Counting the Cost:
Psychological Distress in Career and Auxiliary Firefighters
A consistent finding in the trauma literature is that firefighters are exposed to psychological distress as a result of attending traumatic events. However, few studies have examined this finding in terms of the subgroups that exist in the firefighting population. This study compared the degree of psychological distress reported by career and auxiliary firefighters. Self-report questionnaires, including measures of traumatic incident exposure, general psychological distress (General Health Questionnaire 28) and symptomatic responses to traumatic stressors (Impact of Events Scale Revised), were completed by 75 career and 67 auxiliary Australian firefighters. Career firefighters reported more psychological distress than auxiliary firefighters, with length of firefighter service being associated with the difference in psychological distress reported by the two types of firefighters. The results support the literature linking length of firefighting service with psychological distress. However, a caveat was placed on inferring causal relationships between length of service only and psychological distress.
Counting the Cost:
Psychological Distress in Career and Auxiliary Firefighters
There is an increased awareness in the community and in the academic literature of the psychological distress that may result from repeated exposure to traumatic events experienced as part of a person's every day work (Klein & Alexander, 2000; Wagner, Heinrichs, & Eklert, 1998). Psychological distress includes symptoms ranging from posttraumatic stress disorder and depression (Ursano, Fullerton, Tzu-Cheg Kao, & Bhartiya, 1995), and discontinuity in memory, perception or identity (Koopman, Classen, & Spiegel, 1994) to emotional exhaustion, and low personal accomplishment (Klein & Alexander, 2000). There is growing acceptance that firefighters often need assistance to cope with the consequences of their occupations (Firelife, 2000). The literature has also focused increasing attention on the development of posttraumatic stress in firefighters following a callout to a disaster (Figley, 1995; Mitchell & Dyregov, 1993) and in determining the predictors of traumatic reactions in firefighters (Marmar et al., 1999; Regehr & Glancy, 2000; Weiss, Marmar, Metzler & Ronfeldt, 1995).
The understanding of how firefighters respond to psychological distress and the precise nature of the interaction between event-related and response-related factors (Bryant & Harvey, 1995) is still evolving, as is the understanding of the relationship between the psychological distress experienced by firefighters and occupational stress (Thompson, 2000). The high occurrence of PTSD one in five (Wagner, Heinrichs, & Eklert, 1998), and other psychiatric symptoms in firefighters (Regehr, Hill, & Glancy, 2000), further emphasizes the need to understand the consequences and costs of the work of firefighters. Few studies (Bryant & Harvey, 1996; Ursano, Fullerton, Tsu-Cheg Kao, & Bhartiya, 1995) have differentiated between two major subgroups of firefighters career and auxiliary firefighters and investigated the consequences of firefighting duties for each of these subgroups. This study compared the incidence of psychological distress in career and auxiliary firefighters.
The work of firefighters
Emergency services workers, including firefighters, who repeatedly attend traumatic events are constantly exposed to both the stress of the traumatic event and the stress of helping the victims (Fullerton, McCarroll, Ursano & Wright, 1992; Hytten & Hasle, 1989; Raphael, 1986). This experience can overwhelm the ordinary systems of care that give firefighters a sense of control, connection and meaning in their life (Herman, 1992). Firefighters often have higher levels of exposure than civilian victims to traumatic events and are therefore at higher risk of developing Post Traumatic Stress Disorder (PTSD) and other posttrauma psychological difficulties (Weiss, et al., 1995).
Firefighters and psychological distress
The literature reports a variety of findings concerning the prevalence of a PTSD diagnosis and the longitudinal presence of PTSD symptoms in firefighters after exposure to traumatic events. Studies indicate that emergency services workers, including firefighters, are at risk of developing health problems, chronic symptomatic distress, anxiety, insomnia and work-related PTSD (Raphael, 1986; Ersland, Weisaeth & Sund, 1989; Marmar et al., 1999; Thompson, 2000; McFarlane, 1986). In a German study of 402 professional firefighters, Wagner, Heinrichs and Eklert (1998) found a prevalence rate of 18.2 percent for those with PTSD symptoms. By comparison, in a study of treatment-seeking populations (non-emergency services), Brom, Kebler and Hofman (1993) found that PTSD accounted for ten percent of a traumatized population. In contrast, Helzer, Robins and McEvoy (1987) found that PTSD had a prevalence rate of 1 percent in the general United States population.
Firefighters experience repeated exposure to traumatic events as part of the operational demands of their work. This repeated exposure may increase their risk of developing post traumatic stress disorders (Fullerton, et al., 1992). The above comparisons of the occurrence of PTSD, and PTSD symptoms in non-emergency services populations and firefighters, indicates that firefighters have a significantly greater risk, than the general population, of developing PTSD at a clinical or sub-clinical level.
In seeking to understand the effects of exposure to trauma, the literature initially focused on primary traumatic stress, which related to the experience of traumatic events by a direct victim (Bryant & Harvey, 2000; Ursano, Fullerton, Tzu-Cheg Kao & Bhartiya, 1995). However, it is now recognized that firefighters, who are exposed to both the trauma of the event and the suffering of the victims, may themselves become victims of disasters. Secondary traumatic stress is an experience of trauma that comes from behaviours and emotions resulting from helping or wanting to help a suffering person (Figley, 1995). Incidents such as catastrophic injury to a co-worker, gruesome victim incidents, aiding seriously injured victims of a disaster, vulnerable victims, and exposure to death and dying, have been rated by firefighters as being the most stressful (Beaton, Murphy, Johnson, Pike & Corneil, 1998). The literature has now established that firefighters, whose occupation demands that they repeatedly place themselves in harm's way, are more at risk than the general population, of psychological distress from exposure to traumatic events themselves and from the risks of secondary trauma inherent in assisting the victims of traumatic events.
Positive outcomes of trauma
It is also important to remember that incidents of PTSD and other potentially negative impacts of work-related trauma, are not the only possible post-trauma outcomes. For example, resilience literature has examined factors proposed to mitigate long-term negative consequences of trauma (e.g., Bartone, 2000; Flach, 1990) and recently, psychological researchers have started to systematically examine positive post-trauma changes (e.g., Affleck & Tennen, 1996; Carver, 1998; Tedeschi, Park, & Calhoun, 1998). However, in the study reported herein, it is the negative consequences of experiencing a trauma while fulfilling the role of firefighter, that is of paramount concern.
Differences in the firefighter population
There are two immediately apparent subgroups in the Australian firefighter population: career full-time fighters and auxiliary part-time firefighters. Career firefighters are full-time firefighters who have rostered shifts on duty and definite times when they are off duty. While on duty, they continually train and practise their skills. After callouts, they return to their station and usually have the opportunity to debrief immediately. Auxiliary firefighters are part-time firefighters who are on-call to respond to requests for assistance from the public, or to act as backup for other stations. They are rarely not on-call and so have less of a sense of being off duty. They usually train once a week, and after callouts, return to their occupations or homes. Debriefing of a callout for auxiliary firefighters may have to wait until the next training night when the whole crew is gathered together. There are differences between career and auxiliary firefighters, in terms of amount of training, opportunity to develop depth of social support, experience that facilitates confidence in skills, and the sense of when they are on duty and when they are not (Firefighters, personal communications, May, 2001).
Firefighters do not have a uniform experience of frequency of callouts and similar intensity of events (Bowman, 1999; Paton & Smith, 1996). Firefighters from metropolitan stations may have a different workload from firefighters in regional and rural areas. Metropolitan stations have more frequent callouts, and in the vast majority of events, firefighters work with victims who are not known to them. However, regional and rural firefighters may have a smaller callout frequency, but instead have an increased chance of working with victims who are known to them. Auxiliary firefighters with access to prompt support from other career and auxiliary stations have a different experience in attending callouts, from those in more remote auxiliary stations where assistance takes several hours to arrive.
Firefighters also differ across other factors of relevance to an understanding of the degree of psychological distress they experience. Career firefighters may hold second jobs because of the amount of off-duty time, while auxiliary firefighters may have stressful occupations, for example, nurses and ambulance officers, so both might be vulnerable to differences in stress from their second job (Murphy, Beaton, Pike & Cain, 1994). Firefighters may also differ in the amount of traumatic stress experienced in their lives due to previous occupations and experiences, for example, military service. Moreover, Beaton, Murphy, Johnson, Pike and Corneil (1999) have commented that career firefighters may have more preparatory training and exposure to traumatic incidents than auxiliary firefighters. This training and experience may influence the degree of psychological distress experienced by career firefighters. These perceived differences in workload, the possibility of knowing victims, differing support, callout intensity, second job stress, previous traumatic experiences and training, create different event-related and individual response-related factors that may influence how firefighters, in these different situations, respond to traumatic events.
Initially, the population of firefighters was investigated as if it was an undifferentiated, homogeneous group. However, Mitchell and Dyregrov (1993) observed that emergency services workers, including firefighters, who were pressed into service in times of crisis, were more seriously affected by the events than those who regularly attended such events. Ursano, Fullerton, Tzu-Cheg Kao and Bhartiya (1995) distinguished between the effects of disasters on volunteers working with members of their own community and professionals not related to the disaster community. In a study of exposure of professional firefighters to duty related incident stressors, Beaton et al. (1998) suggested that the findings related to professional firefighters could not be generalised to volunteer firefighters. In a later study, Beaton, Murphy, Johnson, Pike and Corneil (1999) enlarged on this distinction by commenting that volunteer firefighters lacked the training and experience of the full-time firefighters.
All firefighters are at risk of experiencing psychological distress as a result of their occupation. However, Australian firefighters are not a uniform population since they consist of two major subgroups career (full-time) and auxiliary (part-time, volunteer) firefighters. Since individual firefighters experience differing amounts of psychological distress, the two major subgroups may also differ in their experience of psychological distress. The purpose of this study is to investigate the differences between career and auxiliary firefighters. In particular, do career and auxiliary firefighters differ in their experience of psychological distress as a result of their membership of the two major subgroups?
The sample consisted of 75 career firefighters (52.8%) and 67 auxiliary firefighters (47.2%) from the Queensland Fire and Rescue Authority. Career firefighters consisted of 73 males and 2 females and auxiliary firefighters consisted of 62 males and 5 females. Six career fighters (8%) were single, 67 (89.3%) were in a relationship, and 2 (2.7%) were separated. Sixteen auxiliary firefighters (23.9%) were single, and 51 (76.1%) were in a relationship. Both career and auxiliary firefighters belonged to a non metropolitian region that services a major holiday destination, a number of regional centres, small to medium towns and extensive rural areas.
The study used a survey design which consisted of three sections - a demographic survey, the General Health Questionnaire (GHQ-28; Goldberg & Hillier, 1979), and the Impact of Events Scale-Revised (Weiss & Marmar, 1997). Baum et al. (1993) criticised the design of new questionnaires for each study in early trauma research because this methodology did not contribute to the understanding of the consequences of attending traumatic events. They recommended using standardised measures to facilitate consistency in assessing traumatic outcomes, including the use of the Impact of Events Scale (IES) as a subjective measure of psychological symptoms. The IES is the most widely used global self-report instrument for the assessment of posttraumatic stress reactions (Joseph, 2000). McFarlane (1992) recommended the use of the General Health Questionnaire as a valid and sensitive measure of psychiatric impairment in Australian firefighters, as well as in other Australian populations (Henderson, Byrne, & Duncan-Jones, 1981; Tennant, 1977).
Section 1 of the survey collected information about each participant's age, gender, relationship status, rank and length of service and the number of traumatic events they had experienced as a firefighter in the previous twelve months. In addition to providing information about their past and present non-firefighting occupations in Section 1, participants also listed the number of traumatic events experienced as part of these occupations. Traumatic events were defined as the five duty-related incident stressors described by Beaton, et al. (1998).
General Health Questionnaire
Section 2 of the survey collected information about the participants' general psychological distress with the 28-item version of the GHQ. The GHQ-28 was scored using the GHQ method (0-0-1-1) to both index the "caseness of psychological distress and to be consistent with its usage with previous Australian populations (Bryant & Harvey, 1996; Henderson, Byrne & Duncan-Jones, 1981). Following the suggested default threshold scores (Goldberg, Gater, Sartorius, & Ustun, 1997; Goldberg & Williams, 1991), no distress was indicated by a score of 3 or less, mild distress was indicated by scores from 4 to 6, and severe distress indicated by scores greater than 6.
Impact of Events Scale Revised
Section 3 of the survey collected information about participants' symptomatic responses to traumatic stressors with the IES-R. This revised version, with the hyperarousal subscale added to the intrusion and avoidance subscales, related more accurately to the diagnostic criteria for PTSD in the DSM-IV. The original Impact of Events Scale (IES) has demonstrated its validity through a number of studies (Hendrix, Juich & Schumm, 1994) and has been widely used in studying the effects of traumatic events (Fullerton, McCarroll, Ursano, & Wright, 1992; Koopman, Classen, & Spiegel, 1994).
In order to maintain comparability with the original version of the measure, the IES-R used in this survey maintained the one week time frame in the instructions for measuring symptomatic response and was scored with the original values of 0, 1, 3, and 5 for the responses "not at all", "rarely", "sometimes", and "often". Previous Australian research (Bryant & Harvey, 1996; Creamer, Burgess, & Pattison, 1992) used scores of greater than 19 and greater than 29 as indicative of significant and extreme posttraumatic stress, respectively, on the 15-item IES. As this categorisation, and that used originally by Horowitz (1982), do not represent a clinical diagnosis and are arbitrary (Joseph, 2000), threshold scores, proportionally extrapolated from those of the IES, greater than 28 and greater than 43 have been used in this study to indicate significant and extreme posttraumatic stress respectively, as measured by the 22-item IES-R.
Permission to access employees of an Australian Fire and Rescue Authority as participants in the survey was obtained. A brief description of the study was sent to career and auxiliary firestations in the Region. The author requested voluntary participation in the survey by career and auxiliary firefighters. One hundred and eighty-two surveys were distributed by station visits or by mail, to seven fire stations crewed by career firefighters and twelve fire stations crewed by auxiliary firefighters. Distribution of career and auxiliary firefighters in the sample was proportionate to the distribution of career and auxiliary firefighters.
At the stations visited, the researcher explained the rationale of the survey and clarified the instructions on the survey forms before potential participants were asked to sign consent forms and complete the survey. Mailed surveys were administered by the Officer-in-Charge of the station in accordance with written instructions.
One hundred and forty-three surveys (a 79 % response rate) were returned. There was a 100 percent response rate for surveys completed during visits to stations, but only a little more than half this response rate (58 percent) for surveys completed and returned by mail. One participant's results were excluded due to his obtaining scores that were outliers on both tests. Ten cases contained random missing data, which were replaced by the sample means from the respective firefighter type. Because of the scoring method used to index caseness on the GHQ-28 (0, 0, 1, 1), and the nature of the sample surveyed, the sample presented with a high degree of positive kurtosis (>3.5) and positive skewness. To reduce the skewness and kurtosis of the data, raw scores on the GHQ-28 were transformed into ranges indicated by the caseness thresholds suggested by the literature, that is, scores 0 to 3 became 1, scores 4 to 6 became 2 and scores greater than 6 became 3.
Career and auxiliary firefighters differed in terms of years of experience as a firefighter, (t (140) = 6.01, p = .000). Career firefighters reported significantly more firefighting years of experience (M = 15.85, SD = 8.58) than did auxiliary firefighters (M = 7.86, SD = 6.95). Career and auxiliary firefighters also differed significantly with respect to age, (t (140) = 2.61, p <.05). Career firefighters were older (M = 40.75, SD = 8.95) than auxiliary firefighters (M = 36.48, SD = 10.51).
The work of firefighters
Most firefighters (129: 90.8 %) reported attending between 0 and 30 traumatic events in the past twelve months while on duty as a firefighter. Career and auxiliary firefighters differed significantly in terms of the number of traumatic events attended while on duty (t = (140) = 2.63, p < .05) as a firefighter and in the number of traumatic events attended while not on duty as a firefighter (t = (140) = 3.54, p < .01). Career firefighters (M = 15, SD = 15.92) experienced more traumatic events on firefighting duty than auxiliary firefighters (M = 8.88, SD = 11.0). Alternatively, career firefighters (M = 1.27, SD = 2.21) experienced less traumatic events while off duty than auxiliary firefighters (M = 15.84, SD = 35.58).
Firefighters and psychological distress
Using the threshold scores adopted for the GHQ-28, 108 firefighters (76 percent) reported no distress, 16 firefighters (11.3 percent) reported mild distress, and 18 firefighters (12.7 percent) reported severe distress. Table 1 presents the frequency of degree of distress in career and auxiliary firefighters.
Table 1: Frequency of Degree of Distress Reported by GHQ-28 Scores (N = 142)
|No distress||51 (68%)||57 (85.1%)|
|Mild distress||11 (14.7%)||5 (7.5%)|
|Severe distress||13 (17.3)||5 (7.5%)|
Scores on the IES-R indicated that 9.3 percent of career firefighters and 4.5 percent of auxiliary firefighters experienced significant posttraumatic stress. Similarly 13.3 percent of career firefighters and 4.5 percent of auxiliary firefighters experienced extreme posttraumatic stress.
Differences in the firefighting population
A one-way multivariate analyses of variance (MANOVA) was conducted to determine the effect of membership of the two types of firefighters on the two dependent variables, IES-R and GHQ-28 scores. Significant differences were found between the two types of firefighters on the dependent measures, Wilks' Lambda = .94, F(2.139) = 4.79, p <.05. However, the multivariate eta squared indicated that only 6 percent of the multivariate variance of scores on the GHQ-28 and IES-R was associated with being an auxiliary or career firefighter. Post hoc pairwise comparisons, using a Bonferroni adjusted probability rate (p < .013) that allowed for two dependent variables, found that career firefighters scored significantly higher on the IES-R than auxiliary firefighters (p =.008). There was no significant result for type of firefighter and score on the GHQ-28 (p = .021).
When the original MANOVA was conducted with years of experience as a firefighter as a covariate, the original result was modified significantly (Wilks' Lambda = .96, F (2,138) = 2.69, p > .05). Similar analyses with age, number of traumatic events experienced on firefighting duty, and number of traumatic events experienced while not on firefighting duties (the other variables on which career and auxiliary firefighters differed), as separate covariates, produced no change to the original result. A MANOVA, with career and auxiliary firefighters, matched for years of firefighting experience (n = 56), was then conducted to determine the effect of type of firefighter, on IES-R and GHQ-28 scores and indicated no significant effects (p = .72).
Differences in the firefighter population
This study found that career firefighters reported significantly more symptoms of psychological distress, as reported by scores on the IES-R and GHQ-28, than did auxiliary firefighters. However, this difference in reported psychological distress between the two groups of firefighters was not strong. In the previous 12 months, career firefighters attended more traumatic events as part of their firefighting duties than did auxiliary firefighters, while auxiliary firefighters reported experiencing more traumatic events when not on firefighting duty, than did career firefighters. The two groups of firefighters also differed with respect to age, number of traumatic events in the past 12 months experienced on firefighting duty, number of traumatic events while not on firefighting duty and number of years of experience as a firefighter. Of these differences, only the number of years of experience as a firefighter significantly affected the reported symptoms of psychological distress. This is consistent with reports that length of service is associated with the severity and chronicity of adverse emotional reactions (Moran & Britton, 1994), with the occurrence of PTSD symptoms (Wagner, Heinrichs, & Eklert, 1998) and with burnout in firefighters (Murphy, Beaton, Pike & Cain, 1994).
Firefighters and psychological distress
The estimates of the prevalence of psychological distress in firefighters in this study were consistent with previous reports in the literature (Bryant & Harvey, 1996; Thompson, 2000) but potentially were conservative for two reasons. It could be assumed that a percentage of firefighters, with significant levels of occupational stress, would have already retired from the service (See Beaton et al., 1999; Klein & Alexander, 2000). In addition, this study excluded, on ethical grounds, firefighters who had been diagnosed with, or who were being assessed for PTSD, and firefighters who had a history of psychiatric illness.
It is acknowledged that, in this study, not all the psychological distress reported by firefighters can be attributed to firefighting duties as more than half of the sample experienced traumatic events outside their firefighting duties. Similar results have been reported in the literature (Thompson, 2000). While the amount of psychological distress evident in this sample was consistent with that reported in the literature, the complexity of the relationship between psychological distress, the attendance at traumatic events, length of firefighter service and occupational stress (the interaction between event related and response related factors) precludes the deduction of a simple causal relationship between psychological distress in firefighters and attending traumatic events while on firefighting duty.
Relationship between attending traumatic events and psychological
Age, length of firefighting experience, and the number of traumatic events experienced, either during firefighting duties or outside of firefighting duties, may all influence the experiencing of events which are construed as traumatic. However, as age and length of firefighting experience increase, so too does the number of experienced traumatic events. This similarity muddied the relationship between these variables and the difference in psychological distress reported by career and auxiliary firefighters. While the literature reports an association between the number of traumatic events and the development of psychological distress (Bryant & Harvey, 1996), and an association between level of exposure to traumatic events and subsequent psychological distress (Marmar et al., 1999; Weiss, Marmar, Metzler, & Ronfeldt, 1995), it also indicates that age and length of firefighting experience may be a protective factor (Deahl, Gillman, Thomas, Searle & Srinivasan, 1994; Hytten & Hasle, 1989) and a risk factor for PTSD (Corneil, 1995).
As years of experience as a firefighter increases, so too does the number of traumatic events attended. Since only six percent of the differences in psychological distress reported in this study was associated with the variables on which the firefighter groups differed, and the variable that had the most significant effect was length of firefighter experience, this study would indicate that the number of traumatic events attended does not by itself influence the amount of psychological distress reported. It would seem that the number of traumatic events attended may be different from an individual firefighter's level of exposure to these events (again the interaction between event related and response related factors), as only 24 percent of firefighters who experienced traumatic events in this study, reported psychological distress.
However, the literature reports the importance of the cumulative nature of firefighter experience (Mitchell & Bray, 1990) and other influences such as home and personal issues (see Moran & Colless, 1995. So it would seem that the length of firefighting experience, as reported in this study, might be one vehicle by which firefighters accumulate a background level of stress that they take to the experience of firefighting events. This background level of stress may then influence the perception of these firefighting events as traumatic events. It appears that it is this exposure, that is determined by the interaction between the length of experience and the number of traumatic events attended, which may determine the degree of psychological distress.
This study was unable to determine if career and auxiliary firefighters reported different degrees of psychological distress by virtue of being a career firefighter as opposed to an auxiliary firefighter. It was not the career or auxiliary nature of the firefighter that determined the amount of psychological distress reported. Instead, it seemed that psychological distress from the attendance at traumatic events, resulted from a complex interaction of variables such as age, the number of firefighting and non-firefighting traumatic events attended, and length of firefighting service.
This study has indicated that firefighters' reactions to traumatic events and the subsequent development of distress, both psychological and occupational, is due to a complex interaction of variables. This complexity has highlighted some methodological issues. Both the GHQ-28 and the IES-R used to measure psychological distress, were self-report instruments and thus were vulnerable to retrospective distortion by participants. In addition, this study also raises some questions about the use of the GHQ-28 to measure trauma-related responses, since this instrument was unable to distinguish between the general psychological distress of career and auxiliary firefighters, while IES-R scores indicated that career firefighters reported significantly more psychological distress than auxiliary firefighters. As reported elsewhere (Bryant & Harvey, 1995), this may have occurred because the GHQ-28 does not specifically focus on trauma-related responses and participants may have responded to the instrument in terms of their general mental health rather than as a comparison of their present and pre-trauma condition.
The use of the word traumatic in the survey was open to subjective perceptions of what constitutes a traumatic event. Despite the use of examples of traumatic events from the literature, participants' responses and comments made by participants during the completion of the survey, demonstrated the use of a variety of meanings for the term traumatic. For example, for one person traumatic meant the presence of blood, for another, traumatic was defined by their reaction to the event.
The firefighter culture may have also affected how participants responded to the survey since to admit that an event was traumatic may have been understood by participants as evidence of weakness and this might have influenced the degree of disclosure by participants. (The culture may have also determined whether an individual participant took part in the study.)
Anecdotal evidence may verify if auxiliary firefighters might experience some anxiety about the lack of boundaries around their firefighting duties - they have no definite shift hours and are, virtually, permanently on call. It is recommended that further research examine this issue to further the understanding of the development of occupational stress in auxiliary firefighters. Anecdotal evidence also indicated that the location of auxiliary fire stations with respect to their proximity to major highway systems, and the potential for a high frequency of attendance at motor vehicle accidents, and their distance from timely backup from other career and auxiliary stations could also be determinants of occupational stress. Such evidence would suggest that future research investigate these potential determinants of occupational stress.
Between 16 percent and 24 percent of firefighters in this study reported experiencing psychological distress, with career firefighters reporting more psychological distress than auxiliary firefighters. More years of firefighting experience was associated with the degree of psychological distress reported, but there was a great degree of overlap with this variable and the number of traumatic events attended. A caveat was expressed about inferring causal relationships between length of service only and psychological distress, since only 24% of firefighters who experienced traumatic events reported psychological distress. The interaction between length of firefighting experience, level of background stress, and the number of traumatic events experienced was seen to facilitate exposure to traumatic events, with the subsequent potential for the development of psychological distress in firefighters.
Psychological distress, reported by firefighters, was seen to be influenced by attendance at traumatic events as part of their firefighting duties, traumatic events attended while not on duty as a firefighter, military experience and home related stresses. Career firefighters reported significantly more symptoms of psychological distress than did auxiliary firefighters and the reporting of this distress was influenced by the number of years of experience as a firefighter. An implication of this study is that long serving career firefighters may be an at risk group and should be monitored for signs for developing psychological distress.
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