Prevalence and predictors of PTSD, depression and posttraumatic growth among Chinese firefighters

Mental health and post-traumatic stress disorder in firefighters: an integrated analysis from an action research study

Introduction

The presence of post-traumatic stress disorder (PTSD) symptomatology in firefighters is an ever-pressing issue that requires close attention for adequate interventions. The present study investigated PTSD and global psychopathology prevalence in a sample of highly risk-exposed Portuguese firefighters, collected after the widespread deadly wildfires in 2017 that ravaged the country. Following an action research approach, the aim of this study was to depict this sample and examine the impact of cumulative adverse experiences on their mental health, which is a phenomenon worth attention.

Method

From an initial sample of 283 firefighters who manifested interest in participating, a total of 139 firefighters from the Coimbra District, of whom 130 unequivocally experienced a potentially traumatic/adverse event as a firefighter, completed BSI (to obtain indicators on psychopathology), QEPAT (an inventory of adverse events possibly experienced as a firefighter), and PCL-5 (a measure of PTSD symptomatology) through an online survey during the year 2018 by the Regional Medical Organization, as proposed and supervised by the local Centre for Prevention and Treatment of Psychological Trauma (CPTTP).

Results

We found a global prevalence of 8.6% of possible PTSD and 14.4% of possible psychopathology (n = 139). When considering only firefighters who unequivocally reported a potentially traumatic/adverse event as a firefighter (n = 130), 9.2% present possible PTSD, and 13.8% present possible global psychopathology. This sample experienced a mean of 28 adverse events during firefighting work. Linear regressions (n = 118) demonstrated that the perceived severity of the most traumatic event reported and the experience of more adverse events were both related to an increase in PTSD symptomatology. Global psychopathology was associated with PCL-5 scores, with an emphasis on paranoid ideation, hostility, depression, anxiety, and phobic anxiety.

Discussion

The severe wildfires of 2017 did not impact PTSD scores in this sample (collected the year after), suggesting that cumulative adverse events are more important than particular episodes. However, the number of reported events was related to PTSD scores. These results can be used to develop interventions that target all firefighters by addressing risk and protective factors. This action research study motivated specialized aid for firefighters involved in this study.

The Relationship Between Effort-Reward Imbalance and Depressive Symptoms Among Chinese Firefighters: Moderating by Coping Styles

OBJECTIVES

This study aims to examine the association between effort-reward imbalance (ERI) and depressive symptoms among Chinese firefighters and the moderating role of positive and negative coping styles in the above association.

METHODS

A cross-sectional study including 1328 male firefighters was conducted in China. We adopted the Center for Epidemiologic Studies Depression Scale to measure depressive symptoms.

RESULTS

Results showed that ERI was associated with depressive symptoms. Individuals with a higher ERI ratio and greater overcommitment were likely to have higher level of depressive symptoms. Furthermore, negative coping style strengthened the relationship between ERI ratio and overcommitment with depressive symptoms, whereas the positive coping style presented none significant moderation.

CONCLUSIONS

These findings indicate that reforming the effort-reward system might be helpful for mental health promotion among Chinese firefighters.

Text4PTSI: A Promising Supportive Text Messaging Program to Mitigate Psychological Symptoms in Public Safety Personnel

BACKGROUND

Public safety personnel experience various mental health conditions due to their work's complex and demanding nature. There are barriers to seeking support and treatment; hence, providing innovative and cost-effective interventions can help improve mental health symptoms in public safety personnel.

OBJECTIVE

The study aimed to evaluate the impact of Text4PTSI on depression, anxiety, trauma, and stress-related symptoms, and the resilience of public safety personnel after six months of providing supportive text message intervention.

METHODS

Public safety personnel subscribed to Text4PTSI and received daily supportive and psychoeducational SMS text messages for six months. Participants were invited to complete standardized self-rated web-based questionnaires to assess depression, anxiety, posttraumatic stress disorder (PTSD), and resilience symptoms measured on the Patient Health Questionnaire-9 (PHQ-9), Generalized Anxiety Disorder-7 scale (GAD-7), Posttraumatic Stress Disorder Checklist-Civilian Version (PCL-C), and the Brief Resilience Scale (BRS), respectively. The assessment of mental health conditions was conducted at baseline (enrolment) and six weeks, three months, and six months after enrollment.

RESULTS

One hundred and thirty-one subscribers participated in the Text4PTSI program, and eighteen completed both the baseline and any follow-up survey. A total of 31 participants completed the baseline survey and 107 total surveys were recorded at all follow-up time points. The baseline prevalence of psychological problems among public safety personnel were as follows: likely major depressive disorder (MDD) was 47.1%, likely generalized anxiety disorder (GAD) was 37.5%, low resilience was 22.2%, and likely PTSD was 13.3%. At six months post-intervention, the prevalence of likely MDD, likely GAD, and likely PTSD among respondents reduced; however, a statistically significant reduction was reported only for likely MDD (-35.3%, X² (1) = 2.55, p = 0.03). There was no significant change in the prevalence of low resilience between baseline and post-intervention. There was a decrease in the mean scores on the PHQ-9, GAD-7, PCL-C, and the BRS from baseline to post-intervention by 25.8%, 24.7%, 9.5%, and 0.3%, respectively. However, the decrease was only statistically significant for the mean change in GAD-7 scores with a low effect size (t (15) = 2.73, p = 0.02).

CONCLUSIONS

The results of this study suggest a significant reduction in the prevalence of likely MDD as well as the severity of anxiety symptoms from baseline to post-intervention for subscribers of the Text4PTSI program. Text4PTSI is a cost-effective, convenient, and easily scalable program that can augment other services for managing the mental health burdens of public safety personnel.

Does infertility develop posttraumatic growth or anxiety/depressive symptoms? Roles of personality traits, resilience, and social support

PURPOSE

This study aimed to explore levels of posttraumatic growth (PTG) and anxiety/depressive symptoms and the role of personality traits, resilience, and social support as predictors of PTG in infertile men/women.

DESIGN AND METHODS

In our cross-sectional study, 162 infertile individuals (40 men and 122 women) completed the research questionnaires, including PTG, State-Trait Anxiety Inventory, Fertility Problem Inventory, NEO Five-Factor Inventory, Perceived Social Support, Kobasa hardiness short 20-item, and Beck Inventory Depression (BDI-II).

RESULTS

The prevalence of PTG was higher than that of anxiety/depressive symptoms (55.6% vs. 45.7%/40.7%). Neuroticism (β = 0.54 ± 0.25, p < 0.03), extroversion (β = 0.69 ± 0.26, p < 0.01), and resilience (β = 0.33 ± 0.12, p < 0.008) were positive predictors of PTG.

PRACTICE IMPLICATIONS

Infertile men/women with high level of resilience, extroversion, and neuroticism may have more tendency toward personal growth rather than distress. Practitioners ought to direct counseling to promote factors of personal growth.

The Mediating Role of Worker-Occupation Fit in the Relationship Between Occupational Stress and Depression Symptoms in 1988 Medical Workers: A Cross-Sectional Study

Objective

Occupational stress is generally acknowledged as a global phenomenon with significant health and economic consequences. The medical worker is a vulnerable group at a high-level risk for depression symptoms. This study aimed to examine the mediating effect of worker-occupation fit (WOF) in relation to occupational stress and depression symptoms among 1988 medical workers in China.

Methods

A multi-center cross-sectional study was conducted during June and October 2020 in Henan Province, China. The participants were medical workers from four targeted hospitals (included one general and three specialized hospitals). The Depression, Anxiety, and Stress Scale (DASS-21 Scale), Worker-Occupation Fit Inventory (WOFI), as well as questions about demographic and occupational information were administered in questionnaires distributed to 1988 medical workers. Hierarchical linear regression analysis was used to examine the mediating role of worker occupation fit.

Results

In this study, there are 43.5% (n = 864) of medical workers experienced depression symptoms. The mean score of WOF was 31.6 ± 7.1, characteristic fit, need supply fit and demand ability fit were 11.3 ± 2.5, 10.1 ± 2.7, 12.9 ± 2.2, respectively. The occupational stress was negatively related to worker occupation fit (r = -0.395, P < 0.001), characteristic fit (r = -0.529, P < 0.001), need supply fit (r = -0.500, P < 0.001), and demand ability fit (r = -0.345, P < 0.001). The occupational stress and depression symptoms have a positive relationship (r = 0.798, P < 0.001). The proportion of worker occupation fit mediation was 6.5% of total effect for depression symptoms.

Conclusion

Occupational stress has been identified as a risk factor for depression symptoms. Practical strategies for improving medical workers' WOF level would help them better cope with various work-related stressors to reduce depression symptoms. Hospital administrators could reduce medical workers' depression symptoms by taking comprehensive measures to improve the WOF.

A Scoping Review on the Prevalence and Determinants of Post-Traumatic Stress Disorder among Military Personnel and Firefighters: Implications for Public Policy and Practice

Introduction: Firefighters and military personnel are public safety personnel who protect the safety of individuals and their properties. They are usually exposed to traumatic events leaving them at risk of developing mental health conditions such as post-traumatic stress disorder (PTSD). Increasing concern is being raised regarding the mental health impacts, specifically PTSD, among military personnel and firefighters. Objective: There is an increased exposure of firefighters and military personnel to traumatic events and the attendant risk of developing post-traumatic stress disorder. It is crucial to ascertain the level of PTSD amongst this cohort and determinants to formulate policies and practices that mitigate the risk and protect public safety personnel. This scoping review sought to determine the prevalence of PTSD among this cohort globally and to explore determinants of this mental health condition. Methods: A literature search in databases including MEDLINE, CINAHL, PubMed, PsycINFO, and EMBASE was conducted electronically from May 2021 to 31 July 2021. Two reviewers independently assessed full-text articles according to the predefined inclusion criteria and screening process undertaken to identify studies for the review. Articles were screened with a third reviewer, resolving conflicts where necessary and further assessing them for eligibility. During article selection, the PRISMA checklist was adopted, and with the Covidence software, a total of 32 articles were selected for the final examination. For the eligible studies, data extraction was conducted, information was collated and summarized, and the findings were reported. Original qualitative and quantitative data on the prevalence and predictors of PTSD among veterans, military, and firefighters were reported. Results: The prevalence of PTSD was 57% for firefighters and 37.8% for military personnel. Demographic factors, job factors, social support, injuries, physical and psychological factors, and individual traits were the main predictors of PTSD in this cohort. Conclusion: This information is vital for developing and implementing prevention and intervention strategies for PTSD in military personnel and firefighters. Recognizing and addressing factors that predict PTSD will help to improve mental wellbeing and increase productivity. More peer-reviewed studies are needed on the prevalence of PTSD amongst these cohorts.

Psychological Symptoms and Posttraumatic Growth Among the General Population in Wuhan, China During the COVID-19 Pandemic: A Cross-Sectional Study

The aim of the current study was to investigate psychological symptoms and post-traumatic growth (PTG) among the general population in Wuhan, China during the coronavirus disease 2019 (COVID-19) pandemic. An online survey was conducted using convenience sampling. Participants were invited to fill out this questionnaire, which included information on sociodemographic characteristics and other survey objectives. The Psychological Questionnaire for Emergent Events of Public Health (PQEEPH) and the Chinese version of the Posttraumatic Growth Inventory (PTGI) were used. The prevalence of depression, neurasthenia, fear, obsessive-anxiety, and hypochondriasis among 311 participants were 61.1%, 69.8%, 97.8%, 57.2%, and 45%, respectively. Results indicated that a substantial proportion of the general population may have experienced psychological symptoms as well as PTG, due to the COVID-19 pandemic. Findings demonstrate the importance of developing targeted psychological interventions for those at risk for mental health symptoms. [Journal of Psychosocial Nursing and Mental Health Services, xx(xx), xx-xx.].

The impact of the traditional male role norms on the posttraumatic stress disorder among Polish male firefighters

Background

The aim of this study was to explore potential associations between compliance with the traditional male role norms and posttraumatic stress disorder (PTSD) symptoms.

Methods

The study was conducted on 135 male Polish firefighters. The study used the Impact Event Scale-Revised, the Relations/Social Support Scale and the Male Role Norms Scale.

Results

The study revealed that the firefighters that suffered from probable PTSD (over 34% of all the respondents) seemed to comply with the male role norms more strictly than those without PTSD. The reverse was found to be true for the perceived social support. Social status norms and toughness norms understood as expectations that men should achieve high status by means of successful career, etc., and be tough and resilient at all costs to be perceived as “manly” were found to be positively associated with the development of PTSD, while in the case of perceived social support, a negative association was confirmed. The results might yield important clinical implications—traditional male role norms pertaining to toughness and social status might be associated with the increase in chances of developing PTSD after the exposure to potentially traumatic events.

Conclusions

Firefighting as a stereotypically masculine occupation may be associated with the reinforcement of stereotypically masculine behaviors, which in turn is associated with a decreased ability to cope with potentially traumatic stimuli and favoring maladaptive behaviors. The results might suggest that addressing the beliefs about masculinity during psychological intervention in the case of PTSD might be beneficial especially among such masculinized groups as firefighters. The main limitations of the study are: participation of those more eager to participate and reveal personal information; the recall and report bias; the relatively small sample size; sociodemographic data omissions; the study group almost exclusively consisting of firefighters from large urban centers.

The Influence of Post-Traumatic Growth on College Students' Creativity During the COVID-19 Pandemic: The Mediating Role of General Self-Efficacy and the Moderating Role of Deliberate Rumination

Purpose: This study used a moderated mediation model to test the mediating effect of general self-efficacy on the relationship between post-traumatic growth (PTG) and creativity and the moderating effect of deliberate rumination in the second path of the indirect mediation path during the COVID-19 pandemic. Methods: A sample of 881 university students from Guangdong Province, China, was surveyed with the Posttraumatic Growth Inventory, the Runco Ideational Behavior Scale, the General Self-Efficacy Scale, and the Deliberate Rumination Inventory. SPSS (23 version) and PROCESS (3.3 version) were used for correlation analyses, mediation analysis, and moderated mediation analysis. Results: (1) PTG was positively correlated with creativity, self-efficacy, and deliberate rumination. Creativity was positively correlated with self-efficacy and deliberate rumination. Deliberate rumination was positively correlated with self-efficacy. (2) Self-efficacy mediated the relationship between PTG and creativity. (3) Deliberate rumination moderated the second half of the path of "PTG → self-efficacy → creativity." Conclusions: PTG affected creativity directly and also indirectly through self-efficacy. In particular, deliberate rumination moderated the relationship between self-efficacy and creativity, such that the association was stronger when the incidence of deliberate rumination was low. These results provide a more comprehensive understanding of the positive link between PTG and creativity.

Testosterone and occupational burnout in professional male firefighters

Background

Very little is known about the biologic predictors of the occupational burnout in firefighters. The aim of this study was to characterize testosterone profile of active firefighters and quantify its association with three domains of the occupational burnout.

Methods

We enrolled 100 firefighters (median age 28 (interquartile range (IQR) 9.8) years with 5 (IQR 9) years in service) of three fire departments in Almaty, Kazakhstan. Demographics, smoking status, health-related quality of life (HRQL) and burnout scores of Maslach Burnout Inventory were assessed using a questionnaire, while total blood testosterone was measured in venous blood. Logistic regression models were used to quantify the association of blood testosterone with each burnout domain in the adjusted for confounders models.

Results

The median blood testosterone level was 14 (IQR 3.5) nmol/l and was only predicted by age (beta − 0.14, p < 0.01, 79% power). There were no differences in blood testosterone levels between occupational groups (Group 1 (firefighters), 14.6 (IQR 3.4); Group 2 (fire truck drivers), 14.7 (IQR 5.6); Group 3 (shift commanders, division heads, department managers and engineers), 14 (IQR 4.1) nmol/l, Kruskal-Wallis p = 0.32) or departments. Testosterone could not predict EX or CY, but had a negative association with PE score reflecting more burnout (odds ratio 1.18 (95% confidence interval 1.01;1.38)), adjusted for age, mental component of HRQL and education.

Conclusions

Firefighters with higher testosterone may develop burnout in PE earlier, and this should be considered for proper work placement within the rescue system.

Prevalence of Posttraumatic Stress Disorder among Firefighters in Iran: A Systematic Review and Meta-Analysis

Objective: Firefighters are exposed to many different chemicals and physical hazards and experience a significant number of accidents and injuries. They are exposed to high-risk of posttraumatic stress disorder (PTSD).

The purpose of this study was to determine the prevalence of PTSD among Iranian firefighters.

Method: This was a systematic review and meta-analysis. Valid Persian and English keywords were searched in data resources, including SID, Magiran, Irandoc, Google Scholar, PubMed, Scopus, and Web of Science to retrieve articles on the prevalence of PTSD among Iranian firefighters. The STROBE checklist was used to assess the quality of the articles. Heterogeneity among the studies was assessed by I² index. The data were analyzed using Stata14 software.

Results: Of the 316 articles selected in the initial search, 3 articles the inclusion criteria and were used for the meta-analysis. A total of 274 firefighters were studied. The prevalence of PTSD was 23.17% among Iranian firefighters (I² = 92.4%, 95% CI = 6.71-39.62, p < 0.001).

Conclusion: The prevalence of PTSD is among Iranian firefighters relatively high and has been on the rise over the recent years.