SEARCH

SEARCH BY CITATION

Keywords:

  • firefighters;
  • organisational stress;
  • post-traumatic growth;
  • post-traumatic stress disorder;
  • social support

Abstract

  1. Top of page
  2. Abstract
  3. Sources of Trauma
  4. Organisational Factors
  5. Social Support
  6. Coping
  7. The Current Research
  8. Method
  9. Results
  10. Discussion
  11. References

Emergency service workers (e.g., firefighters, police, and paramedics) are exposed to elevated levels of potentially traumatising events through the course of their work. Such exposure can have lasting negative consequences (e.g., post-traumatic stress disorder (PTSD)) and/or positive outcomes (e.g., post-traumatic growth (PTG)). Research had implicated trauma, occupational and personal variables that account for variance in post-trauma outcomes yet at this stage no research has investigated these factors and their relative influence on both PTSD and PTG in a single study. Based in Calhoun and Tedeschi's model of PTG and previous research, in this study regression models of PTG and PTSD symptoms among 218 firefighters were tested. Results indicated organisational factors predicted symptoms of PTSD, while there was partial support for the hypothesis that coping and social support would be predictors of PTG. Experiencing multiple sources of trauma, higher levels of organisational and operational stress, and utilising cognitive reappraisal coping were all significant predictors of PTSD symptoms. Increases in PTG were predicted by experiencing trauma from multiple sources and the use of self-care coping. Results highlight the importance of organisational factors in the development of PTSD symptoms, and of individual factors for promoting PTG.

The effects of traumatic exposure have received much attention in the general population (e.g., survivors of natural disaster, sexual assault) and to a lesser extent in emergency service occupations (e.g., military, ambulance). However the factors that may mitigate or promote post-traumatic stress or post-traumatic growth (PTG) have not yet been authoritatively established. As a profession, firefighters are faced with varied hazardous situations, ranging from fighting bush fires, and cutting accident victims out of motor vehicles, to handling deceased persons, and so have elevated exposure to potentially traumatic events. What has not yet been established is what may account for individual differences in post-trauma outcomes, and how some of the putative key workplace, social support, and coping variables might combine to influence these outcomes. The current research investigates the relative influence of these variables with respect to both post-traumatic stress disorder (PTSD) symptoms and PTG.

The research presented in this article uses Calhoun and Tedeschi's (2013) model of PTG as a conceptual framework in which contextual and personal factors are proposed to influence relationships between a person pre-trauma and post-trauma outcomes. The purpose of this article is to investigate variables that have been found to be influential in general trauma literature (i.e., social support and coping strategies), in combination with those that have been found to be related to stress outcomes in the emergency services (organisational variables and multiple sources of trauma) in a group of firefighters who identified as having experienced trauma through the execution of their work role. There is a dearth of research that examines the Calhoun and Tedeschi (2013) framework for predicting PTG. In addition, we will also examine the impact of these variables on PTSD, as understanding which variables may influence PTG, or PTSD, or both is vital for the creation of post-trauma interventions in the emergency services. The combination of predictor and outcome variables examined in the research contribute significant knowledge to the field of trauma research.

A focus on examining post-traumatic stress in emergency workers is understandable given the sometimes difficult work circumstances. The rate of PTSD in emergency services is assumed to be higher than that in the general population (Wagner, McFee, & Martin, 2010), and while consensus regarding prevalence rates has not been reached, figures around 20% have been found (e.g., Heinrichs et al., 2005). Studies that investigate the precedents and correlates of post-traumatic stress are important for efforts to reduce negative outcomes of trauma in a group of people who are regularly exposed to potentially traumatic events. PTSD is not the only possible post-trauma outcome, however. There are an increasing number of studies with emergency service populations that focus on positive post-trauma changes, particularly PTG (e.g., Shakespeare-Finch, Smith, Gow, Embelton, & Baird, 2003).

A model of PTG was first articulated by Tedeschi and Calhoun (1995) and asserts that some individuals are able to experience positive changes following a traumatic event. PTG is an outcome of effortful and deliberate rumination following the struggle to integrate a traumatic experience into shattered life narratives, rather than a direct result of the trauma itself (Calhoun & Tedeschi, 2013). Because of the focus on the role of automatic and deliberate rumination, as well as the rebuilding of world assumptions, PTG is considered to primarily be a cognitive model of positive post-trauma change. The changes experienced can be in the areas of relating with others, a greater appreciation of life or personal strength, changes in priorities and/or spiritual growth.

The most recent and comprehensive PTG model (Calhoun & Tedeschi, 2013) reiterates that positive post-trauma changes do not deny the ongoing distress that may be experienced by some people and therefore, PTG and PTSD symptoms are both examined in the current research. Furthermore, the model of PTG suggests that event-related, contextual, support, and coping factors may all be important influences on post-trauma outcomes. The following sections detail these factors with respect to previous research and their likely influence on post-trauma outcomes within the context of being a firefighter.

Sources of Trauma

  1. Top of page
  2. Abstract
  3. Sources of Trauma
  4. Organisational Factors
  5. Social Support
  6. Coping
  7. The Current Research
  8. Method
  9. Results
  10. Discussion
  11. References

Trauma experienced as part of the role of being a firefighter has been studied previously (e.g., Heinrichs et al., 2005). One event related factor of trauma exposure not yet explored in firefighters is the effects of additional trauma from employees' personal lives. Shakespeare-Finch et al. (2003), found that PTG was higher in ambulance personnel who had experienced trauma in their personal lives as well as in their work lives, compared with those who reported trauma only in the work context. Consistent with the model of PTG (Calhoun & Tedeschi, 2013), it is argued that the greater personal proximity and emotional relevance of trauma in a personal context, the greater the stimulation of cognitive processes, including disruption to existing schemas, than when trauma is only experienced in the work context. Experiencing multiple sources of trauma may also correspond with higher levels of PTSD symptoms, through the cumulative effect of stressors overwhelming individuals' ability to process and cope with the events.

Organisational Factors

  1. Top of page
  2. Abstract
  3. Sources of Trauma
  4. Organisational Factors
  5. Social Support
  6. Coping
  7. The Current Research
  8. Method
  9. Results
  10. Discussion
  11. References

Organisational factors provide a context within which work trauma occurs, and therefore are conceptually related to post-trauma outcomes (Calhoun & Tedeschi, 2013). Consistent with this notion, there is general agreement that organisational and daily stressors involved in emergency service work are strongly related to post-trauma and stress-related outcomes. A study of firefighters by Meyer et al. (2012) found that occupational stress was the strongest predictor of post-traumatic stress above and beyond social support and coping. Qualitative research asking firefighters about stressful aspects of work found that organisational factors and hassles were frequently cited (Haslam & Mallon, 2003).

Given that organisational stressors have been found to have a negative impact on firefighters, it is possible that a sense of belonging, respect, and support by the organisation may serve as a protective buffer against the effects of stress and potentially traumatic events. A sense of belonging and connection with a particular group has been investigated in a work context (Cockshaw, Shochet, & Obst, 2012) and has been found to be related to reduced reports of anxiety and depression symptoms. Organisational belongingness has not been explicitly investigated in emergency service populations; however, links can be drawn from related concepts.

Tuckey and Hayward (2011) found that camaraderie, as a job-specific resource in Australian volunteer firefighters, was more consistently related to outcomes than general resources for dealing with emotional demands. In this research feeling supported and connected to other volunteer firefighters was a protective factor against burnout and post-traumatic stress. There is less evidence to suggest a relationship between organisational belongingness and PTG, although having a strong sense of community was found to be significantly related to compassion satisfaction in a group of emergency workers (Cicognani, Pietrantoni, Palestini, & Prati, 2009).

Social Support

  1. Top of page
  2. Abstract
  3. Sources of Trauma
  4. Organisational Factors
  5. Social Support
  6. Coping
  7. The Current Research
  8. Method
  9. Results
  10. Discussion
  11. References

The relationship between social support and post-trauma outcomes has been investigated in general trauma populations (e.g., disaster survivors or particular trauma groups), as well as specifically with firefighters. A meta-analysis conducted by Brewin, Andrews, and Valentine (2000) found that reduced social support was consistently and strongly related to PTSD across general and military samples. Studies with firefighters have also generally found that there is a relationship between social support and post-trauma outcomes. Social support has been found to predict PTSD symptoms (e.g., Meyer et al., 2012) and perceptions of support have been shown to be lower in those at a high risk of PTSD (Mitani, Fujita, Nakata, & Shirakawa, 2006). According to the model of PTG, social support may promote deliberate rumination and the active rebuilding of assumptions following a traumatic experience (Calhoun & Tedeschi, 2013). The relationship between social support and PTG has not been investigated in emergency service populations, but a recent meta-analysis provided information regarding social support in non-emergency service populations. Prati and Pietrantoni (2009) conducted a meta-analysis (103 studies) examining the relationship between social support, optimism, and coping strategies with PTG and found all variables had significant relationships. The average effect size for social support was medium.

Coping

  1. Top of page
  2. Abstract
  3. Sources of Trauma
  4. Organisational Factors
  5. Social Support
  6. Coping
  7. The Current Research
  8. Method
  9. Results
  10. Discussion
  11. References

Unravelling the relationship between coping strategies and post-trauma outcomes is complicated by the many different ways to conceptualise and measure coping. Most studies that measure coping have found that at least one of the coping variables studied are related to PTSD symptoms (e.g., Meyer et al., 2012), but the types of strategies included, and those that are found to be significant, vary greatly. A fairly consistent finding is that greater reliance on avoidance coping is related to increases in PTSD symptoms (e.g., Brown, Mulhern, & Joseph, 2002). Research also supports the assertion that there is a relationship between coping and PTG. For example, significant relationships have been found with paramedics (Kirby, Shakespeare-Finch, & Palk, 2011). The meta-analysis by Prati and Pietrantoni (2009) found that positive reappraisal coping not only had a significant relationship with PTG, but evidenced a stronger relationship than social support. Broadly speaking, those strategies that are characterised by avoiding engagement with the traumatic event appear to be related to increases in PTSD symptoms and those that promote engagement, particularly cognitive efforts to understand or resolve the situation, appear to correlate with increases in PTG.

The Current Research

  1. Top of page
  2. Abstract
  3. Sources of Trauma
  4. Organisational Factors
  5. Social Support
  6. Coping
  7. The Current Research
  8. Method
  9. Results
  10. Discussion
  11. References

It was hypothesised that the report of multiple sources of trauma (work and non-work) would be related to higher levels of symptoms of PTSD and higher reports of PTG than those who reported trauma only in the work domain. Meyer et al. (2012) found that the relationship between organisational stress and PTSD was stronger than either of the relationships between coping and PTSD or social support and PTSD. It is therefore predicted that organisational and operational stress will be positively related to PTSD symptoms, and organisational belongingness will be negatively related to PTSD symptoms. Further it was hypothesised that the work context variables would remain strong and significant, even when support and coping are included in the model. As social support has been found to be a significant predictor of PTSD symptoms (e.g., Brewin et al., 2000), it is hypothesised that it would also remain significant in the final model.

Social support and coping are theorised to directly promote PTG through aiding the integration of the event into adjusted world assumptions (Calhoun & Tedeschi, 2013). As such, coping and social support are predicted to be significantly related to PTG above and beyond the effect of work context variables. The meta-analysis by Prati and Pietrantoni (2009) suggests that coping strategies should be stronger predictors of PTG than social support.

Method

  1. Top of page
  2. Abstract
  3. Sources of Trauma
  4. Organisational Factors
  5. Social Support
  6. Coping
  7. The Current Research
  8. Method
  9. Results
  10. Discussion
  11. References

Participants

The participants in this study (N = 218) were firefighters who had all reported experiencing a traumatic event through their work role. The sample primarily consisted of males (96.8%), which is proportionately representative of the male–female ratio in this population. Eighty-four per cent of the participants were married. More than half of the sample was over 45 years of age (56.4%), almost 20% were in the 41–45 years old age bracket. There were 11% of participants between the ages of 36 and 40, 5% between 31 and 35 years old, and the remaining 3% and 2% in 26–30 and 22–25 years old ranges respectively. More people reported experiencing trauma only in the work context (55.5%), and 44.5% reported trauma in both the work and personal domains.

Measures

The survey information relevant to this study included demographics, questions relating to the experience of trauma, and six questionnaires. Participants were given a description of a traumatic experience consistent with that included in the Diagnostic and Statistical Manual of Mental Disorders (DSM IV-TR; APA, 2000). The definition includes the types of events (e.g., threat of harm or death to self or witnessed) as well as the response to the event (fear, helplessness, or horror) that constitutes a trauma within the framework provided by the DSM. This differentiates the common exposure to potentially traumatic events in the emergency services from those that were actually experienced as traumatic by individuals. Participants then indicated if they had experienced trauma in their personal lives and/or through their work.

Post-trauma outcomes

The trauma outcomes of interest in this study were PTSD symptoms and PTG. The Impact of Events Scale-Revised (IES-R; Weiss & Marmar, 1997) assesses symptoms of PTSD across the three domains included in the DSM IV-TR (APA, 2000): hyperarousal, intrusion, and avoidance. The 22 items ask participants to rate how distressing they have found each symptom in the previous 7 days from 0 (not at all) to 4 (extremely). Total scores only were used in this study to give an overall indication of the level of symptomatology experienced by participants. Possible score ranges for all measures and the Cronbach's alphas for the current study are included in Table 1. Creamer, Bell, and Failla (2003) assert that a total score of 33 is a threshold for clinical levels of PTSD symptomatology that offers a high degree of sensitivity and diagnostic reliability. The Posttraumatic Growth Inventory (PTGI; Tedeschi & Calhoun, 1996) measures positive changes experienced as a result of the struggle with a traumatic event. Participants respond to 21 statements regarding the extent to which they perceive that particular changes have occurred following trauma across five factors: new possibilities, relating to others, personal strength, appreciation of life, and spiritual change. Statements are scored on a Likert-type scale from 0 (not at all) to 5 (very great degree). This questionnaire has been used with emergency services populations and found to exhibit good internal consistency (α = 0.95; Kirby et al., 2011, p. 21).

Table 1. Mean, standard deviation, Cronbach's alphas, and data and scale ranges for study variables
VariableData rangeMeanSDScale rangeAlpha
PTSD symptoms0–8819.4219.800–880.97
Posttraumatic growth0–9542.7522.120–1050.95
Operational stress21–13261.4521.5920–1400.93
Organisational stress23–13271.7426.7220–1400.95
Belongingness28–8962.8113.4718–900.93
Receiving social support7–5541.2210.850–550.92
Giving social support14–4533.876.010–450.86
Coping work cognition10–3621.995.039–360.79
 Emotion and support9–2918.313.818–320.65
 Cognitive reappraisal5–2014.133.055–200.77
 Self-care4–158.692.274–160.52
Work context factors

Occupational hassles were measured using the Operational and Organizational Police Stress Questionnaires (PSQ-Op and PSQ-Org respectively; McCreary & Thompson, 2006), adapted slightly to be appropriate for firefighters. These scales include 20 items each to measure operational (e.g., critical incidents) and organisational (e.g., management) hassles. Participants rated how much stress they experience due to the hassles on a Likert-type scale from 1 (no stress at all) to 7 (a lot of stress). These scales have demonstrated good concurrent validity as well as good internal consistency (PSQ-Org α = 0.92, PSQ-Op α = 0.93; McCreary & Thompson, p. 511). The extent that participants felt a sense of belongingness to their organisation was measured using the Psychological Sense of Organisational Membership Scale (Cockshaw & Shochet, 2010). Statements such as ‘I feel like a real part of this organisation’, are rated from 1 (not true at all) to 5 (completely true). Internal consistency for the scale is good (α = 0.94; Cockshaw et al., 2012).

Social support

Social support was assessed using the 2-Way Social Support Scale (Shakespeare-Finch & Obst, 2011). This measure includes instrumental and emotional support and is assessed across both giving and receiving support. Participants rate the 20 statements in terms of how true they are for them from 0 (not at all) to 5 (always), and responses yield subscale scores for giving (9 items) and receiving (11 items) social support. In the current study Cronbach's alpha coefficients demonstrated the scale to be a reliable measure of receiving (α = 0.92) and giving (α = 0.86) social support.

Coping

Given the rather unique application of coping in emergency services, a measure of coping that is tailored to emergency service workers was used in this study. The Coping Response in Rescue Workers (CRRW; McCammon, Durham, & Williamson, 1988) inventory was developed with rescue workers and has been modified and validated with a population of Australian paramedics (Morris, Shakespeare-Finch, & Scott, 2007). The modified version includes 27 of the original 32 items and assesses coping across four domains; cognitive reappraisal of work events, seeking support and emotional expression, general cognitive reappraisal, and self-care. Each coping strategy was rated from 1 (never having used the strategy) to 4 (used the strategy often). Cronbach's alpha coefficients for the four dimensions of the CRRW inventory were weak to moderate (see Table 1).

Procedure

Following ethical approval from a university Human Research Ethics Committee (approval number 1000001344), an invitation to participate and details of informed consent were emailed to employees of a large statewide fire service. Those personnel wishing to be included voluntarily completed the survey online and were not offered an incentive for doing so. Participants were assured of their anonymity.

Results

  1. Top of page
  2. Abstract
  3. Sources of Trauma
  4. Organisational Factors
  5. Social Support
  6. Coping
  7. The Current Research
  8. Method
  9. Results
  10. Discussion
  11. References

There were no multivariate breaches of normality, influential cases or multicollinearity identified suggesting that the data were suitable for regression analyses. Means, ranges, and variance for the sample are included in Table 1, as well as the scale range for comparison. While the PTGI has been widely used it has not been published with Australian firefighters. The average level of PTG reported in this study was consistent with other research examining PTG in emergency service populations (Kirby et al., 2011; Shakespeare-Finch et al., 2003). Using the IES-R cut-off of 33 recommended by Creamer et al. (2003) 23% of the sample reported experiencing clinical levels of PTSD symptoms.

The aim of this article was to investigate the relative predictive ability of work context variables, social support, and coping on PTG and PTSD symptoms. The variables were included in steps primarily to allow for investigation of the additive value of social support and coping above and beyond organisational context, and also to be consistent with the order of variables as suggested by the model of PTG (Calhoun & Tedeschi, 2013). There were a priori reasons for expecting that reporting multiple sources of trauma would be related to changes in post-trauma outcomes. Therefore, a dichotomous variable for trauma source (0 = work, 1 = work and personal) was included in the first step of the regressions. The second step included operational and organisational stress and organisational belongingness as work context variables, the third step included giving and receiving social support, and the final step included the four coping variables.

PTSD symptoms

In the regression model predicting PTSD symptoms, steps 2 to 4 produced significant changes in the variance explained (see Table 2 for each step). The final model accounted for 37% of the variance in PTSD symptoms. While receiving social support was significant in the third step (β = −0.15, p = .046), when the coping variables were introduced in the fourth step, social support was no longer a significant predictor of PTSD symptoms. There were four variables in the final model that were significant (see Table 3 for final beta weights). Operational stress evidenced the largest beta weight, followed by using work-related cognitive coping, organisational stress and trauma source respectively. All of these variables were related to increases in PTSD symptoms; the positive beta weight for trauma source indicating that those with both work and personal trauma reported higher levels of PTSD symptoms, than those experiencing trauma only in the work context. Similarly, the positive beta weight for work event reappraisal coping indicated that increased use of this coping strategy is related to higher levels of PTSD symptoms.

Table 2. Variance accounted for by four steps in PTSD symptoms regression
VariablesRR2SER2Δ 
  1. Note. The variables column indicates only the new variables that were entered for each step, each progressive step also includes all of the previous variables.

Trauma source0.110.0119.730.01F(1,213) = 2.72, p = .10
Work factors0.550.3116.650.29F(3,210) = 29.58, p = .000
Social support0.580.3416.330.03F(2,208) = 5.19, p = .006
Coping0.610.3716.050.04F(4,204) = 2.85, p = .025
Table 3. Beta weights and significance of individual predictors in final PTSD symptoms model
VariableB95% CIβtp
Trauma source2.670.46–4.880.132.38.018
Belongingness0.15−0.09–0.380.101.23.220
Operational stress0.240.08–0.390.262.95.004
Organisational stress0.150.01–0.280.202.14.034
Receiving social support−0.23−0.49–0.03−0.13−1.72.086
Giving social support−0.39−0.82–0.05−0.12−1.73.084
Work event reappraisal0.990.38–1.600.253.21.002
Emotion and support−0.50−1.16–0.15−0.10−1.51.113
Cognitive reappraisal−0.67−1.65–0.31−0.10−1.34.180
Self-care0.17−0.95–1.300.020.31.761

Post-traumatic growth

Thirty-one per cent of the variance in PTG was accounted for by the variables in the full regression model (see Table 4 for each step). In this model, steps 1, 2, and 4 demonstrated significant increases in variance explained. In the second (β = 0.30, p = .000) and third (β = 0.28, p = .001) steps of the model, belongingness was a significant predictor of PTG, although it became non-significant in the final step when the coping strategies were added to the model. Increases in self-care coping and trauma from multiple sources were both significantly related to increases in PTG (see Table 5 for beta weights in the final model).

Table 4. Variance accounted for by the four steps in PTG regression
ModelRR2SER2Δ 
  1. Note. The variables column indicates only the new variables that were entered for each step, each progressive step also includes all of the previous variables.

Trauma source0.240.0621.570.06F(1,213) = 13.07, p = .000
Work factors0.390.1620.580.10F(3,210) = 8.01, p = .000
Social support0.400.1620.620.01F(2,208) = 0.61, p = .545
Coping0.550.3118.920.15F(4,204) = 10.74, p = .000
Table 5. Beta weights and significance of individual predictors in final PTG model
VariableB95% CIβtp
Trauma context4.772.17–7.380.213.61.000
Belongingness0.24−0.03–0.520.151.74.083
Operational stress0.16−0.03–0.350.161.68.094
Organisational stress0.00−0.16–0.160.000.02.984
Receiving social support0.03−0.28–0.340.020.21.838
Giving social support0.08−0.44–0.590.020.29.776
Work event reappraisal0.12−0.60–0.840.030.32.747
Emotion and support0.34−0.43–1.110.060.87.388
Cognitive reappraisal1.05−0.11–2.200.141.79.075
Self-care2.861.54–4.190.294.27.000

Discussion

  1. Top of page
  2. Abstract
  3. Sources of Trauma
  4. Organisational Factors
  5. Social Support
  6. Coping
  7. The Current Research
  8. Method
  9. Results
  10. Discussion
  11. References

This study sought to utilise regression models to predict PTSD symptoms and PTG based in the framework of PTG provided by Calhoun and Tedeschi (2013). The variables included were sources of trauma, work context variables, social support, and coping strategies. The results were models that significantly predicted both PTG and PTSD symptoms, with different combinations of variables. The results yielded mixed support for the study hypotheses. The hypothesis that multiple sources of trauma would be related to increases in both post-trauma outcomes was supported. In the final step of both models, with all other variables included, experiencing work and personal trauma, as opposed to experiencing trauma only through the work role, was a significant predictor of increases in both PTSD symptoms and PTG. The other hypotheses will be addressed as they specifically relate to the post-trauma outcomes below.

PTSD symptoms

Trauma source, operational and organisational stress, work event reappraisal, and social support were significant predictors of PTSD symptoms. It is possible that for PTSD symptoms, the predicted increase afforded by experiencing trauma in both work and personal contexts may reflect a cumulative effect of exposure to such events. This proposition is supported by both operational and organisational stress also being significant predictors in the regression model, which further supports the hypothesis of this research that organisational stressors contribute to symptoms of PTSD. It is a widely held tenant of stress literature that an increase in stressors, without concurrent increases in resources, overwhelms an individual's ability to cope with, and effectively respond to, stressors (Terry, Tonge, & Callan, 1995).

The hypothesis that the work context variables would be the strongest predictors of PTSD symptoms was supported. The addition of the work context variables into the model afforded the largest increase in variance explained. Furthermore, operational and organisational stressors evidenced similar beta weights, suggesting similarly important roles in influencing PTSD symptoms. The hypothesis that organisational belongingness would be a significant predictor of reduction in PTSD symptoms was not supported. The hypothesis was based on research by Tuckey and Hayward (2011), which found that camaraderie was a buffer against PTSD symptoms. The difference may be accounted for by the fact that camaraderie reflects a construct more akin to peer support, rather than organisational-level support and respect, and so further research clarifying this relationship is warranted.

They hypothesised that social support would predict a reduction in PTSD symptoms was only partially supported. Social support was a significant predictor of PTSD symptoms, until coping strategies were included in the final model. The finding contrasts with a majority of literature that has found that social support is related to symptoms of PTSD (e.g., Brewin et al., 2000). This finding, however, supports previous research that found social support to be unrelated to post-trauma outcomes when controlling for other variables (e.g., Cieslak et al., 2009).

The CRRW inventory items assessing work event reappraisal include ‘I tried to figure out the meaning of being in the job’ and ‘I tried to figure out how things may have been different if I had acted in a different way’. Therefore, the finding that the work event reappraisal strategy was a positive predictor of PTSD symptoms may reflect an overlap in the concept of reappraisal and rumination. Rumination may indicate a preoccupation with challenging work events and when paired with unresolved emotional distress, may serve to continually remind the individual of traumatic events, without necessarily allowing for the opportunity to successfully integrate those thoughts. It is important to note though, that this result may also be an artefact of this coping strategy overlapping with the PTSD symptom cluster of intrusion. And so it may not be a predictor of PTSD symptoms, but rather, a reflection of them.

Post-traumatic growth

The variables that were significantly related to PTG were trauma source, organisational belongingness, and self-care coping. The findings regarding PTG and trauma source support the research by Shakespeare-Finch et al. (2003) who also found that PTG was higher in those who had experienced multiple sources of trauma. It is possible that trauma experienced in the work context is considered more distal to emergency service workers; these experiences are in the context of a profession that they have self-selected into knowing that it includes increased exposure to such events (e.g., car accidents and fighting fires). The training for, and repeated exposure to, events that lay persons may consider to be very traumatic, could serve to prepare firefighters for potential trauma to such an extent that their assumptions about the world are not shattered in the same way by work-related events. Without the experience of a ‘seismic’ event, there is no catalyst to engage in the strategies that promote PTG (Calhoun & Tedeschi, 2013).

The relationship between belongingness and PTG was significant until coping strategies were included in the final step. This suggests that belongingness may be a potential correlate of PTG, but one which may have substantial overlap with certain coping variables. It is possible that the variance explained by organisational belonging was shared with that of the seeking support and emotional expression factor of the coping measure, in that having a sense of connection with the organisation may make individuals more likely to seek support.

The hypothesis that social support and coping would be the strongest predictors in the model, and would relate to increases in PTG was partially supported. The largest change in variance explained was due to the addition of coping strategies. However, social support was not found to be a significant predictor of PTG and the only coping strategy to reach significance was self-care coping. This does not necessarily mean that social support is not influential in the PTG process but rather, consistent with Calhoun and Tedeschi's (2013) model of PTG, suggests that the influence of social support on post-trauma outcomes may be mediated by other variables such as self-disclosure or moderated by the shattering of core beliefs.

This research utilised a coping measure that was specifically created for emergency service workers. It was expected that the strategies that promote effortful engagement, such as the work event cognitive reappraisal and the general cognitive reappraisal subscales, would be positively related to PTG. Contrary to this hypothesis, only the self-care variable was a significant coping predictor of PTG. While reasons for this finding are unclear, it may be that the behavioural changes measured by the self-care subscale are more salient than the cognitive changes that would have preceded such behavioural changes.

Practical implications, limitations, and future directions

This research has implications for reducing the risk of firefighters developing symptoms of PTSD and for promoting PTG. While emergency service organisations have policies and procedures in place for responding to difficult work events, this research suggests that it may be important for organisations to be responsive to trauma experienced in employees personal lives, as well as to their general experience of organisational and operational stress. Efforts to reduce or, more practically, cope more effectively with these types of stressors may help to reduce the risk that firefighters go on to develop PTSD symptoms following work trauma. Even more than the effect of the stress associated with operational tasks, the importance of organisational stressors in developing symptoms of PTSD was highlighted by this research. Organisation-based interventions aimed at reducing the stress associated with the organisational aspects of firefighting may reduce the prevalence or intensity of PTSD symptoms.

This research also reinforces that PTG is a possible post-trauma outcome for firefighters. Given the ongoing difficult work circumstances, and repeated exposure to potentially traumatic events, efforts to promote PTG may help individuals to perceive positive benefits in the work they do, which in turn may aid in keeping people well and in the work-role for longer.

As this research was a cross-sectional design, causality cannot be established. It is important to note that those who reported only experiencing trauma within their work role may therefore have only experienced one event that they perceived as traumatic, while those who reported experiencing trauma in both the work and personal contexts must have experienced at least two traumatic events. The number of traumatic events that had been experienced was not elicited in this research, and therefore could not be controlled for. While previous research has not supported a relationship between the number of critical incidents and post-trauma outcomes (e.g., Declercq, Meganck, Deheegher, & Van Hoorde, 2011; Meyer et al., 2012), there should be some care taken in concluding that it was the context of the trauma, rather than the frequency of trauma that was related to outcomes pending further investigation.

Most of the reliability coefficients in this research indicated good internal consistency in the measures. Self-care coping, however, demonstrated a low Cronbach's alpha. While lower coefficients are somewhat expected with scales containing fewer items, some caution in interpreting the results regarding self-care coping is warranted. Longitudinal research, ideally with baseline data collected prior to the experience of work based trauma, is needed to establish precedents and antecedents of trauma exposure and trauma outcomes in firefighters, particularly with regard to social support and organisational belongingness due to the unexpected results found in this research.

This research adds uniquely to the literature through being the first published article to simultaneously use occupation and individual factors to predict both PTG and symptoms of PTSD in firefighters. Firefighters are routinely exposed to potentially traumatic events as part of their daily work roles. In seeking to reduce the chances of negative outcomes, and increase the opportunities for firefighters to experience growth, it is important to identify factors that are modifiable, such as social support and the promotion of effective coping strategies. Experiencing multiple sources of trauma, greater operational and organisational stress, and more use of event reappraisal coping were found to predict increases in PTSD symptoms, with some suggestion that social support may be a protective factor. Increases in PTG were predicted by multiple sources of trauma and the use of self-care coping. There was also some evidence that organisational belongingness may serve to promote PTG. The results add to research by suggesting that different types of variables (i.e., individual or occupational) might need to be targeted to either promote PTG, or to reduce PTSD symptoms in firefighters. This research reinforced the previously reported notion that PTSD and PTG are not necessarily predicted by the same variables and extends this finding to firefighters.

References

  1. Top of page
  2. Abstract
  3. Sources of Trauma
  4. Organisational Factors
  5. Social Support
  6. Coping
  7. The Current Research
  8. Method
  9. Results
  10. Discussion
  11. References