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Military personnel, police officers, firefighters, and other first responders must prepare for and respond to life-threatening crises on a daily basis. This lifestyle places stress on personnel, and particularly so on military personnel who may be isolated from support systems and other resources. The authors conducted a systematic review of studies of interventions designed to prevent, identify, and manage acute occupational stress among military, law enforcement, and first responders. The body of evidence consisted of 38 controlled trials, 35 cohort comparisons, and 42 case studies with no comparison group, reported in 136 publications. Interventions consisted of resilience training, stress inoculation with biofeedback, mindfulness, psychological first aid, front-line mental health centers, two- to seven-day restoration programs, debriefing (including critical incident stress debriefing), third-location decompression, postdeployment mental health screening, reintegration programs, and family-centered programs. Study limitations (risk of bias), directness, consistency, precision, and publication bias were considered in rating the quality of evidence for each outcome area. Overall, interventions had positive effects on return to duty, absenteeism, and distress. However, there was no significant impact on symptoms of psychological disorders such as PTSD, depression, and anxiety. Because of study limitations, inconsistency of results, indirectness, and possible publication bias, there was insufficient evidence to form conclusions about the effects of most specific intervention types, components, settings, or specific populations.

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Service members experience a variety of harmful behaviors, such as sexual assault, sexual harassment, domestic abuse, and suicide, that can affect their overall health and quality of life and be detrimental to force readiness. While response and treatment are vital services to address these harms, a robust prevention system is also needed. The Department of Defense (DoD) asked RAND Corporation researchers to develop a prevention capabilities assessment process for use across the active and reserve forces and to pilot the process during visits at 20 installations that were at higher risk for, or had a greater number of protective factors to mitigate, these harmful behaviors. This report describes how the prevention capabilities assessment process was developed, pilot tested, and assessed for validity. The metrics assessed prevention capabilities in nine areas covering the extent to which military installations prioritized, were prepared to promote, or are currently promoting integrated primary prevention and efforts to create healthy and protective environments and are engaging with service members around these efforts. In pilot tests, Office of the Secretary of Defense (OSD) leaders, researchers, and some installation staff found the metrics beneficial in terms of capturing and providing useful and nuanced information about prevention practices and areas for growth, and the analyses generally supported the validity of the metrics. Moving forward, DoD should continue to validate and refine these metrics as prevention efforts evolve and grow. These metrics, as part of an integrated process of risk identification and assessment, will help DoD track its prevention capability.