Posttraumatic stress disorder (PTSD) symptoms among firefighters: Roles of resilience and locus of control

Exploring the impacts of perceived locus of control on post-traumatic stress disorder among disaster survivors: A systematic review

WHAT IS KNOWN ON THE SUBJECT?: It was previously reported that perceived external locus of control may exacerbate depressive symptoms, is associated with anxiety, boosts stress and general mental distress and weakens resilience against traumatic situations or difficulties. WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE?: Those with a higher external locus of control are more prone to develop PTSD symptoms since the perceived external locus of control is among the predictors of PTSD. An internal locus of control is considered important in preventing PTSD, although an external locus of control appears to be a variable that causes/increases the prevalence of PTSD. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: It is known that nurses are deployed in clinical and fieldwork during disaster and assume key roles both interventional practices and psychosocial education. Thus, it is of particular importance for mental health nurses to be aware of the locus of control in themselves, their colleagues, and the community before, during and after disasters to be able to combat the risk/presence of PTSD.

ABSTRACT

AIM: The present systematic review explored the impacts of perceived locus of control on PTSD among individuals experiencing disasters.

METHOD

This is a systematic review study carried out through a search of the relevant research published in English over the period December 2021 to April 2022. Accordingly, we sought the studies to review on the Web of Science, PubMed, Scopus, Cochrane and Google Scholar databases using the keywords "Child, Children, Adolescent, Adolescence, Adult, Aged, Elderly, Post-Traumatic Stress Disorder, PTSD, Internal-External Control, Locus of Control, Disasters, Natural Disasters."

RESULTS

A total of 1.011 studies were found in the five databases using the keywords above. Following the exclusions, the remaining six studies were recruited for this systematic review. The six studies in question addressed earthquakes (2), hurricanes (1), wildfires (1), SARS (1) and fireworks explosions (1). In the study with wildfire survivors, there was a weak significant association between external locus of control and PTSD among those directly exposed to the disaster (r = .15, p < .01). The study with survivors of the SARS epidemic demonstrated that those with a high perceived chance (external) locus of control suffered PTSD (p = .001). An internal locus of control is considered important in preventing PTSD, although an external locus of control appears to be a variable that causes/increases the prevalence of PTSD.

CONCLUSION

It was concluded that perceived locus of control is related to PTSD in individuals experiencing a disaster. The additional evidence was that post-disaster PTSD among those with a high perceived external locus of control is stronger than those with a high perceived internal locus of control.

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

Introduction

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

Method

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

Results

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

Discussion

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

Psychosocial predictors of distress in East and West Germans during the COVID-19 pandemic

BACKGROUND

Psychological (meaning in life, science attitude, internal locus of control, religiosity), and social factors (social support, cohesion) can counteract stressor-related distress. We investigated these factors' links with peri-pandemic distress (depression, anxiety, intrusions) and whether they weakened the impact of being affected by the COVID-19 pandemic. We compared prior East and West Germans on predictors and distress to investigate if their different backgrounds created lasting differences.

METHODS

A population-representative German sample aged 45 to 70 (N = 380) in terms of age, sex, and school education completed online questionnaires in May-July 2020 and June-July 2021. We examined the predictive relations with correlation, forward inclusion regression, and moderation analyses.

RESULTS

Social support predicted lower distress, also prospectively. Meaning in life predicted lower distress cross-sectionally. Religiosity predicted greater distress. Life meaning and social support partly weakened the link between being affected by the pandemic and distress, religiosity and science attitude strengthened this link. The only significant East/West difference was in religiosity, which was higher in the West.

CONCLUSION

Social resources appeared particularly important in adjusting to the pandemic. The identified predictors may inform interventions. East and West Germans' similarity might indicate that their post-war separation did not create lasting differences in the investigated factors.

An empirical evaluation of The Resilience Shield model

Background

Resilience refers to the process through which individuals deal with the adversity they experience. Previous research has shown there are multiple factors that contribute to individuals’ resilience, leading to increasing interest in the development of multidimensional resilience models. Once such recently proposed model is The Resilience Shield, which clusters groups of protective factors into different shield layers. The stronger these layers, the better the protection against adversity (Pronk et al. in The Resilience Shield, Pan Macmillan Australia, 2021). While this model was based in part on existing literature, no empirical evaluation has occurred to date. The aim of this study was therefore to evaluate the model fit for each of the modifiable shield layers and the overall model, and to examine whether each of the constructs included contributes to observed resilience scores.

Methods

Participants completed a series of questionnaires via The Resilience Shield website assessing constructs relevant to each resilience shield layer. Data from 3337 participants was analysed using Structural Equation Modelling and regression analyses.

Results

The results showed acceptable fit of the measurement model for the Social, Mind, and Professional Layers, but poor fit for the Body Layer. There was also good fit for the overall model. In addition, all but one of the constructs included in The Resilience Shield survey explained independent variance in either dispositional resilience scores, or dispositional vulnerability scores.

Conclusion

These results broadly support the multidimensional structure proposed by The Resilience Shield model and suggest that (at least in the population in which it was tested) this may be an acceptable model to index individuals’ performance on a range of indicators that contribute to resilience.

Applying shared decision-making to screening for trauma and adversity in youth

Youth who have experienced adverse childhood experiences (ACEs) or trauma are at risk for negative outcomes that may be lessened by adversity screening and prevention efforts. However, experts and consumers do not universally embrace adversity screening efforts. Despite significant support for widespread adversity screening, and many guidelines on how to conduct such screening, successful implementation has lagged behind enthusiasm. This paper outlines the challenges of adversity screening and then proposes applying the shared decision-making (SDM) model to improve adversity screening by increasing youths' 1) engagement in adversity screening if doing so is appropriate for them, and 2) disclosure of honest information during screens. Using an SDM approach honors youth preferences and perspectives, which simultaneously accomplishes a third overarching goal: aligning adversity screening with the principles of trauma-informed care.

Oncologists’ Locus of Control, Compassion Fatigue, Compassion Satisfaction, and the Mediating Role of Helplessness

The oncology setting may give rise to significant feelings of helplessness among oncologists via patients’ inevitable deaths or suffering. The current study examines whether and how oncologists’ sense of control (locus of control; LOC) influences their compassion fatigue and satisfaction. Methods: Seventy-three oncologists completed the following questionnaires: the Professional Quality of Life scale; Levenson’s Internal, Powerful Others, and Chance scale; the Guilt Inventory, State Guilt subscale; and the Learned Helplessness scale. Results: Oncologists reported high levels of secondary traumatic stress and burnout and moderate levels of compassion satisfaction. A positive association between oncologists’ external LOC and compassion fatigue, and a negative association between oncologists’ internal LOC and compassion fatigue, were found. Helplessness, but not guilt, had a mediating role in these associations. Internal LOC was also positively associated with compassion satisfaction. Conclusions: The current study highlights oncologists as a population at risk of experiencing compassion fatigue and emphasizes oncologists’ locus of control as a predisposition that plays a role in the development of this phenomenon. Additionally, the cognitive as well as the emotional aspects of control were found to be important factors associated with compassion fatigue.

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

Background

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

Methods

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

Results

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

Conclusions

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

Post-traumatic stress disorder among rural widows in Nsukka: risk factors and wellbeing domains

Losing a spouse to death is recognized as the most adverse life event that may increase the risk of depression, post-traumatic stress disorder, and other psychopathology with studies demonstrating that widows experienced more post-traumatic stress disorder symptoms than their non-widowed counterparts. Although the adverse effect of post-traumatic stress disorder may be stronger for widows in rural areas, the existing literature has shown the need for greater research on post-traumatic stress disorder experiences among vulnerable Igbo rural widows in Nsukka, South Eastern Nigeria. Against this backdrop, this study examined factors that predict post-traumatic stress disorder and the effect of post-traumatic stress disorder on the wellbeing domains of Igbo rural widows. Among the 177 participants, partner intimacy (β = .300, p < .001), cause of husband’s death (sudden vs. anticipated) (β = .183, p < .01), perceived social support (β = –.300, p < .001), number of surviving children at the time of husband’s death (β = .210, p < .01), and age of last child as at the time of husband’s death (β = .355, p < .01) all significantly predicted post-traumatic stress disorder. Domains of wellbeing most negatively affected by post-traumatic stress disorder included general life satisfaction (66.10%), family relationship (62.71%), and overall functioning (61.02%). The findings suggest that post-traumatic stress disorder among Igbo rural widows is a serious health concern that requires mental health professionals identifying high-risk rural widows early for intervention and developing programs aimed at educating and training rural community members on post-traumatic stress disorder and where to seek help on onset.

Zusammenhänge zwischen selbstberichteter Resilienz, wahrgenommener sozialer Unterstützung und Wohlbefinden bei Mitgliedern der Freiwilligen Feuerwehr

Zusammenfassung. Soziale Unterstützung und eine ausgeprägte Resilienz werden in der Forschungsliteratur als protektiv für das psychische Wohlbefinden von Einsatzkräften diskutiert. Die hier dargestellte Untersuchung verfolgt das Ziel, Resilienz und ihren Zusammenhang mit psychischem Wohlbefinden bei der speziellen Gruppe der Freiwilligen Feuerwehr (FF) zu untersuchen. In einer Untersuchung mit mehreren Messzeitpunkten (November 2016-Mai 2018, T1: N = 475, T2: N = 117, T3: N = 58) wurden FF gebeten, Selbstbeurteilungsfragebögen auszufüllen. Es fanden sich geringe bis mittlere Zusammenhänge von Resilienz mit dem psychischen Wohlbefinden ( r = .20-.65). Soziale Unterstützung zeigte kleine Zusammenhänge mit Wohlbefinden ( r = .14, r = .23). Ein indirekter Zusammenhang bestand zwischen wahrgenommener sozialer Unterstützung mit dem psychischen Wohlbefinden, mediiert durch Resilienz. Weiterführende Forschung sollte klären, ob, und ggf. wie Resilienz für diese Berufsgruppe trainierbar ist und ob Verbesserungen im Wohlbefinden damit einhergehen.