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Cited by 31Posttraumatic Stress Disorder ResearchOccupational Health and PerformanceTraumatic Brain Injury Research

What work-related exposures are associated with post-traumatic stress disorder? A systematic review with meta-analysis

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Coenen, Pieter, van der Molen, Henk F·2021·BMJ Open
DOI 10.1136/bmjopen-2021-049651PMC PMC8388294
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Abstract

Objectives: Although there is evidence that work-related exposures cause post-traumatic stress disorder (PTSD), there are few quantitative studies assessing the degree to which these factors contribute to PTSD. This systematic review with meta-analysis identified work-related exposures associated with PTSD, and quantified their contribution to this disorder. Methods: We searched Medline, PsycINFO, Embase, PILOTS and Web of Science (2005–10 September 2019) for longitudinal studies on work-related exposures and PTSD. We described included articles, and conducted meta-analyses for exposures with sufficient homogeneous information. We performed subgroup analyses for risk of bias, study design and PTSD ascertainment. We assessed evidence quality using Grades of Recommendations, Assessment, Development and Evaluation, and estimated population attributable fractions. Results: After screening 8590 records, we selected 33 studies (n=5 719 236). From what was moderate quality evidence at best, we identified various work-related exposures that were associated with PTSD, mainly involving individuals in the military and first responder (eg, police or fire brigade) occupations. These exposures included the number of army deployments (OR: 1.15 (95% CI 1.14 to 1.16)), combat exposure (OR 1.89 (95% CI 1.46 to 2.45)), army deployment (OR 1.79 (95% CI 1.45 to 2.21)) and confrontation with death (OR 1.63 (95% CI 1.41 to 1.90)). Effects were robust across subgroups and exposures attributed modestly (7%–34%) to PTSD. We identified additional exposures in other occupations, including life threats, being present during an attack, and hearing about a colleague’s trauma. Conclusions: We identified various work-related exposures associated with PTSD and quantified their contribution. While exposure assessment, PTSD ascertainment and inconsistency may have biased our findings, our data are of importance for development of preventive interventions and occupational health guidelines.

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  • A larger dose of work-related trauma exposure often confers greater risk for psychopathology.

    “With respect to workplace characteristics, 'dose' of exposure to explicit content may be important, where a larger dose of work-related trauma exposure often confers greater risk for psychopathology (e.g., Coenen & van der Molen, 2021).”

    From I've Seen Enough: Measuring the Toll of Content Moderation on Mental Health (2025) · cites this paper as Coenen & van der Molen, 2021

    The Results (Work-related exposures; page unavailable) associate repeated army deployments and high-frequency violence with greater odds of PTSD, supporting the claim's general point about exposure dose. The paper examines PTSD rather than psychopathology broadly, and its observational associations do not establish that greater exposure causes the increased risk implied by “confers.” (LLM, conf=0.86)

    Experimental — accuracy not yet measured

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Authors
Coenen, P., & van der Molen, H. F.
Affiliations
  • Amsterdam Public Health (NL)
  • Department of Public and Occupational Health, Netherlands Center for Occupational Diseases, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
ORCID
Venue
BMJ Open
Publisher
BMJ
Published
2021-08
Volume
11
Issue
8
Pages
e049651
ISSN
2044-6055 (ISSN-L)
DOI
10.1136/bmjopen-2021-049651
PMC
PMC8388294
OpenAlex
W3194464245
Cited by
31
References
3
Citations by year
2026: 13 · 2025: 5 · 2024: 5 · 2023: 3 · 2022: 3 · 2021: 2
FWCI
0.43
Type
journal article
Language
en
Open access
Licence
Locations
  • BMJ Open (publishedVersion, cc-by-nc)
  • Europe PMC (PubMed Central) (publishedVersion, other-oa)
  • PubMed Central (publishedVersion, cc-by-nc)
  • PubMed (publishedVersion)
  • Pure Amsterdam UMC (publishedVersion, cc-by)
  • Data Archiving and Networked Services (DANS) (submittedVersion, other-oa)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
  • Amsterdam UMC (VU Amsterdam) - Institutional Repository (submittedVersion, other-oa)
  • Data Archiving and Networked Services (DANS) (submittedVersion, cc-by-nc)
Funders
Dutch Ministry of Social Affairs and Employment (22968)
Topics
  • Social Sciences › Psychology › Clinical Psychology › Posttraumatic Stress Disorder Research
  • Health Sciences › Health Professions › Occupational Therapy › Occupational Health and Performance
  • Health Sciences › Medicine › Epidemiology › Traumatic Brain Injury Research
Keywords
post-traumatic stress disorder, military deployment, combat exposure, first responders, police officers, firefighters, occupational injuries, confrontation with death, threat to life, population attributable fraction, occupational health
MeSH terms
Humans, Military Personnel, Stress Disorders, Post-Traumatic

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