"There is a serious danger that fire policy will be developed on the basis of work carried out in the context of the market place rather than being underpinned by research which has been subjected to full process of academic rigour and peer review" Professor D Drysdale (European Vice-Chair, International Association of Fire Safety Sciences) and D T Davis (Chair of the Executive Committee, Institution of Fire Engineers). Fire Engineers Journal 61, 10, 6-7

 

 

 

 

 

 

 

 

 

 


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Durkin, J. (2001) Stress - Who Does It Affect? www.fitting-in.com/Durkin1.htm  (reproduced by kind permission of FIRE)

 

 

Are firefighters stressed, if you think they may be read on.

 

 

I thought firefighting was supposed to be a stressful occupation.  Why else would you need debriefing teams to visit you after a nasty job?  Why else would ‘a spokesperson for the brigade’ emphasise the harrowing nature of the work, the toll it takes, and the efforts required to get over it?  Can you not handle it any more - like we did in the old days?  Is stress not simply a part of it, and why you get paid so much for sitting around most of the time?  Maybe you have recruited people who joined for the wrong reasons such as gaining plenty of time-off, avoidance of a ‘proper’ job and an enhanceable retirement pension.  Maybe not; maybe you have recruited the right people and then treated them so badly that they soon avoided ‘playing the game’ in order to limit the personal damage being inflicted on them, and escape as soon as they felt that they had taken enough.

     

I was warned many times by fire officers trying to guide my career that you can ‘never trust a fireman’.  I have always had trouble with that one; you could have trusted me, and the vast majority of those I worked with.  But what would a firefighter say if you asked them if they were stressed?  Could you trust them to answer honestly?  Would officers be any more honest than their subordinates with their appraisal of themselves if they were asked about their experience of stress?  The ‘footprint’ of stress is commonly identified by clinical psychologists through the measurement of symptoms of anxiety and depression.  A fairly rapid assessment can be made using these self-report measures, if they are accurately completed.  So what would you expect if wholetime operational firefighters based at a city-centre fire station were tested with time-honoured, reliable clinical assessments of stress, administered by a team of psychologists all qualified with postgraduate degrees?  Would firefighters be honest and admit to feelings of dread, agitation and fear if they had them?  Would they invent or exaggerate some feelings just to throw the researchers?  Not easy to answer, if you believed that you could not trust them.  I did trust them, and running against the advice of my mentors of years ago, I encouraged a research team to set about a ‘first-pass’ over an unnecessarily controversial issue - stress in the fire service.

 

Make a prediction.  Twenty-one operational firefighters from  Cambridgeshire Fire & Rescue Service were asked to complete a battery of questionnaires, and then undergo a 45-minute interview.  Assume that you could trust them to be honest with their answers.  What level of anxiety do you think they would report?  How depressed do you think they would feel when asked?  How would they compare to ordinary members of the public?  More anxious/depressed or less?   Remember, firefighting is a stressful job (or so you tell us).  How would they compare with clinically anxious or depressed patients? Patients who are clinically diagnosed know a thing or two about stress, believe me.  Are firefighters close to clinical levels?  Exceeding them?  Or nowhere near?  To test your prediction, we initially used two measures of anxiety and one of depression. 

 

Anxiety

Anxiety was measured using Spielberger’s Stait-Trait Anxiety Inventory1 (STAI).  Two sources of anxiety are probed in completing the STAI; state-anxiety and trait-anxiety.  State-anxiety was measured to provide an indicator of current levels of psychological arousal generated by fears and concerns.  Trait-anxiety was measured as an indicator of enduring, long-term psychological arousal.  Elevated scores in both types of anxiety might give cause for concern, although a high score in state- (current) anxiety might suggest a recent and possibly transient experience of stress.

 

Depression

The depression measure used was Beck’s Depression Inventory2 (BDI).  The BDI offers a reliable indicator of recent episodes of low mood and despondency.  Depression is associated with significant personal losses and disappointments, and a high BDI score in conjunction with high scores on the anxiety measure, would suggest the current and ongoing experience of stress.  Whilst these measures in themselves might not offer an indication of the source of the stress, it would nevertheless alert a psychologist to its presence.

 

Anxiety and Depression Scores

Bear in mind when considering the figures in Table 1 that STAI (anxiety) is measured on a scale of 20-80 with clinical levels being assumed at 45; scores below 45 are therefore regarded as low, and therefore of little concern.  The BDI (depression) is measured on a scale of 0-63 with clinical levels assumed at 14; below 14 is therefore regarded as low.

 

Table 1.

Mean Scores for State-Anxiety, Trait-Anxiety and Depression

Group

State (SD)

Trait (SD)

Depression: BDI (SD)

Operational  firefighters(21)

29.7 (6.5)

34.2 (6.9)

5.0 (3.3)

Controls (52)

35.9 (9.2)

39.8 (12.3)

7.9 (6.7)

Clinical levels exceed

45.0

45.0

14.0

 

 

According to the data presented above, firefighters were well below clinical levels on both types of anxiety and also depression; in fact they were no higher than the ‘control’ group who represented ordinary members of the public.  Did someone say firefighting was a stressful occupation?  These scores indicated an absence of stress, and/or seriously ice-cool copers.  How can this be?  Informal discussions revealed that most of our firefighters had attended a number of serious incidents over many years so this was no ‘backwater’ station where nothing ever happened. 

 

These scores are remarkably low for any occupational group.  Might there be an extraneous downward influence on the scores provided by our operational firefighters?  Might that old chestnut about not trusting firefighters have some basis after all?  What if the firefighters are not exactly untrustworthy, more wishing to show themselves in a favourable light?  After all research teams are invariably composed of attractive and intelligent people(!) and you could be forgiven for attempting to impress.  The anxiety/depression questionnaires are designed simplistically to allow highly distressed individuals to record their experiences.  They involve only a ‘mark’ in response to a statement for completion.  Of course, if the colleague sitting next to you with his arm round his questionnaire steals a glance at your unguarded answer-sheet, he might see your pattern of responses.  What he thinks of those responses, or what he might report to someone else about them might be of some concern to you.  If so, you may complete your questionnaire with a loss of privacy in mind, or even what the researcher might think if they associate you with your particular set of responses.  Consideration of these pitfalls in ‘real-life’ research is crucial to the validity of a study of this type.  Rather than attempt to catch out our firefighters with ‘lie-detectors’ though, or make arbitrary adjustments to try to minimise suspect ‘enhancements’, additional stress-related tests were added that were believed to be more difficult to interpret.  

 

Dissociation

One test of psychological disturbance that is less obvious about what it seeks to unearth, is that obtained through measuring ‘dissociative experiences’ or ‘dissociation’.  Perfectly normal episodes of forgetfulness, confusion and disbelief  are common everyday occurrences for most of us, but in psychiatric conditions they often become increasingly exaggerated, intrusive and frequent.  Post-traumatic stress disorder (PTSD) for example, as defined by the Diagnostic & Statistical Manual of Mental Disorders3 (DSM-IV), includes descriptions of memory loss, detachment and numbing.  Whilst such dissociative experiences may offer something protective by distorting the reality of a traumatic situation, thereby limiting its impact, dissociative experiences produce just that - distortions of reality.  So consider the health and safety, problem-solving and decision-making implications of relying on the judgements and actions of individuals who frequently dissociate.  As can be seen from Figure 1, the increasing severity of a psychiatric disorder produces an increase in dissociation, and the Dissociative Experiences Scale4 (DES) places a number of clinical groups with psychiatric disorders on a 0-100 scale, accordingly.  The use of the DES with firefighters allowed a comparison of their scores with these psychiatric groups.  The DES is shown below:

 

 

Figure 1. 

Dissociative Experiences Scale  (Bernstein & Putnam, 1986)

 

Normal

Alcoholism

Phobias

Agoraphobia

      Schizophrenia

      PTSD    

MPD

    4.3

4.7   

          6.0 

7.4

21.1

31.3

          57.0

 

Time to test your prediction again.  Operational firefighters, as a group, described themselves on our anxiety and depression measures as being neither anxious nor depressed.  How often though would they report increasing confusion and concern over ‘odd’ feelings of unreality that might be indicators of underlying distress?  As mentioned above, there may be a tendency to underreport symptoms that could be interpreted by the researchers (or curious colleagues) as unattractive.  The DES seems to offer a more subtle probe into the privacy of emotional distress than that gained by anxiety and depression questionnaires.  If so, and the DES succeeded in unearthing some underlying disturbances associated with psychiatric disorders, where on the scale would you expect our operational firefighters to fall?

 

 

Table 2.

Dissociative Experiences Scale (DES) score for operational firefighters

 

DES score

Firefighter Group (number)                    Average  (median)      

 


Operational (21)                                           4.3             

 

 

Plotting the score for operational firefighters on the DES scale shows the following:

 

Figure 2.  Dissociative Experiences Scale  (Bernstein & Putnam, 1986)

Normal

Alcoholism

Phobias

Agoraphobia

Schizophrenia

PTSD

Multiple Personality Disorder

4.3

4.7   

6.0 

7.4

21.1

31.3

57.0

 

Operational Firefighters (4.3)

 

As can be seen from Figure 1, the average score derived for ‘normal’ samples is 4.3; exactly the score generated by our operational firefighters.  All three measures of stress (anxiety, depression and dissociation) support the notion that our operational firefighters were not a distressed group. 

 

Summary

Based on the assumption that firefighting is a stressful occupation, a series of psychological tests were carried out on operational firefighters to assess the extent to which they were showing symptoms of stress.  Clinical measures of anxiety, depression and dissociation failed to detect any negative psychological effects in this particular group.  Before we draw the conclusion that firefighters are unaffected by the job that they do, interviews were conducted to assess their performance on autobiographical memory recall - a task that is vulnerable to the detrimental effects of stress.  The results will be published in next month's article.

 

REFERENCES

 

1. Spielberger, C.D., Gorsuch, R.L., Lushene, R., Vagg, P.R. & Jacobs, G.A. (1983)  Manual for the State-Trait Anxiety Inventory.  Palo Alto.

 

2. Beck, A.T. & Steer, R.A. (1987) Beck Depression Inventory Manual. San Antonio, TX: The Psychological Corporation.

 

3. American Psychiatric Association (1994)  Diagnostic and statistical manual of mental disorders (4th edn) Washington, DC: Author.

 

4. Bernstein, E. & Putnam, F. (1986)  Development, Reliability, and Validity of a Dissociation Scale.  Journal of Nervous and Mental Disease  Vol.174 (12): 727-735.

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