Psychological interventions for post-traumatic stress injuries among public safety personnel: a systematic review and meta-analysis

Abstract

Background: Public safety personnel (PSP) are exposed to potentially psychologically traumatic events (PPTE) far more often than the general public, which increases the risk for various post-traumatic stress injuries (PTSIs). While there are many evidence-based psychological interventions for PTSI, the effectiveness of each intervention for PSP remains unclear.

Objectives: The current study assessed the effectiveness and acceptability of psychological interventions for PTSI among PSPs.

Methods: A systematic review and random-effects meta-analysis were performed on the effectiveness and acceptability of psychotherapies for PTSIs (i.e., symptoms of depression, anxiety, post-traumatic stress disorder) among PSP. The review adhered to the PRISMA reporting guidelines and used standardized mean differences (Cohen's d), rate ratios (RR), and their 95% confidence intervals (95% CI) to measure pooled effect sizes across studies; negative d values and RR values less than one indicated a reduction in symptoms compared to baseline or control groups. In addition, heterogeneity was quantified using I², and publication bias was evaluated using Egger's test.

Results: The analyses included data from eight randomized controlled trials representing 402 PSP (79.4% male, 35.3 years). Psychological interventions included narrative exposure therapy (n = 1), cognitive behavioral therapy (n = 2), eclectic psychotherapy (n = 2), eye-movement desensitization and reprocessing (n = 1), supportive counseling (n = 2), and group critical incident stress debriefing (n = 1). The interventions were associated with statistically significant reductions in symptoms associated with PTSD (d = - 1.23; 95% CI - 1.81, - 0.65; 7 studies; I² = 81%), anxiety (- 0.76; 95% CI - 1.28, - 0.24; 3 studies; I² = 47%), and depression (d = - 1.10; 95% CI - 1.62, - 0.58; 5 studies; I² = 64%). There were smaller but statistically significant improvements at follow-up for symptoms of PTSD (d = - 1.29 [- 2.31, - 0.27]), anxiety (d = - 0.82 [- 1.20, - 0.44]), and depression (d = - 0.46 [- 0.77, - 0.14]). There were no statistically significant differences in dropout rates (RR = 1.00 [0.96, 1.05]), suggesting high acceptability across interventions.

Conclusions: There is preliminary evidence that psychotherapies help treat PTSIs in PSP; however, the shortage of high-quality studies on PSP indicates a need for additional research into treating PTSI among PSP.

Systematic review registration: PROSPERO: CRD42019133534.

Fig. 1

PRISMA flow diagram

Fig. 2

Forest plots for psychotherapies’ effectiveness in reducing PTSD symptom severity after the intervention (top) and follow-up (below)

Fig. 3

Forest plots for the effectiveness of psychotherapies for reducing anxiety symptom severity after the intervention (top) and in follow-up (below)

Fig. 4

Forest plots for psychotherapies’ effectiveness in reducing depression symptom severity after the intervention (top) and follow-up (bottom)

Fig. 5

Forest plots of meta-analyses for retention in intervention at (top) primary trial endpoint; (bottom) in the follow-up

Fig. 6

Funnel plots for publication bias in meta-analyses for the effectiveness of psychotherapies for A PTSD symptom severity after intervention and follow-up; B PTSD remission after the intervention and in follow-up; C anxiety symptom severity after intervention and follow-up; D depression symptom severity after the intervention and in follow-up; E retention in intervention at the primary trial endpoint and F retention in intervention at extended follow-up