Several years ago I was in a meeting with the leaders of the International Association of Fire Chiefs’ Safety, Health and Survival section. The topic of suicide came up and there was discussion around whether it was something the fire service needed to focus on.
Someone asked that everyone who knew a firefighter who had committed suicide raise their hand — every chief at the table raised a hand. That’s not surprising as the National Fallen Firefighter Foundation reports that departments are three times more likely to experience a suicide than a line-of-duty death.
Suicide is the 10th leading cause of death in the United States with 13 people per 100,000 dying by suicide annually, and the rate is on the rise. A study published in July by the Centers for Disease Control looked at suicide in 17 states and found that rates of suicide among those in the protective services (which includes both firefighters and police) was 34.1 per 100,000, which put them sixth highest for males.
Among women, those in the protective services had the highest rate of suicide of any occupational group (14.1 per 100,000).
Dr. Stanley and colleagues at Florida State University recently recruited firefighters with the help of the National Fallen Firefighters Foundation to complete a survey about behavioral health.
Among the 1,027 firefighters who responded, nearly half reported having considered suicide during the course of their career. Nearly one in five had developed a plan for their suicide and 15.5 percent had attempted suicide at some point in their career. In comparison, it is estimated that 1.9 to 8.7 percent of the general population have attempted suicide in their lives.
Study limitations
Several factors were related to reporting suicidality. Firefighters in volunteer departments were more than twice as likely to have come up with a suicide plan or attempted suicide as those in career departments.
Those of lower rank and with fewer years of service also were at higher risk. In addition, those who had responded to a completed or attempted suicide were more likely to be at high risk.
A noted limitation to the study is that the recruitment was through online snowball sampling. It is possible, or maybe even likely, that those more at risk for behavioral health problems would be more likely to respond to a survey focused on behavioral health.
It is difficult to know exactly how big the problem is among firefighters given the challenges of assessing suicidal thoughts and behaviors.
Negative stigma within many departments may lead departments to under report deaths or misclassify suicides as accidents. Research on death certificates likely misses volunteer firefighters, as their service is not noted as their occupation.
In a study published this summer in the Journal Professional Psychology: Research and Practice,” Sarah Henderson and colleagues at Nova Southeastern University overviewed the state of the science on suicide risk among firefighters, described approaches to addressing the problem and suggested policy recommendations for fire departments and mental health professionals.
Prevention program
Henderson outlined the risk factors firefighters need to be aware of in their colleagues including: expressing hopelessness, feeling like a burden, previous suicide attempts, changes in sleeping patterns, alcohol abuse, isolation or withdrawal, or anxious or agitated behavior.
She outlines a model program implemented with Broward County (Fla.) Fire and Rescue focused on psycho-educational health trainings addressing depression, stress, substance abuse, sleep and suicide. The training included information about stigma in the firefighter community, coping strategies, and community resources for those having behavioral health challenges.
They also suggest that practitioners need to be aware of the stigma firefighters face related to behavioral health and that firefighters experience repeated exposure to trauma that put them at increased risk.
Regardless of the exact numbers, it is clear that the scope of the problem for firefighters is significant. The job puts firefighters at risk, which makes it important for fire departments to provide resources for their personnel.
It also highlights the importance of crews watching out for each other and being aware when one of their own is having a problem.
