title: Differences in psychiatric symptoms and barriers to mental health care between volunteer and career firefighters.
abstract: Firefighters are at increased risk for mental health problems. However, little is known about differences in psychiatric symptoms between volunteer and career firefighters. This study aimed to (1) describe differences in psychiatric symptoms and barriers to mental health care between U.S. firefighters in volunteer-only and career-only departments; and (2) determine if greater self-reported structural barriers to mental health care (e.g., cost, availability of resources) explain the differences in psychiatric symptom levels. Overall, 525 current U.S. firefighters participated. Analyses of covariance and logistic regression analyses were used to evaluate group differences between volunteer (n=204) and career (n=321) firefighters, adjusting for demographic and occupational characteristics. Volunteer firefighters reported significantly elevated levels of depression, posttraumatic stress, and suicidal symptoms compared to career firefighters. Career firefighters reported relatively elevated levels of problematic alcohol use. Volunteer firefighters additionally reported greater structural barriers to mental health care (e.g., cost, availability of resources), and these barriers accounted for the differences in mental health variables between volunteer and career firefighters. Findings suggest that volunteer firefighters report elevated psychiatric symptoms compared to career firefighters and greater structural barriers to mental health treatment may explain this link. Increased efforts are needed to develop firefighter-specific interventions and bolster mental health service utilization.
authors.affiliation: Department of Psychology, Florida State University, Tallahassee, FL, USA. Electronic address: stanley@psy.fsu.edu.
authors.forename: Ian H
authors.initials: IH
authors.lastname: Stanley
authors.affiliation: Department of Psychology, Florida State University, Tallahassee, FL, USA.
authors.forename: Joseph W
authors.initials: JW
authors.lastname: Boffa
authors.affiliation: Department of Psychology, Florida State University, Tallahassee, FL, USA.
authors.forename: Melanie A
authors.initials: MA
authors.lastname: Hom
authors.affiliation: Durham Veterans Affairs Medical Center, Durham, NC, USA; VA Mid-Atlantic Mental Illness Research, Education and Clinical Center, Durham, NC, USA; Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, USA.
authors.forename: Nathan A
authors.initials: NA
authors.lastname: Kimbrel
authors.affiliation: Department of Psychology, Florida State University, Tallahassee, FL, USA.
authors.forename: Thomas E
authors.initials: TE
authors.lastname: Joiner
mesh_terms: D000293:Adolescent; D000328:Adult; D000428:Alcohol Drinking / Q000523:psychology; D000704:Analysis of Variance; D003863:Depression / Q000523:psychology; D005260:Female; D061388:Firefighters / Q000523:psychology*; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006801:Humans; D016015:Logistic Models; D008297:Male; D008605:Mental Health Services / Q000706:statistics & numerical data*; D008875:Middle Aged; D009784:Occupational Diseases / Q000523:psychology*; D013313:Stress Disorders, Post-Traumatic / Q000523:psychology; D059020:Suicidal Ideation; D014481:United States; D014838:Volunteers / Q000523:psychology*; D055815:Young Adult
keywords: Firefighter; Mental health service use; Psychiatric symptoms