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 rates of PTSD in EFRs are approximately double civilian rates; however, 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 family member with
diagnosed or undiagnosed PTSD.

Inclusion criteria: This review included 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 family 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 Sources of unpublished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
EASY 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 resolved by discussion. 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 studies, 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 with 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) Spouses’ helpseeking and support needs for their EFR partners with PTSD, their children, and 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 focused on the 9/11 World Trade Center terrorist attacks in the United States.
The findings also indicate the need for targeted psychological and social services for EFR family members.