Article

Psychological Inflexibility and Psychopathology in 9-1-1 Telecommunicators

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Abstract

Mental health in 9-1-1 telecommunicators has been understudied in comparison to other emergency responders. This study enrolled a sample of telecommunicators from across the United States (N = 808). As measured by self-report, the prevalence of current probable posttraumatic stress disorder (PTSD) was 17.6% to 24.6%; it was 23.9% for probable major depression. Structural equation modeling revealed a significant direct effect of psychological inflexibility on psychopathology (path coefficient = .32) when considered among duty-related distress and dissociation, neuroticism, anger, and emotion dysregulation. The results provided further evidence of the adverse psychological effects of duty-related trauma exposure, including exposure that is vicarious in nature. The results indicate a need for prevention and intervention in this population, with psychological inflexibility as a potential target in these efforts. Copyright © 2015 Wiley Periodicals, Inc., A Wiley Company.

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... Despite this, results from this review demonstrated that workers within this industry are vulnerable to stress reactions. Prior to the current Covid-19 global pandemic, research indicated that 18% of ERS telecommunicators screened positive for posttraumatic stress disorder (PTSD) [3], and 15% screened positive for major depressive disorder [4]. Rates in ERS telecommunicators were substantially higher than the general population at that time, when 5% of individuals in the U.S. screened positive for PTSD [5] and 8% screened positive for depression [6]. ...
... These results are consistent with previous research reporting that ERS telecommunicators experience significant amounts of stress due to call load [3,5]. According to the Job Demand-Control (JDC) model, the combination of low autonomy and high demand on the job is associated with higher mental strain and reduced wellbeing [24]. ...
... Of all the negative emotions, the total number of dispatched calls was only associated with irritability. These results are compelling given previous research demonstrating that both state and trait anger are predictive of psychopathology in ERS telecommunicators [3]. Other healthcare workers experience high rates of irritability as well [25]. ...
Article
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Emergency telecommunicators are essential first responders tasked with coordinated communication within the emergency response system (ERS). Despite their exposure to significant job demands, little is known about the effect of call load or call type on emotional state within these workers. Therefore, we employed a prospective, intensive longitudinal design to examine whether emergency-eligible call volume would lead to higher intensity negative emotions post-shift when controlling for pre-shift negative emotions and a number of other work and individual factors, including work duration and night shift. A total of 47 ERS telecommunicators (dispatchers, operators, other) completed ratings over working shifts within a two-week period. Call frequency was gathered through the agency Computer-Assisted Dispatch database. Negative emotions of irritation, stress, worry, and fatigue were measured through the Visual Analogue Scale administered before and after shift. Mixed linear modeling demonstrated that telecommunicators who received more calls per hour (Estimate = 3.56, SE = 1.44, p < 0.05) and more-than-usual calls per hour (Estimate = 1.97, SE = .94, p < 0.05) had higher levels of post-shift irritability. Longer-than-usual working hours also predicted higher levels of post-shift irritability (Estimate = 1.32, SE = 0.59, p < 0.05). Call volume did not predict other negative emotions, although secondary analyses demonstrated that a larger number of chronic calls lead to greater levels of post-shift worry. ERS telecommunication agencies aiming to reduce negative emotions in workers may benefit from implementing policies and programs that target working hours, call load, and work-life balance.
... In this same study, communications personnel reported having an average of 17 health complaints per month [4]. Up to one-fourth of communications workers meet some criteria for post-traumatic stress disorder (PTSD), and 24% suffer from depressive symptoms [6]. However, the mechanistic pathways between stress and health among the workers is unclear. ...
... However, the mechanistic pathways between stress and health among the workers is unclear. For example, previous literature shows higher levels of cortisol levels due to stress, obesity, physical complaints, and instances of depression and PTSD but does not detail how stress is connected to these outcomes [3,4,6]. Therefore, research that describes how stress and negative health outcomes are interrelated among communications workers is needed. ...
... Notably, mental health was not identified as a theme in our focus groups, and this may be a function of the stigma associated with self-reporting mental health conditions in a public forum. Other studies on the mental health of communications workers have found that the prevalence of depression (24%) exceeds the rates reported in samples of law enforcement officers [6,18,19], and duty-related experiences were significantly associated with greater mental health concerns [4]. These high rates of stress-related mental health disorders identified in the literature are not surprising given the magnitude of the physical health impacts of stress facing communications workers in our study. ...
Article
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Introduction Law enforcement communications (i.e. 911 dispatch and call takers) is a challenging and stressful occupation. The purpose of this study to identify the main stressors associated with employment in law enforcement communications, and to identify and provide context to how these stressors affect workers’ health and wellbeing. Methods This research study included focus groups with 23 call takers and 911 dispatchers employed by a large, urban law enforcement agency in 2018. Thematic analyses were conducted to identify trends. Results Four themes of stressors emerged (i.e. the high stakes nature of some 911 calls for service; understaffing; supervisor-related stress; and, recruiting practice). Two health-related themes emerged as being occupation-related: weight gain and poor sleep patterns/insufficient sleep). Specifically, participants reported negative eating habits resulting in weight gain and obesity, lack of sleep and irregular sleep schedules, and development of hypertension and/or diabetes since beginning their jobs. Conclusion Law enforcement communications professionals experience a number of the same stressors facing law enforcement officers in patrol. These stressors, combined with the sedentary nature of the job, could result in long-term, chronic health problems.
... Emergency dispatchers are often the first to intervene in a crisis (Lilly et Allen, 2015). They receive calls that can prove complex and troubling (Adams et al., 2015). ...
... Losing control when you think you have it (positive assumptions about the controllability) can result in a feeling of guilt, responsibility or even cause dispatchers to ruminate on what could have been done (Lilly et Pierce, 2013). Lilly and Allen (2015) note that psychopathology of emergency dispatchers is frequently marked by fatigue and doubt, such that this state can compromise their performance at work and endanger the safety of the population. ...
... Once again, these results can be linked to their role. They are often the first to respond in a situation (Lilly and Allen, 2015). They are the ones who mobilize the other emergency services (police, firefighters, paramedics). ...
Article
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Purpose The main purpose of this research is to establish the relationships between emotional self-efficacy and workplace psychological health for emergency dispatchers. Design/methodology/approach A correlational design was used to validate results of the study. Between December 2018 and February 2019, a secure online questionnaire was sent to dispatchers through four emergency call centers. Participation was voluntary. A total of 257 emergency dispatchers participated in this study. Gilbert et al. ’s (2011) scale of workplace psychological health and Deschênes et al. ’s (2019) scale of emotional self-efficacy were used. Multiple linear regression and Pearson's correlation tests were run using the SPSS 25 program in order to establish relationships between the two variables. Findings A total of three emotional competencies positively affect workplace psychological well-being (PWB), i.e. self-efficacy beliefs on managing one's own emotions, on managing other people' emotions and on using one's own emotions. As regards to psychological distress (PD), it is negatively correlated to self-efficacy beliefs on managing and using one's own emotions. Research limitations/implications One of the study's theoretical contributions is to broaden the scientific knowledge of emergency service dispatching, in addition to opening up a new field of study in workplace people management. Practical implications These scientific findings therefore show the importance of emotional self-efficacy in the workplace. The manager or the dispatch leader should focus on developing the following three emotional skills: self-efficacy in managing emotions, managing the emotions felt by others and using emotions. Training allowing the development of these emotional skills should be considered and would be beneficial for emergency dispatchers to maximize their well-being at work. Originality/value To the best of the authors’ knowledge, no other study has focused on emergency dispatchers and included the emotional self-efficacy and workplace mental health variables.
... Plusieurs études démontrent que les métiers du domaine de l'urgence sont plus à risque, dans leurs fonctions, d'être touchés par des problématiques telles que la détresse psychologique, le stress et les syndromes posttraumatiques Gersons et Carlier, 1992;De Soir, Daubechies et Van Den Steene, 2012;Lilly et Allen, 2015). Les travailleurs des métiers d'urgence, qu'ils soient policiers, pompiers ou tous autres professionnels, sont souvent appelés à intervenir dans des situations de crise à répétition, entre autres, lors d'événements impliquant des enfants victimes, des tragédies de masse (p. ...
... Les répartiteurs d'urgence n'échappent pas à tous ces constats sur la détresse psychologique au travail dans les centres d'appels. Toutefois, force est de constater qu'encore trop peu d'études s'intéressent aux conséquences d'une telle profession sur leur santé mentale, émotionnelle et physique (Birze et al., 2008;Lilly et Allen, 2015;Toulouse et al., 2006;Troxell, 2008). Les résultats de l'étude de Toulouse et al. (2006) mettent en lumière les risques sur la santé psychologique au travail des répartiteurs d'urgence. ...
... L'écart est ainsi considérable. D'ailleurs, toujours d'après Lilly et Allen (2015), près d'un quart de leur échantillonnage vivait des symptômes de dépression de modérés à sévères. ...
Article
Full-text available
La présente recherche explore le concept de la reconnaissance au travail. Selon Brun et al. (2002), la reconnaissance au travail constitue une réaction constructive et authentique, de préférence personnalisée, spécifique, cohérente et à court terme qui s’exprime dans les rapports entre humains. À l’instar des résultats de l’étude de Toulouse et al. (2011), qui proposent que les préposés des centrales 911 souffrent d’un manque de reconnaissance important où 90 % des participants présentaient un déséquilibre effort/reconnaissance, l’objet de la présente recherche prend toute son importance. Plus précisément, cette étude qualitative explore des méthodes de reconnaissance qui font du sens pour les répartiteurs d’urgence. Dans le cadre de cette recherche, cinq centres d’urgence ont participé à l’étude. Les participants sont des superviseurs et des répartiteurs à l’emploi. Au total, 10 entrevues semi-dirigées ont été réalisées. 90 % des participants sont des femmes et cumulent en moyenne 12,25 années d’expérience. L’entrevue semi-dirigée consistait à comprendre la réalité du métier de répartiteur et ses besoins de reconnaissance afin de les juxtaposer à la théorie. Un modèle exploratoire de reconnaissance au travail adapté à la réalité des répartiteurs d’urgence inspiré de la théorie de Brun et Dugas (2005) est l’extrant des analyses thématiques. Plus spécifiquement, le modèle exploratoire expose les différents niveaux possibles d’interactions croisées entre les acteurs de la fonction de répartiteur, par exemple, la reconnaissance du policier à l’égard du répartiteur ou encore, l’impact de la reconnaissance entre collègues. En somme, le modèle exploratoire extrait des résultats de cette recherche [...]
... The psychological burden of being the first, first responder is illustrated in the prevalence of psychopathology reported by 9-1-1 TCs. Average levels of reported PTSD symptoms among 9-1-1 TCs have ranged from sub-clinical levels (Lilly & Pierce, 2012) to meeting criteria for probable PTSD (Lilly & Allen, 2015). The prevalence of PTSD among 9-1-1 TCs has ranged from 3.5% in an initial convenience sample of TCs (Pierce & Lilly, 2012) to 24.4% in a larger sample of TCs from across the United States (Lilly & Allen, 2015). ...
... Average levels of reported PTSD symptoms among 9-1-1 TCs have ranged from sub-clinical levels (Lilly & Pierce, 2012) to meeting criteria for probable PTSD (Lilly & Allen, 2015). The prevalence of PTSD among 9-1-1 TCs has ranged from 3.5% in an initial convenience sample of TCs (Pierce & Lilly, 2012) to 24.4% in a larger sample of TCs from across the United States (Lilly & Allen, 2015). ...
... In addition to PTSD, depression is prevalent among 9-1-1 TCs, with rates of probable major depression reaching nearly 25% (Lilly & Allen, 2015). Numerous variables were examined in relation to psychopathology (i.e., depression, PTSD) in TCs including number of years of experience in the field, lifetime trauma exposure, levels of emotion regulation difficulties, event-related distress (i.e., peritraumatic distress and dissociation), anger, and neuroticism. ...
Chapter
Research on the health and wellness of emergency responders has continued to grow over the past two decades, demonstrating the profound impact of duty-related exposure to stress and trauma on responders' physical and mental health. The majority of this important literature has been conducted with field responders, including police officers and firefighters. As the first, first responder, the health and wellness of 9-1-1 telecommunicators has been largely neglected, despite the high levels of recurrent exposure to duty-related traumatic events among this population. This chapter reviews the current empirical literature on mental and physical health in 9-1-1 telecommunicators, followed by discussion on factors within the 9-1-1 work environment that may be responsible for elevated rates of mental and physical health problems. Prevention and intervention efforts for 9-1-1 telecommunicators are then discussed, followed by research showing the potentially profound impact of poor mental health on 9-1-1 telecommunicator performance.
... These telecommunicators work lengthy shifts in which they are consistently exposed to both mundane and emergency calls, such as fires, accidental deaths, homicides, child injuries, and sexual assault (Pierce & Lilly, 2012). They therefore experience a high rate of chronic exposure to potentially traumatizing events, which might enhance risk for psychopathology, including PTSD and depression (Lilly & Allen, 2015). Prior research has not been conducted on the relationship between CTE and PTSS in 911 telecommunicators, nor has it explicitly focused on the role between coping methods and PTSS in this population. ...
... This study is part of a larger study on the physical and mental health of 911 telecommunicators (Lilly & Allen, 2015). This study examines the effects of CTE on duty-related coping and PTSS in 911 telecommunicators to expand the literature on the adverse effects of reexposure to trauma in adulthood and further inform the coping and emergency responding literatures. ...
... The sample is the same as described in Lilly and Allen (2015). Participants were 808 adults who had been employed as 911 telecommunicators for at least a year. ...
Article
A history of childhood trauma exposure has been linked to the development of posttraumatic stress symptoms in adulthood following new exposure. Unhealthy coping behaviors that could develop or be utilized in response to early trauma could lend themselves to psychological issues in adulthood. Emotion-focused and problem-focused coping strategies in relation to stressful duty-related situations are examined as indirect pathways through which childhood trauma exposure could be associated with duty-related posttraumatic stress symptoms in 911 telecommunicators (N = 808). Multiple mediation models revealed that 3 of the 4 emotion-focused coping strategies, but not the problem-focused strategies, functioned as significant mediators in the association between childhood exposure and duty-related posttraumatic stress symptoms. Pairwise comparisons showed that self-controlling and escape-avoidance strategies were the strongest pathways of the indirect childhood trauma exposure–posttraumatic stress symptoms association. Implications of results regarding coping in response to new traumatic events in adulthood and potential research and intervention directions are discussed.
... For example, psychological inflexibility has been found to be significantly higher among individuals with current or lifetime depressive and anxiety disorders, substance use and eating disorders relative to those with no disorder (Levin et al., 2014). Other studies have found a strong association between psychological inflexibility and depressive and PTSD symptomatology (Lilly & Allen, 2015), with additional research demonstrating that psychological inflexibility predicts PTSD symptom severity over time, while controlling for other relevant personality factors (e.g., neuroticism) and baseline PTSD symptoms (Marx & Sloan, 2005;Meyer et al., 2019). Relatedly, research has found higher levels of experiential avoidancea core sub-process contributing to psychological inflexibilityto be related to elevated complicated grief symptomatology following bereavement (Boelen & Reijntjes, 2008;Nam, 2016;Shear et al., 2007). ...
... For example, while psychological inflexibility (along with contributing sub-processes, e.g., experiential avoidance) can be understood as a deficit in the ability to manage or regulate difficult emotions, it is separate to emotion regulation in that, rather than attempting to alter the intensity or duration of an emotional experience, it involves an unwillingness to come into contact with difficult emotions and attempts to avoid or extinguish unwanted emotions completely (Boulanger et al., 2010). Further, contrary to arguments that the specific process of experiential avoidance may be understood as a function of poor emotion regulation (Hofmann & Asmundson, 2008), research has found experiential avoidance accounts for unique variance in predicting disorder-specific psychological symptom severity amongst those with posttraumatic stress (Lilly & Allen, 2015) and borderline personality disorder (Iverson et al., 2012) after controlling for emotion regulation difficulties. Additional research is necessary to further clarify the relationships among these theoretically overlapping constructs and their relative contributions to disorder-specific symptoms. ...
Article
When a loved one is missing, those left behind need to be able to tolerate high levels of uncertainty, sometimes for sustained periods of time. This study aimed to examine the relationship between intolerance of uncertainty (IU) and psychological symptoms among people with a missing loved one, and tested the mediating role of emotion regulation difficulties and psychological inflexibility. A cross-sectional sample of 110 people with a missing loved one completed a questionnaire containing demographics and measures of IU, difficulties in emotion regulation, psychological inflexibility and psychological symptoms. Results indicated that psychological inflexibility was a significant mediator of the associations between IU and psychological distress, prolonged grief and posttraumatic stress symptoms. Emotion regulation difficulties did not emerge as a significant mediator in any of the models. Findings suggest that stronger tendencies to respond negatively to uncertain situations are associated with increased attempts to avoid uncomfortable internal experiences (e.g., thoughts, feelings, memories or sensations) which, in turn, exacerbates psychological symptom levels. The findings have implications for developing interventions aimed at strengthening the ability to tolerate uncertainty and addressing psychological inflexibility among people with a missing loved one.
... In the short term, psychological inflexibility may offer relief and act as a somewhat nonthreatening strategy for regulating emotional manifestation (Hayes et al., 1996;Kashdan et al., 2006). Nevertheless, when it becomes a rigid and inflexible pattern it may be seen as a maladaptive process, being associated with psychopathology and poor quality of life (e.g., Chawla & Ostafin, 2007;Lilly & Allen, 2015). ...
... Several studies have addressed psychological inflexibility and its relationship with other mental health constructs (e.g., depression, anxiety, health quality, self-efficacy), either as a predictor, a mediator, or moderator in a varied range of health conditions such as chronic pain, inflammatory bowel disease, breast cancer, weight related problems (Costa & Pinto-Gouveia, 2011;Ferreira et al., 2016;González-Fernández et al., 2017;Lilly & Allen, 2015) and populations, for example, teachers, adolescents (Hinds et al., 2015;Mellick et al., 2017). Furthermore, Woodruff et al. (2014) found that psychological inflexibility was a stronger predictor of negative indicators of psychological health when compare to self-compassion and mindfulness. ...
Article
Facing an infertility diagnosis and the demands of infertility medical treatment has been widely recognized as a psychologically distressing condition and psychological inflexibility may be a relevant construct to better understand mental health in this population. In this context, the current study aimed to develop a new self-report measure, the Psychological Inflexibility Scale – Infertility (PIS–I), and examine its factor structure and psychometric properties. Based on the Acceptance and Commitment Therapy (ACT) conceptual framework, literature review and clinical expertise in the infertility domain, an initial pool of 18 items was developed. An online survey was conducted with 287 women presenting an infertility diagnosis. Exploratory Factor Analysis revealed that a refined version of the PIS-I, encompassing 16 items, presented a single-component structure accounting for 58.92% of the variance. Psychometric analyses showed an excellent internal consistency and support for the PIS-I convergent, concurrent, and incremental validities was found. Overall, the PIS-I showed to be a context-specific reliable and valid measure of psychological inflexibility for people dealing with infertility, being useful for clinical and research purposes.
... The impacts of shift work and its, sometimes, unstable nature may also enact a harmful effect on stress management while contributing to stress disorders, whereas having a more stable and consistent schedule may be a protective factor against development of stress conditions (Trachik et al., 2015). Lilly and Allen (2015) highlight an important nuance that an ECO's most distressing call may not directly trigger PTSD and its subsequent cluster symptoms, however, symptoms may present more fully following a subsequent call that triggers new symptoms, worsening the already existing pathology. Cumulative and compounded stress is often a significant factor within this population's development of psychopathology in need of intervention and care. ...
... Because of ECO's exposure to violence, death, and trauma, vicarious trauma is a legitimate concern not only for the ECO's health and well-being but the public's, by extension. Lilly and Allen (2015) reiterate that the psychopathology present in stress disorders in ECOs resulting from vicarious trauma may compromise performance. The wellness of ECOs is a public health matter and requires further long-term research with a focus on the benefits of modern technology in stress alleviation and the role of resilience in posttraumatic growth. ...
Research
As Athletic Trainers (ATs), we were interested in musculoskeletal injuries that were causing employees within a tactical setting to miss time from work. Ultimately, we'd like to assess whether or not having ATs within those work environments would be beneficial and reduce the amount of time lost. Further research would need to be conducted to evaluate the measures of effectiveness (MOE), and measures of performance (MOP) with ATs working in this setting.
... 21,22 In one study, call-takers and dispatchers managed calls for both fire and ambulance, 23 and in two studies, they managed calls for fire, police, and ambulance. 24,25 The type of call-taker or dispatcher was not disclosed in two of the studies, 26,27 and one was a literature review. 28 The kappa value for inter-rater reliability was 0.95, which indicated excellent agreement between reviewers in determining whether the records retrieved by the search strategy documented the physical and mental health challenges associated with emergency service call-taking or dispatching. ...
... 6 Emergency service call-takers and dispatchers reported higher levels of traumatic distress compared to police officers, and this level of distress experienced during and immediately after a traumatic call positively correlated with PTSD symptoms and burnout. 3 Veteran dispatchers had the highest rate of PTSD, 27 and exposure to traumatic calls resulted in difficulties sleeping, nightmares, flashbacks, and increases in alcohol consumption. 16,18 Managing traumatic and abusive calls was also associated with a higher desire to leave the occupation and greater levels of emotional exhaustion. ...
Article
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Introduction Emergency service (ambulance, police, fire) call-takers and dispatchers are often exposed to duty-related trauma, placing them at increased risk for developing mental health challenges like stress, anxiety, depression, and posttraumatic stress disorder (PTSD). Their unique working environment also puts them at-risk for physical health issues like obesity, headache, backache, and insomnia. Along with the stress associated with being on the receiving end of difficult calls, call-takers and dispatchers also deal with the pressure and demand of following protocol despite dealing with the variability of complex and stressful situations. Methods A systematic literature review was conducted using the MEDLINE, PubMed, CINAHL, and PsychInfo databases. Results A total of 25 publications were retrieved by the search strategy. The majority of studies (n = 13; 52%) reported a quantitative methodology, while nine (36%) reported the use of a qualitative research methodology. One study reported a mixed-methods methodology, one reported an evaluability assessment with semi-structured interviews, one reported on a case study, and one was a systematic review with a narrative synthesis. Discussion Challenges to physical health included: shift-work leading to lack of physical activity, poor nutrition, and obesity; outdated and ergonomically ill-fitted equipment, and physically confining and isolating work spaces leading to physical injuries; inadequate breaks leading to fatigue; and high noise levels and poor lighting being correlated with higher cortisol levels. Challenges to mental health included: being exposed to traumatic calls; working in high-pressure environments with little downtime in between stressful calls; inadequate debriefing after stressful calls; inappropriate training for mental-health-related calls; and being exposed to verbally aggressive callers. Lack of support from leadership was an additional source of stress. Conclusion Emergency service call-takers and dispatchers experience both physical and mental health challenges as a result of their work, which appears to be related to a range of both operational and support-based issues. Future research should explore the long-term effects of these physical and mental health challenges.
... Peritraumatic stressdefined as the responses during or immediately after trauma exposure-have been shown to predict depression and post-traumatic stress disorder (PTSD) among firefighters, police officers, emergency service personnel [9,10]. Only recently has this same peritraumatic association with depression and PTSD been identified in the TC workforce [11,12]. In a study of secondary trauma exposure, Troxell (2008) reported high levels of peritraumatic distress and a positive relationship between peritraumatic distress and secondary traumatic stress in 9-1-1 TCs [5]. ...
... In a study of secondary trauma exposure, Troxell (2008) reported high levels of peritraumatic distress and a positive relationship between peritraumatic distress and secondary traumatic stress in 9-1-1 TCs [5]. Similarly, high levels of peritraumatic distress and a moderate, positive relationship between peritraumatic distress and PTSD symptom severity have been reported in TCs, suggesting that direct, physical exposure to trauma may not be necessary to increase risk for PTSD in this group of workers [12,13]. However, few studies have focused specifically on the association between TC workplace stress and psychological health. ...
Article
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Background: Our public health emergency response system relies on the "first of the first responders"-the emergency call center workforce that handles the emergency needs of a public in distress. Call centers across the United States have been preparing for the "Next Generation 9-1-1" initiative, which will allow citizens to place 9-1-1 calls using a variety of digital technologies. The impacts of this initiative on a workforce that is already highly stressed is unknown. There is concern that these technology changes will increase stress, reduce job performance, contribute to maladaptive coping strategies, lower employee retention, or change morale in the workplace. Understanding these impacts to inform approaches for mitigating the health and performance risks associated with new technologies is crucial for ensuring the 911 system fulfills its mission of providing optimal emergency response to the public. Methods: Our project is an observational, prospective cohort study framed by the first new technology that will be implemented: text-to-911 calling. Emergency center call takers will be recruited nationwide. Data will be collected by online surveys distributed at each center before text-to-911 implementation; within the first month of implementation; and 6 months after implementation. Primary outcome measures are stress as measured by the Calgary Symptoms of Stress Index, use of sick leave, job performance, and job satisfaction. Primary analyses will use mixed effects regression models and mixed effects logistic regression models to estimate the change in outcome variables associated with text-to-911 implementation. Multiple secondary analyses will examine effects of stress on absenteeism; associations between technology attitudes and stress; effects of implementation on attitudes towards technology; and mitigating effects of job demands, job satisfaction, attitudes towards workplace technology and workplace support on change in stress. Discussion: Our public health dependence on this workforce for our security and safety makes it imperative that the impact of technological changes such as text-to-911 are researched so appropriate intervention efforts to can be developed. Failing to protect our 9-1-1 call takers from predictable health risks would be similar to knowingly exposing field emergency responders to a toxic situation without following OSHA required training and practice standards assuring their protection.
... Additionally, a parent with anxious and/or depressive symptomatology may tend to avoid anxiety-provoking stimuli or distress (e.g., conflicts related to disagreement over parental strategies) and, consequently, withdraw from coparenting interactions [20]. Third, psychological inflexibility, which is often associated with the presence of psychopathology [35,[38][39][40], may be an important factor in the decrease in supportive coparenting behaviors given the association between how parents manage the division of child-related tasks and the degree of flexibility versus rigidity that parents present in this division [37]. For instance, parents with psychopathology may have very strict rules about who should do what, while parents without clinically significant levels of anxious and/or depressive symptoms may approach tasks more flexibly, adjusting responsibilities as situations arise. ...
Article
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The present study aimed to explore the mediating role of supportive coparenting in the relationship between parental psychopathology symptoms and mindful parenting and to explore whether the child’s age group moderates the associations in the model. A sample of 462 parents (94.2% mothers) of preschool and school-aged children completed the Hospital Anxiety and Depression Scale, the Parental Perceptions of Coparenting Questionnaire, and the Interpersonal Mindfulness in Parenting Scale. A moderated mediation model was estimated to analyze the indirect effect of psychopathology symptoms on mindful parenting through supportive coparenting and the moderating role of the child’s age group. Higher levels of parental psychopathology were found to be associated both directly and indirectly (through lower levels of supportive coparenting) with lower levels of mindful parenting, regardless of the child’s age group. The results suggest that supportive coparenting is a relevant explanatory mechanism for the relationship between parental psychopathology and mindful parenting.
... 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). D'autre part, le contexte de travail de cette population repré sente aussi un dé fi sur le plan de leur santé psychologique au travail : ils peuvent ressentir un sentiment d'incomplé tude voire d'impuissance, d'une duré e variant de quelques jours à plusieurs anné es, en ré ponse à l'absence d'information sur les tenants et aboutissants des interventions dont ils gè rent l'appel (Birze et al., 2015 ;Troxell, 2008). ...
Article
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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.
... Les personnels de sécurité publique, soit le personnel des services de police, frontaliers, correctionnels, répartitions, ambulanciers et de sécurité incendie, sont plus à risque d'être touchés par des problématiques telles que la détresse psychologique, le stress et les syndromes post-traumatiques (De Soir et al., 2012;Gersons et Carlier, 1992, 1994Lilly et Allen, 2015). Ces professionnels exercent des activités physiquement exigeantes et très stressantes (Jones, 2017;Robinson et al., 1997). ...
Article
Le milieu de travail est un déterminant essentiel de la santé de ses acteurs (p.ex., troubles musculosquelettiques, dépression, stress, épuisement professionnel). Le personnel de sécurité publique, par son rôle et sa proximité avec le public, est plus à risque d’être touché par des problématiques de santé mentale. La présente revue systématique aborde la question de l’effectivité des procédures organisationnelles de retour au travail du personnel de sécurité publique, à la suite d’une absence pour une problématique de santé mentale. Afin d’y répondre, une recherche exhaustive a répertorié l’ensemble des études présentes dans la littérature scientifique de 1990 à 2019. Trois études ont été retenues selon les critères d’inclusion et l’évaluation de leur qualité. Les procédures efficaces recensées démontrent la priorité de la communication et de l’inclusion de tous les acteurs d’une organisation dans le processus de retour au travail durable; l’enjeu du suivi exemplaire de la procédure établie en amont, par les membres de l’organisation, tels les médecins du travail ou les gestionnaires; et enfin, l’impact d’une meilleure confiance et connaissance de son rôle et des problématiques de santé mentale, sur l’efficacité du gestionnaire ou du médecin du travail, dans la procédure de retour au travail. La principale conclusion de cette revue systématique est que les procédures actuelles ont un effet significatif limité sur le retour au travail durable des travailleurs de ces milieux. Des constats et des recommandations sont avancés.
... One population that merits attention in this literature is emergency telecommunicators (TCs). The emergency TC sample is distinct from those used in previous studies because it is a community sample of individuals who frequently experience work-related trauma exposure and tend to have more symptoms of psychopathology than the general population (Lilly & Allen, 2015;Lilly & Pierce, 2013). ...
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Objectives There is mixed psychometric evidence for the Five-Facet Mindfulness Questionnaire’s (FFMQ) Observing factor (FFMQ-Observing). Recent efforts to improve this construct produced a new Observing Scale consisting of three factors: Body Observing, Emotion Awareness, and External Perception. Using a sample of mostly nonmeditating emergency telecommunicators (TCs), this study explored this new Observing Scale’s factor structure, its viability as a replacement for the FFMQ-Observing factor, and its convergent validity.Methods The FFMQ and additional mindfulness items from the new Observing Scale were administered via an online survey to emergency TCs (N = 242, Mage = 41.84, SD = 9.80, range = 18–72). We performed exploratory factor analysis (EFA) on the Observing Scale, confirmatory factor analysis (CFA) on a novel five-factor model integrating the Observing Scale with the FFMQ (excluding FFMQ-Observing), and correlations among the Observing Scale, the FFMQ, and mindfulness-based practices.ResultsEFA suggested four factors for the Observing Scale: Internal Body Observing, External Body Observing, Emotion Awareness, and External Perception. CFA failed to validate our integrated model, but the Observing Scale was positively correlated with the FFMQ and mindfulness-based practices.Conclusions This study provides preliminary support for an improved Observing Scale, while suggesting a novel, four-factor structure in emergency TCs. Although the Observing Scale was not compatible with the FFMQ, this may reflect measurement error rather than model misspecification given evidence of content overlap and distinctive forms of Body Observing. Future attempts to validate the new Observing Scale in larger samples are encouraged before it may be recommended as an alternative to the FFMQ-Observing factor.
... 1 Recently, Turner KD et al. 2 analyzed several questionnaires (n = 833) of 911 calltakers and dispatchers located in California and concluded that "Results indicated that burnout and work-life balance had significant direct effects on perceived stress and health-related outcomes". In the scientific literature there are many studies on the topic of work-related stress [3][4][5][6][7][8][9] , with a focus on its impact on the workers and not on the impact that stress could have on the work performance of the emergency dispatchers (EDs) and consequently on the whole Emergency Medical Service (EMS), with the exception of Montassier, 10 ...
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Introduction: There are many recent articles published in scientific literature on the topic of work-related stress. However, these studies focus on the effects of stress on the workers and not on the impact that stress could have on their work performance—more specifically on the calltaker’s (emergency dispatcher (ED)) performance and consequently on the whole Emergency Medical Service (EMS). Objective: The objective of this study was to assess whether the number of consecutive hours worked (WH) by the EMDs had an impact on their performance, in terms of case evaluations, and on the type (i.e., Advance Life Support [ALS] vs. Basic Life Support [BLS]) and methods/mode (i.e., with/without Lights and Siren [L&S]) of dispatch of emergency vehicles. Methods: The retrospective descriptive study included cases in the Liguria EMS, Italy, database dated from January 01, 2011 to December 31, 2019. The criticality of priority codes (from the most serious to the least serious: black, red, yellow, green, and white) assigned by the EMDs during the emergency call (EMD criticality; CP) were compared with the priority codes assigned by the field responders (Responder criticality; CR). The data were then analyzed in relation to the WH and descriptive statistics such as sensitivity, relative risk, and predictive values were estimated. Result: A total of 1,599,809 cases were analyzed. Sensitivity for patients with impaired vital functions (red codes) was 76.4% (95% CI: 75.2-77.4) with a positive predictive value of 20.3% (95% CI: 19.2-21.9) and specificity was 87.8% (95% CI: 87.1- 88.8) with a negative predictive value of 98.9% (95% CI: 98.8-99.0). The relative risk ratio (RRR) of inconsistent assessments improves in the first three WHs: -3% at the third WH (0.97, 0.96-0.99) and progressively worsens in the following hours, reaching +6% (1.06; 1.05 – 1.08) at the sixth WH. In the first three WHs, there was also an improvement in the appropriateness of the resources sent: -4% at the third WH (0.96, 0.94 – 0.98) which then progressively worsens thereafter, reaching + 11% (1.11, 1.07 – 1.14) in 7 -12 WH range. Conclusion: The performance of the EMDs, in terms of predictive ability of the priority codes assigned, of the type of resources, and of the sending methods/mode, improved within the first three WHs, then progressively worsened up to the sixth WH. As the number of WHs increased, overtriage and dispatch of emergency vehicles with L&S also increased. Keywords: Working hours, work shift, working-time regulation, emergency medical dispatch, field responders, patient safety, overemployment, overtriage, undertriage.
... La confrontation aux urgences pourrait constituer un facteur de risque spécifique en soit [7]. Toutes les catégories professionnelles sont, à des degrés variables, concernées, mais les intervenants les moins qualifiés semblent davantage exposés à ce risque [8,9]. ...
Article
Résumé Introduction Le stress occasionné par la gestion des appels de détresse reçus au SAMU peut représenter, pour les assistants de regulation médicale (ARM), un risque psychologique. Objectif Étudier les répercussions psychologiques sur les ARM. Méthode Étude prospective, multicentrique, nationale, d’un mois auprès d’ARM de 13 SAMU par questionnaire électronique de cinq sections : caractéristiques de la population, typologie des appels, échelle PCL-5, échelle ProQOL, ressentis et retentissements du travail sur leur vie. Recherche des critères associés à une symptomatologie évocatrice de trouble de stress post-traumatique (TSPT) complet défini par le DSM-5 et PCL-5 ≥ 34. Résultats Tous les ARM ont été confrontés à la mort dont 129 (46 %) dans les sept derniers mois. Trente (11 %) présentaient une symptomatologie évocatrice d’un TSPT complet et 42 (15 %) celle d’un TSPT incomplet. Le groupe TSPT complet avait significativement plus d’ARM ayant au plus le baccalauréat (n = 22, 74 % vs n = 145, 57 % ; p = 0,04). Aucune autre différence n’était significative. Le groupe TSPT complet développait significativement (p < 0,001) plus de stratégies d’atténuation (alcool, drogues, médicaments) (13 % vs 2 %), de retentissements alimentaires (80 % vs 38 %), de troubles du sommeil (75 % vs 21 %), d’anxiété (67 % vs 17 %) et d’arrêts de travail (13 % vs 4 %) que le groupe sans symptomatologie. Deux cent vingt (78 %) ARM déclaraient ne pas être sensibilisés à la symptomatologie psychotraumatique. Conclusion Chez 1/3 des ARM interrogés, une symptomatologie évocatrice de TSPT complet ou incomplet était retrouvée avec des processus psychotraumatiques spécifiques. La formation semble être une protection efficace. Elle doit être renforcée, tout comme la prévention.
... These stressors, coupled with the unpredictability of calls and limited control over the events they are witnessing, may lead to emotional distress [1,2]. Exposure to secondary trauma and work-related stress in 9-1-1 telecommunicators has been associated with posttraumatic stress disorder (PTSD) [3,4], acute stress disorder [5], secondary traumatic stress [6], and occupational burnout [5,6]. The costs of work-related stress extend beyond the individual telecommunicator, including decreased productivity [7], increased absenteeism [7], and increased health care utilization and expenditures [8,9]. ...
Article
Background: Demanding working conditions and secondary exposure to trauma may contribute to a high burden of stress among 9-1-1 telecommunicators, decreasing their ability to work effectively and efficiently. Web-based mindfulness-based interventions (MBIs) can be effective in reducing stress in similar populations. However, low engagement may limit the effectiveness of the intervention. Objective: The aim of this study was to assess participant engagement in a Web-based MBI designed for 9-1-1 telecommunicators. Specifically, we sought to describe the following: (1) participant characteristics associated with intervention engagement, (2) participant perspectives on engaging with the intervention, and (3) perceived challenges and facilitators to engaging. Methods: We used qualitative and quantitative data from participant surveys (n=149) that were collected to assess the efficacy of the intervention. We conducted descriptive and bivariate analyses to identify associations between demographic, psychosocial, and workplace characteristics and engagement. We conducted a thematic analysis of qualitative survey responses to describe participant experiences with the MBI. Results: We found that no individual participant characteristics were associated with the level of engagement (low vs high number of lessons completed). Participant engagement did vary by the call center (P<.001). We identified the following overarching qualitative themes: (1) the participants perceived benefits of mindfulness practice, (2) the participants perceived challenges to engage with mindfulness and the intervention, and (3) intervention components that facilitated engagement. The participants expressed positive beliefs in the perceived benefits of practicing mindfulness, including increased self-efficacy in coping with stressors and increased empathy with callers. The most commonly cited barriers were work-related, particularly not having time to participate in the intervention at work. Facilitators included shorter meditation practices and the availability of multiple formats and types of intervention content. Conclusions: The findings of this study suggest that efforts to improve intervention engagement should focus on organizational-level factors rather than individual participant characteristics. Future research should explore the effect of mindfulness practice on the efficiency and effectiveness of 9-1-1 telecommunicators at work. Trial registration: ClinicalTrials.gov NCT02961621; https://clinicaltrials.gov/ct2/show/NCT02961621.
... Meanwhile, psychological inflexibility refers to rigid psychological reaction against one's value in order to avoid distress, uncomfortable feeling and thought and tend to ignore the present moment [9]. Psychological inflexibility has been suggested as an important element in the etiology and the preservation of psychopathology [10,11]. Psychological inflexibility has positive correlation with symptoms burden that commonly experienced by cancer patient including pain, fatigue, sleep disturbance, cognitive concerns, anxiety, and depressive symptoms. ...
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Psychological inflexibility has been found as one of the predictor to psychopathology in cancer patient. Cancer patients tend to experience psychological inflexibility as a reaction to cancer diagnosis, prognosis and treatment. Therefore, there is a need to identify psychological inflexibility due to its impact on quality of life among cancer patients. Objectives Acceptance and action questionnaire (AAQ II) is a scale used to assess psychological inflexibility. The aim of this study is to translate AAQ II into Malay language and evaluate the psychometric properties of AAQ II Malay version. Methods The AAQ II which has been translated into Malay language via back translation procedure was distributed to 101 cancer patients and 100 non-cancer patients. The evaluation of psychometric properties in this study included content validity index, internal consistency, parallel reliability, exploratory factor analysis, concurrent validity, sensitivity and specificity of AAQ II Malay version. Results AAQ II Malay version has established good content validity index, acceptable internal consistency with Cronbach’s alpha value of 0.91, excellent parallel reliability and adequate concurrent validity. Exploratory factor analysis (EFA) results demonstrated AAQ II Malay version is a unidimensional factor instrument. The result of sensitivity and specificity of AAQ II Malay version indicated cancer patients who scored more than 17.5 were having significant psychological inflexibility. Conclusion AAQ II Malay version is a reliable and valid instrument to measure psychological inflexibility among cancer patient in Malaysia.
... The role of 911 telecommunicators involves repeated exposure to traumatic situations and demands the ability to stay composed under pressure. Consequently, telecommunicators exhibit an increased prevalence of PTSD and depression symptoms (Lilly & Allen, 2015). Although similarities in duty-related trauma exist between first responders, veterans, and telecommunicators, telecommunicators experience indirect exposure to trauma which is devoid of a visual representation of that trauma. ...
... Psychological flexibility has been defined as a presentmindedness approach to situation-response, accepting and adapting own behaviors based on personally held values [40]. In contrast, psychological inflexibility is marked by disabling avoidance and ruminative thoughts, which interfere with personal self-direction [41]. Previous research has evidenced how psychological factors such as inflexibility, hypervigilance, attentional bias and pain catastrophizing, increase abdominal pain sensations and worsen the prognosis of these patients [42]. ...
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Objectives Previous research on gastrointestinal and other medical conditions has shown the presence of incongruence between self- and clinician-reported functioning and its relation with psychopathology. The main objective of this study was to test whether inconsistencies between clinician- and self-assessed functionality can be used to detect psychopathology among patients diagnosed of motor or functional gastrointestinal disorders. Methods One hundred and three patients from a gastroenterology inpatient unit were included in this study. All patients underwent clinical assessment, including intestinal manometry, Rome III criteria for functional gastrointestinal disorders, and psychological and psychiatric evaluation. Patients with suspected gastroparesis underwent a gastric emptying test. Definitive diagnoses were made at discharge. Results Patients with higher levels of incongruence differed in various sociodemographic (age, educational level, work activity and having children) and psychopathological (all SCL-90-R subscales except anxiety and hostility) characteristics. Using general lineal models, incongruence was found to be the variable with stronger relations with psychopathology even when controlling for diagnosis. Interactions were found between incongruence and diagnosis reflecting a pattern in which patients with functional disorders whose subjective evaluation of functioning is not congruent with that of the clinician, have higher levels of psychopathology than patients with motor disorders. Conclusions Incongruence between clinician and self-reported functionality seems to be related to higher levels of psychopathology in patients with functional disorders. These findings underscore the need for routine psychosocial assessment among these patients. Gastroenterologists could use the concept of incongruence and its clinical implications, as a screening tool for psychopathology, facilitating consultation-liaison processes.
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Psychological inflexibility is defined as a transdiagnostic mechanism characterized by rigid efforts to control psychological reactions to painful, undesirable, unpleasant internal experiences. The Acceptance and Action Questionnaire-University Students (AAQ-US) was designed to assess students’ academic context-related psychological inflexibility. This study adapted the AAQ-US to Portuguese and examined its factor structure, validity, and reliability in a college student sample (sample 1: N = 262). Exploratory factor analysis and parallel analysis suggested a two-factor structure. A confirmatory factor analysis was conducted in a second sample to cross-validate the AAQ-US factor structure (sample 2: N = 260). One higher-order factor (psychological inflexibility) with two lower-order factors (cognitive fusion and experiential avoidance) revealed a very good fit to the data. The AAQ-US total and dimensions showed good reliability, convergent and incremental validity. Overall, the Portuguese version of the AAQ-US is a reliable and valid instrument for assessing context-specific psychological inflexibility in university students.
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Background: Although numerous studies have reported on PTSD prevalence in high-risk occupational samples, previous meta-analytic work has been severely limited by the extreme variability in prevalence outcomes. Methods: The present systematic review and meta-regression examined methodological sources of variability in PTSD outcomes across the literature on high-risk personnel with a specific focus on measurement tool selection. Results: The pooled global prevalence of PTSD in high-risk personnel was 12.1% [6.5%, 23.5%], and was similar to estimates obtained in other meta-analytic work. However, meta-regression revealed that PTSD prevalence differed significantly as a function of measurement tool selection, study inclusion criteria related to previous traumatic exposure, sample size, and study quality. PTSD prevalence estimates also differed significantly by occupational group and over time, as has also been reported in previous work, though exploratory examination of trends in measurement selection across these factors suggests that measurement strategy may partially explain some of these previously reported differences. Conclusions: Our results highlight a pressing need to better understand the role of measurement strategies and other methodological choices in characterizing variable prevalence outcomes. Understanding the role of methodological variance will be critical for work attempting to reliably characterize prevalence as well as risk and protective factors for PTSD.
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Emergency Medical Dispatchers (EMDs) provide life-critical telephone-based medical advice 24 hours a day, 365 days a year. EMDs are the first point of contact but rarely, if ever, meet the public whom they serve. They are detached from the scene and less visible than their first responder colleagues, but subject to comparable levels of stress and secondary trauma: they are our faceless heroes. In recent years, recruitment and retention levels are falling: candidates are dropping out before completing their training due to early burnout. Despite their key role, scant attention has been paid to this area of research. This study aims to fill this gap by identifying contributory factors that affect recruitment, career development and retention of EMDs and suggesting improvements to practice. Interpretivism underpinned 11 inductive interviews focused on EMD recruitment, career development and retention. The resultant qualitative data were transcribed verbatim, and then subjected to content analysis using the computer-assisted qualitative data analysis software Atlas.ti. Content analysis resulted in 20 thematic codes, which were refined into seven categories – recruitment, training and career development, required systemic enhancements, role stress, ideal EMD, esprit de corps and optimum skillset - articulated as the optimum skill-set theory. These informed one comprehensive network diagram and two tables to illustrate the links between the codes and categories, explicated by participant quotations. They also elaborate on the theoretical and practical contributions made by the study which provide critical insights for recruiters, in-career EMD and those interested in pursuing a career as an EMD.
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Background: A cohesive body of scientific evidence has documented the adverse impacts of occupational stress on worker health and safety and, to a lesser extent, on organizational outcomes. How such adverse impacts may be prevented and/or ameliorated are important to understand, but progress has been limited due to the lack of a robust and comprehensive theoretical model of occupational stress. Methods: Building on a review of existing theoretical models of occupational stress and an ecological framework, a multilevel conceptual model of occupational stress and strain is proposed that identifies various and potentially interacting sources of occupational stressors as well as potential protective factors. Results: The revised ecological model proposed herein embraces a broad conceptualization of outcomes and includes an individual worker, work unit (team) performance as well as organizational level outcomes; for example, resilience/dysfunction. Conclusion/Application to Practice: This model provides occupational health nurses with an improved understanding of occupational and worker health as well as guidance in developing targeted interventions and generating new lines of occupational stress research.
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Introduction: Previous studies of emergency dispatch personnel have established high levels of emotional labor, burnout, and turnover intention among this population of first responders. This study is the first to investigate the effect of emergency dispatch script protocols on workplace outcomes of burnout and turnover intention. Hypotheses: The study tests two related hypotheses: Greater script comfort among emergency dispatchers will be associated with decreased emotional exhaustion (Hl) and decreased turnover intention (H2). Methods: The study uses multivariate regression to establish baseline models of emotional exhaustion and turnover intention among respondents. Structural equation modeling is then used to explore the direct and mediated relationship between script discomfort and the two outcomes simultaneously. Results: Dispatchers who express more discomfort with script protocols express elevated levels of emotional exhaustion (Hl), but not turnover intention (H2), to a statistically significant degree. This multivariate regression result is validated in a structural equation model (SEM) which solves for both outcome variables simultaneously, and demonstrates the centrality of surface acting in the overall model of both emotional exhaustion and turnover intention. Conclusions: As script protocols continue to increase in use and complexity, emergency dispatch managers and administrators should be cognizant of potential increases in emotional exhaustion among employees. The overall increases documented in this study are small to moderate in size, but given the high baseline levels of burnout among emergency dispatch personnel, any increase is potentially damaging. This study found no significant increase in turnover intention, which was protected against through dispatchers' increased use of surface acting. However, we did not test for or rule out the potential negative outcomes of poorer physical and mental health, increased absenteeism, and increased substance abuse that have been documented in other emotional labor studies.
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Objectives Emergency medical dispatchers (EMDs) experience significant stress in the workplace. Yet, interventions aimed at reducing work-related stress are difficult to implement due to the logistic challenges associated with the relatively unique EMD work environment. This investigation tested the efficacy of a 7-week online mindfulness-based intervention (MBI) tailored to the EMD workforce. Methods Active-duty EMDs from the USA and Canada (n=323) were randomly assigned to an intervention or wait list control condition. Participants completed surveys of stress and mindfulness at baseline, post intervention, and 3 months follow-up. Repeated measures mixed effects models were used to assess changes in stress and mindfulness. Results Differences between the intervention group and control group in pre–post changes in stress using the Calgary Symptoms of Stress Inventory were statistically significant, with a difference of −10.0 (95% CI: −14.9, −5.2, p<0.001) for change from baseline to post intervention, and a difference of −6.5 (95% CI: −11.9, −1.1, p=0.02) for change from baseline to 3 months follow-up. Change in mindfulness scores did not differ between groups. However, increases in mindfulness scores were correlated with greater reductions in stress for all participants, regardless of group (r=−0.53, p<0.001). Conclusions Development of tailored online MBIs for employees working in challenging work environments offer a promising direction for prevention and intervention. This study found that a short, weekly online MBI for EMDs resulted in reductions in reports of stress. Implications of online MBIs in other emergency responding populations and directions for future research are discussed.
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Preliminary evidence has demonstrated the benefits of targeting self-compassion in the treatment of posttraumatic stress disorder (PTSD). However, survivors of childhood maltreatment may present with unique challenges that compromise the effectiveness of these and other PTSD treatments. Specifically, childhood maltreatment victims often exhibit a marked fear and active resistance of self-kindness and warmth (i.e., fear of self-compassion). Victims may also attempt to control distressing internal experiences in a way that hinders engagement in value-based actions (i.e., psychological inflexibility). Research suggests that psychological inflexibility exacerbates the negative effects of fear of self-compassion. The present study expanded on previous research by examining the relations among childhood maltreatment, fear of self-compassion, psychological inflexibility, and PTSD symptom severity in 288 college women. As expected, moderate to severe levels of childhood maltreatment were associated with greater fear of self-compassion, psychological inflexibility, and PTSD symptom severity compared to minimal or no childhood maltreatment. A mediation analysis showed that childhood maltreatment had a significant indirect effect on PTSD symptom severity via fear of self-compassion, although a conditional process analysis did not support psychological inflexibility as a moderator of this indirect effect. A post hoc multiple mediator analysis showed a significant indirect effect of childhood maltreatment on PTSD symptom severity via psychological inflexibility, but not fear of self-compassion. These findings highlight the importance of addressing fear of self-compassion and psychological inflexibility as barriers to treatment for female survivors of childhood maltreatment.
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Background Psychological inflexibilitythe inability to take value-based actions in the presence of unwanted thoughts, feelings, or bodily symptomsis associated with negative health outcomes including depression and anxiety. Objective We aimed to determine the association between the general construct of psychological inflexibility and pain intensity, and upper extremity physical function in patients with musculoskeletal illness in an orthopedics practice. We also set out to test multiple-mediator models proposing that psychological inflexibility affects pain intensity and upper extremity physical function directly, as well as indirectly through depression, anxiety, and pain catastrophizing. Methods One hundred and eight patients with upper extremity illness completed self-report measures of pain intensity, upper extremity physical function, psychological inflexibility, pain catastrophizing, depression, and anxiety in this cross-sectional study. ResultsWe found that psychological inflexibility affected pain intensity and upper extremity physical function directly and indirectly. Pain catastrophizing but not depression or anxiety mediated the association of psychological inflexibility to pain intensity and upper extremity physical function. Conclusions Psychological inflexibility plays an important role in understanding the increased pain and decreased upper extremity physical function in patients with musculoskeletal pain. It also suggests that the cognitive error of pain catastrophizing is one of the mechanisms through which the general construct of psychological inflexibility may influence pain intensity and upper extremity physical function. Psychological treatments aimed at decreasing pain and increasing upper extremity physical function should target both pain catastrophizing and psychological inflexibility.
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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.
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This study presents a new short scale for measuring cumulative trauma dose, types, and profiles that is based on the APA (American Psychological Association) trauma Group (currently division 56) definition of trauma and a new, two-way development-based taxonomy of trauma. The new measure was tested using a sample of 501 Iraqi refugees who are one of the most traumatized groups. The following six salient factors were found: collective identity, family, personal identity, interdependence or secondary, man-made or nature-made survival, and abandonment types of traumas. The study provided evidence of adequate reliability; construct, convergent, divergent and predictive validity of the new scale and provided partial confirmation of the validity of the development-based taxonomy of traumas. A new method was introduced to measure trauma types and profiles and their differential association with different symptom configurations and health disorders. The newly developed measure can be used in clinical trauma-informed settings and in research.
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For journal editors, reviewers, and readers of research articles, structural equation model (SEM) fit has recently become a confusing and contentious area of evaluative methodology. Proponents of two kinds of approaches to model fit can be identified: those who adhere strictly to the result from a null hypothesis significance test, and those who ignore this and instead index model fit as an approximation function. Both have principled reasons for their respective course of action. This paper argues that the chi-square exact-fit test is the only substantive test of fit for SEM, but, its sensitivity to discrepancies from expected values at increasing sample sizes can be highly problematic if those discrepancies are considered trivial from an explanatory-theory perspective. On the other hand, suitably scaled indices of approximate fit do not possess this sensitivity to sample size, but neither are they “tests” of model fit. The proposed solution to this dilemma is to consider the substantive “consequences” of accepting one explanatory model over another in terms of the predictive accuracy of theory-relevant-criteria. If there are none to be evaluated, then it is proposed that no scientifically worthwhile distinction between “competing” models can thus be made, which of course begs the question as to why such a SEM application was undertaken in the first place.
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Firefighters are exposed to a range of potentially traumatic stressors, yet studies examining the impact of this exposure are equivocal. Although some studies suggest increased risk for mental health problems, others suggest unusual resilience. Type of assessment methodology may contribute to the lack of consistent findings. We assessed 142 trauma-exposed, professional firefighters utilizing a standardized clinical interview and self-report measures and found low rates of posttraumatic stress disorder (PTSD) diagnoses (4.2%), and depressive, anxiety, and alcohol-abuse symptoms. Frequency of trauma exposure did not predict psychological symptoms. Perceived social support, occupational stress, coping, as well as the interaction between perceived social support and self-blame were significant predictors of symptoms. Firefighters reporting low-perceived social support and high self-blame demonstrated the highest levels of clinically significant symptoms. These findings may inform education, treatment, and resilience training for emergency personnel.
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We performed a quantitative review of associations between the higher order personality traits in the Big Three and Big Five models (i.e., neuroticism, extraversion, disinhibition, conscientiousness, agreeableness, and openness) and specific depressive, anxiety, and substance use disorders (SUD) in adults. This approach resulted in 66 meta-analyses. The review included 175 studies published from 1980 to 2007, which yielded 851 effect sizes. For a given analysis, the number of studies ranged from three to 63 (total sample size ranged from 1,076 to 75,229). All diagnostic groups were high on neuroticism (mean Cohen's d = 1.65) and low on conscientiousness (mean d = -1.01). Many disorders also showed low extraversion, with the largest effect sizes for dysthymic disorder (d = -1.47) and social phobia (d = -1.31). Disinhibition was linked to only a few conditions, including SUD (d = 0.72). Finally, agreeableness and openness were largely unrelated to the analyzed diagnoses. Two conditions showed particularly distinct profiles: SUD, which was less related to neuroticism but more elevated on disinhibition and disagreeableness, and specific phobia, which displayed weaker links to all traits. Moderator analyses indicated that epidemiologic samples produced smaller effects than patient samples and that Eysenck's inventories showed weaker associations than NEO scales. In sum, we found that common mental disorders are strongly linked to personality and have similar trait profiles. Neuroticism was the strongest correlate across the board, but several other traits showed substantial effects independent of neuroticism. Greater attention to these constructs can significantly benefit psychopathology research and clinical practice.
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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.
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The present study seeks to investigate the extent to which the Acceptance and Action Questionnaire (AAQ-II) is successful in discriminating between experiential avoidance/psychological flexibility on the one hand and the supposed outcomes in terms of psychological well-being of having this trait on the other. This was done using exploratory factor analysis on an item pool containing the AAQ-II items, and items designed for the present study to measure distress and acceptance/non-acceptance, to see what factors are identified and on which factor(/s) the AAQ-II items had the highest factor loadings. Interestingly, the analysis found the items of the AAQ-II to be more strongly related to items designed to measure distress than items designed to measure acceptance/non-acceptance with minimal references to functional outcomes. The results of the study are interpreted and discussed in relation to the widespread use of the AAQ in both clinical and scientific contexts and given the centrality of the measure in empirically validating the ACT model of psychopathology and treatment.
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The aim of this study was to examine the degree in which measurements of trait experiential avoidance (EA) are affected by current emotional disorder and whether EA is a causal factor in the course of emotional disorders (anxiety and depressive disorders) and the development of comorbidity among emotional disorders. In a sample of 2,316 adults aged 18 to 65, consisting of healthy controls, persons with a prior history of emotional disorders, and persons with a current emotional disorder, DSM-IV-based emotional disorders (CIDI: Composite Interview Diagnostic Instrument) were assessed at T2 and 2 (T4) and 4 years later (T6) and experiential avoidance (AAQ: Acceptance and Action Questionnaire) at T2 and T4. Results showed that EA scores were stable over a 2-year period notwithstanding state fluctuations because of current emotional disorder. Moreover, EA scores at T2 predicted changes in distress (major depressive disorder, dysthymia, generalized anxiety disorder) and in fear disorders (social anxiety disorder, panic disorder with or without agoraphobia, agoraphobia without panic) at T4. Finally, EA at T4 mediated the longitudinal association of fear disorders at T2 with distress disorders at T6 as well as of distress disorders at T2 with fear disorders at T6. These findings suggest that EA scores are more than epiphenomena of emotional disorders and that EA may be conceptualized as a relevant transdiagnostic factor affecting the course and development of comorbidity of emotional disorders.
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The present research describes the development and psychometric evaluation of a second version of the Acceptance and Action Questionnaire (AAQ-II), which assesses the construct referred to as, variously, acceptance, experiential avoidance, and psychological inflexibility. Results from 2,816 participants across six samples indicate the satisfactory structure, reliability, and validity of this measure. For example, the mean alpha coefficient is .84 (.78-.88), and the 3- and 12-month test-retest reliability is .81 and .79, respectively. Results indicate that AAQ-II scores concurrently, longitudinally, and incrementally predict a range of outcomes, from mental health to work absence rates, that are consistent with its underlying theory. The AAQ-II also demonstrates appropriate discriminant validity. The AAQ-II appears to measure the same concept as the AAQ-I (r=.97) but with better psychometric consistency.
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Research has consistently demonstrated that stress reactions to potentially traumatic events do not represent a unified phenomenon. Instead, individuals tend to cluster into prototypical response patterns over time including chronic symptoms, recovery, and resilience. We examined heterogeneity in a posttraumatic stress disorder (PTSD) symptom course in a sample of 178 active-duty police officers following exposure to a life-threatening event using latent growth mixture modeling (LGMM). This analysis revealed 3 discrete PTSD symptom trajectories: resilient (88%), distressed-improving (10%), and distressed-worsening (2%). We further examined whether trait and peritraumatic dissociation distinguished these symptom trajectories. Findings indicate that trait and peritraumatic dissociation differentiated the resilient from the distressed-improving trajectory (trait, p < .05; peritraumatic, p < .001), but only peritraumatic dissociation differentiated the resilient from the distressed-worsening trajectory (p < .001). It is essential to explore heterogeneity in symptom course and its predictors among active-duty police officers, a repeatedly exposed group. These findings suggest that police officers may be a highly resilient group overall. Furthermore, though there is abundant evidence that dissociation has a positive linear relationship with PTSD symptoms, this study demonstrates that degree of dissociation can distinguish between resilient and symptomatic groups of individuals.
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We examined the relationships between six emotion-regulation strategies (acceptance, avoidance, problem solving, reappraisal, rumination, and suppression) and symptoms of four psychopathologies (anxiety, depression, eating, and substance-related disorders). We combined 241 effect sizes from 114 studies that examined the relationships between dispositional emotion regulation and psychopathology. We focused on dispositional emotion regulation in order to assess patterns of responding to emotion over time. First, we examined the relationship between each regulatory strategy and psychopathology across the four disorders. We found a large effect size for rumination, medium to large for avoidance, problem solving, and suppression, and small to medium for reappraisal and acceptance. These results are surprising, given the prominence of reappraisal and acceptance in treatment models, such as cognitive-behavioral therapy and acceptance-based treatments, respectively. Second, we examined the relationship between each regulatory strategy and each of the four psychopathology groups. We found that internalizing disorders were more consistently associated with regulatory strategies than externalizing disorders. Lastly, many of our analyses showed that whether the sample came from a clinical or normative population significantly moderated the relationships. This finding underscores the importance of adopting a multi-sample approach to the study of psychopathology.
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Volunteer firefighters in NSW were surveyed for experiences of posttraumatic stress. Firefighters were asked to describe their experiences of stress and indices were obtained of psychological disturbance. Findings indicated that most firefighters felt that their safety had been threatened. One-quarter of firefighters indicated that they experienced significant levels of posttraumatic stress, although many respondents attributed their stress to personal events. Posttraumatic stress was associated with multiple and recent critical incidents. Findings are discussed in terms of etiological factors of posttraumatic stress and the need for appropriate intervention.
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The psychometric properties of the PTSD Checklist (PCL), a new, brief, self-report instrument, were determined on a population of 40 motor vehicle accident victims and sexual assault victims using diagnoses and scores from the CAPS (Clinician Administered PTSD Scale) as the criteria. For the PCL as a whole, the correlation with the CAPS was 0.929 and diagnostic efficiency was 0.900 versus CAPS. Examination of the individual items showed wide ranging values of individual item correlations ranging from 0.386 to 0.788, and with diagnostic efficiencies of 0.700 or better for symptoms. We support the value of the PCL as a brief screening instrument for PTSD.
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