Mental Health, Well-Being and Decision-Making in First Responders and Frontline Workers

A Special Issue of Psychiatry International (ISSN 2673-5318) belonging to the section "Mental Health".

Deadline for manuscript submissions: 31 January 2027 | Viewed by 1491

Editors


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Guest Editor
Department of Psychology, University of Cádiz, 11519 Cádiz, Spain
Interests: judgment and decision-making under risk and uncertainty; occupational stress and mental health; emotional intelligence and well-being; learning analytics and digital tools for psychological assessment

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Guest Editor
Department of Psychology, Liverpool John Moores University, Liverpool, UK
Interests: forensic and clinical psychology; occupational stress and well-being in high-risk professions; police and public safety personnel; psychological assessment and intervention

Special Issue Information

Dear Colleagues,

First responders and frontline workers play a crucial role in maintaining safety, health, and social order. Police officers, firefighters, emergency medical services, dispatch and call-centre operators, military personnel, and frontline healthcare professionals are routinely exposed to critical incidents, traumatic events, and morally challenging situations. These demanding contexts place them at increased risk of a wide spectrum of mental health problems, including post-traumatic stress disorder, depression, anxiety, substance misuse, burnout, and moral injury, as well as difficulties in family and social functioning.

At the same time, many of these professionals display remarkable resilience, effective coping styles, and adaptive decision-making under pressure. Understanding why some individuals and organisations thrive while others struggle is essential to inform prevention, early detection, and evidence-based interventions. There is also a growing need to integrate cognitive and affective mechanisms of decision-making into the study of occupational trauma and well-being in these groups, including how emotions, heuristics, risk perception, and organisational culture shape moment-to-moment choices in high-stakes situations.

The aim of this Special Issue, “Mental Health, Well-Being and Decision-Making in First Responders and Frontline Workers”, is to bring together cutting-edge research and clinical insights on the psychological impact of critical incidents, and on factors that promote or hinder mental health and optimal functioning in these professions. We particularly welcome contributions that…

  • Examine the prevalence, course, and predictors of mental health outcomes (e.g., PTSD, depression, moral injury, burnout, suicidality) in first responders and other frontline workers.
  • Explore decision-making and risk-taking processes under stress, including cognitive, emotional, and social determinants.
  • Identify individual, team, and organisational protective factors such as resilience, social support, leadership, training, and peer-support programmes.
  • Evaluate prevention, early intervention, and treatment approaches tailored to these occupational groups, including digital and scalable interventions.
  • Provide qualitative and mixed-methods accounts of lived experience, stigma, help-seeking, and barriers to care in diverse cultural and institutional contexts.

We encourage submissions from different disciplines (psychology, psychiatry, neuroscience, public health, occupational medicine, sociology, criminology) and from diverse regions of the world. Original research articles, systematic reviews, meta-analyses, case series, brief reports and high-quality conceptual or theoretical papers are all welcome.

We look forward to receiving your contributions and to advancing a nuanced, evidence-based understanding of mental health, well-being, and decision-making among first responders and frontline workers.

Dr. Alberto Paramio
Dr. Ricardo Tejeiro
Guest Editors

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Keywords

  • first responders
  • police and public safety personnel
  • firefighters and emergency medical services
  • frontline healthcare workers
  • critical incidents and occupational trauma
  • PTSD and moral injury
  • burnout and occupational stress
  • decision-making under stress
  • resilience and coping
  • organisational culture and peer support

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Published Papers (2 papers)

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Research

16 pages, 290 KB  
Article
Anxiety and Its Relationship with Professional Quality of Life and Meaning in Life Among Hospital Nursing Personnel: A Cross-Sectional Study
by Vasiliki Tsoulou, Areti Stavropoulou, Angeliki Stamou and Maria Polikandrioti
Psychiatry Int. 2026, 7(4), 180; https://doi.org/10.3390/psychiatryint7040180 - 19 Aug 2026
Viewed by 448
Abstract
Introduction: Nurses in hospital settings frequently experience anxiety, which may adversely affect both their psychological well-being and professional functioning. In this context, Professional Quality of Life (ProQoL) and Meaning in Life are recognized as key factors influencing nurses’ mental health outcomes. Aim: The [...] Read more.
Introduction: Nurses in hospital settings frequently experience anxiety, which may adversely affect both their psychological well-being and professional functioning. In this context, Professional Quality of Life (ProQoL) and Meaning in Life are recognized as key factors influencing nurses’ mental health outcomes. Aim: The aim of the present study was to explore the level of anxiety among nursing personnel in hospital settings and to assess its association with ProQoL and Meaning in Life. Materials and Methods: A cross-sectional study was conducted in a convenience sample of 200 nursing personnel in a public hospital. Data were collected using the Zung Self-Rating Anxiety Scale (SAS), the Professional Quality of Life Scale-5 (ProQoL-5), and the Meaning in Life Questionnaire (MLQ) which also included characteristics of nursing personnel. Results: Anxiety levels were low to mild (39.8 ± 8.7). ProQoL dimensions indicated moderate to high Compassion Satisfaction (35.5 ± 7.3) and moderate levels of Burnout (27.6 ± 5.7) and Secondary Traumatic Stress (26.5 ± 6.1). Regarding Meaning in Life, participants reported high levels of Presence of Meaning (27.1 ± 4.8) and moderate levels of Search for Meaning (21.7 ± 6.7). A statistically significant negative correlation was observed between anxiety and Compassion Satisfaction (r = −0.532, p < 0.001), as well as between anxiety and Presence of Meaning (r = −0.387, p < 0.001). In contrast, anxiety was positively correlated with Burnout (r = 0.652, p < 0.001) and Secondary Traumatic Stress (r = 0.534, p < 0.001). In the multivariable analysis, the self-rating of daily work experience score was associated with increased anxiety levels by 0.9 units for each unit increase (95% CI: 0.2 to 1.7, p < 0.011). Compassion Satisfaction was associated with a decrease in anxiety by 0.4 units (95% CI: −0.6 to −0.2, p < 0.001), while Burnout and Secondary Traumatic Stress were associated with an increase in anxiety by 0.5 (95% CI: 0.2 to 0.8, p < 0.001) and 0.4 units (95% CI: 0.2 to 0.6, p < 0.001), respectively. Conclusions: Self-rated daily work experience, Burnout, and Secondary Traumatic Stress were positively associated with anxiety, whereas Compassion Satisfaction was negatively associated with anxiety. These results illustrate the importance of targeted interventions aimed at reducing anxiety, strengthening ProQoL, and promoting Meaning in Life to support nursing personnel’s well-being. Full article
20 pages, 409 KB  
Article
Latent Classes of Proximal Traumatic Exposure Among Portuguese Police and Security Professionals: Associations with PTSD Symptoms and Psychological Distress
by Hélder António, Sara Albuquerque, Maria Vieira de Castro, Stéphane Bouchard, Pedro Gamito and Ricardo J. Pinto
Psychiatry Int. 2026, 7(4), 173; https://doi.org/10.3390/psychiatryint7040173 - 4 Aug 2026
Viewed by 458
Abstract
Background: Police and security professionals are routinely exposed to potentially traumatic events as part of occupational duties, placing them at increased risk for post-traumatic stress and broader psychological difficulties. This study aimed to identify latent classes of proximal traumatic exposure among Portuguese police/security [...] Read more.
Background: Police and security professionals are routinely exposed to potentially traumatic events as part of occupational duties, placing them at increased risk for post-traumatic stress and broader psychological difficulties. This study aimed to identify latent classes of proximal traumatic exposure among Portuguese police/security professionals and examine their associations with PTSD symptoms and general psychological distress. Methods: A cross-sectional online survey was conducted with Portuguese police/security professionals (N = 644). Latent class analysis (LCA) was applied to 17 indicators of potentially traumatic events coded as directly experienced or witnessed, derived from the Life Events Checklist for DSM-5. PTSD symptoms were assessed using the PTSD Checklist for DSM-5, and general psychological distress was assessed using the Brief Symptom Inventory. Exploratory receiver operating characteristic (ROC) analyses examined whether counts of proximal traumatic events could approximate the LCA-derived classes. Results: A three-class solution was identified, comprising low proximal exposure (37.3%), moderate proximal exposure (40.7%), and high proximal/cumulative exposure (22.0%) classes. The classes reflected a graded cumulative pattern of exposure across traumatic event categories, rather than clearly distinct qualitative configurations defined by specific event types. Higher exposure classes were associated with progressively higher PTSD symptoms and psychological distress, and these associations remained significant after adjustment for sociodemographic and occupational variables. Exploratory receiver operating characteristic (ROC) analyses showed that a simple count of proximal traumatic event categories closely approximated the empirically derived class structure within the present sample. However, the resulting thresholds are sample-specific, exploratory, and should not be interpreted as validated screening cutoffs. Conclusions: Proximal traumatic exposure among police/security professionals appears to follow a graded cumulative structure associated with increased PTSD symptoms and psychological distress. The person-centered analysis provided an empirical test of whether exposure was organized according to qualitatively distinct event configurations or primarily along a cumulative gradient. In this sample, cumulative exposure burden emerged as the dominant organizing dimension. The count-based approximation requires external validation before any screening or decision-making application can be considered. Full article
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