Warren N. Ponder
Natalie Mota
Shay-Lee Bolton- 1One Tribe Foundation, Euless, TX, United States
- 2Department of Clinical Health Psychology, University of Manitoba, Winnipeg, MB, Canada
- 3Departments of Psychiatry and Community Health Sciences, University of Manitoba, Winnipeg, MB, Canada
Editorial on the Research Topic
Mental health services for occupational trauma: decreasing stigma and increasing access, volume 2
First responders, including ambulance personnel, frontline medical workers, physicians, law enforcement officers (LEOs), and nurses are under continued public scrutiny and unprecedented stress that has been compounded by the COVID-19 pandemic (1). The continuous stress (e.g., high demand, understaffing, training and resources), frequent exposure to trauma, and burnout among these groups can have a negative impact on their health and career trajectory (2). However, many members are extremely reticent about seeking mental health treatment to address their distress (3). Burnout and mental health difficulties can manifest differently across cultures. As such, this special issue from international scholars on occupational mental health includes representation from a range of high-risk occupations from Brazilian, Chinese, Danish, South Korean, and American samples.
In a sample of Brazilian physicians, Becker et al. found that almost 12% of healthcare professionals experienced burnout, while in China, Wen et al. showed that burnout significantly mediated the relationship between work and family conflict, and job satisfaction; but that social support moderated the impact of burnout on job satisfaction. This finding underscores the importance of a supportive relationship at work and at home in mitigating the deleterious effects of burnout. Social support is also key to other frontline healthcare professions, such as nursing. In a systematic review and meta-analysis, Chen et al. found an inverse relationship between social support and turnover intention, a measure assessing the likelihood that they would leave their jobs. These results may be useful as a guide for nurse managers, healthcare centers, and policy administrators with actionable items to help reduce turnover, by encouraging and promoting social support.
Sim et al. used a sample of South Korean nurses to examine posttraumatic growth (PTG), burnout, and posttraumatic stress disorder (PTSD) during the COVID-19 pandemic. They found that purposeful rumination, emotional expression and cognitive emotional regulation (cognitive coping while not being overburdened by negative emotions), increased PTG. Furthermore, they showed that PTG was a protective factor both against burnout and persistent PTSD symptoms. Melander et al. investigated social support and PTSD in a sample of Danish ambulance personnel and found that social support predicted higher levels of PTSD symptoms, and that informal managerial and collegial support was preferential to formal social support (e.g., debriefing/defusing, formal training for peer support or a manager). Their sample also overwhelmingly preferred seeking out a family member or close friend for support. These studies further illustrate the importance of social support and protective factors against burnout.
A sizable minority of U.S. first responders—between 17% and 28%—have prior military service (4, 5), and there may be additional institutional (e.g., sensitivity, logistic, and not fitting in) and stigma-related barriers to care that should be considered (6). Ein et al. conducted a rapid review to understand barriers and facilitators related to mental health service utilization in veterans. Some examples of primary barriers included system navigation difficulties and negative attitudes toward mental health, while facilitators included mental health literacy and social support. If this population can overcome perceptions of stigma and potential negative impacts on career trajectory, recent research has recommended a transdiagnostic approach that focuses on emotion regulation (7). To help break down barriers to care, Meyer et al. sought to address stigma, logistical barriers, and lack of therapist cultural competency through implementation of the Unified Protocol in a sample of first responders. They found significant reductions in PTSD, depression, and generalized anxiety symptoms among first responders in this uncontrolled trial with treatment delivered via telehealth (Meyer et al.).
While this special issue fills some of the gaps in the literature, much more can be done. One of the most concerning consequences of burnout and untreated mental health symptoms is an increased risk of substance misuse as a coping mechanism. This can lead to serious career repercussions for members in these occupational roles, including legal consequences. To address this, Fort Worth, Texas created the first Public Safety Employees Treatment Court (PSETC), in the United States, which gives first responders an opportunity for participation in a specialty diversion court program that, if successfully completed, could dismiss their case. The program typically takes 8-to 24-months, and the participants have to adhere to their collaborative treatment plan established at entrance into the program. In the initial study, there were reductions in suicidality, generalized anxiety, depression, emotional distress, and PTSD, while resilience increased (8).
It is also important to continue to understand risk and protective factors for burnout and mental health symptoms in these populations by conducting additional international epidemiological studies. We propose that an interdisciplinary team of scholars and data analysts should leverage international samples using the same assessments for secondary data analytic comparative studies. This taskforce could function in a similar manner to what the National Vietnam Veterans Readjustment Study achieved for Vietnam veterans in the 1980s (9). Using a nationally representative sample, findings from that study elucidated the scale of mental health problems among veterans and, in 1989, led to the first VA-established National Center for PTSD in Boston (10). Since then, the National Center has been at the forefront of the continued study of trauma in veterans and evidence-based solutions to alleviate suffering from posttraumatic stress. First responders deserve the same level of scholarly investigation. We hope this special issue contributes to a larger body of much-needed work in this area.
Author contributions
WP: Conceptualization, Writing – original draft, Writing – review & editing. NM: Writing – review & editing. SB-L: Writing – review & editing.
Conflict of interest
The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.
The author(s) declared that they were an editorial board member of Frontiers, at the time of submission. This had no impact on the peer review process and the final decision.
Generative AI statement
The author(s) declare that no Generative AI was used in the creation of this manuscript.
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References
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2. Baker LD, Richardson E, Fuessel-Herrmann D, Ponder WN, Smith A. Police burnout and organizational stress: job and rank associations. Policing. (2023) 46(4):682–93. doi: 10.1108/PIJPSM-01-2023-0004
3. Ponder WN, Beauchamp A, Schuman DL, Carbajal J, Jetelina KK, Galusha JM. Differences in suicidality in non-treatment-seeking and treatment-seeking law enforcement officers: a cross-sectional study. J Occup Environ Med. (2022) 64(9):797–801. doi: 10.1097/JOM.0000000000002618
4. Baker LD, Ponder WN, Carbajal J, Galusha JM, Hidalgo JE, Price M. Mapping PTSD, depression and anxiety: a network analysis of co-occurring symptoms in treatment-seeking first responders. J Psychiatr Res. (2023) 168:176–83. doi: 10.1016/j.jpsychires.2023.10.038
5. Ponder WN, Walters K, Simons J, Simons R, Jetelina KK, Carbajal J. Network analysis of distress, suicidality, and resilience in a treatment seeking sample of first responders. J Affect Disord. (2023) 320:742–50. doi: 10.1016/j.jad.2022.09.097
6. Ouimette P, Vogt D, Wade M, Tirone V, Greenbaum MA, Kimerling R, et al. Perceived barriers to care among veterans health administration patients with posttraumatic stress disorder. Psychol Serv. (2011) 8(3):212–23. doi: 10.1037/a0024360
7. Schuman DL, Yockey RA, Ponder WN, Carbajal J. Latent profile analysis of transdiagnostic emotional distress, suicidality, and resilience in first responders. J Affect Disord. (2025) 369:436–48. doi: 10.1016/j.jad.2024.09.167
8. Ponder WN, Galusha JM, Lertora I, Tjaden SL, Carbajal J, Young C. Preliminary efficacy of the public safety employee treatment court (PSETC): the first justice-involved program in the United States for first responders. Psychol Trauma. (2025). doi: 10.1037/tra0001915
9. Kulka RA, Schlenger WE, Fairbank JA, Hough RL, Jordan BK, Marmar CR, et al. Trauma and the Vietnam war Generation: Report of Findings from the National Vietnam Veterans Readjustment Study. Research Triangle Park, North Carolina: Brunner/Mazel (1990). Available online at: https://psycnet.apa.org/record/1990-97372-000
Keywords: first responder, occupational health, public safety, health care professionals, mental health, burnout - professional, psychology, resilience
Citation: Ponder WN, Mota N and Bolton S-L (2025) Editorial: Mental health services for occupational trauma: decreasing stigma and increasing access, volume 2. Front. Health Serv. 5:1663204. doi: 10.3389/frhs.2025.1663204
Received: 10 July 2025; Accepted: 15 July 2025;
Published: 28 July 2025.
Edited and Reviewed by: Carolyn Dewa, University of California, Davis, United States
Copyright: © 2025 Ponder, Mota and Bolton. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
*Correspondence: Warren N. Ponder, d2FycmVuQDF0cmliZWZvdW5kYXRpb24ub3Jn; Natalie Mota, bmF0YWxpZS5tb3RhQHVtYW5pdG9iYS5jYQ==; Shay-Lee Bolton, c2hheS1sZWUuYm9sdG9uQHVtYW5pdG9iYS5jYQ==
†ORCID:
Warren N. Ponder
orcid.org/0000-0002-9316-8974