strategy in this group meeting is to begin with materials that the participants are comfortable in discussing, leading to more emotionally intense exchanges, and concluding with a psychoeducational component intended to bring closure to the group. Strategy uses 7 stages: (a) introduction, (b) fact, (c) thought, (d) reaction, (e) symptoms, (f) teaching, and (g) reentry. | Tuckey, MR (2014) [66] | RCT | Firefighters | |
Individual debriefing | 3 sessions in total at 24-h, 1 month, 3 months | The debriefer applies a seven-stage, semi-structured procedure, comprising of: an introduction, facts, thoughts and impressions, emotional reactions, normalization and traumatic stress education, planning for the future, and disengagement. | Carlier, IVE (2000) [67] | NRCT | Police | |
Eclectic group counseling | 1.5–2-h sessions once/week for 3 months | Counseling included the interactive model of cognitive-behavioral therapy, religious interventions, mandala drawing, and reality therapy. | Chongruksa, D (2012) [68] | RCT | Police | |
Crisis debriefing groups | 1 single session | A single session for relieving the distress of emergency service workers encountering traumatic events in the line of duty. | Regehr, C (2001) [69] | Observational | Firefighters | |
Exposure-based therapy and cognitive restructuring | NR | Psychotherapy (i.e., exposure-based therapy and cognitive restructuring, or ETCR) for police officers with partial post-traumatic stress disorder (pPTSD). | Peres, JFP (2011) [70] | NRCT | Police | |
Trauma risk management (TRiM) | NR | Peer support intervention using trained, non-medical personnel to conduct a psychological risk assessment for those exposed to potentially traumatic events. TRiM interviews can be delivered to individuals (a 1:1 intervention) or within small groups; the police service currently uses mostly 1:1 interventions. | Hunt, E (2013) [71] | Cohort study | Police | |
Trauma risk management (TRiM) | NR | NR | Watson (2014) [72]* | NR | NR | |
Other therapies | Exposure therapy | 90-min weekly sessions × 5 | Therapy sessions involving imaginal exposure (e.g., deliberately recounting the trauma) and in vivo exposure (e.g., exposure to stimuli that remind the patient of past trauma). | Tolin, DF (1999) [73] | Case report | Police |
Eye movement desensitization and reprocessing (EMDR) | 5–6 sessions | Psychological treatment for post-traumatic stress disorder (PTSD). | Kitchiner, NJ (2004) [74] | Case report | Firefighters | |
Eye movement desensitization and reprocessing (EMDR) | 2–3-h sessions conducted 3–4 weeks apart | Psychological treatment for PTSD. Subjects were taught coping and “containment” techniques, how to identify and develop support networks, and how to log their trauma-related memories—a necessary precondition for eye movement desensitization and reprocessing (EMDR). The first (pre-EMDR) brain SPECT scans were collected before EMDR took place. This procedure gave bilateral stimulation in the subjects’ palms and fingers, thus allowing them to re-experience traumatic scenes. This was followed by a “reconciliation phase” of treatment, focusing on the re-scripting of relational patterns that might not have been corrected once subjects became detraumatized. | Lansing, K (2005) [75] | Observational | Police | |
Eye movement desensitization and reprocessing (EMDR) | 2-h EMDR sessions × 3 | Psychological treatment for PTSD. The EMDR sessions took place off-site at the office of the therapist assigned to the officer. The stressors identified in the clinical interview served as the focus of the EMDR sessions. | Wilson, SA (2001) [76] | RCT | Police | |
Writing intervention | 15-min writing once/day for 4 consecutive shifts | Emotional disclosure in writing as a coping method for police officers; they received instructions to write about their strong emotions, positive or negative, related to work or not, and about what they plan to do, if anything, as a result of the emotions. | Ireland, M (2007) [77] | RCT | Police |