Mari-Amanda A. Dyal, PhD, Kennesaw State University Todd D. Smith, PhD, Indiana University School of Public Health – Bloomington David M. DeJoy, PhD, University of Georgia Brian A. Moore, PhD, Kennesaw State University
The purpose of this study was to examine the role and impact of sleep health characteristics as they relate to burnout and occupational stress amongst members of the fire service.
There is no question that firefighting is a dangerous job. The inherent occupational hazards associated with firefighting have sustained detrimental psychological, physical, and organizational effects (Rajabi et al., 2020). These hazards have been broadly defined by the Centers for Disease Control (CDC) (2019). Among them are structural hazards, chemical exposures, diesel exhaust, emergency response hazards, fire-damaged floor and job stress. A study by Walker (2016) asked firefighters to rank these hazards with job stress emerging as the highest ranked hazard. Burnout is a preventable outcome of stress that is characterized by physical and mental exhaustion related to being overworked or stressed (Feldman et al., 2020). In the fire service, burnout has been shown to be associated with reduced safe work practices, personal protective equipment usage, work pressure, errors, PTSD, injury, familial discord (Smith et al., 2018; Smith et al., 2019c), and sleep dysfunction (Wolkow et al., 2018). In fact, recent studies have reported that between 40 and 60% of surveyed firefighters experience poor quality sleep (Abbassi et al., 2018; Barger et al., 2016; Hom et al., 2016; Smith et al., 2019a; Smith et al., 2019b; Sullivan et al., 2017). Although the relationship between stress and sleep has been explored in fire service literature (Mehrdad et al., 2013; Lusa et al., 2002; Kim et al., 2006), this relationship has not been examined within the scope of firefighter burnout development. These variables are very dynamic, even more so in the fire service, and this research confirms and presents the relationships among them in ways that have not been considered in the literature to date, thereby contributing to the growing science of influential factors in the fire service that are malleable with appropriate cognitive or behavioral interventions.
Career firefighters were surveyed on perceived occupational stress, all three dimensions of burnout (exhaustion, detachment, and cynicism), and sleep health characteristics as defined by sleep quality and sleep duration. The primary analysis for this study concentrated on conducting and comparing two mediation models using the specified variables. The first model examined occupational stress as predictor, burnout as mediator, and sleep quality as the outcome. The second model examined sleep duration as the predictor, occupational stress as mediator, and burnout as the outcome. Each analysis required OLS regression for the following: 1) confirming the relationship between X and Y (total effect; path c), 2) confirming the relationship between X and M (path a), 3) confirming the relationship between M and Y in the presence of X (path b), and 4) confirming the reduced relationship between X and Y in the presence of M (direct effect; path c?). The sample included 161 career firefighters from a department with 14 stations and approximately 350 sworn personnel serving a population of 190,000 residents.
The results indicate that 1) burnout fully mediated the relationship between occupational stress and sleep quality and 2) occupational stress fully mediated the relationship between sleep duration and burnout for two of the three sleep duration reference groups (6&7 and 6&8). The reference groups in this analysis were based upon the smallest unit of measurement, which was the 6 hours or less category. Therefore, three reference groups emerged (6 hours or less & 7 hours [denoted as 6&7]; 6 hours or less & 8 hours [denoted as 6&8]; 6 hours or less & 9 hours or more [denoted as 6&9]) and were applied to the analyses.
Subjective sleep health characteristics are being impacted by occupational stressors and are also dynamically involved in the response to occupational stressors. As such, ideal interventions to reduce occupational stress and burnout should address the individual needs of firefighters, while being cognizant of the unique culture in the fire service. Therefore, the current research proposes practice recommendations that incorporate a multi-level approach for intervention design and delivery that specifies 1) comprehensive subjective and objective sleep health characteristics, 2) occupational stressors, and 3) burnout indicators and effects. As for research, it is recommended that comprehensive assessments of both subjective and objective markers of sleep health be incorporated into firefighter research to supplement behavioral health assessments and interventions, especially related to burnout and occupational stress.
This research demonstrates the role and impact of sleep health in the context of occupational stress and burnout in the fire service, which has set a course for larger conversations that involve objective and comprehensive measurement in an effort to emphasize firefighter sleep health beyond its current status. Further, this research highlights the complicated nature of these reciprocal relationships and highlights the importance of sleep health in managing occupational stress and burnout in firefighters.