title: Rescuers at risk: a systematic review and meta-regression analysis of the worldwide current prevalence and correlates of PTSD in rescue workers.
abstract: OBJECTIVE
  We sought to estimate the pooled current prevalence of posttraumatic stress disorder (PTSD) among rescue workers and to determine the variables implicated in the heterogeneity observed among the prevalences of individual studies.
  
  
  METHODS
  A systematic review covering studies reporting on the PTSD prevalence in rescue teams was conducted following four sequential steps: (1) research in specialized online databases, (2) review of abstracts and selection of studies, (3) review of reference list, and (4) contact with authors and experts. Prevalence data from all studies were pooled using random effects model. Multivariate meta-regression models were fitted to identify variables related to the prevalences heterogeneity.
  
  
  RESULTS
  A total of 28 studies, reporting on 40 samples with 20,424 rescuers, were selected. The worldwide pooled current prevalence was 10%. Meta-regression modeling in studies carried out in the Asian continent had, on average, higher estimated prevalences than those from Europe, but not higher than the North American estimates. Studies of ambulance personnel also showed higher estimated PTSD prevalence than studies with firefighters and police officers.
  
  
  CONCLUSIONS
  Rescue workers in general have a pooled current prevalence of PTSD that is much higher than that of the general population. Ambulance personnel and rescuers from Asia may be more susceptible to PTSD. These results indicate the need for improving pre-employment strategies to select the most resilient individuals for rescue work, to implement continuous preventive measures for personnel, and to promote educational campaigns about PTSD and its therapeutic possibilities.
authors.affiliation: Institute of Psychiatry, Universidade Federal do Rio de Janeiro (IPUB-UFRJ), Rua Almirante Saddock de Sá, 290/402 Ipanema, Rio de Janeiro, RJ, 22411-040, Brazil. wberger@globo.com
authors.forename: William
authors.initials: W
authors.lastname: Berger
authors.forename: Evandro Silva Freire
authors.initials: ES
authors.lastname: Coutinho
authors.forename: Ivan
authors.initials: I
authors.lastname: Figueira
authors.forename: Carla
authors.initials: C
authors.lastname: Marques-Portella
authors.forename: Mariana Pires
authors.initials: MP
authors.lastname: Luz
authors.forename: Thomas C
authors.initials: TC
authors.lastname: Neylan
authors.forename: Charles R
authors.initials: CR
authors.lastname: Marmar
authors.forename: Mauro Vitor
authors.initials: MV
authors.lastname: Mendlowicz
mesh_terms: D001208:Asia / Q000453:epidemiology; D060731:Emergency Responders / Q000523:psychology / Q000706:statistics & numerical data*; D005060:Europe / Q000453:epidemiology; D006801:Humans; D009656:North America / Q000453:epidemiology; D009784:Occupational Diseases / Q000453:epidemiology*; D011159:Population Surveillance; D015995:Prevalence; D018635:Rescue Work; D013313:Stress Disorders, Post-Traumatic / Q000453:epidemiology*