How a systematic review of the experiences of emergency first responder family members living with post-traumatic stress disorder can inform new models of care

The impact and frequency of natural and man-made disasters and health crises, such as earthquakes, terrorist attacks, and pandemics, are increasingly dire for an ever-growing population. Emergency first responders (EFRs) who attend these events are more frequently associated with psychological risks, such as post-traumatic stress disorder (PTSD). As a result, it is crucial that we understand the experiences of family members of EFRs, who are also affected by the EFRs’ PTSD. Researchers have been aware of intergenerational impacts of trauma since the 1960s and the Holocaust generation1; however, there has been little development of tailored support for EFR service families living with the risk and occurrence of PTSD. A systematic review in this issue of JBI Evidence Synthesis focuses on the experiences and perceptions of EFR family members, and shines a light on this phenomenon and the ripple effect of trauma in EFR service families.2 The findings encapsulate the available qualitative data from spouses and children, and highlight both the mental health and functional impacts, as well as their support needs.2 The findings also inform a set of recommendations for policy, research, and practice for a proposed new model of care.2 EFRs, often called public safety personnel, can refer to vocations such as police, ambulance/paramedics, firefighters, and rescue personnel. There is an established evidence base on the high rates of PTSD in service populations compared with civilian populations.3–5 In Australia, rates of PTSD are significantly higher in both current-serving EFRs (10%) and former-serving EFRs (25%) than they are in the general Australian community (7.3%).3–5 Family members of EFRs have largely been excluded from models of care for EFRs experiencing PTSD. This had been the case in military populations until recently, but policy and practice have gradually changed, and the duty of care now extends beyond the current or former member to include family members. Family members are often carers, but are also care-seekers due to the impacts of the vicarious and secondary trauma they experience. Vicarious traumatization is defined as an individual’s psychoemotional reactions as a result of exposure to others’ traumatic experiences, for example, via verbal accounts or photographs.6 Secondary (indirect) traumatization describes an individual affected by another individual’s PTSD symptoms, who then starts to experience their own symptoms, adopting a similar worldview and maladaptive behaviors.6 Our systematic review included 5 eligible studies, which yielded 53 findings extracted into 9 categories, with 4 broad synthesized findings.2 Despite the small number of included studies, the dependability of the extracted findings was high, with plentiful illustrations of the participants’ voices to support each finding.2 Most of the data addressed the experiences and perceptions of the service members’ spouses, with limited data from their children.2 The spouse’s change of role in the family to carer of the EFR with PTSD was a predominate experience, which involved both overburden and protecting the family unit.2 The included studies were from multiple countries, including Australia,7 New Zealand,8 and Canada.9 Two studies were based in the United States,10,11 both focusing on the World Trade Center terrorist attacks of 9/11. The first synthesized finding addresses the impacts of the EFRs’ PTSD on the functioning of the family, including the impacts on or conflicts in spousal relationships, as well as changes to domestic roles, household chores, parenting, or income earning.2 The second synthesized finding brings together the findings from 2 categories, 1 for EFR spouses’ experiences of vicarious trauma and 1 for the experiences of secondary trauma, including the experiences of overburden as a carer of an EFR with PTSD.2 The third synthesized finding encompasses 4 categories of extracted findings from the included studies on children’s experiences of vicarious trauma, secondary trauma, and/or separation anxiety.2 The final synthesized finding collates 2 categories of findings on spouses’ help-seeking for their EFR partner with PTSD, as well as for themselves and their children, via the EFR organization and other external agencies.2 The findings from this review provide a deeper understanding of the experiences and perceptions of family members of EFRs with PTSD. They give us insight into their needs as individuals and as family units, as children or spouses, and as carers but also as care-seekers needing their own mental health support due to vicarious or secondary trauma, or both. These findings can be used to inform EFR organizations and other providers of support for EFRs and their family members to ensure they receive care. The psychosocial impacts of PTSD and how it affects relationships are highlighted through the families’ perspectives, illuminating the broad-reaching effects of trauma on the families. The findings raise awareness of the need for greater recognition of the early indications of vicarious trauma, secondary trauma, and related conditions in family members, but also overburden of carers and functional impacts.2 There are recommendations for the inclusion of spouses or family members in support programs, including peer support, across the EFR career span to enable effective prevention, monitoring, and early treatment for the EFR, their children, and other family members as required.

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