Posttraumatic stress disorder in firefighters: A proposed model of mediators and moderators.

The diagnosis of posttraumatic stress disorder (PTSD) has been studied extensively in victim populations (e.g., combat veterans and rape victims); however, very little attention has been given to the responders who come to the aid of these victims, specifically firefighters. Firefighters will respond to both a large number, and a wide variety of potentially stressful situations over the course of their careers. The dangers that firefighters encounter were brought to the attention of the public during the terrorist attacks of September 11, 2001. Currently, there is a lack of research on basic information regarding PTSD in firefighters, such as prevalence rates of PTSD and related symptoms. Other factors that may impact PTSD levels also have not received much attention, including characteristics of the stressful event (e.g., perceived danger) and individual differences (e.g., demographic variables, social support, and coping). This study examined 134 firefighters from two states to assess the prevalence of PTSD symptoms, the types of experiences firefighters encounter during the course of their work, and to test mediating and moderating variables that may impact PTSD symptom levels. The prevalence of PTSD ranged from 21.6% using the most common criteria of an IES score greater than 19, to 9.7% using a more stringent criteria (IES score greater than 26) that also included measures of fear, helplessness, or horror, and functional impairment. The strongest predictors of PTSD levels were the Escape-Avoidance subscale of the Ways of Coping Inventory, feelings of helplessness related to the Single Worst Event as a firefighter, and the presence of a second job. Firefighters respond to a variety of calls, nearly every day, most commonly Fires, MVAs (motor vehicle accidents), or Medical Emergencies, with MVAs and Medical Emergencies rated as the most distressing. A number of Ways of Coping subscales (i.e., WOC-Escape Avoidance, WOC-Seeking Social Support, WOC-Accepting Responsibility, WOC-Self-Control, and WOC-Planful Problem Solving) were found to mediate the relation between a firefighter’s response to a traumatic event (Criteria A2: Helplessness) and PTSD symptoms, while military experience, previous psychological treatment, negative emotions, and age at start of service as a firefighter moderated the relation between traumatic events and PTSD symptoms. The implications of these findings for future research and clinical treatment are discussed