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• The Combat and Operational Stress Control (COSC) programs studied, on the whole, had positive effects on return to duty (moderate quality of evidence [QoE]), absenteeism (low QoE), and distress (moderate QoE versus no intervention).
• Most COSC programs reported high levels of acceptability and satisfaction.
• COSC appears to have no significant impact on symptoms or prevalence of psychological disorders such as PTSD, depression, and anxiety.
• Regarding timing, there was insufficient evidence to conclude that any type of predeployment stress control training has a significant effect on psychological symptoms or occupational outcomes.
• Due to study limitations, inconsistency of results, indirectness, and possible publication bias, there was insufficient evidence to form conclusions about the effects of most specific intervention types, components, settings, or specific populations.

Military personnel, police officers, firefighters, and other first responders must prepare for and respond to life-threatening crises on a daily basis. This lifestyle places stress on personnel, and particularly so on military personnel who may be isolated from support systems and other resources. The authors conducted a systematic review of studies of interventions designed to prevent, identify, and manage acute occupational stress among military, law enforcement, and first responders.

The body of evidence consisted of 38 controlled trials, 35 cohort comparisons, and 42 case studies with no comparison group, reported in 136 publications. Interventions consisted of resilience training, stress inoculation with biofeedback, mindfulness, psychological first aid, front-line mental health centers, two- to seven-day restoration programs, debriefing (including critical incident stress debriefing), third-location decompression, postdeployment mental health screening, reintegration programs, and family-centered programs.

Study limitations (risk of bias), directness, consistency, precision, and publication bias were considered in rating the quality of evidence for each outcome area. Overall, interventions had positive effects on return to duty, absenteeism, and distress. However, there was no significant impact on symptoms of psychological disorders such as PTSD, depression, and anxiety. Because of study limitations, inconsistency of results, indirectness, and possible publication bias, there was insufficient evidence to form conclusions about the effects of most specific intervention types, components, settings, or specific populations.

• Chapter One

  Introduction

• Chapter Two

  Methods

• Chapter Three

  Results

• Chapter Four

  Discussion

• Appendix A

  Search Strategies

• Appendix B

  Evidence Table

• Appendix C

  List of Excluded Studies

• Appendix D

  Risk-of-Bias Items, Controlled Trials