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Post-traumatic stress disorder is one of several anxiety disorders listed in the Diagnostic and Statistical Manual of Mental Health Disorders (DSM-IV). It occurs after exposure to a traumatic event often involving threat of death or serious injury. There are three groups of symptoms that occur in post-traumatic stress disorder; re-experiencing, avoidance of associated stimuli and increased arousal.
The vast majority of research on post-traumatic stress disorder has focused on primary post-traumatic stress disorder; that is the experiences of a direct victim of a trauma. With women, rape victims are often studied, whereas war veterans are often studied with men. However, a second type of post-traumatic stress disorder also exists; secondary post traumatic stress disorder. Secondary stress is the stress resulting from helping or wanting to help a traumatised or suffering person. People that work in the emergency services, such as firefighters, are prime candidates to experience secondary post-traumatic stress disorder.
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Why Do Firefighters Experience Post Traumatic Stress?
Firefighters are often exposed to traumatic stress which can be caused by exposure to such things as mutilated bodies, the impact of life threatening situations, physically demanding activities, and great material destruction. Indeed, a survey of 2000 firefighters and paramedics reported that 90% of the sample had encountered at least one distressing mission in the last year that included dead, dying or severley injured persons. These are experiences that may never occur in the lives of members of the general population. Therefore, firefighters are clearly repeatedly exposed to secondary traumatic stress that qualifies as trauma beyond normal human experience. These experiences may induce various psychological and physiological stress reactions and lead to physical complaints, mental disorders such as post-traumatic stress disorder, and substance abuse.
Despite this knowledge, firefighters are rarely considered victims, although the events that they encounter on a day to day basis are considered traumatic. Due to this, there has been a lack of empirical research investigating occupational stress in the emergency services. In fact, research into secondary post-traumatic stress disorder was non-existent until just ten years ago. Many of those in the emergency services with post-traumatic stress disorder do not receive treatment as it is often considered 'part of the job'. However, cognitive behavioral methods are the most effective method of treatment for primary and secondary post-traumatic stress disorder. In the case of the emergency services, who are repeatedly exposed to trauma, coping strategies would be of particular importance.
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Prevalence of Post Traumatic Stress Disorder Among Firefighters
One of the first studies that investigated post-traumatic stress disorder in firefighters was conducted by Wagner et al (1998). They studied a representative sample of 318 German firefighters. The use of a sample considered as representative means that the results can be relatively accurately generalized to other firefighters. Of their sample, 20 were found just to have post-traumatic stress disorder symptoms, 58 were found to have post-traumatic stress disorder symptoms and other psychiatric symptoms, 86 were found to have other psychiatric symptoms, 76 were found to have subsyndromal post-traumatic stress disorder and just 78 were found to be mentally healthy. Of the firefighters with post-traumatic stress disorder 39.7% suffered from depressive disorders, 60.3% displayed social dysfunction and 19% were substance abusers.
The study also found that the development of post-traumatic stress disorder symptoms were not depedent on certain functions within a fire department. As long as the firefighters maintained an active duty status, they remained at risk of exposure to trauma associated stimuli. Furthermore, they found that job experience (duration of employment) and number of distressing missions during the last month were the strongest predictors of the extent of the traumatic stress suffered. In closing, based on their findings, Wagner et al (1998) suggest that 18.2% of all firefighters suffer from post-traumatic stress disorder symptoms, and that almost half suffer from further psychiatric symptoms.
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Wagner,D., Heinrichs, M., & Ehlert, U. (1998) Prevalence of symptoms of posttraumatic stress disorder in German professional firefighters. American Journal of Psychiatry, 155, 1727-1732.