World Trade Center Health Program NYU School of Medicine Clinical Center of Excellence at Bellevue Hospital Center, Department of Psychiatry, New York University, New York, NY 10016, USA.
Clin Psychol Rev. 2012 Jul;32(5):370-80. doi: 10.1016/j.cpr.2012.04.001. Epub 2012 Apr 13.
First responders are generally considered to be at greater risk for full or partial posttraumatic stress disorder (PTSD) than most other occupations because their duties routinely entail confrontation with traumatic stressors. These critical incidents typically involve exposure to life threat, either directly or as a witness. There is a substantial literature that has examined the risk factors, symptom presentation, course, and comorbidities of PTSD in this population. However, to our knowledge, there are no systematic reviews of treatment studies for first responders. We conducted 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. We especially sought to identify randomized controlled trials (RCTs) whose primary outcome was PTSD. Our search identified 845 peer-reviewed articles of which 0.002% (n=2) were bona fide RCTs of PTSD treatment in first responders. Both studies tested a psychosocial treatment. We did not locate a single psychopharmacologic RCT for PTSD in first responders. An additional 2 psychosocial studies and 13 case or observational studies comprised the remaining extant literature. Though both RCTs showed significant large treatment effects (d=1.37; h=0.92), the literature is startlingly sparse and is not sufficient for evidence-based recommendations for first responders.
急救人员通常被认为比大多数其他职业面临更大的完全或部分创伤后应激障碍（PTSD）风险，因为他们的职责通常需要面对创伤性应激源。这些关键事件通常涉及到生命威胁的直接或间接暴露，无论是作为目击者。有大量文献研究了该人群中 PTSD 的风险因素、症状表现、病程和共病。然而，据我们所知，针对急救人员的治疗研究尚无系统评价。我们对 PTSD 治疗文献（英语和非英语）进行了系统评价，以便根据我们对急救人员 PTSD 治疗的了解，评估这些治疗建议。我们特别寻求确定以 PTSD 为主要结局的随机对照试验（RCT）。我们的搜索确定了 845 篇同行评议的文章，其中只有 0.002%（n=2）是针对急救人员 PTSD 治疗的真正 RCT。这两项研究都测试了一种心理社会治疗。我们没有找到针对急救人员 PTSD 的单一精神药理学 RCT。另外两项心理社会研究和 13 项病例或观察性研究构成了其余现有的文献。尽管这两项 RCT 都显示出显著的大治疗效果（d=1.37；h=0.92），但文献非常稀少，不足以提供针对急救人员的循证建议。
