Suicide in the fire service has reached alarming proportions, surpassing line of duty deaths (LODD) in firefighters. According to the National Fire Protection Association (NFPA), there were 60 firefighter LODD in 2017. Compare this to 91 firefighter suicides.
SUD is a common issue within the first responder community. Current research suggests that those in fire service engage in binge drinking at almost double the rate of the general public.
PTSD symptoms include intrusion, avoidance, negative cognition and mood, and alteration in arousal response. Notify a peer or seek clinical care if you think you may have this disorder.
Firefighters experience depressive disorders at more that twice the rate of the general public (17% vs 7%). Resources are available to help.
The firefighter is not the only one affected by the job. Spouses, partners, significant others, children and even parents can all face challenges.
Ask mental health professionals and they will tell you that everything is related to sleep. Many mental health (and physical) issues can be affected by poor sleep.
Research has not determined the extent of the firefighter suicide problem, but it is clear that firefighters do complete suicide.
According to the National Fire Protection Association (NFPA), the number of suicides among firefighters is much higher than the LODD rate.
2019: 48 LODD, 119 Suicide
2018: 64 LODD, 82 Suicides
2017: 60 LODD, 91 Suicides
2016: 69 LODD, 99 Suicides
2015: 68 LODD, 94 Suicides
While there is no clear consensus on the rates of suicidal ideation among firefighters, it is clear that the fire service community must remain vigilant regarding warning signs.
Again, no clear consensus exists, however, firefighters must be aware of potential warning signs of suicide.
Studies show that 90% of all completed suicides show some sign before they occur. Know the signs!
Expressing feeling that the world would be better off without them
Giving away possessions
Anxious, reckless behavior
Extreme mood swings
Blood Alcohol Concentration (BAC) is measured as a percentage and is directly related to certain behavioral effects.
0.05% - Lowered alertness, good feeling, reduced inhibitions
0.08% - The relative risk of being involved in a fatal crash is 3x that of a sober driver
0.10% - Slower reaction times
0.15% - Large, consistent increases in reaction time
0.20% - Marked depression in sensory and motor capacity
0.25% - Severe motor disturbance, great impairment
0.30% - Stupor, no comprehension of events
0.35% - Used in the past for surgical anesthesia. May cause death
0.40% - 50% mortality rate
Hart & Ksir, 2018
The Centers for Disease Control and Prevention (CDC) estimates that 2,200 people die each year due to alcohol toxicity.
Studies show that the rate of firefighter binge drinking is near double that of the general population.
The Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-V) describes the conditions that must be present to diagnose AUD. Two must be present within a 12-month month period and this MUST be diagnosed by a licensed clinician.
1. Alcohol is often taken in larger amounts or over a longer period than was intended.
2. There is a persistent desire or unsuccessful efforts to cut down or control alcohol use.
3. A great deal of time is spent in activities necessary to obtain alcohol, use alcohol,
or recover from its effects.
4. Craving, or a strong desire or urge to use alcohol.
5. Recurrent alcohol use resulting in a failure to fulfill major role obligations at work,
school, or home.
6. Continued alcohol use despite having persistent or recurrent social or interpersonal
problems caused or exacerbated by the effects of alcohol.
7. Important social, occupational, or recreational activities are given up or reduced because of alcohol use.
8. Recurrent alcohol use in situations in which it is physically hazardous.
9. Alcohol use is continued despite knowledge of having a persistent or recurrent
physical or psychological problem that is likely to have been caused or exacerbated
10. Tolerance, as defined by either of the following:
a. A need for markedly increased amounts of alcohol to achieve intoxication or desired effect.
b. A markedly diminished effect with continued use of the same amount of alcohol.
11. Withdrawal, as manifested by either of the following:
a. The characteristic withdrawal syndrome for alcohol (refer to Criteria A and B of
the criteria set for alcohol withdrawal, pp. 499-500).
b. Alcohol (or a closely related substance, such as a benzodiazepine) is taken to
relieve or avoid withdrawal symptoms.
Like the general population, firefighters are at risk for abuse of both illicit and over the counter (OTC) drugs. Categories include:
Tobacco is recognized as the most dangerous public health threat related to substances, greater than all other drug substances combined, including alcohol (Hart & Ksir, 2018). Tobacco may be considered a drug because it acts as the delivery mechanism for nicotine - a psychoactive substance (Hart & Ksir, 2018).
According to the World Health Organization (WHO), smoking is responsible for 5 million deaths annually.
Nicotine is one of the most toxic drugs known. 60 mg is a lethal dose. One cigar contains two lethal doses (Hart & Ksir, 2018).
Smokeless tobacco is not a safe alternative to cigarettes. It carries with it an increased risk of cancer of the mouth, pharynx, and esophagus (Hart & Ksir, 2018).
High risk behavior may be addictive as well.
Most Americans will suffer some sort of traumatic event in their lifetime. Depending on the consulting resource, prevalence ranges from 50-90%. Only 8% will be afflicted with PTSD, however. Two main reasons for this, presumably, are resilience and support. Resilience relates to "bouncing back" from the traumatic event by employing effective coping strategies. Support refers to the availability of interpersonal communication.
The true rate of PTSD in the firefighter population is unknown. Many studies have been conducted and rates have been documented between 4% (lower than the general population) and 30% (3x that of the general population).
PTSD must be diagnosed by a licensed clinician and be the result of one or more traumatic events.
Signs and symptoms of PTSD include intrusion, avoidance, alterations in cognition or mood, and alterations in arousal.
Intrusion: Flashbacks, unwanted memories of the event, or nightmares
Avoidance: Staying away from people, events, or places that remind of the event
Alterations in cognition or mood: Consistent negativity, irritability, and self-blame
Alterations in arousal: Hypervigelance, exaggerated startle response
While it is true that several studies have identified firefighters as having a higher level of depression than the public, again, there is no consensus in the literature.
We know that the firefighter is not the only one in the family that is affected by the job. Spouse/significant other/partner, children, friends, and even parents may be affected.
Sometimes, firefighters do not want to discuss work issues or critical incidents at home. Observable signs may be present, however. Often, the first signs of trouble present themselves at home.
One of the most important things you can do is learn psychological first aid, particularly how to recognize signs of trouble. Early recognition and intervention are critical.
One of the few areas in which research tends to agree and where a consensus seems to have been established is sleep.
20% of the general population.
37% of the firefighter population.
Risk of the following conditions increases with inadequate sleep.
Talk to your doctor if you think you may have an issue.
According to a recent study, as much as 25% of those over the age of 18 have experienced divorce. Male firefighters have a similar incidence of divorce as the general public. Females, however are 3x more likely to divorce than their male counterparts.
The JFPSG is here for you. If you just need to vent or require structured couples or individual therapy, we can help. Our clinicians are experts in the field of marriage and family counseling. Please give us a call.
Post-divorce, the need for support is heightened. We are here for you in these times as well. Our peer supporters are here to listen and our clinicians are here to treat divorce-related issues. Please give us a call.
Anxiety is a common problem. It is estimated that around 18% of the population suffer from some form of it. Please watch our short video.
For those who feel they may have a problem with any mental health issues, a good first step may be to go see your primary care physician. If you don't have one, find one. Primary care physicians can rule out physical causes for problems and help refer you to the help you need, if necessary.