Shirley A. Murphy

Coping responses and posttraumatic stress symptomatology in urban fire service personnel

Emergency workers, including urban fire fighters and paramedics, must cope with a variety of duty-related stressors including traumatic incident exposures. Little is known about coping responses of emergency workers or whether their coping responses predict future mental health outcomes. The previously formulated Coping Responses of Rescue Workers Inventory (CRRWI) underwent a principal components analysis employing a sample (N = 220) of urban fire fighters and paramedics. Six empirically and theoretically distinct CRRWl components were identified which were relatively stable over a 6-month period. Scores on one of the CRRWI scales, but neither years of service nor their past half years traumatic incident exposures, predicted future changes in self-reports of posttraumatic stress symptomatology.

Exposure to duty-related incident stressors in urban firefighters and paramedics.

Little is known about the variables that might be associated with posttraumatic stress symptomatology in high-risk occupational groups such as professional firefighters and paramedics. A sample of 173 urban professional firefighter/EMTs and firefighter/paramedics rated and ranked the stressfulness of 33 actual and/or potential duty-related incident stressors. They also reported whether they had experienced each of these incident stressors within the past 6 months and, if they had, to recall on how many occasions within the past 6 months. A principal components analysis of their rescaled incident stressor ratings yielded five components: Catastrophic Injury to Self or Co-worker, Gruesome Victim Incidents, Render Aid to Seriously Injured, Vulnerable Victims, Minor Injury to Self and Death & Dying Exposure.

Broad-spectrum group treatment for parents bereaved by the violent deaths of their 12- to 28-year-old children: a randomized controlled trial.

This study assessed the efficacy of a 10-week broad-spectrum intervention offered to bereaved parents about 4 months after the deaths of their 12--28-year-old children due to accidents, homicide, or suicide. For three outcomes of distress there was a significant interaction between treatment and baseline values for each outcome for mothers both immediately posttreatment and 6 months later. The intervention appeared to be the most beneficial for mothers most distressed at baseline. Fathers showed no immediate benefits of treatment. Further research is needed to investigate these unexpected results for fathers and to further characterize those who benefit from similar programs.

Occupational Stressors, Stress Responses, and Alcohol Consumption Among Professional Firefighters: A Prospective, Longitudinal Analysis

This dual-site longitudinal prospective study monitored and measured change in self-reported occupational stressors, emotional trauma, symptoms of stress, and alcohol consumption in urban firefighters. Study participants were 188 firefighters employed by two urban fire departments. The results showed that of 19 occupational stressors examined, only 5 (26%) changed significantly over time, and of those 5, only two—job skill concerns and concerns regarding reduction in force and benefits—decreased, reflecting less bothersome subjective ratings. Of the 12 measures of posttraumatic and other symptoms of stress, 9 (75%) increased significantly over time and none decreased significantly, whereas alcohol consumption was stable over time. Job stressors, trauma caseness, and stress response symptoms at baseline were strongly and significantly associated with the same measures at the two-year follow-up. The implications of the findings for prevention and remediation of stress disorders in fire service personnel are considered. It can be concluded that the stressful nature of urban firefighting is significantly associated with negative health outcomes, including the potential overreliance on alcohol use.

The Urgency of Substance Abuse Education in Schools of Nursing

The abuse of alcohol and drugs has become a major health and social problem in the United States. Nurses comprise the largest segment of health-care professionals, yet report their educational experiences offer little to prepare them to develop substance abuse prevention and intervention programs. This article identifies factors that contribute to this educational gap, discusses challenges in planning and implementing substance abuse curricula, and offers specific guidelines for improving educational experiences.

Suicide Ideation Among Parents Bereaved by the Violent Deaths of Their Children

Suicidal behaviors of parents bereaved by a childs suicide have received considerable attention by researchers, but deaths by other violent causes have not. We observed 175 bereaved parents for five years following three types of violent death: accidents, homicides, and suicides. The results showed that the incidence of suicidal ideation (SI) among the study parents was 13% ( n = 34) over the 5 years and 9% ( n = 24) at the initial data collection four months after the death of an adolescent or young adult child. Comparisons of study parents grouped by the presence or absence of SI showed that after corrections were made for the number of t -tests conducted, statistically significant differences on three of four outcome variables remained (mental distress, depression, and posttraumatic stress disorder [PTSD], but not on acceptance of the childs death). The groups also differed significantly on four of seven mediating variables examined. The hypothesis that parents whose children died by suicide would report the highest incidence of suicidal ideation was not supported. Regression analyses showed that SI was a significant predictor of depression one year, but not five years, after the violent death of a child. The hypothesis that SI would predict both depression and PTSD one year postdeath was not supported. Clinical and policy recommendations are offered.

Sampling Bias and Other Methodological Threats to the Validity of Health Survey Research

Data from a longitudinal occupational health survey of professional fire fighters were used to explore the potential impact of two types of methodological bias: sample selection and reactivity. No significant differences on demographic variables were observed between the group who first responded after a within-study change in survey administration format (Delayed) and respondents who had completed surveys since the studys inception (Initial). However, statistically significant differences in the studys 26 outcome measures provided some evidence that between-group differences did exist and that an “administration format” type of response bias was also potentially present. The effect sizes associated with the 37 observed significant differences ranged from small to medium. These results provide a context for a reexamination of standard techniques for the identification and interpretation of survey research biases. Methods are suggested to strengthen tests for selection bias and to minimize the impact of response biases.

Parents' Perceptions of Adolescent Sibling Grief Responses after an Adolescent or Young Adult Child's Sudden, Violent Death

The violent death of an adolescent or young adult child is a highly traumatic event for surviving families. A major family adaptation issue relates to individual differences in coping with violent death. This article reports the findings from four data collection points of parental responses over an 18-month time frame to an open-ended question about the difficulties experienced by surviving adolescent children after their siblings death. The data show that parents reported that they perceived little change over time in their childrens responses; surviving adolescents continued to have multiple grief reactions and behavioral changes up to 2 years after the siblings death. There were parental role differences between mothers and fathers across time in the perceptions of sibling grief. Further research is needed to understand the sibling grief process following violent death and to develop nursing interventions to support bereaved families.

Work and nonwork stressors, negative affective states, and pain complaints among firefighters and paramedics

Prior research has suggested that occupational stressors may contribute to the etiology, progression, and chronicity of pain problems in workers. This study used anonymous survey methods to assess the prevalence and frequency of self-reported pain symptoms and their relationships to demographic variables, sources of occupational stressors, nonwork stressors and affective distress in a large sample (N≈2000) of employed career public sector firefighters and paramedics. The findings were consistent with those of previous studies of high strain workers. More than 95% of the firefighter/paramedic sample reported at least one pain complaint (using a 1 week assessment time frame). A hierarchical multiple regression analysis entering demographic, occupational, and nonwork stressors, as well as measures of negative affective states targeting total pain scores, yielded significant relationships. Five occupational stressors were associated with respondent pain complaints. The results also suggest that negative affective states mediated the relationships between work and nonwork variables, and pain complaint outcomes. The implications of these findings for the development of preventive interventions for firefighters and paramedics as well as other emergency service workers are considered.

Mental Distress and Family Functioning among Married Parents Bereaved by a Child's Sudden Death

A childs sudden death is a highly traumatic event for parents and siblings. This study examined mental distress and family functioning in a sample of 32 married couples that were part of a larger study of parents whose adolescent or young adult children had died suddenly by accident, suicide, or homicide. Parents were recruited into the study 4–7 months after the childs death. Cohesion, flexibility, and mental distress were the variables of interest, and individual scores were compared at three time points: baseline, 6 and 18 months later. The variables examined point to theoretical and practical problems clinicians might encounter when planning interventions with bereaved families to promote optimal coping, cohesion, and flexibility after a childs violent death.