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Stanley IH, Smith LJ, Boffa JW, Tran JK, Schmidt NB, Joiner TE, Vujanovic AA. Anxiety sensitivity and suicide risk among firefighters: A test of the depression-distress amplification model. Compr Psychiatry 2018; 84:39-46. [PMID: 29684659 PMCID: PMC6402324 DOI: 10.1016/j.comppsych.2018.03.014] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2017] [Revised: 02/18/2018] [Accepted: 03/28/2018] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Firefighters represent an occupational group at increased suicide risk. How suicidality develops among firefighters is poorly understood. The depression-distress amplification model posits that the effects of depression symptoms on suicide risk will be intensified in the context of anxiety sensitivity (AS) cognitive concerns. The current study tested this model among firefighters. METHODS Overall, 831 firefighters participated (mean [SD] age = 38.37 y [8.53 y]; 94.5% male; 75.2% White). The Center for Epidemiologic Studies Depression Scale (CES-D), Anxiety Sensitivity Index-3 (ASI-3), and Suicidal Behaviors Questionnaire-Revised (SBQ-R) were utilized to assess for depression symptoms, AS concerns (cognitive, physical, social), and suicide risk, respectively. Linear regression interaction models were tested. RESULTS The effects of elevated depression symptoms on increased suicide risk were augmented when AS cognitive concerns were also elevated. Unexpectedly, depression symptoms also interacted with AS social concerns; however, consistent with expectations, depression symptoms did not interact with AS physical concerns in the prediction of suicide risk. CONCLUSIONS In the context of elevated depression symptoms, suicide risk is potentiated among firefighters reporting elevated AS cognitive and AS social concerns. Findings support and extend the depression-distress amplification model of suicide risk within a sample of firefighters. Interventions that successfully impact AS concerns may, in turn, mitigate suicide risk among this at-risk population.
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Affiliation(s)
- Ian H. Stanley
- Department of Psychology, Florida State University, 1107 West Call Street, Tallahassee, FL 32306, USA
| | - Lia J. Smith
- Department of Psychology, University of Houston, 3695 Cullen Boulevard, Houston, TX 77204, USA
| | - Joseph W. Boffa
- Department of Psychology, Florida State University, 1107 West Call Street, Tallahassee, FL 32306, USA
| | - Jana K. Tran
- Houston Fire Department, 1801 Smith Street, Suite 626, Houston, TX 77002, USA
| | - N. Brad Schmidt
- Department of Psychology, Florida State University, 1107 West Call Street, Tallahassee, FL 32306, USA
| | - Thomas E. Joiner
- Department of Psychology, Florida State University, 1107 West Call Street, Tallahassee, FL 32306, USA
| | - Anka A. Vujanovic
- Department of Psychology, University of Houston, 3695 Cullen Boulevard, Houston, TX 77204, USA, Corresponding author at: Trauma and Stress Studies Center, University of Houston, Department of Psychology, 3695 Cullen Boulevard, 126 Heyne Building, Houston, TX 77204, USA. (A.A. Vujanovic)
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Boffa JW, Stanley IH, Smith LJ, Mathes BM, Tran JK, Buser SJ, Schmidt NB, Vujanovic AA. Posttraumatic Stress Disorder Symptoms and Suicide Risk in Male Firefighters: The Mediating Role of Anxiety Sensitivity. J Nerv Ment Dis 2018; 206:179-186. [PMID: 29309295 PMCID: PMC5825264 DOI: 10.1097/nmd.0000000000000779] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Posttraumatic stress disorder (PTSD) symptoms are positively related to suicide risk among firefighters. One mechanism that may account for this relationship is anxiety sensitivity (AS) cognitive concerns-the fear that cognitive symptoms of anxiety will have catastrophic consequences. We sought to replicate the mediating effect of AS cognitive concerns on the relationship between PTSD symptoms and suicide risk among 214 trauma-exposed male firefighters with non-zero suicide risk. Bootstrap mediation analyses tested AS cognitive concerns as a statistical mediator of PTSD symptoms (total and symptoms clusters scores) and suicide risk, controlling for depression symptoms and relevant demographic variables. AS cognitive concerns statistically mediated the relationship between PTSD symptoms (total score, as well as intrusion, avoidance, and arousal-reactivity symptoms clusters) and suicide risk; however, the reverse was also true. AS cognitive concerns may confer risk for suicide among trauma-exposed firefighters. Firefighters may benefit from AS-specific interventions, which are shown to reduce PTSD symptoms and suicidality.
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Affiliation(s)
- Joseph W. Boffa
- Department of Psychology, Florida State University, 1107 W. Call Street, Tallahassee, Florida, USA
| | - Ian H. Stanley
- Department of Psychology, Florida State University, 1107 W. Call Street, Tallahassee, Florida, USA
| | - Lia J. Smith
- Department of Psychology, University of Houston, 126 Heyne Building, 3695 Cullen Boulevard, Houston, Texas, USA
| | - Brittany M. Mathes
- Department of Psychology, Florida State University, 1107 W. Call Street, Tallahassee, Florida, USA
| | - Jana K. Tran
- Houston Fire Department, 1801 Smith Street, Suite 626, Houston, Texas, USA
| | - Sam J. Buser
- Houston Fire Department, 1801 Smith Street, Suite 626, Houston, Texas, USA
| | - Norman B. Schmidt
- Department of Psychology, Florida State University, 1107 W. Call Street, Tallahassee, Florida, USA
| | - Anka A. Vujanovic
- Department of Psychology, University of Houston, 126 Heyne Building, 3695 Cullen Boulevard, Houston, Texas, USA
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Psarros C, Theleritis C, Kokras N, Lyrakos D, Koborozos A, Kakabakou O, Tzanoulinos G, Katsiki P, Bergiannaki JD. Personality characteristics and individual factors associated with PTSD in firefighters one month after extended wildfires. Nord J Psychiatry 2018; 72:17-23. [PMID: 28871848 DOI: 10.1080/08039488.2017.1368703] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND Firefighters participate in activities with intense physical and psychological stress and are constantly at risk to develop various psychopathological reactions. AIMS To investigate psychological reactions in firefighters one month after devastating wildfires in Greece, during August 2007, which lead to the devastation of large areas and the death of 43 people among whom three were firefighters. METHODS One month after the wildfires, a joint task force of mental health clinicians was organized in order to provide psychological support and to investigate the psychological consequences of wildfires to firefighters. One hundred and two firefighters, living within the fire-devastated area, who were on duty for the whole period of wildfires were interviewed and assessed with the use of several questionnaires and inventories. RESULTS Post-traumatic stress disorder (PTSD) was detected in 18.6% of firefighters. Multiple logistic regression found that existence of fear of dying during firefighting, insomnia and increased scores in neuroticism, as well as in depression subscale of the SCL-90, were significantly associated with greater likelihood for having PTSD. Additionally those firefighters who worked permanently had 70% lower probability of having PTSD vs. those seasonally employed. CONCLUSIONS Insomnia, depressive symptoms, as well as personality characteristics as neuroticism and the perception of fear of imminent death during firefighting operations may precipitate the development of PTSD in firefighters. Within this context, mental health clinicians should be aware that the early detection of these predisposing factors may facilitate the prevention and mitigation of PTSD in firefighters particularly those who are seasonally employed.
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Affiliation(s)
- Constantin Psarros
- a 1st Department of Psychiatry , National and Kapodistrian University of Athens, Eginition Hospital , Athens , Greece
| | - Christos Theleritis
- a 1st Department of Psychiatry , National and Kapodistrian University of Athens, Eginition Hospital , Athens , Greece
| | - Nikolaos Kokras
- a 1st Department of Psychiatry , National and Kapodistrian University of Athens, Eginition Hospital , Athens , Greece
| | - Dimitris Lyrakos
- a 1st Department of Psychiatry , National and Kapodistrian University of Athens, Eginition Hospital , Athens , Greece
| | - Angelos Koborozos
- a 1st Department of Psychiatry , National and Kapodistrian University of Athens, Eginition Hospital , Athens , Greece
| | - Olga Kakabakou
- a 1st Department of Psychiatry , National and Kapodistrian University of Athens, Eginition Hospital , Athens , Greece
| | - Georgios Tzanoulinos
- a 1st Department of Psychiatry , National and Kapodistrian University of Athens, Eginition Hospital , Athens , Greece
| | - Panagiota Katsiki
- a 1st Department of Psychiatry , National and Kapodistrian University of Athens, Eginition Hospital , Athens , Greece
| | - Joanna Despoina Bergiannaki
- a 1st Department of Psychiatry , National and Kapodistrian University of Athens, Eginition Hospital , Athens , Greece.,b University Mental Health Research Institute (UMHRI) , Athens , Greece
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Hom MA, Matheny NL, Stanley IH, Rogers ML, Cougle JR, Joiner TE. Examining Physical and Sexual Abuse Histories as Correlates of Suicide Risk Among Firefighters. J Trauma Stress 2017; 30:672-681. [PMID: 29083498 DOI: 10.1002/jts.22230] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2017] [Revised: 06/21/2017] [Accepted: 07/27/2017] [Indexed: 11/09/2022]
Abstract
Research indicates that physical and sexual abuse are associated with increased suicide risk; however, these associations have not been investigated among firefighters-an occupational group that has been shown to be at elevated suicide risk. This study examined whether physical and sexual abuse histories are associated with (a) career suicide ideation, plans, and attempts; and (b) current suicide risk (controlling for theoretically relevant symptoms) in this occupational group. A sample of 929 U.S. firefighters completed self-report surveys that assessed lifetime history of physical and sexual abuse; career suicide ideation, plans, and attempts; current suicide risk; and theoretically relevant symptoms. Logistic regression analyses revealed that individuals who reported a history of physical abuse were significantly more likely to report career suicide ideation, adjusted odds ratio [AOR] = 6.12, plans, AOR = 13.05, and attempts, AOR = 23.81, than those who did not. A similar pattern of findings emerged for individuals who reported a sexual abuse history, AORs = 7.83, 18.35, and 29.58 respectively. Linear regression analyses revealed that physical and sexual abuse histories each significantly predicted current suicide risk, even after controlling for theoretically relevant symptoms and demographics, pr2 = .07 and .06, respectively. Firefighters with a history of physical and/or sexual abuse may be at increased risk for suicidal thoughts and behaviors. A history of physical and sexual abuse were each significantly correlated with current suicide risk in this population, even after accounting for the effects of theoretically relevant symptoms. Thus, when conceptualizing suicide risk among firefighters, factors not necessarily related to one's firefighter career should be considered.
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Affiliation(s)
- Melanie A Hom
- Department of Psychology, Florida State University, Tallahassee, Florida, USA
| | - Natalie L Matheny
- Department of Psychology, Florida State University, Tallahassee, Florida, USA
| | - Ian H Stanley
- Department of Psychology, Florida State University, Tallahassee, Florida, USA
| | - Megan L Rogers
- Department of Psychology, Florida State University, Tallahassee, Florida, USA
| | - Jesse R Cougle
- Department of Psychology, Florida State University, Tallahassee, Florida, USA
| | - Thomas E Joiner
- Department of Psychology, Florida State University, Tallahassee, Florida, USA
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Stanley IH, Hom MA, Spencer-Thomas S, Joiner TE. Suicidal thoughts and behaviors among women firefighters: An examination of associated features and comparison of pre-career and career prevalence rates. J Affect Disord 2017. [PMID: 28641147 DOI: 10.1016/j.jad.2017.06.016] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Women protective service workers die by suicide at a higher rate than women workers in other occupational groups. However, no study has examined rates and correlates of suicidal thoughts and behaviors among women firefighters, despite the potential for these data to inform suicide screening, prevention, and intervention initiatives. The purpose of this study is to describe and compare pre-career and career rates of suicidal thoughts and behaviors and identify their sociodemographic and occupational correlates among women firefighters. METHODS Data were obtained from 313 current U.S. women firefighters who completed a web-based survey (mean age = 37.30y, SD = 9.70y, 92.7% White). RESULTS Pre-career rates of suicide ideation, plans, attempts, and non-suicidal self-injury (NSSI) were found to be 28.4%, 10.2%, 5.8%, and 11.2%, respectively. Career rates of suicide ideation, plans, attempts, and NSSI were found to be 37.7%, 10.9%, 3.5%, and 9.3%, respectively. Pre-career rates of suicide ideation (OR = 4.760, 95% CI = 2.820-8.034, p < 0.001), plans (OR = 4.867, 95% CI = 2.067-11.463, p < 0.001), attempts (OR = 7.175, 95% CI = 1.726-29.828, p = 0.007), and NSSI (OR = 9.676, 95% CI = 4.130-22.670, p < 0.001) were significantly associated with career suicidality. With few exceptions, neither sociodemographic characteristics nor firefighter experiences were associated with career suicidal symptoms. LIMITATIONS Study limitations include a cross-sectional design and convenience sample recruitment strategy. CONCLUSIONS Women firefighters report elevated rates of suicidal thoughts and behaviors. Suicidal symptoms occurring prior to one's tenure as a firefighter-and not solely an aspect of firefighter career experiences-should be considered in suicide risk screening, prevention, and intervention initiatives. Studies examining modifiable suicide risk factors and correlates (e.g., psychiatric symptoms, workplace harassment) are needed.
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Affiliation(s)
- Ian H Stanley
- Department of Psychology, Florida State University, Tallahassee, FL, USA.
| | - Melanie A Hom
- Department of Psychology, Florida State University, Tallahassee, FL, USA
| | | | - Thomas E Joiner
- Department of Psychology, Florida State University, Tallahassee, FL, USA
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Stanley IH, Hom MA, Spencer-Thomas S, Joiner TE. Examining anxiety sensitivity as a mediator of the association between PTSD symptoms and suicide risk among women firefighters. J Anxiety Disord 2017. [PMID: 28645017 DOI: 10.1016/j.janxdis.2017.06.003] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Posttraumatic stress disorder (PTSD) symptoms are associated with increased suicide risk. Anxiety sensitivity (AS)-the fear of anxiety-related sensations-is both a vulnerability factor for and consequence of PTSD symptoms. AS also predicts suicide risk. To our knowledge, no study has examined whether AS concerns account for the association between PTSD symptoms and suicide risk. METHOD A total of 254 women firefighters completed a web-based mental health survey. The Life Events Checklist for DSM-5 (LEC-5) was administered as a prelude to the PTSD Checklist for DSM-5 (PCL-5) to assess for exposure to a Criterion A event. The PCL-5, Anxiety Sensitivity Index-3 (ASI-3), and Suicidal Behaviors Questionnaire-Revised (SBQ-R) were utilized to assess PTSD symptoms, AS concerns, and suicide risk, respectively. Bootstrap mediation analyses were conducted, controlling for depression symptoms as measured by the Center for Epidemiologic Studies Depression Scale-Revised (CESD-R). RESULTS Global and cognitive AS concerns, but neither physical nor social AS concerns, were statistically significant mediators of the relationship between PTSD symptoms (total score, re-experiencing and numbing clusters) and suicide risk. Alternate mediation models testing PTSD symptoms as a mediator of the relationship between AS concerns and suicide risk were not statistically significant, supporting the specificity of our proposed model. CONCLUSIONS Anxiety sensitivity concerns-specifically, cognitive AS concerns-account for the link between PTSD symptoms and suicide risk among women firefighters. Among firefighters with elevated PTSD symptoms, interventions that address cognitive AS concerns may thwart the trajectory to suicidal thoughts and behaviors.
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Affiliation(s)
- Ian H Stanley
- Department of Psychology, Florida State University, 1107 West Call Street, Tallahassee, FL 32306, USA.
| | - Melanie A Hom
- Department of Psychology, Florida State University, 1107 West Call Street, Tallahassee, FL 32306, USA
| | | | - Thomas E Joiner
- Department of Psychology, Florida State University, 1107 West Call Street, Tallahassee, FL 32306, USA
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