The mental health toll of service: an examination of self-reported impacts of public safety personnel careers in a treatment-seeking population

Recent Data Lead to Shift in PTSD Criteria

Public safety personnel (PSP), such as police officers, firefighters, correctional workers, and paramedics, routinely face work stressors that increase their risk of developing posttraumatic stress disorder (PTSD). PSP may additionally face moral transgressions in the workplace (e.g., witnessing human suffering, working within broken systems), heightening the risk of moral injury (MI) in this population. Research among military personnel and health care workers shows an association between MI and PTSD; however, less is known about the association between these constructs among PSP. Canadian PSP completed an online survey between June 2022 and June 2023, including a demographic questionnaire and measures of PTSD, MI, dissociation, depression, anxiety, stress, and childhood adversity. Latent variable structural equation modeling (SEM) was performed to ascertain the impact of a latent MI construct (i.e., shame, trust violation, functional impairment) on a latent PTSD construct (i.e., intrusions, avoidance, negative alterations in cognition and mood, hyperreactivity, depersonalization, derealization). Sex, age, depression, anxiety, stress, and childhood adversity were included as covariates. A total of 314 PSP were included in the data analysis. A latent variable SEM regressing PTSD onto MI and including covariates accounted for 83.7% of the variance in PTSD. MI was the strongest predictor compared to all covariates and was significantly associated with PTSD symptoms, β =.506, p <.001, above and beyond the impacts of sex, age, depression, anxiety, stress, and childhood adversity. These findings are consistent with research among military members and health care providers and highlight the importance of further exploring MI among PSP.

Social support may be a protective factor for the mental health of public safety personnel (PSP), who are frequently exposed to potentially psychologically traumatic events and report substantial post-traumatic stress disorder (PTSD) and major depressive disorder (MDD) symptoms. Research examining perceived social support and its association with PTSD and MDD in different PSP categories (e.g. firefighters, paramedics) is limited. To examine differences in perceived social support across PSP and determine whether perceived social support is associated with differences in rates of MDD and PTSD. We asked Canadian PSP, including correctional workers and officers, public safety communications officials, firefighters, paramedics, municipal and provincial police officers, and Royal Canadian Mounted Police (RCMP) officers, to complete an online anonymous survey that assessed socio-demographic information (e.g. occupation, sex, marital status, service years), social supports and symptoms of mental disorders, including PTSD and MDD. Analyses included ANOVA and logistic regression models. Perceived social support differed by PSP occupation. RCMP officers reported lower social support than all other PSP except paramedics. For most PSP categories, PSP who reported greater social support were less likely to screen positive for PTSD (adjusted odds ratios [AORs]: 0.90-0.93). Across all PSP categories, greater perceived social support was associated with a decreased likelihood of screening positive for MDD (AORs: 0.85-0.91). Perceived social support differs across some PSP categories and predicts PTSD and MDD diagnostic status. Studies involving diagnostic clinical interviews, longitudinal designs and social support interventions are needed to replicate and extend our results.

Public safety personnel (PSP) are individuals who work to ensure the safety and security of communities (eg, correctional workers, firefighters, paramedics, and police officers). PSP have a high risk of developing mental disorders and face unique barriers to traditional mental health treatments. The PSP Wellbeing Course is a transdiagnostic, internet-delivered cognitive behavioral therapy (iCBT) course tailored to assist PSP with symptoms of depression, anxiety, and posttraumatic stress disorder (PTSD). The initial course outcomes are promising, but some clients report some challenges with learning skills and recommend adding additional resources. Mindfulness meditations, which help people to experience the world and their reactions to the world in open and nonjudgmental ways, may complement the existing PSP Wellbeing Course. This study aims to examine the feasibility of mindfulness meditations in iCBT tailored for PSP. Information was gathered to evaluate engagement and client experiences with mindfulness meditations, symptom change, and the relationship between mindfulness meditation use and symptom change. A mixed methods study was conducted on PSP enrolled in the PSP Wellbeing Course who were offered 5 mindfulness meditations during the program (ie, 1/lesson). Clients completed questionnaires on depression, anxiety, PTSD, anger, insomnia, resilience, and mindfulness at pretreatment and at 8 weeks; an 8-week treatment satisfaction questionnaire; and brief weekly measures of mindfulness meditation engagement. We used paired sample t tests (2-tailed) to assess changes in outcomes over time and partial correlations to assess whether mindfulness meditation use predicted outcomes at posttreatment. A total of 12 clients were interviewed about their perceptions of the mindfulness meditations, and interviews were analyzed using directed content analysis. Among the 40 clients enrolled, 27 (68%) reported using the mindfulness meditations, practicing for an average of 4.8 (SD 8.1) minutes each week. Most interviewees described the mindfulness meditations as beneficial but also reported challenges, such as discomfort while sitting with their feelings. Clients provided suggestions for better integration of mindfulness into iCBT. Overall, clients who completed the PSP Wellbeing Course with mindfulness meditations experienced statistically significant improvements in symptoms of anxiety (P=.001), depression (P=.001), PTSD (P=.001), and anger (P=.001) but not insomnia (P=.02). Clients also experienced improvements in resilience (P=.01) and mindfulness (P=.001). Self-reported time spent meditating was not associated with changes in symptoms over time. This study provides new insight into the integration of mindfulness meditations with iCBT for PSP. It demonstrates the partial feasibility of adding mindfulness meditations to iCBT, revealing that some, but not all, PSP engaged with the meditations and reported benefits. PSP reported using the mindfulness meditations inconsistently and described challenges with the meditations. Improvements can be made to better integrate mindfulness meditation into iCBT, including offering mindfulness meditation as an optional resource, providing more psychoeducation on managing challenges, and offering shorter meditations.

Civilians in war may suffer from distress not only during the peritraumatic phase, manifested in early trauma-related symptoms, but also after the trauma ends, as reflected in posttraumatic stress disorder (PTSD). Evidence has suggested that early trauma-related symptoms underlie the development of PTSD. Additionally, research has revealed relations between sensory responsiveness and both early trauma-related symptoms and PTSD, thus implying that individuals with sensory modulation difficulties may exhibit elevated symptomatology at the peritraumatic phase and may be at risk for PTSD. Nevertheless, the cross-sectional design of former studies allowed neither identifying the directionality of the relationship between sensory modulation and PTSD nor exploring the role of early trauma-related symptoms within this relationship. The current prospective study, which was aimed at bridging these knowledge gaps, was conducted among a convenience sample of Israeli adults (n = 209) during rocket attacks (T1) and 40-71 days after ceasefire (T2). Background variables, sensory modulation difficulties, early trauma-related symptoms, and PTSD symptoms were assessed online via self-report measures. Results revealed that high sensory responsiveness was related to early trauma-related symptoms and predicted PTSD symptoms of hyperarousal, intrusion, and negative alterations in mood and cognitions. Moreover, early trauma-related symptomatology mediated the relations between high sensory responsiveness and PTSD symptoms of intrusion and negative alterations in mood and cognitions. The current findings suggest that high sensory responsiveness is a risk factor for PTSD and that early trauma-related symptomatology may serve as a mechanism underlying the relationship between high sensory responsiveness and PTSD. (PsycInfo Database Record (c) 2025 APA, all rights reserved).

This study assessed the moderating role of adversity beliefs in the association between post-traumatic stress symptoms (PTSSs) and internet addiction (IA) in adolescents over 9.5 years old in the period after the Wenchuan earthquake. We recruited a total of 776 middle-school students in the area hit by the earthquake. The students were asked to complete a negative life events scale, the DSM-5 PTSD checklist, the Chinese adversity beliefs scale, and the Chinese internet addiction scale. We found that PTSSs, including intrusive symptoms, negative alterations in mood and cognition symptoms (NAMC), and hyperarousal symptoms but not avoidance symptoms, had positive predictive effects on IA. Positive adversity beliefs had negative predictive effects on IA. A moderating effect analysis showed that positive adversity beliefs could buffer the influence of PTSSs’ negative alterations in mood and cognition symptoms on IA. However, positive adversity beliefs were not found to have a buffering role in the relationship between intrusive, avoidance, and hyperarousal PTSS symptoms and IA.

Public Safety Personnel (PSP) such as police officers, firefighters, and paramedics are at an increased risk of post-traumatic stress disorder (PTSD) due to frequent exposure to potentially psychologically traumatic events. Return-to-work trajectories can be challenging, as treatment programs are often not tailored to PSP, leading to long-term disability. To better support PSP, the work disability insurance authority in Ontario, Canada commissioned a mental health treatment program for PSP who receive benefits for a diagnosis of PTSD. Staff in this program received specialized training by a credible PSP organization (Wounded Warriors Canada) for working with PSP. We conducted a formative evaluation of this pilot program. Qualitative, semi-structured interviews were conducted with service providers (n = 11) and PSP clients who had completed the program (n = 19). The aim was to understand whether and how the program met client needs, how it could be improved, and how this could inform other mental health treatment programs for PSP. Using descriptive qualitative methods, we found that participants reflected positively on the program’s appropriateness, acceptability, and effectiveness. Credibility was a central concern across all three domains. Having a program that was exclusive to PSP allowed staff to tailor their treatment approach to unique PSP needs, which offered credibility as a PSP treatment program, and it made it possible for PSP to be in an environment where they felt safe.

Public Safety Personnel (PSP) such as police officers, firefighters, and paramedics are at an increased risk of post-traumatic stress disorder (PTSD) due to frequent exposure to potentially psychologically traumatic events. Return-to-work trajectories can be challenging, as treatment programs are often not tailored to PSP, leading to long-term disability. To better support PSP, the work disability insurance authority in Ontario, Canada commissioned a mental health treatment program for PSP who receive benefits for a diagnosis of PTSD. Staff in this program received specialized training by a credible PSP organization (Wounded Warriors Canada) for working with PSP. We conducted a formative evaluation of this pilot program. Qualitative, semi-structured interviews were conducted with service providers (n = 11) and PSP clients who had completed the program (n = 19). The aim was to understand whether and how the program met client needs, how it could be improved, and how this could inform other mental health treatment programs for PSP. Using descriptive qualitative methods, we found that participants reflected positively on the program's appropriateness, acceptability, and effectiveness. Credibility was a central concern across all three domains. Having a program that was exclusive to PSP allowed staff to tailor their treatment approach to unique PSP needs, which offered credibility as a PSP treatment program, and it made it possible for PSP to be in an environment where they felt safe.

Poor sleep quality is associated with numerous mental health concerns and poorer overall physical health. Sleep disturbances are commonly reported by public safety personnel (PSP) and may contribute to the risk of developing mental disorders or exacerbate mental disorder symptoms. The current investigation was designed to provide estimates of sleep disturbances among PSP and explore the relationship between sleep quality and mental health status. PSP completed screening measures for sleep quality and diverse mental disorders through an online survey. Respondents (5813) were grouped into six categories: communications officials, correctional workers, firefighters, paramedics, police officers, and Royal Canadian Mounted Police (RCMP). Many PSP in each category reported symptoms consistent with clinical insomnia (49–60%). Rates of sleep disturbances differed among PSP categories (p < 0.001, ω = 0.08). Sleep quality was correlated with screening measures for post-traumatic stress disorder (PTSD), depression, anxiety, social anxiety disorder, panic disorder, and alcohol use disorder for all PSP categories (r = 0.18–0.70, p < 0.001). PSP who screened positive for insomnia were 3.43–6.96 times more likely to screen positive for a mental disorder. All PSP reported varying degrees of sleep quality, with the lowest disturbances found among firefighters and municipal/provincial police. Sleep appears to be a potentially important factor for PSP mental health.

Public safety personnel (PSP; e.g., correctional workers, firefighters, paramedics, and police officers) are frequently exposed to potentially psychologically traumatic events (PPTEs) and report posttraumatic stress disorder (PTSD) difficulties more frequently than the general population. The PTSD checklist for DSM-5 (PCL-5) is a commonly used measure to screen PSP for PTSD. A single previous study assessed PCL-5 factorial invariance among PSP but used a small homogenous sample. The current study evaluated factorial invariance with a large (n = 5,855) and diverse PSP sample. Multigroup confirmatory factor analyses (mCFAs; n = 98) were conducted using six competing factor models of the PCL-5 across seven PSP sectors, five age groups, and two gender groups. The seven-factor hybrid model of PTSD (i.e., reexperiencing, avoidance, negative alterations in cognitions and mood, hyperarousal, intrusion, emotional numbing, dysphoria, dysphoric arousal, anxious arousal, anhedonia, negative affect) produced consistently superior fit across all sectors assessed and produced marginally better absolute values than the six-factor anhedonia model, supporting PCL-5 factorial invariance among PSP. The current study is the first to use a large and diverse PSP sample to assess PCL-5 factorial invariance. The results support the PCL-5 as invariant across PSP sectors, age groups, and men and women. Consistent with other studies, the seven-factor hybrid model of PTSD produced the best fit, followed closely by the six-factor anhedonia model. Future research could use structured clinical interviews to further investigate the factorial structure and invariance of PTSD symptoms among PSPs. (PsycInfo Database Record (c) 2025 APA, all rights reserved).

There is an increased incidence of some mental health disorders such as post-traumatic stress disorder (PTSD) in some members of the military and in some public safety personnel (PSP) such as firefighters, police officers, paramedics, and dispatchers. Upon retirement from the armed forces, many individuals go on to second careers as PSP. Individuals with prior military experience may be at even greater risk than nonveterans for developing mental health disorders. The present study was designed to examine the relationship between prior military service and symptoms of mental health disorders in PSP. This is a cross-sectional, observational study. Data for this study were collected from an anonymous, web-based, self-report survey of PSP in Canada. Invitations to participate were sent to PSP via their professional organizations. Indications of mental disorder(s) and symptom severity were assessed using well-validated self-report screening measures. Of the survey respondents who provided this information, 631 (6.8%) had prior armed forces experience; however, not all responses were complete. Ex-military PSP reported significantly more exposure to traumatic events and were approximately 1.5 times more likely to screen positive for indications of PTSD, mood, anxiety, or acute stress disorders and to have contemplated suicide than those without prior armed forces experience. In our study, individuals in PSP with prior service experience in the armed forces were more likely to screen positive for indicators of some mental health disorders. Accordingly, mental health practitioners should inquire about previous service in the armed forces when screening, assessing, and treating PSP.

Loneliness is a powerful predictor of several medical and psychiatric conditions that are highly prevalent in Veterans, including depression and PTSD. Despite this, few studies have examined loneliness in Veterans or how best to intervene upon Veteran loneliness. Additional empirical research is needed in these areas in order to define clear intervention targets and improve Veteran care. In this pilot study, we used 62 Veterans' self-reported loneliness and symptoms of post-traumatic stress to examine whether specific symptom clusters of post-traumatic stress were associated with greater loneliness. Post-traumatic stress was measured using the PTSD Checklist for DSM-5, and responses were further parsed into four symptom clusters: intrusions, avoidance, negative alterations in mood and cognition (excluding the social withdrawal item), and alterations in arousal and reactivity. Results revealed that only the negative alterations in mood and cognition symptom cluster was associated with increased Veteran loneliness, even after adjusting for sociodemographic factors, social isolation, and symptoms of depression. These analyses were also repeated using a subset of our sample (n = 29) who completed repeated measures of the PTSD Checklist. Results again revealed that the same symptom cluster predicted Veteran loneliness over 1 year later. This pilot study demonstrates the value of a publicly available PTSD measure for identifying lonely Veterans and highlights how reducing negative alterations in mood and cognition may serve as a potentially critical target for future Veteran loneliness interventions.

The weak link between subjective symptom-based diagnostics for posttraumatic psychopathology and objective neurobiological indices hinders the development of effective personalized treatments. To identify early neural networks associated with posttraumatic stress disorder (PTSD) development among recent trauma survivors. This prognostic study used data from the Neurobehavioral Moderators of Posttraumatic Disease Trajectories (NMPTDT) large-scale longitudinal neuroimaging dataset of recent trauma survivors. The NMPTDT study was conducted from January 20, 2015, to March 11, 2020, and included adult civilians who were admitted to a general hospital emergency department in Israel and screened for early PTSD symptoms indicative of chronic PTSD risk. Enrolled participants completed comprehensive clinical assessments and functional magnetic resonance imaging (fMRI) scans at 1, 6, and 14 months post trauma. Data were analyzed from September 2023 to March 2024. Traumatic events included motor vehicle incidents, physical assaults, robberies, hostilities, electric shocks, fires, drownings, work accidents, terror attacks, or large-scale disasters. Connectome-based predictive modeling (CPM), a whole-brain machine learning approach, was applied to resting-state and task-based fMRI data collected at 1 month post trauma. The primary outcome measure was PTSD symptom severity across the 3 time points, assessed with the Clinician-Administered PTSD Scale for DSM-5 (CAPS-5). Secondary outcomes included Diagnostic and Statistical Manual of Mental Disorders (Fifth Edition) (DSM-5) PTSD symptom clusters (intrusion, avoidance, negative alterations in mood and cognition, hyperarousal). A total of 162 recent trauma survivors (mean [SD] age, 33.9 [11.5] years; 80 women [49.4%] and 82 men [50.6%]) were included at 1 month post trauma. Follow-up assessments were completed by 136 survivors (84.0%) at 6 months and by 133 survivors (82.1%) at 14 months post trauma. Among the 162 recent trauma survivors, CPM significantly predicted PTSD severity at 1 month (ρ = 0.18, P < .001) and 14 months (ρ = 0.24, P < .001) post trauma, but not at 6 months post trauma (ρ = 0.03, P = .39). The most predictive edges at 1 month included connections within and between the anterior default mode, motor sensory, and salience networks. These networks, with the additional contribution of the central executive and visual networks, were predictive of symptoms at 14 months. CPM predicted avoidance and negative alterations in mood and cognition at 1 month, but it predicted intrusion and hyperarousal symptoms at 14 months. In this prognostic study of recent trauma survivors, individual differences in large-scale neural networks shortly after trauma were associated with variability in PTSD symptom trajectories over the first year following trauma exposure. These findings suggest that CPM may identify potential targets for interventions.

Cognitive models of posttraumatic stress disorder (PTSD) propose that rumination about a trauma may increase particular symptom clusters. One type of rumination, termed counterfactual thinking (CFT), refers to thinking of alternative outcomes for an event. CFT centered on a trauma is thought to increase intrusions, negative alterations in mood and cognitions (NAMC), and marked alterations in arousal and reactivity (AAR). The theorized relations between CFT and specific symptom clusters have not been thoroughly investigated. Also, past work has not evaluated whether the relation is confounded by depressive symptoms, age, gender, or number of traumatic events experienced. The current study examined the unique associations between CFT and PTSD symptom clusters according to the Diagnostic and Statistical Manual of Mental Disorders (American Psychiatric Association, 2013) in 51 trauma-exposed treatment-seeking individuals. As predicted, CFT was associated with all PTSD symptom clusters. After controlling for common predictors of PTSD symptom severity (i.e., age, depressive symptoms, and number of traumatic life events endorsed), we found CFT to be significantly associated with the intrusion and avoidance symptom clusters but not the AAR or NAMC symptom clusters. Results from the present study provide further support for the role of rumination in specific PTSD symptom clusters above and beyond symptoms of depression, age, and number of traumatic life events endorsed. Future work may consider investigating interventions to reduce rumination in PTSD. (PsycINFO Database Record

Background: Given the highly stressful environment surrounding the SARS-CoV-2 pandemic, healthcare workers (HCW) and public safety personnel (PSP) are at an elevated risk for adverse psychological outcomes, including posttraumatic stress disorder (PTSD) and alcohol/substance use problems. As such, the study aimed to identify associations between PTSD severity, related dissociation and emotion dysregulation symptoms, and alcohol/substance use problems among HCWs and PSP. Methods: A subset of data (N = 498; HCWs = 299; PSP = 199) was extracted from a larger study examining psychological variables among Canadian HCWs and PSP during the pandemic. Structural equation modelling assessed associations between PTSD symptoms and alcohol/substance use-related problems with dissociation and emotion dysregulation as mediators. Results: Among HCWs, dissociation fully mediated the relation between PTSD and alcohol-related problems (indirect effect β = .133, p = .03) and emotion dysregulation partially mediated the relation between PTSD and substance-related problems (indirect effect β = .151, p = .046). In PSP, emotion dysregulation fully mediated the relation between PTSD and alcohol-related problems (indirect effects β = .184, p = .005). For substance-related problems among PSP, neither emotion dysregulation nor dissociation (ps >.05) had any effects. Conclusion: To our knowledge, this is the first study examining associations between PTSD severity and alcohol/substance use-related problems via mediating impacts of emotion dysregulation and dissociation among HCWs and PSP during the SARS-CoV-2 pandemic. These findings highlight dissociation and emotion dysregulation as important therapeutic targets for structured interventions aimed at reducing the burden of PTSD and/or SUD among Canadian HCWs or PSP suffering from the adverse mental health impacts of the SARS-CoV-2 pandemic.