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Kaufman CC, McHugh RK, Drury M, Merrill JG, Rosmarin DH. Spirituality/Religion Among First Responders With and Without Posttraumatic Stress Disorder and Alcohol Misuse. J Dual Diagn 2024:1-12. [PMID: 38560884 DOI: 10.1080/15504263.2024.2330619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/04/2024]
Abstract
Objective: To examine the co-occurrence of alcohol misuse and posttraumatic stress disorder (PTSD) and potential sources of coping (e.g., spirituality/religion) and clinically relevant variables among first responders (e.g., firefighters, law enforcement corrections officers, paramedics). Method: We assessed rates of independent and co-occurring alcohol misuse and PTSD among a national online sample of 320 first responders as well as the prevalence and salience of S/R, guilt, shame, moral injury, aspects of S/R, and treatment interest. Results: In our sample, 46.88% (n = 150) met criteria for comorbid alcohol misuse and probable PTSD and individuals with these comorbid conditions reported significantly greater negative religious coping, moral injury, and shame than all other diagnostic groups (i.e., independent alcohol misuse, independent PTSD, and neither). Correlations also revealed significant relationships between alcohol misuse and PTSD symptomatology with positive and negative religious coping, moral injury, shame, guilt, interest in treatment, and interest in spiritually integrated treatment. Conclusions: Findings highlight the high rates of independent and co-occurring alcohol misuse and PTSD among first responders as well as the salience of S/R in this population.
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Affiliation(s)
- Caroline C Kaufman
- Department of Psychiatry, Harvard Medical School, Belmont, Massachusetts, USA
- Spirituality and Mental Health Program, McLean Hospital, Belmont, Massachusetts, USA
| | - R Kathryn McHugh
- Department of Psychiatry, Harvard Medical School, Belmont, Massachusetts, USA
- McLean Hospital Stress, Anxiety, and Substance Use Laboratory, Belmont, Massachusetts, USA
| | - Mia Drury
- Spirituality and Mental Health Program, McLean Hospital, Belmont, Massachusetts, USA
| | - Julia G Merrill
- Department of Geriatrics, McLean Hospital, Belmont, Massachusetts, USA
| | - David H Rosmarin
- Department of Psychiatry, Harvard Medical School, Belmont, Massachusetts, USA
- Spirituality and Mental Health Program, McLean Hospital, Belmont, Massachusetts, USA
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2
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Beahm JD, McCall HC, Carleton RN, Jones N, Hadjistavropoulos HD. Examining how organizational leaders perceive internet-delivered cognitive behavioural therapy for public safety personnel using the RE-AIM implementation framework. Internet Interv 2024; 35:100718. [PMID: 38318086 PMCID: PMC10840103 DOI: 10.1016/j.invent.2024.100718] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2023] [Revised: 01/21/2024] [Accepted: 01/23/2024] [Indexed: 02/07/2024] Open
Abstract
Background Within Canada, internet-delivered cognitive behavioural therapy (ICBT) has recently been tailored by PSPNET to meet the needs of public safety personnel (PSP) to help address high rates of mental health problems within this population. Perceptions and outcomes of ICBT among PSP are promising, but it remains unknown how PSPNET is perceived by PSP organizational leaders. It is important to assess this gap because these leaders have significant potential to influence the uptake of ICBT. Methods In the current study, PSP leaders (n = 10) were interviewed to examine their perceptions of PSPNET and opportunities to improve ICBT implementation. The RE-AIM evaluation framework was used to assess PSP leaders' perceptions of PSPNET in terms of reach, effectiveness, adoption, implementation, and maintenance. Results The results evidenced that leaders perceived PSPNET as effective in reaching and serving PSP and PSP organizations. PSP leaders reported perceiving ICBT as effectively implemented, especially for being freely offered to individual PSP and for improving PSP's access to experienced therapists specifically trained to work with PSP. Participants indicated organizations have promoted and will continue promoting PSPNET longer-term, facilitating adoption and maintenance. Factors perceived as facilitating successful service delivery included building relationships and trust with PSP organizations and general support for PSP leadership mental health initiatives. PSP leaders identified perceived areas for improving ICBT implementation (e.g., ensuring leaders have access to data on PSPNET uptake and outcomes, creating promotional videos, expanding availability of PSPNET to other provinces, offering additional options for receiving therapist support). Implications Overall, the study provides insights into PSP leaders' perceptions of the implementation of ICBT among PSP and ideas for optimizing implementation efforts.
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Affiliation(s)
- Janine D. Beahm
- Department of Psychology, University of Regina, 3737 Wascana Pkwy, Regina, SK S4S 0A2, Canada
- PSPNET, University of Regina, 2 Research Drive, Regina, SK S4T 2P7, Canada
| | - Hugh C. McCall
- Department of Psychology, University of Regina, 3737 Wascana Pkwy, Regina, SK S4S 0A2, Canada
- PSPNET, University of Regina, 2 Research Drive, Regina, SK S4T 2P7, Canada
| | - R. Nicholas Carleton
- Department of Psychology, University of Regina, 3737 Wascana Pkwy, Regina, SK S4S 0A2, Canada
- PSPNET, University of Regina, 2 Research Drive, Regina, SK S4T 2P7, Canada
| | - Nicholas Jones
- PSPNET, University of Regina, 2 Research Drive, Regina, SK S4T 2P7, Canada
- Department of Justice Studies, University of Regina, 3737 Wascana Pkwy, Regina, SK S4S 0A2, Canada
| | - Heather D. Hadjistavropoulos
- Department of Psychology, University of Regina, 3737 Wascana Pkwy, Regina, SK S4S 0A2, Canada
- PSPNET, University of Regina, 2 Research Drive, Regina, SK S4T 2P7, Canada
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3
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Knobloch LK, Owens JL. The REBOOT First Responders Program: Insights of U.S. Graduates. JOURNAL OF RELIGION AND HEALTH 2023; 62:4088-4111. [PMID: 37747663 DOI: 10.1007/s10943-023-01887-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 07/31/2023] [Indexed: 09/26/2023]
Abstract
The REBOOT First Responders program offers spiritual care for occupational stress. Although prior work suggests benefits to the program, no research has considered attendees' experiences in an open-ended way. The aim of this study was to document first responders' thoughts about the effectiveness, evaluation, and effects of the course in their own words. Interviews with 36 graduates living in the U.S. indicated favorable perceptions of the course. Reasons for success included the program's tangible benefits, community atmosphere, and faith-based approach (RQ1). Strengths involved helping first responders realize they are not alone and educating them about trauma; recommended upgrades involved customizing to specific occupations and offering ongoing support (RQ2). Effects included more self-acceptance, enhanced spirituality, better relationships, a more constructive view of trauma, and greater optimism about the future (RQ3). These results have implications for improving spiritual care for first responders.
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Affiliation(s)
- Leanne K Knobloch
- Department of Communication, University of Illinois Urbana-Champaign, 3001 Lincoln Hall, 702 South Wright Street, Urbana, IL, 61801, USA.
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4
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Fisher MP, Lavender CD. Ensuring Optimal Mental Health Programs and Policies for First Responders: Opportunities and Challenges in One U.S. State. Community Ment Health J 2023; 59:1341-1351. [PMID: 36947386 PMCID: PMC10031720 DOI: 10.1007/s10597-023-01121-1] [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: 10/02/2022] [Accepted: 03/14/2023] [Indexed: 03/23/2023]
Abstract
This study examined opportunities and challenges faced by individuals working to advance mental health policy and programming for first responders. We utilized qualitative content analysis and interviews with 16 firefighters, emergency medical services professionals, law enforcement officers, and others involved in programming or policy in the U.S. state of Ohio. Six themes characterized opportunities and challenges encountered: (1) variations in programming and policy exist across jurisdictions; (2) opportunities exist to enhance mental health awareness and self-care training for first responders; (3) need exists for specialized mental health clinicians accustomed to and capable of effectively working with first responders; (4) confidentiality protections are lacking for peer supporters not trained in critical incident stress management; (5) having an internal champion and broader support is key to program and policy advancement; and (6) interdepartmental collaboration provides opportunities for sharing resources and best practices. Results illustrate continued need for strategic policymaking, program development, and coordination.
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Affiliation(s)
- Michael P Fisher
- Department of Health Policy, Management & Leadership, School of Public Health, West Virginia University, P.O. Box 9190, Morgantown, WV, 26505, USA.
| | - Catherine D Lavender
- Department of Occupational Therapy & Occupational Science, College of Health Professions, Towson University, 8000 York Road, Linthicum Hall, Towson, MD, 21252, USA
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5
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Loveless AM, Games KE, Shea ME, Thews KN, Winkelmann ZK. Experiences of Athletic Trainers in Tactical Athlete Settings When Managing Patients With Mental Health Conditions. J Athl Train 2023; 58:865-875. [PMID: 35724359 PMCID: PMC11215713 DOI: 10.4085/1062-6050-0148.22] [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] [Indexed: 11/09/2022]
Abstract
CONTEXT Researchers have demonstrated that job demands impair tactical athletes' mental health. Mental health stigmas in this population and limited resources may prevent individuals from receiving care. Athletic trainers (ATs) are often the first, and sometimes the only, contact for mental health concerns. Previous literature indicated that ATs desired more psychosocial training and experience. OBJECTIVE To investigate ATs' preparedness and experiences managing patients with mental health conditions in the tactical athlete setting. DESIGN Consensual qualitative research study. SETTING One-on-one, semistructured interviews. PATIENTS OR OTHER PARTICIPANTS Fifteen ATs (men = 7, women = 8; age = 36 ± 10 years; experience in tactical athlete setting = 4 years [range, 6 months-20 years]; military = 12, law enforcement = 2; fire service = 1). MAIN OUTCOME MEASURE(S) Interviews followed a 9-question protocol focused on job setting preparation, mental health training, and perceived role managing patients with mental health concerns. Interviews were audio recorded and transcribed verbatim. A 3-person coding team convened for data analysis following the consensual qualitative research tradition. Credibility and trustworthiness were established using a stability check, member checking, and multianalyst triangulation. RESULTS Four domains emerged surrounding ATs' mental health management experiences with tactical athletes: (1) population norms, (2) provider preparation, (3) provider context, and (4) structure of job responsibilities. Most ATs felt their educational experiences lacked comprehensive mental health training. Some participants described formal employer resources that were optional or mandatory for their job, whereas others engaged in self-education to feel prepared for this setting. Participants shared that unfamiliar experiences, such as divorce and deployment, influenced their context as providers. Most ATs had no policy related to mental health care and referral, indicating it was outside their responsibilities or they were unsure of role delineation. CONCLUSIONS For ATs working with tactical athletes, our respondents suggested that additional mental health education and training are necessary. They also indicated that improvement is needed in job structure regarding role delineation and the establishment of policies regarding behavioral health.
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Affiliation(s)
- Amy M. Loveless
- Department of Exercise Science, University of South Carolina, Columbia
| | - Kenneth E. Games
- Department of Applied Medicine and Rehabilitation, Indiana State University, Terre Haute
| | - Maura E. Shea
- First Line Tactical Athlete Program, Forte Sports Medicine and Orthopedics, Indianapolis, IN
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6
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Olthuis JV, Kaltenbach E, Giberson E, Saryeddine T, Asmundson GJG, Carleton RN, Cramm H, Crombach A, Devlin J, Mack J, Lingley-Pottie P, Rao S, Sullivan M, Wozney L, McGrath PJ. Paraprofessional delivery of online narrative exposure therapy for firefighters. J Trauma Stress 2023; 36:772-784. [PMID: 37291963 DOI: 10.1002/jts.22941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Revised: 03/21/2023] [Accepted: 04/08/2023] [Indexed: 06/10/2023]
Abstract
Firefighters are at increased risk for developing posttraumatic stress disorder (PTSD) and face numerous barriers to accessing mental health care. Innovative ways to increase access to evidence-based interventions are needed. This study was a case series testing the acceptability, feasibility, and preliminary effectiveness of a paraprofessional-delivered, virtual narrative exposure therapy (eNET) intervention for PTSD. Participants were 21 firefighters who met the criteria for clinical or subclinical probable PTSD and completed 10-12 sessions of eNET via videoconference. Participants completed self-report measures pre- and postintervention and at 2- and 6-month follow-ups as well as a postintervention qualitative interview. Paired samples t tests evidenced statistically significant decreases in PTSD, anxiety, and depressive symptom severity and functional impairment from pre- to postintervention, ds = 1.08-1.33, and in PTSD and anxiety symptom severity and functional impairment from preintervention to 6-month follow-up, ds = 0.69-1.10. The average PTSD symptom severity score fell from above to below the clinical cutoff for probable PTSD at postintervention and follow-ups. Qualitative interviews indicated that paraprofessionals were considered central to participants' success and experience with the intervention. No adverse events or safety concerns were raised. This study is an important step in demonstrating that appropriately trained and supervised paraprofessionals can effectively deliver eNET to firefighters with PTSD.
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Affiliation(s)
- Janine V Olthuis
- Department of Psychology, University of New Brunswick, Fredericton, New Brunswick, Canada
| | | | - Emma Giberson
- Department of Psychology, University of New Brunswick, Fredericton, New Brunswick, Canada
| | - Tina Saryeddine
- Canadian Association of Fire Chiefs, Ottawa, Ontario, Canada
- Telfer School of Management, University of Ottawa, Ottawa, Ontario, Canada
| | | | - R Nicholas Carleton
- Department of Psychology, University of Regina, Regina, Saskatchewan, Canada
| | - Heidi Cramm
- School of Rehabilitation Therapy, Queen's University, Kingston, Ontario, Canada
| | - Anselm Crombach
- Department of Psychology, Universität des Saarlandes, Saarbrücken, Germany
| | - Julie Devlin
- Conservation and Protection, Fisheries and Oceans Canada, Ottawa, Ontario, Canada
| | - Jeff Mack
- Fredericton Fire Department, Fredericton, New Brunswick, Canada
| | - Patricia Lingley-Pottie
- IWK Health Centre, Halifax, Nova Scotia, Canada
- Department of Psychiatry, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Sanjay Rao
- Department of Psychiatry, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Michael Sullivan
- Department of Psychology, McGill University, Montreal, Québec, Canada
| | - Lori Wozney
- IWK Health Centre, Halifax, Nova Scotia, Canada
| | - Patrick J McGrath
- IWK Health Centre, Halifax, Nova Scotia, Canada
- Department of Psychiatry, Dalhousie University, Halifax, Nova Scotia, Canada
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7
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Riccardi E, Fontana L, Pacella D, Fusco F, Marinaro I, Costanzo G, Vassallo F, Triassi M, Iavicoli I. Impact of Covid-19 pandemic on psychological well-being of firefighters. Saf Health Work 2023:S2093-7911(23)00036-7. [PMID: 37361372 PMCID: PMC10268815 DOI: 10.1016/j.shaw.2023.06.002] [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: 12/01/2022] [Revised: 04/26/2023] [Accepted: 06/10/2023] [Indexed: 06/28/2023] Open
Abstract
Background Covid-19 pandemic represented a unique stressful event that affected the physical health and the psychological well-being (PWB) of individuals and communities. Monitoring PWB is essential to clarify the burden on mental health effects but also to define targeted psychological-supporting measures. This cross-sectional study evaluated the PWB of Italian firefighters during the pandemic. Methods Firefighters recruited during the pandemic period filled out a self-administered questionnaire the Psychological General Well-Being Index during the health surveillance medical examination. This tool is usually used to assess the global PWB and explores six subdomains: anxiety, depressed mood, positive well-being, self-control, general health, and vitality. The influencing role of age, gender, working activities, Covid-19 and pandemic restrictive measures was also explored. Results A total of 742 firefighters completed the survey. The aggregate median PWB global score was in the "no distress" range (94.3±10.3) resulting higher than that observed in studies conducted using the same tool in the Italian general population during the same pandemic period. Similar findings were observed in the specific subdomains thus suggesting that investigated population was in good PWB condition. Interestingly, significantly better outcomes were detected in the younger firefighters. Conclusion Our data showed a satisfactory PWB situation in firefighters that could be related to different professional factors such as work organization, mental and physical training. In particular, our results would suggest the hypothesis that in firefighters, the maintaining of a minimum/moderate level of physical activity (consisting of even just going to work) might had a profoundly positive impact on psychological health and well-being.
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Affiliation(s)
- Elisabetta Riccardi
- Department of Public Health, University of Naples "Federico II", Via S. Pansini 5, 80131 Naples, Italy
| | - Luca Fontana
- Department of Public Health, University of Naples "Federico II", Via S. Pansini 5, 80131 Naples, Italy
| | - Daniela Pacella
- Department of Public Health, University of Naples "Federico II", Via S. Pansini 5, 80131 Naples, Italy
| | - Fabio Fusco
- Department of Public Health, University of Naples "Federico II", Via S. Pansini 5, 80131 Naples, Italy
| | - Ilaria Marinaro
- Department of Public Health, University of Naples "Federico II", Via S. Pansini 5, 80131 Naples, Italy
| | - Giovanna Costanzo
- Department of Public Health, University of Naples "Federico II", Via S. Pansini 5, 80131 Naples, Italy
| | - Francesco Vassallo
- Regional Direction of Campania Firefighters, Via del Sole 10, 80138 Naples, Italy
| | - Maria Triassi
- Department of Public Health, University of Naples "Federico II", Via S. Pansini 5, 80131 Naples, Italy
| | - Ivo Iavicoli
- Department of Public Health, University of Naples "Federico II", Via S. Pansini 5, 80131 Naples, Italy
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8
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Sidossis A, Lan FY, Hershey MS, Hadkhale K, Kales SN. Cancer and Potential Prevention with Lifestyle among Career Firefighters: A Narrative Review. Cancers (Basel) 2023; 15:cancers15092442. [PMID: 37173909 PMCID: PMC10177420 DOI: 10.3390/cancers15092442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Revised: 04/13/2023] [Accepted: 04/19/2023] [Indexed: 05/15/2023] Open
Abstract
Career firefighters are at considerable risk for chronic diseases, including an increased risk of various cancers, compared to the general population. Over the last two decades, several systematic reviews and large cohort studies have demonstrated that firefighters have statistically significant increases in overall and site-specific cancer incidence and site-specific cancer mortality compared to the general population. Exposure assessment and other studies have documented exposures to a variety of carcinogens in fire smoke and within the fire station. Other occupational factors such as shift work, sedentary behavior, and the fire service food culture may also contribute to this working population's increased cancer risk. Furthermore, obesity and other lifestyle behaviors such as tobacco use, excessive alcohol consumption, poor diet, inadequate physical activity, and short sleep duration have also been associated with an increased risk of certain firefighting-associated cancers. Putative prevention strategies are proposed based on suspected occupational and lifestyle risk factors.
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Affiliation(s)
- Amalia Sidossis
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA 02138, USA
| | - Fan-Yun Lan
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA 02138, USA
- Division of Occupational Medicine, Cambridge Health Alliance/Harvard Medical School, Cambridge, MA 02139, USA
- Institute of Health and Welfare Policy, National Yang Ming Chiao Tung University, Taipei 112, Taiwan
- Occupational Medicine, Department of Family Medicine, National Yang Ming Chiao Tung University Hospital, Yilan 260, Taiwan
| | - Maria S Hershey
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA 02138, USA
| | - Kishor Hadkhale
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA 02138, USA
- Division of Occupational Medicine, Cambridge Health Alliance/Harvard Medical School, Cambridge, MA 02139, USA
- Faculty of Social Sciences Health Sciences (Epidemiology), Tampere University, 33100 Tampere, Finland
| | - Stefanos N Kales
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA 02138, USA
- Division of Occupational Medicine, Cambridge Health Alliance/Harvard Medical School, Cambridge, MA 02139, USA
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9
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Landry CA, Beahm JD, McCall HC, Hadjistavropoulos HD. Sustaining and Expanding Internet-Delivered Cognitive Behavioral Therapy (ICBT) for Public Safety Personnel across Canada: A Survey of Stakeholder Perspectives. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:ijerph20085592. [PMID: 37107874 PMCID: PMC10139003 DOI: 10.3390/ijerph20085592] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Revised: 03/16/2023] [Accepted: 04/12/2023] [Indexed: 05/10/2023]
Abstract
Public safety personnel (PSP) experience an elevated risk of mental health problems and face barriers to treatment. Internet-delivered cognitive behavioral therapy (ICBT) has been tailored to PSP to improve access to mental health care. In this study, we sought to investigate perceptions of ICBT, particularly among those with and without prior knowledge of ICBT and between PSP leaders and non-leaders. A survey was administered to 524 PSP from across Canada to identify (a) how PSP perceive ICBT, (b) the extent of organizational support for tailored ICBT in PSP organizations, particularly leadership's support, and (c) perceived facilitators and barriers to funding tailored ICBT. The results indicated that PSP perceive ICBT to have more advantages than disadvantages. PSP who had previously heard of tailored ICBT had more positive perceptions. PSP indicated that there is a need for ICBT, and PSP leaders indicated their support for the implementation of tailored ICBT. The study identified that there is a need for increasing awareness of the effectiveness of and need for ICBT in order to facilitate funding of services. Overall, the current study indicates that PSP support ICBT as a valued form of therapy and that policy makers and service providers seeking to provide ICBT to PSP may increase support for ICBT services through more education and awareness.
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Affiliation(s)
- Caeleigh A. Landry
- Department of Psychology, University of Regina, 3737 Wascana Pkwy, Regina, SK S4S 0A2, Canada
- PSPNET, University of Regina, 2 Research Drive, Regina, SK S4T 2P7, Canada
| | - Janine D. Beahm
- Department of Psychology, University of Regina, 3737 Wascana Pkwy, Regina, SK S4S 0A2, Canada
- PSPNET, University of Regina, 2 Research Drive, Regina, SK S4T 2P7, Canada
| | - Hugh C. McCall
- Department of Psychology, University of Regina, 3737 Wascana Pkwy, Regina, SK S4S 0A2, Canada
- PSPNET, University of Regina, 2 Research Drive, Regina, SK S4T 2P7, Canada
| | - Heather D. Hadjistavropoulos
- Department of Psychology, University of Regina, 3737 Wascana Pkwy, Regina, SK S4S 0A2, Canada
- PSPNET, University of Regina, 2 Research Drive, Regina, SK S4T 2P7, Canada
- Correspondence:
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10
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McKeon G, Wells R, Steel Z, Hadzi-Pavlovic D, Teasdale S, Vancampfort D, Rosenbaum S. An online mental health informed physical activity intervention for emergency service workers and their families: A stepped-wedge trial. Digit Health 2023; 9:20552076221149294. [PMID: 36703879 PMCID: PMC9871982 DOI: 10.1177/20552076221149294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Accepted: 12/18/2022] [Indexed: 01/20/2023] Open
Abstract
Objective Emergency service workers are at risk of experiencing poor mental health due to repeated exposure to potentially traumatic events. Promoting healthy lifestyle factors may help improve health outcomes and quality of life among this population. This study aimed to evaluate the efficacy of a 10-week physical activity (PA) and diet programme delivered via Facebook for sedentary emergency service workers and their support partners on levels of psychological distress. Methods We delivered a 10-week intervention via a private Facebook group facilitated by exercise physiologists, a dietitian and peer-facilitators. Weekly education modules and telehealth calls were delivered, and participants were provided with a PA tracking device (Fitbit accelerometer). A stepped-wedge design was applied to compare levels of psychological distress (K6) during baseline, to intervention by comparing slopes of change. Secondary pre-post outcomes included mental health symptoms, PA, quality of life, social support to exercise, sleep quality and suicidal ideation. Results In total, N=90 participants (n=47 emergency service workers and n=43 support partners) were recruited in 4 cohorts (aged 42.3±11.5 years, 51% male). Levels of psychological distress did not change significantly during the baseline (control) slope and reduced significantly during the first 6 weeks of intervention (intervention slope 1). The slopes were significantly different, b=-0.351, p = 0.003 (i.e. the trajectories of change) and improvements plateaued until follow up. Retention was high (92%) and improvements in mental health symptoms, minutes of PA, sedentary time and quality of life were significant. Conclusions Our intervention delivered via social media is feasible and associated with reduced levels of psychological distress among emergency service workers and support partners. Trial registration Australian New Zealand Clinical Trials Registry (ACTRN): 12619000877189.
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Affiliation(s)
- Grace McKeon
- Discipline of Psychiatry and Mental Health,
University of
New South Wales, Sydney, Australia,School of Population Health, University of New South
Wales, Sydney, Australia,Grace McKeon, University of New South
Wales, Randwick, NSW 2052, Australia.
| | - Ruth Wells
- Discipline of Psychiatry and Mental Health,
University of
New South Wales, Sydney, Australia
| | - Zachary Steel
- Discipline of Psychiatry and Mental Health,
University of
New South Wales, Sydney, Australia,St John of God Health Care North Richmond Hospital, North Richmond,
Australia
| | - Dusan Hadzi-Pavlovic
- Discipline of Psychiatry and Mental Health,
University of
New South Wales, Sydney, Australia
| | - Scott Teasdale
- Discipline of Psychiatry and Mental Health,
University of
New South Wales, Sydney, Australia,Mingardens Neuroscience Network, Sydney, Australia
| | - Davy Vancampfort
- KU Leuven Department of Rehabilitation Sciences, Leuven,
Belgium,University Psychiatric Center KU Leuven, Leuven-Kortenberg,
Belgium
| | - Simon Rosenbaum
- Discipline of Psychiatry and Mental Health,
University of
New South Wales, Sydney, Australia
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11
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Nicholson TP, Blazer EC, Hymes AS, Ginley MK. A Qualitative Investigation into the Trauma Exhibited by First Responders Impacted by the Opioid Epidemic. Int J Ment Health Addict 2023:1-22. [PMID: 36619000 PMCID: PMC9810250 DOI: 10.1007/s11469-022-00993-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/13/2022] [Indexed: 01/04/2023] Open
Abstract
This qualitative study aimed to capture the lived experiences of first responders (FRs) combatting the opioid epidemic in an effort to better understand how the increase in opioids, opioid-related harm, and opioid-related death has affected the FR profession. FRs (N = 30) from Tennessee partook in semi-structured interviews investigating the impact of responding to opioid-related incidents. Using a phenomenological approach, three response themes emerged including (1) opioid epidemic burden on FR mental health, (2) variable availability and effectiveness of resources, and (3) identified roles of FRs in reducing the impact of the epidemic. The findings indicate that FRs are experiencing posttraumatic stress and secondary traumatic stress symptoms due to a shift in their duties, as well as repeated exposures to the adverse impacts of opioid use. This study finds a deficit in resources and support to combat the mental health repercussions FRs have experienced due to the epidemic. Given that FRs are often directly involved in preventing opioid-related deaths, ensuring that they are well resourced is an essential component of harm reduction and will ultimately augment care for individuals experiencing opioid-related harm.
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Affiliation(s)
- Thalia P. Nicholson
- Department of Psychology, East Tennessee State University, 420 Rogers Stout-Hall, P.O. Box 70649, Johnson City, TN 37614 USA
| | - Erin C. Blazer
- Department of Counseling, Carson Newman, 1646 Russell Avenue, Jefferson City, TN 37760 USA
| | - Aaron S. Hymes
- Department of Counseling, Milligan University, P.O. Box 22, Milligan, TN 37682 USA
| | - Meredith K. Ginley
- Department of Psychology, East Tennessee State University, 420 Rogers Stout-Hall, P.O. Box 70649, Johnson City, TN 37614 USA
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12
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Mental Health Among Firefighters: Understanding the Mental Health Risks, Treatment Barriers, and Coping Strategies. J Occup Environ Med 2022; 64:e714-e721. [PMID: 36069858 DOI: 10.1097/jom.0000000000002680] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND Firefighters are at high-risk of mental health. This study qualitatively assessed the pathways toward mental health in firefighters. METHODS A two-phased assessment was conducted incorporating in-depth interviews (n = 52) and 10 focus group discussions (n = 82) with firefighters. Thematic analysis was used to develop codes and themes that informed the development of a conceptual model. RESULTS Firefighters recognized personalizing events by relating calls to their personal lives or prior life experiences as the main risk factor. Department debriefing with fire chiefs or leadership after traumatic events was reported as the primary coping strategy firefighters found most effective. Stigma and lack of medical professionals understanding the firefighter culture were identified as barriers for accessing mental health services or their effectiveness. DISCUSSION Pathways toward mental health in firefighters were identified that could be used to improve current strategies to protect their well-being.
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13
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Lawn S, Waddell E, Rikkers W, Roberts L, Beks T, Lawrence D, Rioseco P, Sharp T, Wadham B, Daraganova G, Van Hooff M. Families' experiences of supporting Australian veterans and emergency service first responders (ESFRs) to seek help for mental health problems. HEALTH & SOCIAL CARE IN THE COMMUNITY 2022; 30:e4522-e4534. [PMID: 35662301 PMCID: PMC10084143 DOI: 10.1111/hsc.13856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Revised: 03/26/2022] [Accepted: 05/05/2022] [Indexed: 06/15/2023]
Abstract
The objective of this phenomenological study was to describe families' experiences of supporting veterans and emergency service first responders (ESFRs) (known also as public safety personnel) to seek help for a mental health problem. In-depth semi-structured open-ended interviews were undertaken with 25 family members of Australian veterans and ESFRs. Fourteen participants were family members of police officers. Data were analysed thematically. Participants described a long and difficult journey of supporting the person's help-seeking across six themes. Traumatic exposures, bullying in the workplace and lack of organisational support experienced by veterans/ESFRs caused significant family distress. Families played a vital role in help-seeking but were largely ignored by veteran/ESFR organisations. The research provides a rich understanding of distress and moral injury that is experienced not only by the service members but is transferred vicariously to their family within the mental health help-seeking journey. Veteran and ESFR organisations and mental health services need to shift from a predominant view of distress as located within an individual (intrapsychic) towards a life-course view of distress as impacting families and which is more relational, systemic, cultural and contextual.
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Affiliation(s)
- Sharon Lawn
- Flinders UniversityAdelaideSouth AustraliaAustralia
- Lived Experience Australia LtdAdelaideSouth AustraliaAustralia
- Flinders UniversityOpen Door InitiativeAdelaideSouth AustraliaAustralia
| | - Elaine Waddell
- Flinders UniversityAdelaideSouth AustraliaAustralia
- Flinders UniversityOpen Door InitiativeAdelaideSouth AustraliaAustralia
| | - Wavne Rikkers
- Curtin UniversityPerthWestern AustraliaAustralia
- University of Western AustraliaPerthWestern AustraliaAustralia
| | - Louise Roberts
- Flinders UniversityAdelaideSouth AustraliaAustralia
- Flinders UniversityOpen Door InitiativeAdelaideSouth AustraliaAustralia
| | | | - David Lawrence
- Curtin UniversityPerthWestern AustraliaAustralia
- University of Western AustraliaPerthWestern AustraliaAustralia
| | - Pilar Rioseco
- Australian Institute of Family StudiesMelbourneVictoriaAustralia
| | | | - Ben Wadham
- Flinders UniversityAdelaideSouth AustraliaAustralia
- Flinders UniversityOpen Door InitiativeAdelaideSouth AustraliaAustralia
| | - Galina Daraganova
- Australian Institute of Family StudiesMelbourneVictoriaAustralia
- South‐Eastern Melbourne Primary Health NetworkMelbourneVictoriaAustralia
| | - Miranda Van Hooff
- Military and Emergency Services Health Australia (MESHA)The Hospital Research Foundation GroupAdelaideSouth AustraliaAustralia
- University of South Australia AdelaideSouth AustraliaAustralia
- University of AdelaideAdelaideSouth AustraliaAustralia
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14
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Frazer H, Hansen C, Searle A, Lawrence-Wood E, Van Hooff M. Exploration of potential indicators of burnout, psychological distress and post-traumatic stress disorder, among Australian female first responders. Psychiatry Res 2022; 316:114771. [PMID: 35987064 DOI: 10.1016/j.psychres.2022.114771] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2022] [Revised: 08/02/2022] [Accepted: 08/03/2022] [Indexed: 11/27/2022]
Abstract
There is limited research on the psychological wellbeing of female first responders (FRs) and therefore we explore potential indicators of burnout, psychological distress and post-traumatic stress disorder among Australian female FRs. We conducted an online health survey among Australian female FRs (fire, police, paramedical, aeromedical, remote area and other e.g., State Emergency Service). Of the 422 eligible participants who submitted the online survey, 286 completed at least 80% of all survey questions and were used in the final analyses. The main outcomes of interest were moderate burnout (compared to low burnout) and high scores for combined PCL-5/K10 (compared to low scores). Using logistical regression stepwise regression models, we analysed associations between the outcomes of interest and various work-psychosocial factors. Results showed the strongest indicators of moderate burnout to be, 1) returning to work with <12-hour break, 2) exposure to gossip and slander, 3) not enough time to do things, 4) and having experienced rape/sexual assault. The strongest indicators of higher PCL-5/K10 scores were, 1) exposure to unpleasant teasing, 2) pressure at work and home, 3) having experienced physical violence (e.g., beaten/mugged), and 4) someone close to them died unexpectedly. These findings show workforce stressors have more impact on female FRs psychological wellbeing, compared to lifetime traumatic exposures.
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Affiliation(s)
- Helen Frazer
- Military and Emergency Services Health Australia, The Hospital Research Foundation, Adelaide, South Australia, Australia; The University of Adelaide, South Australia, Australia.
| | - Craig Hansen
- Military and Emergency Services Health Australia, The Hospital Research Foundation, Adelaide, South Australia, Australia; The University of Adelaide, South Australia, Australia
| | - Amelia Searle
- Flinders Medical Centre, Pain Management Unit, South Australia, Australia; Flinders University, South Australia, Australia; Charles Darwin University, the Northern Territory, Australia
| | | | - Miranda Van Hooff
- Military and Emergency Services Health Australia, The Hospital Research Foundation, Adelaide, South Australia, Australia; The University of Adelaide, South Australia, Australia; The University of South Australia, Adelaide, South Australia, Australia
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15
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Sharif L, Almutairi K, Sharif K, Mahsoon A, Banakhar M, Albeladi S, Alqahtani Y, Attar Z, Abdali F, Wright R. Quantitative research on the impact of COVID-19 on frontline nursing staff at a military hospital in Saudi Arabia. Nurs Open 2022; 10:217-229. [PMID: 35866613 PMCID: PMC9349684 DOI: 10.1002/nop2.1297] [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: 02/01/2022] [Revised: 06/17/2022] [Accepted: 06/28/2022] [Indexed: 01/04/2023] Open
Abstract
AIM The aim of the study was to examine the relationship between stress, psychological symptoms and job satisfaction among frontline nursing staff at a military hospital in Saudi Arabia during the COVID-19 pandemic. DESIGN Descriptive cross-sectional study. METHODS Data were collected using an online survey. All Registered Nurses (N = 1,225) working at a military hospital between February to April 2021 were contacted, 625 responded (51%). Data were analysed using descriptive and multivariate analysis, Student's t-test for independent samples and one-way analysis of variance followed by Tukey's multiple comparison tests. RESULTS Stress was experienced more significantly than depression or anxiety. Approximately 29% of the change in scores for psychological symptoms was explained by age group, being a Saudi national and working in emergency departments (F[3,620] = 19.063, p < 0.0001). A 37% change in nursing stress scores was explained by nationality and work department. (F[5,618] = 19.754, p < 0.0001). A 29% change in job satisfaction scores was explained by nationality and work department (F[3,620] = 19.063, p < 0.0001).
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Affiliation(s)
- Loujain Sharif
- Faculty of NursingKing Abdulaziz UniversityJeddahSaudi Arabia
| | | | - Khalid Sharif
- King Fahad Armed Forces Hospital (KFAFH)JeddahSaudi Arabia
| | - Alaa Mahsoon
- Faculty of NursingKing Abdulaziz UniversityJeddahSaudi Arabia
| | - Maram Banakhar
- Faculty of NursingKing Abdulaziz UniversityJeddahSaudi Arabia
| | - Salwa Albeladi
- King Fahad Armed Forces Hospital (KFAFH)JeddahSaudi Arabia
| | | | - Zalikha Attar
- King Fahad Armed Forces Hospital (KFAFH)JeddahSaudi Arabia
| | - Farida Abdali
- King Fahad Armed Forces Hospital (KFAFH)JeddahSaudi Arabia
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16
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Du BB, Yung M, Gruber J, Yazdani A. Organizational strategies to address posttraumatic stress injuries among Canadian paramedics. Work 2022; 72:1035-1045. [DOI: 10.3233/wor-210614] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND: Paramedics are a high-risk occupational group for posttraumatic stress injuries (PTSI), and increasingly, evidence suggests that organizational factors play a significant role. While several resources for paramedic services to address PTSI exist, there is limited knowledge as to which PTSI-related programs and practices are implemented and how they are perceived in the workplace. OBJECTIVES: This research aimed to explore key informants’ perspectives on existing and desired organizational-wide initiatives for, as well as the challenges and potential solutions to, the primary prevention, early detection and intervention, and disability management of PTSI in Canadian paramedic services. METHODS: Semi-structured interviews were conducted with 12 key informants from jurisdictions across Canada who have over five years of work experience in prehospital care. Interviews were audio-recorded, transcribed, and analyzed using thematic analysis. RESULTS: Eight recurrent organizational elements (themes) for addressing PTSI emerged: psychologically safe and healthy work culture; consistent supervisor support, mental health training and awareness, opportunities for recovery and maintaining resiliency, recognition of PTSI and its diverse risk factors, access to a variety of support initiatives for PTSI, communication during medical leave, and meaningful work accommodations. CONCLUSIONS: While organizational-wide initiatives were in place for the primary prevention, early detection and intervention, and disability management of PTSI, systemic challenges with coordination, resource allocation, and worker engagement were also identified. These challenges prevented paramedic services from optimally addressing PTSI in their workplace. Integrating considerations from the eight organizational elements to address PTSI into broader existing management systems may have merit in overcoming the systemic challenges.
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Affiliation(s)
- Bronson B. Du
- Canadian Institute for Safety, Wellness, and Performance, School of Business, Conestoga College Institute of Technology and Advanced Learning, Kitchener, ON, Canada
| | - Marcus Yung
- Canadian Institute for Safety, Wellness, and Performance, School of Business, Conestoga College Institute of Technology and Advanced Learning, Kitchener, ON, Canada
| | - Jennifer Gruber
- Canadian Institute for Safety, Wellness, and Performance, School of Business, Conestoga College Institute of Technology and Advanced Learning, Kitchener, ON, Canada
| | - Amin Yazdani
- Canadian Institute for Safety, Wellness, and Performance, School of Business, Conestoga College Institute of Technology and Advanced Learning, Kitchener, ON, Canada
- Centre of Research Expertise for the Prevention of Musculoskeletal Disorders, Waterloo, ON, Canada
- School of Public Health and Health Systems, University of Waterloo, Waterloo, ON, Canada
- School of Geography and Earth Sciences, McMaster University, Hamilton, ON, Canada
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17
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Jones C, Smith-MacDonald L, Pike A, Bright K, Bremault-Phillips S. Workplace Reintegration Facilitator Training Program for Mental Health Literacy and Workplace Attitudes of Public Safety Personnel: Pre-Post Pilot Cohort Study. JMIR Form Res 2022; 6:e34394. [PMID: 35471413 PMCID: PMC9092236 DOI: 10.2196/34394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Revised: 03/09/2022] [Accepted: 03/25/2022] [Indexed: 11/13/2022] Open
Abstract
Background
Public safety personnel (PSP) impacted by operational stress injuries can find themselves needing both time off work and support reintegrating back into the workforce. Work reintegration programs have been introduced in PSP organizations to support those who aim to return to work. One such peer-led workplace reintegration program (RP) was created in 2009 by members of the Edmonton Police Service (EPS). The primary goal of the EPSRP is to assist PSP in returning to work as soon as possible following a critical incident, illness, or injury while diminishing the potential for long-term psychological injury. The EPSRP is delivered by peers through 3 interrelated components: (1) the Reintegration Program Facilitator Training (RPFT) Program; (2) a short-term Critical Incident RP; and (3) a long-term RP. There is a dire need for research that incorporates strong study designs to the determine long-term effectiveness of the program on increasing workplace reintegration, improving mental health knowledge, and creating culture change within PSP organizations. Simultaneously, the efficacy, effectiveness, and fidelity of the RPFT in providing the tools, mental health knowledge, and skills the RP peer facilitators will need for the RP must be evaluated.
Objective
The purpose of this quasi-experimental pre-post pilot cohort study is to evaluate the effectiveness of the EPSRPFT course on influencing mental health knowledge and attitudes of RPFT attendees who will be future RP peer facilitators.
Methods
This pre-post cohort study collected data via 2 questionnaires from RPFT participants (N=60) which included the Mental Health Knowledge Survey (MAKS) and the Open Minds Survey of Workplace Attitudes (OMSWA). Descriptive, parametric (sample t tests), and nonparametric (Wilcoxon signed rank tests) statistics were used to compare the pre- and post-RPFT results and to analyze results by gender and profession.
Results
Statistically significant changes were observed in pre-post questionnaire scores in the domains of mental health attitudes and knowledge.
Conclusions
Although results are explorative, the RPFT may facilitate positive changes in workplace mental health attitudes and knowledge among PSP. It is hoped these findings will contribute to a broader evidence base that can inform changes to the program, practices, and policies, and inform decision-making regarding the EPSRP.
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Affiliation(s)
- Chelsea Jones
- Heroes in Mind, Advocacy and Research Consortium, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, AB, Canada
- Department of Psychiatry, Leiden University Medical Centre, Leiden, Netherlands
- Alberta Health Services, Edmonton, AB, Canada
| | - Lorraine Smith-MacDonald
- Heroes in Mind, Advocacy and Research Consortium, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, AB, Canada
| | - Ashley Pike
- Heroes in Mind, Advocacy and Research Consortium, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, AB, Canada
| | - Katherine Bright
- Heroes in Mind, Advocacy and Research Consortium, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, AB, Canada
| | - Suzette Bremault-Phillips
- Heroes in Mind, Advocacy and Research Consortium, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, AB, Canada
- Department of Occupational Therapy, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, AB, Canada
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18
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Leung TY, Shen Q. Implementing a post‐traumatic stress disorder screening for first responders in rural area. Public Health Nurs 2022; 39:788-796. [DOI: 10.1111/phn.13058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Revised: 01/14/2022] [Accepted: 01/19/2022] [Indexed: 11/29/2022]
Affiliation(s)
- Tak Yee Leung
- Advance Practice Provider US Acute Care Solutions LLC/St. Catherine Hospital Garden City KS
| | - Qiuhua Shen
- School of Nursing University of Kansas Medical Center Kansas City KS
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19
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Auth NM, Booker MJ, Wild J, Riley R. Mental health and help seeking among trauma-exposed emergency service staff: a qualitative evidence synthesis. BMJ Open 2022; 12:e047814. [PMID: 35110304 PMCID: PMC8811562 DOI: 10.1136/bmjopen-2020-047814] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVES To identify factors and contexts that may contribute to mental health and recovery from psychological difficulties for emergency service workers (ESWs) exposed to occupational trauma, and barriers and facilitators to help-seeking behaviour among trauma-exposed ESWs. BACKGROUND ESWs are at greater risk of stressor-related psychopathology than the general population. Exposure to occupational stressors and trauma contribute to the observed rates of post-trauma psychopathology in this occupational group with implications for workforce sustainability. Types of organisational interventions offered to trauma-exposed ESWs are inconsistent across the UK, with uncertainty around how to engage staff. DESIGN Four databases (OVID MEDLINE, EMBASE, PsycINFO and SCOPUS) were systematically searched from 1 January 1980 to March 2020, with citation tracking and reference chaining. A modified Critical Appraisal Skills Programme tool and quality appraisal prompts were used to identify fatally flawed studies. Qualitative studies of trauma-exposure in front-line ESWs were included, and data were extracted using a customised extraction table. Included studies were analysed using thematic synthesis. RESULTS A qualitative evidence synthesis was conducted with 24 qualitative studies meeting inclusion criteria, as defined by the PerSPEcTiF framework. Fourteen descriptive themes emerged from this review, categorised into two overarching constructs: (1) factors contributing to mental health (such as the need for downtime, peer support and reassurance) and (2) factors influencing help-seeking behaviour (such as stigma, the content/form/mandatory nature of interventions, and mental health literacy issues including emotional awareness and education). CONCLUSION ESWs reported disconnect between the organisations' cultural positioning on trauma-related mental health, the reality of undertaking the role and the perceived applicability and usefulness of trauma interventions. Following traumatic exposure, ESWs identify benefitting from recovery time and informal support from trusted colleagues. A culture which encourages help seeking and open dialogue around mental health may reduce stigma and improve recovery from mental ill health associated with trauma exposure.
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Affiliation(s)
| | | | - Jennifer Wild
- Experimental Psychology, University of Oxford, Oxford, UK
| | - Ruth Riley
- Social and Community Medicine, University of Bristol, Bristol, UK
- Department of Applied Health Research, University of Birmingham, Birmingham, UK
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20
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O'Toole M, Mulhall C, Eppich W. Breaking down barriers to help-seeking: preparing first responders' families for psychological first aid. Eur J Psychotraumatol 2022; 13:2065430. [PMID: 35572389 PMCID: PMC9103391 DOI: 10.1080/20008198.2022.2065430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND First responders regularly encounter both operational stressors and potentially traumatic events, increasing their risk of mental health issues (Declercq et al., 2011). Due to unique cultural complexities, they turn mostly to peers for early psychosocial support (Isaac & Buchanan, 2021). However, peer support and/or mental health assistance may not always be available or easy to access and first responders' mental health suffers. OBJECTIVE We need more accessible routes to crisis intervention to ensure first responder resilience and wellbeing, so they may continue to function in the service of public safety. Family members and close friends may be ideally placed to provide this immediate care. This article outlines the protective role of social support as an early intervention strategy to mitigate the effects of first responder trauma, exploring the potential opportunity for family members and friends to play an increasingly supportive role in their loved one's wellbeing. This paper serves as a call to action for practical educational interventions that will prepare family members for these critical conversations. CONCLUSION We see potential in combining early intervention theory, psychoeducation, and a strengths-based gender specific positive psychology approach. Further study should investigate how best to help first responders break down barriers to support, by bolstering their existing social supports and ultimately reducing the stigma associated with experiencing traumatic stress. HIGHLIGHTS By training family members in psychological first aid, we may strengthen existing social support for first responders, providing more options for, and potentially breaking down stigma associated with help-seeking.
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Affiliation(s)
- Michelle O'Toole
- RCSI SIM Centre for Simulation Education and Research, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Claire Mulhall
- RCSI SIM Centre for Simulation Education and Research, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Walter Eppich
- RCSI SIM Centre for Simulation Education and Research, RCSI University of Medicine and Health Sciences, Dublin, Ireland
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21
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Wright HM, Fuessel-Hermann D, Pazdera M, Lee S, Ridge B, Kim JU, Konopacki K, Hilton L, Greensides M, Langenecker SA, Smith AJ. Preventative Care in First Responder Mental Health: Focusing on Access and Utilization via Stepped Telehealth Care. FRONTIERS IN HEALTH SERVICES 2022; 2:848138. [PMID: 36925868 PMCID: PMC10012773 DOI: 10.3389/frhs.2022.848138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Accepted: 03/31/2022] [Indexed: 11/13/2022]
Abstract
First responders are at high risk for disorders that arise from repeat exposure to stress and trauma (Post Traumatic Stress Disorder, depression, and problematic alcohol use). Although mental health treatments are available, first responders often do not access them, anchored by barriers that include: lack of knowledge, stigma, negative experience with mental health providers, and time-based burdens. In this study, we designed an intervention to address these barriers, extending a Planned-Action framework. Step 1 involved self-report screening for four mental health risks (PTSD, depression, anxiety, and alcohol use risk), delivered to all personnel electronically, who were free to either consent and participate or opt-out. The detection of risk(s) in Step 1 led to scheduling a Step 2 telehealth appointment with a trained clinician. We report descriptive statistics for participation/attrition/utilization in Steps 1 and 2, rates of risk on four mental health variables, and rate of adherence to follow-up treatment recommendations. Step 1: In total, 53.3% of personnel [229 of 429 full-time employees (221 males; eight females; 95% White; 48% paramedic or Emergency Medical Technician; 25% captain; 19% engineer; 7% other)] initially opted-in by consenting and completing the brief remote screening survey. Among those who opted-in and completed (n = 229), 43% screened positive for one or more of the following mental health risks: PTSD (7.9%); depression (9.6%); anxiety (13.5%); alcohol use (36.7%). Step 2: A maximum of three attempts were made to schedule "at risk" individuals into Step 2 (n = 99). Among the 99 who demonstrated a need for mental health treatment (by screening positive for one or more risk), 56 (56.6%) engaged in the telehealth appointment. Of the 56 who participated in Step 2 clinical appointments, 38 were recommended for further intervention (16.6% of full-time personnel who participated). Among the 38 firefighters who were recommended to seek further mental health services, 29 were adherent/followed through (76.3% of those who received recommendations for further services). Taken together, evidence-based, culturally conscious, stepped care models delivered via the virtual/telehealth medium can promote access, utilization, and cost-effective mental health services for first responders. Implications are for informing larger, more rigorous dissemination and implementation efforts.
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Affiliation(s)
- Hannah M Wright
- Department of Psychiatry, University of Utah School of Medicine, Huntsman Mental Health Institute, Salt Lake City, UT, United States
| | | | - Myah Pazdera
- Department of Psychiatry, University of Utah School of Medicine, Huntsman Mental Health Institute, Salt Lake City, UT, United States
| | - Somi Lee
- Department of Psychiatry, University of Utah School of Medicine, Huntsman Mental Health Institute, Salt Lake City, UT, United States
| | - Brook Ridge
- Department of Psychiatry, University of Utah School of Medicine, Huntsman Mental Health Institute, Salt Lake City, UT, United States
| | - Joseph U Kim
- Department of Psychiatry, University of Utah School of Medicine, Huntsman Mental Health Institute, Salt Lake City, UT, United States.,Salt Lake City Veterans Affairs (VA) Medical Center, Salt Lake City, UT, United States
| | - Kelly Konopacki
- Department of Psychiatry, University of Utah School of Medicine, Huntsman Mental Health Institute, Salt Lake City, UT, United States
| | - Layne Hilton
- United Fire Authority, Salt Lake City, UT, United States
| | | | - Scott A Langenecker
- Department of Psychiatry, University of Utah School of Medicine, Huntsman Mental Health Institute, Salt Lake City, UT, United States
| | - Andrew J Smith
- Department of Psychiatry, University of Utah School of Medicine, Huntsman Mental Health Institute, Salt Lake City, UT, United States.,Department of Psychiatry, Geisel School of Medicine at Dartmouth, Hanover, NH, United States.,Lyda Hill Institute for Human Resilience, University of Colorado, Colorado Springs, CO, United States
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22
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Beahm JD, McCall HC, Carleton RN, Titov N, Dear B, Hadjistavropoulos HD. Insights into internet-delivered cognitive behavioural therapy for public safety personnel: Exploration of client experiences during and after treatment. Internet Interv 2021; 26:100481. [PMID: 34815951 PMCID: PMC8593259 DOI: 10.1016/j.invent.2021.100481] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Revised: 11/01/2021] [Accepted: 11/09/2021] [Indexed: 12/26/2022] Open
Abstract
Canadian public safety personnel (PSP) experience high rates of mental health problems and barriers to receiving care. Internet-delivered cognitive behavioural therapy (ICBT) may help reduce barriers to care; however, there is no literature involving qualitative analyses of client feedback to describe PSP experiences with ICBT. Identifying these experiences is important because it can inform future use of ICBT with this group that has unique needs. The current study was designed to explore how clients (N = 82) experienced ICBT that had been tailored to meet their needs; specifically, the study assessed their perceptions of program impacts, what clients found helpful, and client suggestions for improvements. The ICBT course included five core lessons, client stories, and nine initial additional resources, as well as flexible frequencies (optional, once weekly, or twice weekly) and durations (8 to 16 weeks) of therapist support. A qualitative reliability thematic analysis was used to analyze client communications and feedback. Responses to a Treatment Satisfaction Questionnaire administered at eight weeks post-enrollment were available for 57 clients. Client emails with therapists were also examined among all clients, including an additional 25 clients who did not complete the Treatment Satisfaction Questionnaire. Themes identified in the qualitative analyses were related to: reported impacts and hindering events, helpful and challenging course skills and content, helpful aspects of the course, and areas for improvement. Clients who completed the Treatment Satisfaction Questionnaire and those who did not reported beneficial impacts from the program, with the most commonly endorsed themes being skill development and normalizing mental health issues. Hindering events were experienced by both groups and included timeline challenges, technology challenges, and negative effects. Comments from both groups suggested that clients had more success than challenges when practicing the skills. Thought challenging was the skill most frequently identified as helpful. Clients described many aspects of the program as helpful with the most frequently endorsed themes being the course format and content, the flexible nature of the course, access to additional materials and case stories, and therapist assistance. Clients also provided suggestions for improving the course (e.g., case stories, additional resources, timelines audio and videos). Overall, client communications suggest that ICBT is accepted and perceived as beneficial among PSP. These results informed rapid improvements to the ICBT program tailored for PSP and may inform others seeking to provide digital mental health services to PSP.
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Affiliation(s)
- Janine D. Beahm
- Department of Psychology, University of Regina, 3737 Wascana Pkwy, Regina, SK S4S 0A2, Canada,PSPNET, University of Regina, 2 Research Drive, Regina, SK S4T 2P7, Canada
| | - Hugh C. McCall
- Department of Psychology, University of Regina, 3737 Wascana Pkwy, Regina, SK S4S 0A2, Canada,PSPNET, University of Regina, 2 Research Drive, Regina, SK S4T 2P7, Canada
| | - R. Nicholas Carleton
- Department of Psychology, University of Regina, 3737 Wascana Pkwy, Regina, SK S4S 0A2, Canada,PSPNET, University of Regina, 2 Research Drive, Regina, SK S4T 2P7, Canada
| | - Nick Titov
- Department of Psychology, Macquarie University, Sydney, Australia,eCentreClinic, Macquarie University, Sydney, Australia
| | - Blake Dear
- Department of Psychology, Macquarie University, Sydney, Australia,eCentreClinic, Macquarie University, Sydney, Australia
| | - Heather D. Hadjistavropoulos
- Department of Psychology, University of Regina, 3737 Wascana Pkwy, Regina, SK S4S 0A2, Canada,PSPNET, University of Regina, 2 Research Drive, Regina, SK S4T 2P7, Canada,Corresponding author at: PSPNET, University of Regina, 2 Research Drive, Regina, SK S4T 2P7, Canada.
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23
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Motreff Y, Pirard P, Vuillermoz C, Rabet G, Petitclerc M, Stene LE, Baubet T, Chauvin P, Vandentorren S. Mental health care utilization by first responders after Paris attacks. Occup Med (Lond) 2021; 72:81-90. [PMID: 34729607 PMCID: PMC8863088 DOI: 10.1093/occmed/kqab150] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background First responders (FRs) are frequently exposed to potentially traumatic events, including terror attacks, and may consequently be at risk of developing mental health disorders. Prior research suggests that FRs with mental health disorders often do not receive appropriate treatment. More knowledge is needed about their use of mental health care (MHC). Aims This study aimed to identify factors associated with receiving immediate support, post-immediate support and engagement in MHC among FRs of the November 2015 terror attacks in Paris. Methods A web-based study was conducted 8–12 months after the attacks on 663 FRs who were mobilized during the night and/or the aftermath of the attacks. Logistic regression was performed to analyse factors associated with MHC. Results Overall, 44 FRs sought MHC. Among FRs with post-traumatic stress disorder (PTSD), partial PTSD or depression (n = 60), 38% sought MHC (n = 23). Post-immediate support was associated with immediate support, and both were associated with knowing someone who could help regarding the potential psychological risks following a traumatic event. MHC engagement was associated with a history of MHC, post-immediate support and the presence of PTSD, partial PTSD or depression. Conclusions Among FRs with PTSD, partial PTSD or depression, few sought MHC. Improved access to MHC for FRs after terror attacks is essential. Knowing someone who could help regarding potential psychological risks may facilitate immediate and/or post-immediate support. Furthermore, post-immediate support could encourage engagement in MHC. Efforts should be made before and after potentially traumatic events to ensure mental health education for FR.
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Affiliation(s)
- Y Motreff
- Santé publique France, Direction des maladies non transmissibles et traumatismes, Saint-Maurice, France.,INSERM, Sorbonne Université, Institut Pierre Louis d'Epidémiologie et de Santé Publique (IPLESP), Department of Social Epidemiology, Paris, France
| | - P Pirard
- Santé publique France, Direction des maladies non transmissibles et traumatismes, Saint-Maurice, France.,MOODS, INSERM U 1018, CESP, Université Paris-Saclay, Faculté de Médecine Paris-Saclay, Le Kremlin Bicêtre, France
| | - C Vuillermoz
- INSERM, Sorbonne Université, Institut Pierre Louis d'Epidémiologie et de Santé Publique (IPLESP), Department of Social Epidemiology, Paris, France
| | - G Rabet
- Santé publique France, Direction appui, traitements et analyses des données, Saint-Maurice, France
| | - M Petitclerc
- Service médical d'urgence-bureau de santé et de prévention, Brigade de sapeurs-pompiers de Paris, 1, place Jules-Renard, Paris, France.,Université Sorbonne Paris Nord, Ecole doctorale Erasme, Laboratoire UTRPP, Villetaneuse, France
| | - L Eilin Stene
- Norwegian Centre for Violence and Traumatic Stress Studies (NKVTS), Oslo, Norway
| | - T Baubet
- Université Sorbonne Paris Nord, Ecole doctorale Erasme, Laboratoire UTRPP, Villetaneuse, France.,APHP Hôpital Avicenne, Psychopathology Department for Children, Adolescents, General Psychiatry and Specialized Addiction, Bobigny, France.,Centre National de Ressources et de Résilience Lille-Paris (CN2R), Lille, France
| | - P Chauvin
- INSERM, Sorbonne Université, Institut Pierre Louis d'Epidémiologie et de Santé Publique (IPLESP), Department of Social Epidemiology, Paris, France
| | - S Vandentorren
- INSERM, Sorbonne Université, Institut Pierre Louis d'Epidémiologie et de Santé Publique (IPLESP), Department of Social Epidemiology, Paris, France.,Santé publique France, Direction des régions, Saint-Maurice, France
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24
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Workplace Mental Health Awareness Training: A Cluster Randomized Controlled Trial. J Occup Environ Med 2021; 63:311-316. [PMID: 33350660 DOI: 10.1097/jom.0000000000002121] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To investigate the efficacy of a workplace mental health awareness training program on help-seeking and mental health outcomes. METHODS A cluster randomized controlled trial was conducted comparing those who received standard training (N = 210) or standard training with a mental health awareness module (N = 208). Both groups were followed up for 3 years with the primary outcome being likelihood to seek help. RESULTS Rates of likely help-seeking were slightly higher in the intervention group 6 months after the training, but this was not maintained over time. There was no significant difference between study conditions for mental health outcomes or actual help-seeking among those with probable mental disorder at any time point. CONCLUSIONS Workplace mental health awareness training has a limited short-term impact on likelihood of help-seeking and does not appear to improve mental health outcomes.
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Grabbe L, Higgins MK, Baird M, Pfeiffer KM. Impact of a Resiliency Training to Support the Mental Well-being of Front-line Workers: Brief Report of a Quasi-experimental Study of the Community Resiliency Model. Med Care 2021; 59:616-621. [PMID: 33827106 PMCID: PMC8191373 DOI: 10.1097/mlr.0000000000001535] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Front-line workers (FLW) are at risk for secondary traumatic stress, burnout, and related psychiatric sequelae: depression, anxiety, suicidality, posttraumatic stress disorder, and sleep and substance use disorders. FLW are in need of self-care programs to support their mental health. METHODS Quasi-experimental study to assess the impact of a simple mental well-being and emotional regulation training, the Community Resiliency Model (CRM), using a convenience sample of FLW. Baseline scores of mental well-being and stress measures were compared with follow-up scores at 3 time points. Outcomes were psychological wellness (World Health Organization-5 Well-being Index); resilience (Connor-Davidson Resilience Scale-10); traumatic stress (Secondary Traumatic Stress Scale); physical symptoms (Somatic Symptom Scale-8). RESULTS Of the 104 participants who enrolled and attended the CRM training, 73 (70.2%) completed at least 1 posttest. Well-being scores increased at 1 year with a small-moderate effect size (Cohen d=0.32). Resilience scores increased with a small-moderate effect size by 1 year (Cohen d=0.36). Secondary traumatic stress scores declined, with the largest effect at 1 week (Cohen d=0.49). Somatic symptoms decreased at each posttest, with the largest change occurring from baseline to 1 week (d=0.39). Participants reported an awareness of body sensations helped them when overwhelmed as a means of calming themselves. CONCLUSIONS After a 3-hour CRM training, participants reported improved mental well-being and decreased secondary traumatic stress and somatic symptoms. This simple body awareness intervention may be a good resource during the COVID-19 pandemic.
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Affiliation(s)
- Linda Grabbe
- Nell Hodgson Woodruff School of Nursing, Emory University
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26
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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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