Mental health and wellbeing interventions for uniformed service personnel: a mixed methods systematic review

Abstract Background Uniformed service personnel are routinely exposed to occupational trauma in their roles which contribute to elevated rates of mental health conditions. A wide range of mental health and wellbeing interventions may help uniformed service personnel manage their psychological responses to challenging incidents at work. Previous reviews of those interventions have focused on single groups of professionals or intervention types, limiting cross-sector insights. This review uses a mixed methods approach to synthesise evidence associated with mental health and wellbeing interventions across uniformed services. Methods The protocol was registered with PROSPERO (CRD42024605877). A mixed methods systematic review was conducted using the Joanna Briggs Institute (JBI) convergent segregated approach. Searches were conducted in Medline, CINAHL, Web of Science and PsycINFO (Dec 2024). Screening and quality appraisal (Mixed Methods Appraisal Tool) were performed independently by two reviewers. Due to heterogeneity, findings were narratively synthesised. Quantitative and qualitative results were integrated following the JBI approach. Results Eighty-six primary studies from 22 countries were included, covering a range of professions and intervention types. Synthesis of quantitative data from 82 studies showed that mindfulness-based training, resilience coaching, cognitive behavioural therapies and supported lifestyle activities demonstrated reduced symptoms of PTSD, anxiety and depression. However, interventions such as Critical Incident Stress Debriefing (CISD) and peer support yielded mixed results. Qualitative data from 9 studies were grouped into 5 categories: enhanced emotional insight, improved interpersonal relationships, perceived effectiveness, barriers to engagement and delivery challenges. Participants valued interventions that fostered self-awareness and support but cited stigma, guilt and logistical constraints as significant barriers. Integration of quantitative and qualitative findings revealed alignment in outcomes for several interventions, while highlighting evidence gaps, such as the lack of qualitative data for many interventions and limited exploration of cultural and organisational barriers. Conclusions Mental health interventions for uniformed service personnel show promise but are influenced by delivery format, occupational culture and contextual factors. This review underscores the need for delivering interventions informed by ecological models, standardised outcome sets and deeper qualitative exploration into stigma and engagement barriers.