Post-traumatic stress disorder in emergency response

Abstract

Introduction: Emergency workers are exposed to potentially traumatic situations, so it would be of interest to show whether there is a relationship between these professionals and the development of Post-Traumatic Stress Disorder (PTSD). The aim is to know if there is evidence of such relationship, in addition to identify associated vulnerability factors and effective preventive and therapeutic interventions.

Method: Systematic review through bibliographic research in MEDLINE in PUBMED, SCOPUS, EMBASE, WOS, Cochrane Library Plus, IBECS, LILACS and CISDOC databases, using MeSH terms «emergency responders» and «stress disorder, post-traumatic». CONSORT, STROBE quality standards were applied and we checked the evidence using the SIGN system.

Results: They were selected 6 RCTs (n = 783) and 1 historical cohort study (n = 4487). The most frequent risk factors are: female sex 2.93 (1.42-6.07), diagnosis of depression or anxiety 4.72 (2.33-9.57) in chronicity and substance abuse 5.12 (2.62-9.97) in worsening of PTSD. There are no improvements in preventive interventions (p = 0.712-0.749) and (p = 0.246-0.881). In 2 RCTs, a reduction in the severity of PTSD symptoms was evidenced by Cognitive Behavioral Therapy (CBT) (p = 0.001 and 0.05). There are 2 RCTs with oxytocin that reveal an impact on neural regions for emotional management (p = 0.0024-0.044).

Conclusions: There is a causal relationship between PTSD and emergency workers (evidence 2+). As a treatment, CBT is effective in reducing PTSD symptoms (evidence 1+). The aforementioned vulnerability factors were shown as the most important (evidence 1+). Oxytocin showed evidence as a therapeutic ally (evidence 1+).