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What the research says about PTSD in first responders.

A plain-language guide to the studies behind the statistics: how common PTSD is across public safety roles, what drives the risk, how researchers measure it, and where the evidence still falls short.

This page discusses suicide. If you're struggling right now, call or text 988 any time.

  • Last reviewed
  • 17 sources
  • About 12 minutes to read
On this page
Help shape the researchOur first responder questionnaire is in development. Get notified

The short version

Across countries, roles and study designs, the same pattern keeps showing up: the people who answer emergencies carry a heavier mental health load than the public they serve.

  • About 1 in 10

    rescue workers had current PTSD in a pooled analysis of studies from around the world1, roughly double the share of U.S. adults with PTSD in a given year2.

  • 1 in 7

    police officers met criteria for PTSD in pooled data covering more than 272,000 officers in 24 countries3.

  • 243 vs. 222

    In 2017, at least 243 U.S. police officers and firefighters died by suicide, compared with 222 who died in the line of duty4.

  • Peer support

    was linked to significantly lower PTSD symptoms among police, one of the clearest protective factors in the research3.

How common is PTSD in first responders?

There's no single answer, because no study has measured every responder the same way. What exists is a set of meta-analyses that pool many smaller studies, plus large surveys of specific groups. Read together, they point in the same direction, even where the exact figures differ.

PTSD estimates by group

Share of each group with current or probable PTSD. Not directly comparable; see notes below.

  • U.S. adultsAny given year, reference point2
    5%
  • Rescue workers worldwideMeta-analysis, current PTSD1
    10%
  • Ambulance personnelMeta-analysis, 18 studies5
    11%
  • PoliceMeta-analysis, 24 countries3
    14.2%
  • Canadian public safety personnelSurvey, screened positive6
    23.2%
  • U.S. corrections professionalsSurvey, symptoms in past 30 days7
    27%
  • Meta-analysis pooling many studies
  • Single large survey
  • General population reference

Why the numbers vary so much

  • Screens versus diagnoses. Most studies use self-report questionnaires, which flag probable PTSD. Only a clinical interview confirms a diagnosis.
  • Different time windows. Some studies ask about the past month, others the past year or a whole career.
  • Who answers. People who volunteer for mental health surveys may differ from those who don't, and responders who left the job because of symptoms are often missing8.
  • When and where. The year data were collected explained part of the variation in ambulance studies, with some evidence that rates have fallen over recent decades5. The Canadian team cautioned that direct comparisons with the general population aren't possible because of differences in method6.

What we know, role by role

Research coverage is uneven. Police and paramedics have been studied the most; dispatchers, corrections staff and volunteer firefighters far less.

  • Law enforcement

    14.2%met criteria for PTSD, pooled global estimate3

    The largest pooled analysis to date drew on 272,463 officers in 24 countries. Alongside PTSD, it estimated depression at 14.6%, hazardous drinking at 25.7% and suicidal ideation at 8.5%. The strongest predictors of PTSD were occupational stress and avoidant coping, and officers with more peer support reported fewer symptoms3.

    Gap: Most included studies focused on male officers in general duties, so the findings may fit women and specialist units less well3.

  • Fire service

    46.8%reported suicidal thoughts at some point in their career9

    A national survey of 1,027 current and retired firefighters also found that 19.2% had made a suicide plan and 15.5% had attempted suicide during their careers9. Volunteer firefighters were more than twice as likely as career firefighters to report a plan or an attempt10.

    Gap: The survey used a convenience sample. Research based on death certificates also tends to miss volunteers, because firefighting isn't recorded as their occupation10.

  • EMS and paramedics

    11%PTSD prevalence, pooled across 18 studies5

    A review of 27 studies covering 30,878 ambulance personnel estimated rates of 11% for PTSD, 15% for depression, 15% for anxiety and 27% for general psychological distress5. An earlier worldwide analysis also found higher PTSD estimates among ambulance personnel than among firefighters or police1.

    Gap: Rates appear to have declined over the decades studied, and the research can't yet say whether that reflects better support, different measures or changes in who takes part5.

  • 911 dispatch

    32%of potentially traumatic calls were followed by high distress8

    The first study of PTSD symptoms in 911 telecommunicators surveyed 171 dispatchers. Distress during calls was linked to later PTSD symptom severity, suggesting that hearing a trauma unfold, without being physically present, can be enough to raise risk8.

    Gap: Dispatcher samples remain small and self-selected, and published prevalence figures vary widely. This is one of the clearest gaps in the field.

  • Corrections

    27%reported PTSD symptoms in the past 30 days7

    Among security staff the rate rose to 31%. Every participant reported at least one incident involving violence, injury or death during their career, with an average of 28 such incidents7.

    Gap: This study was published by a corrections-focused nonprofit, and corrections staff are often left out of first responder research altogether.

What drives the risk

The calls matter, but they aren't the whole story. Research keeps pointing to the conditions around the calls as well.

  • Cumulative exposure

    Risk builds over a career, not one call. One estimate cited in the Ruderman white paper puts the average police officer's career exposure at 188 critical incidents4.

  • Occupational stress

    In pooled police data, occupational stress was the strongest risk factor for depression and suicidal ideation, and one of the two strongest for PTSD3.

  • Sleep disruption

    Between 49% and 60% of Canadian public safety personnel reported symptoms consistent with clinical insomnia. Those who screened positive for insomnia were roughly 3.4 to 7 times more likely to screen positive for a mental disorder11.

  • Chronic pain

    Nearly a quarter (23.1%) of Canadian public safety personnel reported significant mental health symptoms together with chronic pain, and pain was tied to higher odds of screening positive for PTSD12.

  • Avoidant coping

    Pushing memories away and steering clear of reminders was one of the strongest predictors of PTSD symptoms in police3.

  • Peer support Protective

    Officers with more peer support had significantly lower PTSD symptoms, a finding that supports peer programs like the ones in our directory3.

Suicide: the hardest numbers to get

The Ruderman Family Foundation's 2018 white paper counted at least 140 police officer suicides and 103 firefighter suicides in 2017, against 129 and 93 line-of-duty deaths. Its authors noted that the true numbers are likely higher, because suicides among responders are underreported4.

National tracking is still catching up. Since January 2022, the FBI has accepted reports to its Law Enforcement Suicide Data Collection, which covers current and former officers, corrections officers and 911 operators, but agency participation is voluntary13. Its 2023 report captured 32 suicides from 22 agencies for 2022, out of roughly 17,500 local agencies nationwide. An independent count by First H.E.L.P. and CNA found 1,287 law enforcement and corrections suicides from 2016 to 2022, an average of 184 a year14.

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How researchers measure PTSD

Knowing which tool a study used tells you what its numbers can and can't mean. These are the instruments you'll see most often, and the ones our questionnaire will build on.

Common PTSD instruments
ToolWhat it isScoringBest used for
PC-PTSD-5Primary Care PTSD Screen for DSM-5A trauma-exposure question followed by 5 yes-or-no symptom questions150 to 5. A cut-point of 3 was first suggested; later VA research found 4 best balanced false positives and false negatives, with a lower cut-point possibly better for women15Fast screening. Anyone who screens positive needs further assessment15
PCL-5PTSD Checklist for DSM-520 self-report items, one for each DSM-5 symptom, each rated 0 to 4160 to 80. Scores of 31 to 33 or higher suggest probable PTSD; validation studies have recommended cut-points from 28 to 3716Screening, research and tracking symptom change over time. Developed by the VA's National Center for PTSD16
CAPS-5Clinician-Administered PTSD ScaleA structured interview conducted by a trained clinicianDetermines whether DSM-5 criteria are metDiagnosis, and as the reference standard for validating shorter screens17

About the self-check on our home page

  • It uses adapted PC-PTSD-5 symptom questions with a cut-point of 3. That choice favors catching more people who may need follow-up over avoiding false alarms.
  • Like every screen on this list, it can't diagnose PTSD. A positive result is a reason to talk to a trauma-trained clinician.

Where the evidence falls short

These gaps shaped what we want to ask in our own questionnaire.

  1. Convenience samplesSeveral key studies relied on whoever chose to respond, which can skew results in either direction9,8.
  2. The people who leftResponders who quit or retired because of symptoms are rarely counted, so surveys of people still working may understate the problem8.
  3. Rural and volunteer servicesSmall departments and volunteer squads are hard to reach, and volunteers are easy to miss in occupational records10.
  4. Dispatch and correctionsBoth groups face heavy exposure but have a fraction of the research devoted to police and paramedics.
  5. Women and specialist rolesPolice research has mostly studied men in general duties3.
  6. Snapshots, not careersMost studies capture one moment in time. Few follow responders across a career to show how risk builds.
  7. Incomplete suicide dataVoluntary reporting means national counts remain partial13,14.

Our research: a first responder questionnaire

Borderline Help is developing a questionnaire that gathers PTSD symptom information alongside the details research often misses: role, years of service, career or volunteer status, call exposure and access to support. The goal is a clearer picture of responders in Kentucky and beyond, especially in the rural and volunteer services that national studies tend to overlook.

In development

Built to be safe to answer.

These principles will guide every question we ask.

  • Anonymous by defaultNo names, badge numbers or department identifiers required.
  • Validated measuresSymptom questions based on established public-domain tools, so results can be compared with published research.
  • Support built inCrisis lines on every screen, and a clear way to stop at any point.
  • Independent ethics reviewReviewed by an independent ethics board before any data is collected.
  • Findings shared backSummary results published here for the community that made them possible.

Get notified when it opens

We'll email you once, when the questionnaire launches. You can also volunteer to test it first.

Enter an email address like name@example.com.

Choose the role that fits best.

Sources

  1. Berger W, et al. (2012). Rescuers at risk: a systematic review and meta-regression analysis of the worldwide current prevalence and correlates of PTSD in rescue workers. Social Psychiatry and Psychiatric Epidemiology. Read on PubMed Central
  2. National Center for PTSD, U.S. Department of Veterans Affairs. How common is PTSD in adults? ptsd.va.gov
  3. Syed S, Ashwick R, Schlosser M, Jones R, Rowe S, Billings J. (2020). Global prevalence and risk factors for mental health problems in police personnel: a systematic review and meta-analysis. Occupational and Environmental Medicine, 77(11). doi:10.1136/oemed-2020-106498
  4. Heyman M, Dill J, Douglas R. (2018). The Ruderman White Paper on Mental Health and Suicide of First Responders. Ruderman Family Foundation. rudermanfoundation.org
  5. Petrie K, Milligan-Saville J, Gayed A, et al. (2018). Prevalence of PTSD and common mental disorders amongst ambulance personnel: a systematic review and meta-analysis. Social Psychiatry and Psychiatric Epidemiology, 53, 897–909. doi:10.1007/s00127-018-1539-5
  6. Carleton RN, Afifi TO, Turner S, et al. (2018). Mental disorder symptoms among public safety personnel in Canada. Canadian Journal of Psychiatry, 63, 54–64. doi:10.1177/0706743717723825
  7. Spinaris CG, Denhof MD, Kellaway JA. (2012). Posttraumatic stress disorder in United States corrections professionals: prevalence and impact on health and functioning. Desert Waters Correctional Outreach. Abstract at ojp.gov
  8. Pierce H, Lilly MM. (2012). Duty-related trauma exposure in 911 telecommunicators: considering the risk for posttraumatic stress. Journal of Traumatic Stress.
  9. Stanley IH, Hom MA, Hagan CR, Joiner TE. (2015). Career prevalence and correlates of suicidal thoughts and behaviors among firefighters. Journal of Affective Disorders. Abstract
  10. FireRescue1. Firefighter suicide tackled in new studies. Coverage of research by Stanley and colleagues. firerescue1.com
  11. Angehrn A, et al. (2020). Sleep quality and mental disorder symptoms among Canadian public safety personnel. International Journal of Environmental Research and Public Health. Record
  12. Carleton RN, Afifi TO, Taillieu T, et al. (2018). Anxiety-related psychopathology and chronic pain comorbidity among public safety personnel. Journal of Anxiety Disorders. doi:10.1016/j.janxdis.2018.03.006
  13. Federal Bureau of Investigation. (2023). Law Enforcement Suicide Data Collection. CJIS Link. le.fbi.gov
  14. NewsNation. Law enforcement suicides hit over 1,200 since 2016. Reporting on an analysis by First H.E.L.P. and CNA. newsnationnow.com
  15. Prins A, Bovin MJ, Smolenski DJ, et al. (2016). The Primary Care PTSD Screen for DSM-5 (PC-PTSD-5): development and evaluation within a veteran primary care sample. Journal of General Internal Medicine, 31(10), 1206–1211. Scoring guidance from the National Center for PTSD (2022). ptsd.va.gov
  16. Weathers FW, Litz BT, Keane TM, Palmieri PA, Marx BP, Schnurr PP. (2013). The PTSD Checklist for DSM-5 (PCL-5). National Center for PTSD. Summary and scoring via ISTSS. istss.org
  17. Bovin MJ, et al. (2021). Diagnostic accuracy and acceptability of the Primary Care PTSD Screen for DSM-5 among US veterans. JAMA Network Open. Read on PubMed Central

This page summarizes published research for general education and is not medical advice. Figures come from different populations, time periods and methods, so they shouldn't be compared directly. Last reviewed October 4, 2026.

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