استرس شغلی و خودکشی در میان آتش نشانان: بررسی نقش بافر از تحمل سختی Occupational stress and suicidality among firefighters: Examining the buffering role of distress tolerance

1. Introduction Over the past several years, research has identified firefighters to be an occupational group at increased risk for suicide (see Stanley, Hom, & Joiner, 2016, for review). One study of 1,027 male and female career and volunteer firefighters throughout the United States (U.S.) found rates of suicide ideation and attempts occurring throughout one‘s career as a firefighter (i.e., career rates) to be 46.8% and 15.5%, respectively (Stanley et al., 2015). Similarly, a separate investigation of female firefighters found elevated rates of suicidality, with 37.7% reporting career suicide ideation and 3.5% reporting a career suicide attempt (Stanley et al., 2017a). Moreover, converging data from the U.S. Centers for Disease Control and Prevention (CDC) suggest that firefighters are at increased risk for suicide (McIntosh et al., 2016). The CDC found that workers in protective service roles, including firefighters, demonstrate elevated rates of death by suicide compared to other occupational groups (McIntosh et al., 2016; see also Tiesman et al., 2015). Thus, together with research demonstrating elevated rates of mental health disorders associated with increased suicide risk among firefighters (Carleton et al., 2017), research into factors that exacerbate and mitigate suicide risk among this population is deserving of increased empirical inquiry. Indeed, the occupational responsibilities of firefighters include routine exposure to events that may pose a substantial risk for serious injury or death, such as running into burning buildings, extracting car accident victims from the side of a busy highway, and recovering dead bodies, some of which are themselves suicide fatalities (see Kimbrel et al., 2016). These traumatic exposures could, in part, contribute to a diagnosis of posttraumatic stress disorder (PTSD; American Psychiatric Association, 2013). Incidentally, to date, four separate investigations have implicated PTSD symptoms in the pathogenesis of suicidal thoughts and behaviors among firefighters (Boffa et al., 2018b, 2017; Martin et al., 2016; Stanley et al., 2017b). However, beyond on-the-job traumatic exposures, there are many other occupational stressors experienced by firefighters (Henderson et al., 2016). These stressors include sleep disturbances, due in part to long and erratic shift schedules (U.S. Department of Labor, 2015), marital and family stress (Sanford et al., 2017), and harassment (Griffith et al., 2016). The mosaic of occupational stressors experienced by firefighters may, in part, contribute to elevated rates of suicidal thoughts and behaviors observed across multiple studies (Stanley et al., 2017a, 2015). Nevertheless, research examining the effects of occupational stress on suicidal and suicide-related symptoms among firefighters is scarce, with a few exceptions.