Stress and Coping Strategies Among Firefighters and Recruits

Assessing the association between probable posttraumatic stress disorder symptoms and quality of life among emergency service workers using path analysis

BACKGROUND

Emergency service workers have highly stressful occupations; the stressors encountered can contribute to the development of mental disorders such as depression, anxiety, and posttraumatic stress disorder (PTSD).

OBJECTIVE

The present study used a conceptual model and survey to identify variables influencing the association between probable PTSD and quality of life (QOL) in emergency service workers.

METHOD

PTSD was assessed using the Impact of Event Scale-Revised. QOL was assessed using the Medical Outcomes Study 36-Item Short-Form Health Survey. Path analysis was used to determine whether stress-coping (Brief Coping Orientation to Problems Experienced [Brief COPE] scores), social support (Multidimensional Scale of Perceived Social Support [MSPSS] scores), and resilience (Connor-Davidson Resilience Scale scores) explain the association between probable PTSD and QOL among 220 emergency service workers in Japan.

RESULTS

Impact of Event Scale-Revised scores were significantly positively associated with Brief COPE Active coping scores and significantly negatively associated with MSPSS scores. Brief COPE Active coping and MSPSS scores were significantly positively associated with Connor-Davidson Resilience Scale scores, which were in turn significantly positively associated with Medical Outcomes Study 36-Item Short-Form Health Survey scores.

CONCLUSION

Active coping in response to stressful situations is important for maintaining good mental health among emergency service workers. Active coping and social support may strengthen resilience, and resilience may improve QOL. Screening for mental health and QOL should include simultaneous assessment of stress-coping, social support, and resilience. Although the findings of this cross-sectional study are important, it could not confirm a causal relationship between PTSD and QOL.

Organizational Drivers of Burnout and Work Engagement: A Multilevel Study in Portuguese Firefighter Brigades

In this study, we analyzed how organization-level demands and organizational-level social support relate to the core dimensions of burnout and work engagement, controlling for individual resources (i.e., proactive coping) and demands (i.e., acute demands) using the Job Demands-Resources Theory. In a sample of 1487 Portuguese firefighters nested within 70 fire brigades, hierarchical linear modeling indicated that: (1) proactive coping was related to lower burnout and higher work engagement, whereas acute demands were related to higher burnout and lower work engagement (for vigor only); (2) proactive coping moderated the relationship between acute demands and vigor; and (3) unexpectedly, social support from colleagues was not related to firefighters’ well-being, whereas organization-level demands were related to higher burnout and lower work engagement. These results suggest the need to implement practices and policies to guarantee the relevant conditions for improving the well-being of firefighters, to develop coping strategies in a proactive way, and finally, to enhance support from colleagues.

The mediating role of coping in the relationship of posttraumatic stress disorder symptoms (PTSS) and job burnout among Chinese firefighters

PURPOSE

The study aims to explore the relationship of posttraumatic stress disorder symptoms (PTSS) and job burnout among firefighters, as well as the mediating effect of coping in the relationship of PTSS and job burnout.

METHODS

A total of 431 firefighters participated in the study by completing a questionnaire package including Maslach Burnout Inventory-General Survey (MBI-GS), PTSD Checklist for DSM-5 (PCL-5), and Coping Strategy Indicator (CSI).

RESULTS

(1) The level of firefighters' emotional exhaustion of job burnout varied significantly by age groups [F (2, 428) = 4.33, p < 0.05], and working years [F (2, 428) = 3.22, p < 0.05]; the level of cynicism of job burnout varied significantly by working years [F (2, 428) = 3.63, p < 0.05]. (2) PTSS was significantly and positively associated with job burnout (β = 0.899, p < 0.001). (3) Both avoidant coping and problem-solving mediated the relationship between PTSS and job burnout (β = 0.212, p < 0.001; β = 0.145, p < 0.001).

CONCLUSIONS

Firefighters with higher level of PTSS are more likely to have job burnout. Avoidant coping and problem-solving play the mediating role in the relationship between PTSS and job burnout. The clinical implications for firefighters' interventions are discussed.

Coping With COVID-19: Emergency Stress, Secondary Trauma and Self-Efficacy in Healthcare and Emergency Workers in Italy

Coping with the coronavirus disease (COVID-19) is a significant risk factor for the psychological distress of health workers. Hence, this study explores the relationship between coping strategies used by healthcare and emergency workers in Italy to manage the stress factors related to the COVID-19 emergency, which may result in the risk of developing secondary trauma. We study differences between healthcare (n = 121) and emergency workers (n = 89) in terms of their coping strategies, emergency stress, and secondary trauma, as well as the relationships of these differences to demographic variables and other stress factors (Instructions and Equipment). For this purpose, we collected data from participants through the following questionnaires online: Secondary Traumatic Stress Scale - Italian Version, The Coping Self-Efficacy Scale - Short Form, an original questionnaire on stressors, and the Emergency Stress Questionnaire (to assess organizational-relational, physical, decisional inefficacy, emotional, cognitive, and COVID-19 stress). We performed a t-test, correlational analysis, and hierarchical regression. The analyses reveal that compared with the emergency worker group, the health worker group has greater levels of emergency stress and arousal and is more willing to use problem-focused coping. Healthcare workers involved in the treatment of COVID-19 are exposed to a large degree of stress and could experience secondary trauma; hence, it is essential to plan prevention strategies for future pandemic situations. Moreover, individual efficacy in stopping negative emotions and thoughts could be a protective strategy against stress and secondary trauma.

Using Ecological Momentary Assessment to Examine the Effects of Duty Status on Acute Stress and Tiredness in Firefighters: A Pilot Study

OBJECTIVE

Characterize firefighters' acute stress and tiredness by duty status (ie, "off night/day," "on night/day").

METHODS

Thirty nine career firefighters completed three, eight-day smartphone-based ecological momentary assessment periods with seven surveys per day assessing stress and tiredness. Mixed-effects location scale models examined duty status effects on stress and tiredness.

RESULTS

Firefighters' lowest stress and tiredness levels were when off-duty (β = 16.27 and β = 24.71, respectively) and their highest levels were when on-duty (β = 24.47 and β = 32.18, respectively). Within-subject effects of duty status accounted for a larger proportion of variability in stress and tiredness for all duty types, except for stress when "on-duty night/off-duty day."

CONCLUSIONS

Firefighters had more similar stress and tiredness outcomes when they were on-duty and less similar outcomes when off-duty. This could be due to firefighters having more similar experiences when they are on- versus off-duty.

Coping and Its Relation to PTSD in Greek Firefighters

Firefighters are exposed continuously to intense stress situations and traumatic incidents, and are at high risk of developing posttraumatic stress disorder (PTSD). Coping mechanisms and behaviors have been examined as factors contributing to PTSD. The strategies that may be used to cope with stress and/or trauma differ between individuals and also between different professions and traumatic events (). Although there is a vast literature on stress and coping processes that exists, very few studies investigated the way individual firefighters cope with trauma. Among several questionnaires that have been used to examine the effects of different types of coping mechanisms after traumatic incidents is the Albert Einstein College of Medicine-Coping Style Questionnaire (AECOM-CSQ; ). In August 2007, large areas in the Peloponnese, Greece, were devastated by wildfires. One month after the event, experienced researchers visited the affected area to provide psychological support and to investigate the psychosocial consequences among the local professional firefighters. One hundred two firefighters that were on duty for the entire period of firefighting (several days) were interviewed using several questionnaires, among them the AECOM-CSQ. Our hypothesis was that firefighters who presented with PTSD would be more inclined toward engaging in avoidance coping mechanisms. A total of 18.6% of the firefighters were found to have PTSD according to ICD-10 criteria. Logistic regression showed that firefighters using the coping mechanisms of minimization and blame were associated with the greater likelihood of PTSD. It seems that specific coping mechanisms used by firefighters immediately after the traumatic event might contribute to the development of PTSD.

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

Professional firefighters frequently encounter stressful events in the line of duty, which may lead to the development of posttraumatic stress symptoms (PTSS). However, it remains unclear how PTSS relates to ways of coping in this population. We evaluated the differences in ways of coping between firefighters and the general population, and we determined the relationship between ways of coping and PTSS in both groups. Professional firefighters (N = 212) and adults from the general population (N = 500) completed measures of potentially traumatic events (PTEs), the Ways of Coping Checklist, the Beck Depression Inventory, the Childhood Trauma Questionnaire. Participants who reported experiencing at least one PTE also completed the Impact of Events Scale-Revised to assess PTSS severity. Firefighters showed greater use of problem-focused coping, seeking social support, and wishful thinking than did the general population. In the firefighters group only, there were negative correlations between PTSS and problem-focused coping and seeking social support; however, the opposite was found in the general population. This study identified the unique relationship between ways of coping and PTSS in professional firefighters. Our findings highlighted that active coping, including problem-focused and seeking social support, might play a key role in alleviating firefighters' post-traumatic stress reactions.

The Primary Prevention of PTSD in Firefighters: Preliminary Results of an RCT with 12-Month Follow-Up

AIM

To develop and evaluate an evidence-based and theory driven program for the primary prevention of Post-traumatic Stress Disorder (PTSD).

DESIGN

A pre-intervention / post-intervention / follow up control group design with clustered random allocation of participants to groups was used. The "control" group received "Training as Usual" (TAU).

METHOD

Participants were 45 career recruits within the recruit school at the Department of Fire and Emergency Services (DFES) in Western Australia. The intervention group received a four-hour resilience training intervention (Mental Agility and Psychological Strength training) as part of their recruit training school curriculum. Data was collected at baseline and at 6- and 12-months post intervention.

RESULTS

We found no evidence that the intervention was effective in the primary prevention of mental health issues, nor did we find any significant impact of MAPS training on social support or coping strategies. A significant difference across conditions in trauma knowledge is indicative of some impact of the MAPS program.

CONCLUSION

While the key hypotheses were not supported, this study is the first randomised control trial investigating the primary prevention of PTSD. Practical barriers around the implementation of this program, including constraints within the recruit school, may inform the design and implementation of similar programs in the future.

TRIAL REGISTRATION

Australian New Zealand Clinical Trials Registry (ANZCTR) ACTRN12615001362583.

Retirement Policies and Support for Emergency Service Personnel: The Transition to Retirement

L’objectif principal de cette étude a été d’examiner les politiques et les procédures pour soutenir les employés prenant leur retraite de leur travail aux services d’urgence. On a mené des entrevues avec les participants qui connaissaient bien les politiques et les procédures actuelles d’un grand ambulance (n = 8) et le service d’incendie (n = 6) en Irlande. Quatre thèmes principaux ont été révelés: (1) «Je ne pense pas que ce soit un bon travail d’etre ambulancier d’urgence quand on a 65 ans»; (2) “ils se sentent véritablement un tout petit peu isolé”; (3) l’amélioration du «choc culturel»; et (4) «Je continue a m’avancer en espérant que tout aille pour le mieux. » Les conclusions indiquent que la retraite est un changement majeur de la vie, et mettent en évidence la nécessité pour une préparation de pré-retraite plus structurée et efficace. Les éléments uniques au personnel des services d’urgence comprennent: le stress physique et émotionnel intense impliqué dans les services d’urgence; une forte identification avec ce service; et un manque de clarté sur les règles et les droits, exigeant meilleure renseignements et préparation pour prendre sa retraite.

Trauma-exposed firefighters: relationships among posttraumatic growth, posttraumatic stress, resource availability, coping and critical incident stress debriefing experience

This project examines protective factors associated with resilience/posttraumatic growth and risk factors associated with posttraumatic stress among firefighters exposed to critical incidents. The participants were 286 (257 men and 29 women) volunteer and paid firefighters in Whatcom County, Washington. Participants completed an anonymous survey asking about demographics, critical incident exposure, posttraumatic stress symptoms, posttraumatic growth, resource availability, coping, occupational stress and critical incident stress debriefing experience. Most participants had significant critical incident exposure, and about half had attended critical incident stress debriefing sessions. Posttraumatic growth was associated with being female, critical incident exposure, critical incident stress debriefing attendance, posttraumatic stress symptoms (negative association), occupational support, occupation satisfaction, occupational effort, problem-focused coping, emotion-focused coping and personal characteristic resources. Posttraumatic stress symptoms were positively associated with years of firefighting, burnout, occupational effort and disengagement coping and negatively associated with critical incident stress debriefing attendance, posttraumatic growth, social support, internal locus of control, personal characteristic resources, energy resources and condition resources. The findings support conservation of resources stress theory and show that the maintenance and acquisition of resources can offset losses and facilitate resilience/posttraumatic growth. Implications of the findings for enhancing firefighter resources, facilitating resilience and minimizing occupational stressors are discussed.

Vital analysis: annotating sensed physiological signals with the stress levels of first responders in action

First responders such as firefighters are exposed to extreme stress and fatigue situations during their work routines. It is thus desirable to monitor their health using wearable sensing but this is a complex and still unsolved research challenge that requires large amounts of properly annotated physiological signals data. In this paper we show that the information gathered by our Vital Analysis Framework can support the annotation of these vital signals with the stress levels perceived by the target user, confirmed by the analysis of more than 4600 hours of data collected from real firefighters in action, including 717 answers to event questionnaires from a total of 454 different events.