The weight of words: a scoping review of depression and suicidal ideation among 911 call takers and dispatchers

Abstract

Background

Communicators in public safety, such as 911 telecommunicators, emergency medical dispatchers, and police and fire dispatchers, frequently deal with distressing calls, traumatic narratives, and high-stakes decisions. Despite not being physically present at crisis scenes, these experts endure psychological stress on par with first responders. This scoping review examines the prevalence and determinants of depression and suicidal ideation among public safety communicators and their co-occurrence, summarizes the occupational and personal risk factors contributing to these outcomes, and evaluates proposed mitigation strategies.

Results

The research indicates that depression is reported at elevated rates in this workforce, ranging from 8.4% to 73%, depending on the population and the sensitivity of the instrument, based on 11 quantitative studies published between 1995 and 2025. Although less studied, suicidal ideation appears to be significantly higher in this group compared to the general population. Contributing factors include indirect trauma exposure, shift work, emotional suppression, organizational neglect, and a history of trauma. The frequent co-occurrence of depression and suicidal ideation supports the Interpersonal Theory of Suicide as a relevant explanatory framework.

Conclusions

Despite accumulating evidence, research is methodologically limited due to cross-sectional designs, inconsistent screening tools, and sample homogeneity. Existing interventions, such as peer support, debriefing, and trauma-informed training, are inconsistently applied and under-evaluated. The findings highlight a pressingneed for longitudinal research, targeted interventions, and workplace reforms that take into account the unique psychological burdens associated with communicator roles. Addressing depression and suicide risk among these professionals is critical to ensuring both workforce well-being and the continued effectiveness of public safety systems.

Background

Public safety communicators (henceforth “communicators”) such as telecommunicators taking 911 calls and dispatching for traditional services like police, fire, and ambulance, as well as emergency telecommunicators from less traditional agencies (e.g., public transit) who liaise with the 911 service, are the unrecognized lifelines of public safety systems. Often operating under high-pressure conditions, they are required to maintain composure while coordinating life-saving responses and managing emotionally charged calls from the public (Osório et al., 2025). The communicator’s role often requires rapid decision-making under pressure, exposure to traumatic events, and the responsibility of conveying information that can protect and even save lives (Rees et al., 2015). Although communicators are not physically present at crisis scenes, their psychological exposure to trauma is significant, and the emotional toll of their work is increasingly recognized within occupational health research (Pierce & Lilly, 2012). Beyond these stressors, recruitment into these roles follows several distinct pathways: individuals may join as career-oriented recruits motivated specifically by this career, as transitional recruits viewing the role as a stepping stone toward becoming a police officer or firefighter, as necessity-driven recruits seeking immediate employment, or as reassigned police or firefighter personnel due to physical or psychological limitations. This recruitment diversity, when considered alongside high turnover rates, relatively low compensation, and evidence that external recruits may present with more pre-existing psychosocial vulnerabilities, shapes the occupational and mental health profile of this workforce. These occupational context factors not only highlight the structural challenges communicators face but may also heighten their risk for adverse mental health outcomes even before exposure to job-related trauma. Moreover, these professionals often serve as first points of contact in emergencies, meaning they are subjected to repeated exposure to trauma narratives, distressing content, and high-stakes decision-making, which can contribute to elevated risks of mental health issues, including depression and suicidal ideation (Saldanha et al., 2025). Despite the critical social role communicators play, their occupational mental health challenges have received limited academic attention.

Recent studies have shed light on the prevalence of psychological strain among emergency communication professionals. These psychological strains include burnout, posttraumatic stress disorder (PTSD), secondary traumatic stress, anxiety, suicidal ideation, and depression among emergency personnel (Osório, et al., 2025; Giaume et al., 2024; Saldanha et al., 2025). Risk factors contributing to these outcomes include prolonged shift work, exposure to traumatic content, lack of organizational support, and the perceived invisibility of their work within the emergency response system (Smith et al., 2019; Tracy & Tracy, 1998). Stigma surrounding mental health in these professions, compounded by a culture of resilience and underreporting, also contributes to underdiagnosis and insufficient support systems (Smith et al., 2019).

Among the most pressing concerns is depression, which emerges as a frequent and consequential outcome of the emotional labor and chronic stress inherent in communication roles (Osório, et al., 2025; Saldanha et al., 2025). Numerous studies have linked depression in this population to an increased risk of suicidal ideation, underscoring the need for targeted research and intervention (Carleton, Afifi, Turner, Taillieu, LeBouthillier et al., 2018b; Verble et al., 2024). In the broader psychological literature, depression is widely recognized as a proximal risk factor for suicidal ideation (Cougle et al., 2009; Klonsky et al., 2016; Stanley et al., 2015), particularly when co-occurring with occupational burnout, trauma exposure, increased and prolonged exposure, and feelings of social isolation, factors commonly reported by communicators. The Interpersonal Theory of Suicide (IPTS), first introduced by Joiner (2005) and later expanded by Van Orden et al. (2010), provides a useful framework for understanding how depression within this workforce can develop into suicidal ideation. According to the IPTS, suicidal desire arises when individuals experience both perceived burdensomeness and thwarted belongingness. The risk of suicidal behavior increases when these conditions co-occur and are accompanied by acquired capability, often developed through repeated exposure to pain or fear (Stanley et al., 2017). These constructs align closely with the lived experiences of communicators, who frequently report emotional exhaustion, secondary traumatic stress, and organizational isolation (Lilly & Allen, 2015; Smith et al., 2019; Tracy & Tracy, 1998). While initially developed for broader populations, the IPTS has increasing relevance for emergency communication professionals and can help explain the psychological pathways from occupational strain to suicidal ideation.

Despite growing awareness of these challenges, the mental health of communicators remains underrepresented in academic research. Much of the existing literature continues to focus on emergency responders attending the scene, such as police officers, firefighters, and paramedics, with minimal attention to those who provide critical communication support behind the scenes. This oversight is compounded by internal stigma, which discourages help-seeking and obscures the true extent of psychological distress within this group. As a result, gaps remain in both the identification of risk factors and the development of effective support strategies. Although some studies have examined mental health outcomes among subgroups of communicators, such as 911 telecommunicators or fire dispatchers, there is currently no comprehensive synthesis of the psychological risks and protective factors across the broader category of public safety communicators. The fragmented nature of emergency communication studies limits our ability to draw generalizable conclusions, identify systemic contributors to depression and suicidal ideation, or evaluate the effectiveness of existing interventions.

Suicide attempts among public safety communicators are rare and under-reported, with limited empirical data available. Most documented cases in policing involve operational officers facing significant personal stressors, rather than communication staff. Nevertheless, suicidal ideation is a key early risk marker and an actionable target for preventive interventions (Harmer et al., 2025). Given the scarcity of data on suicide attempts and the clinical and public health importance of addressing ideation, this review focuses on suicidal ideation and depression. These outcomes are interrelated, serve as proximal markers for suicide risk, and remain insufficiently studied in the literature on communicators.

This scoping review addresses this critical gap by synthesizing the current state of knowledge on depression and suicidal ideation among public safety communication professionals. It examines the prevalence of depression and suicidal ideation in this group, identifies contributing occupational and psychosocial factors, explores their interrelationship, and summarizes proposed prevention and support strategies. The current review aims to advance scholarly understanding of the mental health challenges facing communicators and to inform future research and evidence-based policy and practice in support of this essential yet often invisible segment of the public safety workforce.

Methods

This scoping review was structured around a set of interrelated research questions aimed at investigating the prevalence, antecedents, and interaction of depression and suicidal ideation among public safety communication professionals. We sought to determine what proportion of communicators screen positive for symptoms of depression or suicidal ideation and whether these symptoms are primarily linked to occupational stressors or also shaped by non-occupational factors such as trauma histories and adverse childhood experiences. Additional questions explored the specific workplace conditions that contribute to the onset or intensification of symptoms, the presence of identifiable predictors, and the frequency and nature of comorbidity between depression and suicidal ideation within this occupational group. The paper draws on a larger dataset that also examines anxiety, PTSD, secondary trauma, and burnout among communicators. While it is acknowledged that the prevalence of suicide and depression is lower relative to these other conditions, the present analysis focuses specifically on suicidal ideation and depression, given their role as key markers of broader psychological vulnerability and their well-established links in the literature.

To address these questions with methodological consistency and ensure the reliability of findings, the review was limited to quantitative studies published in peer-reviewed academic journals and written in English. Quantitative methodologies were prioritized due to their capacity to provide empirical data on symptom prevalence, comorbidity, and correlates, data essential for identifying health trends and informing occupational health interventions. Given the intended applicability of this review to North American contexts, especially Canada, we prioritized research conducted in Anglophone countries with comparable public safety infrastructures. Countries such as Canada, the United States, and the United Kingdom share common legal, political, and institutional traditions rooted in colonial histories and common law systems, enhancing the comparability of research findings across these jurisdictions. Moreover, English-language journals tend to have a broad international reach, thereby increasing access to globally relevant literature.

Although the review was not constrained by a single methodological framework, it was informed by the PRISMA Extension for Scoping Reviews (Tricco et al., 2018). However, our approach extended beyond conventional scoping review practices by incorporating a critical appraisal of study design, methodological quality, and theoretical contributions. This additional interpretive layer enabled a more analytical synthesis of the literature and supported the development of recommendations for researchers seeking to integrate depression or suicidal ideation screening tools into studies of public safety communication work. Ensuring current practitioners reviewed the framework and the language allowed for relevance to the scope of practice.

Search strategy

The search strategy was designed to broadly capture the literature on health outcomes among public safety communication professionals, without initially restricting the scope to depression or suicidal ideation. This inclusive approach allowed us to identify studies addressing a range of health-related issues and to examine how depression and suicidal ideation are positioned within the broader landscape of occupational health research.

Searches were conducted between April and May 2025 across three major academic databases: EBSCOhost, Web of Science, and Google Scholar. The search window extended from 1995 to 2025, beginning with Tod W. Burke’s, 1995 study, Dispatcher Stress, which surveyed civilian police dispatchers in New Jersey (Burke, 1995). Burke’s work represents a foundational moment in the scholarly recognition of the unique psychological stressors experienced by public safety communication professionals and laid the groundwork for subsequent mental health research in this field.

Recognizing the variability in job titles and roles within communication centers, including dispatchers, call takers, and radio operators, we constructed a search expression to account for this occupational diversity. Boolean logic was applied using the following base search strings: (“emergency dispatcher” OR “911 operator” OR “call taker” OR “public safety communicator”) AND “health*” and the same occupational terms paired with “job stress*.” The wildcard asterisk (*) allowed us to capture variations such as “healthcare” and “stressors.” These initial expressions were used in EBSCOhost to identify a foundational body of literature.

We then expanded the search on EBSCOhost, Web of Science, and Google Scholar, targeting specific mental health outcomes identified through the preliminary search. These outcomes included secondary traumatic stress, burnout, trauma, anxiety, PTSD (post-traumatic stress disorder), depression, suicide, voice problems, and musculoskeletal issues. In this phase, each condition replaced the general terms “health” or “job stress” in the original expressions while maintaining the Boolean structure and wildcard use. To ensure comprehensiveness, we also hand-searched the reference lists of existing literature reviews and consulted a doctoral dissertation proposal authored by a member of the research team. This iterative process of bibliographic mining continued until thematic saturation was reached and no additional relevant studies were identified.

Selection and organization of studies

To be eligible for inclusion, studies were required to meet four criteria: they had to focus specifically on public safety communication professionals, include a quantitative measure of depression or suicidal ideation, be classified as original empirical research, and be published in English in a peer-reviewed journal. Studies were excluded if they did not meet all inclusion criteria or if they were review articles, commentaries, editorials, or brief notes that lacked original data.

After database searches were completed, all duplicate records were removed. Title and abstract screening were conducted using the pre-established inclusion and exclusion criteria. Remaining articles were subjected to full-text review, which was independently conducted by all members of the research team. Any discrepancies in inclusion decisions were resolved through discussion and consensus. This multistage review process ensured that only studies aligned with the review’s core questions and methodological standards were retained. A flow diagram illustrating the search and selection process of sources is presented in Fig. 1.

Fig. 1.

Flow diagram of Search and Selection of Sources

To assess the methodological quality of the included studies, we conducted a critical appraisal focusing on sample characteristics, research design, measurement instruments, and analytic rigor. This evaluative component enabled us to identify strengths and limitations across the existing evidence base and to highlight areas in need of further empirical investigation.

Results

This scoping review, conducted according to predefined inclusion and exclusion criteria, identified eleven empirical studies that assessed the prevalence of depression among public safety professionals, with a particular emphasis on emergency communication personnel, including dispatchers, call-takers, and telecommunicators. These professionals serve as the first point of contact in emergency response systems. They are frequently exposed to traumatic content, high-pressure decision-making, caller instructions, and emotionally intense interactions. Yet, they have received considerably less attention in the occupational mental health literature compared to other frontline responders such as police officers, firefighters, or paramedics. The identified studies reveal varying rates of depressive symptoms, shaped by methodological differences, regional contexts, and occupational demands. Beyond depression, the review also summarized findings from three empirical studies that investigated suicidal ideation within this workforce. Although limited in number, these studies underscore the significant psychological burden faced by emergency communicators and provide initial evidence of heightened suicide risk in this population. Together, these findings highlight a critical gap in the literature and point to the need for more targeted, methodologically rigorous research that addresses the unique stressors and mental health vulnerabilities of communicators across diverse professional and national contexts.

Suicidal ideation

All three studies (Carleton, Afifi, Turner, Taillieu, LeBouthillier et al., 2018b; O’Dare et al., 2023; Verble et al., 2024) employed cross-sectional survey methodologies; they diverged in their sampling frames, assessment instruments, and subpopulations of focus (Table 3). Collectively, the studies bring renewed empirical attention to a subset of public safety personnel whose occupational stressors resulting in suicidal ideation have historically been understudied despite growing concern.

Table 3.

Comparative summary of suicidal ideation and risk among public safety communicators

Article	Country	Population	Design	Psychometric tool	Sample size	Suicidal Ideation and Risk
Carleton, Afifi, Turner, Taillieu, LeBouthillier, et al. (2018b)	Canada	Public Safety Personnel from six occupational groups, including Call centre operators/dispatchers	CS	● Based on Statistics Canada’s questions	● Total = 5,148 ● Female = 33.4%	Total (All PSP): Past Year: ● Suicidal ideation: 10.1% ● Suicide plan: 4.1% ● Suicide attempts: 0.3% Lifetime: ● Suicidal ideation: 27.8% ● Suicide plan: 13.3% ● Suicide attempts: 4.6% Call Centre Operators/Dispatchers: Past Year: ● Suicidal ideation: 9.5% ● Suicide plan: 2.5% ● Suicide attempts: 0.4% Lifetime: ● Suicidal ideation: 28.7% ● Suicide plan: 13.6% ● Suicide attempts: 8.6%
O’Dare et al. (2023)	United States of America	Public safety telecommunicator officers (PSTCOs)	CS	● Tool = SBQR ● Cut-off = > 7	● Total = 54 ● Male = 31.5% ● Female = 66.7%	● Suicidal ideation = 9.3%
Verble et al. (2024)	United States of America	Wildland fire dispatchers	CS	● Tool = C-SSRS ● Suicide risk is assessed and classified into none, low, moderate, and high. ● Any positive response assigns a risk level.	● Total = 510 ● Male = 40% ● Female = 59%	● Suicide risk: 32% ● Low risk = 15% ● Moderate risk = 7% ● High risk = 10% ● Treatment for Suicidal thoughts = 27.3% ● Suicidal thoughts tend to worsen with job = 30.3%

Here, CS = Cross-sectional, SBQR = Suicide Behaviors Questionnaire-Revised, and C-SSRS = Columbia-Suicide Severity Rating Scale

Depression

Nine of the eleven studies identified focused exclusively on communicators (Regehr et al., 2013; Lilly & Allen, 2015; Kindermann et al., 2020; London et al., 2020; Ferrau, 2022; O’Dare et al., 2023; Blalock et al., 2024; Giaume et al., 2024; Verble et al., 2024). The remaining two (Carleton, Afifi, Turner, Taillieu, Duranceau et al., 2018a; Groll et al., 2020) adopted a broader approach, examining public safety professionals more generally and including communicators within their scope. However, in one of these broader studies (Groll et al., 2020), findings related to communicators were reported in aggregate under the general category of public safety personnel.

Geographically, the studies spanned five countries: the United States (Lilly & Allen, 2015; London et al., 2020; O’Dare et al., 2023; Verble et al., 2024; Blalock et al., 2024), Canada (Regehr et al., 2013; Carleton, Afifi, Turner, Taillieu, Duranceau et al., 2018a; Groll et al., 2020), Germany (Kindermann et al., 2020), Sweden (Ferrau, 2022), and France (Giaume et al., 2024). The United States contributed the majority of studies, followed by Canada, with the remainder conducted in Europe. Despite this cross-cultural breadth, the methodological design was strikingly uniform, as all studies employed cross-sectional approaches, thereby limiting causal inference and the ability to track mental health trajectories over time.

A range of validated depression screening instruments was used across the studies. The Patient Health Questionnaire-9 (PHQ-9) featured prominently (Carleton, Afifi, Turner, Taillieu, Duranceau et al., 2018a; Groll et al., 2020; O’Dare et al., 2023; Verble et al., 2024; Blalock et al., 2024), while other tools included the Beck Depression Inventory-II (BDI-II) (Regehr et al., 2013; Lilly & Allen, 2015; London et al., 2020), PHQ-4 (Kindermann et al., 2020), Depression, Anxiety, and Stress Scale-21 (DASS-21) (Groll et al., 2020), Montgomery-Åsberg Depression Rating Scale – Self-rating Version (MADRS-S) (Ferrau, 2022), and the Hospital Anxiety and Depression Scale (HAD) (Giaume et al., 2024). Although the choice of instrument varied, each was employed to reliably detect depressive symptoms in high-stress occupational contexts. Among six depression scales, the PHQ-9 stands out as the most balanced and widely applicable. Validated in large clinical samples, it shows strong construct validity (r =.73) in association with the SF-20 scales (20-Item Short-Form Survey), high internal consistency (α = 0.89/0.86), and strong test-retest reliability (r =.84), making it practical for both clinical and research use (Kroenke et al., 2001). The BDI-II has excellent reliability (α = 0.93) and validity (r =.93), but its length may limit use in fast-paced settings (Dozois et al., 1998). DASS-21 is strong for measuring depression, anxiety, and stress together but is mainly used with psychology students and validated in other populations, showing good convergent validity (r =.74 with BDI) and high reliability (α = 0.91 Depression) (Lovibond & Lovibond, 1995). PHQ-4 is the briefest, with acceptable reliability (α = 0.85), but less detailed (Kroenke et al., 2009). MADRS-S is ideal for monitoring severity in diagnosed patients, with strong interrater reliability (r =.89–0.97) (Montgomery & Asberg, 1979). HAD works well in medical settings and avoids physical illness bias, though its validity with clinical ratings is slightly lower (r =.70–0.74). Overall, PHQ-9 offers one of the best balances of validity, reliability, brevity, and versatility.

Findings consistently revealed elevated rates of depression among communicators. Across the board, communicators demonstrated elevated rates of depressive symptoms ranging from 8.4% to 73% (Table 1). In one of the most alarming studies, Blalock et al. (2024) reported that 35.6% of Emergency Communication Operators (ECOs) scored above the PHQ-9 clinical cutoff for depression, and 57% reported at least some level of depressive symptoms, with 26.4% mild, 13.1% moderate, 11.1% moderately severe, and 6.3% severe. In a similarly concerning result, Carleton, Afifi, Turner, Taillieu, Duranceau, et al. (2018a) observed that 33.2% of call operators screened positive, surpassing the 26.4% rate in the broader public safety professional population. Even more sobering, Verble et al. (2024) found that 73% of wildland fire dispatchers met the criteria for depression when applying a more stringent PHQ-9 cutoff (> 14), including a staggering 33% with mild symptoms, 15% with moderate symptoms, and 25% with severe symptoms. This figure stands among the highest reported in the literature. Several other studies echoed these elevated rates. Lilly and Allen (2015) noted that nearly 15% of 911 telecommunicators experienced moderate depression and 9% experienced severe depression, as measured by the BDI-II. Kindermann et al. (2020) identified that 15.5% of emergency call-takers screened positive using the PHQ-2. Giaume et al. (2024) documented a 16.6% depression rate among French emergency medical dispatchers, and London et al. (2020) found that 24.2% of U.S. 911 telecommunicators exhibited moderate to severe depression, particularly when childhood trauma was present. Collectively, these findings underscore a critical occupational health concern, highlighting the vulnerability of communicators to depression due to the unique demands and stressors of their roles.

Table 1.

Characteristics of studies reporting the depression prevalence among public safety communicators

Article	Country	Population	Design	Psychometric tool and cut-off score	Sample size	Depression prevalence
Regehr et al. (2013)	Canada	Police communicators	CS	● Tool = BDI-II ● Minimal = 0–13 ● Mild = 14–19 ● Moderate = 20–28 ● Severe = 29–63	● Total = 113 ● Male = 13.3% ● Female = 86.7%	● Minimal depression = 84% ● Mild depression = 8% ● Moderate depression = 7.1% ● Severe depression = 1 individual (1.1%)
Lilly and Allen (2015)	United States of America	911 telecommunicators	CS	● Tool = BDI-II ● Minimal = 0–13 ● Mild = 14–19 ● Moderate = 20–28 ● Severe = 29–63	● Total = 808 ● Female = 73.6%	● Moderate depression = 14.9% ● Severe depression = 9.0%
Carleton, Afifi, Turner, Taillieu, Duranceau, et al. (2018a)	Canada	Public Safety Personnel from six occupational groups, including Call centre operators/dispatchers	CS	● Tool = PHQ-9 ● Cut-off = > 9	● Total = 5813 ● Male = 67.5% ● Female = 32.5%	● Total sample = 26.4% ● Call centre operators/dispatchers = 33.2%
Groll et al. (2020)	Canada	Canadian public safety personnel (PSP)	CS	● Tool = PHQ-9 and DASS-21 ● Cut-off for PHQ-9 = > 10 ● Cut-off for DASS-21 = 0 (does not apply to me at all) to 3 (applies to me very much or most of the time).	● Total = 9,260 ● Military experience = 597 ● Males = 90.6% ● Females = 9.4% ● No military experience = 7126 ● Males = 64% ● Females = 36%	● According to PHQ-9: ● With military experience = 12.8% ● Without military experience = 8.4% ● According to DASS-21, prior military experience was significantly more likely to screen positive for major depressive disorder (MDD) and reported higher levels of depressive symptom severity.
Kindermann et al. (2020)	Germany	Emergency call-takers and dispatchers (ECDs)	CS	● Tool = PHQ-4 Depression Subscale: PHQ-2 ● Cut-off = ≥ 3	● Total = 71 ● Male = 85.9% ● Female = 14.1%	● Depression = 15.5%
London et al. (2020)	United States of America	911 telecommunicators	CS	● Tool = BDI-II ● Cut-off = ≥ 20	● Total = 788 ● Female = 73.7%	● Moderate to severe depression = 24.2%
Ferrau (2022)	Sweden	Emergency dispatchers	CS	● Tool = MADRS-S ● Cut-off = 12–20 for mild depression, ● 21–35 for moderate depression, ● > 35 for severe depression	● Total = 97	● Depressive symptoms = 51.5% (50 respondents) ● Mild symptoms = 30 respondents ● Moderate symptoms = 20 respondents
O’Dare et al. (2023)	United States of America	Public safety telecommunicator officers (PSTCOs)	CS	● Tool = PHQ-9 ● Cut-off = ≥ 10	● Total = 54 ● Male = 31.5% ● Female = 66.7%	● Moderate to severe depression = 18.4%
Blalock et al. (2024)	United States of America	Emergency Communication Operators (ECOs)	CS	● Tool = PHQ-9 ● Cut-off = ≥ 10	● Total = 742 ● Male = 25.4% ● Female = 74%	● Above the cutoff score for depression = 35.6% ● Depressive symptoms = 57% ● Mild depression = 26.4% ● Moderate depression = 13.1% ● Moderately severe depression = 11.1% ● Severe depression = 6.3%
Giaume et al. (2024)	France	Emergency Medical Dispatchers (EMD) working at the 112-call center	CS	● Tool = HAD ● Cut-off = ≤ 7 = no symptoms ● 8–11 = doubtful symptoms ● ≥ 11 = clear symptoms	● Total = 109 ● Male = 98% ● Female = 2%	● Depression = 16.6%
Verble et al. (2024)	United States of America	Wildland fire dispatchers	CS	● Tool = PHQ-9 ● Cut-off = > 14	● Total = 510 ● Male = 40% ● Female = 59%	● Depression = 73% ● Mild depression = 33% ● Moderate depression = 15% ● Severe depression = 25%

Here, CS = Cross-sectional, PHQ-9 = Patient Health Questionnaire-9, BDI-II = Beck Depression Inventory-II, PHQ-4 = Patient Health Questionnaire-4, MADRS-S = Montgomery-Åsberg Depression Rating Scale – Self-rating Version, HAD = Hospital Anxiety and Depression Scale

Table 1 summarizes key attributes of each study, including national context, occupational focus, methodological design, sample characteristics, instruments used, and reported depression outcomes. This comparative overview reveals both a wide prevalence range (from 8.4% to 73%) and notable methodological inconsistencies, particularly in terms of screening cutoffs and symptom severity stratification. Some studies, such as Blalock et al. (2024), offered granular breakdowns of symptom severity, while others reported only binary outcomes. Groll et al. (2020) stands out for its comparative nature: This study compares public safety professionals, including communicators, with and without military experience, revealing significantly higher depression rates among the former group. These types of subgroup analyses enhance understanding of risk differentials within communicator populations.

As illustrated in Fig. 2, the prevalence of depression among communicators in the United States exceeds that of the general U.S. population (Brody et al., 2025). A comparable trend is observed in Canada (Fig. 3), where depression rates among communicators are similarly elevated relative to the general population (Stephenson, 2023). Although both groups demonstrate higher rates than their respective national averages, the prevalence appears marginally greater among U.S. communicators than among their Canadian counterparts.

Fig. 2.

Prevalence rate of depression in the USA

Fig. 3.

Prevalence rate of depression in Canada

In addition, Table 2 contrasts prevalence rates by instrument type, illustrating how methodological choices, especially the selection of depression screening tools and cutoff thresholds, can influence reported prevalence. For example, the PHQ-9, employed in five studies, produced the widest range of reported prevalence, from 8.4% to 73%, underscoring both its sensitivity and the variability across contexts and populations.

Table 2.

Comparative summary of depression prevalence by measurement tool across reviewed studies

Psychometric tool	Number of studies	Range of Depression Prevalence (in %)
PHQ-9	5	8.4–73
BDI-II	3	16–24.2.2
PHQ-4	1	15.5
MADRS-S	1	51.5
HAD	1	16.6
Overall range	11	8.4–73

Here, PHQ-9 = Patient Health Questionnaire-9, BDI-II = Beck Depression Inventory-II, PHQ-4 = Patient Health Questionnaire-4, MADRS-S = Montgomery-Åsberg Depression Rating Scale – Self-rating Version, HAD = Hospital Anxiety and Depression Scale.

Collectively, this body of literature highlights the urgent need for role-specific mental health interventions tailored to the distinct challenges faced by emergency communicators. The documented high prevalence of depressive symptoms, their severity, and the consistent underrepresentation of this group in the broader literature on public safety professionals all point to a pressing occupational health concern. Future research should prioritize longitudinal designs, deeper qualitative exploration, and policy-oriented interventions to better support this essential workforce.

The studies captured diverse roles within the communication field. Carleton, Afifi, Turner, Taillieu, LeBouthillier, et al. (2018b), the only Canadian study, offered the broadest scope, examining multiple public safety professional groups, including call centre operators, dispatchers, municipal/provincial police, Royal Canadian Mounted Police, paramedics, and correctional officers. O’Dare et al. (2023) focused exclusively on public safety telecommunicator officers (PSTCOs) in the United States, while Verble et al. (2024) investigated a more niche cohort, wildland fire dispatchers, also in the U.S. Despite differing focal populations, all three studies converged on the finding that suicide risk is markedly present among emergency communication professionals.

Table 3 provides a side-by-side comparison of the methodological and empirical features of these studies. It details variables such as country of origin, sample size, gender composition, suicide risk assessment tools, and reported prevalence rates of suicidal ideation. This comparative framework not only foregrounds variations in reported prevalence rates but also illuminates how methodological differences, such as the choice of screening tool, may shape the contours of risk detection. For example, Carleton, Afifi, Turner, Taillieu, LeBouthillier, et al. (2018b), using Statistics Canada indicators, reported that 9.5% of communicators experienced suicidal ideation in the past year, and a striking 28.7% had experienced such ideation over their lifetime. Lifetime rates for suicide planning and attempts were 13.6% and 8.6%, respectively, while past-year rates were 2.5% and 0.4%. These data underscore the enduring psychological burden faced by communicators, whose roles often involve repeated exposure to traumatic calls without closure or resolution. In contrast, O’Dare et al. (2023), employing the Suicide Behaviors Questionnaire-Revised (SBQR), found that 9.3% of PSTCOs met the threshold for being at risk of suicide, a comparable figure to Carleton, Afifi, Turner, Taillieu, LeBouthillier, et al.‘s (2018b) annual ideation rate. Although O’Dare et al. (2023) did not disaggregate their data by type of suicidal behavior (ideation vs. planning vs. attempts), the use of a validated risk scale allowed for a broader conceptualization of suicidal vulnerability, capturing even subclinical indicators. Verble et al. (2024) extended the scope of inquiry to wildland fire dispatchers and applied the Columbia-Suicide Severity Rating Scale (C-SSRS) to stratify suicide risk into discrete levels. Their findings revealed that 32% of dispatchers exhibited some level of suicide risk: 15% at low risk, 7% at moderate risk, and 10% at high risk. The inclusion of stratified risk levels added important granularity to the field, enabling a more nuanced understanding of risk gradations across populations that may otherwise be treated as a monolith in suicide prevention strategies.

When suicidal risk assessment scales were compared, the Statistics Canada questions stood out as being designed for population-level monitoring and show consistency across survey cycles; however, they lack formal psychometric validation and measures of internal consistency (Statistics Canada, 2018). In contrast, the Suicidal Behaviors Questionnaire-Revised (SBQ-R) demonstrates strong predictive validity and good internal consistency (α ≈ 0.87–0.88), particularly in clinical and adolescent samples (Osman et al., 2001). The Columbia-Suicide Severity Rating Scale (C-SSRS) also shows strong convergent, divergent, and predictive validity, with high internal consistency in some samples (α > 0.93) (Posner et al., 2011). While both the SBQ-R and C-SSRS are psychometrically robust for assessing suicide risk, the Statistics Canada instrument is more suitable for broad health surveillance.

Moreover, Fig. 4 illustrates that the prevalence of suicidal ideation among communication professionals in the United States exceeds rates typically reported in the general population National Institute of Mental Health (2025). A comparable pattern is evident in Canada (Government of Canada, 2023) (Fig. 5), where communicators similarly report higher rates of suicidal thoughts than the general population. Available evidence suggests that suicidal ideation may be more prevalent among communicators in both countries; however, given the small number of studies, these findings should be interpreted cautiously. Within this limited evidence base, U.S. communicators appear to exhibit slightly higher rates than their Canadian counterparts, pointing to a potentially greater mental health burden among American communication professionals.

Fig. 4.

Prevalence rate of suicidal ideation in the USA

Fig. 5.

Prevalence rate of suicidal ideation in Canada

The variation in results presented in Table 3 underscores several key insights. First, despite methodological differences, the studies converge on a shared finding: communicators report substantially elevated rates of suicidal ideation compared to the general population (Figs. 4 and 5). Second, cross-national differences, particularly between Canadian and U.S. samples, may reflect both contextual disparities in the workplace and cultural factors shaping disclosure. Third, the diversity of instruments used points to a broader issue in the field: the absence of standardized screening protocols for this occupational group, which hampers direct comparisons but also highlights an opportunity for future methodological alignment. Importantly, the elevated rates of ideation and risk identified in these studies signal an urgent need for targeted intervention. Emergency communicators often operate under conditions of chronic stress and acute trauma, yet unlike other first responders, they may lack formal peer support, routine mental health assessments, or organizational mechanisms for psychological recovery. Collectively, the descriptive summary, supported by Table 3, demonstrates that suicide risk among communicators is not only a measurable phenomenon but one of considerable magnitude. These findings warrant greater empirical attention and underscore the importance of integrating suicide prevention strategies into occupational health policies for this high-risk group.

Discussion

This discussion summarizes the findings from empirical studies published between 1995 and 2025 to identify contributing factors to depression and suicidal ideation among communicators, explore the interrelationship between these two mental health outcomes, and assess proposed mitigation strategies. As critical but often overlooked members of the emergency response system, 911 call-takers, dispatchers, and other communication professionals operate in high-stress environments characterized by indirect trauma exposure, chronic organizational stressors, and limited institutional support. The literature reveals that depression is not only prevalent within this occupational group but is also a key psychological mechanism underlying suicidal ideation.

While other psychological strains, such as anxiety, PTSD, and secondary traumatic stress, are also highly prevalent and may exert more immediate effects on workers and organizations, impairing daily functioning and contributing to turnover, burnout, and organizational strain (Giaume et al., 2024; Osório et al., 2025; Saldanha et al., 2025), suicidal ideation and depression remain critical for understanding early risk and guiding interventions. Only one Canadian study has reported suicide attempts among public safety communicators, whereas most studies report suicidal ideation, highlighting a gap this review addresses. Focusing on ideation allows timely identification of at-risk individuals and the development of preventive strategies before crises escalate. By emphasizing suicidal ideation alongside depression, this review underscores the clinical and public health importance of early intervention in this occupational group. These outcomes are interrelated, serve as proximal markers for suicide risk, and remain insufficiently studied in the literature on communicators.

Contributing factors to depression and suicidal ideation

A consistent theme across the reviewed literature is the confluence of occupational, organizational, and personal factors that contribute to psychological distress. Repeated exposure to potentially traumatic events (PTEs), particularly through auditory channels, emerges as a distinctive occupational hazard. Studies by Carleton et al. (2019) and Dare et al. (2023) identify exposure to distressing calls, such as those involving violent death or assault, as significantly associated with both depression and suicidal ideation. Although many studies group PTEs broadly, emerging work (e.g., Giaume et al., 2024; Verble et al., 2024) emphasizes the unique psychological burden of hearing trauma rather than witnessing it directly, a sensory distinction critical in dispatcher roles.

Organizational stressors such as shift work, understaffing, and lack of recognition are repeatedly linked to higher depression rates (Carleton et al., 2020), and these systemic pressures compound over time. Emotional suppression, a common coping strategy in communication centers, has been shown to amplify rather than alleviate depressive symptoms, contributing to a culture where distress is internalized and left untreated (London et al., 2020; Verble et al., 2024).

Personal factors also modulate risk. For instance, prior trauma histories, such as childhood adversity, heighten vulnerability to depression in response to occupational exposures (London et al., 2020). Demographic variables such as younger age, female gender, and marital instability further interact with occupational stress to increase suicidal ideation (Carleton, Afifi, Turner, Taillieu, LeBouthillier et al., 2018b; Verble et al., 2024). Notably, Verble et al. (2024) found that more than 30% of dispatchers reported their job had intensified suicidal thoughts, while 56% indicated it had exacerbated their depression. Yet, only a minority of those at risk had sought treatment, underscoring a severe service gap.

Secondary traumatic stress is also strongly implicated. Ferrau (2022) found a significant correlation (r =.822, p <.001) between secondary trauma and depression, indicating that vicarious trauma is not just emotionally taxing; it is clinically consequential. Similarly, Groll et al. (2020) report that dispatchers with prior military service exhibited higher rates of suicidal contemplation, suggesting that pre-existing trauma histories may compound the psychological effects of emergency communication work.

Finally, sleep disruption and physical health are important contributors to depressive symptoms. Studies by Lilly et al. (2016) and Giaume et al. (2024) demonstrate clear links between poor sleep quality and elevated depression, revealing a biopsychosocial cycle in which occupational stress degrades physical health, which in turn exacerbates psychological vulnerability.

Depression as a mechanism for suicidal ideation

While not all studies explicitly foreground suicidal ideation, several reveal moderate to strong correlations between depression and suicide risk. Verble et al. (2024) identified statistically significant associations between depressive symptoms and suicidal ideation (r =.32** for high suicide risk; r =.26** for any risk), supporting the conclusion that depression serves as a primary conduit for suicide vulnerability among PSCs. These findings align with broader psychiatric literature linking depression to heightened suicide risk and reinforce the notion that addressing depression is a critical pathway to suicide prevention in this group.

The co-occurrence of depression, suicidal ideation, and chronic pain also points to a broader pattern of psychophysiological burden. Carleton, Afifi, Turner, Taillieu, Duranceau, et al. (2018a) found that 23.1% of PSCs screened positive for comorbid mental disorders and chronic pain, suggesting that the interplay between physical and psychological suffering may reinforce feelings of helplessness and despair.

Evaluation of mitigation strategies

Despite growing awareness of the problem, mitigation strategies remain inconsistently applied. Structural reforms, such as improving staffing levels, reducing shift volatility, and providing trauma-informed supervision, are frequently recommended but under-implemented (Carleton et al., 2020; O’Dare et al., 2023). Creating space for emotional expression, debriefings, and access to embedded mental health supports could reduce the compounding effect of unprocessed trauma.

Interventions must also target individual vulnerabilities, especially among those with known trauma histories. London et al. (2020) recommend approaches that promote emotional regulation and cognitive processing rather than emotional suppression. Sleep-focused interventions and physical wellness programs could further buffer against depression onset.

Importantly, several scholars (O’Dare et al., 2023; Verble et al., 2024) argue for tailored therapeutic approaches that address auditory exposure and indirect trauma, such as auditory-based exposure therapy or narrative restructuring. However, the development and testing of such interventions remain in early stages.

Moreover, Muñoz et al. (2012) claim that between 22% and 38% of major depressive episodes could be prevented through the implementation of effective interventions, an assertion supported by empirical evidence. Similarly, Harmer et al. (2025) emphasize that suicidal ideation is a preventable phenomenon when identified early and addressed through appropriate mitigation strategies and sustained management. These findings highlight the critical importance of proactive mental health care: with timely, evidence-based interventions, both depression and suicidal ideation can be significantly reduced, underscoring the potential for prevention to transform outcomes in communicators.

Methodological considerations and future directions

Methodologically, the field faces limitations. Most studies rely on cross-sectional, self-report data, which limits causal claims and may underestimate true prevalence due to stigma and self-selection bias. The absence of data from those who have died by suicide or avoided participation due to psychological distress leaves significant blind spots. The overrepresentation of white, cisgender, and heterosexual participants also hinders intersectional analysis.

To advance understanding and intervention, future research should adopt longitudinal and mixed-methods designs, incorporate clinical diagnostic tools, and pursue greater demographic inclusivity. Qualitative studies capturing lived experience would also enrich current knowledge and help refine trauma-informed approaches tailored to the communication workforce.

Conclusion

Depression and suicidal ideation among communicators stem from a converging web of trauma exposure, organizational dysfunction, and personal vulnerability. Depression is reported at elevated rates and also acts as a key mechanism linking chronic stress to suicidal ideation. The unique features of dispatcher work, particularly indirect exposure to trauma through auditory channels, make this population especially susceptible to cumulative stress injury. While some promising mitigation strategies exist, systemic barriers and research gaps persist. Addressing this occupational mental health crisis requires integrated, evidence-based, and context-sensitive interventions, as well as methodologically robust research that fully captures the complexity of this essential yet often invisible workforce. Given the limited number of studies and variability in measurement approaches, these findings should be interpreted with caution. Strengthening the evidence base through inclusive, longitudinal, and intervention-focused research will be essential to support the well-being and sustainability of this critical workforce.

Authors’ contributions

MC conceived the idea of writing this paper. MC, DR, GF, and CL searched the databases and collected the data. DR wrote the initial draft of the manuscript. All authors reviewed and approved the final version of the manuscript.

Funding

This research was supported by the Government of Alberta through the Supporting Psychological Health in First Responders program (Grant No. 23SPHIFR31-2). The authors thank the Government of Alberta for making this work possible.

Data availability

No datasets were generated or analysed during the current study.

Declarations

Ethics approval and consent to participate

Not applicable.

Competing interests

The authors declare no competing interests.