The effectiveness of mental health screening amongst first responders

Abstract

Background The mental health of first responders is an area of growing concern, with recent studies indicating significantly higher rates of PTSD, anxiety and depression than found in the general population (Berger et al., 2012; Syed et al., 2020). Many organisations use mental health screening to identify individuals at risk of developing posttraumatic stress disorder (PTSD) or other mental health conditions, though its effectiveness conducted pre- or post-employment is unclear. Aims This research aims to investigate the role that mental health screening may have in predicting PTSD and other types of psychological injury in first responders. Methods A systematic review of the research literature related to pre-employment screening of personality and other factors which may be predictive of later depression or PTSD symptoms in first responders was conducted. Nested case-control studies of 300 serving police officers with pre-employment personality screening (MMPI-2) data linked to information on long-term sick leave for psychological injury was analysed. A separate set of linked mental health surveys was conducted to examine variance in the number and severity of symptoms reported. Results Measures of dynamic factors including physiological responses to simulated trauma and maladaptive coping styles had stronger evidence as predictors of psychological vulnerability than assessments of static factors such as trauma history or pre-existing psychopathology. With the nested case control studies, conditional logistic regression analyses found no associations between any of the MMPI-2 scale scores, either in isolation or combination, and later psychological injury (OR = 0.89; 95% CI 0.78-1.02). Possible reasons for these findings are discussed, one being the under-reporting of symptoms. This hypothesis was tested by comparing responses on identical validated questionnaires (DASS-21 and PCL-5) administered by different organisations. As expected, police officers reported significantly lower levels of anxiety (p < 0.05) and PTSD (p < 0.001) symptoms on the employer-administered survey compared to the anonymous independent survey. Conclusions The available research evidence does not support the type of pre-employment mental health screening conducted by many first responder organisations. The under-reporting of symptoms in employer-administered surveys is a major barrier to the effectiveness of any screening