Firefighters are repeatedly exposed to potentially traumatic events and occupational stressors (i.e. physical strain, shift work that results in disrupted sleep schedules), thus they experience an increased prevalence rate for a variety of psychological disorders and suicidality. Firefighter culture is unique and those firefighters who endorse mental health concerns and treatment barriers vary by subpopulation (volunteer, career, wildland) and geographical factors (rural vs. urban). Mental health providers must understand the complexity and nuances of the firefighter vocational experience to effectively work with this subpopulation. Extant literature suggests that anticipating negative outcomes from treatment, stigma, and structural barriers inhibit treatment engagement. These treatment engagement factors likely interact at various time points and influence firefighter mental health outcomes. Practice implications highlight how these barriers can be addressed via peer support, informal support, telehealth approaches (e.g., digital storytelling), work-recovery strategies, mindfulness, and critical incident stress management. Future implications suggest that firefighters would benefit from updated clinical practice guidelines specific to this subpopulation to provide optimal care. The emergent research in this area allows for a more advanced understanding of firefighter mental health, highlights research gaps, and appropriate training of culturally competent mental health providers that incorporates diversity factors. The objective of this article is to (a) describe firefighters’ mental health prevalence rates, (b) discuss specific help-seeking and treatment engagement strategies, and (c) review practice implications and research recommendations to enhance cultural competency for mental health providers with the aim of increasing utilization of firefighter-specific behavioral health services.
Firefighter paramedics are frequently exposed to dangerous and stressful situations due to their occupational duties. Repeated exposure to traumatic events can take a cumulative toll on an individual’s physical and mental health and potentially lead to a diagnosis of posttraumatic stress disorder. Although it is very common and expected for individuals to endorse symptoms of posttraumatic stress disorder immediately following a traumatic event, a large number are able to recover with minimal changes in functioning. Resiliency has emerged as a significant construct in explaining how humans cope with adversity and trauma. Resiliency can be defined as the ability to successfully cope, adapt, or manage stressful or traumatic situations. This study identified potential psychological and behavioral health variables that mediate the relationship between resiliency and posttraumatic stress symptoms (PTSS). Specifically, the primary objective of this article was to examine how depression, anxiety, and sleep mediate the relationship between resiliency and PTSS in firefighter paramedics. Participants included 125 full-time firefighter paramedics. Voluntary recruitment occurred at one South Florida fire department that comprised four fire stations. Participants were recruited for the study via their employee e-mail. Participants completed a battery of self-report questionnaires administered by clinical psychology doctoral students from a local university. Results suggest depression, anxiety, and sleep significantly mediate the relationship between resiliency and PTSS. The clinical implications of these findings and future research directions are discussed.
Some research suggests that firefighters are possibly at greater risk than other at-risk first responder/public service populations for suicidality (e.g., police, Veterans, active duty military non-deployed males; Martin et al., 2017 ; Stanley et al., 2015; Stanley et al., 2016 ). Behavioral autopsies have been utilized to elucidate the clinical picture of other at-risk populations; however, to date there is no proposed or applied model for a suicide behavior autopsy in fire personnel. Developing a standardized suicide behavior autopsy will allow for a comprehensive understanding of firefighters who die by suicide and highlight potential areas for intervention. The aim of this paper is to integrate best practices for autopsy procedures from other high-risk populations into a comprehensive theoretical model for a proposed behavioral health autopsy for firefighters. Our recommended protocol is presented along with relevant limitations, clinical implications, and recommendations for future research.
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