Behavioral Health Conditions in Firefighters

The nature of the work of firefighters, including repeated exposure to painful and provocative experiences and erratic sleep schedules, can pose significant risk to firefighters' mental health.¹ To add to that risk, firefighters face many barriers to seeking help, including stigma and the cost of treatment. According to one study, for instance, volunteer firefighters have greater structural barriers to the use of mental health services (including cost, inadequate transportation, difficulty getting time off from work, and availability of resources) than career firefighters and the general population.¹

Depression

As with emergency medical service (EMS) professionals, depression is commonly reported in firefighters, and studies have found various rates and severity of depression. One study found that volunteer firefighters reported markedly elevated levels of depression as compared to career firefighters (with an odds ratio for volunteer firefighters of 16.85 and for career firefighters of 13.06).¹ The researchers observed that greater structural barriers to mental health care (such as cost and availability of resources) may explain the increased levels of depression observed among volunteer firefighters. Additionally, competing demands for volunteer firefighters (having a separate job) create stress vulnerabilities that contribute to the development or exacerbation of behavioral health conditions. Organizational factors (such as more systematic and stringent recruitment and screening within career departments relative to volunteer departments) may contribute to the difference in the levels of behavioral health symptoms.¹ In another study, 22.2 percent of female career firefighters were at risk of depression, while 38.5 percent of the female volunteer firefighters were at risk of depression.² This could be attributed to the social pressures associated with working in a male-dominated profession.³ Additionally, although women firefighters reported similar job stressors to men, they also reported experiencing significantly more occupational discrimination than their male peers.

Stress and Post-Traumatic Stress Disorder/Symptoms

Stress and post-traumatic stress symptoms have been reported in a number of studies. For instance, according to a literature review, over 50 percent of firefighter deaths are due to stress and exhaustion.⁴ Most of the firefighters in the United States (U.S.) are volunteers (about 69 percent). A study investigating the suicidality of firefighters, while being flawed because it was a sample of convenience and therefore potentially attracted individuals who had more often been suicidal, has reported markedly elevated levels of post-traumatic stress in volunteer firefighters, while career firefighters reported higher levels of post-traumatic stress disorder (PTSD).¹

Substance Use

Career firefighters reported higher levels of problematic alcohol use and PTSD as compared to the volunteer firefighters, while the volunteers reported higher levels of depression and suicide attempts and ideations.¹ Recent (past month) heavy or binge alcohol drinking was reported in approximately 50 percent of male firefighters, and driving while intoxicated was reported in 9 percent of male firefighters.² Female firefighters account for 5.1 percent of the total number of firefighters.³ In a study evaluating the health of this population, 83.3 percent of the professional female firefighters had tried smoking, and 22.2 percent were current smokers in comparison to 17.9 percent of women in the general population.³ Additionally, 88.9 percent of them had drunk alcohol in the past month. Nearly 54 percent of the volunteer female firefighters had tried smoking, and 15.4 percent were current smokers.³ In another study targeting female firefighters, more than 60.5 percent drank more than what is recommended by the 2015–2020 Dietary Guidelines for Americans, binge drinking was reported in 39.5 percent in this population as compared to 12–15 percent of the females in the general population, and 4.3 percent reported driving while intoxicated.²

Suicide/Suicide Ideation

Suicidal ideation has been reported in firefighters at higher rates than in the general population—but, as noted, research in this area has often used convenience samples and may not be entirely reliable and valid. Currently available studies do suggest that firefighters may be more likely to think about and attempt suicide than people in the U.S. as a whole. In a convenience sample study related to suicide attempts and ideations, firefighters were reported to have higher attempt and ideation rates than the general population.⁵ In 1,027 current and retired U.S. firefighters, the prevalence estimates of suicidal ideation, plans, and attempts were 46.8 percent, 19.2 percent, and 15.5 percent, respectively, as compared to the lifetime rates of ideations, plans, and attempts of 13.5 percent, 3.9 percent, and 4.6 percent among the general U.S. population.⁶ In a national sample of firefighters, current post-traumatic stress symptoms were found to be associated with 5.2 percent higher odds of attempting suicide during their firefighting careers.⁷

References

1. Stanley, I.H., Boffa, J.W., Hom, M.A., Kimbrel, N.A., & Joiner, T.E. (2017). Differences in psychiatric symptoms and barriers to mental health care between volunteer and career firefighters. Psychiatry Research, 247, 236–242. doi: 10.1016/j.psychres.2016.11.037
2. Haddock, C.K., Poston, W.S.C., Jahnke, S.A., & Jitnarin, N. (2017). Alcohol use and problem drinking among women firefighters. Women's Health Issues, 27(6), 632–638. doi: 10.1016/j.whi.2017.07.003
3. Jahnke, S.A., Poston, W.S., Haddock, C.K., Jitnarin, N., Hyder, M.L., & Horvath, C. (2012). The health of women in the U.S. fire service. BMC Women's Health, 12, 39. doi: 10.1186/1472-6874-12-39
4. Dowdall-Thomae, C., Gilkey, J., Larson, W., & Arend-Hicks, R. (2012). Elite firefighter/first responder mindsets and outcome coping efficacy. International Journal of Emergency Mental Health and Human Resilience, 14(4), 269–281.
5. Stanley, I.H., Hom, M.A., & Joiner, T.E. (2016). A systematic review of suicidal thoughts and behaviors among police officers, firefighters, EMTs, and paramedics. Clinical Psychology Review, 44, 25–44. doi: 10.1016/j.cpr.2015.12.002
6. Stanley, I.H., Hom, M.A., Hagan, C.R., & Joiner, T.E. (2015). Career prevalence and correlates of suicidal thoughts and behaviors among firefighters. Journal of Affective Disorders, 187, 163–171. doi: 10.1016/j.jad.2015.08.007
7. Boffa, J.W., Stanley, I.H., Hom, M.A., Norr, A.M., Joiner, T.E., & Schmidt, N.B. (2017). PTSD symptoms and suicidal thoughts and behaviors among firefighters. Journal of Psychiatric Research, 84, 277–283. doi: 10.1016/j.jpsychires.2016.10.014