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mental health
professional

The impact of post-traumatic stress on first responders: analysis of cortisol, anxiety, depression, sleep impairment and pain

02 December 2015
Features
02 December 2015
Volume 5 · Issue 3

Abstract

First responders are an often ignored group facing emotional and physical stress that is similar to that of law enforcement personnel and military veterans. Fifty first responder employees were invited to participate in the study, of which 34 completed the following psychological and biological measures: 1) the PTSD Checklist—Civilian Version (PCL-C); 2) State Trait Inventory for Cognitive and Somatic Anxiety (STICSA); 3) the Center for Epidemiology Studies Depression Scale (CES-D); 4) the Pittsburgh Sleep Quality Index (PSQI); 5) Alcohol Use Disorders Identification Test (AUDIT); 6) Cornell Musculoskeletal Discomfort Questionnaire (CMDQ); 7) heart rate and blood pressure during two consecutive days; 8) body mass index (BMI); and 9) salivary cortisol measured once. Among participants, 18% (n=6) met criteria for anxiety, 47% for depression (n=16) and 33% (n=12) for PTSD. Comparison of statistical models assessing the predictive strength of physical and behavioural health measures found PTSD to be the strongest predictor for depression, anxiety, poor sleep quality, musculoskeletal pain, cortisol and BMI.

A substantial portion of first responders met criteria for PTSD and anxiety. Assessing the impact of these conditions may best be achieved through physical health measures (cortisol, BMI, heart rate) in addition to psychometric screening tools (PCL, CESD, STICSA).

First responders—the emergency medical technicians (EMTs) and paramedics who respond to everyday emergencies and tragedies—may experience psychological and physical stress similar to that experienced by law enforcement personnel and military veterans. Stress is defined as an event or events in which environmental demands, internal demands, or both tax or exceed the adaptive resources of an individual or their tissue system.

Stress results in hormonal (e.g. cortisol dysregulation) changes that can directly and indirectly strain the body's tissue systems and contribute to weight gain, hypertension, sleep problems, musculoskeletal pain and poor mental health (depression, anxiety). Traumatic stress refers to the stress associated with tragedies and life-threatening events such as those often witnessed by paramedics and EMTs. The physiological problems that often accompany the type of traumatic stress first responders experience may contribute to disability and include neuroendocrine changes and high levels of depressive symptomology (Stam, 2007).

Paramedics and EMTs have a larger than average number of work-related injuries and illnesses, yet the impact of physical and psychological stressors associated with their work has been understudied (Hanson, 2007; O'Mahony et al, 2008; Merchant et al, 2009; Reichard and Jackson, 2010; Bureau of Labor Statistics, 2015). Occupational stress is considered one of the strongest factors in the development of hypertension, the significance of which is evident in the 75% prevalence rate of pre-hypertension and hypertension among first responders reported in a recent study (Kales et al, 2009; Levy-Gigi and Richter-Levin, 2014).

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Anxiety
Cortisol
Depression
First responders
Paramedics
Post-traumatic stress