A prospective study of pre-trauma risk factors for post-traumatic stress disorder and depression (original) (raw)
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PTSD in Paramedics: Resilience and Sense of Coherence
Background: Paramedics are frequently subjected to traumatic experiences and have higher PTSD prevalence rates than people in the general population. However, the vast majority of paramedics do not develop PTSD. While several risk factors for PTSD have been established, little is known about protective factors. It has been suggested that a good sense of coherence (SOC) and high resilience lower the risk for developing PTSD. Aims: To examine whether SOC and resilience are associated with PTSD severity in paramedics. Method: A cross-sectional study investigated SOC, resilience and PTSD in paramedics (N = 668). PTSD was assessed with the Posttraumatic Stress Diagnostic Scale (PDS); resilience and SOC were measured with the Resilience Scale (RS-11) and the Sense of Coherence Scale (SOC-L9). Further measures included preparation of dealing with traumatic events and availability of psychological help. Results: As expected, both resilience and SOC were negatively correlated with PTSD symptoms. The regression analysis showed that 19.2% of the total variance in symptom severity was explained by these variables. However, SOC was a better predictor than resilience for PTSD severity, as it accounted for more unique variance. Paramedics who were prepared for dealing with work-related traumatic events and who received psychological help had less severe PTSD symptoms and higher SOC scores than paramedics for whom these services were not available. Conclusions: Enhancing resilience, and especially SOC, seems a promising approach to reduce PTSD symptom severity in high risk groups like paramedics.
BMC Emergency Medicine, 2014
Background Emergency healthcare workers, including trainees and individuals in related occupations are at heightened risk of developing posttraumatic stress disorder (PTSD) and depression owing to work-related stressors. We aimed to investigate the type, frequency, and severity of direct trauma exposure, posttraumatic stress symptoms and other psychopathology amongst paramedic trainees. In order to create a risk profile for individuals who are at higher occupational risk of developing PTSD, we examined risk and resilience factors that possibly contributed to the presence and severity of posttraumatic symptomatology. Methods Paramedic trainees (n = 131) were recruited from a local university. A logistic regression analysis was conducted using the explanatory variables age, gender, population group, trauma exposure, depression, alcohol abuse, alcohol dependence, resilience and social support. Results 94% of paramedic trainees had directly experienced trauma, with 16% meeting PTSD crit...
Post-traumatic symptoms and disability in paramedics
Canadian journal of psychiatry. Revue canadienne de psychiatrie
The concern that secondary gain may result in an overreporting of trauma symptoms in those seeking compensation or taking stress leave from work has raised questions about the relation between posttraumatic stress and disability. This study attempts to examines the relation between traumatic stress symptoms and the use of work leave in an anonymous sample of emergency-service workers who are not currently seeking compensation. A total of 86 paramedics completed questionnaires that addressed exposure to traumatic events, use of mental health stress leave, social support, current level of distress, and personality patterns. Comparisons were made between groups who had used mental health stress (MHS) leave and those who had not. Logistic regression was used to determine the best predictors of using leaves. Current levels of social support were associated with previous use of mental health stress leave. In addition, significantly more individuals who had taken MHS leave in the past repo...
International Journal of Environmental Research and Public Health
There is growing recognition in research and policy of a mental health crisis among Canada’s paramedics; however, despite this, epidemiological surveillance of the problem is in its infancy. Just weeks before the emergence of the COVID-19 pandemic, we surveyed paramedics from a single, large, urban paramedic service in Ontario, Canada to assess for symptom clusters consistent with post-traumatic stress disorder (PTSD), major depressive disorder, and generalized anxiety disorder and to identify potential risk factors for each. In total, we received 589 completed surveys (97% completion rate) and found that 11% screened positive for PTSD, 15% screened positive for major depressive disorder, and 15% screened positive for generalized anxiety disorder, with one in four active-duty paramedics screening positive for any of the three as recently as February 2020. In adjusted analyses, the risk of a positive screen varied as a function of employment classification, gender, self-reported resi...
PloS one, 2016
To develop and evaluate an evidence-based and theory driven program for the primary prevention of Post-traumatic Stress Disorder (PTSD). A pre-intervention / post-intervention / follow up control group design with clustered random allocation of participants to groups was used. The "control" group received "Training as Usual" (TAU). Participants were 45 career recruits within the recruit school at the Department of Fire and Emergency Services (DFES) in Western Australia. The intervention group received a four-hour resilience training intervention (Mental Agility and Psychological Strength training) as part of their recruit training school curriculum. Data was collected at baseline and at 6- and 12-months post intervention. We found no evidence that the intervention was effective in the primary prevention of mental health issues, nor did we find any significant impact of MAPS training on social support or coping strategies. A significant difference across condition...
The Cochrane library, 2021
BackgroundMilitary personnel and frontline emergency workers may be exposed to events that have the potential to precipitate negative mental health outcomes such as depression, symptoms of post‐traumatic stress and even post‐traumatic stress disorder (PTSD). Programmes have been designed to build psychological resilience before staff are deployed into the field. This review presents a synthesis of the literature on these “pre‐deployment resilience‐building programmes”.ObjectivesThe objective of this review was to assess the effectiveness of programmes that seek to build resilience to potentially traumatic events among military and frontline emergency service personnel prior to their deployment. These resilience programmes were compared to other interventions, treatment as usual or no intervention.Search methodsStudies were identified through searches of electronic databases including Ovid MEDLINE, Embase, PsycINFO, Web of Science and Google Scholar. The initial search took place in January 2019, with an updated search completed at the end of September 2020.Selection criteriaOnly studies that used a randomised controlled trial (RCT)/cluster‐RCT methodology were included. The programmes being evaluated must have sought to build resilience prior to exposure to trauma. Study participants must have been 18 years or older and be military personnel or frontline emergency workers.Data collection and analysisStudies that met the inclusion criteria were assembled. Data extracted included methods, participants’ details, intervention details, comparator details, and information on outcomes. The primary outcomes of interest were resilience, symptoms of post‐traumatic stress and PTSD. Secondary outcomes of interest included acute stress disorder, depression, social support, coping skills, emotional flexibility, self‐efficacy, social functioning, subjective levels of aggression, quality of sleep, quality of life and stress. Assessment of risk of bias was also completed. A total of 28 studies were included in a narrative synthesis of results.Main resultsAll 28 included studies compared an experimental resilience building intervention versus a control or no intervention. There was a wide range of therapeutic modalities used, including cognitive behavioural therapy (CBT) informed programmes, biofeedback based programmes, stress‐management programmes, mindfulness and relaxation programmes, neuropsychological‐based programmes, and psychoeducational‐informed programmes. The main outcomes are specified here, secondary outcomes such as depression, social support, coping skills, self‐efficacy, subjective levels of aggression and stress are reported in text. No studies reported on the following pre‐specified outcomes; acute stress disorder, emotional flexibility, social functioning, quality of sleep and quality of life.ResilienceEight studies reported resilience as an outcome. We narratively synthesised the data from these studies and our findings show that five of these interventions had success in building resilience in their respective samples. Two of the studies that reported significant results utilised a CBT approach to build resilience, while the other three successful programmes were mindfulness‐based interventions.Symptoms of post‐traumatic stressOur narrative synthesis of results included eight studies. Two of the eight studies produced significant reductions in symptoms of post traumatic stress compared to controls. These interventions used neuropsychological and biofeedback intervention models respectively.PTSD casenessFour studies reported PTSD caseness as an outcome. Our narrative synthesis of results suggests that evidence is mixed as to the effectiveness of these interventions in reducing clinical diagnosis of PTSD. One study of a neuropsychology‐orientated Attention Bias Modification Training (AMBT) programme had success in reducing both symptoms of post‐traumatic stress and numbers of participants receiving a diagnosis of PTSD. A stress‐management programme reported that, when baseline differences in rates of pre‐deployment mental health issues were controlled for, participants in the control condition were at 6.9 times the risk of a diagnosis of PTSD when compared to the intervention group.Given the diversity of intervention designs and theoretical orientations used (which included stress‐management, neuropsychological and psychoeducational programmes), a definitive statement on the efficacy of pre‐deployment programmes at reducing symptoms of post‐traumatic stress and PTSD cannot be confidently offered.Authors' conclusionsWhile a number of evaluations of relevant programmes have been published, the quality of these evaluations limits our ability to determine if resilience‐building programmes 'work' in terms of preventing negative outcomes such as depression, symptoms of post‐traumatic stress and diagnoses of PTSD. Based on our findings we recommend that future research should: a) report pre‐/post‐means and standard deviation scores for scales used within respective studies, b) take the form of large, RCTs with protocols published in advance, and c) seek to measure defined psychological facets such as resilience, PTSD and stress, and measure these concepts using established psychometric tools. This will provide more certainty in future assessments of the evidence base. From a clinical implications point of view, overall there is mixed evidence that the interventions included in this review are effective at safe guarding military personnel or frontline emergency workers from experiencing negative mental health outcomes, including PTSD, following exposure to potentially traumatic events. Based on this, practitioners seeking to build resilience in their personnel need to be aware of the limitations of the evidence base. Practitioners should have modest expectations in relation to the efficacy of resilience‐building programmes as a prophylactic approach to employment‐related critical incident traumas.
European Journal of Psychotraumatology
Background: Volunteer firefighters belong to a risk population regarding the development of posttraumatic stress disorder (PTSD). However, given the frequency of work-related trauma, PTSD prevalences seem relatively low. Protective factors appear to be effective and are the focus of this study. Objective: We investigated the PTSD-prevalence as well as the influence of trauma exposure and the impact of protective factors resilience and Sense of Coherence (SoC) on symptoms of PTSD in volunteer firefighters. Method: Data from 232 participants of an online questionnaire study were analysed using a path model approach. Results: 'The results suggest a possible prevalence of PTSD of 12.5% and 2.2% for partial PTSD based on self-report measures. SoC and trauma event load proved to be independent of each other, as no intercorrelations were found. But both directly predicted PTSD severity. Higher resilience scores predicted the participants' Sense of Coherence, but PTSD severity was only indirectly affected by resilience, which was entirely mediated by SoC. Further, although SoC and trauma load increase with age and years of job experience, it is only SoC that affects PTSD severity, not age or years of experience. Conclusions: The results emphasize that not only exposure to potentially traumatic events predicts the later probability of developing symptoms of PTSD, but that the integration of stressful experiences into the self-concept (associated with SoC) is essential for the development of PTSD. Future research should address the question of causality between SoC and PTSD, and consider which factors moderate the SoC.
Secondary traumatic stress and resilience among EMS
Journal of Paramedic Practice, 2018
Aim: The current study investigated the positive and negative psychological adaptations that are a result of secondary traumatic stress, and the role of resilience among paramedics and emergency medical technicians (EMTs). Methods: Emergency medical service (EMS) providers anonymously completed four validated questionnaires on: secondary traumatic stress, post-traumatic growth, resilience, and changes in outlook. Relationships between these constructs and demographics were explored. Findings: Overall, EMS participants reported a higher-than-average positive change in outlook. Resilience (p<0.001) was significantly inversely related to secondary traumatic stress and negative change in outlook. EMS working part-time demonstrated a significantly higher level of resilience (p=0.005) compared with full-time. Post-traumatic growth was significantly higher (p=0.03) in EMTs compared with paramedics. No significant differences (p>0.05) were detected between years of experience for any ...
Post Traumatic Stress Disorder (PTSD) in Emergency Responders Scoping Study: Annotated Bibliography
2014
Purpose of the Study: To study the prevalence and correlates of PTSD, anxiety and depression among emergency ambulance personnel. Method/Measures: .Emergency ambulance personnel (N = 617) in a large British ambulance service completed a questionnaire. Measures included prevalence of PTSD, anxiety and depression, as well as degree of stress related to incident and to organization, and cognitive appraisals of stressful events. Scientific Quality: Peer-reviewed. The authors used established statistical methods and had a moderate sample size. Quality = high.