Firefighters, posttraumatic stress disorder, and barriers to treatment: Results from a nationwide total population survey

PLOS ONE, Nov 2019

Repeated exposure to traumatic experiences may put professional firefighters at increased risk of developing posttraumatic stress disorder (PTSD). To date, however, the rate of PTSD symptoms, unmet need for mental health treatment, and barriers to treatment have only been investigated in subsamples rather than the total population of firefighters. We conducted a nationwide, total population-based survey of all currently employed South Korean firefighters (n = 39,562). The overall response rate was 93.8% (n = 37,093), with 68.0% (n = 26,887) complete responses for all variables. The rate of current probable PTSD was estimated as 5.4%. Among those with current probable PTSD (n = 1,995), only a small proportion (9.7%) had received mental health treatment during the past month. For those who had not received treatment, perceived barriers of accessibility to treatment (29.3%) and concerns about potential stigma (33.8%) were reasons for not receiving treatment. Although those with higher PTSD symptom severity and functional impairment were more likely to seek treatment, greater symptom severity and functional impairment were most strongly associated with increased concerns about potential stigma. This nationwide study points to the need for new approaches to promote access to mental health treatment in professional firefighters.

A PDF file should load here. If you do not see its contents the file may be temporarily unavailable at the journal website or you do not have a PDF plug-in installed and enabled in your browser.

Alternatively, you can download the file locally and open with any standalone PDF reader:

https://journals.plos.org/plosone/article/file?id=10.1371/journal.pone.0190630&type=printable

Firefighters, posttraumatic stress disorder, and barriers to treatment: Results from a nationwide total population survey

January Firefighters, posttraumatic stress disorder, and barriers to treatment: Results from a nationwide total population survey Jieun E. Kim 0 1 2 Stephen R. Dager 0 2 Hyeonseok S. Jeong 0 2 Jiyoung Ma 0 1 2 Shinwon Park 0 1 2 Jungyoon Kim 0 1 2 Yera Choi 0 1 2 Suji L. Lee 0 1 2 Ilhyang Kang 0 1 2 Eunji Ha 0 1 2 Han Byul Cho 0 2 Sunho Lee 0 1 2 Eui-Jung Kim 0 2 Sujung Yoon 0 1 2 In Kyoon Lyoo 0 1 2 0 Current address: Ewha Brain Institute, Ewha Womans University , Seoul , South Korea 1 Ewha Brain Institute, Ewha Womans University , Seoul , South Korea , 2 Department of Brain and Cognitive Sciences, Ewha Womans University , Seoul , South Korea , 3 Department of Radiology, University of Washington, Seattle, Washington, United States of America, 4 Department of Bioengineering, University of Washington, Seattle, Washington, United States of America, 5 Department of Radiology, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea , Seoul , South Korea , 6 Department of Psychiatry, University of Utah, Salt Lake City, Utah, United States of America, 7 Department of Psychiatry, Ewha Womans University , Seoul , South Korea 2 Editor: Soraya Seedat, Stellenbosch University , SOUTH AFRICA Repeated exposure to traumatic experiences may put professional firefighters at increased risk of developing posttraumatic stress disorder (PTSD). To date, however, the rate of PTSD symptoms, unmet need for mental health treatment, and barriers to treatment have only been investigated in subsamples rather than the total population of firefighters. We conducted a nationwide, total population-based survey of all currently employed South Korean firefighters (n = 39,562). The overall response rate was 93.8% (n = 37,093), with 68.0% (n = 26,887) complete responses for all variables. The rate of current probable PTSD was estimated as 5.4%. Among those with current probable PTSD (n = 1,995), only a small proportion (9.7%) had received mental health treatment during the past month. For those who had not received treatment, perceived barriers of accessibility to treatment (29.3%) and concerns about potential stigma (33.8%) were reasons for not receiving treatment. Although those with higher PTSD symptom severity and functional impairment were more likely to seek treatment, greater symptom severity and functional impairment were most strongly associated with increased concerns about potential stigma. This nationwide study points to the need for new approaches to promote access to mental health treatment in professional firefighters. - Data Availability Statement: All relevant data are within the paper and its Supporting Information files. Funding: This study was partly supported by the Field-oriented Support of Fire Fighting Technology Research and Development Program funded by the National Fire Agency (MPSS-Fire Fighting Safety2016-86); and by the Korean Ministry of Health and Welfare (A121080). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. Introduction Professional firefighters respond to a variety of life-threatening perils [1] in their efforts to provide essential community services. Therefore, they are frequently exposed to traumatic events and have an increased risk for developing posttraumatic stress disorder (PTSD) [2, 3]. Previously, there have been studies that examined PTSD prevalence in firefighters who had been exposed to traumatic incidents [1, 4±7] and other studies that examined it in a subpopulation of firefighters without reference to an index trauma[3, 8]. However, as far as we know, no study has assessed the nationwide and total population of professional firefighters in regards to probable PTSD rates and status quo of receiving mental treatment. Therefore, large-scale and total population-based studies are required in this high-risk population. Over the last few decades, there has been rapid and substantial progress in developing evidence-based treatments of PTSD that employ a variety of pharmacological, psychotherapeutic, and behavioral interventions [9, 10]. These interventions provide clinicians with diverse and efficacious treatment approaches for this potentially debilitating disorder. Treatment intervention has been shown to be a critical predictor of the illness course [11]. Despite the importance and availability of effective treatments, their actual delivery to affected individuals suffering from symptoms of PTSD may be suboptimal. Unmet treatment needs and contributing factors have been reported for war veterans [12, 13], community-based general population [14, 15], and first responders who were involved in the aftermath of the World Trade Center terrorist attacks [5]. Symptom severity has been reported as a major factor that influences individuals to seek mental health treatment [ 5, 14, 16, 17 ]. However, even in the most severely affected individuals, mental health treatment needs may be unm (...truncated)


This is a preview of a remote PDF: https://journals.plos.org/plosone/article/file?id=10.1371/journal.pone.0190630&type=printable

Jieun E. Kim, Stephen R. Dager, Hyeonseok S. Jeong, Jiyoung Ma, Shinwon Park, Jungyoon Kim, Yera Choi, Suji L. Lee, Ilhyang Kang, Eunji Ha, Han Byul Cho, Sunho Lee, Eui-Jung Kim, Sujung Yoon, In Kyoon Lyoo. Firefighters, posttraumatic stress disorder, and barriers to treatment: Results from a nationwide total population survey, PLOS ONE, 2018, Volume 13, Issue 1, DOI: 10.1371/journal.pone.0190630