Differences in psychiatric symptoms and barriers to mental health care between volunteer and career firefighters

Abstract

Firefighters are at increased risk for mental health problems. However, little is known about differences in psychiatric symptoms between volunteer and career firefighters. This study aimed to (1) describe differences in psychiatric symptoms and barriers to mental health care between U.S. firefighters in volunteer-only and career-only departments; and (2) determine if greater self-reported structural barriers to mental health care (e.g., cost, availability of resources) explain the differences in psychiatric symptom levels. Overall, 525 current U.S. firefighters participated. Analyses of covariance and logistic regression analyses were used to evaluate group differences between volunteer (n=204) and career (n=321) firefighters, adjusting for demographic and occupational characteristics. Volunteer firefighters reported significantly elevated levels of depression, posttraumatic stress, and suicidal symptoms compared to career firefighters. Career firefighters reported relatively elevated levels of problematic alcohol use. Volunteer firefighters additionally reported greater structural barriers to mental health care (e.g., cost, availability of resources), and these barriers accounted for the differences in mental health variables between volunteer and career firefighters. Findings suggest that volunteer firefighters report elevated psychiatric symptoms compared to career firefighters and greater structural barriers to mental health treatment may explain this link. Increased efforts are needed to develop firefighter-specific interventions and bolster mental health service utilization.

Exposure to suicide and suicide bereavement among women firefighters: Associated suicidality and psychiatric symptoms

“…Notably, suicide exposure that occurred specifically during participants’ firefighting careers was associated with significantly greater levels of perceived burdensomeness and thwarted belongingness, particularly among volunteer firefighters and not career firefighters. These results suggest a potentially greater impact of career suicide exposure on volunteer firefighters, consistent with previous work indicating that volunteer firefighters may report more severe suicide‐related symptoms than career firefighters (Stanley et al., ).…”

“…It may be useful, in particular, to examine cumulative exposure to suicide. Fifth, we did not collect data regarding whether firefighters received postvention services or other sources of support to cope with suicide loss, which may have impacted our pattern of results—especially because volunteer firefighters may face greater barriers to care than career firefighters (Stanley et al., ). Use of postvention services has been associated with improved mental health outcomes (see Ho et al., , for review); therefore, we recommend that future studies assess support sought following a suicide loss.…”

“…Based on prior research highlighting differences in clinical severity between career and volunteer firefighters (Stanley et al., ), we conducted exploratory moderation analyses to evaluate whether firefighter status moderated the relationship between suicide exposure and psychiatric symptom severity. Additionally, based on theoretical and empirical work suggesting that the vast majority of those who die by suicide may have clinically significant psychiatric symptoms (Joiner, Buchman‐Schmitt, & Chu, ; Joiner, Hom, Hagan, & Silva, ), we conducted exploratory analyses to evaluate whether psychiatric symptoms might account for the relationship between lifetime suicide exposure and SBQ‐R suicide risk.…”

Anxiety sensitivity and suicide risk among firefighters: A test of the depression-distress amplification model

“…Moreover, the department represents firefighters serving predominately in a full-time, paid capacity. This point is important in light of previous research demonstrating that career firefighters report, on average, less severe psychiatric symptoms than volunteer firefighters [64]. This may, in part, explain the relatively lower depression symptoms, AS concerns, and suicide risk scores in this sample compared to previous firefighter investigations; as noted above, this fire department has also proactively provisioned internal suicide prevention efforts [65].…”

Examining Physical and Sexual Abuse Histories as Correlates of Suicide Risk Among Firefighters

“…The Florida State University Institutional Review Board approved this study. Of note, additional articles focused on other psychiatric symptoms clusters have been published using these data (see Chu et al, 2016;Chu et al, 2017;Boffa et al, 2017;Hom et al, 2016;Stanley, Boffa, Hom, Kimbrel, & Joiner, 2017).…”