Post-traumatic stress disorder and common mental disorders among male FRs: a narrative review of occupational risk factors, diagnostic approaches, evidence-based interventions, and quality of life outcomes

irst responders (FRs), including Law enforcement officers (LEOs), firefighters, and paramedics, face repeated trauma exposure and organizational stressors that elevate the risk for post-traumatic stress disorder (PTSD) and common mental disorders (CMDs). Given this disproportionate burden, male FRs, constituting the majority of this workforce, encounter additional help-seeking barriers rooted in occupational culture and masculine role expectations. This narrative review synthesizes evidence (2019–2025) on epidemiology, risk factors, diagnostic strategies, prevention frameworks, treatment modalities, and quality-of-life outcomes associated with PTSD and CMDs among male FRs. A comprehensive literature search was conducted across PubMed, PsycINFO, MEDLINE, and Scopus for peer-reviewed articles published between January 2019 and March 2025 addressing mental health outcomes in first responder populations. PTSD prevalence among FRs ranges from 7–37%, with depression (15–25%), anxiety (15–20%), and hazardous alcohol use (25–30%) frequently co-occurring. Risk determinants include cumulative trauma exposure, moral injury, organizational stressors, shift work-induced sleep disruption, and stigma. Validated screening instruments, including the Posttraumatic Stress Disorder Checklist for the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (PCL-5), Patient Health Questionnaire-9 (PHQ-9), and Generalized Anxiety Disorder-7 (GAD-7), demonstrate acceptable psychometric properties in this population. Cognitive processing therapy (CPT), prolonged exposure, and Eye Movement Desensitization and Reprocessing (EMDR) show large effect sizes (Cohen’s d = 0.8–1.5) for PTSD reduction. Integrated management combining psychotherapy with sleep interventions and workplace accommodations yields superior functional outcomes. Male FRs require integrated workplace-based clinical programs addressing trauma exposure, organizational stressors, and cultural barriers. Future research should prioritize longitudinal designs and implementation science approaches.

Post-traumatic stress disorder; First responders; Occupational mental health; Common mental disorders; Male mental health; Evidence-based treatments

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