By Todd LeDuc
The advent of 2018 is a good time to take a look at what we know about firefighter behavioral health from occupational stressors. We as a service have been keenly focusing efforts on occupational risks to our physical health such as cancer and cardiovascular disease. Partners and colleagues from Nova Southeastern University’s College of Psychology have worked to help clarify the science behind we know of occupational behavioral health risk to firefighters and develop resources such as behavioral health awareness training
The past decade has witnessed a significant increase in clinical and research attention directed to the behavioral health concerns among firefighters. The research in this area is providing evidence-based validation demonstrating that firefighters (in general, as an occupation) demonstrate higher levels of various psychological disorders when compared to members of the general population (e.g., “Stress and Coping Strategies Among Firefighters and Recruits,” Chamberlin and Green, 2010; “Mental health conditions, individual and job characteristics and sleep disturbances among firefighters.,” de Barros et al., 2013; “Firefighter suicide: The need to examine cultural change,” Henderson, Van Hasselt, LeDuc, & Couwels, 2016). There are indications that substance abuse in firefighters occurs at extraordinarily high rates (approximately 25-30 percent) (“Psychological distress and alcohol use among fire fighters., Boxer & Wild, 1993). Also, Haddock et al. (Alcohol use among firefighters in the Central United States.,” 2012) reported that firefighters were likely to binge drink and that a substantial number drank on nearly half of the days they were off duty. Sleep disturbances also have been shown to be common in firefighters and have been endorsed as one of their most prominent stressors. In fact, Carey et al. (“Sleep problems, depression, substance use, social bonding, and quality of life in professional firefighters.,” 2011) found that firefighters rated poor sleep as more common than smoking, caffeine use, and drinking. And in a survey of nearly 7,000 firefighters from 66 departments, Barger et al. (“Implementing a Sleep Health Education and Sleep Disorders Screening Program in Fire Departments,” 2015) found that 37 percent of them screened positive for at least one sleep disorder (sleep apnea, insomnia).
More recent research focusing on firefighters has produced alarming findings concerning the problem of post-traumatic stress disorder (PTSD) in firefighters. Numerous studies indicate that about 4-6 percent of the general population report PTSD symptomatology, whereas fire service studies demonstrate the rate of this disorder may be as high as 37% percent in firefighters (Exposure to traumatic incidents and prevalence of posttraumatic stress symptomatology in urban firefighters in two countries., Corneil et al., 1999; “Prevalence of posttraumatic stress disorder symptoms in firefighters,” Del Ben, Scotti, Chen, & Fortson, 2006). Also, sleep disturbances and substance abuse have been shown to be common in firefighters have been shown to be common in firefighters with PTSD (“A preliminary investigation of post-traumatic stress symptoms among firefighters,” Haslam & Mallon, 2003). The problem that has understandably drawn the most attention and concern, however, is that of suicide in firefighters. According to the National Fallen Firefighters Foundation (2014), a fire department is three times more likely within a given year to experience a suicide than a line-of-duty death (“Suicide among North Carolina professional firefighters,” Savia, 2008). Suicide is clearly occurring at a high rate in this population (“A Firefighter’s Silent Killer: Suicide,” Antonellis & Thompson, 2012; Suicide Surveillance, “Prevention, and Intervention Measures for the US Fire Service,” Gist, Taylor, & Raak, 2011; Henderson et al., 2015). This point is underscored by indications that while approximately 2-9 percent of the general adult population have attempted suicide at least once in their lifetime (“Suicide and Suicidal Behavior,” Nock et al. 2008), more than 15 percent of firefighters undertook at least one suicide attempt during their career (“Career prevalence and correlates of suicidal thoughts and behaviors among firefighters.,” Stanley et al., 2015). Further, Stanley et al. (2015) found that about 47 percent of firefighters experienced suicidal ideation during their career and 19 percent had a plan for suicide.
The impact of repeated trauma exposures has been widely implicated in the development and maintenance of trauma-related disorders. Henderson et al. (2016) demonstrated that repeated trauma exposure elevates the risk of firefighters developing stress-related disorders, such as PTSD and suicide potential. Also, PTSD, sleep disturbances, and substance abuse can potentially elevate suicide risk. Moreover, the presence of suicidal risk factors (e.g., increased alcohol or drug use, social withdrawal or isolation, agitated behavior, expressions of hopelessness and helplessness, changes in sleeping patterns, suicidal ideation and prior attempts) and a lack of protective factors (e.g., familial and social support system, sense of purpose, good physical health, goal/future orientation) greatly increase the risk of self-harm.
The problems delineated above have underscored now more than ever the need for programs geared toward the unique behavioral health needs of firefighters. Programs have been implemented to increase awareness of suicide and educate firefighters on suicide and its risk factors. Houston (TX) Fire Department’s Suicide Prevention Program (“Suicide Prevention in Fire Service: The Houston Fire Department (HFD) Model,” Finney et al., 2015) was developed following three active-duty suicides and four retiree suicides between 2001 and 2007. This peer-based suicide prevention team approach included active-duty firefighters who were trained on suicide and mental health issues to provide presentations to fellow firefighters. Their Firefighter Support Network also trained these firefighters to identify, assess, and deal with crisis situations and were available to peers as a resource to seek further professional assistance when needed.
Other groups have employed peer-based programs with the goal of intervening for suicide. Since 2000, police have used the crisis hotline Cop-2-Cop, a peer support-based program for assessment and mental health referrals to practitioners who have experience working with law enforcement. Similarly, the military has created several peer support programs over the last decade to deal with the high suicide rate in their personnel. An example is “Buddy-to-Buddy,” in which peers serve as a support system and encourage help-seeking more successfully than “outsiders.”
Departments adopting peer counseling or support programs aim to recognize early signs and symptoms of suicide risk and assist firefighters in seeking professional help. Peers within a firehouse can observe many of the risk factors for suicide and other mental health problems (e.g., anxiety, depression, substance abuse, etc.). If they ae able to recognize signs of serious problem behavior, a tragedy may be averted. Peer support training is critical to assuring that peers are equipped with the necessary skills and resources to provide an effective safety net for peers who maybe struggling with behavioral health and needing assistance. The National Fallen Firefighters Foundation (NFFF) has recognized the importance of proactive addressing psychological support through its life safety initiative number thirteen. These resources provide numerous tools for departments to utilize in building their tool box for behavioral health support programs and can be accessed at www.everyonegoeshome.com/16-initiatives/
The message is clear for departments large and small: taking a moment to understand the magnitude of fire service occupational risk to mental wellness and reassess the support resources available to your members so that the right pieces are in place to assist.
Todd J. LeDuc, MS, CFO, CEM, FIFirE, is a 27-year veteran of and an assistant chief with Broward County (FL) Fire Rescue, an internally accredited metro fire department. He is also the secretary of the International Association of Fire Chief’s Association Safety, Health & Survival Board. He has a master’s degree in executive fire service leadership, is a peer reviewer for agency accreditation and professional credentialing. He is a credentialed chief officer, a certified emergency manager, and a fellow in the Institute of Fire Engineers. You can reach LeDuc by email at firstname.lastname@example.org.