Sickness absence among peer-supported drivers after occupational trauma

Post-incident psychosocial interventions after a traumatic incident in the workplace: a systematic review of current research evidence and clinical guidance

Background: After a traumatic incident in the workplace organisations want to provide support for their employees to prevent PTSD. However, what is safe and effective to offer has not yet been established, despite many organisations offering some form of intervention after a traumatic event.Objective: To systematically review the evidence for post-incident psychosocial interventions offered within one month of a workplace trauma, and to compare the content, effectiveness and acceptability of these interventions. Given the lack of a yet clearly established evidence-base in this field, we sought to examine both published empirical research as well as guidelines published by expert groups working with staff in high-risk roles.Methods: We conducted systematic searches for empirical research across bibliographic databases and searched online for clinical practice guidelines to April 2023. We were also referred to potentially relevant literature by experts in workplace trauma. Both empirical research and clinical guidelines were appraised for their quality.Results: A total of 80 research studies and 11 clinical practice guidelines were included in the review. Interventions included Critical Incident Stress Debriefing (CISD), Critical Incident Stress Management (CISM), unspecified Debriefing, Trauma Risk Management (TRiM), Psychological First Aid (PFA), EMDR, CBT and group counselling. Most research and guidance were of poor quality. The findings of this review do not demonstrate any harm caused by CISD, CISM, PFA, TRiM, EMDR, group counselling or CBT interventions when delivered in a workplace setting. However, they do not conclusively demonstrate benefits of these interventions nor do they establish superiority of any specific intervention. Generic debriefing was associated with some negative outcomes. Current clinical guidelines were inconsistent with the current research evidence base. Nevertheless, interventions were generally valued by workers.Conclusions: Better quality research and guidance is urgently needed, including more detailed exploration of the specific aspects of delivery of post-incident interventions.

Impact of Railway Critical Incidents on Train Drivers and Effectiveness of Critical Incident Management and Support Protocols: A Recovery Trajectory Analysis

OBJECTIVE

Train drivers are regularly involved in railway critical incidents (CI) and critical incident management and support protocols (CIMSPs) have been developed to support them. This study describes the impact of CIs and evaluates the effectiveness of CIMSPs.

METHODS

We interviewed 74 train drivers 1 week, 1, 3, and 6 months after a CI. We performed Linear growth model analyses to describe recovery paths and the effect of CIMSPs, considering the effect of CI complexity, proximity to victims, social support, self-assessment of health, use of resources, and attribution of responsibility.

RESULTS

CIs have a significant negative impact on train drivers. Recovery paths can be explained by the level of implementation of CIMSPs, and other contributing factors.

CONCLUSIONS

CIMSPs are effective in reducing the negative impact of CIs and should be implemented rigorously by employers.

Evaluation of the Implementation of a Railway Critical Incident Management and Support Protocol to Help Train Drivers Cope With Accidents and Suicides

OBJECTIVE

Railway accidents and suicides can have severe psychological consequences for train drivers. This study evaluates the implementation of railway critical incident management and support protocols (CIMSP) by employers. It also identifies environmental factors, characteristics of critical incidents, and types of work relations affecting implementation.

METHODS

A longitudinal study was conducted with 74 train drivers. Participants were interviewed 1 week, 1, 3, and 6 months after a critical incident. Correlational analyses were performed to identify factors associated with implementation and satisfaction.

RESULTS

CIMSP are generally partially applied by employers when a railway incident occurs. Workers' satisfaction toward implementation of the protocol is moderate. Obstacles to implementation are: geographic isolation, severity of the incident, and poor quality of work relations.

CONCLUSIONS

These obstacles should be addressed in CIMSP design and implementation strategies.

Occupational exposure and post-traumatic stress disorder: A rapid review

BACKGROUND

Post-Traumatic Stress Disorder (PTSD) can result from occupational exposures and poses a considerable burden to workers, their families, workplaces and to society in general.

OBJECTIVE

Our objective was to conduct a rapid review of the literature to answer the question: "Which occupations have exposures that may lead to a PTSD diagnosis?"

METHODS

A rapid review was conducted in six steps: review question development, literature search, study selection (inclusion/exclusion), study characterization, data extraction, and data synthesis.

RESULTS

The search identified 3428 unique references which were reviewed to find 16 relevant studies in 23 articles. The articles revealed associations between PTSD and rescue workers (police, firefighters, etc.), health care professionals, transit drivers, and bank employees which seem well supported by the literature. Some studies also suggest potential associations with PTSD and construction and extraction, electricians, manufacturing, installation, maintenance and repair, transportation and material moving, and clerical workers.

CONCLUSIONS

A rapid review of the peer-reviewed scientific literature of PTSD prevalence or treatment suggests many occupations have exposures that could be associated with PTSD. Occupational traumatic events were most often associated with PTSD diagnosis. More research is needed to better understand the association between occupation and PTSD.

Peer Support and Crisis-Focused Psychological Interventions Designed to Mitigate Post-Traumatic Stress Injuries among Public Safety and Frontline Healthcare Personnel: A Systematic Review

Public safety personnel (PSP) and frontline healthcare professionals (FHP) are frequently exposed to potentially psychologically traumatic events (PPTEs), and report increased rates of post-traumatic stress injuries (PTSIs). Despite widespread implementation and repeated calls for research, effectiveness evidence for organizational post-exposure PTSI mitigation services remains lacking. The current systematic review synthesized and appraised recent (2008-December 2019) empirical research from 22 electronic databases following a population-intervention-comparison-outcome framework. Eligible studies investigated the effectiveness of organizational peer support and crisis-focused psychological interventions designed to mitigate PTSIs among PSP, FHP, and other PPTE-exposed workers. The review included 14 eligible studies (n = 18,849 participants) that were synthesized with qualitative narrative analyses. The absence of pre-post-evaluations and the use of inconsistent outcome measures precluded quantitative meta-analysis. Thematic services included diverse programming for critical incident stress debriefing, critical incident stress management, peer support, psychological first aid, and trauma risk management. Designs included randomized control trials, retrospective cohort studies, and cross-sectional studies. Outcome measures included PPTE impacts, absenteeism, substance use, suicide rates, psychiatric symptoms, risk assessments, stigma, and global assessments of functioning. Quality assessment indicated limited strength of evidence and failures to control for pre-existing PTSIs, which would significantly bias program effectiveness evaluations for reducing PTSIs post-PPTE.