Article

The mental health of fire-fighters: An examination of the impact of repeated trauma exposure

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Abstract

Objective: Emergency workers, such as fire-fighters, are routinely exposed to potentially traumatic events. While a number of studies have examined the occurrence of post-traumatic stress disorder, the role of multiple traumas on other mental health sequelae, such as depression and alcohol misuse, among emergency workers remains unclear. This study aimed to assess the prevalence of post-traumatic stress disorder, depression and alcohol misuse in a sample of current and retired fire-fighters and examine their relationship with cumulative trauma exposure. Method: A cross-sectional survey was completed by current (n = 488) and retired (n = 265) fire-fighters from Fire and Rescue New South Wales, Australia. Demographic and occupational information was collected, including the number of fatal incidents fire-fighters reported attending across years of service. Validated, self-report measures were used to determine probable caseness for post-traumatic stress disorder, depression and heavy drinking. Results: Among current fire-fighters, rates of post-traumatic stress disorder and depression were 8% and 5%, respectively, while 4% reported consumption of more than 42 alcoholic drinks per week. Retired fire-fighters reported significantly greater levels of symptomatology, with the prevalence estimates of post-traumatic stress disorder at 18% (p = 0.001), depression at 18% (p < 0.001) and heavy drinking at 7%. There was a significant positive linear relationship between the number of fatal incidents attended and rates of post-traumatic stress disorder, depression and heavy drinking. Conclusion: Fire-fighters suffer from high rates of mental disorders, with rates of post-traumatic stress disorder, depression and heavy drinking continuing to rise in a linear manner with each additional trauma exposure. The level of psychiatric morbidity among retired fire-fighters appears to be particularly high. Our findings have important implications for the ongoing debates surrounding the detection of mental disorders in high-risk occupations and for policy considerations around the welfare of current and retired emergency workers.

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... Public safety personnel (PSP) and healthcare workers (HCWs) are exposed to potentially traumatic events in the line of duty, including routine exposure to human suffering. This puts them at high risk for negative mental health outcomes such as posttraumatic stress injury/disorder, compassion fatigue, and burnout [1][2][3][4][5][6][7]. This paper reports on the findings of a narrative literature review that framed the development of a novel wellness program for public safety personnel (PSP) and healthcare workers (HCWs), and details the components of the program. ...
... This can lead to cynicism and emotional withdrawal in all facets of life [55,56]. John Wayne syndrome has been well reported in PSP and has been shown to impact staff and learners [3,16,56], with a similar culture seen in HCWs [57,58]. Both populations are at high risk of negative mental health outcomes due to similar occupational stressors of exposure to human suffering in high-pressure situations, along with expectations that they are the "heroes". ...
... Identification of those in distress enables timely intervention, reduces mental/physical sequelae and improves productivity [3,[86][87][88]. Furthermore, this can protect compromised individuals from being exposed to another traumatic event prior to receiving adequate emotional support. ...
Article
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Public safety personnel (PSP) and healthcare workers (HCWs) are frequently exposed to traumatic events and experience an increased rate of adverse mental health outcomes compared to the public. Some organizations have implemented wellness programming to mitigate this issue. To our knowledge, no programs were developed collaboratively by researchers and knowledge users considering knowledge translation and implementation science frameworks to include all evidence-informed elements of posttraumatic stress prevention. The Social Support, Tracking Distress, Education, and Discussion Community (STEADY) Program was developed to fill this gap. It includes (1) peer partnering; (2) distress tracking; (3) psychoeducation; (4) peer support groups and voluntary psychological debriefing following critical incidents; (5) community-building activities. This paper reports on the narrative literature review that framed the development of the STEADY framework and introduces its key elements. If successful, STEADY has the potential to improve the mental well-being of PSP and HCWs across Canada and internationally.
... To date, the literature is mixed with respect to the importance of various risk and protective factors in understanding PTSD prevalence in firefighters. Although a number of studies report no relationship between frequency or severity of CI exposure and PTSD prevalence in firefighters (Chamberlin & Green, 2010;Meyer et al., 2012;Pinto et al., 2015), others report that factors related to CI exposure, such as the type or frequency of exposure, are predictive of meeting screening cutoffs for PTSD (Corneil et al., 1999;Harvey et al., 2016). Nontraumatic organizational stress has also been associated with PTSD outcomes in firefighters (Meyer et al., 2012). ...
... In contrast, seven studies reported significant associations between incident-specific factors and PTSD symptoms. Frequency of exposure or number of incidents experienced was found to predict PTSD symptoms in five studies (Bryant & Harvey, 1996;Chen et al., 2007;Harvey et al., 2016;Regehr et al., 2001;Wagner et al., 1998), whereas time since exposure (either most recent or most distressing exposure) was a significant predictor of PTSD in two studies (Bryant & Harvey, 1996;Kehl et al., 2014). ...
... Nine studies examined the relationship between years of service and PTSD in firefighters (Corneil et al., 1999;Harvey et al., 2016;Kehl et al., 2014;Meyer et al., 2012;Nydegger et al., 2011;Oginska-Bulik, 2016;Oginska-Bulik & Langer, 2007;Pinto et al., 2015;Wagner et al., 1998). All were of medium or high quality. ...
... Firefighting is known to be highly stressful, challenging, and full of immense physical and emotional pressures [1][2][3][4][5][6][7]. The physical demands of firefighting depend on the task and on the unpredictable working conditions [2,[8][9][10]. ...
... Research on MT within the tactical athlete population, specifically with FFs, has been predominantly focused on identifying individuals more likely to suffer from stress and stress-related, physical, and psychological illness. Research has revealed high levels of mental stress in FFs associated with exposure to trauma [3] and the emotional demands of work [6]. However, there have been no recordings of MT and changes in FFs' MT in response to physiological strains, nor has MT's influence on FFs' occupational performance in the PAT been recorded. ...
Article
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Physical ability test (PAT) evaluates firefighters’ (FF) occupational capacity. The contribution of anaerobic systems during PAT and mental toughness (MT) relationship to PAT is unexplored. PAT modeling based on anaerobic fitness (AF), MT, and respective relationships were examined. Fourteen male FFs (Age: 29.0 ± 7.0 years) completed a PAT composed of occupationally-specific tasks in full gear. On a separate day, a series of AF assessments were performed (handgrip-dynamometry: HG; vertical-jump: VJ; Margaria-Kalamen: MK; 300-yard shuttle run: 300YD). MT was evaluated using military training MT inventory (MTMTI) and sports MT questionnaire (SMTQ). We tested the PAT model using multiple backward regression and related correlations coefficients at p < 0.05. A 78% proportion of PAT was explained by AF parameters (F2,13 = 20.2, <0.05). PAT was significantly correlated with HG (r = −0.71, p < 0.01), VJ (r = −0.73, p < 0.01), MK (r = −0.75, p < 0.01), and with 300YD (r = 0.60, p < 0.05). MT did not demonstrate significant correlation with PAT (p > 0.01). Anaerobic system significantly contributes to PAT performance. FFs should optimize AF training, which would allow for enhanced occupational performance in PAT. Further investigation into psychological determinants of FFs is recommended.
... Rodrigues et al. (2018) observed, that although 'fire' situations were more common during shifts, 'accidents' were more stressful for firefighters. Firefighters suffer from mental disorders, such as post-traumatic stress disorder or depression (Santo de Oliveira et al. 2012;Harvey et al. 2016). Their incidence is even higher in retired firefighters (8% and 5% for current firefighters, 18% and 18% for retired firefighters, respectively) and increases with the number of fatal incidents (trauma exposure) (Santo de Oliveira et al. 2012;Harvey et al. 2016). ...
... Firefighters suffer from mental disorders, such as post-traumatic stress disorder or depression (Santo de Oliveira et al. 2012;Harvey et al. 2016). Their incidence is even higher in retired firefighters (8% and 5% for current firefighters, 18% and 18% for retired firefighters, respectively) and increases with the number of fatal incidents (trauma exposure) (Santo de Oliveira et al. 2012;Harvey et al. 2016). Moreover, cardiorespiratory fitness, arterial stiffness and sleep quality were correlated with firefighters' occupational stress, which is an important factor behind the elevated risk of cardiovascular diseases in this occupational group (Yook 2019). ...
Article
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Health status depends on multiple genetic and non-genetic factors. Nonheritable factors (such as lifestyle and environmental factors) have stronger impact on immune responses than genetic factors. Firefighters work is associated with exposure to air pollution and heat stress, as well as: extreme physical effort, mental stress, or a changed circadian rhythm, among others. All these factors can contribute to both, short-term and long-term impairment of the physical and mental health of firefighters. Increased levels of some inflammatory markers, such as pro-inflammatory cytokines or C-reactive protein (CRP) have been observed in firefighters, which can lead to local, acute inflammation that promotes a systemic inflammatory response. It is worth emphasizing that inflammation is one of the main hallmarks of cancer and also plays a key role in the development of cardiovascular and respiratory diseases. This article presents possible causes of the development of an inflammatory reaction in firefighters, with particular emphasis on airway inflammation caused by smoke exposure.
... This finding aligned with previous surveys showing that firefighters have a higher risk of experiencing psychological problems than the general population (Substance Abuse and Mental Health Services Administration, 2018;United Voice WA, 2018), as well as with a broader systematic review which indicated an elevated risk of PTSD among first responders in disaster contexts compared to the general population (Galea, Nandi, & Vlahov, 2005). Additionally, the repeat trauma exposure among firefighters constitutes an occupational hazard that could be a potential contributing cause of the increase in prevalence over time (Harvey et al., 2016). This is supported by an American study (Jahnke, Poston, Haddock, & Murphy, 2016) that found it was more common for firefighters to have poorer mental health due to repeat trauma exposure, rather than a single event. ...
... It also concords with the broader literature on the impacts of repeat disaster exposure (Leppold, Gibbs, Block, Reifels, & Quinn, 2022). In view of the large number of volunteer emergency responders involved in the rescue of recent bushfire events in Australia (Mao, 2019), sustained psychological support and resources tailored to this particular occupational group are required (Harvey et al., 2016;Milligan-Saville et al., 2018). ...
Article
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Background: The long-term health effects of bushfires include the potential to trigger new and exacerbate existing mental health problems. Objective: This review aimed to determine the prevalence of long-term mental health issues in Australian populations exposed to bushfires. Method: A systematic search was conducted in five databases (Embase, Medline, PsycINFO, Scopus, and Web of Science) to identify studies focusing on Australian populations impacted by bushfires with the prevalence of mental health issues reported at 2+ years after bushfire. The Joanna Briggs Institute prevalence critical appraisal tool was utilised. We conducted meta-analyses to determine the prevalence of general psychological distress in the general population, and a narrative synthesis. Results: We included 21 articles based on 5 studies and conducted on 3 bushfire events. Meta-analyses showed a pooled prevalence of 14% (95% CI 12%-16%) for psychological distress in the general population at 2-4 years post bushfire. The overall prevalence of long-term psychological problems in firefighters at 2-7 years ranged from 28% to 47.6%. The prevalence of some psychological issues decreased with time and was directly proportional to the level of bushfire impact. Conclusions: As the magnitude of long-term bushfire-related mental health impacts in Australia is severe, it is important to monitor psychological problems and assist communities in future. Future research needs include: (a) more studies on the full range of long-term psychological impacts of bushfires, and (b) consensus on instruments and diagnostic criteria to define mental health issues. Highlights: First systematic review of long-term bushfire mental health issues in Australia.Indicating substantial mental health problems among affected populations.Long-term issues were linked to bushfire impact and elevated among firefighters.Highlighting need for further rigorous research on long-term disaster sequalae.
... Importantly, the interplay between trauma exposure and PTSD in this population requires further research. There appears to be a tipping point related to trauma exposure and the onset of PTSD (27). It is likely that exposure to personal trauma influences this tipping point. ...
... With reference to occupational trauma, it should be noted that whilst emergency workers do indeed cite such trauma as being problematic for their mental health, they also weight organizational pressures almost equally in terms of negative mental health consequences (28). Although research suggests a relationship between length of service and PTSD symptoms (24,27) not all studies support this finding (29). It is conceivable that greater years of service exposes emergency responders to a greater number of trauma, both at and outside of work, and may contribute to PTSD onset. ...
Article
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Emergency responders are exposed to potentially traumatic events in their line of work and as such, are at increased risk of developing post-traumatic stress disorder (PTSD). Little is known about the characteristics of trauma associated with PTSD symptoms in this population. This study analyzed the self-reported worst traumatic event on the PTSD checklist for DSM-5 for a sample of N = 610 emergency responders, working as police officers, paramedics, firefighters or search and rescue personnel. Sufficient information was available to code 98% (N = 603) participants' trauma; 84% (N = 509) met DSM-V criterion A trauma. Of the participants reporting criterion A trauma, 56.9% (N = 290) participants reported being most affected by a traumatic event that occurred in their personal lives, 41.5% (N = 211) participants reported being most affected by a work-related traumatic event and 1.6% (N = 8) reported criterion A events that were work-related and had occurred prior to their role as an emergency responder (e.g., combat). Paramedics were significantly more likely to report occupational trauma as their worst event whereas police officers, firefighters, and search and rescue workers reported personal trauma as their worst event. Personal trauma was associated with significantly greater PTSD symptom severity than occupational trauma. Emergency responders identifying as women were significantly more likely to report personal than work-related trauma as their index event and men were more likely to report work-related than personal trauma as being linked to their PTSD symptoms. The results underscore the need to consider the broader context of trauma in the emergence of PTSD symptoms in emergency workers.
... First responders are regularly exposed to trauma and report high rates of mental health morbidities including depression, posttraumatic stress disorder (PTSD), suicidal thoughts and behaviour, as well as heavy alcohol use [1][2][3]. Despite these mental health concerns, many first responders are reluctant to engage in conventional mental health care when needed due to stigma and barriers to care [4,5]. ...
... Participants were also asked to indicate the approximate number of critical incidents they had attended to since becoming a first responder. The first two items on serious injuries and fatalities were based on a previous study on the impact of cumulative exposure on first responder mental health [1]. Two other items asked participants of any direct or indirect experience of physical or sexual assault or learned that any of these events occurred to a close family member or friend. ...
Preprint
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BACKGROUND First responders are regularly exposed to trauma, yet many are reluctant to engage in conventional mental health programs aimed at prevention or early intervention. There is emerging evidence for preventative programs that target cognitive and behavioural change, as well as programs that integrate both physical and mental training such as mindfulness and yoga training. However, acceptability amongst first responders and the feasibility of delivering this type of training online is not yet known. OBJECTIVE This pilot study aims to evaluate the feasibility and acceptability of an online mind-body tactical resilience training program designed for first responders. Additionally, we aim to examine the preliminary effectiveness of the training program on mental health outcomes, adaptive cognitive strategies and improved work productivity. METHODS A total of 42 first responders based in the United States enrolled in the online training program. Participants were administered questionnaires prior to enrolling in the 6-week online program and at the end of program. Primary outcomes of feasibility, acceptability, and usability was measured using self-reported data and program adherence statistics. Secondary outcomes measured symptoms of posttraumatic stress disorder (PTSD), psychological distress, emotion regulation, stress mindset, psychological preparedness, and work performance. RESULTS Overall, the training program was well-received with high self-reported scores for feasibility and acceptability, as well as engagement data. The median number of hours spent on the online program was 7.57 hours, with an adherence rate of 42.9%. Those who responded to the follow-up assessment reported significant improvement in stress mindset compared to baseline, with a mean increase of 5.42 (95% CI: -8.475, -2.358, t11=-3.898, P=.002). A marginally significant trend in reduced PTSD symptoms was also found, with a mean decrease of 1.58 (95% CI: -0.007, 3.174, t11=2.191, P =.051). All other secondary outcomes were not significant. CONCLUSIONS These findings suggest that a mind-body tactical resilience training program delivered in an online format is feasible and acceptable amongst first responders and may alter some key cognitive stress mindsets and PTSD symptom levels. Further research is warranted to examine the effectiveness of this type of resilience training in preventing the development of mental disorders within this population. CLINICALTRIAL ACTRN12621000471886
... Studies are needed to explicate the ways in which these high-frequency, but often overlooked, events may contribute to drinking risk. Further, in light of dose effects that have been documented previously in self-medication drinking (Guinle & Sinha, 2020;Harvey et al., 2016), understanding how these drinking patterns unfold over time in the wake of such lower-level but frequently occurring experiences can shed light on trajectories of drinking risk. ...
... Thus, it may seem surprising that in our longitudinal study, more exposure to VSC but not FSA predicted sustained elevations in alcohol use and related consequences. One explanation may be that traumas such as VSC, which occur with greater frequency, may actually result in more distress and thus greater use of alcohol to manage this distress (Guinle & Sinha, 2020;Harvey et al., 2016). This is consistent with self-medication dose-response conceptualizations and would underscore the importance of the ubiquity of VSC occurrences as important for conferring drinking risk. ...
Article
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Objective: Verbal sexual coercion (VSC) is the most prevalent and pervasive form of sexual victimization that women experience, yet the long-term harmful effects of this type of experience are unknown. The current study examined the effects of verbal sexual coercion versus forcible sexual assault (FSA) on alcohol use and alcohol consequences, two deleterious outcomes that have been linked to sexual victimization. Method: In a sample of college women (N = 649), lifetime history of VSC and FSA were examined as predictors of trajectories of alcohol outcomes with latent growth models. Participants were assessed at six timepoints over their first year of college, a critical transition period of increased risk for both alcohol use and trauma exposure. We also examined the influence of victimization characteristics, such as relationship to the perpetrator and revictimization experiences in these associations. Results: VSC experiences were predictive of higher levels of alcohol use and alcohol-related consequences (i.e., intercept). This risk was sustained throughout the first year of college. VSC experiences did not predict changes (i.e., slope) in alcohol outcomes over this time. In contrast, FSA was not predictive of either initial level or change in alcohol use and consequences over time. Conclusion: Findings highlight the importance of distinguishing among types of coercive experiences, as they show unique associations with later harmful outcomes. Verbal sexual coercion, common in the lives of young women but often overlooked in the extant literature, is associated with substantial negative impact during the first year of college. (PsycInfo Database Record (c) 2021 APA, all rights reserved).
... Some authors have identified being younger, or beginning a career in the Fire and Rescue Service at a young age, as risk factors for developing PTSD 58 . Others have documented a higher prevalence of PTSD among retired when compared to serving firefighters 59 . Thus, given the relatively older modal age of surveyed firefighters (between 45 and 54 years old, Wolffe et al. 18 ), and the exclusion of retired/ex-firefighters, it is possible that the prevalence of PTSD in UK firefighters is under-represented in the survey. ...
Article
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Exposure to trauma, high-stress situations, and disrupted sleep are well known risk factors affecting firefighters’ mental health. Little is known about the association between firefighters’ exposure to fire contaminants and mental health disorders. The UK Firefighter Contamination Survey assessed firefighters’ health and capacity for occupational exposure to contaminants. Participants were invited to anonymously complete its 64 questions online. Logistic regression analyses assessed the associations between self-reported mental health disorders and proxies of contaminant exposure. Results found that firefighters who notice soot in their nose/throat for more than a day after attending fires (Odds Ratio (OR) = 1.8, 1.4–2.4), and those who remain in their personal protective equipment (PPE) for over 4 h after fires (OR = 1.9, 1.2–3.1), were nearly twice as likely to report mental health disorders. Significantly increased odds ratios for all three outcomes of interest (anxiety, depression and/or any mental health disorders) were also found among firefighters who take PPE home to clean. Sleeping problems were reported by 61% of firefighters. These firefighters were 4.2 times more likely to report any mental health disorder (OR = 4.2, 3.7–4.9), 2.9 times more likely to report anxiety (OR = 2.9, 2.4–3.5) and 2.3 times more likely to report depression (OR = 2.3, 1.9–2.8) when compared to firefighters who did not report sleep issues. Effective decontamination measures within UK Fire and Rescue Services, together with firefighters’ wellness, may play a crucial role in protecting firefighters’ mental health.
... The majority of those studies in the literature described urban fires, mostly related to the collapse of the World Trade Centre (WTC) on 11 September 2001 (9/11) [24][25][26], while others were related to wildland fires, prescribed [27][28][29][30] or not [13,[31][32][33]. Still, comparisons correlating those types of fires with the lung function of firefighters are lacking. ...
Article
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Firefighters are exposed to a range of harmful substances during firefighting. Exposure to fire smoke has been associated with a decrease in their lung function. However, the cause–effect relationship between those two factors is not yet demonstrated. This meta-analysis aimed to evaluate the potential associations between firefighters’ occupational exposure and their lung function deterioration. Studies were identified from PubMed, Web of Science, Scopus and Science Direct databases (August 1990–March 2021). The studies were included when reporting the lung function values of Forced Expiratory Volume in 1 s (FEV1) or Forced Vital Capacity (FVC). The meta-analyses were performed using the generic inverse variance in R software with a random-effects model. Subgroup analysis was used to determine if the lung function was influenced by a potential study effect or by the participants’ characteristics. A total of 5562 participants from 24 studies were included. No significant difference was found between firefighters’ predicted FEV1 from wildland, 97.64% (95% CI: 91.45–103.82%; I2 = 99%), and urban fires, 99.71% (95% CI: 96.75–102.67%; I2 = 98%). Similar results were found for the predicted FVC. Nevertheless, the mean values of firefighters’ predicted lung function varied significantly among studies, suggesting many confounders, such as trials’ design, statistical methods, methodologies applied, firefighters’ daily exposure and career length, hindering an appropriate comparison between the studies.
... Post-incident deaths are also generally due to cerebrovascular accidents (CVA), cardiac arrest, trauma, or strokes. According to a study, due to receptive trauma exposure, firefighters suffer from high rates of mental disorders or Post-Traumatic Stress Disorder (PTSD) [43,44]. ...
Article
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While occupants are evacuating from the fire scene, firefighters are entering life-threatening environments, exposed to hot and toxic fire smoke and risks of structural failures or collapses. Each year, numerous firefighters lose their lives due to fatal injuries in the line of duty and long-term health problems. Although well-established prescriptive designs for occupant fire safety are available, most codes ignore 'firefighters' safety in complex and life-threatening situations. This paper establishes a framework for smart firefighting operations based on the critical fire events or consequences. It also reviews the major causes of firefighting casualties in the building fire. A library of the critical and precursor fire events is generated to guide the future design of smart firefighting and building fire safety. The influence factors like occupancy type and construction material are also discussed. A decision event tree containing the critical events is proposed for the incident command officer to carry out risk analysis based on real-time information from the fire scene. Using the library of the critical events and building IoT sensor networks, the trained artificial intelligence (AI) models can forecast the dynamic critical events in super real-time, display the future fire scene in the digital twin, and the estimated time and probability of their occurrence. This smart firefighting framework enables a super real-time forecast of future critical fire events, provides the information to firefighters in a language that they understand and improves operational efficiency and safety.
... Firefighters work long hours under shift work schedule demands and mandatory staffing, prompting deterioration of natural coping resources [e.g., social supports, restorative sleep; (1)(2)(3)(4)]. Chronic physical and psychological stress exposures, paired with degradation of natural coping processes, leaves firefighters at risk for physical and mental health problems [e.g., (5)(6)(7)(8)(9)(10)(11)(12)(13)(14)]. A recent study showed that more than 50% of firefighters may be at risk for PTSD, depression, anxiety, and/or alcohol use disorder (15). ...
Article
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First responders are at high risk for disorders that arise from repeat exposure to stress and trauma (Post Traumatic Stress Disorder, depression, and problematic alcohol use). Although mental health treatments are available, first responders often do not access them, anchored by barriers that include: lack of knowledge, stigma, negative experience with mental health providers, and time-based burdens. In this study, we designed an intervention to address these barriers, extending a Planned-Action framework. Step 1 involved self-report screening for four mental health risks (PTSD, depression, anxiety, and alcohol use risk), delivered to all personnel electronically, who were free to either consent and participate or opt-out. The detection of risk(s) in Step 1 led to scheduling a Step 2 telehealth appointment with a trained clinician. We report descriptive statistics for participation/attrition/utilization in Steps 1 and 2, rates of risk on four mental health variables, and rate of adherence to follow-up treatment recommendations. Step 1: In total, 53.3% of personnel [229 of 429 full-time employees (221 males; eight females; 95% White; 48% paramedic or Emergency Medical Technician; 25% captain; 19% engineer; 7% other)] initially opted-in by consenting and completing the brief remote screening survey. Among those who opted-in and completed (n = 229), 43% screened positive for one or more of the following mental health risks: PTSD (7.9%); depression (9.6%); anxiety (13.5%); alcohol use (36.7%). Step 2: A maximum of three attempts were made to schedule “at risk” individuals into Step 2 (n = 99). Among the 99 who demonstrated a need for mental health treatment (by screening positive for one or more risk), 56 (56.6%) engaged in the telehealth appointment. Of the 56 who participated in Step 2 clinical appointments, 38 were recommended for further intervention (16.6% of full-time personnel who participated). Among the 38 firefighters who were recommended to seek further mental health services, 29 were adherent/followed through (76.3% of those who received recommendations for further services). Taken together, evidence-based, culturally conscious, stepped care models delivered via the virtual/telehealth medium can promote access, utilization, and cost-effective mental health services for first responders. Implications are for informing larger, more rigorous dissemination and implementation efforts.
... A recent study surveying 5813 PSP in Canada found that 36.7% of municipal police, 34.1% of firefighters, 50.2% of Royal Canadian Mounted Police (RCMP), and 49.1% of paramedical staff screened positive for a mental health condition, such as posttraumatic stress disorder (PTSD), depression, anxiety, or substance abuse [3]. These prevalence rates are similar to those in other nations where there are elevated rates of mental health conditions and suicidality among their PSP when compared to the civilian public [4][5][6][7][8]. In an Australian study, 1 in 3 emergency services personnel were reported to experience high or very high psychological distress [7]. ...
Article
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Background: Public safety personnel (PSP) impacted by operational stress injuries can find themselves needing both time off work and support reintegrating back into the workforce. Work reintegration programs have been introduced in PSP organizations to support those who aim to return to work. One such peer-led workplace reintegration program (RP) was created in 2009 by members of the Edmonton Police Service (EPS). The primary goal of the EPSRP is to assist PSP in returning to work as soon as possible following a critical incident, illness, or injury while diminishing the potential for long-term psychological injury. The EPSRP is delivered by peers through 3 interrelated components: (1) the Reintegration Program Facilitator Training (RPFT) Program; (2) a short-term Critical Incident RP; and (3) a long-term RP. There is a dire need for research that incorporates strong study designs to the determine long-term effectiveness of the program on increasing workplace reintegration, improving mental health knowledge, and creating culture change within PSP organizations. Simultaneously, the efficacy, effectiveness, and fidelity of the RPFT in providing the tools, mental health knowledge, and skills the RP peer facilitators will need for the RP must be evaluated.
... The distinctive circumstances of firefighters' activity encompass a substantial risk for injury, health problems (e.g., cardiovascular disease, pulmonary disease, cancer) or death. Firefighters are repeatedly exposed to potentially traumatic events, making them vulnerable to high occupational stress and mental health problems such as posttraumatic stress disorder (PTSD), depression, anxiety, substance use disorders, and sleep disorders (Janhnke et al., 2016;Harvey et al., 2016;Sawhney et al., 2018;Wagner & Pasca, 2019). Furthermore, PTSD, even at subclinical levels, has been identified as a risk factor for individuals' burnout (Chiang et al., 2021) and suicide in firefighters (Bing-Canar et al., 2019;Panagioti et al., 2009;Stanley et al., 2015). ...
Article
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Background and Aim: The current study aimed to translate the Firefighter Coping Self-Efficacy Scale (FFCSE) and explore its dimensionality and psychometric characteristics. Method: This cross-sectional study was authorised by the National Emergency and Civil Protection Authority and disseminated by firefighters' stations from different districts. A sample of 155 firefighters completed online the following self-report instruments: Firefighter Coping Self-Efficacy Scale, Comprehensive Assessment of Acceptance and Commitment Therapy Processes, World Health Organization Index-5, Perceived Stress Scale and Patients Health Questionnaire-4. An exploratory factor analysis was computed, and reliability and validity studies were conducted. Results: The Portuguese version of the FFCSE items revealed, in general, good psychometric characteristics, except for item 10 ("Having dreams about difficult calls"). The factor structure was one-dimensional. The FFCSE showed good internal consistency, and the associations with the other variables were in the expected direction. No differences were found between men and women in the FFCSE mean scores. There was no statistically significant association between the FFCSE and age, years of education or length of service as firefighters. Conclusions: The FFCSE proved to be a one-dimensional measure of perceived self-efficacy to deal with the demands inherent to the firefighter activity. The results suggest that it is a valid and reliable measure, useful in research, clinical and training contexts for these professionals.
... Indeed, studies show that between 80 and 100% of emergency and rescue personnel have experienced at least one traumatic event during service (3)(4)(5). Due to this accumulation of traumatic events, emergency and rescue personnel experience higher levels of psychological stress and are consequently at greater risk of developing mental health problems (6,7). ...
Article
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Objective The present study aimed to assess the frequency of trauma exposure, the prevalence of possible post-traumatic stress disorder (PTSD), the extent of resilience, and sense of coherence among personnel of the Swiss alpine rescue association (ARS).Methods Using a trilingual online survey approach, 465 mountain rescuers of the ARS were surveyed using the Posttraumatic Diagnostic Scale (PDS), the PTSD Checklist 5 (PCL-5), the Resilience Scale 13 and 14 (RS-13/-14), the Perceived Stress Scale 10 (PSS-10), the General Health Questionnaire 12 (GHQ-12), the Pittsburg Sleep Quality Index (PSQI), the Sense of Coherence Scale 13 (SOC-13), and the Berlin Social Support Scales (BSSS).ResultsAlthough the rate of mountain rescuers having witnessed or experienced a traumatic event was high (71%), the prevalence of possible PTSD was low (0.9%). The sample showed high resilience and high sense of coherence. Resilience was positively correlated with work experience. Low perceived stress and high sense of coherence predicted resilience. The severity of PTSD symptoms was mainly predicted by low sense of coherence. Sense of coherence mediated the interaction between resilience and severity of PTSD symptoms.Conclusion The findings suggest that resilience and sense of coherence are indicative for the low prevalence of possible PTSD among mountain rescuers, and may therefore represent valuable screening and training parameters for mountain rescue personnel.
... A recent study surveying 5813 PSP in Canada found that 36.7% of municipal police, 34.1% of firefighters, 50.2% of Royal Canadian Mounted Police (RCMP), and 49.1% of paramedical staff screened positive for a mental health condition, such as posttraumatic stress disorder (PTSD), depression, anxiety, or substance abuse [3]. These prevalence rates are similar to those in other nations where there are elevated rates of mental health conditions and suicidality among their PSP when compared to the civilian public [4][5][6][7][8]. In an Australian study, 1 in 3 emergency services personnel were reported to experience high or very high psychological distress [7]. ...
Article
Background: Public safety personnel (PSP) impacted by operational stress injuries can find themselves needing both time off work and support reintegrating back into the workforce. Work reintegration programs have been introduced in PSP organizations to support those who aim to return to work. One such peer-led workplace reintegration program (RP) was created in 2009 by members of the Edmonton Police Service (EPS). The primary goal of the EPSRP is to assist PSP in returning to work as soon as possible following a critical incident, illness, or injury while diminishing the potential for long-term psychological injury. The EPSRP is delivered by peers through 3 interrelated components: (1) the Reintegration Program Facilitator Training (RPFT) Program; (2) a short-term Critical Incident RP; and (3) a long-term RP. There is a dire need for research that incorporates strong study designs to the determine long-term effectiveness of the program on increasing workplace reintegration, improving mental health knowledge, and creating culture change within PSP organizations. Simultaneously, the efficacy, effectiveness, and fidelity of the RPFT in providing the tools, mental health knowledge, and skills the RP peer facilitators will need for the RP must be evaluated. Objective: The purpose of this quasi-experimental pre-post pilot cohort study is to evaluate the effectiveness of the EPSRPFT course on influencing mental health knowledge and attitudes of RPFT attendees who will be future RP peer facilitators. Methods: This pre-post cohort study collected data via 2 questionnaires from RPFT participants (N=60) which included the Mental Health Knowledge Survey (MAKS) and the Open Minds Survey of Workplace Attitudes (OMSWA). Descriptive, parametric (sample t tests), and nonparametric (Wilcoxon signed rank tests) statistics were used to compare the pre- and post-RPFT results and to analyze results by gender and profession. Results: Statistically significant changes were observed in pre-post questionnaire scores in the domains of mental health attitudes and knowledge. Conclusions: Although results are explorative, the RPFT may facilitate positive changes in workplace mental health attitudes and knowledge among PSP. It is hoped these findings will contribute to a broader evidence base that can inform changes to the program, practices, and policies, and inform decision-making regarding the EPSRP.
... Within a local Australian context, Harvey and colleagues et al. (2016) identified the prevalence of PTSD among a sample of 488 current and 265 retired firefighters as 8% and 18%, respectively. There is a significant positive linear association between the number of traumatic work-related incidents and rates of PTSD (Harvey et al., 2016). Similar associations between trauma exposure and the prevalence of PTSD have also been reported internationally among police officers (Ménard et al., 2016) and paramedics (Rybojad et al., 2016;Fjeldheim et al., 2014). ...
Article
First responders are exposed to repetitive work‐related trauma and, thus, are at risk of developing posttraumatic stress disorder (PTSD). Eye‐movement desensitization and reprocessing (EMDR) is a psychotherapy intervention designed to treat symptoms of posttraumatic stress. We conducted a systematic review to examine the viability of EMDR among first responders. The primary aim of this review was to identify studies that have trialed EMDR among first responders and evaluate its effectiveness in reducing trauma‐related symptoms; a secondary aim was to identify whether EMDR has been used as an early intervention for this cohort and determine its effectiveness as such. Four databases were searched. Studies were included if they evaluated the extent to which EMDR was effective in alleviating symptoms stemming from work‐related trauma exposure among first responders. The findings from each study were reported descriptively, and eight studies that evaluated the efficacy of EMDR in this population were included. There was substantial variation in how EMDR was implemented, particularly in the type, duration, frequency, and timing. The findings suggest that EMDR can alleviate symptoms of work‐related trauma exposure among first responders; however, findings regarding early intervention were inconclusive, and a methodological quality assessment revealed that all studies were classified as being of either weak or medium quality. Although this review provides preliminary insights into the effectiveness of EMDR for first responders, the conclusions that can be drawn from the literature are limited, and the findings highlight several gaps in the literature.
... Emergency service workers (ESWs) and returning military personnel report estimated prevalence rates of 10% and up to 19%, respectively, for post-traumatic stress disorder (PTSD), compared with rates of 3% to 4% in the general population [1][2][3]. Evidence suggests that this cumulative exposure to trauma over time is associated with an increased risk of developing PTSD, depression and heavy drinking in both populations [4][5][6][7]. This burden of mental health problems highlights an urgent need to actively investigate how mental health problems can be avoided amongst first responder populations [8,9]. ...
Article
Background: First responder populations, such as emergency services and the military, report elevated levels of mental health problems. Although post-deployment or post-incident psychosocial support interventions are widely implemented within these services, its effectiveness in preventing the development of mental disorders is unclear. Aims: To systematically assess which, if any, post-deployment or post-incident psychosocial interventions are effective at preventing the development of post-traumatic stress disorder (PTSD) and common mental disorders (CMD) amongst military and emergency service worker (ESW) settings. Methods: A systematic review was conducted by searching four databases for any randomized controlled trials (RCTs) or controlled trials of post-deployment or post-incident interventions. The primary outcomes assessed were differences in symptoms of PTSD and CMD. Study quality was examined using the Downs and Black checklist. Pooled effect sizes and 95% CI were calculated using random-effects modelling for main meta-analyses, planned subgroup and sensitivity analyses. Results: From 317 articles, seven RCTs were included in the final meta-analysis. Interventions identified included psychological debriefing, screening, stress education, team-based skills training and a peer-delivered risk assessment. A very small but significant effect was found for team-based skills training in reducing CMD symptoms. Some evidence was also found for team cohesion training in reducing both PTSD and CMD. Conclusions: Limited evidence was found for post-deployment or post-incident psychosocial interventions within military and ESW populations. More high-quality studies, particularly among ESW settings, are urgently needed to determine how to better prevent the development of trauma related disorders after exposure.
... Exposure to traumatic events entail increased risk of developing posttraumatic stress symptoms, as well as other forms of psychological distress such as depression and anxiety [6]. Accordingly, Posttraumatic Stress Disorder (PTSD) has been shown to be elevated among first responders (Emergency Medical Services (EMS), fire service, police force) compared to the general population [7,8]. ...
Article
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Background Posttraumatic stress disorder (PTSD) has been shown to be elevated among first responders (Emergency Medical Services, fire service, police force) compared to the general population. Examining the prevalence of mental health issues in a work force with an elevated occupational risk is fundamental towards ensuring their wellbeing and implementing safeguard measures. The goal of this study is therefore to report the prevalence of depression, anxiety, posttraumatic development, and PTSD in Norwegian ambulance personnel. Methods This study is a cross-sectional, anonymous, web-based survey (Questback®), performed among operative personnel employed in the Emergency Medical Services in the Regional Health Trust of Central Norway between 18. February and 9. April 2021. The study was sent to 1052 eligible participants. Questions reported demographic data, a traumatic events exposure index, Patient Health Questionnaire-9 (Depression), Generalized Anxiety Disorder-7 scale, Posttraumatic symptom scale (PTSD) and Posttraumatic change scale. Results The response rate in this study was 45.5% (n = 479/1052). The mean age of respondents was 37.1 years (std. 11.1) and 52.8% (n = 253) were male. Of the respondents, 80.6% (n = 386) were married or had a partner, and 91.6% (n = 439) reported having access to a peer support programme, with 34.9% (n = 167) reporting that they had utilized peer support. In this study, 5% (n = 24) showed a prevalence of manifest posttraumatic stress disorder symptoms, while 8.6% (n = 41) reported moderate to severe depression and 2.9% (n = 14) presented moderate to severe symptoms of general anxiety. Of the respondents, 77.2% (n = 370) reported personal growth because of their work experiences. Conclusions This study indicates that Norwegian ambulance personnel report a prevalence of posttraumatic stress symptoms and depression, which is slightly higher for men, and lower for the female proportion in this study, when compared to an adult Norwegian population. The vast majority of respondents reported personal growth because of their work experience, and both the degree of peer support and having a partner seem to influence levels of posttraumatic stress and -development.
... Exposure to traumatic events entail increased risk of developing posttraumatic stress symptoms, as well as other forms of psychological distress such as depression and anxiety [6]. Accordingly, Posttraumatic Stress Disorder (PTSD) has been shown to be elevated among rst responders (Emergency Medical Services (EMS), re service, police force) compared to the general population [7,8]. ...
Preprint
Full-text available
Background Posttraumatic Stress Disorder (PTSD) has been shown to be elevated among first responders (Emergency Medical Services, fire service, police force) compared to the general population. Examining the prevalence of mental health issues in a work force with an elevated occupational risk is fundamental towards ensuring their wellbeing and implementing safeguard measures. The goal of this study is therefore to report the prevalence of depression, anxiety, posttraumatic development, and PTSD in Norwegian ambulance personnel. Methods This study is a cross-sectional, anonymous, web-based survey (Questback®), performed among operative personnel employed in the Emergency Medical Services in the Regional Health Trust of Central Norway between 18. February and 9. April 2021. The study was sent to 1052 eligible participants. Questions reported demographic data, a traumatic events exposure index, Patient Health Questionnaire-9 (Depression), Generalized Anxiety Disorder-7 scale, Posttraumatic symptom scale (PTSD) and Posttraumatic change scale. Results The response rate in this study was 45.5 % (n=479/1052). The mean age of respondents was 37.1 years (std. 11.1) and 52.8 % (n=253) were male. Of the respondents, 80.6% (n=386) were married or had a partner, and 91.6% (n=439) reported having access to a peer support programme, with 34.9% (n=167) reporting that they had utilized peer support. In this study, 5 % (n=24) showed a prevalence of manifest posttraumatic stress disorder symptoms, while 8.6 % (n=41) reported moderate to severe depression and 2.9 % (n=14) presented moderate to severe symptoms of general anxiety. Of the respondents, 77.2 % (n=370) reported personal growth because of their work experiences. Conclusions This study indicates that Norwegian ambulance personnel report a prevalence of posttraumatic stress symptoms and depression, which is slightly higher for men, and lower for the female proportion in this study, when compared to an adult Norwegian population. The vast majority of respondents reported personal growth because of their work experience, and both the degree of peer support and having a partner seem to influence levels of posttraumatic stress and -development.
... According to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), the diagnosis of PTSD is characterized by four broad symptom clusters that include intense reliving of the traumatic event through disruptive memories and nightmares, avoidance of reminders of the event, negative cognitions and mood, and hyperarousal (8). It is estimated that 1 in 10 active emergency service workers (9), one in six retired emergency personnel (10), one in five frontline health workers, including nurses (11), and one in six emergency doctors (12) meet criteria for PTSD. Current PTSD treatment guidelines are focused on symptom reduction, with first-line treatments involving cognitive behavioral therapies and pharmacotherapy (13,14). ...
Article
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Context: Emergency service and medical frontline workers are exposed to significant occupational stressors that may confer an increased risk of poor mental health, including posttraumatic stress disorder (PTSD). Emerging evidence suggests that physical activity and its structured subset, exercise, may be effective in improving symptoms of PTSD in veterans; however, the potential efficacy for other populations at high risk of occupational trauma exposure is currently unclear. Given the potential of physical activity interventions to improve both PTSD symptoms and physical comorbidities, there has been increasing interest in the potential role in the treatment of PTSD. Objective: The purpose of this review was to investigate the associations between physical activity levels and PTSD symptoms in emergency service and frontline medical workers. Design: A systematic review was conducted by searching major electronic databases for relevant studies published from database inception until February 2021. Eligibility Criteria: Studies among traditional emergency service occupations, e.g., police officers, firefighters, paramedics, and medical frontline workers, including doctors and nurses, were included. Study Selection: Experimental and observational studies with or without control groups were eligible for inclusion. Main Outcome Measure: The primary outcome measure was symptoms of PTSD. Results: The search identified eight eligible studies (four experimental and four observational). Three of the experimental studies showed that exercise significantly reduced symptoms of PTSD in emergency service personnel, including police and nurses. Based on the results of results of three studies, physical activity may be inversely associated with PTSD symptom severity among nurses and firefighters. Conclusions: Existing research suggests that physical activity may improve symptoms of PTSD in emergency service personnel and frontline workers. Considering physical activity promotion initiatives for occupations at high risk of trauma exposure may therefore be warranted to promote mental health. The existing research has several methodological limitations, and findings should therefore be interpreted with caution until further robust studies are available.
... The prevalence of PTSD in this profession is also high, amounting to 9.5-31.8% [23][24][25][26], and its presence is associated with a high suicide risk [25]. ...
Article
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The prevalence of sleep paralysis (SP) is estimated at approximately 7.6% of the world’s general population. One of the strongest factors in the onset of SP is PTSD, which is often found among professional firefighters. Our study aimed to assess in the professional firefighter population (n = 831) (1) the prevalence of SP, (2) the relationship between SP and PTSD and (3) the relationship between SP and other factors: the severity of the stress felt, individual tendency to feel anxious and worried and lifestyle variables. The incidence of SP in the study group was 8.7%. The high probability of PTSD was found in 15.04% of subjects and its presence was associated with 1.86 times the odds of developing SP [OR = 1.86 (95% CI: 1.04–3.33); p = 0.04]. Officers who experienced at least 1 SP during their lifetime had significantly higher results in the scales: PCL-5, STAI-T, PSWQ. The number of SP episodes was positively correlated with the severity of symptoms measured by the PCL-5, PSS-10, STAI and PSWQ questionnaires. Further research is needed to assess the importance of SP among the firefighter population in the context of mental and somatic health and to specify methods of preventing SP episodes.
... Emergency service workers (ESWs), including firefighters, are regularly exposed to trauma as part of their work. The repeated exposure places them at high risk of poor mental health, including posttraumatic stress disorder (PTSD) [1]. There is increasing recognition of the impact of emergency service work [2,3], with poor social support, high occupational stress and maladaptive coping strategies associated with an increased prevalence of mental health problems [2, 4,5]. ...
Article
Full-text available
Emergency service workers (ESWs) are at high risk of experiencing poor mental health, including posttraumatic stress disorder (PTSD). Programs led by ex-service organizations may play an unrecognized but critical role in mental health prevention and promotion. Behind the Seen (BTS) is an Australian ex-service organization that runs workshops to raise awareness and facilitate conversations around the mental health of ESWs. The purpose of the study is to conduct a qualitative evaluation of workshop participants’ experiences, to understand the acceptability and perceived usefulness over the immediate- (within 1 month), intermediate- (6 months) and longer-terms (12 months). Participants (n = 59 ESWs) were recruited using purposive sampling across five fire and rescue services in metropolitan, regional, and rural locations. Focus groups methodology was used for data collection and data were analyzed using iterative categorization techniques. Participants reported (i) a high perceived need for education about PTSD, (ii) highly salient aspects of the presentation that made for a positive learning experience, including the importance of the lived experiences of the facilitators in the learning process, (iii) key features of changes to intentions, attitudes, and behavior, and (iv) major aspects of the organizational context that affected the understanding and uptake of the program’s key messages. BTS was perceived as an acceptable means of delivering mental health, PTSD, and help-seeking information to ESWs. The program is a promising candidate for scaling-up and further translation.
... T raumatic events are described in the 5th Edition of Diagnostic and Statistical of Mental Disorders as exposure to actual or threatened death, serious injury or sexual violation (DSM-5) [1]. Refugees comprise a high-risk population with regard to trauma exposure [2] and have higher risks of mental disorders in the long term, such as anxiety, depression, posttraumatic stress disorder and somatic complaints, such as pain. These mental disorders emerge in refugees after their exposure to war, violence or exile [3] and moreover, chronic pain and anxiety/depression are largely comorbid [4]. ...
... First responders, including police, firefighters, and paramedics, are regularly exposed to traumatic events. This repeated exposure puts them at an increased risk of experiencing psychological distress and poor mental health [1]. Overall, 1 in 3 first responders report having high or very high levels of psychological distress [2], whereas 1 in 10 first responders experience posttraumatic stress disorder (PTSD) [3]. ...
Article
Full-text available
Background First responders (eg, police, firefighters, and paramedics) are at high risk of experiencing poor mental health. Physical activity interventions can help reduce symptoms and improve mental health in this group. More research is needed to evaluate accessible, low-cost methods of delivering programs. Social media may be a potential platform for delivering group-based physical activity interventions. Objective This study aims to examine the feasibility and acceptability of delivering a mental health–informed physical activity program for first responders and their self-nominated support partners. This study also aims to assess the feasibility of applying a novel multiple time series design and to explore the impact of the intervention on mental health symptoms, sleep quality, quality of life, and physical activity levels. Methods We co-designed a 10-week web-based physical activity program delivered via a private Facebook group. We provided education and motivation around different topics weekly (eg, goal setting, overcoming barriers to exercise, and reducing sedentary behavior) and provided participants with a Fitbit. A multiple time series design was applied to assess psychological distress levels, with participants acting as their own control before the intervention. ResultsIn total, 24 participants (12 first responders and 12 nominated support partners) were recruited, and 21 (88%) completed the postassessment questionnaires. High acceptability was observed in the qualitative interviews. Exploratory analyses revealed significant reductions in psychological distress during the intervention. Preintervention and postintervention analysis showed significant improvements in quality of life (P=.001; Cohen d=0.60); total depression, anxiety, and stress scores (P=.047; Cohen d=0.35); and minutes of walking (P=.04; Cohen d=0.55). Changes in perceived social support from family (P=.07; Cohen d=0.37), friends (P=.10; Cohen d=0.38), and sleep quality (P=.28; Cohen d=0.19) were not significant. Conclusions The results provide preliminary support for the use of social media and a multiple time series design to deliver mental health–informed physical activity interventions for first responders and their support partners. Therefore, an adequately powered trial is required. Trial RegistrationAustralian New Zealand Clinical Trials Registry (ACTRN): 12618001267246; https://anzctr.org.au/Trial/Registration/TrialReview.aspx?ACTRN=12618001267246.
... While the issue of delayed or otherwise deficient helpseeking for mental disorders is not contentious, the possible role of workplace mental health screening in addressing the problem has been actively debated over many years [4,5]. The debate is particularly important for those working in roles such as first responders (police officers, firefighters and paramedics), who experience significant job-related stressors including repeated exposure to potentially traumatic events [6] [7]. Research has consistently found that first responders are more likely than the general population to experience psychological distress as a result of their work [8][9][10], and that they are less likely to seek professional help [11,12]. ...
Article
Full-text available
Background Mental health screening in the workplace aims to identify employees who are becoming symptomatic, in order to provide timely support and evidence-based interventions to those affected. Given the stigma associated with mental illness, accurate disclosure of mental health symptoms cannot be assumed. The present study sought to investigate factors associated with the accurate reporting of mental health symptoms amongst police officers. Methods A total of 90 serving police officers completed identical mental health screening surveys, one administered by the employer and the other anonymously by an independent organisation. Responses were then linked to compare differences in the number and severity of mental health symptoms reported on each questionnaire. Results Comparisons of matched self-report scores indicated that employees under-reported symptoms of mental health disorders when completing screening administered by their employer, with only 76.3% of symptoms declared. Under-reporting occurred regardless of gender and symptom type. Less senior staff ( p = 0.05) and those with the most severe post-traumatic stress disorder and common mental disorder symptoms ( p = 0.008) were significantly more likely to under-report symptoms. Conclusions Employer-administered mental health screening is not able to accurately capture all mental health symptoms amongst first responders. The fact that the severity of symptoms predicted the level of under-reporting means that simple changes to cut-off values cannot correct this problem.
... 5,6 Unlike military personnel who may have time-limited active deployments, police and emergency services personnel may be exposed to traumatic experiences repeatedly over the course of a long career, which may impact on mental health and wellbeing. [7][8][9][10][11][12][13] While operational staff may be assumed to have higher levels of exposure to trauma, non-operational staff can also be involved in responding to traumatic events, may be vicariously exposed to trauma, and may suffer from expectations and lack of access to support services that may be provided primarily for operational personnel. [12][13][14][15][16][17] Significant gaps have been identified in the literature on police and emergency services mental wellbeing, including lack of large scale or national studies, no studies examining the prevalence of self-harming and substance use behaviors, and lack of investigation into help-seeking behavior. ...
Article
Answering the Call, the Australian National Police and Emergency Services Mental Health and Wellbeing Study, surveyed 14,868 Australian ambulance, fire and rescue, police, and state emergency service employees. Emergency services personnel had lower rates of mental wellbeing and higher rates of psychological distress and probable PTSD than the general adult population. Overall 30% had low wellbeing, 21% had high and 9% had very high psychological distress, and 10% had probable PTSD. An estimated 5% had suicidal ideation and 2% had a suicide plan in the past 12 months, while 16% binge drink at least weekly. Only one in five of those with very high psychological distress or probable PTSD felt they received adequate support for their condition. These findings highlight the risk of mental health conditions associated with work in the emergency services sector.
... Many programmes and services are underpinned by strategies and frameworks which have been developed specifically to aid emergency services organisations in supporting the mental health and wellbeing of their workforces (Beyond Blue Ltd, 2017;EAP Assist, 2017;NSW Government, 2016; The Council of Ambulance Authorities Inc, 2017). While these strategies are evidence-based and well-intentioned, it is apparent from both a recent Senate Inquiry into the mental health of first responders (The Commonwealth of Australia, Senate Education and Employment References Committee, 2019), and research findings (Beyond Blue Ltd, 2018;Harvey et al., 2016), that these are not always successful, with levels of post-traumatic stress disorder (PTSD) amongst this population estimated at around twice that of the general adult population (Berger et al., 2012;Beyond Blue Ltd, 2018) and deaths from intentional selfharm currently averaging 12 a year (NCIS, 2019). The Senate Inquiry Committee concluded that more could be done to reduce the severity and chronicity of PTSD and distress, and ideally, to prevent mental ill health from occurring at all (The Commonwealth of Australia, Senate Education and Employment References Committee, 2019). ...
Article
Full-text available
Objective: This study aimed to determine patterns of help-seeking among first responders for conditions such as post-traumatic stress disorder (PTSD) and psychological distress. Method: Data from Answering the Call, the Australian national survey of the mental health and wellbeing of police and emergency services, was analysed to determine mental health help-seeking associations, as well as to measure patterns of service use. This encompassed 14,868 employees across the ambulance, fire and rescue, police, and state emergency services sectors. Results: Over half of employees needing help for a mental health issue neither sought nor received help. First responders with severe mental distress who delayed seeking help reported that they needed a lot more help than they received. Poor help-seeking behaviour and experiences were found to be associated with high levels of PTSD and psychological distress, low levels of mental health literacy, and career concerns. No significant differences were found between the sectors with all employees exhibiting high levels of poor help-seeking behaviour. For organisation-sourced services and programmes, usage levels and perceptions of usefulness were consistently low. Conclusions: Findings support the importance of early help-seeking amongst first responders with emerging mental health conditions. All sectors exhibited sub-optimal help-seeking behaviour and experiences. The problems go beyond the organisational structures, policies and programmes of any individual sector and are likely to be systemic. While all organisations provide mental health and wellbeing programmes and services, they are either not well taken-up, or are not considered sufficiently useful by the people they are designed to help. KEY POINTS What is already known about this topic: • First responders are known to be at high risk of developing mental health conditions. • The rate of PTSD in Australian first responders is twice that in the general population. • Early and appropriate treatment is essential in preventing mental health conditions from worsening or becoming chronic. What this study adds: • This study shows consistently high levels of sub-optimal help-seeking behaviour and experiences among Australian emergency services employees across all sectors. • Over half of emergency services employees needing help for a mental health issue neither sought nor received help. • Usage and perceived usefulness of organisational mental health and wellbeing programs/services are very low.
... All in the cohort had been exposed during the Fort McMurray fire and without a non-deployed group we were dependent on finding dose-response relationships to attribute effects to the fire itself: this was evident, to a degree for PTSD. Moreover, almost all the firefighters will have been exposed to multiple fires and difficult events as a first responder and much of the observed high prevalence of mental ill-health may reflect such cumulative exposures (Harvey et al. 2016). ...
Article
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Background We aimed to determine the relationship between childhood abuse and mental ill-health in firefighters deployed to a devastating fire that engulfed Fort McMurray Methods A stratified sample of 282 firefighters was selected from a cohort of 1234 for assessment by Structured Clinical Interview (SCID) for DSM-5 diagnostic criteria and the Childhood Experience of Care and Abuse questionnaire (CECA-Q). Diagnoses were grouped as post-traumatic stress disorder (PTSD), anxiety disorders, depressive disorders and substance use disorders. Scales extracted from the CECA-Q included parental loss, antipathy, neglect, physical punishment, sexual abuse and support from a same-age confidant. The relation to diagnostic group was examined by multivariable logistic regression Results 192 SCID interviews and 188 CECA-Qs were completed: 124 met DSM-5 criteria for diagnoses including anxiety disorder (56), depressive disorder (54), PTSD (77) and substance use disorder (43). Childhood sexual abuse was reported by 24 firefighters all of whom met DSM-5 diagnostic criteria. Sexual abuse and a childhood confidant differentiated diagnoses in an initial multivariable model of those with psychiatric disorders. Compared to those without a psychiatric diagnosis, father's antipathy was related to anxiety and substance use, physical punishment to PTSD and substance use. A childhood same-age confidant protected against anxiety, depression and PTSD. Fire exposures related only to PTSD. Limitations The comparison group without mental disorders was small. Childhood abuse information was collected retrospectively and may be biased by current state. Conclusions Firefighters’ mental health is a function of both work-role traumas and childhood events. Occupational health provision must address this complexity.
... The result suggests that PERMA may play a crucial role between emergency workers' depression and quality of life [49]. As related research affirms [50], South Korean emergency workers' efforts and some intervention programs and education to improve wellbeing may alleviate depression and enhance quality of life. ...
Article
Full-text available
Emergency workers are frequently exposed to hazardous situations and such life patterns can influence their wellbeing. This study examined the relationships among South Korean emergency workers’ precedents and consequences of positive emotion, engagement, relationship, meaning, and achievement (PERMA), a wellbeing concept, and offered solutions. A total of 597 emergency workers in Daegu, South Korea, participated in a survey. This study measured post-traumatic stress disorder syndrome, burnout, depression, PERMA, quality of life, life satisfaction, and sleep quality to test the relationships. Results demonstrated that post-traumatic stress disorder syndrome and burnout predicted distracting sleep behavior and sleep health. Depression was significantly related to PERMA. The better the emergency workers’ PERMA was, the better their quality of life and life satisfaction were. PERMA significantly predicted sleep behavior, a portion of sleep quality. Depression had an indirect influence on quality of life mediated by PERMA. Post-traumatic stress disorder syndrome, burnout, and PERMA were significant predictors of low sleep health and sleep behavior. The results indicate that South Korean emergency workers struggle with depression and sleep quality. As the data were collected during the coronavirus disease 19 pandemic, individual efforts and relevant programs to improve South Korean emergency workers’ PERMA and sleep quality in a crisis are recommended. Possible solutions to improve the wellbeing of South Korean emergency workers are suggested.
... 4 Previous studies have reported high rates of posttraumatic stress disorder (PTSD), depression and heavy drinking amongst first responders, with preliminary evidence also showing that they are at elevated risk for suicidal thoughts and behaviors. [5][6][7] Yet many are reluctant to seek help even when mental health services are readily available to them. A study of rescue workers after the 9/11 World Trade Centre terrorist attacks found that more than half of symptomatic workers who were referred to mental health treatment chose not to attend at all. 8 This finding is unsurprising, given that stigma of mental illness remains one of the key deterrents to help-seeking. ...
Article
Objective: To investigate the efficacy of a workplace mental health awareness training program on help-seeking and mental health outcomes. Methods: A cluster randomized controlled trial was conducted comparing those who received standard training (N = 210) or standard training with a mental health awareness module (N = 208). Both groups were followed up for three years with the primary outcome being likelihood to seek help. Results: Rates of likely help-seeking were slightly higher in the intervention group six months after the training, but this was not maintained over time. There was no significant difference between study conditions for mental health outcomes or actual help-seeking among those with probable mental disorder at any time point. Conclusions: Workplace mental health awareness training has a limited short-term impact on likelihood of help-seeking and does not appear to improve mental health outcomes.
Article
Background: Due to the job characteristics, firefighters are repeatedly exposed to trauma incidents. However, not all firefighters exhibit the same level of post-traumatic stress disorder (PTSD) or post-traumatic growth (PTG). Despite this, few studies have looked into firefighters’ PTSD and PTG. Objective: This study identified subgroups of firefighters based on their PTSD and PTG levels, and investigated the influence of demographic factors and PTSD/PTG-related factors on latent class classification. Method: Latent profile analysis was used to examine the patterns of PTSD and PTG among 483 firefighters in South Korea. Using a cross-sectional design, demographic factors and job factors were examined as group covariates through a three-step approach. PTSD-related factors such as depression and suicide ideation, as well as PTG-related factors such as emotion-based response were analysed as differentiating factors. Results: Four classes were identified and named ‘Low PTSD-low PTG (65.2%),’ ‘Mid PTSD-mid PTG (15.5%),’ ‘Low PTSD-high PTG (15.3%),’ and ‘High PTSD-mid PTG (3.9%).’ The likelihood of belonging to the group with high trauma-related risks increased with more rotating shift work and years of service. The differentiating factors revealed differences based on the levels of PTSD and PTG in each group. Conclusions: 34.8% of firefighters experienced changes due to traumatic events while on the job, and some required serious attention. Modifiable job characteristics, such as the shift pattern, indirectly affected PTSD and PTG levels. Individual and job factors should be considered together when developing trauma interventions for firefighters.
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.
Article
Objective: Estimate the association of post-traumatic stress disorder (PTSD) and sleep latency among retired firefighters. Methods: Baseline health survey data collected from retried career Florida firefighters participating in an ongoing prospective cohort study from 2017-2021 was analyzed. Risk for PTSD was assessed using a 4-item primary care PTSD screening construct, and sleep onset latency was assessed by self-reported length of time to fall asleep. Results: Among the 500 participants, 8.0% screened positive for PTSD risk, 37.6% had prolonged sleep onset latency (≥20 minutes to fall asleep). Retired firefighters with PTSD risk were 2.7 times more likely (adjusted odds ratio = 2.70 [95%Cl:1.27-5.75]) to have prolonged sleep latency compared to those without PTSD risk while controlling for covariates. Conclusions: Retired firefighters who screen positive for PTSD risk are three-time more likely to report delayed sleep onset latency.
Article
Background and objectives Affective responses to trauma cues in individuals with posttraumatic stress (PTS) can evoke a desire to drink and may shed light on novel mechanisms of PTS-drinking. The present study aimed to (1) identify and characterize patterns of acute emotional responses (ER) to trauma cues and (2) examine how these patterns influence drinking urge. Methods University students (N = 304; Mage = 19; 52.3% female) completed a structured clinical interview to confirm trauma history and PTS. At an experimental session one week later, participants completed a series of three trauma cue exposures. Affect and drinking urge were measured at baseline, after each cue exposure, and at experiment's end. Results Latent profile analysis of ER yielded a five-profile solution: (1) Nonresponders (2) Low Responders (3) Moderate Responders (4) Resilient Responders and (5) High Responders. Profiles differed by trait neuroticism, PTS, and emotion dysregulation, with High Responders as the most severe group. In latent growth curve models, profiles significantly predicted alcohol urge trajectories in a graded pattern. High Responders, with the greatest affective intensity, showed the strongest urge. Duration of affect was also implicated with Resilient Responders, who had similar intensity but faster overall affective recovery time compared to High Responders, demonstrating lower mean levels of urge. Limitations External validity is limited. Conclusions Individual differences in ER to trauma cues are important for understanding alcohol urge. Findings can inform integrative treatments for PTS-drinking by targeting ER to shorten affective recovery to trauma reminders and reduce the need for alcohol use as a regulation strategy.
Article
Background Emergency service workers (ESW) are known to be at increased risk of mental disorders but population-level and longitudinal data regarding their risk of suicide are lacking. Method Suicide data for 2001–2017 were extracted from the Australian National Coronial Information Service (NCIS) for two occupational groups: ESW (ambulance personnel, fire-fighters and emergency workers, police officers) and individuals employed in all other occupations. Age-standardised suicide rates were calculated and risk of suicide compared using negative binomial regression modelling. Results 13 800 suicide cases were identified among employed adults (20–69 years) over the study period. The age-standardised suicide rate across all ESW was 14.3 per 100 000 (95% CI 11.0–17.7) compared to 9.8 per 100 000 (95% CI 9.6–9.9) for other occupations. Significant occupational differences in the method of suicide were identified ( p < 0.001). There was no evidence for increased risk of suicide among ESW compared to other occupations once age, gender and year of death were accounted for (RR = 0.99, 95% CI 0.84–1.17; p = 0.95). In contrast, there was a trend for ambulance personnel to be at elevated risk of suicide (RR = 1.41, 95% CI 1.00–2.00, p = 0.053). Conclusion Whilst age-standardised suicide rates among ESW are higher than other occupations, emergency service work was not independently associated with an increased risk of suicide, with the exception of an observed trend in ambulance personnel. Despite an increased focus on ESW mental health and wellbeing over the last two decades, there was no evidence that rates of suicide among ESW are changing over time.
Article
Background and objectives: Parents of children with medical complexity (CMC) experience high levels of stress and adverse mental health outcomes. Pediatric medical traumatic stress (PMTS) could be an important contributor that has not yet been explored. PMTS describes parents' reactions to their child's illness and medical treatment and can lead to post-traumatic stress symptoms. This is the first study to describe the experiences and impact of PMTS among parents of CMC. Methods: We conducted semi-structured interviews with twenty-two parents of CMC. Reflexive thematic analysis was used to generate themes that described the experiences of PMTS and potential contributing factors in the healthcare setting. Themes were validated by study participants. Results: Parents experienced a spectrum of events and circumstances that impacted PMTS. These corresponded to three major themes: (a) the distinctive context of being the parent of a CMC; (b) interactions with healthcare providers that can hurt or heal; and (c) system factors that set the stage for trauma. The consequences of repeated PMTS were a common point of emphasis amongst all the themes. Parents identified numerous changes that could mitigate PMTS such as acknowledgement of trauma and provision of proactive mental health support. Conclusions: Our study highlights the issue of PMTS among parents of CMC and presents opportunities to mitigate their traumatic experiences. Supporting the integration of trauma-informed care practices, increasing awareness of PMTS and advocating for parental mental health services could better support parents and families.
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Post-traumatic stress disorder (PTSD) is a severe and heterogenous psychiatric disorder that was first defined as a mental disorder in 1980. Currently, the Diagnostic and Statistical Manual of Mental Disorders Fifth Edition (DSM-5) and the International Classification of Diseases 11th Edition (ICD-11) offer the most widely accepted diagnostic guidelines for PTSD. In both diagnostic categories, experiencing a traumatic event (TE) is the necessary criterion for diagnosing PTSD. The TEs described in the DSM-5 include actual or threatened death, serious injury, sexual violence, and other extreme stressors, either directly or indirectly. More than 70% of adults worldwide are exposed to a TE at least once in their lifetime, and approximately 10% of individuals develop PTSD after experiencing a TE. The important features of PTSD are intrusion or re-experiencing fear memories, pervasive sense of threat, active avoidance, hyperarousal symptoms, and negative alterations of cognition and mood. Individuals with PTSD have high comorbidities with other psychiatric diseases, including major depressive disorder, generalized anxiety disorder, and substance use disorder. Multiple lines of evidence suggest that the pathophysiology of PTSD is complex, involving abnormal neural circuits, molecular mechanisms, and genetic mechanisms. A combination of both psychotherapy and pharmacotherapy is used to treat PTSD, but has limited efficacy in patients with refractory PTSD. Because of the high prevalence, heavy burden, and limited treatments, PTSD is a psychiatric disorder that requires urgent attention. In this review, we summarize and discuss the diagnosis, prevalence, TEs, pathophysiology, and treatments of PTSD and draw attention to its prevention.
Article
Background Firefighters are faced with numerous work-related demands and stressors, including exposure to potentially traumatic events, and are thus at an increased risk for poor mental health outcomes. To better understand the mental health of trauma-exposed firefighters, the current study sought to examine the association of fatigue sensitivity with posttraumatic stress disorder (PTSD), anxiety, and depressive symptom severity in a cross-sectional study design. Methods Participants included 107 (Mage = 40.8 years; SDage = 8.95; age range: 21–67 years; 95.0% male) trauma-exposed firefighters. Results Findings from the current study indicated that fatigue sensitivity was a statistically significant clinical correlate of PTSD, anxiety, and depressive symptom severity. The statistically significant incremental effects were small to medium across the mental health variables, but evident after accounting for years in the fire service, sleep quality, and trauma load. Conclusions The present data provide initial empirical evidence for the role of fatigue sensitivity in terms of a broad range of mental health indices among trauma-exposed firefighters.
Article
Adli bir olayı öğrenen kolluğun yapacağı ilk işlem olay yerine, olayın büyüklüğüne, muhtemel etki alanına ve faillerin sayısına göre yeterli personel ve donanım ile ilk tedbirlerin uygulanması amacıyla ve en kısa sürede olay yerine intikal etmektir. Olay yerinde yapılacak ilk işlemlerden bir tanesi de olay yeri alanının belirlenmesi ve delillerin bulunduğu yerde koruma altına alınmasıdır. Çünkü delil olmadan mahkemelerin mahkûmiyet kararı verememesi veya adli olayların faili meçhul kalması sebebiyle son zamanlarda ülkeler olay yeri incelemesine odaklanmaktadır. Olay yeri incelemesi suç soruşturmasının ilk ve en önemli aşamasıdır. Soruşturmanın tamamını etkileyecek olan bu çalışma çok dikkatli bir şekilde yerine getirilip tüm delillerin kayıt altına alınarak adli olayın aydınlatılması gerekir. Ancak bütün bu işlemler yapılırken suç aleti ve olayla ilgisi olduğu belli olan suç eşyaları ve diğer deliller genelde koruma altına alınırken ayakkabı izleri ilk bakışta dikkat çekmediğinden, bilgisizlik ve ihmalkârlıktan kaynaklı gerek kolluk kuvvetleri gerekse olay yerindeki diğer ilgisiz kişiler tarafından zarar verilmektedir. Oysa her adli olayda ayakkabı izlerinin olmaması mümkün değildir. Bu makalede suç soruşturmasında olay yeri incelemesinin önemine bu işlem yapılırken nelere dikkat edilmesi gerektiğinden bahsedilmektedir.
Article
Background and Aim: The current study aimed to translate the Firefighter Coping Self-Efficacy Scale (FFCSE) and explore its dimensionality and psychometric characteristics. Method: This cross-sectional study was authorised by the National Emergency and Civil Protection Authority and disseminated by firefighters' stations from different districts. A sample of 155 firefighters completed online the following self-report instruments: Firefighter Coping Self-Efficacy Scale, Comprehensive Assessment of Acceptance and Commitment Therapy Processes, World Health Organization Index-5, Perceived Stress Scale and Patients Health Questionnaire-4. An exploratory factor analysis was computed, and reliability and validity studies were conducted. Results: The Portuguese version of the FFCSE items revealed, in general, good psychometric characteristics, except for item 10 ("Having dreams about difficult calls"). The factor structure was one-dimensional. The FFCSE showed good internal consistency, and the associations with the other variables were in the expected direction. No differences were found between men and women in the FFCSE mean scores. There was no statistically significant association between the FFCSE and age, years of education or length of service as firefighters. Conclusions: The FFCSE proved to be a one-dimensional measure of perceived self-efficacy to deal with the demands inherent to the firefighter activity. The results suggest that it is a valid and reliable measure, useful in research, clinical and training contexts for these professionals.
Article
Introduction The 2019-2020 “Black Summer” bushfires in Australia focused the attention of the nation on the critical role that volunteer firefighters play in the response to such a disaster, spurring a national conversation about how to best support those on the frontline. The objective of this research was to explore the impact of the Black Summer bushfires on volunteer firefighter well-being and to investigate how to deliver effective well-being support. Methods An explorative qualitative design underpinned by a phenomenological approach was applied. Participant recruitment followed a multi-modal sampling strategy and data were collected through semi-structured, in-depth interviews. Results Qualitative data were collected from 58 participants aged from 23 to 61-years-of-age (average age of 46 years). All self-reported as volunteer firefighters who had responded to the Black Summer bushfires in Australia. Just over 80% of participants were male and the majority lived in the Australian states of New South Wales (65%) and Victoria (32%). All participants reported impact on their well-being, resulting from cumulative trauma exposure, responding to fires in local communities, intense work demands, minimal intervals between deployments, and disruption to primary employment. In regard to supporting well-being, four key themes emerged from data analysis: (1) Well-being support needs to be both proactive and reactive and empower local leaders to “reach in” while encouraging responders to “reach out;” (2) Employee Assistance Programs (EAPs) should not be the only well-being support option available; (3) The sharing of lived experience is important; and (4) Support programs need to address self-stigmatization. Conclusion Participants in this research identified that effective well-being support needs to be both proactive and reactive and holistic in approach.
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La atención prehospitalaria o la respuesta a una emergencia en el escenario prehospitalario, definido en un contexto internacional, comprende todas las intervenciones médicas y de transporte realizadas a pacientes que presentan eventos médicos o traumáticos en diferentes escenarios fuera del ámbito hospitalario. Quienes realizan la labor prehospitalaria deben enfrentarse a situaciones y escenarios variados, complejos y no controlados; todas estas situaciones implican estar expuestos a una variabilidad de riesgos que pueden ser prevenibles si se toman las medidas necesarias para mitigarlos. Los riesgos biológicos, biomecánicos, psicosociales, físicos, asociados a la violencia física y verbal, entre otros, exponen a este personal al desarrollo de accidentes de trabajo y enfermedades laborales en muchas ocasiones de magnitudes severas y con graves consecuencias. Caracterizar la labor prehospitalaria plantea muchos desafíos, la atención del paciente varía con cada llamada, y esta, a su vez, presenta retos únicos dependiendo del estado clínico, la necesidad de cada paciente y el escenario donde se está presentando el evento. Conocer con más detalle los riesgos laborales de esta profesión que diariamente se expone a situaciones diversas y diseñar estrategias para mejorar la salud y el bienestar de los trabajadores de esta área, se traduce en una atención médica de emergencia más efectiva y eficiente, contribuyendo a mejorar la calidad y a fortalecer los sistemas de salud en el ámbito prehospitalario.
Article
Purpose Young adults have been particularly adversely affected by COVID-19-related disruptions, especially in relation to industries with an over-representation of young adults. This study, a report, aims to discuss the findings from survey data from young adults who reported poorer mental health comparative to older generations prior to the pandemic. Drawing on the international literature and the research findings, the authors propose recommendations for rebuilding the workplace post-pandemic to support young adult's mental health. Design/methodology/approach Data from 1,999 respondents from 200 organisations in the UK were sought in relation to workplace well-being and mental health through a 15-item multiple choice online survey. Overall, 17% of the sample were senior management, 31% junior management, 37% in non-management roles and a further 15% stated “other”. Exploratory quantitative analyses were undertaken to assess differences in responses to questions between age groups. Findings Participants in the 16–25-year-old age group were more likely than any other age group to report that work adversely affected their mental health, that their mental health challenges influenced their performance at work, that they had witnessed colleagues' employment negatively influenced by mental health challenges and they felt more comfortable citing physical health challenges for absence than mental health difficulties. Originality/value COVID-19-related disruptions meant a large-scale move to remote working for many people. As we return to physical workplaces, we have an exciting opportunity to reform and improve the status quo. The findings, in relation to the mental health of young adults, highlight key risk factors that need to be addressed.
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Objectives Firefighters are regularly exposed to potentially traumatic and injurious events and are at increased risk for developing posttraumatic stress disorder (PTSD) symptoms, pain, and pain-related disability. Mindfulness (i.e., present-oriented awareness and nonjudgmental acceptance of cognitions and bodily sensations) may influence PTSD-pain relations in firefighter populations and inform mutual maintenance models. The current cross-sectional study sought to examine the moderating role of mindfulness on the associations between PTSD symptom severity and pain-related disability and intensity among trauma-exposed firefighters. Methods Firefighters (N = 266; Mage = 40.48, SD = 9.70; 92.5% male) were recruited from a large, southwestern metropolitan area and voluntarily completed an online, self-report survey advertised throughout the fire department. Results Accounting for covariates (i.e., age, years in the fire service, trauma load), a significant interactive effect of PTSD symptom severity and mindfulness on pain-related disability (ΔR² = 0.05, B = − 0.16, p < .001), but not pain intensity, emerged. Simple slope analyses revealed that PTSD symptom severity was associated with pain-related disability for those with low, but not high mindfulness. Post hoc analyses examining mindfulness facets revealed significant main effects of acting with awareness, non-judging of inner experience, and nonreactivity to inner experience on pain-related disability. Significant interactive effects of observing, describing, and nonreactivity to inner experience with PTSD symptom severity on pain-related disability emerged. Conclusions Mindfulness moderates PTSD symptom severity and pain-related disability associations in trauma-exposed firefighters. Future work should further examine these associations among first responders, using experimental and/or longitudinal methodologies.
Article
Background Firefighting has been associated with posttraumatic stress disorder (PTSD) and other mental health conditions. We previously found that among Fire Department of the City of New York (FDNY) responders to the World Trade Center (WTC) disaster, higher-intensity WTC-exposure predicted PTSD symptoms, depressive symptoms, and subjective cognitive concerns. The present study aims to compare these symptoms in the FDNY WTC-exposed cohort versus a comparison cohort of non-FDNY, non-WTC-exposed firefighters. Methods The study population included WTC-exposed male firefighters from FDNY (N = 8466) and non-WTC-exposed male firefighters from Chicago (N = 1195), Philadelphia (N = 770), and San Francisco (N = 650) fire departments who were employed on 9/11/2001 and completed a health questionnaire between 3/1/2018 and 12/31/2020. Current PTSD symptoms, depressive symptoms, and subjective cognitive concerns were assessed via validated screening instruments. Multivariable linear regression analyses stratified by fire department estimated the impact of covariates on each outcome. Results Adjusted mean PTSD symptom scores ranged from 23.5 ± 0.6 in Chicago firefighters to 25.8 ± 0.2 in FDNY, and adjusted mean depressive symptom scores ranged from 7.3 ± 0.5 in Chicago to 9.4 ± 0.6 in Philadelphia. WTC-exposure was associated with fewer subjective cognitive concerns (β = −0.69 ± 0.05, p < .001) after controlling for covariates. Across cohorts, older age was associated with more cognitive concerns, but fewer PTSD and depressive symptoms. Conclusions WTC-exposed firefighters had fewer cognitive concerns compared with non-WTC-exposed firefighters. We were unable to estimate associations between WTC exposure and PTSD symptoms or depressive symptoms due to variability between non-WTC-exposed cohorts. Longitudinal follow-up is needed to assess PTSD, depressive, and cognitive symptom trajectories in firefighter populations as they age.
Article
Firefighters are chronically exposed to potentially traumatic events, augmenting their risk of developing posttraumatic stress disorder (PTSD). The current study aimed to examine the incremental associations of lower-order dimensions of anxiety sensitivity (AS), examined concurrently, and PTSD symptom severity among a sample of trauma-exposed firefighters. We hypothesized that AS physical and cognitive concerns would be strongly associated with all PTSD symptom clusters and overall symptom severity, after controlling for theoretically relevant covariates (trauma load; years in fire service; alcohol use severity; depressive symptom severity). Participants were comprised of firefighters (N = 657) who completed an online questionnaire battery and endorsed PTSD Criterion A trauma exposure. Results revealed that the AS cognitive concerns, but not AS physical concerns, was significantly and robustly associated with overall PTSD symptom severity, intrusion symptoms, and negative alterations in cognitions and mood (∆R2’s = .028–.042; p’s < .01); AS social concerns was incrementally associated with PTSD avoidance (∆R2 = .03, p < .01). Implications for firefighter-informed, evidence-based interventions are discussed.
Article
The present investigation evaluated the preliminary impact of COVID-19 exposure on first responder mental health. Data were collected between June and August 2020. The sample was comprised of 189 first responders (M age = 47.58, SD = 10.93; 21% female), recruited nationally, who completed an online survey. Results indicated that COVID-19-exposed first responders were more likely to be emergency medical services [EMS] personnel (vs. non-EMS) in career (vs. volunteer) roles. COVID-19-exposed first responders reported higher alcohol use severity; no other between-group differences were noted. COVID-19-related worry and medical vulnerability were incrementally associated with more severe symptoms of anxiety and depression; only COVID-19-related worry was associated with alcohol use severity. Among the subset of first responders (n = 122) who reported COVID-19 exposure, COVID-19-related worry was significantly associated with PTSD symptom severity. Covariates included gender, trauma load, years as a first responder, and COVID-19 exposure. Clinical and policy implications as well as future directions will be discussed.
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Aims: Major depressive disorders are common, with substantial impact on individuals/society. Brief scales for depression severity, based on a small number of characteristics all of which are necessary for diagnosis, have been recommended in self-reported versions for clinical work or research when aiming to quickly and accurately measure depression. We have examined psychometric properties of a brief 6-item version of the Symptom Checklist (SCL), the Symptom Checklist core depression scale (SCL-CD6) and aimed to identify a cut-point for epidemiological research. Methods: The psychometric evaluation of the SCL-CD6 was mainly performed by a Mokken analysis of unidimensionality in a random sample of 1476 residents in the Stockholm County, aged 18-64 years. The standardization of SCL-CD6 was based on ROC analysis, using the Major Depression Inventory as index of validity. Predictive validity was subsequently assessed using register data on hospital admissions and purchases of prescribed medications linked to a sample of 5985 participants in the Swedish Longitudinal Occupational Survey of Health (SLOSH). Results: The SCL-CD6 obtained a coefficient of homogeneity of 0.70 by Mokken analysis, which indicates high unidimensionality and a meaningful dimensional measure of depression severity. By ROC we identified a score of 17 or higher (total range 0-24) as the best cut-point for major depression (sensitivity 0.68, specificity 0.98) which predicted subsequent purchases of antidepressants as well as hospitalisations with a depressive episode. Conclusions: The SCL-CD6 was found a valid depression scale with higher unidimensionality than longer epidemiological instruments and thus particularly suitable for assessment in larger population surveys.
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The Satisfaction With Life Scale (SWLS) was developed to assess satisfaction with the respondent’s life as a whole. The scale does not assess satisfaction with life domains such as health or finances but allows subjects to integrate and weight these domains in whatever way they choose. Normative data are presented for the scale, which shows good convergent validity with other scales and with other types of assessments of subjective well-being. Life satisfaction as assessed by the SWLS shows a degree of temporal stability (e.g., 54 for 4 years), yet the SWLS has shown sufficient sensitivity to be potentially valuable to detect change in life satisfaction during the course of clinical intervention. Further, the scale shows discriminant validity from emotional well-being measures. The SWLS is recommended as a complement to scales that focus on psychopathology or emotional well-being because it assesses an individuals’ conscious evaluative judgment of his or her life by using the person’s own criteria.
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Emergency service personnel are at high risk of developing post-traumatic stress disorder (PTSD). However, there is little in-depth information on the psychological responses of firefighters to the daily incidents that they attend. This preliminary study aimed to investigate the PTSD symptoms of firefighters in relation to traumatic events experienced by them, and the availability of social support. Thirty-one UK fire service workers completed an adapted version of the Post-traumatic Diagnostic Scale (PDS; Foa, 1995) to investigate the existence of post-traumatic stress disorder (PTSD). They were also individually interviewed to explore the symptoms they had experienced, what events these were related to, types of social support and coping strategies. Two participants reached the DSM-IV criteria for PTSD. Rumination and sleep disturbance were the most commonly reported PTSD symptoms. Participants reported high levels of social support from within the service and outside. The results suggest that fire service personnel are at risk of developing some symptoms of PTSD; however most had not experienced severe enough symptoms for PTSD to be diagnosed. The study suggests that high levels of social support may play a role in buffering firefighters from the development of PTSD.
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Spontaneous neoplasms in Mongolian gerbils have an incidence of 20% to 26.8%, but osteosarcomas occur at a much lower rate. Here we report a 1-y-old Mongolian gerbil with a spontaneous osteosarcoma at the level of the proximal tibia, with metastases to the pectoral muscles and lungs. Grossly, the tibial mass obliterated the tibia and adjacent muscles, and an axillary mass with a bloody, cavitary center expanded the pectoral muscles. Microscopically, the tibial mass was an infiltrative, osteoblastic mesenchymal neoplasm, and the axillary mass was an anaplastic mesenchymal neoplasm with hemorrhage. The lung contained multiple metastatic foci. Immunohistochemistry for osteonectin was strongly positive in the tibial, axillary, and pulmonary metastases. Although osteosarcoma is the most common primary malignant bone neoplasm that occurs spontaneously in all laboratory and domestic animal species and humans, it arises less frequently than does other neoplasms. The current case of spontaneous osteoblastic osteosarcoma of the proximal tibia and metastases to the pectoral muscles and lung in a Mongolian gerbil is similar in presentation, histology, and predilection site of both osteoblastic and telangiectatic osteosarcomas in humans. In addition, this case is an unusual manifestation of osteosarcoma in the appendicular skeleton of a Mongolian gerbil.
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Background: Longitudinal symptoms of post-traumatic stress disorder (PTSD) are often characterized by heterogeneous trajectories, which may have unique pre-, peri- and post-trauma risk and protective factors. To date, however, no study has evaluated the nature and determinants of predominant trajectories of PTSD symptoms in World Trade Center (WTC) responders. Method: A total of 10835 WTC responders, including 4035 professional police responders and 6800 non-traditional responders (e.g. construction workers) who participated in the WTC Health Program (WTC-HP), were evaluated an average of 3, 6 and 8 years after the WTC attacks. Results: Among police responders, longitudinal PTSD symptoms were best characterized by four classes, with the majority (77.8%) in a resistant/resilient trajectory and the remainder exhibiting chronic (5.3%), recovering (8.4%) or delayed-onset (8.5%) symptom trajectories. Among non-traditional responders, a six-class solution was optimal, with fewer responders in a resistant/resilient trajectory (58.0%) and the remainder exhibiting recovering (12.3%), severe chronic (9.5%), subsyndromal increasing (7.3%), delayed-onset (6.7%) and moderate chronic (6.2%) trajectories. Prior psychiatric history, Hispanic ethnicity, severity of WTC exposure and WTC-related medical conditions were most strongly associated with symptomatic trajectories of PTSD symptoms in both groups of responders, whereas greater education and family and work support while working at the WTC site were protective against several of these trajectories. Conclusions: Trajectories of PTSD symptoms in WTC responders are heterogeneous and associated uniquely with pre-, peri- and post-trauma risk and protective factors. Police responders were more likely than non-traditional responders to exhibit a resistant/resilient trajectory. These results underscore the importance of prevention, screening and treatment efforts that target high-risk disaster responders, particularly those with prior psychiatric history, high levels of trauma exposure and work-related medical morbidities.
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Reserve and National Guard forces have been mobilized to an unprecedented degree in recent overseas conflicts. There is concern that rates of psychological problems may continue to rise for many years after deployment. The authors conducted a cohort study of 552 United Kingdom Reservists who deployed to Iraq in 2003 and 391 nondeployed Reservists. Measures of mental health and social functioning were collected a mean of 16 months and 4.8 years after return from possible deployment. At the first follow-up, deployment was associated with increased common mental disorder, post-traumatic stress disorder (PTSD), and poor general health. By the second follow-up, those who had deployed were no longer at increased risk for common mental disorder or poor general health and had good levels of social functioning. However, those who deployed continued to have over twice the odds of PTSD (odds ratio = 2.42, 95% confidence interval: 1.04, 5.62) and were more likely to report actual or serious consideration of separation from their partner. In conclusion, the authors found that the majority of mental health and social problems following deployment are transient. However, Reservists who deployed in the Iraq War remain at increased risk of PTSD and relationship problems 5 years after their tour of duty.
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Over the last century, prevention has become an increasingly important part of modern healthcare. For example, the decline in infectious diseases is due more to preventive strategies such as immunisation and hygiene than to Alexander Fleming's discovery of penicillin. Life style changes and prophylactic medication have reduced coronary heart disease over the last decades. There is now an increased focus on how to prevent mental disorders.1 The arguments supporting a preventative approach to depression are compelling. While effective treatments for depression are available, the experience of a depressive illness is both distressing and associated with poorer physical health,2 occupational dysfunction3 and increased mortality.4 In most countries depression is usually treated by general practitioners, who do not feel sufficiently resourced to provide optimal treatment.5 Even in the unlikely event of optimal treatment being delivered to all affected patients, cost-effectiveness models suggest only 35–50% of the overall burden of illness would be alleviated.6 The standard …
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Symptoms of posttraumatic stress disorder (PTSD) have been extensively studied in victim populations (e.g., survivors of sexual assault), but not nearly as thoroughly in the responders who come to the aid of those victims, particularly firefighters. The prevalence rates for PTSD (as defined by previous authors) in firefighters vary widely, from 6.5% to 37%, using various cutoff scores on a variety of measures (primarily self-report) with rather dissimilar samples and events. This study utilized the Posttraumatic Stress Disorder Checklist (PCL), a measure consistent with current DSM-IV criteria, to evaluate the prevalence of PTSD symptoms in 131 firefighters from two US states. Using a standard cutoff score on the PCL, a prevalence rate of 8% was found. When measures of fear, helplessness, or horror (DSM-IV Criterion A2) and functional impairment (Criterion F) were included, a lower prevalence rate of 5% was obtained, a rate lower than typically is found in previously published reports. Previous psychological treatment, age at which the firefighters started working, Miscellaneous Calls, and the response of horror following the firefighter's Single Worst Event predicted PTSD symptoms. The present findings highlight the importance of using a symptom measure consistent with the full DSM-IV criteria to more fully assess firefighters’ responses of fear, helplessness, and horror.
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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 sought to estimate the pooled current prevalence of posttraumatic stress disorder (PTSD) among rescue workers and to determine the variables implicated in the heterogeneity observed among the prevalences of individual studies. A systematic review covering studies reporting on the PTSD prevalence in rescue teams was conducted following four sequential steps: (1) research in specialized online databases, (2) review of abstracts and selection of studies, (3) review of reference list, and (4) contact with authors and experts. Prevalence data from all studies were pooled using random effects model. Multivariate meta-regression models were fitted to identify variables related to the prevalences heterogeneity. A total of 28 studies, reporting on 40 samples with 20,424 rescuers, were selected. The worldwide pooled current prevalence was 10%. Meta-regression modeling in studies carried out in the Asian continent had, on average, higher estimated prevalences than those from Europe, but not higher than the North American estimates. Studies of ambulance personnel also showed higher estimated PTSD prevalence than studies with firefighters and police officers. Rescue workers in general have a pooled current prevalence of PTSD that is much higher than that of the general population. Ambulance personnel and rescuers from Asia may be more susceptible to PTSD. These results indicate the need for improving pre-employment strategies to select the most resilient individuals for rescue work, to implement continuous preventive measures for personnel, and to promote educational campaigns about PTSD and its therapeutic possibilities.
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Since the World Trade Center (WTC) attacks on September 11, 2001, the Fire Department, City of New York Monitoring Program has provided physical and mental health screening services to rescue/recovery workers. This study evaluated performance of the self-report PTSD Checklist (PCL) as a screening tool for risk of posttraumatic stress disorder (PTSD) in firefighters who worked at Ground Zero, compared with the interviewer-administered Diagnostic Interview Schedule (DIS). From December 2005 to July 2007, all retired firefighter enrollees completed the PCL and DIS on the same day. Sensitivity, specificity, receiver operating characteristic (ROC) curves, and Youden index (J) were used to assess properties of the PCL and to identify an optimum cutoff score. Six percent of 1,915 retired male firefighters were diagnosed with PTSD using the DIS to assess DSM-IV criteria. Depending on the PCL cutoff, the prevalence of elevated risk relative to DSM-IV criteria varied from 16% to 22%. Youden index identified an optimal cutoff score of 39, in contrast with the frequently recommended cutoff of 44. At 39, PCL sensitivity was 0.85, specificity was 0.82, and the area under the ROC curve was 0.91 relative to DIS PTSD diagnosis. This is the first study to validate the PCL in retired firefighters and determine the optimal cutoff score to maximize opportunities for PTSD diagnosis and treatment.
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This paper reports on a statistically significant association between alcohol use and deployment to the 2003 Iraq War. It assesses the occupational factors and deployment experiences associated with heavy drinking in regular UK servicemen deployed to Iraq in the first phase of the 2003 Iraq War (Operation TELIC 1, the military codename for the conflict in Iraq). A random representative sample of 3578 regular male UK Armed Forces personnel who were deployed to Iraq during Operation TELIC 1 participated in a cross-sectional postal questionnaire study (response rate 61%). Participants completed a questionnaire, between June 2004 and March 2006 (ie, after deployment), about their health, including a measure of alcohol use (Alcohol Use Disorders Identification Test, AUDIT) and questions about their experiences on deployment to Iraq. Heavy drinkers were identified as those scoring 16 or above on the AUDIT. After adjustment for sociodemographic and military factors, and the presence of psychological distress, heavy drinkers were more likely to have had major problems at home during (odds ratio (OR) 1.33, 95% confidence interval (CI) 1.04 to 1.70) and following their deployment (OR 1.68, 95% CI 1.32 to 2.14). Being deployed with their parent unit (OR 1.28, 95% CI 1.02 to 1.61), medium to high in-theatre unit comradeship (medium: OR 1.35, 95% CI 1.04 to 1.77; high: OR 1.35, 95% CI 1.02 to 1.79) and poor unit leadership (OR 1.78, 95% CI 1.37 to 2.31) were also associated with heavy drinking. Deployment experiences and problems at home during and following deployment, as well as the occupational milieu of the unit, influence personnel's risk of heavy drinking.
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Little is known about the U-shaped relation between alcohol intake and health beyond findings related to cardiovascular disease. Medically certified sickness absence is a health indicator in which coronary heart disease is only a minor factor. To investigate the relation between alcohol intake and sickness absence, records regarding medically certified sick leaves from all causes were assessed for 4 years (1997-2000) in a cohort of 1,490 male and 4,952 female municipal employees in Finland. Hierarchical Poisson regression, adjusted for self-reported behavioral and biologic risk factors, psychosocial risk factors, and cardiovascular diseases, was used to estimate the rate ratios and their 95% confidence intervals, relating sickness absence to each level of alcohol consumption. For both men and women, a significant curvilinear trend was found between level of average weekly alcohol consumption and sickness absence. The rates of medically certified sickness absence were 1.2-fold higher (95% confidence interval: 1.1, 1.3) for never, former, and heavy drinkers compared with light drinkers. The U-shaped relation between alcohol intake and health is not likely to be explained by confounding due to psychosocial differences or inclusion of former drinkers in the nondrinkers category. Moderate alcohol consumption also may reduce health problems other than cardiovascular disease.