Anxiety sensitivity and suicide risk among firefighters: A test of the depression-distress amplification model
Section snippets
Background
Suicide represents a significant public health concern, with over 40,000 individuals in the United States (U.S.) dying by suicide annually [1]. One segment of the U.S. population that research has revealed may be at a particularly increased risk for suicide is firefighters [2]. For example, Stanley et al. [3] examined 1027 current and retired firefighters throughout the U.S. and found career rates (i.e., those occurring throughout one's tenure as a firefighter) of suicidal ideation and suicide
Participants
Data from 831 firefighters were available for the current study, which was part of a larger ongoing project examining stress and health-related behaviors among firefighters in a large southern U.S. metropolitan area. In this department, all firefighters also perform emergency medical service (EMS) duties. To be included in the study, participants must have been current firefighters aged 18 years of age or older. See Table 1 for a summary of participant characteristics.
Procedure
Firefighters completed a
Results
Means, standard deviations, normality statistics, and intercorrelations between study variables are presented in Table 2. Results of regression analyses are presented in Table 3. The average scores of CES-D depression symptoms in our study were lower than the CES-D scores reported by Hom et al. [23] in a separate sample of 880 current and retired firefighters (M [SD] = 10.60 [7.80] vs. M [SD] = 13.49 [11.24], t[1709] = −6.145, p < 0.001). The average scores of ASI-3 global AS were also lower in
Discussion
The purpose of the current study was to test the depression-distress amplification model of suicide risk among a large sample of firefighters. Findings revealed that the effects of depression symptoms on suicide risk are amplified by AS cognitive concerns. This finding persisted even after controlling for other domains of AS concerns (i.e., physical, social), demonstrating the strength with which AS cognitive concerns may make an individual experiencing depressed mood vulnerable to suicidality.
Acknowledgment
This work was supported in part by the Military Suicide Research Consortium (MSRC), an effort supported by the Office of the Assistant Secretary of Defense for Health Affairs under Award Nos. (W81XWH-10-2-0181, W81XWH-16-2-0003). Opinions, interpretations, conclusions and recommendations are those of the authors and are not necessarily endorsed by the MSRC or the Department of Defense. The funders had no role in study design; in the collection, analysis and interpretation of data; in the
References (71)
- et al.
A systematic review of suicidal thoughts and behaviors among police officers, firefighters, EMTs, and paramedics
Clin Psychol Rev
(2016) - et al.
Career prevalence and correlates of suicidal thoughts and behaviors among firefighters
J Affect Disord
(2015) - et al.
Suicidal thoughts and behaviors among women firefighters: an examination of associated features and comparison of pre-career and career prevalence rates
J Affect Disord
(2017) - et al.
Suicide in U.S workplaces, 2003–2010
Am J Prev Med
(2015) - et al.
An interactive model of anxiety sensitivity relevant to suicide attempt history and future suicidal ideation
J Psychiatr Res
(2012) - et al.
Anxiety sensitivity cognitive concerns predict suicide risk
Psychiatry Res
(2015) - et al.
Anxiety sensitivity, anxiety frequency and the prediction of fearfulness
Behav Res Ther
(1986) - et al.
Examining the unique relations between anxiety sensitivity factors and suicidal ideation and past suicide attempts
Psychiatry Res
(2015) - et al.
Anxiety sensitivity cognitive concerns predict suicidality among smokers
J Affect Disord
(2012) - et al.
Examining anxiety sensitivity as a mediator of the association between PTSD symptoms and suicide risk among women firefighters
J Anxiety Disord
(2017)
Distress tolerance and anxiety sensitivity cognitive concerns: testing the incremental contributions of affect dysregulation constructs on suicidal ideation and suicide attempt
Behav Ther
The depression distress amplification model in adolescents: a longitudinal examination of anxiety sensitivity cognitive concerns, depression and suicidal ideation
J Adolesc
Test of the depression distress amplification model in young adults with elevated risk of current suicidality
Psychiatry Res
Suicide risk among male substance users in residential treatment: evaluation of the depression-distress amplification model
Psychiatry Res
The role of anxiety sensitivity cognitive concerns in suicidal ideation: a test of the depression-distress amplification model in clinical outpatients
Psychiatry Res
Anxiety disorders and suicidality in the National Comorbidity Survey-Replication
J Psychiatr Res
Psychometric properties of the Center for Epidemiologic Studies Depression Scale (CES-D) in French clinical and nonclinical adults
Rev Epidemiol Sante Publique
Validation of the Center for Epidemiologic Studies Depression Scale in screening for major depressive disorder among retired firefighters exposed to the world trade center disaster
J Affect Disord
Measurement of depressive symptoms in cancer patients
J Psychosom Res
Investigating the role of hopelessness in the relationship between PTSD symptom change and suicidality
J Affect Disord
Mild traumatic brain injury and suicide risk among a clinical sample of deployed military personnel: evidence for a serial mediation model of anger and depression
J Psychiatr Res
Anxiety sensitivity as a mechanism for gender discrepancies in anxiety and mood symptoms
J Psychiatr Res
Gender differences in dimensions of anxiety sensitivity
J Anxiety Disord
Assessment of anxiety sensitivity in young American Indians and Alaska natives
Behav Res Ther
Anxiety sensitivity within the anxiety disorders: disorder-specific sensitivities and depression comorbidity
Behav Res Ther
Examination of a brief anxiety sensitivity cognitive concerns intervention on suicidality among individuals with obsessive-compulsive symptoms
Contemp Clin Trials
What makes a quality therapy? A consideration of parsimony, ease, and efficiency
Behav Ther
Differences in psychiatric symptoms and barriers to mental health care between volunteer and career firefighters
Psychiatry Res
Suicide prevention in fire service: the Houston fire department (HFD) model
Aggress Violent Behav
WISQARS: web-based injury statistics query and reporting system
Correlates of suicidality in firefighter/EMS personnel
J Affect Disord
Suicide rates by occupational group — 17 states, 2012
Morb Mortal Wkly Rep
Anxiety sensitivity: theory, research, and treatment of the fear of anxiety
Robust dimensions of anxiety sensitivity: development and initial validation of the anxiety sensitivity index-3
Psychol Assess
Expectancy model of fear
Cited by (11)
Cognitive effects on firefighters in oklahoma from their initial start of service till the present
2023, Applied Research Approaches to Technology, Healthcare, and BusinessThe Relationship between Effort-Reward Imbalance and Depressive Symptoms among Chinese Firefighters: Moderating by Coping Styles
2023, Journal of Occupational and Environmental MedicineAssociations between Public Service Motivation, Depression and Anxiety among Firefighters: A Chain Mediation Model of Employee Resilience and Job Satisfaction
2023, Journal of Homeland Security and Emergency ManagementPutative risk and resiliency factors among Royal Canadian Mounted Police cadets
2023, Frontiers in PsychologyPsychological Diseases in Firefighters: A Short Review
2023, Studies in Systems, Decision and ControlDepression Screening Implementation: Quality Improvement Project in a Primary Care Clinic for First Responders
2022, Workplace Health and Safety
Conflicts of interest: none.