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

Scand J Trauma Resusc Emerg Med. 2025 Oct 3;33(1):161. doi: 10.1186/s13049-025-01479-z.

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).

PMID:41044626 | DOI:10.1186/s13049-025-01479-z