ArticlePDF Available

PTSD and Depressive Symptoms in 911 Telecommunicators: The Role of Peritraumatic Distress and World Assumptions in Predicting Risk

Authors:

Abstract and Figures

Continued exposure to trauma increases risk for both depression and PTSD. This may be particularly true for individuals with work-related exposure to trauma such as 911 telecommunicators, a group with significant exposure to work-related trauma that has received limited empirical attention. The present study examines current symptoms of PTSD and depression in telecommunicators and the extent to which peritraumatic distress and world assumptions interact to predict psychopathology. A sample of 171 911 telecommunicators from across the country completed a survey that assessed current symptoms of depression and PTSD, as well as exposure to different types of work-related events, peritraumatic distress, and world assumptions. Symptoms of PTSD and depression were significantly related to peritraumatic distress, self-worth, and benevolence of the world. Analyses revealed that the relationship between peritraumatic distress and both current depression and PTSD was significantly stronger for individuals who reported more negative assumptions about the benevolence of the world and self-worth. Further, positive assumptions regarding the controllability of the world were associated with PTSD, particularly in individuals who reported high peritraumatic distress. The results suggest that 911 telecommunicators experience significant work-related exposure to trauma, yet retain somewhat positive world assumptions. The important role of world assumptions in explaining the link between peritraumatic distress and posttrauma psychopathology in the form of current PTSD and depression is discussed. (PsycINFO Database Record (c) 2013 APA, all rights reserved)
Content may be subject to copyright.
Psychological Trauma: Theory, Research,
Practice, and Policy
PTSD and Depressive Symptoms in 911
Telecommunicators: The Role of Peritraumatic Distress
and World Assumptions in Predicting Risk
Michelle M. Lilly and Heather Pierce
Online First Publication, January 9, 2012. doi: 10.1037/a0026850
CITATION
Lilly, M. M., & Pierce, H. (2012, January 9). PTSD and Depressive Symptoms in 911
Telecommunicators: The Role of Peritraumatic Distress and World Assumptions in Predicting
Risk. Psychological Trauma: Theory, Research, Practice, and Policy. Advance online
publication. doi: 10.1037/a0026850
PTSD and Depressive Symptoms in 911 Telecommunicators:
The Role of Peritraumatic Distress and World Assumptions in
Predicting Risk
Michelle M. Lilly and Heather Pierce
Northern Illinois University
Continued exposure to trauma increases risk for both depression and PTSD. This may be particularly
true for individuals with work-related exposure to trauma such as 911 telecommunicators, a group
with significant exposure to work-related trauma that has received limited empirical attention. The
present study examines current symptoms of PTSD and depression in telecommunicators and the
extent to which peritraumatic distress and world assumptions interact to predict psychopathology. A
sample of 171 911 telecommunicators from across the country completed a survey that assessed
current symptoms of depression and PTSD, as well as exposure to different types of work-related
events, peritraumatic distress, and world assumptions. Symptoms of PTSD and depression were
significantly related to peritraumatic distress, self-worth, and benevolence of the world. Analyses
revealed that the relationship between peritraumatic distress and both current depression and PTSD
was significantly stronger for individuals who reported more negative assumptions about the
benevolence of the world and self-worth. Further, positive assumptions regarding the controllability
of the world were associated with PTSD, particularly in individuals who reported high peritraumatic
distress. The results suggest that 911 telecommunicators experience significant work-related expo-
sure to trauma, yet retain somewhat positive world assumptions. The important role of world
assumptions in explaining the link between peritraumatic distress and posttrauma psychopathology
in the form of current PTSD and depression is discussed.
Keywords: peritraumatic distress, world assumptions, PTSD, depression, emergency responders
Research has shown PTSD symptomatology to be notably high
in adults with ongoing duty-related trauma exposure. For example,
rates of PTSD in firefighters have been estimated to range between
12.5 and 22% (Corneil, Beaton, Murphy, Johnson, & Pike, 1999;
McFarlane & Papay, 1992; Wagner, Heinrichs, & Ehlert, 1998). In
police officers, rates of PTSD have been shown to range from
13–35% (Boyle, 1987; Mann & Neece, 1990; Neylan et al., 2005;
Robinson, Sigman, & Wilson, 1997), with rates even higher in
police officers exposed to duty-related shootings (46%; Gersons,
1989). The rate of PTSD symptoms consistent with a clinical
diagnosis was 19% in police officers who worked in the aftermath
of Hurricane Katrina (West et al., 2008).
Exposure to trauma also enhances risk for depressive symptoms,
though research on rates of depression in individuals with expo-
sure to duty-related trauma has remained limited. However, re-
search has suggested that exposure to duty-related trauma in-
creases risk for depression in police officers (Hartley, Violanti,
Fekedulegn, Andrew, & Burchfiel, 2007). In a study of retired
firefighters exposed to the World Trade Center disaster, 7%
reported symptoms consistent with a diagnosis of Major De-
pression on the Center of Epidemiologic Studies Depression
Scale (CES-D-m; Radloff, 1977), with an additional 36% re-
porting symptoms considered at “elevated risk” for Major De-
pression (Chiu et al., 2010).
While trauma exposure directly increases risk for PTSD and/or
depression, empirical investigation in the last decade has identified
intervening variables that enhance risk for adverse psychological
sequelae. Emotional and cognitive factors have received signifi-
cant attention, including the extent to which an individual experi-
ences emotional distress during a traumatic event and posttrauma
cognitions. For example, greater peritraumatic emotional distress
has been especially implicated in risk for the development of
PTSD (Brunet et al., 2001; Karam et al., 2010; Ozer, Best, Lipsey,
& Weiss, 2003) and the negative self-cognitions frequently ob-
served in depression (Miller, Handley, Markman, & Miller, 2010).
The same has been found for posttrauma cognitions about the
world, or world assumptions (Janoff-Bulman, 1989, 1992).
World assumption theory states that individuals typically de-
velop in childhood the following three fundamental assumptions
that aid in organizing external input: the world is benevolent (i.e.,
most people do not expect bad things to happen to them or others),
the world is meaningful (i.e., people have control over their lives
and things happen for a reason), and the self is worthy (i.e., people
believe that they deserve good things to happen to them). These
assumptions allow an individual to navigate their social world
without anxiety that may be present if one were to believe the
Michelle M. Lilly and Heather Pierce, Department of Psychology,
Northern Illinois University.
Correspondence concerning this article should be addressed to Michele
M. Lilly, NIU, Department of Psychology, Psychology-Computer Science
Building, DeKalb, IL 60115.. E-mail: mlilly1@niu.edu
Psychological Trauma: Theory, Research, Practice, and Policy © 2012 American Psychological Association
2012, Vol. ●●, No. , 000– 000 1942-9681/12/$12.00 DOI: 10.1037/a0026850
1
world to be essentially malevolent or uncontrollable. World as-
sumption theory has much in common with other cognitive and
psychological theories that have been linked to the development of
psychopathology, such as the Hopelessness Theory of depression,
which contends that depression forms out of the tendency of an
individual to make cognitive attributions that are internal, global,
and stable (Abramson et al., 2002; Abramson, Metalsky, & Alloy,
1989). The world assumptions construct may also overlap with the
internal working model of attachment theory (Bowlby, 1969/
1982). This theory emphasizes how a healthy infant– caregiver
relationship produces within developing children an ability to not
only regulate emotions, but also a cognitive attributional style that
sees the world as benevolent and safe to explore, and both instills
and maintains a healthy sense of self-worth in the individual.
The theory of world assumptions argues that assumptions are
malleable and can be shattered in the face of a traumatic experi-
ence. In fact, a significant link has been found between trauma
exposure, mental health, and world assumptions. For example,
more diminished world assumptions was associated with PTSD in
South African trauma survivors (Magwaza, 1999), in a community
sample of trauma survivors (Goldenberg & Matheson, 2005), and
in survivors of intimate partner violence (Lilly, Howell, &
Graham-Bermann, in press). More negative world assumptions in
the presence of depressive symptoms have also been observed in
undergraduate students (Harris & Valentiner, 2002) and intimate
partner violence survivors (Lilly, Valdez, & Graham-Bermann,
2011). Yet, limited empirical work has examined world assump-
tions in first responders. Wagner, McFee, and Martin (2009) found
that the world assumptions of firefighters were no more negative
than a control group of blue-collar workers who did not regularly
experience job-related trauma exposure, with the exception of the
benevolence of the world subscale. The authors argued this may be
due to the fact that firefighters reported more overall job satisfac-
tion because they find their work meaningful in its contribution to
the community. Harris, Baloglu, and Stacks (2002) used structural
equation modeling to show that critical incident debriefing was
positively, though weakly, associated with better world assump-
tions in firefighters exposed to duty-related trauma, and that de-
briefing was significantly, inversely related to negative affectivity
as measured by depressive and anxiety symptoms. This might
suggest that debriefing may be related to the restoration of more
positive assumptions in the aftermath of duty-related trauma for
firefighters, and that this may be related to lowered risk for
posttrauma depression and anxiety.
In police officers, world assumptions have been linked to low-
ered risk for PTSD. Yuan et al. (2011), for example, conducted a
2-year prospective study, in which cognitions of police academy
cadets related to self-worth and benevolence of the world were
assessed. The authors found that having more positive assumptions
regarding the benevolence of the world seemed a protective factor
against developing duty-related PTSD 2 years after the completion
of training. This study suggests that beliefs in the benevolence of
the world may be a particularly important cognitive factor that
assists individuals in creating meaning around, and recovering
from, traumatic events experienced while on duty in ways that
protect against the development of PTSD. Further, Wang et al.
(2010) found that cognitions related to self-worth were important
in predicting 2-year prospective depression symptoms in police
officers. Given the centrality of self-worth in conceptualizations of
depression, this finding is not surprising. In sum, it appears as
though particular constructs within the world assumptions theory
may be more specifically related to posttrauma psychopathology in
samples of first responders. Benevolence of the world, for in-
stance, has been more strongly associated with PTSD in both
firefighters and police officers, while self-worth has been more
strongly associated with posttrauma depression scores. The world
assumptions of 911 telecommunicators, however, have never been
examined, nor has an exploration of the relationship between
world assumptions and psychopathology been conducted in this
population.
Finally, while world assumptions and peritraumatic distress
have both been shown to increase risk for depression and PTSD
independently, the ways in which these factors interact has not
been explored and may provide some theoretical support for
Janoff-Bulman’s original theory. Janoff-Bulman contends that as-
sumptions are typically positive until confronted by highly con-
tradictory information that is presented in a context of high emo-
tional distress. Yet, no research to date has explored whether there
is (a) a relationship between level of peritraumatic distress and
more diminished world assumptions, and (b) whether these factors
interact in ways that significantly predict posttrauma symptom
picture. One might theorize that peritraumatic distress will be most
deleterious for individuals that report more negative world as-
sumptions in the aftermath of trauma.
This study examines current symptoms of PTSD and depression
in a sample of 911 telecommunicators. We wished to examine
whether heightened reports of work-related peritraumatic distress
were related to more diminished world assumptions and whether
these factors interact to predict depression and PTSD symptoms.
The following hypotheses were proposed: (1) peritraumatic dis-
tress will be significantly, positively correlated with both current
PTSD and depressive symptoms, (2) assumptions regarding self-
worth, controllability and benevolence of the world will be in-
versely related to PTSD and depressive symptoms, (3) greater
levels of peritraumatic distress will be related to more diminished
assumptions of self-worth, controllability and benevolence of the
world, and (4) world assumptions will significantly moderate the
relationship between peritraumatic distress and both current PTSD
and depressive symptoms. We contend that peritraumatic distress
will be more significantly, positively correlated to PTSD and
depressive symptoms for individuals twho report more negative
world assumptions.
Method
Participants
A total of 171 911 telecommunicators across the United States
completed the survey. The sample was predominantly female (n
126, 74%) and European American (n131, 77%) with an
average age of 38.85 (SD 9.61). Most of the participants were
married and/or living with a partner (n107, 63%), however, a
significant minority reported being single (n30, 18%) or di-
vorced (n31, 18%). All participants were currently working as
a telecommunicator with an average of 11.85 (SD 8.16) years of
service. Most participants had either a college degree (n58,
34%) or some college or vocational training (n80, 47%).
2LILLY AND PIERCE
Measures
PTSD symptoms. The Posttraumatic Stress Diagnostic Scale
(PDS; Foa, 1995) was used to assess severity of PTSD symptoms
in the last month. The PDS is a 49-item measure that asks partic-
ipants to identify a traumatic life event that they experienced as
“the worst” or one that “stuck with them.” Participants were asked
to focus on an upsetting event that occurred while on duty. With a
focus on this event, participants were asked whether they had
experienced symptoms of hyperarousal, reexperiencing, and
avoidance symptoms in the last month in relationship to the event,
with response options of 0 Not at all or only one time,1Once
a week or less/once in awhile,22– 4 times a week/half the time,
and 3 5 or more times a week/almost always. A symptom score
was created by tallying symptom items, with higher scores indi-
cating more severe PTSD symptoms. The internal consistency of
the PDS for the present sample was ␣⫽.92.
Depressive symptoms. The Depression subscale of the
Symptom Checklist-90-R (SCL-90 –R; Derogatis, 1994) was used.
Participants are asked to consider whether they have been affected
by measure items in the past week with response options of 0
Not at all,1A little bit,2Moderately,3Quite a bit, and
4Extremely. The Depression subscale includes 13 items and
scores are generated by averaging item responses. Higher scores
represent more disturbances related to depressive symptoms. The
internal consistency for the Depression subscale in this sample was
␣⫽.91.
Peritraumatic distress. The Peritraumatic Distress Inventory
(PDI; Brunet et al., 2001) was used to assess emotional distress
during and immediately after the participants’ most upsetting
experience at work. The PDI is a 13-item measure with response
options of 0 Not at all,1Slightly,2Somewhat,3Very,
and 4 Extremely true. The PDI score was created by tallying all
13 items, with higher scores reflecting the presence of greater
peritraumatic emotional distress. Internal consistency for the PDI
was ␣⫽.86.
World assumptions. The World Assumptions Scale (WAS;
Janoff-Bulman, 1989) is a 32-item measure that assesses partici-
pants’ cognitions about the world and self. A 6-point scale is used
with response options of 1 Strongly disagree,2Disagree,
3Somewhat disagree,4Somewhat agree,5Agree, and
6Strongly agree. The original measure contains eight subscales,
but for the present study, only the self-worth (WAS–SW), benev-
olence of the world (WAS–BW) and controllability (WAS–
CONT) subscales were used. Each of these subscales includes four
items. Examples include: “The good things that happen in this
world far outnumber the bad” (benevolence of the world), “Peo-
ple’s misfortunes result from mistakes they have made” (control-
lability), and “I often think I am no good at all” (self-worth). The
subscale scores were produced by reverse coding specified items
and tallying items on the subscale, with higher scores reflecting
more positive assumptions. The internal consistency for the sub-
scale scores were: benevolence of the world ␣⫽.86, self-worth
␣⫽.77, controllability ␣⫽.77.
Exposure to distressing calls. To assess participants’ expo-
sure to different types of work-related calls, the Potentially Trau-
matic Events Questionnaire (Troxell, 2008) was used. The ques-
tionnaire assesses whether participants have experienced 21
different types of traumatic calls that telecommunicators may field.
These events range from violent domestic calls to traffic accidents
with fatalities to calls involving family or friends. To our knowl-
edge, this is only the second time that this questionnaire has been
used. As such, the psychometric properties of the measure have not
been fully investigated.
Procedure
Participants were approached to participate in the survey
through a number of sources: recruitment letters at randomly
selected agencies, professional association list serves, professional
organization online forums, and social networking interest groups
discussion boards. The option to complete the survey online or via
hard copies was presented. No financial incentive was offered. The
study was approved by the institutional review board (IRB) at
Northern Illinois University.
Results
The sample reported exposure to an average of 15.32 different
types of potentially traumatizing calls (SD 3.50). For most calls,
over 75% of the sample reported exposure to that type of call,
including calls such as structure fires, violent domestics, and
armed robbery. However, several types of calls produced more
equal distribution (i.e., calls involving friends or family; 55%) or
were comparatively underreported by the sample: riots/mob action
(38.6%), hostage situation (43.9%), plane crash (34.5%), officer
shot (31.6%), and line-of-duty death (32.3%). Despite a high rate
of exposure to potentially traumatizing duty-related events, current
PTSD symptom reports in the last month were surprisingly low
(M7.07, SD 8.13). The mean score for depression symptoms
was .65 (SD .68). The depression score for females and males
in the sample were at the 58th and 61st percentile, respectively, for
female and male nonpatient samples (Derogatis, 1994).
A correlation matrix examining the primary variables of interest
confirm the first hypothesis; namely, peritraumatic distress was
significantly, positively related to both PTSD symptoms (r.34,
p.001) and depressive symptoms (r.36, p.001) (see Table
1). The second hypothesis was also partially confirmed as current
PTSD symptoms were significantly, inversely related to self-worth
(r⫽⫺.16, p.042) and benevolence of the world (r⫽⫺.22, p
.004), and similarly, depressive symptoms were significantly, in-
versely related to self-worth (r⫽⫺.20, p.011) and benevolence
of the world (r⫽⫺.19, p.012). Controllability was not
significantly related to current PTSD (r.07, p.399) or
depressive symptoms (r.09, p.233). Hypothesis three was
Table 1
Correlation Matrix of Primary Variables of Interest (N171)
123 456
1. WAS Self-worth
2. WAS Controllability .07
3. WAS Benevolence of
World .19
.03
4. Peritraumatic Distress .21
ⴱⴱ
.13 .02
5. PTSD Symptoms .16
.07 .22
ⴱⴱ
.34
ⴱⴱⴱ
6. Depressive symptoms .20
.09 .19
.36
ⴱⴱⴱ
.65
ⴱⴱⴱ
p.05.
ⴱⴱ
p.01.
ⴱⴱⴱ
p.001.
3
PREDICTING RISK IN 911 TELECOMMUNICATORS
also only partially confirmed as peritraumatic distress was signif-
icantly related to self-worth (r.21, p.006), but was not
significantly associated with controllability (r⫽⫺.13, p.089)
or benevolence of the world (r.02, p.773).
A series of moderation analyses were conducted to examine
whether world assumption variables interacted with peritraumatic
distress to predict posttrauma psychopathology. The methodology
for testing moderation prescribed by Frazier, Tix, and Barron
(2004) was used. World assumptions and peritraumatic distress
were standardized to reduce multicollinearity. The first set of
regression analyses examined benevolence of the world as a mod-
erator of the relationship between peritraumatic distress, and both
current PTSD and depressive symptoms (see Table 2). For both
outcome variables, the analyses showed main effects for greater
peritraumatic distress and more negative benevolence of the world,
with each uniquely predicting variance in PTSD and depressive
symptoms. Benevolence of the world also served as a significant
moderator of the relationship between peritraumatic distress and
both current PTSD (see Figure 1) and depressive symptoms (see
Figure 2). More specifically, peritraumatic distress conferred the
greatest risk for posttrauma psychopathology when individuals
reported beliefs that the world is unsafe and malevolent.
Similar analyses were completed substituting self-worth as the
moderator (see Table 3). Significant main effects were observed
such that greater peritraumatic distress and lower self-worth ac-
counted for unique variance in current PTSD and depressive
symptoms. A significant moderating effect was observed for de-
pressive symptoms; peritraumatic distress was more strongly as-
sociated with depressive symptoms in the presence of more dimin-
ished self-worth (see Figure 3). While reports of current PTSD
symptoms were greatest for individuals high on peritraumatic
distress with more negative self-worth, the interaction term was
not significant (p.068).
The final regression analysis was performed testing controlla-
bility as the moderating variable (see Table 4). The analyses
revealed that peritraumatic distress continues to have a significant,
positive association with psychopathology in the presence of con-
trollability. No main effect was observed for controllability,
though controllability it is important to note that controllability
showed a positive relationship with current PTSD symptoms and
depressive symptoms. Further, greater peritraumatic distress con-
ferred significantly greater risk for current PTSD symptoms for
individuals that had more positive assumptions about the control-
lability of the world, not more negative assumptions (see Figure 4).
While the direction of moderating effect was the same for depres-
sion, the interaction term was not significant (p.093).
Discussion
This study is the first to examine depression and PTSD symp-
toms in 911 telecommunicators, a population at great risk for
adverse mental health given high levels of duty-related trauma
exposure. We sought to examine the influence of peritraumatic
distress on current depression and PTSD symptoms, as well as to
determine whether distress is moderated by the extent to which
world assumptions are diminished in the face of trauma exposure.
While research has consistently shown relationships between peri-
traumatic distress and posttrauma psychopathology (Brunet et al.,
2001; Karam et al., 2010; Miller et al., 2010; Ozer et al., 2003), as
well as links between diminished world assumptions and both
PTSD and depression symptoms (Goldenberg & Matheson, 2005;
Harris & Valentiner, 2002; Lilly, Howell, & Graham-Bermann, in
press; Lilly, Valdez, & Graham-Bermann, 2011; Magwaza, 1999),
the present study wished to provide some preliminary support to
world assumption theory, which argues that assumptions are shat-
tered during traumatic events that are extremely emotionally dis-
tressing. Though a cross-sectional design cannot fully answer this
question, it is one step in examining whether world assumptions
Figure 1. Benevolence of the world as a moderator of the relationship
between peritraumatic distress and PTSD symptoms.
Table 2
WAS Benevolence of the World as a Moderator of the Relationship Between Peritraumatic
Distress (PDI) and Both PTSD Symptoms and Depressive Symptoms
Dependent variable Predictors Adj. R
2
SE p
PTSD Symptoms .19
PDI 2.76 .56 .000
ⴱⴱⴱ
WAS–BW 1.58 .57 .007
ⴱⴱ
PDI WAS–BW 1.46 .56 .010
Depressive Symptoms .20
PDI .25 .05 .001
ⴱⴱⴱ
WAS–BW .11 .05 .021
PDI WAS–BW .13 .05 .007
ⴱⴱ
p.05.
ⴱⴱ
p.01.
ⴱⴱⴱ
p.001.
4LILLY AND PIERCE
are connected to peritraumatic experiences, and can help explain
why peritraumatic distress has been so strongly linked to the
development of depression and PTSD symptoms.
Consistent with predictions, an interaction effect was observed
between peritraumatic distress and benevolence of the world in
predicting both current depression and PTSD symptoms. More
diminished assumptions about the benevolence of the world ac-
centuated the effect of peritraumatic distress on both depression
and PTSD symptoms. Similar effects were detected when consid-
ering self-worth as a moderator in the relationship between peri-
traumatic distress and psychopathology such that individuals at
greatest risk for depression symptoms were those that reported
both heightened levels of distress and concurrently more dimin-
ished self-worth. Given that self-worth is not a required criterion
for diagnosis of PTSD, but is for depression, it perhaps makes
sense that self-worth would be more strongly implicated in depres-
sion than PTSD. This is also consistent with previous work with
firefighters and police officers, which showed that self-worth was
implicated in depression, but not PTSD (Wagner et al., 2009;
Wang et al., 2010).
These results provide some preliminary support for the impor-
tant role of both peritraumatic distress and world assumptions in
predicting posttrauma psychopathology, which may provide im-
portant information relevant for training and preventing psycho-
pathology in telecommunicators. Specifically, strong emotional
reactions at the time of an upsetting duty-related event should be
targeted for prevention of psychopathology, and further, an em-
phasis should also be placed on the extent to which individuals
retain more positive cognitions about the benevolence of the world
and self-worth. This study suggests that individuals whose as-
sumptions are less strongly diminished in the presence of trauma
fare better, even if they have experienced significant distress
during duty-related events.
The final moderation analyses produced unanticipated results.
Though it was hypothesized that having more diminished control-
lability would be related to heightened risk for current depression
and PTSD symptoms, and further, that negative controllability
would moderate the relationship between distress and psychopa-
thology, the observed direction of effect was the opposite to that
anticipated. A significant interaction was observed between con-
trollability and peritraumatic distress in predicting PTSD, such that
having more positive assumptions about one’s control over the
world accentuated the relationship between distress and PTSD
symptoms. A similar effect was also observed for depression,
though the interaction term achieved only the level of a trend. One
possibility for these seemingly countertheoretical findings is that
controllability serves a particular occupational role for telecom-
municators. The job of a telecommunicator involves trying to
gather information from callers that are often hysterical and lack
control. If the telecommunicator is unable to sufficiently pacify a
caller to a point where the caller can communicate important
information, the telecommunicator will be ineffective. As such,
Figure 2. Benevolence of the world as a moderator of the relationship
between peritraumatic distress and depressive symptoms.
Table 3
WAS Self-Worth (WAS–SW) as a Moderator of the Relationship Between Peritraumatic Distress
(PDI) and Both PTSD Symptoms and Depressive Symptoms
Dependent variable Predictors Adj. R
2
SE p
PTSD Symptoms .18
PDI 2.89 .60 .000
ⴱⴱⴱ
WAS–SW 1.96 .58 .001
ⴱⴱ
PDI WAS–SW .95 .52 .068
Depressive Symptoms .24
PDI .26 .05 .000
ⴱⴱⴱ
WAS–SW .20 .05 .000
ⴱⴱⴱ
PDI WAS–SW .11 .04 .008
ⴱⴱ
p.05.
ⴱⴱ
p.01.
ⴱⴱⴱ
p.001.
Figure 3. Self-worth as a moderator of the relationship between peritrau-
matic distress and depressive symptoms.
5
PREDICTING RISK IN 911 TELECOMMUNICATORS
telecommunicators may begin to believe that they possess greater
control over sometimes horrific circumstances than they actually
possess. No telecommunicator can completely control what occurs
during a call and it may be that significant peritraumatic distress is
experienced in reaction to calls over which the telecommunicator
attempted to garner control, but was unable. This may significantly
enhance risk for depression and PTSD as the telecommunicator
may feel responsible for how events unfolded or may ruminate
over what they could have done differently. These results suggest
that prevention and intervention efforts may be focused on cogni-
tions regarding control, especially in regards to PTSD. Further,
world assumptions theory needs continued empirical examination
and may be more nuanced in predicting mental health depending
on the context of the trauma and level of distress experienced.
Strengths of the present study include its emphasis on the mental
health of a population that has received strikingly limited empirical
investigation despite significant exposure to potentially traumatiz-
ing events. Limited information is known about the risk for de-
pression and PTSD among this population and further data that
may inform training and prevention efforts. The cross-sectional
design places some limitations on the conclusions that can be
drawn regarding the proposed temporal order of effects and future
research incorporating prospective designs is necessary. Because
of this limitation, it is not possible to know whether the telecom-
municators’ current symptomatology has increased, decreased, or
remained stable over time. It is possible that the cross-section of
scores for this sample represent PTSD and depression that may
have significantly remitted over time, and may have been worse
directly following exposure to upsetting calls. Continued research
to parse out the complex interrelationships between emotions and
cognitions in predicting posttrauma symptom picture is warranted.
References
Abramson, L. Y., Alloy, L. B., Hogan, M. E., Whitehouse, W. G., Dono-
van, P., Rose, D. T., . . . Raniere, D. (2002). Cognitive vulnerability to
depression: Theory and evidence. In R. L. Leahy & E. T. Dowd (Eds.),
Clinical advances in cognitive psychotherapy: Theory and application
(pp. 75–92). New York, NY: Springer.
Abramson, L. Y., Metalsky, G. I., & Alloy, L. B. (1989). Hopelessness
depression: A theory-based subtype of depression. Psychological Re-
view, 96, 358 –372. doi:10.1037/0033-295X.96.2.358
Bowlby, J. (1969/1982). Attachment and loss, Vol. 1: Attachment. New
York, NY: Basic Books.
Boyle, J. D. (1987). Posttraumatic stress disorder: A law enforcement
perspective. Law and Order, 35, 52–55.
Brunet, A., Weiss, D. S., Metzler, T. J., Best, S. R., Neylan, T. C., Rogers,
C., . . . Marmar, C. R. (2001). The Peritraumatic Distress Inventory: A
proposed measure of PTSD criterion A2. The American Journal of
Psychiatry, 158, 1480 –1485. doi:10.1176/appi.ajp.158.9.1480
Chiu, S., Webber, M. P., Zeig-Owens, R., Gustave, J., Lee, R., Kelly, K. J.,
. . . Prezant, D. J. (2010). Validation of the Center for Epidemiologic
Studies Depression Scale in screening for major depressive disorder
among retired firefighters exposed to the World Trade Center disaster.
Journal of Affective Disorders, 121, 212–219. doi:10.1016/
j.jad.2009.05.028
Corneil, W., Beaton, R., Murphy, S., Johnson, C., & Pike, K. (1999).
Exposure to traumatic incidents and prevalence of posttraumatic stress
symptomatology in urban firefighters in two countries. Journal of Oc-
cupational Health Psychology, 4, 131–141. doi:10.1037/1076-
8998.4.2.131
Derogatis, L. (1994). SCL-90-R Symptom Checklist-90-R: Administration,
scoring and procedures manual (3rd ed.). Minneapolis, MN: NCS.
Foa, E. B. (1995). Posttraumatic Stress Diagnostic Scale–Manual. Min-
neapolis, MN: National Computer Systems.
Frazier, P. A., Tix, A. P., & Barron, K. E. (2004). Testing moderator and
mediator effects in counseling psychology research. Journal of Coun-
seling Psychology, 51, 115–134. doi:10.1037/0022-0167.51.1.115
Gersons, B. P. R. (1989). Patterns of PTSD among police officers follow-
ing shooting incidents: A two-dimensional model and treatment impli-
cations. Journal of Traumatic Stress, 2, 247–257. doi:10.1002/
jts.2490020302
Table 4
WAS Controllability (WAS–CONT) as a Moderator of the Relationship Between Peritraumatic
Distress (PDI) and Both PTSD Symptoms and Depressive Symptoms
Dependent variable Predictors Adj. R
2
SE p
PTSD Symptoms .15
PDI 2.80 .59 .000
ⴱⴱⴱ
WAS–CONT .83 .59 .160
PDI WAS–CONT 1.37 .62 .028
Depressive Symptoms .16
PDI .25 .05 .000
ⴱⴱⴱ
WAS–CONT .09 .05 .063
PDI WAS–CONT .09 .05 .093
p.05.
ⴱⴱ
p.01.
ⴱⴱⴱ
p.001.
Figure 4. Controllability as a moderator of the relationship between
peritraumatic distress and PTSD symptoms.
6LILLY AND PIERCE
Goldenberg, I., & Matheson, K. (2005). Inner representations, coping, and
posttraumatic stress symptomatology in a community sample of trauma
survivors. Basic and Applied Social Psychology, 27, 361–369. doi:
10.1207/s15324834basp2704_9
Harris, H. N., & Valentiner, D. P. (2002). World assumptions, sexual assault,
depression, and fearful attitudes toward relationships. Journal of Interpersonal
Violence, 17, 286 –305. doi:10.1177/0886260502017003004
Harris, M. B., Baloglu, M., & Stacks, J. R. (2002). Mental health of
trauma-exposed firefighters and critical incident stress debriefing. Jour-
nal of Loss and Trauma, 7, 223–238. doi:10.1080/10811440290057639
Hartley, T. A., Violanti, J. M., Fekedulegn, D., Andrew, M. E., & Burch-
fiel, C. M. (2007). Associations between major life events, traumatic
incidents, and depression among Buffalo police officers. International
Journal of Emergency Mental Health, 9, 25–35. Retrieved from http://
www.ncbi.nlm.nih.gov/pubmed/11227748
Janoff-Bulman, R. (1989). Assumptive worlds and the stress of traumatic
events: Applications of the schema construct. Social Cognition, 7, 113–
136. Retrieved from http://www.guilford.com/cgi-bin/cartscript_new
.cgi?p.pr/ jnco.htm&dirperiodicals /per_psych&cart_id18000.25606
Janoff-Bulman, R. (1992). Shattered assumptions: Towards a new psychol-
ogy of trauma. New York, NY: Free Press.
Karam, E. G., Andrews, G., Bromet, E., Petukhova, M., Ruscio, A. M.,
Salamoun, M., . . . Kessler, R. C. (2010). The role of criterion A2 in the
DSM–IV diagnosis of posttraumatic stress disorder. Biological Psychi-
atry, 68, 465– 473. doi:10.1016/j.biopsych.2010.04.032
Lilly, M. M., Howell, K. H., & Graham-Bermann, S. A. (in press). World
assumptions, religiosity and PTSD in survivors of intimate partner
violence. Forthcoming in Violence Against Women.
Lilly, M. M., Valdez, C. E., & Graham-Bermann, S. A. (2011). The
mediating effect of world assumptions on the relationship between
trauma exposure and depression. Journal of Interpersonal Violence, 26,
2499 –2516. doi:10.1177/0886260510383033
Magwaza, A. (1999). Assumptive world of traumatized South African
adults. The Journal of Social Psychology, 139, 622– 630. doi:10.1080/
00224549909598422
Mann, J. P., & Neece, J. (1990). Workers’ compensation for law enforce-
ment related posttraumatic stress disorder. Behavioral Sciences and the
Law, 8, 447– 456. doi:10.1002/bsl.2370080410
McFarlane, A. C., & Papay, P. (1992). Multiple diagnoses in posttraumatic
stress disorder in the victims of a natural disaster. Journal of Nervous
and Mental Disease, 180, 498 –504. doi:10.1097/00005053-199208000-
00004
Miller, A. K., Handley, I. M., Markman, K. D., & Miller, J. H. (2010).
Deconstructing self- blame following sexual assault: The critical roles of
cognitive content and process. Violence Against Women, 16, 1120
1137. doi:10.1177/1077801210382874
Neylan, T. C., Brunet, A., Pole, N., Best, S. R., Metzler, T. J., Yehuda, R.,
& Marmar, C. R. (2005). PTSD symptoms predict waking salivary
cortisol levels in police officers. Psychoneuroendocrinology, 30, 373–
381. doi:10.1016/j.psyneuen.2004.10.005
Ozer, E. J., Best, S. R., Lipsey, T. L., & Weiss, D. S. (2003). Predictors of
posttraumatic stress disorder and symptoms in adults: A meta-analysis.
Psychological Bulletin, 129, 52–73. doi:10.1037/0033-2909.129.1.52
Radloff, L. S. (1977). The CES-D scale: A self report depression scale for
research in the general population. Applied Psychological Measurement,
1, 385– 401. doi:10.1177/014662167700100306
Robinson, H. M., Sigman, M. R., & Wilson, J. P. (1997). Duty-related
stressors and PTSD in suburban police officers. Psychological Reports,
3, 835– 845. doi:10.2466/pr0.1997.81.3.835
Troxell, R. (2008). Indirect exposure to the trauma of others: The experi-
ences of 9-1-1 telecommunicators (Doctoral dissertation). Retrieved
from ProQuest Dissertations and Theses database (Publication no.
3335425).
Wagner, D., Heinrichs, M., & Ehlert, U. (1998). Prevalence of symptoms
of posttraumatic stress disorder in German professional firefighters. The
American Journal of Psychiatry, 155, 1727–1732. Retrieved from http://
ajp.psychiatryonline.org/
Wagner, S. L., McFee, J. A., & Martin, C. A. (2009). Effects of traumatic
stress on firefighters’ world assumptions. Traumatology, 15, 75– 84.
doi:10.1177/1534765608323441
Wang, Z., Inslicht, S. S., Metzler, T. J., Henn-Haase, C., McCaslin, S. E.,
Tong, H., . . . Marmar, C. R. (2010). A prospective study of predictors
of depression symptoms in police. Psychiatry Research, 175, 211–216.
doi:10.1016/j.psychres.2008.11.010
West, C., Bernard, B., Mueller, C., Kitt, M., Driscoll, R., & Tak, S. (2008).
Mental health outcomes in police personnel after Hurricane Katrina.
Journal of Occupational and Environmental Medicine, 50, 689 695.
doi:10.1097/JOM.0b013e3181638685
Yuan, C., Wang, Z., Inslicht, S. S., McCaslin, S. E., Metzler, T. J.,
Henn-Haase, C., . . . Marmar, C. R. (2011). Protective factors for post-
traumatic stress disorder symptoms in a prospective study of police
officers. Psychiatry Research, 188, 45–50. doi:10.1016/j.psychres
.2010.10.034
Received July 11, 2011
Revision received November 15, 2011
Accepted December 5, 2011
7
PREDICTING RISK IN 911 TELECOMMUNICATORS
... While the satisfaction of serving in a crucial helping profession can contribute positively to the mental health and well-being of telecommunicators, they can also face significant trauma in crisis calls and other job-related factors like shift work, inappropriate training for mental health calls, caller abuse, and lack of support from leadership (Smith et al., 2019). Indeed, over 75% of telecommunicators endorse receiving at least one potentially traumatic call in their career (Lilly & Pierce, 2013). For these and other factors (e.g., childhood trauma and increased psychological inflexibility), emergency telecommunicators are at risk for mental health concerns, such as posttraumatic stress disorder (PTSD), secondary traumatic stress (STS), and burnout, despite the compassion satisfaction potentially offered by such a crucial service job (Allen et al., 2016;Figley, 1995;Figley & Ludick, 2017;Lilly & Allen, 2015;Medina-Arias, 2020). ...
... In 13%-33% of surveyed telecommunicators, exposure to traumatic calls has previously been suggested to be sufficient enough to induce posttraumatic stress symptoms (PTSS) consistent with a diagnosis of PTSD (Allen et al., 2016;Blalock et al., 2024;Kindermann et al., 2020;Pierce & Lilly, 2012;Steinkopf et al., 2018). Researchers have identified several factors associated with increased PTSS in telecommunicators, including the level of distress experienced during a traumatic call (Lilly & Pierce, 2013;Pierce & Lilly, 2012) and trauma exposure in childhood (Allen et al., 2016). Beyond peritraumatic details and preemployment trauma history, increased levels of first responder job-related cumulative trauma exposure have been found to be associated with greater PTSS (Milligan-Saville et al., 2018) even after adjusting from childhood trauma for first responders (Lee et al., 2017). ...
Article
Full-text available
Emergency telecommunicators face unique challenges that put them at risk for posttraumatic stress symptoms (PTSS), secondary traumatic stress (STS), and burnout; but their work can provide compassion satisfaction. This study examined the extent of PTSS, STS, burnout, sleep difficulties, and compassion satisfaction among telecommunicators using quantitative and qualitative data while exploring job-related factors, trauma types, and mental health needs. A cross-sectional survey of telecommunicators (N = 358) included the Pittsburgh Sleep Quality Index, Professional Quality of Life, Posttraumatic Stress Disorder Checklist for Diagnostic and Statistical Manual of Mental Disorders, fifth edition, Life Events Checklist, and the question, “What do you need right now for your mental health?” The study found that approximately one-third met the criterion for possible posttraumatic stress disorder, with most reporting moderate STS, burnout, and compassion satisfaction. More weekly hours and higher cumulative trauma exposure correlated with increased PTSS. While factors such as shift, tenure, and salary exhibited minimal association with outcomes, satisfaction with these factors did. Sleep dysfunction was associated with increased PTSS, STS, burnout, and decreased compassion satisfaction. The PTSS severity was related to personal cumulative trauma history but not job-related trauma history. Telecommunicators with a traumatic index event involving both personal and work settings (e.g., calls related to family/friends) were more prone to burnout. Telecommunicators want workplace logistics, management, and culture changes to improve their mental health. The results indicate that the psychological toll on telecommunicators resembles that of other first responders. More research is needed to explore psychological mechanisms and industry actions that support positive outcomes.
... Diğer yandan davranışçı yaklaşıma göre de stresörle baş edemeyeceğine yönelik inanç kişinin olay sırasında daha fazla olumsuz duygu deneyimlemesine, bu da olay sonrası TSSB geliştirme olasılığının artmasına neden olmaktadır. Alanyazında birçok çalışma hem afetzedelerde hem de polis ve acil yardım çalışanlarında olay sırasında deneyimlenen korku, çaresizlik gibi olumsuz duyguların travma sonrası stres belirtilerinin gelişmesinde önemli bir faktör olduğuna işaret etmektedir (Bryant ve Harvey, 1996;Cankardaş ve Sofuoğlu, 2019;Lilly ve Pierce, 2013;Maia ve ark., 2011). ...
... İtfaiye çalışanlarında gelişen travmatik stres belirtilerinde en yüksek etkinin olay sırasında deneyimlenen psikolojik sıkıntı olduğu, bu sıkıntı düzeyi arttıkça TSSB olasılığının 4.4 kat arttığı görülmüştür. Bu bulgu alanyazındaki peri-travmatik sıkıntının olay sonrası travmatik stres düzeyini yordadığına işaret eden çalışmaları destekler niteliktedir (Bryant ve Harvey, 1996;Cankardaş ve Sofuoğlu, 2019;Lilly ve Pierce, 2013;Maia ve ark., 2011). Seligman'ın öğrenilmiş çaresizlik yaklaşımına göre, karşılaştığı stresörü kontrol edilemez olarak algılamak travmatik olay deneyimleyen kişilerin TSSB belirtileri geliştirmelerinde önemli bir etkiye sahiptir (Maier ve Seligman, 1976). ...
Article
Full-text available
Firefighters are at high risk of experiencing mental disorders like other first responders. Although the studies on the prevalence of mental health problems in firefighters are common in the literature, it is seen that there are limited studies on the causes of these problems. This study aimed to investigate the risk of depression and traumatic stress symptoms among firefighters working in Turkey. In addition, it was aimed to investigate the variables before and during the event that predicted the traumatic stress symptoms. For this purpose, data were collected from the 468 firefighters working in the fire department of 35 provinces that agreed to participate in the study by using the Behavior, Safety, and Culture-First Responders, Patient Health Questionnaire-2, and Impact of Events Scale. It was seen that approximately half of the firefighters met the diagnosis of possible post-traumatic stress disorder, and approximately one fifth had a risk of depression. It was observed that the level of distress experienced during the event was the variable that explained the higher variance in the level of traumatic stress symptoms. Findings indicate that firefighters should have access to the psychological support system. Thus, it may be possible to prevent the continuation of mental problems and decrease in the quality of life.
... Emergency telecommunicators are experiencing high rates of occupational stress despite not being physically present at the scene of an emergency (Lewis, 2022;Lilly et al., 2016;McAleavy et al., 2021;Meischke et al., 2018;Perez et al., 2021;Ramey et al., 2017). Research has shown that emergency telecommunicators experience symptoms such as post-traumatic stress disorder (PTSD), depression, and anxiety (Kindermann, et al., 2020;Klimley et al., 2018) comparable to police officers, firefighters, and paramedics (Pierce & Lilly, 2013). In addition to psychological strains, stress in this workforce has also been associated with high levels of obesity and a higher risk of metabolic syndrome (Lilly et al., 2016). ...
Article
Full-text available
Background Most agree that occupational stress is caused by workplace strains, tensions, and demands that originate from characteristics of the work. The accumulation of multiple types of stress has been found to have calamitous effects on health and well-being. One such occupation, emergency telecommunicators, experiences a multitude of stressors within their day-to-day work environment. Structural stressors are the sources of stress that are embedded in the way the work is designed and reinforced through workplace policies, practices, and procedures. This scoping review aimed to analyze occupational stressors directly promulgated by the structure and work design that impact emergency telecommunicators and to identify recommended organizational interventions. Methods This scoping review utilized the methodological framework of Arksey and O’Malley which examined research literature, identified gaps in the literature, and mapped key concepts. Electronic databases of CINAHL, MEDLINE, PsychINFO, PychNET, PubMed, Social Index, and Academic Search Complete were used to identify relevant literature on occupational stress of emergency telecommunicators. Results Across 17 included articles, four key themes related to workplace stressors of emergency telecommunicators were identified: (a) staffing problems, (b) poor physical work environment, (c) career development issues, and (d) inequity. The four themes were derived from literature to extract stressors related to workplace policies, procedures, and practices. Implications for stakeholders to reduce stress were interwoven in the themes. This review aimed to expand on existing literature pertaining to structural stressors that have an impact on emergency telecommunicators.
... Conversely, while 9-1-1 telecommunicators are not physically on scene and do not have a physically strenuous job, they receive the first notification of an emergency; are often the only lifeline to a person until other first responders arrive; and are exposed to the sounds, emotions, and, in certain settings, videos of the events throughout the call (Pierce, & Lilly, 2012). The intense emotional stress that all first responders face may lead to adverse mental health issues, including depression, anxiety, post-traumatic stress, sleep disturbance, and suicidal behaviors (Bentley et al., 2013;CDC, n.d.c;Lilly & Pierce, 2013;Pierce & Lilly, 2012;Vargas de Barros, Martins, Saitz, & Ronzani, 2013;Violanti et al., 2016). ...
Article
Full-text available
Introduction: First responders, including law enforcement officers (LEOs), firefighters, emergency medical services (EMS) clinicians, and public safety telecommunicators, face unique occupational stressors and may be at elevated risk for suicide. This study characterized suicides among first responders and identifies potential opportunities for additional data collection. Methods: Using suicides identified from the three most recent years of National Violent Death Reporting System data with industry and occupation codes from the NIOSH Industry and Occupation Computerized Coding System (2015-2017), decedents were categorized as first responders or non-first responders based on usual occupation. Chi-square tests were used to evaluate differences in sociodemographic and suicide circumstances between first and non-first responders. Results: First responder decedents made up 1% of all suicides. Over half of first responders (58%) were LEOs, 21% were firefighters, 18% were EMS clinicians, and 2% were public safety telecommunicators. Compared to non-first responder decedents, more first responders served in the military (23% vs. 11%) and used a firearm as the method of injury (69% vs. 44%). Among first responder decedents for whom circumstances were known, intimate partner problems, job problems, and physical health problems were most frequent. Some common risk factors for suicide (history of suicidal thoughts, previous suicide attempt, alcohol/substance abuse problem) were significantly lower among first responders. Selected sociodemographics and characteristics were compared across first responder occupations. Compared to firefighters and EMS clinicians, LEO decedents had slightly lower percentages of depressed mood, mental health problems, history of suicidal thoughts, and history of suicide attempts. Conclusions: While this analysis provides a small glimpse into some of these stressors, more detailed research may help inform future suicide prevention efforts and interventions. Practical application: Understanding stressors and their relation to suicide and suicidal behaviors can facilitate suicide prevention among this critical workforce.
... Positive, albeit weak, correlations between the dimensions of world assumptions and post-traumatic growth (H1) are consistent with those previously obtained in various populations. For example, Lilly and Pierce [89] found that people who believe that the world is benevolent, things occur for a reason, and the self is worthy of respect display lower anxiety or depressive symptoms than their counterparts who present assumptions of the world as a dangerous place and a scarce sense of self-worth. This is possibly due to the cognitive engagement in the processing of a traumatic experience. ...
Article
Full-text available
Background: Although post-traumatic growth is believed to be the result of complex interplays between various factors, cognitive variables appear to play a special role in these interactions. Yet, research on this topic is scant. Therefore, the first purpose of this study was to verify whether there is a direct relationship between world assumptions and post-traumatic growth among Polish cancer patients. As the effect of psychological change in post-traumatic growth may be affected by basic beliefs about the world and oneself, the second goal was to assess whether this association is moderated by rumination. Methods: The study included 215 Polish cancer patients. The Post-traumatic Growth and Depreciation Inventory-Expanded version-(intrusive and deliberate rumination), the World Assumption Scale, and the Event-related Rumination Inventory were applied. Results: Positive, albeit weak, correlations were found between the dimensions of world assumptions and post-traumatic growth. Post-traumatic growth correlated negatively with intrusive rumination and positively with deliberate rumination. The outcomes show that the level of post-traumatic growth resulting from world assumptions is significantly different at various levels of intrusive and deliberate rumination. Conclusion: Lower/medium intrusive rumination seems to strengthen the relationship between benevolence of the world/worthiness of the self and post-traumatic growth, and higher deliberate rumination tends to reinforce the relationship between meaningfulness and post-traumatic growth.
... Parmi ces mé tiers exigeants se trouve celui des ré partiteurs d'urgence, travailleurs encore trop peu mis en lumiè re, qui n'é chappent pourtant pas à cette ré alité . Plusieurs chercheurs s'inté ressent aux facteurs de risques sur la santé psychologique au travail des ré partiteurs d'urgence, notamment la nature traumatisante des appels qu'ils reçoivent, la demande psychologique é levé e, la faible latitude dé cisionnelle, le soutien de l'organisation insuffisant et le manque de reconnaissance dans le leadership (Lilly & Pierce, 2013 ;Toulouse et al., 2006). De plus, la pré valence des symptô mes de dé pression modé ré s à sé vè res et de stress post-traumatique est davantage pré sentes chez les ré partiteurs que dans d'autres populations des mé tiers d'urgence comme les pompiers par exemple (Lilly & Allen, 2015 ;Meyer et al., 2012). ...
Article
Full-text available
Résumé L’objectif de cette recherche est d’évaluer les relations entre la reconnaissance au travail et la santé psychologique au travail des répartiteurs d’urgence par un devis corrélationnel prédictif. Les données collectées du questionnaire en ligne sécurisé envoyé aux répartiteurs via quatre centres d’appels d’urgence (n = 155) ont mesuré la santé psychologique au travail (Gilbert et al., 2011) et la reconnaissance organisationnelle (Brun et Dugas, 2005). Les résultats des analyses de régression linéaire multiples confirment partiellement les liens hypothétiques entre les deux variables : ils attestent que la reconnaissance provenant de l’organisation et des collègues expliquent partiellement le bien-être psychologique au travail (R² = .25, p < .001) et la détresse psychologique au travail (R² = .30, p < .001) des répartiteurs d’urgence.
Article
Full-text available
Background: The association between mental health and work has led to multiple meanings and definitions, leading to generalizations and equivalences that do not always reflect similar meanings. Objectives/Methods: To map and analyze the definitions of mental health related to work in the literature and identify the professional practices arising, a systematic review was carried out following PRISMA 2020 guidelines. Six databases were selected for consultation, which was carried out in March 2023. Results: From the search, 26 articles were selected and most of them do not define the concept of mental health, nor the influence of work on mental health–illness processes. Few articles report working conditions and the professional environment as generators of stress. Even if these conditions exist, the studies highlight that individuals already had previous personality traits that made them susceptible to disorders. Conclusions: Failure to adopt clear theoretical–methodological references regarding the concept of mental health and its relationship with work weakens the field and professional practice. Moreover, the literature does not point to changes in work or indicate possibilities for returning to assisted/ compatible work, vocational reorientation, or other means of overcoming the problem within work and organizations, with significant impacts on the design of public policies in the field.
Article
This study explores the experiences of bereaved siblings in Israel, examining how different causes of death affect their psychological well-being. We recruited three groups of siblings who lost loved ones as a result of military service, terrorism, or civilian circumstances. A total of 159 bereaved siblings completed questionnaires measuring complications of grief (CG), posttraumatic stress disorder (PTSD), and world assumptions. Results indicated that siblings who experienced civilian loss exhibited the highest prevalence of CG, while no significant differences in PTSD levels were observed across the groups. Both CG and PTSD were associated with the world assumptions regarding the benevolence of the world and sense of self-worth. The study also examined how demographic variables influence siblings' well-being and coping with loss. Overall, the findings emphasize the importance of recognizing the unique experiences of bereaved siblings and underscore the necessity of tailored support to address their individualized needs.
Chapter
First responders are exposed to traumatic circumstances at a much greater frequency than the average person; indeed, they are literally called to situations where they are expected to become directly involved in matters involving violence, loss, and depravity. As the name implies, first responders are not mere witnesses; they cannot cross their arms, shield their eyes, or walk away for a bit when things become difficult. First responders are the people in charge – the ones who handle the problems. They are our community’s helpers, protectors, enforcers, and guardians. This chapter introduces some findings from the National Wellness Survey (NWS) for Public Safety Personnel that assesses psychological symptoms, suicidality, PTSD and secondary traumatic stress, job burnout, social desirability, and substance use. Our (this author was a codeveloper of the NWS) goal was to shed light on these and other important questions relating to the mental well-being of first responders.
Thesis
Full-text available
Suffering. Salvation’s conduit. People are often reluctant to talk about suffering, unable to find words. This reluctance usually lasts until, in the midst of crisis, the only way ahead is through suffering. In these crises, people typically reach out to caregivers—pastors and priests, counselors and social workers. But what if the same reluctance affects these caregivers? What if they, too, are often unable to find adequate words? Jesus—Man of Sorrows—makes plain the imperative of taking up our cross. How is this accomplished? This dissertation offers an answer, a theology of suffering focused on spiritual formation—formation into the image of a suffering God. Emerging from lived experiences in valleys of adversity, this formational theology offers conceptual and practical ways to narrate biographies of adversity, then help others give sorrow words and grow, thus taking up our cross.
Article
Full-text available
A review of 2,647 studies of posttraumatic stress disorder (PTSD) yielded 476 potential candidates for a meta-analysis of predictors of PTSD or of its symptoms. From these, 68 studies met criteria for inclusion in a meta-analysis of 7 predictors: (a) prior trauma, (b) prior psychological adjustment, (c) family history of psychopathology, (d) perceived life threat during the trauma, (e) posttrauma social support, (f) peritraumatic emotional responses, and (g) peritraumatic dissociation. All yielded significant effect sizes, with family history, prior trauma, and prior adjustment the smallest (weighted r = .17) and peritraumatic dissociation the largest (weighted r = .35). The results suggest that peritraumatic psychological processes, not prior characteristics, are the strongest predictors of PTSD.
Article
Full-text available
Male firefighters (n = 94) were compared with male workers (n = 91) from a variety of blue-collar, non—emergency service occupations. Responses on the World Assumptions Scale were examined in combination with the Impact of Events Scale—Revised and the Symptom Checklist-90. Initial hypotheses suggested that firefighters would report disrupted world assumptions and that these disrupted assumptions would be linked with greater mental health symptomatology. Results revealed that firefighters were not different from controls on world assumptions and that world assumptions were unrelated to years of service. These results suggest that the psychological reactions of workers exposed to high levels of job-related traumatic stress may not be consistent with that described in previous literature regarding primary victims. Consequently, it is suggested that more research is needed that specifically addresses psychological outcomes for firefighters and other high-trauma occupations. The findings also suggest that benevolence may be particularly important in relation to mental health in firefighters and that this belief may be useful in the prevention of posttraumatic symptomatology.
Article
Full-text available
Interest in critical incident stress debriefings for firefighters has grown over the last decade. Some researchers report that debriefings protect firefighters from stress-related disorders, including posttraumatic stress disorder (PTSD). Proponents of the interventions claim extraordinary need and success. Controlled and correlational studies have largely failed to demonstrate therapeutic effects, and some report iatrogenic effects. This study examined the relationships between debriefings and several mental health variables in a large sample of firefighters. Debriefing had a weak inverse correlation with negative affectivity and a weak positive correlation with positive world assumptions. No relationship was found between debriefing and PTSD.
Article
Full-text available
Work on the psychological aftermath of traumatic events suggests that people ordinarily operate on the basis of unchallenged, unquestioned assumptions about themselves and the world. A heuristic model specifying the content of people's assumptive worlds is proposed. The schema construct in social cognition is used to explore the role of these basic assumptions following traumatic events. A major coping task confronting victims is a cognitive one, that of assimilating their experience and/or changing their basic schemas about themselves and their world. Various seemingly inappropriate coping strategies, including self-blame, denial, and intrusive, recurrent thoughts, are discussed from the perspective of facilitating the victim's cognitive coping task. A scale for measuring basic assumptions is presented, as is a study comparing the assumptive worlds of people who did or did not experience particular traumatic events in the past. Results showed that assumptions about the benevolence of the impersonal world, chance, and self-worth differed across the two populations. Findings suggest that people's assumptive worlds are affected by traumatic events, and the impact on basic assumptions is still apparent years after the negative event. Further research directions suggested by work on schemas are briefly discussed.
Article
The current study examines the relationships among world assumptions, history of adult sexual assault, depressive symptoms, and fearful attitudes toward relationships. Three hundred and sixty-one female college students completed the Assumptive World Scales and a set of questionnaires to assess their sexual assault history subsequent to age 15, levels of depressive symptoms, sexual aversion, paranoia/self-consciousness, and fear of intimacy. Factor analysis of the Assumptive World Scales items revealed five dimensions that had clear relationships with factors proposed in the initial study. These five Assumptive Worlds dimensions accounted for significant variance in depression. These dimensions also accounted for significant variance in sexual aversion, paranoia/self-consciousness, and fear of intimacy, even when controlling for levels of depressive symptoms and sexual assault severity. The implications of these findings for research on sexual assault, cognitive schema, and interpersonal functioning are discussed.
Article
To assess whether coping styles mediated the relation between inner representations and posttraumatic stress symptomatology, a community sample of self-defined trauma survivors (N = 95) completed the World Assumptions Scale, Ways of Coping Checklist - Revised, and Trauma Symptom Inventory. Regression analyses indicted that individuals with more positive inner representations reported experiencing less symptomatology and tended to use more active and less passive coping strategies. Furthermore, the relation between inner representations and the extent of symptomatology was mediated through the use of passive coping strategies, although the latter 2 variables were likely reciprocally related. The implications of these findings for the well-being of trauma survivors were discussed.