Mental Health Issues of Firefighters: an Exploration

Professional firefighters perform a vital role in our society. They protect the rule of law, ensure our safety and provide assistance in emergencies and it is a strenuous and unique occupation due to the high levels of stress and risk involved as well as the low control nature of the job. Many psychological and physical health issues are prevalent in the professional firefighters’ population and constitute a dominant area of investigation. However, there is an increasing realization that emergency work can come at a personal cost and that the regular exposure to trauma inherent in the role may be creating a large burden of mental and physical health problems but limited attention has been given to describing factors that can contribute to firefighters’ job performance and overall well-being, such as sleep problems, depression, substance use, social bonding, and quality of life.

Sleep disturbance, fatigue, and work-related accidents are common among shift workers who typically work 8-hour rotating shifts (e.g., daytime/night time). However, in many fire departments, extended rotating shift of 10 hour (h) days / 14 h nights are common instead of the standard three 8 h-shift rotating schedule. Evidence suggests that although extended rotating shifts do not add any additional health hazards beyond that of the standard 8 h shift, fatigue, decreased alertness, and poor mood are more prevalent among firefighters working night shifts. In fact, working time is more predictive of impaired alertness and increased occupational accidents. Researches indicates that sleep deprivation (In general population, the rates of PTSD and depression might be as low as 1.9% and 10%, respectively. Yet higher rates are seen in firefighters and other rescue workers exposed to human disasters, for PTSD and depression, respectively. Experienced firefighters are more likely to be exposed to human disasters given their time in the role. Yet, it has been found that there is a linear positive relationship between years of job experience as a firefighter and levels of traumatic stress and depression when comparing experienced firefighters with new recruits; that are experienced firefighters were more likely to report lower levels of social support and self-esteem. Amount and variance of workload, group conflicts, social support, role ambiguity, and self-esteem were all found to be predictive of depressive symptoms among firefighters. Nevertheless, job strain and depression has been repeatedly linked to increased risk of cardiovascular mortality, which are likely to be as high as 44% in professional firefighters and four-fold risk when compared to other first responders. Assessing depressive symptoms in firefighters, therefore, is an important initial step in understanding the mental health needs of this population and preventing adverse physical and psychosocial health-related events. Additional concerns are that depression, as well as susceptibility to stress, might increase the risk of suicidal behavior, but may also have reciprocal influences with alcohol drinking pattern.

Alcohol consumption has been associated with relief of anxiety. A concern, however, is when alcohol consumption becomes a hazardous behavior. Hazardous drinking places the firefighter and others at risk. Alcohol consumption behavior among persons and those in their social networks is highly correlated, concerning for a group of firefighters who are joined together for extended periods of time. In similar populations (e.g. military), heavy drinking pattern can be as high as 67% prevalent among men and 9% among women, with binge drinking pattern occurring in 48% of men and 31% of women, both patterns were higher than the general population.

Team Work

The concept of brotherhood as social bonding and connection is deeply rooted among firefighters. Brotherhood has been defined by firefighters as a historical, traditional, and universal ideal characterized by inherent dedication, love, respect, and support for one another, living by a code of unspoken duty, trust, honor, and loyalty, and the establishment of membership and close relationships, connections, and bonds. Firefighters develop close social bonds and connections with one another as a result of living in the firehouse and working closely together for extended periods of time when scheduled for duty.

Shift Work

Firefighters work long shifts that are sometimes boring, sometimes sleep disrupted, yet sometimes dangerous and 'thrilling.' In a survey analysis (Beaton, 1993), sleep disturbance was reported as the most bothersome stressor for both firefighters and paramedics. Research on shift workers in many occupations suggests that they are at risk for stress related disorders.

Second Job Stress

Because of low pay and long periods of off duty time, 25% to 40% of firefighters hold second jobs. Thus, they are vulnerable to carryover effects of 'second job stress'. High Demand/Low Control Assignments Karasek (1988) specifically identified 'firemen' as employees of a high demand/low control occupation, i.e., having repeated demands placed on them with little choice of assignments. High demand/low control job characteristics are antecedents to decreased job satisfaction and increased exhaustion, depression, and burnout. Thus, workers in high demand/low control jobs may perform below their ability levels and simultaneously be vulnerable to stress and burnout.

Personality Attributes/humanitarian Motives

There is evidence of self imposed internal conflicts among firefighters that appear to be a combination of personality traits and denial of the need for assistance. Mitchell (1990) identified 12 personality traits of emergency services personnel (which includes firefighters and paramedics) that may contribute to cumulative stress: needs to be needed; to be in control; to rescue; to seek stimulation, novelty, and risks; and to obtain immediate gratification. In addition, they are driven by obsessive perfectionism and other compulsive behaviors.

Mental Health

Firefighting personnel may experience increased rates of psychiatric symptoms, including depression, anxiety, loss of appetite, lack of sleep, and constant worry or fear, after witnessing or experiencing a traumatic event. These symptoms can lead to a significant increase in psychiatric problems and may require professional intervention. Firefighting personnel are confronted with occupational and daily life stressors as they try to balance their work in life-saving efforts with the needs and demands of family life. Even though they face stress every day, little is known about how they cope with it.

Indubitably, fire fighters are at a greater risk of exposure to harmful effects of toxic substances along with severe emotional trauma that may result from severe emotional distress resulting in considerable lowering down of quality of life . This also leads to several psychiatric impairments like anxiety, stress, depression, PTSD etc which are important dimensions of mental health. Hence, the present study has been an attempt to study the mental health issues of fire fighters in Haryana, India. 100 fire fighters were examined in terms of issues related to Depression, Anger, Mania, Anxiety, Somatic, Suicidal, Psychosis, Sleep, memory, Repetitive, Dissociative, Personality and Substance abuse. The use of SPSS was required for detailed data analysis. The results revealed that the present sample of fire fighters (n = 100) scored high on the dimensions of anxiety, depression and substance abuse.

The present study is alarming in that it indicates that the mental health of fire fighters is at considerable risk in the present scenario. One-on-one interactions with the mental health professionals along with group counseling strategies may help in the enhancement of mental status thereby lowering the perceived impact of psychosocial stressors and physical conditions. There is surprisingly little research on the present research topic compared to the voluminous research that exists on mental health and few researches have been done on fire fighters and that too in the foreign countries and not in India. Research on fire fighter is scarcer than research on mental health. There is a gap between researches done in this area, therefore, to know the present scenario of mental health of fire personnel, the present study was focused on the mental health issues of fire fighters.