The purpose of this study is to provide basic data for the development of effective intervention programs by systematic review and meta-analyzing domestic and abroad prior research for the past 10 years on the post-traumatic stress disorder intervention program for firefighters.
This study was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis(PRISMA). The key question were as follows: research subjects were firefighters; intervention were post-traumatic stress disorder intervention programs; comparison groups were those that were not provided with interventions; the results of interventions were outcomes measured using post-traumatic stress disorder evaluation scales; study design is an experimental study. Four domestic and four abroad databases were used, and 7 domestic and 4 abroad studies that met the criteria of this study were selected for systematic review and meta-analysis through the process of searching, screening and selecting data.
The results of this study are as follows:
1. The general characteristics of the 7 domestic studies, 5 pre-experimental designs were the most common, and all the selected studies were attempted intervention with different programs.
Most of the intervention period was 8 weeks, total number of sessions was 10 and time per sessions was 60 minutes. In the form of sessions, individual counseling and group therapy were the most common with 4 studies, and PCL-5 was the most common measure of post-traumatic stress disorder.
The general characteristics of the 4 abroad studies, 3 randomized controlled trial designs were the most common, and all the selected studies attempted intervention with different programs. The intervention period varied from the 3 days to 24 weeks, most of the total number of sessions was 4 and time per sessions was 90 minutes. Individual counseling was the most common form of session, and all studies used different scales to measure post-traumatic stress disorder.
2. The results of the quality evaluation of 7 domestic studies, all studies were assessed to have low risk of bias in the selection of participants, measurement of intervention(exposure), and selective outcome reporting, and 4 studies in the confounding variables were assessed to be uncertain. In the blinding for outcome assessment and incomplete outcome data, the risk of bias was evaluated as low in 5 studies, respectively.
The results of the quality evaluation of 4 abroad studies, the 3 randomized controlled trial study was evaluated to have a low risk of bias in the random sequence generation, incomplete outcome data, selective reporting, and other bias. In the allocation concealment and blinding of participants and personnel, 2 studies were evaluated as low, and all 3 studies were assessed to be uncertain about the blinding of outcome assessment. In addition, the quality assessment results for the 1 non-randomized controlled trial study showed that the risk of bias was low in the selection of participants, measurement of intervention(exposure), blinding for outcome assessment, and selective outcome reporting. It was evaluated as uncertain in the confounding variables, and the bias risk was evaluated as high in the incomplete outcome data.
3. The overall effect size of the post-traumatic stress disorder intervention program was .409 (95% CI: .174~645, p<0.05) in domestic and .374 (95% CI: .028~719, p<0.05) in abroad. The heterogeneity test was performed, and the level was Q=86.955, =91.950(df=7, p=.000) in domestic, and Q=11.437, =73.769(df=3, p=.010) in abroad, showing highly heterogeneity.
4. In the domestic studies, the statistically significantly higher effect sizes were music therapy(5.105) in the type of program, 3 to 5 sessions(1.215) in total number of sessions, 60 to 90 minutes(3.122) in per session, and group therapy(0.860) in the form of sessions. In the abroad studies, the statistically significantly higher effect sizes were narrative exposure therapy(1.186) in the type of program.
Various domestic and abroad intervention methods for post-traumatic stress disorder of firefighters have low effects. The program is likely to have a high effect if it consists of 3 to 5 sessions, 60-90 minutes per session, and group therapy based on music therapy and narrative exposure therapy. Therefore, based on the results of this study, it is necessary to develop and apply a post-traumatic stress disorder intervention program for firefighters.