1
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Pan Y. Admiration and motivation: key factors in managing PTSD among firefighters. BMC Public Health 2024; 24:1871. [PMID: 39004732 PMCID: PMC11246576 DOI: 10.1186/s12889-024-19420-x] [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] [Received: 04/22/2024] [Accepted: 07/09/2024] [Indexed: 07/16/2024] Open
Abstract
Post-traumatic stress disorder (PTSD) presents a significant challenge for firefighters. While research suggests that admiration may have a positive impact on individual psychological well-being, its specific influence on PTSD among firefighters remains unexplored. This study aims to investigate the association between admiration, motivation (both internal and external), and PTSD in a sample of 2156 firefighters in order to identify effective coping strategies for managing PTSD in this population. The findings indicate a statistically significant inverse relationship between admiration and PTSD, with motivation acting as a mediator. Furthermore, it is noteworthy that internal motivation is negatively correlated with PTSD in the model, while external motivation shows a positive correlation. The results suggest that feelings of admiration are associated with firefighter PTSD via motivation. Specifically, internal motivation stemming from admiration appears to have a mitigating effect on PTSD symptoms, while external motivation is linked to exacerbation of these symptoms. These results have implications for the development of theoretical frameworks and practical interventions aimed at preventing PTSD among firefighters.
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Affiliation(s)
- Yang Pan
- School of Physical Education, Shandong University, Jinan, China.
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2
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Fox H, Preston TJ, Morabito D, Schmidt NB, Albanese BJ. The interactive effects of AS and trauma exposure on suicide capability and suicide risk. J Psychiatr Res 2023; 167:100-107. [PMID: 37862905 DOI: 10.1016/j.jpsychires.2023.10.011] [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: 11/07/2022] [Revised: 09/04/2023] [Accepted: 10/06/2023] [Indexed: 10/22/2023]
Abstract
BACKGROUND Trauma exposure has been linked with heightened suicide risk purportedly through habituation to threatening stimuli, thereby reducing fear of suicide. However, no research has examined variables that may influence this process. Anxiety sensitivity (AS) is one cognitive-affective factor that may strengthen the relationship between trauma exposure and reduced fear of suicide by amplifying traumatic reactivity. The present study evaluated this by examining the interaction of AS and trauma exposure type (e.g., direct vs. witnessed) predicting fear of suicide and self-reported suicide risk. METHODS Participants (n = 124) were recruited for a long-term (∼3-4 years) follow-up after participation in a clinical trial targeting suicide risk factors and were asked to complete self-report measures of trauma history, AS, fear of suicide, and suicide risk. RESULTS Significant interactions emerged such that a greater number of direct traumasexperienced predicted lower fear of suicide and greater suicide risk among those with greater AS. The interactive effect of witnessed traumas and AS predicting suicidality was insignificant. Results remained even after including relevant covariates. DISCUSSION The current findings suggest that AS augments the effects of repeated trauma exposure on fear of suicide and suicide risk. It is plausible these painful and provocative events are more potent among those with high AS due to the amplification of traumatic affective responses, though future research examining the longitudinal relations is needed to confirm this process.
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Affiliation(s)
- Hailey Fox
- Department of Psychological Sciences, Auburn University, Auburn, AL, USA
| | - Thomas J Preston
- Department of Psychological Sciences, Auburn University, Auburn, AL, USA
| | - Danielle Morabito
- Department of Psychology, Florida State University, Tallahassee, FL, USA
| | - Norman B Schmidt
- Department of Psychology, Florida State University, Tallahassee, FL, USA
| | - Brian J Albanese
- Department of Psychological and Brain Sciences, Texas A&M University, College Station, TX, USA.
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3
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Louis N, Ragheb M, Ibrahim O, Salim A, E. Dean Y, Kishk RM, Elsaid NMAB, Salem A, Shah J, Aiash H, Eida M. Assessment of post-traumatic stress disorder and health-related quality of life among patients recovered from mild-to-moderate COVID-19 and their close contacts: A cross-sectional study. Medicine (Baltimore) 2023; 102:e35210. [PMID: 37800844 PMCID: PMC10553092 DOI: 10.1097/md.0000000000035210] [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: 03/08/2023] [Accepted: 08/23/2023] [Indexed: 10/07/2023] Open
Abstract
The pandemic of COVID-19 is a traumatic event with distressing implications for mental health and several aspects of life. This study aimed to assess Post-traumatic Stress Disorder (PTSD) and Health-Related Quality of Life (HRQoL) among patients who experienced mild-to-moderate COVID-19 and their household contacts. This cross-sectional descriptive study was conducted between May 2020 and November 2020, in Ismailia and Suez governorates. A convenient sampling method was used. The sample size was calculated according to the prevalence of PTSD in COVID-19 patients to be 200 adult participants from both sexes, 100 patients with history of recent COVID-19 infection (up to 2 months after recovery) and their close family. COVID-19 was confirmed by a nasal swab sample tested by PCR in addition to suggestive symptoms and/or positive computed tomography lung findings. Data was collected by using the Arabic version of the Post-Traumatic Stress disorder checklist 5 (PCL5-PTSD) and the Arabic version of Health-Related Quality of Life (HRQoL). The questionnaire was collected through interviews at the Endemic and Infectious diseases and Family medicine outpatient clinics. Of the 200 studied participants, evidence of PTSD was found in 112 (56%) participants; all COVID-19 cases and 12 of their close-contact relatives. Impaired HRQoL was evident in 107 (53.5%) participants; all the COVID-19 cases and 7 contacts. The mean values total scores of the PTSD and HRQoL and its domains were significantly higher among cases compared to their contacts. The most frequently impaired domain was social (55%), psychological (54.5%), impairment (53.5%) followed by physical (48.5%) and the least was health perception (33.5%). The mean values of PTSD, HRQoL and their domains were significantly higher among participants who recalled respiratory symptoms and who had comorbid illness. The odds ratio of PTSD and HRQoL was 0.27 (95% CI: 0.2-0.36) and 0.3 (95% CI: 0.23-0.39) in participants who had more than a case of COVID-19 within their families. All the studied COVID-19 participants showed PTSD and impaired HRQoL, compared to 12% and 7% of their contacts, respectively. Past COVID-19 was associated with impairment of all domains of HRQoL and the most affected were the physical, psychological and impairment domains.
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Affiliation(s)
- Nageh Louis
- Endemic and Infectious Diseases Department, Faculty of Medicine, Suez Canal University, Ismailia, Egypt
| | - Mostafa Ragheb
- Endemic and Infectious Diseases Department, Faculty of Medicine, Suez Canal University, Ismailia, Egypt
| | - Omneya Ibrahim
- Psychiatry and Neurology Department, Faculty of Medicine, Suez Canal University, Ismailia, Egypt
| | - Almaza Salim
- Family Medicine Department, Faculty of Medicine, Port-Said University, Port-Said, Egypt
| | - Yomna E. Dean
- Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Rania M. Kishk
- Department of Microbiology and Immunology, Faculty of Medicine, Suez Canal University, Ismailia, Egypt
| | - Noha M. Abu Bakr Elsaid
- Department of Public Health, Community, Environmental and Occupational Medicine, Faculty of Medicine, Suez Canal University, Ismailia, Egypt
- Department of Basic Medical Sciences, Faculty of Medicine, King Salman International University, South Sinai, Egypt
| | - Ayman Salem
- Department of Internal Medicine, Faculty of Medicine, Suez Canal University, Ismailia, Egypt
| | - Jaffer Shah
- Kateb University, Medical Research Center, Kabul, Afghanistan
| | - Hani Aiash
- Department of Family Medicine, Faculty of Medicine, Suez Canal University, Ismailia, Egypt
- SUNY, Upstate Medical University, Syracuse, NY
| | - Mohammed Eida
- Endemic and Infectious Diseases Department, Faculty of Medicine, Suez Canal University, Ismailia, Egypt
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Leonard SJ, McGrew SJ, Lebeaut A, Vujanovic AA. PTSD Symptom Severity and Alcohol Use among Firefighters: The Role of Emotion Regulation Difficulties. J Dual Diagn 2023; 19:209-220. [PMID: 37802496 DOI: 10.1080/15504263.2023.2260324] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/10/2023]
Abstract
OBJECTIVE Heightened rates of posttraumatic stress disorder (PTSD) symptoms and alcohol use have been documented among firefighters. Emotion regulation difficulties (ERD) are clinically relevant to both PTSD and alcohol use. Few studies have examined the role of ERD in the association of PTSD symptoms with alcohol use severity and alcohol use motives among firefighters. Thus, the present investigation examined the indirect effect of PTSD symptom severity on alcohol use severity and alcohol use motives through ERD. METHODS The sample was comprised of 685 firefighters (Mage = 38.65, SD = 8.57, 93.6% male) recruited from an urban fire department in the southern U.S. to complete an online survey. Indirect effects were calculated using 10,000 bootstrapped samples. Effects were examined after accounting for years of fire service, occupational stress, trauma load (i.e., number of traumatic event types experienced); in models evaluating alcohol use motives as outcomes, other alcohol use motives (i.e., alternate motives subscales) were included as additional covariates. RESULTS First, ERD explained the association of PTSD symptom severity with alcohol use coping motives (β = .01, SE = .003, 95% CI [.004-.01]). Furthermore, ERD did not significantly account for the association of PTSD symptom severity with alcohol use severity (β = .02, SE = .01, 95% CI [-.004-.04]), alcohol use enhancement motives (β = -.003, SE = .002, 95%CI [-.007-.000]), alcohol use social motives (β = .004, SE = .002, 95% CI [-.000-.01]), or alcohol use conformity motives (β = -.002, SE = .002, 95% CI [-.006-.02]). CONCLUSIONS Results demonstrated that, among firefighters, PTSD symptom severity is positively related to alcohol use coping motives through heightened ERD. Clinical implications and future directions are discussed.
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Affiliation(s)
| | - Shelby J McGrew
- University of Houston, Houston, Texas, USA
- Trauma and Stress Studies Center, Department of Psychological and Brain Sciences, Texas A&M University, College Station, Texas, USA
| | | | - Anka A Vujanovic
- University of Houston, Houston, Texas, USA
- Trauma and Stress Studies Center, Department of Psychological and Brain Sciences, Texas A&M University, College Station, Texas, USA
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Suomi A, Bolton A, Pasalich D. The Prevalence of Post-Traumatic Stress Disorder in Birth Parents in Child Protection Services: Systematic Review and Meta-analysis. TRAUMA, VIOLENCE & ABUSE 2023; 24:1032-1046. [PMID: 34736361 DOI: 10.1177/15248380211048444] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
BACKGROUND Birth parents of children in the statutory child protection system have disproportionally high rates of trauma exposure and mental health problems, however, little is known about the extent to which this population display symptoms of Post-Traumatic Stress Disorder (PTSD) or Complex PTSD. This study provides a systematic review and meta-analysis of the PTSD rates in parent samples involved in the child protection services. METHOD Articles were identified by searching PSYCINFO, Medline, CINAHL, and PILOTS. The search included terminology pertaining to parents, trauma, and child protective services and we included all peer-reviewed articles that reported a valid measure of PTSD and child protection service involvement. RESULTS Fifteen studies were included in the review with a combined prevalence estimate for PTSD based on 11 studies (n = 4871) was 26.0% (95% CI 20.0-32.0%) for mothers, and estimate based on three studies (n = 2606) was 13.0% (95% CI 7.0%-18.0%) for fathers and 23.0% (95% CI 17.0-29.0) for all parents based on 7848 responses. Four studies that did not report prevalence rates, reported sample mean scores for PTSD that were consistently higher than in general population. Factors associated with parents' PTSD symptoms included mental health co-morbidities, victimization of physical and sexual violence, and perpetration of child abuse. CONCLUSION There are high rates of PTSD in parents involved in the protective system, thus more targeted efforts are needed to identify and adequately address trauma symptoms of parents as part of child protection interventions.
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Affiliation(s)
- Aino Suomi
- Institute of Child Protection Studies, 95359Australian Catholic University, Canberra, VIC, Australia
- Research School of Population Health, 2219Australian National University, Canberra, ACT, Australia
| | - Annalese Bolton
- Matilda Centre, University of Sydney, Sydney, NSW, Australia
- Forensic Psychology Clinic, 7800University of New South Wales, Sydney, NSW, Australia
| | - Dave Pasalich
- Research School of Psychology, 2219Australian National University, Canberra, ACT, Australia
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Khoury JMB, Jamshidi L, Shields RE, Nisbet J, Afifi TO, Fletcher AJ, Stewart SH, Asmundson GJG, Sauer-Zavala S, Krätzig GP, Carleton RN. Putative risk and resiliency factors among Royal Canadian Mounted Police cadets. Front Psychol 2023; 14:1048573. [PMID: 37008880 PMCID: PMC10053504 DOI: 10.3389/fpsyg.2023.1048573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Accepted: 02/20/2023] [Indexed: 03/17/2023] Open
Abstract
ObjectiveMental health disorders are prevalent among active-duty Royal Canadian Mounted Police (RCMP) officers. The current study was designed to assess whether RCMP cadets commencing the Cadet Training Program are inherently at greater risk of developing mental health challenges by statistically comparing cadet putative risk and resiliency scores to scores from young adult populations. The study was also designed to assess for sociodemographic differences in putative risk and resiliency variables among RCMP cadets in order to facilitate future comparisons.MethodsCadets (n = 772; 72.2% men) completed self-report measures of several putative risk variables (i.e., anxiety sensitivity, fear of negative evaluation, pain anxiety, illness and injury sensitivity, intolerance of uncertainty, and state anger) and resiliency. Scores were statistically compared to samples from Canadian, American, Australian, and European young adult populations.ResultsCadets had statistically significantly lower scores on all putative risk variables and statistically significantly higher resiliency scores compared to the young adult populations. In the cadet sample, there were statistically significant differences in putative risk and resiliency variables across gender and sex.ConclusionCadets’ significantly lower scores on putative risk variables and higher scores on resiliency suggest that they may be psychologically strong; as such, it may be that the nature of police work, as opposed to inherent individual differences in risk and resiliency, accounts for active-duty RCMP officers’ comparatively higher prevalence of mental health disorders over time.Clinical Trial Registration: ClinicalTrials.gov, Identifier NCT05527509.
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Affiliation(s)
- Juliana M. B. Khoury
- Canadian Institute for Public Safety Research and Treatment-Institut Canadien de recherche et de traitement en sécurité publique (CIPSRT-ICRTSP), University of Regina/Université de Regina, Regina, SK, Canada
- Department of Community Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Laleh Jamshidi
- Canadian Institute for Public Safety Research and Treatment-Institut Canadien de recherche et de traitement en sécurité publique (CIPSRT-ICRTSP), University of Regina/Université de Regina, Regina, SK, Canada
| | - Robyn E. Shields
- Canadian Institute for Public Safety Research and Treatment-Institut Canadien de recherche et de traitement en sécurité publique (CIPSRT-ICRTSP), University of Regina/Université de Regina, Regina, SK, Canada
- Department of Community Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Jolan Nisbet
- Canadian Institute for Public Safety Research and Treatment-Institut Canadien de recherche et de traitement en sécurité publique (CIPSRT-ICRTSP), University of Regina/Université de Regina, Regina, SK, Canada
| | - Tracie O. Afifi
- Department of Sociology and Social Studies, University of Regina, Regina, SK, Canada
| | - Amber J. Fletcher
- Mood, Anxiety, and Addiction Comorbidity (MAAC) Lab, Departments of Psychiatry and Psychology and Neuroscience, Dalhousie University, Halifax, NS, Canada
| | - Sherry H. Stewart
- Anxiety and Illness Behaviours Laboratory, Department of Psychology, University of Regina, Regina, SK, Canada
| | | | - Shannon Sauer-Zavala
- Treatment Innovation for Psychological Services Research Program, Department of Psychology, University of Kentucky, Lexington, KY, United States
| | | | - R. Nicholas Carleton
- Canadian Institute for Public Safety Research and Treatment-Institut Canadien de recherche et de traitement en sécurité publique (CIPSRT-ICRTSP), University of Regina/Université de Regina, Regina, SK, Canada
- Department of Community Health Sciences, University of Manitoba, Winnipeg, MB, Canada
- *Correspondence: R. Nicholas Carleton,
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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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Affective Depression Mediates PTSD to Suicide in a Sample of Treatment-Seeking First Responders. J Occup Environ Med 2023; 65:249-254. [PMID: 36221301 DOI: 10.1097/jom.0000000000002724] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVE The aim of this study was to examine the associations of comorbid posttraumatic stress disorder (PTSD), affective or somatic depression, and suicide among first responders (FRs). METHOD We used baseline data from FRs ( N = 232) who sought services at a nonprofit mental health agency specializing in treating trauma exposed FRs. We conducted two PROCESS simple mediation models with PTSD as the predictor, affective depression and somatic depression as the mediators, and suicidality as the dependent variable. RESULTS Affective depression significantly mediated the relationship between PTSD and suicidality, whereas somatic depression did not. The direct effect of PTSD on suicidality was not significant. LIMITATIONS These data are cross-sectional and should be followed up with longitudinal analyses across the course of treatment. CONCLUSIONS To reduce suicide risk, it is recommended that clinicians target affective depression instead of PTSD symptoms.
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9
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Mental health of UK firefighters. Sci Rep 2023; 13:62. [PMID: 36627314 PMCID: PMC9832123 DOI: 10.1038/s41598-022-24834-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Accepted: 11/21/2022] [Indexed: 01/12/2023] Open
Abstract
Exposure to trauma, high-stress situations, and disrupted sleep are well known risk factors affecting firefighters' mental health. Little is known about the association between firefighters' exposure to fire contaminants and mental health disorders. The UK Firefighter Contamination Survey assessed firefighters' health and capacity for occupational exposure to contaminants. Participants were invited to anonymously complete its 64 questions online. Logistic regression analyses assessed the associations between self-reported mental health disorders and proxies of contaminant exposure. Results found that firefighters who notice soot in their nose/throat for more than a day after attending fires (Odds Ratio (OR) = 1.8, 1.4-2.4), and those who remain in their personal protective equipment (PPE) for over 4 h after fires (OR = 1.9, 1.2-3.1), were nearly twice as likely to report mental health disorders. Significantly increased odds ratios for all three outcomes of interest (anxiety, depression and/or any mental health disorders) were also found among firefighters who take PPE home to clean. Sleeping problems were reported by 61% of firefighters. These firefighters were 4.2 times more likely to report any mental health disorder (OR = 4.2, 3.7-4.9), 2.9 times more likely to report anxiety (OR = 2.9, 2.4-3.5) and 2.3 times more likely to report depression (OR = 2.3, 1.9-2.8) when compared to firefighters who did not report sleep issues. Effective decontamination measures within UK Fire and Rescue Services, together with firefighters' wellness, may play a crucial role in protecting firefighters' mental health.
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Henson C, Truchot D, Canevello A. PTSD and PTG in French and American Firefighters: A Comparative Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:11973. [PMID: 36231272 PMCID: PMC9614603 DOI: 10.3390/ijerph191911973] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Revised: 09/16/2022] [Accepted: 09/21/2022] [Indexed: 06/16/2023]
Abstract
Studies show that experiencing traumatic events can lead to positive psychological change, or posttraumatic growth (PTG). In the hope of promoting PTG, authors have been focusing on identifying the factors that may foster PTG. Despite these attempts, the literature shows inconsistencies, making it difficult to know which variables may be involved in the process of growth. Indeed, authors seem to disagree on the nature of the relationship between PTSD and PTG, time since the event, social support, intrusive rumination, and sociodemographics. Thus, this study aims to clarify these discrepancies, and verify whether the processes involved are the same across two different cultural groups, both of which are confronted with traumatic events regularly: 409 American firefighters, and 407 French firefighters. Results indicate that, in both samples, PTG is positively related to PTSD, subjective perceptions of the event, stress during the event, disruption of core-beliefs, and deliberate rumination; and unrelated to social support, core-self evaluations, and socio-demographic variables (age, gender, relationship status, etc.). However, time since the event and the number of years on the job only predicted PTG in the American sample, while colleague and emotional support only predicted PTG in the French sample. Additionally, American firefighters reported more growth, more social support, more positive self-perceptions, more intrusive rumination, and more neuroticism than French firefighters. These results suggest that the process of growth, as defined by Tedeschi and Calhoun, is relatively stable among firefighters, but that some differences do exist between cultural groups.
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Affiliation(s)
- Charlotte Henson
- Laboratory of Psychology, Université Bourgogne Franche-Comté à Besançon, 25000 Besançon, France
- Department of Psychology, University of North Carolina at Charlotte, Charlotte, NC 28223, USA
| | - Didier Truchot
- Laboratory of Psychology, Université Bourgogne Franche-Comté à Besançon, 25000 Besançon, France
| | - Amy Canevello
- Department of Psychology, University of North Carolina at Charlotte, Charlotte, NC 28223, USA
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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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12
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Alexithymia and Emotional Deficits Related to Posttraumatic Stress Disorder: An Investigation of Content and Process Disturbances. Case Rep Psychiatry 2022; 2022:7760988. [PMID: 35103107 PMCID: PMC8800611 DOI: 10.1155/2022/7760988] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Accepted: 01/08/2022] [Indexed: 01/31/2023] Open
Abstract
Background Posttraumatic stress disorder (PTSD) is a debilitating mental disorder that develops in the aftermath of traumatic life experiences, especially those that occurred in childhood. PTSD is associated with intrusive memories, distressing dreams, dissociative reactions, avoidance of trauma-related stimuli, negative mood and sense of well-being, increased arousal and irritability, and clinically significant distress and impaired functioning. Case Presentation. The following case report presents a 42-year-old male displaying symptoms of PTSD, alexithymia, and depression. Conclusion Untreated alexithymia may aggravate the trauma and cause the development of PTSD and depression.
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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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Zegel M, Lebeaut A, Healy N, Tran JK, Vujanovic AA. Mental Health Correlates of Probable Posttraumatic Stress Disorder, Probable Alcohol Use Disorder, and Their Co-Occurrence among Firefighters. Behav Modif 2021; 46:395-421. [PMID: 34323099 DOI: 10.1177/01454455211033517] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Firefighters demonstrate high rates of posttraumatic stress disorder (PTSD) and alcohol use disorder (AUD). Research has yet to compare how these diagnoses and their co-occurrence relate to firefighter mental health. This study evaluated trauma load, PTSD, alcohol use, depression, sleep, suicide risk, anger, and occupational stress across four discrete groups of firefighters (N = 660): (1) trauma-exposed only (n = 471), (2) probable PTSD-only (n = 36), (3) probable AUD-only (n = 125), and (4) probable PTSD-AUD (n = 28). Firefighters completed an online survey. Firefighters with probable PTSD-AUD demonstrated higher scores on all criterion variables, except trauma load, compared to firefighters with probable AUD-only or trauma-only. Firefighters with probable PTSD-AUD and probable PTSD-only reported similar levels of all indices, except alcohol use severity and suicide risk, which were higher among the probable PTSD-AUD group. Results provide preliminary empirical evidence of the deleterious impact of PTSD-AUD comorbidity among firefighters.
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Affiliation(s)
| | | | | | - Jana K Tran
- National Aeronautics and Space Administration (NASA), Houston, TX, USA
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15
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Brooks JR, Lebeaut A, Zegel M, Walker RL, Vujanovic AA. Anxiety sensitivity and suicide risk: Mindfulness as a psychological buffer for Black adults. J Affect Disord 2021; 289:74-80. [PMID: 33945917 DOI: 10.1016/j.jad.2021.04.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Revised: 03/18/2021] [Accepted: 04/12/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND Anxiety sensitivity (AS), defined as the fear of anxiety-related sensations, is associated with increased risk for suicide and related behavior. However, investigations of AS have centered on primarily non-Hispanic White men and women and with limited attention to clinically relevant underlying factors. METHODS The purpose of this preliminary study was to examine the indirect effect of AS on suicide ideation and elevated suicide risk through mindfulness in a sample of 307 Black adults (79.2% female; Mage = 22.4, SD = 5.6). Participants completed an online questionnaire battery that included measures of AS, mindfulness, suicide ideation, and elevated suicide risk. RESULTS After controlling for age and gender, results indicated that AS was directly and indirectly associated with suicide ideation and elevated suicide risk via lower levels of mindfulness. LIMITATIONS Limitations include using a cross-sectional methodological design and exclusive reliance on self-report measures. CONCLUSIONS These findings provide preliminary insight into novel risk and protective factors that influence suicide ideation and elevated suicide risk among Black Americans.
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Affiliation(s)
- Jasmin R Brooks
- Department of Psychology, University of Houston, Houston, TX
| | - Antoine Lebeaut
- Department of Psychology, University of Houston, Houston, TX
| | - Maya Zegel
- Department of Psychology, University of Houston, Houston, TX
| | - Rheeda L Walker
- Department of Psychology, University of Houston, Houston, TX
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16
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Lebeaut A, Leonard SJ, Healy N, Raines AM, Buser SJ, Vujanovic AA. Associations between Lower-Order Anxiety Sensitivity Facets and PTSD Symptomatology among Trauma-Exposed Firefighters. Behav Modif 2021; 46:294-320. [PMID: 34008431 DOI: 10.1177/01454455211016819] [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: 11/16/2022]
Abstract
Firefighters are chronically exposed to potentially traumatic events, augmenting their risk of developing posttraumatic stress disorder (PTSD). The current study aimed to examine the incremental associations of lower-order dimensions of anxiety sensitivity (AS), examined concurrently, and PTSD symptom severity among a sample of trauma-exposed firefighters. We hypothesized that AS physical and cognitive concerns would be strongly associated with all PTSD symptom clusters and overall symptom severity, after controlling for theoretically relevant covariates (trauma load; years in fire service; alcohol use severity; depressive symptom severity). Participants were comprised of firefighters (N = 657) who completed an online questionnaire battery and endorsed PTSD Criterion A trauma exposure. Results revealed that the AS cognitive concerns, but not AS physical concerns, was significantly and robustly associated with overall PTSD symptom severity, intrusion symptoms, and negative alterations in cognitions and mood (∆R2's = .028-.042; p's < .01); AS social concerns was incrementally associated with PTSD avoidance (∆R2 = .03, p < .01). Implications for firefighter-informed, evidence-based interventions are discussed.
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Affiliation(s)
| | | | | | - Amanda M Raines
- Southeast Louisiana Veterans Health Care System, New Orleans, LA, USA
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17
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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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18
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Zwetzig SE, Koch LM, Blount TH, Graham MM, Peterson AL. Massed Prolonged Exposure for PTSD in Two Firefighters: Preliminary Case Study Findings. Behav Modif 2021; 46:427-452. [PMID: 33906480 DOI: 10.1177/01454455211011977] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Military service members and first responders experience significant trauma exposure in the line of duty. Service members who transition to first-responder positions may be at an increased risk for developing PTSD due to the cumulative effects of trauma exposure. A common criticism of the standard delivery methods for most evidence-based treatments for PTSD is high dropout rates. Massed-prolonged exposure (Massed-PE) has been demonstrated to be efficacious and reduces dropouts by about 50%. This case study is the first of its kind to specifically assess the clinical utility of using Massed-PE to treat PTSD in two firefighters. Results from this case study indicate that both firefighters had significant reductions in their PTSD symptoms. Massed-PE may be an effective approach to treating PTSD in firefighters and may help overcome some of the barriers of conventional treatment delivery. Additional controlled research is needed to further evaluate this promising treatment approach in firefighter populations.
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Affiliation(s)
- Sarah E Zwetzig
- University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA
| | - Lauren M Koch
- University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA
| | - Tabatha H Blount
- University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA
| | - Melissa M Graham
- Psychological Services, San Antonio Fire Department, San Antonio, Texas, USA
| | - Alan L Peterson
- University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA.,South Texas Veterans Health Care System, San Antonio, Texas, USA.,University of Texas at San Antonio, San Antonio, Texas, USA
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19
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Chen J, Li J, Zhou Y, Liu X, Xu W. Enhancement from being present: Dispositional mindfulness moderates the longitudinal relationship between perceived social support and posttraumatic growth in Chinese firefighters. J Affect Disord 2021; 279:111-116. [PMID: 33045552 DOI: 10.1016/j.jad.2020.09.137] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Revised: 08/17/2020] [Accepted: 09/28/2020] [Indexed: 11/25/2022]
Abstract
BACKGROUND Among impact factors of firefighters' posttraumatic growth (PTG) investigated in previous research, perceived social support has been considered as a major protective one and has gained persuasive evidence for its positive association with PTG. However, little is known about the factors influencing the relationship between firefighters' perceived social support and PTG. This study explored whether dispositional mindfulness moderates the longitudinal relationship between perceived social support and PTG. METHODS A total of 340 Chinese firefighters who have worked for at least one year reported their levels of perceived social support from within/outside their families (The Perceived Social Support Scale; PSSS) and dispositional mindfulness (Mindfulness Attention Awareness Scale; MAAS) at baseline, and they reported their posttraumatic growth (Posttraumatic Growth Inventory; PTGI) at both baseline and 3-month follow-up. RESULTS The current study found that for individuals with higher levels of dispositional mindfulness, their perceived social supports within family was positively associated with PTG, while for individuals with lower levels of dispositional mindfulness, there is no significant relationship between them. However, dispositional mindfulness did not moderate the relationship between social support from outside and PTG. LIMITATION Generalizations of our findings to sufferers of other traumatic experiences or different age groups need to be done with caution. CONCLUSIONS These findings suggest that individuals with high levels of dispositional mindfulness are more likely to benefit from the attention and awareness on the present experiences with greater compassion and hence are more able to acquire positive resources, which leads to greater development of PTG.
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Affiliation(s)
- Jing Chen
- Beijing Key Laboratory of Applied Experimental Psychology, National Demonstration Center for Experimental Psychology Education (Beijing Normal University), Faculty of Psychology, Beijing Normal University; School of Psychology, Nanjing Normal University
| | - Jie Li
- The Department of Psychology, Renmin University of China, Beijing, 100872, China; The Laboratory of the Department of Psychology, Renmin University of China, Beijing, 100872, China
| | - Yuyang Zhou
- College of Business, Florida International University
| | - Xiaoyan Liu
- Beijing Key Laboratory of Applied Experimental Psychology, National Demonstration Center for Experimental Psychology Education (Beijing Normal University), Faculty of Psychology, Beijing Normal University
| | - Wei Xu
- Beijing Key Laboratory of Applied Experimental Psychology, National Demonstration Center for Experimental Psychology Education (Beijing Normal University), Faculty of Psychology, Beijing Normal University; The Department of Psychology, Renmin University of China, Beijing, 100872, China; The Laboratory of the Department of Psychology, Renmin University of China, Beijing, 100872, China.
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20
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Cardiovascular risk as a moderator of associations among anxiety sensitivity, distress tolerance, PTSD and depression symptoms among trauma-exposed firefighters. J Psychosom Res 2020; 139:110269. [PMID: 33039951 DOI: 10.1016/j.jpsychores.2020.110269] [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: 06/04/2020] [Revised: 09/30/2020] [Accepted: 10/03/2020] [Indexed: 01/06/2023]
Abstract
BACKGROUND Firefighters experience frequent and severe trauma exposure, which places them at elevated risk for posttraumatic stress disorder (PTSD) and major depression. Cardiovascular issues may exacerbate the effects of mental health risk factors, such as anxiety sensitivity (AS) and distress tolerance (DT), on PTSD and depression. The current study investigated cardiovascular risk as a moderator of associations between risk factors (AS and DT) and psychiatric symptoms (PTSD and depression) among firefighters. METHODS Participants were 836 trauma-exposed active duty firefighters (93.90% men; with mean age 38 years, [SD = 9]). Participants endorsing at least one of three cardiovascular risk items-experiencing current high blood pressure, history of heart problems, and experiencing chest pains in the past 2 years-were considered high in cardiovascular risk. RESULTS A structural equation model indicated that higher AS was associated with greater PTSD (β = 0.38, p < .01) and depression symptoms (β = 0.32, p < .01); lower DT was associated with greater PTSD (β = -0.18, p < .01) and depression symptoms (β = -0.31, p < .01). Multigroup analyses showed that cardiovascular risk moderated the association between 1) AS and PTSD symptoms, but not 2) AS and depression symptoms, 3) DT and PTSD symptoms, or 4) DT and depression symptoms. For those high in cardiovascular risk, higher AS was associated more strongly with greater PTSD symptoms (high cardiovascular risk group: β = 0.46, p < .01]; low cardiovascular risk group: β = 0.33, p < .01). CONCLUSIONS High cardiovascular risk may contribute to PTSD symptoms among trauma-exposed firefighters with high AS. These results highlight the importance of considering physical and mental health vulnerabilities in first responder populations.
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21
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Suicidal ideation among nurses: Unique and cumulative effects of different subtypes of sleep problems. J Affect Disord 2020; 276:600-607. [PMID: 32871691 DOI: 10.1016/j.jad.2020.07.095] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2020] [Revised: 06/10/2020] [Accepted: 07/05/2020] [Indexed: 01/01/2023]
Abstract
BACKGROUND Nurses have high rates of sleep problems, and higher risk of suicide than the general population. However, there is no empirical evidence showing the extent to which sleep problems among nurses are related to suicidal ideation. METHODS Multistage stratified cluster sampling was performed to recruit nurses from tertiary hospitals in Shandong, China. Item 9 of the Patient Health Questionnaire-9 was used to assess suicidal ideation. The Pittsburgh Sleep Quality Index was used to assess different subtypes of sleep problems. RESULTS Overall prevalence of suicidal ideation among the sample was 10.8%. Nurses with sleep problems were at high risk for suicidal ideation (bOR = 1.79, 95% CI = 1.20-2.65). Among different sleep problem subtypes, only "cannot breathe comfortably" was independently related to suicidal ideation. Different subtypes of sleep problems had cumulative effects on suicidal ideation: the more subtypes of sleep problems nurses experienced, the higher the likelihood of suicidal ideation. LIMITATIONS The cross-sectional study design prevents inferring causation, and the use of self-report measures may lead to recall bias. Other physical/mental conditions, besides depression, were not assessed. Statistical power may have been insufficient due to the small sub-sample who reported suicidal ideation. Also, the generalizability of the results is limited, as the sample only comprised nurses in tertiary hospitals. CONCLUSIONS Nurses experiencing sleep problems were associated with increased likelihood of suicidal ideation. It may be beneficial to incorporate sleep problems into routine screening and intervention for suicide prevention in clinical practice.
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22
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Sahebi A, Yousefi K, Moayedi S, Golitaleb N, Esmaeili Vardanjani A, Golitaleb M. Prevalence of Posttraumatic Stress Disorder among Firefighters in Iran: A Systematic Review and Meta-Analysis. IRANIAN JOURNAL OF PSYCHIATRY 2020; 15:358-365. [PMID: 33240386 PMCID: PMC7610073 DOI: 10.18502/ijps.v15i4.4301] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
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.
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Affiliation(s)
- Ali Sahebi
- Department of Health in Disasters and Emergencies, School of Public Health and Safety, Shahid Beheshti University of Medical Sciences, Tehran, Iran.,Clinical Research Development Unit, Shahid Mostafa Khomeini Hospital, Ilam University of Medical Sciences, Ilam, Iran
| | - Kosar Yousefi
- Clinical Research Development Unit, Shahid Mostafa Khomeini Hospital, Ilam University of Medical Sciences, Ilam, Iran
| | - Siamak Moayedi
- Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore, United States
| | - Najaf Golitaleb
- Social Determinants of Health Research Center, Lorestan University of Medical Sciences, Khorramabad, Iran
| | - Ali Esmaeili Vardanjani
- Department of Critical Care Nursing and Management, School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran.,School of Nursing and Midwifery, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Mohamad Golitaleb
- Department of Critical Care Nursing, School of Nursing, Arak University of Medical Sciences, Arak, Iran
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23
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Lebeaut A, Tran JK, Vujanovic AA. Posttraumatic stress, alcohol use severity, and alcohol use motives among firefighters: The role of anxiety sensitivity. Addict Behav 2020; 106:106353. [PMID: 32087474 DOI: 10.1016/j.addbeh.2020.106353] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Revised: 01/10/2020] [Accepted: 02/09/2020] [Indexed: 12/16/2022]
Abstract
INTRODUCTION Firefighters are vulnerable to developing posttraumatic stress disorder (PTSD) and alcohol use disorder (AUD). Anxiety sensitivity (AS) is a cognitive-affective mechanism with clinical relevance to both PTSD and AUD. The current study examined the potential role of AS in the association of PTSD symptomatology with alcohol use severity and alcohol use motives among a large sample of firefighters. Heightened PTSD and high AS were expected to be associated with alcohol use severity and coping-oriented alcohol use motives. Heightened PTSD symptomatology was expected to be indirectly associated with alcohol use severity and coping motives through high AS. Covariates included number of years in the fire service and the number of traumatic event types endorsed. METHODS Participants included 652 urban firefighters (93.3% male; Mage = 38.7, SD = 8.57). Firefighters completed an online questionnaire battery. RESULTS PTSD symptomatology was positively associated with alcohol use and coping motives. AS was positively associated with alcohol use coping motives but not alcohol use severity. AS partially explained the association between PTSD symptomatology and coping, conformity, and social motives, but did not significantly account for the relationship between PTSD symptom severity and enhancement motives or alcohol use severity. CONCLUSIONS Among firefighters, the association between PTSD and alcohol use coping, conformity, and social motives is partially accounted for by AS. Clinical and research implications are discussed.
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Angehrn A, Krakauer RL, Carleton RN. The Impact of Intolerance of Uncertainty and Anxiety Sensitivity on Mental Health Among Public Safety Personnel: When the Uncertain is Unavoidable. COGNITIVE THERAPY AND RESEARCH 2020; 44:919-930. [PMID: 32848288 PMCID: PMC7434797 DOI: 10.1007/s10608-020-10107-2] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND Public safety personnel (PSP; e.g., correctional workers and officers, firefighters, paramedics, police officers, public safety communications officials) are regularly exposed to potentially traumatic events and considerable uncertainty as part of their employment. Canadian PSP screen positively for mental disorders at much higher rates than the general population. Intolerance of uncertainty (IU) and anxiety sensitivity (AS) are empirically-supported vulnerability factors associated with the development and maintenance of mental disorders. METHODS The present study was designed to assess IU and AS across PSP-a population regularly encountering uncertainty-with and without mental disorders (n = 4304; 33.3% women), and across normative clinical, community, and undergraduate samples. Further, the study examined the relationship between IU and AS and mental disorders among PSP. RESULTS There were significant differences across groups on IU and AS scores (ps < .001). All PSP, with and without a positive screen for a mental disorder, reported lower IU and AS than clinical samples; however, PSP without mental disorders reported lower IU and AS than all other groups (ps < .001). CONCLUSION Increased resilience or the development of coping skills to manage regular exposures to uncertain threat may help explain why PSP reported low levels of IU and AS despite higher prevalence of mental disorders. Implications for PSP training and treatment are discussed.
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Affiliation(s)
- Andréanne Angehrn
- Anxiety and Illness Behaviour Laboratory, Department of Psychology, University of Regina, Regina, SK S4S 0A2 Canada
| | - Rachel L Krakauer
- Anxiety and Illness Behaviour Laboratory, Department of Psychology, University of Regina, Regina, SK S4S 0A2 Canada
| | - R Nicholas Carleton
- Anxiety and Illness Behaviour Laboratory, Department of Psychology, University of Regina, Regina, SK S4S 0A2 Canada
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Abstract
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.
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26
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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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Hyun DS, Jeung DY, Kim C, Ryu HY, Chang SJ. Does Emotional Labor Increase the Risk of Suicidal Ideation among Firefighters? Yonsei Med J 2020; 61:179-185. [PMID: 31997627 PMCID: PMC6992451 DOI: 10.3349/ymj.2020.61.2.179] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Revised: 12/05/2019] [Accepted: 12/26/2019] [Indexed: 11/27/2022] Open
Abstract
PURPOSE To investigate whether emotional labor is associated with suicidal ideation in Korean firefighters. MATERIALS AND METHODS Data were obtained from the Firefighter Research: Enhancement of Safety & Health (FRESH) Study, which was designed to investigate the effects of job characteristics on mental and physical health among Korean firefighters. A total of 18101 firefighters were chosen from a nationwide sample. The Korean Emotional Labor Scale (K-ELS) was used to evaluate exposure to emotional labor, which consisted of five sub-factors: emotional demand and regulation, overload and conflict in customer service, emotional disharmony and hurt, organizational surveillance and monitoring, and lack of a supportive and protective system in the organization. RESULTS Firefighters who were in the risk group were more likely to experience suicidal ideation than those in the normal group for each of the five sub-scales of emotional labor. The estimated mean values for suicidal ideation in the risk group were significantly higher than those in the normal group: 1.667 (95% CI: 1.344-2.069) for emotional demand and regulation, 1.590 (95% CI: 1.243-2.033) for overload and conflict in customer service, 2.409 (95% CI: 1.954-2.969) for emotional disharmony and hurt, 2.214 (95% CI: 1.832-2.676) for organizational surveillance and monitoring, and 1.665 (95% CI: 1.387-1.999) for lack of a supportive and protective system in the organization. CONCLUSION These results suggest that experience and exposure to chronic and excessive emotional labor might play a crucial role in the development of suicidal ideation among firefighters.
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Affiliation(s)
- Dae Sung Hyun
- Departments of Biostatistics and Computing, Graduate School, Yonsei University, Seoul, Korea
- Department of Preventive Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Da Yee Jeung
- Department of Dental Hygiene, Hanyang Women's University, Seoul, Korea
| | - Changsoo Kim
- Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Hye Yoon Ryu
- Department of Preventive Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea
- Institute of Occupational and Environment Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Sei Jin Chang
- Department of Preventive Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea
- Institute of Occupational and Environment Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea.
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Naguy A, Alwetayan S, AlKhadhari S. Anhedonia as a transdiagnostic construct. Asian J Psychiatr 2020; 48:101604. [PMID: 30639127 DOI: 10.1016/j.ajp.2019.01.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2018] [Revised: 12/31/2018] [Accepted: 01/02/2019] [Indexed: 11/17/2022]
Affiliation(s)
- Ahmed Naguy
- Kuwait Centre for Mental Health, Jamal Abdul-Nassir St., Shuwaikh 21315, Kuwait.
| | - Salem Alwetayan
- Kuwait Centre for Mental Health, Jamal Abdul-Nassir St., Shuwaikh 21315, Kuwait
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29
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Tae H, Jeong BR, Chae JH. Sleep problems as a risk factor for suicide: Are certain specific sleep domains associated with increased suicide risk? J Affect Disord 2019; 252:182-189. [PMID: 30986733 DOI: 10.1016/j.jad.2019.04.053] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2018] [Revised: 04/02/2019] [Accepted: 04/08/2019] [Indexed: 10/27/2022]
Abstract
OBJECTIVES The purpose of this study was to examine the relationship between sleep problems and suicidal ideation in depressive patients. BACKGROUND AND AIMS Evidence from diverse settings and populations indicates that sleep problems are associated with suicidal ideation. However, relationships between them are not well defined. This study was conducted in order to explore whether poor sleep was associated with suicidal ideation above and beyond depression and whether specific domains of sleep were related to suicidal ideation. We also determined whether the association between sleep problems and suicidal ideation was mediated by depression. MATERIALS AND METHODS Patients aged 18-65 years from an outpatient clinic at Seoul St. Mary's Hospital were recruited for this study. From September 2010 to November 2017, a total of 909 participants were included in the final sample. The Beck Depression Inventory (BDI) and Pittsburgh Sleep Quality Index (PSQI) were used to assess psychiatric symptoms. Independent samples t-test, chi-square test, Pearson correlation analyses, hierarchical multiple regression analyses, and mediation analyses were performed using SPSS PROCESS macro. RESULTS The majority of participants with suicidal ideation also had sleep problems (94.9%). After controlling for age, marital status, and depressive symptoms, total sleep problems estimated by the PSQI global score were also significant associated with suicidal ideation. Among seven sleep components derived from the PSQI, several components including cough or snore loudly, have bad dreams, and use sleep medication were associated with increased suicide risk. Also, the relationship between sleep problems and suicidal ideation was mediated by depressive symptoms indirectly. There was no convincing direct relationship between sleep problems and suicidal ideation. CONCLUSIONS Investigating the pathways which connect sleep problems and suicidality is fundamental to the development of suicide prevention. While it might be premature to suggest specific interventions, it would be important for clinicians to consider evaluating and managing sleep problems in the context of suicidality.
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Affiliation(s)
- Hyejin Tae
- Department of Psychiatry, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Republic of Korea
| | - Bo Ram Jeong
- Catholic Biomedical Industrial Institute, The Catholic University of Korea, Seoul, Republic of Korea
| | - Jeong-Ho Chae
- Department of Psychiatry, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Republic of Korea.
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Stanley IH, Boffa JW, Tran JK, Schmidt NB, Joiner TE, Vujanovic AA. Posttraumatic stress disorder symptoms and mindfulness facets in relation to suicide risk among firefighters. J Clin Psychol 2019; 75:696-709. [PMID: 30672591 DOI: 10.1002/jclp.22748] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
OBJECTIVE Posttraumatic stress disorder (PTSD) symptoms are associated with increased suicide risk among firefighters. Few studies have examined modifiable factors, such as mindfulness facets, that might attenuate this association. This study examined the interactive effects of PTSD symptoms and mindfulness facets in relation to suicide risk among firefighters. METHOD Overall, 831 career firefighters were assessed for PTSD symptoms, mindfulness facets, and suicide risk via the PTSD Checklist for DSM-5, Five Facet Mindfulness Questionnaire, and Suicidal Behaviors Questionnaire-Revised, respectively. RESULTS Greater PTSD symptoms were associated with more severe suicide risk; however, higher levels of two specific mindfulness facets, acting with awareness and nonjudging of inner experience, attenuated this association. By contrast, higher levels of the observing facet of mindfulness potentiated the association between PTSD symptoms and suicide risk. CONCLUSIONS Suicide prevention initiatives among firefighters, particularly those experiencing trauma-related sequelae, might benefit from the inclusion of mindfulness-based practices alongside frontline empirically-supported approaches.
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Affiliation(s)
- Ian H Stanley
- Department of Psychology, Florida State University, Tallahassee, Florida
| | - Joseph W Boffa
- Department of Psychology, Florida State University, Tallahassee, Florida
| | | | | | - Thomas E Joiner
- Department of Psychology, Florida State University, Tallahassee, Florida
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Kim JI, Park H, Kim JH. Alcohol use disorders and insomnia mediate the association between PTSD symptoms and suicidal ideation in Korean firefighters. Depress Anxiety 2018; 35:1095-1103. [PMID: 30028563 DOI: 10.1002/da.22803] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2018] [Revised: 05/10/2018] [Accepted: 06/04/2018] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND There has been a strong association between posttraumatic stress disorder (PTSD) and suicidal ideation, which are both major mental health concerns in firefighters. Alcohol use disorders (AUDs) and insomnia are linked with both PTSD and suicidal ideation, but no studies have examined whether the relationship between PTSD and suicidal ideation can be explained by AUDs and insomnia. The purpose of this study was to investigate the mediating role of AUDs and insomnia in the relationship between PTSD symptoms and suicidal ideation. METHODS A total of 7190 Korean firefighters filled out self-reported questionnaires to assess the number of exposure to incident stressors and the severity of PTSD symptoms, suicidal ideation, AUDs, and insomnia. Hierarchical multivariable linear regression analyses were performed to identify the relationship of AUDs and insomnia with suicidal ideation. Path analyses were applied to investigate the mediation effects of AUDs and insomnia on the relationship between PTSD symptoms and suicidal ideation. RESULTS AUDs and insomnia showed significant associations with suicidal ideation, even after adjusting for demographic factors, number of traumatic events, and PTSD symptoms. The relationship between PTSD symptoms and suicidal ideation was partially mediated by AUDs and insomnia. AUDs also had both direct and indirect effects on suicidal ideation, with the indirect effect mediated by insomnia. CONCLUSIONS We presented a model in which AUDs and insomnia mediate the relationship between PTSD symptoms and suicidal ideation in firefighters. Efforts to treat AUDs and alleviate insomnia could be beneficial in minimizing suicidal ideation in firefighters.
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Affiliation(s)
- Johanna Inhyang Kim
- Department of Public Health Medical Services, Seoul National University Bundang Hospital, Gyeonggi-do 13620, Republic of Korea
| | - Heyeon Park
- Department of Public Health Medical Services, Seoul National University Bundang Hospital, Gyeonggi-do 13620, Republic of Korea
| | - Jeong-Hyun Kim
- Department of Public Health Medical Services, Seoul National University Bundang Hospital, Gyeonggi-do 13620, Republic of Korea.,Department of Psychiatry, Seoul National University Bundang Hospital, Gyeonggi-do 13620, Republic of Korea
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Stanley IH, Boffa JW, Rogers ML, Hom MA, Albanese BJ, Chu C, Capron DW, Schmidt NB, Joiner TE. Anxiety sensitivity and suicidal ideation/suicide risk: A meta-analysis. J Consult Clin Psychol 2018; 86:946-960. [PMID: 30335426 PMCID: PMC6469498 DOI: 10.1037/ccp0000342] [Citation(s) in RCA: 70] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
OBJECTIVE Suicide is a global public health concern. To inform the prevention and treatment of suicidality, it is crucial to identify transdiagnostic vulnerability factors for suicide and suicide-related conditions. One candidate factor is anxiety sensitivity (AS)-the fear of anxiety-related sensations-which has been implicated in the pathogenesis of a host of mental health outcomes, including suicidal thoughts and behaviors. Importantly, AS is distinct from trait anxiety and negative affectivity, highlighting its potential incremental utility in the understanding of psychopathology. Despite a burgeoning body of literature demonstrating that AS is linked to suicidal thoughts and behaviors, this research has yet to be synthesized. METHOD This meta-analysis includes 33 articles representing 34 nonredundant samples (N = 14,002) that examined at least one relationship between AS global or subfactor (i.e., cognitive, physical, social) scores and suicidal ideation and/or suicide risk. RESULTS Findings revealed small-to-moderate and moderate associations between global AS and suicidal ideation (r = .24, 95% confidence interval (CI): [.21, .26], p < .001) and suicide risk (r = .35, 95% CI [.31, .38], p < .001), respectively. All AS subfactors evinced significant associations with suicidal ideation (rs = .13-.24) and suicide risk (rs = .22-.32). CONCLUSIONS AS is related to suicidal ideation and global suicide risk. Research is needed to disentangle AS from other indices of distress in the prediction of suicidal thoughts and behaviors. Theoretical and clinical implications of these findings are discussed. (PsycINFO Database Record (c) 2018 APA, all rights reserved).
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Affiliation(s)
| | | | | | | | | | | | - Daniel W Capron
- Department of Psychology, University of Southern Mississippi
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Smith LJ, Bartlett BA, Tran JK, Gallagher MW, Alfano C, Vujanovic AA. Sleep Disturbance Among Firefighters: Understanding Associations with Alcohol Use and Distress Tolerance. COGNITIVE THERAPY AND RESEARCH 2018. [DOI: 10.1007/s10608-018-9955-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Stanley IH, Boffa JW, Smith LJ, Tran JK, Schmidt NB, Joiner TE, Vujanovic AA. Occupational stress and suicidality among firefighters: Examining the buffering role of distress tolerance. Psychiatry Res 2018; 266:90-96. [PMID: 29857292 PMCID: PMC6397653 DOI: 10.1016/j.psychres.2018.05.058] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2017] [Revised: 04/29/2018] [Accepted: 05/23/2018] [Indexed: 11/24/2022]
Abstract
Past research indicates that firefighters are at increased risk for suicide. Firefighter-specific occupational stress may contribute to elevated suicidality. Among a large sample of firefighters, this study examined if occupational stress is associated with multiple indicators of suicide risk, and whether distress tolerance, the perceived and/or actual ability to endure negative emotional or physical states, attenuates these associations. A total of 831 firefighters participated (mean [SD] age = 38.37y[8.53y]; 94.5% male; 75.2% White). The Sources of Occupational Stress-14 (SOOS-14), Distress Tolerance Scale (DTS), and Suicidal Behaviors Questionnaire-Revised (SBQ-R) were utilized to examine firefighter-specific occupational stress, distress tolerance, and suicidality, respectively. Consistent with predictions, occupational stress interacted with distress tolerance, such that the effects of occupational stress on suicide risk, broadly, as well as lifetime suicide threats and current suicidal intent, specifically, were attenuated at high levels of distress tolerance. Distress tolerance may buffer the effects of occupational stress on suicidality among firefighters. Pending replication, findings suggest that distress tolerance may be a viable target for suicide prevention initiatives within the fire service.
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Affiliation(s)
- Ian H. Stanley
- Department of Psychology, Florida State University, 1107 West Call Street, Tallahassee, FL 32306, USA
| | - Joseph W. Boffa
- Department of Psychology, Florida State University, 1107 West Call Street, Tallahassee, FL 32306, USA
| | - Lia J. Smith
- Department of Psychology, University of Houston, 3695 Cullen Boulevard, Houston, TX 77204, USA
| | - Jana K. Tran
- Houston Fire Department, 1801 Smith Street, Suite 626, Houston, TX 77002, USA
| | - N. Brad Schmidt
- Department of Psychology, Florida State University, 1107 West Call Street, Tallahassee, FL 32306, USA
| | - Thomas E. Joiner
- Department of Psychology, Florida State University, 1107 West Call Street, Tallahassee, FL 32306, USA
| | - Anka A. Vujanovic
- Department of Psychology, University of Houston, 3695 Cullen Boulevard, Houston, TX 77204, USA,Corresponding author. (A.A. Vujanovic)
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Stanley IH, Smith LJ, Boffa JW, Tran JK, Schmidt NB, Joiner TE, Vujanovic AA. Anxiety sensitivity and suicide risk among firefighters: A test of the depression-distress amplification model. Compr Psychiatry 2018; 84:39-46. [PMID: 29684659 PMCID: PMC6402324 DOI: 10.1016/j.comppsych.2018.03.014] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2017] [Revised: 02/18/2018] [Accepted: 03/28/2018] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Firefighters represent an occupational group at increased suicide risk. How suicidality develops among firefighters is poorly understood. The depression-distress amplification model posits that the effects of depression symptoms on suicide risk will be intensified in the context of anxiety sensitivity (AS) cognitive concerns. The current study tested this model among firefighters. METHODS Overall, 831 firefighters participated (mean [SD] age = 38.37 y [8.53 y]; 94.5% male; 75.2% White). The Center for Epidemiologic Studies Depression Scale (CES-D), Anxiety Sensitivity Index-3 (ASI-3), and Suicidal Behaviors Questionnaire-Revised (SBQ-R) were utilized to assess for depression symptoms, AS concerns (cognitive, physical, social), and suicide risk, respectively. Linear regression interaction models were tested. RESULTS The effects of elevated depression symptoms on increased suicide risk were augmented when AS cognitive concerns were also elevated. Unexpectedly, depression symptoms also interacted with AS social concerns; however, consistent with expectations, depression symptoms did not interact with AS physical concerns in the prediction of suicide risk. CONCLUSIONS In the context of elevated depression symptoms, suicide risk is potentiated among firefighters reporting elevated AS cognitive and AS social concerns. Findings support and extend the depression-distress amplification model of suicide risk within a sample of firefighters. Interventions that successfully impact AS concerns may, in turn, mitigate suicide risk among this at-risk population.
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Affiliation(s)
- Ian H. Stanley
- Department of Psychology, Florida State University, 1107 West Call Street, Tallahassee, FL 32306, USA
| | - Lia J. Smith
- Department of Psychology, University of Houston, 3695 Cullen Boulevard, Houston, TX 77204, USA
| | - Joseph W. Boffa
- Department of Psychology, Florida State University, 1107 West Call Street, Tallahassee, FL 32306, USA
| | - Jana K. Tran
- Houston Fire Department, 1801 Smith Street, Suite 626, Houston, TX 77002, USA
| | - N. Brad Schmidt
- Department of Psychology, Florida State University, 1107 West Call Street, Tallahassee, FL 32306, USA
| | - Thomas E. Joiner
- Department of Psychology, Florida State University, 1107 West Call Street, Tallahassee, FL 32306, USA
| | - Anka A. Vujanovic
- Department of Psychology, University of Houston, 3695 Cullen Boulevard, Houston, TX 77204, USA, Corresponding author at: Trauma and Stress Studies Center, University of Houston, Department of Psychology, 3695 Cullen Boulevard, 126 Heyne Building, Houston, TX 77204, USA. (A.A. Vujanovic)
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Paulus DJ, Gallagher MW, Bartlett BA, Tran J, Vujanovic AA. The unique and interactive effects of anxiety sensitivity and emotion dysregulation in relation to posttraumatic stress, depressive, and anxiety symptoms among trauma-exposed firefighters. Compr Psychiatry 2018; 84:54-61. [PMID: 29694933 DOI: 10.1016/j.comppsych.2018.03.012] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2017] [Revised: 03/22/2018] [Accepted: 03/29/2018] [Indexed: 10/17/2022] Open
Abstract
BACKGROUND Firefighters are chronically exposed to traumatic events. Relatedly, past work has documented high rates of psychiatric problems, such as posttraumatic stress symptoms and depression, among firefighters. Less is known regarding anxiety symptoms among firefighters. Moreover, little work has examined risk/maintenance factors related to these symptoms among firefighters. Doing so may be important to developing interventions tailored to trauma-exposed firefighters. The current study examined symptoms of posttraumatic stress, depression, panic disorder, and social anxiety among trauma-exposed firefighters. PROCEDURE Using structural equation modeling, the main and interactive effects of anxiety sensitivity and emotion dysregulation were examined in relation to these symptom outcomes. Participants included 787 male urban firefighters reporting at least one past traumatic event. RESULTS There was a statistically significant main effect of anxiety sensitivity on each outcome. Emotion dysregulation exerted a statistically significant main effect on posttraumatic stress, depression, and social anxiety symptoms. Interactive effects of anxiety sensitivity and emotion dysregulation did not reach statistical significance but examination of effect sizes suggests that interactive effects may be present for posttraumatic stress symptoms (R2 = 0.011), depression (R2 = 0.008), and panic (R2 = 0.016) such that emotion dysregulation is more strongly related to outcomes when anxiety sensitivity levels are relatively lower. All effects were evident after controlling for trauma severity and history of armed forces service. CONCLUSION Overall, results suggest that anxiety sensitivity and emotion dysregulation represent unique risk/maintenance factors related to a broad range of emotional symptoms among trauma-exposed firefighters. These findings replicate patterns found among the general population and extend the findings to potentially vulnerable firefighters.
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Affiliation(s)
- Daniel J Paulus
- University of Houston, Department of Psychology, Houston, TX, USA.
| | - Matthew W Gallagher
- University of Houston, Department of Psychology, Houston, TX, USA; Texas Institute of Measurement Evaluation and Statistics (TIMES), Houston, TX, USA
| | | | - Jana Tran
- Houston Fire Department, Houston, TX, USA
| | - Anka A Vujanovic
- University of Houston, Department of Psychology, Houston, TX, USA.
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