Posttraumatic Stress Disorder Symptoms and Suicide Risk in Male Firefighters

Abstract

Posttraumatic stress disorder (PTSD) symptoms are positively related to suicide risk among firefighters. One mechanism that may account for this relationship is anxiety sensitivity (AS) cognitive concerns-the fear that cognitive symptoms of anxiety will have catastrophic consequences. We sought to replicate the mediating effect of AS cognitive concerns on the relationship between PTSD symptoms and suicide risk among 214 trauma-exposed male firefighters with non-zero suicide risk. Bootstrap mediation analyses tested AS cognitive concerns as a statistical mediator of PTSD symptoms (total and symptoms clusters scores) and suicide risk, controlling for depression symptoms and relevant demographic variables. AS cognitive concerns statistically mediated the relationship between PTSD symptoms (total score, as well as intrusion, avoidance, and arousal-reactivity symptoms clusters) and suicide risk; however, the reverse was also true. AS cognitive concerns may confer risk for suicide among trauma-exposed firefighters. Firefighters may benefit from AS-specific interventions, which are shown to reduce PTSD symptoms and suicidality.

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

“…AS cognitive concerns are characterized by perceptions that anxiety-related sensations have catastrophic psychological outcomes, such as “going crazy.” Recently, Stanley et al [17] found that AS—specifically, AS cognitive concerns—mediated the relationship between posttraumatic stress disorder symptoms (PTSD) symptoms (cf. anxiety-related sensations) and suicide risk among a sample of female firefighters; this finding was replicated in a sample of male firefighters [18]. In sum, AS cognitive concerns are implicated in increased suicide risk in the context of other psychiatric symptoms, and this effect is also relevant to conceptualizing suicide risk among firefighters.…”

A Relational Model for Stress: A Systematic Review of the Risk and Protective Factors for 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]. In addition to presenting evidence for the prevalence of PTSD, the symptoms recurrently mentioned by studies were depression (N = 16), alcohol abuse (N = 11), suicidal ideation or behaviors (N = 10) and avoidance (N = 6).…”

“…Through this analysis, we identified the main risk and protective factors for the development of PTSD and other stress-related diseases in firefighters as being the perception of stress, social and organizational support, training and experience, usually associated with being a volunteer or professional firefighter, and the choice of coping strategies. These factors influence each other, offering evidence that stress-related diseases are the result of a set of failures that may occur before, during and after potentially traumatic events [12,14,16,27,[29][30][31][32].…”

“…Most analyzed studies began by stating that professionals who work in crisis and catastrophe scenarios are recurrently exposed to traumatic events and have a great risk of developing stress-related diseases [13,[15][16][17]26,46]. However, some studies presented low rates of PTSD in firefighters, giving cultural issues and the fear of stigma as the reasons for these results [14][15][16]. In addition, training and organizational support were indicated as the most relevant factors when comparing results between professional and volunteer firefighters.…”

“…The maladaptive strategies aim to avoid engagement with the traumatic event, increasing the symptomatic chart [20,40,45,51]. Subsequently, they may contribute to the belief that the symptoms are dangerous and should be avoided by establishing a negative feedback cycle [16]. Avoidance behaviors were mentioned as increasing the frequency and intensity of traumatic memories, thus resulting in an escalation of distress, which could lead to the application of more avoidance strategies.…”