First responders provide essential services to the entire community. These brave individuals provide on-scene response and face challenging and dangerous situations every day. They consistently risk their own lives despite facing multiple dangers in order to provide support to disaster survivors, and as such, bear some of the greatest risks to their mental health.
Although mental health awareness has increased over the past years, there remains a considerable amount of stigma. Given this, a limited number of first responders will seek support in managing their mental health. This results in both short and long term implications on the individual as well as their loved ones, in addition to the community and economy. As a result, the prevalence of stress disorders, anxiety, and depression in first responders continue to grow.
With this in mind, we can begin to examine the toll that responding to traumatic events takes on first responders, and importantly, what can be done to address it.
First responders face deeply distressing and stressful events on a daily basis, which can result in the physical chemistry of the brain changing over time. These biochemical changes are linked to mental and behavioural changes, and while these changes differ in expression from one individual to another, we can note some commonalities.
Research has demonstrated a strong relationship between first responders (paramedics, firefighters, and police officers) and mental health outcomes, and these occupations are considered to be at the highest risk for stress-induced disorders. In fact, a majority of first responders experience certain mental health conditions, most commonly including acute stress disorder, post-traumatic stress disorder, and depression.
The DSM-5, which is a tool used by clinicians to diagnose and categorize mental health issues, classifies Acute Stress Disorder (ASD) as a subtype of anxiety. This tends to arise when an individual has experienced or witnessed an event involving actual or threatened and perceived death or injury, and responded with some form of fear, horror, or helplessness.
While symptoms may present immediately following the traumatic event, a clinical diagnosis is made between 3 and 30 days after an individual has experienced the following 5 symptoms:
1. Arousal: hyper-vigilance, inability to focus, irritated mood or affect
2. Avoidance: conscious removal or avoidance of memories, people, or feelings associated with the trauma
3. Dissociation: a strong sense of physical displacement, feeling detached from reality, difficulty remembering the trauma
4. Intrusion: intrusive and recurrent thoughts or flashbacks to the event
5. Negative Mood: depressed mood, difficulty expressing positive emotions
Post Traumatic Stress Disorder (PTSD) is similar in that it is classified with the same five symptoms, however, such symptoms are often more intrusive and enduring.
Although similar to one another, ASD and PTSD express certain differences. For instance, individuals presenting with ASD tend to express immediate symptoms following a traumatic event which could subside, whereas individuals presenting with PTSD retain long-term symptoms. In serious circumstances, PTSD is known to follow ASD or even occur without having ASD presented in the first place.
As the most common psychiatric disorder, depression is classified by the DSM-5 as experiencing persistent feelings of sadness, hopelessness, and a loss of interest in previously enjoyable activities.
A clinical diagnosis of depression can be made if 5 of the following symptoms are present for a minimum of two weeks, with at least one symptom being either a depressed mood or experiencing a loss of interest or pleasure.
1. Depressed mood occurring most of the day, nearly every day
2. Loss of interest or pleasure in all or most activities
3. Weight loss or decrease/increase in appetite nearly every day
4. A slowing down of thought and physical movement
5. Fatigue or total loss of energy
6. Feeling extreme guilt or worthlessness
7. Being indecisive or having an inability to think or concentrate
8. Thoughts or attempts of suicide
While common, depression is a very serious mood disorder that remains prevalent among first responders.
Intervention and support is crucial for first responders, particularly if they are demonstrating some of the above indicators of ASD, PTSD, and depression. Without taking action to minimize the incidence of this, many first responders die by suicide on a daily basis.
A systematic review of suicidal thoughts and behaviours among first responders revealed a lifetime prevalence rate of 8% feeling life isn’t worth living, 10.4% having serious thoughts of suicide, and 3.1% had previously attempted suicide.
In addition, first responders who had duties as both EMTs and firefighters had a sixfold increase in suicide attempts when compared to firefighting alone.
The question remains: What do we do about this?
Promoting improved mental health for you and those around you starts with speaking up. This can mean speaking to those around you or reaching out to a trained professional.
Taking the first step in your journey and reaching out for the help that you deserve takes courage. Digging deep and pushing through the stigma that surrounds you can limit stigma in hindering your growth.
For more information on the mental health and wellness of first responders, follow our blog series where we dive deeper into this in the upcoming articles.
* Coming soon: First Responders and Mental Health Part 2: Counselling For First Responders. Together, We Can End The Stigma Surrounding Mental Health
Written by Laura Anderson, MA, MSW, RSW