Mental health outcomes and intervention strategies for first responders exposed to disasters and occupational trauma: a scoping review

Background First responders are exposed to potentially traumatic events during disaster-related deployments or through cumulative occupational trauma in their routine work. Repeated exposure to critical incidents is associated with an elevated risk of post-traumatic stress symptoms and other mental health outcomes. Although numerous intervention programs exist, literature rarely differentiates between preparedness-oriented, early supportive, and therapeutic approaches, and underreports contextual factors such as organisational support. A structured synthesis is therefore needed to inform stepped-care models within disaster response systems. Objectives The aim of the review was to map and synthesise evidence on psychological outcomes and intervention approaches for first responders and public safety personnel following potentially traumatic events during disaster-related deployments or through routine occupational trauma. Methods We searched PubMed and Google Scholar for studies published between 2015 and 2024 in English or German, and screened reference lists. Eligible studies included first responders or public safety personnel who had been exposed to potentially traumatic events and reported psychological outcomes and/or interventions. Two reviewers conducted two-stage screening, resolving disagreements by consensus. In line with scoping review methodology, no risk-of-bias assessment was performed. Results Fourteen studies (published 2017–2024) were included: nine cross-sectional studies, one single-group pretest–posttest study, one programme evaluation, one randomised controlled trial, one qualitative study, and one systematic review/meta-analysis. Frequently reported outcomes included post-traumatic stress symptoms, depression, anxiety, burnout, alcohol use as well as other mental health constructs. Exposure intensity, social isolation, maladaptive coping, lack of preparatory training, and lower education were associated with poorer outcomes, whereas social support, optimism, perceived preparedness, and organisational factors appeared protective. With respect to interventions, three approaches emerged: psychological preparedness and resilience-based interventions strengthen preparedness and coping resources; early supportive approaches, including peer-based and digital formats, offer accessible support; and therapeutic interventions show the strongest evidence for reducing established symptoms. Conclusion This review reveals patterns of psychological distress among first responders and proposes a pragmatic framework mapping interventions onto a continuum from preparedness through early support to therapy, supporting stepped-care planning. It also identifies key evidence gaps—few controlled trials, limited intervention reporting, heterogeneous outcomes—and outlines priorities for future research.