The human brain is a marvelous, yet complicated system. Researchers spend entire careers studying what makes the brain act or react to certain experiences. A mental health issue stemming from life’s experiences has culturally been seen as a sign of weakness, but actually is part of a very complex architecture that’s unique from person to person.
In order to gain an understanding of how stress plays a role in the lives of first responders, we need to start answering some hard questions: What leads to burn-out? What’s associated with PTSD? How is lack of sleep affecting the mental health states of first responders? These are all questions that have a need to be answered to not only benefit the individual, but also organizations and the emergency responder industry.
As an epidemiologist, I surround myself with existing data, publications and information prior to approaching a project or topic. Specifically looking at research on first responder mental health, it’s concerning to see such a lack of data and research on this topic.
Putting it into perspective, I have compared the military population to the emergency responder population; both groups have approximately two million individuals within their respective organizations, whether full-time, part-time or volunteers. When I performed a search in the PubMed database for research publications pertaining to “mental health and military,” I received over 4,400 results; but when I looked at “mental health and first responder,” I only received 53 results. Even more shocking, when I browsed through the abstracts, I found that a majority of these studies focused on the patients that first responders deal with, not the mental health of first responders themselves.
The CrewCare Project
The CrewCare project and app, which was released in February 2018, originated from hearing of daily struggles and concerns related to the mental health of first responders and a desire to support individuals throughout the industry. Many of my coworkers are passionate about the topic of mental health, whether they were first responders in their previous careers or have family or friends within the career field.
As a software solutions and data analytics company, ImageTrend has the technology to create pathways to reach first responders in a way that allows for confidentiality when sharing information about a sensitive topic like mental health. Even though the tool used for this project is a free mobile app available to any emergency responder, it can be especially beneficial for responders in rural areas, volunteers who may not have the same access to employee benefits, or agencies that aren’t providing the necessary mental health support needed.
Not only did we envision this project helping individuals, but also departments and the industry as a whole. The anonymously collected data can be analyzed to provide further insight into the career challenges that emergency responders are facing as well as other career and life struggles. The results can also highlight what’s working and what’s not working within departments that need to be encouraged and implemented, or adjusted and changed.
The project has collected information from individuals working in EMS, Fire, law enforcement and military. Questions were asked pertaining to lifestyle, family, support, career, finances and more. As of November 2018, almost 2,700 emergency responders have downloaded and used the CrewCare app. I specifically analyzed any respondents that identified themselves in professions related to EMS and/or fire related, which accounted for 1,843 individuals. I wanted to highlight three areas that provide a good overview related to mental health issues, sleep deprivation and career stress.
When looking at the characteristics of individuals who provided information for this project, most respondents were between the ages of 20–49 (82%). The breakdown of male to female was 75% and 25% respectively, and 13% of the total respondents identified themselves as either a veteran or active duty military. When looking at the career breakdown, 55% said they were in EMS, 35% said they were a combination of Fire and EMS, and 10% were Fire only. (See Figure 1.)
Health behaviors were also collected, and I found some interesting information starting with nicotine use: 31% of male respondents and 20% of female respondents said they used nicotine products. According to the CDC, this is 5% higher in both male and female respondents compared to the U.S. adult population.1 Another 83% of respondents said they wanted to lose weight, which is much higher than the 53% U.S. adult population wanting to lose weight.2
Depression screening questions were also asked throughout the CrewCare app. The first question asked respondents how often they felt down, depressed or hopeless in the last 14 days: 22% reported they did nearly every day or more than half the days. Another 18% felt like a failure or that they had let themselves or family down every day, or more than half the days, in the last 14 days. (See Figures 2A and 2B.)
When looking at post-traumatic stress disorder (PTSD), 68% of respondents thought they had or maybe had PTSD at some point.
Another question asked was if respondents had someone they could ask for emotional support if they needed it: 83% said “yes,” which was encouraging, but that still left 17% of respondents not feeling like they had a support network when needed. When asked if they felt they could seek mental health help at work, 63% said “yes” or “not sure” that there would be negative consequences. Specifically asking if they felt they could talk to their supervisor about mental health, only 34% strongly agreed or agreed. (See Figure 3.) About half (49%) of respondents strongly agreed or agreed that their agency offered sufficient mental health/employee assistance program services.
When reviewing the sleep data collected in CrewCare, 80% of respondents reported getting less than seven hours of sleep per day compared to the general adult population of only 35% saying they get less than seven hours of sleep.3
Almost 29% of respondents said they wake up feeling exhausted a majority of the week (i.e., four or more days). Approximately 30% of individuals reported a diagnosed sleeping disorder and only about half of respondents rated their quality of sleep as either “good” or “very good.” (See Figures 4A and 4B.)
Research on the lack of sleep has shown to have negative effects not only physically, but also mentally. Adults sleeping less than seven hours in a 24-hour period were more likely to report being obese, didn’t participate in physical activity during leisure time, and smoked cigarettes compared to those that got seven or more hours of sleep.4
Individuals sleeping less than the recommended seven hours were also more likely to report chronic issues such as heart attack, stroke, asthma, arthritis and depression compared to those getting seven or more hours of sleep.4
When focusing on the mental health and sleep deprivation, research has shown they are closely related. According to Harvard Mental Health, sleeping issues are associated with mental health disorders and that chronic sleep issues affect 50–80% of psychiatric conditions compared to 10–18% of the general adult population.5
First responder careers are unique in several ways, from the job itself to the hours worked, and even the mental effects it can have on the individual. Gaining an understanding of how the emergency response career field differs from the overall U.S. workforce can help ideate ways to improve job turnover, employee satisfaction and other challenges first responders face.
The number of hours worked, and when first responders work, can vary from one organization to another, but 86% of CrewCare respondents reported working more than 40 hours a week. A 2014 survey showed that about 50% of U.S. adults work more than 40 hours per week.6 Another interesting characteristic of emergency responder work is that 65% of respondents said they had more than one job, in comparison only 5% of the general population has more than one job.7 A negative consequence of the number of hours worked, along with the type of work may also be a contributor to burnout, 44% of CrewCare respondents said they felt burnt out in either their current position and/or their career field.
A component of job satisfaction is how well you like or get along with your coworkers and supervisor. CrewCare specifically looked at support pertaining to coworkers and supervisors. About 23% of respondents felt they had little or no support from their coworkers, and another 41% felt they had little or no support from their supervisor.
Respondents were also asked what they liked least and most about their jobs. This was an opportunity to type what they wanted without being prompted with multiple choice questions. After analyzing the qualitative data and organizing the results by similar themes, the top three things respondents liked least about their job: 1) management/politics; 2) death/grief; and 3) unappreciative patients/individuals. The top three things they enjoyed most about their job: 1) helping others, 2) meeting new people; and 3) variety in the work. Respondents were also asked about the most mentally difficult calls they go on with the top three reasons being: 1) pediatric; 2) fatalities/suicides; and 3) calls that they felt helpless in helping the individual. (See Figure 5.)
Where Do We Go from Here?
As an epidemiologist, exploring the data can sometimes lead to more questions than answers. My work doesn’t stop at answering initial questions, but finding explanations for those results and continuing to answer more questions that arise. CrewCare continues to evolve by refining topics necessary to support the research and by updating crucial resources and crisis contacts for first responders.
Emergency responders will hopefully continue to come forward and share their stories to not only shed light on the reality of the profession but also to facilitate changes that need to be made. In order for these stories to have a greater impact, they need credible and publishable data that will encourage actionable change at department and industry levels.
The CrewCare project is a start in the right direction, and our intention is that it will make a dent in the research needed for this industry. We hope it encourages others to implement data-driven initiatives that help combat emergency responder mental health issues.
1. Centers for Disease Control and Prevention. (Nov. 7, 2017.) One in five US adults still using tobacco products in 2015. Retrieved Nov. 12, 2018, from www.cdc.gov/media/releases/2017/p1109-tobacco-product-usage.html.
2. Swift A. (Nov. 22, 2016.) Fewer Americans in this decade want to lose weight. Gallup. Retrieved Oct. 4 2018, from https://news.gallup.com/poll/198074/fewer-americans-lose-weight-past-decade.aspx.
3. American Sleep Association. (n.d.) Sleep and sleep disorder statistics. Retrieved Oct. 4, 2018, from www.sleepassociation.org/about-sleep/sleep-statistics/.
4. Centers for Disease Control and Prevention. (May 17, 2017.) Short sleep duration among US adults. Retrieved Oct. 5, 2018, from www.cdc.gov/sleep/data_statistics.html.
5. Harvard Mental Health Letter. (June 19, 2018.) Sleep and mental health: Sleep deprivation can affect your mental health. Harvard Health Publishing. Retrieved Nov. 12, 2018, from www.health.harvard.edu/newsletter_article/Sleep-and-mental-health.
6. Bureau of Labor Statistics. (July 19, 2018.) 4.9 percent of workers held more than one job at the same time in 2017. Retrieved Sep. 5, 2018, from www.bls.gov/opub/ted/2018/4-point-9-percent-of-workers-held-more-than-one-job-at-the-same-time-in-2017.htm.
7. Saad L. (Aug. 29, 2014.) The “40-hour” workweek is actually longer by seven hours. Gallup. Retrieved Sep. 5, 2018, from https://news.gallup.com/poll/175286/hour-workweek-actually-longer-seven-hours.aspx.