Posttraumatic Stress and Suicidality Among Firefighters: The Moderating Role of Distress Tolerance

A Relational Model for Stress: A Systematic Review of the Risk and Protective Factors for Stress-Related Diseases in Firefighters

“…In the selected articles, more than traumatic stress or the PTSD diagnosis, the risk and protective factors and symptoms presented by firefighters were the main themes addressed ( Supplementary Table S1 presents a summary of 52 studies on PTSD and stress-related diseases in firefighters). Regarding PTSD rates, deviations were verified-while some studies reported PTSD rates of 26.6% [10] and 31.8% [11] among firefighters, others indicated 13% [12], or even 2.7% [13]. The reasons for a such variation in PTSD prevalence may be related to: the location of data collection, such as when it occurred inside fire departments-due to the lack of homogeneity in samples in relation to the risk faced or, when they are homogeneous, the workplace may inhibit the emotional manifestations [14]; cultural characteristics [15]; or fear of stigma, a common aspect among these professionals [16][17][18][19].…”

“…Most studies began by mentioning the scarcity of research on topics related to traumatic stress in firefighters. The analyzed articles varied in the focus chosen to address the consequences of repeated exposure to critical incidents, ranging from alcohol abuse [26,49] and suicidal ideation and behaviors [10,11,16,35] to the influence of social support and organizational belongingness [41], and post-traumatic growth [36,38]. Regardless of the approach, all studies agreed that professionals who work in crisis and catastrophe scenarios are continually exposed to potentially traumatic events, configuring a high-risk group for the development of stress-related diseases [14,15,25].…”

“…However, the gaps mentioned in most studies remain due to the lack of longitudinal studies comparing firefighter samples, including clinical monitoring, which does not allow the reliability of the prevalence rate of PTSD and other stress-related diseases among firefighters. The reasons for the use of cross-sectional research with self-report questionnaires are usually justified by being preliminary surveys aiming to encourage the discussion and interest of other researchers, advertising the need to replicate the research in larger samples, including control groups and with more appropriate techniques to the specificities intended to be investigated [10,11,13,16,20,35,41,49,54].…”

“…Indeed, several studies have shown that the source and context of the trauma were related to increased PTSD symptoms (p <0.05) [1,12,20,28,46]. Then, the severity and exposure time enter in this model, since trauma load [10,45] and the number of critical incidents [14,25,31] were significantly related to PTSD symptom severity (both p range <0.01 to <0.001). Notably, personality traits such as extraversion (p <0.001) [40], impulsivity (p = 0.003) [21], optimism (p <0.05) [40], self-forgiveness (p <0.001) [18], distress tolerance ( p<0.001) [50], and resiliency (p <0.001) [24,33,55] seem to affect all other variables which influence the perception of stress, thereby affecting the choice of coping strategies.…”

“…In the last few years, an attempt to identify the main risk and protective factors for the development of PTSD and other stress-related diseases in specific populations, such as firefighters, has been observed. The findings in this field indicate that there are some factors for the development of stress-related diseases which may be considered for the general population (type, severity and exposure time to a traumatic event and social support), and others that take greater importance within certain contexts, namely the fear of stigma, the need to meet organizational expectations, the sense of camaraderie, and the occupational conditions [10,15,16]. On the other hand, while societal expectations were cited as relevant in the perception and interpretation the firefighters have of the event [29], the pressure and lack of recognition of their efforts by the population /society were not considered by the identified studies.…”