Depression & PTSD Shown to Be Strongest Predictors of Suicide

Although the firefighting profession is among the most stressful jobs, and it is widely believed that firefighters are at greater risk for suicide, few studies have looked at the reasons why some firefighters consider suicide as an option. With so many fires, line-of-duty deaths and other critical incidents, the wear and tear of daily life may become unbearable for some. This repeated exposure to traumatic situations puts firefighters and EMS personnel at a higher risk for developing mental health difficulties (e.g., depression, anxiety, post-traumatic stress) that may interfere with the job, relationships and taking care of one’s self in many ways. In some cases, when these difficulties become even more overwhelming, fire and EMS personnel may begin having thoughts of hurting themselves or taking their lives (suicidal ideation and/or attempts).

Suicide continues to be a growing personal and public health problem for the general population, with approximately 800,000 individuals worldwide committing suicide each year (CDC, 2014). In the fire service community, limited data suggest that our rates of suicidal ideation and/or attempts are higher than those of the general population and more similar to the rates of suicide among combat veterans and police officers.

HFD study

The psychology staff at the Houston Fire Department (HFD) has conducted many research studies to better direct psychological treatment for firefighters in our department, as well as to try to inform administrative decisions regarding mental health in the fire service more broadly.

One study surveyed 3,036 firefighter/EMS personnel in 2008 in an effort address the issue at the department and, more broadly, across the country. We asked the department’s members to complete questionnaires regarding several variables that might be related to suicidal thoughts or actions: race/ethnicity, alcohol use, depression symptoms, post-traumatic stress disorder (PTSD) symptoms, number of years of service, relationship status, suicidal ideation and suicide attempts (e.g., “Have you ever seriously considered suicide since joining the department?”).

Research on other trauma-exposed populations has found that these factors were related to suicidal ideation or attempts in those groups. Specifically, when individuals have symptoms of depression that make them feel worthless, or symptoms of PTSD that make them constantly re-experience past traumas, they may consider ending their lives to stop their pain.

Results

We found that depression (feeling down, hopeless, poor sleep/appetite) and PTSD symptom severity (easily startled, reliving past traumatic event, avoiding things that are too similar to past traumas) were the strongest predictors of suicidal ideation and attempts in the department. African-American participants reported less post-traumatic stress symptom severity than white participants and were also less likely to be alcohol dependent.

Years of service was not found to be related to suicidal ideation or attempts. Some previous research has suggested that more years of duty in the fire service has been associated with more suicide. This is based on the idea that the accumulated build-up of traumatic calls and scenes over time becomes too much. However, other research has suggested that newer firefighters (e.g., rookies) are at greater risk for suicide because they are more traumatized by severe situations that they encounter early in their careers and do not have the resources to know how to cope with these bad calls. Our results did not support either theory. What we found was that levels of depression and PTSD symptoms were much more predictive in who might consider suicide as an option.

Similarly, earlier research on suicide among other trauma-exposed groups has generally shown that being partnered or married is a protective factor against suicide risk as compared to being unmarried, divorced or separated; however, we did not find this to be true in our study. Firefighters, more than most other professions, get a great deal of their emotional support from their crew and other firefighters, especially with work-related problems. It could be that firefighters in this department spend more time with and confide in members of the “brotherhood” and “sisterhood” of the fire service rather than spouses and/or partners. This could explain why relationship status did not predict lifetime suicidal ideation or attempts.

Finally, alcohol use was also not predictive of suicidal ideation or attempts among our department of firefighters. Many times after traumatic incidents, firefighters use alcohol as a way to deal with what they have seen and “move on” to make it to the next shift. It may be that alcohol use among crewmembers may actually serve as a method of coping with traumatic scenes through the use of social support. Frequently, firefighters will find support through crewmembers, and this could very often occur in the presence of alcohol. In our study, alcohol was not directly related to suicidal ideation or attempts, but it could be indirectly related through other factors (e.g., depression).   

In sum

The limited research on firefighters and suicide, as well as anecdotal reports, suggest that suicide is a substantial problem in the fire service. Unfortunately, there have been very few studies on the causes of firefighter suicides. Our study attempted to identify factors that could be used to recognize firefighters that might be at greater risk for considering suicide. We found that the strongest predictors of suicidal ideation and attempts among firefighters were depression and PTSD symptom severity. If fire departments across the country are attempting to reduce suicides, it is critical to address these two mental health issues. By increasing awareness, prevention and treatment of depression and post-traumatic stress among members, fire departments will be targeting the underlying explanations of the problem of suicide among firefighter/EMS personnel.