A systematic review of probable posttraumatic stress disorder in first responders following man-made mass violence

Highlights

• Systematic review of probable PTSD in first responders after man-made mass violence.

• Review only yielded 20 studies that fit the inclusion criteria.

• The prevalence rates of probable PTSD ranged from 1.3% to 22.0%.

• The majority of the articles focused on the September 11th terrorist attacks.

Abstract

The current study was a systematic review examining probable posttraumatic stress disorder (PTSD) in first responders following man-made mass violence. A systematic literature search yielded 20 studies that fit the inclusion criteria. The prevalence rates of probable PTSD across all 20 studies ranged from 1.3% to 22.0%. Fifteen of the 20 articles focused on first responders following the September 11th terrorist attacks and many of the studies used the same participant recruitment pools. Overall, the results of the systematic review described here suggest that our understanding of PTSD in first responders following man-made mass violence is based on a very small set of articles that have focused on a few particular events. This paper is meant to serve as a call for additional research and to encourage more breadth in the specific incidents that are examined.

Introduction

First responders exposed to major disasters (e.g., natural disasters, transportation accidents, terrorist attacks) are at increased risk of posttraumatic stress disorder (PTSD) when compared to first responders who have not worked major disasters and the overall prevalence of PTSD in the general population (Berger et al., 2012, Fullerton et al., 2004). This increase in risk is due to a range of experiences, such as exposure to potential physical harm, witnessing injury and death, and learning upsetting details about horrifying events (Berger et al., 2012). For example, the 12-month prevalence of PTSD among the general population in the United States is approximately 4% (Kessler et al., 2005), whereas the worldwide current prevalence rate among first responders who have worked major disasters is 10% (Berger et al., 2012). The heightened risk demonstrated in first responders following disasters is particularly concerning because empirical evidence suggests that the prevalence of such events is increasing. From 1980 to 1989, there were 2870 disasters, which included natural disasters, technological accidents and man-made mass violence incidents (Eshghi and Larson, 2008). Conversely, from 2000 to 2005, the number of disasters had increased to almost 5000 incidents.

In the quake of recent disasters, particularly mass violence purposely caused by humans (e.g., terrorist attacks, bombings), there has been a growing interest in the mental health of first responders and an emphasis on the quality of care provided to these workers. These events are of particular interest because evidence suggests that man-made disasters lead to more negative psychological consequences than natural disasters (Norris et al., 2002). Therefore, although previous systematic reviews have been conducted on PTSD among first responders (e.g., Berger et al., 2012), these prior studies have largely failed to focus on the effects of man-made mass violence in this population. Furthermore, the present study included a wider range of search terms than Berger et al. (2012) to capture a wider range of relevant articles. The increasing attention on the mental health of first responders is promising because the goal of this area of the literature is to inform interventions and improve support provided to these individuals. The aim of the present study was to conduct a systematic literature search to identify the number of studies conducted on PTSD in first responders following man-made mass violence, determine which specific incidents have been investigated in the literature, and extract the prevalence rates of probable PTSD demonstrated in each study.