Alcohol Use Problems, Posttraumatic Stress Disorder, and Suicide Risk Among Trauma-Exposed Firefighters

Abstract

Alcohol use problems are associated with suicidal desire and may provide an avenue to suicidal ideation and behavior. However, the influence of posttraumatic stress disorder (PTSD) on the nature of the relationship between alcohol use problems and suicide risk is not well understood. In particular, the potential for PTSD to moderate the association between alcohol use problems and suicide risk remains unexplored. The present study investigated the main and interactive effects of alcohol use problems (Alcohol Use Disorders Identification Test) and PTSD symptoms (PTSD Checklist for DSM-5) on suicide risk (Suicide Behaviors Questionnaire-Revised) in a sample of 632 trauma-exposed firefighters (93.5% men; M age = 38.44 years, SD = 8.59). Hierarchical logistic regression analyses evaluated whether the main and interactive effects of PTSD symptom severity and alcohol use disorders were significantly related to suicide risk, above and beyond age and cumulative trauma. The main effects of PTSD symptom severity (odds ratio, 1.76; p < 0.001) and alcohol use problems (odds ratio, 1.37; p = 0.391) significantly positively predicted suicide risk; however, PTSD symptoms did not moderate an association between alcohol use problems and suicide risk after accounting for these main effects (p > 0.05). A secondary, exploratory aim demonstrated that all PTSD symptom clusters significantly positively predicted suicide risk (p's < 0.001), although none of these clusters interacted with alcohol use problems to predict suicide risk (p's > 0.05). Theoretical and clinical implications are discussed as they relate to the importance of screening for PTSD and alcohol use disorder among firefighter populations.

Association Between Positive Results on the Primary Care–Posttraumatic Stress Disorder Screen and Suicide Mortality Among US Veterans

“…This symptom has been associated with suicidal ideation in previous research. 26 , 28 , 30 , 45 , 46 A positive response to item 4 may indicate feelings of social isolation or thwarted belongingness, which may be one of the most important factors in suicidal desire, as described by the interpersonal theory of suicide. 47 , 48 This finding highlights the need to improve social support systems and encourage engagement in meaningful activities, which may not only reduce PTSD symptoms but potentially help to mitigate the risk of suicide.…”

The prevalence and clinical impairment of subthreshold PTSD using DSM‐5 criteria in a national sample of Korean firefighters

“…The definition of trauma in DSM‐5 is broader than that of DSM‐IV as it includes secondary trauma, which is defined as “stress deriving from helping others who are suffering or have been traumatized” (Figley, 1983). Firefighters are regularly exposed to traumatic events like fires or explosions, medical emergencies, natural disasters, and exposure to dead or dying individuals (Bing‐Canar et al, 2019). Moreover, considering the high rate of duty‐related secondary trauma in firefighters (Greinacher, Derezza‐Greeven, Herzog, & Nikendei, 2019), this population could be considered as a valuable population in studying the relationship of secondary traumas and subthreshold PTSD.…”

Post-traumatic stress disorder in volunteer firefighters: influence of specific risk and protective factors

“…Therefore, firefighters with increasing professional years have an increasing risk of developing PTSD, but also of various other mental disorders (cf. Bartlett, Gallagher, Tran, & Vujanovic, 2019;Bing-Canar et al, 2019;Nagamine et al, 2016).…”