Dr. Robert J Rotunda

Background: Stress and repetitive exposures to potentially traumatizing events are inherent to first-responder professions. Firefighters and other crisis responders are often exposed to incidents in their work environments and are at risk of developing acute or posttraumatic symptomatology, depression, and anxiety, as well as harmful patterns of alcohol consumption. Most prior research and theory suggests that many firefighters use alcohol to cope with past and current stressors, and that increased drinking accompanies ongoing exposures to stressful occupational hazards. Objectives: The primary aim of this research was to examine alcohol consumption and mental health variables associated in the literature with alcohol misuse. Participants included 546 predominantly male career firefighters in the U.S. Using a cross-sectional design, we examined alcohol misuse in the context of self-reported depression, generalized anxiety, PTSD, and suicidal ideation using previously validated measures. Results: Based on the AUDIT's recommended cut score of 8, 38.8% of our sample reported drinking at hazardous levels. Hazardous alcohol use was also significantly associated with several mental health indicators with correlations ranging from .28 to .34. Regression analyses revealed that over 14% of the variance in AUDIT scores could be explained by psychological symptom measures, and 29% of the variance in suicide risk was explained by a model using both alcohol and mental health measures. Conclusions: Findings suggest that psychological distress is associated with hazardous drinking, and that more consistent screening and referral for these issues, as well as multi-level interventions, are needed to effectively address these behavioral health concerns among firefighters.

Firefighters experience a high level of traumatic incidents in their work. This high level of exposure puts them at risk for trauma-related symptoms. These trauma symptoms include PTSD, suicide risk, alcohol misuse, and depression, and anxiety. Furthermore, repeated exposure has been found to lead to desensitization, flashbacks, irritability, and PTSD. Exposure to natural disasters may also impact ecospirituality. A survey was designed to include the Life Events Checklist, PHQ-9, GAD-7, PCL-5, and the SBQ-R. This survey was administered to firefighters from Northwest Florida in the fall of 2020 and spring of 2021. Participants were found to have higher levels of PTSD, anxiety, depression, and suicidal risk than the general population. Participants were further asked about their volunteering for religious organization activity. A significant relationship was found between volunteering for religious organization and mental health screeners. Religious volunteering predicted lower levels of PTSD symptoms, depression, and anxiety. The effect size was small.

Objective-Seeking mental health services can be challenging for first responders due to various barriers that impede access to care. The objective of this study was to gain a deeper understanding of the subjective experiences, perceptions, and meanings associated with seeking services among first responders.
Methods-The survey-design instrument consisted of questions regarding stress, psychological health, health-related difficulties, and potential barriers to treatment that first responders may experience. The questions were asked in multiple formats including multiple choice, select all that apply, and one open-ended question. This paper includes responses from the optional open-ended question (n = 78). Researchers conducted data analysis using ATLAS.ti and the analysis followed a thematic approach.
Results-Three (3) themes and several sub-themes were identified. First responders provided diverse explanations for their reluctance to seek care, such as organisational and leadership factors, stigma related to mental health, concerns about being red-flagged, limited access to care, and the financial implications of treatment. A prevailing sentiment was a lack of trust in the mental health field.
Discussion-By giving voice to the lived experiences of first responders, this study can inform the development of targeted interventions and support programs that address their specific needs and enhance overall well-being of first responders.

Firefighters are trained to respond to a wide range of emergencies, and over the course of responding to emergencies, are exposed to a variety of potentially traumatic events. Repeated exposure to traumatic events may adversely impact firefighters' mental health. Combined with stigma surrounding help-seeking, lack of systematic resources and referral programs, and other barriers to care, firefighters do not routinely receive a continuum of trauma informed, assessment and treatment services from trained professionals. The purpose of this paper is to describe an evidence-informed approach to a reciprocal, collaborative model among social work and public health practice, policy, and research; and to offer a framework for researchers, clinicians, and policy advocates to more effectively achieve goals of preventing and treating trauma exposure in firefighters. This paper provides a comprehensive literature review, as well as describes a case study of a successful public health intervention for mitigating exposure to trauma among a population of firefighters. The significant contribution of mental health issues to the burden of disease among our firefighters is a matter of considerable public health concern. Effective approaches to mitigating behavioral health needs must bridge both mental health disciplines and public health to minimally, include access to evidence-based assessment and treatment, peer support capacity building, widely available mental health education, and leadership development to promote culture change. When considering a model for services with firefighters, reciprocal collaboration among researchers, health care professionals, first responder organizations, families, and other relevant community stakeholders is essential for success.

Purpose-The purpose of this paper is to articulate the results of a comprehensive literature review and grassroots outreach with first responder organizations to present an operationalized framework for organizations to utilize as a blueprint in developing customized behavioral health access program (BHAP) programs.Design/methodology/approach- Historically, authorities having jurisdiction (AHJ)over fire service organizations have primarily offered behavioral health interventions through Employee Assistance Programs (EAPs) or commercial insurance carriers. These programs are necessary but may prove insufficient to meet the scope and needs of trauma-exposed firefighters and the firefighters' families.Findings- A BHAP is a comprehensive and operationalized plan which clearly specifies the mental health services fire department members and families need, where those services are available within their communities and levels and standards of care that are expected in the provision of these services.Originality/value- The BHAP is becoming a world standard of behavioral health care for first responders. While some fire service agencies are beginning to create BHAP guides, developing and implementing a BHAP can be time consuming and overwhelming, particularly for departments with limited internal and external resources. While the results of this review focus on BHAP within the fire service, this framework is applicable across all first responder professions.

Firefighters are exposed to a variety of potentially traumatic incidents in their work (Sattler et al., 2014). High levels of trauma exposure put firefighters at risk for mental disorders and symptoms. Using a survey designed to assess the mental health needs of firefighters from a hurricane disaster zone. the authors examined the prevalence of depression, anxiety, posttraumatic stress disorder, alcohol misuse. and suicide. The authors found that the firefighters in the sample reported moderate-to-high levels of mental health symptoms. Moreover, we found that job-related exposure to natural disaster plays a statistically significant role in predicting posttraumatic stress disorder, which provides further evidence of increased risk for mental health symptoms among first responders. More research is necessary to determine the types of events that contribute significantly to negative mental health responses in firefighters.

The present program consultation and evaluation examines the use of a martial-arts (MA) program in a middle-school physical education (PE) setting. Prior work and anecdotal reports suggest that MA instruction has the potential to produce both physical and psychosocial benefits for adult and adolescent participants, but rarely has a systematic program been implemented in schools. At the impetus of an MA organization, self-report measures of emotional intelligence and behavior of seventy 7th- and 8th-grade boys and girls who participated in a structured 18-session tae kwon do program as a component of their school’s PE curriculum were compared with those of 45 students who received typical PE class instruction. Participant satisfaction with the tae kwon do program and feedback received from the MA instructors and PE teachers suggest that this sport can be successfully integrated into school-based PE classes; this represents an opportunity to provide a novel programming alternative to students that promotes exercise and continued pursuit of physical activities, nonviolence, and respect of self and others. The project content, process, and challenges in working with a client MA organization to develop the curriculum, gaining entry into a public school, and explaining limitations of the research are discussed.

This study examined changes in the beliefs and behaviors of 156 offenders who participated in a Duluth model batterer intervention program. Sixty-seven percent of the participants completed both baseline and post intervention assessments of verbal, emotional, and physical aggression. Archival follow-up data, acquired approximately 9 years after completion of the program, were obtained from public records and were used to compare recidivism among program completers and noncompleters. Program completion was not associated with decreased levels of recidivism, which was defined as any violent crime. The results revealed that over one third of the participants from this batterer intervention program eventually reoffended. This finding is consistent with most existing research in this area, and suggests the need for more effective and coordinated individual, group, and community-wide interventions as well as more randomized controlled trials. Batterers who completed the 24-week program, however, did report decreases in physical and verbal aggression at the postassessment period. Limitations of this local program evaluation project and implications for future batterer intervention research are discussed.

Data were collected from university employees (N = 129) and Society for Human Resource Management (SHRM) members (N = 103) to assess the impact of workaholism on work-family conflict, job satisfaction, and perceptions of leisure time. The results, using two different measures of workaholism (Workaholism Battery, Work Addiction Risk Test), indicated that greater scores on the Workaholic Risk Test were significantly related to greater work-family conflict and less gratification with leisure (or nonwork) time. In terms of the Workaholism Battery, high Drive scores were also found to relate to more work-family conflict. However, Work Enjoyment scores were associated with less work-family conflict, as well as greater scores indicative of satisfaction with the job and the work itself. The need to examine various facets of workaholism and implications for organizational interventions are discussed.

Outcomes after behavioral couples therapy (BCT) were compared for 19 dually diagnosed veterans with combat-related PTSD and a substance use disorder (SUD, primarily alcohol dependence) and 19 veterans with SUD only. Clients with and without comorbid PTSD had very similar pre-treatment clinical profiles on dimensions of substance misuse, relationship functioning, and psychological symptoms. Further, both PTSD and non-PTSD clients showed good compliance with BCT, attending a high number of BCT sessions, taking Antabuse, and going to AA. Finally, both PTSD and non-PTSD groups improved from before BCT to immediately after and 12 months after BCT. Specific improvements noted were increased relationship satisfaction and reductions in drinking, negative consequences of drinking, male-to-female violence, and psychological distress symptoms. Extent and pattern of improvement over time were similar whether the client had PTSD or not. The present results suggest that BCT may have promise in treating clients with comorbid SUD and combat-related PTSD.