Abstract
Background: Rescue teams and emergency services face high levels of mental health problems due to their frequent exposure to traumatic situations. Critical incident stress debriefing (CISD) is widely used as a psychological intervention for emergency responders and military personnel exposed to traumatic events. However, its effectiveness remains controversial, with systematic reviews yielding mixed results and some evidence of negative and harmful outcomes. This systematic review, conducted according to PRISMA guidelines, evaluates the evidence on the efficacy of CISD in mitigating psychological distress and preventing post-traumatic stress disorder (PTSD). Methods: A systematic search was conducted in PubMed and PsycINFO from inception to November 2024. Eligibility criteria included randomized controlled trials (RCTs) and cohort studies assessing the impact of CISD on PTSD, anxiety, depression, and psychological distress. Two independent reviewers screened studies, extracted data, and assessed the risk of bias using the PEDro scale. Data narrative synthesis was applicable. Results: A total of 6 out of 371 studies were included, comprising 4751 participants. The PEDro scale showed that one study was of high methodological quality, four were of acceptable quality, and two had deficiencies. The findings revealed mixed outcomes: while some studies reported a reduction in PTSD symptoms, others found no significant effect or even potential harm. Heterogeneity in intervention implementation, population characteristics, and study quality influenced the results. Risk of bias was moderate to high in several studies, with limitations in sample size and follow-up duration. No specific effects have been studied in mountain rescue teams. Conclusions: Current evidence does not unequivocally support the efficacy of CISD in preventing PTSD and psychological distress. Given methodological concerns and potential adverse effects, alternative debriefing methods, such as Battlemind debriefing, warrant further exploration. Future research should focus on well-powered RCTs with standardized intervention protocols to enhance reliability.