Childhood care and abuse in firefighters assessed for mental ill-health following the Fort McMurray fire of May 2016.

Abstract

• All of the firefighters reporting sexual abuse had at least one mental disorder. • A same-age childhood confidant was protective for anxiety, depression and PTSD. • Parents’ use of physical punishment related to substance use disorders and PTSD. • PTSD related to both childhood experiences and events during and since the fire. • Treatment of mental disorders in firefighters should address this complex etiology. We aimed to determine the relationship between childhood abuse and mental ill-health in firefighters deployed to a devastating fire that engulfed Fort McMurray A stratified sample of 282 firefighters was selected from a cohort of 1234 for assessment by Structured Clinical Interview (SCID) for DSM-5 diagnostic criteria and the Childhood Experience of Care and Abuse questionnaire (CECA-Q). Diagnoses were grouped as post-traumatic stress disorder (PTSD), anxiety disorders, depressive disorders and substance use disorders. Scales extracted from the CECA-Q included parental loss, antipathy, neglect, physical punishment, sexual abuse and support from a same-age confidant. The relation to diagnostic group was examined by multivariable logistic regression 192 SCID interviews and 188 CECA-Qs were completed: 124 met DSM-5 criteria for diagnoses including anxiety disorder (56), depressive disorder (54), PTSD (77) and substance use disorder (43). Childhood sexual abuse was reported by 24 firefighters all of whom met DSM-5 diagnostic criteria. Sexual abuse and a childhood confidant differentiated diagnoses in an initial multivariable model of those with psychiatric disorders. Compared to those without a psychiatric diagnosis, father's antipathy was related to anxiety and substance use, physical punishment to PTSD and substance use. A childhood same-age confidant protected against anxiety, depression and PTSD. Fire exposures related only to PTSD. The comparison group without mental disorders was small. Childhood abuse information was collected retrospectively and may be biased by current state. Firefighters’ mental health is a function of both work-role traumas and childhood events. Occupational health provision must address this complexity.