Stress and psychopathology in emergency medical services providers
Creators: name: Feldman, Avtalya Rose
Publisher: name: The University of Texas at Austin
Year: 2023
Subjects: First responders
EMS
Trauma
Stress

description: Emergency first responders are exposed to highly stressful and often traumatic events at frequencies far beyond that of almost any other occupation and experience elevated rates of stress-linked psychopathology. Despite these elevated rates of psychopathology, this population remains critically understudied, and our understanding of what factors allow some to exhibit resilience, while others develop symptoms of distress, remains limited. The overarching aim of this dissertation is to further our understanding of the factors that both protect from and contribute to the development of psychopathology in this population. In our first study, we longitudinally examined psychosocial predictors of posttraumatic stress disorder (PTSD), depression, and anxiety symptoms in first responders. Results revealed that a) increases in PTSD symptoms, b) increases in depression symptoms, and c) increases in anxiety symptoms at 3-month follow-up were each predicted by worse sleep and lower social support at baseline. In particular, the sleep subscale of disturbed sleep and the social support subscale of appraisal appeared to be driving these effects. Our second study examined the effect of objectively measured, emergency response incidents on PTSD symptoms in new versus experienced first responders. Results revealed that time on the job significantly moderated the relationship between emergency incidents and PTSD symptoms. Specifically, in first-year EMS providers, there was a positive relationship between number of incidents and PTSD symptoms, whereas in more senior EMS providers, calls did not significantly predict symptoms of PTSD. These results provide evidence of a linear relationship between objective counts of emergency incidents and PTSD symptoms. The fact that this relationship exists uniquely in new first responders has important clinical implications for prevention efforts in this population. In our third study, we sought to examine qualitative, linguistic responses in this population. First responders were asked to describe recent positive and negative occurrences in their lives, as well as asked why they became first responders. We utilized the Linguistic Inquiry and Word Count (LIWC) software program to analyze these responses and their relationship to quantitative measures of depression, PTSD, and anxiety symptoms. Due, likely, to small sample size and the necessity of combining all prompts, our results were inconsistent and difficult to generalize. On the one hand, we found evidence suggesting that greater use of risk related words and negative emotion words are predictive of symptoms of psychopathology. This finding extends previous research and may serve as a useful starting point for future linguistic analysis in this population. On the other hand, we found a number of results that were inconsistent with previous research and existing theoretical frameworks. These inconsistencies call into question our ability to make valid, real-world interpretations from this linguistic dataset. Future directions based on lessons learned from this project are discussed. Our hope is that this body of research contributes important information to our understanding of risk in first responders and sets the stage for future interventions in this important population.