Global PTSD prevalence among active first responders and trends over recent years: A systematic review and meta-analysis

First responders in emergency services are inherently exposed to potentially psychologically traumatic events, increasing their risk for PTSD, burnout, and work incapacity. The current meta-analysis aimed to comprehensively compare PTSD prevalence within varied first responders in the context of both routine exposures and large-scale disasters, assess trends over recent years and differences between economic contexts. In January 2025, five databases were searched for peer-reviewed observational studies on employed or volunteering samples. Publication date was limited to post-2008, given meta-analyses addressing similar questions captured literature until this point. Random effects meta-analyses and meta-regressions explored trends over time and the impacts of exposure category, occupation, economic context, volunteer status, sex, and PTSD measurement. Analyses included 138 studies (173 independent samples). General samples with routine exposures possessed greater prevalence (14.3 %) than samples exposed to large-scale disasters (8.3 %). For the first time, there was some evidence of increasing prevalence over time within routine exposure samples. Low/middle-income countries and non-volunteers exhibited greater PTSD prevalence than high-income countries and volunteers. Prevalence varied based on PTSD outcome measurement, although no differences emerged between occupational and sex subgroups. Increasing PTSD prevalence over time appears to have been largely driven by increases observed since the COVID-19 pandemic, yet important questions remain regarding why prevalence has not decreased in relation to increasing efforts to support this population's mental health. All first responder occupations appear equally prone to PTSD, and thus equally in need of intervention. Workers in low/middle-income countries are particularly vulnerable to PTSD, potentially due to more limited resourcing.