Michelle L. Pennington, MPH, Baylor Scott & White Health; Jordan E. Smith, MPH, Baylor Scott & White Health; Elizabeth Coe, PsyD, Baylor Scott & White Health; Nathan A. Kimbrel, PhD, Durham Veterans Affairs Medical Center; Rose T. Zimering, PhD, Veterans Affairs Boston Healthcare System; Suzy B. Gulliver, PhD, Baylor Scott & White Health
The purpose of the current study was to investigate how stigma related to sources of help-seeking among firefighters. We hypothesized that firefighters who reported stigma would prevent them from using behavioral health services would be less likely to seek help from fire service related sources (i.e. Department or Union EAP/MAP services, coworkers, officers, chaplains).
Due to occupational stress and exposure to potentially traumatic events, firefighters are at an increased risk of developing many behavioral health conditions. Most fire departments offer “in house” behavioral health programs for professional firefighters. Despite their availability, many firefighters do not utilize the formal care options provided by the department. Previous studies among emergency personnel revealed that stigma concerns, fear of breach of confidentiality, and negative career outcomes prevent individuals from seeking care. Additionally, a study of firefighters in the UK found that the majority of firefighters relied on social support over professional care. To our knowledge, this is the first study to investigate how stigma relates to sources of help-seeking among firefighters.
In a larger study, 2,156 career firefighters completed an anonymous online survey regarding firefighter attitudes and beliefs about behavioral health. Participants were asked to what degree they agreed or disagreed with the statement: “Stigma prevents me from using behavioral health services.” This item used a 5-point Likert-scale with answers dichotomized such that 1=strongly disagree, 2=disagree, and 3=neither agree nor disagree were coded as no while 5=strongly agree and 4=agree were coded as yes. Sources of help-seeking were assessed through six questions on a 5-point Likert-scale that asked “If I needed assistance or counseling, I would go to: 1) Spouse/family, 2) Coworker, 3) Officer, 4) Chaplain, 5) Private professional services, 6) Department or Union EAP/MAP services.” These items were dichotomized such that 1=strongly disagree and 2=disagree were categorized as no while 5=strongly agree and 4=agree were categorized as yes. Individuals who answered 3=neither agree nor disagree were excluded from analysis for that item. The PROC GENMOD procedure with a log-binomial distribution was then used to estimate the association between firefighters reporting stigma and whether they would seek help from a source.
Associations between stigma regarding behavioral health services and sources of help-seeking are presented in Table 1. Firefighters who reported stigma would prevent them from using behavioral health services were less likely to report that they would seek help from Department or Unions EAP/MAP services (risk ratio[RR]=0.72; 95% confidence interval[CI]=0.65-0.80), coworkers (RR=0.86; 95% CI=0.78-0.94), and officers (RR=0.70; 95% CI=0.60-0.82), when compared to respondents who said stigma would not prevent them from using services.
Firefighters who reported stigma would prevent them from using behavioral health services were less likely to report that they would seek help from Department or Unions EAP/MAP services, coworkers, and officers when compared to respondents who said stigma would not prevent them from using services. These findings support previous research indicating that stigma is a barrier to accessing behavioral healthcare. Findings that firefighters reporting stigma concerns are less likely to seek help from coworkers and officers are concerning given the benefits of social support. Research has shown that social support among firefighters is associated with lower levels of suicidality. Social support has also been shown to increase coping efficacy following a traumatic event. Strengths of this study include the large, international sample size and to our knowledge, it is the first study to investigate how stigma is related to sources of help-seeking among firefighters. Limitations include: 1) the survey is not a psychometrically validated instrument, and stigma was not measured using a validated scale, and 2) the survey did not query actual personal use of behavioral health care services, so we could not explore actual help-seeking behaviors, but only hypothetical sources of support.
Firefighters who reported stigma concerns were less likely to report that they would seek help from fire service related sources (i.e. EAP/MAP, coworkers, officers) when compared to respondents who did not report stigma concerns. However, these firefighters were no less likely to report that they would seek help from sources outside the fire department (i.e. private profession services, spouse/family). Because our data was gathered prior to the implementation of the International Association of Fire Fighter’s Peer Support Training Program, future research investigating how stigma affects help-seeking from a peer support specialist is needed. Follow-up research is also warranted to examine how interventions to decrease stigma around mental health and service use in firefighters can increase help-seeking from various sources.