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Durkin, J. (2001) Stress - Who Does It Affect? www.fitting-in.com/Durkin1.htm (reproduced by kind permission of FIRE) |
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Are firefighters stressed, if you think they may be read on. |
I thought firefighting was supposed to be a stressful
occupation. Why else would you need
debriefing teams to visit you after a nasty job? Why else would ‘a spokesperson for the brigade’ emphasise the
harrowing nature of the work, the toll it takes, and the efforts required to
get over it? Can you not handle it any
more - like we did in the old days? Is
stress not simply a part of it, and why you get paid so much for sitting around
most of the time? Maybe you have
recruited people who joined for the wrong reasons such as gaining plenty of
time-off, avoidance of a ‘proper’ job and an enhanceable retirement
pension. Maybe not; maybe you have
recruited the right people and then treated them so badly that they soon
avoided ‘playing the game’ in order to limit the personal damage being
inflicted on them, and escape as soon as they felt that they had taken enough.
I was warned many times by fire officers trying to guide my
career that you can ‘never trust a fireman’.
I have always had trouble with that one; you could have trusted me, and
the vast majority of those I worked with.
But what would a firefighter say if you asked them if they were
stressed? Could you trust them to
answer honestly? Would officers be any
more honest than their subordinates with their appraisal of themselves if they
were asked about their experience of stress?
The ‘footprint’ of stress is commonly identified by clinical
psychologists through the measurement of symptoms of anxiety and
depression. A fairly rapid assessment
can be made using these self-report measures, if they are accurately completed. So what would you expect if wholetime operational
firefighters based at a city-centre fire station were tested with
time-honoured, reliable clinical assessments of stress, administered by a team
of psychologists all qualified with postgraduate degrees? Would firefighters be honest and admit to
feelings of dread, agitation and fear if they had them? Would they invent or exaggerate some
feelings just to throw the researchers?
Not easy to answer, if you believed that you could not trust them. I did trust them, and running against the
advice of my mentors of years ago, I encouraged a research team to set about a
‘first-pass’ over an unnecessarily controversial issue - stress in the fire
service.
Make a prediction.
Twenty-one operational firefighters from Cambridgeshire Fire & Rescue Service were asked to complete a
battery of questionnaires, and then undergo a 45-minute interview. Assume that you could trust them to be
honest with their answers. What level
of anxiety do you think they would report?
How depressed do you think they would feel when asked? How would they compare to ordinary members
of the public? More anxious/depressed
or less? Remember, firefighting is a
stressful job (or so you tell us). How
would they compare with clinically anxious or depressed patients? Patients who
are clinically diagnosed know a thing or two about stress, believe me. Are firefighters close to clinical
levels? Exceeding them? Or nowhere near? To test your prediction, we initially used two measures of
anxiety and one of depression.
Anxiety
Anxiety was measured using Spielberger’s Stait-Trait Anxiety
Inventory1 (STAI). Two
sources of anxiety are probed in completing the STAI; state-anxiety and
trait-anxiety. State-anxiety was
measured to provide an indicator of current levels of psychological arousal generated
by fears and concerns. Trait-anxiety
was measured as an indicator of enduring, long-term psychological arousal. Elevated scores in both types of anxiety
might give cause for concern, although a high score in state- (current) anxiety
might suggest a recent and possibly transient experience of stress.
Depression
The depression measure used was Beck’s Depression Inventory2
(BDI). The BDI offers a reliable
indicator of recent episodes of low mood and despondency. Depression is associated with significant
personal losses and disappointments, and a high BDI score in conjunction with
high scores on the anxiety measure, would suggest the current and ongoing
experience of stress. Whilst these
measures in themselves might not offer an indication of the source of the
stress, it would nevertheless alert a psychologist to its presence.
Anxiety and Depression Scores
Bear in mind when considering the figures in Table 1 that
STAI (anxiety) is measured on a scale of 20-80 with clinical levels being
assumed at 45; scores below 45 are therefore regarded as low, and therefore of
little concern. The BDI (depression) is
measured on a scale of 0-63 with clinical levels assumed at 14; below 14 is
therefore regarded as low.
Table 1.
Mean Scores for State-Anxiety, Trait-Anxiety and Depression
|
Group |
State (SD) |
Trait (SD) |
Depression: BDI (SD) |
|
Operational firefighters(21) |
29.7 (6.5) |
34.2 (6.9) |
5.0 (3.3) |
|
Controls (52) |
35.9 (9.2) |
39.8 (12.3) |
7.9 (6.7) |
|
Clinical levels exceed |
45.0 |
45.0 |
14.0 |
According to the data presented
above, firefighters were well below clinical levels on both types of anxiety
and also depression; in fact they were no higher than the ‘control’ group who
represented ordinary members of the public.
Did someone say firefighting was a stressful occupation? These scores indicated an absence of stress,
and/or seriously ice-cool copers. How
can this be? Informal discussions
revealed that most of our firefighters had attended a number of serious
incidents over many years so this was no ‘backwater’ station where nothing ever
happened.
These scores are remarkably low for any occupational
group. Might there be an extraneous
downward influence on the scores provided by our operational firefighters? Might that old chestnut about not trusting
firefighters have some basis after all?
What if the firefighters are not exactly untrustworthy, more wishing to
show themselves in a favourable light?
After all research teams are invariably composed of attractive and
intelligent people(!) and you could be forgiven for attempting to impress. The anxiety/depression questionnaires are
designed simplistically to allow highly distressed individuals to record their
experiences. They involve only a ‘mark’
in response to a statement for completion.
Of course, if the colleague sitting next to you with his arm round his
questionnaire steals a glance at your unguarded answer-sheet, he might see your
pattern of responses. What he thinks of
those responses, or what he might report to someone else about them might be of
some concern to you. If so, you may
complete your questionnaire with a loss of privacy in mind, or even what the
researcher might think if they associate you with your particular set of
responses. Consideration of these
pitfalls in ‘real-life’ research is crucial to the validity of a study of this
type. Rather than attempt to catch out
our firefighters with ‘lie-detectors’ though, or make arbitrary adjustments to
try to minimise suspect ‘enhancements’, additional stress-related tests were
added that were believed to be more difficult to interpret.
Dissociation
One test of psychological disturbance that is less obvious
about what it seeks to unearth, is that obtained through measuring
‘dissociative experiences’ or ‘dissociation’.
Perfectly normal episodes of forgetfulness, confusion and disbelief are common everyday occurrences for most of
us, but in psychiatric conditions they often become increasingly exaggerated,
intrusive and frequent. Post-traumatic
stress disorder (PTSD) for example, as defined by the Diagnostic &
Statistical Manual of Mental Disorders3 (DSM-IV), includes
descriptions of memory loss, detachment and numbing. Whilst such dissociative experiences may offer something
protective by distorting the reality of a traumatic situation, thereby limiting
its impact, dissociative experiences produce just that - distortions of
reality. So consider the health and
safety, problem-solving and decision-making implications of relying on the
judgements and actions of individuals who frequently dissociate. As can be seen from Figure 1, the increasing
severity of a psychiatric disorder produces an increase in dissociation, and
the Dissociative Experiences Scale4 (DES) places a number of
clinical groups with psychiatric disorders on a 0-100 scale, accordingly. The use of the DES with firefighters allowed
a comparison of their scores with these psychiatric groups. The DES is shown below:
Figure 1.
Dissociative Experiences Scale
(Bernstein & Putnam, 1986)
|
Normal |
Alcoholism |
Phobias |
Agoraphobia |
Schizophrenia |
PTSD |
MPD |
|
4.3 |
4.7 |
6.0 |
7.4 |
21.1 |
31.3 |
57.0 |
Time to test your prediction again. Operational firefighters, as a group,
described themselves on our anxiety and depression measures as being neither
anxious nor depressed. How often though
would they report increasing confusion and concern over ‘odd’ feelings of
unreality that might be indicators of underlying distress? As mentioned above, there may be a tendency
to underreport symptoms that could be interpreted by the researchers (or
curious colleagues) as unattractive.
The DES seems to offer a more subtle probe into the privacy of emotional
distress than that gained by anxiety and depression questionnaires. If so, and the DES succeeded in unearthing
some underlying disturbances associated with psychiatric disorders, where on
the scale would you expect our operational firefighters to fall?
Table 2.
Dissociative Experiences Scale (DES) score for operational firefighters
DES
score
Firefighter Group (number) Average (median)
Operational (21) 4.3
Plotting the
score for operational firefighters on the DES scale shows the following:
Figure 2.
Dissociative Experiences Scale
(Bernstein & Putnam, 1986)
|
Normal |
Alcoholism |
Phobias |
Agoraphobia |
Schizophrenia |
PTSD |
Multiple Personality Disorder |
|
4.3 |
4.7 |
6.0 |
7.4 |
21.1 |
31.3 |
57.0 |
Operational Firefighters (4.3)
As can be seen from Figure 1, the average score derived for
‘normal’ samples is 4.3; exactly the score generated by our operational firefighters. All three measures of stress (anxiety,
depression and dissociation) support the notion that our operational
firefighters were not a distressed group.
Summary
Based on the assumption that firefighting is a stressful
occupation, a series of psychological tests were carried out on operational
firefighters to assess the extent to which they were showing symptoms of
stress. Clinical measures of anxiety,
depression and dissociation failed to detect any negative psychological effects
in this particular group. Before we
draw the conclusion that firefighters are unaffected by the job that they do,
interviews were conducted to assess their performance on autobiographical
memory recall - a task that is vulnerable to the detrimental effects of
stress. The results will be published
in next month's article.
REFERENCES
1. Spielberger, C.D., Gorsuch, R.L., Lushene, R., Vagg, P.R. & Jacobs, G.A. (1983) Manual for the State-Trait Anxiety Inventory. Palo Alto.
2. Beck, A.T. & Steer, R.A. (1987) Beck Depression Inventory Manual. San Antonio, TX: The
Psychological Corporation.
3. American Psychiatric Association (1994) Diagnostic
and statistical manual of mental disorders (4th edn) Washington,
DC: Author.
4. Bernstein, E. & Putnam, F. (1986) Development, Reliability, and Validity of a
Dissociation Scale. Journal of Nervous and Mental Disease Vol.174 (12): 727-735.
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