Rescuers at Risk: Posttraumatic Stress Symptoms Among Police Officers, Fire Fighters, Ambulance Personnel, and Emergency and Psychiatric Nurses

Leila M Soravia, Simon Schwab, Sebastian Walther, Thomas Müller, Leila M Soravia, Simon Schwab, Sebastian Walther, Thomas Müller

Abstract

Emergency personnel and rescue workers may be at a risk of posttraumatic stress symptoms (PTSS) due to exposure to trauma and work-related stressors. Though rescuers of different professions are often engaged in the same type of emergency, they have different tasks and responsibilities and receive different training in coping with traumatic events and stress; hence, we speculated that the salience of identified risk factors for PTSS vary across their respective professions. The present cross-sectional survey aimed to identify influencing variables on PTSS, well-being, and suicidal ideation that can act differently across professions of rescue workers and emergency personnel. In this anonymous online study, data from 1,002 rescue workers and emergency personnel in Switzerland, were collected: 499 police officers, 239 firefighters, 97 ambulance personnel, and 85 emergency and 82 psychiatric nurses. PTSS, coping strategies, well-being, suicidal ideation, previously experienced and work-related trauma, and self-efficacy were measured and analyzed using multiple regression and structural equation modeling (SEM). The prevalence of suspected posttraumatic stress disorder varied across the professions, ranged from 8% (firefighters) to 22% (psychiatric nurses), and was associated with psychological strain and suicidal ideation. The SEM showed that dysfunctional coping strategies, self-efficacy, previously experienced and work-related trauma, years on job, and female sex explained up to 78% of PTSS and that PTSS itself explained up to 68% of the psychological strain experienced in the different professions. Independent of the profession, dysfunctional coping such as alcohol use, avoidance, and distraction, as well as work-related trauma were the most robust predictors of PTSS. However, while self-efficacy was a risk factor for police officers, firefighters and ambulance personnel, it was a protective factor for emergency and psychiatric nurses. Furthermore, female sex was only a risk factor for ambulance personnel and emergency nurses. In agreement with prior research, emergency personnel and rescuers exhibited enhanced prevalence of PTSS and suspected PTSD, leading to significant psychological strain and suicidal ideation. However, risk factors varied across the professions. Thus, the development of profession-specific trainings to improve self-efficacy and coping with work-related stressors to reduce PTSS, and enhance quality of life, is needed for individuals in such high-risk professions. Clinical Trial Registration: ClinicalTrials.gov Nr. NCT03842553.

Keywords: PTSD; coping; rescue workers; risk factors; well-being.

Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Copyright © 2021 Soravia, Schwab, Walther and Müller.

Figures

Figure 1
Figure 1
Stressful job-related circumstances, such as dealing with situations involving people (aggressive and violent people, dealing with deaths or suicide, threats, dealing with relatives, involvement of children) and job-related conditions (incorrect or wrong information about the emergency situation, shift work, time pressure) are rated regarding experienced stress levels (never = never experienced; little = no or little stress; strong = strong or very strong stress).
Figure 2
Figure 2
Structural equational modeling: variables associated with PTSS and psychological strain. PTSS, Posttraumatic Symptom Scale; BSI GSI, Brief Symptom Inventory, Subscale Global Severity Index; BSI PST, Brief Symptom Inventory, Subscale Positive Symptom Total; GHQ, General Health Questionnaire 12, subscales psychological and physiological well-being.

References

    1. Berger W, Coutinho ESF, Figueira I, Marques-Portella C, Luz MP, Neylan TC, et al. . Rescuers at risk: a systematic review and meta-regression analysis of the worldwide current prevalence and correlates of PTSD in rescue workers. Soc Psychiatry Psychiatr Epidemiol. (2012) 47:1001–11. 10.1007/s00127-011-0408-2
    1. Neuner F, Schauer M, Karunakara U, Klaschik C, Robert C, Elbert T. Psychological trauma and evidence for enhanced vulnerability for posttraumatic stress disorder through previous trauma among West Nile refugees. BMC Psychiatry. (2004) 4:34. 10.1186/1471-244X-4-34
    1. Streb M, Häller P, Michael T. PTSD in paramedics: resilience and sense of coherence. Behav Cognit Psychotherapy. (2014) 42:452–63. 10.1017/S1352465813000337
    1. Morren M, Yzermans CJ, Van Nispen RM, Wevers SJ. The health of volunteer firefighters three years after a technological disaster. J Occup Health. (2005) 47:523–32. 10.1539/joh.47.523
    1. Stewart SH, Mitchell TL, Wright KD, Loba P. The relations of PTSD symptoms to alcohol use and coping drinking in volunteers who responded to the Swissair Flight 111 airline disaster. J Anxiety Disord. (2004) 18:51–68. 10.1016/j.janxdis.2003.07.006
    1. Marmar CR, Weiss DS, Metzler TJ, Ronfeldt HM, Foreman C. Stress responses of emergency services personnel to the Loma Prieta earthquake Interstate 880 freeway collapse and control traumatic incidents. J Trauma Stress. (1996) 9:63–85. 10.1002/jts.2490090107
    1. Laposa JM, Alden LE. Posttraumatic stress disorder in the emergency room: exploration of a cognitive model. Behav Res Ther. (2003) 41:49–65. 10.1016/S0005-7967(01)00123-1
    1. Brewin CR, Andrews B, Valentine JD. Meta-analysis of risk factors for posttraumatic stress disorder in trauma-exposed adults. J Consult Clin Psychol. (2000) 68:748. 10.1037/0022-006X.68.5.748
    1. Brown SP, Westbrook RA, Challagalla G. Good cope, bad cope: adaptive and maladaptive coping strategies following a critical negative work event. J Appl Psychol. (2005) 90:792. 10.1037/0021-9010.90.4.792
    1. Stratta P, Capanna C, Dell'Osso L, Carmassi C, Patriarca S, Di Emidio G, et al. Resilience and coping in trauma spectrum symptoms prediction: a structural equation modeling approach. Pers Individ Dif . (2015) 77:55–61. 10.1016/j.paid.2014.12.035
    1. Wittmann L, Moergeli H, Martin-Soelch C, Znoj H, Schnyder U. Comorbidity in posttraumatic stress disorder: a structural equation modelling approach. Compr Psychiatry. (2008) 49:430–40. 10.1016/j.comppsych.2008.02.004
    1. Martin-Soelch C, Schnyder U. Resilience and vulnerability factors in response to stress. Front Psychiatry. (2019) 10:732. 10.3389/fpsyt.2019.00732
    1. Folkman S, Moskowitz JT. Coping: pitfalls and promise. Annu Rev Psychol. (2004) 55:745–74. 10.1146/annurev.psych.55.090902.141456
    1. Freeman D, Fowler D. Routes to psychotic symptoms: trauma, anxiety and psychosis-like experiences. Psychiatry Res. (2009) 169:107–12. 10.1016/j.psychres.2008.07.009
    1. Lazarus RS. From psychological stress to the emotions: a history of changing outlooks. Annu Rev Psychol. (1993) 44:1–21. 10.1146/annurev.ps.44.020193.000245
    1. Wagner D, Heinrichs M, Ehlert U. Prevalence of symptoms of posttraumatic stress disorder in German professional firefighters. Am J Psychiatry. (1998) 155:1727–32. 10.1176/ajp.155.12.1727
    1. Benotsch EG, Brailey K, Vasterling JJ, Uddo M, Constans JI, Sutker PB. War zone stress, personal and environmental resources, and PTSD symptoms in Gulf War Veterans: a longitudinal perspective. J Abnorm Psychol. (2000) 109:205. 10.1037/0021-843X.109.2.205
    1. Maguen S, Lucenko BA, Reger MA, Gahm GA, Litz BT, Seal KH, et al. . The impact of reported direct and indirect killing on mental health symptoms in Iraq war veterans. J Trauma Stress. (2010) 23:86–90. 10.1002/jts.20434
    1. North CS, Tivis L, McMillen JC, Pfefferbaum B, Spitznagel EL, Cox J, et al. . Psychiatric disorders in rescue workers after the Oklahoma City bombing. Am J Psychiatry. (2002) 159:857–9. 10.1176/appi.ajp.159.5.857
    1. Orcutt HK, Erickson DJ, Wolfe J. The course of PTSD symptoms among Gulf War veterans: a growth mixture modeling approach. J Trauma Stress. (2004) 17:195–202. 10.1023/B:JOTS.0000029262.42865.c2
    1. Perrin MA, DiGrande L, Wheeler K, Thorpe L, Farfel M, Brackbill R. Differences in PTSD prevalence and associated risk factors among World Trade Center disaster rescue and recovery workers. Am J Psychiatry. (2007) 164:1385–94. 10.1176/appi.ajp.2007.06101645
    1. Schwarzer R, Jerusalem M. Skalen zur Erfassung von Lehrer- und Schülermerkmalen: Dokumentation der psychometrischen Verfahren im Rahmen der Wissenschaftlichen Begleitung des Modellversuchs Selbstwirksame Schulen. Berlin: Freie Universität Berlin; (1999).
    1. Bandura A. Self-efficacy: toward a unifying theory of behavioral change. Psychol Rev. (1977) 84:191–215. 10.1037/0033-295X.84.2.191
    1. Coolidge FL, Segal DL, Hook JN, Stewart S. Personality disorders and coping among anxious older adults. J Anxiety Disord. (2000) 14:157–72. 10.1016/S0887-6185(99)00046-8
    1. Maercker A. Posttraumatische-Stress-Skala-10 (PTSS-10). Angstdiagnostik–Grundlagen und Testverfahren. Berlin; Heidelberg: Springer; (2003). p. 401–3.
    1. Weisaeth L. Torture of a Norwegians ship's crew: the torture, stress reactions and psychiatric aftereffects. Acta Psychiatr Scand. (1989) 80:63–72. 10.1111/j.1600-0447.1989.tb05255.x
    1. Aardal-Eriksson E, Eriksson TE, Holm A-C, Lundin T. Salivary cortisol and serum prolactin in relation to stress rating scales in a group of rescue workers. Biol Psychiatry. (1999) 46:850–5. 10.1016/S0006-3223(98)00381-3
    1. Holen A, Sund A, Weisaeth L. The Alexander Kielland Disaster March 27th 1980: Psychological Reactions Among the Survivors. Oslo: Division of Disaster Psychiatri, University of Oslo; (1983).
    1. Stoll C, Kapfhammer H, Rothenhäusler H, Haller M, Briegel J, Schmidt M, et al. . Sensitivity and specificity of a screening test to document traumatic experiences and to diagnose post-traumatic stress disorder in ARDS patients after intensive care treatment. Intensive Care Med. (1999) 25:697–704. 10.1007/s001340050932
    1. Goldberg D. General Health Questionnaire (GHQ-12). Windsor, UK: Nfer-Nelson; (1992).
    1. Schrnitz N, Kruse J, Tress W. Psychometric properties of the General Health Questionnaire (GHQ-12) in a German primary care sample. Acta Psychiatr Scand. (1999) 100:462–8. 10.1111/j.1600-0447.1999.tb10898.x
    1. Laposa JM, Alden LE, Fullerton LM. Work stress and posttraumatic stress disorder in ED nurses/personnel (CE). J Emerg Nurs. (2003) 29:23–8. 10.1067/men.2003.7
    1. Team RC. R: A Language and Environment for Statistical Computing. (2018). Available online at:
    1. Rosseel Y. Lavaan: an R package for structural equation modeling and more. Version 0.5–12 (BETA). J Stat Software. (2012) 48:1–36. 10.18637/jss.v048.i02
    1. Von Elm E, Altman DG, Egger M, Pocock SJ, Gøtzsche PC, Vandenbroucke JP. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. Ann Int Med. (2007) 147:573–7. 10.7326/0003-4819-147-8-200710160-00010
    1. Mealer ML, Shelton A, Berg B, Rothbaum B, Moss M. Increased prevalence of post-traumatic stress disorder symptoms in critical care nurses. Am J Respir Crit Care Med. (2007) 175:693–7. 10.1164/rccm.200606-735OC
    1. Berger W, Figueira I, Maurat AM, Bucassio EP, Vieira I, Jardim SR, et al. . Partial and full PTSD in Brazilian ambulance workers: prevalence and impact on health and on quality of life. J Trauma Stress. (2007) 20:637–42. 10.1002/jts.20242
    1. Jacobowitz W. PTSD in psychiatric nurses and other mental health providers: a review of the literature. Issues Ment Health Nurs. (2013) 34:787–95. 10.3109/01612840.2013.824053
    1. Takahashi C, Chida F, Nakamura H, Akasaka H, Yagi J, Koeda A, et al. . The impact of inpatient suicide on psychiatric nurses and their need for support. BMC Psychiatry. (2011) 11:38. 10.1186/1471-244X-11-38
    1. Vlahov D, Galea S, Resnick H, Ahern J, Boscarino JA, Bucuvalas M, et al. . Increased use of cigarettes, alcohol, and marijuana among Manhattan, New York, residents after the September 11th terrorist attacks. Am J Epidemiol. (2002) 155:988–96. 10.1093/aje/155.11.988
    1. Pfefferbaum B, Doughty DE. Increased alcohol use in a treatment sample of Oklahoma City bombing victims. Psychiatry. (2001) 64:296–303. 10.1521/psyc.64.4.296.18598
    1. Conrod PJ, Stewart SH. Experimental studies exploring functional relations between posttraumatic stress disorder and substance use disorder. Trauma Subst Abuse. (2003):57–71. 10.1037/10460-003
    1. Stewart SH. Alcohol abuse in individuals exposed to trauma: a critical review. Psychol Bull. (1996) 120:83. 10.1037/0033-2909.120.1.83
    1. Benight CC, Bandura A. Social cognitive theory of posttraumatic recovery: the role of perceived self-efficacy. Behav Res Ther. (2004) 42:1129–48. 10.1016/j.brat.2003.08.008
    1. Benight CC, Cieslak R, Molton IR, Johnson LE. Self-evaluative appraisals of coping capability and posttraumatic distress following motor vehicle accidents. J Consult Clin Psychol. (2008) 76:677. 10.1037/0022-006X.76.4.677
    1. Benight CC, Harper ML. Coping self-efficacy perceptions as a mediator between acute stress response and long-term distress following natural disasters. J Trauma Stress. (2002) 15:177–86. 10.1023/A:1015295025950
    1. Heinrichs M, Wagner D, Schoch W, Soravia LM, Hellhammer DH, Ehlert U. Predicting posttraumatic stress symptoms from pretraumatic risk factors: a 2-year prospective follow-up study in firefighters. Am J Psychiatry. (2005) 162:2276–86. 10.1176/appi.ajp.162.12.2276
    1. Chung MC, Allen RD, Dennis I. The impact of self-efficacy, alexithymia and multiple traumas on posttraumatic stress disorder and psychiatric co-morbidity following epileptic seizures: a moderated mediation analysis. Psychiatry Res. (2013) 210:1033–41. 10.1016/j.psychres.2013.07.041
    1. Connor KM, Davidson JR. Development of a new resilience scale: the Connor-Davidson resilience scale (CD-RISC). Depress Anxiety. (2003) 18:76–82. 10.1002/da.10113
    1. Martin-Soelch C, Schnyder U. Resilience and Vulnerability. (2020).
    1. Swanson JW, McGinty EE, Fazel S, Mays VM. Mental illness and reduction of gun violence and suicide: bringing epidemiologic research to policy. Ann Epidemiol. (2015) 25:366–76. 10.1016/j.annepidem.2014.03.004
    1. Weinberger SE, Hoyt DB, Lawrence HC, Levin S, Henley DE, Alden ER, et al. Firearm-related injury and death in the United States: a call to action from 8 health professional organizations and the American Bar Association. Ann Int Med. (2015) 162:513–6. 10.7326/M15-0337
    1. Metzl JM, MacLeish KT. Mental illness, mass shootings, and the politics of American firearms. Am J Public Health. (2015) 105:240–9. 10.2105/AJPH.2014.302242
    1. Brent DA, Perper JA, Allman CJ, Moritz GM, Wartella ME, Zelenak JP. The presence and accessibility of firearms in the homes of adolescent suicides: a case-control study. JAMA. (1991) 266:2989–95. 10.1001/jama.266.21.2989

Source: PubMed

Sponzoři a spolupracovníci

Zdravotní podmínky

Drogové intervence

3
Předplatit