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Ericsson CR, Rudman A, Lindström V, Nordquist H. 'We are expected to be problem solvers'-Paramedics' performance expectations through the lens of organizational socialization: An interview study. Nurs Open 2024; 11:e70014. [PMID: 39239758 PMCID: PMC11377957 DOI: 10.1002/nop2.70014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Revised: 06/18/2024] [Accepted: 08/04/2024] [Indexed: 09/07/2024] Open
Abstract
AIM To explore Finnish paramedics' perceptions of work-related performance expectations in relation to work experience, and understand how organizational socialization contributes to understanding paramedics' performance expectations. DESIGN A qualitative design with a deductive-inductive approach utilizing a social constructivist framework. The organizational socialization framework by Wanberg was used as the theoretical basis. METHODS Data were collected between May and August 2023, using group and individual interviews of newly graduated (n = 9) and experienced paramedics (n = 13). Participants were recruited via social media channels. Data were first analyzed deductively, according to constructs of the organizational socialization framework (role clarity, task mastery, and social acceptance), then inductively, using codes not utilized in the deductive phase. DATA SOURCES Interviewed Finnish paramedics (N = 22), both newly graduated paramedics (n = 9) and experienced paramedics (n = 13). The interviews were performed remotely and then transcribed into text. RESULTS Our findings showed comparable performance expectations between newly graduated and experienced paramedics, mismatches in role clarity of paramedic work, challenges in both learning and upholding professional competence, and difficulties of social acceptance into the paramedic community. There were variations in how expectations were perceived between groups, indicating that experience might partly affect how paramedics identify and manage performance expectations. The organizational socialization framework enables the contextualization of these performance expectations. CONCLUSIONS AND IMPLICATIONS Paramedic work involves challenges to upholding clinical competence, aligning to a professional role, and social integration into the professional community. Our research contributes to understanding how paramedics perceive these challenges as performance expectations in different stages of their careers and how they could be managed utilizing a framework for organizational socialization. The socialization of paramedics into the workforce needs to account for these performance expectations, especially considering the changing paradigm of paramedic work, role, and societal expectations. PATIENT OR PUBLIC CONTRIBUTION No Patient or Public Contribution.
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Affiliation(s)
- Christoffer R Ericsson
- Faculty of Medicine, University of Helsinki, Helsinki, Finland
- School of Business and Healthcare, Arcada University of Applied Sciences, Helsinki, Finland
| | - Ann Rudman
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Department of Health and Welfare, Dalarna University, Falun, Sweden
| | - Veronica Lindström
- Department of Nursing, Umeå University, Umeå, Sweden
- Ambulance Service Umeå, Umeå, Sweden
- Sophiahemmet University, Stockholm, Sweden
| | - Hilla Nordquist
- Faculty of Medicine, University of Helsinki, Helsinki, Finland
- Department of Healthcare and Emergency Care, South-Eastern Finland University of Applied Sciences, Kotka, Finland
- Faculty of Social Sciences, University of Helsinki, Helsinki, Finland
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Holland-Winkler AM, Greene DR, Oberther TJ. The Cyclical Battle of Insomnia and Mental Health Impairment in Firefighters: A Narrative Review. J Clin Med 2024; 13:2169. [PMID: 38673442 PMCID: PMC11050272 DOI: 10.3390/jcm13082169] [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: 03/04/2024] [Revised: 03/27/2024] [Accepted: 04/05/2024] [Indexed: 04/28/2024] Open
Abstract
The occupational requirements of full-time non-administrative firefighters include shift-work schedules and chronic exposure to alerting emergency alarms, hazardous working conditions, and psychologically traumatic events that they must attend and respond to. These compiling and enduring aspects of the career increase the firefighter's risk for insomnia and mental health conditions compared to the general population. Poor sleep quality and mental health impairments are known to coincide with and contribute to the symptom severity of one another. Thus, it is important to determine approaches that may improve sleep and/or mental health specifically for firefighters, as their occupation varies in many aspects from any other occupation. This review will discuss symptoms of insomnia and mental health conditions such as PTSD, anxiety, depression, substance abuse, and suicide in firefighters. The influencing factors of sleep and mental health will be examined including anxiety sensitivity, emotional regulation, and distress tolerance. Current sleep and mental health interventions specific to full-time firefighters are limited in number; however, the existing experimental studies will be outlined. Lastly, this review will provide support for exploring exercise as a possible intervention that may benefit the sleep and mental health of this population.
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Affiliation(s)
- Angelia M. Holland-Winkler
- Department of Kinesiology, Augusta University, 3109 Wrightsboro Road, Augusta, GA 30909, USA; (D.R.G.); (T.J.O.)
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Schenarts PJ, Scarborough AJ, Abraham RJ, Philip G. Teaching Before, During, and After a Surgical Resuscitation. Surg Clin North Am 2024; 104:451-471. [PMID: 38453313 DOI: 10.1016/j.suc.2023.10.004] [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: 03/09/2024]
Abstract
Teaching during a surgical resuscitation can be difficult due to the infrequency of these events. Furthermore, when these events do occur, the trainee can experience cognitive overload and an overwhelming amount of stress, thereby impairing the learning process. The emergent nature of these scenarios can make it difficult for the surgical educator to adequately teach. Repeated exposure through simulation, role play, and "war games" are great adjuncts to teaching and preparation before crisis. However, surgical educators can further enhance the knowledge of their trainees during these scenarios by using tactics such as talking out loud, targeted teaching, and debriefing.
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Affiliation(s)
- Paul J Schenarts
- Department of Surgery, School of Medicine, Creighton University, Omaha, NE, USA.
| | - Alec J Scarborough
- Department of Surgery, School of Medicine, Creighton University, Omaha, NE, USA
| | - Ren J Abraham
- Department of Surgery, School of Medicine, Creighton University, Omaha, NE, USA
| | - George Philip
- Department of Surgery, School of Medicine, Creighton University, Omaha, NE, USA
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Ahmed Pihlgren S, Johansson L, Holmes EA, Kanstrup M. Exploring healthcare workers' experiences of a simple intervention to reduce their intrusive memories of psychological trauma: an interpretative phenomenological analysis. Eur J Psychotraumatol 2024; 15:2328956. [PMID: 38533843 PMCID: PMC10977018 DOI: 10.1080/20008066.2024.2328956] [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: 12/07/2023] [Accepted: 03/02/2024] [Indexed: 03/28/2024] Open
Abstract
ABSTRACTBackground: Many healthcare workers (HCWs) endured psychologically traumatic events at work during the coronavirus disease 2019 (COVID-19) pandemic. For some, these events are re-experienced as unwanted, recurrent, and distressing intrusive memories. Simple psychological support measures are needed to reduce such symptoms of post-traumatic stress in this population. A novel intervention to target intrusive memories, called an imagery-competing task intervention (ICTI), has been developed from the laboratory. The intervention includes a brief memory reminder cue, then a visuospatial task (Tetris® gameplay using mental rotation instructions for approximately 20 min) thought to interfere with the traumatic memory image and reduce its intrusiveness. The intervention has been adapted and evaluated in a randomized controlled trial (RCT) with Swedish HCWs (ClinicalTrials.gov identifier: NCT04460014).Objective: We aimed to explore how HCWs who worked during the COVID-19 pandemic experienced the use of a brief intervention to reduce their intrusive memories of work-related trauma.Method: Interpretative phenomenological analysis was used for in-depth understanding of the lived experiences of HCWs who used the intervention. Seven participants from the RCT were interviewed by an independent researcher without prior knowledge of the intervention. Interviews were conducted via telephone and transcribed verbatim.Results: Four general themes were generated: 'Triggers and troublesome images', 'Five Ws regarding support - what, when, why, by/with who, for whom', 'Receiving it, believing it, and doing it' and 'The intervention - a different kind of help'; the last two included two subthemes each. The results reflect participants' similarities and differences in their lived experiences of intrusive memories, support measures, and intervention impressions and effects.Conclusion: HCWs' experiences of the novel ICTI reflect a promising appraisal of the intervention as a potential help measure for reducing intrusive memories after trauma, and gives us a detailed understanding of HCWs' needs, with suggestions for its adaption for future implementation.Trial registration: ClinicalTrials.gov identifier: NCT04460014.
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Affiliation(s)
- Sara Ahmed Pihlgren
- Department of Psychology, Uppsala University, Uppsala, Sweden
- Division of Psychology, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Lotta Johansson
- The Neurosurgical Intensive Care Unit, Sahlgrenska University Hospital, Gothenburg, Sweden
- Institute of Health and Caring Sciences, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Emily A. Holmes
- Division of Psychology, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Marie Kanstrup
- Department of Psychology, Uppsala University, Uppsala, Sweden
- Division of Psychology, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Theme Women’s Health and Allied Health Professionals, Medical Unit for Medical Psychology, Karolinska University Hospital, Solna, Sweden
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ODare K, Dillard D, King E, Dilks J, Herzog J, Rotunda R, Close F, Hartman M. The 2nd Alarm Project: Bridging Social Work and Public Health to Improve Mental Wellness in the Fire Service. SOCIAL WORK IN PUBLIC HEALTH 2024; 39:93-104. [PMID: 38367222 DOI: 10.1080/19371918.2024.2318382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/19/2024]
Abstract
Firefighters are trained to respond to a wide range of emergencies, and over the course of responding to emergencies, are exposed to a variety of potentially traumatic events. Repeated exposure to traumatic events may adversely impact firefighters' mental health. Combined with stigma surrounding help-seeking, lack of systematic resources and referral programs, and other barriers to care, firefighters do not routinely receive a continuum of trauma informed, assessment and treatment services from trained professionals. The purpose of this paper is to describe an evidence-informed approach to a reciprocal, collaborative model among social work and public health practice, policy, and research; and to offer a framework for researchers, clinicians, and policy advocates to more effectively achieve goals of preventing and treating trauma exposure in firefighters. This paper provides a comprehensive literature review, as well as describes a case study of a successful public health intervention for mitigating exposure to trauma among a population of firefighters. The significant contribution of mental health issues to the burden of disease among our firefighters is a matter of considerable public health concern. Effective approaches to mitigating behavioral health needs must bridge both mental health disciplines and public health to minimally, include access to evidence-based assessment and treatment, peer support capacity building, widely available mental health education, and leadership development to promote culture change. When considering a model for services with firefighters, reciprocal collaboration among researchers, health care professionals, first responder organizations, families, and other relevant community stakeholders is essential for success.
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Affiliation(s)
- Kellie ODare
- Institute of Public Health, Florida A & M University, Tallahassee, FL, USA
| | - Dana Dillard
- Social Work Program, Mississippi State University, Starkville, MS, USA
| | - Erin King
- Department of Social Work, University of West Florida, Pensacola, FL, USA
| | - John Dilks
- Department of Social Work, University of West Florida, Pensacola, FL, USA
| | - Joseph Herzog
- Department of Social Work, University of West Florida, Pensacola, FL, USA
| | - Robert Rotunda
- Department of Psychology, University of West Florida, Pensacola, FL, USA
| | - Fran Close
- Institute of Public Health, Florida A & M University, Tallahassee, FL, USA
| | - Megan Hartman
- Department of Social Work, University of West Florida, Pensacola, FL, USA
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Noda Y, Asano K, Shimizu E, Hirano Y. Assessing the association between probable posttraumatic stress disorder symptoms and quality of life among emergency service workers using path analysis. Work 2024; 77:573-587. [PMID: 37718827 DOI: 10.3233/wor-220551] [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: 09/19/2023] Open
Abstract
BACKGROUND Emergency service workers have highly stressful occupations; the stressors encountered can contribute to the development of mental disorders such as depression, anxiety, and posttraumatic stress disorder (PTSD). OBJECTIVE The present study used a conceptual model and survey to identify variables influencing the association between probable PTSD and quality of life (QOL) in emergency service workers. METHOD PTSD was assessed using the Impact of Event Scale-Revised. QOL was assessed using the Medical Outcomes Study 36-Item Short-Form Health Survey. Path analysis was used to determine whether stress-coping (Brief Coping Orientation to Problems Experienced [Brief COPE] scores), social support (Multidimensional Scale of Perceived Social Support [MSPSS] scores), and resilience (Connor-Davidson Resilience Scale scores) explain the association between probable PTSD and QOL among 220 emergency service workers in Japan. RESULTS Impact of Event Scale-Revised scores were significantly positively associated with Brief COPE Active coping scores and significantly negatively associated with MSPSS scores. Brief COPE Active coping and MSPSS scores were significantly positively associated with Connor-Davidson Resilience Scale scores, which were in turn significantly positively associated with Medical Outcomes Study 36-Item Short-Form Health Survey scores. CONCLUSION Active coping in response to stressful situations is important for maintaining good mental health among emergency service workers. Active coping and social support may strengthen resilience, and resilience may improve QOL. Screening for mental health and QOL should include simultaneous assessment of stress-coping, social support, and resilience. Although the findings of this cross-sectional study are important, it could not confirm a causal relationship between PTSD and QOL.
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Affiliation(s)
- Yoshikazu Noda
- Research Center for Child Mental Development, Chiba University, Chiba, Japan
- Department of Nursing, Faculty of Human Care at Makuhari, Tohto University, Chiba, Japan
| | - Kenichi Asano
- Research Center for Child Mental Development, Chiba University, Chiba, Japan
- Department of Psychological Counseling, Faculty of Psychology, Mejiro University, Tokyo, Japan
| | - Eiji Shimizu
- Research Center for Child Mental Development, Chiba University, Chiba, Japan
- United Graduate School of Child Development (Osaka University, Kanazawa University, Hamamatsu University School of Medicine, Chiba University and University of Fukui), Osaka, Japan
- Department of Cognitive Behavioral Physiology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Yoshiyuki Hirano
- Research Center for Child Mental Development, Chiba University, Chiba, Japan
- United Graduate School of Child Development (Osaka University, Kanazawa University, Hamamatsu University School of Medicine, Chiba University and University of Fukui), Osaka, Japan
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Jahnke SA, Watson P, Leto F, Jitnarin N, Kaipust CM, Hollerbach BS, Haddock CK, Poston WSC, Gist R. Evaluation of the Implementation of the NFFF Stress First Aid Intervention in Career Fire Departments: A Cluster Randomized Controlled Trial. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:7067. [PMID: 37998298 PMCID: PMC10671183 DOI: 10.3390/ijerph20227067] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Revised: 10/24/2023] [Accepted: 10/27/2023] [Indexed: 11/25/2023]
Abstract
Firefighting is inherently dangerous, though recently concerns have shifted from traditional fireground injuries (burns and asphyxiation) to a focus on mental and behavioral health. Although firefighters are remarkably resilient, research suggests many suffer negative psychological consequences from repeated exposures to trauma. While the Stress First Aid (SFA) model has gained increased attention and adoption among fire departments as a model for behavioral health training, it has not been formally evaluated. This cluster randomized controlled trial used a crossover design comparing the immediate SFA group to delayed SFA control to test the impact of the SFA on firefighters' mental and behavioral health changes after 10-12 months (n = 400; Mage = 37.6, 4.8% women). A convenience sample of 79 firefighters (Mage = 41.4; 8.7% women) provided evaluations on one or more of the training modules. Participants reported satisfaction with all training components (Peer team training 97.6%, Online SFA 94.9%, Curbside Manner 88.4%, After Action Review 89.4%) and reported success in changing personnel's perception of their department's ability to respond to behavioral health issues (SFA M = 3.93, Control 3.50; t = 2.52, p = 0.042). Future work should focus on additional resources and training to augment existing efforts to help departments continue their efforts.
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Affiliation(s)
- Sara A. Jahnke
- Center for Fire, Rescue & EMS Health Research, NDRI-USA, Inc., Leawood, KS 66224, USA; (S.A.J.); (N.J.); (C.M.K.); (C.K.H.); (W.S.C.P.)
| | - Patricia Watson
- National Center for PTSD, White River Junction, VT 05009, USA;
| | - Frank Leto
- FDNY, Counseling Services Unit, Fort Totten, NY 10314, USA;
| | - Nattinee Jitnarin
- Center for Fire, Rescue & EMS Health Research, NDRI-USA, Inc., Leawood, KS 66224, USA; (S.A.J.); (N.J.); (C.M.K.); (C.K.H.); (W.S.C.P.)
| | - Christopher M. Kaipust
- Center for Fire, Rescue & EMS Health Research, NDRI-USA, Inc., Leawood, KS 66224, USA; (S.A.J.); (N.J.); (C.M.K.); (C.K.H.); (W.S.C.P.)
| | - Brittany S. Hollerbach
- Center for Fire, Rescue & EMS Health Research, NDRI-USA, Inc., Leawood, KS 66224, USA; (S.A.J.); (N.J.); (C.M.K.); (C.K.H.); (W.S.C.P.)
| | - Christopher K. Haddock
- Center for Fire, Rescue & EMS Health Research, NDRI-USA, Inc., Leawood, KS 66224, USA; (S.A.J.); (N.J.); (C.M.K.); (C.K.H.); (W.S.C.P.)
| | - W. S. Carlos Poston
- Center for Fire, Rescue & EMS Health Research, NDRI-USA, Inc., Leawood, KS 66224, USA; (S.A.J.); (N.J.); (C.M.K.); (C.K.H.); (W.S.C.P.)
| | - Richard Gist
- KCMO Fire Department, Kansas City, MO 64106, USA;
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Hershey MS, Bouziani E, Chen XY(M, Lidoriki I, Hadkhale K, Huang YC, Filippou T, López-Gil JF, Gribble AK, Lan FY, Sotos-Prieto M, Kales SN. Surviving & Thriving; a healthy lifestyle app for new US firefighters: usability and pilot study protocol. Front Endocrinol (Lausanne) 2023; 14:1250041. [PMID: 37908746 PMCID: PMC10614295 DOI: 10.3389/fendo.2023.1250041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Accepted: 09/11/2023] [Indexed: 11/02/2023] Open
Abstract
In the United States (US), new firefighters' fitness and health behaviors deteriorate rapidly after fire academy graduation. Over the long-term, this increases their risks for chronic diseases. This study protocol describes the proposed usability testing and pilot study of a newly designed and developed healthy lifestyle smartphone app, "Surviving & Thriving", tailored towards young US firefighters. "Surviving & Thriving" will provide interactive educational content on four lifestyle factors; nutrition, sleep, physical activity, and resilience, and include a personalized journey, habit tracker, and elements of gamification to promote engagement and long-term healthy behavior change. The first phase of the app development entails alpha testing by the research team and pre-beta testing by a fire service expert panel which will help refine the app into a pre-consumer version. Upon completion of the full app prototype, beta 'usability' testing will be conducted among new fire academy graduates from two New England fire academies to collect qualitative and quantitative feedback via focus groups and satisfaction surveys, respectively. A last phase of piloting the app will evaluate the app's efficacy at maintaining/improving healthy lifestyle behaviors, mental health metrics, and physical fitness metrics. We will also evaluate whether firefighters' perceived "health cultures" scores (ratings of each fire station's/fire department's environments as to encouraging/discouraging healthy behaviors) modify the changes in health metrics after utilizing the app for three to six months. This novel user-friendly app seeks to help new firefighters maintain/improve their health and fitness more effectively, reducing their risk of lifestyle-related chronic disease. Firefighters who can establish healthy habits early in their careers are more likely to sustain them throughout their lives.
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Affiliation(s)
- Maria Soledad Hershey
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, United States
| | - Eleni Bouziani
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, United States
- Department of Medicine, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Xin Yu (Maggie) Chen
- Harvard Faculty of Arts and Sciences, William James Hall, Cambridge, MA, United States
- Department of Occupational Medicine, Cambridge Health Alliance, Harvard Medical School, Cambridge, MA, United States
| | - Irene Lidoriki
- Department of Occupational Medicine, Cambridge Health Alliance, Harvard Medical School, Cambridge, MA, United States
| | - Kishor Hadkhale
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, United States
- Department of Occupational Medicine, Cambridge Health Alliance, Harvard Medical School, Cambridge, MA, United States
| | - Ya-Chin Huang
- Department of Occupational Medicine, Cambridge Health Alliance, Harvard Medical School, Cambridge, MA, United States
- Department of Preventive Medicine, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
- Department of Occupational & Environmental Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | | | - José Francisco López-Gil
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, United States
- One Health Research Group, Universidad de Las Américas, Quito, Ecuador
| | - Anne Katherine Gribble
- Department of Occupational Medicine, Cambridge Health Alliance, Harvard Medical School, Cambridge, MA, United States
- Illawarra Shoalhaven Local Health District, NSW Health, Warrawong, NSW, Australia
| | - Fan-Yun Lan
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, United States
- Institute of Health and Welfare Policy, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Mercedes Sotos-Prieto
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, United States
- Department of Preventive Medicine and Public Health, School of Medicine, Universidad Autónoma de Madrid, and IdiPaz (Instituto de Investigación Sanitaria Hospital Universitario La Paz), Madrid, Spain
- Center for Biomedical Research in Epidemiology and Public Health Network (CIBERESP) [Consorcio Centro de Investigación Biomédica en Red (CIBER) of Epidemiology and Public Health], Madrid, Spain
- Madrid Institute for Advanced Studies (IMDEA)-Food Institute, The Campus of International Excellence (CEI), The Spanish National Research Council (CSIC), The Autonomous University of Madrid (UAM), Madrid, Spain
| | - Stefanos N. Kales
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, United States
- Department of Occupational Medicine, Cambridge Health Alliance, Harvard Medical School, Cambridge, MA, United States
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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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10
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Pao C, Arbona C, Fan W, Tran J. Duty-related trauma and PTSD symptoms in US urban firefighters. Occup Med (Lond) 2023; 73:324-331. [PMID: 37523669 DOI: 10.1093/occmed/kqad076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/02/2023] Open
Abstract
BACKGROUND Little is known about the multi-dimensional nature of traumatic duty-related events encountered by firefighters in relation to their post-traumatic stress disorder (PTSD) risk. AIMS To describe the types of duty-related events encountered by career firefighters and explore if years in the fire service or total event load moderated the association of trauma exposure to PTSD symptoms. METHODS Participants included 755 career, male firefighters (19% of the department's firefighters and 76% of those who accessed the electronic anonymous survey). The Duty-Related Incident Stressors scale was used to assess exposure to 25 potentially traumatic events (event load) and self-appraisal of the stress associated with these events, grouped by type of event (indirect, direct and colleague-related). The Post-Traumatic Stress Disorder Checklist was used to assess PTSD symptoms. RESULTS Firefighters rated colleague-related events as the most stressful, followed by indirect and direct events. Event load (r = 0.25) and indirect, direct and colleague-related events stress (r = 0.32-0.35) were positively associated with PTSD symptoms. Results of moderation analyses indicated that event load served as a risk factor in the relation of indirect events stress to PTSD symptoms, and as a buffer in the relation of direct events stress to PTSD symptoms. Years in the fire service were not associated with PTSD symptoms nor moderated the relation of event stress to PTSD symptoms. CONCLUSIONS Findings underscored the importance of considering the differential effects that types of duty-related traumatic events and cumulative exposure to trauma may have on firefighters' PTSD symptoms.
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Affiliation(s)
- C Pao
- Mental Health, South Texas Veterans Healthcare System, San Antonio, TX 78223-1633, USA
| | - C Arbona
- Department of Psychological, Health, and Learning Sciences, University of Houston, Houston, TX 77204, USA
| | - W Fan
- Department of Psychological, Health, and Learning Sciences, University of Houston, Houston, TX 77204, USA
| | - J Tran
- National Aeronautics and Space Administration (NASA), Houston, TX 77058, USA
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11
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Igboanugo S, Mielke J. The allostatic load model: a framework to understand the cumulative multi-system impact of work-related psychosocial stress exposure among firefighters. Health Psychol Behav Med 2023; 11:2255026. [PMID: 37711429 PMCID: PMC10498803 DOI: 10.1080/21642850.2023.2255026] [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: 12/14/2022] [Accepted: 08/28/2023] [Indexed: 09/16/2023] Open
Abstract
Firefighting is recognised as a profession where health and well-being can be affected by a variety of occupational factors, such as physical, thermal, and chemical stressors. Along with the risks intuitively associated with the fire service, however, psychosocial stress has begun to attract attention as another variable deserving of consideration. Indeed, long-term exposure to work-related psychosocial stress has been linked with poor health outcomes in many workers; however, despite this association, very little has been done to examine how such stressors become biologically embedded in firefighters. To help facilitate research into how psychosocial stress can affect health-related outcomes in the fire service, we propose a framework centered on the notion of allostatic load. First, we reviewed the occupational characteristics that may generate psychosocial stress within firefighters before introducing allostatic load (that is, dysregulation across various physiological systems caused by the need to manage ongoing stressors). Next, we provided a summary of how allostatic load can be measured and touched on the framework's utility for studying the cumulative effects of work-related stress on firefighter health. After this, factors that may influence the steps leading from stress exposure to health outcomes were discussed; in particular, we commented upon how research in this area should consider specific non-modifiable (age, sex, and ethnicity) and modifiable (psychosocial resources and behavioural habits) factors. Finally, we presented methodological barriers and opportunities that may arise when using the allostatic load framework with this professional group. By introducing the framework, we hope to provide a tool that may be used by those interested in stress-health research in firefighters to build the evidence needed to inform primary prevention measures.
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Affiliation(s)
- Somkene Igboanugo
- School of Public Health Sciences, University of Waterloo, Waterloo, Canada
- Patient Education and Engagement, University Health Network, Toronto, Canada
| | - John Mielke
- School of Public Health Sciences, University of Waterloo, Waterloo, Canada
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Giaume L, Jimenez A, Kedzierewicz R, Jost D, Pery M, Trouvé J, Burlaton G, Travers S, Prunet B, Trousselard M. FIRECARE: An Evidence-Based Prevention Program to Reduce Burnout among Prehospital Caregivers: Benefits of a Combined Mindfulness, Heart Coherence Training, and Positive Psychology Intervention. PREHOSP EMERG CARE 2023; 28:342-351. [PMID: 37698362 DOI: 10.1080/10903127.2023.2258204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Accepted: 09/07/2023] [Indexed: 09/13/2023]
Abstract
BACKGROUND Burnout among emergency health care professionals is well-described, especially during the COVID-19 pandemic. Prevention interventions, such as mindfulness, focus on the management of stress. OBJECTIVE To evaluate the effects of the FIRECARE program (a mindfulness intervention, supplemented by heart coherence training and positive psychology workshops) on burnout, secondary stress, compassion fatigue, and mindfulness among advanced life support ambulance staff of the Paris Fire Brigade. MATERIALS AND METHODS We used a non-randomized, two-group quasi-experimental study design with a waitlist control and before-and-after measurements in each group. The intervention consisted of six, once-weekly, 2.5-h sessions that included individual daily meditation and cardiac coherence practice. The study compared intervention and waitlist control groups, and investigated baseline, post-program, and 3-month follow-up change on burnout (measuring using the ProQOL-5 scale) and mindfulness (measuring using the FMI scores). Baseline burnout (measured using the ProQOL-5) was evaluated and used in the analysis. RESULTS Seventy-four 74 participants volunteered to participate; 66 were included in the final analysis. Of these, 60% were classified as suffering from moderate burnout, the 'burnout cluster'. A comparison of intervention and waitlist control groups found a decrease in the burnout score in the burnout cluster (p = 0.0003; partial eta squared = 0.18). However, while secondary stress fell among the burnout cluster, it was only for participants in the intervention group; scores increased for those in the waitlist group (p = 0.003; partial eta squared = 0.12). The pre-post-intervention analysis of both groups also showed that burnout fell in the burnout cluster (p = 0.006; partial eta squared = 0.11). At 3-month follow-up, the burnout score was significantly reduced in the intervention group (p = 0.02; partial eta squared = 0.07), and both the acceptance (p = 0.007) and mindfulness scores (p = 0.05; partial eta squared = 0.05) were increased in the baseline burnout cluster. CONCLUSION FIRECARE may be a useful approach to preventing and reducing burnout among prehospital caregivers.
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Affiliation(s)
- Louise Giaume
- Emergency Medical Department, Paris Fire Brigade, Paris, France
| | | | - Romain Kedzierewicz
- Unité d'instruction et d'intervention de la Sécurité civile, Brignoles, France
| | - Daniel Jost
- Emergency Medical Department, Paris Fire Brigade, Paris, France
| | - Marie Pery
- Emergency Medical Department, Paris Fire Brigade, Paris, France
| | - Julien Trouvé
- Psychology Department, Paris Fire Brigade, Paris, France
| | | | | | - Bertrand Prunet
- Hospital of Instruction of the Armed Forces Laveran, Marseille, France
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Kling HE, Koru-Sengul T, Solle NS, Louzado-Feliciano P, Lee DJ, Kobetz EN, Caban-Martinez AJ. Weight Status and Binge Drinking Among Male and Female Florida Firefighters. J Occup Environ Med 2023; 65:e565-e570. [PMID: 37253243 PMCID: PMC10524551 DOI: 10.1097/jom.0000000000002894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
OBJECTIVE The aim of the study is to examine the association between weight status and binge drinking among Florida firefighters. METHODS Health survey data collected between 2015 and 2019 among Florida firefighters participating in the Annual Cancer Survey were analyzed for weight class (healthy, overweight, obese) and binge-drinking behaviors. Binary logistic regression models were fit and stratified by sex while controlling for sociodemographic and health characteristics. RESULTS Among 4002 firefighter participants, 45.1% binge drink, 50.9% are overweight, and 31.3% are obese. Among male firefighters, being overweight (adjusted odds ratio = 1.34; 95% confidence interval = 1.10-1.64) or obese (1.29; 1.04-1.61) was significantly associated with binge drinking compared with healthy weight counterparts. In female firefighters, being obese (2.25; 1.21-4.22) was significantly associated with binge drinking but being overweight was not. CONCLUSIONS Being overweight or obese is selectively associated with binge drinking among male and female firefighters.
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Affiliation(s)
- Hannah E. Kling
- Department of Public Health Sciences, University of Miami, Miller School of Medicine, Miami, FL, USA
| | - Tulay Koru-Sengul
- Department of Public Health Sciences, University of Miami, Miller School of Medicine, Miami, FL, USA
- Department of Sylvester Comprehensive Cancer Center, University of Miami, Miller School of Medicine, Miami, FL, USA
| | - Natasha Schaefer Solle
- Department of Public Health Sciences, University of Miami, Miller School of Medicine, Miami, FL, USA
- Department of Medicine and University of Miami, Miller School of Medicine, Miami, FL, USA
- Department of Sylvester Comprehensive Cancer Center, University of Miami, Miller School of Medicine, Miami, FL, USA
| | - Paola Louzado-Feliciano
- Department of Public Health Sciences, University of Miami, Miller School of Medicine, Miami, FL, USA
| | - David J. Lee
- Department of Public Health Sciences, University of Miami, Miller School of Medicine, Miami, FL, USA
- Department of Sylvester Comprehensive Cancer Center, University of Miami, Miller School of Medicine, Miami, FL, USA
| | - Erin N. Kobetz
- Department of Public Health Sciences, University of Miami, Miller School of Medicine, Miami, FL, USA
- Department of Medicine and University of Miami, Miller School of Medicine, Miami, FL, USA
- Department of Sylvester Comprehensive Cancer Center, University of Miami, Miller School of Medicine, Miami, FL, USA
| | - Alberto J. Caban-Martinez
- Department of Public Health Sciences, University of Miami, Miller School of Medicine, Miami, FL, USA
- Department of Sylvester Comprehensive Cancer Center, University of Miami, Miller School of Medicine, Miami, FL, USA
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14
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Sharp P, Caperchione CM, Brown GA, Stadnyk A, Marin E, Hulin B, Wade J, Mott B, Gabriel M, Impellizzeri F, Fullagar HHK. A pragmatic strength and conditioning intervention for firefighters: Feasibility of the Tactical Athlete Resilience Program (TARP). Health Promot J Austr 2023; 34:60-69. [PMID: 36054639 PMCID: PMC10091986 DOI: 10.1002/hpja.656] [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: 03/27/2022] [Revised: 08/04/2022] [Accepted: 08/28/2022] [Indexed: 01/27/2023] Open
Abstract
ISSUE ADDRESSED Firefighting is physically and mentally taxing and recruits are expected to have optimal health and fitness. However, physical fitness tends to decline following initial training, placing firefighters at an increased risk for stress and injury. Efforts are needed to engage and support firefighters in maintaining adequate health and fitness to withstand the rigorous demands of their occupation. This study examined the feasibility of TARP, a pragmatic strength and conditioning intervention for metropolitan-based firefighters, delivered in collaboration with a professional National Rugby League club. METHODS A mixed-methods approach was utilised to examine program implementation, recruitment and sample characteristics, intervention satisfaction and acceptability, and participants' response to the intervention. Evaluation measures included field notes taken during steering committee meetings, participant flow data, baseline and follow-up outcome measures, self-report questionnaires, and telephone interviews with a sample of participants. RESULTS Participants (N = 113) were predominantly men (82%) with a mean age of 43 ± 9.3 years and BMI of 26.6 ± 2.9 kg/m2 . Program satisfaction was high (95% very satisfied or somewhat satisfied) among program completers (42% retention). Key strengths of the program included delivery through the professional sports club, quality of facilities and equipment, and scheduling flexibility. Future programs should consider incorporating education or training to support behaviour change maintenance and strategies to retain participants at follow-up. CONCLUSIONS Results provide valuable insights into the design and delivery of interventions for firefighters and demonstrate the importance of strong partnerships between community stakeholders.
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Affiliation(s)
- Paul Sharp
- School of Sport, Exercise and Rehabilitation, University of Technology Sydney, Sydney, New South Wales, Australia.,School of Nursing, University of British Columbia, Vancouver, Canada.,Department of Psychiatry, University of British Columbia, Vancouver, Canada
| | - Cristina M Caperchione
- School of Sport, Exercise and Rehabilitation, University of Technology Sydney, Sydney, New South Wales, Australia
| | - Georgia A Brown
- School of Sport, Exercise and Rehabilitation, University of Technology Sydney, Sydney, New South Wales, Australia
| | - Antony Stadnyk
- School of Sport, Exercise and Rehabilitation, University of Technology Sydney, Sydney, New South Wales, Australia
| | - Elizabeth Marin
- School of Sport, Exercise and Rehabilitation, University of Technology Sydney, Sydney, New South Wales, Australia
| | - Billy Hulin
- South Sydney Rabbitohs Rugby League Football Club, Sydney, New South Wales, Australia
| | - Jarrod Wade
- South Sydney Rabbitohs Rugby League Football Club, Sydney, New South Wales, Australia
| | - Brendan Mott
- Fire and Rescue NSW, Sydney, New South Wales, Australia
| | - Mark Gabriel
- Fire and Rescue NSW, Sydney, New South Wales, Australia
| | - Franco Impellizzeri
- School of Sport, Exercise and Rehabilitation, University of Technology Sydney, Sydney, New South Wales, Australia
| | - Hugh H K Fullagar
- School of Sport, Exercise and Rehabilitation, University of Technology Sydney, Sydney, New South Wales, Australia
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15
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Odes R, Chin DL, Li J, Hong O. Association of Occupational Stress With Tinnitus Among Career Firefighters in the United States. J Occup Environ Med 2023; 65:e30-e35. [PMID: 36306205 DOI: 10.1097/jom.0000000000002742] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE This study explores the relationship between occupational stress and tinnitus among firefighters, a group often exposed to two tinnitus risk factors: high stress and noise. METHODS This cross-sectional study includes 240 firefighters in the United States. Data describing demographic characteristics, occupational stress, noise exposure, and tinnitus were collected by survey. Occupational stress was measured using the short version of the Effort-Reward Imbalance Questionnaire. RESULTS Forty-three percent of participants reported experiencing tinnitus within the past month. For occupational stress, higher effort (odds ratio, 1.25; 95% confidence interval, 1.05 to 1.49) and higher effort-reward ratio (odds ratio, 12.28; 95% confidence interval, 3.08 to 48.86) were associated with increased odds of tinnitus, after adjustment for demographic characteristics and noise exposure. CONCLUSIONS Occupational stress may increase the likelihood of tinnitus for firefighters, an already at-risk group of workers. Health providers should incorporate stress assessment into tinnitus management programs.
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Affiliation(s)
- Rachel Odes
- From the Occupational and Environmental Health Nursing Graduate Program, School of Nursing, University of California San Francisco, San Francisco, California (Drs Odes, Chin, and Hong); National Clinician Scholars Program, Institute for Health Policy Studies, University of California San Francisco, San Francisco, California (Dr Odes); and Department of Environmental Health Sciences, Fielding School of Public Health, School of Nursing, University of California Los Angeles, Los Angeles, California (Dr Li)
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Wolffe TAM, Robinson A, Clinton A, Turrell L, Stec AA. Mental health of UK firefighters. Sci Rep 2023; 13:62. [PMID: 36627314 PMCID: PMC9832123 DOI: 10.1038/s41598-022-24834-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Accepted: 11/21/2022] [Indexed: 01/12/2023] Open
Abstract
Exposure to trauma, high-stress situations, and disrupted sleep are well known risk factors affecting firefighters' mental health. Little is known about the association between firefighters' exposure to fire contaminants and mental health disorders. The UK Firefighter Contamination Survey assessed firefighters' health and capacity for occupational exposure to contaminants. Participants were invited to anonymously complete its 64 questions online. Logistic regression analyses assessed the associations between self-reported mental health disorders and proxies of contaminant exposure. Results found that firefighters who notice soot in their nose/throat for more than a day after attending fires (Odds Ratio (OR) = 1.8, 1.4-2.4), and those who remain in their personal protective equipment (PPE) for over 4 h after fires (OR = 1.9, 1.2-3.1), were nearly twice as likely to report mental health disorders. Significantly increased odds ratios for all three outcomes of interest (anxiety, depression and/or any mental health disorders) were also found among firefighters who take PPE home to clean. Sleeping problems were reported by 61% of firefighters. These firefighters were 4.2 times more likely to report any mental health disorder (OR = 4.2, 3.7-4.9), 2.9 times more likely to report anxiety (OR = 2.9, 2.4-3.5) and 2.3 times more likely to report depression (OR = 2.3, 1.9-2.8) when compared to firefighters who did not report sleep issues. Effective decontamination measures within UK Fire and Rescue Services, together with firefighters' wellness, may play a crucial role in protecting firefighters' mental health.
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Affiliation(s)
- Taylor A M Wolffe
- Centre for Fire and Hazards Sciences, University of Central Lancashire, Preston, Lancashire, PR1 2HE, UK
| | - Andrew Robinson
- Centre for Fire and Hazards Sciences, University of Central Lancashire, Preston, Lancashire, PR1 2HE, UK
- Royal Preston Hospital, Lancashire Teaching Hospitals NHS Foundation Trust, Preston, Lancashire, PR2 9HT, UK
| | - Anna Clinton
- Centre for Fire and Hazards Sciences, University of Central Lancashire, Preston, Lancashire, PR1 2HE, UK
| | - Louis Turrell
- Centre for Fire and Hazards Sciences, University of Central Lancashire, Preston, Lancashire, PR1 2HE, UK
- Royal Preston Hospital, Lancashire Teaching Hospitals NHS Foundation Trust, Preston, Lancashire, PR2 9HT, UK
| | - Anna A Stec
- Centre for Fire and Hazards Sciences, University of Central Lancashire, Preston, Lancashire, PR1 2HE, UK.
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Crivatu IM, Horvath MAH, Massey K. The Impacts of Working With Victims of Sexual Violence: A Rapid Evidence Assessment. TRAUMA, VIOLENCE & ABUSE 2023; 24:56-71. [PMID: 34000946 PMCID: PMC9660261 DOI: 10.1177/15248380211016024] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
AIM Supporting clients who have experienced trauma can lead to trauma symptoms in those working with them; workers in the sexual violence field are at heightened risks of these. This article collated and critically appraised papers, published from 2017 onward, in the area of people assisting victims of sexual violence. It explores the impacts and effects the work has on them, their coping and self-care mechanisms, and organizational support offered to them. DESIGN A question-based rapid evidence assessment with a triangulated weight of evidence approach was used. Academic and nonacademic databases were searched. Twenty-five papers were included for analysis based on the inclusion/exclusion criteria. RESULTS Most studies were of medium to high methodological quality. Negative impacts included trauma symptoms, disrupted social relationships, behavioral changes, and emotional and psychological distress. Ability to manage negative impacts was influenced by overall organizational support, availability of training, supervision and guidance, workloads and caseload characteristics, individual characteristics, and their coping and self-care mechanisms. Positive impacts included empowering feelings, improved relationships, compassion satisfaction, and posttraumatic growth. CONCLUSIONS Impacts are significant. Support at work and in personal life increases staff's ability to cope and find meaning in their role. Implications for research and practice are discussed.
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Affiliation(s)
| | | | - Kristina Massey
- School of Law, Criminal Justice and Policing, Canterbury Christ Church
University, United Kingdom
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18
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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: 2] [Impact Index Per Article: 1.0] [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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Firefighter Well-Being Defined and Operationalized at the Organizational and Worker Level: A Qualitative Study. J Occup Environ Med 2022; 64:e736-e743. [PMID: 35993618 DOI: 10.1097/jom.0000000000002685] [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
OBJECTIVE The aim of the study is to define and explore organizational- and worker-level factors of firefighter well-being. METHODS Qualitative data were collected using interviews and focus group sessions among 17 career firefighters across 4 fire departments. Interviews were recorded and transcribed, and a general inductive approach was used to code similar concepts into themes. RESULTS Firefighters defined well-being as being content with oneself and being able to balance ones' emotional, mental, and physical health. Themes contributing to firefighter well-being include the nature of the job, the influence of others, and physical health. Subthemes mapping to themes include dealing with trauma, compartmentalizing work and home life, coworkers and station culture, the role of superiors on attitudes and practices, being a reliable firefighter, and lack of sleep. CONCLUSIONS Career firefighters describe well-being as a holistic approach to balancing emotional, mental, and physical health.
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20
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Goodrich JM, Jung AM, Furlong MA, Beitel S, Littau S, Gulotta J, Wallentine D, Burgess JL. Repeat measures of DNA methylation in an inception cohort of firefighters. Occup Environ Med 2022; 79:656-663. [PMID: 35332072 PMCID: PMC9484361 DOI: 10.1136/oemed-2021-108153] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Accepted: 03/11/2022] [Indexed: 11/04/2022]
Abstract
OBJECTIVES Firefighters face exposures associated with adverse health outcomes including risk for multiple cancers. DNA methylation, one type of epigenetic regulation, provides a potential mechanism linking occupational hazards to adverse health outcomes. We hypothesised that DNA methylation profiles would change in firefighters after starting their service and that these patterns would be associated with occupational exposures (cumulative fire-hours and fire-runs). METHODS We profiled DNA methylation with the Infinium MethylationEPIC in blood leucocytes at two time points in non-smoking new recruits: prior to live fire training and 20-37 months later. Linear mixed effects models adjusted for potential confounders were used to identify differentially methylated CpG sites over time using data from 50 individuals passing all quality control. RESULTS We report 680 CpG sites with altered methylation (q value <0.05) including 60 with at least a 5% methylation difference at follow-up. Genes with differentially methylated CpG sites were enriched in biological pathways related to cancers, neurological function, cell signalling and transcription regulation. Next, linear mixed effects models were used to determine associations between occupational exposures with methylation at the 680 loci. Of these, more CpG sites were associated with fire-runs (108 for all and 78 for structure-fires only, q<0.05) than with fire-hours (27 for all fires and 1 for structure fires). These associations were independent of time since most recent fire, suggesting an impact of cumulative exposures. CONCLUSIONS Overall, this study provides evidence that DNA methylation may be altered by fireground exposures, and the impact of this change on disease development should be evaluated.
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Affiliation(s)
- Jaclyn M Goodrich
- Department of Environmental Health Sciences, University of Michigan School of Public Health, Ann Arbor, Michigan, USA
| | - Alesia M Jung
- Department of Community, Environment, and Policy, University of Arizona Mel and Enid Zuckerman College of Public Health, Tucson, Arizona, USA
| | - Melissa A Furlong
- Department of Community, Environment, and Policy, University of Arizona Mel and Enid Zuckerman College of Public Health, Tucson, Arizona, USA
| | - Shawn Beitel
- Department of Community, Environment, and Policy, University of Arizona Mel and Enid Zuckerman College of Public Health, Tucson, Arizona, USA
| | - Sally Littau
- Department of Community, Environment, and Policy, University of Arizona Mel and Enid Zuckerman College of Public Health, Tucson, Arizona, USA
| | | | | | - Jefferey L Burgess
- Department of Community, Environment, and Policy, University of Arizona Mel and Enid Zuckerman College of Public Health, Tucson, Arizona, USA
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21
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Kauffman B, Manning K, Zvolensky MJ, Vujanovic AA. Fatigue sensitivity and mental health among trauma-exposed firefighters. FATIGUE: BIOMEDICINE, HEALTH & BEHAVIOR 2022; 10:146-156. [PMID: 36968246 PMCID: PMC10035633 DOI: 10.1080/21641846.2022.2095523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Background Firefighters are faced with numerous work-related demands and stressors, including exposure to potentially traumatic events, and are thus at an increased risk for poor mental health outcomes. To better understand the mental health of trauma-exposed firefighters, the current study sought to examine the association of fatigue sensitivity with posttraumatic stress disorder (PTSD), anxiety, and depressive symptom severity in a cross-sectional study design. Methods Participants included 107 (M age = 40.8 years; SD age = 8.95; age range: 21-67 years; 95.0% male) trauma-exposed firefighters. Results Findings from the current study indicated that fatigue sensitivity was a statistically significant clinical correlate of PTSD, anxiety, and depressive symptom severity. The statistically significant incremental effects were small to medium across the mental health variables, but evident after accounting for years in the fire service, sleep quality, and trauma load. Conclusions The present data provide initial empirical evidence for the role of fatigue sensitivity in terms of a broad range of mental health indices among trauma-exposed firefighters.
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Affiliation(s)
- Brooke Kauffman
- Department of Psychology, University of Houston, Houston, TX, USA
| | - Kara Manning
- Department of Psychology, University of Houston, Houston, TX, USA
| | - Michael J. Zvolensky
- Department of Psychology, University of Houston, Houston, TX, USA
- Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
- HEALTH Institute, University of Houston, Houston, TX, USA
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22
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Sharp ML, Solomon N, Harrison V, Gribble R, Cramm H, Pike G, Fear NT. The mental health and wellbeing of spouses, partners and children of emergency responders: A systematic review. PLoS One 2022; 17:e0269659. [PMID: 35704626 PMCID: PMC9200352 DOI: 10.1371/journal.pone.0269659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Accepted: 05/26/2022] [Indexed: 11/18/2022] Open
Abstract
Emergency responders (ERs), often termed First Responders, such as police, fire and paramedic roles are exposed to occupational stressors including high workload, and exposure to trauma from critical incidents, both of which can affect their mental health and wellbeing. Little is known about the impact of the ER occupation on the mental health and wellbeing of their families. The aim of the current study was to investigate what mental health and wellbeing outcomes and experiences have been researched internationally in ER families, and to examine the prevalence and associated risk and protective factors of these outcomes. We conducted a systematic review in accordance with an a priori PROSPERO approved protocol (PROSPERO 2019 CRD42019134974). Forty-three studies were identified for inclusion. The majority of studies used a quantitative, cross-sectional design and were conducted in the United States; just over half assessed police/law enforcement families. Themes of topics investigated included: 1) Spousal/partner mental health and wellbeing; 2) Couple relationships; 3) Child mental health and wellbeing; 4) Family support and coping strategies; and 5) Positive outcomes. The review identified limited evidence regarding the prevalence of mental health and wellbeing outcomes. Family experiences and risk factors described were ER work-stress spillover negatively impacting spousal/partner wellbeing, couple relationships, and domestic violence. Traumatic exposure risk factors included concerns family had for the safety of their ER partner, the negative impact of an ER partners’ mental health problem on the couples’ communication and on family mental health outcomes. Protective factors included social support; however, a lack of organisational support for families was reported in some studies. Study limitations and future research needs are discussed. Progressing this area of research is important to improve knowledge of baseline needs of ER families to be able to target interventions, improve public health, and support ER’s operational effectiveness.
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Affiliation(s)
- Marie-Louise Sharp
- Department of Psychological Medicine, King’s Centre for Military Health Research, King’s College London, London, United Kingdom
- * E-mail:
| | - Noa Solomon
- Care Quality Commission, London, United Kingdom
| | - Virginia Harrison
- Faculty of Arts and Social Sciences, School of Psychology and Counselling, The Open University, London, United Kingdom
- The Centre for Policing Research and Learning, The Open University, London, United Kingdom
| | - Rachael Gribble
- Department of Psychological Medicine, King’s Centre for Military Health Research, King’s College London, London, United Kingdom
| | - Heidi Cramm
- Faculty of Health Sciences, School of Rehabilitation Therapy, Queen’s University, Kingston, Canada
| | - Graham Pike
- Faculty of Arts and Social Sciences, School of Psychology and Counselling, The Open University, London, United Kingdom
- The Centre for Policing Research and Learning, The Open University, London, United Kingdom
| | - Nicola T. Fear
- Department of Psychological Medicine, King’s Centre for Military Health Research, King’s College London, London, United Kingdom
- Academic Department of Military Mental Health, Department of Psychological Medicine, King’s College London, London, United Kingdom
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Jitnarin N, Jahnke SA, Poston WSC, Haddock CK, Kaipust CM. Posttraumatic stress disorder (PTSD) and mental health comorbidity in firefighters. JOURNAL OF WORKPLACE BEHAVIORAL HEALTH 2022. [DOI: 10.1080/15555240.2022.2081172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Nattinee Jitnarin
- Center for Fire, Rescue and EMS Health Research, NDRI – USA, Inc, Leawood, Kansas, USA
| | - Sara A. Jahnke
- Center for Fire, Rescue and EMS Health Research, NDRI – USA, Inc, Leawood, Kansas, USA
| | - Walker S. C. Poston
- Center for Fire, Rescue and EMS Health Research, NDRI – USA, Inc, Leawood, Kansas, USA
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Davidson S, Jahnke S, Jung AM, Burgess JL, Jacobs ET, Billheimer D, Farland LV. Anti-Müllerian Hormone Levels among Female Firefighters. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:5981. [PMID: 35627519 PMCID: PMC9141260 DOI: 10.3390/ijerph19105981] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Revised: 05/11/2022] [Accepted: 05/12/2022] [Indexed: 02/04/2023]
Abstract
Female firefighters have occupational exposures which may negatively impact their reproductive health. Anti-müllerian hormone (AMH) is a clinical marker of ovarian reserve. We investigated whether AMH levels differed in female firefighters compared to non-firefighters and whether there was a dose-dependent relationship between years of firefighting and AMH levels. Female firefighters from a pre-existing cohort completed a cross-sectional survey regarding their occupational and health history and were asked to recruit a non-firefighter friend or relative. All participants provided a dried blood spot (DBS) for AMH analysis. Linear regression was used to assess the relationship between firefighting status and AMH levels. Among firefighters, the influence of firefighting-related exposures was evaluated. Firefighters (n = 106) and non-firefighters (n = 58) had similar age and BMI. Firefighters had a lower mean AMH compared to non-firefighters (2.93 ng/mL vs. 4.37 ng/mL). In multivariable adjusted models, firefighters had a 33% lower AMH value than non-firefighters (-33.38%∆ (95% CI: -54.97, -1.43)). Years of firefighting was not associated with a decrease in AMH. Firefighters in this study had lower AMH levels than non-firefighters. More research is needed to understand the mechanisms by which firefighting could reduce AMH and affect fertility.
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Affiliation(s)
- Samantha Davidson
- Department of Epidemiology and Biostatistics, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ 85724, USA; (S.D.); (A.M.J.); (E.T.J.); (D.B.)
| | - Sara Jahnke
- Center for Fire, Rescue & EMS Health Research, NDRI-USA, Inc., Leawood, KS 66224, USA;
| | - Alesia M. Jung
- Department of Epidemiology and Biostatistics, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ 85724, USA; (S.D.); (A.M.J.); (E.T.J.); (D.B.)
- Department of Community, Environment & Policy, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ 85724, USA;
| | - Jefferey L. Burgess
- Department of Community, Environment & Policy, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ 85724, USA;
- Cancer Prevention and Control Program, University of Arizona Cancer Center, Tucson, AZ 85719, USA
| | - Elizabeth T. Jacobs
- Department of Epidemiology and Biostatistics, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ 85724, USA; (S.D.); (A.M.J.); (E.T.J.); (D.B.)
- Cancer Prevention and Control Program, University of Arizona Cancer Center, Tucson, AZ 85719, USA
| | - Dean Billheimer
- Department of Epidemiology and Biostatistics, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ 85724, USA; (S.D.); (A.M.J.); (E.T.J.); (D.B.)
| | - Leslie V. Farland
- Department of Epidemiology and Biostatistics, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ 85724, USA; (S.D.); (A.M.J.); (E.T.J.); (D.B.)
- Cancer Prevention and Control Program, University of Arizona Cancer Center, Tucson, AZ 85719, USA
- Department of Obstetrics and Gynecology, College of Medicine-Tucson, University of Arizona, Tucson, AZ 85724, USA
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Soteriades ES, Vogazianos P, Tozzi F, Antoniades A, Economidou EC, Psalta L, Spanoudis G. Exercise and Occupational Stress among Firefighters. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:4986. [PMID: 35564381 PMCID: PMC9101080 DOI: 10.3390/ijerph19094986] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Revised: 04/13/2022] [Accepted: 04/18/2022] [Indexed: 12/04/2022]
Abstract
The aim of our study was to evaluate the potential association between physical activity and occupational stress among firefighters. Data were collected from Cypriot firefighters through a web-based battery of internationally validated questionnaires completed anonymously (COPSOQ, DASS). A total of 430 firefighters (response rate 68%) completed the survey (age range: 21-60 years). More than half of the firefighters (54%) reported either no or minimal physical activity. A total of 11% of firefighters reported moderate to extremely severe stress based on the DASS-S scale. Using multivariable-adjusted logistic regression models, we showed that firefighters who exercised had 50% lower risk of occupational stress, and using a categorical model, we found that every hour per week of increased physical activity among firefighters was associated with 16% lower risk of occupational stress after adjusting for age, education, smoking, and body mass index (OR = 1.16; p = 0.05). In addition, our findings suggest an inverse dose-response relationship between physical activity and occupational stress among firefighters. Physical activity appears to be inversely associated with occupational stress and serves as an important mitigating factor of occupational stress in firefighters. Further research is warranted to evaluate the potential effect of exercise interventions on occupational stress, and the overall mental health of firefighters and other occupational groups.
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Affiliation(s)
- Elpidoforos S. Soteriades
- Healthcare Management Program, School of Economics and Management, Open University of Cyprus, Nicosia 2220, Cyprus
- Environmental and Occupational Medicine and Epidemiology (EOME), Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA 02115, USA
| | - Paris Vogazianos
- Department of Social and Behavioral Sciences, School of Humanities, Social and Education Sciences, European University Cyprus, Nicosia 1516, Cyprus;
| | - Federica Tozzi
- Stremble Ventures Ltd., Limassol 4042, Cyprus; (F.T.); (A.A.)
| | | | | | - Lilia Psalta
- School of Sciences, UCLan Cyprus, Larnaka 7080, Cyprus;
- Department of Psychology, University of Cyprus, Nicosia 1678, Cyprus;
| | - George Spanoudis
- Department of Psychology, University of Cyprus, Nicosia 1678, Cyprus;
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Dynamic Psychotherapy as a PTSD Treatment for Firefighters: A Case Study. Healthcare (Basel) 2022; 10:healthcare10030530. [PMID: 35327008 PMCID: PMC8954085 DOI: 10.3390/healthcare10030530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Revised: 03/11/2022] [Accepted: 03/12/2022] [Indexed: 02/01/2023] Open
Abstract
In Portugal, forest fires are responsible for disasters that tend to be repeated annually, leading to dramatic consequences, such as those that have occurred in 2017, with the destruction of hundreds of houses and the deaths of dozens of people. Firefighters who are exposed to these potentially traumatic events are considered a high-risk group for the development of stress-related disorders. The aim of this study was to monitor the progress of two firefighters with symptoms of post-traumatic stress disorder (PTSD) treated through dynamic psychotherapy (DP) and to assess the feasibility of implementing this intervention within fire departments. A female firefighter and a male firefighter, with similar sociodemographic characteristics and PTSD symptom severity, were selected to verify the treatment applicability for both genders. The symptomatology changes were assessed through a set of instruments (PHQ-15, PCL-5, BSI, DASS, and CALPAS-P) applied every three months over 15 months (including pre-treatment, treatment period, and post-treatment). DP seemed to be an effective treatment for PTSD symptoms, with patients showing a state of increasing improvement even after the end of treatment. The acceptability to firefighters, the treatment adherence, the therapeutic alliance, and the reduction in PTSD symptoms suggest feasibility for implementing this intervention inside the Portuguese fire departments.
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Smith E, Holmes L, Larkin B, Mills B, Dobson M. Supporting Volunteer Firefighter Well-Being: Lessons from the Australian "Black Summer" Bushfires. Prehosp Disaster Med 2022; 37:1-4. [PMID: 35232517 DOI: 10.1017/s1049023x22000322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
INTRODUCTION The 2019-2020 "Black Summer" bushfires in Australia focused the attention of the nation on the critical role that volunteer firefighters play in the response to such a disaster, spurring a national conversation about how to best support those on the frontline. The objective of this research was to explore the impact of the Black Summer bushfires on volunteer firefighter well-being and to investigate how to deliver effective well-being support. METHODS An explorative qualitative design underpinned by a phenomenological approach was applied. Participant recruitment followed a multi-modal sampling strategy and data were collected through semi-structured, in-depth interviews. RESULTS Qualitative data were collected from 58 participants aged from 23 to 61-years-of-age (average age of 46 years). All self-reported as volunteer firefighters who had responded to the Black Summer bushfires in Australia. Just over 80% of participants were male and the majority lived in the Australian states of New South Wales (65%) and Victoria (32%). All participants reported impact on their well-being, resulting from cumulative trauma exposure, responding to fires in local communities, intense work demands, minimal intervals between deployments, and disruption to primary employment. In regard to supporting well-being, four key themes emerged from data analysis: (1) Well-being support needs to be both proactive and reactive and empower local leaders to "reach in" while encouraging responders to "reach out;" (2) Employee Assistance Programs (EAPs) should not be the only well-being support option available; (3) The sharing of lived experience is important; and (4) Support programs need to address self-stigmatization. CONCLUSION Participants in this research identified that effective well-being support needs to be both proactive and reactive and holistic in approach.
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Affiliation(s)
- Erin Smith
- Edith Cowan University, School of Medical and Health Sciences, Joondalup, Perth, Western Australia
- DART Centre Asia Pacific, C/O Phoenix Australia Centre for Posttraumatic Mental Health Carlton, Victoria, Australia
| | - Lisa Holmes
- Edith Cowan University, School of Medical and Health Sciences, Joondalup, Perth, Western Australia
| | - Brigid Larkin
- Edith Cowan University, School of Medical and Health Sciences, Joondalup, Perth, Western Australia
| | - Brennen Mills
- Edith Cowan University, School of Medical and Health Sciences, Joondalup, Perth, Western Australia
| | - Mark Dobson
- Fire and Rescue NSW, Sydney South, New South Wales, Australia
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Mindful attention training workshop for firefighters: Design and methodology of a pilot randomized clinical trial. Contemp Clin Trials Commun 2022; 27:100905. [PMID: 35284687 PMCID: PMC8907682 DOI: 10.1016/j.conctc.2022.100905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Revised: 02/17/2022] [Accepted: 02/26/2022] [Indexed: 11/21/2022] Open
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Obuobi-Donkor G, Oluwasina F, Nkire N, Agyapong VI. A Scoping Review on the Prevalence and Determinants of Post-Traumatic Stress Disorder among Military Personnel and Firefighters: Implications for Public Policy and Practice. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:1565. [PMID: 35162587 PMCID: PMC8834704 DOI: 10.3390/ijerph19031565] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Revised: 01/23/2022] [Accepted: 01/24/2022] [Indexed: 12/31/2022]
Abstract
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.
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Affiliation(s)
- Gloria Obuobi-Donkor
- Department of Psychiatry, University of Alberta, Edmonton, AB T6G 2B7, Canada; (F.O.); (N.N.); (V.I.A.)
| | - Folajinmi Oluwasina
- Department of Psychiatry, University of Alberta, Edmonton, AB T6G 2B7, Canada; (F.O.); (N.N.); (V.I.A.)
| | - Nnamdi Nkire
- Department of Psychiatry, University of Alberta, Edmonton, AB T6G 2B7, Canada; (F.O.); (N.N.); (V.I.A.)
| | - Vincent I.O. Agyapong
- Department of Psychiatry, University of Alberta, Edmonton, AB T6G 2B7, Canada; (F.O.); (N.N.); (V.I.A.)
- Department of Psychiatry, Dalhousie University, Halifax, NS B3H 2E2, Canada
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Zhang Y, Workman A, Russell MA, Williamson M, Pan H, Reifels L. The long-term impact of bushfires on the mental health of Australians: a systematic review and meta-analysis. Eur J Psychotraumatol 2022; 13:2087980. [PMID: 35957633 PMCID: PMC9359172 DOI: 10.1080/20008198.2022.2087980] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND The long-term health effects of bushfires include the potential to trigger new and exacerbate existing mental health problems. OBJECTIVE This review aimed to determine the prevalence of long-term mental health issues in Australian populations exposed to bushfires. METHOD A systematic search was conducted in five databases (Embase, Medline, PsycINFO, Scopus, and Web of Science) to identify studies focusing on Australian populations impacted by bushfires with the prevalence of mental health issues reported at 2+ years after bushfire. The Joanna Briggs Institute prevalence critical appraisal tool was utilised. We conducted meta-analyses to determine the prevalence of general psychological distress in the general population, and a narrative synthesis. RESULTS We included 21 articles based on 5 studies and conducted on 3 bushfire events. Meta-analyses showed a pooled prevalence of 14% (95% CI 12%-16%) for psychological distress in the general population at 2-4 years post bushfire. The overall prevalence of long-term psychological problems in firefighters at 2-7 years ranged from 28% to 47.6%. The prevalence of some psychological issues decreased with time and was directly proportional to the level of bushfire impact. CONCLUSIONS As the magnitude of long-term bushfire-related mental health impacts in Australia is severe, it is important to monitor psychological problems and assist communities in future. Future research needs include: (a) more studies on the full range of long-term psychological impacts of bushfires, and (b) consensus on instruments and diagnostic criteria to define mental health issues. HIGHLIGHTS First systematic review of long-term bushfire mental health issues in Australia.Indicating substantial mental health problems among affected populations.Long-term issues were linked to bushfire impact and elevated among firefighters.Highlighting need for further rigorous research on long-term disaster sequalae.
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Affiliation(s)
- Yanqin Zhang
- Melbourne School of Population and Global Health, The University of Melbourne, Parkville, Australia
| | - Annabelle Workman
- Melbourne Climate Futures, Melbourne Law School, The University of Melbourne, Parkville, Australia
| | - Melissa A Russell
- Centre of Epidemiology and Biostatics, Melbourne School of Population and Global Health, The University of Melbourne, Parkville, Australia
| | - Michelle Williamson
- Centre for Mental Health, Melbourne School of Population and Global Health, The University of Melbourne, Parkville, Australia
| | - Haotai Pan
- Melbourne School of Population and Global Health, The University of Melbourne, Parkville, Australia
| | - Lennart Reifels
- Centre for Mental Health, Melbourne School of Population and Global Health, The University of Melbourne, Parkville, Australia
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Solle NS, Santiago KM, Feliciano PL, Calkins MM, Fent K, Jahnke S, Parks N, Buren H, Grant C, Burgess JL, Caban-Martinez AJ. Perceptions of Work-Related Health and Cancer Risks Among Women Firefighters: A Qualitative Study. J Occup Environ Med 2021; 63:e846-e852. [PMID: 34538836 PMCID: PMC8814999 DOI: 10.1097/jom.0000000000002386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVES We use a qualitative method to gain further insight into women firefighters' experiences, perceptions of cancer, health, and safety risks in the fire service. METHODS We conducted six focus groups with U.S. women firefighters. Participants engaged in a 60 to 75-minute, semi-structured discussion and completed a sociodemographic questionnaire. A qualitative descriptive approach was used to inductively create themes. Data collection concluded when saturation was met. RESULTS Forty-nine women firefighters participated. Qualitative results indicated the main health concerns include: occupational cancer risks including, risks related to hazardous exposures, sleep disruption and stress; and women's health concerns including, cancer, pregnancy and breastfeeding, and lack of resources. CONCLUSIONS Women firefighters are concerned about their risk for cancer due to their occupation and identify a lack of resources specific to health and safety needs of women firefighters.
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Affiliation(s)
- Natasha Schaefer Solle
- Department of Medicine, University of Miami, Leonard M. Miller School of Medicine, Miami, FL 33136 USA
- Sylvester Comprehensive Cancer Center, University of Miami, Leonard M. Miller School of Medicine, Miami, FL 33136 USA
| | - Katerina M. Santiago
- Department of Public Health Sciences, University of Miami, Leonard M. Miller School of Medicine, Miami, FL 33136 USA
| | - Paola Louzado Feliciano
- Department of Public Health Sciences, University of Miami, Leonard M. Miller School of Medicine, Miami, FL 33136 USA
| | - Miriam M. Calkins
- Division of Field Studies and Engineering (DFSE), National Institute for Occupational Safety and Health, Cincinnati OH 45226, USA
| | - Kenny Fent
- Division of Field Studies and Engineering (DFSE), National Institute for Occupational Safety and Health, Cincinnati OH 45226, USA
| | - Sara Jahnke
- Center for Fire, Rescue & EMS Health Research, National Development & Research Institutes, Leawood, KS, USA
| | | | | | - Casey Grant
- Fire Protection Research Foundation, Quincy, MA 02169, USA
| | - Jefferey L. Burgess
- Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ 85724, USA
| | - Alberto J. Caban-Martinez
- Department of Public Health Sciences, University of Miami, Leonard M. Miller School of Medicine, Miami, FL 33136 USA
- Sylvester Comprehensive Cancer Center, University of Miami, Leonard M. Miller School of Medicine, Miami, FL 33136 USA
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Jahnke SA, Kaipust C, Jitnarin N, Hollerbach BS, Koeppel MDH, Haddock CK, Poston WSC. Prevalence and predictors of obesity among women in the fire service. Occup Environ Med 2021; 79:289-294. [PMID: 34697223 DOI: 10.1136/oemed-2021-107590] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Accepted: 10/01/2021] [Indexed: 11/04/2022]
Abstract
OBJECTIVES Firefighter health has received a great deal of increased attention over the past decade, but most work has been specific to men in the fire service due to small numbers of women, likely due to challenges with recruitment and retention of women in the fire service. While findings suggest men in the fire service struggle with high rates of overweight and obesity due to a number of occupational challenges, limited data are available on large samples of women firefighters. METHODS Using snowball sampling techniques, we conducted an online survey of both career (N=2,398) and volunteer (N=781) women firefighters. RESULTS Rates of obesity for both career (15.4%) and volunteer (31.6%) women firefighters were not only lower than men in the fire service (33.5% career and 43.2% volunteer), but also lower than the general population (41.1%). Women career and volunteer firefighters who engaged in heavy physical activity were less likely to be obese. Being a racial or ethnic minority firefighter was associated with being obese, as was serving more than 20 years in the fire service. CONCLUSION Findings highlight that women firefighters have been successful in overcoming the occupational risks, such as a challenging nutrition environment, inconsistent schedules, limited time for fitness, and the metabolic impact of shift work, that put firefighters at increased risk for obesity.
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Affiliation(s)
- Sara A Jahnke
- Center for Fire, Rescue, and EMS Health Research, NDRI-USA, Inc, Leawood, Kansas, USA
| | - Christopher Kaipust
- Center for Fire, Rescue, and EMS Health Research, NDRI-USA, Inc, Leawood, Kansas, USA
| | - Nattinee Jitnarin
- Center for Fire, Rescue, and EMS Health Research, NDRI-USA, Inc, Leawood, Kansas, USA
| | - Brittany S Hollerbach
- Center for Fire, Rescue, and EMS Health Research, NDRI-USA, Inc, Leawood, Kansas, USA
| | - Maria D H Koeppel
- Center for Fire, Rescue, and EMS Health Research, NDRI-USA, Inc, Leawood, Kansas, USA
| | - Christopher K Haddock
- Center for Fire, Rescue, and EMS Health Research, NDRI-USA, Inc, Leawood, Kansas, USA
| | - Walker S C Poston
- Center for Fire, Rescue, and EMS Health Research, NDRI-USA, Inc, Leawood, Kansas, USA
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Sopp MR, Michael T, Lass-Hennemann J, Haim-Nachum S, Lommen MJJ. Longitudinal associations between hair cortisol, PTSD symptoms, and sleep disturbances in a sample of firefighters with duty-related trauma exposure. Psychoneuroendocrinology 2021; 134:105449. [PMID: 34687966 DOI: 10.1016/j.psyneuen.2021.105449] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Revised: 09/15/2021] [Accepted: 10/11/2021] [Indexed: 01/04/2023]
Abstract
Several studies have found evidence of altered cortisol levels in patients with posttraumatic stress disorder (PTSD). Based on these findings, it is assumed that these patients may show signs of cortisol dysregulation after trauma. Posttrauma cortisol levels are thus considered a potential biomarker of PTSD. However, longitudinal studies using indicators of long-term cortisol secretion such as hair cortisol concentrations (HCC) are scarce. The current study investigated prospective associations between HCC and PTSD symptoms in a sample of Dutch firefighters taking into account varying levels of work-related trauma severity. In addition, we assessed posttraumatic sleep disturbances as a secondary outcome measure to investigate whether effects generalize to this frequent comorbidity of PTSD. Three hundred seventy-one Dutch firefighters with a mean of 14.01 years of work experience were included in the analyses. Baseline assessment included the collection of hair samples and the measurement of work-related trauma severity, PTSD symptoms, and sleep disturbances. PTSD symptoms and sleep disturbance were re-assessed after six and twelve months. Multilevel analyses indicate a significant positive correlation between HCC and baseline PTSD symptoms in those with average or above-average work-related trauma severity. A similar pattern was evident for posttraumatic sleep disturbances at baseline. Moreover, higher HCC predicted more posttraumatic sleep disturbances after 6 months in participants with above-average work-related trauma severity. No other associations emerged for PTSD symptoms or posttraumatic sleep disturbances at six or twelve months. As such, our study supports the existence of a cross-sectional association between HCC and trauma symptoms, which may vary for different levels of subjective trauma severity. The longitudinal stability of this association should be reinvestigated by future research.
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Affiliation(s)
- M R Sopp
- Division of Clinical Psychology and Psychotherapy, Department of Psychology, Campus A1 3, Saarland University, D-66123 Saarbrücken, Germany
| | - T Michael
- Division of Clinical Psychology and Psychotherapy, Department of Psychology, Campus A1 3, Saarland University, D-66123 Saarbrücken, Germany.
| | - J Lass-Hennemann
- Division of Clinical Psychology and Psychotherapy, Department of Psychology, Campus A1 3, Saarland University, D-66123 Saarbrücken, Germany
| | - S Haim-Nachum
- School of Education, Bar-Ilan University, Ramat-Gan, Israel
| | - M J J Lommen
- Department of Clinical Psychology and Experimental Psychopathology, University of Groningen, Grote Kruisstraat 2/1, 9712 TS Groningen, The Netherlands
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Ericsson CR, Nordquist H, Lindström V, Rudman A. Finnish paramedics' professional quality of life and associations with assignment experiences and defusing use - a cross-sectional study. BMC Public Health 2021; 21:1789. [PMID: 34610798 PMCID: PMC8490964 DOI: 10.1186/s12889-021-11851-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Accepted: 09/22/2021] [Indexed: 12/04/2022] Open
Abstract
Background Paramedics experience traumatic events and social emergencies during assignments while also being subjected to verbal and physical threats. Consequently, they are at risk for burnout and secondary traumatic stress, factors inherent to professional quality of life. Defusing and peer-support potentially decrease such symptoms; however, perceived defusing needs and use are not always balanced. Our aim was to explore Finnish paramedics’ professional quality of life, using the Professional Quality of Life Scale, with associations to EMS assignment experiences as well as formal and informal defusing need and use over a 12-month period. Methods A quantitative study of 257 Finnish paramedics using a cross-sectional design. Study outcomes were secondary traumatic stress (STS), compassion satisfaction (CS), and burnout (BO) scores using the modified 9-item Short Professional Quality of Life scale (ProQOL). Likert-type scales were used to collect participants’ recollections of assignment experiences and defusing from a 12-month period. Associations were explored using Spearman’s correlation coefficients. Results Short ProQOL score medians were STS 4.00 (IQR 3), BO 6.00 (IQR 3) and CS 13.00 (IQR 3). STS and BO correlated to experiences of social emergencies and traumatic events while BO correlated to experiences of threat situations (r = 0.206, p = .001). Paramedics perceived a need for defusing in general associated with STS (r = 0.178, p < .001) and participated in informal defusing. Participation in defusing of any form did not associate with ProQOL scores. Conclusions Finnish paramedics’ more frequent experiences of social emergencies, traumatic events, and paramedic-directed threat situations were associated with higher levels of STS and BO. STS was also associated with paramedics’ increased need for defusing and use of informal peer defusing, although neither STS, BO or CS scores associated to any defusing form. Managing paramedics STS and BO, while fostering CS, could therefore be a future research focus. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-021-11851-0.
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Affiliation(s)
- Christoffer R Ericsson
- Faculty of Medicine, University of Helsinki, Helsinki, Finland. .,Department of Healthcare, Arcada University of Applied Sciences, Jan Magnus Janssons plats 1, 00560, Helsinki, Finland.
| | - Hilla Nordquist
- South-Eastern Finland University of Applied Sciences, Kotka, Finland
| | - Veronica Lindström
- Department of Neurobiology, Care Sciences and Society, Section of Nursing, Karolinska Institutet, Stockholm, Sweden
| | - Ann Rudman
- Department of Health and Welfare, Dalarna University, Falun, Sweden
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Mueller AK, Singh A, Webber MP, Hall CB, Prezant DJ, Zeig‐Owens R. PTSD symptoms, depressive symptoms, and subjective cognitive concerns in WTC-exposed and non-WTC-exposed firefighters. Am J Ind Med 2021; 64:803-814. [PMID: 34415073 DOI: 10.1002/ajim.23285] [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: 05/14/2021] [Revised: 08/05/2021] [Accepted: 08/09/2021] [Indexed: 11/12/2022]
Abstract
BACKGROUND Firefighting has been associated with posttraumatic stress disorder (PTSD) and other mental health conditions. We previously found that among Fire Department of the City of New York (FDNY) responders to the World Trade Center (WTC) disaster, higher-intensity WTC-exposure predicted PTSD symptoms, depressive symptoms, and subjective cognitive concerns. The present study aims to compare these symptoms in the FDNY WTC-exposed cohort versus a comparison cohort of non-FDNY, non-WTC-exposed firefighters. METHODS The study population included WTC-exposed male firefighters from FDNY (N = 8466) and non-WTC-exposed male firefighters from Chicago (N = 1195), Philadelphia (N = 770), and San Francisco (N = 650) fire departments who were employed on 9/11/2001 and completed a health questionnaire between 3/1/2018 and 12/31/2020. Current PTSD symptoms, depressive symptoms, and subjective cognitive concerns were assessed via validated screening instruments. Multivariable linear regression analyses stratified by fire department estimated the impact of covariates on each outcome. RESULTS Adjusted mean PTSD symptom scores ranged from 23.5 ± 0.6 in Chicago firefighters to 25.8 ± 0.2 in FDNY, and adjusted mean depressive symptom scores ranged from 7.3 ± 0.5 in Chicago to 9.4 ± 0.6 in Philadelphia. WTC-exposure was associated with fewer subjective cognitive concerns (β = -0.69 ± 0.05, p < .001) after controlling for covariates. Across cohorts, older age was associated with more cognitive concerns, but fewer PTSD and depressive symptoms. CONCLUSIONS WTC-exposed firefighters had fewer cognitive concerns compared with non-WTC-exposed firefighters. We were unable to estimate associations between WTC exposure and PTSD symptoms or depressive symptoms due to variability between non-WTC-exposed cohorts. Longitudinal follow-up is needed to assess PTSD, depressive, and cognitive symptom trajectories in firefighter populations as they age.
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Affiliation(s)
- Alexandra K. Mueller
- Fire Department of the City of New York Bureau of Health Services Brooklyn New York USA
- Department of Medicine, Pulmonology Division Montefiore Medical Center Bronx New York USA
| | - Ankura Singh
- Fire Department of the City of New York Bureau of Health Services Brooklyn New York USA
- Department of Medicine, Pulmonology Division Montefiore Medical Center Bronx New York USA
| | - Mayris P. Webber
- Fire Department of the City of New York Bureau of Health Services Brooklyn New York USA
- Department of Epidemiology and Population Health Albert Einstein College of Medicine Bronx New York USA
| | - Charles B. Hall
- Department of Epidemiology and Population Health Albert Einstein College of Medicine Bronx New York USA
| | - David J. Prezant
- Fire Department of the City of New York Bureau of Health Services Brooklyn New York USA
- Department of Medicine, Pulmonology Division Montefiore Medical Center Bronx New York USA
| | - Rachel Zeig‐Owens
- Fire Department of the City of New York Bureau of Health Services Brooklyn New York USA
- Department of Medicine, Pulmonology Division Montefiore Medical Center Bronx New York USA
- Department of Epidemiology and Population Health Albert Einstein College of Medicine Bronx New York USA
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Identifying the risk features for occupational stress in medical workers: a cross-sectional study. Int Arch Occup Environ Health 2021; 95:451-464. [PMID: 34599409 PMCID: PMC8486163 DOI: 10.1007/s00420-021-01762-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Accepted: 09/15/2021] [Indexed: 12/31/2022]
Abstract
Objective Occupational stress is considered a worldwide epidemic experienced by a large proportion of the working population. The identification of characteristics that place people at high risk for occupational stress is the basis of managing and intervening in this condition. In this study, we aimed to identify and validate the risk features for occupational stress among medical workers using a risk model and nomogram. Methods This cross-sectional study included 1988 eligible participants from Henan Province in China. Occupational stress and worker-occupation fit were measured with the Depression, Anxiety and Stress Scales (DASS-21) and Worker-Occupation Fit Inventory (WOFI). The identification of risk features was achieved through constructing multiple logistic regression model, and the risk features were used to develop the risk model and nomogram. Receiver operating characteristic (ROC) curves and calibration plots were generated to assess the effectiveness and calibration of the risk model. Results Among 1988 participants in our study, there were 42.5% (845/1988) medical workers experienced occupational stress. The risk features for occupational stress included poor work-occupation fit (WOF score < 25, expected risk: 77.3%), nurse population (expected risk: 63.1%), male sex (expected risk: 67.2%), work experience duration of 11–19 years (expected risk: 54.5%), experience of a traumatic event (expected risk: 65.3%) and the lack of a regular exercise habit (expected risk: 60.2%). For medical workers who have these risk features, the expected risk probability of occupational stress would be 90.2%. Conclusion The current data can be used to identify medical workers at risk of developing occupational stress. Identifying risk features for occupational stress and the work-occupation fit can support hierarchical stress management in hospitals. Supplementary Information The online version contains supplementary material available at 10.1007/s00420-021-01762-3.
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Nazari G, MacDermid JC, Sinden K, D'Amico R, Brazil A, Carleton N, Cramm H. Prevalence of exposure to critical incidents in firefighters across Canada. Work 2021; 67:215-222. [PMID: 32955483 DOI: 10.3233/wor-203267] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Firefighters partake in and are exposed to a range of potentially traumatic events throughout their careers and the impact of such critical events could last a life time. Therefore, capturing such lifetime exposures is necessary for supporting firefighter health. OBJECTIVE To estimate the prevalence of critical incidents in firefighters across Canada and determine whether the number of critical events varied based on age, gender, years of service; and to integrate our prevalence estimates using meta-analysis with previous studies to provide a pooled estimate. METHODS We recruited 464 firefighters. Firefighters were asked to complete a self-report Critical Incident Inventory (CII) survey that included questions on exposure to critical events throughout their firefighting careers. Individual CII items were summarized as percentages, number of exposures, the total number and percentages of exposures to each of the six CII sub-scales. We also performed a multivariate enter regression analysis with the CII total score as dependant variable, and age, gender, years of service as independent variables, to estimate if the number of critical incidents among firefighters varied based on age, gender and years of service. RESULTS Among the 390 full-time firefighters, 376 (96.4%) indicated exposure to some type of critical incident. More specifically, 351 (90%) reported a "respond to incident involving one or two deaths", and 314 (81%) reported a "respond to incident involving multiple serious injuries". Age, gender and years of service accounted for only 37.4% of the variance in the number of critical incidents among firefighters. In addition, our pooled estimate results of previous similar studies indicated an overall prevalence estimate of critical incident exposures was 93.40% (4 studies, 1725 of 1877 firefighters, 95% CI: 82.26 -99.30). CONCLUSIONS Nearly all (96.4%) firefighters were exposed to some form of critical event over the span of their entire firefighting careers. Age, gender and years of service accounted for one-third of the variance in the number of critical incident exposures among firefighters.
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Affiliation(s)
- Goris Nazari
- School of Physical Therapy, Health and Rehabilitation, Western University, London, ON, Canada.,Collaborative Program in Musculoskeletal Health Research, Bone and Joint Institute, Western University, London, ON, Canada
| | - Joy C MacDermid
- School of Physical Therapy, Health and Rehabilitation, Western University, London, ON, Canada.,Roth McFarlane Hand and Upper Limb Centre, St. Joseph's Hospital, London, ON, Canada
| | - Kathryn Sinden
- School of Kinesiology, Lakehead University, Thunder Bay, ON, Canada
| | - Robert D'Amico
- Secretary, Hamilton Professional Fire Fighters Association, Canada
| | - Amanda Brazil
- Faculty of Education, University of Prince Edward Island, Charlottetown, Prince Edward Island, Canada
| | - Nicholas Carleton
- Anxiety and Illness Behaviours Laboratory, University of Regina, Regina, Saskatchewan, Canada
| | - Heidi Cramm
- School of Rehabilitation Therapy & Canadian Institute for Military & Veteran Health Research (CIMVHR), Queen's University, Kingston, ON, Canada
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Lamb D, Withnall RD. A qualitative study to investigate the psychosocial effects of operational deployments on Medical Emergency Response Team personnel. Stress Health 2021; 37:364-377. [PMID: 33112039 DOI: 10.1002/smi.3001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Revised: 09/07/2020] [Accepted: 09/22/2020] [Indexed: 11/11/2022]
Abstract
The stressors associated with emergency medical teams responding to critical incidents are well documented; however, the impact of such duties on the UK military personnel had never been investigated. This study explored the psychosocial effects of Medical Emergency Response Teams (MERT) operating in Afghanistan to inform the development of a Resilience Model. A structured and contextually relevant process could then be applied for a team's preparation for, delivery of and recovery from, their duties. A qualitative cross-sectional design used semi-structured interviews and 15 multidisciplinary team members participated. Interviews were transcribed verbatim and data were systematically analysed using grounded theory. Emergent theory poses that developing resilience against the demands of this role is dependent upon personnel having a realistic understanding of the deployed environment by phased immersion within it. This preparatory training generates situational awareness, trust and strong team cohesion, which together with peer and organizational support are necessary factors to effectively cope with the role. To limit the costs of caring, there is a need for MERT personnel to segregate the physiological and emotional aspects of delivering care to the injured; those unable to do so may be at greater risk of poor mental health outcomes. The preparatory training of MERT personnel must be further developed to provide an immersive environment that more closely matches the reality of the role. A period of stability is required post deployment with the support of peers to enable personnel to more efficiently transition back to their home life.
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Affiliation(s)
- Di Lamb
- Academic Department of Military Nursing, Royal Centre for Defence Medicine, Birmingham, UK
| | - Rich Dj Withnall
- Royal Centre for Defence Medicine, Research & Clinical Innovation, Birmingham, UK
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Langtry J, Owczarek M, McAteer D, Taggart L, Gleeson C, Walshe C, Shevlin M. Predictors of PTSD and CPTSD in UK firefighters. Eur J Psychotraumatol 2021; 12:1849524. [PMID: 33680343 PMCID: PMC7874934 DOI: 10.1080/20008198.2020.1849524] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Background: Globally, professional firefighters are often exposed to traumatic events and are at high risk of developing posttraumatic stress disorder (PTSD) symptoms. Objective: With the publication of the 11th edition of the International Classification of Diseases (ICD-11) there arose a need for research based on the new diagnostic criteria, and the associated disorder, Complex PTSD (CPTSD). Method: Participants were 1300 former or present firefighters from the UK. Prevalence rates of PTSD and CPTSD were estimated using International Trauma Questionnaire in accordance with ICD-11 criteria, and service related and personal trauma exposure were also assessed using an anonymous online questionnaire. Multinomial logistic regression was performed to assess how service and personal trauma exposure predicted PTSD and CPTSD. Results: CPTSD criteria were met by 18.23% (95% CI 16.13-20.33%) and PTSD criteria were met by 5.62% (95% CI 4.37-6.87%) of the sample. Experiencing higher levels of service-related trauma significantly increased the risk for both PTSD and CPTSD, and nonwork related trauma uniquely predicted CPTSD but not PTSD. Conclusions: This study provided the first examination of the new ICD-11 criteria for PTSD and CPTSD in a large sample of firefighters, and CPTSD was more common than PTSD. Exposure to multiple different types of trauma increased the odds of PTSD and CPTSD.
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Affiliation(s)
- John Langtry
- School of Psychology, Ulster University, Coleraine, Northern Ireland
| | - Marcin Owczarek
- School of Psychology, Ulster University, Coleraine, Northern Ireland
| | - Donal McAteer
- School of Psychology, Ulster University, Coleraine, Northern Ireland
| | - Laurence Taggart
- School of Psychology, Ulster University, Coleraine, Northern Ireland
| | - Christina Gleeson
- School of Psychology, Ulster University, Coleraine, Northern Ireland
| | - Catherine Walshe
- School of Psychology, Ulster University, Coleraine, Northern Ireland
| | - Mark Shevlin
- School of Psychology, Ulster University, Coleraine, Northern Ireland
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Schäfer SK, Sopp MR, Staginnus M, Lass-Hennemann J, Michael T. Correlates of mental health in occupations at risk for traumatization: a cross-sectional study. BMC Psychiatry 2020; 20:335. [PMID: 32586338 PMCID: PMC7318450 DOI: 10.1186/s12888-020-02704-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Accepted: 05/28/2020] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Hospitals, police stations, and fire departments are highly demanding workplaces. Staff members are regularly exposed to various stressors including traumatic events. Correspondingly, several studies report high rates of mental health issues among these occupations. Nevertheless, despite these challenging circumstances, some staff members manage to sustain their mental health. The current study is the first to investigate three health-promoting factors simultaneously among three different, highly demanding occupations. METHODS The present cross-sectional survey investigated health-promoting factors (sense of coherence - SOC, trait-resilience, locus of control - LOC) and mental health outcomes (general psychopathological symptom burden, posttraumatic stress, burnout) in medical staff (n = 223), police officers (n = 257), and firefighters (n = 100). RESULTS Among all occupations, SOC, trait-resilience, and an internal LOC were negatively associated with general psychopathological symptoms, posttraumatic stress, and burnout symptoms. By contrast, all these outcome measures were positively correlated with an external LOC. Multiple regression models including all health-promoting factors explained 56% of the variance in general psychopathological symptoms and 27% in posttraumatic stress symptoms. Among all occupations, SOC was the strongest predictor of both general psychopathological symptom burden and posttraumatic stress symptoms. Multigroup path analyses revealed minor differences across occupations, mainly driven by a stronger influence of LOC in police officers. CONCLUSION Across all occupations, SOC was identified as the most important health-promoting factor. Future longitudinal studies should further examine the causal link between health-promoting factors and mental distress in different workplaces. Such studies will also allow for further development and evaluation of resilience promoting programs.
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Affiliation(s)
- Sarah K. Schäfer
- Department of Psychology, Saarland University, Building A1 3, 66123 Saarbruecken, Germany
| | - M. Roxanne Sopp
- Department of Psychology, Saarland University, Building A1 3, 66123 Saarbruecken, Germany
| | - Marlene Staginnus
- Department of Psychology, Saarland University, Building A1 3, 66123 Saarbruecken, Germany
| | - Johanna Lass-Hennemann
- Department of Psychology, Saarland University, Building A1 3, 66123 Saarbruecken, Germany
| | - Tanja Michael
- Department of Psychology, Saarland University, Building A1 3, 66123 Saarbruecken, Germany
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A Relational Model for Stress: A Systematic Review of the Risk and Protective Factors for Stress-Related Diseases in Firefighters. PSYCH 2020. [DOI: 10.3390/psych2010008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Firefighters are considered a high-risk group for the development of PTSD and other stress-related diseases. More than the exposure to potentially traumatic events, personal and occupational characteristics have been pointed out as interfering in the perception of stress, which may lead to the emergence of mental and physical symptoms. This study aimed to analyze the relationship between the main factors that contribute to stress-related diseases in firefighters. A systematic review was conducted in order to identify original articles focusing on risk and protective factors for stress in this population. Personality traits, training, experience in extreme situations and social and organizational support influence the perception of stress and, consequently, the choice of coping strategies, which may protect against or potentiate the stress reactions. The findings of this study allow us to draw a relational model that represents the dynamics among the factors related to stress in firefighters. The development of PTSD and other stress-related diseases depends on a host of pre-trauma and post-trauma factors and, although training is an important protective factor, being prepared to face extreme situations does not mean being immune to traumatic stress.
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Chiang ES, Riordan KM, Ponder J, Johnson C, Cox KS. Distinguishing Firefighters With Subthreshold PTSD From Firefighters With Probable PTSD or Low Symptoms. JOURNAL OF LOSS & TRAUMA 2020. [DOI: 10.1080/15325024.2020.1728494] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- Evelyn S. Chiang
- Psychology Department, University of North Carolina Asheville, Asheville, North Carolina, USA
| | - Kevin M. Riordan
- Psychology Department, University of North Carolina Asheville, Asheville, North Carolina, USA
| | - Joy Ponder
- Asheville Fire Department, Asheville, North Carolina, USA
| | - Chris Johnson
- Asheville Fire Department, Asheville, North Carolina, USA
| | - Keith S. Cox
- Psychology Department, University of North Carolina Asheville, Asheville, North Carolina, USA
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Denkova E, Zanesco AP, Rogers SL, Jha AP. Is resilience trainable? An initial study comparing mindfulness and relaxation training in firefighters. Psychiatry Res 2020; 285:112794. [PMID: 32078885 DOI: 10.1016/j.psychres.2020.112794] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Revised: 01/13/2020] [Accepted: 01/16/2020] [Indexed: 12/17/2022]
Abstract
Motivated by the growing interest in promoting resilience in first responders and other professionals who face threatening professional circumstances, the current study investigated the effectiveness of offering a short-form mindfulness training (MT) program to firefighters. The overarching question was to determine if psychological and cognitive markers of resilience are bolstered via MT. Firefighters (n = 121) were assigned to an MT program (n = 42), an active-comparison relaxation training program (RT, n = 31), or served as no-training controls (NTC, n = 48). Both the MT and RT programs were contextualized for firefighters and consisted of 4, 2-h training sessions delivered over 4 weeks by the same expert trainer, as well as 10-15 min of daily out-of-class practice. Intent-to-treat analyses revealed a significantly greater increase in psychological resilience from baseline (T1) to post-training (T2) in firefighters who received MT vs. RT or no training. In addition, positive affect and objective attentional task performance demonstrated a greater increase over time (from T1 to T2) with more days per week of out-of-class practice for the MT group but not for the RT group. These results suggest that MT moreso than RT bolsters markers of resilience in firefighters.
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Affiliation(s)
- Ekaterina Denkova
- Department of Psychology, University of Miami, 5665 Ponce de Leon, Coral Gables 33146, FL, USA
| | - Anthony P Zanesco
- Department of Psychology, University of Miami, 5665 Ponce de Leon, Coral Gables 33146, FL, USA
| | | | - Amishi P Jha
- Department of Psychology, University of Miami, 5665 Ponce de Leon, Coral Gables 33146, FL, USA.
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Chen X, Zhang L, Peng Z, Chen S. Factors Influencing the Mental Health of Firefighters in Shantou City, China. Psychol Res Behav Manag 2020; 13:529-536. [PMID: 32753981 PMCID: PMC7342484 DOI: 10.2147/prbm.s249650] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Accepted: 06/17/2020] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Firefighters are routinely exposed to occupational stress and are therefore vulnerable to psychological problems. PATIENTS AND METHODS This study assessed the prevalence of mental health symptoms and potential contributing factors in a sample of firefighters in Shantou city, in the Guangdong Province of China. We conducted a cross-sectional survey with 335 firefighters, including 329 male and 6 female firefighters. We used a questionnaire which assessed anxiety and depression, as indicated by the Zung Self-Rating Anxiety Scale (SAS) and Self-Rating Depression Scale (SDS), as well as other mental health symptoms, using the Symptom Checklist-90 (SCL-90). Basic information and potential-related factors were also collected. RESULTS The average age of participants was 27.38 (SD ± 6.11) years. Assessed by the indexed score of different scales, SAS and SDS positive screening rates were 6.86% and 22.68%, respectively. SCL-90 scores indicated that 6.86% of participants had mental health symptoms. Logistic regression analysis showed that educational level, firefighter rank, and birth order were associated with mental health outcomes. Firefighters in Shantou were also shown to have better mental health outcomes than the Chinese military, but worse than the national population of firefighters. CONCLUSION These findings indicated the mental health of firefighters is not good. It is necessary to explore effective approaches to help preventing and treating mental disorder in firefighters.
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Affiliation(s)
- Xiaojun Chen
- Department of Hospital Office, The First Affiliated Hospital of Shantou University Medical College, Shantou, People’s Republic of China
| | - Lishao Zhang
- Department of Hospital Office, The First Affiliated Hospital of Shantou University Medical College, Shantou, People’s Republic of China
| | - Zhekuang Peng
- Department of Public Health, The Third Affiliated Hospital of SunYet-Sen University, Guangzhou, People’s Republic of China
| | - Shaoxing Chen
- Department of Hospital Office, The First Affiliated Hospital of Shantou University Medical College, Shantou, People’s Republic of China
- Correspondence: Shaoxing Chen Department of Public Health, The First Affiliated Hospital of Shantou University Medical College, 57# Changping Road, Shantou515041, People’s Republic of ChinaTel +86-754-88252184 Email
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Haim-Nachum S, Levy-Gigi E. A chink in the armor: The influence of training on generalization learning impairments after viewing traumatic stimuli. Cognition 2019; 193:104021. [DOI: 10.1016/j.cognition.2019.104021] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2018] [Revised: 06/30/2019] [Accepted: 07/01/2019] [Indexed: 02/07/2023]
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Rouse PC, Turner PJF, Siddall AG, Schmid J, Standage M, Bilzon JLJ. The interplay between psychological need satisfaction and psychological need frustration within a work context: A variable and person-oriented approach. MOTIVATION AND EMOTION 2019. [DOI: 10.1007/s11031-019-09816-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
AbstractA plethora of empirical data support a positive (or “brighter”) pathway to optimal human functioning as specified within Basic Psychological Needs Theory (Ryan and Deci in Psychol Inq 11(4):319–33, 2000). Yet, far less is known about the negative (or “darker”) pathway, a process evoking of human dysfunction and ill-being (cf. Vansteenkiste and Ryan in J Psychother Integr 23(3):263, 2013). Further, debate surrounds the independence and interplay between psychological need satisfaction and psychological need frustration and how these dynamic constructs are experienced within individuals. In this work, variable and person-oriented analyses were employed to: (i) investigate the relationships between the basic psychological needs and symptoms of stress, depression and anxiety as well as with life satisfaction; and (ii) identify different psychological need profiles and their relationship with psychological function. Participants (N = 2236; M Age = 42.16 years; SD = 7.8) were UK-based operational firefighters who completed an online survey. Results of regression analyses showed a moderating effect of psychological need satisfaction on the relationship between need frustration and negative psychological symptoms. Latent profile analyses revealed five distinct basic psychological need profiles that carry implications for human psychological functioning. Some support for an asymmetrical relationship between need satisfaction and need frustration emerged (Vansteenkiste and Ryan in J Psychother Integr 23(3):263, 2013), yet, examples of above average need satisfaction and frustration scores were also observed. Worker profiles where psychological need frustration prevailed over need satisfaction had the poorest psychological health.
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Jitnarin N, Poston WSC, Haddock CK, Jahnke SA. Tobacco Use among Women Firefighters. Womens Health Issues 2019; 29:432-439. [PMID: 31229361 PMCID: PMC6755060 DOI: 10.1016/j.whi.2019.05.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2018] [Revised: 04/30/2019] [Accepted: 05/16/2019] [Indexed: 11/21/2022]
Abstract
OBJECTIVES Firefighters play a crucial role in protecting the lives and property of the communities they serve. Health and readiness for duty among women firefighters is of great concern because they are a significantly understudied group in this critical occupation. A tobacco-free fire service has been strongly promoted, but there are no published data on the extent and types of tobacco use among women firefighters. METHODS Data were collected as part of a national online study of the health of women in the fire service. RESULTS A total of 1,712 women firefighters completed questions regarding tobacco use. Unadjusted smoking and smokeless tobacco rates were 5.1% and 1.2%, respectively. Age standardized smoking rates were lower than those of male firefighters and U.S. adult women. Smokeless tobacco use prevalence was very low compared with male firefighters, but comparable with U.S. adult women. Tobacco users were more likely to have lower education and income and were younger when compared with those who did not use tobacco. There was a strong association between tobacco use and problem and binge drinking. CONCLUSIONS Current findings suggest that the rates of cigarette and smokeless tobacco use are relatively low among women firefighters. Unhealthy lifestyle behaviors such as problem and binge drinking were strongly associated with tobacco use.
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Affiliation(s)
- Nattinee Jitnarin
- Center for Fire, Rescue & EMS Health Research, Institute for Biobehavioral Health Research, National Development and Research Institutes, Leawood, Kansas.
| | - Walker S C Poston
- Center for Fire, Rescue & EMS Health Research, Institute for Biobehavioral Health Research, National Development and Research Institutes, Leawood, Kansas
| | - Christopher K Haddock
- Center for Fire, Rescue & EMS Health Research, Institute for Biobehavioral Health Research, National Development and Research Institutes, Leawood, Kansas
| | - Sara A Jahnke
- Center for Fire, Rescue & EMS Health Research, Institute for Biobehavioral Health Research, National Development and Research Institutes, Leawood, Kansas
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Qualitative Assessment of Barriers and Ideal Wellness Programming Among Rural Firefighters. J Occup Environ Med 2019; 61:e266-e271. [PMID: 31166282 DOI: 10.1097/jom.0000000000001594] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE The purpose of this study was to determine and assess the perceived physical and psychosocial barriers to, and the constitution of, ideal health and wellness programming among rural firefighters. METHODS Open-ended, semi-structured interviews were conducted and recorded on 40 rural, structural firefighters. Responses to each question were qualitatively analyzed to determine themes. RESULTS Several themes emerged in regards to the physical and psychosocial stressors of the profession. Three themes emerged relating to the self-perceived barriers to overall health and wellness. There was also agreement in the components of an "ideal" workplace health and wellness program to help overcome perceived barriers. CONCLUSIONS The themes that emerged from the interviews with this population are similar to firefighters who work in a more urban area. This indicates that the stressors and barriers firefighters face may be occupation, and not location, driven.
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Sritharan J, MacLeod JS, McLeod CB, Peter A, Demers PA. Prostate cancer risk by occupation in the Occupational Disease Surveillance System (ODSS) in Ontario, Canada. Health Promot Chronic Dis Prev Can 2019; 39:178-186. [PMID: 31091061 PMCID: PMC6580924 DOI: 10.24095/hpcdp.39.5.02] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
INTRODUCTION Previous Canadian epidemiologic studies have identified associations between occupations and prostate cancer risk, though evidence is limited. However, there are no well-established preventable risk factors for prostate cancer, which warrants the need for further investigation into occupational factors to strengthen existing evidence. This study uses occupation and prostate cancer information from a large surveillance cohort in Ontario that linked workers' compensation claim data to administrative health databases. METHODS Occupations were examined using the Occupational Disease Surveillance System (ODSS). ODSS included 1 231 177 male workers for the 1983 to 2015 period, whose records were linked to the Ontario Cancer Registry (OCR) in order to identify and follow up on prostate cancer diagnoses. Cox proportional hazard models were used to calculate age-adjusted hazard ratios and 95% CI to estimate the risk of prostate cancer by occupation group. RESULTS A total of 34 997 prostate cancer cases were diagnosed among workers in ODSS. Overall, elevated prostate cancer risk was observed for men employed in management/ administration (HR 2.17, 95% CI = 1.98-2.38), teaching (HR 1.99, 95% CI = 1.79-2.21), transportation (HR 1.20, 95% CI = 1.16-1.24), construction (HR 1.09, 95% CI = 1.06-1.12), firefighting (HR 1.62, 95% CI = 1.47-1.78), and police work (HR 1.20, 95% CI = 1.10-1.32). Inconsistent findings were observed for clerical and farming occupations. CONCLUSION Associations observed in white collar, construction, transportation, and protective services occupations were consistent with previous Canadian studies. Findings emphasize the need to assess job-specific exposures, sedentary behaviour, psychological stress, and shift work. Understanding specific occupational risk factors can lead to better understanding of prostate cancer etiology and improve prevention strategies.
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Affiliation(s)
- Jeavana Sritharan
- Occupational Cancer Research Centre, Cancer Care Ontario, Toronto, Ontario, Canada
| | - Jill S MacLeod
- Occupational Cancer Research Centre, Cancer Care Ontario, Toronto, Ontario, Canada
| | - Christopher B McLeod
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
- Institute for Work & Health, Toronto, Ontario, Canada
| | - Alice Peter
- Population Health and Prevention, Cancer Care Ontario, Toronto, Ontario, Canada
| | - Paul A Demers
- Occupational Cancer Research Centre, Cancer Care Ontario, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
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Porto LGG, Schmidt ACB, de Souza JM, Nogueira RM, Fontana KE, Molina GE, Korre M, Smith DL, Junqueira LF, Kales SN. Firefighters’ basal cardiac autonomic function and its associations with cardiorespiratory fitness. Work 2019; 62:485-495. [DOI: 10.3233/wor-192883] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Luiz Guilherme G. Porto
- Faculty of Physical Education of the University of Brasilia, Campus Darcy Ribeiro, Brasilia, DF, Brazil
- Scholarship from the Conselho Nacional de Desenvolvimento Cientifico e Tecnologico, CNPq, Brazil
- Cardiovascular Laboratory of the Faculty of Medicine, University of Brasilia, DF, Brazil, Campus Darcy Ribeiro, Brasilia, DF, Brazil
- Environmental and Occupational Medicine and Epidemiology Program, Department of Environmental Health, Harvard T. H. Chan School of Public Health, Boston, MA, USA
| | | | - Jessica Maximo de Souza
- Physiotherapy Course, Faculty of Ceilandia, University of Brasilia, Campus Ceilândia, Brasilia, DF, Brazil
| | - Rosenkranz Maciel Nogueira
- Faculty of Physical Education of the University of Brasilia, Campus Darcy Ribeiro, Brasilia, DF, Brazil
- Federal District (Brasilia) Military Firefighter Brigade, CBMDF, SAM lote D, modulo E, Brasilia, Brazil
| | - Keila E. Fontana
- Faculty of Physical Education of the University of Brasilia, Campus Darcy Ribeiro, Brasilia, DF, Brazil
| | - Guilherme E. Molina
- Faculty of Physical Education of the University of Brasilia, Campus Darcy Ribeiro, Brasilia, DF, Brazil
- Cardiovascular Laboratory of the Faculty of Medicine, University of Brasilia, DF, Brazil, Campus Darcy Ribeiro, Brasilia, DF, Brazil
| | - Maria Korre
- Environmental and Occupational Medicine and Epidemiology Program, Department of Environmental Health, Harvard T. H. Chan School of Public Health, Boston, MA, USA
- Health and Human Physiological Sciences Department, Skidmore College, Saratoga Springs, NY, USA
| | - Denise L. Smith
- Health and Human Physiological Sciences Department, Skidmore College, Saratoga Springs, NY, USA
| | - Luiz Fernando Junqueira
- Cardiology Division, Clinical Medicine Area, Cardiovascular Laboratory of the Faculty of Medicine, University of Brasilia, Brasilia, DF, Brazil
| | - Stefanos N. Kales
- Environmental and Occupational Medicine and Epidemiology Program, Department of Environmental Health, Harvard T. H. Chan School of Public Health, Boston, MA, USA
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