Silent crisis on the frontlines: a systematic review of suicidal behaviors among disaster responders - epidemiology, risk pathways, and evidence-based interventions.

IF 3.1 2区医学 Q1 EMERGENCY MEDICINE

Scandinavian Journal of Trauma Resuscitation & Emergency Medicine Pub Date : 2025-10-03 DOI:10.1186/s13049-025-01479-z

Shandiz Moslehi, Asghar Tavan, Mehdi Khezeli, Samira Soleimanpour, Sajjad Narimani

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引用次数: 0

Abstract

Background: First responders (including paramedics, firefighters, police, and dispatchers) experience significantly elevated suicide risk due to repeated trauma exposure, high rates of PTSD and depression, and systemic barriers to mental healthcare. This systematic review examines (1) suicide prevalence, (2) psychological and occupational risk factors, and (3) interventions across different emergency service roles and global contexts.

Method: This study rigorously adhered to the PRISMA guidelines in conducting a systematic and comprehensive analysis of 24 peer-reviewed studies (up to February 2025), meticulously sourced from PubMed, Scopus, Web of Science, and Embase. Only studies providing unique qualitative or quantitative insights into Suicidal Behaviors Among Disaster Responders were included. The extracted data was meticulously examined using advanced thematic analysis and robust descriptive statistics, ensuring a deep, evidence-based exploration of this critical issue.

Results: The systematic analysis of 24 studies revealed four critical categories shaping suicidal behaviors among disaster responders: (1) Epidemiology and Prevalence, highlighting elevated risks in firefighters and EMS personnel; (2) Psychological and Occupational Risk Factors, including PTSD, depression, and workplace burnout; (3) Systemic and Cultural Barriers, such as stigma and rural access gaps; and (4) Interventions and Solutions, demonstrating efficacy in trauma-focused therapies, peer support, and policy reforms like Houston's zero-suicide program. Thematic synthesis underscored the interplay of individual vulnerabilities and structural failures, urging integrated, occupation-specific prevention strategies.

Conclusion: Effective prevention requires integrated clinical interventions (trauma-focused therapies), organizational reforms (routine screenings), and cultural shifts (destigmatization).

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前线无声的危机：对灾难应对者自杀行为的系统回顾——流行病学、风险途径和基于证据的干预措施。

背景：第一响应者（包括护理人员、消防员、警察和调调员）由于反复的创伤暴露、高PTSD和抑郁症发生率以及精神卫生保健的系统性障碍，自杀风险显著增加。本系统综述研究了(1)自杀患病率，(2)心理和职业风险因素，以及(3)不同应急服务角色和全球背景下的干预措施。方法：本研究严格遵循PRISMA指南，对24项同行评议的研究（截至2025年2月）进行了系统和全面的分析，精心筛选了PubMed， Scopus， Web of Science和Embase。只有研究提供了独特的定性或定量见解自杀行为在灾难响应者包括在内。使用先进的专题分析和强大的描述性统计对提取的数据进行了细致的检查，确保对这一关键问题进行深入的、基于证据的探索。结果：通过对24项研究的系统分析，揭示了影响灾害应急人员自杀行为的4个关键类别：(1)流行病学和流行病学，其中消防员和急救人员的自杀风险较高；(2)心理和职业风险因素，包括创伤后应激障碍、抑郁和工作倦怠；(3)系统和文化障碍，如耻辱和农村准入差距；(4)干预和解决方案，展示了以创伤为中心的治疗、同伴支持和政策改革（如休斯顿的零自杀计划）的有效性。专题综合强调了个人脆弱性和结构性缺陷的相互作用，敦促采取针对具体职业的综合预防战略。结论：有效的预防需要综合临床干预（以创伤为重点的治疗）、组织改革（常规筛查）和文化转变（去污名化）。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Scandinavian Journal of Trauma Resuscitation & Emergency Medicine EMERGENCY MEDICINE-

CiteScore

6.10

自引率

6.10%

发文量

审稿时长

6-12 weeks

期刊介绍： The primary topics of interest in Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine (SJTREM) are the pre-hospital and early in-hospital diagnostic and therapeutic aspects of emergency medicine, trauma, and resuscitation. Contributions focusing on dispatch, major incidents, etiology, pathophysiology, rehabilitation, epidemiology, prevention, education, training, implementation, work environment, as well as ethical and socio-economic aspects may also be assessed for publication.