Elsevier

Journal of Affective Disorders

Volume 208, 15 January 2017, Pages 177-183
Journal of Affective Disorders

Correlates of suicidality in firefighter/EMS personnel

https://doi.org/10.1016/j.jad.2016.08.078Get rights and content

Highlights

  • Depression was significantly associated with lifetime suicidal ideation and suicide attempts.

  • PTSD symptom severity was significantly associated with lifetime suicidal ideation and attempts.

  • Rates of suicidal ideation were higher before joining the department than ideation after joining.

  • Rates of suicide attempts were higher before joining the department than attempts after joining.

Abstract

Background

Firefighter and Emergency Medical Services (EMS) personnel experience higher rates of lifetime suicidal ideation and attempts than the general population and other protective service professions. Several correlates of suicidality (alcohol use, depression, posttraumatic stress) have been identified in the literature as applicable to firefighter/EMS populations; however, few studies to date have examined the specific correlates of suicidality (lifetime suicidal ideation and/or attempts) in a firefighter/EMS sample.

Methods

Participants (N=3036) from a large, urban fire department completed demographic and self-report measures of alcohol dependence, depression, posttraumatic stress disorder (PTSD) symptom severity, and lifetime suicidal ideation and attempts. Participants in this sample performed both firefighter and EMS duties, were predominately male (97%), White (61.6%), and 25–34 years old (32.1%).

Results

Through hierarchical linear regressions, depression (β=.22, p<.05) and PTSD symptom severity (β=.21, p<.05) were significantly associated with lifetime suicidal ideation (R2 =17.5). Depression (β=.15, p<.001), and PTSD symptom severity (β=.07, p<.01) were significantly associated with lifetime suicide attempts (R2=5.1).

Limitations

Several limitations are addressed in the current study. The survey was a self-report pre-existing dataset and lifetime suicidal ideation and attempts were measured using sum scores. Additionally, the disproportionately large sample of males and large, urban setting, may not generalize to female firefighters and members of rural community fire departments.

Conclusions

The current study highlights the importance of targeting depression and PTSD symptom severity in efforts to reduce suicidality in firefighter/EMS personnel.

Introduction

The firefighting profession is among the most dangerous and stressful occupations, yet the existing literature base lacks empirical evidence examining the effects of stress in both firefighter and Emergency Services (EMS) populations (Corneil et al., 1999, Finney et al., 2015). Recent research suggests that firefighters are at increased risk for adverse mental health concerns, such as posttraumatic stress disorder (PTSD) and depression (American Psychiatric Association, 2000), due to repeated exposure to traumatic and critical incidents (Homish et al., 2012, Armstrong et al., 2015, Pinto et al., 2015). These experiences place firefighter/EMS personnel at an increased risk for suicidality. Generally, protective service workers (police officers, firefighters, EMS) have among the highest rates of suicide fatalities in the workplace (Milner et al., 2015, Tiesman et al., 2015).

Suicidality, which encompasses varying degrees of suicidal ideation, attempts and suicidal behaviors (Krysinska and Lester, 2010), represents a growing public health concern for the general population in the U.S. and elsewhere. In fact, approximately 40,000 people in the U.S. and 800,000 worldwide commit suicide each year (Centers for Disease Control CDC, 2015). The lifetime prevalence rates for the general population of suicidal ideation (5.6–14.3%), plans (3.9%), attempts (1.9–8.7%), and non-suicidal self-injury (5.9%) (Nock et al., 2008) are lower than the rates found in the firefighter population. Furthermore, firefighters endorse suicidal ideation (46.8%), plans (19.2%), attempts (15.5%), and non-suicidal self-injury (16.4%) at much higher rates, which underscores the high-risk nature of this occupation (Stanley et al., 2015).

As compared with other high-risk service professions, firefighters exhibit comparable, if not higher, rates of suicidal ideation, attempts, and plans. For example, in a study examining suicidal ideation in police officers, 13% exhibited suicidal ideation (Steyn et al., 2013) as compared to the 46.8% rate of suicidal ideation found in firefighters (Stanley et al., 2015). Additionally, several studies have found the suicide rates of veterans to be similar to the general population. For example, veterans endorsed lower rates of suicidal ideation (3.8–13.9%), attempts (.4–2.4%), and plans (5.3%) than firefighters have endorsed. Such discrepancies demonstrate the severity of suicidality in the firefighter population (Bossarte et al., 2014, Nock et al., 2014).

The complexity of the etiology and maintenance of suicidality presents a challenge in accurately capturing its underlying mechanisms. Many psychiatric symptoms and demographic characteristics are associated with increased risk for suicidality in several populations (e.g., general, police officers, college students, military populations), with depression and PTSD being among the strongest risk correlates. (Corneil et al., 1999, Brezo et al., 2006, Bacharach et al., 2008, Stack and Scourfield, 2015, Stanley et al., 2015). Little is still known about the specific factors that are associated with suicidality among firefighters/EMS personnel. The high prevalence of mental health concerns and increased exposure to trauma in this population warrants a closer empirical examination. For the purpose of the current study, suicidality will be defined as suicidal ideation and suicide attempts.

Section snippets

Correlates of suicidality in current literature

In order to address the staggering suicide rates of this population, it is necessary to conduct a thorough examination the correlates of suicidality unique to firefighter/EMS personnel. Therefore, the following section identifies factors associated with suicidality in the literature that are pertinent to firefighter/EMS personnel (Carpenter et al., 2015, Stanley et al., 2015).

Participants

A total of 3036 participants completed a self-report survey, which represented approximately 76% of the department's personnel. The only criterion for participation was employment by the department. Additionally, all participants provided written informed consent to participate. In this department, firefighter and EMS roles are combined, which differs from many other departments in which these positions are separate roles. All firefighters are trained to perform both firefighting and EMS

Descriptive statistics and bivariate correlations

Missing data were found to be 2.7% of the total data and missing completely at random (MCAR; Little's MCAR test: χ2=9.63, df=6, p=.14). Maximum likelihood estimates using the expectation maximization algorithm were employed to compute values for the missing data prior to regression analysis (Allison, 2001).

A preliminary analysis was conducted to examine the bivariate correlations of the variables included in the study. None of the significant correlations exceeded .80, indicating

Regression results

Lifetime Suicidal Ideation. A hierarchical linear regression was conducted with lifetime suicidal ideation as the outcome variable and included variables that were significantly correlated with lifetime suicidal ideation (p's<.05) at the bivariate level (years of service, relationship status, race/ethnicity, PTSD symptom severity, depression, and alcohol dependence). The overall model was statistically significant, R2=.18, F(3, 2662)=51.29, p<001. The adjusted R2 was .17, reflecting a

Discussion

Firefighters report higher rates of suicidal ideation, plans, and attempts (46.8%, 19.2%, and 15.5%, respectively) as compared to both general (5.6–14.3%, 3.9%, and 1.9–8.7%, respectively) and military populations (3.8–13.9%, 5.3%, and 0.4–2.4%, respectively) (Nock et al., 2008, Nock et al., 2014, Stanley et al., 2015). Furthermore, those firefighters who also respond to Emergency Medical Services (EMS) calls are six times more likely to have made a career suicide attempt (Stanley et al., 2015

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