Table 2.
Characteristics of articles retrieved in a systematic review of self-harming (suicidal) behaviors among disaster responders
| N | Authors | Goals | Type of Study | Year | country | Important key finding | Checklist |
|---|---|---|---|---|---|---|---|
| [1] | Rosalie S. Aldrich1 et al. | investigating the relationship between suicide exposure and depression, anxiety, and post-traumatic stress disorder (PTSD) among three occupational groups with a high likelihood of suicide exposure. | cross-sectional | 2020 | USA | Exposure to suicide was significantly associated with poorer mental health outcomes, particularly elevated symptoms of depression, anxiety, and post-traumatic stress disorder (PTSD). Greater frequency or intensity of exposure correlated with increased severity of these psychological symptoms | STROBE |
| [2] | Shelby N. Baker et al. | This study sought to replicate and extend the Three-Step Theory of Suicide (3ST) by investigating the role of physical and psychological pain in Step 1 among first responders. | Research Trends | 2025 | USA | The findings corroborate the Three-Step Theory of Suicide (3ST) and underscore the significant role of physical pain in shaping suicidal desire among first responders. | STROBE |
| [3] | Brooke A. Bartlett et al. | This study examined the moderating role of distress tolerance (DT) in the relationship between posttraumatic stress disorder (PTSD) symptomatology and suicidality among firefighters | Original Article | 2018 | USA | Firefighters exhibiting more severe PTSD symptoms coupled with lower distress tolerance (DT) demonstrated the greatest global suicide risk and highest perceived likelihood of future suicide attempts. | JBI |
| [4] | Joseph W. Boffa et al. | Examining the association between posttraumatic stress symptoms (PTSS) and both history of suicidal ideation (SI) and prior suicide attempts in a national sample of firefighters. | cross-sectional | 2017 | USA | After accounting for established suicidality risk factors, results demonstrated that elevated posttraumatic stress symptoms (PTSS) significantly predicted increased likelihood of both lifetime suicidal ideation (SI) and previous suicide attempts | STROBE |
| [5] | Joseph W. Boffa et al. | This study sought to replicate the mediating role of anxiety sensitivity (AS) cognitive concerns in the relationship between PTSD symptoms and suicide risk among 214 trauma-exposed male firefighters who reported non-zero suicide risk. | cross-sectional survey | 2019 | USA | Anxiety sensitivity (AS) cognitive concerns mediated the bidirectional relationship between PTSD symptoms (total score and symptom clusters) and suicide risk in firefighters. These findings suggest AS cognitive concerns represent a modifiable risk factor for suicidality in this population, with AS-specific interventions potentially reducing both PTSD symptoms and suicide risk | STROBE |
| [6] | Derrick L. Edwards et al. | Examining the association between emotional exhaustion and suicide risk among emergency responders | cross-sectional survey | 2020 | USA | Emergency responders reporting high emotional exhaustion demonstrated mean suicide risk scores nearing the clinically significant threshold (cut-off ≥ 7). | STROBE |
| [7] | Emmanuel J. Finney et al. | Assessing suicide prevalence and prevention strategies in firefighter populations | Observational descriptive multicenter study and interview | 2015 | USA | The HFD Suicide Prevention Program, launched in 2007, established the coordinated FAN team to address members’ mental health needs, resulting in zero active-duty suicides for five years and the prevention of at least three near-certain cases | CASP |
| [8] | Michael P. Fisher, et al. | This study investigates the opportunities and barriers encountered by professionals developing and implementing mental health policies and programs for first responders | Qualitative research | 2023 | USA | Effective mental health programs and policies for first responders remain critically needed. Governmental and non-governmental stakeholders must prioritize strategic development and implementation, informed by systematic analysis of existing challenges and opportunities | CASP |
| [9] | Austin J. Gallyer, B.S, et al. | The study explored alcohol use as a suicide risk factor in firefighters, testing interpersonal theory variables as potential mediators across two large samples | cross-sectional | 2018 | USA | Perceived burdensomeness (PB) and thwarted belongingness (TB) may mediate the alcohol use-suicidal ideation relationship, with significant gender differences observed in this mediating effect. | JBI |
| [10] | Nathaniel Andrew Healy | This study investigated the moderating role of global sleep disturbance and its five facets (sleep efficiency, perceived sleep quality, daily disturbances, bad dreams, and pain) in the relationship between PTSD symptom severity and suicide risk among firefighters | Analytical Cross-Sectional Study- Thesis | 2020 | USA | Significant interaction effects were found between PTSD symptom severity and global sleep disturbance, sleep efficiency, perceived sleep quality, and daily disturbances in relation to suicide risk. | JBI |
| [11] | Elizabeth Henderson et al. | Examining suicidal ideation among U.S. firefighters by integrating the Neuman Systems Model and Joiner’s Interpersonal-Psychological Theory, identifying key risk factors and informing targeted prevention strategies. | Conceptual study | 2021 | USA | Firefighters’ suicidal ideation stems from occupational stressors and interpersonal struggles, requiring holistic interventions that address both systemic pressures and psychological vulnerabilities. | JBI |
| [12] | Joseph Herzog et al. | Examining the prevalence of trauma-related mental health symptoms (PTSD, depression, anxiety, alcohol misuse, and suicidal ideation) among firefighters in a U.S. hurricane disaster zone and assess the impact of job-related natural disaster exposure on PTSD severity. | Cross-sectional survey study | 2022 | USA | Firefighters exposed to natural disasters during duty showed significantly higher PTSD symptoms, with 18.9% meeting provisional PTSD criteria, highlighting occupational trauma as a critical mental health risk factor in this population. | STORBE |
| [13] | Johanna Inhyang Kim et al. | This study aimed to investigate whether alcohol use disorders (AUDs) and insomnia mediate the relationship between PTSD symptoms and suicidal ideation among Korean firefighters, using a cross-sectional design to explore these interconnected mental health risks. | Cross-sectional survey study | 2018 | South Korea | The study revealed that AUDs and insomnia partially mediate the association between PTSD symptoms and suicidal ideation, highlighting their critical roles in exacerbating suicide risk in this high-stress occupational group. | STORBE |
| [14] | Michael J Kyron et al. | This study aimed to assess the prevalence and predictors of suicidal thoughts and behaviors among Australian police and emergency services employees, examining both personal (e.g., mental health, substance use) and workplace (e.g., stigma, bullying) risk factors. | Cross-sectional survey | 2020 | Australia | Emergency services personnel reported higher rates of suicidal thoughts and plans compared to the general Australian population, with workplace factors like bullying and stigma, as well as personal factors like PTSD and psychological distress, significantly associated with increased risk. | STORBE |
| [15] | Milner et al. | This study aimed to compare suicide rates among emergency and protective service workers (e.g., police, ambulance, firefighters, defense, and prison officers) to other occupations in Australia over a 12-year period (2001–2012) and analyze suicide methods. | Retrospective mortality study | 2016 | Australia | Emergency and protective service workers had significantly higher suicide rates than other occupations, with the highest risk observed among ambulance personnel, defense force members, and prison officers. Hanging was the most common method, except for police, who predominantly used firearms. | CASP |
| [16] | Heyeon Park et al. | This study aimed to measure the 1-year prevalence of suicidal ideation among Korean firefighters and investigate its correlates, including demographic, occupational, and clinical factors. | Cross-sectional survey | 2019 | South Korea | The 1-year prevalence of suicidal ideation among Korean firefighters was 10.66%, significantly higher than the general population. Key correlates included female gender, recent traumatic experiences, high occupational stress, emotional labor, and psychiatric symptoms like PTSD and depression. | STROBE |
| [17] | Renkiewicz. et al. | This cross-sectional study conducted in the United States aimed to investigate the prevalence of suicidality among Emergency Medical Services (EMS) personnel and identify key predictors, including personal trauma profiles, occupational stress, and sociodemographic factors. | Cross-sectional survey | 2022 | USA | The study revealed that 24.5% of EMS personnel reported lifetime suicidality, with Indigenous race, prior military service, sexual minority status, childhood emotional abuse, and burnout being significant predictors. The findings highlight the urgent need for targeted mental health interventions in this high-risk profession. | STROBE |
| [18] | Yücel Şavklı et al. | This cross-sectional and correlational study conducted in Türkiye aimed to examine the moderating role of resilience in the relationship between post-traumatic stress disorder (PTSD) symptoms and suicidal ideation among firefighters, addressing a gap in research on protective factors for this high-risk group. | Cross-sectional survey | 2023 | Türkiye | The study found that PTSD symptoms significantly increased suicidal ideation, particularly among firefighters with low resilience levels. Resilience acted as a buffer, weakening this relationship when present at moderate or high levels, underscoring the need for resilience-building interventions in psychological programs for firefighters. | STROBE |
| [19] | Donna et al. | This study aimed to identify distinct profiles of emotional distress, suicidality, and resilience among treatment-seeking first responders in the United States using latent profile analysis (LPA), to better understand their mental health needs and inform targeted interventions. | Cross-sectional survey | 2025 | USA | The LPA revealed five distinct emotional distress profiles, ranging from minimal to severe, with depression and generalized anxiety as strong predictors of class membership. Resilience moderated distress levels, highlighting the need for transdiagnostic interventions that address comorbid symptoms while enhancing resilience in this high-risk population. | STROBE |
| [20] | Smith | This study aimed to investigate the risk factors associated with suicidal ideation and behavior among wildland firefighters in the United States, focusing on PTSD symptoms, alcohol use, and occupational exposure to suicide. | Cross-sectional survey | 2024 | USA | The study found that 22% of wildland firefighters reported a history of suicide attempts, and PTSD symptoms were significantly associated with suicidal ideation and behavior, while alcohol use and suicide exposure were not. | JBA |
| [21] | STREEB et al. | This study examined how critical incidents, coping self-efficacy, and social support relate to suicide risk factors (thwarted belongingness, perceived burdensomeness, fearlessness about death) in firefighters, integrating IPTS and SCT frameworks. | Cross-sectional survey | 2018 | USA | Trauma coping self-efficacy mediated the link between critical incidents and suicide risk factors, with social support from significant others buffering this relationship. | JBA |
| [22] | Robin Verble et al. | This study aimed to assess mental health risks among U.S. wildland fire dispatchers, focusing on anxiety, depression, PTSD, and suicidal ideation linked to occupational trauma and job stressors. | Cross-sectional survey | 2024 | USA | Wildland fire dispatchers exhibited higher rates of mental health disorders (e.g., 73% depression, 32% suicidal ideation) than the general population and other emergency responders, with disparities tied to demographics and trauma exposure. | STROBE |
| [23] | Neil H. Vigil et al. | This study aimed to determine the proportionate mortality ratio (PMR) of suicide among firefighters and emergency medical technicians (EMTs) in the United States compared to the general working population, focusing on occupational risk factors. | Retrospective cohort study | 2021 | USA | Firefighters had a significantly higher PMR for suicide (172, 95% CI 153–193), especially those aged 65–90 (PMR 234), while EMTs showed elevated but non-significant PMRs (124, 95% CI 99–153). | CASP |
| [24] | Kinga Witczak-Błoszyk et al. | This study aimed to assess work-related suicide exposure, occupational burnout, and coping mechanisms among emergency medical services (EMS) personnel in Poland, while exploring psychosocial determinants such as age, gender, and access to psychological support. | Cross-sectional study | 2022 | Poland | Nearly all EMS personnel (98%) reported suicide exposure, with 43% finding it distressing. High burnout levels, particularly relational deterioration, were linked to suicide exposure, while access to psychological support reduced burnout symptoms. | STROBE |