Predicting post‐traumatic growth and post‐traumatic stress in firefighters

Latent profile analysis of post-traumatic stress and post-traumatic growth among firefighters

Background: Due to the job characteristics, firefighters are repeatedly exposed to trauma incidents. However, not all firefighters exhibit the same level of post-traumatic stress disorder (PTSD) or post-traumatic growth (PTG). Despite this, few studies have looked into firefighters' PTSD and PTG.Objective: This study identified subgroups of firefighters based on their PTSD and PTG levels, and investigated the influence of demographic factors and PTSD/PTG-related factors on latent class classification.Method: Latent profile analysis was used to examine the patterns of PTSD and PTG among 483 firefighters in South Korea. Using a cross-sectional design, demographic factors and job factors were examined as group covariates through a three-step approach. PTSD-related factors such as depression and suicide ideation, as well as PTG-related factors such as emotion-based response were analysed as differentiating factors.Results: Four classes were identified and named 'Low PTSD-low PTG (65.2%),' 'Mid PTSD-mid PTG (15.5%),' 'Low PTSD-high PTG (15.3%),' and 'High PTSD-mid PTG (3.9%).' The likelihood of belonging to the group with high trauma-related risks increased with more rotating shift work and years of service. The differentiating factors revealed differences based on the levels of PTSD and PTG in each group.Conclusions: 34.8% of firefighters experienced changes due to traumatic events while on the job, and some required serious attention. Modifiable job characteristics, such as the shift pattern, indirectly affected PTSD and PTG levels. Individual and job factors should be considered together when developing trauma interventions for firefighters.

Psychological Variables Associated With Post-Traumatic Stress Disorder in Firefighters: A Systematic Review

Firefighters are repeatedly exposed to work-related potential traumatic events and have an increased risk of developing post-traumatic stress disorder (PTSD). However, the mechanisms implicated in this relationship are not clear. The aim of this study was to analyse the risk and protective factors related to the development of PTSD in firefighters. According to PRISMA, a systematic review of scientific literature was conducted in Web of Science, PsycINFO, Scopus, PubMed and the Cochrane Central Register of Controlled Trials. Quality in Prognosis Studies (QUIPS) was used as the methodological quality indicator of the selected articles (PROSPERO reference CRD42020213009). Prognostic studies involving active firefighters with presence of post-traumatic symptomatology, presenting original findings, and written in Spanish or English were included. A total of 1768 potentially eligible articles were identified. According to the inclusion criteria, 87 articles were selected to evaluate the full text. Finally, 19 articles were included, comprising 12,298 active firefighters. There is high heterogeneity in the variables evaluated in the different studies. Taking the data for which this review has found more evidence (moderate support), operational stress, job duration, burnout, expressive suppression and rumination could be risk factors of PTSD, and belongingness and dispositional mindfulness could be protective factors. Other variables with weak support (e.g. resilience) were analysed. This review analyses the available literature, highlighting its scarcity for future research on the subject. Due to repeated trauma exposure, it is important to continue investigations and bear these variables in mind for the prevention of PTSD in firefighters.

Unchanging dynamics in posttraumatic growth in cancer patients: ways of coping and illness perception

Introduction

This study aims to address the positive changes due to traumatic experiences, such as being diagnosed with cancer and experiencing this disease for a certain period. Within this purpose, socio-demographic and disease-related variables, coping ways and illness perceptions that affect posttraumatic growth in cancer patients were examined. Secondly, the findings of this study, which is one of the first studies on posttraumatic growth in cancer patients in Turkey, were compared with the findings of current studies on the subject.

Method

Datums were collected by an interview form and three scales (Posttraumatic Growth Scale, Ways of Coping Inventory and Illness Perception Scale-R) to 78 cancer outpatients in Istanbul University Oncology Institute in 2007.

Results

Results showed that cancer patients have higher posttraumatic growth levels than the mean. According to analysis, posttraumatic growth total score between confrontive coping (t = -2.344, p < 0.05), self-controlling (t = -3.704, p < 0.001), accepting responsibility (t = -3.032, p < 0.01), escape-avoidance (t = -2.285, p < 0.05), planful problem solving (t = -2.502, p < 0.05), positive reappraisal (t = -5.241, p < 0.001), and seeking social support (t = -3.527, p < 0.01) has relationship. Also, there is a relation between posttraumatic growth subscales and the Revised form of Illness Perception Questionnaire; Change in relationships with others subscale (t = 2.887, p < 0.01) and Change in self-perception subscale (t = 2.660, p < 0.01) between timeline (acute/chronic), Change in self-perception subscale between timeline (cyclical) (t = -2.788, p < 0.01) and uncontrollable body factors (t = -1.916, p < 0.05) Change in philosophy of life subscale between external attributions (t = -2.057, p < 0.05) and Change in relationships with others subscale (t = -2.920, p < 0.01) between chance factors. It was found that positive reappraisal (F = 78.290, p < 0.001), self-controlling (F = 39.814, p < 0.001), and distancing (F = 46.311, p < 0.001) were significant predictors of posttraumatic growth total score. Results showed that ways of coping and illness perceptions were essential variables in posttraumatic growth.

Discussion

Studies on posttraumatic growth in Turkey and the world have significantly increased in recent years. This study aimed to examine the findings obtained from cancer patients in 2007 in discussion with the findings in the current literature. In this context, it is seen that the relevant variables affecting posttraumatic growth in cancer patients in different cultures do not change.

Walk the line: a systemic perspective on stress experienced by emergency medical personnel by comparing military and civilian prehospital settings

Introduction

Emergency Medicine (EM) personnel in both military and civilian prehospital settings are often exposed to stressful and extreme events. Therefore, a cross-pollination between both contexts in terms of coping strategies may generate new information for purposes of training, prevention, and support programs. In the current study, we aimed at comparing both contexts to understand the type of stress events personnel experience; whether experience differs between civilian and military personnel; and how they cope with it.

Methods

We used a mixed method approach, combining the results of a quantitative questionnaire and a thematic analysis of 23 in-depth semi-structured interviews to gain additional qualitative information.

Results

Whereas the questionnaire pointed to a significant preference for task-oriented coping over avoidant and emotion-oriented coping, the interviews offered a more nuanced insight, showing a constant aim to position themselves on a continuum between emotional disconnection from the patient to preserve operationality on the one hand; and remaining enough empathic to preserve humanity on the other hand. We further identified an ambivalent awareness regarding emotions and stress, a vulnerable disbalance between an excessive passion for the job with the sacrifice of own's personal life (for a growing volatile and dangerous working environment) and a lack of recognition from both the patient and organizational environment. The combination of these factors may carry the risk for moral injury and compassion fatigue. Therefore, mutual trust between the organizational level and EM personnel as well as among team members is crucial.

Discussion

The results are discussed from a systemic SHELL perspective, indicating how the specific profile of EM personnel relates to the software, hardware, environmental and liveware components of their professional and private life. Trainings on stress- and risk awareness should be approached both on an individual and systemic level, knowing that there is clearly no "one-size-fits-all" manner.

The role of cognitive flexibility in moderating the effect of school-related stress exposure

Educators are exposed to various stressful events as part of their ongoing work, including violence, sexual assaults, suicidal behavior, and loss or illness of students or their family members. Previous studies revealed an increased risk of developing PTSD symptoms in healthcare and supportive professionals exposed to repeated stress as part of their work. Cognitive flexibility might be a protective factor against the negative effect of such stress. The current study aimed to examine the interactive effects of school-related stress exposure and cognitive flexibility on the tendency to develop Post Traumatic Stress Disorder (PTSD) symptoms and the coping abilities of educators. One hundred and fifty educators (86.5% female; M_age = 43.08, M_{teaching_experience} = 12.90) volunteered to participate in this study. They completed questionnaires measuring levels of stress exposure, cognitive flexibility, coping ability, and PTSD symptoms. Analyses revealed that cognitive flexibility moderated the relationship between school-related stress exposure and both PTSD symptoms severity and maladaptive coping. Specifically, whereas educators with low cognitive flexibility exhibited positive associations between continuous stress exposure and both levels of PTSD symptoms and maladaptive coping, no such association was found among educators with high cognitive flexibility. The results highlight the importance of cognitive flexibility as a protective factor against the harmful effects of possible stress exposure in school environments. Awareness of the crucial role of cognitive flexibility as a protective factor for educators can be a breakthrough in improving educators' well-being and adaptive functioning.

Decent Work, Posttraumatic Stress Disorder, and Posttraumatic Growth From the Psychology of Working Perspective: A Three-Wave Study of Military Personnel

Scholarly interest in the relationship between decent work and mental health based on the Psychology of Working Theory has recently increased. This study evaluated the indirect effects of survival, social contribution, and self-determination needs satisfaction on the relationship between decent work and trauma-related mental health among military personnel. We conducted a three-wave survey over 1 year. Results showed that decent work predicted satisfaction of the three basic needs. Additionally, survival needs directly predicted posttraumatic stress disorder symptoms, while social contribution and self-determination needs directly predicted posttraumatic growth. Finally, decent work had a significant indirect effect on posttraumatic stress disorder symptoms via survival needs, whereas decent work had significant indirect effects on posttraumatic growth via social contribution and self-determination needs. Our findings suggest that the more military personnel perceive their work as decent and feel that their three basic needs are fulfilled, the more posttraumatic stress disorder symptoms diminish, and posttraumatic growth increases. We discuss the implications and need for follow-up studies.

Peer support facilitates post-traumatic growth in first responders: A literature review

Introduction

First responders are routinely exposed to traumatic workplace incidents that can result in post-traumatic stress disorder (PTSD). First responder organizations utilize different types of peer led programs to support first responders following a critical incident including the Critical Incident Stress Management Program (CISM) and stand-alone peer support programs. Little research has been done to determine the benefits or limitations of stand-alone peer support programs on the mental health of first responders. The aim of this project was to understand what characteristics of peer support facilitate post-traumatic growth (PTG) in first responders.

Methods

A literature search was completed using the City University of Seattle library database, ResearchGate and Google Scholar. The studies used in this review were found on EBCSOhost, ProQuest, PubMed and Wiley Online. This review includes literature published since 2006 that references post-traumatic growth in first responders, and/or their preferences for support, their coping styles and organizational impacts on growth. Thematic analysis was conducted to identify the themes and patterns in the final 10 research papers.

Results

This literature review identified five themes of formal and informal peer interactions that support PTG in first responders. (1) Peer support assists first responders with the processing of traumatic events and (2) managing organizational stressors. (3) Peer support alone may not lead to PTG and requires the use of adaptive coping behaviours. (4) First responders who actively engage with peer support experience increased well-being and (5) relational safety with peers encourages disclosure that leads to post-traumatic growth.

Conclusion

Formal and informal peer support contribute to post-traumatic growth (PTG) in first responders. Further research needs to be done to differentiate between the effects of trained peer support and support from colleagues.

Dynamic Psychotherapy as a PTSD Treatment for Firefighters: A Case Study

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.

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.

Change in 9/11-related post-traumatic stress symptoms following cancer diagnosis

OBJECTIVE

Cancer can be a life-threatening stressor that may evoke pre-existing post-traumatic stress disorder (PTSD). We assessed change in 9/11-related PTSD symptoms following cancer diagnosis in a 9/11-exposed cohort, the World Trade Center Health Registry.

METHODS

We examined enrollees who had a first-time post-9/11 invasive cancer diagnosis and at least one pre- and two post-diagnosis 9/11-related PTSD assessments from enrolment through 2015. PTSD symptoms were measured using 17-item PTSD Checklist (PCL, range 17-85). Cancer was identified from New York State Cancer Registry and categorized as localized or advanced stage. We used piecewise spline linear mixed-effects models to examine rate of change in PCL scores from pre- to post-diagnosis periods, and whether the change differed by gender or stage, with time as fixed and random effects, adjusting for baseline age, race, and education.

RESULTS

9/11-related PTSD symptoms were slightly increasing in the pre-diagnosis period, while this trend reversed in the post-diagnosis period (β: -0.38; 95% CI: -0.60, -0.15). This trend was driven by male rescue/recovery workers (RRW), among whom significant decrease in rate of change in PCL scores was observed for those with advanced stage (slope change difference [95% CI]: -1.81 [-2.73, -0.90]). No significant difference in rate of change was observed among non-RRW. Among females, PCL scores tended to decrease slightly, with no significant difference in rate of change between pre- and post-diagnosis periods.

CONCLUSIONS

We observed significant reduction in the rate of change in 9/11-related PTSD symptoms among male RRW. The underlying mechanism is unknown, necessitating future research.

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

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

Mental health and wellbeing of Australian police and emergency services employees

Answering the Call, the Australian National Police and Emergency Services Mental Health and Wellbeing Study, surveyed 14,868 Australian ambulance, fire and rescue, police, and state emergency service employees. Emergency services personnel had lower rates of mental wellbeing and higher rates of psychological distress and probable PTSD than the general adult population. Overall 30% had low wellbeing, 21% had high and 9% had very high psychological distress, and 10% had probable PTSD. An estimated 5% had suicidal ideation and 2% had a suicide plan in the past 12 months, while 16% binge drink at least weekly. Only one in five of those with very high psychological distress or probable PTSD felt they received adequate support for their condition. These findings highlight the risk of mental health conditions associated with work in the emergency services sector.

Post-traumatic stress, personal risk and post-traumatic growth among UK journalists

Background: Journalists covering traumatic news events can develop symptoms of post-traumatic stress disorder (PTSD). However, they may also experience perceived post-traumatic growth (PTG). The outcome may be affected by whether work-related traumatic stress has a degree of personal risk. Objective: To investigate the relationship between PTSD symptoms and PTG among journalists who experienced work-related trauma and to examine whether positive associations would exist between exposure to personal risk and PTG. Method: A web-based survey measuring post-traumatic stress symptoms and post-traumatic growth was completed by print and broadcast journalists (N = 69) working for UK-based media organizations. An open-ended question asked participants how media organizations can help to promote growth after work-related trauma. Results: The findings show a significant relationship between PTSD symptoms and PTG (p = 0.04). Journalists working in war-zones had significantly more PTSD symptoms (p < .001) and PTG scores (p < .001) than those who did not. Journalists who described their worst, work-related trauma as having a degree of personal, life-threatening risk, also reported higher levels of PTG than those who did not (p < .001). This was consistent across all PTG subscales. Conclusions: This study, the first to examine PTSD symptoms, personal risk and post-traumatic growth within journalists, suggests those working in conflict areas experience significantly higher levels of post-traumatic stress and post-traumatic growth, than those who do not. Those who experience personal risk also had high PTG levels. Media companies can help develop PTG by recognizing when personal risk plays a role in covering demanding assignments. Participants suggested organizations also needed to allow sufficient time for reflection and meaning-making for all those working in hostile environments.

Enhancement from being present: Dispositional mindfulness moderates the longitudinal relationship between perceived social support and posttraumatic growth in Chinese firefighters

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.

Social Embeddedness of Firefighters, Paramedics, Specialized Nurses, Police Officers, and Military Personnel: Systematic Review in Relation to the Risk of Traumatization

Background: Firefighters, paramedics, specialized nurses working in Intensive Care Units (ICUs), Operating Rooms (OR), and Emergency Rooms (ER), police officers and military personnel are more frequently exposed to potentially traumatic events than the general population; they are considered high-risk professionals. To reduce the risk of traumatization it is of great importance to be embedded in a social environment with supportive relationships. Methods: We performed a systematic review (based on the PRISMA-Guidelines) looking for social connections within the environment in which high-risk professionals are embedded (work, home, community), to obtain evidence on the impact of these connections on the risk of traumatization. Additionally, we aim to identify relevant supportive relationships in the professionals' environments. We identified the relevant scientific literature by searching, without time, and language restriction, five electronic bibliographic databases: MEDLINE, PsycINFO, Sociological Abstracts, CINAHL, and Web of Science. These databases were last searched in January 2019. Results: A qualitative analysis of the 89 eligible (out of 9,047 screened) studies shows that for firefighters, paramedics, and emergency nurses social connections in their work environment are predominantly supportive relationships and may protect them against traumatization. In other occupations (OR-nurses, ICU-nurses, police officers), however, social connections at work are not only a source of support but are also a source of stress. For military personnel study results are inconclusive as to whether their social connections at work or at home support them against traumatization. In so far as connections are supportive, their sources vary greatly from one occupational group to another; they differ between work vs. home as well as within work between peers vs. supervisor. Conclusions: Being embedded in a social environment, i.e., having social connections, is important but not always sufficient to protect high-risk professionals against traumatization. For, while these connections may be the antecedents of supportive relationships, they can also be the antecedents of damaging relationships. Additionally, the sources of supportive relationships differ among groups. This suggests that knowledge of how the social structures of the occupational groups differ may increase our understanding of the impact of social connections and relationships, including socialization, on the risk of traumatization of high-risk professionals.

The Relationship between "Self-Care Ability" and Psychological Changes among Hemodialysis Patients

Aim:

The study investigates and analyzes the relationship among the concepts of demoralization, posttraumatic growth, and self-care ability in patients undergoing hemodialysis.

Methods:

The cross-sectional descriptive correlational study was conducted in 2017 on 150 hemodialysis patients selected through census in Buali Hospital, Ardabil, Iran. Demoralization scale, the posttraumatic growth inventory, and self-care questionnaire were used for cross-sectional data collection. Data were analyzed using descriptive statistics, Pearson and Spearman correlation coefficient.

Results:

The mean and standard deviation of demoralization, posttraumatic growth, and self-care were 36.25 ± 18.84, 63.17 ± 17.71, and 33.89 ± 6.40, respectively. Self-care ability was positively associated with posttraumatic growth (r = 0.287) and negatively related to demoralization (r = −0.168). Self-care ability was also found to be desirable in 84.7% of the patients.

Conclusions:

Hemodialysis patients can experience both positive and negative psychological changes. Self-care ability is associated with reductions in negative psychological problems and increases in positive psychological changes. Health-care providers can, therefore, help hemodialysis patients to improve their psychological conditions by making plans for improving self-care abilities.

Considering the Impact of Early Trauma on Coping and Pathology to Predict Posttraumatic Growth Among 9-1-1 Telecommunicators

Recent research has demonstrated that first responders may report posttraumatic growth (PTG), positive psychological changes that arise in the aftermath of a trauma. Less is known regarding the perception of PTG among 9-1-1 telecommunicators, a group of first responders exposed to a high degree of lifetime trauma, including duty-related trauma as well as early and non-duty-related trauma. Moreover, the impact of childhood trauma on the processes involved in the perception of growth is less clear. While some distress is needed to facilitate processes that lead to the perception of PTG, it has been suggested that positive associations between PTG and pathology reflect avoidant coping or represent an illusory component of PTG. Structural equation models were used to examine early trauma exposure, coping, and pathology in predicting PTG among 9-1-1 telecommunicators (N = 788). In separate models using active and avoidant forms of coping, childhood trauma exposure had an indirect effect on PTG through coping. In a model considering both forms of coping, childhood trauma had an indirect effect on PTG through psychopathology, but not through coping. The results show that early trauma exposure leads to the perception of growth through pathways indicative of both adaptive and maladaptive coping processes.

Crescimento Pós-Traumático em Profissionais de Emergências: Uma Revisão Sistemática de Estudos Observacionais

Resumo A exposição a eventos traumáticos pode gerar Crescimento Pós-Traumático (CPT). O objetivo do presente estudo foi realizar uma revisão sistemática das publicações sobre prevalência de CPT e sua associação com estressores ocupacionais entre profissionais de emergências. A revisão foi baseada no método PRISMA e previamente registrada no PROSPERO. A busca foi realizada nas bases de dados Medical Literature Analysis and Retrieval System Online (Medline), Literatura Latino-Americana e do Caribe em Ciências da Saúde (Lilacs) e Scientific Electronic Library Online (ScIELO). Dentre os resultados, não foi possível identificar a prevalência de CPT. Estressores operacionais foram associados ao CPT. Estressores organizacionais foram raramente investigados. Concluiu-se que o CPT é um dos focos em estudos sobre reações pós-traumáticas entre profissionais de emergências e está associado a estressores ocupacionais. Por isso, trata-se de um construto importante para compreender a saúde mental desses profissionais, dada a organização e a natureza de suas tarefas no trabalho.

Job Crafting and Performance in Firefighters: The Role of Work Meaning and Work Engagement

The Job Demands-Resources (JD-R) model was often utilized as an explanatory framework when investigating the strain process among first responders in general and firefighters in particular. Yet, little is known about the motivational processes whithin firefighters. The aim of this study is to expand the knowledge regarding the motivational process of firefighters by investigating job crafting and introducing work meaning within the motivational framework of the JD-R model, in relation to job performance. A cross-sectional survey design was used to collect data from one sample consisting of Romanian firefighters (n = 1,151). Structural equation modeling indicated the existence of both a direct and an indirect effect between job crafting and job performance through work meaning and work engagement. Our findings suggest that firefighters actively engage in job crafting behaviors and also that work meaning can be an outcome of job crafting. Results also encourage further research related to the way work meaning impacts job performance, through its link with work engagement. This study raises attention on how Fire departments may be able to create a climate that emphasizes meaningfulness and engagement, together with opportunities toward job redesign and a focus process based on efficiency gain.

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

Firefighters are considered a high-risk group for the development of PTSD and other stress-related diseases. More than the exposure to potentially traumatic events, personal and occupational characteristics have been pointed out as interfering in the perception of stress, which may lead to the emergence of mental and physical symptoms. This study aimed to analyze the relationship between the main factors that contribute to stress-related diseases in firefighters. A systematic review was conducted in order to identify original articles focusing on risk and protective factors for stress in this population. Personality traits, training, experience in extreme situations and social and organizational support influence the perception of stress and, consequently, the choice of coping strategies, which may protect against or potentiate the stress reactions. The findings of this study allow us to draw a relational model that represents the dynamics among the factors related to stress in firefighters. The development of PTSD and other stress-related diseases depends on a host of pre-trauma and post-trauma factors and, although training is an important protective factor, being prepared to face extreme situations does not mean being immune to traumatic stress.

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

OBJECTIVE

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

METHODS

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

RESULTS

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

CONCLUSION

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

Posttraumatic Growth at Work

The phenomenon of posttraumatic growth—the transformative positive change that can occur as a result of a struggle with great adversity—has been a focus of interest for psychologists for more than two decades. Research on work-related posttraumatic growth has concentrated primarily on contexts that are inherently traumatic, either through direct exposure to trauma, such as in the military, or through secondary trauma, such as in professions that provide care for traumatized others. There is also an emerging literature on posttraumatic growth in “ordinary” work. Organized into seven sections, this review draws on the research on posttraumatic growth in response to both personal and work-based adversity to build a model of work-related posttraumatic growth. Later sections raise challenges in the study of posttraumatic growth at work and identify critical future research directions. Practical implications for organizations and their members are considered throughout the review and are summarized at the end.

Predicting Posttraumatic Growth among Firefighters: The Role of Deliberate Rumination and Problem-Focused Coping

Exposure to work-related traumatic incidents in firefighters may result in positive psychological changes which are termed “posttraumatic growth”. This study aimed to construct structure equation modeling based on the model of posttraumatic growth in firefighters. Methods: A total of 226 firefighters who had experienced a work-related traumatic incident participated. The participants from three municipal fire departments and seven fire stations completed an anonymous survey asking about extraversion, optimism, calling in the workplace, problem-focused coping, deliberate rumination, and posttraumatic growth. The model fit indices were suitable for the recommended level. Seven of the 11 paths established in the initial hypothetical model were identified. The variables of deliberate rumination, problem-focused coping, and extraversion had a significant effect on the posttraumatic growth of firefighters, with an explanatory power of 38.7%. The findings show that it is important to develop strategies to enhance deliberate rumination and problem-focused coping for firefighters after work-related traumatic events.

Conceptualization, Assessment, and Treatment of Traumatic Stress in First Responders: A Review of Critical Issues

First responders are regularly confronted with exposure to traumatic events, including potentially life-threatening situations as well as the grave injuries and deaths of colleagues and civilians. Evidence indicates that the prevalence of posttraumatic stress disorder (PTSD) is substantially higher among first responders than the general population. This article provides information about the outpatient trauma services at McLean Hospital's LEADER (Law Enforcement, Active Duty, Emergency Responder) program to assist clinicians who encounter these first responders in their practices or who are specifically interested in working with this patient population. We begin by synthesizing the literature on the prevalence of PTSD in first responders following work-related exposure to traumatic stress, and by addressing the occupation-specific risk factors and the third-variable risk factors that may contribute to potentiated risk. We then discuss assessment strategies and treatment options used in our program, which is tailored for individuals who are dealing with mental health issues stemming from occupation-specific traumatic-stress exposure. We also address the unique challenges of treating traumatized first responders with more complex issues such as traumatic stress exposure across the lifespan and safety issues, including acute suicidality. We conclude by discussing notable gaps in the literature, including the need to investigate why and how women present with different PTSD symptoms than men and how these differences need to be taken into account in determining appropriate treatment for women.

Sense of coherence is linked to post-traumatic growth after critical incidents in Austrian ambulance personnel

BACKGROUND

Ambulance personnel, as well as other emergency services like fire-fighters or the police force, are regularly confronted with experiences of extreme psychological distress and potentially traumatizing events in the line of their daily duties. As a consequence, this occupational group is exposed to an elevated risk of developing symptoms of Post-Traumatic Stress (PTSS). Subsequently, symptoms of Post-Traumatic Stress have been observed as potentially co-occurring with Post-Traumatic Growth (PTG) in ambulance personnel as well. Therefore, in this study we hypothesized that Sense of Coherence (SOC) might play an important role as an underlying feature in enabling growth after stressful experiences in Austrian ambulance personnel.

METHODS

In this study, voluntary and full-time ambulance personnel (n = 266) of the Austrian Red Cross ambulance service completed an online survey including the Sense of Coherence Scale (SOC-29), the Post-Traumatic Growth Inventory (PTGI) and the Impact of Event Scale Revised (IES-R) for the assessment of PTSS. In line with theoretical considerations, a two-step cluster analysis limited to four clusters and further ANOVAs were conducted.

RESULTS

Four clusters were confirmed and labelled PTSS-low/PTG-low, PTSS-low/PTG-high, PTSS-high/PTG-high and PTSS-high/PTG-low. Further ANOVAs revealed substantial cluster differences in SOC, with higher SOC-levels in PTSS-high/PTG-high than in PTSS-high/PTG-low (p < .01), in PTSS-low/PTG-high than in PTSS-low/PTG-low (p < .01) and in PTSS-low/PTG-high than in PTSS-high/PTG-low (p < .01).

CONCLUSIONS

Our findings point to a significant association between SOC and the development of PTG in ambulance personnel. Furthermore, the results suggest that growth and stress after critical incidents are independent from each other and can co-exist. Therefore, promoting SOC (e.g., meaningfulness) in ambulance personnel - e.g., through psychological interventions - might preserve and enhance psychological health after critical incidents.

Workplace relationships impact self-rated health: A survey of Swedish municipal health care employees

BACKGROUND

The impact of positive social relationships on the health of municipal employees in the elder care sector in Sweden needs further examination.

OBJECTIVE

To explore the association between health and relationships among elderly care employees using a salutogenic perspective.

METHOD

Survey of all employees (n = 997) in special housing, home care and Disabled Support and Services in a Swedish municipality. The questionnaire, which had a salutogenic perspective, included information on self-rated health from the previously validated SHIS (Salutogenic Health Indicator Scale), psychosocial work environment and experiences, social climate, and health-promoting workplace relationships.

RESULTS

The response rate was 69% . Results of a multivariable linear regression model showed four significant predictors of health: general work experiences, colleague belongingness and positive relationships with managers and care recipients. In another model, colleague belongingness was significantly related to satisfaction with care recipients, work, length of employment as well as general work experiences and relationships with managers.

CONCLUSION

Strengthening of positive work relationships, not only between workmates but also with managers and care recipients, seems to be an essential area for employee health promotion. Colleague belongingness may be deepened by development of a positive work climate, including satisfactory work experiences, positive manager relationships and a stable work force.

Research into Australian emergency services personnel mental health and wellbeing: An evidence map

BACKGROUND

Evidence maps are a method of systematically characterising the range of research activity in broad topic areas and are a tool for guiding research priorities.

AIMS

'Evidence-mapping' methodology was used to quantify the nature and distribution of recent peer-reviewed research into the mental health and wellbeing of Australian emergency services personnel.

METHODS

A search of the PsycINFO, EMBASE and Cochrane Library databases was performed for primary research articles that were published between January 2011 and July 2016.

RESULTS

In all, 43 studies of primary research were identified and mapped. The majority of the research focused on organisational and individual/social factors and how they relate to mental health problems/wellbeing. There were several areas of research where very few studies were detected through the mapping process, including suicide, personality, stigma and pre-employment factors that may contribute to mental health outcomes and the use of e-health. No studies were detected which examined the prevalence of self-harm and/or harm to others, bullying, alcohol/substance use, barriers to care or experience of families of emergency services personnel. In addition, there was no comprehensive national study that had investigated all sectors of emergency services personnel.

CONCLUSION

This evidence map highlights the need for future research to address the current gaps in mental health and wellbeing research among Australian emergency services personnel. Improved understanding of the mental health and wellbeing of emergency services personnel, and the factors that contribute, should guide organisations' wellbeing policies and procedures.

Association between resiliency and posttraumatic growth in firefighters: the role of stress appraisal

The purpose of this study was to establish the relation between resiliency and the level of positive changes, comprising posttraumatic growth in a group of firefighters experiencing job-related traumatic events and the mediating role of stress appraisal in this relation. The study was performed on a group of 100 firefighters from firefighting and rescue brigades, out of which 75 admitted to experiencing a traumatic event. Firefighters covered by the study were on average 31.51 years old (SD = 6.34). A Polish version of Posttraumatic Growth Inventory, the Resiliency Assessment Scale and Stress Appraisal Questionnaire were used in the study. The results have shown that 22.7% of firefighters displayed low, 58.6% average and 18.7% high intensity of positive changes resulting from a traumatic event. Resiliency poorly correlates with posttraumatic growth expressed in changes in self-perception, and strongly correlates with stress appraisal, negatively correlates with threat and harm/loss and positively correlates with challenge. Appraisal of stress as a threat and challenge appeared to be mediators of the relationship between resiliency and posttraumatic growth.