PTSD symptoms and suicidal thoughts and behaviors among firefighters

doi:10.1016/j.jpsychires.2016.10.014

Journal of Psychiatric Research

Volume 84, January 2017, Pages 277-283

https://doi.org/10.1016/j.jpsychires.2016.10.014 Get rights and content

Highlights

•
PTSD symptoms and suicidal behaviors were measured in a large firefighter sample.
•
Greater PTSD symptoms were related to risk for suicide ideation (SI) and attempts.
•
PTSD numbing and re-experiencing symptoms uniquely predicted risk for SI.
•
PTSD re-experiencing symptoms uniquely predicted risk for previous attempts.

Abstract

Research into the causes and prevention of suicide has been deemed a national priority, with a recent focus on sectors of the workforce, such as firefighters, who experience occupational hazards that may confer risk for suicide. Elevated levels of posttraumatic stress symptoms (PTSS), which show robust relationships with both suicidal ideation (SI) and suicide attempts, are common among firefighters. However, no study to date has investigated the relationship between PTSS and suicidality among firefighters. The current study therefore aimed to identify the degree to which PTSS were related were related to a history of SI and prior attempts in a national sample of firefighters (N = 893). Results revealed that greater PTSS were associated with greater risk of reporting lifetime SI and prior attempts, after controlling for other known risk factors for suicidality. Exploratory models investigating the unique contributions of individual PTSS clusters to suicidality found that numbing and re-experiencing PTSS were significantly related to SI, but only re-experiencing was related to prior attempts. The theoretical and clinical implications of these relationships, particularly among firefighters, are discussed.

Section snippets

The current study

The current study utilizes data from a large, national sample of current firefighters to test the hypothesis that greater current PTSS are significantly related to career SI (i.e., reported to have been present during their firefighting tenure) and history of attempts (‘yes’ or ‘no’). Second, separate exploratory models were tested with re-experiencing, avoidance, numbing, and hyperarousal symptom clusters entered simultaneously to further investigate the ill-understood, unique relationships

Participants and procedure

Participants (N = 893) were current United States firefighters selected from a larger sample of respondents to a national web-based survey on firefighter behavioral health. Of the original sample (N = 1027), 110 (10.7%) participants were excluded because they reported having retired from the fire service, and another 24 (2.3%) individuals were excluded because they did not provide information pertaining to prior suicide attempts. Though current firefighters in this sample were significantly

Depressive Symptom Inventory—Suicidality Subscale (DSI-SS; Metalsky and Joiner, 1997)

The DSI-SS is a 4-item self-report measure designed to assess the severity of suicidal ideation over the previous two weeks. Individuals respond to each item on a 4-point Likert-scale, with total scores ranging from 0 to 12. Increasing scores represent greater severity of suicidal ideation. For this study, participants were asked to answer questions based on their experiences since becoming a firefighter. Although this measure was not designed to index SI over this extended time frame,

Results

Analyses were conducted in SPSS version 22, including a missing value pattern analysis that identified less than 6% of values missing. Missing data were handled with multiple imputation using multivariate normal distribution in SPSS. For all analyses, race was collapsed into three categories (i.e., Caucasian, Native American, and Other), due to the low number of individuals identified as Asian, African American, and Other resulting in poor model fit when including a six-category race variable.

Discussion

Results of this study supported hypotheses that within a large, national sample of current firefighters, current PTSS would be significantly associated with SI and suicide attempts during their firefighting careers, beyond depression symptoms and other known risk variables (i.e., military status, race, sex, and age). Results of exploratory PTSS cluster analyses suggested that re-experiencing and numbing symptoms are uniquely related to career SI in current firefighters, even after accounting

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Firefighters are at increased risk of developing posttraumatic stress disorder (PTSD) due to exposure to potentially traumatic events during their careers. However, little is known about the prevalence of PTSD among this population, particularly when taking moderating variables into account. Using Gaussian Graphical Models and Directed Acyclic Graphs, we conducted network analyses to examine the interactions between clusters of PTSD symptoms, perceived stress, hardiness, and experiential avoidance among 187 firefighters. The data and code are published with the paper. Experiential avoidance, as part of psychological inflexibility, was found to be the only variable that interacted with PTSD symptomatology. Strong positive associations were observed between experiential avoidance and the “negative mood and cognitions” subscale of the PTSD Checklist for DSM-5 (PCL-5). Through this association, other PTSD symptoms were activated, particularly avoidance and arousal. Our findings suggest that experiential avoidance and negative mood and cognition symptoms are particularly important in the expression of PTSD symptomatology in firefighters. In addition, experiential avoidance may be used as a coping strategy to reduce perceived stress during potentially traumatic events. Therefore, experiential avoidance may be a prime target for future interventions and training focused on flexible self-regulation strategies in this population.
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This study investigated the relationship between trauma exposure and suicidal ideation. Moreover, this study examines the moderating roles of organizational climate on the association between trauma exposure and suicidal ideation in Korean male firefighters.
A total of 15,104 male firefighters who completed a questionnaire were analyzed. The data were obtained using an online self-administered questionnaire from the Firefighter Research on Enhancement of Safety and Health Study. Poisson regression analysis was performed to determine the effects of trauma exposure on suicidal ideation and the moderating effect of organizational climate.
The results showed that 389 firefighters (2.6%) responded that they had experienced suicidal ideation. In the final model, trauma exposure was positively related to suicidal ideation (adjusted risk ratio [aRR], 1.076; 95% confidence interval [CI]: 1.051–1.103), and organizational climate was negatively associated with suicidal ideation (aRR, 0.772; 95% CI: 0.739–0.806). Additionally, the interaction term (trauma exposure × organizational climate) was related to suicidal ideation (aRR, 1.016; 95% CI: 1.009–1.023).
This study suggests that trauma exposure might play a significant role in developing suicidal ideation and that positive organizational climate moderates the negative effects of trauma exposure on suicidal ideation among firefighters. It is necessary to perform a follow-up study of various intervention strategies to maintain a healthy organizational climate or work environment. Such interventions should promote lasting trust within teams, provide social support and belonging, and nurture job value.
Predicting PTSD symptoms in firefighters using a fear-potentiated startle paradigm and machine learning
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Citation Excerpt :
The lifetime prevalence of PTSD is between 1.3 % and 12.2 % (Ferry, 2013). As PTSD can occur after a single traumatic event or from prolonged exposure to trauma, firefighters are more likely to develop PTSD (Boffa et al., 2017; Shi et al., 2021). Early identification of individuals at risk of PTSD is a major challenge (Shalev et al., 2017; Schultebraucks et al., 2020a).
This study develops a fear-potentiated startle paradigm (FPS) and a machine learning approach to accurately predict PTSD symptoms using electrogram data. A three-phase fear-potentiated startle paradigm was designed to assess the conditioning, generalization, and extinction of fear. Electrooculogram and electrocardiogram signals were collected during the FPS. A total of 1107 Chinese firefighters participated in the study. The Chinese version PCL-C was administered to all subjects. A cutoff of 38 or higher is used to indicate PTSD symptoms. Electrogram features were extracted and selected to build a machine learning model to classify individuals. The machine learning model was 5-fold cross validated. The importance of the selected features was calculated. Classification performance metrics were evaluated for the machine learning model. The machine learning model can identify firefighters with a PCL-C score of 38 or above with sensitivity and specificity both above 0.85 when 5-fold cross validated on a 1107-person sample. The area under the receiver operating characteristic curve of the model is 0.93. Features related to fear generalization are found to be the most important. The proposed fear-potentiated startle paradigm and machine learning approach can accurately predict PTSD symptoms in Chinese firefighters, which can improve the screening and diagnosis of PTSD.
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PTSD symptoms and suicidal thoughts and behaviors among firefighters

Highlights

Abstract

Section snippets

The current study

Participants and procedure

Depressive Symptom Inventory—Suicidality Subscale (DSI-SS; Metalsky and Joiner, 1997)

Results

Discussion

J. Anxiety Disord.

Behav. Res. Ther.

J. Psychiatr. Res.

J. Psychiatr. Res.

Aggress. Violent Behav.

J. Anxiety Disord.

J. Psychosom. Res.

Behav. Res. Ther.

Clin. Psychol. Rev.

Behav. Res. Ther.

Clin. Psychol. Rev.

Psychiatry Res.

Compr. Psychiatry

Lancet Psychiatry

J. Anxiety Disord.

Clin. Psychol. Rev.

Cogn. Behav. Pract.

J. Affect. Disord.

Clin. Psychol. Rev.

Am. J. Prev. Med.

Hopelessness depression: a theory-based subtype of depression

Psychol. Rev.

Diagnostic and Statistical Manual of Mental Disorders

Are avoidance and numbing distinct PTSD symptom clusters?

J. Trauma. Stress

A systematic review and evaluation of measures for suicidal ideation and behaviors in population-based research

Psychol. Assess.

Hopelessness as a predictor of eventual suicide

Ann. N. Y. Acad. Sci.

Specific symptoms predict suicidal ideation in Vietnam combat veterans with chronic post-traumatic stress disorder

Mil. Med.

Trends of elevated PTSD risk in firefighters exposed to the World Trade Center disaster: 2001-2005

Public Health Rep.

Longitudinal study of probable post-traumatic stress disorder in firefighters exposed to the World Trade Center disaster

Am. J. Ind. Med.

Cumulative trauma, hyperarousal, and suicidality in the general population: a path analysis

J. Trauma Dissociation

Reexperiencing symptoms and the interpersonal-psychological theory of suicidal behavior among deployed service members evaluated for traumatic brain injury

J. Clin. Psychol.

Combat exposure and risk for suicidal thoughts and behaviors among military personnel and veterans: a systematic review and meta-analysis

Suicide Life Threat.

Posttraumatic stress in volunteer firefighters: predictors of distress

J. Nerv. Ment. Dis.

Posttraumatic stress reactions in volunteer firefighters

J. Trauma. Stress

Social support, stress, and suicidal ideation in professional firefighters

Am. J. Health Behav.

WISQARS: Web-based Injury Statistics Query and Reporting System

WISQARS: Cost of Injury Reports

The impact of suicide on the family

Crisis

Performance characteristics of the PTSD Checklist in retired firefighters exposed to the World Trade Center disaster

Ann. Clin. Psychiatry

Exposure to traumatic incidents and prevalence of posttraumatic stress symptomatology in urban firefighters in two countries

J. Occup. Health Psychol.

PTSD, depression, and their comorbidity in relation to suicidality: cross-sectional and prospective analyses of a national probability sample of women

Depress. Anxiety

Posttraumatic stress disorder and suicidal ideation: the role of specific symptoms within the framework of the interpersonal-psychological theory of suicide

Psychol. Trauma Theory Res. Pract. Policy

The role of posttraumatic stress disorder symptom clusters in the prediction of passive suicidal ideation

Psychol. Trauma Theory Res. Pract. Policy

Prevalence of posttraumatic stress disorder symptoms in firefighters

Work Stress