Protecting High-Risk Workers: Available Evidence and Implications for Guidelines

Introduction: Evidence-based guidelines for psychosocial care support the well-being of workers in high-risk fields like ambulance services, the fire brigade, and the police. Between 2022 and 2024, the Dutch guidelines were fully revised. Part of this revision involved a systematic literature review to examine (1) psychological effects of impactful events on uniformed personnel and factors that influence these risks, and (2) available evidence for effective prevention strategies. Methods: Two comprehensive searches were conducted in Ovid Medline ALL (1949-2022), PsycINFO (Ovid; 1806-2022), and PTSDpubs (National Center for PTSD, US; 1871-2022) between September and November 2022, with an update in summer 2024. Both searches were registered in PROSPERO. A wide range of search terms was used, derived from existing guidelines, expanded with new terms, and peer-reviewed by experts to ensure relevance. Two independent researchers screened the results and extracted key data, with 15-20% double-checked for consistency. Methodological quality of all included studies was assessed. Results: For study one, 1,413 studies were screened, resulting in 43 included studies. The quality of studies (using AMSTAR criteria) was generally low, and most were cross-sectional. Effects were found in several domains: somatic, psychological, social, work-related, behavioral, and ethical. Risk factors included aspects of the incident, personal history, work pressure, and coping style, while protective factors included work meaningfulness, social support, and training. For study two, 2,334 studies were screened, with 22 RCTs included. Twenty-five prevention interventions were identified, most being selective (48%) or universal (40%) in nature. However, study quality was generally low (according to the Cochrane Risk of Bias tool), with some interventions showing mixed outcomes. Conclusion: The identified factors and prevention studies are valuable for understanding and addressing mental health challenges in high-risk occupations. However, the review highlights a lack of high-quality empirical knowledge, complicating the development of evidence-based guidelines and urging for expert-based co-creation models.