Experiences and perceptions of family members of emergency first responders with post-traumatic stress disorder: a qualitative systematic review.

OBJECTIVE: The objective of this review was to examine the perceptions and experiences of family members of emergency first responders (EFRs) with post-traumatic stress disorder (PTSD).

INTRODUCTION: Research indicates that EFR rates of PTSD are approximately double civilian rates, however, very little is known about the resultant effects on their family members. This review identifies the qualitative literature and data examining the perceptions and experiences of families with a current or former EFR member with diagnosed or undiagnosed PTSD.

INCLUSION CRITERIA: This review includes all relevant articles, books, reports, and doctoral theses in English, globally, with no time limits, examining the experiences of family members of current or former EFRs with diagnosed or undiagnosed PTSD. All possible familial configurations and family members were considered, including nuclear, separated, and blended families, of an EFR. There were no age restrictions on EFRs or their family members or limitations on recency of service. EFRs included police, ambulance/paramedics, firefighters, and rescue personnel.

METHODS: The databases searched included MEDLINE (PubMed), PsycINFO (Ovid), Embase, CINAHL (EBSCOhost), and Scopus. Hand-searching of relevant journals was conducted across Australian Paramedic, Australasian Journal of Paramedicine, British Paramedic Journal, International Paramedic Practice, Irish Journal of Paramedicine, Journal of Paramedic Practice, Prehospital and Disaster Medicine, and Prehospital Emergency Care. Sources of unpublished studies and gray literature, such as dissertations, were searched via PTSDpubs (ProQuest) and OpenGrey (DANS ESASY Data Archive). The search was updated in October 2021. Titles, abstracts, and full texts were screened by 2 independent reviewers against the inclusion criteria, and any conflicting views were to be resolved by discussion or a third reviewer, which was not required. Results were critically appraised for methodological quality. Post-data extraction results were synthesized and evaluated for credibility and dependability in accordance with the a priori protocol.

RESULTS: The search yielded 1264 records and 48 were deemed eligible for full-text review. Seven studies were critically appraised, and 5 studies were agreed upon for inclusion in the synthesis. From these 5 results, 53 findings were extracted with associated illustrations and synthesized into 9 categories. Following meta-aggregation, 4 broad synthesized findings were developed: i) Changed family member roles, spousal relationships difficulties and family functioning when living with an EFR PTSD; ii) Spouses of an EFR with PTSD, may experience vicarious trauma, secondary trauma, and/or overburden as a consequence of protecting the family unit; iii) Children of an EFR parent with PTSD may experience secondary trauma, vicarious trauma and/or separation anxiety; and iv) Spouse's help seeking and support needs for their EFR Partners with PTSD, their children and for themselves. The first 3 findings received a low ConQual score due to low dependability and moderate credibility. The final finding received a moderate ConQual score due to low dependability and high credibility.

CONCLUSIONS: The findings of the 5 qualitative studies included in the review showed significant mental health and functional impacts for family members of EFR with PTSD. Most studies focused on spouses, with some limited data on children. Two of the 5 studies included focused on the 9/11 World Trade Center terrorist attacks in the United States of America. The findings also indicate the need for targeted psychological and social services for EFR family members. Recommendations derived from the synthesized findings of this review include the need for further qualitative research, not only to deepen the understanding of the impacts and needs of EFR with PTSD on family members, but also to inform the design and provision of support services.

SYSTEMATIC REVIEW REGISTRATION NUMBER: PROSPERO CRD42020196605.