Methods

This study followed PRISMA guidelines for systematic reviews and meta‑analyses. We searched PubMed, SCOPUS, Web of Science, and regional Persian databases (SID, IranMedex, Magiran, MedLib) as well as Google Scholar through August 25, 2025. Search terms combined MeSH and free‑text keywords (for example, “mental health,” “promotion,” “well‑being,” “mindfulness,” “intervention,” “firefighters,” “occupational performance”).
Inclusion criteria were: (1) population: firefighters; (2) intervention: mental health promotion programs; (3) comparator: control or non‑intervention groups; (4) outcomes: health, behavioral status, depression, anxiety, occupational performance; (5) design: randomized controlled trials (RCTs); and (6) language: English or Persian.
Two reviewers independently screened studies, with a third reviewer resolving disagreements. Extracted data included study characteristics, intervention type, frequency, duration, and outcome measures. Study quality was assessed using the PEDro scale (high: 7–11; fair: 5–6; poor: ≤4). Meta‑analysis was performed in Comprehensive Meta‑Analysis (v2.0), calculating standardized mean differences (SMDs) with 95% confidence intervals (CIs). Heterogeneity was assessed with I², and publication bias with funnel plots and Egger’s regression test. Statistical significance was set at p ≤ 0.05.

Results

From 329 database records plus four manually identified studies, 59 abstracts were screened and 21 full texts reviewed; nine RCTs with 1,460 participants met inclusion criteria.
Interventions included mindfulness‑based programs (e.g., MindShield), psychoeducational workshops, resilience training, mind‑body exercises, and high‑intensity interval programs. Intervention durations ranged from 4 to 24 weeks, with 2–4 sessions per week. Five studies were rated high quality and four fair; none were rated poor.
General health and behavioral outcomes: Nine intervention arms showed significant improvement versus controls (SMD = 1.41; 95% CI: 1.26–1.55; p = 0.001), with substantial heterogeneity (I² = 75.51%). No major publication bias was detected (Egger’s test p = 0.43).
Occupational performance: Seven intervention arms showed significant gains (SMD = 1.61; 95% CI: 1.25–1.97; p = 0.001), with moderate heterogeneity (I² = 52.80%) and no evidence of publication bias (Egger’s test p = 0.75).

Discussion and Conclusion

This systematic review and meta‑analysis provide strong evidence that mental health promotion interventions significantly improve firefighters’ health outcomes and occupational performance. These benefits likely stem from improved emotional regulation, reduced stress, more adaptive coping, and strengthened social support—particularly in group‑based programs.
The results align with prior research documenting high rates of PTSD, depression, and anxiety among firefighters, while extending the evidence base by focusing specifically on preventive and promotive interventions [28]. Practically, fire services should consider integrating structured programs—such as mindfulness training, resilience workshops, psychoeducation, and mind‑body activities—into routine practice to enhance well‑being, reduce burnout, improve efficiency, and lower absenteeism.
Limitations of the review include incomplete reporting of allocation concealment in included trials, heterogeneity across interventions, language restrictions, and limited data on adherence and feasibility. Future research should assess long‑term sustainability, include more diverse populations (e.g., female firefighters), and evaluate program fidelity [29, 30].
In summary, mental health promotion exercises significantly improve general health, behavioral outcomes, and occupational performance among firefighters. Implementing structured, evidence‑based programs can strengthen workforce resilience, enhance quality of life, and support effective emergency response systems.

Ethical Considerations

This study is a systematic review and meta‑analysis of previously published trials and involved no new human or animal participants. All data were drawn from studies that reported institutional ethical approval.

Funding

There is no funding support.

Authors’ Contribution

All authors contributed equally to the conceptualization and writing of the article. Each author reviewed and approved the final manuscript, agreeing on all aspects of the work.

Conflict of Interest

Authors declared no conflict of interest.