Trauma and work factors as predictors of firefighters' psychiatric distress

Mental health and post-traumatic stress disorder in firefighters: an integrated analysis from an action research study

Introduction

The presence of post-traumatic stress disorder (PTSD) symptomatology in firefighters is an ever-pressing issue that requires close attention for adequate interventions. The present study investigated PTSD and global psychopathology prevalence in a sample of highly risk-exposed Portuguese firefighters, collected after the widespread deadly wildfires in 2017 that ravaged the country. Following an action research approach, the aim of this study was to depict this sample and examine the impact of cumulative adverse experiences on their mental health, which is a phenomenon worth attention.

Method

From an initial sample of 283 firefighters who manifested interest in participating, a total of 139 firefighters from the Coimbra District, of whom 130 unequivocally experienced a potentially traumatic/adverse event as a firefighter, completed BSI (to obtain indicators on psychopathology), QEPAT (an inventory of adverse events possibly experienced as a firefighter), and PCL-5 (a measure of PTSD symptomatology) through an online survey during the year 2018 by the Regional Medical Organization, as proposed and supervised by the local Centre for Prevention and Treatment of Psychological Trauma (CPTTP).

Results

We found a global prevalence of 8.6% of possible PTSD and 14.4% of possible psychopathology (n = 139). When considering only firefighters who unequivocally reported a potentially traumatic/adverse event as a firefighter (n = 130), 9.2% present possible PTSD, and 13.8% present possible global psychopathology. This sample experienced a mean of 28 adverse events during firefighting work. Linear regressions (n = 118) demonstrated that the perceived severity of the most traumatic event reported and the experience of more adverse events were both related to an increase in PTSD symptomatology. Global psychopathology was associated with PCL-5 scores, with an emphasis on paranoid ideation, hostility, depression, anxiety, and phobic anxiety.

Discussion

The severe wildfires of 2017 did not impact PTSD scores in this sample (collected the year after), suggesting that cumulative adverse events are more important than particular episodes. However, the number of reported events was related to PTSD scores. These results can be used to develop interventions that target all firefighters by addressing risk and protective factors. This action research study motivated specialized aid for firefighters involved in this study.

Duty-related trauma and PTSD symptoms in US urban firefighters

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.

The effect of cranial techniques on the heart rate variability response to psychological stress test in firefighter cadets

Heart rate variability (HRV) is a simple tool to monitor cardiovascular stress. The proper function of the cardiovascular system is a problem among firefighters. Physical activity has health benefits correlated with psychological stress. Physically active people should be more resilient to psychological stress, but this has not always been demonstrated. The aim of this study was to determine whether cranial techniques would have an effect on HRV parameters. Osteopathy in the cranium reduces stress and improves cardiovascular function. Fifty-seven firefighter cadets aged 18-24 years (21.63 ± 1.41) participated in the study. All subjects had their heart rate variability measured and were randomly assigned either to the cranial techniques (CS) group, with therapy performed once a week for 5 weeks), or to the control group (CO). After 5 weeks, heart rate variability was measured again in both groups. In the Friedman test, in the CS group there was a statistically significant effect of cranial techniques on Heart Rate (HR) and Low Frequency (LF), but not on High Frequency (HF); in the CO group, a statistically significant difference was observed for HR, HF and LF. In the Nemenyi test, in the CS group there was a statistically significant difference for HR and LF and in the CO group for HR, HF and LF. After applying hierarchical clustering with Euclidean measure and the complete method, dendrograms were drawn up showing similarities for HR, HF and LF values. The cranial techniques and touch might exert a beneficial effect on HRV. Both factors can be used in stressful situations to lower HRV.

Coping Strategies for Exposure to Trauma Situations in First Responders: A Systematic Review

Objective:

The objective of the present work was to characterize the coping strategies used by first responders to emergencies in the face of exposure to traumatic events.

Methods:

A systematic search was performed in the databases MEDLINE (Ovid), EMBASE, LILACS (Latin American and Caribbean Literature in Health Sciences), and the Cochrane Central Registry of Controlled Clinical Trials (CENTRAL) from their inception through February 2022. First responders to emergencies with training in the prehospital area and who used validated measurement instruments for coping strategies were included.

Results:

First responders to emergencies frequently used nonadaptive coping strategies, with avoidance or disconnection being one of the main strategies, as a tool to avoid confronting difficult situations and to downplay the perceived stressful event. The nonadaptive coping strategies used by these personnel showed a strong relationship with posttraumatic stress disorder (PTSD) symptoms, burnout syndrome, psychiatric morbidity, and chronic stress. As part of the adaptive strategies, active coping was found, which includes acceptance, positive reinterpretation, focusing on the problem, self-efficacy, and emotional support, either social or instrumental, as protective strategies for these personnel.

Conclusions:

Developing adaptive coping strategies, whether focused on problems or seeking emotional support, can benefit emergency personnel in coping with stressful situations. These coping strategies should be strengthened to help prevent people from experiencing long-term negative effects that could arise from the traumatic events to which they are exposed. Active coping strategies instead of avoidance strategies should be promoted.

Health outcomes of psychosocial stress within firefighters: A systematic review of the research landscape

BACKGROUND AND OBJECTIVES

Much of the research surrounding firefighter health has concerned the hazards intuitively associated with the occupation, such as physical, thermal, and chemical risks. However, an additional aspect of their work environment, psychosocial stressors, has begun to attract a growing level of attention. Work-related psychosocial stress may best be described as mental and emotional strain caused by a combination of workplace events and characteristics, and the objective of our review was to identify the health outcomes associated with these stressors in firefighters.

METHODS

A systematic review was performed of studies reporting on the psychosocial stressors and the associated health outcomes experienced by firefighters. Data sources included the MEDLINE, PsychInfo, and CINAHL databases.

RESULTS

Twenty-nine studies met the inclusion criteria. Upon analysis, we found that firefighters experienced a range of psychosocial stressors (including interpersonal conflict and concerns over organizational fairness) and observed that these stressors were associated with a number of health-related outcomes that could be arranged into six areas: depression-suicidality, non-depressive mental health problems, burnout, alcohol use disorders, sleep quality, and physiological parameters and somatic disorders.

CONCLUSION

Our findings strongly suggest that work-related psychosocial stressors can affect the health and well-being of those in the fire service, and highlight that interventions meant to address these psychosocial risk factors should focus upon promoting self-esteem, enhancing self-efficacy, and strengthening social support.

Effect of work-related events on depressive symptoms in Japanese employees: a web-based longitudinal study

While a number of work-related events have been proposed as risk factors for depression, a majority of studies have focused only on a few events in a single study. Therefore, we conducted a web-based longitudinal study to comprehensively investigate the impact of various work-related events on depressive symptoms. Ten thousand Japanese workers representing the Japanese working population were recruited online and questioned on their experiences of 36 work-related events in the past year. Their depressive symptoms were also assessed based on the Center for Epidemiologic Studies Depression Scale. Two years later, 3,098 participants responded to a follow-up study. By excluding 1,030 participants who were classified as being depressed in the baseline survey, data of 2,068 participants were analyzed. Odds ratios (OR) were calculated using multivariate logistic regression to assess the effect of work-related events on depressive symptoms. Sixteen events were found to be risk factors and were sorted into four types as follows: experience of an accident or disaster (OR: 4.78-7.67), excessive responsibility (OR: 3.01-3.62), drastic change in workstyle or workload (OR: 2.38-3.08), and interpersonal conflict (OR: 2.41-11.16). The current results, including magnitude relationship of ORs, should be utilized for promoting psychosocially healthy work environment.

Baixas na linha de frente: absenteísmo entre bombeiros durante o combate à pandemia da COVID-19

Resumo Objetivos: descrever o absenteísmo relacionado a casos suspeitos (com infecção respiratória aguda) e confirmados da COVID-19 e a outros diagnósticos entre bombeiros de Minas Gerais, Brasil. Métodos: foram analisados os registros oficiais sobre afastamento do trabalho por problemas de saúde (licença-saúde). A análise foi organizada em: 1) gráficos estratificados por grupo de diagnóstico; 2) análises descritivas da proporção de licenças-saúde e do percentual de dias de trabalho perdidos por infecção respiratória aguda; 3) comparação (qui-quadrado) da proporção de licenças-saúde e do percentual de dias de trabalho perdidos por infecção respiratória aguda e por outros diagnósticos entre 2019 e 2020. Resultados: a análise gráfica mostrou um padrão regular de licenças-saúde antes do início da pandemia, um pico de licenças-saúde por infecção respiratória aguda após o início da pandemia e um novo padrão de licenças-saúde após o período de pico. A proporção de licenças-saúde e o percentual de dias de trabalho perdidos por infecção respiratória aguda aumentaram, respectivamente, 312% e 580% em 2020. Em contraste, o percentual de dias de trabalho perdidos por outros diagnósticos diminuiu 16%. Conclusão: a mudança no perfil de absenteísmo entre bombeiros reflete o vínculo formal de emprego, as políticas institucionais e a percepção de risco sobre a COVID-19.