Australian & New Zealand Journal of Psychiatry, 00(0)
Introduction
There are currently over 80,000 paid Australian emergency services personnel comprising paramedics, firefighters, police officers and state emergency services workers (Black Dog Institute, 2015). These personnel work alongside approximately 420,000 emergency volunteers (Australian Bureau of Statistics, 2010). For these emergency services personnel, exposure to traumatic events and other stressors is an integral part of the role (McFarlane et al., 2009). Recent changes to Criterion A, the stressor criteria for post-traumatic stress disorder (PTSD) in The Diagnostic and Statistical Manual of Mental Disorders (5th ed.; DSM-5;
Research into Australian emergency services personnel mental health and wellbeing: An evidence map
Tracey Varker1, Olivia Metcalf1, David Forbes1, Katherine Chisolm1, Sam Harvey2,3, Miranda Van Hooff 4, Alexander McFarlane4, Richard Bryant5 and Andrea J Phelps1
Abstract
Background: Evidence maps are a method of systematically characterising the range of research activity in broad topic areas and are a tool for guiding research priorities.
Aims: ‘Evidence-mapping’ methodology was used to quantify the nature and distribution of recent peer-reviewed research into the mental health and wellbeing of Australian emergency services personnel.
Methods: A search of the PsycINFO, EMBASE and Cochrane Library databases was performed for primary research articles that were published between January 2011 and July 2016.
Results: In all, 43 studies of primary research were identified and mapped. The majority of the research focused on organisational and individual/social factors and how they relate to mental health problems/wellbeing. There were several areas of research where very few studies were detected through the mapping process, including suicide, personality, stigma and pre-employment factors that may contribute to mental health outcomes and the use of e-health. No studies were detected which examined the prevalence of self-harm and/or harm to others, bullying, alcohol/substance use, barri-ers to care or experience of families of emergency services personnel. In addition, there was no comprehensive national study that had investigated all sectors of emergency services personnel.
Conclusion: This evidence map highlights the need for future research to address the current gaps in mental health and wellbeing research among Australian emergency services personnel. Improved understanding of the mental health and wellbeing of emergency services personnel, and the factors that contribute, should guide organisations’ wellbeing policies and procedures.
KeywordsEmergency services, mental health, evidence mapping, wellbeing, literature review
1 Phoenix Australia Centre for Posttraumatic Mental Health, Department of Psychiatry, The University of Melbourne, Carlton, VIC, Australia
2 School of Psychiatry, University of New South Wales, Sydney, NSW, Australia3 Black Dog Institute, Randwick, NSW, Australia4 Centre for Traumatic Stress Studies, The University of Adelaide, Adelaide, SA, Australia
5 School of Psychology, University of New South Wales, Sydney, NSW, Australia
Corresponding author:Tracey Varker, Phoenix Australia Centre for Posttraumatic Mental Health, Department of Psychiatry, The University of Melbourne, Level 3, Alan Gilbert Building, 161 Barry Street, Carlton, VIC 3053, Australia. Email: [email protected]
738054 ANP0010.1177/0004867417738054ANZJP ArticlesVarker et al.research-article2017
Australian & New Zealand Journal of Psychiatry, 00(0)
American Psychiatric Association, 2013), are of particular relevance for emergency services personnel. Criterion A was broadened to include repeated or extreme exposure to aver-sive details of traumatic events. This includes, for example, attending the aftermath of accidents or disasters and repeated viewing of objectionable material such as child pornography and terrorism-related images. In addition, the requirement for the individual to respond at the time of the trauma with intense fear, helplessness or horror has been dropped from Criterion A. These changes reflect an increase in our under-standing of how trauma is experienced in the workplace and affects employees, particularly emergency service personnel (Levin et al., 2014). Not only do emergency services person-nel experience a range of different types of trauma, they may also experience different trauma reactions compared to members of the general population who are exposed to sin-gle, unexpected trauma. Specifically, reactions such as anger and guilt are often reported, rather than the typical reactions of fear or horror (Black Dog Institute 2015).
It is important to note that in most instances, as with other trauma-exposed populations, the majority of emer-gency services personnel are expected to react to traumatic experiences with mild, transient distress that ultimately results in return to normal function (Benedek et al., 2007). However, the risk of developing PTSD increases with the number of exposures to traumatic events (Brewin et al., 2000). Emergency services personnel rarely develop PTSD following initial exposure to a single traumatic incident. More commonly, in those who develop PTSD, it follows repeated exposures over many years. This can be under-stood as a process of sensitisation and kindling, whereby repeated experiences of traumatic incidents result in pro-gressively more severe reactions over time such that events that would not previously have affected the individual begin to trigger adverse psychological reactions (McFarlane, 2010). As the risk of PTSD increases with cumulative trauma, the rates of disorder may be expected to be higher among long-term emergency services employees than new recruits (Phoenix Australia, 2013). This was borne out in a recent study of the mental health of current and retired fire-fighters (Harvey et al., 2016).
Importantly, the mental health challenges that can face emergency services personnel go beyond PTSD. Depression rates after experiencing a traumatic event in Japanese and US emergency services personnel are thought to be between 16% and 26% (Kleim and Westphal, 2011). The Australian media in recent years has described Australian emergency services personnel in a state of crisis, with annualised sui-cide rates increasing by between 450% and 800% over the past few years, in contrast to more stable rates of suicide in other Australian samples (Koubaridis, 2015; May, 2016). Furthermore, the full range of mental health problems expe-rienced by emergency services personnel is not necessarily trauma related. Factors such as working conditions and employment-related stressors have been linked to wellbeing
(Hart and Cotton, 2003). For example, several studies have found that police officers consider general organisational experiences–for example, management practices, career opportunities, decision-making, clarity of role and perfor-mance feedback – to be more stressful than operational pres-sures such as danger, threats and attending the aftermath of incidents with fatalities (Hart et al. 1994). Similarly, low morale has been found to be a stronger determinant of with-drawal behaviours (e.g. stress-related absenteeism and intention to submit a stress-related workers’ compensation claim) in police than overt psychological distress (Cotton and Hart, 2003). Research has also shown that beyond the context of traumatic events, other mental health disorders are highly prevalent in emergency services personnel. For example, alcohol use disorders were present in 30–36% of US firefighters (Murphy et al., 1999) and 37% of Australian police officers (Davey et al., 2001). There is, however, an absence in the literature of reported prevalence rates of other mental health problems such as PTSD, depression and anxi-ety in Australian emergency services personnel.
Evidence maps are a relatively new method for identify-ing, organising and summarising scientific evidence on a broad topic (Bragge et al., 2011; Miake-Lye et al., 2016). Although systematic reviews are more methodologically sound and comprehensive, they are highly targeted and less well suited to heterogeneous groups (Callahan et al., 2012). Maps are designed to collate and summarise studies rather than provide synthesis or aggregate data, and quality appraisal is not always included (Callahan et al., 2012). The capacity for breadth in evidence mapping allows it to iden-tify evidence gaps in order to guide future research efforts. Evidence maps are based on an explicit research question in relation to the field of enquiry, which may vary in depth, but should be informed by end users (Callahan et al., 2012). The end user may be researchers or research funding bodies who can identify gaps in the evidence, which in turn will create opportunities for new research. The research ques-tion drives the search for, and collection of, appropriate studies using explicit and reproducible methods at each stage (Arksey and O’Malley, 2005; Katz et al., 2003). Because the scope of this research question is so broad, it is well suited to an evidence map.
This paper presents the results of an evidence map that we conducted on recent mental health and wellbeing research in Australian emergency services personnel. It is the first synthesis of research into emergency services per-sonnel health and wellbeing. To date, there has been no col-lation or summary of the current literature on Australian emergency services personnel, in relation to mental health and wellbeing. The extent, range and nature of peer-reviewed research is summarised in the current paper. This process of taking stock of the evidence is an essential first step in obtaining an overview of the breadth of research activities related to the mental health and wellbeing of Australian emergency services personnel.
Varker et al. 3
Australian & New Zealand Journal of Psychiatry, 00(0)
Method
The Australian emergency services personnel mental health and wellbeing evidence mapping project was undertaken by the researchers as part of a larger project being con-ducted by beyondblue, a national organisation that provides information and support to help Australians affected by depression, anxiety and suicide. After consulting with experts in the area of emergency services personnel mental health and wellbeing, the questions and scope of the evi-dence map were defined. This process revealed two areas of focus for the map, namely
1. What current evidence exists regarding the mental health and wellbeing of Australian emergency ser-vices personnel?
2. What areas are, and are not, well researched?
Search strategy
To identify relevant literature, a broad search of relevant databases was conducted: the PsycINFO, EMBASE and the Cochrane Library databases were searched for rele-vant peer-reviewed literature. The search was not con-strained by methodology, outcome, intervention or topic of investigation, in order to make the search broad and inclusive. In order to capture current literature and keep pace with the changing landscape of research in this area, the search period was constrained from January 2011 to July 2016. The search terms were determined after con-sultations with experts in the area of the mental health and wellbeing of Australian emergency services personnel. The following search terms were used: ‘police officer’ OR ‘police’ OR ‘policem*n’ OR ‘policewom*n’ OR ‘law enforcement’ OR ‘fire*fighter*’ OR ‘fire service person-nel’ OR ‘firem*n’ OR ‘firewom*n’ OR ‘fire officer’ OR ‘first*responder*’ OR ‘response worker’ OR ‘emergency worker’ OR ‘emergency service* worker’ OR ‘emergency service* personnel’ OR ‘emergency response service per-sonnel’ OR ‘emergency service*’ OR ‘paramedic*’ OR ‘emergency medical service*’ OR ‘ambulance worker’ OR ‘ambulance service worker’ OR ‘ambulance person-nel’ OR ‘ambulance officer’ OR ‘ambulance’ OR ‘ambu-lance service*’ OR ‘disaster worker*’ OR ‘post-disaster worker’ OR ‘rescue worker’ OR ‘rescuer*’ OR ‘high*risk occupation’ OR ‘high*risk job*’ OR ‘state emergency ser-vice’ OR ‘SES’ OR ‘search and rescue’ AND Australia or Australian or NSW or ‘New South Wales’ or Victorian or Queensland or QLD or ‘Northern Territory’ or ‘South Australia’ or ‘Western Australia’.
Inclusion and exclusion criteria
Studies were eligible for inclusion if the population of interest was Australian emergency services personnel, the
focus of the study was mental health or wellbeing, the study presented original research (i.e. the study was not solely an opinion piece, review or editorial), the study had been pub-lished since 2011 in a peer-reviewed journal and the study was published in English. Studies were excluded if the area of mental health related solely to the emergency services personnel’s interactions with the public (e.g. police restraints of mentally ill individuals; empathy levels in par-amedics for their patients) rather than the emergency ser-vices personnel’s own mental health. Studies were also excluded if they solely investigated aspects of emergency services personnel as they relate to the operation of the organisation (e.g. factors that contribute to retention of vol-unteer firefighters; preparedness of paramedic personnel based on quality of clinical placement). A single study can often have multiple publications and as such, the primary reference for each study was established. This process pre-vented counting one study multiple times and misrepresent-ing the number of studies in a particular area. The authors took a conservative approach and unless the study clearly indicated it was a secondary study, it was considered unique in order to avoid under-representing the research field.
Screening and positioning the relevant evidence in the map (i.e. charting)
The titles and abstracts of all potentially relevant papers identified by the searches of the databases were collated. Where a title or abstract reported a trial that appeared to be eligible for inclusion, the full article was obtained. The full text was then assessed against the inclusion and exclusion criteria. Information extracted from the studies included sample size and participants, data sources/methodology, aims/objectives and key findings. Given that the purpose of the evidence map is to simply provide an overview of the extent, range and nature of the research activity, it is not necessary to appraise or describe research findings in detail (Hetrick et al., 2010). An evidence map is not meant to drill into the detail of individual articles to the same extent as systematic reviews.
Studies that met the inclusion criteria were then catego-rised according to the focus of the research described at the abstract level. Seven research foci were identified: (1) interventions related to mental health and/or wellbeing; (2) potentially traumatic event (PTE)/PTSD-related; (3) preva-lence/incidence of mental health and/or wellbeing; (4) psy-chological factors relating to work-related injury; (5) sleep and fatigue; (6) organisational factors relating to mental health and/or wellbeing and (7) social/individual factors relating to mental health and/or wellbeing. Studies were also categorised by the location that the sample was obtained from, in terms of what Australian state(s) or terri-tory, and by the service participants worked in (e.g. Police, State Emergency Service, Paramedic, etc.)
4 ANZJP Articles
Australian & New Zealand Journal of Psychiatry, 00(0)
Results
The initial searches identified 2200 potentially relevant studies. After deleting 224 duplicates, 1976 studies were retained to be screened on the title and abstract. Based on the title and abstract screening, full texts were retrieved for 124 studies. Based on the information provided by the full text of the retrieved publications, 43 studies were deemed eligible for inclusion in the final map, and a further 6 stud-ies were secondary publications (a flowchart of the search is presented in Figure 1). A map of recent research examin-ing the mental health and wellbeing of Australian emer-gency services personnel was produced (see Table 1). In Table 2, an overview of the characteristics of these studies
is provided. Please note that a study can have more than one outcome and therefore can be counted more than once in the table count. A list of citations for all studies included in the map is available on request.
Service
The emergency services populations with the largest num-ber of studies were paramedics (45% of the studies), fol-lowed by police (33% of the studies) and firefighters (21%). No studies were conducted with a multi-service population (i.e. more than one service in the one study). On the basis of the study title, a number of other studies appeared to have involved a multi-service population, but at the full-text
Figure 1. Flowchart of search for studies.
Varker et al. 5
Australian & New Zealand Journal of Psychiatry, 00(0)
Tabl
e 1.
Evi
denc
e m
ap o
f num
ber
of p
ublic
atio
ns e
xam
inin
g th
e m
enta
l hea
lth a
nd w
ellb
eing
of A
ustr
alia
n em
erge
ncy
serv
ices
wor
kers
.
Res
earc
h fo
cus
Loca
tion
serv
ice
Inte
rven
tions
PTE/
PTSD
Prev
alen
ce/
inci
denc
ePs
ycho
logi
cal f
acto
rs
of w
ork-
rela
ted
inju
rySl
eep
and
fatig
ueO
rgan
isat
iona
l fac
tors
re
latin
g to
MH
/wel
lbei
ngSo
cial
/indi
vidu
al fa
ctor
s re
latin
g to
MH
/wel
lbei
ng
Mul
ti s
tate
F
iref
ight
ers
1
P
aram
edic
s1
22
P
olic
e1
22
2
S
ES
AC
T
F
iref
ight
ers
P
aram
edic
s
P
olic
e
S
ES
NS
W
F
iref
ight
ers
11
P
aram
edic
s
P
olic
e1
S
ES
NT
F
iref
ight
ers
P
aram
edic
s
P
olic
e
S
ES
QL
D
F
iref
ight
ers
P
aram
edic
s1
12
P
olic
e2
S
ES
(Con
tinue
d)
6 ANZJP Articles
Australian & New Zealand Journal of Psychiatry, 00(0)
Res
earc
h fo
cus
Loca
tion
serv
ice
Inte
rven
tions
PTE/
PTSD
Prev
alen
ce/
inci
denc
ePs
ycho
logi
cal f
acto
rs
of w
ork-
rela
ted
inju
rySl
eep
and
fatig
ueO
rgan
isat
iona
l fac
tors
re
latin
g to
MH
/wel
lbei
ngSo
cial
/indi
vidu
al fa
ctor
s re
latin
g to
MH
/wel
lbei
ng
SA
F
iref
ight
ers
11
21
P
aram
edic
s1
P
olic
e1
S
ES
TA
S
F
iref
ight
ers
P
aram
edic
s
P
olic
e
S
ES
VIC
F
iref
ight
ers
P
aram
edic
s2
12
2
P
olic
e1
S
ES
WA
F
iref
ight
ers
11
P
aram
edic
s
P
olic
e1
S
ES
Unk
now
n
F
iref
ight
ers
11
P
aram
edic
s1
12
P
olic
e2
12
2
S
ES
MH
: men
tal h
ealth
; SES
: sta
te e
mer
genc
y se
rvic
e.
Tabl
e 1.
(C
ontin
ued)
Varker et al. 7
Australian & New Zealand Journal of Psychiatry, 00(0)
Tabl
e 2.
Cha
ract
eris
tics
of s
tudi
es in
clud
ed in
the
evi
denc
e m
ap.
Aut
hor
(yea
r)T
itle
of t
he s
tudy
Aim
s/ob
ject
ives
Part
icip
ants
Dat
a so
urce
s/
Met
hodo
logy
Mai
n fin
ding
s
Par
amed
ics
A
dam
s et
al.
(201
5)A
n in
terp
reta
tive
phen
omen
olog
ical
ana
lysi
s of
str
ess
and
wel
lbei
ng
in e
mer
genc
y m
edic
al
disp
atch
ers
Expl
ore
stre
ss a
nd
wel
lbei
ng a
mon
g em
erge
ncy
med
ical
di
spat
cher
s
16 e
mer
genc
y m
edic
al
disp
atch
ers
(unk
now
n lo
catio
n)
Dat
a so
urce
s: Q
ualit
ativ
e in
terv
iew
sM
etho
dolo
gy: C
ross
-se
ctio
nal
(1)
Des
pite
the
phy
sica
l dis
tanc
es fr
om
the
scen
e, e
mer
genc
y m
edic
al d
ispa
tche
rs
expe
rien
ced
vica
riou
s tr
aum
a; (
2) o
rgan
isat
iona
l fa
ctor
s im
pact
ed o
n th
e tr
aum
atic
rea
ctio
n an
d (3
) th
is e
xper
ienc
e ca
n be
rel
ated
to
post
-tr
aum
atic
gro
wth
.
Br
onie
cki e
t al
. (2
011)
Pre-
empl
oym
ent
risk
fact
ors
for
back
, nec
k an
d sh
ould
er
mus
culo
skel
etal
inju
ries
and
cl
aim
s in
am
bula
nce
offic
ers
Det
erm
ine
whe
ther
pr
e-em
ploy
men
t m
edic
al,
phys
ical
or
psyc
holo
gica
l as
sess
men
ts c
an p
redi
ct
futu
re b
ack,
new
and
sh
ould
er m
uscu
losk
elet
al
inju
ries
and
cla
ims
42–2
56
ambu
lanc
e of
ficer
s fr
om S
A
Dat
a so
urce
s: V
ario
us d
ata
sets
con
tain
ing
clai
ms
info
rmat
ion
Met
hodo
logy
: Ret
rosp
ectiv
e ob
serv
atio
nal s
tudy
bas
ed
on li
nked
dat
a se
ts
(1)
Anx
ious
per
sona
lity
type
s, a
s op
pose
d to
st
able
per
sona
lity
type
s an
d (2
) co
ncep
tual
ra
ther
tha
n pr
actic
al p
erso
nalit
y ty
pes
wer
e at
gr
eate
r ri
sk o
f an
inju
ry o
r su
bmitt
ing
a cl
aim
.
Br
unet
to e
t al
. (2
012)
Emot
iona
l int
ellig
ence
(EI
), jo
b sa
tisfa
ctio
n, w
ellb
eing
an
d en
gage
men
t: ex
plai
ning
or
gani
satio
nal c
omm
itmen
t an
d tu
rnov
er in
tent
ions
in
polic
ing
Expl
ore
how
EI a
ffect
job
satis
fact
ion,
wel
lbei
ng
and
enga
gem
ent
and
in t
urn,
per
cept
ions
of
orga
nisa
tiona
l com
mitm
ent
and
turn
over
inte
ntio
ns
193
polic
e of
ficer
s (u
nkno
wn
loca
tion)
Dat
a so
urce
s: Se
lf-re
port
qu
estio
nnai
res
Met
hodo
logy
: Cro
ss-
sect
iona
l
Ove
rall
EI w
as fo
und
to p
redi
ct p
olic
e of
ficer
s’
perc
eptio
ns o
f wel
lbei
ng a
nd jo
b sa
tisfa
ctio
n.
Fem
ales
had
hig
her
EI t
han
mal
es. T
he a
utho
rs
high
light
the
impo
rtan
ce o
f pol
ice
offic
ers
bein
g em
otio
nally
aw
are
in a
dditi
on t
o ha
ving
phy
sica
l fit
ness
and
kno
wle
dge.
C
ourt
ney
et a
l. (2
010)
Car
ing
for
the
care
rs:
fatig
ue, s
leep
and
men
tal
heal
th in
Aus
tral
ian
para
med
ic s
hift
wor
kers
Inve
stig
ate
fatig
ue, s
leep
qu
ality
, men
tal h
ealth
and
ph
ysic
al a
ctiv
ity
342
para
med
ic
shift
wor
kers
fr
om t
he
Mel
bour
ne
Am
bula
nce
Serv
ice
Dat
a so
urce
s: Se
lf-re
port
qu
estio
nnai
res
Met
hodo
logy
: Cro
ss-
sect
iona
l com
pari
son
to p
revi
ous
data
of
com
mun
ity s
ampl
es
Part
icip
ants
had
sig
nific
antly
hig
her
leve
ls
of fa
tigue
, dep
ress
ion,
anx
iety
, str
ess
and
sign
ifica
ntly
poo
rer
slee
p qu
ality
tha
n re
fere
nce
sam
ples
.
C
ourt
ney
et a
l. (2
013)
Car
ing
for
the
coun
try:
fa
tigue
, sle
ep a
nd m
enta
l he
alth
in A
ustr
alia
n ru
ral
para
med
ic s
hift
wor
kers
Expl
ore
the
men
tal a
nd
phys
ical
hea
lth o
f rur
al
para
med
ic s
hift
wor
kers
150
para
med
ic
shift
wor
kers
fr
om R
ural
A
mbu
lanc
e V
icto
ria
Dat
a so
urce
s: Se
lf-re
port
qu
estio
nnai
res
Met
hodo
logy
: Cro
ss-
sect
iona
l com
pari
son
to p
revi
ous
data
of
met
ropo
litan
-bas
ed
sam
ples
Rur
al p
aram
edic
shi
ft w
orke
rs r
epor
ted
incr
ease
d le
vels
of f
atig
ue a
nd d
epre
ssio
n,
anxi
ety
and
stre
ss (
rega
rdle
ss o
f age
or
gend
er)
and
poor
qua
lity
slee
p in
com
pari
son
to
refe
renc
e gr
oups
. The
sam
ple
also
rep
orte
d le
ss
phys
ical
act
ivity
.
(Con
tinue
d)
8 ANZJP Articles
Australian & New Zealand Journal of Psychiatry, 00(0)
Aut
hor
(yea
r)T
itle
of t
he s
tudy
Aim
s/ob
ject
ives
Part
icip
ants
Dat
a so
urce
s/
Met
hodo
logy
Mai
n fin
ding
s
G
ayto
n an
d Lo
vell
(201
2)R
esili
ence
in a
mbu
lanc
e se
rvic
e pa
ram
edic
s an
d its
re
latio
nshi
ps w
ith w
ellb
eing
an
d ge
nera
l hea
lth
(1)
Ass
ess
if tim
e in
pa
ram
edic
ser
vice
is
asso
ciat
ed w
ith in
crea
sed
resi
lienc
e or
if t
he
prof
essi
on a
ttra
cts
indi
vidu
als
with
hig
h re
silie
nce;
(2)
Eva
luat
e th
e re
latio
nshi
p be
twee
n re
silie
nce,
gen
eral
hea
lth
and
wel
lbei
ng
146
QLD
pa
ram
edic
s an
d 73
firs
t- a
nd
seco
nd-y
ear
stud
ents
Dat
a so
urce
s: Se
lf-re
port
qu
estio
nnai
reM
etho
dolo
gy: C
ross
-se
ctio
nal
Expe
rien
ced
para
med
ics
disp
laye
d si
gnifi
cant
ly
high
er le
vels
of r
esili
ence
tha
n pa
ram
edic
al
stud
ents
. Fur
ther
mor
e, t
hat
resi
lienc
e w
as
sign
ifica
ntly
cor
rela
ted
with
gen
eral
hea
lth a
nd
wel
lbei
ng.
K
irby
et
al.
(201
1)A
dapt
ive
and
mal
adap
tive
copi
ng s
trat
egie
s pr
edic
t po
st-t
raum
a ou
tcom
es in
am
bula
nce
pers
onne
l
Expl
ore
adap
tive
and/
or m
alad
aptiv
e co
ping
st
rate
gies
in r
elat
ion
to
wor
k-re
late
d po
st-t
raum
a ou
tcom
es
125
QLD
pa
ram
edic
s w
ho
had
expe
rien
ced
a tr
aum
atic
eve
nt
Dat
a so
urce
s: Se
lf-re
port
su
rvey
que
stio
nnai
res
Met
hodo
logy
: Cro
ss-
sect
iona
l
Spec
ific
adap
tive
and
mal
adap
tive
copi
ng
stra
tegi
es w
ere
diffe
rent
ially
ass
ocia
ted
with
po
st-t
raum
a ou
tcom
es: a
dapt
ive
copi
ng
stra
tegi
es a
re a
ssoc
iate
d w
ith p
rom
otin
g sp
ecifi
c po
sitiv
e ch
ange
s af
ter
trau
ma
and
low
er le
vels
of
intr
usio
n, w
ith m
alad
aptiv
e co
ping
link
ed t
o gr
eate
r ri
sk o
f neg
ativ
e sy
mpt
oms.
M
agui
re e
t al
. (2
014)
Occ
upat
iona
l inj
ury
risk
am
ong
Aus
tral
ian
para
med
ics:
an
anal
ysis
of
natio
nal d
ata
Iden
tify
the
occu
patio
nal
risk
s fo
r A
ustr
alia
n pa
ram
edic
s, b
y de
scri
bing
th
e ra
te o
f inj
urie
s an
d fa
talit
ies
and
com
pari
ng
thos
e ra
tes
with
oth
erre
port
s
6725
par
amed
ics
who
rep
orte
d to
Saf
e W
ork
Aus
tral
ia fo
r a
seri
ous
wor
k in
jury
bet
wee
n 20
00 a
nd 2
010
Dat
a so
urce
s: D
ata
set
on
occu
patio
nal i
njur
y cl
aim
s pr
ovid
ed b
y of
ficia
ls fr
om
Safe
Wor
k A
ustr
alia
Met
hodo
logy
: Ret
rosp
ectiv
e
The
ris
k of
ser
ious
inju
ry a
mon
g A
ustr
alia
n pa
ram
edic
s w
as fo
und
to b
e m
ore
than
sev
en
times
hig
her
than
the
Aus
tral
ian
natio
nal
aver
age.
The
fata
lity
rate
for
para
med
ics
was
ab
out
six
times
hig
her
than
the
nat
iona
l ave
rage
. Ev
ery
2 ye
ars,
one
par
amed
ic d
ied
and
30
wer
e se
riou
sly
inju
red
in v
ehic
le c
rash
es; 1
0 A
ustr
alia
n pa
ram
edic
s w
ere
seri
ousl
y in
jure
d ea
ch y
ear
as a
res
ult
of a
n as
saul
t. T
he in
jury
ra
te fo
r pa
ram
edic
s w
as m
ore
than
tw
o tim
es
high
er t
han
the
rate
for
polic
e of
ficer
s. 1
% o
f pa
ram
edic
s m
ade
clai
ms
for
inju
ry r
esul
ting
from
ex
posu
re t
o tr
aum
atic
eve
nts.
M
cMan
amny
et
al.
(201
3)O
ccup
atio
nal r
isks
in
unde
rgra
duat
e st
uden
t pa
ram
edic
clin
ical
pl
acem
ents
Inve
stig
ate
para
med
ic
stud
ents
’ exp
erie
nces
of
occu
patio
nal r
isks
dur
ing
clin
ical
pla
cem
ents
122
para
med
ic
stud
ents
cur
rent
ly
enro
lled
in a
pr
ehos
pita
l Ba
chel
or d
egre
e at
Aus
tral
ian
univ
ersi
ties
Dat
a so
urce
s: Se
lf-re
port
qu
estio
nnai
res
and
focu
s gr
oup
inte
rvie
ws
Met
hodo
logy
: Cro
ss-
sect
iona
l
11%
rep
orte
d ve
rbal
abu
se, 4
% r
epor
ted
phys
ical
as
saul
t an
d 5%
rep
orte
d ex
posu
re t
o se
xual
ised
be
havi
our.
12%
rep
orte
d ex
peri
enci
ng s
igni
fican
t di
stre
ss a
nd 4
% r
epor
ted
incu
rrin
g an
inju
ry o
r ill
ness
.
(Con
tinue
d)
Tabl
e 2.
(C
ontin
ued)
Varker et al. 9
Australian & New Zealand Journal of Psychiatry, 00(0)
Aut
hor
(yea
r)T
itle
of t
he s
tudy
Aim
s/ob
ject
ives
Part
icip
ants
Dat
a so
urce
s/
Met
hodo
logy
Mai
n fin
ding
s
Py
per
and
Pate
rson
(2
016)
Fatig
ue a
nd m
enta
l hea
lth in
A
ustr
alia
n ru
ral a
nd r
egio
nal
ambu
lanc
e pe
rson
nel
Inve
stig
ate
leve
ls o
f fa
tigue
, str
ess
and
emot
iona
l tra
uma
in r
ural
an
d re
gion
al a
mbu
lanc
e pe
rson
nel
134
rura
l an
d re
gion
al
ambu
lanc
e pe
rson
nel
(unk
now
n lo
catio
n)
Dat
a so
urce
s: Q
ualit
ativ
e su
rvey
and
sel
f-rep
ort
ques
tionn
aire
sM
etho
dolo
gy: C
ross
-se
ctio
nal
(1)
Rur
al a
nd r
egio
nal a
mbu
lanc
e pe
rson
nel
expe
rien
ce h
igh
leve
ls o
f fat
igue
and
em
otio
nal
trau
ma
at w
ork;
(2)
the
re a
re u
niqu
e st
ress
ors
asso
ciat
ed w
ith r
ural
and
reg
iona
l am
bula
nce
wor
k in
clud
ing
trea
ting
pers
onal
ly k
now
n pa
tient
s, w
orki
ng a
lone
and
long
res
pons
e tim
es
and
(3)
trea
ting
pers
onal
ly k
now
n pa
tient
s m
ay
also
hav
e po
sitiv
e im
pact
s on
rur
al a
nd r
egio
nal
ambu
lanc
e pe
rson
nel.
R
ober
ts e
t al
. (2
015)
Occ
upat
iona
l inj
ury
risk
am
ong
ambu
lanc
e of
ficer
s an
d pa
ram
edic
s co
mpa
red
with
oth
er h
ealth
care
w
orke
rs in
Vic
tori
a,
Aus
tral
ia: a
naly
sis
of
wor
kers
’ com
pens
atio
n cl
aim
s fr
om 2
003
to 2
012
Inve
stig
ate
occu
patio
nal
risk
of m
uscu
losk
elet
al
and
men
tal i
njur
y am
ong
ambu
lanc
e of
ficer
s an
d pa
ram
edic
s an
d co
mpa
re
with
nur
se p
rofe
ssio
nals
, so
cial
and
wel
fare
pr
ofes
sion
als
and
care
rs
and
aide
s in
Vic
tori
a,
Aus
tral
ia
Vic
tori
an
heal
thca
re
wor
kers
who
pu
t in
cla
ims
rece
ived
bet
wee
n 20
03 a
nd 2
012
(214
,355
Wor
k C
over
cla
ims)
Dat
a so
urce
s: T
he V
icto
rian
C
ompe
nsat
ion
Res
earc
h D
atab
ase
Met
hodo
logy
: Ret
rosp
ectiv
e
Am
bula
nce
offic
ers
and
para
med
ics
had
sign
ifica
ntly
hig
her
rate
s of
men
tal i
njur
y co
mpa
red
to a
ll ot
her
heal
thca
re p
rofe
ssio
ns.
Sh
akes
pear
e-Fi
nch
et a
l. (2
015)
Soci
al s
uppo
rt, s
elf-e
ffica
cy,
trau
ma
and
wel
lbei
ng
in e
mer
genc
y m
edic
al
disp
atch
ers
Det
erm
ine
the
pred
icto
rs
of p
sych
olog
ical
wel
lbei
ng
and
post
-tra
uma
resp
onse
s in
em
erge
ncy
med
ical
di
spat
cher
s
60 Q
LD
emer
genc
y m
edic
al
disp
atch
ers
Dat
a so
urce
s: O
nlin
e se
lf-re
port
que
stio
nnai
res
Met
hodo
logy
: Cro
ss-
sect
iona
l
(1)
Self-
effic
acy
and
rece
ivin
g so
cial
sup
port
w
ere
foun
d to
be
sign
ifica
nt p
redi
ctor
s of
ps
ycho
logi
cal w
ellb
eing
; (2)
rec
eivi
ng s
ocia
l su
ppor
t w
as a
lso
foun
d to
be
a si
gnifi
cant
pr
edic
tor
of P
TSD
and
of p
ost-
trau
mat
ic g
row
th,
but
not
givi
ng s
ocia
l sup
port
and
(3)
shi
ft w
ork
emer
ged
as a
sig
nific
ant
nega
tive
pred
icto
r of
PT
SD b
ut n
ot o
f wel
lbei
ng.
Sh
akes
pear
e-Fi
nch
and
Dal
ey (
2016
)
Wor
kpla
ce b
elon
ging
ness
di
stre
ss a
nd r
esili
ence
in
emer
genc
y se
rvic
e w
orke
rs
Inve
stig
ate
whe
ther
w
orkp
lace
bel
ongi
ngne
ss
pred
icte
d ps
ycho
logi
cal
dist
ress
and
res
ilien
ce
740
QLD
am
bula
nce
offic
ers
Dat
a so
urce
s: Se
lf-re
port
qu
estio
nnai
res
Met
hodo
logy
: Cro
ss-
sect
iona
l
Wor
kpla
ce b
elon
ging
ness
was
sig
nific
antly
as
soci
ated
with
red
uced
dis
tres
s le
vels
and
en
hanc
ed r
esili
ence
leve
ls a
fter
con
trol
ling
for
seve
rity
of t
raum
a ex
posu
re a
nd le
ngth
of
serv
ice.
The
var
iabl
es e
xam
ined
in t
his
stud
y ex
plai
ned
25%
of v
aria
nce
in p
sych
olog
ical
di
stre
ss a
nd n
earl
y 16
% o
f res
ilien
ce v
aria
nce
dem
onst
ratin
g th
at a
dditi
onal
fact
ors
are
asso
ciat
ed w
ith t
he d
istr
ess
and
resi
lienc
e co
nstr
ucts
.
(Con
tinue
d)
Tabl
e 2.
(C
ontin
ued)
10 ANZJP Articles
Australian & New Zealand Journal of Psychiatry, 00(0)
Aut
hor
(yea
r)T
itle
of t
he s
tudy
Aim
s/ob
ject
ives
Part
icip
ants
Dat
a so
urce
s/
Met
hodo
logy
Mai
n fin
ding
s
Sm
ith e
t al
. (2
011)
Fear
, fam
iliar
ity a
nd t
he
perc
eptio
n of
ris
k: a
qu
antit
ativ
e an
alys
is o
f di
sast
er-s
peci
fic c
once
rns
of
para
med
ics
Expl
ored
par
amed
ics’
pe
rcep
tion
of r
isk
and
will
ingn
ess
to w
ork,
with
a
spec
ific
focu
s on
iden
tifyi
ng
whi
ch t
ype
of d
isas
ters
th
at p
aram
edic
s as
soci
ate
with
gre
ater
leve
ls o
f fea
r,
fam
iliar
ity a
nd r
isk.
175
Aus
tral
ian
para
med
ics
Dat
a so
urce
s: Se
lf-re
port
le
vel o
f fea
r an
d fa
mili
arity
ac
ross
40
disa
ster
sc
enar
ios.
Met
hodo
logy
: Cro
ss-
sect
iona
l
Para
med
ics
rank
ed n
ucle
ar a
nd r
adio
logi
cal
even
ts a
nd o
utbr
eaks
of n
ew a
nd h
ighl
y in
fect
ious
dis
aste
rs h
ighe
st fo
r fe
ar a
nd
unfa
mili
arity
.
So
fiano
poul
os
et a
l. (2
011)
Se
cond
stu
dy
auth
ored
by
Pate
rson
et
al.
(201
4)
The
exp
lora
tion
of p
hysi
cal
fatig
ue, s
leep
and
dep
ress
ion
in p
aram
edic
s: a
pilo
t st
udy
Not
e. A
sec
ond
peer
-re
view
ed p
ublic
atio
n w
as
prod
uced
usi
ng a
sub
-set
of
thi
s da
ta s
et: T
itle:
Wha
t pa
ram
edic
s th
ink
abou
t w
hen
they
thi
nk a
bout
fa
tigue
: Con
trib
utin
g fa
ctor
s
Inve
stig
ate
the
impa
ct o
f sh
ift w
ork
on p
hysi
cal
fatig
ue, s
leep
and
ps
ycho
logi
cal f
acto
rs
amon
g pa
ram
edic
s
60 p
aram
edic
s (u
nkno
wn
loca
tion)
Dat
a so
urce
s: Se
lf-re
port
qu
estio
nnai
res
Met
hodo
logy
: Cro
ss-
sect
iona
l con
veni
ence
sa
mpl
e
(1)
92%
of p
aram
edic
s re
port
ed r
ecen
t fa
tigue
an
d 88
% s
aid
it af
fect
ed t
heir
wor
k; (
2) 2
7%
had
mild
dep
ress
ion
and
10%
had
mod
erat
e de
pres
sion
and
(3)
alm
ost
60%
of p
aram
edic
s re
ceiv
ed e
noug
h sl
eep,
whe
reas
30%
and
10
% r
epor
ted
bein
g ex
cess
ivel
y sl
eepy
and
da
nger
ousl
y sl
eep,
res
pect
ivel
y.
W
illia
ms
et a
l. (2
012)
Para
med
ic e
mpa
thy
leve
ls: r
esul
ts fr
om s
even
A
ustr
alia
n U
nive
rsiti
es
Ass
ess
the
exte
nt o
f em
path
y in
par
amed
ic
stud
ents
acr
oss
seve
n A
ustr
alia
n un
iver
sitie
s
783
para
med
ic
first
-, se
cond
- an
d th
ird-
year
un
derg
radu
ate
para
med
ic
stud
ents
from
se
ven
Aus
tral
ian
univ
ersi
ties
Dat
a so
urce
s: Se
lf-re
port
qu
estio
nnai
res
Met
hodo
logy
: Cro
ss-
sect
iona
l
Fem
ales
had
gre
ater
mea
n em
path
y sc
ores
tha
n m
ales
.
W
illia
ms
et a
l. (2
013)
Mea
sure
men
t of
em
path
y le
vels
in u
nder
grad
uate
pa
ram
edic
stu
dent
s
Ass
ess
para
med
ics’
em
path
y an
d at
titud
es
tow
ards
pat
ient
s w
ith
spec
ific
cond
ition
s. S
econ
d,
to e
xplo
re im
pact
of y
ear
of s
tudy
and
gen
der
on
empa
thy
leve
ls
94 fi
rst-
, sec
ond-
an
d th
ird-
year
A
ustr
alia
n un
derg
radu
ate
para
med
ic
stud
ents
from
on
e un
iver
sity
Dat
a so
urce
s: Se
lf-re
port
qu
estio
nnai
res
Met
hodo
logy
: Cro
ss-
sect
iona
l
Mal
es h
ad s
igni
fican
tly h
ighe
r em
path
y sc
ores
th
an fe
mal
es. E
mpa
thy
scor
es d
id n
ot s
igni
fican
tly
diffe
r ac
ross
yea
r of
stu
dy
W
illia
ms
et a
l. (2
015)
Und
ergr
adua
te p
aram
edic
st
uden
ts’ e
mpa
thy
leve
ls: a
2-
year
long
itudi
nal s
tudy
Ass
ess
both
the
leve
l of
em
path
y ov
er 2
-yea
r pe
riod
from
six
Aus
tral
ian
univ
ersi
ties
1719
firs
t-,
seco
nd-
and
thir
d-ye
ar p
aram
edic
un
derg
radu
ate
para
med
ic
stud
ents
Dat
a so
urce
s: Se
lf-re
port
qu
estio
nnai
res
Met
hodo
logy
: Lon
gitu
dina
l (fi
rst-
, sec
ond-
and
thi
rd-
year
stu
dent
s ac
ross
201
1 an
d 20
12).
(1)
Fem
ales
had
gre
ater
mea
n em
path
y sc
ores
th
an m
ales
and
(2)
em
path
y sc
ores
did
not
de
clin
e as
the
stu
dent
s pr
ogre
ssed
thr
ough
the
ir
degr
ee
(Con
tinue
d)
Tabl
e 2.
(C
ontin
ued)
Varker et al. 11
Australian & New Zealand Journal of Psychiatry, 00(0)
Aut
hor
(yea
r)T
itle
of t
he s
tudy
Aim
s/ob
ject
ives
Part
icip
ants
Dat
a so
urce
s/
Met
hodo
logy
Mai
n fin
ding
s
W
illia
ms
et a
l. (2
016)
Empa
thy
leve
ls in
un
derg
radu
ate
para
med
ic
stud
ents
: a 3
-yea
r lo
ngitu
dina
l stu
dy
Ass
ess
both
the
leve
l of
empa
thy
and
chan
ges
in
empa
thy
in p
aram
edic
st
uden
ts o
ver
a 3-
year
pe
riod
from
one
uni
vers
ity.
552
first
-, se
cond
- an
d th
ird-
year
pa
ram
edic
un
derg
radu
ate
para
med
ic
stud
ents
Dat
a so
urce
s: Se
lf-re
port
qu
estio
nnai
res
Met
hodo
logy
: Lon
gitu
dina
l (fi
rst-
, sec
ond-
and
thi
rd-
year
stu
dent
s ac
ross
200
8,
2009
and
201
0).
(1)
Fem
ales
had
slig
htly
hig
her
empa
thy
scor
es
than
mal
es; (
2) p
aram
edic
stu
dent
s di
spla
y lo
wer
em
path
y th
an t
hose
rep
orte
d by
fello
w s
tude
nts
who
com
plet
ed o
ther
hea
lthca
re p
rofe
ssio
nal
stud
ies
repo
rted
with
in t
he li
tera
ture
and
(3)
no
clin
ical
ly s
igni
fican
t de
clin
e in
em
path
y w
as fo
und.
Fire
fight
ers
A
rmst
rong
et
al.
(201
4)
Seco
nd s
tudy
w
as a
utho
red
by A
rmst
rong
et
al.
(201
6)
Pred
ictin
g po
st-t
raum
atic
gr
own
and
post
-tra
umat
ic
stre
ss in
fire
fight
ers
Not
e. A
sec
ond
peer
-re
view
ed p
ublic
atio
n w
as p
rodu
ced
usin
g a
sub-
set
of t
his
data
set
: Ti
tle: O
rgan
izat
iona
l be
long
ingn
ess
med
iate
s th
e re
latio
nshi
p be
twee
n so
urce
s of
str
ess
and
post
-tra
uma
outc
omes
in
firef
ight
ers
Inve
stig
ate
the
pred
ictiv
e ab
ility
of w
ork
cont
ext
vari
able
s, s
ocia
l sup
port
an
d co
ping
on
post
-tr
aum
atic
gro
wth
(PT
G)
and
PTSD
sym
ptom
s.
218
firef
ight
ers
who
rep
orte
d ex
peri
enci
ng a
w
ork-
rela
ted
trau
mat
ic e
vent
(u
nkno
wn
loca
tion)
Dat
a so
urce
s: Se
lf-re
port
qu
estio
nnai
res
Met
hodo
logy
: Cro
ss-
sect
iona
l
Fact
ors
pred
ictin
g PT
SD s
ympt
oms
incl
uded
ex
peri
enci
ng m
ultip
le s
ourc
es o
f tra
uma,
hi
gher
leve
ls o
f org
anis
atio
nal a
nd o
pera
tiona
l st
ress
and
util
isin
g co
gniti
ve r
eapp
rais
al c
opin
g.
Incr
ease
s in
PT
G w
ere
pred
icte
d by
exp
erie
ncin
g tr
aum
a fr
om m
ultip
le s
ourc
es a
nd u
se o
f sel
f-ca
re c
opin
g.
D
awso
n et
al.
(201
5)Fa
tigue
ris
k m
anag
emen
t by
vo
lunt
eer
firef
ight
ers:
use
of
info
rmal
str
ateg
ies
to
augm
ent
form
al p
olic
y
Iden
tify
info
rmal
str
ateg
ies
used
in v
olun
teer
fire
-fig
htin
g an
d ex
amin
e ho
w t
hese
str
ateg
ies
are
tran
smitt
ed a
cros
s th
e w
orkf
orce
30 v
olun
teer
fir
efig
hter
s w
ith
min
imum
5 ye
ars
of e
xper
ienc
e (u
nkno
wn
loca
tion)
Dat
a so
urce
s: Q
ualit
ativ
e in
terv
iew
sM
etho
dolo
gy: C
ross
-se
ctio
nal
Info
rmal
fatig
ue-m
anag
emen
t be
havi
ours
at
the
indi
vidu
al, t
eam
and
bri
gade
leve
ls w
ere
empl
oyed
. Inf
orm
al s
trat
egie
s w
ere
ofte
n pr
iori
tised
ove
r m
ore
trad
ition
al m
etho
ds w
hich
fr
eque
ntly
res
ulte
d in
fire
fight
s ch
oosi
ng b
etw
een
pers
onal
saf
ety
and
serv
ice
deliv
ery.
How
ever
, in
form
al fa
tigue
-man
agem
ent
beha
viou
rs a
re n
ot
seen
as
an in
tegr
al p
art
of t
he s
afet
y m
anag
emen
t sy
stem
for
fatig
ue.
H
arve
y et
al.
(201
5)T
he m
enta
l hea
lth o
f fir
efig
hter
s: a
n ex
amin
atio
n of
the
impa
ct o
f rep
eate
d tr
aum
a ex
posu
re
Ass
ess
the
prev
alen
ce
of p
ost-
trau
mat
ic s
tres
s di
sord
er, d
epre
ssio
n an
d al
coho
l mis
use
in a
sa
mpl
e of
cur
rent
and
re
tired
fire
fight
ers
and
exam
ine
thei
r re
latio
nshi
p w
ith c
umul
ativ
e tr
aum
a ex
posu
re
488
curr
ent
and
265
retir
ed
firef
ight
ers
from
N
SW
Dat
a so
urce
s: Se
lf-re
port
qu
estio
nnai
res
Met
hodo
logy
: Cro
ss-
sect
iona
l
(1)
Cur
rent
fire
fight
er r
ates
of P
TSD
and
de
pres
sion
wer
e 8%
and
5%
, res
pect
ivel
y,
whi
le 4
% r
epor
ted
heav
y dr
inki
ng; (
2) r
etir
ed
firef
ight
ers
repo
rted
sig
nific
antly
gre
ater
leve
ls o
f sy
mpt
omat
olog
y, w
ith t
he p
reva
lenc
e es
timat
es
of P
TSD
and
dep
ress
ion
at 1
8% d
epre
ssio
n an
d he
avy
drin
king
at
7% a
nd (
3) c
umul
ativ
e tr
aum
a ha
d an
effe
ct o
n PT
SD, d
epre
ssio
n an
d he
avy
drin
king
(Con
tinue
d)
Tabl
e 2.
(C
ontin
ued)
12 ANZJP Articles
Australian & New Zealand Journal of Psychiatry, 00(0)
Aut
hor
(yea
r)T
itle
of t
he s
tudy
Aim
s/ob
ject
ives
Part
icip
ants
Dat
a so
urce
s/
Met
hodo
logy
Mai
n fin
ding
s
H
uynh
et
al.
(201
4)
Seco
nd s
tudy
w
as a
utho
red
by H
uynh
et
al.
(201
3)
The
job
dem
ands
res
ourc
es
mod
el in
em
erge
ncy
serv
ice
volu
ntee
rs:
exam
inin
g th
e m
edia
ting
role
s of
exh
aust
ion,
w
ork
enga
gem
ent
and
orga
nisa
tiona
l co
nnec
tedn
ess
Not
e. A
sec
ond
peer
-re
view
ed p
ublic
atio
n w
as
prod
uced
usi
ng a
sub
-set
of
thi
s da
ta s
et: T
itle:
Soc
ial
supp
ort
mod
erat
es t
he
impa
ct o
f dem
ands
on
burn
out
and
orga
nisa
tiona
l co
nnec
tedn
ess:
a t
wo-
wav
e st
udy
of v
olun
teer
fir
efig
hter
s
Exam
ine
the
role
s of
th
ree
med
iato
rs in
the
re
latio
nshi
p be
twee
n jo
b ch
arac
teri
stic
s an
d vo
lunt
eer
wel
lbei
ng
887
volu
ntee
r fir
efig
hter
s fo
r th
e C
ount
ry F
ire
Serv
ice
Dat
a so
urce
s: Se
lf-re
port
qu
estio
nnai
res
Met
hodo
logy
: Cro
ss-
sect
iona
l
Job
dem
ands
wer
e po
sitiv
ely
rela
ted
to
exha
ustio
n, w
hich
, in
turn
, was
link
ed t
o ill
-he
alth
and
tur
nove
r in
tent
ions
. Job
res
ourc
es
wer
e po
sitiv
ely
rela
ted
to w
ork
enga
gem
ent
and
orga
nisa
tiona
l con
nect
edne
ss, w
hich
wer
e, in
tu
rn, n
egat
ivel
y re
late
d to
tur
nove
r in
tent
ions
.
Pa
ters
on e
t al
. (2
016)
Soun
d th
e al
arm
: hea
lth a
nd
safe
ty r
isks
ass
ocia
ted
with
al
arm
res
pons
e fo
r sa
lari
ed
and
reta
ined
met
ropo
litan
fir
efig
hter
s
Inve
stig
ate
the
alar
m
resp
onse
pro
cedu
re fo
r A
ustr
alia
n m
etro
polit
an
firef
ight
ers,
iden
tifyi
ng
com
mon
and
div
erge
nt
sour
ces
of r
isk
for
sala
ried
an
d re
tain
ed s
taff
(ala
rm
resp
onse
ref
ers
to t
he
proc
edur
e by
whi
ch
firef
ight
ers
are
aler
ted
to
a si
tuat
ion
requ
irin
g th
eir
actio
n)
46 m
etro
polit
an
firef
ight
ers
from
tw
o A
ustr
alia
n st
ates
(un
know
n lo
catio
n)
Dat
a so
urce
s: Q
ualit
ativ
e in
terv
iew
sM
etho
dolo
gy: C
ross
-se
ctio
nal
Slee
p an
d fa
tigue
, act
ual r
espo
nse
to t
he a
larm
st
imul
us, w
ork–
life
bala
nce
and
trau
ma
emer
ged
as s
ourc
es o
f ris
k ex
peri
ence
d di
ffere
ntly
by
sala
ried
and
ret
aine
d fir
efig
hter
s. K
ey fi
ndin
gs
incl
uded
rep
orts
of f
atig
ue in
bot
h gr
oups
, but
pa
rtic
ular
ly in
the
cas
e of
ret
aine
d fir
efig
hter
s w
ho m
anag
e pr
imar
y em
ploy
men
t as
wel
l as
thei
r re
tain
ed p
ositi
on. T
his
also
tra
nsla
ted
into
a
poor
sen
se o
f wor
k–lif
e ba
lanc
e.
Sk
effin
gton
et
al.
(201
6)T
raum
a ex
posu
re a
nd p
ost-
trau
mat
ic s
tres
s di
sord
er
with
in fi
re a
nd e
mer
genc
y se
rvic
es in
Wes
tern
A
ustr
alia
Expl
ore
the
rela
tions
hip
betw
een
trau
ma
expo
sure
an
d m
enta
l hea
lth
outc
omes
, inc
ludi
ng t
he
role
of s
ocia
l sup
port
and
co
ping
sty
le
210
Wes
tern
A
ustr
alia
n ca
reer
fir
efig
hter
s
Dat
a so
urce
s: Se
lf-re
port
qu
estio
nnai
res
Met
hodo
logy
: Cro
ss-
sect
iona
l (se
lf-se
lect
ion
and
rand
om s
ampl
ing)
(1)
97%
end
orse
d th
e pe
rson
al e
xper
ienc
e of
at
leas
t on
e po
tent
ially
tra
umat
ic e
vent
(PT
E) o
ver
the
past
5 ye
ars
with
83%
rep
ortin
g ex
posu
re
to t
wo
or m
ore;
(2)
91%
sco
red
over
the
cut
-of
f for
PT
SD a
nd (
3) t
raum
a ex
posu
re, s
ocia
l su
ppor
t an
d co
ping
sty
le s
igni
fican
tly c
ontr
ibut
ed
to le
vels
of P
TSD
sym
ptom
atol
ogy.
(Con
tinue
d)
Tabl
e 2.
(C
ontin
ued)
Varker et al. 13
Australian & New Zealand Journal of Psychiatry, 00(0)
Aut
hor
(yea
r)T
itle
of t
he s
tudy
Aim
s/ob
ject
ives
Part
icip
ants
Dat
a so
urce
s/
Met
hodo
logy
Mai
n fin
ding
s
Sk
effin
gton
et
al.
(201
6)T
he p
rim
ary
prev
entio
n of
PT
SD in
fire
fight
ers:
pr
elim
inar
y re
sults
of a
n R
CT
with
12-
mon
th fo
llow
-up
Dev
elop
and
eva
luat
e an
evi
denc
e-ba
sed
and
theo
ry-d
rive
n pr
ogra
mm
e fo
r th
e pr
imar
y pr
even
tion
of P
TSD
45 c
aree
r re
crui
ts
firef
ight
ers
in
Wes
tern
Aus
tral
ia
Dat
a so
urce
s: Se
lf-re
port
qu
estio
nnai
res
Met
hodo
logy
: Clu
ster
ed
RC
T w
ith 1
2-m
onth
fo
llow
-up
The
re w
as n
o ev
iden
ce t
hat
the
inte
rven
tion
was
effe
ctiv
e in
the
pri
mar
y pr
even
tion
of
men
tal h
ealth
issu
es n
or a
ny s
igni
fican
t im
pact
on
soc
ial s
uppo
rt o
r co
ping
str
ateg
ies.
A
sign
ifica
nt d
iffer
ence
acr
oss
cond
ition
s in
tra
uma
know
ledg
e w
as fo
und.
T
ucke
y an
d H
ayw
ard
(201
1)
Glo
bal a
nd o
ccup
atio
n-sp
ecifi
c em
otio
nal r
esou
rces
as
buf
fers
aga
inst
the
em
otio
nal d
eman
ds o
f fir
e-fig
htin
g
Exam
ine
glob
al (
gene
ral)
emot
iona
l res
ourc
es a
nd
an o
ccup
atio
n-sp
ecifi
c em
otio
nal r
esou
rce
(cam
arad
erie
) as
pot
entia
l bu
ffers
aga
inst
the
de
lete
riou
s ef
fect
s of
em
otio
nal d
eman
ds o
n fir
efig
hter
s
547
SA C
ount
ry
Fire
Ser
vice
vo
lunt
eer
firef
ight
ers
Dat
a so
urce
s: Se
lf-re
port
qu
estio
nnai
reM
etho
dolo
gy: C
ross
-se
ctio
nal
Thr
ough
pat
h an
alys
is, c
amar
ader
ie w
as
iden
tifie
d as
hav
ing
the
mos
t co
nsis
tent
pr
otec
tive
effe
cts
agai
nst
poor
psy
chol
ogic
al
heal
th. T
he e
ffect
s of
glo
bal e
mot
iona
l res
ourc
es
wer
e no
t as
con
sist
ent
T
ucke
y an
d Sc
ott
(201
4)G
roup
Cri
tical
Inci
dent
St
ress
Deb
rief
ing
(CSI
D)
with
em
erge
ncy
serv
ices
pe
rson
nel:
a ra
ndom
ised
co
ntro
lled
tria
l
Eval
uate
the
effi
cacy
of
Gro
up C
ISD
in t
he
prev
entio
n of
pos
t-tr
aum
atic
str
ess
and
the
prom
otio
n of
ret
urn
to
norm
al fu
nctio
ning
67 S
A v
olun
teer
fir
efig
hter
s w
ho
expe
rien
ced
a PT
E
Dat
a so
urce
s: Se
lf-re
port
qu
estio
nnai
res
Met
hodo
logy
: RC
T
com
pari
ng (
1) C
ISD
with
(2
) st
ress
man
agem
ent
educ
atio
n an
d (3
) sc
reen
ing
CIS
D w
as a
ssoc
iate
d w
ith s
igni
fican
tly le
ss
alco
hol u
se p
ost-
inte
rven
tion
rela
tive
to
scre
enin
g on
ly a
nd s
igni
fican
tly g
reat
er p
ost-
inte
rven
tion
qual
ity o
f life
rel
ativ
e to
edu
catio
n.
The
re w
ere
no s
igni
fican
t ef
fect
s on
pos
t-tr
aum
atic
str
ess
or p
sych
olog
ical
dis
tres
s.
Polic
e
Ba
lmer
et
al.
(201
4)Ps
ycho
logi
cal r
esili
ence
of
Wes
tern
Aus
tral
ian
polic
e of
ficer
s: r
elat
ions
hip
betw
een
resi
lienc
e,
copi
ng s
tyle
, psy
chol
ogic
al
func
tioni
ng a
nd
dem
ogra
phic
s
Exam
ine
the
rela
tions
hip
betw
een
resi
lienc
e, c
opin
g st
yles
, psy
chol
ogic
al
func
tioni
ng a
nd
dem
ogra
phic
var
iabl
es
285
WA
pol
ice
offic
ers
Dat
a so
urce
s: Se
lf-re
port
qu
estio
nnai
res
Met
hodo
logy
: Cro
ss-
sect
iona
l
(1)
Gre
ater
use
of r
atio
nal c
opin
g an
d le
ss u
se
of e
mot
iona
l cop
ing
was
pre
dict
ive
of r
esili
ence
; (2
) ps
ycho
logi
cal f
unct
ioni
ng d
id n
ot p
redi
ct
resi
lienc
e an
d re
silie
nce
decr
ease
d w
ith a
ge
and
year
s of
ser
vice
; (3)
the
re w
ere
no g
ende
r di
ffere
nces
for
resi
lienc
e an
d (4
) de
mog
raph
ic
vari
able
s in
fluen
ced
copi
ng s
tyle
s in
tha
t w
hile
bo
th g
ende
rs p
refe
rred
rat
iona
l cop
ing,
fem
ales
us
ed e
mot
iona
l cop
ing
stra
tegi
es m
ore,
whi
le
mal
es u
sed
deta
ched
cop
ing
mor
e
(Con
tinue
d)
Tabl
e 2.
(C
ontin
ued)
14 ANZJP Articles
Australian & New Zealand Journal of Psychiatry, 00(0)
Aut
hor
(yea
r)T
itle
of t
he s
tudy
Aim
s/ob
ject
ives
Part
icip
ants
Dat
a so
urce
s/
Met
hodo
logy
Mai
n fin
ding
s
Bu
rke
and
Shak
espe
are-
Finc
h (2
011)
Mar
kers
of r
esili
ence
in n
ew
polic
e of
ficer
s: a
ppra
isal
of
pot
entia
lly t
raum
atis
ing
even
tsN
ote:
A s
econ
d pe
er-
revi
ewed
pub
licat
ion
was
pr
oduc
ed b
ased
on
the
prot
ocol
for
this
stu
dy.
Title
: The
dev
elop
men
t an
d im
plem
enta
tion
of t
he
prom
otin
g re
silie
nt o
ffice
rs
(PR
O)
prog
ram
me
Tes
t th
e ef
ficac
y of
a n
ew
prog
ram
me
desi
gned
to
prom
ote
men
tal h
ealth
78 n
ewly
re
crui
ted
polic
e of
ficer
s in
the
Q
LD P
olic
e Se
rvic
e
Dat
a so
urce
s: Se
lf-re
port
qu
estio
nnai
res
Met
hodo
logy
: Lon
gitu
dina
l co
hort
The
exp
erie
nce
of a
tra
umat
ic e
vent
pri
or
to jo
inin
g th
e po
lice
may
faci
litat
e po
sitiv
e em
otio
nal o
utco
mes
from
exp
osur
e to
adv
erse
ev
ents
on
the
job
D
olla
rd e
t al
. (2
012)
Psyc
hoso
cial
saf
ety
clim
ate
mod
erat
es t
he jo
b de
man
d–re
sour
ce in
tera
ctio
n in
pr
edic
ting
wor
kgro
up
dist
ress
Not
e: A
sec
ond
peer
-re
view
ed p
ublic
atio
n w
as
prod
uced
usi
ng t
his
data
se
t: Ti
tle: O
rgan
izat
ion–
envi
ronm
ent
adap
tatio
n: A
m
acro
-leve
l shi
ft in
mod
elin
g w
ork
dist
ress
and
mor
ale
Tes
t th
e co
ntex
tual
effe
cts
of p
sych
osoc
ial s
afet
y cl
imat
e on
wor
k st
ress
th
eori
es o
f job
dem
ands
, jo
b re
sour
ces
and
psyc
holo
gica
l dis
tres
s
319
polic
e of
ficer
s (c
onst
able
s in
fron
t lin
e ac
tiviti
es o
nly)
fr
om 2
3 st
atio
ns
in a
n A
ustr
alia
n st
ate
(unk
now
n lo
catio
n)
Dat
a so
urce
s: Se
lf-re
port
qu
estio
nnai
res
Met
hodo
logy
: Lon
gitu
dina
l w
ith t
wo
time
poin
ts
14 m
onth
s ap
art
Hig
h em
otio
nal r
esou
rces
mod
erat
ed t
he
posi
tive
rela
tions
hip
betw
een
emot
iona
l de
man
ds a
nd c
hang
e in
wor
kgro
up d
istr
ess
but
only
whe
n th
ere
wer
e hi
gh le
vels
of u
nit
psyc
hoso
cial
saf
ety
clim
ate.
The
aut
hors
em
phas
ise
the
impo
rtan
ce o
f str
engt
heni
ng
psyc
hoso
cial
saf
ety
clim
ate
as a
mea
ns t
o re
duce
th
e he
alth
har
min
g ef
fect
s of
em
otio
nal d
eman
ds
via
the
impr
oved
upt
ake
of e
mot
iona
l res
ourc
es
by e
mpl
oyee
s.
El
liott
and
Lal
(2
016)
Bloo
d pr
essu
re, s
leep
qua
lity
and
fatig
ue in
shi
ft-w
orki
ng
polic
e of
ficer
s: e
ffect
s of
a
12-h
our
rost
er s
yste
m o
n ca
rdio
vasc
ular
and
sle
ep
heal
th
Inve
stig
ate
whe
ther
shi
ft
wor
k ha
s a
dire
ct e
ffect
up
on b
lood
pre
ssur
e re
gula
tion
206
gene
ral-d
uty
NSW
pol
ice
offic
ers
Dat
a so
urce
s: Bl
ood
pres
sure
and
sel
f-rep
ort
ques
tionn
aire
sM
etho
dolo
gy: C
ross
-se
ctio
nal
Poor
sle
ep q
ualit
y an
d fa
tigue
wer
e pr
edom
inat
e in
the
sam
ple
(69%
and
51%
, res
pect
ivel
y).
The
re w
as a
sig
nific
ant
incr
ease
in s
ysto
lic b
lood
pr
essu
re fo
r fe
mal
es a
fter
shi
ft w
ork.
Blo
od
pres
sure
and
fatig
ue w
ere
stro
ngly
rel
ated
for
all
polic
e of
ficer
s.
K
elty
and
G
ordo
n (2
015)
No
burn
out
at t
his
coal
fa
ce: m
anag
ing
occu
patio
nal
stre
ss in
fore
nsic
per
sonn
el
and
the
impl
icat
ions
for
fore
nsic
and
cri
min
al ju
stic
e ag
enci
es
Det
erm
ine
how
cri
me
scen
e in
vest
igat
ors
man
age
thei
r st
ress
ful o
ccup
atio
n
19 c
rim
e sc
ene
inve
stig
ator
s fr
om
arou
nd A
ustr
alia
Dat
a so
urce
s: Ps
ycho
met
ric
and
qual
itativ
e ps
ycho
logi
cal p
rofil
es o
f to
p-pe
rfor
min
g cr
ime
scen
e in
vest
igat
ors
Met
hodo
logy
: Cro
ss-
sect
iona
l
The
cri
me
scen
e in
vest
igat
ors
wer
e aw
are
of t
he
pote
ntia
l str
ess
of t
heir
occ
upat
ion
and
activ
ely
enga
ged
in s
elf-s
tres
s m
anag
emen
t st
rate
gies
.
(Con
tinue
d)
Tabl
e 2.
(C
ontin
ued)
Varker et al. 15
Australian & New Zealand Journal of Psychiatry, 00(0)
Aut
hor
(yea
r)T
itle
of t
he s
tudy
Aim
s/ob
ject
ives
Part
icip
ants
Dat
a so
urce
s/
Met
hodo
logy
Mai
n fin
ding
s
La
Mon
tagn
e et
al.
(201
6)A
n in
tegr
ated
wor
kpla
ce
men
tal h
ealth
inte
rven
tion
in
a po
licin
g co
ntex
t: pr
otoc
ol
for
a cl
uste
r-ra
ndom
ised
co
ntro
l tri
al
Dev
elop
the
pro
toco
l fo
r a
clus
ter-
rand
omis
ed
tria
l to
eval
uate
the
im
plem
enta
tion
and
effe
ctiv
enes
s of
a
wor
kpla
ce m
enta
l hea
lth
inte
rven
tion
All
polic
e of
ficer
s fr
om 2
4 st
atio
ns
loca
ted
in in
ner
and
oute
r Ea
ster
n an
d N
orth
wes
t po
lice
dist
rict
s in
V
icto
ria
Dat
a so
urce
s: Se
lf-re
port
qu
estio
nnai
res
Met
hodo
logy
: Tw
o-ar
m
clus
ter-
rand
omis
ed t
rial
w
ith 1
2 po
lice
stat
ions
re
ceiv
ing
the
inte
rven
tion
and
12 r
ecei
ving
wai
t-lis
t co
ntro
l
N/A
La
rsen
et
al.
(201
6)T
he in
jury
pro
file
of a
n A
ustr
alia
n sp
ecia
list
polic
ing
unit
To
inve
stig
ate
the
inju
ries
su
stai
ned
by a
n A
ustr
alia
n sp
ecia
list
polic
e di
visi
on
138
polic
e of
ficer
s (u
nkno
wn
loca
tion)
Dat
a so
urce
s: In
jury
re
cord
s sp
anni
ng 4
year
s (2
010–
2014
)M
etho
dolo
gy: C
ross
-se
ctio
nal
138
repo
rted
inju
ries
, 58
on m
ultip
le o
ccas
ions
. 22
9 in
juri
es a
nd 7
6 cl
aim
s ra
ised
. Phy
sica
l in
juri
es w
ere
the
mos
t co
mm
on. 1
1 in
juri
es
wer
e ca
tego
rise
d as
wor
kpla
ces
stre
ss. I
njur
ies
asso
ciat
ed w
ith w
orkp
lace
str
ess
aros
e fr
om
a m
ix o
f stim
uli,
incl
udin
g ac
ute
or c
hron
ic
expo
sure
to
criti
cal i
ncid
ents
(e.
g. s
hoot
ing,
ho
mic
ide)
, offi
ce s
tres
s an
d bu
llyin
g
Le
wis
et
al.
(201
4)O
rgan
isat
iona
l im
plem
enta
tion
of
psyc
holo
gica
l fir
st a
id (
PFA
): tr
aini
ng fo
r m
anag
ers
and
peer
s
Eval
uate
the
effe
ctiv
enes
s of
PFA
tra
inin
g (in
clud
ing
psyc
hoed
ucat
ion
on P
TEs
) to
indi
vidu
als
from
the
Q
ueen
slan
d Po
lice
Serv
ice
321
man
ager
s an
d 26
1 pe
er
supp
orte
rs fr
om
the
QLD
Pol
ice
Serv
ice
Dat
a so
urce
s: Se
lf-re
port
qu
estio
nnai
res
Met
hodo
logy
: Pre
-pos
t
Tra
inin
g le
d to
incr
ease
s in
thr
ee k
ey d
omai
ns:
know
ledg
e re
late
d to
PT
Es a
nd P
FA, s
elf-
repo
rted
ski
lls r
equi
red
to r
espo
nd a
ppro
pria
tely
to
a P
TE
and
conf
iden
ce t
o re
spon
d to
PT
Es.
La
wso
n et
al.
(201
2)M
enta
l hea
lth o
f a p
olic
e fo
rce:
est
imat
ing
prev
alen
ce
of w
ork-
rela
ted
depr
essi
on
in A
ustr
alia
with
out
a di
rect
na
tiona
l mea
sure
Aim
ed t
o es
timat
e th
e ri
sk
of w
ork-
rela
ted
depr
essi
on
in A
ustr
alia
n w
orke
rs b
y ex
trap
olat
ing
from
the
pr
eval
ence
of d
epre
ssio
n in
po
lice
offic
ers.
631
polic
e of
ficer
s (u
nkno
wn
loca
tion)
Dat
a so
urce
s: Se
lf-re
port
qu
estio
nnai
res
Met
hodo
logy
: Cro
ss-
sect
iona
l
Dep
ress
ion
prev
alen
ce in
pol
ice
offic
ers
rang
ed
from
37%
to
66%
.
N
oble
t et
al.
(201
2)U
sing
job
stra
in a
nd
orga
nisa
tiona
l jus
tice
mod
els
to p
redi
ct m
ultip
le fo
rms
of e
mpl
oyee
per
form
ance
be
havi
ours
am
ong
Aus
tral
ian
polic
ing
pers
onne
l
Exam
ine
the
rela
tions
hip
betw
een
stre
ss-r
elat
ed
wor
king
con
ditio
ns a
nd
thre
e fo
rms
of e
mpl
oyee
pe
rfor
man
ce b
ehav
iour
s in
rol
e be
havi
ours
, ci
tizen
ship
beh
avio
urs
dire
cted
at
othe
r in
divi
dual
s an
d ci
tizen
ship
be
havi
ours
dir
ecte
d at
the
or
gani
satio
n.
640
polic
e of
ficer
s(u
nkno
wn
loca
tion)
Dat
a so
urce
s: Se
lf-re
port
qu
estio
nnai
res
Met
hodo
logy
: Cro
ss-
sect
iona
l
Ove
rall
resu
lts in
dica
ted
that
a s
igni
fican
t pr
opor
tion
of t
he v
aria
nce
in a
ll th
ree
outc
ome
mea
sure
s w
as a
ttri
bute
d to
the
add
itive
effe
cts
of d
eman
d, c
ontr
ol a
nd s
uppo
rt.
(Con
tinue
d)
Tabl
e 2.
(C
ontin
ued)
16 ANZJP Articles
Australian & New Zealand Journal of Psychiatry, 00(0)
Aut
hor
(yea
r)T
itle
of t
he s
tudy
Aim
s/ob
ject
ives
Part
icip
ants
Dat
a so
urce
s/
Met
hodo
logy
Mai
n fin
ding
s
Po
wel
l and
T
omyn
(20
11)
Life
sat
isfa
ctio
n am
ong
polic
e of
ficer
s w
orki
ng
in t
he a
rea
of c
hild
-abu
se
inve
stig
atio
n
Inve
stig
ate
the
role
of
life
satis
fact
ion
in P
olic
e of
ficer
s w
orki
ng in
chi
ld-
abus
e in
vest
igat
ion
214
polic
e of
ficer
s w
orki
ng
in c
hild
-abu
se
inve
stig
atio
n fr
om
four
sta
tes
in
Aus
tral
ia
Dat
a so
urce
s: A
sin
gle
ques
tion
Met
hodo
logy
: Cro
ss-
sect
iona
l
(1)
Ove
rall
life
satis
fact
ion
for
child
-abu
se
inve
stig
ator
s w
as lo
w b
ut it
was
sim
ilar
to t
hat
of t
he g
ener
al p
opul
atio
n; (
2) t
here
was
no
diffe
renc
es in
life
sat
isfa
ctio
n be
twee
n ge
nder
an
d (3
) de
gree
of e
xpos
ure
to t
raum
a m
ater
ial
and
asso
ciat
ed w
orkp
lace
str
esso
rs w
as n
ot
asso
ciat
ed w
ith li
fe s
atis
fact
ion.
Po
wel
l et
al.
(201
3)W
orkp
lace
str
esso
rs fo
r in
vest
igat
ive
inte
rvie
wer
s of
ch
ild-a
buse
vic
tims
Iden
tify
the
natu
re a
nd
prev
alen
ce o
f wor
kpla
ce
stre
ssor
s fa
ced
by
inte
rvie
wer
s of
chi
ld s
exua
l as
saul
t vi
ctim
s
68 p
rofe
ssio
nals
, of
whi
ch 4
1 w
ere
polic
e (A
ustr
alia
w
ide)
Dat
a so
urce
s: In
tern
et
disc
ussi
on fo
rum
Met
hodo
logy
: Cro
ss-
sect
iona
l
(1)
Thr
ee s
tres
sors
wer
e id
entif
ied:
inad
equa
te
reco
gniti
on o
f spe
cial
ised
ski
lls, h
igh-
wor
kloa
d de
man
ds a
nd in
tera
genc
y te
nsio
ns a
nd (
2)
expo
sure
to
child
-abu
se r
epor
ts w
as n
ot r
aise
d as
a s
tres
sor.
Po
wel
l et
al.
(201
4)Po
lice
offic
ers’
str
ateg
ies
for
copi
ng w
ith t
he s
tres
s of
in
vest
igat
ing
Inte
rnet
chi
ld
expl
oita
tion
(ICE)
.N
ote:
A s
econ
d pe
er-
revi
ewed
pub
licat
ion
was
pr
oduc
ed u
sing
thi
s da
ta
set:
Title
: Pol
ice
offic
ers’
pe
rcep
tions
of t
heir
re
actio
ns t
o vi
ewin
g IC
E m
ater
ial
To
exam
ine
the
copi
ng
stra
tegi
es o
f IC
E in
vest
igat
ors
32 IC
E in
vest
igat
ors
(Aus
tral
ia w
ide)
Dat
a so
urce
s: Q
ualit
ativ
e in
terv
iew
sM
etho
dolo
gy: C
ross
-se
ctio
nal
Ove
rall,
the
par
ticip
ants
cop
ed w
ith t
he jo
b w
ell a
nd e
mpl
oyed
sev
eral
pro
duct
ive
copi
ng
stra
tegi
es.
T
omyn
et
al.
(201
5)Ex
amin
atio
n of
the
su
bjec
tive
wel
lbei
ng o
f A
ustr
alia
n IC
E in
vest
igat
ors
Inve
stig
ate
the
wel
lbei
ng o
f po
lice
offic
ers
wor
king
in
child
-abu
se in
vest
igat
ion
139
polic
e of
ficer
s w
orki
ng
in c
hild
-abu
se
inve
stig
atio
n (u
nkno
wn
loca
tion)
co
mpa
red
to
55,6
97 A
ustr
alia
ns
adul
ts
Dat
a so
urce
s: T
he
Aus
tral
ian
Uni
ty W
ellb
eing
In
dex
data
set
from
200
1 to
201
2M
etho
dolo
gy: C
ross
-se
ctio
nal c
ohor
t
Aus
tral
ian
polic
e of
ficer
s w
ho w
ork
in t
he
conf
ront
ing
area
of I
CE
inve
stig
atio
n ha
ve
a hi
gher
tha
n no
rmat
ive
leve
l of s
ubje
ctiv
e w
ellb
eing
.
T
ucke
y et
al.
(201
2)Ps
ycho
soci
al c
ultu
re a
nd
path
way
s to
psy
chol
ogic
al
inju
ry w
ithin
pol
icin
g
Expl
ore
the
evol
utio
n of
w
ork-
rela
ted
psyc
holo
gica
l in
jury
in p
olic
ing,
focu
sing
on
the
rol
e of
pol
ice
psyc
hoso
cial
cul
ture
25 S
outh
A
ustr
alia
n po
lice
offic
ers
Dat
a so
urce
s: Se
mi-
stru
ctur
ed in
terv
iew
, fo
cus
grou
ps a
nd w
ritt
en
subm
issi
ons
Met
hodo
logy
: Cro
ss-
sect
iona
l
The
psy
chos
ocia
l con
text
sur
roun
ding
op
erat
iona
l pol
icin
g pl
ayed
a c
ritic
al r
ole
in p
sych
olog
ical
inju
ry d
evel
opm
ent
and
prog
ress
ion
CIS
D: C
ritic
al In
cide
nt S
tres
s D
ebri
efin
g; E
I: em
otio
nal i
ntel
ligen
ce; I
CE:
Inte
rnet
chi
ld e
xplo
itatio
n; N
SW: N
ew S
outh
Wal
es; P
FA: p
sych
olog
ical
firs
t ai
d; P
TE:
pot
entia
lly t
raum
atic
eve
nt; P
TSD
: pos
t-tr
aum
atic
str
ess
diso
rder
; QLD
: Que
ensl
and;
RC
T: r
ando
mis
ed c
ontr
olle
d tr
ial;
SA: S
outh
Aus
tral
ia; W
A: W
este
rn A
ustr
alia
.
Tabl
e 2.
(C
ontin
ued)
Varker et al. 17
Australian & New Zealand Journal of Psychiatry, 00(0)
assessment stage, it was found the majority included a sin-gle-service population. Of interest, there was a significant amount of research on sub-groups of emergency services personnel, such as volunteer firefighters, police investiga-tors of child abuse and emergency medical dispatchers.
Location
Studies were conducted with emergency services personnel from Queensland (14%), South Australia (12%), Victoria (10%), Western Australia (7%) and New South Wales (5%). No studies were conducted with samples that were predom-inately from the ACT, NT or Tasmania, although personnel from these states may have been included in some of the multi-state studies (this was not specified). Around 35% of studies did not list the state(s) that their sample was recruited from. While 17% of the studies were multi-state, there were no studies that representatively sampled all Australian emergency services personnel populations at the national level. The few multi-state studies were narrow in their scope, with one study investigating injured paramed-ics who reported to Safe Work Australia (Maguire et al., 2014), three studies investigating paramedic students enrolled in degrees at Australian universities (McManamny et al., 2013; Williams et al., 2012, 2015), two studies inves-tigating Internet child exploitation investigators (Powell et al., 2013, 2014) and a final study investigating crime scene investigators from around Australia (Kelty and Gordon, 2015). No studies were both multi-service and national in focus.
Research focus
As can be seen from the map (Table 1), the most commonly investigated area of research was organisational factors as they relate to mental health problems and/or wellbeing (13 studies: Adams et al., 2015; Armstrong et al., 2014; Dollard et al., 2012; Gayton and Lovell, 2012; Huynh et al., 2014; McManamny et al., 2013; Noblet et al., 2012; Powell et al., 2013; Powell and Tomyn, 2011; Shakespeare-Finch and Daley, 2016; Smith et al., 2011; Tuckey et al., 2012; Tuckey and Hayward, 2011). This includes factors such as opera-tional aspects (e.g. shift work, potential occupational risks, job demands); aspects of the individual’s career (e.g. student compared to later career workers) and aspects related to emotional resources, or lack thereof, within the workplace (feelings of workplace belongingness; perceived workplace support and sense of camaraderie and bullying). The least researched areas were psychological factors relating to work injury (five studies: Broniecki et al., 2011; Larsen et al., 2016; Maguire et al., 2014; Roberts et al., 2015; Tuckey et al., 2012) and intervention studies targeting mental health or wellbeing (five studies: Burke and Shakespeare-Finch, 2011; LaMontagne et al., 2016; Lewis et al., 2014; Skeffington et al., 2016; Tuckey and Scott, 2014).
Overwhelmingly, the research investigated the impact of mental health on the individual emergency services person-nel. Only one study included both current serving and retired personnel, while six studies involved student para-medic samples. Similarly, few studies involved non-opera-tional personnel. Two studies involved emergency medical dispatchers, and one study involved fire and emergency services personnel and support personnel.
There were several areas of research where very few studies were detected through the mapping process. These include suicide, personality, stigma, pre-employment fac-tors that may contribute to mental health outcomes and the use of e-health. No studies were detected which examined the prevalence of self-harm and/or harm to others, bullying, substance use and barriers to care.
Discussion
This investigation set out to answer two questions: how much research has been undertaken into the mental health and wellbeing of emergency services personnel and what areas are well-researched or conversely under-researched? The resulting evidence map is the first to summarise and describe the characteristics of primary research studies examining the mental health and wellbeing of Australian emergency services personnel, allowing us to identify pri-orities for future research.
The evidence map shows that a substantial amount of research into the mental health and wellbeing of Australian emergency services personnel has been undertaken in the past 5 years. Specifically, a number of studies have investi-gated the organisational factors that impact emergency ser-vices workers’ mental health and wellbeing, as well as individual and social factors that impact mental health and wellbeing. However, there are several gaps within this broad area of research. In particular, there was little inves-tigation of suicide/self-harm or alcohol or substance use disorders. Both of these domains are critical to our under-standing of mental health and wellbeing among emergency services personnel and warrant further research. With respect to suicidality in particular, the findings of higher rates of suicidal ideation than the Australian average among military personnel (McFarlane and Hodson, 2011), a popu-lation that shares repeated exposure to PTEs, highlight the need for further research into suicidality among emergency services personnel.
No studies focused on the experiences of families of emergency services personnel and the potential for ‘spillo-ver’ or how emergency services personnel work both posi-tively or negatively affects the lives of Australian families and loved ones. Again, drawing from military populations, there is evidence that a military career can dramatically impact the lives of family members and loved ones (Australian Centre for Posttraumatic Mental Health, 2012), and early research (Alexander and Walker, 1998; Cowlishaw
18 ANZJP Articles
Australian & New Zealand Journal of Psychiatry, 00(0)
et al., 2010; Murphy et al., 1999; Thompson et al., 2001) suggests that the same may be true in emergency services families.
Unfortunately, the sum of research to date does not permit a comprehensive understanding of the mental health and wellbeing of emergency services personnel. Systematic study with consistency in design and measurement across each sec-tor of the emergency services and a broad focus on the full range of mental health and wellbeing outcomes would pro-vide an important population-based estimate of the preva-lence of mental health disorders across each of the Australian emergency services, as well as critical information on risk and protective factors. This information is required in order to develop evidence-based strategies to promote the wellbeing of emergency services personnel through prevention and early intervention at the individual and organisational levels and targeted strategies for high-risk sub-groups.
Limitations
Evidence mapping is a means of systematically identifying, organising and summarising the evidence pertaining to a broad topic. Defining the boundaries of this or any other evi-dence map is a somewhat subjective step. However, in this instance, we were guided by expert advice and by the end users, beyondblue. Evidence maps differ from other types of systematic reviews in that they provide a snapshot of the existing literature without quality assessment or extensive data synthesis. As such, no assessment of the quality of the studies, or bias in their methodologies was made for the cur-rent study, meaning that it is not possible to make judgments about the quality of research that has been conducted within this area. Given that the primary question of interest was what current evidence exists regarding the mental health and wellbeing of Australian emergency services personnel, the search period was constrained to the past 5 years.
Conclusion
The mental health of Australian emergency services per-sonnel is in the spotlight with the increasing recognition of the potential impact of repeated workplace trauma and the stressors associated with these occupations. Although research has been conducted in Australian emergency ser-vices personnel in the past 5 years, it has been uncoordi-nated and piecemeal. Significantly less is known about the mental health and wellbeing of emergency services person-nel compared to other trauma-exposed populations in Australia. In the first instance, systematic study with con-sistency in design and measurement across each sector of the emergency services that addresses prevalence of mental health disorders is needed. This research is critical to estab-lish the nature and size of the problem as well as allow comparisons between service types. On the basis of this research, a host of other research questions follow,
including attitudes towards help-seeking and barriers to care, the availability and uptake of mental health supports, the provision of evidence-based care and the effectiveness of return-to-work rehabilitation programmes.
Declaration of Conflicting Interests
The author(s) declared no potential conflicts of interest with respect to the research, authorship and/or publication of this article.
Funding
This evidence mapping project was funded by beyondblue as part of its Police and Emergency Services Program. The study sponsor had no role in the study design, data collection, analysis, interpre-tation or writing of this report.
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