Mental Health and Occupational Stress Among Emergency Telecommunicators: A Systematic Review and Meta-analysis

To systematically review the (1) incidence, prevalence, and severity of mental health issues and occupational stress issues among emergency telecommunicators, and (2) effectiveness and harms of interventions to promote resistance and resilience regarding these issues. We searched Medline, Embase, CENTRAL, and CINAHL, ClinicalTrials.gov, journals, and websites from January 1, 2001, through June 30, 2024. We conducted duplicate screening of titles and abstracts followed by full-texts of potentially relevant records. We included studies of telecommunicators in high-income countries that reported the incidence/prevalence/severity of mental health issues and occupational stress issues or evaluated interventions targeting resistance/resilience regarding these issues. We excluded studies of telecommunicators in training during the study. We assessed the risk of bias using study design-specific tools, conducted meta-analyses using random-effects models, and evaluated strength of evidence (SoE) per Agency for Healthcare Research and Quality methods. We registered the systematic review prospectively in PROSPERO (CRD42023465325). We included 31 studies (29 cross-sectional studies, 1 pre-post study, and 1 randomized controlled trial) that evaluated a total of 6,621 participants. Research Question 1 (30 studies): No study reported on incidence of any outcome. During routine practice, prevalence estimates were: any depression 15.5%, suicidal ideation 12.4%, suicide plans 5.7%, suicide attempts 0.7%, alcohol abuse 15.5%, high/extreme peri-traumatic distress 5%, high secondary traumatic stress 16.3%, and acute stress disorder 17% (low SoE for each). In terms of severity, on average, depressive symptoms and stress were mild/low to moderate, burnout was mild to severe (moderate SoE); peri-traumatic distress was moderate, and secondary traumatic stress was mild (low SoE). After critical incidents, the prevalence of high and medium general stress was 39.7% and 28.2%, respectively (low SoE). In terms of severity, on average, burnout and general stress were moderate (low SoE). Research Question 2 (2 studies): The evidence was insufficient regarding the impacts of interventions on anxiety, depression, posttraumatic stress disorder, and alcohol use. The prevalence and severity of mental health and occupational stress issues in the emergency telecommunicator workforce merits greater attention. Much more research is needed regarding the effectiveness of interventions for strengthening the resistance and resilience of the workforce.