In 2020, there were approximately 364,300 professional firefighters employed within the United States (Fahy et al., 2022); not accounting for volunteer or wildland firefighters. While many people believe professional firefighters spend the majority of their time responding to residential or commercial fires, the reality is that firefighters are far more likely to respond to calls for rescue or medical aid. For example, two-thirds of the 36,416,000 calls for service in 2020 were for medical aid, while less than four percent were for fire suppression.
As first responders, professional firefighters are routinely exposed to duty-related trauma and stressors that place them at an increased risk of mental health problems, including posttraumatic stress disorder (PTSD; Harvey et al., 2016; Johnson et al., 2020; MacDermid et al., 2019). These stressors can include shiftwork and length of the workweek, departmental politics, as well as the multiple critical incidents firefighters typically experience throughout their career.
Critical incidents, such as witnessing fatalities, can result in considerable distress and overwhelm a firefighter’s coping skills (Everly & Mitchell, 2008), with repeated exposures negatively impacting upon their mental health and overall well-being. Studies have found that prevalence rates for PTSD in firefighters following repeated exposure to traumatic events range from 6.7% to 13% (Jitnarin et al., 2022; Kehl et al., 2015; Harvey et al., 2016). Moreover, the more fatalities the firefighter witnessed, the higher the likelihood they were suffering from a mental health and co-occurring alcohol use disorder, with firefighters endorsing moderate symptoms of depression (11%) and unsafe drinking habits (24%; Harvey et al., 2016).
Since PTSD, depression, and alcohol use disorder increase the risk for suicidal ideation, attempts, and completion (Martin et al., 2017; Stanley et al., 2015), it is imperative to obtain a comprehensive picture of firefighter mental health and well-being in order to treat current mental health problems, as despite training to help others during times of crisis, firefighters are reluctant to seek mental health services when they are in crisis.
The National Wellness Survey for Public Safety Personnel
In collaboration with the Behavioral Analysis Unit of the United States Marshals Service and Nova Southeastern University, the Fairfax County (Virginia) Police Department (FCPD) established the National Wellness Survey for Public Safety Personnel. The objective was to determine (1) the prevalence and severity of anxiety, depression, PTSD, alcohol use, and suicidal ideation in a national sample of professional firefighters, (2) access to mental health resources, and (3) barriers to seeking treatment.
Professional Stressors
Personal Stressors
Female Stressors
Trauma Exposure
Coping Strategies
Mental Health Measures
On empirically validated mental health instruments:
38% of respondents endorsed anxiety symptoms beyond the minimal severity threshold and 16.7% endorsed anxiety symptoms that met or exceeded the diagnostic criteria for generalized anxiety disorder.
41% of respondents endorsed at least mild depressive symptoms and 19.3% endorsed depressive symptoms that met or exceeded the diagnostic criteria for major depressive disorder.
11.7% of respondents received scores suggesting PTSD treatment may be beneficial for symptom reduction.
28.1% of respondents indicated they consumed alcohol to an extent that represented a potential problem with alcohol abuse.
8.1% of respondents reported experiencing thoughts of passive suicide ideation (e.g., thoughts of wishing they were dead or wishing they could go to sleep and not wake up), and 5% reported having thoughts of active suicide ideation.
Utilization of Behavioral Health Resources
Respondents were asked to report their accessibility to, and interest in, engaging with behavioral health resources offered by their department or elsewhere in the community. Professional firefighters accessed various services:
Within their department | Outside resources | |
Doctoral-level psychologist or non-doctoral-level counselor | 16.3% | 12.4% |
Psychiatrist | 6.9% | 8.5% |
Peer support team member | 19.3% | N/A |
Chaplain, clergy, or other spiritual services | 10.2% | 6% |
Primary care physician or practitioner | N/A | 14.3% |
Barriers to Seeking Treatment
Of respondents who expressed an interest in seeking assistance but had not followed through, the following were the most endorsed reasons for not doing so:
“I wanted to handle it on my own” (36.7%)
“It’s the way I am – I don’t ask for help” (25.5%)
“Stigma – concerns I’d appear weak” (24.7%)
“Concerns about confidentiality” (24.2%)
“Fears it would impact my career, future employment, or security clearance” (23.4%)
“I just keep putting it off” (21.3%)
“I didn’t think it was a big deal” (20.2%)
“Stigma – concerns I’d appear unstable or ‘crazy’” (19.4%)
In response to being asked if they believed a co-worker seeking counseling or mental health treatment for stress-related problems may hurt their career, 9.6% responded “Yes,” 21.3% responded “Not sure,” and 66.6% responded “No.” The remaining 2.5% did not respond to this question.
Discussion
Over the course of their career, professional firefighters will be repeatedly exposed to traumatic events. Unfortunately, such exposure has a harmful impact on the overall mental health and well-being of fire service professionals (Jahnke et al., 2016). While firefighters indicated the top two professional stressors they encounter are responding to critical incidents and being directly involved in them, only a small number of firefighters met diagnostic criteria for PTSD (Kehl et al., 2015). Jahnke et al. (2016) propose that the disparate rates of PTSD in firefighters are likely due to the varying calls for service they respond to in their respective communities, in that not all firefighters respond to the same types of critical incidents. Additionally, employing agencies may not adequately prepare their personnel to face potentially traumatic events, which can affect how firefighters deal with post-incident distress.
Firefighters experience depression and anxiety as a consequence of their participation in critical incidents. While they may not meet full criteria for either disorder, it is important to note that firefighters exposed to multiple critical incidents are at an increased risk of experiencing symptoms of multiple mental health disorders. For example, firefighters who report symptoms of PTSD are also likely to report symptoms of depression, anxiety, and/or alcohol use disorder (Harvey et al., 2016; Jitnarin et al., 2022). Tomaka et al. (2017) found that one-third of firefighters’ had drinking habits that met criteria for requiring intervention, in comparison to 5.8% of the general population (National Institute on Alcohol Abuse and Alcoholism, 2020). Although such statistics reflect the normalization of alcohol use in firefighter culture, they also emphasize the importance of assessing problematic drinking within the fire service.
Professional firefighters are trained to help others during a crisis, yet these first responders are reluctant to seek mental health services when they are in crisis. For many firefighters, it’s not just a job, but who they are, and admitting to experiencing job-related PTSD or depression may feel tantamount to saying they are not cut out for the profession. Resultantly, barriers to treatment still exist (Gulliver et al., 2019; Hom et al., 2016), with many fearing their problems will not remain confidential or that their reputation will be tarnished. Firefighters therefore prefer to rely on social supports at work to alleviate the stress of critical incidents (Jahnke et al., 2014), rather than seeking “outsider” mental health professionals who do not understand their job or culture (Gulliver et al., 2019). Interestingly, it appears that stigma is purely associated with the firefighters’ own mental health care and not that of their peers, with two-thirds of firefighters not believing that a co-worker’s career would be hurt if that person sought mental health treatment.
While professional firefighters share similarities with other first responders in terms of the stress and trauma they experience, their specific duties and the culture of the fire service create unique challenges. To adequately prepare recruits for the nature of the job, strategies directed at integrating behavioral health and peer support programs into fire departments’ safety and wellness initiatives should therefore be implemented as early as the fire academy, and should be continued throughout their career (International Association of Fire Fighters, 2018). By providing access to mental health services, training on trauma and stress management, creating a culture of openness and support, and promoting self-care practices, fire departments can help reduce the stigma associated with mental health, decrease the number of suicides in the fire service, and strengthen the resilience of their personnel. Research suggests that professional firefighters are severely affected by their jobs, so prioritizing mental health is crucial for the well-being of firefighters themselves, the effectiveness of their work, and the safety of the communities they serve. In turn, firefighters will be able to successfully cope with the challenges of their job and lead more fulfilling lives both on and off duty.
