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Lommen MJJ, Hoekstra S, van den Brink RHS, Lenaert B. Fear generalization predicts post-traumatic stress symptoms: A two-year follow-up study in Dutch fire fighters. J Anxiety Disord 2024; 103:102855. [PMID: 38484507 DOI: 10.1016/j.janxdis.2024.102855] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Revised: 01/20/2024] [Accepted: 03/07/2024] [Indexed: 04/21/2024]
Abstract
INTRODUCTION Excessive fear generalization has been associated with pathological anxiety, including posttraumatic stress disorder (PTSD). However, studies investigating the longitudinal relationship between generalization and the development of anxiety symptomatology are scarce. This study aims to test the predictive value of fear generalization for PTSD symptoms in a high-risk profession sample and to explore the relationship between generalization and neuroticism, which are both linked to PTSD. METHOD Longitudinal data from a multi-wave study in 529 Dutch fire-fighters were used. Fear generalization, PTSD symptoms and neuroticism were assessed at baseline. PTSD symptoms were reevaluated at six, 12, 18, and 24 months. Generalization was assessed in a differential conditioning paradigm by measuring expectancies of an aversive outcome when presented with stimuli similar to previously conditioned stimuli. RESULTS Higher expectancy ratings towards stimuli most similar to safety signals predicted PTSD symptoms at follow-up after controlling for baseline PTSD symptoms, whereas higher expectancy ratings towards stimuli most similar to danger signals was associated with neuroticism. Neuroticism weakened the predictive power of fear generalization when considered simultaneously. DISCUSSION These findings suggest that heightened fear generalization is associated with the development of anxiety and trauma-related symptoms. Targeting problematic fear generalization may be a promising intervention approach.
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Affiliation(s)
- Miriam J J Lommen
- Department of Clinical Psychology and Experimental Psychopathology, University of Groningen, the Netherlands.
| | | | - Rob H S van den Brink
- Department of Psychiatry, Rob Giel Research Center, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Bert Lenaert
- Department of Life Span Psychology, Faculty of Psychology, Open University, Heerlen, the Netherlands; Department of Neuropsychology and Psychopharmacology, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, the Netherlands
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Song M, Desai IK, Meyer A, Shah H, Saloner B, Sherman SG, Allen ST, Tomko C, Schneider KE, Krawczyk N, Whaley S, Churchill J, Harris SJ. Exploring trauma and wellbeing of people who use drugs after witnessing overdose: A qualitative study. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2023; 122:104239. [PMID: 37890394 DOI: 10.1016/j.drugpo.2023.104239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Revised: 10/17/2023] [Accepted: 10/18/2023] [Indexed: 10/29/2023]
Abstract
BACKGROUND The national overdose crisis is often quantified by overdose deaths, but understanding the traumatic impact for those who witness and respond to overdoses can help elucidate mental health needs and opportunities for intervention for this population. Many who respond to overdoses are people who use drugs. This study adds to the literature on how people who use drugs qualitatively experience trauma resulting from witnessing and responding to overdose, through the lens of the Trauma-Informed Theory of Individual Health Behavior. METHODS We conducted 60-min semi-structured, in-depth phone interviews. Participants were recruited from six states and Washington, DC in March-April 2022. Participants included 17 individuals who witnessed overdose(s) during the COVID-19 pandemic. The interview guide was shaped by theories of trauma. The codebook was developed using a priori codes from the interview guide; inductive codes were added during content analysis. Transcripts were coded using ATLAS.ti. RESULTS A vast majority reported trauma from witnessing overdoses. Participants reported that the severity of trauma varied by contextual factors such as the closeness of the relationship to the person overdosing or whether the event was their first experience witnessing an overdose. Participants often described symptoms of trauma including rumination, guilt, and hypervigilance. Some reported normalization of witnessing overdoses due to how common overdoses were, while some acknowledged overdoses will never be "normal." The impacts of witnessing overdose on drug use behaviors varied from riskier substance use to increased motivation for treatment and safer drug use practices. CONCLUSION Recognizing the traumatic impact of witnessed overdoses is key to effectively addressing the full range of sequelae of the overdose crisis. Trauma-informed approaches should be central for service providers when they approach this subject with clients, with awareness of how normalization can reduce help-seeking behaviors and the need for psychological aftercare. We found increased motivation for behavior change after witnessing, which presents opportunity for intervention.
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Affiliation(s)
- Minna Song
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, 615N Wolfe St, Baltimore, MD 21205, USA.
| | - Isha K Desai
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, 615N Wolfe St, Baltimore, MD 21205, USA; Department of Health Policy and Management, George Washington University, 950 New Hampshire Ave, #2, Washington, DC 20052, USA
| | - Avery Meyer
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, 615N Wolfe St, Baltimore, MD 21205, USA
| | - Hridika Shah
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, 615N Wolfe St, Baltimore, MD 21205, USA
| | - Brendan Saloner
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, 615N Wolfe St, Baltimore, MD 21205, USA
| | - Susan G Sherman
- Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, 615N Wolfe St, Baltimore, MD 21205, USA
| | - Sean T Allen
- Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, 615N Wolfe St, Baltimore, MD 21205, USA
| | - Catherine Tomko
- Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, 615N Wolfe St, Baltimore, MD 21205, USA
| | - Kristin E Schneider
- Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, 615N Wolfe St, Baltimore, MD 21205, USA
| | - Noa Krawczyk
- Center for Opioid Epidemiology and Policy, Department of Population Health, New York University Grossman School of Medicine, 180 Madison Ave, New York, NY, 10065, USA
| | - Sara Whaley
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, 615N Wolfe St, Baltimore, MD 21205, USA
| | - Jade Churchill
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, 615N Wolfe St, Baltimore, MD 21205, USA
| | - Samantha J Harris
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, 615N Wolfe St, Baltimore, MD 21205, USA
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Williams R, Kemp V, Burgess J, Murray E, Stokes S, Wood A, Batt-Rawden S, Bland L, Lockey D. Practical psychosocial care for providers of pre-hospital care: a summary of the report 'valuing staff, valuing patients'. Scand J Trauma Resusc Emerg Med 2023; 31:77. [PMID: 37946286 PMCID: PMC10636848 DOI: 10.1186/s13049-023-01141-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Accepted: 10/25/2023] [Indexed: 11/12/2023] Open
Abstract
BACKGROUND Caring for people who are ill or injured in pre-hospital environments is emotionally draining and physically demanding. This article focuses on the Psychosocial and Mental Health Programme commissioned by the Faculty of Pre-Hospital Care (FPHC) at the Royal College of Surgeons of Edinburgh (RCSEd) in 2018 to investigate the experiences and needs of responders to pre-hospital emergencies and make recommendations. It summarises the report to FPHC published in 2022, and adds material from research published subsequently. METHOD FPHC appointed a team to undertake the work. Team members conducted a literature review, and a systematic review of the literature concerning the impacts on the mental health of pre-hospital practitioners. They conducted fieldwork, participated in training and had conversations with trainees and established practitioners, and took evidence from the Pre-hospital Emergency Medicine Trainees Association (PHEMTA). RESULTS The Results summarise the evidence-based theoretical background derived from the programme and practical guidance for practitioners, professional organisations, and employers who deliver pre-hospital care on the implications of, preventing and intervening with pre-hospital providers who experience psychosocial and mental health problems. CONCLUSION This paper summarises the outputs from a multidisciplinary programme of scholarship, research, and fieldwork. The authors condense the findings and the guidance developed by the Programme Team to provide a summary of the report and guidance on implementation. They believe that the recommendations are applicable to all healthcare organisations and particularly those that employ responders to emergencies and provide pre-hospital care.
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Affiliation(s)
- Richard Williams
- Welsh Institute for Health and Social Care, Faculty of Pre-Hospital Care, University of South Wales, Edinburgh, UK
- Director of the Psychosocial Care and Mental Healthcare Programme for the Faculty of Pre-Hospital Care, Royal College of Surgeons of Edinburgh 2018-2022, Edinburgh, UK
| | - Verity Kemp
- Psychosocial Care and Mental Healthcare Programme for the Faculty of Pre-Hospital Care, Royal College of Surgeons of Edinburgh 2018-2022, Edinburgh, UK
| | - Jennifer Burgess
- Cumbria, Northumberland, Tyne and Wear NHS Trust and Newcastle University, Newcastle Upon Tyne, UK
| | - Esther Murray
- Institute for Health Sciences Education, Faculty of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Suzy Stokes
- Emergency Medicine and Pre-Hospital Emergency Medicine, Oxford University Hospitals and Thames Valley Air Ambulance, Stokenchurch, UK
| | - Andrew Wood
- Anaesthesia and Pre-Hospital Emergency Medicine, Barts Health NHS Trust, London, UK
| | - Samantha Batt-Rawden
- Intensive Care Medicine and Pre-Hospital Emergency Medicine, Ashford and St Peter's NHS Foundation Trust, Cambridge, UK
| | - Laura Bland
- Pre-Hospital and Emergency Medicine, Somerset Foundation Trust and Dorset and Somerset Air Ambulance, Henstridge, UK
- Faculty of Pre-Hospital Care, Intercollegiate Board for Training in Pre-Hospital Emergency Medicine, Edinburgh, UK
| | - David Lockey
- Faculty of Pre-Hospital Care, Royal College of Surgeons of Edinburgh, Edinburgh, UK.
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Lalani K, O’Neal M, Joannou SL, Gopal B, Champagne-Langabeer T. Helping Frontline Workers in Texas-A Framework for Resource Development. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:6935. [PMID: 37887673 PMCID: PMC10606751 DOI: 10.3390/ijerph20206935] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Revised: 10/06/2023] [Accepted: 10/11/2023] [Indexed: 10/28/2023]
Abstract
First responders disproportionately experience occupational stress when compared to the general population, and COVID-19 has exacerbated this stress. The nature of their duties as law enforcement officers, firefighters, and medics exposes them to repeated trauma, increasing their risk of developing a broad array of mental health issues, including post-traumatic stress disorder (PTSD), substance use disorder (SUD), and compassion fatigue. This paper describes the need for resources for frontline workers and provides a framework for creating and implementing resources. A team of interdisciplinary subject matter experts developed two major resources. The first resource was a 24/7 helpline to support first responders and healthcare workers experiencing substance use or mental health concerns. The second resource was the First Responders Educational Campaign, which developed and delivered focused training modules on useful topics covering substance use and mental health concerns as they pertain to this workforce. Utilizing core interprofessional principles, content was sourced from multiple disciplines and contrasting perspectives to provide a comprehensive understanding of mental health and substance use issues. The curriculum was designed so that the content was interdisciplinary, interprofessional, and accessible to audiences across disciplines and professions. After engaging more than 1500 individuals, resources developed here have augmented mental health and substance use support resources available to the target population.
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Affiliation(s)
- Karima Lalani
- School of Public Health, University of Washington, Seattle, WA 98195, USA;
| | - Meredith O’Neal
- McWilliams School of Biomedical Informatics, The University of Texas Health Science Center at Houston (UTHealth Houston), Houston, TX 77030, USA
| | - Simone Lee Joannou
- McWilliams School of Biomedical Informatics, The University of Texas Health Science Center at Houston (UTHealth Houston), Houston, TX 77030, USA
| | - Bhanumathi Gopal
- McWilliams School of Biomedical Informatics, The University of Texas Health Science Center at Houston (UTHealth Houston), Houston, TX 77030, USA
| | - Tiffany Champagne-Langabeer
- McWilliams School of Biomedical Informatics, The University of Texas Health Science Center at Houston (UTHealth Houston), Houston, TX 77030, USA
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Hureau DM, Wilson T, Jackl HM, Arthur J, Patterson C, Papachristos AV. Exposure to gun violence among the population of Chicago community violence interventionists. SCIENCE ADVANCES 2022; 8:eabq7027. [PMID: 36563162 PMCID: PMC9788757 DOI: 10.1126/sciadv.abq7027] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Accepted: 11/29/2022] [Indexed: 06/17/2023]
Abstract
Gun violence is a leading cause of premature death and a driver of racial disparities in life expectancy in the United States. Community-based interventions are the foremost policy strategy for reducing gun violence without exacerbating harm associated with criminal justice approaches. However, little is known about the interventionist workforce. In 2021, we used a researcher-guided survey to obtain a near-census of Chicago violence interventionists (n = 181, 93% response rate). Workers were mostly male (84%) and Black (80.9%), with a mean age of 43.6 years. Interventionists commonly experienced work-related exposure to violence and direct victimization. A total of 59.4% witnessed someone being shot at, whereas 32.4% witnessed a victim struck by gunfire. During work hours, 19.6% were shot at, while 2.2% were nonfatally shot. Single-year rates of gun violence victimization exceeded those of Chicago police. Results suggest that investment in community violence intervention should prioritize improving worker safety and reducing violence exposure while developing support for vulnerable frontline practitioners.
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Affiliation(s)
- David M. Hureau
- School of Criminal Justice, University at Albany, SUNY, Albany, NY
| | - Theodore Wilson
- School of Criminal Justice, University at Albany, SUNY, Albany, NY
| | - Hilary M. Jackl
- School of Criminal Justice, University at Albany, SUNY, Albany, NY
| | - Jalon Arthur
- Chicago CRED (Creating Real Economic Destiny), Chicago, IL, USA
| | - Christopher Patterson
- Office of Firearm Violence Prevention, Illinois Department of Human Services, Chicago, IL, USA
| | - Andrew V. Papachristos
- Department of Sociology, Northwestern University, Evanston, IL, USA
- Institute for Policy Research, Northwestern University, Evanston, IL, USA
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Bonumwezi JL, Tramutola D, Lawrence J, Kobezak HM, Lowe SR. Posttraumatic stress disorder symptoms, work-related trauma exposure, and substance use in first responders. Drug Alcohol Depend 2022; 237:109439. [PMID: 35623285 DOI: 10.1016/j.drugalcdep.2022.109439] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2021] [Revised: 03/14/2022] [Accepted: 04/02/2022] [Indexed: 11/03/2022]
Abstract
BACKGROUND Posttraumatic stress disorder (PTSD) symptoms have been shown to increase the likelihood of substance use in the general population. First responders (e.g., EMTs, paramedics, and firefighters) are routinely exposed to potentially traumatic events (PTEs) as part of their regular duties, increasing their risk for a range of adverse mental health outcomes including PTSD symptoms. However, no study to our knowledge has explored the relationship between PTEs, PTSD symptoms, and substance use in this population. In the current study, we examined whether PTSD symptoms were associated with alcohol and drug use in first responders above and beyond demographic variables, job-related characteristics, social support, and cumulative work-related PTE exposure, and whether work-related PTE exposure had an indirect effect on substance use via PTSD symptoms. METHODS Participants (N = 885; mean age = 37.13; 59.0% male; 91.5% White) were recruited from all 50 U.S. states, the Virgin Islands, and Puerto Rico to complete an online survey. RESULTS In hierarchical regression analyses, PTSD symptoms were significantly associated with alcohol and drug use above and beyond all the other variables. Work-related PTE exposure was not a significant predictor of either outcome once PTSD symptoms were included, suggesting that PTEs confer risk for substance use via their association with PTSD symptoms. This finding was confirmed by an analysis showing that PTE exposure had a significant indirect effect on both alcohol and drug use via PTSD symptoms. CONCLUSION Results support the need for periodic assessment of both PTSD symptoms and substance use in first responders.
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Affiliation(s)
| | | | | | - Holly M Kobezak
- Department of Psychology, Binghamton University (SUNY), Binghamton, NY, USA
| | - Sarah R Lowe
- Department of Social and Behavioral Sciences, Yale School of Public Health, Yale University, New Haven, CT, USA
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Morris H, Hatzikiriakidis K, Savaglio M, Dwyer J, Lewis C, Miller R, Skouteris H. Eye movement desensitization and reprocessing for the treatment and early intervention of trauma among first responders: A systematic review. J Trauma Stress 2022; 35:778-790. [PMID: 35064977 DOI: 10.1002/jts.22792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Revised: 11/09/2021] [Accepted: 11/11/2021] [Indexed: 11/09/2022]
Abstract
First responders are exposed to repetitive work-related trauma and, thus, are at risk of developing posttraumatic stress disorder (PTSD). Eye-movement desensitization and reprocessing (EMDR) is a psychotherapy intervention designed to treat symptoms of posttraumatic stress. We conducted a systematic review to examine the viability of EMDR among first responders. The primary aim of this review was to identify studies that have trialed EMDR among first responders and evaluate its effectiveness in reducing trauma-related symptoms; a secondary aim was to identify whether EMDR has been used as an early intervention for this cohort and determine its effectiveness as such. Four databases were searched. Studies were included if they evaluated the extent to which EMDR was effective in alleviating symptoms stemming from work-related trauma exposure among first responders. The findings from each study were reported descriptively, and eight studies that evaluated the efficacy of EMDR in this population were included. There was substantial variation in how EMDR was implemented, particularly in the type, duration, frequency, and timing. The findings suggest that EMDR can alleviate symptoms of work-related trauma exposure among first responders; however, findings regarding early intervention were inconclusive, and a methodological quality assessment revealed that all studies were classified as being of either weak or medium quality. Although this review provides preliminary insights into the effectiveness of EMDR for first responders, the conclusions that can be drawn from the literature are limited, and the findings highlight several gaps in the literature.
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Affiliation(s)
- Heather Morris
- Health and Social Care Unit, School of Public Health and Preventive Medicine, Monash University, Victoria, Australia
| | - Kostas Hatzikiriakidis
- Health and Social Care Unit, School of Public Health and Preventive Medicine, Monash University, Victoria, Australia
| | - Melissa Savaglio
- Health and Social Care Unit, School of Public Health and Preventive Medicine, Monash University, Victoria, Australia
| | | | - Catrin Lewis
- Division of Psychological Medicine and Clinical Neurosciences, Cardiff University, Wales, UK
| | | | - Helen Skouteris
- Health and Social Care Unit, School of Public Health and Preventive Medicine, Monash University, Victoria, Australia.,Warwick Business School, Warwick University, Coventry, UK
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Sopp MR, Haim-Nachum S, Wirth BE, Bonanno GA, Levy-Gigi E. Leaving the door open: Trauma, updating, and the development of PTSD symptoms. Behav Res Ther 2022; 154:104098. [DOI: 10.1016/j.brat.2022.104098] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2021] [Revised: 02/09/2022] [Accepted: 04/08/2022] [Indexed: 02/07/2023]
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Lowery A, Cassidy T. Health and well-being of first responders: The role of psychological capital, self-compassion, social support, relationship satisfaction, and physical activity. JOURNAL OF WORKPLACE BEHAVIORAL HEALTH 2022. [DOI: 10.1080/15555240.2021.1990776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
| | - Tony Cassidy
- School of Psychology, Ulster University, Coleraine, UK
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Craddock TB, Telesco G. Police Stress and Deleterious Outcomes: Efforts Towards Improving Police Mental Health. JOURNAL OF POLICE AND CRIMINAL PSYCHOLOGY 2022; 37:173-182. [PMID: 34776601 PMCID: PMC8575544 DOI: 10.1007/s11896-021-09488-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 10/25/2021] [Indexed: 05/21/2023]
Abstract
Police officers are subjected, daily, to critical incidents and work-related stressors that negatively impact nearly every aspect of their personal and professional lives. They have resisted openly acknowledging this for fear of being labeled. This research examined the deleterious outcomes on the mental health of police officers, specifically on the correlation between years of service and change in worldviews, perception of others, and the correlation between repeated exposure to critical events and experiencing Post-Traumatic Symptoms. The Cumulative Career Traumatic Stress Questionnaire- Revised (Marshall in J Police Crim Psychol 21(1):62-71, 2006) was administered to 408 current and prior law enforcement officers across the United States. Significant correlations were found between years of service and traumatic events; traumatic events and post-traumatic stress symptoms; and traumatic events and worldview/perception of others. The findings from this study support the literature that perpetual long-term exposure to critical incidents and traumatic events, within the scope of the duties of a law enforcement officer, have negative implications that can impact both their physical and mental wellbeing. These symptoms become exacerbated when the officer perceives that receiving any type of service to address these issues would not be supported by law enforcement hierarchy and could, in fact, lead to the officer being declared unfit for duty. Finally, this research discusses early findings associated with the 2017 Law Enforcement Mental Health and Wellness Act and other proactive measures being implemented within law enforcement agencies who are actively working to remove the stigma associated with mental health in law enforcement.
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Affiliation(s)
- Tina B. Craddock
- Department of Social Science, 344 Gilchrist Education and Psychology Complex (Office), Division of Academic Affairs, Elizabeth City State University, 1704 Weeksville Road, Elizabeth City, NC 27909 USA
| | - Grace Telesco
- Abraham S. Fischler College of Education, School of Criminal Justice, Nova Southeastern University, 3301 College Ave, Davie, FL 33314 USA
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Cole SP, Siddiqui S. Well-being in the intensive care unit: Looking Beyond COVID-19. Anesthesiol Clin 2022; 40:373-382. [PMID: 35659408 PMCID: PMC8802563 DOI: 10.1016/j.anclin.2022.01.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
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Mikutta C, Schmid JJ, Ehlert U. Resilience and Post-traumatic Stress Disorder in the Swiss Alpine Rescue Association. Front Psychiatry 2022; 13:780498. [PMID: 35401258 PMCID: PMC8985199 DOI: 10.3389/fpsyt.2022.780498] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Accepted: 02/14/2022] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE The present study aimed to assess the frequency of trauma exposure, the prevalence of possible post-traumatic stress disorder (PTSD), the extent of resilience, and sense of coherence among personnel of the Swiss alpine rescue association (ARS). METHODS Using a trilingual online survey approach, 465 mountain rescuers of the ARS were surveyed using the Posttraumatic Diagnostic Scale (PDS), the PTSD Checklist 5 (PCL-5), the Resilience Scale 13 and 14 (RS-13/-14), the Perceived Stress Scale 10 (PSS-10), the General Health Questionnaire 12 (GHQ-12), the Pittsburg Sleep Quality Index (PSQI), the Sense of Coherence Scale 13 (SOC-13), and the Berlin Social Support Scales (BSSS). RESULTS Although the rate of mountain rescuers having witnessed or experienced a traumatic event was high (71%), the prevalence of possible PTSD was low (0.9%). The sample showed high resilience and high sense of coherence. Resilience was positively correlated with work experience. Low perceived stress and high sense of coherence predicted resilience. The severity of PTSD symptoms was mainly predicted by low sense of coherence. Sense of coherence mediated the interaction between resilience and severity of PTSD symptoms. CONCLUSION The findings suggest that resilience and sense of coherence are indicative for the low prevalence of possible PTSD among mountain rescuers, and may therefore represent valuable screening and training parameters for mountain rescue personnel.
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Affiliation(s)
- Christian Mikutta
- University Hospital of Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland.,Privatklinik Meiringen, Meiringen, Switzerland
| | - Julia J Schmid
- Department of Clinical Psychology, University of Zurich, Zurich, Switzerland
| | - Ulrike Ehlert
- Department of Clinical Psychology, University of Zurich, Zurich, Switzerland
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The relation of unrest-related distress with probable depression during and after widespread civil unrest. Glob Ment Health (Camb) 2022; 9:322-327. [PMID: 36618736 PMCID: PMC9806963 DOI: 10.1017/gmh.2022.27] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Revised: 04/20/2022] [Accepted: 04/29/2022] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND This study investigated whether subjective unrest-related distress was associated with probable depression during and after the 2019 anti-ELAB movement in Hong Kong. METHODS Population-representative data were collected from 7157 Hong Kong Chinese in four cross-sectional surveys (July 2019-July 2020). Logistic regression examined the association between subjective unrest-related distress and probable depression (PHQ-9 ⩾ 10), stratified by the number of conflicts/protests across the four timepoints. RESULTS Unrest-related distress was positively associated with probable depression across different numbers of conflicts/protests. CONCLUSION Unrest-related distress is a core indicator of probable depression. Public health interventions should target at resolving the distress during seemingly peaceful period after unrest.
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Cherry N, Beach J, Galarneau JM. The Health of Firefighters Deployed to the Fort McMurray Fire: Lessons Learnt. Front Public Health 2021; 9:692162. [PMID: 34858913 PMCID: PMC8632044 DOI: 10.3389/fpubh.2021.692162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Accepted: 10/18/2021] [Indexed: 11/29/2022] Open
Abstract
Introduction: Firefighters were working in exceptionally difficult conditions during the Fort McMurray/Horse River fire in May 2016. Methods: From mid-May, we recruited firefighters from 13 fire services as they returned from the fire. In October 2016 we extended recruitment to all Alberta-based firefighters deployed to the fire. In December 2017-May 2018 we sent a first online follow-up: this concentrated on mental health supports. The second follow-up, in October 2018-January 2019, included screening scales for respiratory ill-health and PTSD. All three contacts included visual analogue scales for chest symptoms and the Hospital Anxiety and Depression Scale. We estimated exposure to PM2.5, and calculated an exposure mitigation index from reports of respiratory protective equipment (RPE). Results: We recruited 1,234 firefighters and examined the relation of respiratory symptoms to estimated particulate exposure. The relation was strong immediately post fire but weakened over time. We found less chest tightness and cough in those whose RPE in the first week mitigated exposure by at least 10%. We examined the relation between particulate exposure and mental ill-health from screening questionnaires and found those with high exposure (reflecting the ferocity of the fire) had poorer mental health scores. Firefighters reporting their "worst moment during the fire" was life threatening were more anxious at second follow-up. Overall both anxiety and depression scores increased at successive contacts, more so in those with mental ill-health recorded in physician billing records before the fire. Discussion: The results from this study overall suggest on-going fire-related health effects in a substantial minority of firefighters, similar to those reported in the longitudinal follow-up of firefighters after the collapse of the World Trade Centre. Self-reports of both respiratory symptoms and mental ill-health were strongly related, soon after the fire, to estimated particulate exposures. Anxiety increased over time since the fire in those who felt their life or safety had been threatened, underlining the need for ongoing support. Our conclusions about the benefits of rapid research relate particularly to the collection of biomarkers of exposure as quickly and widely as possible, and the establishment of a nominal list of participants before they are too widely dispersed.
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Affiliation(s)
- Nicola Cherry
- Division of Preventive Medicine, University of Alberta, Edmonton, AB, Canada
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Sopp MR, Michael T, Lass-Hennemann J, Haim-Nachum S, Lommen MJJ. Longitudinal associations between hair cortisol, PTSD symptoms, and sleep disturbances in a sample of firefighters with duty-related trauma exposure. Psychoneuroendocrinology 2021; 134:105449. [PMID: 34687966 DOI: 10.1016/j.psyneuen.2021.105449] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Revised: 09/15/2021] [Accepted: 10/11/2021] [Indexed: 01/04/2023]
Abstract
Several studies have found evidence of altered cortisol levels in patients with posttraumatic stress disorder (PTSD). Based on these findings, it is assumed that these patients may show signs of cortisol dysregulation after trauma. Posttrauma cortisol levels are thus considered a potential biomarker of PTSD. However, longitudinal studies using indicators of long-term cortisol secretion such as hair cortisol concentrations (HCC) are scarce. The current study investigated prospective associations between HCC and PTSD symptoms in a sample of Dutch firefighters taking into account varying levels of work-related trauma severity. In addition, we assessed posttraumatic sleep disturbances as a secondary outcome measure to investigate whether effects generalize to this frequent comorbidity of PTSD. Three hundred seventy-one Dutch firefighters with a mean of 14.01 years of work experience were included in the analyses. Baseline assessment included the collection of hair samples and the measurement of work-related trauma severity, PTSD symptoms, and sleep disturbances. PTSD symptoms and sleep disturbance were re-assessed after six and twelve months. Multilevel analyses indicate a significant positive correlation between HCC and baseline PTSD symptoms in those with average or above-average work-related trauma severity. A similar pattern was evident for posttraumatic sleep disturbances at baseline. Moreover, higher HCC predicted more posttraumatic sleep disturbances after 6 months in participants with above-average work-related trauma severity. No other associations emerged for PTSD symptoms or posttraumatic sleep disturbances at six or twelve months. As such, our study supports the existence of a cross-sectional association between HCC and trauma symptoms, which may vary for different levels of subjective trauma severity. The longitudinal stability of this association should be reinvestigated by future research.
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Affiliation(s)
- M R Sopp
- Division of Clinical Psychology and Psychotherapy, Department of Psychology, Campus A1 3, Saarland University, D-66123 Saarbrücken, Germany
| | - T Michael
- Division of Clinical Psychology and Psychotherapy, Department of Psychology, Campus A1 3, Saarland University, D-66123 Saarbrücken, Germany.
| | - J Lass-Hennemann
- Division of Clinical Psychology and Psychotherapy, Department of Psychology, Campus A1 3, Saarland University, D-66123 Saarbrücken, Germany
| | - S Haim-Nachum
- School of Education, Bar-Ilan University, Ramat-Gan, Israel
| | - M J J Lommen
- Department of Clinical Psychology and Experimental Psychopathology, University of Groningen, Grote Kruisstraat 2/1, 9712 TS Groningen, The Netherlands
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Afshari A, Borzou SR, Shamsaei F, Mohammadi E, Tapak L. Emergency Medical Service Providers' Perception of Health-Threatening Stressors in Emergency Missions: A qualitative Study. Ethiop J Health Sci 2021; 31:517-524. [PMID: 34483608 PMCID: PMC8365476 DOI: 10.4314/ejhs.v31i3.8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2020] [Accepted: 01/12/2021] [Indexed: 11/26/2022] Open
Abstract
Background Unknown and unpredictable situations cause emergency medical service (EMS) providers to experience various stressful factors. These factors are affected by sociocultural conditions and expectations of the casualty and affect EMS providers' performance and health at the incident scene. The present study was conducted to explore EMS providers' perception of stressful and health-threatening factors in emergency missions. Method This qualitative conventional content analysis was conducted in 2020. The participants included 16 EMS providers working at the Emergency Medical Services Department in Hamadan Province, Iran. The participants were selected using purposive sampling and underwent semi-structured interviews until data saturation. Data were analyzed using the Graneheim and Lundman method. Results Analysis of the interview data yielded six subcategories (i.e., incident scene hazards, violence-related injuries, physical injuries caused by patient care/handling, ambulance crash-related injuries, emotional impact of patients' suffering and ailments, and highly stressful missions), two main categories (i.e., physical injuries and psychological tensions), and a theme of occupational injuries. Conclusions According to the results, in addition to having concerns about caring for patients and saving the injured, EMS providers also worry about potential threats to their own health. The present study identified and described some major stressors in emergency missions. Thus, for a better and more effective efficiency, the present study results can be used to reduce or modify stressors in EMS providers.
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Affiliation(s)
- Ali Afshari
- Nursing and Midwifery School, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Seyed Reza Borzou
- Chronic Diseases (Home Care) Research Center, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Farshid Shamsaei
- Maternal and Child Care Research Center, Behavioral Disorders and Substance Abuse Research Center, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Eesa Mohammadi
- Faculty of Medical Sciences, Nursing Department, Tarbiat Modares University, Tehran, Iran
| | - Leili Tapak
- Department of Biostatistics, School of Public Health, Modeling of Noncommunicable diseases Research Center, Hamadan University of Medical Sciences, Hamadan, Iran
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Sun Y, Song H, Liu H, Mao F, Sun X, Cao F. Occupational stress, mental health, and self-efficacy among community mental health workers: A cross-sectional study during COVID-19 pandemic. Int J Soc Psychiatry 2021; 67:737-746. [PMID: 33176527 DOI: 10.1177/0020764020972131] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND During the COVID-19, community mental health care workers (CMHWs) faced much heavier workloads, which make them vulnerable to mental problems. AIM This study aims to investigate coronavirus disease-related occupational stress and its single and cumulative effect on mental health and self-efficacy among CMHWs. METHODS A quick-response online cross-sectional survey WA conducted during the coronavirus disease outbreak. A total of 536 CMHWs were recruited in March 2020, in China. Demographics, occupational stress, depression, anxiety, positive and negative emotions, and self-efficacy were collected. Logistic regression analysis was employed to test the single and cumulative effect of occupational stress on mental health and self-efficacy. RESULTS CMHWs did not show high level of depression or anxiety in this study. Those who provided service for suspected people who were quarantined reported higher risk of depression and anxiety. Staying out for more than 3 days was a risk factor of depression while cleaning/sterilising streets or communities was a protective factor of depression. Those who received psychiatric training showed higher positive emotion and self-efficacy, and providing psychological assistance online increased the self-efficacy. CMHWs with two different types of work had 0.996 times more risk of depression than those with only one type of work. CONCLUSION The potential cumulative effect of occupation stress suggested that reasonable job assignment and organisational support are necessary safeguards for CMHWs.
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Affiliation(s)
- Yaoyao Sun
- School of Nursing, Shandong University, Jinan, Shandong Province, P.R.China
| | - Haidong Song
- Mental Health Center Zhejiang University School of Medicine, Hangzhou Seventh People's Hospital, Hangzhou, Zhejiang Province, P.R.China
| | - Hong Liu
- School of Nursing, Shandong University, Jinan, Shandong Province, P.R.China
| | - Fangxiang Mao
- School of Nursing, Shandong University, Jinan, Shandong Province, P.R.China
| | - Xiaohua Sun
- Mental Health Center Zhejiang University School of Medicine, Hangzhou Seventh People's Hospital, Hangzhou, Zhejiang Province, P.R.China
| | - Fenglin Cao
- School of Nursing, Shandong University, Jinan, Shandong Province, P.R.China
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Parental Occupational Exposure is Associated With Their Children's Psychopathology: A Study of Families of Israeli First Responders. J Occup Environ Med 2021; 62:904-915. [PMID: 32769795 DOI: 10.1097/jom.0000000000001971] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To examine the association between parental occupational exposure to traumatic events and their children's mental health in families of First Responders (FRs), a neglected area of research. METHODS In 208 families of Israeli FRs, children's symptoms and comorbidity patterns of seven psychiatric disorders were regressed on parental work-related variables, controlling for relevant covariates. RESULTS Having a father working as a FR and higher paternal exposure were associated with a greater number of separation anxiety and posttraumatic stress symptoms, respectively. Maternal exposure was associated with a greater number of symptoms of generalized anxiety, panic disorder, depression, and oppositional defiant disorder, and with increased odds of comorbid internalizing symptomatology. CONCLUSIONS Additional research on children of FRs is encouraged. An adaption to this understudied population of family-centered interventions available for military families could inform targeted prevention efforts.
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Development and Validation of an Instrument to Measure Work-Related Stress among Rescue Workers in Traumatic Mass-Casualty Disasters. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18168340. [PMID: 34444094 PMCID: PMC8392681 DOI: 10.3390/ijerph18168340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Revised: 08/04/2021] [Accepted: 08/05/2021] [Indexed: 11/16/2022]
Abstract
Rescue workers are a population at high-risk for mental problems as they are exposed to work-related stress from confrontation with traumatic events when responding to a disaster. A reliable measure is needed to assess rescue workers’ work-related stress from their surveillance of a disaster scene to help prevent severe PTSD and depressive symptoms. The purpose of this study was to develop and validate the Work-Related Stress Scale (WRSS) designed to measure stress in rescue workers after responding to traumatic mass-casualty events. An exploratory sequential mixed methods procedure was employed. The qualitative phase of the item generation component involved in-depth interviews of 7 experienced rescue workers from multiple specialties who had taken part in 1 or 2 mass-casualty events: the 2018 Hualien earthquake or the 2016 Tainan earthquake. In the quantitative phase, a modified Delphi approach was used to achieve consensus ratings by the same 7 raters on the items and to assess content validity. Construct validity was determined by confirmatory factor analysis using a broader sample of 293 rescue workers who had taken part in 1 of 2 mass-casualty events: the 2018 Hualien earthquake or the 2021 Hualien train derailment. The final WRSS consists of 16 items total and 4 subscales: Physical Demands, Psychological Response, Environmental Interruption, and Leadership, with aggregated alphas of 0.74–0.88. The WRSS was found to have psychometric integrity as a measure of stress in rescue workers after responding to a disaster.
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20
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Cherry N, Galarneau J, Haynes W, Sluggett B. The role of organizational supports in mitigating mental ill health in firefighters: A cohort study in Alberta, Canada. Am J Ind Med 2021; 64:593-601. [PMID: 33945167 PMCID: PMC8252071 DOI: 10.1002/ajim.23249] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Revised: 02/25/2021] [Accepted: 03/22/2021] [Indexed: 12/17/2022]
Abstract
Introduction Little is known about the effectiveness of ongoing mental health support in reducing the mental health impacts of a traumatic deployment. Methods A cohort of firefighters was established among those deployed to a devastating wildfire in Alberta, Canada in May 2016. Firefighters completed three questionnaires: at recruitment giving details of exposures, a first follow‐up reporting mental health supports before, during, and after the fire and a second follow‐up, at least 30 months after the fire, with screening questionnaires for anxiety, depression, and posttraumatic stress disorder (PTSD). Fire chiefs were interviewed about mental health provisions. The impact of supports on mental ill health was estimated, adjusting for clustering within fire service and potential confounders. Results Of 1234 firefighters in the cohort, 840 completed the questionnaire on mental health supports. In total, 78 of 82 fire chiefs were interviewed. Analysis of the impact of supports on mental ill health included 745 firefighters from 67 fire services. Only 45.8% of reports of peer support were concordant between firefighters and fire chiefs. After adjusting for confounding, the odds ratios (OR) for peer support reported by both fire chief and firefighter were depressive disorder: OR = 0.22, 95% confidence interval (CI), 0.08–0.61; anxiety disorder: OR = 0.45, 95% CI, 0.24–0.82; PTSD: OR = 0.62, 95% CI, 0.37–1.02. Symptoms of anxiety and depression but not PTSD were reduced by resiliency training before the fire and by support offered within 48 h of return from deployment. Conclusion The results suggest peer support in firefighters is protective but its availability is poorly recognized. PTSD was somewhat less responsive, perhaps reflecting the cumulative effects of previous exposures.
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Affiliation(s)
- Nicola Cherry
- Division of Preventive Medicine University of Alberta Edmonton Alberta Canada
| | | | - Whitney Haynes
- Division of Preventive Medicine University of Alberta Edmonton Alberta Canada
| | - Bryan Sluggett
- Division of Preventive Medicine University of Alberta Edmonton Alberta Canada
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21
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Khazaei A, Navab E, Esmaeili M, Masoumi H. Prevalence and Related Factors of Post-Traumatic Stress Disorder in Emergency Medical Technicians; a Cross-sectional Study. ARCHIVES OF ACADEMIC EMERGENCY MEDICINE 2021; 9:e35. [PMID: 34027430 PMCID: PMC8126347 DOI: 10.22037/aaem.v9i1.1157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Introduction: Ongoing exposure to a variety of Pre-hospital Emergencies (PE) has placed Emergency Medical Technicians (EMTs) at serious psychiatric compromise such as Post-Traumatic Stress Disorder (PTSD). The present study aimed to evaluate the prevalence and associated factors of PTSD among EMTs. Methods: This prospective cross-sectional study was conducted on EMTs in the Emergency Medical Services (EMS) in west of Iran. A baseline information questionnaire including personal work-related characteristics and the PTSD checklist of DSM-5 (PCL-5) were used for data collection. Non-parametric tests and multivariate linear regression were used to evaluate the associated factors of PTSD in these participants. Results: Among the participants, 22% of technicians had PTSD-diagnostic criteria. The mean total PCL-5 score was 21.60 ± 11.45, while the scores were 38.02 ± 6.08 and 17.47 ± 8.36 in the PTSD-diagnosed and undiagnosed groups, respectively. The most common symptom of the clusters was negative alterations in cognition with a mean score of 7.42 ± 4.63. After adjusting confounders, the number of missions (t= 2.50, P= 0.013), work experience (t= -3.24, P= 0.001) and number of shifts (t: 26.38, P < 0.001) were significantly corelated with PCL-5 score. Conclusion: The results indicated that the prevalence of PTSD among EMTs personnel of Hamedan province is high. EMTs with the age of ≤ 30 years, work experience of ≤ 10 years, married status, informal employment, emergency medical technician's degree, and more than 8 shifts per month, as well as no previous training history had a higher total PCL-5 score.
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Affiliation(s)
- Afshin Khazaei
- Intensive Care and Management Nursing Department, School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran
| | - Elham Navab
- Critical Care Department, Nursing and Midwifery Care Research Center, School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran
| | - Maryam Esmaeili
- Disaster and Emergency Management Department, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Habib Masoumi
- Critical Care and Geriatric Nursing Department, School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran
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22
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Haim-Nachum S, Sopp MR, Michael T, Shamay-Tsoory S, Levy-Gigi E. No distance is too far between friends: associations of comfortable interpersonal distance with PTSD and anxiety symptoms in Israeli firefighters. Eur J Psychotraumatol 2021; 12:1899480. [PMID: 33889312 PMCID: PMC8043555 DOI: 10.1080/20008198.2021.1899480] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Background: Previous research indicates that PTSD patients may show alterations in interpersonal distance regulation (IDR). However, it is not clear whether altered IDR is correlated with psychopathology after trauma and whether attentional processes might be involved in these alterations. Objective: The current study investigated IDR and attentional processing in a sample of Israeli firefighters. Method: Twenty-four participants completed an experimental IDR task as well as measures of PTSD and anxiety. During the task, event-related potentials were recorded to assess attentional processing as reflected in the P1 and N1 components. Results: Participants who did not choose a closer distance towards friends than strangers experienced greater anxiety. Moreover, participants who showed attentional avoidance towards strangers reported more PTSD symptoms. By contrast, participants who showed hypervigilant attention towards strangers reported greater anxiety. Conclusions: Our results demonstrate an association between IDR, PTSD, and anxiety after trauma. Future studies should re-investigate these associations in larger samples and explore potential implications for prevention and treatment.
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Affiliation(s)
| | - M Roxanne Sopp
- Division of Clinical Psychology and Psychotherapy, Department of Psychology, Saarland University, Saarbrücken, Germany
| | - Tanja Michael
- Division of Clinical Psychology and Psychotherapy, Department of Psychology, Saarland University, Saarbrücken, Germany
| | | | - Einat Levy-Gigi
- School of Education, Bar-Ilan University, Ramat-Gan, Israel.,The Gonda Multidisciplinary Brain Research Center, Bar-Ilan University, Ramat-Gan, Israel
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23
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Chopko BA, Palmieri PA, Adams RE. Trauma-Related Sleep Problems and Associated Health Outcomes in Police Officers: A Path Analysis. JOURNAL OF INTERPERSONAL VIOLENCE 2021; 36:NP2725-NP2748. [PMID: 29642766 DOI: 10.1177/0886260518767912] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Police officers are frequently exposed to two different types of potentially traumatic events: one dealing with physical threats to self and the other involving the witnessing of harm to others. These different types of traumatic experiences are thought to produce various posttraumatic reactions. Furthermore, sleep problems are also reported as a hallmark of posttraumatic stress disorder. There is evidence, however, that sleep problems may mediate the relationship between posttraumatic stress disorder symptoms and health outcomes, especially physical health and depression. Previous research has shown this to be the case among officers from large urban agencies. The purpose of the present study was to test a model involving a pathway from trauma type and posttraumatic stress disorder symptoms to physical health and depression that is mediated by sleep quality in officers (N = 193) using data from small- to mid-size police agencies. Results revealed that sleep problems served as a mediator between posttraumatic stress disorder hyperarousal and avoidance symptoms and health outcomes, that the trauma types are related to different posttraumatic stress disorder symptoms, and that complicated relationships exist between the study variables. In addition, the results indicated that approximately 25% of our sample displayed probable partial posttraumatic stress disorder or probable full posttraumatic stress disorder, causing substantial functional impairment. Suggestions for improving officer health and performance in the field are provided. Specifically, it appears that interventions designed to address posttraumatic stress disorder hyperarousal symptoms related to personal life threat and the posttraumatic stress disorder avoidance symptoms related to the witnessing of human suffering may maximize officer sleep quality and ultimately overall wellness. In particular, mindfulness-based interventions are well suited for addressing these symptom clusters.
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24
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Morrison K, Su S, Keck M, Beidel DC. Psychometric properties of the PCL-5 in a sample of first responders. J Anxiety Disord 2021; 77:102339. [PMID: 33249315 DOI: 10.1016/j.janxdis.2020.102339] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Revised: 11/05/2020] [Accepted: 11/09/2020] [Indexed: 11/18/2022]
Abstract
Given that first responders experience elevated rates of posttraumatic stress disorder and suicide, there is a need for evidence-based assessments and treatments to accurately assess, diagnose, and evaluate treatment outcome. This study examined the psychometric properties of the Posttraumatic Stress Disorder (PTSD) Checklist for DSM-5 (PCL-5) in a sample of 133 firefighters/emergency medical technicians and police officers seeking treatment for PTSD. The results indicated that PCL-5 scores showed strong internal consistency and convergent and discriminant validity. Signal detection analyses indicated a good diagnostic accuracy and an optimal cutoff score of 41 for detecting PTSD. Consistent with recent studies, confirmatory factor analyses indicated that the anhedonia model of PTSD best fit the data. Overall, findings support use of the PCL-5 as a psychometrically sound measure of PTSD in individuals at high risk for exposure to trauma.
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Affiliation(s)
- Krystal Morrison
- UCF RESTORES, University of Central Florida, 4111 Pictor Lane, Orlando, FL, 32816, United States.
| | - Shiyang Su
- University of Central Florida, 4111 Pictor Lane, Orlando, FL, 32816, United States.
| | - Michelle Keck
- UCF RESTORES, University of Central Florida, 4111 Pictor Lane, Orlando, FL, 32816, United States.
| | - Deborah C Beidel
- UCF RESTORES, University of Central Florida, 4111 Pictor Lane, Orlando, FL, 32816, United States.
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25
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Wolf JJ, McVeigh J, Vallières F, Hyland P, MacLachlan M. Death anxiety, self-worth, and exposure to human donor remains: A longitudinal study of Irish medical students. DEATH STUDIES 2020; 46:875-884. [PMID: 32628572 DOI: 10.1080/07481187.2020.1783030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
This study aimed to investigate the relationship between death anxiety levels at pre-exposure to human donor remains, post-exposure self-worth, and post-exposure death anxiety levels, among a sample of Irish medical students. A multi-wave prospective study was conducted, using questionnaires administered at six time-points. Path analysis was used to investigate the effect of pre-exposure death anxiety levels and post-exposure self-worth on post-exposure death anxiety levels. Baseline death anxiety was found to predict post-exposure death anxiety. Furthermore, self-worth at one month of exposure was found to mediate the relationship between pre-exposure death anxiety levels and death anxiety levels at six months.
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Affiliation(s)
- Jonathan J Wolf
- School of Psychology, Trinity College Dublin, Dublin, Ireland
| | - Joanne McVeigh
- School of Applied Psychology, University College Cork, Cork, Ireland
- Assisting Living and Learning (ALL) Institute, Maynooth University, Maynooth, Ireland
| | - Frédérique Vallières
- School of Psychology, Trinity College Dublin, Dublin, Ireland
- Centre for Global Health, Trinity College Dublin, Dublin, Ireland
| | - Philip Hyland
- Assisting Living and Learning (ALL) Institute, Maynooth University, Maynooth, Ireland
- Centre for Global Health, Trinity College Dublin, Dublin, Ireland
- Department of Psychology, Maynooth University, Maynooth, Ireland
| | - Malcolm MacLachlan
- Assisting Living and Learning (ALL) Institute, Maynooth University, Maynooth, Ireland
- Centre for Global Health, Trinity College Dublin, Dublin, Ireland
- Department of Psychology, Maynooth University, Maynooth, Ireland
- Centre for Rehabilitation Studies, Stellenbosch University, Cape Town, South Africa
- Olomouc University Social Health Institute, Palacký University, Olomouc, Czech Republic
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26
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Arcosy CV, Vilete LMP, Marques-Portella C, Mendlowicz MV, Luz MP, Figueira I, Berger W. Possible outcomes of cumulative trauma in mental-health: a case report. JORNAL BRASILEIRO DE PSIQUIATRIA 2020. [DOI: 10.1590/0047-2085000000282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
ABSTRACT To discuss the resilience factors that may have prevented a patient from developing post-traumatic stress disorder (PTSD) after exposure to a variety of severe potentially traumatic events. A thirty-eight-year-old civilian has been exposed to at least ten dramatic situations of violence in his work and personal life. He developed only a few mild post-traumatic symptoms after being exposed to a particularly gruesome incident during work. Even though the number and severity of potentially traumatic events may be alarming, this does not determine that the patient will inexorably develop PTSD, or other disorders. The study of protective factors is mandatory so that we can acknowledge and develop more effective ways to prevent and treat disorders.
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27
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Schäfer SK, Sopp MR, Staginnus M, Lass-Hennemann J, Michael T. Correlates of mental health in occupations at risk for traumatization: a cross-sectional study. BMC Psychiatry 2020; 20:335. [PMID: 32586338 PMCID: PMC7318450 DOI: 10.1186/s12888-020-02704-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Accepted: 05/28/2020] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Hospitals, police stations, and fire departments are highly demanding workplaces. Staff members are regularly exposed to various stressors including traumatic events. Correspondingly, several studies report high rates of mental health issues among these occupations. Nevertheless, despite these challenging circumstances, some staff members manage to sustain their mental health. The current study is the first to investigate three health-promoting factors simultaneously among three different, highly demanding occupations. METHODS The present cross-sectional survey investigated health-promoting factors (sense of coherence - SOC, trait-resilience, locus of control - LOC) and mental health outcomes (general psychopathological symptom burden, posttraumatic stress, burnout) in medical staff (n = 223), police officers (n = 257), and firefighters (n = 100). RESULTS Among all occupations, SOC, trait-resilience, and an internal LOC were negatively associated with general psychopathological symptoms, posttraumatic stress, and burnout symptoms. By contrast, all these outcome measures were positively correlated with an external LOC. Multiple regression models including all health-promoting factors explained 56% of the variance in general psychopathological symptoms and 27% in posttraumatic stress symptoms. Among all occupations, SOC was the strongest predictor of both general psychopathological symptom burden and posttraumatic stress symptoms. Multigroup path analyses revealed minor differences across occupations, mainly driven by a stronger influence of LOC in police officers. CONCLUSION Across all occupations, SOC was identified as the most important health-promoting factor. Future longitudinal studies should further examine the causal link between health-promoting factors and mental distress in different workplaces. Such studies will also allow for further development and evaluation of resilience promoting programs.
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Affiliation(s)
- Sarah K. Schäfer
- Department of Psychology, Saarland University, Building A1 3, 66123 Saarbruecken, Germany
| | - M. Roxanne Sopp
- Department of Psychology, Saarland University, Building A1 3, 66123 Saarbruecken, Germany
| | - Marlene Staginnus
- Department of Psychology, Saarland University, Building A1 3, 66123 Saarbruecken, Germany
| | - Johanna Lass-Hennemann
- Department of Psychology, Saarland University, Building A1 3, 66123 Saarbruecken, Germany
| | - Tanja Michael
- Department of Psychology, Saarland University, Building A1 3, 66123 Saarbruecken, Germany
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28
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Lee W, Lee YR, Yoon JH, Lee HJ, Kang MY. Occupational post-traumatic stress disorder: an updated systematic review. BMC Public Health 2020; 20:768. [PMID: 32448255 PMCID: PMC7245752 DOI: 10.1186/s12889-020-08903-2] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Accepted: 05/12/2020] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Although numerous studies on occupational post-traumatic stress disorder (PTSD) have been conducted prior to the 1950-2010 seminal systematic review by Skogstad et al., the prevalence, risk factors, and impact of this disorder following traumatic events in occupational settings remain unclear. This study aims to address this knowledge gap by reviewing the literature published after 2010. METHODS We reviewed literature from databases such as PubMed and Google Scholar using PRISMA guidelines to identify studies that address occupational PTSD and examined the status (prevalence or incidence), the risk factors, and the health effects of PTSD among workers. RESULTS In total, 123 articles were identified, and finally, 31 (25.2%) articles were selected after excluding duplicates. Various occupational traumatic physical events were reported such as natural or manmade disaster, explosion, accident, handling refugee corpses, or bullying at work. Risk of PTSD was closely associated with working conditions, severity of injury, history of mental disorder, occurrence of psychiatric symptoms at the time of the event, personality, interpersonal relationships, etc. Workers with PTSD were likely to experience a deterioration of physical and psychological health and impairment of social and occupational functioning. CONCLUSIONS Our review suggests that many workers remain highly vulnerable to occupational PTSD and its consequences.
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Affiliation(s)
- Wanhyung Lee
- Department of Occupational and Environmental Medicine, Gil Medical Center, Gachon University College of Medicine, Incheon, Republic of Korea
| | - Yi-Ryoung Lee
- Department of Occupational and Environmental Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 222, Banpo-daero, Seocho-gu, Seoul, 06591, Republic of Korea
| | - Jin-Ha Yoon
- The Institute for Occupational Health, Yonsei University College of Medicine, Seoul, Republic of Korea
- Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Hye-Ji Lee
- Occupational Safety and Health Research Institute, Ulsan, Republic of Korea
| | - Mo-Yeol Kang
- Department of Occupational and Environmental Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 222, Banpo-daero, Seocho-gu, Seoul, 06591, Republic of Korea.
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Heroes in crisis: Trauma centers should be screening for and intervening on posttraumatic stress in our emergency responders. J Trauma Acute Care Surg 2020; 89:132-139. [DOI: 10.1097/ta.0000000000002671] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
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Haim-Nachum S, Levy-Gigi E. A chink in the armor: The influence of training on generalization learning impairments after viewing traumatic stimuli. Cognition 2019; 193:104021. [DOI: 10.1016/j.cognition.2019.104021] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2018] [Revised: 06/30/2019] [Accepted: 07/01/2019] [Indexed: 02/07/2023]
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"You can see those concentric rings going out": Emergency personnel's experiences treating overdose and perspectives on policy-level responses to the opioid crisis in New Hampshire. Drug Alcohol Depend 2019; 204:107555. [PMID: 31542630 PMCID: PMC6924616 DOI: 10.1016/j.drugalcdep.2019.107555] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2019] [Revised: 07/09/2019] [Accepted: 07/09/2019] [Indexed: 12/17/2022]
Abstract
BACKGROUND In parallel to a substantial increase in opioid overdose deaths in New Hampshire (NH), emergency personnel experienced an increase in opioid-related encounters. To inform public health responses to this crisis, insights into the experiences and perspectives of those emergency personnel who treat opioid-related overdoses are warranted. AIMS Systematically examine emergency personnel's experiences treating opioid overdoses and obtain their perspectives on policy-level responses to the opioid crisis in NH. METHODS Semi-structured qualitative interviews were conducted with 18 first responders [firefighters (n = 6), police officers (n = 6), emergency medical service providers (n = 6)] and 18 emergency department personnel employed in six NH counties. Interviews focused on emergency personnel's perspectives on fentanyl/heroin formulations, experiences treating overdoses, harm reduction strategies, and experiences with treatment referral. Interviews were audio recorded, transcribed verbatim, and analyzed using content analysis. RESULTS Emergency personnel cited the potency and inconsistency of fentanyl-laced heroin as primary drivers of opioid overdose. Increases in overdose-related encounters took a substantial emotional toll on emergency personnel, who described a range of responses including feelings of burnout, exhaustion, and helplessness. While some emergency personnel felt conflicted about the implementation of harm reduction strategies like syringe services programs, others emphasized the necessity of these services. Emergency personnel expressed frustration with barriers to treatment referral in the state and recommended immediate treatment access after overdose events. CONCLUSIONS Findings suggest that interventions addressing trauma and burnout are necessary to support emergency personnel, while expanded harm reduction and treatment access are critical to support those who experience opioid overdose in NH.
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Brooks SK, Rubin GJ, Greenberg N. Traumatic stress within disaster-exposed occupations: overview of the literature and suggestions for the management of traumatic stress in the workplace. Br Med Bull 2019; 129:25-34. [PMID: 30544131 DOI: 10.1093/bmb/ldy040] [Citation(s) in RCA: 52] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2018] [Revised: 10/30/2018] [Accepted: 11/27/2018] [Indexed: 01/18/2023]
Abstract
BACKGROUND Many people who experience a disaster will do so as part of an occupational group, either by chance or due to the nature of their role. SOURCES OF DATA This review is based on literature published in scientific journals. AREAS OF AGREEMENT There are many social and occupational factors, which affect post-disaster mental health. In particular, effective social support-both during and post-disaster-appears to enhance psychological resilience. AREAS OF CONTROVERSY There is conflicting evidence regarding the best way to support trauma-exposed employees. Many organisations carry out post-incident debriefing despite evidence that this is unhelpful. GROWING POINTS Employees who are well supported tend to have better psychological outcomes and as a result may be more likely to perform well at work. AREAS TIMELY FOR DEVELOPING RESEARCH The development and evaluation of workplace interventions designed to help managers facilitate psychological resilience in their workforce is a priority. Successful interventions could substantially increase resilience and reduce the risk of long-term mental health problems in trauma-exposed employees.
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Affiliation(s)
- Samantha K Brooks
- The National Institute for Health Research (NIHR) Health Protection Research Unit in Emergency Preparedness and Response at King's College London, Weston Education Centre, 10 Cutcombe Road, London, UK
| | - G James Rubin
- The National Institute for Health Research (NIHR) Health Protection Research Unit in Emergency Preparedness and Response at King's College London, Weston Education Centre, 10 Cutcombe Road, London, UK
| | - Neil Greenberg
- The National Institute for Health Research (NIHR) Health Protection Research Unit in Emergency Preparedness and Response at King's College London, Weston Education Centre, 10 Cutcombe Road, London, UK
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Khazaei A, Esmaeili M, Navab E. The Most and Least Stressful Prehospital Emergencies from Emergency Medical Technicians' View Point; a Cross-Sectional Study. ARCHIVES OF ACADEMIC EMERGENCY MEDICINE 2019; 7:e20. [PMID: 31432030 PMCID: PMC6637806] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
INTRODUCTION Exposure to different prehospital emergencies (PE) may have a different impact on Emergency Medical Technicians (EMTs) based on the characteristics and circumstances of the emergency. The present study aimed to prioritize PE types according to their stressfulness as well as their correlation with post traumatic stress disorders (PTSD). METHOD In this cross-sectional study, all EMTs in the Emergency Medical Services (EMS) of Hamadan province were invited to participate, voluntarily. The study questionnaire comprised of two parts: a) personal characteristics and prioritizing PE types in terms of their stressfulness and b) The PTSD checklist. Kruskal-Wallis test was used for examining the relationship between total PTSD score and the most and the least stressful PEs. Multivariate logistic regression was also used to predict the impact of different types of PEs on PTSD. RESULTS 259 EMTs with the mean age of 32.79±6.16 years were studied. The total mean score of PTSD on PCL-5 was 21.60±11.45. Also, 20.1% of technicians met the criteria for PTSD. The mean age of technicians who met PTSD criteria was less than that of technicians who did not meet PTSD criteria (28 vs. 33 years, P<0.001). The most and least stressful emergencies were cardiovascular (24.7%) and environmental (26.3%) emergencies, respectively. There was a significant correlation between the most (Kruskal-Wallis=40.92, df=12, p < 0.001) and the least stressful emergencies (Kruskal-Wallis=28.22, df=15, p = 0.02) from EMTs' viewpoint and PTSD score. Multivariate logistic analysis showed that gynecologic (aOR=2.28, Wald=5.83, p=0.016) and allergic (aOR=0.12, Wald=10.16, p=0.01) emergencies were significant predictive factors of PTSD. CONCLUSION Based on the view point of the studied EMTs, cardiac and environmental emergencies were the most and least stressful emergencies. The frequency of PTSD in this series was about 20% and it significantly correlated with younger age, lower experience, higher number of shifts, non-official employment and EMT degree. Based on multivariate logistic analysis, gynecologic and allergic emergencies were the only significant predictive factors of PTSD.
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Affiliation(s)
- Afshin Khazaei
- Intensive Care and Management Nursing Department, School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran.
| | - Maryam Esmaeili
- Critical Care and Geriatric Nursing Department, School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran.
| | - Elham Navab
- Critical Care and Geriatric Nursing Department, School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran.
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