Relationship between ways of coping and posttraumatic stress symptoms in firefighters compared to the general population in South Korea

The Intertwining of Posttraumatic Stress Symptoms, Alcohol, Tobacco or Nicotine Use, and the COVID-19 Pandemic: A Systematic Review

BACKGROUND

Posttraumatic stress symptoms (PTSSs) and alcohol, tobacco, or nicotine use are frequently associated conditions. The COVID-19 pandemic has been a stressful situation globally and has worsened mental health conditions and addictions in the population. Our systematic review explores the links between PTSSs and (1) alcohol use and (2) tobacco or nicotine use during the COVID-19 pandemic.

METHODS

We searched the PubMed, PsycINFO, and Web of Science databases for studies published between January 2020 and 16 December 2021. We included studies published in English concerning adults or adolescents. Included articles dealt simultaneously with the COVID-19 pandemic, PTSSs, and alcohol, tobacco, or nicotine use. The reports included were cross-sectional, longitudinal, or cohort studies. We categorized the reports according to the population explored. Our main outcomes are the impacts of PTSSs on (1) alcohol use and (2) tobacco and nicotine use and their relation to COVID-19-related stressors (worries, exposure, lockdown, and infection, either of self or relatives).

RESULTS

Of the 503 reports identified, 44 were assessed for eligibility, and 16 were included in our review, encompassing 34,408 participants. The populations explored were the general population, healthcare workers, war veterans, patients with substance use disorders, and other vulnerable populations. Most studies were online surveys (14) with cross-sectional designs (11). Every study explored alcohol use, while only two assessed tobacco use. In most populations explored, a high level of PTSSs was associated with alcohol use increase. COVID-19-related stress was frequently correlated with either high PTSSs or alcohol use. In healthcare workers, PTSSs and alcohol use were not associated, while COVID-19 worries were related to both PTSSs and alcohol use.

DISCUSSION

1. PTSSs and increased alcohol use are frequently associated, while COVID-19 worries might trigger both conditions and worsen their association. Alcohol use increase may represent either an inadequate way of coping with PTSSs or a vulnerability amid the COVID-19 pandemic, leading to PTSSs. As most studies were cross-sectional online surveys, longitudinal prospective studies are needed to ascertain the direction of the associations between these conditions. These studies need to be sufficiently powered and control for potential bias and confounders. 2. Our review highlighted that research about PTSSs and tobacco or nicotine use is scarce.

Coping Strategies for Exposure to Trauma Situations in First Responders: A Systematic Review

Objective:

The objective of the present work was to characterize the coping strategies used by first responders to emergencies in the face of exposure to traumatic events.

Methods:

A systematic search was performed in the databases MEDLINE (Ovid), EMBASE, LILACS (Latin American and Caribbean Literature in Health Sciences), and the Cochrane Central Registry of Controlled Clinical Trials (CENTRAL) from their inception through February 2022. First responders to emergencies with training in the prehospital area and who used validated measurement instruments for coping strategies were included.

Results:

First responders to emergencies frequently used nonadaptive coping strategies, with avoidance or disconnection being one of the main strategies, as a tool to avoid confronting difficult situations and to downplay the perceived stressful event. The nonadaptive coping strategies used by these personnel showed a strong relationship with posttraumatic stress disorder (PTSD) symptoms, burnout syndrome, psychiatric morbidity, and chronic stress. As part of the adaptive strategies, active coping was found, which includes acceptance, positive reinterpretation, focusing on the problem, self-efficacy, and emotional support, either social or instrumental, as protective strategies for these personnel.

Conclusions:

Developing adaptive coping strategies, whether focused on problems or seeking emotional support, can benefit emergency personnel in coping with stressful situations. These coping strategies should be strengthened to help prevent people from experiencing long-term negative effects that could arise from the traumatic events to which they are exposed. Active coping strategies instead of avoidance strategies should be promoted.

Post-traumatic stress disorder in volunteer firefighters: influence of specific risk and protective factors

BACKGROUND

Volunteer firefighters belong to a risk population regarding the development of posttraumatic stress disorder (PTSD). However, given the frequency of work-related trauma, PTSD prevalences seem relatively low. Protective factors appear to be effective and are the focus of this study.

OBJECTIVE

We investigated the PTSD-prevalence as well as the influence of trauma exposure and the impact of protective factors resilience and Sense of Coherence (SoC) on symptoms of PTSD in volunteer firefighters.

METHOD

Data from 232 participants of an online questionnaire study were analysed using a path model approach.

RESULTS

'The results suggest a possible prevalence of PTSD of 12.5% and 2.2% for partial PTSD based on self-report measures. SoC and trauma event load proved to be independent of each other, as no intercorrelations were found. But both directly predicted PTSD severity. Higher resilience scores predicted the participants' Sense of Coherence, but PTSD severity was only indirectly affected by resilience, which was entirely mediated by SoC. Further, although SoC and trauma load increase with age and years of job experience, it is only SoC that affects PTSD severity, not age or years of experience.

CONCLUSIONS

The results emphasize that not only exposure to potentially traumatic events predicts the later probability of developing symptoms of PTSD, but that the integration of stressful experiences into the self-concept (associated with SoC) is essential for the development of PTSD. Future research should address the question of causality between SoC and PTSD, and consider which factors moderate the SoC.

If only… a systematic review and meta-analysis of social, temporal and counterfactual comparative thinking in PTSD

Comparative thinking is ubiquitous in human cognition. Empirical evidence is accumulating that PTSD symptomatology is linked to various changes in social, temporal and counterfactual comparative thinking. However, no systematic review and meta-analysis in this line of research have been conducted to this date. We searched titles, abstracts and subject terms of electronic records in PsycInfo and Medline from inception to January 2019 with various search terms for social, temporal and counterfactual comparative thinking as well as PTSD. Journal articles were included if they reported a quantitative association between PTSD and social, temporal and/or counterfactual comparative thinking in trauma-exposed clinical or sub-clinical samples. A total of 36 publications were included in the qualitative synthesis. The number of publications on the association between PTSD and social and temporal comparative thinking was too scarce to warrant a meta-analytic review. A narrative review of available literature suggests that PTSD is associated with distortions in social and temporal comparative thinking. A meta-analysis of 24 independent samples (n = 4423) assessing the association between PTSD and the frequency of counterfactual comparative thinking yielded a medium to large positive association of r =.464 (p <.001, 95% CI =.404; .520). Higher study quality was associated with higher magnitude of association in a meta-regression. Most studies collected data cross-sectionally, precluding conclusions regarding causality. Overall, study quality was found to be moderate. More longitudinal and experimental research with validated comparative thinking measures in clinical samples is needed to acquire a more sophisticated understanding of the role of comparative cognitions in the aetiology and maintenance of PTSD. Comparative thinking might be a fruitful avenue for a better understanding of posttraumatic reactions and improving treatment.

A Relational Model for Stress: A Systematic Review of the Risk and Protective Factors for Stress-Related Diseases in Firefighters

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.

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

OBJECTIVE

The study aims to investigate the psychological state of firefighters and to provide suggestions for working with firefighters in order to improve their mental health for the long term.

METHODS

A questionnaire packet on depression, posttraumatic stress disorder (PTSD), and posttraumatic growth (PTG) was given to firefighters studying in a firefighter school of Nanjing to complete. A total of 409 valid questionnaires were retrieved.

RESULTS

(1) The prevalence of depression, PTSD, and PTG were 27.94%, 4.89% and 59.41% respectively. (2) Firefighters whose major were Information Communication and Equipment Safety reported higher levels of depression and PTSD compared to firefighters in other majors [F (3, 386) = 5.43, p < 0.001; F (3, 386) = 4.57, p < 0.01]. (3) There was no significant difference in PTG scores regardless of the majors and the length of military service of firefighters [F (3, 386) = 0.52, p > 0.05; F (3, 386) = 0.29, p > 0.05].

CONCLUSION

Firefighters did have a certain level of mental stress in their lives, and the mental stress levels were significantly different among firefighters with different majors and length of military service.