Predictors of Suicide and Differences in Attachment Styles and Resilience Among Treatment-Seeking First-Responder Subtypes

Abstract

Objective: To identify the predictors of suicide for firefighters (FFs), emergency medical technicians (EMTs), and law enforcement officers (LEOs). Methods: We used baseline data from FFs/EMTs (n = 69) and LEOs (n = 81) to investigate the unique predictors for both first-responder subtypes. We conducted confirmatory factor analysis on validated assessments of posttraumatic stress disorder (PTSD) and depression. Measures of attachment, resilience, PTSD, depression, generalized anxiety, trauma history, and substance use were the independent variables in two backward stepwise regressions predicting suicide. Results: Substance use and somatic depression were significant predictors for LEOs, whereas affective depression, anhedonia, externalizing behaviors, trauma history, and generalized anxiety were significant predictors for FFs/EMTs. Limitations: These data are cross-sectional and should be modeled longitudinally over the course of treatment. Conclusion: Separate constructs influence suicide for LEOs and FFs/EMTs.

Validation of the PCL-5, PHQ-9, and GAD-7 in a Sample of First Responders

“…Among treatment-seeking FRs, 25.3% were categorized as secure, 19% dismissive, 25.3% preoccupied, and 30.4% as fearful (Schuman et al, unpulished data, 2022b). Comparing LEOs and FFs/EMTs, LEOs were 233% times more likely to be securely attached 58 . Also, LEOs were 62% more likely to not be classified as preoccupied compared with FFs/EMTs 58 .…”

“…58 Also, LEOs were 62% more likely to not be classified as preoccupied compared with FFs/EMTs. 58 In a sample of treatment-seeking veterans, 84 researchers found that attachment avoidance and attachment anxiety might be working as a reciprocal feedback loop between PTSD and suicidality as others have hypothesized. 85 Of FRs at baseline (before the assignment of a treating clinician), when categorizing attachment in its nominal classifications, FRs with secure attachment had the lowest PTSD, suicidality, depression, and generalized anxiety scores but also had the highest resilience scores compared with dismissive, preoccupied, and fearfully attached participants.…”

“…Clinically, focusing on generalized anxiety reduction might be beneficial to the overall symptom constellation and treatment outcome. At baseline, the GAD-7 significantly predicted a decrease in suicidality among FFs/EMTs 58 . Similarly, generalized anxiety could be conceptualized as a general nervousness about seeking mental health treatment 58 …”

“…At baseline, the GAD-7 significantly predicted a decrease in suicidality among FFs/EMTs 58 . Similarly, generalized anxiety could be conceptualized as a general nervousness about seeking mental health treatment 58 …”

“…58 Similarly, generalized anxiety could be conceptualized as a general nervousness about seeking mental health treatment. 58…”