Department of Psychology, University of Toronto, Toronto, Canada.
Department of Psychiatry, University of Calgary, Calgary, Canada.
Syst Rev. 2021 Apr 28;10(1):126. doi: 10.1186/s13643-021-01677-7.
Public safety personnel and frontline healthcare professionals are at increased risk of exposure to potentially psychologically traumatic events (PPTE) and developing posttraumatic stress injuries (PTSI, e.g., depression, anxiety) by the nature of their work. PTSI are also linked to increased absenteeism, suicidality, and performance decrements, which compromise occupational and public health and safety in trauma-exposed workers. Evidence is lacking regarding the effectiveness of "prevention" programs designed to mitigate PTSI proactively. The purpose of this review is to measure the effectiveness of proactive PTSI mitigation programs among occupational groups exposed to PPTE on measures of PTSI symptoms, absenteeism, and psychological wellness.
Five electronic databases were searched per PRISMA guidelines for English or French peer-reviewed studies from 2008 to 2019 evaluating PTSI and psychological wellness in adults exposed to occupational PPTE. The risk of bias was assessed using the Newcastle-Ottawa Scale.
We identified 42 studies evaluating 3182 public safety and frontline healthcare professionals, PPTE-exposed educational staff, and miners. Significant overlap was found across program themes that included mindfulness, psychoeducation, resilience promotion, and stress management strategies. Post-program effect sizes were small (SMD < 0.5) to moderate (SMD < 0.8) for reductions in PTSI symptoms and for promoting measures of well-being as indicated by a meta-analysis on 36 studies. There was no evidence for significant reductions in substance use, absenteeism, or biomarkers of distress except for heart rate. Subgroup analyses indicated that multimodal programs effectively improved general psychological health, while resilience programs improved measures of depression, burnout, coping, and resilience. Effect sizes for resilience, depression, and general psychological health improvements were greatest immediately or 1-month post-training, while improvements in PTSD symptoms and coping were larger at longer follow-up. Studies were of moderate quality and risk of bias.
The current results showcase modest evidence for time-limited reductions in PTSI following participation in holistic programs that promote resilience, stress, and emotion regulation among at-risk workers. Implications for organizational implementation of proactive PTSI mitigation programs and areas of future research are discussed.
PROSPERO (CRD42019133534).
由于工作性质，公共安全人员和一线医护人员接触潜在心理创伤性事件（PPTE）并发展创伤后应激障碍（PTSD，例如抑郁、焦虑）的风险增加。PTSD 还与旷工、自杀倾向和表现下降有关，这会损害创伤暴露工人的职业和公共健康和安全。缺乏关于旨在主动减轻 PTSD 的“预防”计划有效性的证据。本综述的目的是衡量接触 PPTE 的职业群体中主动减轻 PTSD 计划在 PTSD 症状、旷工和心理健康方面的有效性。
根据 PRISMA 指南，对 2008 年至 2019 年期间评估接触职业性 PPTE 的成年人 PTSD 和心理健康的英语或法语同行评审研究进行了五项电子数据库搜索。使用纽卡斯尔-渥太华量表评估偏倚风险。
我们确定了 42 项研究，评估了 3182 名公共安全和一线医护人员、接触 PPTE 的教育工作者和矿工。在包括正念、心理教育、促进适应力和压力管理策略在内的计划主题中发现了显著的重叠。对 36 项研究进行的荟萃分析表明，计划后 PTSD 症状减少和促进幸福感的测量值的效应量较小（SMD<0.5）到中等（SMD<0.8）。除心率外，没有证据表明药物使用、旷工或压力生物标志物显著减少。亚组分析表明，多模式计划可有效改善一般心理健康，而适应力计划可改善抑郁、倦怠、应对和适应力的测量值。适应力、抑郁和一般心理健康改善的效应量在培训后立即或 1 个月时最大，而 PTSD 症状和应对的改善在随访时间较长时更大。研究质量和偏倚风险为中等。
目前的结果表明，在参加促进高危工人适应力、压力和情绪调节的整体计划后，PTSD 会有短暂的减轻，但效果有限。讨论了在组织中实施主动减轻 PTSD 计划的意义和未来研究的领域。
PROSPERO（CRD42019133534）。
