Article

First responder mental healthcare: Evidence-based prevention, postvention, and treatment

Authors:
  • Psychological Solutions LLC (private practice)
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Abstract

Recent national tragedies of hurricanes, mass shootings, gun violence in schools, wild fires, and mudslides have drawn our attention to the trauma of affected individuals and schoolchildren, but less to the stressors of first responders. While commonly regaled as “heroes,” responders face a scarcity of systemic and tailored mental health support. First responders are susceptible to witnessing a wide array of traumatic events, often in their own communities, that contribute to their stress (Benedek, Fullerton, & Ursano, 2007; Castellano & Plionis, 2006; Kleim & Westphal, 2011). This article critiques systemic resources for first responders’ mental healthcare; addresses their personal-social characteristics as well as workplace cultural stigma about help-seeking attitudes; and includes a needs assessment of first responders’ resilience that was conducted by one of the authors (Roysircar, 2008a). Using this evidence-based practice knowledge about first responders, the authors present three hypothetical vignettes that highlight the different challenges that commonly effect first responders and recommend interventions. The authors advocate for access to specialized resources that enhance first responders’ preparedness for a potentially traumatic event (i.e., prevention education); increase their coping skills and social connections after an event (i.e., postvention service); and provide ongoing mental healthcare (i.e., treatment) that is culturally tailored to first responders’ unique needs arising from their work context and identity.

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... Interviewing survivors and first responders who sought treatment following a disaster may offer a starting point for understanding what type of treatments are effective. First responders especially, experience trauma on a regular basis and are in need of effective mental health treatments (Lanza et al., 2018). ...
... These disorders and other behavioral responses to trauma have been shown to vary based upon occupation (Wesemann et al., 2018). Researchers are now advocating for more evidence-based prevention and treatment programs to improve first responder mental healthcare (Haugen, McCrillis, Smid and Nijdam, 2017;Lanza et al., 2018). However, there is a gap in the literature as to what treatment modalities are effective for all survivors of disasters (Goldman & Galea, 2014). ...
... These findings are indicative of how traumatic events can affect first responders in multiple ways over time, and organizations such as the National Fallen Firefighters recognize the need for treatments that are effective and specific to first responders (Jones et al., 2018). The literature illustrates how the impact of traumatic events on first responders' mental health is common knowledge, and the stressors are short-term rather than cumulative and persisting over time (Lanza et al., 2018). What is unknown is effective treatments from the voices of those who have suffered (and possibly continue to suffer) and sought treatment (Goldman & Galea, 2014). ...
Thesis
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The general societal problem is unmet mental health needs following disasters. Although some interventions have been found to be effective in random controlled studies, the effectiveness of treatments with mental health providers and the general population are needed to evaluate how well they work in the real world. Learning about effective interventions in treating survivors and first responders following disasters is important so resources are not wasted on ineffective treatments. Accordingly, the purpose of this qualitative method, case-study was to explore survivor and first responder perceptions about effective mental health treatments following disasters. A multiple embedded case study was used to reveal perceptions about effective treatments following different types of disasters and differences in perceptions as a function of subunit (survivors and first responders). Five adult survivors and five adult first responders were interviewed via Zoom to hear their ‘voice.’ This research extends the value of universalism of Schwartz’s theory of basic values. One subtype of universalism is the concern for those in the larger society and the world. The problem with the theory was no guideline or map was offered to implement this value. This study offers one. There were three main differences between survivors and first responders. Survivors found psychotropic medications helpful and first responders found couples therapy and pets to be effective treatments. Group and individual therapy were noted by both groups to be helpful, along with provider effectiveness and selftreatments. The implications are 12 sessions of therapy after disasters may be insufficient, and group therapy needs to be offered. It is recommended that therapists be trained in trauma and first responder culture, and couples therapy be offered to support first responders. Additionally, it is recommended that studies be done in other countries since this one was confined to the United States, and that children and adolescents be included. Finally, it is recommended that more studies be done on how pets aid in the healing process, and if one type of pet is preferable over another.
... Past studies have found that despite being at high risk, healthcare providers (Chew-Graham et al., 2003;Clement et al., 2015;Dyrbye et al., 2015;Epstein & Privitera, 2019;Firth-Cozens, 2001;Givens & Tjia, 2002;Gulliver et al., 2010;Kirch, 2021;Moutier, 2018;Schwenk et al., 2010) and first responders (Castellano & Plionis, 2006;Jones, 2017;Kleim & Westphal, 2011;Lanza et al., 2018;Velazquez & Hernandez, 2019;Zolnikov & Furio, 2020) underutilize mental healthcare due to workplace stigma. Moreover, Chinese frontline HCW's reluctance to access psychological assistance might be further exacerbated by China's historical and contemporary societal context. ...
... Given the high prevalence of mental health consequences among first responders in general, frontline HCW may benefit from prevention programs (Kleim & Westphal, 2011;Lanza et al., 2018), including psychoeducation about what symptoms warrant intervention. Further, given that the HCW voiced concerns about burdening the mental health system, additional information about the scope of the mental health services provided to them might ease such reluctance. ...
... In addition to increasing mental health service access, cultivating effective support from social relationships may be particularly beneficial to frontline HCW in the Chinese cultural and societal context, as compared to taking a psychopathological approach inherited from medical/psychiatric models of suffering (Luhrmann, 2000). At the same time, given that HCW's individual experiences would inevitably vary, and mental health stigma is widespread among HCW and first responders (Chew-Graham et al., 2003;Drew & Martin, 2021;Harris et al., 2019;Kleim & Westphal, 2011;Lanza et al., 2018;K. Wang et al., 2018), HCW might benefit from further normalization of work challenges, so they could feel less pressured when engaging in self-care or seeking services. ...
Article
Full-text available
Frontline health providers who worked in Hubei, China during the initial outbreak of the novel coronavirus (COVID-19) experienced poorer mental health outcomes than those who worked elsewhere in China, but many of these workers denied psychological challenges and did not use resources when offered. This study investigated challenges, mental health, sources of strength and coping strategies among frontline healthcare professionals working in the initial Hubei COVID-19 outbreak. Healthcare workers (N = 23) who went to Hubei during the COVID-19 outbreak completed a semi-structured interview about their experiences at the frontline and use of mental health resources. Thematic analysis revealed several challenges participants faced as a result of their work conditions. The vast majority of participants reported physical and psychological symptoms. Nevertheless, some denied experiencing any distress and none accessed psychological assistance as a way of self-care. Participants' described their social network as particularly helpful as they were coping with the intensive work demands, and that their strong sense of responsibility for patients and trust in the medical system were sources of strength. Our findings highlight that even in the face of stress-related challenges, health care workers may not seek care for their physical and psychological symptoms, which may lead to persistent mental health consequences. Implications for providing mental health services to healthcare providers and first responders are discussed in the Chinese cultural and societal context; we offer considerations for bridging health resources in China with the potential for establishing a more responsive and equitable mental health infrastructure.
... When dealing with these symptoms and disorders, dysfunctional coping strategies play a crucial role [6][7][8]. Therefore, in order to decrease the reliance on these strategies and to reduce their negative impact, programs and interventions ought to be developed (e.g., [4,9,10]), which calls for the need to deepen the knowledge on the variables than can contribute to dysfunctional coping. Specifically, research needs to compare the contribution of personal characteristics, such as resilience, and of occupational factors, such as perceived stress in potentially traumatic incidents. ...
... These findings are consistent with previous studies in Portugal [22] and with international studies [21,10]. However, in this study rescuers only achieved a score of 175 out of 275, highlighting that more work can be done to enhance this characteristic [9,10]. Furthermore, is important to note that the instrument used to measure resilience [33,17] conceptualizes it as a positive psychological trait and as beliefs of personal competence and of self and life acceptance, which may or may not promote a positive adjustment. ...
... Training may benefit from being focused on how EMTs experience and cope with stressful and potentially traumatic stimuli. Studies suggested this training can include psychoeducation and practical exercises (through roleplaying or virtual reality), focused on psychological first aid and stress management (e.g., [1,44,9,10,45]). These topics can be explored individually and when interacting with victims, family members and/or colleagues. ...
Article
Background: Emergency Medical Technicians (EMTs) are at high risk for traumatic disorders, and these disorders are more likely if they resort to dysfunctional coping. However, few studies have examined how dysfunctional coping can be decreased, specifically by comparing the impact of personal characteristics, such as resilience, and of occupational factors, such as stress. This study examines the contribution of resilience and perceived stress on EMTs’ dysfunctional coping. Methods: A total of 502 EMTs (66% men), with a job experience of approximately 8 years (SD = 3.84), answered the Resilience Scale (Self and Life Acceptance; Personal Competence; Total score), Brief Cope, and Anxiety Depression Stress Scales. Results: EMTs reported high resilience, low stress and dysfunctional coping. Resilience dimensions, specifically self and life acceptance, and stress contributed to dysfunctional coping. Stress displayed the highest regression coefficient. The effect of self and life acceptance on dysfunctional coping was no longer significant when accounting for stress, revealing a full mediation effect. Conclusions: How EMTs perceive stress can mitigate the protective role of acceptance on the use of dysfunctional coping. These findings suggest EMTs’ occupational training may benefit from focusing on how to manage stressful and critical incidents, as well as on how to cope with stress.
... There is, however, limited research on resiliency in first responders (Lanza et al. 2018), especially in terms of whether it functions as a mechanism by which OS does or does not result in negative mental health consequences. Protective factors that counteract the development of adverse mental health consequences include a greater sense of self-worth, adaptive social functioning across occupational, social leisure activities, and familial domains (i.e., better social adjustment) during police academy training (Yuan et al. 2011) and social support, with the latter being the most robust predictor for PTSD after traumatic events (Brewin et al. 2000;Ozer et al. 2003). ...
... Resiliency-promotion paradigms have been found to be effective in several domains; for instance, Arnetz et al. (2008) have found that implementing such paradigms may improve well-being, promote stress resiliency, and optimize job performance in a sample of police officers. Additionally, Lanza et al. (2018) have advocated for enhancing resiliency in first responders via self-care workshops for prevention, postvention, and treatment for occupation-related stress and trauma. Notably, there is limited research on resiliency in first responders; thus, Lanza et al.'s (2018) argument was predicated on inferring information from existing findings on the benefits of self-compassion (Germer and Neff 2013) and self-care for professional work (APA, 2002). ...
... First, we were unable to conduct analyses differentially by employment role, which precludes our ability to determine the extent to which our findings figure prominently across all forms of first responder groups. As it stands, Kleim and Westphal (2011) have discussed that first responders face unique mental health consequences and have unique needs based on their employment type (e.g., firefighters, police, volunteers, etc.); thus, any form of resiliency-promoting intervention may need to be specific to employment type (Lanza et al. 2018). ...
Article
First responders experience substantial stress due to the nature of their work (Carleton et al. 2017). Occupational stress (OS) results from a myriad of employment conditions (e.g., ambiguous work expectations, unreasonable workload; Osipow 1998). OS can lead to maladaptive anger, which negatively impacts personal well-being and work performance (Velichkovsky 2009). In contrast, resilience to demanding working conditions is associated with lower state and trait anger (Wilson et al. 2001); thus, resilience may serve a protective ‘buffer’ role against anger in the face of stress. Thus, we hypothesized that resiliency would mediate relations between dimensions of OS and anger. The current study included 201 first responders (male = 77.6%; Mage = 43.73 years (SD = 10.97); police officers = 64.2%) who completed measures of OS (OSI-R; Osipow 1998), Anger (DSM-5 CC Anger; APA 2013), and Resiliency (CD-RISC; Connor and Davidson 2003). Results indicated that resiliency mediated relations between five components of OS and anger: Role Overload (p < .001); Insufficiency (p < .001); Role Boundary (p < .001); Role Ambiguity (p < .001); and Role Responsibility (p < .001). Results support the importance of resiliency-enhancing interventions to offset the experience of anger when confronted with occupational stress in first responders.
... These professionals may belong to functional organizations as paid employees or as volunteers; some have undergone training and practiced aid work in disaster situations, while others have no specific training (Alexander & Klein, 2009). They are the first to arrive at the scene and help the victims, and thus are exposed first-hand to situations that are potentially traumatic, resulting in significantly higher rates of post-traumatic stress disorder (PTSD) compared to the general population (Berger et al., 2012;Kleim & Westphal, 2011;Lanza et al., 2018;Wilson, 2015). ...
... Accordingly, several researchers have pointed to a need to facilitate organizational actions to ensure the wellbeing of first responders, including constructed methods of intervention, team cohesion, and social support (Brooks et al., 2016;Howe et al., 2001;Lanza et al., 2018;Molnar et al., 2017). These steps reinforce the context in which first responders operate, and thus enhance resilience as a dynamic process of individualenvironment interaction (M. ...
Article
Purpose This study sought to explore the lived experience of trained social work students as first responders in a shared war reality. Method: Data were gathered from three focus groups conducted with social work students following their professional intervention during a period of protracted warfare. Results: The main theme depicts a movement from an experience of uncertainty to certainty, as the students shifted from being subjects under threat to being object-helpers on duty. Discussion: The findings highlight the interactive nature of individual and environmental aspects of resilience as a dynamic process in the face of adversity. Practical implications are discussed in the context of first responders’ resilience in a shared war reality. Conclusion: First responders must experience certainty in order to function effectively. To provide more support to novice helpers, a first responders training program should be implemented as part of the mandatory curriculum of social work studies.
... These results offer us a first glance as how to improve participation; our participants asked for an easy-to-access, flexible, and tailored intervention, initiated by PFA provider, where confidentiality and privacy are offered. These directions are congruent with findings from the larger literature that recommend psychosocial intervention to be culturally tailored to first responders' needs and concerns (Lanza et al., 2018;Richins et al., 2020). Furthermore, being visible and available, initiating contact after observation, being careful about confidentiality, ensuring a flexible delivery, as well as being culturally informed are elements included in original Brymer's guidelines for delivering PFA (Brymer et al., 2006). ...
... Most of our participants described how the PFA intervention helped to destigmatize post-traumatic stress reactions and more general mental health concerns. The PFA intervention helped to reduce systemic and internalized stigma regarding mental health issues and seeking-help behaviors as it is expected from a mental health intervention among first responders (Lanza et al., 2018;Szeto et al., 2019;Wild et al., 2020). PFA fosters sensitivity and understanding among EMS workers regarding mental illness. ...
Article
Psychological First Aid (PFA) is a promising early intervention for managing mental health symptoms and providing psychosocial support after exposure to a traumatic event (TE) among high-risk organizations such as Emergency Medical Service (EMS). However, recipients’ experience with PFA remains understudied. This study aimed to explore the perception of EMS workers (n = 13) who received PFA administered by a peer helper using a qualitative inductive approach. Findings from a thematic analysis indicated that the PFA intervention addresses EMS workers’ immediate needs in congruence with Hobfoll’s five essential principles to enhance coping and recovery after a TE. Specific components of the intervention, such as its time-sensitive nature and the closeness with peers, were especially appreciated by EMS workers. The PFA intervention appeared to have a beneficial impact on recipients, regarding the reduction of stigma, the increase of help-seeking behaviors, and the decrease of organizational difficulties. In conclusion, the PFA intervention offered by peer helpers is appreciated by recipients and is a beneficial first step toward supporting EMS workers in the aftermath of workplace trauma. These qualitative findings contribute to the current literature by informing further research about PFA intervention in other high-risk organizations and quantitative studies aiming to test PFA’s efficacy in such settings.
... Appropriate resources and successful coping strategies (e.g., Döllinger 2014; Lanza, Roysircar, and Rodgers 2018) can nurture resilience. According to well-established psychological models of stress and coping, resources and coping strategies seem to contribute to stable health and the successful handling of stressful events (Adler and Castro 2013;Antonovsky 1979;Bakker and Demerouti 2007;Becker 1992;Lazarus and Folkman 1984). ...
... Based on the results of previous studies described, the findings of our preliminary work and the relationships between resources, coping strategies and resilience, we hypothesize that both resources and coping strategies can directly contribute to resilience (e.g., Lanza Roysircar, and Rodgers 2018;Moran 1990;Netuveli et al. 2008;Pietrantoni and Prati 2008;Swanson et al. 2018), and these are therefore included in the analysis of possible predictors of resilience. ...
Preprint
Emergency service workers are exposed to many stressors during their work that can lead to pressure, strain and other negative consequences. If they recover after traumatic events and do not show long-term negative consequences, this is referred to as resilience. Certain individual, institutional and social resources and strategies are key factors that influence people's ability to cope successfully. However, those specific resources and coping strategies that can enhance resilience have not yet been studied in detail among emergency service workers, even though they are exposed to various impacts on a daily basis. The present study investigated a total of 774 emergency service workers operating in Germany. It used well-established questionnaires designed to investigate resources, coping styles, and resilience, and multiple linear regression analysis was performed on the responses. The results indicate that emergency service workers are exposed to stressors, especially on the institutional level. However, they possess personal, social and institutional resources and coping strategies that enhance resilience. Personal resources like self-efficacy and ambiguity tolerance prove to be the strongest predictors of emergency service workers' resilience. Problem-focused coping is found to increase resilience, whereas emotion-oriented coping seems to be related negatively. Measures that increase resilience should be included in education and training, as is discussed in the practical implications. Training materials such as learning games support the development of ambiguity tolerance and self-efficacy of emergency service personnel while stress tests for organizations enhance the operating capabilities of emergency organizations even.
... Porém, dada a impossibilidade de intervir junto das contingências e estímulos potencialmente traumáticos aos quais os profissionais do INEM são diariamente expostos, é salientada a importância de intervir juntos dos profissionais, procurando privilegiar o bem-estar e desenvolver uma cultura de aprendizagem, amenizando o sofrimento no trabalho (Areosa, 2018;Salanova et al., 2016). Tal como defendido pelo Job Demands-Resources Model (e.g.,Bakker, Demerouti, & Schaufeli, 2003), para fazer face às exigências profissionais, e às suas potenciais consequências para a saúde dos trabalhadores, é importante o desenvolvimento e promoção de recursos profissionais, nomeadamente estratégias que permitam a gestão das exigências e desafios técnicos e psicológicos (Lanza, Roysircar, & Rodgers, 2018;Tonkin, Malinen, Naswäll, & Kuntz, 2018). Contudo, para tal ser exequível, é fundamental a compreensão destas exigências e potencial traumático associado, bem como das estratégias de coping adaptativas utilizadas e que possam ser promovidas pela estrutura organizacional, nomeadamente através de formações contínuas e da psicoeducação. ...
... De modo geral, reconhece-se, então, a importância de promover organizações e profissionais de emergência mais resilientes e saudáveis e, portanto, de preparar os profissionais integrados nestas instituições, tecnicamente e psicologicamente (Ishak & Williams, 2018;Lanza et al., 2018;Tonkin et al., 2018). Esta preparação poderá incidir nas estratégias de coping, dada a impossibilidade de minimizar a exposição a estímulos potencialmente traumáticos, com claro impacto na saúde psicológica/ocupacional (e.g., Petrie et al., 2018). ...
Article
Full-text available
Atualmente as organizações de emergência devem ser resilientes, o que implica profissionais mais preparados, técnica e psicologicamente. Contudo, pela impossibilidade de minimizar a exposição a estímulos potencialmente traumáticos, esta preparação poderá incidir nas estratégias de coping e na promoção da saúde ocupacional dos profissionais de emergência. Pretendem-se conhecer os níveis de trauma e coping, sua variação em função de características sociodemográficas/profissionais, e identificar o papel preditor do coping no trauma. Participaram 535 técnicos de emergência pré-hospitalar que preencheram anonimamente o Impact of Event Scale– Revised e o Brief Cope. Encontraram-se valores baixos de trauma e coping, e os profissionais com filhos e mais anos de serviço apresentaram mais trauma, enquanto o sexo feminino apresentou valores superiores nas estratégias de coping funcionais e disfuncionais. Estas estratégias foram o principal preditor do trauma (23 a 28.7%), nomeadamente as disfuncionais/evitamento. Os dados permitiram refletir sobre sintomatologia traumática e estratégias do seu enfrentamento num grupo profissional pouco estudado, bem como sobre a possibilidade de adequar políticas institucionais de saúde ocupacional, potenciando a resiliência organizacional. Sugere-se desenvolver formações regulares que integrem psicoeducação e sejam dirigidas à utilização de estratégias de coping mais adaptativas, especialmente para profissionais do sexo feminino, com filhos e mais experiência profissional.
... First responders experience a strong camaraderie, which encourages fire and EMS personnel to depend mainly on peers for support (Regehr, Hill, Goldberg, & Hughes, 2002;Stanley et al., 2016). While common coping for work-related stress and trauma are social supports, due to stigma and first responder culture, there is aversion to using peers as supports in interest of preserving a reputation and image at work (Lanza, Roysircar, & Rodgers, 2018). To address critical incidents experienced in the field, the first responder population can benefit from mental health treatment conducive to the unique population and impact of experiences in the field (Jones, 2017). ...
... By creating a comfortable space for the client to tell stories, the counselor allows for the expression of positive and negative stories as a dominant narrative emerges regarding the work, culture, and experiences unique to first responders. Through the process of deconstructing the dominant narrative, first responders are able to externalize the problem, mitigating the stigma of trauma responses and the tendency to attribute typical reactions to personal weakness (Lanza et al., 2018). Externalizing the problem can also involve naming the problem to help separate the problem from the client's personhood. ...
Chapter
First responders, including Emergency Medical Services personnel and firefighters, support community members in times of crisis. When responding to emergencies, first responders often experience both direct and vicarious trauma. Over time, the pace and intensity of a career as a first responder leads to poor health habits and high risk for mental health issues including posttraumatic stress disorder. Due to concern about peer perception and mental health stigma, these professionals are less likely to seek mental health supports to manage and process trauma. This chapter explores Narrative Therapy as an ideal option for mental health treatment of first responder trauma, providing a collaborative approach to therapy using the natural coping strategy of storytelling.
... However, they are arguably 'the forgotten profession' within the healthcare system. Their contribution to the health and wellbeing of the community and to healthcare is overshadowed by more dominant dialogues and debates about community services, acute care and hospital emergency department tensions and resource demands [1][2][3][4]. ...
... In Australia, the nature of ambulance work, the uncontrolled and often unpredictable environments, the everyday experience of trauma, and the cumulative nature of that trauma all play a key role in the development and impact of mental distress and psychological injury [3][4][5]. In addition to the nature of the work, organisational and occupational factors such as workload, work demands, shift work, limited time for debriefing or downtime, the hierarchical nature of supervision, and the lack of recognition are clearly shown to have effects on the well-being of ambulance personnel that are as significant as, if not greater than, the nature of the work itself [3,5,6]. ...
Article
Full-text available
Background: High rates of mental distress, mental illness, and the associated physical effects of psychological injury experienced by ambulance personnel has been widely reported in quantitative research. However, there is limited understanding of how the nature of ambulance work contributes to this problem, the significant large toll that emergency medical response takes on the individual, and particularly about late and cumulative development of work-related distress among this first responder workforce. Methods: This study examined peer-reviewed qualitative research published from 2000 to 2018 to outline the effect of emergency medical response work on the psychological, psychosocial, and physical health of paramedics, ambulance officers, ambulance volunteers, and call-takers. Databases searched included: Ovid Medline, CINAHL, Ovid EMcare, PsychInfo and Scopus. The systematic review was organised around five key areas: impact of the work on psychological wellbeing; impact of psychological stress on physical wellbeing; how work-related well-being needs were articulated; effects of workflow and the nature of the work on well-being; and, effects of organisational structures on psychological and physical well-being. Results: Thirty-nine articles met the eligibility criteria. Several factors present in the day-to-day work of ambulance personnel, and in how organisational management acknowledge and respond, were identified as being significant and contributing to mental health and well-being, or increasing the risk for developing conditions such as PTSD, depression, and anxiety. Ambulance personnel articulated their well-being needs across four key areas: organisational support; informal support; use of humour; and individual mechanisms to cope such as detachment and external supports. Conclusions: Interactions between critical incidents and workplace culture and demands have an overwhelming impact on the psychological, physical and social well-being of ambulance personnel. These include day-to-day managerial actions and responses, the impact of shift work, poorly-managed rosters, and long hours of work with little time between for recovery. Mental health issues result from exposure to traumatic events, and the way managers and peers respond to worker distress. Ambulance personnel suffering from work-related stress feel abandoned by peers, management, and the service, during illness, in return-to-work, and post-retirement. Policy, programmes and interventions, and education need to occur at an individual, peer, organisational, and government level.
... The result has been that ambulance personnel and organisations are faced with the legacy of, and negative effects on, mental well-being that their role and the environments they work within create. [2][3][4] The nature of the work, the uncontrolled and often unpredictable environments, the everyday experience of trauma, and the cumulative nature of that trauma all play a key role in the development and impact of mental distress and psychological injury. 3,5 Organisational and occupational factors such as workload, work demands, shift work, limited time for debriefing or downtime, the hierarchical nature of supervision, and the lack of recognition are clearly shown to have effects on the well-being of ambulance personnel that are as significant as, if not greater than, the nature of the work itself. ...
Research
Full-text available
The scoping literature review of peer-reviewed and grey qualitative literature addressed the psychological, physical, and social well-being of paramedics, ambulance officers, ambulance volunteers and call-takers.
... The result has been that ambulance personnel and organisations are faced with the legacy of, and negative effects on, mental well-being that their role and the environments they work within create. [2][3][4] The nature of the work, the uncontrolled and often unpredictable environments, the everyday experience of trauma, and the cumulative nature of that trauma all play a key role in the development and impact of mental distress and psychological injury. 3,5 Organisational and occupational factors such as workload, work demands, shift work, limited time for debriefing or downtime, the hierarchical nature of supervision, and the lack of recognition are clearly shown to have effects on the well-being of ambulance personnel that are as significant as, if not greater than, the nature of the work itself. ...
Research
Full-text available
The scoping literature review of peer-reviewed and grey qualitative literature addressed the psychological, physical, and social well-being of paramedics, ambulance officers, ambulance volunteers and call-takers.
... Such factors common to responder populations include the emphasis on honor, steadiness, emotional suppression, and solidarity with colleagues, often at the expense of social and family relationships (e.g., Woody, 2005). Knowledge of these unique cultural components may be critical for understanding how WTC responders experience and make sense of themselves and the world (Lanza et al., 2018). Furthermore, the therapist should listen for experiences of illness and loss in the past, specifically the way in which emotions related to illness and loss were expressed in the responder's family of origin and in the workplace. ...
Article
Objective To date, nearly 10,000 World Trade Center (WTC) responders have been diagnosed with at least one type of WTC-related cancer, and over 70 types of cancer have been related to WTC occupational exposure. Due to the observed latency period for malignancies, the WTC Health Program anticipates increases in rates of new cancer diagnoses. Given the growing number of cancer diagnoses in this population, there is an urgent need to develop a novel intervention to address the psychosocial needs of WTC responders with cancer. Meaning-centered psychotherapy (MCP) is a structured psychotherapeutic intervention originally developed to help patients with advanced cancer find and sustain meaning in life despite illness-related limitations. Existential distress and loss of meaning are critical and understudied elements of psychological health that have been widely overlooked among WTC responders with cancer. Method We have adapted MCP for WTC responders (MCP-WTC) for the treatment of WTC responders who have been diagnosed with WTC-certified cancers. MCP-WTC aims to target the complex crisis in meaning faced by those responders who responded to the 9/11 attacks and subsequently were diagnosed with cancer as a result of their service. Results We describe the adaptation of MCP-WTC and the application of this intervention to meet the unique needs of those exposed to the terrorist attacks of September 11, 2001 (9/11), participated in the rescue, recovery, and clean-up effort at Ground Zero, and were diagnosed with WTC-related cancer. We highlight the novel aspects of this intervention which have been designed to facilitate meaning-making in the context of the patient's response to 9/11 and subsequent diagnosis of cancer. Significance of results This work provides a rationale for MCP-WTC and the potential for this intervention to improve the quality of life of WTC responders and help these patients navigate life after 9/11 and cancer.
... H ealth professionals operating in conflict zones are at severe risk of mental breakdown, given their continuous direct and indirect exposure to traumatic events and extreme conditions of stress and violence (Cocker & Joss, 2016;Warner & Miller, 2017). Trauma-related syndromes, psychological distress (as a primary consequence of trauma), and compassion fatigue (a form of secondary traumatization) are the most frequently reported burdens in the aftermath of catastrophic war events (Kerig, 2019;Lanza, Roysircar, & Rodgers, 2018;Tyson, 2007). ...
Article
Health-care workers operating in conflict zones are at severe risk of psychological consequences, given their extended exposure to traumatic events under conditions of stress and violence. This quantitative, cross-sectional study was designed to explore the relationships between personal resources (sources of functioning)-operationalized as sense of coherence, posttraumatic growth, and perceived well-being-psychological distress, and trauma symptoms in a specific population of health workers exposed to war and violence. Palestinian health professionals (N = 181) completed quantitative measures of well-being, posttraumatic growth, sense of coherence, psychological distress, and traumatic response. The data were analyzed using structural equation modeling (SEM). The outcomes suggest that sources of psychological functioning consistently play a role in the mental health of different types of health professionals. Health-care workers in an environment characterized by instability and ongoing risk need to protect their own mental health by mobilizing sources of resistance and resilience, such as a sense of coherence, subjective well-being, and growth. We discuss the clinical implications of these findings and offer recommendations for training and supervision. (PsycInfo Database Record (c) 2020 APA, all rights reserved).
... 6,7,8 Rates of PTSD prevalence for adults who are employed in high stress or high danger contexts range from 0-32%, with 0-8% observed in police officers, 4-17% for combat veterans returning from Iraq and Afghanistan, and 8-32% for emergency first responders. 9,10,11 Exposure to stressful events/traumas, especially during childhood, has been positively correlated with the development of disorders of depression, such as Major Depressive Disorder (MDD). 5,12,13,14 MDD affects 16.6% of the population and is described as a loss of pleasure in activities, increased fatigue, depressed mood or attitude, changes in sleep, feeling guilt or remorse, increased difficulty making decisions, and/or recurring thoughts of death or suicide. ...
... Workplace disclosures are particularly challenging because revelation may have potential occupational and relational consequences (Butler & Modaff, 2016). Prior research has demonstrated that perceptions of support from peers and supervisors have been associated with improved health outcomes in law enforcement (Bernabe & Botia, 2016;Lanza et al., 2018). However, these individuals are also habitually reluctant to discuss work-related stress because they are concerned about the potential adverse outcomes of sharing personal mental health-related information with peers, leadership, and close personal relationships (Evans et al., 2013;Morman et al., 2019). ...
Article
Throughout the United States, police officers experience cumulative stress and their mental health-related concerns often remain unaddressed. Recently, police departments have begun to offer more mental health support resources in an attempt to mitigate this issue. However, the underutilization of such support is a serious problem. The overall goal of this dissertation is to develop a grounded theory of mental health communication in law enforcement. Employing a constructivist grounded theory approach, data were collected in two sequential phases. Phase one involved 48 in-depth semi-structured interviews with active and retired police officers to examine how the messages police officers receive from society, police departments, and interpersonal relationships shape their perceptions of mental health. Guided by the findings in phase one, a one-time anonymous online survey was completed by 58 additional active police officers to further explore their preferences for mental health-related communication in receiving support and information about available resources in phase two. The theory explains and illustrates how two potential routes, involving multiple layers of influence, can shape police officers' views of mental health and support seeking. Theoretically, this dissertation extends our current understanding of disclosure decisions and the role of communication in officers' willingness to seek mental health support. The grounded theory presented in this dissertation also yields several practical implications for policymakers, department leadership, and families of vi police officers. Moreover, the grounded theory provides a foundation for building a more comprehensive explanation of mental health communication in first responder professions.
... Feeling closely connected to others has been shown to be a major factor contributing to demonstrating positive adaptation following high levels of adversity. The importance of social connection for resilience has been demonstrated among members of the general population (Richards, 2016;Zautra et al., 2008), first responders (Lanza et al., 2018), and military personnel (Bowen & Martin, 2011;Cacioppo et al., 2016;Griffith, 2015;Solomon et al., 1986). In high-risk occupational settings like the military, the importance of social bonds is a foundation for trust and survival, and studies of military personnel have also highlighted the link between lack of social connection and mental health symptoms, including the probability of suicide (Cacioppo et al., 2016;Griffith, 2015;Solomon et al., 1986). ...
Article
The present research examined social connection as a mediator through which perceived resilience prior to a combat deployment predicts fewer posttraumatic stress disorder (PTSD) symptoms for soldiers exposed to high levels of combat. Soldiers (N = 1,222) completed the Brief Resilience Scale (BRS) and a measure of PTSD symptoms prior to deploying to Afghanistan (Time 1) and measures of combat exposure and social connection immediately after the deployment (Time 2). Soldiers then completed measures of PTSD symptoms at 3 months (Time 3) and 10-12 months (Time 4) following the deployment. Within the context of the Conservation of Resources (COR) model, perceived resilience and social connection represented personal and social resources that allow military personnel to demonstrate better mental health when confronted with the traumatic stressor of combat exposure. Perceived resilience prior to the deployment interacted with combat exposure to predict PTSD symptoms at Time 3 and Time 4 after controlling for baseline PTSD symptoms. Perceived resilience was more strongly related to PTSD symptoms under higher levels of combat exposure. Moderated mediation models provided support for social connection as a mediator of the relationship between perceived resilience at baseline and PTSD symptoms at Time 3 and 4 under higher levels of combat exposure. The results provide some of the first empirical evidence regarding the predictive value of perceived resilience prior to potentially traumatic exposure and document social connection as an important resource linking perceived resilience to positive adaptation after adversity. (PsycInfo Database Record (c) 2021 APA, all rights reserved).
... First responders are at risk for sustaining injuries, experiencing life-threatening events, and witnessing harm to others (Lanza et al., 2018). The nature of their exposure can be repeated and cumulative over time (Donnelly & Bennett, 2014), indicating an increased risk for post-traumatic stress, anxiety, and depressive symptoms, as well as suicidal behavior (Jones et al., 2018). ...
Article
First responders are continually exposed to trauma-related events. Resilience is evidenced as a protective factor for mental health among first responders. However, there is a lack of assessments that measure the construct of resilience from a strength-based perspective. The present study used archival data from a treatment-seeking sample of 238 first responders to validate the 22-item Response to Stressful Experiences Scale (RSES-22) and its abbreviated version, the RSES-4, with two confirmatory factor analyses. Using a subsample of 190 first responders, correlational analyses were conducted of the RSES-22 and RSES-4 with measures of depressive symptoms, post-traumatic stress, anxiety, and suicidality confirming convergent and criterion validity. The two confirmatory analyses revealed a poor model fit for the RSES-22; however, the RSES-4 demonstrated an acceptable model fit. Overall, the RSES-4 may be a reliable and valid measure of resilience for treatment seeking first responder populations.
... Personal coping strategies are central to the self-care of PSP who have frequent PPTE exposures [16]. PSP can develop coping strategies to help them recognize and process physical or psychological stressors that cause distress requiring the use of personal resources and attention [14,17]. ...
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Public safety personnel (PSP) experience a disproportionately high number of on-the-job stressors compared to the general population. PSP develop self-initiated actions, or coping strategies , that either confront the situation (approach strategies) or avoid the situation (avoidance strategies) to reduce the impact of stressors on their well-being. Understanding how PSP cope with stress is critical to ensuring their safety and that of the public. In the current study, we examined the coping strategies of PSP (n = 828 in the total sample). Participants managed their experiences of occupational stress or distress using three primary approach coping strategies: education (learning about mental illness and their causes), self-reliance (processes of self-reflection), and treatment (pharma-ceutical, psychotherapy) that were considered adaptive. Results demonstrate PSP used multiple coping strategies simultaneously to deal with occupational stress. PSP who reported doing better tended to attribute their success to treatment, specifically psychotherapy, either alone or in combination with other interventions, and almost always emphasizing important supports from co-workers , families, and friends. Changing workplace culture could help to de-pathologize the effects of stress reactions being perceived as individual "failings".
... First responders are often exposed to traumatic events [1][2][3][4][5][6] that can be stressful and affect mental health [7]. Police officers (POs) are highly exposed to chronic stressors such as dangerous situations, injuries, violence, and the need to report and testify about psychologically stressful scenes [8]. ...
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Hopelessness is a particularly critical condition and a risk factor for suicide. Many studies have reported that this condition is common in some occupations and is associated with high stress that is not properly managed. This study examined the prevalence of hopeless status (HS) in a sample of police officers (POs) and the association of hopelessness with depression, burnout, and suicidality. In total, 127 out of 231 POs participated in the survey; they were assessed with the Beck Hopelessness Scale, the Beck Depression Scale, and the Maslach Burnout Inventory. A total of 26.5% of POs reported hopelessness, and a significant association was found with depression and burnout; in individual cases, these conditions were associated with suicidal thoughts. In a multivariate logistic regression model adjusted for confounding variables, depression, emotional exhaustion, and reduction of personal accomplishment were significantly associated with HP status. Depression (OR = 3.02, 95% CI: 1–9.12) and emotional exhaustion (OR = 1.88, 95% CI: 1.06–3.32) significantly increased the risk of hopelessness, while personal accomplishment (OR = 0.57, 95% CI: 0.32–1) was a protective factor. Hopelessness appears to be a very important factor to consider when assessing POs’ mental health.
Chapter
First responders, including Emergency Medical Services personnel and firefighters, support community members in times of crisis. When responding to emergencies, first responders often experience both direct and vicarious trauma. Over time, the pace and intensity of a career as a first responder leads to poor health habits and high risk for mental health issues including posttraumatic stress disorder. Due to concern about peer perception and mental health stigma, these professionals are less likely to seek mental health supports to manage and process trauma. This chapter explores Narrative Therapy as an ideal option for mental health treatment of first responder trauma, providing a collaborative approach to therapy using the natural coping strategy of storytelling.
Chapter
Mental health professionals are only recently beginning to understand the risks for stress-related disorders experienced by first responders. For example, it is clear that first responders are at increased risk for Post-Traumatic Stress Disorder. Unfortunately, clinicians currently have a limited repertoire with which to treat these disorders. Treatments for PTSD have been developed for use with military patients, for the most part. It is not clear that these treatments are appropriate, and effective, for first responders. In this chapter, the authors describe a pilot study designed to evaluate whether one specific treatment approach creates similar clinical outcomes for first responders as have been observed for a military sample. The results indicate that clinical outcomes for first responders were nearly identical as those obtained with military personnel. The results are discussed in terms of future directions for research in this area.
Chapter
The study examined the relationships among resilience, self-care, self-compassion of first responders. In addition, the study assessed the contributions of protective and risk factors to responders' resilience and disaster response competencies. Five research hypotheses and three research questions were examined with Pearson r correlations, multiple regressions, one t-test, one MANOVA, and post hoc tests, showing significant and meaningful results. In addition, the internal consistency reliabilities of the DRCQ scales were investigated which were strong to very strong. It was hypothesized and shown that there were significant positive relationships among self-care, self-compassion, and resilience. A second hypothesis was retained that the two dimensions of self-care (i.e., self-care practices and physical safety) were predictors of self-compassion. Responders who consciously observed self-care practices fostered and strengthened self-compassion and vice versa.
Chapter
First responders include police officers, firefighters, and emergency medical technicians. Given occupational demands, first responders are chronically exposed to stress and potentially traumatic events in the line-of-duty. An emergent literature has documented the mental health sequelae of first responding. The goal of this article is to provide an overview of mental health among first responders, including a review of prevalent mental health conditions, discussion of risk and protective factors related to mental health and well-being, and discussion of the efficacy of evidence-based mental health treatments. This article will also discuss clinical applications and research recommendations regarding first responder mental health.
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Public safety personnel (PSP) are routinely exposed to potentially psychologically traumatic events (PPTEs) that, in turn, can result in posttraumatic stress injuries (PTSI), including burnout and increased symptoms of depression and anxiety. However, the longitudinal impact of PPTEs on PSP coping remains unclear. Coping can be operationalized as various strategies (i.e., behaviours, skills, thought and emotion regulation) for dealing with stressors, which are broadly categorized as either approach (adaptive, positive, social support) or avoidant coping strategies (maladaptive withdrawal, avoidance, substance use). This systematic review and meta‐analysis aims to evaluate longitudinal coping outcomes among PSP. Thirteen eligible repeated‐measures studies explicitly evaluated coping in 1,854 police officers, firefighters, and rescue and recovery workers. Study designs included randomized‐control trials, within‐subject interventions, and observational studies. Effect sizes (Cohen’s d) at follow‐up were described in 11 studies. Separate meta‐analyses reveal small (d < 0.2) but non‐significant improvements in approach and avoidant coping. Studies were of moderate quality and low risk of publication bias. Heterogeneity in outcome measures, follow‐up durations, and study types precluded subgroup analyses. The current findings can inform the development and evaluation of organizational training programs that effectively promote sustained adaptive coping for PSP and mitigate PTSIs. This article is protected by copyright. All rights reserved.
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Psychological First Aid (PFA) consists of a systematic set of helping actions aimed at reducing initial post-trauma distress and supporting short- and long-term adaptive functioning. Designed as an initial component of a comprehensive disaster/trauma response, PFA is constructed around eight core actions: contact and engagement, safety and comfort, stabilization, information gathering, practical assistance, connection with social supports, information on coping support, and linkage with collaborative services. PFA for children and adolescents focuses on these same core actions, with modifications to make them developmentally appropriate. Formal evaluation of the effectiveness of PFA is needed and it is hoped that development of a PFA Field Operations Guide will facilitate such evaluation.
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Providing psychological first aid (PFA) is generally considered to be an important element in preliminary care of disaster victims. Using the best available scientific basis for courses and educational materials, the Belgian Red Cross-Flanders wants to ensure that its volunteers are trained in the best way possible. To identify effective PFA practices, by systematically reviewing the evidence in existing guidelines, systematic reviews and individual studies. Systematic literature searches in five bibliographic databases (MEDLINE, PsycINFO, The Cochrane Library, PILOTS and G-I-N) were conducted from inception to July 2013. Five practice guidelines were included which were found to vary in the development process (AGREE II score 20-53%) and evidence base used. None of them provides solid evidence concerning the effectiveness of PFA practices. Additionally, two systematic reviews of PFA were found, both noting a lack of studies on PFA. A complementary search for individual studies, using a more sensitive search strategy, identified 11 237 references of which 102 were included for further full-text examination, none of which ultimately provides solid evidence concerning the effectiveness of PFA practices. The scientific literature on psychological first aid available to date, does not provide any evidence about the effectiveness of PFA interventions. Currently it is impossible to make evidence-based guidelines about which practices in psychosocial support are most effective to help disaster and trauma victims.
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The present article describes the prevalence and predictors of adverse mental health reactions in first responders, a population exposed to stress (rather than a population who are exposed). Mental health impairments in first responders exact considerable personal and public costs and are likely to negatively affect work performance, including providing care to trauma survivors. This article provides an update on first responders’ mental health and examines predictors of trauma-related psychopathology in this population. This information is of vital importance for the development and implementation of prevention and intervention strategies.
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Trauma-related assistance in response to disasters or catastrophes is needed locally, regionally, nationally, and internationally, and the authors argue that there is a necessity for counseling psychologists and counseling psychology programs to incorporate it into their prevention, training, and social justice repertoire. Counseling psychologists are in a unique position to engage in disaster relief efforts because of their values and training, particularly around work with diverse clients. The authors present examples from two training programs of disaster mental health work completed in the field with students and their preparation of students for this work. They discuss some struggles and challenges in involving students and interventions for resolutions and further show how real-world crisis situations and interventions can easily be used as training tools. The authors discuss a number of themes that emerged throughout the disaster site examples, including students’ flexibility, openness to cultural issues, self-care, good interpersonal skills, resilience, and compassion.
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The literature is extensive about explanatory behavioral and social effects with an individual or micro focus. A somewhat less programmatic literature exits in social justice that considers systemic or macro factors: for example, mental health service and its structures that perpetuate inequity and disparity in service delivery. Social privilege arises from macro-level environments wherein certain social identities of race, class, gender, sexuality, and religion are considered normative with perceived natural rights, whereas those not thus privileged are questioned and discredited. The article approaches privilege as a therapist attitudinal variable, a subjective experience as well as perception of entitlement, which can be remediated through the practice of multicultural counseling competencies. As a multicultural competency, group therapists are expected to learn about groups with different social classes, their privileged cultures and feelings of entitlement as opposed to marginalized cultures, and their feelings of disempowerment and disidentification with privileged classes. Group therapists are encouraged to examine their own values, biases, and assumptions that emanate from their middle-class, higher-education standing and to advocate against counseling dynamics that marginalize and oppress group therapy members who are different from other group members as well as from the leader. Social privilege and multicultural competencies are inversely related.
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The Competency Benchmarks document outlines core foundational and functional competencies in professional psychology across three levels of professional development: readiness for practicum, readiness for internship, and readiness for entry to practice. Within each level, the document lists the essential components that comprise the core competencies and behavioral indicators that provide operational descriptions of the essential elements. This document builds on previous initiatives within professional psychology related to defining and assessing competence. It is intended as a resource for those charged with training and assessing for competence. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
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The disclosure of emotional events to various social intimates (disclosure targets) was measured in 2 samples (soldiers and first responders) at risk for posttraumatic stress disorder (PTSD), as well as a comparison sample of college students. These 3 groups completed survey measures of disclosure, and at risk groups also completed measures of PTSD symptoms and social support. Groups at risk for PTSD were less likely to disclose emotions related to potentially traumatic events than were college students reporting general emotional disclosure. Overall, disclosure of positive emotions was more likely than disclosure of negative emotions. Furthermore, amount of disclosure depended on the person to whom the individual disclosed. Within groups at risk for PTSD, social support was associated with lower levels of PTSD. However, this relationship was mediated by emotional disclosure to each target. Disclosure of positive emotions generally was associated with lower levels of PTSD, and disclosure of negative emotions to those with similar at-risk status was associated with greater levels of PTSD. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
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We estimate the effect of deployment location and length on risk of developing post-traumatic stress disorder (PTSD). We draw a random sample of active duty enlisted personnel serving between 2001 and 2006 from a TRICARE beneficiary database and link deployment characteristics from the contingency tracking system. Using logistic regressions, we found that deployment to Iraq/Afghanistan increases the odds of developing PTSD substantially, relative to those in other duties, with the largest effect observed for the Navy (OR = 9.06, p < 0.01) and the smallest effect for the Air Force (OR = 1.25, p < 0.01). A deployment longer than 180 days increases the odds of PTSD by 1.11 to 2.84 times compared to a short tour. For Army and Navy, a deployment to Iraq/Afghanistan further exacerbates the adverse effect of tour length.
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Disasters are widely reported, commonplace events that characteristically leave an enormous legacy of human suffering through death, injury, extensive infrastructural damage, and disorganization to systems and communities. The economic costs may be almost incalculable. Professional and civilian first responders play a vital role in mitigating these effects. However, to maximize their potential with the minimum health and welfare costs to first responders, it is important to have a good understanding of the demands of such work on them, how they cope, and what enables them to fulfill their roles. This review will explore these themes by highlighting important findings and areas of uncertainty.
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Previous studies have examined individual dietary and lifestyle factors in relation to type 2 diabetes, but the combined effects of these factors are largely unknown. We followed 84,941 female nurses from 1980 to 1996; these women were free of diagnosed cardiovascular disease, diabetes, and cancer at base line. Information about their diet and lifestyle was updated periodically. A low-risk group was defined according to a combination of five variables: a bodymass index (the weight in kilograms divided by the square of the height in meters) of less than 25; a diet high in cereal fiber and polyunsaturated fat and low in trans fat and glycemic load (which reflects the effect of diet on the blood glucose level); engagement in moderate-to-vigorous physical activity for at least half an hour per day; no current smoking; and the consumption of an average of at least half a drink of an alcoholic beverage per day. During 16 years of follow-up, we documented 3300 new cases of type 2 diabetes. Overweight or obesity was the single most important predictor of diabetes. Lack of exercise, a poor diet, current smoking, and abstinence from alcohol use were all associated with a significantly increased risk of diabetes, even after adjustment for the body-mass index. As compared with the rest of the cohort, women in the low-risk group (3.4 percent of the women) had a relative risk of diabetes of 0.09 (95 percent confidence interval, 0.05 to 0.17). A total of 91 percent of the cases of diabetes in this cohort (95 percent confidence interval, 83 to 95) could be attributed to habits and forms of behavior that did not conform to the low-risk pattern. Our findings support the hypothesis that the vast majority of cases of type 2 diabetes could be prevented by the adoption of a healthier lifestyle.
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Hammond and Brooks's enthusiasm for critical incident stress debriefing (CISD) [1] causes them to ignore findings suggesting inert or iatrogenic effects of this procedure. So far the data on the effectiveness of debriefing are almost overwhelmingly negative, particularly at follow-up assessments. For example, Carlier et al. [2] found that among police officers who responded to a civilian plane crash, those who underwent debriefing exhibited significantly more disaster-related hyperarousal symptoms at an 18-month follow-up than those who did not receive the treatment. Mayou et al. [3] showed that subjects admitted to hospital after a road traffic accident who received CISD had a significantly worse outcome at 3 years in terms of general psychiatric symptoms, travel anxiety, and overall level of functioning. Bisson et al. [4] found that among a sample of burn trauma victims, 26% of the debriefing group had PTSD at 13-month follow-up, compared with 9% of the control group. Importantly, the Cochrane Review of 11 clinical trials found no evidence that debriefing reduced general psychological morbidity, depression, or anxiety, and recommended that compulsory debriefing of victims of trauma should cease [5]. By Hammond and Brooks's own admission, most of the evidence supporting the use of CISD is anecdotal or can be found only in unpublished dissertations. Moreover, the limited published data suggesting a positive effect have often confused respondents' reports of satisfaction over their debriefing experience with objective measures of traumatic stress [6]. Such satisfaction reports most probably reflect respondents' gratitude for the attention of a debriefer rather than a decrease in psychological symptoms [3]. In addition to other flaws in the studies cited by Hammond and Brooks (such as having the investigator conduct the debriefing sessions), between-group treatment effects remained non-significant [7], no treatment effect size was reported [7,8], or no treatment was described [8]. Although Hammond and Brooks's concern for disaster response workers is laudable, their enthusiasm for CISD as an unvalidated intervention is misplaced. Until data are produced that support the use of psychoprophylactic treatment, advocating it is inappropriate and misguided.
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Many people are exposed to loss or potentially traumatic events at some point in their lives, and yet they continue to have positive emotional experiences and show only minor and transient disruptions in their ability to function. Unfortunately, because much of psychology's knowledge about how adults cope with loss or trauma has come from individuals who sought treatment or exhibited great distress, loss and trauma theorists have often viewed this type of resilience as either rare or pathological. The author challenges these assumptions by reviewing evidence that resilience represents a distinct trajectory from the process of recovery, that resilience in the face of loss or potential trauma is more common than is often believed, and that there are multiple and sometimes unexpected pathways to resilience.
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First responders, including military health care workers, public health service workers, and state, local, and volunteer first responders serve an important role in protecting our nation's citizenry in the aftermath of disaster. Protecting our nation's health is a vital part of preserving national security and the continuity of critical national functions. However, public health and public safety workers experience a broad range of health and mental health consequences as a result of work-related exposures to natural or man-made disasters. This chapter reviews recent epidemiologic studies that broaden our understanding of the range of health and mental health consequences for first responders. Evidence-based psychopharmacologic and psychotherapeutic interventions for posttraumatic distress reactions and psychiatric disorders are outlined. Finally, the application of public health intervention models for the assessment and management of distress responses and mental disorders in first-responder communities is discussed.
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A growing body of evidence suggests that most adults exposed to potentially traumatic events are resilient. However, research on the factors that may promote or deter adult resilience has been limited. This study examined patterns of association between resilience and various sociocontextual factors. The authors used data from a random-digit-dial phone survey (N = 2,752) conducted in the New York City area after the September 11, 2001, terrorist attack. Resilience was defined as having 1 or 0 posttraumatic stress disorder symptoms and as being associated with low levels of depression and substance use. Multivariate analyses indicated that the prevalence of resilience was uniquely predicted by participant gender, age, race/ethnicity, education, level of trauma exposure, income change, social support, frequency of chronic disease, and recent and past life stressors. Implications for future research and intervention are discussed.
Article
Objective: It is unclear how many first responders experience barriers to care and stigma regarding mental health care, and how this influences their help-seeking. A systematic review and meta-analysis was conducted on barriers to care and mental health stigma in first responders and their empirical relationship with psychosocial and psychiatric variables. Methods: The databases Medline, Embase PsycINFO, CINAHL, PILOTS, LILACS, Sociological Abstracts, SocINDEX, and Social Citation Index were searched to identify relevant studies. A quality assessment and meta-analysis was performed. Results: Fourteen articles met inclusion criteria, from which data from 12 samples were extracted for meta-analyses. All studies measured stigma regarding mental health care and 33.1% of first responders (95% CI 26.7-40.1; 12 individual samples) endorsed stigma items. The systematic review revealed that the most frequently endorsed items were fears regarding confidentiality and negative career impact. Five of 14 studies measured barriers to mental health care and 9.3% of first responders (95% CI 7.0-12.3; 4 individual samples) endorsed barriers to care items. The most frequently endorsed barriers were scheduling concerns and not knowing where to get help. Indications were found for more stigma and barriers in individuals with mental health problems. Conclusions: Stigma and barriers to care are experienced by a significant proportion of firs responders, which can potentially lead to delayed presentation in mental health care and therefore, increased risk of chronicity of post-trauma psychopathology for these groups. The current systematic review draws attention to the paucity of research in this area, particularly in non-Western samples.
Article
Responding to a national appeal for mental health volunteers to assist with disaster relief efforts is an altruistic act. However, the reality of the actual work of a mental health volunteer can be jarring. In the course of providing services to traumatized individuals, mental health providers are in a position to share the emotional burden of the trauma, become a witness to the damage, recognize the realities of dealing with federal and state agencies, and observe the inequitable distribution of resources. The following is my story of what it was like before, during, and after my experience as a mental health volunteer in the Gulfport/Biloxi, Mississippi area two months after the destruction of August 2005. I hope that sharing my story will encourage other mental health counselors to play a role in responding to the needs created by events like Hurricane Katrina.
Article
Responding to critical incidents may result in 5.9-22 % of first responders developing psychological trauma and posttraumatic stress disorder. These impacts may be physical, mental, and/or behavioral. This population remains at risk, given the daily occurrence of critical incidents. Current treatments, primarily focused on combat and rape victims, have included single and double interventions, which have proven helpful to some but not all victims and one standard of care has remained elusive. However, even though the need is established, research on the treatment interventions of first responders has been limited. Given the multiplicity of impacts from psychological trauma and the inadequacies of responder treatment intervention research thus far, this paper proposes a paradigmatic shift from single/double treatment interventions to a multi-modal approach to first responder victim needs. A conceptual framework based on psychological trauma is presented and possible multi-modal interventions selected from the limited, extant first responder research are utilized to illustrate how the approach would work and to encourage clinical and experimental research into first responder treatment needs.
Article
This article, motivational in purpose, encourages counselors to be engaged in the growing movement for social justice advocacy in counseling. Analyses of a macrolevel framework of advocacy extend to microlevel operations of recruitment, sociopolitical education, diversity management, and self‐care of counselor‐advocates. Case studies and exemplars illustrate views expressed.
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Self-compassion is conceptualized as containing 3 core components: self-kindness versus self-judgment, common humanity versus isolation, and mindfulness versus overidentification, when relating to painful experiences. Research evidence demonstrates that self-compassion is related to psychological flourishing and reduced psychopathology. Mindful Self-Compassion (MSC) is an 8-week training program, meeting 2.5 hours each week, designed to help participants cultivate self-compassion. MSC contains a variety of meditations (e.g., loving-kindness, affectionate breathing) as well as informal practices for use in daily life (e.g., soothing touch, self-compassionate letter writing). A detailed clinical case illustrates the journey of a client through the 8 weeks of MSC training, describing the key features of each session and the client's response.
Article
Two distinct fields, crisis intervention (which targets civilian populations) and disaster mental health services (which targets first responders), have emerged in response to natural and man-made disasters. As a consequence of 9/11 and Hurricane Katrina, questions have been raised whether the occupational ecology of first responders has significantly changed. Two new concepts, the "high-risk rescuer" and the "rescuer-victim," are identified. Using three field cases, this paper describes and analyzes the application of three different crisis intervention models for law enforcement first responders during 9/11 and Hurricane Katrina: (a) psychological first aid, (b) critical incident stress management, and (c) the Federal Emergency Management Association/Substance Abuse Crisis Counseling Program. Implications for meeting the mental health needs of first responders post-9/11 and -Hurricane Katrina are discussed.
Article
discusses the emergence of information that forms the basis of our understanding of Compassion Fatigue and Compassion Stress / recognize that something specific must be done to counteract the challenges of Compassion Stress and Fatigue / we now know . . . that something can be done to help caring [health] professionals / we can help professionals to recognize their shortcomings—their special vulnerability to Compassion Stress and Fatigue—and help them cope more effectively with the cost of caring / there is no doubt that traumatic events will continue to occur and affect hundreds of thousands of people each year / these traumatized people require the services of professionals who are well prepared to help and, in turn, to help themselves / therefore, we need to keep these caring professionals at work and satisfied why are there so few reports of secondary trauma / why STSD [secondary traumatic stress disorder] / definition of secondary traumatic stress [STS] and stress disorder / contrasts between STS and other concepts / countertransference and secondary stress / burnout and secondary stress / why Compassion Stress and Compassion Fatigue / implications for training and educating the next generation of professionals (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Article
There are plenty of theories that may support the protective role of social support in the aftermath of potentially traumatic events. This meta-analytic review examined the role of received and perceived social support in promoting mental health among first responders (e.g., firefighters, police officers, and paramedics or emergency medical services personnel). Results showed that the effect sizes derived from 37 empirical studies ranged from 0 to 0.46. The overall weighted mean effect size was of medium magnitude (r=0.27). Moreover, moderator analysis showed that the effect size of perceived social support (r=0.31) was significantly higher than the effect size of received social support (r=0.22). Participants' age and gender or research design did not exert an influence on the relationship between social support and mental health. Theoretical implications and limitations are discussed. © 2010 Wiley Periodicals, Inc.
Article
When a suicide is completed, police officers are often among the first responders. Little attention has been paid to the emotional and psychological impact on the police officer in this specific situation. This study examines the effects encounters with completed suicides have on the emotional and psychological well-being of the police officer. This is a qualitative study, which intends to bring alive the feelings, thoughts, actions, choices, and challenges of police officers who have encountered completed suicides as imparted through participants' stories. Interviews were done with eight police officers. In addition, interviews were done with a coroner, a police chaplain, and a police psychologist to add some unique perspectives to the police officers’ experiences of encountering completed suicides. Interviews were done in a semi-structured, focused format involving an ongoing fine-tuning of questions. The overarching finding reveals the central role played by police culture in shaping how police officers come to perceive this experience, and how they subsequently choose to mediate it. This study identifies ten strategies police officers use to mediate this experience, and discusses the possible psychological consequences of employing each strategy. KeywordsPolice-Suicide-First responders-Police trauma-Police culture-Police stress
Article
The aim of the ethnographic research reported here was to increase knowledge concerning the values and social and emotional characteristics of 9/11 responders in order to benefit others in subsequent manmade disasters. The research is based on a series of in-depth interviews conducted with ground zero first responders; firefighters, police officers, fire and police chaplains, and media persons. The materials that emerged from the study indicate that psychodynamic concepts, such as post-traumatic stress, may be too individualistically formulated to take into account the significant factors that acted as the basis for the resilience of these responders.
Article
The development of acute and posttraumatic stress symptoms after a traumatic event is common and often leads to personal distress, functional impairment, and economic consequences in trauma victims and their loved ones. Hence, the prevention of acute and chronic posttraumatic stress is an important public health priority. This article aims to review the current evidence regarding immediate (within hours) and early (within days and weeks) psychological and behavioral interventions to prevent posttraumatic stress symptoms. Acute distress management, psychological debriefing and other immediate unspecific interventions within the first hours following a traumatic event have so far not demonstrated efficacy in preventing posttraumatic stress symptoms. So far, there are no randomized controlled trials (RCTs) that have examined immediate trauma-focused cognitive behavioral interventions. In contrast, some, but not many, studies have shown that cognitive behavioral interventions are efficacious if administered within days or weeks after a traumatic event. For other early interventions after trauma exposure, there is no, or only weak, evidence in support of their efficacy. However, conclusions are limited by the small numbers of trials examining immediate and early interventions. Today, there is no empirical evidence to support any immediate intervention within hours after the traumatic event to prevent posttraumatic stress symptoms. With regard to early interventions in the first days or weeks after trauma, literature is also sparse, but supports brief cognitive behavioral interventions as a first choice. There is an urgent need for RCTs to examine if behavioral interventions immediately following a traumatic event might be able to reduce the burden of acute and posttraumatic stress symptoms.
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The public safety, human services, health, and relief workers who comprise the first wave of a response to natural or man-made disasters play a critical role in emergency preparedness. These first responders provide care and services in the immediate aftermath of emergencies and may remain in affected communities for weeks or months. They often work long hours under stressful conditions, witnessing the human harms, physical destruction, and psychological devastation that can accompany disasters.
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This is the 1st longitudinal examination of trajectories of resilience and resistance (rather than ill-being) among a national sample under ongoing threat of mass casualty. The authors interviewed a nationally representative sample of Jews and Arabs in Israel (N = 709) at 2 times during a period of terrorist and rocket attacks (2004-2005). The resistance trajectory, exhibiting few or no symptoms of traumatic stress and depression at both time points, was substantially less common (22.1%) than has previously been documented in studies following single mass casualty events. The resilience trajectory, exhibiting initial symptoms and becoming relatively nonsymptomatic, was evidenced by 13.5% of interviewees. The chronic distress trajectory was documented among a majority of participants (54.0%), and a small proportion of persons were initially relatively symptom-free but became distressed (termed delayed distress trajectory; 10.3%). Less psychosocial resource loss and majority status (Jewish) were the most consistent predictors of resistance and resilience trajectories, followed by greater socioeconomic status, greater support from friends, and less report of posttraumatic growth.
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The present study examined the temporal relationship between posttraumatic stress disorder (PTSD) and social support among 128 male veterans treated for chronic PTSD. Level of perceived interpersonal support and stressors were assessed at two time points (6 months apart) for four different potential sources of support: spouse, relatives, nonveteran friends, and veteran peers. Veteran peers provided relatively high perceived support and little interpersonal stress. Spouses were seen as both interpersonal resources and sources of interpersonal stress. More severe PTSD symptoms at Time 1 predicted greater erosion in perceived support from nonveteran friends, but not from relatives. Contrary to expectations, initial levels of perceived support and stressors did not predict the course of chronic PTSD symptoms.
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In response to Anastasi's (1958) long-standing challenge, the authors propose an empirically testable theoretical model that (a) goes beyond and qualifies the established behavioral genetics paradigm by allowing for nonadditive synergistic effects, direct measures of the environment, and mechanisms of organism-environment interaction, called proximal processes, through which genotypes are transformed into phenotypes; (b) hypothesizes that estimates of heritability (e.g., h2) increase markedly with the magnitude of proximal processes; (c) demonstrates that heritability measures the proportion of variation in individual differences attributable only to actualized genetic potential, with the degree of nonactualized potential remaining unknown; (d) proposes that, by enhancing proximal processes and environments, it is possible to increase the extent of actualized genetic potentials for developmental competence.
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To promote early identification of mental health problems among combat veterans, the Department of Defense initiated population-wide screening at 2 time points, immediately on return from deployment and 3 to 6 months later. A previous article focusing only on the initial screening is likely to have underestimated the mental health burden. To measure the mental health needs among soldiers returning from Iraq and the association of screening with mental health care utilization. Population-based, longitudinal descriptive study of the initial large cohort of 88 235 US soldiers returning from Iraq who completed both a Post-Deployment Health Assessment (PDHA) and a Post-Deployment Health Re-Assessment (PDHRA) with a median of 6 months between the 2 assessments. Screening positive for posttraumatic stress disorder (PTSD), major depression, alcohol misuse, or other mental health problems; referral and use of mental health services. Soldiers reported more mental health concerns and were referred at significantly higher rates from the PDHRA than from the PDHA. Based on the combined screening, clinicians identified 20.3% of active and 42.4% of reserve component soldiers as requiring mental health treatment. Concerns about interpersonal conflict increased 4-fold. Soldiers frequently reported alcohol concerns, yet very few were referred to alcohol treatment. Most soldiers who used mental health services had not been referred, even though the majority accessed care within 30 days following the screening. Although soldiers were much more likely to report PTSD symptoms on the PDHRA than on the PDHA, 49% to 59% of those who had PTSD symptoms identified on the PDHA improved by the time they took the PDHRA. There was no direct relationship of referral or treatment with symptom improvement. Rescreening soldiers several months after their return from Iraq identified a large cohort missed on initial screening. The large clinical burden recently reported among veterans presenting to Veterans Affairs facilities seems to exist within months of returning home, highlighting the need to enhance military mental health care during this period. Increased relationship problems underscore shortcomings in services for family members. Reserve component soldiers who had returned to civilian status were referred at higher rates on the PDHRA, which could reflect their concerns about their ongoing health coverage. Lack of confidentiality may deter soldiers with alcohol problems from accessing treatment. In the context of an overburdened system of care, the effectiveness of population mental health screening was difficult to ascertain.
Article
Military personnel, emergency first responders, and others whose work environments include exposure to traumatic events are at risk for developing posttraumatic stress disorder (PTSD). To help prevent negative sequelae, there is a strong need to identify well-operationalized, empirically supported, theoretically framed models of healthy adaptation to potentially traumatic events. Cognitive-behavioral theories (CBTs) describe etiological factors in trauma, guide research that has identified risk for PTSD, and help develop interventions that can effectively reduce posttrauma symptomatology. In this article, the authors draw on CBT and empirical research on post-traumatic stress to propose possible cognitive-behavioral mechanisms in trauma adaptation. They then suggest directions for future research, including areas for prevention interventions for at-risk professionals.
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