Elsevier

Comprehensive Psychiatry

Volume 84, July 2018, Pages 39-46
Comprehensive Psychiatry

Anxiety sensitivity and suicide risk among firefighters: A test of the depression-distress amplification model

https://doi.org/10.1016/j.comppsych.2018.03.014Get rights and content

Highlights

  • Suicide risk is elevated among firefighters.

  • We examined the effects of anxiety sensitivity (AS) and depression symptoms on suicide risk.

  • High AS cognitive concerns and depression symptoms interacted to predict suicide risk.

  • High AS social concerns and depression symptoms also interacted to predict suicide risk.

  • Findings support and extend the depression-distress amplification model of suicide risk among firefighters.

Abstract

Background

Firefighters represent an occupational group at increased suicide risk. How suicidality develops among firefighters is poorly understood. The depression-distress amplification model posits that the effects of depression symptoms on suicide risk will be intensified in the context of anxiety sensitivity (AS) cognitive concerns. The current study tested this model among firefighters.

Methods

Overall, 831 firefighters participated (mean [SD] age = 38.37 y [8.53 y]; 94.5% male; 75.2% White). The Center for Epidemiologic Studies Depression Scale (CES-D), Anxiety Sensitivity Index—3 (ASI-3), and Suicidal Behaviors Questionnaire—Revised (SBQ-R) were utilized to assess for depression symptoms, AS concerns (cognitive, physical, social), and suicide risk, respectively. Linear regression interaction models were tested.

Results

The effects of elevated depression symptoms on increased suicide risk were augmented when AS cognitive concerns were also elevated. Unexpectedly, depression symptoms also interacted with AS social concerns; however, consistent with expectations, depression symptoms did not interact with AS physical concerns in the prediction of suicide risk.

Conclusions

In the context of elevated depression symptoms, suicide risk is potentiated among firefighters reporting elevated AS cognitive and AS social concerns. Findings support and extend the depression-distress amplification model of suicide risk within a sample of firefighters. Interventions that successfully impact AS concerns may, in turn, mitigate suicide risk among this at-risk population.

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

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  • Conflicts of interest: none.

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