Survey most Americans about what they think the biggest mental health concern faced by firefighters is, and they almost always respond with post traumatic stress disorder (PTSD). They’re not wrong. The U.S. Fire Administration reports that approximately 20% of firefighters meet the criteria for PTSD at some point during their career, compared to a 6.8% lifetime risk for the general U.S. population. Meanwhile, one study on PTSD among veterans, military, and firefighters found that the prevalence of PTSD was 57% for firefighters, compared to just under 38% for military personnel. In either case, it comes as no surprise when one considers what firefighters are exposed to. In addition to their primary role in managing municipal fires and wildfires which are wrought with traumatic experiences, they are often first among first responders to arrive on the scene of horrific accidents and incidents.
It is logical for fire departments and personnel to be mindful of PTSD symptoms and to seek treatment accordingly. However, it’s critical for all involved to recognize that these American heroes must be made aware of, assessed for, and have access to counseling and therapy for mental and behavioral health issues that cooccur with occupational PTSD. Read ahead to learn more.
Why Mental and Behavioral Health Support Strategies for Firefighters Must Consider More than PTSD
I. Cooccurring Anxiety and Depression
Anxiety and stress along with mild to moderate depression are all comorbid with firefighter PTSD. A systematic review found that the mean prevalence of depression in firefighters is just under 19%, compared to about 5% for the general population. Anxiety rates are on-par with that of the general population at around 20%, although studies have found that when firefighters are exposed to particularly disastrous events they may exhibit significant lifts in scores for anxiety. For instance, in the Fort McMurray, Alberta, Canada wildfire of 2016 (which U.S. firefighters were deployed to assist with) nearly 31% of those exposed were diagnosed with anxiety after the event.
II. Cooccurring Behavioral Health Concerns Firefighters May be More Vulnerable To
Firefighter behavioral health is often compromised when they turn to unhealthy coping strategies to deal with occupational PTSD, anxiety, and depression. Complicating matters further, is that firefighter shifts/schedules may create an environment and opportunity that is more conducive to participation in such strategies/activities. For instance, in the state of California, swing shifts have firefighters working 24 hours, every other day, for five days. After the fifth day, firefighters will be off-duty for 96-hours, or four days. This is common across all U.S. states. When not called to respond to an incident, a significant portion of a 24-hour shift can be spent engaged in activities that help them escape the negative feelings and emotions that many carry each day into their respective firehall and living quarters. The four-day downtime when off-duty also provides greater opportunity (compared to the general population’s work schedule) to engage in unhealthy coping activities. These activities and the compulsive behaviors that may form are addressed below.
a) Alcohol Use Disorder
Researchers find that compared to less than 30% of the general population, firefighters have lifetime rates of alcohol use disorder (AUD) as high as 50%, alcohol coping motives as being a factor in the development of AUD.
b) Problem Gambling
Harmless games of poker are a common site in fire halls as those on-staff bide the time until the bell calls them to duty. However, for those who use gambling to cope with negative feelings, problematic behavior can be formed. This is especially concerning now that opportunity to gamble has exponentially increased with the proliferation of online casino gaming and sports betting. One study found that the overall rate of firefighters with gambling disorder, or who show signs of problematic behavior, is over 12%.
c) Unhealthy Gaming
Fire station living quarters across the nation are outfitted with video game consoles, and most firefighters have at least one gaming app on their personal digital devices. As with online gambling, most are able to manage their participation without developing a disorder. However, unhealthy behavior may be formed among vulnerable firefighters who turn to gaming to bury mental health struggles.
“My first day off shift I would usually come home, nap, then get on and play some video games. It helped me chill and just decompress. We (my wife) would have fights about how much time I spent gaming, but I told her at least I was at home and not in some bar drinking. It wasn’t until I completely missed my daughter’s game one day, barely realizing the family was gone, that I realized, yeah, maybe I have a problem.” (FireFighter Nation)
d) Hypersexuality Disorders
Hypersexuality disorders such as sex addiction and problematic use of pornography can also form among vulnerable firefighters who use sex/porn to cope with negative feelings associated with PTSD and comorbid issues. While there has yet to be significant research conducted on the matter, fire departments are reporting concerns within their halls.
“More and more officers and firefighters are accessing pornographic web sites while on duty. I can honestly say that a lot of people I’ve worked with had issues with alcohol, drug use, and sex addiction. There is no excuse for these behaviors, but the stress level is very high, and a lot of firefighters ease stress by acting out in a variety of ways. Pornography is the number #1 vice that challenges our firefighters to remain morally sound and morally courageous while on duty. It has become so destructive that department management had to have legal departments write special orders, directives, and operational memorandums on the non-access or keeping of pornographic material in print or electronically.” [Stan Tarnowski, Fire Chief (Ret.)]
e) Anger, Irritability, and Aggression
Studies confirm that firefighters exhibit significantly higher scores on physical aggression, verbal aggression, indirect aggression, and hostility. Further, the same body of research finds that these behaviors impact spouses and partners who express dissatisfaction to these behaviors with their own outbursts of anger. A viscous cycle ensues, which may be why firefighters have one of the highest divorce rates when compared to other occupations.
III. In Consideration of Veteran Firefighters
Concluding this look at firefighter mental health problems and associated behavioral health concerns is a consideration for military veterans. Like with law enforcement agencies in the United States, many firefighters are military veterans. Studies indicate that 9% to 23% of firefighters have served in the U.S. Armed Forces. Conclusions can therefore be drawn about this specific segment within firefighter populations. Not only are there inferences regarding occupational PTSD, there may be greater instances of behavioral health disorders. For instance, given that problem gambling among the military is 3.5 times higher than it is with the general population, and that up to 23% of firefighters have a military background, it becomes clear that closer analysis is required to better protect the segment.
If you’re a firefighter who struggles with mental / behavioral health and need assistance beyond what is provided by your department, please reach out to Kindbridge right away. You will receive a confidential assessment with a counselor who specializes in PTSD, anxiety, stress, depression, and cooccurring issues. We will build a customized treatment strategy that works for your specific struggles. Click the banner below to get started.
If you’re instead charged with finding mental health support services for one or more municipal fire department, or something larger that can be instituted by an appointed board, Kindbridge is who you need to connect to today. We work closely with the U.S. Armed Forces in treating problem gambling and cooccurring issues for veterans and active military. This makes us uniquely qualified to build a custom program for your firefighters too. Reach out to initiate conversation about what Kindbridge can do to protect our nation’s first responders.
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