The associations between job stress and physical and mental health in firefighters: a systematic review

Background Firefighters are exposed to psychosocial stressors including interpersonal conflict, organizational injustice, and discrimination. This systematic review investigated the associations between work-related psychosocial stress and physical and mental health outcomes among firefighters. Methods A comprehensive search was performed in PubMed, PsycINFO, CINAHL, Scopus, Web of Science, and Google Scholar from inception to May 2026. Original cross-sectional, longitudinal, and cohort studies examining associations between job stress and health outcomes in firefighters were included. The review focused on six outcome domains: (1) depression and suicidality, (2) non-depressive mental health problems (PTSD symptoms, anxiety, burnout), (3) alcohol use disorders, (4) sleep quality, (5) somatic disorders (cardiovascular, musculoskeletal, gastrointestinal), and (6) physical performance. Quality assessment was conducted using the Newcastle–Ottawa Scale (NOS). A thematic narrative synthesis was employed due to methodological heterogeneity. Findings were synthesized narratively, with key odds ratios (ORs) extracted and presented in summary tables. Results Thirty-four original studies involving 87,242 firefighters across Asia, North America, Europe, and South America were included. The strongest associations were observed for organizational system stress with self-reported depressive symptoms (OR = 8.03 in the longitudinal study), discrimination and harassment with self-reported PTSD symptoms (OR = 2.21) and anxiety (OR = 2.56) in female firefighters, and lack of reward with gastrointestinal disorders (OR = 2.17–2.39) and musculoskeletal disorders (OR = 2.39). Protective factors including social support, self-efficacy, and resilience consistently buffered stress-related health outcomes. Physical performance declined with age (12–13% decrease in strength and power), and less experienced firefighters demonstrated greater physiological stress responses. Conclusion Job stress is associated with pervasive and clinically significant adverse health outcomes in firefighters. The available evidence, predominantly cross-sectional, suggests associations rather than causal effects. Organizational interventions targeting workplace fairness, conflict reduction, and anti-discrimination policies, alongside individual-level resilience training, are warranted. Protecting firefighter health through evidence-based stress prevention is an occupational health priority. PROSPERO registration number CRD420261417550.