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Understanding stress and suicide in emergency responders

EMS leaders learn suicide risk factors and the imperative to provide a non-punitive culture for seeking help


JACKSONVILLE, Fla. — EMS leaders were called on to address the rising rate of suicide among emergency responders at the Pinnacle EMS Leadership forum by psychologist and researcher Susan Balaban, PhD.

Attendees learned about suicidality, which is thinking about suicide from smallest thought to making a plan, is normal. Acting on suicidality is less common.

Significant risk factors for suicide in emergency responders include higher exposure to stress, lower access to institutional resources like an employee assistant program, and alcohol consumption as a coping strategy. Previous psychiatric symptoms and sleep problems are predictors of mental health problems in emergency responders.

Balaban, the Uniformed Services Program clinical manager at Brattleboro Retreat, shared that there is a higher rate of negative early life experiences in emergency responders than the general population. “People tell me ‘I am safe and I keep others safe,’” Balaban said when describing why some people who had traumatic childhood experiences where they had to be more hyper-vigilant chose a career in the uniform services. “A child who grows up in hardship is able to, on their own, deal with things by themselves and is at much higher risk of developing PTSD and problems with substance abuse.”

Memorable quote: Tragically normal

“Planning suicide, thinking about suicide, suicide is not unusual. It’s not only normal. It’s common place and that is tragic.”

Key takeaways: Emergency responder suicide

  • General predictors for suicide include poor problem-solving abilities, passive and fatalistic behavior, black and white thinking, hopelessness, intense pessimism, futility, limited social networks and frequent conflict.
  • EMS providers face extraordinary stressors regularly and cumulatively while still being relatively resilient to stress.
  • Research on emergency responder suicide is limited, often follows major incidents, and is difficult to conduct because of variable, non-standardize population.
  • Impediments to seeking help include disincentive to use sick time, punitive response to seeking help, misperceptions and stigma and confidentiality concerns.
  • People that seek and receive treatment for PTSD are able to return to work and perform at least at the same level as before. Evidence-based treatments for PTSD incorporate exposure-based therapies and mental visualizations.

There is no evidence-based method for predicting suicide. There are risk factors, but the idea of suicide prediction is a myth in search of facts. Balaban concluded the presentation by sharing that research shows the best results come from a team approach of skilled mental health professionals, outreach coordinators, and structured and familiar networks of peer support in concert with education and destigmatization.

Greg Friese, MS, NRP, is the Lexipol Editorial Director, leading the efforts of the editorial team on Police1, FireRescue1, Corrections1 and EMS1. Greg served as the EMS1 editor-in-chief for five years. He has a bachelor’s degree from the University of Wisconsin-Madison and a master’s degree from the University of Idaho. He is an educator, author, national registry paramedic since 2005, and a long-distance runner. Greg was a 2010 recipient of the EMS 10 Award for innovation. He is also a three-time Jesse H. Neal award winner, the most prestigious award in specialized journalism, and the 2018 and 2020 Eddie Award winner for best Column/Blog. Connect with Greg on LinkedIn.