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It’s like immunizing your brain: Depression, PTSD and suicide prevention

Seven resolutions for increasing your resilience to prevent psychological and emotional trauma in emergency services


It’s time that we find ways to prevent, not just treat, psychological and emotional trauma.


Regardless of what your favorite social media thread says, those of us in the medical profession that know getting vaccinated to prevent things like smallpox, hepatitis, chicken pox, diphtheria, tetanus, measles, mumps, flu and the like is better than treatment. Likewise, it’s better to put on a helmet when riding your bike, skateboard, crotch rocket or snowboard, than to try to remember third grade through your traumatic brain injury. It’s better to use condoms, body armor and seatbelts, than it is to be treated for syphilis, a gunshot wound to the chest, or a hip dislocated in a car crash.

We have learned through experience, science and common sense that a lot of physical suffering can be prevented. Yet, when it comes to psychological or emotional injury for us and our colleagues, we have historically focused on treatment rather than prevention.

Don’t get me wrong. If I get shot, I want a rock star EMS team, a talented trauma surgeon and a stellar hospital team available to take care of me. Providing CISM, peer support teams, chaplains, employee assistance programs, psychological first aid, trauma-trained psychotherapists, therapy dogs and the like is essential to take care of our folks who have experienced psychological and emotional trauma. But it’s time that we find ways to prevent, not just treat, psychological and emotional trauma.

PTSD, suicide risk in first responders

We all see the reports about EMS providers, firefighters, police officers, doctors and nurses who’ve died by suicide. When you look at the research, it shows we have a real problem. A 2017 First Responder Mental Health Survey conducted by the University of Phoenix found that of the 2,000 emergency service providers surveyed:

  • 34% of them had a formal mental health disorder diagnosis

  • 27% were diagnosed with depression

  • 10% had PTSD

The general population has a PTSD rate of 1.3-3.5% and returning Iraq war veterans have a PTSD rate of 3-6%. One study of 1,027 firefighters found that 46.8% of them had suicidal thoughts. Every study that’s been published shows that our PTSD and suicide rate in emergency services is more than double that of the general population.

One of the most studied PTSD-causing series of events of my lifetime was the terrorist attacks on Sept. 11, 2001. When they assessed emergency responders 5 or 6 months after the attack, they found between 8 and 12% of them had PTSD. A reassessment of the same responders two and a half years after the attack found a PTSD rate of 16.4 to 17.2%. There are a couple of theories behind the increase. One is delayed-onset PTSD that does not show up until six months or more post-event. The other is that some of the responders may have been initially reluctant to reveal to researchers or counselors that they were having symptoms like recurrent nightmares, overwhelming anxiety, feeling suspicious of everyone, actively avoiding anything that could remind them of the event, etc.

The association between resilience and mental health

What’s the difference between those who acquire PTSD and have suicidal thoughts, and those who don’t? While there is still a lot to be learned about this topic, there’s clear evidence that resilience is a big part of the picture. A meta-analysis of 52 research studies on resilience and its relationship to depression, PTSD and suicide found “a strong association between resilience and mental health.”

Resilience is the ability to advance despite adversity and live a good life. High levels of resilience seem to inoculate people against depression, anxiety, PTSD/PTSI and suicidal thoughts. Resilient people are better able to deal with day-to-day stresses. Sure, they get upset when their smartphone falls into the toilet while texting or someone cuts them off in traffic, but they bounce back quickly.

High resilience makes you a better problem-solver and more creative, and improves the quality of your relationships. Resilience is a key ingredient in bravery. It’s an essential component to achieving big goals, like getting into medical school, buying a house or becoming chief of your department.

Neuroscience describes several ingredients that work synergistically to create resilience. These include:

  1. Goals. The ability to set goals and the tenacity to achieve them.

  2. Emotional regulation. The ability to recognize and moderate your emotional response to things that happen in your life in the moment.

  3. Prolem-solving skills. Building a resource system that helps you get answers to tough questions.

  4. Sleep. The ability to fall asleep, stay asleep and have adequate deep sleep for 7-8 hours.

  5. Nutrition. That advice to eat more fruits, vegetables and whole grains really does matter – added artificial sugar has a much bigger impact on your brain than you might imagine.

  6. Exercise. You don’t need to be an Olympic competitor, but it’s important to move, stretch and do some kind of resistance several times a week.

  7. Collaboration. Healthy supportive relationships may be more important to your mental and physical health than not smoking, maintaining your weight and exercise.

The side effects to following this prescription for building resilience include less chronic disease and more happiness. The best time to start building your resilience and the resilience of your team is 10 years ago, but if you start today, you’ll see the benefits immediately.

The 911 Training Institute’s Jim Marshall offers strategies for preventing PTSD, decreasing suicides and increasing happiness in first responders. Read more: Building First Responder Resilience.

This article was originally posted Dec. 2, 2019. It has been updated.

Mike Taigman uses more than four decades of experience to help EMS leaders and field personnel improve the care/service they provide to patients and their communities. Mike is the Improvement Guide for FirstWatch, a company which provides near-real time monitoring and analysis of data along with performance improvement coaching for EMS agencies.

He teaches Improvement Science in the Master’s in Healthcare Administration and Interprofessional Leadership at the University of California San Francisco and the Emergency Health Services Management Graduate Program at the University of Maryland Baltimore County. He’s the author of “Super-Charge Your Stress Management in the Age of COVID-19.” Contact him at