The Relationship Between Duty-Related Trauma Exposure and PTSD Symptom Severity in Urban Firefighters
Pao, Christine Wen
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Background: Many firefighters are also emergency medical service personnel. Therefore, they respond not only to fire calls, but also to an array of different incidents, including motor vehicle accidents, accidents involving serious injury or death, suicides, and pediatric death cases. Research suggests that repeated trauma exposure may play a role in the high rates of PTSD reported in firefighter samples. Such studies, however, have failed to account for firefighters' actual experience of repeated trauma on the job, and have not examined the impact of exposure to multiple types of traumatic events or peritraumatic risk factors. Due to the risky nature of their work, as well as their routine exposure to trauma, there is a pressing need for research on the duty-related correlates of PTSD among firefighters. Purpose: The present study extended previous research by examining the role that various duty-related trauma characteristics play in firefighters’ experience of PTSD symptoms. This study explored the relationships between PTSD symptoms and years of fire service, trauma load, and appraised stressfulness. Further, the study examined whether type of traumatic experiences (i.e., direct experience, indirect experience, or colleague-related) contribute differentially to PTSD risk. Methods: This cross-sectional, quantitative study utilized archival data collected from 995 career firefighters in a large, urban fire department. The study used a measure of trauma exposure composed of potentially traumatic, duty-related incidents specific to firefighters. Two multiple regression analyses separately examined the association of trauma type and years of service, trauma load, and appraised stressfulness to PTSD symptoms. Two moderation analyses were also conducted to separately examine whether appraised stressfulness or trauma load moderate the relationship between years of service and PTSD symptom severity. Results: The findings confirmed that firefighters are exposed to a wide array of traumatic events. Participants rated colleague-related traumatic events as more stressful than both direct and indirect events and witnessing the duty-related death of a coworker as the most stressful traumatic event. With regards to traumatic event categories, across indirect, direct, colleague-related, and total traumatic events, both appraised stressfulness and trauma load contributed significant variance to PTSD symptoms. Neither trauma load nor appraised stressfulness moderated the relationship of years of service to PTSD symptoms across all traumatic event categories. Conclusion: Future research warrants increased focus on the specific characteristics of traumatic events that may contribute to firefighters’ psychological distress. Researchers should also focus on developing and validating measures that accurately and comprehensively capture the types of traumatic events that firefighters experience. The findings highlight the importance of developing adequate screening measures to accurately capture the types of traumas that firefighters face on the job, in order to guide effective treatment for this high-risk group.