PTSD symptoms and suicidal ideation in US female firefighters

Comparative analysis of the effect of interactive audio-visual based art therapy and music therapy in reducing suicidal ideation among school children who survived abduction

This study looked at how exposure to interactive TV-based music and art therapy could assist in reducing suicidal thoughts of secondary school female children who survived abduction in Nigeria. A quasi-experiment was carried out in three randomly selected secondary schools in Northern Nigeria. The study sample comprised 470 students divided into three groups to form control group 235, art therapy group 118 and music therapy group 117. Results suggest that participants exposed to interactive TV-based art therapy and music therapy reported a lower score for suicidal ideation compared to the control group that was not exposed to any form of therapy aside from routine clinic checkups. Specifically, those exposed to interactive TV-based art therapy reported a lesser suicidal ideation score than the music and the control group. We recommend the introduction of interactive TV-based music therapy and art therapy in reducing suicidal ideation among children that survived kidnapping in Nigeria.

A preliminary study investigating the neglected domain of mental health in Australian lifesavers and lifeguards

BACKGROUND

Surf lifesavers and lifeguards have provided essential education, preventative, and rescue services to the Australian community for over 110 years. In this first responder role, surf lifesavers and lifeguards are inadvertently exposed to high risk and trauma related experiences, which may negatively impact mental well-being. To date however, there has been limited research into the mental health of surf lifesavers and lifeguards, and no studies at all on the mental health of adolescent surf lifesavers. The preliminary study aimed to measure the exposure of potentially traumatic events (PTEs), post-traumatic stress symptoms (PTSS), self-efficacy, social support, and attitudes towards mental health problems in Surf Life Saving (SLS) members.

METHODS

An anonymous, online survey was developed (adolescent and adult versions) and created to measure the domain of mental health in surf lifesavers and lifeguards. Pearson's correlations investigated relationships between PTEs, PTSS, self-efficacy, social support, attitudes towards mental health problems, age, years as a SLS member, and years patrolling. Spearman's Rank was used for violations of normality.

RESULTS

A total of 57 surf lifesavers/lifeguards aged 13-59 years were included in the final analysis. There was a significant positive relationship between exposure to direct trauma and PTSS, which in turn, were associated with greater negative attitudes towards mental health problems towards the mental health of others, and lower levels of self-efficacy. Male and female adults with PTSS reported lower social support, whereas for adolescent males, a positive relationship between direct trauma and PTSS was observed.

CONCLUSION

This research is the first to explore the mental health of Australian surf lifesavers and lifeguards. The results highlight the potential risks to mental health and well-being associated with this first responder role. More research to protect the vulnerability of this population is warranted.

Organizational Factors and Their Impact on Mental Health in Public Safety Organizations

Public safety personnel (PSP), including correctional officers, firefighters, paramedics, and police officers, have higher rates of mental health conditions than other types of workers. This scoping review maps the impact of organizational factors on PSP mental health, reviewing applicable English language primary studies from 2000-2021. JBI methodology for scoping reviews was followed. After screening, 97 primary studies remained for analysis. Police officers (n = 48) were the most frequent population studied. Correctional officers (n = 27) and paramedics (n = 27) were the second most frequently identified population, followed by career firefighters (n = 20). Lack of supervisor support was the most frequently cited negative organizational factor (n = 23), followed by negative workplace culture (n = 21), and lack of co-worker support (n = 14). Co-worker support (n = 10) was the most frequently identified positive organizational factor, followed by supervisor support (n = 8) and positive workplace culture (n = 5). This scoping review is the first to map organizational factors and their impact on PSP mental health across public safety organizations. The results of this review can inform discussions related to organizational factors, and their relationship to operational and personal factors, to assist in considering which factors are the most impactful on mental health, and which are most amenable to change.

Diversity, Equity, and Inclusion in the United States Emergency Medical Services Workforce: A Scoping Review

OBJECTIVE

Emergency medical services (EMS) workforce demographics in the United States do not reflect the diversity of the population served. Despite some efforts by professional organizations to create a more representative workforce, little has changed in the last decade. This scoping review aims to summarize existing literature on the demographic composition, recruitment, retention, and workplace experience of underrepresented groups within EMS.

METHODS

Peer-reviewed studies were obtained from a search of PubMed, CINAHL, Web of Science, ProQuest Thesis and Dissertations, and non-peer-reviewed ("gray") literature from 1960 to present. Abstracts and included full-text articles were screened by two independent reviewers trained on inclusion/exclusion criteria. Studies were included if they pertained to the demographics, training, hiring, retention, promotion, compensation, or workplace experience of underrepresented groups in United States EMS by race, ethnicity, sexual orientation, or gender. Studies of non-EMS fire department activities were excluded. Disputes were resolved by two authors. A single reviewer screened the gray literature. Data extraction was performed using a standardized electronic form. Results were summarized qualitatively.

RESULTS

We identified 87 relevant full-text articles from the peer-reviewed literature and 250 items of gray literature. Primary themes emerging from peer-reviewed literature included workplace experience (n = 48), demographics (n = 12), workforce entry and exit (n = 8), education and testing (n = 7), compensation and benefits (n = 5), and leadership, mentorship, and promotion (n = 4). Most articles focused on sex/gender comparisons (65/87, 75%), followed by race/ethnicity comparisons (42/87, 48%). Few articles examined sexual orientation (3/87, 3%). One study focused on telecommunicators and three included EMS physicians. Most studies (n = 60, 69%) were published in the last decade. In the gray literature, media articles (216/250, 86%) demonstrated significant industry discourse surrounding these primary themes.

CONCLUSIONS

Existing EMS workforce research demonstrates continued underrepresentation of women and non-White personnel. Additionally, these studies raise concerns for pervasive negative workplace experiences including sexual harassment and factors that negatively affect recruitment and retention, including bias in candidate testing, a gender pay gap, and unequal promotion opportunities. Additional research is needed to elucidate recruitment and retention program efficacy, the demographic composition of EMS leadership, and the prevalence of racial harassment and discrimination in this workforce.

A Scoping Review on the Prevalence and Determinants of Post-Traumatic Stress Disorder among Military Personnel and Firefighters: Implications for Public Policy and Practice

Introduction: Firefighters and military personnel are public safety personnel who protect the safety of individuals and their properties. They are usually exposed to traumatic events leaving them at risk of developing mental health conditions such as post-traumatic stress disorder (PTSD). Increasing concern is being raised regarding the mental health impacts, specifically PTSD, among military personnel and firefighters. Objective: There is an increased exposure of firefighters and military personnel to traumatic events and the attendant risk of developing post-traumatic stress disorder. It is crucial to ascertain the level of PTSD amongst this cohort and determinants to formulate policies and practices that mitigate the risk and protect public safety personnel. This scoping review sought to determine the prevalence of PTSD among this cohort globally and to explore determinants of this mental health condition. Methods: A literature search in databases including MEDLINE, CINAHL, PubMed, PsycINFO, and EMBASE was conducted electronically from May 2021 to 31 July 2021. Two reviewers independently assessed full-text articles according to the predefined inclusion criteria and screening process undertaken to identify studies for the review. Articles were screened with a third reviewer, resolving conflicts where necessary and further assessing them for eligibility. During article selection, the PRISMA checklist was adopted, and with the Covidence software, a total of 32 articles were selected for the final examination. For the eligible studies, data extraction was conducted, information was collated and summarized, and the findings were reported. Original qualitative and quantitative data on the prevalence and predictors of PTSD among veterans, military, and firefighters were reported. Results: The prevalence of PTSD was 57% for firefighters and 37.8% for military personnel. Demographic factors, job factors, social support, injuries, physical and psychological factors, and individual traits were the main predictors of PTSD in this cohort. Conclusion: This information is vital for developing and implementing prevention and intervention strategies for PTSD in military personnel and firefighters. Recognizing and addressing factors that predict PTSD will help to improve mental wellbeing and increase productivity. More peer-reviewed studies are needed on the prevalence of PTSD amongst these cohorts.

Is It Personal? The Effect of Personal vs. Occupational Trauma on PTSD Symptom Severity in Emergency Responders

Emergency responders are exposed to potentially traumatic events in their line of work and as such, are at increased risk of developing post-traumatic stress disorder (PTSD). Little is known about the characteristics of trauma associated with PTSD symptoms in this population. This study analyzed the self-reported worst traumatic event on the PTSD checklist for DSM-5 for a sample of N = 610 emergency responders, working as police officers, paramedics, firefighters or search and rescue personnel. Sufficient information was available to code 98% (N = 603) participants' trauma; 84% (N = 509) met DSM-V criterion A trauma. Of the participants reporting criterion A trauma, 56.9% (N = 290) participants reported being most affected by a traumatic event that occurred in their personal lives, 41.5% (N = 211) participants reported being most affected by a work-related traumatic event and 1.6% (N = 8) reported criterion A events that were work-related and had occurred prior to their role as an emergency responder (e.g., combat). Paramedics were significantly more likely to report occupational trauma as their worst event whereas police officers, firefighters, and search and rescue workers reported personal trauma as their worst event. Personal trauma was associated with significantly greater PTSD symptom severity than occupational trauma. Emergency responders identifying as women were significantly more likely to report personal than work-related trauma as their index event and men were more likely to report work-related than personal trauma as being linked to their PTSD symptoms. The results underscore the need to consider the broader context of trauma in the emergence of PTSD symptoms in emergency workers.

Characteristics and Experiences of Women Physicians and Professionals in NAEMSP

Introduction:One of the six guiding principles of the EMS Agenda 2050 is to foster a socially equitable care delivery system. A specific recommendation within this principle is that "local EMS leadership, educators and clinicians [should] reflect the diversity of their communities." Research has shown that women comprise a minority of emergency medicine services (EMS) field clinicians. In academic settings, women are represented at lower rates among experienced EMS faculty than within Emergency Medicine clinicians or faculty at large. The reasons for these differences are also unknown. Little data exist describing the number or experience of female physicians and professionals in EMS.Purpose:Our objective was to describe the composition and experiences of EMS physicians, researchers and professionals who participate in the Women in EMS group of the National Association of EMS Physicians (NAEMSP).Methods:We performed a cross-sectional, mixed-methods descriptive study of women belonging to the Women in EMS Committee of NAEMSP. A survey was sent to the 143 members of this group using a list-serve, and the data was collected in Redcap.Results:Seventy-four people completed the survey. Respondents were 96% female, 82% Caucasian, 11% underrepresented minorities (URM), and 7% LGBTQI. Of the 88% that are physicians, 78% are board certified in Emergency Medicine, compared to 55% in EMS.Forty-eight percent reported they received some form of mentorship. Among these respondents, a minority reported female mentorship, which was usually from a remote rather than local mentor (41% vs. 15%).Eighty-three percent of respondents had experienced some form of discrimination or harassment in their career, but only 68% reported their workplace culture discourages such behavior. Thirty-three percent of respondents report receiving unequal recognition because of gender.Thematic evaluation of the qualitative responses showed that respondents felt there were fewer barriers to mentorship and professional advancement opportunities in local work versus national engagement.Conclusions:In a survey evaluating representation of female professionals in EMS, participants reported on their career representations, and experiences of gender-based inequity within their EMS career settings. Several opportunities exist to improve diversity, equity, and inclusion for women in EMS based on our findings.

Prevalence of Posttraumatic Stress Disorder among Firefighters in Iran: A Systematic Review and Meta-Analysis

Objective: Firefighters are exposed to many different chemicals and physical hazards and experience a significant number of accidents and injuries. They are exposed to high-risk of posttraumatic stress disorder (PTSD).

The purpose of this study was to determine the prevalence of PTSD among Iranian firefighters.

Method: This was a systematic review and meta-analysis. Valid Persian and English keywords were searched in data resources, including SID, Magiran, Irandoc, Google Scholar, PubMed, Scopus, and Web of Science to retrieve articles on the prevalence of PTSD among Iranian firefighters. The STROBE checklist was used to assess the quality of the articles. Heterogeneity among the studies was assessed by I² index. The data were analyzed using Stata14 software.

Results: Of the 316 articles selected in the initial search, 3 articles the inclusion criteria and were used for the meta-analysis. A total of 274 firefighters were studied. The prevalence of PTSD was 23.17% among Iranian firefighters (I² = 92.4%, 95% CI = 6.71-39.62, p < 0.001).

Conclusion: The prevalence of PTSD is among Iranian firefighters relatively high and has been on the rise over the recent years.

Trauma and work factors as predictors of firefighters' psychiatric distress

BACKGROUND

Studies into the mental health of firefighters have primarily focussed on individual factors (e.g. biological and psychological factors). Little is known about how exposure to traumatic events and psychosocial and organizational work factors influence firefighters' mental health despite the evidence that these are important for employee health.

AIMS

To study job demands, job control, social support and operational trauma as predictors of firefighters' psychiatric morbidity, and whether job control and social support moderate these relationships.

METHODS

Participants were drawn from a longitudinal cohort study of firefighters in Brazil. Portuguese-language variants of the Self-Report Questionnaire (SRQ-20) and Traumatic Events List for Emergency Professionals measured psychiatric morbidity and exposure to traumatic events. Job demands, job control and social support were measured by the Job Stress Scale. Hierarchical regressions were run controlling for socio-demographics and previous psychiatric morbidity. Subsequent regression steps first included the proposed predictors followed by their interactions.

RESULTS

Thirteen per cent of the sample (n = 40/312) met the caseness criteria indicating psychiatric morbidity. Operational trauma, job demands, job control and social support predicted psychiatric morbidity. Both job control and social support functioned as moderators and where these moderators were high, the job demands and psychiatric morbidity relationships were weaker.

CONCLUSIONS

These findings show that psychosocial factors and operational trauma predict firefighters' psychiatric morbidity. Crucially, the results that improving social support and job control could mitigate the detrimental influence of job demands highlight the need for more research and practice towards organizational-level interventions.

The prevalence and clinical impairment of subthreshold PTSD using DSM-5 criteria in a national sample of Korean firefighters

BACKGROUND

Firefighters are at high risk for subthreshold and full-threshold posttraumatic stress disorder (PTSD) due to their frequent exposure to various traumatic events. Although individuals with subthreshold PTSD have increased impairment, often needing treatment, the rates of subthreshold PTSD in firefighters remain unknown. Moreover, there is currently no consensus regarding the definition of subthreshold PTSD. The purpose of this study was to investigate the rates and clinical impairment of subthreshold PTSD according to various definitions in a national sample of firefighters.

METHODS

A total of 45,698 Korean firefighters completed self-reported questionnaires to assess the severity of PTSD symptoms, suicidal behavior, depression, alcohol use problems, and PTS-related functional impairment. Six different definitions used in the literature were used to calculate the prevalence rate of subthreshold PTSD. Multivariable linear regression and analysis of variance were performed to identify the relationship of subthreshold PTSD with suicidal behavior, depression, alcohol use problems, and PTS-related functional impairment.

RESULTS

The rate of full-threshold PTSD was 2.63%, and the rate of subthreshold PTSD ranged from 1.79% to 17.98%. The individuals with subthreshold PTSD most commonly failed the D criteria, which included negative alterations in cognition and mood. Regardless of the definition used, subthreshold PTSD was found to be associated with increased suicidal behavior, depression, alcohol use problems, and functional impairment.

CONCLUSIONS

Subthreshold PTSD appears to be equal to or more frequent than full-threshold PTSD in Korean firefighters and associated with various negative clinical outcomes. Further effort to detect and treat subthreshold PTSD in firefighters may be essential.

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.

Alcohol use and mental health symptoms in female firefighter recruits

BACKGROUND

Limited research suggests that female firefighters report problem drinking at higher rates than the general population.

AIMS

To identify longitudinal drinking patterns in female firefighters, make comparisons to male firefighters and examine problem drinking in relation to post-traumatic stress disorder (PTSD) and depression.

METHODS

Study participants included 33 female and 289 male firefighter recruits, who were assessed over their first 3 years of fire service.

RESULTS

Female firefighters consumed increasing numbers of drinks per week, with a median of 0.90 drinks per week at baseline, and 1.27 drinks in year 3. Female firefighters reported binge drinking at high rates, with nearly half binging at least once per year across all time points (44-74%). The percentage that reported binge drinking three or more times per month doubled over the course of the study (from 9% to 18%). Overall, males reported higher rates of binge drinking and a greater number of drinks per week; however, binge drinking rates among females increased over time and became comparable to rates of binge drinking among males. A greater percentage of female than male firefighters met the criteria for problem drinking by year 1. Problem drinking was associated with screening positive for PTSD at year 1 and depression at year 2, but not with occupational injury.

CONCLUSIONS

Over time, female firefighters reported increasing amounts of drinking, more frequent binge drinking and more negative consequences from drinking. These findings along with existing literature indicate female firefighters change their drinking in the direction of their male counterparts.