Risk and Protective Factors for Behavioral Health in First Responders

Many studies have assessed the risk and protective factors for behavioral health issues among first responders. In general, these factors can be categorized based on the time relative to the disaster—before, during, or after the event occurs.

Pre-Disaster/Event Risk and Protective Factors

One study suggested that collateral behavioral-health damage in first responders may be attributed to being unfit mentally or physically prior to a disaster to perform relief work, as well as inadequate training, unrealistic expectations from leadership, and arbitrary decisions or shows of favoritism.¹ Another team of investigators found that life events, including personal trauma and loss prior to the disaster, were associated with an increased risk of post-disaster mental health issues.²

Among protective factors, according to one literature review, are occupational factors, such as longer duration of employment, which acted as protective against post-traumatic stress disorder (PTSD) and burnout, whereas lower job satisfaction was associated with higher risk.² Specialized training, elevated level of professional mastery, and assurance in personal and team capabilities acted as protective factors and were associated with reduced stress.^2,3

Resilience, or "the ability to successfully adapt to stressors, maintaining psychological wellbeing in the face of adversity" acts as a protective factor against many mental and behavioral health issues.⁴ In a cohort of police officers followed after Hurricane Katrina, resilience, satisfaction with life, and gratitude helped mitigate symptoms of PTSD.⁵ In a study about emergency service retirees, those who reported higher levels of resilience had better quality-of-life scores than those with low resilience.⁶ Some people have higher resilience, but others can be trained to increase their resiliency and hence improve their odds for better quality of life, as well as reducing their risk for developing conditions, such as PTSD or depression.⁷

Risk and Protective Factors During the Disaster/Event

Risk factors during the event for first responders include exposure to the disaster or event itself. For instance, in a literature review reporting on factors determining psychological outcomes (including stress, wellbeing, mental disorders, resilience, and personal growth) in humanitarian-aid workers or similar professionals deployed to help with the aftermath of a disaster, the proximity to the epicenter of the disaster was associated with higher levels of mental health issues.² One study found that heavy disaster exposure following Hurricane Katrina was associated with hazardous alcohol consumption in police officers.⁸ Another study found that long work hours in unfamiliar or demanding circumstances and not taking a day off each week led to fatigue, mental distress, job dissatisfaction, and subjective health complaints.² Dealing with serious injuries or bodies of the dead resulted in the higher probability of developing PTSD, depression, alcohol problems, anxiety, stress, and fatigue symptoms.²

Time on-site was also associated with the development of mental health problems, and first responders who stayed longer at the scene reported higher levels of mental health issues, as did early arrivals (both reporting higher levels of PTSD and depression).² Identification with survivors was associated with higher levels of obsessive–compulsive symptoms and PTSD, and becoming emotionally involved resulted in secondary or vicarious victimization, or having symptoms similar to survivors because of the indirect traumatic exposure through close interaction with them.^2,3

Job duties or qualities during the disaster or event were associated with an elevated risk of mental health issues. Not having enough job-related information; adding extra, unfamiliar, or conflicting duties or too many people to supervise; direct survivor or family contacts; longer assignments; longer time working with children; working with clients who discussed morbid materials; excessive exposure to gory sights and sounds and environmental hazards; and working as mental health workers were all associated with increased levels of stress.^1,2 Poor leadership and lack of interagency agreement were additional stressors during the disaster period.²

Low perceived safety was associated with increased levels of depression, anxiety, and other psychiatric symptoms.² In addition, being harmed, being seriously injured, or having a severe trauma was associated with an increase of as much as 25.6 times the probability of developing PTSD relative to those who had no similar experiences.²

Among protective factors during a disaster for first responders, social support appears to be important, particularly organizational support, in terms of good relationships with leaders and coworkers. Supportive, approachable leaders and camaraderie among responders helped with the first responders' psychological wellbeing. Social support was associated with the reduced risk of behavioral health problems, while poor relationships with coworkers and dissatisfaction with supervisors predicted PTSD.^2,3

Post-Disaster/Event Risk and Protective Factors

Having one's personal life affected by a disaster was associated with higher levels of mental health issues in first responders, and post-disaster life events (such as a divorce or the breakup of a relationship) were associated with distress, depression, and PTSD.^2,9 Watching television for more than four hours per day one month after the disaster was predictive of PTSD symptoms and emotional distress in rescue workers. Additionally, volunteer firefighters with chronic PTSD were significantly more distressed by television reminders of the disaster.^2,3 Publicity and media coverage of the disaster can be a trigger of disaster recall, and criticism from the media is often taken personally by responders.³

Neurotic personality and avoidance coping, or the deliberate avoidance of traumatic thoughts, was associated with greater psychological stress and PTSD.^2,9 Also, not receiving acknowledgement or thanks as a disaster-relief worker was associated with mental health problems.¹

A review study found that professional mental-health help (such as critical incident stress debriefing, or CISD, and/or psychological counseling) was helpful to disaster responders in the immediate phase following an incident.² However, in a study with firefighters, while some reported positive experiences with CISD, others found the intervention intrusive and reported feeling more distressed after it. They reported experiencing benefits from peer support and using the crew for bonding after negative incidents.¹⁰

References

1. Mitchell, J.T. (2011). Collateral damage in disaster workers. International Journal of Emergency Mental Health and Human Resilience, 13(2), 121–125.
2. Brooks, S.K., Dunn, R., Amlot, R., Greenberg, N., & Rubin, G.J. (2016). Social and occupational factors associated with psychological distress and disorder among disaster responders: A systematic review. BioMed Central (BMC) Psychology, 4, 18. doi: 10.1186/s40359-016-0120-9
3. Brooks, S.K., Dunn, R., Sage, C.A., Amlot, R., Greenberg, N., & Rubin, G.J. (2015). Risk and resilience factors affecting the psychological wellbeing of individuals deployed in humanitarian relief roles after a disaster. Journal of Mental Health, 24(6), 385–413. doi: 10.3109/09638237.2015.1057334
4. Haglund, M.E.M., Nestadt, P.S., Cooper, N.S., Southwick, S.M., & Charney, D.S. (2007). Psychobiological mechanisms of resilience: Relevance to prevention and treatment of stress-related psychopathology. Developmental Psychopathology, 19(3), 889–920.
5. McCanlies, E.C., Mnatsakanova, A., Andrew, M.E., Burchfiel, C.M., & Violanti, J.M. (2014). Positive psychological factors are associated with lower PTSD symptoms among police officers: Post Hurricane Katrina. Stress & Health, 30(5), 405–415. doi: 10.1002/smi.2615
6. Bracken-Scally, M., McGilloway, S., Gallagher, S., & Mitchell, J.T. (2014). Life after the emergency services: An exploratory study of well being and quality of life in emergency service retirees. International Journal of Emergency Mental Health, 16(1), 223–231.
7. Hesketh, I., Cooper, C.L., & Ivy, J. (2015). Well-being, austerity and policing: Is it worth investing in resilience training? The Police Journal, 88(3), 220–230.
8. Heavey, S., Homish, G.G., Andrew, M.E., McCanlies, E., Mnatsakanova, A., Violanti, J.M., & Burchfiel, C.M. (2015, March). Law enforcement officers' involvement level in Hurricane Katrina and alcohol use. International Journal of Emergency Mental Health, 17(1), 267–273.
9. Garbern, S.C., Ebbeling, L.G., & Bartels, S.A. (2016). A systematic review of health outcomes among disaster and humanitarian responders. Prehospital and Disaster Medicine, 31(6), 635–642. doi: 10.1017/s1049023x16000832
10. Jahnke, S.A., Gist, R., Poston, W.S.C., & Haddock, C.K. (2014). Behavioral health interventions in the fire service: Stories from the firehouse. Journal of Workplace Behavioral Health, 29(2), 113–126.