Objective: Firefighters are an important sample of convenience to study traumatic exposure and symptom development. This study assessed trauma exposure inside and outside of fire service, diagnosed posttraumatic stress disorder (PTSD) and associated disorders using clinical interviews and self-report measures, then tested the hypothesis that trauma exposure would predict distress in firefighters over the first 3 years in service. Method: In total, 322 professional firefighter recruits were assessed during academy training and through their first 3 years of service. Diagnostic assessments were conducted by psychologists annually, and symptom checklists were completed by telephone every 4 months. Results: Firefighter recruits were exposed to approximately nine potentially traumatic events (PTEs) in the first 3 years of fire service, with 66% of these events occurring in the line of duty. Very few (3%) developed diagnoses of PTSD, major depression, or generalized anxiety disorder. Models of distress supported a trait model of distress. Distress was stable within individuals over time, and although those reporting more distress also reported more trauma exposure, variation in distress over time was not predicted by trauma exposure. Conclusions: Professional firefighters experience frequent exposure to potentially traumatic events during their early careers. This exposure, although large, does not result in a large proportion of mental health diagnoses. Distress was consistent and low, which provides evidence of the resilient nature of those selecting a career in emergency service. Future work is needed to understand the disconnection between the current rigorously collected prospective data and the existing literature regarding the increased risk of PTSD and associated disorders in fire service.

No abstract

Background and aimsAlthough multiracial people comprise the fastest growing population in the United States, multiracial youth are nearly invisible in alcohol research. This meta‐analysis synthesized the youth alcohol literature to estimate the magnitude of difference in alcohol use as a function of multiracial status.Design and MeasurementsEmpirical studies reporting multiracial and monoracial comparisons in youth (aged 10–24 years) alcohol use were identified through a systematic literature search. A random‐effects meta‐analysis was conducted using 85 effect sizes extracted from 16 studies assessing life‐time, past‐year, past‐month and binge alcohol use.Setting and ParticipantsA total of n=1 555 635 youth were assessed in the United States.FindingsMultiracial youth are suggested to be more likely to endorse life‐time alcohol use than Asian youth [number of studies (k) = 3; odds ratio (OR) = 1.81, 95% confidence interval (CI) = 1.01, 3.24; p = 0.04], with significant between‐study heterogeneity (Q = 8.42; p < 0.001; I2 = 76%) in effect size comparisons. Multiracial youth are suggested to be more likely to endorse past‐month alcohol use than Black (k = 6; OR = 1.54, 95% CI = 1.38, 1.71; p < 0.001) and Asian (k = 4; OR = 2.09, 95% CI = 1.52, 2.88; p < 0.001) youth, but less likely than White (k = 6; OR = 0.87, 95% CI = 0.84, 0.91; p < 0.001) youth, with significant between‐study heterogeneity for Black youth (Q = 11.94; p = 0.03; I2 = 58%) in effect size comparisons. Lastly, multiracial youth are suggested to be more likely to endorse binge alcohol use than Black (k = 4; OR = 1.98, 95% CI = 1.62, 2.44; p < 0.001) and Asian (k = 4; OR = 2.82, 95% CI = 2.28, 3.48; p < 0.001) youth, but less likely than White (k = 5; OR = 0.75, 95% CI = 0.70, 0.81; p < 0.001) and American Indian/Alaska Native (k = 3; OR = 0.78, 95% CI = 0.71, 0.85; p < 0.001) youth, with significant between‐study heterogeneity among Black (Q = 23.99; p < 0.001; I2 = 87%) and Asian (Q = 17.76; p < 0.001; I2 = 83%) youth in effect size comparisons.ConclusionsIn the United States, multiracial youth report distinct alcohol use patterns compared with monoracial youth and may be at elevated alcohol use risk compared with Black and Asian youth.

Background Limited research suggests that female firefighters report problem drinking at higher rates than the general population. Aims To identify longitudinal drinking patterns in female firefighters, make comparisons to male firefighters and examine problem drinking in relation to post-traumatic stress disorder (PTSD) and depression. Methods Study participants included 33 female and 289 male firefighter recruits, who were assessed over their first 3 years of fire service. Results Female firefighters consumed increasing numbers of drinks per week, with a median of 0.90 drinks per week at baseline, and 1.27 drinks in year 3. Female firefighters reported binge drinking at high rates, with nearly half binging at least once per year across all time points (44–74%). The percentage that reported binge drinking three or more times per month doubled over the course of the study (from 9% to 18%). Overall, males reported higher rates of binge drinking and a greater number of drinks per week; however, binge drinking rates among females increased over time and became comparable to rates of binge drinking among males. A greater percentage of female than male firefighters met the criteria for problem drinking by year 1. Problem drinking was associated with screening positive for PTSD at year 1 and depression at year 2, but not with occupational injury. Conclusions Over time, female firefighters reported increasing amounts of drinking, more frequent binge drinking and more negative consequences from drinking. These findings along with existing literature indicate female firefighters change their drinking in the direction of their male counterparts.

Peer support, as part of a recovery-oriented approach to treatment, is a valuable resource across various clinical and nonclinical populations. Specifically, in fire service, peer support may bridge the gap between firefighters' behavioral health needs and access to professional services. The current chapter summarizes the literature on peer support utility, presents data on barriers to treatment, and describes the roles clinicians can fill in partnering with fire service peer support to enhance the quality and reach of behavioral health services offered to fire service personnel. Finally, future research directions are outlined to continue the conversation about how to improve collaborations between peer supporters, clinicians, and others working to support the needs and strengths of firefighters.