Understanding mental health among military veterans in the fire service
Introduction
Firefighters represent a unique population by virtue of their exposure to chronic stress and potentially traumatic events (PTE, e.g., natural disasters, car accidents, terrorist attacks; (McCammon, 1996). Thus, firefighters are at heightened risk for the development of negative mental health outcomes, such as alcohol misuse, depression, suicidal thoughts/behaviors, and posttraumatic stress disorder (PTSD; Haslam and Mallon, 2003, Martin et al., 2017, Stanley et al., 2016). Despite the elevated risk for psychological disturbances among firefighters, there still remains a dearth of information regarding their mental health. Recent guidelines from the National Fallen Firefighters Foundation underscore as the highest priority efforts aimed at identifying and studying segments of firefighters who are at heightened risk for psychological disturbance (National Fallen Firefighters Foundation, 2016). Hence, further research is needed to understand correlates of mental health outcomes in firefighters, generally, and to identify segments of firefighters who may be at elevated risk for psychological disturbances. These research efforts have significant potential to inform evidence-based intervention and prevention efforts for this vulnerable, understudied population.
Military veterans are one such segment of the firefighter population that may be at increased risk for the development of negative mental health outcomes. Previous research has suggested that up to 44% of firefighters in the U.S. are military veterans (Meyer et al., 2012). Notably, the proportion of military veterans in the Meyer et al. (2012) study may have been due, in part, to higher-priority hiring policies for veterans in that particular department. To date, there have been no published studies examining nationally representative samples of U.S. firefighters, and as a result, no estimates on the proportion of firefighters with military service experience are available. Similar to firefighters, military veterans may experience chronic exposure to stress (e.g., deployment) and PTE (e.g., killing during combat; Maguen et al., 2011). As such, a vast literature has documented that military veterans experience high rates of various types of adverse mental health outcomes (e.g., alcohol use disorder, PTSD, suicide; Jacobson et al., 2008, Seal et al., 2009, U.S. Department of Veterans Affairs 2016), in comparison to the general population.
Although research examining military veteran subsamples in comparison to non-veteran subsamples among firefighters is scarce, available research suggests that firefighters who have served in the military are at risk for worsened mental health outcomes in comparison to firefighters who have not served in the military. For example, Stanley et al. (2015) found that active duty military status among firefighters was associated with increased risk for reporting suicidal thoughts and behaviors. Similarly, Paulus et al. (2017) noted significantly higher PTSD and depressive symptoms among firefighters who endorsed active duty military status. Unfortunately, no studies to date have been focused explicitly upon understanding the mental health of military veterans in the fire service.
Theoretically, the potentially stressful and traumatic events experienced by firefighters who served in the military may predispose them to higher levels of psychological disturbances, as a result of progressively increased responsivity to additional traumas or stressors endured in the fire service. For example, the stress sensitization model, defined as an individual's enhanced reactivity to stressors as a result of prior exposure to extreme stressors (Hammen et al., 2000, Smid et al., 2012), has been supported among trauma-exposed populations including combat veterans (Smid et al., 2013, Smid et al., 2012). Thus, individuals who begin a firefighter career with prior exposure to military-related stressors and military-related PTE may be particularly vulnerable to developing negative mental health consequences once exposed to the stressors of the fire service.
Therefore, the current study aimed to contribute to the extant literature by providing a focused examination on the mental health symptomatology of military veterans, as compared to non-veterans, within the fire service. Specifically, we compare military veterans and non-veterans in the fire service on the following mental health outcomes: alcohol use, sleep disturbance, depression, suicidality, trauma exposure, and posttraumatic stress symptoms. We hypothesized that firefighters who endorsed military veteran status would report higher rates of trauma exposure and general mental health symptomatology, across all indices, in comparison to firefighters who did not endorse prior service in the military. We also conducted exploratory analyses comparing military veteran and non-military veteran firefighters on cutoff scores for potentially hazardous drinking, significant sleep disturbance, clinical depression, global suicide risk, and PTSD diagnosis.
Section snippets
Participants
This study is a secondary analysis of data from a larger project examining stress and health-related behaviors among firefighters. The overall sample included 910 career firefighters (94.7% male; Mage = 38.4, SD = 8.6), of whom 5 endorsed current active duty status and 204 endorsed prior active duty status. For the purposes of this study, we combined firefighters endorsing current and past active military duty to represent military veteran status. Thus, our sample included 209 (23.0%)
Results
Descriptive statistics among all demographic variables are presented in Table 1. Significant between-group differences were noted with regard to age, gender, and race/ethnicity, and these variables were included as covariates in subsequent analyses.
Discussion
The current study examined mental health symptomatology of military veterans, as compared to non-military veterans, in the fire service. Our hypothesis was partially supported by the data. First, firefighters who were military veterans, compared to non-veterans, reported significantly greater levels of sleep disturbance (η2 = 0.01), depression (η2 = 0.01), and PTSD (η2 = 0.01) symptomatology, although the magnitude of the between-group effects was small. Post hoc analyses revealed that military
Declarations of interest
None.
References (47)
- et al.
The Pittsburgh sleep quality index: A new instrument for psychiatric practice and research
Psychiatry Res.
(1989) - et al.
Suicide prevention in fire service: The Houston Fire Department (HFD) model
Aggress. Violent Behav.
(2015) - et al.
The Pittsburgh sleep quality index as a screening tool for sleep dysfunction in clinical and non-clinical samples: A systematic review and meta-analysis
Sleep Med. Rev.
(2016) - et al.
Main and interactive effects of depression and posttraumatic stress in relation to alcohol dependence among urban male firefighters
Psychiatry Res
(2017) - et al.
Differences in psychiatric symptoms and barriers to mental health care between volunteer and career firefighters
Psychiatry Res
(2017) - et al.
Career prevalence and correlates of suicidal thoughts and behaviors among firefighters
J. Affect. Disord.
(2015) - et al.
A systematic review of suicidal thoughts and behaviors among police officers, firefighters, EMTs, and paramedics
Clin. Psychol. Rev.
(2016) Diagnostic and statistical manual of mental disorders
(2013)- et al.
The Alcohol Use Disorders Identification Test (AUDIT) and the SMAST-13: Predictive validity in a rural primary care sample
Alcohol and Alcoholism
(1993) - et al.
A systematic review and evaluation of measures for suicidal ideation and behaviors in population-based research
Psychol. Assess.
(2015)
The Posttraumatic Stress Disorder Checklist for DSM-5 (PCL-5): development and initial psychometric evaluation
J. Trauma. Stress
The Alcohol Use Disorders Identification Test (AUDIT): validation of a screening instrument for use in medical settings
J. Stud. Alcohol
Psychometric properties of the PTSD Checklist for Diagnostic and Statistical Manual of Mental Disorders-Fifth Edition (PCL-5) in veterans
Psychol. Assess.
Psychological distress and alcohol use among fire fighters
Scand. J. Work. Environ. Health
Detailed Assessment of Posttraumatic Stress: DAPS: Professional Manual
Sleep problems, depression, substance use, social bonding, and quality of life in professional firefighters
J. Occup. Environ. Med. Am. Coll. Occup. Environ. Med.
A computerized, self-administered questionnaire to evaluate posttraumatic stress among firefighters after the World Trade Center collapse
Am. J. Public Health
Validation of the Alcohol Use Disorders Identification Test in university students: AUDIT and AUDIT-C
Adicciones
Epidemiology of DSM-5 alcohol use disorder: results from the National Epidemiologic Survey on Alcohol and Related Conditions III
JAMA Psychiatry
Alcohol use among firefighters in the Central United States
Occup. Med
Depression and sensitization to stressors among young women as a function of childhood adversity
J. Consult. Clin. Psychol.
A preliminary investigation of post-traumatic stress symptoms among firefighters
Work Stress
Cited by (13)
An analysis of suicides among first responders ─ Findings from the National Violent Death Reporting System, 2015–2017
2023, Journal of Safety ResearchAn epidemiologic study of suicide among firefighters: Findings from the National Violent Death Reporting System, 2003 - 2017
2021, Psychiatry ResearchCitation Excerpt :Firefighter decedents were also more likely to have served in the Armed Forces compared to non-firefighters. Many firefighters are military veterans, with previous studies in fire service reporting 9% to 23% of the samples having served in the Armed Forces (Bartlett et al., 2018; Stanley et al., 2015, 2019). In fact, many fire departments have hiring preferences for military veterans leading some departments to exclusively enroll military veterans into their fire academy (e.g. Boston Fire Department).
PTSD symptom severity and impulsivity among firefighters: Associations with alcohol use
2019, Psychiatry ResearchCitation Excerpt :Similar patterns of associations were expected. This study is a secondary analysis of data from a larger project examining stress and health-related behaviors among firefighters (e.g., Bartlett et al., 2018a, 2018b; Smith et al., 2018) . The overall sample included 654 firefighters (Mage = 38.65, SD = 8.60) in a large, urban fire department (see Tables 1).
How many prison officers are ex-military personnel? Estimating the proportion of armed forces leavers within the prison workforce of England and Wales
2022, Howard Journal of Crime and JusticeDoes Past Military Experience Impact Fear Reactivity in Active-Duty Firefighters? Well, It Is Complicated
2022, Psychological Trauma: Theory, Research, Practice, and Policy