Due to occupational stress and exposure to potentially traumatic events, firefighters are at an increased risk for the development of many behavioral health conditions. While volunteer and career firefighters represent two distinct subgroups, little research has examined differences in the availability of, and barriers to, behavioral health care between these populations. This study examined perceived availability and barriers to behavioral health care services among 2,156 career and 227 volunteer firefighters. Volunteer firefighters were less likely to report availability of drug and alcohol or family and couple services, but more likely to report availability of a trained peer support system and follow-up care compared to career firefighters. Volunteer firefighters were over five times more likely to consider cost a barrier to accessing behavioral health services compared to career firefighters; however, they were less likely to report lack of support from leadership, fear of breach of confidentiality, and clinicians who are unaware of work culture as barriers. Volunteer and career firefighters were equally likely to report stigma as a barrier. These findings have important implications for understanding how to strengthen departmental resources and to design targeted interventions to increase access to behavioral health services. Impact StatementThis study suggests that there are meaningful differences in availability of behavioral health resources between career and volunteer. While cost was a greater barrier to accessing services among volunteer firefighters, stigma was a common barrier for both volunteer and career firefighters. These findings have important implications for understanding how to strengthen departmental resources and to design targeted interventions to increase access to behavioral health services.

Racial disparities in health are a major public health problem in the United States, especially when comparing chronic disease morbidity and mortality for Black versus White Americans. These health disparities are primarily due to insidious anti-Black racism that permeates American history, current culture and institutions, and interpersonal interactions. But how does racism get under the skull and the skin to influence brain and bodily processes that impact the health of Black Americans? In the present article, we present a model describing the possible neural and inflammatory mechanisms linking racism and health. We hypothesize that racism influences neural activity and connectivity in the salience and default mode networks of the brain and disrupts interactions between these networks and the executive control network. This pattern of neural functioning in turn leads to greater sympathetic nervous system signaling, hypothalamic-pituitary-adrenal axis activation, and increased expression of genes involved in inflammation, ultimately leading to higher levels of proinflammatory cytokines in the body and brain. Over time, these neural and physiological responses can lead to chronic physical and mental health conditions, disrupt wellbeing, and cause premature mortality. Given that research in this area is underdeveloped to date, we emphasize opportunities for future research that are needed to build a comprehensive mechanistic understanding of the brain-body pathways linking anti-Black racism and health.

LAY SUMMARY Behavioural health peer support connects individuals to needed professional services (e.g., counselling) and provides benefits in groups of people that might face more challenges, like military Veterans. Different training exists for peer supporters, but not a lot of information is available to demonstrate if these trainings, or checking in with trained peers, is helpful. This study took a peer support training program used in fire service and updated it to fit the needs of Veterans and Veteran family members (V/VFM) in Texas, United States. Texas has a lot of Veterans and lacks enough mental health providers (e.g., psychologists). In this study, V/VFM were trained in peer support skills and had six months of peer check-in calls after the training. The trainees completed a test before training asking about their engagement and confidence with helping others, as well as a test after training asking these questions again and assessing satisfaction with training. Results show training was appropriate and acceptable. V/VFM appreciated the check ins and showed increases in confidence in their ability to help others. They tried to help more peers and were more successful when they did reach out. This study describes one way peer support can improve mental health access.

Background Head injuries are common injury in the fire service; however, very little data exist on the risks this may pose to the development of post-traumatic stress disorder (PTSD) and depression in this high-risk population. Aims Our study aimed to compare levels of PTSD and depression symptoms in firefighters with a line-of-duty head injury, non-line-of-duty head injury and no head injury. Methods In this cross-sectional study, we assessed current PTSD and depression symptoms as well as retrospective head injuries. Results Seventy-six per cent of the total sample reported at least one head injury in their lifetime. Depression symptoms were significantly more severe among firefighters with a line-of-duty head injury compared to those with no head injury, but not compared to those who sustained a non-line-of-duty head injury. Depression symptoms did not differ between firefighters with a non-line-of-duty head injury and those with no head injury. PTSD symptoms were significantly more severe among firefighters with a line-of-duty head injury compared to both firefighters with no head injury and those with a non-line-of-duty head injury. Conclusions We found that firefighters who reported at least one line-of-duty head injury had significantly higher levels of PTSD and depression symptoms than firefighters who reported no head injuries. Our findings also suggest head injuries sustained outside of fire service could have less of an impact on the firefighter’s PTSD symptom severity than head injuries that occur as a direct result of their job.

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