Network analysis of posttraumatic stress disorder in a treatment-seeking sample of US firefighters and emergency medical technicians.

BACKGROUND: First responders, including firefighters and emergency medical technicians (EMTs), are under extreme stress from repeated exposure to potentially traumatic events. To optimize treatment for this population, it is critical to understand how the various posttraumatic stress disorder (PTSD) symptom factors are associated with one another so these relations may be targeted in treatment. METHOD: Using a sample of treatment-seeking firefighters/EMTs (N = 342), we conducted a partial correlation network analysis of the eight-factor model. A Bayesian directed acyclic graph (DAG) was used to estimate causal associations between clusters. RESULTS: Approximately 37 % of the sample screened positive for probable PTSD. Internal re-experiencing and external re-experiencing had the strongest edges. In the DAG, internal re-experiencing was the parent node and was potentially predictive of external re-experiencing, negative affect, dysphoric arousal, and avoidance. LIMITATIONS: Data were drawn from a treatment-seeking sample that may not generalize to all firefighters/EMTs. CONCLUSIONS: The current findings are consistent with prior research suggesting re-experiencing plays a critical role in developing and maintaining PTSD symptoms. Future research should investigate non-treatment-seeking first responders, as well as EMTs and firefighters as individual populations.

First Responder Attitudes Regarding Working Near a Supervised Injection Facility: Relationship to Burnout, Secondary Traumatic Stress, and Compassion Satisfaction.

BACKGROUND: Emergency responders are the most frequent overdose responders, however, little is known about the impact of supervised injection facility (SIF) location on first responders. The purpose of this study was to determine whether firefighter/paramedic attitudes about being stationed near an SIF were related to burnout, secondary traumatic stress, and compassion satisfaction. METHODS: Firefighter/paramedics from Vancouver Fire and Rescue Services (n = 54) completed an online survey. General linear models were used to assess differences in burnout, secondary traumatic stress, and compassion satisfaction based on attitudes regarding being stationed near an SIF while controlling for occupational stress. FINDINGS: Firefighters with negative attitudes regarding station placement near an SIF experienced more burnout compared with those with neutral/mixed attitudes and less compassion satisfaction compared with those with positive attitudes. There were no differences between those with positive and neutral/mixed attitudes. CONCLUSIONS: These findings have implications for education and training of emergency responders stationed near SIFs. They also highlight the need for more research into the effects of and possible clinical opportunities needed to support first responders' work near an SIF. APPLICATION TO PRACTICE: While these findings represent early exploratory evidence, increased burnout and reduced compassion satisfaction may be common reactions among first responders who experience negative attitudes toward SIFs. Prevention efforts could incorporate programs to enhance health and well-being of first responders and education regarding substance use and harm reduction, while workforce surveillance for signs of distress or burnout could be implemented to trigger additional mental health services and interventions. while policymakers should remain aware of SIF-related impacts on all stakeholders, including first responders.

Stamp Out Stigma: a national campaign to decrease stigma and increase behavioral health in fire service.

Firefighters are at risk for behavioral health problems; however, mental health stigma is a barrier to seeking treatment. Although effective treatments exist, many firefighters report that internal stigma prohibits presentation for effective care. This study aimed to decrease stigma about behavioral health in fire service through the development and delivery of a peer-led anti-stigma intervention campaign called Stamp Out Stigma (SOS). SOS consisted of three related phases. During Phase 1 (n = 12), we produced testimonials and piloted the videos with firefighters to determine which were most compelling. During Phase 2 (n = 23), we beta-tested our training curriculum with two departments, resulting in a significant decrease in internalized stigma but not in self-stigma. During Phase 3 (n = 73), we presented the curriculum to two cohorts of firefighters. Participation in the SOS workshop was associated with a significant decrease in firefighters' self-stigma from pre-, M = 22.7, SD = 6.3, to post-workshop, M = 20.8, SD = 5.5, t(66) = 3.2, p = 0.002. Participation in the SOS workshop was associated with a significant decrease in firefighters' internalized stigma, M = 2.0, SD = 0.5, to post-workshop, M = 1.8, SD = 0.4, t(66) = 2.8, p = 0.007. The SOS approach to stigma reduction is promising for modifying negative attitudes toward mental health and treatment seeking among professional firefighters.

Working near a supervised injection facility: A qualitative study of perspectives of firefighter-emergency medical responders.

BACKGROUND: While firefighter-emergency medical responders (FF-EMR) are important stakeholders in cities considering the implementation of a supervised injection facility (SIF), there is little information on perspectives of first responders who serve these communities. The aim of the present study was to identify FF-EMR perspectives on working near a SIF. METHODS: FF-EMRs from Vancouver Fire and Rescue Services completed an online survey that queried participant perspectives on working near a SIF. RESULTS: Four main themes were identified: positive effects, negative effects, duration of assignment, and sense of duty. Similar percentages of first responders reported positive (22.2%) and negative aspects (25.9%) of working near the SIF, while some (18.5%) indicated preference for a short-term assignment to the SIF area. FF-EMRs most commonly described a sense of duty (35.2%). CONCLUSIONS: To our knowledge, our study is the first to identify FF-EMR perspectives related to work near a SIF. Perspectives and concerns of first responders should be considered in policy debates about implementation of new SIFs to guarantee an adequately-prepared first responder workforce.

Behavioral health programs in fire service: Surveying access and preferences.

Due to the stressful nature of the job, firefighters are likely to be at increased risk for behavioral health problems. This study examined the access, attitudes, and preferences of a large sample of professional firefighters (N = 2,156) toward behavioral health services using an online survey. Overall, 81% of participants reported that they had access to behavioral health services through their fire service department, although smaller departments were less likely to offer such services. Despite available programs within fire service, firefighters most commonly reported that they would seek outside help from their spouse/family (67%) or private professional services (60%). Firefighters with fewer years in service were more likely to go to a spouse/family member, coworker, or officer for help, whereas those with more years were more likely to seek private professional services. Few firefighters directly stated that stigma would prevent them from using behavioral health services, yet a large percentage of firefighters (68%) reported that they would not recommend these services to colleagues, and stigma-related barriers were still among the most significant reported. "Clinicians who understand firefighter work culture" was rated as one of the most important components to a successful behavioral health program; a lack thereof rated as one of the most significant barriers. Offered together, these findings suggest that greater exploration of stigma in fire service is warranted, and attention toward training culturally competent clinicians to work with firefighters is needed. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Is Cumulative Exposure to Suicide Attempts and Deaths a Risk Factor for Suicidal Behavior Among Firefighters? A Preliminary Study.

The association between cumulative exposure to suicide attempts and deaths and suicidal behavior was examined in a sample of 61 professional firefighters. On average, firefighters reported 13.1 (SD = 16.6) exposures over the course of their lifetime. Cumulative exposure to suicide attempts and deaths was positively correlated with suicidal behavior (r = .38, p = .004). Moreover, firefighters with 12+ exposures were more likely to screen positive for risk of suicidal behavior (OR = 7.885, p = .02). Additional research on the potential impact of cumulative exposure to suicide attempts and deaths on firefighters' health and safety is needed.

In the wake of suicide: Developing guidelines for suicide postvention in fire service.

This project aimed to develop a standard operating procedure (SOP) for suicide postvention in Fire Service. First, an existing SOP was refined through expert review. Next, focus groups were conducted with fire departments lacking a peer suicide postvention SOP; feedback obtained guided revisions. The current article describes the iterative process used to evaluate and revise a Suicide Postvention SOP into a Postvention guideline that is available for implementation and evaluation. Postventions assist survivors in grief and bereavement and attempt to prevent additional negative outcomes. The implementation of suicide postvention guidelines will increase behavioral wellness within Fire Service.

Internal consistency, test-retest reliability, and predictive validity for a Likert-based version of the Sources of occupational stress-14 (SOOS-14) scale.

This study examined the psychometric properties of a Likert-based version of the Sources of Occupational Stress-14 (SOOS-14) scale. Internal consistency for the SOOS-14 ranged from 0.78-0.84, whereas three-month test-retest reliability was 0.51. In addition, SOOS-14 scores were prospectively associated with symptoms of PTSD and depression at a three-month follow-up assessment.