Economic Evaluation of Proactive PTSI Mitigation Programs for Public Safety Personnel and Frontline Healthcare Professionals: A Systematic Review and Meta-Analysis.

Public safety personnel and frontline healthcare professionals are at increased risk of exposure to potentially psychologically traumatic events (PPTEs) and developing post-traumatic stress injuries (PTSIs, e.g., depression, anxiety) by the nature of their work. PTSI is also connected to increased absenteeism, suicidality, and performance decrements, which compromise occupational and public health and safety in trauma-exposed workers. There is limited evidence on the cost effectiveness of proactive "prevention" programs aimed at reducing the risk of PTSIs. The purpose of this meta-analysis is to measure the economic effectiveness of proactive PTSI mitigation programs among occupational groups exposed to frequent occupational PPTEs, focusing on the outcomes related to PTSI symptoms, absenteeism, and psychological wellness. Findings from 15 included studies demonstrate that proactive interventions can yield substantial economic and health benefits, with Return On Investment (ROI) values ranging widely from -20% to 3560%. Shorter interventions (≤6 months) often produced higher returns, while longer interventions (>12 months) showed more moderate or negative returns. Notably, the level at which an intervention is targeted significantly affects outcomes-programs aimed at managers, such as the 4 h RESPECT training course, demonstrated a high ROI and broad organizational impact by enhancing leadership support for employee mental health. Sensitivity analyses highlighted significant variability based on the organizational context, program design, and participant characteristics. The majority of proactive interventions successfully reduced psychological distress and enhanced workplace outcomes, although thoughtful consideration of program design and implementation context is essential.