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Title page for ETD etd-03222013-162020


Type of Document Dissertation
Author Wighton, Lynne Gray
Author's Email Address lwighton@aya.yale.edu
URN etd-03222013-162020
Title Psychological Debriefing and First Responders: A Meta-Analysis
Degree PhD
Department Interdisciplinary Studies: Health Services Research and Policy
Advisory Committee
Advisor Name Title
Craig Anne Heflinger, Ph.D. Committee Chair
Elizabeth E. Weiner, PhD, RN-BC, FACMI, FAAN Committee Member
Kenneth A. Wallston, Ph.D. Committee Member
Mark W. Lipsey, Ph.D. Committee Member
Keywords
  • First Responders
  • Psychological Debriefing
  • Critical Incident Stress Debriefing (CISD)
  • Meta-Analysis
  • Posttraumatic Stress Disorder (PTSD)
Date of Defense 2012-04-26
Availability unrestricted
Abstract
After almost thirty years of world-wide use, there is still an ongoing debate about the effectiveness of using a single session of Psychological Debriefing (PD) after a potentially traumatic experience (high-risk event) to allay and/or prevent symptoms of Acute Stress Disorder, Posttraumatic Stress Disorder and/or other commonly experienced symptoms of distress. Moreover, even though the use of PD is endemic in the First Responder (FR) culture, there has been no published quantitative analysis of PD effects on FRs after a high-risk event. Therefore, the meta-analysis conducted in this dissertation is the first quantitative examination of the existing evidence about the effectiveness of single-session PD on distress experienced by FRs after a high-risk event. This meta-analysis has two aims: 1) to determine if FRs who attended a PD intervention experience less distress compared to those who did not attend; 2) to summarize the strengths and limitations of the research in this field.

The overall result of this meta-analysis was a small, positive effect in favor of PD lowering distress, however this result is not statistically significant (ESsm = .11 (90% CI -.05 to .27). Having 10 or fewer years on the job was the FR characteristic most strongly associated with positive effects of PD. The PD characteristics most strongly associated with positive effects were: when the leader was a mental health professional; PD was mandatory; and the department (vs. FRs) determined a PD was needed. No difference in effect was found in terms of PD protocol (Critical Incident Stress Debriefing--CISD, partial CISD, or other).

The strengths of this meta-analysis are: use of a circumscribed population (FRs); distinguishes between large- and limited-scope events; assesses effectiveness of PD characteristics; use of the first assessment after the PD as the outcome; and includes measures of symptoms of both Posttraumatic Stress Disorder, as well as general psychological/physiological health; and addresses within-study group equivalence. The limitations of this meta-analysis stem from deficits in reporting on characteristics of interest in the source studies and the lack of within-study group equivalence. These limitations are severe and must be considered when interpreting the results.

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