Understanding U.S. First Responder Mental and Behavioral Health during the COVID-19 Pandemic: A Scoping Review

Background and Purpose: First responders, including firefighters, emergency medical services personnel, and law enforcement, experience occupational stressors and potentially traumatic incidents that increase their risk of adverse mental and behavioral health outcomes. Potentially exacerbating this risk, first responders were on the front lines throughout the COVID-19 pandemic, continuing to provide emergency services within their communities while dealing with the impacts of the pandemic themselves. Although there is some comprehensive literature on the global effects of the COVID-19 pandemic on first responder mental health, less is known about the mental and behavioral health of U.S. first responders related to the COVID-19 pandemic. This scoping review aims to identify and map existing research on mental and behavioral health outcomes reported among U.S. first responders during the COVID-19 pandemic, highlighting gaps in knowledge and informing future research and practices toward improved support systems for this key population.

Methods: Peer-reviewed articles published in English between 2020 and 2025 were identified using pre-specified Boolean search (e.g., including but not limited to “first responder*” AND “COVID-19” AND “mental health”) in Academic Search Complete, APA PsycInfo, Psychology and Behavioral Sciences Collection, SocINDEX Full Text, Article First, and Google Scholar. After duplicate removal, 917 articles were imported into Covidence for screening, and 86 articles underwent full-text review. In total, 18 articles met all eligibility criteria, and data were charted on the articles’ purpose, design, sample characteristics, first responder role, key outcomes, analysis, and findings. Findings were reported following PRISMA-ScR guidelines.

Results: Firefighters, emergency medical services personnel, and law enforcement officers were represented across the included studies, including nationwide and geographically specific samples. The methodologies used varied, including quantitative, qualitative, and mixed methods. Included studies suggest that U.S. first responders experienced adverse mental and behavioral health outcomes during the COVID-19 pandemic; first responders tended to report heightened levels of depression, anxiety, alcohol consumption, and burnout. These articles further highlighted the underlying mechanisms of (intra)personal, socio-environmental, occupational, and health-related factors.

Conclusion and Implications: To the best of our knowledge, this is the first scoping review of mental and behavioral health outcomes of U.S. first responders during the COVID-19 pandemic. While these articles shed light on the mental and behavioral health experiences of U.S. first responders during the COVID-19 pandemic, there remains a gap in understanding the long-term effects of the COVID-19 pandemic in this population. Further, first responders from minoritized backgrounds were not well-represented in the included articles, despite evidence of disproportionate COVID-19-related adverse outcomes among minoritized groups. Five years since the onset of the COVID-19 pandemic, there remain lessons to be learned about how to best support the mental and behavioral health of U.S. first responders, with a focus on resilience, posttraumatic growth, adaptive coping strategies, and inclusion of family members and peers. Mapping the breadth of scholarship on this topic has implications for future research and interventions supporting first responder mental and behavioral health as they continue to navigate a challenging and unpredictable public safety landscape, including emergent stressors such as measles outbreaks and increased numbers of disasters.