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Schuman DL, Yockey RA, Ponder WN, Carbajal J. Latent profile analysis of transdiagnostic emotional distress, suicidality, and resilience in first responders. J Affect Disord 2024; 369:436-448. [PMID: 39341288 DOI: 10.1016/j.jad.2024.09.167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Revised: 09/23/2024] [Accepted: 09/25/2024] [Indexed: 09/30/2024]
Abstract
BACKGROUND First responders (i.e., law enforcement officers, firefighters, and emergency medical technicians/paramedics), experience significantly higher occupational trauma exposure than U.S. adult workers outside these fields, leading to increased risks of comorbid mental health disorders. Repeated and intense trauma exposure may combine with personal factors to place them at higher risk for suicide. Conversely, first responders may show higher levels of psychological resilience in the face of occupational trauma experiences. Some research exists on resilience, though little is known about suicide resilience in first responder populations. METHODS We used latent profile analysis (LPA) on a treatment-seeking sample of first responders (N = 340) with measures of posttraumatic stress disorder (PTSD), generalized anxiety, depression, suicidality, and resilience. RESULTS We determined the best fit was a five-class solution, including the following emotional distress categories: minimal (19 %), mild (33 %), moderate (8 %), moderately severe (27 %), and severe (13 %) emotional distress. In this study, all multivariate analyses of variance (MANOVAs) were statistically significant and had large effect sizes ranging from the lowest (resilience) to the largest (depression). LIMITATIONS We used self-report assessments and not a clinical interview. Also, we did not have data on measures of substance use, emotional dysregulation (e.g., attachment), or trauma exposure. CONCLUSIONS This study underscores the critical need for developing and implementing transdiagnostic interventions that not only address the spectrum of emotional distress and suicidality but also actively enhance resilience among treatment-seeking first responders.
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Affiliation(s)
- Donna L Schuman
- School of Social Work, University of Texas at Arlington, Arlington, TX, United States
| | - R Andrew Yockey
- Department of Public Health, University of Mississippi, Oxford, MS, United States
| | | | - Jose Carbajal
- School of Social Work, Stephen F. Austin State University, Nacogdoches, TX, United States
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Messman BA, Compton SE, Majeed I, Weiss NH, Contractor AA. Beyond the mean: examining associations between intraindividual variability in posttraumatic stress disorder symptoms and posttrauma reckless behaviors. ANXIETY, STRESS, AND COPING 2024; 37:615-631. [PMID: 38268223 PMCID: PMC11266525 DOI: 10.1080/10615806.2024.2307465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Revised: 01/07/2024] [Accepted: 01/14/2024] [Indexed: 01/26/2024]
Abstract
BACKGROUND/OBJECTIVES Posttrauma reckless behaviors have been linked to the onset and exacerbation of posttraumatic stress disorder (PTSD) symptoms. However, PTSD symptoms fluctuate across time, triggered by environmental stimuli in daily life, referred to as (intraindividual) variability in PTSD symptoms. DESIGN We utilized experience sampling methods to investigate associations between engagement in posttrauma reckless behaviors and variability in PTSD symptoms and the moderating role of emotion dysregulation in this association. METHODS Data from 166 trauma-exposed university students (Mage = 21.43 ± 5.07, 85.4% women) were collected between January 2019 to August 2020. Participants completed baseline and follow-up surveys to assess engagement in posttrauma reckless behaviors and daily surveys (10-days) to assess variability in PTSD symptoms. Results. Analyzes indicated greater baseline engagement in posttrauma reckless behaviors was associated with greater 10-day variability in PTSD symptoms (β = 0.23, p = .031), and baseline emotion dysregulation moderated this association (β = -0.33, p = .003). Additionally, greater 10-day variability in PTSD symptoms was associated with greater follow-up engagement in posttrauma reckless behaviors (β = 0.14, p = .045). CONCLUSIONS Findings substantiate the interplay between engagement in posttrauma reckless behaviors and daily fluctuations in PTSD symptoms and support therapeutically targeting both engagement in posttrauma reckless behaviors and emotion dysregulation to impact PTSD symptoms.
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Affiliation(s)
- Brett A Messman
- Department of Psychology, University of North Texas, Denton, TX, USA
| | - Sidonia E Compton
- Department of Psychology, University of North Texas, Denton, TX, USA
| | - Ifrah Majeed
- Department of Psychology, University of North Texas, Denton, TX, USA
| | - Nicole H Weiss
- Department of Psychology, University of Rhode Island, Kingston, RI, USA
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Shin Y, Nam JK, Park M, Lee A, Kim Y. Latent transition analysis on post-traumatic stress and post-traumatic growth among firefighters. Eur J Psychotraumatol 2024; 15:2387477. [PMID: 39140605 PMCID: PMC11328797 DOI: 10.1080/20008066.2024.2387477] [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: 12/11/2023] [Revised: 07/12/2024] [Accepted: 07/21/2024] [Indexed: 08/15/2024] Open
Abstract
Background: Firefighters, in the course of their professional responsibilities, confront an array of stressors contingent upon the distinctive characteristics of their duties.Objective: This study investigated the longitudinal impact of trauma incidents during duty on firefighters using latent transition analysis.Method: Data from 346 firefighters in South Korea who had experienced trauma events while on duty were utilized. Initially, latent groups were identified based on the relationship between post-traumatic stress disorder (PTSD) and post-traumatic growth (PTG). Groups were labelled based on the analysis of differences in PTSD, mental health, and growth-related factors among classified groups. Subsequently, transition probabilities and patterns from Time 1 to Time 2 were examined, followed by an investigation into variances based on demographic factors (gender, age) and occupational factors (work experience, shift pattern) using variance analysis and multinomial logistic regression analysis.Results: First, at Time 2, a five-group model was classified into 'Growth,' 'Resilience or Numbness,' 'Struggle,' 'Partial Struggle,' and 'PTSD' groups. Second, upon examining the transition patterns between latent groups, four patterns emerged: 'continued distress,' 'growth,' 'adaptation,' and 'escalated distress.' Third, the 'Struggle' group showed a 0% probability of transitioning to the 'Growth' group, whereas it displayed the highest probability among the groups transitioning to the 'PTSD' group. Fourth, latent transition analysis results showed a strong tendency for the 'Growth' group and 'Resilience or Numbness' group to remain in the same category. Fifth, age was found to be a significant factor affecting the transition of latent groups.Conclusion: This research represents the inaugural attempt to longitudinally investigate the interplay between PTSD and PTG among firefighters.
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Affiliation(s)
- Yongchan Shin
- Counseling & Welfare Center for Youth, Dangjin City Youth Foundation, Dangjin-si, South Korea
| | - JeeEun Karin Nam
- Graduate School of Education, Kyung Hee University, Seoul, South Korea
| | - Minho Park
- Korea Institute for Curriculum and Evaluation, Jincheon-gun, South Korea
| | - Aeyoung Lee
- Department of Counseling and Psychotherapy, Inje University, Gimhae-si, South Korea
| | - Youngkeun Kim
- Department of Counseling and Psychotherapy, Inje University, Gimhae-si, South Korea
- Department of Psychology, University of Windsor, Windsor, Canada
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4
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Smith LM. Risk Factors Associated with Suicidal Ideation and Suicidal Behavior in Wildland Firefighters. Arch Suicide Res 2024:1-15. [PMID: 38896466 DOI: 10.1080/13811118.2024.2355222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/21/2024]
Abstract
INTRODUCTION Wildland firefighters are posited to have a higher suicide rate than general firefighters and the general population. However, the rates and risk factors of suicide among wildland firefighters is not fully understood. METHODS For this preregistered study, 564 participants were recruited from Facebook to obtain a final sample of 246 participants with valid data who were current or former wildland firefighters in the United States. Participants completed online measures of suicidal ideation, history of suicidal behaviors, posttraumatic stress disorder (PTSD) symptoms, problematic alcohol use, and occupational exposure to suicide. RESULTS In this sample, 22% of wildland firefighters reported a history of at least one suicide attempt, and 36.7% reported current suicidal ideation. PTSD symptoms, but not problematic alcohol use or exposure to suicide, were positively associated with suicidal ideation and a history of suicide attempts. Additionally, PTSD symptoms explained significantly more variance in suicidal ideation than depression symptoms alone. CONCLUSIONS Wildland firefighters demonstrate rates of suicide attempts that exceed those of non-wildland firefighters and of the general population at large. In addition, PTSD symptoms may contribute to suicidal thoughts and behaviors (STB) in this population. This is the largest study of STB in wildland firefighters to date.
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5
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Sarabia JR, Dellor E, Freisthler B, Kieninger K. Exploring the association between post-critical incident intervention preferences and self-reported coping self-efficacy among firefighters. J Trauma Stress 2024; 37:504-515. [PMID: 38476048 DOI: 10.1002/jts.23029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2023] [Revised: 02/07/2024] [Accepted: 02/08/2024] [Indexed: 03/14/2024]
Abstract
Critical incident stress debriefing (CISD) is a commonly utilized intervention in the fire service that aims to minimize psychological harm and adverse mental health outcomes after a potentially traumatic incident. This study aimed to explore firefighter preferences regarding CISD and alternative post-critical incident interventions in relation to firefighter coping self-efficacy (FFCSE) and trauma coping self-efficacy (CSE-T). Firefighters (N = 241) completed an online survey and provided complete data. Most participants were White (n = 203, 84.2%), non-Hispanic (n = 221, 91.7%) men (94.2%; n = 227). CISD was the most preferred intervention among firefighters (n = 113, 46.9%) as compared to informal peer support (n = 31, 12.9%), formal one-on-one counseling (n = 29, 12.0%), and no intervention (n = 68, 28.2%). Firefighters who preferred CISD had statistically significant lower levels of FFCSE, R2 = .033-.044, ps = .012-.030, and CSE-T, R2 = .035-.061 ps = .017-.024, compared to those who preferred no intervention. Firefighters who preferred formal one-on-one counseling had statistically significantly lower levels of FFCSE, R2 = .033-.044, ps = .003-.011, and CSE-T, R2 = .035-0.061, p < .001-p = .002, compared to those who preferred no intervention. The findings from this study may guide future research to increase knowledge on firefighter intervention preferences and the association between preference and coping self-efficacy.
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Affiliation(s)
- Joselyn R Sarabia
- College of Social Work, The Ohio State University, Colombus, Ohio, USA
| | - Elinam Dellor
- College of Social Work, The Ohio State University, Colombus, Ohio, USA
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Holland-Winkler AM, Greene DR, Oberther TJ. The Cyclical Battle of Insomnia and Mental Health Impairment in Firefighters: A Narrative Review. J Clin Med 2024; 13:2169. [PMID: 38673442 PMCID: PMC11050272 DOI: 10.3390/jcm13082169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2024] [Revised: 03/27/2024] [Accepted: 04/05/2024] [Indexed: 04/28/2024] Open
Abstract
The occupational requirements of full-time non-administrative firefighters include shift-work schedules and chronic exposure to alerting emergency alarms, hazardous working conditions, and psychologically traumatic events that they must attend and respond to. These compiling and enduring aspects of the career increase the firefighter's risk for insomnia and mental health conditions compared to the general population. Poor sleep quality and mental health impairments are known to coincide with and contribute to the symptom severity of one another. Thus, it is important to determine approaches that may improve sleep and/or mental health specifically for firefighters, as their occupation varies in many aspects from any other occupation. This review will discuss symptoms of insomnia and mental health conditions such as PTSD, anxiety, depression, substance abuse, and suicide in firefighters. The influencing factors of sleep and mental health will be examined including anxiety sensitivity, emotional regulation, and distress tolerance. Current sleep and mental health interventions specific to full-time firefighters are limited in number; however, the existing experimental studies will be outlined. Lastly, this review will provide support for exploring exercise as a possible intervention that may benefit the sleep and mental health of this population.
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Affiliation(s)
- Angelia M. Holland-Winkler
- Department of Kinesiology, Augusta University, 3109 Wrightsboro Road, Augusta, GA 30909, USA; (D.R.G.); (T.J.O.)
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Vo HT, Dao TD, Duong TV, Nguyen TT, Do BN, Do TX, Pham KM, Vu VH, Pham LV, Nguyen LTH, Le LTH, Nguyen HC, Dang NH, Nguyen TH, Nguyen AT, Nguyen HV, Nguyen PB, Nguyen HTT, Pham TTM, Le TT, Nguyen TTP, Tran CQ, Nguyen KT. Impact of long COVID-19 on posttraumatic stress disorder as modified by health literacy: an observational study in Vietnam. Osong Public Health Res Perspect 2024; 15:33-44. [PMID: 38481048 PMCID: PMC10982660 DOI: 10.24171/j.phrp.2023.0261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Revised: 01/04/2024] [Accepted: 01/12/2024] [Indexed: 04/04/2024] Open
Abstract
BACKGROUND The prevalence of posttraumatic stress disorder (PTSD) has increased, particularly among individuals who have recovered from coronavirus disease 2019 (COVID-19) infection. Health literacy is considered a "social vaccine" that helps people respond effectively to the pandemic. We aimed to investigate the association between long COVID-19 and PTSD, and to examine the modifying role of health literacy in this association. METHODS A cross-sectional study was conducted at 18 hospitals and health centers in Vietnam from December 2021 to October 2022. We recruited 4,463 individuals who had recovered from COVID-19 infection for at least 4 weeks. Participants provided information about their sociodemographics, clinical parameters, health-related behaviors, health literacy (using the 12-item short-form health literacy scale), long COVID-19 symptoms and PTSD (Impact Event Scale-Revised score of 33 or higher). Logistic regression models were used to examine associations and interactions. RESULTS Out of the study sample, 55.9% had long COVID-19 symptoms, and 49.6% had PTSD. Individuals with long COVID-19 symptoms had a higher likelihood of PTSD (odds ratio [OR], 1.86; 95% confidence interval [CI], 1.63-2.12; p<0.001). Higher health literacy was associated with a lower likelihood of PTSD (OR, 0.98; 95% CI, 0.97-0.99; p=0.001). Compared to those without long COVID-19 symptoms and the lowest health literacy score, those with long COVID-19 symptoms and a 1-point health literacy increment had a 3% lower likelihood of PTSD (OR, 0.97; 95% CI, 0.96-0.99; p=0.001). CONCLUSION Health literacy was found to be a protective factor against PTSD and modified the negative impact of long COVID-19 symptoms on PTSD.
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Affiliation(s)
- Han Thi Vo
- International Ph.D. Program in Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
- Department of Psychiatry, Hue University of Medicine and Pharmacy, Hue University, Hue, Vietnam
| | - Tien Duc Dao
- Institute of Oncology and Nuclear Medicine, Military Hospital, Ho Chi Minh, Vietnam
| | - Tuyen Van Duong
- International Ph.D. Program in Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
- School of Nutrition and Health Sciences, Taipei Medical University, Taipei, Taiwan
| | - Tan Thanh Nguyen
- Department of Orthopedics, Can Tho University of Medicine and Pharmacy, Can Tho, Vietnam
- Director Office, Can Tho University of Medicine and Pharmacy Hospital, Can Tho, Vietnam
| | - Binh Nhu Do
- Department of Infectious Diseases, Vietnam Military Medical University, Hanoi, Vietnam
- Department of Military Science, Vietnam Military Medical University, Hanoi, Vietnam
| | - Tinh Xuan Do
- Department of Psychiatry, Military Hospital 103, Hanoi, Vietnam
| | - Khue Minh Pham
- Faculty of Public Health, Hai Phong University of Medicine and Pharmacy, Hai Phong, Vietnam
| | - Vinh Hai Vu
- Infectious and Tropical Diseases Department, Viet Tiep Hospital, Hai Phong, Vietnam
| | - Linh Van Pham
- Department of Pulmonary and Cardiovascular Diseases, Hai Phong University of Medicine and Pharmacy Hospital, Hai Phong, Vietnam
| | - Lien Thi Hong Nguyen
- Department of Pulmonary and Cardiovascular Diseases, Hai Phong University of Medicine and Pharmacy Hospital, Hai Phong, Vietnam
| | - Lan Thi Huong Le
- Director Office, Thai Nguyen National Hospital, Thai Nguyen, Vietnam
- Training and Direction of Healthcare Activity Center, Thai Nguyen National Hospital, Thai Nguyen, Vietnam
- Biochemistry Department, Thai Nguyen National Hospital, Thai Nguyen, Vietnam
| | - Hoang Cong Nguyen
- Director Office, Thai Nguyen National Hospital, Thai Nguyen, Vietnam
- President Office, Thai Nguyen University of Medicine and Pharmacy, Thai Nguyen, Vietnam
| | - Nga Hoang Dang
- Training and Direction of Healthcare Activity Center, Thai Nguyen National Hospital, Thai Nguyen, Vietnam
- Department of Quality Control, Thai Nguyen National Hospital, Thai Nguyen, Vietnam
| | | | - Anh The Nguyen
- Director Office, Hospital for Tropical Diseases, Hai Duong, Vietnam
| | - Hoan Van Nguyen
- Infectious and Tropical Diseases Department, Viet Tiep Hospital, Hai Phong, Vietnam
- Department of Infectious Diseases, Hai Phong University of Medicine and Pharmacy, Hai Phong, Vietnam
| | | | - Hoai Thi Thanh Nguyen
- Training and Direction of Healthcare Activity Center, Kien An Hospital, Hai Phong, Vietnam
| | - Thu Thi Minh Pham
- Faculty of Public Health, Hai Phong University of Medicine and Pharmacy, Hai Phong, Vietnam
- School of Public Health, College of Public Health, Taipei Medical University, Taipei, Taiwan
| | - Thuy Thi Le
- President Office, Da Nang University of Medical Technology and Pharmacy, Da Nang, Vietnam
- Faculty of Medical Laboratory Science, Da Nang University of Medical Technology and Pharmacy, Da Nang, Vietnam
| | - Thao Thi Phuong Nguyen
- Institute for Community Health Research, University of Medicine and Pharmacy, Hue University, Hue, Vietnam
| | - Cuong Quoc Tran
- Faculty of Public Health, Pham Ngoc Thach University of Medicine, Ho Chi Minh, Vietnam
| | - Kien Trung Nguyen
- Department of Health Promotion, Faculty of Social and Behavioral Sciences, Hanoi University of Public Health, Hanoi, Vietnam
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Hamilton NA, Russell J, Hamadah K, Youngren W, Toon A, Nguyen TA, Joles K. Screening for Comorbidity of Sleep Disorders in Career Firefighters. J Occup Environ Med 2024; 66:43-50. [PMID: 37853663 DOI: 10.1097/jom.0000000000002993] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2023]
Abstract
BACKGROUND The purpose of this study was to assess the prevalence and sequelae of insomnia, obstructive sleep apnea (OSA), and comorbid OSA and insomnia (COMISA). METHOD In the morning, after a shift end, Midwest career firefighters ( N = 89) in a midsized city completed an electronic battery of questionnaire to screen for OSA, daytime sleepiness, insomnia, presleep arousal, nightmares, mental and physical health symptoms, and a one-night sleep diary. RESULTS Prevalence of firefighters exceeding screening thresholds: OSA: 54%; insomnia: 30%; COMISA: 17%; four or more nightmares per month: 15%. Firefighters who met criteria for COMISA had shorter total sleep time, less restful and worse sleep quality, higher depression and anxiety symptoms, and presleep arousal symptoms than firefighters without self-reported sleep problems. CONCLUSIONS Many firefighters are at elevated risk of individual behavioral sleep disorders, COMISA, and daytime dysfunction.
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Affiliation(s)
- Nancy A Hamilton
- From the University of Kansas, Lawrence, Kansas (N.A.H., J.R., K.H., W.Y., A.T., T.A.N.); and Lawrence, Douglas County Fire and Medical, Lawrence, Kansas (K.J.)
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9
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Pennington ML, Ylitalo KR, Thomas KL, Coe E, Humphries M, Gulliver SB. Suicides among American Indian/Alaska Native firefighters: Data from the National Violent Death Reporting System, 2003 - 2017. Psychiatry Res 2023; 330:115593. [PMID: 37951031 DOI: 10.1016/j.psychres.2023.115593] [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: 06/12/2023] [Revised: 11/01/2023] [Accepted: 11/04/2023] [Indexed: 11/13/2023]
Abstract
Suicide is a significant public health problem in the United States and disproportionally affects male American Indian/Alaska Natives (AI/AN). Suicide is particularly problematic among AI/AN firefighters who are more likely to report suicide ideation, planning, attempts, and risk compared to non-Hispanic white (NHW) firefighters. The aim of the current study was to compare non-Hispanic AI/AN firefighter and NHW firefighter suicide decedents by demographics and risk/precipitating factors using National Violent Death Reporting System data for 45 male non-Hispanic AI/AN firefighter and 588 male NHW firefighter decedents who died by suicide. Compared to NHW firefighter decedents, AI/AN firefighter decedents were significantly younger and had significantly higher odds of experiencing alcohol use problems and a recent death/suicide of a family member/friend. AI/AN firefighter decedents had significantly lower odds of documented mental health problems, documented diagnosis of depression/dysthymia, receipt of mental health treatment, or leaving a suicide note compared to NHW firefighter decedents. Results from this study may inform tailored suicide prevention and screening efforts among first responders with the goal of lowering suicide mortality among AI/AN firefighters and fire service as a whole.
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Affiliation(s)
- Michelle L Pennington
- Department of Public Health, Baylor University, Waco, TX, USA; Warriors Research Institute, Baylor Scott & White Health, Waco, TX, USA.
| | - Kelly R Ylitalo
- Department of Public Health, Baylor University, Waco, TX, USA
| | | | - Elizabeth Coe
- Warriors Research Institute, Baylor Scott & White Health, Waco, TX, USA
| | - Mariah Humphries
- George W. Truett Theological Seminary, Baylor University, Waco, TX, USA
| | - Suzy B Gulliver
- Warriors Research Institute, Baylor Scott & White Health, Waco, TX, USA; Department of Psychiatry and Behavioral Science, Texas A&M Health Science Center, Temple, TX, USA
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10
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Gulliver SB, Pennington ML, Cardenas M, Lewis JE, Cammarata CM, Leto F, Ostiguy WJ, Meyer EC, Kimbrel NA. Stamp Out Stigma: a national campaign to decrease stigma and increase behavioral health in fire service. Cogn Behav Ther 2023; 52:625-640. [PMID: 37489115 DOI: 10.1080/16506073.2023.2233695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Accepted: 06/27/2023] [Indexed: 07/26/2023]
Abstract
Firefighters are at risk for behavioral health problems; however, mental health stigma is a barrier to seeking treatment. Although effective treatments exist, many firefighters report that internal stigma prohibits presentation for effective care. This study aimed to decrease stigma about behavioral health in fire service through the development and delivery of a peer-led anti-stigma intervention campaign called Stamp Out Stigma (SOS). SOS consisted of three related phases. During Phase 1 (n = 12), we produced testimonials and piloted the videos with firefighters to determine which were most compelling. During Phase 2 (n = 23), we beta-tested our training curriculum with two departments, resulting in a significant decrease in internalized stigma but not in self-stigma. During Phase 3 (n = 73), we presented the curriculum to two cohorts of firefighters. Participation in the SOS workshop was associated with a significant decrease in firefighters' self-stigma from pre-, M = 22.7, SD = 6.3, to post-workshop, M = 20.8, SD = 5.5, t(66) = 3.2, p = 0.002. Participation in the SOS workshop was associated with a significant decrease in firefighters' internalized stigma, M = 2.0, SD = 0.5, to post-workshop, M = 1.8, SD = 0.4, t(66) = 2.8, p = 0.007. The SOS approach to stigma reduction is promising for modifying negative attitudes toward mental health and treatment seeking among professional firefighters.
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Affiliation(s)
- Suzy B Gulliver
- Baylor Scott & White Warriors Research Institute, Waco, TX, USA
- Department of Psychiatry & Behavioral Science, Texas A&M University Health Science Center, Temple, TX, USA
| | | | - Megan Cardenas
- Baylor Scott & White Warriors Research Institute, Waco, TX, USA
| | - Jordan E Lewis
- Baylor Scott & White Warriors Research Institute, Waco, TX, USA
| | - Claire M Cammarata
- New York City Fire Department Counseling Services Unit, New York, NY, USA
| | - Frank Leto
- New York City Fire Department Counseling Services Unit, New York, NY, USA
| | | | - Eric C Meyer
- Department of Rehabilitation Science and Technology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Nathan A Kimbrel
- Durham Veterans Affairs Medical Center, Durham, NC, USA
- VA Mid-Atlantic Mental Illness Research, Education, and Clinical Center, Durham, NC, USA
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, USA
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11
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Hershey MS, Bouziani E, Chen XY(M, Lidoriki I, Hadkhale K, Huang YC, Filippou T, López-Gil JF, Gribble AK, Lan FY, Sotos-Prieto M, Kales SN. Surviving & Thriving; a healthy lifestyle app for new US firefighters: usability and pilot study protocol. Front Endocrinol (Lausanne) 2023; 14:1250041. [PMID: 37908746 PMCID: PMC10614295 DOI: 10.3389/fendo.2023.1250041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Accepted: 09/11/2023] [Indexed: 11/02/2023] Open
Abstract
In the United States (US), new firefighters' fitness and health behaviors deteriorate rapidly after fire academy graduation. Over the long-term, this increases their risks for chronic diseases. This study protocol describes the proposed usability testing and pilot study of a newly designed and developed healthy lifestyle smartphone app, "Surviving & Thriving", tailored towards young US firefighters. "Surviving & Thriving" will provide interactive educational content on four lifestyle factors; nutrition, sleep, physical activity, and resilience, and include a personalized journey, habit tracker, and elements of gamification to promote engagement and long-term healthy behavior change. The first phase of the app development entails alpha testing by the research team and pre-beta testing by a fire service expert panel which will help refine the app into a pre-consumer version. Upon completion of the full app prototype, beta 'usability' testing will be conducted among new fire academy graduates from two New England fire academies to collect qualitative and quantitative feedback via focus groups and satisfaction surveys, respectively. A last phase of piloting the app will evaluate the app's efficacy at maintaining/improving healthy lifestyle behaviors, mental health metrics, and physical fitness metrics. We will also evaluate whether firefighters' perceived "health cultures" scores (ratings of each fire station's/fire department's environments as to encouraging/discouraging healthy behaviors) modify the changes in health metrics after utilizing the app for three to six months. This novel user-friendly app seeks to help new firefighters maintain/improve their health and fitness more effectively, reducing their risk of lifestyle-related chronic disease. Firefighters who can establish healthy habits early in their careers are more likely to sustain them throughout their lives.
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Affiliation(s)
- Maria Soledad Hershey
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, United States
| | - Eleni Bouziani
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, United States
- Department of Medicine, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Xin Yu (Maggie) Chen
- Harvard Faculty of Arts and Sciences, William James Hall, Cambridge, MA, United States
- Department of Occupational Medicine, Cambridge Health Alliance, Harvard Medical School, Cambridge, MA, United States
| | - Irene Lidoriki
- Department of Occupational Medicine, Cambridge Health Alliance, Harvard Medical School, Cambridge, MA, United States
| | - Kishor Hadkhale
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, United States
- Department of Occupational Medicine, Cambridge Health Alliance, Harvard Medical School, Cambridge, MA, United States
| | - Ya-Chin Huang
- Department of Occupational Medicine, Cambridge Health Alliance, Harvard Medical School, Cambridge, MA, United States
- Department of Preventive Medicine, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
- Department of Occupational & Environmental Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | | | - José Francisco López-Gil
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, United States
- One Health Research Group, Universidad de Las Américas, Quito, Ecuador
| | - Anne Katherine Gribble
- Department of Occupational Medicine, Cambridge Health Alliance, Harvard Medical School, Cambridge, MA, United States
- Illawarra Shoalhaven Local Health District, NSW Health, Warrawong, NSW, Australia
| | - Fan-Yun Lan
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, United States
- Institute of Health and Welfare Policy, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Mercedes Sotos-Prieto
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, United States
- Department of Preventive Medicine and Public Health, School of Medicine, Universidad Autónoma de Madrid, and IdiPaz (Instituto de Investigación Sanitaria Hospital Universitario La Paz), Madrid, Spain
- Center for Biomedical Research in Epidemiology and Public Health Network (CIBERESP) [Consorcio Centro de Investigación Biomédica en Red (CIBER) of Epidemiology and Public Health], Madrid, Spain
- Madrid Institute for Advanced Studies (IMDEA)-Food Institute, The Campus of International Excellence (CEI), The Spanish National Research Council (CSIC), The Autonomous University of Madrid (UAM), Madrid, Spain
| | - Stefanos N. Kales
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, United States
- Department of Occupational Medicine, Cambridge Health Alliance, Harvard Medical School, Cambridge, MA, United States
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12
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Fisher MP, Lavender CD. Ensuring Optimal Mental Health Programs and Policies for First Responders: Opportunities and Challenges in One U.S. State. Community Ment Health J 2023; 59:1341-1351. [PMID: 36947386 PMCID: PMC10031720 DOI: 10.1007/s10597-023-01121-1] [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: 10/02/2022] [Accepted: 03/14/2023] [Indexed: 03/23/2023]
Abstract
This study examined opportunities and challenges faced by individuals working to advance mental health policy and programming for first responders. We utilized qualitative content analysis and interviews with 16 firefighters, emergency medical services professionals, law enforcement officers, and others involved in programming or policy in the U.S. state of Ohio. Six themes characterized opportunities and challenges encountered: (1) variations in programming and policy exist across jurisdictions; (2) opportunities exist to enhance mental health awareness and self-care training for first responders; (3) need exists for specialized mental health clinicians accustomed to and capable of effectively working with first responders; (4) confidentiality protections are lacking for peer supporters not trained in critical incident stress management; (5) having an internal champion and broader support is key to program and policy advancement; and (6) interdepartmental collaboration provides opportunities for sharing resources and best practices. Results illustrate continued need for strategic policymaking, program development, and coordination.
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Affiliation(s)
- Michael P Fisher
- Department of Health Policy, Management & Leadership, School of Public Health, West Virginia University, P.O. Box 9190, Morgantown, WV, 26505, USA.
| | - Catherine D Lavender
- Department of Occupational Therapy & Occupational Science, College of Health Professions, Towson University, 8000 York Road, Linthicum Hall, Towson, MD, 21252, USA
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13
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Blekić W, Ben Taieb S, Kandana Arachchige KG, Rossignol M, Schultebraucks K. Stress response and experiential avoidance among firefighters: Preliminary insights from network analyses. J Psychiatr Res 2023; 165:132-139. [PMID: 37499484 PMCID: PMC10546386 DOI: 10.1016/j.jpsychires.2023.07.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Revised: 07/13/2023] [Accepted: 07/15/2023] [Indexed: 07/29/2023]
Abstract
Firefighters are at increased risk of developing posttraumatic stress disorder (PTSD) due to exposure to potentially traumatic events during their careers. However, little is known about the prevalence of PTSD among this population, particularly when taking moderating variables into account. Using Gaussian Graphical Models and Directed Acyclic Graphs, we conducted network analyses to examine the interactions between clusters of PTSD symptoms, perceived stress, hardiness, and experiential avoidance among 187 firefighters. The data and code are published with the paper. Experiential avoidance, as part of psychological inflexibility, was found to be the only variable that interacted with PTSD symptomatology. Strong positive associations were observed between experiential avoidance and the "negative mood and cognitions" subscale of the PTSD Checklist for DSM-5 (PCL-5). Through this association, other PTSD symptoms were activated, particularly avoidance and arousal. Our findings suggest that experiential avoidance and negative mood and cognition symptoms are particularly important in the expression of PTSD symptomatology in firefighters. In addition, experiential avoidance may be used as a coping strategy to reduce perceived stress during potentially traumatic events. Therefore, experiential avoidance may be a prime target for future interventions and training focused on flexible self-regulation strategies in this population.
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Affiliation(s)
- Wivine Blekić
- Department of Psychiatry, NYU Grossman School of Medicine, New York, NY, USA.
| | - Souhaib Ben Taieb
- Department of Computer Science, University of Mons, Mons, Belgium; Big Data and Machine Learning Lab, University of Mons, Mons, Belgium
| | | | - Mandy Rossignol
- Department of Cognitive Psychology and Neuropsychology, University of Mons, Belgium
| | - Katharina Schultebraucks
- Department of Psychiatry, NYU Grossman School of Medicine, New York, NY, USA; Department of Population Health, NYU Grossman School of Medicine, New York, NY, USA
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14
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Baker LD, Smith AJ. Adapting the Primary Care PTSD Screener for firefighters. Occup Med (Lond) 2023; 73:142-147. [PMID: 36864556 DOI: 10.1093/occmed/kqad019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/04/2023] Open
Abstract
BACKGROUND By the nature of their work, first responders are at risk for post-traumatic stress disorder (PTSD). Efficient screening instruments are useful to identify at-risk first responders and connect them to services. AIMS The current study aimed to (i) evaluate the diagnostic properties of the Primary Care PTSD for DSM-5 (PC-PTSD-5) scale among firefighters, (ii) explore the use of an adapted PC-PTSD-5 on a five-point Likert-type scale and (iii) examine sensitivity and specificity of the adapted instrument in this population. METHODS Pooled data were analysed among firefighters (N = 92) from a treatment-seeking sample (n = 36) and a population health screening sample (n = 56). Participants completed an adapted version of the PC-PTSD-5 and the Post-Traumatic Stress Disorder Checklist for DSM-5 (PCL-5). Receiver operating characteristic curve analyses were performed, referencing PCL-5 cut-off/probable diagnostic threshold scores. RESULTS The PC-PTSD-5 demonstrated excellent operating characteristics overall. A threshold of 3 was optimal for discriminating probable PTSD using a proxy for the original PC-PTSD-5 (range: 0-5), whereas a score of 9 was identified for the PC-PTSD-5 permutation that allowed for more response variability (range: 0-20). CONCLUSIONS Our preliminary data suggest the PC-PTSD-5 may be a useful tool for brief firefighter screening, with suggested cut-offs that require further replication and expanded investigation.
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Affiliation(s)
- L D Baker
- Department of Mental Health Service, George E. Wahlen VA Medical Center, Salt Lake City, UT 84148, USA
| | - A J Smith
- Department of Psychiatry, Geisel School of Medicine at Dartmouth, Hanover, NH 03755, USA
- Lyda Hill Institute for Human Resilience, University of Colorado, Colorado Springs, CO 80918, USA
- Department of Psychiatry, University of Utah, Huntsman Mental Health Institute, Salt Lake City, UT 84108, USA
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15
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Ponder WN, Carbajal J, Whitworth J, Schuman DL, Galusha JM, Yockey RA. Predictors of Suicide and Differences in Attachment Styles and Resilience Among Treatment-Seeking First-Responder Subtypes. J Occup Environ Med 2023; 65:321-329. [PMID: 36730737 DOI: 10.1097/jom.0000000000002750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE To identify the predictors of suicide for firefighters (FFs), emergency medical technicians (EMTs), and law enforcement officers (LEOs). METHODS We used baseline data from FFs/EMTs (n = 69) and LEOs (n = 81) to investigate the unique predictors for both first-responder subtypes. We conducted confirmatory factor analysis on validated assessments of posttraumatic stress disorder (PTSD) and depression. Measures of attachment, resilience, PTSD, depression, generalized anxiety, trauma history, and substance use were the independent variables in two backward stepwise regressions predicting suicide. RESULTS Substance use and somatic depression were significant predictors for LEOs, whereas affective depression, anhedonia, externalizing behaviors, trauma history, and generalized anxiety were significant predictors for FFs/EMTs. LIMITATIONS These data are cross-sectional and should be modeled longitudinally over the course of treatment. CONCLUSION Separate constructs influence suicide for LEOs and FFs/EMTs.
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Affiliation(s)
- Warren N Ponder
- From the One Tribe Foundation, Fort Worth, Texas (W.N.P.); Stephen F. Austin State University (J.C.); University of Central Florida (J.W.); University of Texas at Arlington (D.L.S.); Private Practice, Dallas Texas (J.M.G.); and University of North Texas Health Science Center (A.Y.)
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16
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Back CY, Hyun DS, Chang SJ, Jeung DY. Trauma Exposure and Suicidal Ideation among Korean Male Firefighters: Examining the Moderating Roles of Organizational Climate. Saf Health Work 2023; 14:71-77. [PMID: 36941935 PMCID: PMC10024171 DOI: 10.1016/j.shaw.2022.11.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Revised: 11/21/2022] [Accepted: 11/23/2022] [Indexed: 12/03/2022] Open
Abstract
Background This study investigated the relationship between trauma exposure and suicidal ideation. Moreover, this study examines the moderating roles of organizational climate on the association between trauma exposure and suicidal ideation in Korean male firefighters. Methods A total of 15,104 male firefighters who completed a questionnaire were analyzed. The data were obtained using an online self-administered questionnaire from the Firefighter Research on Enhancement of Safety and Health Study. Poisson regression analysis was performed to determine the effects of trauma exposure on suicidal ideation and the moderating effect of organizational climate. Results The results showed that 389 firefighters (2.6%) responded that they had experienced suicidal ideation. In the final model, trauma exposure was positively related to suicidal ideation (adjusted risk ratio [aRR], 1.076; 95% confidence interval [CI]: 1.051-1.103), and organizational climate was negatively associated with suicidal ideation (aRR, 0.772; 95% CI: 0.739-0.806). Additionally, the interaction term (trauma exposure × organizational climate) was related to suicidal ideation (aRR, 1.016; 95% CI: 1.009-1.023). Conclusions This study suggests that trauma exposure might play a significant role in developing suicidal ideation and that positive organizational climate moderates the negative effects of trauma exposure on suicidal ideation among firefighters. It is necessary to perform a follow-up study of various intervention strategies to maintain a healthy organizational climate or work environment. Such interventions should promote lasting trust within teams, provide social support and belonging, and nurture job value.
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Affiliation(s)
- Chi-Yun Back
- Department of Preventive Medicine, Wonju College of Medicine, Yonsei University, Wonju, Republic of Korea
| | - Dae-Sung Hyun
- Department of Non-benefits Management, National Health Insurance Service, Wonju 26424, Republic of Korea
| | - Sei-Jin Chang
- Department of Preventive Medicine and Institute of Occupational & Environmental Medicine, Wonju College of Medicine, Yonsei University, Wonju, Republic of Korea
| | - Da-Yee Jeung
- Department of Dental Hygiene, Hanyang Women's University, Seoul, Republic of Korea
- Corresponding author.
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17
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Lim J, Moon KK. Exploring the Effect of Emotional Labor on Turnover Intention and the Moderating Role of Perceived Organizational Support: Evidence from Korean Firefighters. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:4379. [PMID: 36901390 PMCID: PMC10002436 DOI: 10.3390/ijerph20054379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Revised: 02/25/2023] [Accepted: 02/27/2023] [Indexed: 06/18/2023]
Abstract
Synthesizing the conservation of resource theory, proximal withdrawal state theory, and job demands-resources theory, the present study examined the relationships between two dimensions of emotional labor (i.e., surface and deep acting) and turnover intention, as well as the moderating role of perceived organizational support in these relationships, such as the context of Korean firefighters. Using survey data drawn from fire organizations in Gyeonggi-do, the largest province of South Korea, we found that both surface and deep acting are positively related to firefighter turnover intentions. Further analysis indicates that the perceived organizational support of firefighters, vital for public health and safety, attenuates the positive relationship between surface acting and turnover intention but has no significant moderating effect on the relationship between deep acting and turnover intention. Our results suggest that perceived organizational support acts through essential psychological resources to recover the loss of emotional resources and contributes to the retention of firefighter personnel who primarily perform challenging and stressful work, including firefighting and offering emergency medical services. Thus, this study examines a crucial tool to ensure firefighters' public mental health.
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Affiliation(s)
- Jaeyoung Lim
- Department of Public Administration and Social Welfare, Chosun University, Gwangju 61452, Republic of Korea
| | - Kuk-Kyoung Moon
- Department of Public Administration, Inha University, Incheon 22212, Republic of Korea
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18
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Toczko M, Fyock-Martin M, McCrory S, Martin J. Effects of fitness on self-reported physical and mental quality of life in professional firefighters: An exploratory study. Work 2023; 76:1589-1596. [PMID: 37393477 DOI: 10.3233/wor-220673] [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] [Indexed: 07/03/2023] Open
Abstract
BACKGROUND The work-related stress experienced by firefighters is associated with numerous health issues. In the general population, improving physical fitness is associated with improvements in both mental and physical quality of life. OBJECTIVE The purpose of the study was to examine whether fitter professional firefighters report greater physical and mental quality of life. METHODS Twenty-three professional firefighters (males = 21, females = 2; age: 36.78±7.12yrs; height: 176.96±5.67 cm; weight: 88.20±16.02 kg; years of service: 8.70±6.62years) volunteered for the study. Participants completed a fitness protocol that included the wall sit and reach, Y-balance test, vertical jump, 1 repetition maximum bench press, pull-ups to failure, push-ups to failure, a plank hold and 1-mile run. The short form 36 questionnaire was used to assess overall quality of life. Firefighters were divided into "high" and "low" groups for physical and mental quality of life. Group differences in fitness parameters were assessed using a multivariate analysis of covariance with gender, age, years of service, height, and body mass as co-variates. RESULTS Firefighters with lower mental quality of life had lower body fat percentages (p = 0.003), fat mass (p = 0.036), greater fat free mass (p = 0.015), vertical jump height (p = 0.024) and performed more pull-ups (p = 0.003). There were no significant differences in any of the fitness measures between high and low physical quality of life groups. CONCLUSION The findings indicate that physical fitness of firefighters is not indicative of overall health. Firefighters might use exercise to cope for psychological stress and a holistic approach to improve firefighter quality of life is recommended.
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Affiliation(s)
- Michael Toczko
- Sports Medicine Assessment Research & Testing (SMART) Laboratory, George Mason University, Manassas, VA, USA
| | - Marcie Fyock-Martin
- Sports Medicine Assessment Research & Testing (SMART) Laboratory, George Mason University, Manassas, VA, USA
| | - Stuart McCrory
- Sports Medicine Assessment Research & Testing (SMART) Laboratory, George Mason University, Manassas, VA, USA
| | - Joel Martin
- Sports Medicine Assessment Research & Testing (SMART) Laboratory, George Mason University, Manassas, VA, USA
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19
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Shin Y, Nam JK, Lee A, Kim Y. Latent profile analysis of post-traumatic stress and post-traumatic growth among firefighters. Eur J Psychotraumatol 2023; 14:2159048. [PMID: 37052101 PMCID: PMC9848271 DOI: 10.1080/20008066.2022.2159048] [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: 01/14/2022] [Accepted: 10/20/2022] [Indexed: 01/12/2023] Open
Abstract
Background: Due to the job characteristics, firefighters are repeatedly exposed to trauma incidents. However, not all firefighters exhibit the same level of post-traumatic stress disorder (PTSD) or post-traumatic growth (PTG). Despite this, few studies have looked into firefighters' PTSD and PTG.Objective: This study identified subgroups of firefighters based on their PTSD and PTG levels, and investigated the influence of demographic factors and PTSD/PTG-related factors on latent class classification.Method: Latent profile analysis was used to examine the patterns of PTSD and PTG among 483 firefighters in South Korea. Using a cross-sectional design, demographic factors and job factors were examined as group covariates through a three-step approach. PTSD-related factors such as depression and suicide ideation, as well as PTG-related factors such as emotion-based response were analysed as differentiating factors.Results: Four classes were identified and named 'Low PTSD-low PTG (65.2%),' 'Mid PTSD-mid PTG (15.5%),' 'Low PTSD-high PTG (15.3%),' and 'High PTSD-mid PTG (3.9%).' The likelihood of belonging to the group with high trauma-related risks increased with more rotating shift work and years of service. The differentiating factors revealed differences based on the levels of PTSD and PTG in each group.Conclusions: 34.8% of firefighters experienced changes due to traumatic events while on the job, and some required serious attention. Modifiable job characteristics, such as the shift pattern, indirectly affected PTSD and PTG levels. Individual and job factors should be considered together when developing trauma interventions for firefighters.
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Affiliation(s)
- Yongchan Shin
- Student Counseling Center, Tongmyong University, Busan, South Korea
| | - JeeEun Karin Nam
- Graduate School of Education, Ewha Womans University, Seoul, South Korea
| | - Aeyoung Lee
- Department of Counseling and Psychotherapy, Inje University, Gimhae, South Korea
| | - Youngkeun Kim
- Department of Counseling and Psychotherapy, Inje University, Gimhae, South Korea
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20
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Li Y, Li N, Zhang L, Liu Y, Zhang T, Li D, Bai D, Liu X, Li L. Predicting PTSD symptoms in firefighters using a fear-potentiated startle paradigm and machine learning. J Affect Disord 2022; 319:294-299. [PMID: 36162659 DOI: 10.1016/j.jad.2022.09.094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Revised: 05/19/2022] [Accepted: 09/20/2022] [Indexed: 10/14/2022]
Abstract
This study develops a fear-potentiated startle paradigm (FPS) and a machine learning approach to accurately predict PTSD symptoms using electrogram data. A three-phase fear-potentiated startle paradigm was designed to assess the conditioning, generalization, and extinction of fear. Electrooculogram and electrocardiogram signals were collected during the FPS. A total of 1107 Chinese firefighters participated in the study. The Chinese version PCL-C was administered to all subjects. A cutoff of 38 or higher is used to indicate PTSD symptoms. Electrogram features were extracted and selected to build a machine learning model to classify individuals. The machine learning model was 5-fold cross validated. The importance of the selected features was calculated. Classification performance metrics were evaluated for the machine learning model. The machine learning model can identify firefighters with a PCL-C score of 38 or above with sensitivity and specificity both above 0.85 when 5-fold cross validated on a 1107-person sample. The area under the receiver operating characteristic curve of the model is 0.93. Features related to fear generalization are found to be the most important. The proposed fear-potentiated startle paradigm and machine learning approach can accurately predict PTSD symptoms in Chinese firefighters, which can improve the screening and diagnosis of PTSD.
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Affiliation(s)
- Yuanhui Li
- Adai Technology (Beijing) Co., Ltd., Beijing, China
| | - Nan Li
- Department of Industrial Engineering, Tsinghua University, Beijing, China
| | - Liqun Zhang
- Adai Technology (Beijing) Co., Ltd., Beijing, China
| | - Yanru Liu
- Adai Technology (Beijing) Co., Ltd., Beijing, China
| | | | - Dai Li
- Adai Technology (Beijing) Co., Ltd., Beijing, China
| | | | - Xiang Liu
- Department of Industrial Engineering, Tsinghua University, Beijing, China.
| | - Lingjiang Li
- Mental Health Institute, the Second Xiangya Hospital, Central South University, Changsha, China.
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21
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The Moderating Role of Emotional Intelligence on the Relationship Between Conflict Management Styles and Burnout among Firefighters. Saf Health Work 2022; 13:448-455. [PMID: 36579009 PMCID: PMC9772482 DOI: 10.1016/j.shaw.2022.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Revised: 07/05/2022] [Accepted: 07/05/2022] [Indexed: 12/31/2022] Open
Abstract
Background While the organizational factors that account for firefighters' burnout have been extensively explored, the individual factors related to how they regulate interpersonal conflicts and emotions remain to be investigated. Previous research has demonstrated the association between emotional intelligence and conflict management styles and burnout, but no study has looked at the interrelationships among these factors in high-risk sectors. The present exploratory study aimed to fill this research gap by investigating the relationships between conflict management style, emotional intelligence and burnout in a sample of firefighters. Methods A cross-sectional study was conducted with 240 French firefighters. Measures comprised validated scales of conflict management styles, emotional intelligence and burnout. Results Results showed that the integrating conflict style reduced burnout. They also revealed the effects of emotion regulation on burnout, whereby the awareness and management of one's own emotions reduced burnout. Moreover, awareness of one's own emotions moderated the relationship between integrating conflict resolution style and burnout, whereby the effect of integrating style on reduced burnout was higher when awareness of one's own emotions was high. Conclusion These results reveal that strategies used by firefighters to regulate their emotions in order to meet the emotional demands specific to their job are important for reducing the emotional exhaustion component of burnout. Training programs for conflict and emotion management are needed to preserve the mental health of firefighters and ensure the safety of interventions.
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22
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Reduced working memory performance in PTSD and suicide among veterans presenting for treatment. J Psychiatr Res 2022; 156:299-307. [PMID: 36283133 DOI: 10.1016/j.jpsychires.2022.10.043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2022] [Revised: 10/06/2022] [Accepted: 10/17/2022] [Indexed: 12/12/2022]
Abstract
Suicide is among the leading causes of death in the United States, underscoring the continued need to understand the mechanisms underlying suicide risk. A growing body of research has examined the role of working memory deficits in suicidal thoughts and behaviors (STBs), yet little research has evaluated putative pathways via which working memory impairments may heighten suicide risk. Elevated posttraumatic stress symptoms (PTSS) represent one plausible mechanism through which poor working memory performance may increase STBs. The present study utilized data from 140 treatment-seeking veterans who presented for an intake evaluation in the PTSD Clinical Team of a large VA Medical Center. Veterans completed self-report measures, a semi-structured PTSD evaluation, and a digit span working memory test. In addition to concurrent suicidal ideation assessed during the intake, additional information regarding past suicide attempts, presence of a safety plan, documentation of past suicidal behaviors, and engagement with suicide crisis lines were collected via electronic medical records. Consistent with hypotheses, a significant indirect path emerged such that poor working memory performance predicted greater suicidal ideation, greater likelihood of a past suicide attempt, and greater latent suicide risk via increased PTSS. However, no direct effect of working memory on STBs or indirect paths of PTSS on STBs via working memory emerged. These findings suggest that the relation between working memory and STBs may be explained by PTSS severity.
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Burzee Z, Bowers C, Beidel D. A re-evaluation of Stuart's police officer stigma scale: Measuring mental health stigma in first responders. Front Public Health 2022; 10:951347. [PMID: 36203658 PMCID: PMC9530805 DOI: 10.3389/fpubh.2022.951347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Accepted: 08/16/2022] [Indexed: 01/24/2023] Open
Abstract
Stigma about mental illness is often identified as one of the most prominent obstacles to seeking mental health services. This seems to be particularly true among first responders. Unfortunately, the research regarding stigma in first responders is lacking. This may be due, in part, to the absence of appropriate measurement tools to allow such research. Police Officer Stigma Scale (POSS) has recently been developed to address this issue, but its psychometric properties have gone largely untested. Therefore, this study sought to identify the underlying factor structure and internal consistency of the POSS. This paper used a sample of 135 first responders. Using factor analysis with an orthogonal rotation on Stuart's 11-item POSS, the participant's results revealed two main components, accounting for a total of 72.79% of the overall variance. Factor one is "maltreatment of colleagues with a mental disorder," and is associated with six of the 11 items on the scale, such as "Most police officers believe that a colleague who has had a mental illness is not trustworthy." Factor two is "fear of disclosing a mental disorder." It includes items such as "Most police officers would not disclose to a supervisor/manager if they were experiencing a mental illness." Findings from this research are similar to the results of previous studies with components such as unwillingness to disclose a mental health condition, fear of how the public will treat an individual with a mental disorder, and anger toward those who decide to seek treatment or get diagnosed with a mental illness. These findings imply that Stuart's POSS is reliable but needs to include two components rather than one. With the two main components, further research can now be conducted to understand why and ultimately mitigate maltreatment or stigma against first responders with a mental health condition.
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Affiliation(s)
- Zachery Burzee
- Department of Psychology, University of Central Florida, Orlando, FL, United States
| | - Clint Bowers
- Department of Psychology, University of Central Florida, Orlando, FL, United States
- UCF RESTORES, University of Central Florida, Orlando, FL, United States
| | - Deborah Beidel
- UCF RESTORES, University of Central Florida, Orlando, FL, United States
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24
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Weinberg M, Kimchy Elimellech A. Civilian Military Security Coordinators Coping with Frequent Traumatic Events: Spirituality, Community Resilience, and Emotional Distress. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:8826. [PMID: 35886676 PMCID: PMC9322548 DOI: 10.3390/ijerph19148826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Revised: 07/17/2022] [Accepted: 07/18/2022] [Indexed: 02/04/2023]
Abstract
Civilian military security coordinators are a unique kind of first responders. They live in communities that are close to the border and are responsible for the security of their community in routine and emergency situations until the arrival of the army or the police. Their role puts them at an elevated risk of experiencing emotional distress and developing PTSD. The present study, which was conducted in Israel following terror incidents over the year 2018, aimed to examine the relationships between spirituality and perceived community resilience, on the one hand, and PTSD symptoms and stress, on the other, among civilian military security coordinators. One hundred and thirteen (n = 113) civilian military security coordinators living up to 12.4 miles from the border who are routinely exposed to terror and other traumatic events completed demographic, spirituality, community resilience, PTSD, and stress questionnaires. Structural-equation-model analyses showed that spirituality was negatively associated with PTSD symptoms and stress. However, perceived community resilience was not associated with PTSD symptoms or stress. In addition, age was negatively associated with PTSD symptoms and stress. Financial situation was also negatively associated with PTSD symptoms and stress and incidence of exposure to terror and security threats was associated only with PTSD symptoms. Theoretical and practical implications are discussed.
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Affiliation(s)
- Michael Weinberg
- School of Social Work, Faculty of Welfare and Health Sciences, University of Haifa, Haifa 3498838, Israel;
| | - Adi Kimchy Elimellech
- School of Social Work, Faculty of Welfare and Health Sciences, University of Haifa, Haifa 3498838, Israel;
- Sha’ar Menashe Mental Health Center, Haifa 3785000, Israel
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25
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Tao Y, Liu X, Hou W, Niu H, Wang S, Ma Z, Bi D, Zhang L. The Mediating Role of Emotion Regulation Strategies in the Relationship Between Big Five Personality Traits and Anxiety and Depression Among Chinese Firefighters. Front Public Health 2022; 10:901686. [PMID: 35719646 PMCID: PMC9205204 DOI: 10.3389/fpubh.2022.901686] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Accepted: 04/27/2022] [Indexed: 11/30/2022] Open
Abstract
Identification of protective factors to prevent firefighters' anxiety and depression is meaningful. We explored whether emotion-regulation strategies mediate the relationship between personality traits and anxiety and depression among Chinese firefighters. Approximately, 716 Chinese firefighters were recruited and completed the Emotion Regulation Questionnaire (ERQ), Self-Rating Anxiety Scale (SAS), Self-Rating Depression Scale (SDS), and Big Five Inventory−2 (BFI-2) Scale. Results (N = 622) indicated that only negative emotionality traits could predict anxiety symptoms. Meanwhile, the multilevel mediation effect analyses showed that conscientiousness through cognitive reappraisal could reduce anxiety and depression symptoms in Chinese firefighters. Our findings clarify Chinese firefighters' underlying emotion-regulation process between personality traits and anxiety and depression. Implications, limitations, and future directions are discussed.
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Affiliation(s)
- Yanqiang Tao
- Faculty of Psychology, Beijing Key Laboratory of Applied Experimental Psychology, Beijing Normal University, Beijing, China
| | - Xiangping Liu
- Faculty of Psychology, Beijing Key Laboratory of Applied Experimental Psychology, Beijing Normal University, Beijing, China
| | - Wenxin Hou
- Faculty of Psychology, Beijing Key Laboratory of Applied Experimental Psychology, Beijing Normal University, Beijing, China
| | - Haiqun Niu
- School of Psychology, Nanjing Normal University, Nanjing, China
| | - Shujian Wang
- Faculty of Psychology, Beijing Key Laboratory of Applied Experimental Psychology, Beijing Normal University, Beijing, China
| | - Zijuan Ma
- School of Psychology, South China Normal University, Guangzhou, China
| | - Dan Bi
- Yichun 1st High School, Yichun, China
| | - Liang Zhang
- College of Education for the Future, Beijing Normal University at Zhuhai, Zhuhai, China
- Student Mental Health Education Center Northeast Agricultural University, Harbin, China
- *Correspondence: Liang Zhang
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Yuan H, Ren L, Ma Z, Li F, Liu J, Jin Y, Chen C, Li X, Wu Z, Cheng S, Song L, Wang C, Liu X, Yang Q. Network structure of PTSD symptoms in Chinese male firefighters. Asian J Psychiatr 2022; 72:103062. [PMID: 35339873 DOI: 10.1016/j.ajp.2022.103062] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Revised: 02/24/2022] [Accepted: 03/09/2022] [Indexed: 11/20/2022]
Abstract
The network perspective of mental disorder offers a novel way of understanding the psychopathology of post-traumatic stress disorder (PTSD). In this framework, PTSD may arise from direct interactions between its symptoms. In the present study, we used the Post-Traumatic Stress Disorder Checklist-civilian Version (PCL-C) to investigate the network structure of PTSD symptoms in 994 Chinese male firefighters. We also calculated the micro (i.e., edges weight and node expected influence) and middle (i.e., community) indicators of the final network. Nine strongest edges existed in the final network were from the same dimension of PCL-C, like "avoidance of thoughts" and "avoidance of reminders". Symptoms "emotional reactivity", "avoidance of reminders" and "exaggerated startle response" had the highest expected influence. As for the results of community detection, the spinglass and walktrap algorithm detected the same three communities which are slightly different from the original dimensions of PCL-C (i.e., symptoms "avoidance of thoughts", "avoidance of reminders" and "trauma-related amnesia" of avoidance dimension of PCL-C were added to the intrusion dimension of PCL-C). The present study explored the network structure of PTSD symptoms in Chinese male firefighters and provided several implications for clinical prevention and intervention to address the mental health needs in this special group.
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Affiliation(s)
- Huiling Yuan
- Department of Military Medical Psychology, Air Force Medical University, 710032 Xi'an, China
| | - Lei Ren
- Department of Military Medical Psychology, Air Force Medical University, 710032 Xi'an, China
| | - Zhujing Ma
- Department of Military Medical Psychology, Air Force Medical University, 710032 Xi'an, China
| | - Fengzhan Li
- Department of Military Medical Psychology, Air Force Medical University, 710032 Xi'an, China
| | - Jianjun Liu
- Tenth Policlinic, Air Force 986 Hospital, 710054 Xi'an, China
| | - Yinchuan Jin
- Department of Military Medical Psychology, Air Force Medical University, 710032 Xi'an, China
| | - Chen Chen
- Department of Military Medical Psychology, Air Force Medical University, 710032 Xi'an, China
| | - Xiao Li
- Department of Military Medical Psychology, Air Force Medical University, 710032 Xi'an, China
| | - Zhongying Wu
- Department of Military Medical Psychology, Air Force Medical University, 710032 Xi'an, China
| | - Sizhe Cheng
- Department of Military Medical Psychology, Air Force Medical University, 710032 Xi'an, China
| | - Lei Song
- Department of Military Medical Psychology, Air Force Medical University, 710032 Xi'an, China
| | - Chaoxian Wang
- Department of Military Medical Psychology, Air Force Medical University, 710032 Xi'an, China
| | - Xufeng Liu
- Department of Military Medical Psychology, Air Force Medical University, 710032 Xi'an, China.
| | - Qun Yang
- Department of Military Medical Psychology, Air Force Medical University, 710032 Xi'an, China.
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Dynamic Psychotherapy as a PTSD Treatment for Firefighters: A Case Study. Healthcare (Basel) 2022; 10:healthcare10030530. [PMID: 35327008 PMCID: PMC8954085 DOI: 10.3390/healthcare10030530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Revised: 03/11/2022] [Accepted: 03/12/2022] [Indexed: 02/01/2023] Open
Abstract
In Portugal, forest fires are responsible for disasters that tend to be repeated annually, leading to dramatic consequences, such as those that have occurred in 2017, with the destruction of hundreds of houses and the deaths of dozens of people. Firefighters who are exposed to these potentially traumatic events are considered a high-risk group for the development of stress-related disorders. The aim of this study was to monitor the progress of two firefighters with symptoms of post-traumatic stress disorder (PTSD) treated through dynamic psychotherapy (DP) and to assess the feasibility of implementing this intervention within fire departments. A female firefighter and a male firefighter, with similar sociodemographic characteristics and PTSD symptom severity, were selected to verify the treatment applicability for both genders. The symptomatology changes were assessed through a set of instruments (PHQ-15, PCL-5, BSI, DASS, and CALPAS-P) applied every three months over 15 months (including pre-treatment, treatment period, and post-treatment). DP seemed to be an effective treatment for PTSD symptoms, with patients showing a state of increasing improvement even after the end of treatment. The acceptability to firefighters, the treatment adherence, the therapeutic alliance, and the reduction in PTSD symptoms suggest feasibility for implementing this intervention inside the Portuguese fire departments.
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Wright HM, Fuessel-Hermann D, Pazdera M, Lee S, Ridge B, Kim JU, Konopacki K, Hilton L, Greensides M, Langenecker SA, Smith AJ. Preventative Care in First Responder Mental Health: Focusing on Access and Utilization via Stepped Telehealth Care. FRONTIERS IN HEALTH SERVICES 2022; 2:848138. [PMID: 36925868 PMCID: PMC10012773 DOI: 10.3389/frhs.2022.848138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Accepted: 03/31/2022] [Indexed: 11/13/2022]
Abstract
First responders are at high risk for disorders that arise from repeat exposure to stress and trauma (Post Traumatic Stress Disorder, depression, and problematic alcohol use). Although mental health treatments are available, first responders often do not access them, anchored by barriers that include: lack of knowledge, stigma, negative experience with mental health providers, and time-based burdens. In this study, we designed an intervention to address these barriers, extending a Planned-Action framework. Step 1 involved self-report screening for four mental health risks (PTSD, depression, anxiety, and alcohol use risk), delivered to all personnel electronically, who were free to either consent and participate or opt-out. The detection of risk(s) in Step 1 led to scheduling a Step 2 telehealth appointment with a trained clinician. We report descriptive statistics for participation/attrition/utilization in Steps 1 and 2, rates of risk on four mental health variables, and rate of adherence to follow-up treatment recommendations. Step 1: In total, 53.3% of personnel [229 of 429 full-time employees (221 males; eight females; 95% White; 48% paramedic or Emergency Medical Technician; 25% captain; 19% engineer; 7% other)] initially opted-in by consenting and completing the brief remote screening survey. Among those who opted-in and completed (n = 229), 43% screened positive for one or more of the following mental health risks: PTSD (7.9%); depression (9.6%); anxiety (13.5%); alcohol use (36.7%). Step 2: A maximum of three attempts were made to schedule "at risk" individuals into Step 2 (n = 99). Among the 99 who demonstrated a need for mental health treatment (by screening positive for one or more risk), 56 (56.6%) engaged in the telehealth appointment. Of the 56 who participated in Step 2 clinical appointments, 38 were recommended for further intervention (16.6% of full-time personnel who participated). Among the 38 firefighters who were recommended to seek further mental health services, 29 were adherent/followed through (76.3% of those who received recommendations for further services). Taken together, evidence-based, culturally conscious, stepped care models delivered via the virtual/telehealth medium can promote access, utilization, and cost-effective mental health services for first responders. Implications are for informing larger, more rigorous dissemination and implementation efforts.
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Affiliation(s)
- Hannah M Wright
- Department of Psychiatry, University of Utah School of Medicine, Huntsman Mental Health Institute, Salt Lake City, UT, United States
| | | | - Myah Pazdera
- Department of Psychiatry, University of Utah School of Medicine, Huntsman Mental Health Institute, Salt Lake City, UT, United States
| | - Somi Lee
- Department of Psychiatry, University of Utah School of Medicine, Huntsman Mental Health Institute, Salt Lake City, UT, United States
| | - Brook Ridge
- Department of Psychiatry, University of Utah School of Medicine, Huntsman Mental Health Institute, Salt Lake City, UT, United States
| | - Joseph U Kim
- Department of Psychiatry, University of Utah School of Medicine, Huntsman Mental Health Institute, Salt Lake City, UT, United States.,Salt Lake City Veterans Affairs (VA) Medical Center, Salt Lake City, UT, United States
| | - Kelly Konopacki
- Department of Psychiatry, University of Utah School of Medicine, Huntsman Mental Health Institute, Salt Lake City, UT, United States
| | - Layne Hilton
- United Fire Authority, Salt Lake City, UT, United States
| | | | - Scott A Langenecker
- Department of Psychiatry, University of Utah School of Medicine, Huntsman Mental Health Institute, Salt Lake City, UT, United States
| | - Andrew J Smith
- Department of Psychiatry, University of Utah School of Medicine, Huntsman Mental Health Institute, Salt Lake City, UT, United States.,Department of Psychiatry, Geisel School of Medicine at Dartmouth, Hanover, NH, United States.,Lyda Hill Institute for Human Resilience, University of Colorado, Colorado Springs, CO, United States
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29
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Rugo-Cook KF, Kerig PK, Crowell SE, Bryan CJ. Fluid vulnerability theory as a framework for understanding the association between posttraumatic stress disorder and suicide: A narrative review. J Trauma Stress 2021; 34:1080-1098. [PMID: 34881461 DOI: 10.1002/jts.22782] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Revised: 09/08/2021] [Accepted: 09/09/2021] [Indexed: 12/11/2022]
Abstract
Suicide is a persistent issue in the United States and across the globe. A large body of published research shows that posttraumatic stress disorder (PTSD) increases the risk of suicidal ideation, suicidal behaviors, and death by suicide. However, the existing literature examining why that association might pertain is widely dispersed across disciplines (e.g., psychology, nursing) and lacks an integrative theoretical framework, making it difficult to conceptualize the current state of science in this area. Therefore, the primary aims of this narrative review were to (a) provide a comprehensive and interdisciplinary critique of the current state of knowledge regarding mechanisms that underlie the association between PTSD and suicide and (b) organize that knowledge according to a specified theoretical framework. The framework guiding this review is "fluid vulnerability theory," a diathesis-stress model of suicide that emphasizes the dynamic nature of suicide risk across cognitive, emotional, behavioral, and physiological domains. A summary of the findings, including patterns that emerged, gaps that remain, and recommendations for the advancement of science and practice in this area are addressed in this narrative review.
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Affiliation(s)
- Kelsi F Rugo-Cook
- Department of Psychology, University of Utah, Salt Lake City, Utah, USA
| | - Patricia K Kerig
- Department of Psychology, University of Utah, Salt Lake City, Utah, USA
| | - Sheila E Crowell
- Department of Psychology, University of Utah, Salt Lake City, Utah, USA
| | - Craig J Bryan
- The Ohio State University Wexner Medical Center, Columbus, Ohio, USA.,VISN 2 Center of Excellence for Suicide Prevention, Canandaigua, New York, USA
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Sleep Paralysis among Professional Firefighters and a Possible Association with PTSD-Online Survey-Based Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18189442. [PMID: 34574367 PMCID: PMC8468000 DOI: 10.3390/ijerph18189442] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Revised: 08/25/2021] [Accepted: 09/02/2021] [Indexed: 11/20/2022]
Abstract
The prevalence of sleep paralysis (SP) is estimated at approximately 7.6% of the world’s general population. One of the strongest factors in the onset of SP is PTSD, which is often found among professional firefighters. Our study aimed to assess in the professional firefighter population (n = 831) (1) the prevalence of SP, (2) the relationship between SP and PTSD and (3) the relationship between SP and other factors: the severity of the stress felt, individual tendency to feel anxious and worried and lifestyle variables. The incidence of SP in the study group was 8.7%. The high probability of PTSD was found in 15.04% of subjects and its presence was associated with 1.86 times the odds of developing SP [OR = 1.86 (95% CI: 1.04–3.33); p = 0.04]. Officers who experienced at least 1 SP during their lifetime had significantly higher results in the scales: PCL-5, STAI-T, PSWQ. The number of SP episodes was positively correlated with the severity of symptoms measured by the PCL-5, PSS-10, STAI and PSWQ questionnaires. Further research is needed to assess the importance of SP among the firefighter population in the context of mental and somatic health and to specify methods of preventing SP episodes.
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A Mediterranean Lifestyle Is Associated With Lower Hypertension Prevalence and Better Aerobic Capacity Among New England Firefighter Recruits. J Occup Environ Med 2021; 62:466-471. [PMID: 32730021 DOI: 10.1097/jom.0000000000001868] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Examine the association between healthy Mediterranean lifestyle practices and cardiovascular disease (CVD) risk factors among New England firefighter recruits. METHODS A MEDI-Lifestyle score was used to measure adherence to a Mediterranean lifestyle (not smoking, increased physical activity, high adherence to Mediterranean diet, non-obese body mass index, decreased screen time, adequate nightly sleep, and napping) among the recruits. MEDI-Lifestyle scores were cross-sectionally analyzed with blood pressure, aerobic capacity, and other CVD risk factors. RESULTS Among 92 recruits, high adherence to MEDI-Lifestyle was significantly associated with a decreased risk of prevalent hypertension (odds ratio [OR] = 0.14 [0.03-0.71]) and a greater probability of high aerobic capacity (OR = 5.80 [1.05-32.05]) as compared with low adherence in age- and sex-adjusted analyses. CONCLUSIONS Increased adherence to MEDI-Lifestyle is associated with a better CVD risk profile in firefighter recruits.
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32
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Pandemic-related mental health risk among front line personnel. J Psychiatr Res 2021; 137:673-680. [PMID: 33189356 DOI: 10.1016/j.jpsychires.2020.10.045] [Citation(s) in RCA: 38] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Revised: 10/28/2020] [Accepted: 10/30/2020] [Indexed: 10/24/2022]
Abstract
The mental health of frontline workers is critical to a community's ability to manage crises and disasters. This study assessed risks for mental health problems (traumatic stress, depression, anxiety, alcohol use, insomnia) in association with pandemic-related stressors in a sample of emergency and hospital personnel (N = 571). Respondents completed self-report surveys online from April 1st to May 7th, 2020 in the Rocky Mountain region of the United States. Results showed that roughly fifteen to thirty percent of respondents screened positive for each disorder. Odds of screening positive were similar between groups for probable acute traumatic stress, depressive disorder, anxiety disorder, and alcohol use disorder; emergency personnel reported significantly higher rates of insufficient sleep than healthcare workers. Logistic regressions showed that respondents who reported having an immunocompromised condition had higher odds of acute traumatic stress, anxiety, and depression. Having an immunocompromised household member was associated with higher odds of insufficient sleep and anxiety. Being in a direct care provision role was associated with higher odds of screening positive for risky alcohol use. Being in a management role over direct care providers was associated with higher odds of screening positive for anxiety, risky alcohol use, and insufficient sleep. There was an inverse relationship between number of positive COVID-19 cases and anxiety, such that as positive cases went up, anxiety decreased. Overall, the mental health risks that we observed early in the COVID-19 pandemic are elevated above previous viral outbreaks (SARS) and comparable to rates shown in disasters (9/11 attacks; Hurricane Katrina).
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33
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Johnson CM, Holmes SC, Suvak MK, Song J, Shields N, Lane JEM, Sijercic I, Cohen ZD, Stirman SW, Monson CM. The Effect of PTSD Symptom Change on Suicidal Ideation in a Combined Military and Civilian Sample Engaged in Cognitive Processing Therapy. Behav Ther 2021; 52:774-784. [PMID: 33990249 DOI: 10.1016/j.beth.2020.10.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Revised: 09/25/2020] [Accepted: 10/02/2020] [Indexed: 11/30/2022]
Abstract
In light of the well-established relationship between posttraumatic stress disorder (PTSD) and suicidal ideation (SI), there has been a push for treatments that simultaneously improve symptoms of PTSD and decrease SI. Using data from a randomized controlled hybrid implementation-effectiveness trial, the current study investigated the effectiveness of Cognitive Processing Therapy (CPT; Resick, Monson, & Chard, 2016) on PTSD and SI. The patient sample (N = 188) was diverse in military and veteran status, gender, and comorbidity, and 73% of the sample endorsed SI at one or more points during CPT. Participants demonstrated significant improvement in SI over the course of CPT. Multilevel growth curve modeling revealed a significant association between PTSD symptom change and change in SI. Results from cross-lagged multilevel regressions indicated that PTSD symptoms predicted SI in the next session, yet SI in a given session did not predict PTSD symptoms in the next session. Potentially relevant clinical factors (i.e., military status, gender, depression diagnosis, baseline SI, study consultation condition) were not associated with the relationship between PTSD symptoms and SI. These results add to the burgeoning literature suggesting that evidence-based treatments for PTSD, like CPT, reduce suicidality in a range of individuals with PTSD, and that this reduction is predicted by improvements in PTSD symptoms.
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Affiliation(s)
- Clara M Johnson
- Dissemination and Training Division, National Center for PTSD
| | - Samantha C Holmes
- College of Staten Island, City University of New York; Yale School of Medicine
| | | | - Jiyoung Song
- Dissemination and Training Division, National Center for PTSD
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34
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Supporting the Mental Health and Well-Being of First Responders from Career to Retirement: A Scoping Review. Prehosp Disaster Med 2021; 36:475-480. [PMID: 33928892 DOI: 10.1017/s1049023x21000431] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
INTRODUCTION First responders are at greater risk of mental ill health and compromised well-being compared to the general population. It is important to identify strategies that will be effective in supporting mental health, both during and after the first responder's career. METHODS A scoping review was conducted using the PubMed database (1966 to October 1, 2020) and the Google Scholar database (October 1, 2020) using relevant search terms, truncation symbols, and Boolean combination functions. The reference lists of all relevant publications were also reviewed to identify further publications. RESULTS A total of 172 publications were retrieved by the combined search strategies. Of these, 56 met the inclusion criteria and informed the results of this overview paper. These publications identified that strategies supporting first responder mental health and well-being need to break down stigma and build resilience. Normalizing conversations around mental health is integral for increasing help-seeking behaviors, both during a first responder's career and in retirement. Organizations should consider the implementation of both pre-retirement and post-retirement support strategies to improve mental health and well-being. CONCLUSION Strategies for supporting mental health and well-being need to be implemented early in the first responder career and reinforced throughout and into retirement. They should utilize holistic approaches which encourage "reaching in" rather than placing an onus on first responders to "reach out" when they are in crisis.
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Carmassi C, Bertelloni CA, Dell'Oste V, Luperini C, Marazziti D, Rossi R, Dell'Osso L. PTSD and Suicidal Behaviors Amongst L'Aquila 2009 Earthquake Young Survivors. Front Public Health 2021; 9:590753. [PMID: 33643987 PMCID: PMC7902690 DOI: 10.3389/fpubh.2021.590753] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2020] [Accepted: 01/19/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Post-traumatic stress disorder (PTSD) is one of the most frequent and severe psychiatric consequences of natural disasters, frequently associated with suicidality. The aim of this study was at examining the possible relationships between suicidal behaviors and full-blown or partial PTSD, in a sample of young earthquake survivors. The second aim was at investigating the specific role of PTSD symptoms on suicidality. Methods: A total of 475 young adults who survived the L'Aquila 2009 earthquake, one of the most severe Italian disasters of the last decades, were recruited and assessed after 21 months from the catastrophe. Participants were evaluated by two questionnaires assessing subthreshold psychopathology, the Trauma and Loss Spectrum Self-Report (TALS-SR) to investigate both full and partial PTSD, and two specific Mood Spectrum Self-Report (MOODS-SR) sub-domains exploring suicidality, namely suicidal ideation and suicide attempts. Results: The ensuing findings showed that suicidal ideation and suicide attempts were present, respectively, in 40 (8.4%) and 11 (2.3%) survivors. Rates of suicidal ideation were significantly more elevated in full-blown PTSD subjects (group 1), as compared with those suffering from partial (group 2) or no PTSD (group 3). Interestingly, group 2 subjects showed significantly more suicidal ideation than healthy individuals, and less than those of group 1, while the frequency of suicide attempts was similar across the three groups. Suicidal ideation was associated with higher scores in the following TALS-SR domains: grief-reactions, re-experiencing, avoidance and numbing, maladaptive coping, and personal characteristics/risk factor. Conclusions: The results of the present study support and extend previous findings on the role of PTSD symptoms in suicidality after a severe earthquake. However, as compared with available literature, they also highlight the significant impact of sub-threshold PTSD manifestations in increasing the suicide risk in survivors of a mass disaster.
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Affiliation(s)
- Claudia Carmassi
- Department of Clinical and Experimental Medicine, Section of Psychiatry, University of Pisa, Pisa, Italy
| | - Carlo Antonio Bertelloni
- Department of Clinical and Experimental Medicine, Section of Psychiatry, University of Pisa, Pisa, Italy
| | - Valerio Dell'Oste
- Department of Clinical and Experimental Medicine, Section of Psychiatry, University of Pisa, Pisa, Italy
| | - Chiara Luperini
- Department of Clinical and Experimental Medicine, Section of Psychiatry, University of Pisa, Pisa, Italy.,Department of Experimental Medicine, University of L'Aquila, L'Aquila, Italy
| | - Donatella Marazziti
- Department of Clinical and Experimental Medicine, Section of Psychiatry, University of Pisa, Pisa, Italy
| | - Rodolfo Rossi
- Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Liliana Dell'Osso
- Department of Clinical and Experimental Medicine, Section of Psychiatry, University of Pisa, Pisa, Italy
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Lee SJ, Cho YJ, Hyun MH. Self-Injurious Thoughts and Behaviors Interview-Korean Version: Psychometric Properties. Psychiatry Investig 2021; 18:157-165. [PMID: 33601871 PMCID: PMC7960749 DOI: 10.30773/pi.2020.0302] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Accepted: 12/05/2020] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE There is currently no structured interview tool developed that comprehensively evaluates self-injurious thoughts and behaviors (SITB) in Korea. The Self-injurious Thoughts and Behaviors Interview (SITBI) collectively measures suicidal ideation, plans, gestures, attempts, and non-suicidal self-injuries (NSSI). The SITBI's reliability and validity have been established with it being widely used in English speaking countries. This study evaluated the psychometric validity of the Korean version of the SITBI (SITBI-K). METHODS The SITBI's validity as a diagnostic assessment tool for NSSI and suicidal behavior disorder (SBD), as defined by the Diagnostic and Statistical Manual of Mental Disorders-5th edition, was examined. Analyses were performed on 108 university students reporting experiences of suicidal thoughts and behaviors (female 84.26%, mean age=22.10, ±SD 3.33). RESULTS The SITBI-K displayed excellent interrater reliability, with a credible test-retest reliability at two months. Construct validity examined the correlation between the SITBI-K's modules and approved the self-report results. Appropriate convergent and discriminant validities were obtained for suicidal ideation, plans, gestures, attempts, and NSSI. CONCLUSION The SITBI-K showed excellent psychometric validity at a level comparable to the original. Its clinical utility for both NSSI and SBD diagnoses was confirmed.
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Affiliation(s)
- Seo Jeong Lee
- Department of Psychiatry, Chung-Ang University Hospital, Seoul, Republic of Korea
| | - Ye Jin Cho
- Department of Psychology, Chung-Ang University, Seoul, Republic of Korea
| | - Myoung Ho Hyun
- Department of Psychology, Chung-Ang University, Seoul, Republic of Korea
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37
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Stanley IH, Marx BP, Keane TM, Vujanovic AA. PTSD symptoms among trauma-exposed adults admitted to inpatient psychiatry for suicide-related concerns. J Psychiatr Res 2021; 133:60-66. [PMID: 33310501 PMCID: PMC7856162 DOI: 10.1016/j.jpsychires.2020.12.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Revised: 11/18/2020] [Accepted: 12/01/2020] [Indexed: 11/15/2022]
Abstract
Individuals admitted to inpatient psychiatry for suicide-related concerns are at increased risk of suicide post-discharge, necessitating an understanding of factors, such as posttraumatic stress disorder (PTSD), that are associated with suicide-related hospitalizations. In this study, we examined if individuals admitted for suicide-related concerns were more likely than those admitted for other reasons to have elevated PTSD symptoms or a probable PTSD diagnosis. We also examined the moderating role of impulsivity. Participants were 188 trauma-exposed adult psychiatric inpatients (M [SD]age = 33.6 y [11.7 y], 63.3% male, 46.3% white). We used the Life Events Checklist for DSM-5, PTSD Checklist for DSM-5, Beck Scale for Suicide Ideation, and Barratt Impulsiveness Scale-11 to assess trauma exposure, PTSD symptoms, suicidal ideation severity, and impulsivity, respectively. We controlled for trauma load, number of psychiatric diagnoses, and comorbid depressive and substance use disorders. Patients admitted for suicide-related concerns (55.3%; n = 104), compared with those admitted for other reasons (44.7%; n = 84), had more severe PTSD symptoms, corresponding to medium-to-large effect sizes; associations were stronger at higher levels of impulsivity. Additionally, patients admitted for suicide-related concerns were nearly four times more likely than their counterparts to screen positive for a provisional PTSD diagnosis. Among the subset of individuals admitted for suicide-related concerns, greater PTSD symptoms were associated with more severe suicidal ideation. In sum, PTSD symptoms are elevated among psychiatric inpatients admitted for suicide-related concerns, and among this subgroup, greater PTSD symptom severity covaries with suicidal ideation severity. Screening for and treating PTSD, and attending to cooccurring impulsivity, in psychiatric inpatients may reduce suicide risk.
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Affiliation(s)
- Ian H Stanley
- Department of Psychiatry, Boston University School of Medicine, USA; National Center for PTSD, VA Boston Healthcare System, USA.
| | - Brian P Marx
- Department of Psychiatry, Boston University School of Medicine, USA; National Center for PTSD, VA Boston Healthcare System, USA
| | - Terence M Keane
- Department of Psychiatry, Boston University School of Medicine, USA; National Center for PTSD, VA Boston Healthcare System, USA
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Chu CS, Chou PH, Wang SC, Horikoshi M, Ito M. Associations Between PTSD Symptom Custers and Longitudinal Changes in Suicidal Ideation: Comparison Between 4-Factor and 7-Factor Models of DSM-5 PTSD Symptoms. Front Psychiatry 2021; 12:680434. [PMID: 34867502 PMCID: PMC8635060 DOI: 10.3389/fpsyt.2021.680434] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2021] [Accepted: 10/20/2021] [Indexed: 11/13/2022] Open
Abstract
Objective: The association between posttraumatic stress disorder (PTSD) and suicidal ideation (SI) is well-known. However, a few studies have investigated the associations between PTSD symptom clusters based on the fifth edition of the Diagnostic and Statistical Manual for Mental Disorders (DSM-5) and changes in suicide risk longitudinally. Methods: We adopted a longitudinal study design using data from the National Survey for Stress and Health of 3,090 of the Japanese population. The first and second surveys were conducted on November 2016 and March 2017, respectively. The suicidal ideation attributes scale was applied to assess the severity of suicidal ideation at baseline and the follow-up period. A multivariate linear regression model was conducted to examine the associations between the 4- or 7-factor model of PTSD symptom clusters at baseline and longitudinal changes in SI. Results: Overall, 3,090 subjects were analyzed (mean age, 44.9 ± 10.9 years; 48.8% female) at Baseline, and 2,163 completed the second survey. In the 4-factor model, we found that the severity of negative alternations in cognition and mood were significantly associated with increased SI after 4 months. In the 7-factor model, we found that the severity of anhedonia and externalizing behavior at baseline was significantly associated with increased SI during the follow-up period. Conclusions: We found that the seven-factor model of DSM-5 PTSD symptoms may provide greater specificity in predicting longitudinal SI change in the general population. Closely monitoring specific PTSD core symptoms may be more effective in mitigating key clinical and functional outcomes.
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Affiliation(s)
- Che-Sheng Chu
- Department of Psychiatry, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan.,Center for Geriatrics and Gerontology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan.,Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Po-Han Chou
- Department of Psychiatry, China Medical University Hsinchu Hospital, China Medical University, Hsinchu, Taiwan.,Department of Psychiatry, China Medical University Hospital, China Medical University, Taichung, Taiwan.,Department of Biological Science and Technology, National Chiao Tung University, Hsinchu, Taiwan.,Biological Optimal Imaging Lab, Department of Photonics, College of Electrical and Computer Engineering, National Chiao Tung University, Hsinchu, Taiwan
| | - Shao-Cheng Wang
- Department of Psychiatry, Taoyuan General Hospital, Ministry of Health and Welfare, Taoyuan, Taiwan.,Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States.,Department of Medical Laboratory Science and Biotechnology, Chung Hwa University of Medical Technology, Tainan, Taiwan
| | - Masaru Horikoshi
- National Center for Cognitive-Behavior Therapy and Research, National Center of Neurology and Psychiatry, Tokyo, Japan
| | - Masaya Ito
- National Center for Cognitive-Behavior Therapy and Research, National Center of Neurology and Psychiatry, Tokyo, Japan
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Kwon A, Lee HS, Lee SH. The Mediation Effect of Hyperarousal Symptoms on the Relationship Between Childhood Physical Abuse and Suicidal Ideation of Patients With PTSD. Front Psychiatry 2021; 12:613735. [PMID: 33841200 PMCID: PMC8032896 DOI: 10.3389/fpsyt.2021.613735] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Accepted: 03/03/2021] [Indexed: 12/11/2022] Open
Abstract
Objective: This study examined the relationship of childhood physical abuse, posttraumatic stress disorder (PTSD), depression, and suicide in patients with PTSD through path analysis. Materials and Methods: A total of 114 patients with PTSD (36 men and 78 women) were recruited and completed psychological assessments including the Childhood Trauma Questionnaire, the scale for suicidal ideation, the clinician-administered PTSD scale for the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, the PTSD checklist, and the Hospital Anxiety and Depression Scale. Structural equation modeling was used to evaluate the results. We developed a model including childhood physical abuse experience as the causal variable, suicidal ideation as a result variable, and PTSD and depression as mediation variables. PTSD symptoms were divided into four clusters [intrusion, avoidance, negative cognition and mood, and altered arousal and reactivity (hyperarousal)] to determine predictive power for suicide. Results: PTSD symptoms fully mediated the relationship between childhood physical abuse and suicidal ideation. Furthermore, PTSD symptoms fully mediated the relationship between childhood physical abuse and depression. Among the PTSD symptoms, hyperarousal was the only symptom cluster that mediated the relationship between childhood physical abuse and suicidal ideation. The symptom clusters of negative cognition and mood as well as hyperarousal mediated the relationship between childhood physical abuse and depression. Conclusions: This study presents a link between childhood physical abuse and current symptoms in patients with PTSD, and highlights specific PTSD symptom clusters (i.e., hyperarousal, negative cognition and mood) that may increase the risk for psychopathology later in life.
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Affiliation(s)
- Aeran Kwon
- Department of Social Welfare and Counseling, Chodang University, Muan, South Korea
| | - Hyun Seo Lee
- Clinical Emotion and Cognition Research Laboratory, Inje University, Goyang, South Korea
| | - Seung-Hwan Lee
- Clinical Emotion and Cognition Research Laboratory, Inje University, Goyang, South Korea.,Department of Psychiatry, Inje University, Ilsan-Paik Hospital, Goyang, South Korea
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Morabito DM, Boffa JW, Bedford CE, Chen JP, Schmidt NB. Hyperarousal symptoms and perceived burdensomeness interact to predict suicidal ideation among trauma-exposed individuals. J Psychiatr Res 2020; 130:218-223. [PMID: 32841904 DOI: 10.1016/j.jpsychires.2020.07.029] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Revised: 07/16/2020] [Accepted: 07/20/2020] [Indexed: 11/28/2022]
Abstract
The association between posttraumatic stress disorder (PTSD) and suicidal ideation is well-established and recent prospective studies have demonstrated the unique role of hyperarousal symptoms. In particular, over-arousal may elevate suicide risk in the presence of interpersonal vulnerability factors including thwarted belongingness, perceived burdensomeness, and acquired capability. Therefore, the current study sought to examine the differential associations between PTSD symptom clusters and suicidality and the impact of interpersonal risk factors. Trauma-exposed adults (N = 247) completed a questionnaire battery at baseline and three-month follow-up, as part of a larger randomized controlled trial of computerized interventions for suicide risk. Given the focus of the current study, treatment condition was controlled for in all analyses. Results indicated that hyperarousal symptoms significantly predict suicidality, while reexperiencing and avoidance symptoms do not. Specifically, greater hyperarousal symptoms predicted increased suicidal ideation among individuals with high perceived burdensomeness. Although the interaction effect was not significant, hyperarousal symptoms were also pertinent among individuals with high acquired capability. Taken together, findings suggest that assessment of hyperarousal symptoms and perceived burdensomeness may serve to identify trauma-exposed individuals at greater risk for suicide. Additionally, these factors may serve as effective intervention targets.
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Affiliation(s)
- Danielle M Morabito
- Department of Psychology, Florida State University, 1107 W. Call Street, Tallahassee, FL, 32306, USA.
| | - Joseph W Boffa
- Department of Psychology, Florida State University, 1107 W. Call Street, Tallahassee, FL, 32306, USA
| | - Carter E Bedford
- Department of Psychology, Florida State University, 1107 W. Call Street, Tallahassee, FL, 32306, USA
| | - Jimmy P Chen
- Furman University, 3300 Poinsett Hwy, Greenville, SC, USA, 29613
| | - Norman B Schmidt
- Department of Psychology, Florida State University, 1107 W. Call Street, Tallahassee, FL, 32306, USA
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Associations between PTSD symptoms and suicide risk: A comparison of 4-factor and 7-factor models. J Psychiatr Res 2020; 129:47-52. [PMID: 32563777 DOI: 10.1016/j.jpsychires.2020.06.004] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Revised: 05/11/2020] [Accepted: 06/01/2020] [Indexed: 11/21/2022]
Abstract
BACKGROUND While posttraumatic stress disorder (PTSD) symptoms in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) are categorized into four clusters, emerging studies suggest the disorder is best characterized by seven symptom clusters: re-experiencing, avoidance, negative affect, anhedonia, externalizing behaviors, and anxious and dysphoric arousal symptoms. However, data are sparse regarding the relation between this novel model of DSM-5 PTSD symptoms and suicide risk. METHODS Using data from the National Survey for Stress and Health, a sample of 6180 Japanese individuals, we evaluated the relationship between suicide ideation and PTSD symptoms using 4- and 7-factor models. RESULTS Different association patterns were observed between each model and suicidal ideation. In the 4-factor model, we found re-experiencing feelings (odds ratio [OR] = 1.03, 95% confidence interval [CI] = 1.01-1.06, p = 0.002), negative alterations in cognition and mood symptoms (OR = 1.08, 95%CI = 1.06-1.09, p < 0.001), and hyperarousal (OR = 1.03, 95% CI = 1.01-1.05, p = 0.014) were associated with increased suicide ideation. In the 7-factor model, we found re-experiencing feelings (OR = 1.04, 95%CI = 1.02-1.06, p = 0.001), negative affect (OR = 1.04, 95%CI = 1.01-1.07, p = 0.012), anhedonia (OR = 1.08-1.16, 95%CI, p < 0.001), and externalizing behavior (OR = 1.12, 95%CI = 1.07-1.17, p < 0.001) were associated with increased suicide risk. CONCLUSIONS A more refined 7-factor model of DSM-5 PTSD symptoms may help us understand their associations with comorbid psychopathology and suicide. Prevention and treatment efforts that target distinct aspects of the PTSD phenotype may be more effective in mitigating key clinical and functional outcomes in this population.
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Huang Q, An Y, Li X. Coping strategies as mediators in the relation between perceived social support and job burnout among Chinese firefighters. J Health Psychol 2020; 27:363-373. [PMID: 32883114 DOI: 10.1177/1359105320953475] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Perceived social support is a known factor in preventing job burnout in many professions. However, the influence of coping strategies on perceived social support and job burnout remains unclear. The current study investigated firefighters using data from a two-wave study to fill this gap in knowledge. Chinese firefighters (N = 340) participated in the study for 3-months. Results indicated that perceived social support at baseline predicted job burnout at the 3-month follow-up through coping strategies. We concluded that perceived social support acts through positive coping strategies to reduce job burnout in Chinese firefighters.
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Affiliation(s)
- Qi Huang
- School of Psychology, Nanjing Normal University, Nanjing, P. R. China
| | - Yuanyuan An
- School of Psychology, Nanjing Normal University, Nanjing, P. R. China
| | - Xiaohui Li
- School of Family and Consumer Sciences, Northern Illinois University, DeKalb, USA
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Cooper SA, Szymanski BR, Bohnert KM, Sripada RK, McCarthy JF. Association Between Positive Results on the Primary Care-Posttraumatic Stress Disorder Screen and Suicide Mortality Among US Veterans. JAMA Netw Open 2020; 3:e2015707. [PMID: 32880649 PMCID: PMC7489804 DOI: 10.1001/jamanetworkopen.2020.15707] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
IMPORTANCE Suicide rates are higher among veterans compared with nonveterans, and the prevalence of posttraumatic stress disorder (PTSD) is higher among veterans compared with the general adult population in the US. To date, no study has examined the association between PTSD screening results and suicide mortality among veterans. OBJECTIVE To examine whether veterans receiving care in the US Veterans Health Administration (VHA) health system who had positive results on the Primary Care-Posttraumatic Stress Disorder Screen (PC-PTSD) had a greater risk of suicide mortality compared with those who had negative results and to assess whether such risk decreased over time. DESIGN, SETTING, AND PARTICIPANTS Multivariable proportional hazards regression models were used to evaluate suicide mortality risk through December 31, 2016, among a cohort of veterans who received the PC-PTSD in the VHA health system. The VHA administers the PC-PTSD to patients nationwide, and screening results are routinely documented in the VHA Corporate Data Warehouse. The PC-PTSD includes 4 questions regarding PTSD symptoms, to which patients respond with either a positive (yes) or negative (no) answer. All patients who completed the PC-PTSD in 2014 and who did not have a diagnosis of PTSD in the year before screening were included in the analysis. A score of 3 or 4 on the PC-PTSD indicated a positive result, and a score of 0, 1, or 2 indicated a negative result. Data collection and analyses were performed from November 13, 2018, to June 18, 2019. EXPOSURES Primary Care-Posttraumatic Stress Disorder Screen (PC-PTSD). MAIN OUTCOMES AND MEASURES Suicide mortality risk, as assessed through data obtained from the US Veterans Affairs/Department of Defense Mortality Data Repository. RESULTS A total of 1 693 449 PC-PTSDs were completed by 1 552 581 individual veteran patients in 2014. Most of the patients were White (73.9%), married (52.2%), male (91.1%), 55 years or older (62.5%), and had completed only 1 PC-PTSD (92.1%). In multivariable analyses, positive PC-PTSD results (ie, total scores of 3 or 4) were associated with a 58% increase in the risk of suicide mortality at 1 day after screening (hazard ratio [HR], 1.58; 95% CI, 1.19-2.10) and a 26% increase in the risk of suicide mortality at 1 year after screening (HR, 1.26; 95% CI, 1.07-1.48). A positive response on item 4 ("felt numb or detached from others, activities, or your surroundings") of the PC-PTSD was associated with a 70% increase in suicide mortality risk at 1 day after screening (HR, 1.70; 95% CI, 1.27-2.28). CONCLUSIONS AND RELEVANCE Positive PC-PTSD results, and specifically reports of feeling numb or detached, were associated with increases in the risk of suicide mortality. These associations decreased over time. The findings of this study can inform interpretation of PC-PTSD responses and suggest the importance of recent improvements made to the VHA suicide risk assessment.
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Affiliation(s)
- Samantha A. Cooper
- Serious Mental Illness Treatment Resource and Evaluation Center, Office of Mental Health and Suicide Prevention, Department of Veterans Affairs, Ann Arbor, Michigan
| | - Benjamin R. Szymanski
- Serious Mental Illness Treatment Resource and Evaluation Center, Office of Mental Health and Suicide Prevention, Department of Veterans Affairs, Ann Arbor, Michigan
| | - Kipling M. Bohnert
- Department of Veterans Affairs Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, Michigan
- Department of Psychiatry, University of Michigan, Ann Arbor
| | - Rebecca K. Sripada
- Department of Veterans Affairs Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, Michigan
- Department of Psychiatry, University of Michigan, Ann Arbor
| | - John F. McCarthy
- Serious Mental Illness Treatment Resource and Evaluation Center, Office of Mental Health and Suicide Prevention, Department of Veterans Affairs, Ann Arbor, Michigan
- Department of Veterans Affairs Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, Michigan
- Department of Psychiatry, University of Michigan, Ann Arbor
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Noor N, Pao C, Dragomir-Davis M, Tran J, Arbona C. PTSD symptoms and suicidal ideation in US female firefighters. Occup Med (Lond) 2020; 69:577-585. [PMID: 31064010 DOI: 10.1093/occmed/kqz057] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND Little is known regarding the mental health of women firefighters. AIMS To identify demographic, work-related and mental health characteristics associated with post-traumatic stress disorder (PTSD) symptoms and lifetime suicidal ideation in female firefighters compared with male colleagues. METHODS Participants were firefighters (75 women and 2564 men) employed in a large urban fire department in the USA. Chi-square, correlations, t-tests and analyses of variance were conducted to examine the predictors of PTSD symptoms and lifetime suicide ideation in men and women. RESULTS Approximately 20% of women scored positively for PTSD and 30% reported lifetime suicidal ideation. Women with PTSD symptoms were more likely to be in their mid-career years (11-20) than in their first 10 years (87% versus 44%; χ2 = 8.77, P < 0.05) and to have received counselling (53% versus 14%; χ2 = 8.11, P < 0.01). Being single (73% versus 58%; χ2 = 6.02, P < 0.05), having a second job (68% versus 38%; χ2 = 5.79, P < 0.05) and having received counselling (41% versus 11%; χ2 = 8.51, P < 0.01) predicted suicide ideation. Depression and general stress positively predicted PTSD symptoms and suicide ideation. PTSD also predicted suicide ideation. CONCLUSIONS Compared to male firefighters, women were at high risk for PTSD symptoms and suicide ideation. Particularly for women, few socio-demographic and work-related variables were associated with these outcomes. Mental health variables predicted depression and suicide ideation for both gender groups. Therefore, in screening and intervention efforts, it may be most fruitful to focus on mental health risk correlates of PTSD and suicide ideation.
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Affiliation(s)
- N Noor
- The Menninger Clinic, Houston, TX, USA
| | - C Pao
- Department of Psychological, Health, and Learning Sciences, University of Houston, Houston, TX, USA
| | - M Dragomir-Davis
- Department of Psychological, Health, and Learning Sciences, University of Houston, Houston, TX, USA
| | - J Tran
- Firefighter Support Network, Houston Fire Department, Houston, TX, USA
| | - C Arbona
- Department of Psychological, Health, and Learning Sciences, University of Houston, Houston, TX, USA
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Meina M, Ratajczak E, Sadowska M, Rykaczewski K, Dreszer J, Bałaj B, Biedugnis S, Węgrzyński W, Krasuski A. Heart Rate Variability and Accelerometry as Classification Tools for Monitoring Perceived Stress Levels-A Pilot Study on Firefighters. SENSORS (BASEL, SWITZERLAND) 2020; 20:E2834. [PMID: 32429383 PMCID: PMC7285091 DOI: 10.3390/s20102834] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Revised: 05/03/2020] [Accepted: 05/09/2020] [Indexed: 12/18/2022]
Abstract
Chronic stress is the main cause of health problems in high-risk jobs. Wearable sensors can become an ecologically valid method of stress level assessment in real-life applications. We sought to determine a non-invasive technique for objective stress monitoring. Data were collected from firefighters during 24-h shifts using sensor belts equipped with a dry-lead electrocardiograph (ECG) and a three-axial accelerometer. Levels of stress experienced during fire incidents were evaluated via a brief self-assessment questionnaire. Types of physical activity were distinguished basing on accelerometer readings, and heart rate variability (HRV) time series were segmented accordingly into corresponding fragments. Those segments were classified as stress/no-stress conditions. Receiver Operating Characteristic (ROC) analysis showed true positive classification as stress condition for 15% of incidents (while maintaining almost zero False Positive Rate), which parallels the amount of truly stressful incidents reported in the questionnaires. These results show a firm correspondence between the perceived stress level and physiological data. Psychophysiological measurements are reliable indicators of stress even in ecological settings and appear promising for chronic stress monitoring in high-risk jobs, such as firefighting.
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Affiliation(s)
- Michał Meina
- Faculty of Physics, Astronomy and Informatics, Department of Applied Informatics, Nicolaus Copernicus University in Toruń, Grudziądzka 5, 87-100 Torun, Poland;
| | - Ewa Ratajczak
- Faculty of Physics, Astronomy and Informatics, Department of Applied Informatics, Nicolaus Copernicus University in Toruń, Grudziądzka 5, 87-100 Torun, Poland;
- Faculty of Philosophy and Social Sciences, Institute of Psychology, Nicolaus Copernicus University in Toruń, Podmurna 74, 87-100 Torun, Poland; (M.S.); (J.D.); (B.B.)
- Centre for Modern Interdisciplinary Technologies, Nicolaus Copernicus University in Toruń, Wileńska 4, 87-100 Torun, Poland;
| | - Maria Sadowska
- Faculty of Philosophy and Social Sciences, Institute of Psychology, Nicolaus Copernicus University in Toruń, Podmurna 74, 87-100 Torun, Poland; (M.S.); (J.D.); (B.B.)
| | - Krzysztof Rykaczewski
- Centre for Modern Interdisciplinary Technologies, Nicolaus Copernicus University in Toruń, Wileńska 4, 87-100 Torun, Poland;
| | - Joanna Dreszer
- Faculty of Philosophy and Social Sciences, Institute of Psychology, Nicolaus Copernicus University in Toruń, Podmurna 74, 87-100 Torun, Poland; (M.S.); (J.D.); (B.B.)
| | - Bibianna Bałaj
- Faculty of Philosophy and Social Sciences, Institute of Psychology, Nicolaus Copernicus University in Toruń, Podmurna 74, 87-100 Torun, Poland; (M.S.); (J.D.); (B.B.)
| | - Stanisław Biedugnis
- Institute of Safety Engineering, The Main School of Fire Service, Słowackiego 52/54, 01-629 Warsaw, Poland;
| | - Wojciech Węgrzyński
- Fire Research Department, Building Research Institute (ITB), 00-611 Warsaw, Poland;
| | - Adam Krasuski
- Institute of Safety Engineering, The Main School of Fire Service, Słowackiego 52/54, 01-629 Warsaw, Poland;
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Alden LE, Matthews LR, Wagner S, Fyfe T, Randall C, Regehr C, White M, Buys N, Carey MG, Corneil W, White N, Fraess-Phillips A, Krutop E. Systematic literature review of psychological interventions for first responders. WORK AND STRESS 2020. [DOI: 10.1080/02678373.2020.1758833] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- L. E. Alden
- Department of Psychology, University of British Columbia, Vancouver, Canada
| | - L. R. Matthews
- Faculty of Health Sciences, University of Sydney, Sydney, Australia
| | - S. Wagner
- School of Health Sciences, University of Northern British Columbia, Prince George, Canada
| | - T. Fyfe
- School of Health Sciences, University of Northern British Columbia, Prince George, Canada
| | - C. Randall
- School of Allied Health Sciences, Griffith University, Brisbane, Australia
| | - C. Regehr
- Faculty of Social Work, University of Toronto, Toronto Ontario, Canada
| | - M. White
- Department of Family Practice, University of British Columbia, Vancouver, Canada
| | - N. Buys
- School of Allied Health Sciences, Griffith University, Brisbane, Australia
| | - M. G. Carey
- School of Nursing, University of Rochester, Rochester, NY, USA
| | - W. Corneil
- School of Health Sciences, University of Ottawa, Ottawa, Canada
| | - N. White
- School of Health Sciences, University of Northern British Columbia, Prince George, Canada
| | - A. Fraess-Phillips
- School of Health Sciences, University of Northern British Columbia, Prince George, Canada
| | - E. Krutop
- School of Health Sciences, University of Northern British Columbia, Prince George, Canada
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Weber FC, Norra C, Wetter TC. Sleep Disturbances and Suicidality in Posttraumatic Stress Disorder: An Overview of the Literature. Front Psychiatry 2020; 11:167. [PMID: 32210854 PMCID: PMC7076084 DOI: 10.3389/fpsyt.2020.00167] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2019] [Accepted: 02/21/2020] [Indexed: 12/11/2022] Open
Abstract
A causal relationship between sleep disturbances and suicidal behavior has been previously reported. Insomnia and nightmares are considered as hallmarks of posttraumatic stress disorder (PTSD). In addition, patients with PTSD have an increased risk for suicidality. The present article gives an overview about the existing literature on the relationship between sleep disturbances and suicidality in the context of PTSD. It aims to demonstrate that diagnosing and treating sleep problems as still underestimated target symptoms may provide preventive strategies with respect to suicidality. However, heterogeneous study designs, different samples and diverse outcome parameters hinder a direct comparison of studies and a causal relationship cannot be shown. More research is necessary to clarify this complex relationship and to tackle the value of treatment of sleep disturbances for suicide prevention in PTSD.
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Affiliation(s)
- Franziska C. Weber
- Department of Psychiatry and Psychotherapy, University of Regensburg, Regensburg, Germany
| | - Christine Norra
- LWL Hospital Paderborn, Psychiatry-Psychotherapy-Psychosomatics, Ruhr University of Bochum, Bochum, Germany
| | - Thomas C. Wetter
- Department of Psychiatry and Psychotherapy, University of Regensburg, Regensburg, Germany
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Fraysse C, Gignoux-Froment F, Juzan N, Cazes N, Poinso F, Paul F. Mesure de la prévalence du trouble de stress post-traumatique chez les marins-pompiers de Marseille. ANNALES FRANCAISES DE MEDECINE D URGENCE 2020. [DOI: 10.3166/afmu-2020-0218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Objectif : En France, peu d’études ont exploré la prévalence du trouble de stress post-traumatique (TSPT) chez les pompiers. Une étude de 2007 retrouve un taux de 1 %, identique à celui de la population générale. Or, les pompiers sont surexposés aux interventions potentiellement traumatogènes et sont donc à risque de traumatismes vicariants, c’est-à-dire par procuration. L’objectif de notre étude était d’estimer la prévalence du TSPT chez les marins-pompiers du bataillon de marins-pompiers de Marseille.
Matériel et méthodes : Durant six mois, les marins-pompiers se présentant à leur visite médicale périodique au service médical d’unité ont rempli un autoquestionnaire comprenant des données sociodémographiques, professionnelles et la Posttraumatic Stress Disorder Checklist Scale (PCLS) avec un seuil à 44.
Résultats : Parmi les 356 sauveteurs inclus, soit un taux de réponse de 86 %, 4 % (IC 95 % : [2 ; 7]) avaient un TSPT. Les facteurs associés étaient une fatigue durable, des répercussions négatives sur la vie familiale, professionnelle, sociale et le ressenti d’un manque de soutien institutionnel.
Conclusion : Ces résultats confirment que les sauveteurs constituent une population à risque. Afin de comparer avec les études internationales, de nouvelles recherches avec la PCL-5 seraient souhaitables.
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49
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A Relational Model for Stress: A Systematic Review of the Risk and Protective Factors for Stress-Related Diseases in Firefighters. PSYCH 2020. [DOI: 10.3390/psych2010008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Firefighters are considered a high-risk group for the development of PTSD and other stress-related diseases. More than the exposure to potentially traumatic events, personal and occupational characteristics have been pointed out as interfering in the perception of stress, which may lead to the emergence of mental and physical symptoms. This study aimed to analyze the relationship between the main factors that contribute to stress-related diseases in firefighters. A systematic review was conducted in order to identify original articles focusing on risk and protective factors for stress in this population. Personality traits, training, experience in extreme situations and social and organizational support influence the perception of stress and, consequently, the choice of coping strategies, which may protect against or potentiate the stress reactions. The findings of this study allow us to draw a relational model that represents the dynamics among the factors related to stress in firefighters. The development of PTSD and other stress-related diseases depends on a host of pre-trauma and post-trauma factors and, although training is an important protective factor, being prepared to face extreme situations does not mean being immune to traumatic stress.
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Chiang ES, Riordan KM, Ponder J, Johnson C, Cox KS. Distinguishing Firefighters With Subthreshold PTSD From Firefighters With Probable PTSD or Low Symptoms. JOURNAL OF LOSS & TRAUMA 2020. [DOI: 10.1080/15325024.2020.1728494] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- Evelyn S. Chiang
- Psychology Department, University of North Carolina Asheville, Asheville, North Carolina, USA
| | - Kevin M. Riordan
- Psychology Department, University of North Carolina Asheville, Asheville, North Carolina, USA
| | - Joy Ponder
- Asheville Fire Department, Asheville, North Carolina, USA
| | - Chris Johnson
- Asheville Fire Department, Asheville, North Carolina, USA
| | - Keith S. Cox
- Psychology Department, University of North Carolina Asheville, Asheville, North Carolina, USA
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