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Traynor A, Doyle B, Eppich W, Tjin A, Mulhall C, O'Toole M. "This is it…this is our normal" - the voices of family members and first responders experiencing duty-related trauma in Ireland. Compr Psychiatry 2024; 133:152499. [PMID: 38776684 DOI: 10.1016/j.comppsych.2024.152499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Revised: 03/25/2024] [Accepted: 05/08/2024] [Indexed: 05/25/2024] Open
Abstract
BACKGROUND Compared to other occupational groups, first responders (FR) experience worse mental health outcomes due to duty-related trauma and occupational stressors. Despite their best efforts, they bring this stress home to friends and family. Consequently, FR and their supporters suffer from increased psychosocial difficulties and experience stigma and other barriers to help-seeking. Prior work offers little opportunity for open dialogue and shared understanding of the repercussions of this occupation for all members of the first responder community. In this qualitative study, we aimed to: (i) explore the lived experience of Irish FR and their family members (FM) related to occupational stressors, and (ii) identify opportunities to engage FM with existing organizational supports available for FR. METHODS Using a community based participatory research (CBPR) approach, we conducted six focus groups involving a total of fourteen participants comprising FR, organizational representatives, and FM. All focus groups were audio recorded, transcribed, and analyzed using reflexive thematic analysis. FINDINGS FR and FM shared their experiences of both joining and learning to live as members of the FR community in Ireland. Through our analysis, we identified a main theme of 'crossing thresholds', characterizing their transformative learning experiences. This learning experience includes recognizing the consequences of this new role for them as individuals and for their relationships. Participants also shared how they have learned to cope with the consequences of their roles and what they need to better support each other. CONCLUSIONS FM are often unheard, hidden members of the first responder community in Ireland, highlighting an unmet need for FR organizations to acknowledge FM role in supporting FR and to provide them with the appropriate training and resources required. Training for new recruits needs to move beyond the tokenistic involvement of FM and encourage knowledge sharing among experienced and novice members. Cultural change is required to support help-seeking among FR and foster a sense of peer support and community among families.
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Affiliation(s)
- Angeline Traynor
- RCSI SIM Centre for Simulation Education and Research, RCSI (Royal College of Surgeons in Ireland) University of Medicine and Health Sciences, Ireland; School of Psychology, University of Galway, Arts Millenium Extension, University Road, Galway, Ireland
| | - Brian Doyle
- RCSI SIM Centre for Simulation Education and Research, RCSI (Royal College of Surgeons in Ireland) University of Medicine and Health Sciences, Ireland.
| | - Walter Eppich
- RCSI SIM Centre for Simulation Education and Research, RCSI (Royal College of Surgeons in Ireland) University of Medicine and Health Sciences, Ireland; Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, Australia
| | - Anna Tjin
- RCSI SIM Centre for Simulation Education and Research, RCSI (Royal College of Surgeons in Ireland) University of Medicine and Health Sciences, Ireland; Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, Kings College London, London SE5 8AB, UK
| | - Claire Mulhall
- RCSI SIM Centre for Simulation Education and Research, RCSI (Royal College of Surgeons in Ireland) University of Medicine and Health Sciences, Ireland
| | - Michelle O'Toole
- RCSI SIM Centre for Simulation Education and Research, RCSI (Royal College of Surgeons in Ireland) University of Medicine and Health Sciences, Ireland
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Zhang M, Liu B, Ke W, Cai Y, Zhang L, Huang W, Yan X, Chen H. Correlation analysis between occupational stress and metabolic syndrome in workers of a petrochemical enterprise: based on two assessment models of occupational stress. BMC Public Health 2024; 24:802. [PMID: 38486274 PMCID: PMC10938751 DOI: 10.1186/s12889-024-18305-3] [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: 12/11/2023] [Accepted: 03/07/2024] [Indexed: 03/18/2024] Open
Abstract
BACKGROUND Occupational stress is becoming a common phenomenon around the world. Being in a high occupational stress state for a long time may destroy the metabolic balance of the body, thereby increasing the risk of metabolic diseases. There is limited evidence regarding the correlation between occupational stress and metabolic syndrome (MetS), particularly in the petrochemical workers. METHODS A total of 1683 workers of a petrochemical enterprise in China were included in the survey by cluster sampling method. The occupational stress assessment was carried out by the Job Content Questionnaire and the Effort-Reward Imbalance Questionnaire, and the general demographic characteristics, work characteristics, occupational hazards, lifestyle and health examination data of the participants were collected. Logistic regression and multiple linear regression were used to analyze the correlations and influencing factors between occupational stress and its dimensions with MetS and its components. RESULTS A total of 1683 questionnaires were sent out, and 1608 were effectively collected, with an effective recovery rate of 95.54%. The detection rates of occupational stress in Job Demand-Control (JDC) and Effort-Reward Imbalance (ERI) models were 28.4% and 27.2%, respectively. In this study, 257 participants (16.0%) were diagnosed with MetS. Compared with the non-MetS group, body mass index (BMI), waist circumference (WC), systolic blood pressure (SBP), diastolic blood pressure (DBP), triglycerides (TG) and fasting blood-glucose (FBG) levels were significantly higher in the MetS group, and high density lipoprotein-cholesterol (HDL-C) levels were significantly lower (P < 0.001). The results of multiple linear regression showed that after adjusting for nation, marital status, education, work system, smoking and drinking, and further adjusting for occupational hazards, the D/C ratio was significantly negatively correlated with SBP in the JDC model. Social support was negatively correlated with WC. In the ERI model, there was a significant positive correlation between over-commitment and FBG. CONCLUSIONS The detection rates of occupational stress and MetS were high in workers of a petrochemical enterprise. In the JDC model, occupational stress was negatively correlated with SBP, and social support was negatively correlated with WC. In the ERI model, there was a significantly positive correlation between over-commitment and FBG.
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Affiliation(s)
- Min Zhang
- Guangdong Province Hospital for Occupational Disease Prevention and Treatment, 510300, Guangzhou, Guangdong, China
- School of Public Health, Shanxi Medical University, 030001, Taiyuan, Shanxi, China
| | - Bin Liu
- Shenzhen Luohu People's Hospital, 518000, Shenzhen, Guangdong, China
| | - Weiyi Ke
- Guangdong Province Hospital for Occupational Disease Prevention and Treatment, 510300, Guangzhou, Guangdong, China
| | - Yashi Cai
- Guangdong Province Hospital for Occupational Disease Prevention and Treatment, 510300, Guangzhou, Guangdong, China
| | - Lingyu Zhang
- Guangdong Province Hospital for Occupational Disease Prevention and Treatment, 510300, Guangzhou, Guangdong, China
| | - Weixu Huang
- Guangdong Province Hospital for Occupational Disease Prevention and Treatment, 510300, Guangzhou, Guangdong, China
| | - Xuehua Yan
- Guangdong Province Hospital for Occupational Disease Prevention and Treatment, 510300, Guangzhou, Guangdong, China.
| | - Huifeng Chen
- Guangdong Province Hospital for Occupational Disease Prevention and Treatment, 510300, Guangzhou, Guangdong, China.
- School of Public Health, Shanxi Medical University, 030001, Taiyuan, Shanxi, China.
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Halperin O, Idilbi N, Robes D, Biderman SN, Malka-Zeevi H, Green G. Predicting post-traumatic stress disorder: The complex relationship between burnout, intentions to leave and emotional support among health care professionals. Nurs Outlook 2024; 72:102134. [PMID: 38301290 DOI: 10.1016/j.outlook.2024.102134] [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: 10/11/2023] [Revised: 01/01/2024] [Accepted: 01/10/2024] [Indexed: 02/03/2024]
Abstract
BACKGROUND Health care professionals working in delivery rooms often encounter stressful situations. Understanding their challenges and the support they receive is essential for improving their well-being and consequently patient care. PURPOSE Examining the relationship between burnout, intentions to leave, post-traumatic stress disorder (PTSD) symptoms, and complex PTSD among health care professionals, and identifying their predictors. METHODS A mixed methods design, including a survey among 196 midwives and gynecologists assessing burnout, intentions to leave, exposure to negative work experiences and PTSD, as well as 15 semi-structured interviews. DISCUSSION Most participants experienced multiple difficult events in the delivery room, reporting insufficient emotional support. Burnout and lack of emotional support were significant predictors of PTSD symptoms. Participants expressed a need for emotional support to cope with complex situations. CONCLUSION Burnout among midwives must be addressed through prevention and intervention programs. Emotional support is essential in mitigating PTSD symptoms among midwives and gynecologists, enhancing their resilience and well-being.
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Affiliation(s)
- Ofra Halperin
- Nursing Department, Max Stern Academic College of Emek-Yezreel, Emek-Yezreel, Israel.
| | - Nasra Idilbi
- Nursing Department, Max Stern Academic College of Emek-Yezreel, Emek-Yezreel, Israel; Galilee Medical Center, Nahariya, Israel
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Riviere LA, Kim PY, Baker MD, Beymer MR. Training, Deployment Preparation, and Behavioral Health of New York National Guard Personnel Deployed to Assist with COVID-19 Decedent Work. Mil Med 2024; 189:e705-e713. [PMID: 37847572 DOI: 10.1093/milmed/usad395] [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] [Received: 06/23/2023] [Revised: 08/26/2023] [Accepted: 09/21/2023] [Indexed: 10/19/2023] Open
Abstract
INTRODUCTION A small body of research conducted mostly among civilians has shown that adequate training and preparation can prevent or reduce the development of behavioral health problems in first responders. Several civilian studies have shown that social support is protective against behavioral health problems. However, very few studies have examined the impact of these factors on the behavioral health of military first responders. Military first responders, who serve in the aftermath of natural disasters and disease outbreaks such as the coronavirus disease 2019 (COVID-19) pandemic, are often members of the National Guard (NG). The purpose of this study was to examine the impact of mortuary affairs training/handling human remains, role preparation, equipment preparation, and unit social support provided to families on the behavioral health of New York (NY) NG personnel deployed to assist the NY Office of Chief Medical Examiner with handling the remains of COVID-19 decedents. MATERIALS AND METHODS We invited 410 NYNG personnel who deployed for the Office of Chief Medical Examiner mission to complete an anonymous online questionnaire 3 to 6 months post-mission. Of the 158 participants, we used the data of the 141 participants who provided consent. Standard behavioral health measures (depression, anxiety, post-traumatic stress disorder, alcohol misuse, and insomnia) as well as study-specific items designed to understand the unique dynamics of this deployment were included. Hierarchical logistic regression analysis was used to examine the relationships between mortuary training, role preparation, equipment preparation, and unit support with behavioral health. RESULTS Close to two-thirds of the sample reported that they had not been trained in mortuary affairs/handling human remains before the mission. We also found that that lower levels of role preparation and unit support provided to the service members' families increased the odds of meeting criteria for one or more behavioral health problems, but that training in mortuary affairs and equipment preparation was unrelated to behavioral health. CONCLUSIONS Our research points to the importance of emotionally and cognitively preparing service members for the specific dynamics of a deployment and the roles that that they are expected to play. Furthermore, it suggests that supporting the families of NG personnel during domestic missions can benefit the behavioral health of the NG personnel. Additional research is needed to corroborate these findings, particularly the impact of unit support provided to family members on service members' behavioral health.
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Affiliation(s)
- Lyndon A Riviere
- Center for Military Psychiatry & Neuroscience, Walter Reed Army Institute of Research, Silver Spring, MD 20910, USA
| | - Paul Y Kim
- Center for Military Psychiatry & Neuroscience, Walter Reed Army Institute of Research, Silver Spring, MD 20910, USA
| | - Matthew D Baker
- New York Army National Guard, Connecticut Street Armory-C, Buffalo, NY 14213, USA
| | - Matthew R Beymer
- Division of Behavioral and Social Health Outcomes Practice, Defense Centers for Public Health-Aberdeen, Aberdeen Proving Ground, MD 21010, USA
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Zhang J, Yang X, Zhang X, Liu Y, Liu M, Fang Y, Liu M, Wu M. Mediating effects of social support and presenteeism on turnover intention and post-traumatic stress disorder among Chinese nurses in the post-pandemic era: a cross-sectional study. Front Public Health 2024; 12:1323126. [PMID: 38420027 PMCID: PMC10899410 DOI: 10.3389/fpubh.2024.1323126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Accepted: 01/30/2024] [Indexed: 03/02/2024] Open
Abstract
Background The shift in national policies for epidemic prevention and control in the post-pandemic era is undoubtedly a challenge for health care professionals. Nurses, as an important part of the health care professional population, have an even greater impact on their mental health and occupational safety. This may expose nurses to post-traumatic stress disorder (PTSD) and presenteeism, and ultimately lead to their turnover. Objective This study aimed to investigate the relationship between turnover intention and post-traumatic stress disorder among Chinese nurses during post-pandemic era, and the mediating role of social support and presenteeism. Methods In this study, a multicentre cross-sectional survey was conducted in April 2023 among nursing staff in several tertiary general hospitals in northern China, with online data collection using the Turnover intention Scale (PTSD), the Impact of Events Scale (IES), the Social Support Scale (SSS), and the Stanford presenteeism Scale (STAS) and the relationship between variables was analyzed using hierarchical multivariate regression, and Structural Equation Modeling (SEM) was used to analyze the relationship between post-traumatic stress disorder and the Turnover intention from the pathway between. Results Data were collected from 2,513 nurses who met the inclusion criteria, in which general information such as age, department, specific department, Professional title, history of alcohol consumption, form of employment, Years of working, and Average working hours per day were statistically significant with the difference in the turnover intention. The results of the study showed a 32% high turnover intention among nurses in the post-pandemic era, which was lower than the turnover intention during the pandemic. The results of hierarchical multiple regression analysis showed that post-traumatic stress disorder, social support, and presenteeism were significant predictors of turnover intention. The total effect of post-traumatic stress disorder on turnover intention to work was 0.472 [bias modified 95% confidence interval (0.415-0.483), p < 0.001]. Social support and attendance played a partially intermediate role in post-traumatic stress disorder and propensity to leave (an indirect effect of 26% of the total effect). Conclusion Turnover intention and post-traumatic stress disorder levels are high and social support plays an important role in the tendency to leave the job and post-traumatic stress disorder, healthcare institution can be achieved by strengthening social support for nurses in the post-epidemic era and preventing the occurrence of presenteeism.
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Affiliation(s)
- Jingshuo Zhang
- School of Nursing, Xuzhou Medical University, Xuzhou, Jiangsu, China
| | - Xin Yang
- School of Nursing, Xuzhou Medical University, Xuzhou, Jiangsu, China
| | - Xiaoman Zhang
- School of Nursing, Xuzhou Medical University, Xuzhou, Jiangsu, China
| | - Yuping Liu
- The Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, China
| | - Mengshi Liu
- School of Nursing, Xuzhou Medical University, Xuzhou, Jiangsu, China
| | - Yu Fang
- School of Nursing, Xuzhou Medical University, Xuzhou, Jiangsu, China
| | - Mengjie Liu
- School of Nursing, Xuzhou Medical University, Xuzhou, Jiangsu, China
| | - Min Wu
- School of Nursing, Xuzhou Medical University, Xuzhou, Jiangsu, China
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Muysewinkel E, Vesentini L, Van Deynse H, Vanclooster S, Bilsen J, Van Overmeire R. A day in the life: psychological impact on emergency responders during the 22 March 2016 terrorist attacks. Front Psychiatry 2024; 15:1353130. [PMID: 38410678 PMCID: PMC10894950 DOI: 10.3389/fpsyt.2024.1353130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2023] [Accepted: 01/19/2024] [Indexed: 02/28/2024] Open
Abstract
Introduction Terrorist attacks can cause severe long-term mental health issues that need treatment. However, in the case of emergency responders, research is often vague on the type of stressors that emergency responders encounter. For example, in addition to the threat that they work under, studies have shown that ill-preparation adds to the stress experienced by emergency responders. However, few studies have looked into the experience of emergency responders. In this study, we looked at the experience of emergency responders during the 22 March 2016 terrorist attacks in Belgium. Methods We used a qualitative design, in which we interviewed different types of emergency responders. Police officers, nurses, soldiers, firefighters, and Red Cross volunteers were included. Interviews were coded by two researchers and analyzed using a thematic approach. Results Four large themes were developed: constant threat and chaos, frustrations with lack of preparedness and training, ethical decisions, and debriefings. In addition, although emergency responders encountered constant threat, they often felt that they were ill-prepared for such attacks. One specific example was their lack of training in tourniquet usage. Furthermore, in a disaster setting, the emergency responders had to make life-and-death decisions for which they were not always prepared. Finally, debriefings were conducted in the aftermath of the attacks. Whereas most were perceived as positive, the debriefings among police officers were viewed as insufficient. Conclusions Emergency responding to terrorist attacks has many different dimensions of events that can cause stress. Our study revealed that preparation is key, not only in terms of material but also in terms of ethics and debriefings.
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Affiliation(s)
- Emilie Muysewinkel
- Mental Health and Wellbeing Research Group, Vrije Universiteit Brussel, Brussel, Belgium
- Department of Public Health, Vrije Universiteit Brussel, Brussel, Belgium
| | - Lara Vesentini
- Mental Health and Wellbeing Research Group, Vrije Universiteit Brussel, Brussel, Belgium
| | - Helena Van Deynse
- Department of Public Health, Vrije Universiteit Brussel, Brussel, Belgium
| | - Stephanie Vanclooster
- Mental Health and Wellbeing Research Group, Vrije Universiteit Brussel, Brussel, Belgium
| | - Johan Bilsen
- Mental Health and Wellbeing Research Group, Vrije Universiteit Brussel, Brussel, Belgium
| | - Roel Van Overmeire
- Mental Health and Wellbeing Research Group, Vrije Universiteit Brussel, Brussel, Belgium
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Gelaw A, Parker S, Johnson A, Nguyen H, Jolly A, Forner V, Deng C, Collie A. Determinants of psychological injury among health and social care workers in community settings: A systematic review. Work 2024; 78:3-27. [PMID: 38578915 DOI: 10.3233/wor-230426] [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: 04/07/2024] Open
Abstract
BACKGROUND Health and Social Care (HSC) workers face psychological health risks in the workplace. While many studies have described psychological injuries in HSC workers, few have examined the determinants. Previous research has primarily focused on hospitals, lacking systematic reviews of community-based settings. OBJECTIVE To systematically identify and appraise current evidence on the determinants of psychological injuries among HSC workers in community settings. METHODS Searches were conducted in three bibliographic databases, supplemented by citation searches. Included studies focused on community-based HSC workers, reporting statistical associations between psychological injury and personal, health, occupational, or organizational factors. Quantitative studies published in English between January 1, 2000 and August 15, 2023 were included. Quality appraisal was undertaken using the JBI critical appraisal checklist. RESULTS Sixty-six studies were included. Study quality was highly variable, and all studies were cross-sectional. Twenty-three studies linked psychological injury with occupational factors (e.g. low job control, high job demands and low job satisfaction). Thirteen studies observed an association between work environment and psychological injury, and a further eleven between workplace social support and psychological injury. Fewer studies have examined the relationship between psychological injury and personal/individual factors. CONCLUSION Occupational and organisational factors are significantly associated with psychological health among HSA workers, in community settings. These aspects of job design, work environment and workplace relationships are modifiable, suggesting an opportunity for work design interventions to improve workers' psychological health and reduce the prevalence of psychological injury in this sector.
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Affiliation(s)
- Asmare Gelaw
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Sharon Parker
- Future of Work Institute, Curtin University, Perth, WA, Australia
| | - Anya Johnson
- The University of Sydney Business School, The University of Sydney, Sydney, NSW, Australia
| | - Helena Nguyen
- The University of Sydney Business School, The University of Sydney, Sydney, NSW, Australia
| | - Anu Jolly
- Future of Work Institute, Curtin University, Perth, WA, Australia
| | - Vivien Forner
- The University of Sydney Business School, The University of Sydney, Sydney, NSW, Australia
| | - Connie Deng
- The University of Sydney Business School, The University of Sydney, Sydney, NSW, Australia
| | - Alex Collie
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
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Witkowski K, Lofaro RJ, Headley AM, Contreras S, Remington CL, Ganapati NE. Understanding problematic substance use among first responders during the COVID-19 pandemic: A survey of law enforcement, fire, and EMS workers in the United States. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2024; 123:104261. [PMID: 38006639 DOI: 10.1016/j.drugpo.2023.104261] [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: 06/21/2023] [Revised: 09/27/2023] [Accepted: 11/09/2023] [Indexed: 11/27/2023]
Abstract
BACKGROUND First responders have experienced increased levels of stress, anxiety, and depression due to job-related pressures associated with the COVID-19 pandemic. However, little is known about the factors associated with first responder drug and alcohol use during this time. METHODS We conducted a nationwide survey of first responders (n = 2801) to understand the relationship between work pressures, workplace support strategies, and problematic substance use during the early stages of the COVID-19 pandemic. We employed structural equation modeling to analyze whether burnout mediated these relationships. RESULTS Descriptive statistics showed that 60.8 % reported no concerns with substance use. While general workplace support strategies were negatively associated with problematic substance use, specific COVID-related strategies, such as providing compensation during quarantine, were positively associated with problematic substance use. Burnout fully mediated relationships between workplace support strategies and problematic substance use. Finally, providing spaces at work to decompress was negatively associated with problematic substance use and burnout. CONCLUSION Although work pressures increased burnout and problematic substance use among first responders, general workplace support strategies (e.g., decompression spaces) reduced problematic substance use while some COVID-related strategies (e.g. compensation during quarantine) increased problematic substance use. Policy interventions to address problematic substance use should focus on providing spaces for first responders to decompress at work, as well as implementing strategies (e.g., access to mental health services, time off) to reduce burnout. However, organizations should be mindful that not all interventions will have their intended impact and some interventions may unintentionally contribute to negative employee outcomes.
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Affiliation(s)
- Kaila Witkowski
- Florida Atlantic University, Department of Public Administration, United States.
| | - Ryan J Lofaro
- Georgia Southern University, Department of Public and Nonprofit Studies, United States
| | | | - Santina Contreras
- University of Southern California, Department of Urban Planning and Spatial Analysis, United States
| | - Christa L Remington
- University of South Florida, Department of Public Administration, United States
| | - N Emel Ganapati
- Florida International University, Department of Public Policy and Administration, United States
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Mehra R, Meda M, Pichon B, Gentry V, Smith A, Nicholls M, Ryan Y, Woods J, Tote S. Whole-genome sequencing links cases dispersed in time, place, and person while supporting healthcare worker management in an outbreak of Panton-Valentine leucocidin meticillin-resistant Staphylococcus aureus; and a review of literature. J Hosp Infect 2023; 141:88-98. [PMID: 37678435 DOI: 10.1016/j.jhin.2023.08.019] [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: 05/03/2023] [Revised: 08/21/2023] [Accepted: 08/23/2023] [Indexed: 09/09/2023]
Abstract
This is a report on an outbreak of Panton-Valentine leucocidin-producing meticillin-resistant Staphylococcus aureus (PVL-MRSA) in an intensive care unit (ICU) during the COVID-19 pandemic that affected seven patients and a member of staff. Six patients were infected over a period of ten months on ICU by the same strain of PVL-MRSA, and a historic case identified outside of the ICU. All cases were linked to a healthcare worker (HCW) who was colonized with the organism. Failed topical decolonization therapy, without systemic antibiotic therapy, resulted in ongoing transmission and one preventable acquisition of PVL-MRSA. The outbreak identifies the support that may be needed for HCWs implicated in outbreaks. It also demonstrates the role of whole-genome sequencing in identifying dispersed and historic cases related to the outbreak, which in turn aids decision-making in outbreak management and HCW support. This report also includes a review of literature of PVL-MRSA-associated outbreaks in healthcare and highlights the need for review of current national guidance in the management of HCWs' decolonization regimen and return-to-work recommendations in such outbreaks.
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Affiliation(s)
- R Mehra
- Department of Infection Prevention and Control, Frimley Health NHS Foundation Trust, Frimley, UK
| | - M Meda
- Department of Infection Prevention and Control, Frimley Health NHS Foundation Trust, Frimley, UK.
| | - B Pichon
- UK Health and Security Agency, UK
| | - V Gentry
- Department of Infection Prevention and Control, Frimley Health NHS Foundation Trust, Frimley, UK
| | - A Smith
- Department of Infection Prevention and Control, Frimley Health NHS Foundation Trust, Frimley, UK
| | | | - Y Ryan
- UK Health and Security Agency, UK
| | - J Woods
- Department of Anaesthetics and ITU, Frimley Health NHS Foundation Trust, Frimley, UK
| | - S Tote
- Department of Anaesthetics and ITU, Frimley Health NHS Foundation Trust, Frimley, UK
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Hansson J, Padyab M. How the availability and adequacy of social support affect the general mental health of Swedish police officers. Front Psychol 2023; 14:1196320. [PMID: 37908822 PMCID: PMC10613646 DOI: 10.3389/fpsyg.2023.1196320] [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: 03/29/2023] [Accepted: 10/02/2023] [Indexed: 11/02/2023] Open
Abstract
Police work is stressful. A protective function against work stress and harm to mental health is social support, either within or outside work. This cross-sectional study analyzes the associations of quantitative (availability) and qualitative (adequacy) aspects of social support with general mental health among Swedish police officers. A total of 728 officers responded to a national survey. Bivariate analyses (t-test and chi square) identified continuous and categorical variables (respectively) statistically significantly associated with sex and social support. Pearson correlation coefficient was provided to indicate the associations between general mental health and different types of social support. Sex-stratified logistic regression modeling calculated crude and adjusted odds ratios (OR) with 95% confidence intervals (CI) and assessed the relationships between different types of social support, sociodemographic variables and general mental health. The findings show that low adequacy of attachment is associated with poorer mental health among female officers, although female officers also reported higher availability of both social interaction and attachment compared to male officers. We found an association between low work-related social support and poorer mental health among single male police officers. Moreover, police officers who worked shifts, were younger, had less work experience, and/or had no children reported higher availability of attachment, whereas older police officers reported higher adequacy of social interaction compared to younger police officers. Variation in the quantity and quality of close social relationships seems to be important to mental health. Police organizations need to be aware of this in their efforts to make the work environment more supportive. Social support might create an environment where officers feel more comfortable discussing their mental health concerns and seeking assistance.
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Affiliation(s)
- Jonas Hansson
- Police Education Unit, Umeå University, Umeå, Sweden
| | - Mojgan Padyab
- Police Education Unit, Umeå University, Umeå, Sweden
- Department of Social Work, Umeå University, Umeå, Sweden
- Center for Demographic and Aging Research (CEDAR), Umeå University, Umeå, Sweden
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Liu Y, Zou L, Yan S, Zhang P, Zhang J, Wen J, Mao J, Li L, Wang Y, Fu W. Burnout and post-traumatic stress disorder symptoms among medical staff two years after the COVID-19 pandemic in Wuhan, China: Social support and resilience as mediators. J Affect Disord 2023; 321:126-133. [PMID: 36280200 PMCID: PMC9585849 DOI: 10.1016/j.jad.2022.10.027] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2022] [Revised: 10/01/2022] [Accepted: 10/18/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND Evidence on the relationship between burnout and post-traumatic stress disorder (PTSD) is limited. We aimed to evaluate the association between burnout and PTSD symptoms among medical staff two years after the coronavirus disease 2019 (COVID-19) pandemic in Wuhan, China, and explore the mediating roles of social support and psychological resilience. METHODS A multicenter survey was conducted online from January to March 2022 among healthcare professionals from six general hospitals. Hierarchical linear regression was used to detect the predictors of PTSD symptoms. Structural equation modeling (SEM) was used to analyze the pathways from burnout to PTSD symptoms. RESULTS Hierarchical linear regression showed that burnout, social support, and psychological resilience were significant predictors of PTSD symptoms among medical staff. In the SEM, the standardized total effect of burnout on PTSD symptoms was 0.336(bias-corrected 95 % confidence interval [0.303, 0.367], P < 0.001). Social support and psychological resilience partially mediated the relationship between burnout and PTSD symptoms (indirect effects accounted for 22.3 % of the total effect). LIMITATIONS Owing to the cross-sectional design, only clues to causal explanations can be provided. CONCLUSIONS Burnout has significant direct and indirect effects on PTSD symptoms. Furthermore, social support and psychological resilience might be effective ways to reduce the impact of burnout on PTSD symptoms in medical staff after a major public health outbreak.
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Affiliation(s)
- Yifang Liu
- School of Nursing, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Li Zou
- Department of Neurology, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Shijiao Yan
- Department of Emergency Medicine, Hunan Provincial People's Hospital/The First Affiliated Hospital, Hunan Normal University, Changsha, Hunan, China,School of Public Health, Hainan Medical University, Haikou, China
| | - Pu Zhang
- Department of Cardiology, Taihe Hospital, Hubei University of Medicine, Shiyan, China
| | - Jun Zhang
- Department of Endocrinology, Taihe Hospital, Hubei University of Medicine, Shiyan, China
| | - Jing Wen
- School of Nursing, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jing Mao
- School of Nursing, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Longti Li
- Department of Nursing, Taihe Hospital, Hubei University of Medicine, Shiyan, China
| | - Ying Wang
- Department of Nursing, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Wenning Fu
- School of Nursing, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
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12
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Tjin A, Traynor A, Doyle B, Mulhall C, Eppich W, O’Toole M. Turning to 'Trusted Others': A Narrative Review of Providing Social Support to First Responders. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:16492. [PMID: 36554368 PMCID: PMC9778548 DOI: 10.3390/ijerph192416492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Revised: 11/30/2022] [Accepted: 12/05/2022] [Indexed: 06/17/2023]
Abstract
First responders, such as paramedics and firefighters, encounter duty-related traumatic exposures, which can lead to post-traumatic stress (PTS). Although social support protects against PTS, we know little about how first responders' families, spouses/partners, friends, and care-partners (i.e., 'trusted others') provide social support. This narrative review explores support behaviors, coping strategies, and resources trusted others use to support first responders. A structured literature search yielded 24 articles. We used House's (1981) conceptual framework to inform our analysis. We identified three main themes: providing support, finding support, and support needs. Additionally, we describe trusted others' self-reported preparedness, coping strategies, and barriers to providing social support. We found that trusted others provided different types of support: (a) emotional (fostering a safe space, giving autonomy over recovery, facilitating coping mechanisms, prioritizing first responders' emotional needs); (b) instrumental (prioritizing first responders' practical needs, handling household tasks, supporting recovery); (c) appraisal (active monitoring, verbal reassurance, positive reframing), and (d) informational (seeking informal learning). In their role, trusted others sought formal (organizational) and informal (peer and personal) support and resources, alongside intrapersonal and interpersonal coping strategies. Identified barriers include inadequate communication skills, maladaptive coping, and disempowering beliefs. Thus, we offer practical, treatment, and social support recommendations.
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13
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Wu R, Zhu H, Wu MY, Wang GH, Jiang CL. Childhood Trauma and Suicide: The Mediating Effect of Stress and Sleep. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19148493. [PMID: 35886344 PMCID: PMC9317506 DOI: 10.3390/ijerph19148493] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Revised: 07/03/2022] [Accepted: 07/05/2022] [Indexed: 02/04/2023]
Abstract
This study aimed to investigate the relationship between suicide risk, perceived stress, and sleep quality through a structural equation modeling approach. This study used convenience sampling to survey 780 undergraduate and graduate students aged 18–30 years. Students were invited to participate in the online questionnaires, which included the Beck Scale for Suicide Ideation, the Suicidal Behaviors Questionnaire-Revised, the Perceived Stress Scale, the Childhood Trauma Questionnaire-Short Form, and the Pittsburgh Sleep Quality Index. The results showed that suicide ideation and suicidal behavior were positively correlated with childhood trauma, stress, and sleep. A well-fitted structural equation model (χ2 = 1.52, df = 1, χ2/df = 1.52, RMSEA = 0.03, CFI = 1.00, NFI = 1.00) was constructed in this study. The hierarchical regression test showed significance in all the path coefficients of the model. The total effect of emotional abuse on suicide behaviors was 49.5%. The mediating effects accounted for 73.7% of the total effects of emotional abuse on suicidal behaviors. The results demonstrate efforts targeting stress and poor sleep might mitigate the risk of suicidal behaviors among individuals with early emotional abuse experiences.
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Affiliation(s)
- Ran Wu
- Counseling and Psychological Services Center, East China Normal University, Shanghai 200062, China
- Department of Stress Medicine, Faculty of Psychology, Second Military Medical University, Shanghai 200433, China
| | - Hong Zhu
- Counseling and Psychological Services Center, East China Normal University, Shanghai 200062, China
| | - Meng-Yang Wu
- Counseling and Psychological Services Center, East China Normal University, Shanghai 200062, China
| | - Guang-Hai Wang
- Pediatric Translational Medicine Institution, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai 200127, China
| | - Chun-Lei Jiang
- Department of Stress Medicine, Faculty of Psychology, Second Military Medical University, Shanghai 200433, China
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14
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Zou Y, Lu Y, Zhou F, Liu X, Ngoubene-Atioky AJ, Xu K, Hong L, Shen G, Wu H, Cai Z, Liu Y, Chen L, Bao D. Three Mental Health Symptoms of Frontline Medical Staff Associated With Occupational Stressors During the COVID-19 Peak Outbreak in China: The Mediation of Perceived Stress and the Moderation of Social Support. Front Psychol 2022; 13:888000. [PMID: 35712133 PMCID: PMC9197123 DOI: 10.3389/fpsyg.2022.888000] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Accepted: 05/09/2022] [Indexed: 11/13/2022] Open
Abstract
The outbreak of COVID-19 epidemic has increased work demands for medical staff and has a certain impact on their mental health. The present study aimed to examine the role of perceived stress and social support in explaining the association between the occupational stressors and three mental health symptoms (i.e., anxiety, depression, and insomnia) of frontline medical staff. Five hundred twenty five frontline medical staff were investigated online after the outbreak of the COVID-19 (16 February, 2020-2 March, 2020) in China. The results found that the prevalence of anxiety, depression, and insomnia among frontline medical staff were 39.8, 29.9, and 37.9%, respectively. Occupational stressors were associated with anxiety, depression, and insomnia symptoms. Perceived stress significantly mediated this link. Social support moderated the second half of the indirect effect of occupational stressors on anxiety and depression symptoms. Under the epidemic situation of COVID-19, for frontline medical staff, high perceived stress and low social support may increase vulnerability for mental health symptoms triggered by occupational stressors. Thus, improving the social support and promoting the cognitive reappraisal of perceived stress may help to maintain mental health among medical staff.
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Affiliation(s)
- Yang Zou
- School of Mental Health, Wenzhou Medical University, Wenzhou, China
| | - Yinhuan Lu
- Affiliated Cixi Hospital, Wenzhou Medical University, Ningbo, China
| | - Fan Zhou
- School of Mental Health, Wenzhou Medical University, Wenzhou, China
- Department of Pediatrics, The Second Affiliated Hospital and Yuying Children’s Hospital of Wenzhou Medical University, Wenzhou, China
| | - Xiaoyue Liu
- School of Mental Health, Wenzhou Medical University, Wenzhou, China
| | | | - Kewei Xu
- School of Mental Health, Wenzhou Medical University, Wenzhou, China
| | - Liuzhi Hong
- School of Mental Health, Wenzhou Medical University, Wenzhou, China
| | - Guanghui Shen
- School of Mental Health, Wenzhou Medical University, Wenzhou, China
| | - Huifen Wu
- The Affiliated Xiangshan Hospital of Wenzhou Medical University, Ningbo, China
| | - Zhaohong Cai
- The Affiliated Xiangshan Hospital of Wenzhou Medical University, Ningbo, China
| | - Yanlong Liu
- School of Mental Health, Wenzhou Medical University, Wenzhou, China
| | - Li Chen
- School of Mental Health, Wenzhou Medical University, Wenzhou, China
| | - Donger Bao
- The Affiliated Xiangshan Hospital of Wenzhou Medical University, Ningbo, China
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15
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Coping in the Emergency Medical Services: Associations with the personnel’s stress, self-efficacy, job satisfaction, and health. CLINICAL PSYCHOLOGY IN EUROPE 2022; 4:e6133. [DOI: 10.32872/cpe.6133] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Accepted: 01/16/2022] [Indexed: 11/25/2022] Open
Abstract
Background
Emergency Medical Services personnel (EMSP) are recurrently exposed to chronic and traumatic stressors in their occupation. Effective coping with occupational stressors plays a key role in enabling their health and overall well-being. In this study, we examined the habitual use of coping strategies in EMSP and analyzed associations of coping with the personnel’s health and well-being.
Method
A total of N = 106 German Red Cross EMSP participated in a cross-sectional survey involving standardized questionnaires to report habitual use of different coping strategies (using the Brief-COPE), their work-related stress, work-related self-efficacy, job satisfaction, as well as mental and physical stress symptoms.
Results
A confirmatory factor analysis corroborated seven coping factors which have been identified in a previous study among Italian emergency workers. Correlation analyses indicated the coping factor “self-criticism” is associated with more work-related stress, lower job satisfaction, and higher depressive, posttraumatic, and physical stress symptoms. Although commonly viewed as adaptive coping, the coping factors “support/venting”, “active coping/planning”, “humor”, “religion”, and “positive reappraisal” were not related to health and well-being in EMSP. Exploratory correlation analyses suggested that only “acceptance” was linked to better well-being and self-efficacy in EMSP.
Conclusion
Our results emphasize the need for in-depth investigation of adaptive coping in EMSP to advance occupation-specific prevention measures.
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16
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Craw ES, Buckley TM, Miller-Day M. "This Isn't Just Busy, This is Scary": Stress, Social Support, and Coping Experiences of Frontline Nurses During the COVID-19 Pandemic. HEALTH COMMUNICATION 2022:1-11. [PMID: 35296202 DOI: 10.1080/10410236.2022.2051270] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Despite having previous experience and extensive trauma training, the COVID-19 pandemic presented unprecedented challenges for nurses working in hospital settings. During the pandemic, nurses struggle to care for patients and protect themselves from infection, while navigating ongoing organizational changes. Guided by prior literature on social support and coping, this study explores nurses' experiences of coping with stress while treating COVID-19 patients during the pandemic. In-depth semi-structured interviews were conducted with 14 active staff nurses working in hospitals and one licensed practical nurse (LPN) at a rehabilitation center who treated COVID-19 patients during the pandemic. An inductive thematic analysis was employed to analyze those data, and three overarching themes emerged: (1) nurses' unique experiences in the [COVID-19] trenches, (2) nobody else understands, and (3) coping with stress together. Practically, this study is heuristic and generates an increased understanding of professional communication during times of healthcare crises, illuminating the need to enhance communication skills for both staff nurses and management. This study also extends our understanding of communal coping in the context of healthcare organizations.
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17
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Ryan M, Ryznar R. The Molecular Basis of Resilience: A Narrative Review. Front Psychiatry 2022; 13:856998. [PMID: 35599764 PMCID: PMC9120427 DOI: 10.3389/fpsyt.2022.856998] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Accepted: 03/14/2022] [Indexed: 12/12/2022] Open
Abstract
Resilience refers to the adaptability of a person - an ability to "bounce-back" from stressors. We question if resilience can be strengthened, potentially to decrease the risk of stress-related disorders. Unfortunately, the molecular origins of resilience are complicated and not yet well understood. In this review, we examine the various physiological biomarkers of resilience, including the associated genes, epigenetic changes, and protein biomarkers associated with resilient phenotypes. In addition to assessing biomarkers that may indicate higher levels of resilience, we also review at length the many biomarkers that confer lower levels of resilience and may lead to disorders of low resilience, such as anxiety and depression. This large and encompassing review may help to identify the possible therapeutic targets of resilience. Hopefully these studies will lead to a future where stress-related disorders can be prevented, rather than treated.
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Affiliation(s)
- Megan Ryan
- College of Osteopathic Medicine, Rocky Vista University, Parker, CO, United States
| | - Rebecca Ryznar
- Molecular Biology, Department of Biomedical Sciences, Rocky Vista University, Parker, CO, United States
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18
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O'Toole M, Mulhall C, Eppich W. Breaking down barriers to help-seeking: preparing first responders' families for psychological first aid. Eur J Psychotraumatol 2022; 13:2065430. [PMID: 35572389 PMCID: PMC9103391 DOI: 10.1080/20008198.2022.2065430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND First responders regularly encounter both operational stressors and potentially traumatic events, increasing their risk of mental health issues (Declercq et al., 2011). Due to unique cultural complexities, they turn mostly to peers for early psychosocial support (Isaac & Buchanan, 2021). However, peer support and/or mental health assistance may not always be available or easy to access and first responders' mental health suffers. OBJECTIVE We need more accessible routes to crisis intervention to ensure first responder resilience and wellbeing, so they may continue to function in the service of public safety. Family members and close friends may be ideally placed to provide this immediate care. This article outlines the protective role of social support as an early intervention strategy to mitigate the effects of first responder trauma, exploring the potential opportunity for family members and friends to play an increasingly supportive role in their loved one's wellbeing. This paper serves as a call to action for practical educational interventions that will prepare family members for these critical conversations. CONCLUSION We see potential in combining early intervention theory, psychoeducation, and a strengths-based gender specific positive psychology approach. Further study should investigate how best to help first responders break down barriers to support, by bolstering their existing social supports and ultimately reducing the stigma associated with experiencing traumatic stress. HIGHLIGHTS By training family members in psychological first aid, we may strengthen existing social support for first responders, providing more options for, and potentially breaking down stigma associated with help-seeking.
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Affiliation(s)
- Michelle O'Toole
- RCSI SIM Centre for Simulation Education and Research, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Claire Mulhall
- RCSI SIM Centre for Simulation Education and Research, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Walter Eppich
- RCSI SIM Centre for Simulation Education and Research, RCSI University of Medicine and Health Sciences, Dublin, Ireland
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19
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Kleine B, Muschalla B. Zusammenhänge zwischen selbstberichteter Resilienz, wahrgenommener sozialer Unterstützung und Wohlbefinden bei Mitgliedern der Freiwilligen Feuerwehr. ZEITSCHRIFT FUR ARBEITS-UND ORGANISATIONSPSYCHOLOGIE 2021. [DOI: 10.1026/0932-4089/a000355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Zusammenfassung. Soziale Unterstützung und eine ausgeprägte Resilienz werden in der Forschungsliteratur als protektiv für das psychische Wohlbefinden von Einsatzkräften diskutiert. Die hier dargestellte Untersuchung verfolgt das Ziel, Resilienz und ihren Zusammenhang mit psychischem Wohlbefinden bei der speziellen Gruppe der Freiwilligen Feuerwehr (FF) zu untersuchen. In einer Untersuchung mit mehreren Messzeitpunkten (November 2016-Mai 2018, T1: N = 475, T2: N = 117, T3: N = 58) wurden FF gebeten, Selbstbeurteilungsfragebögen auszufüllen. Es fanden sich geringe bis mittlere Zusammenhänge von Resilienz mit dem psychischen Wohlbefinden ( r = .20-.65). Soziale Unterstützung zeigte kleine Zusammenhänge mit Wohlbefinden ( r = .14, r = .23). Ein indirekter Zusammenhang bestand zwischen wahrgenommener sozialer Unterstützung mit dem psychischen Wohlbefinden, mediiert durch Resilienz. Weiterführende Forschung sollte klären, ob, und ggf. wie Resilienz für diese Berufsgruppe trainierbar ist und ob Verbesserungen im Wohlbefinden damit einhergehen.
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Affiliation(s)
- Berit Kleine
- Institut für Psychologie, Technische Universität Braunschweig
| | - Beate Muschalla
- Institut für Psychologie, Technische Universität Braunschweig
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Jilili M, Liu L, Yang A. The impact of perceived discrimination, positive aspects of caregiving on depression among caregivers: mediating effect of job satisfaction. CURRENT PSYCHOLOGY 2021. [DOI: 10.1007/s12144-021-01397-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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