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Working conditions, exposure to trauma and the mental health of firefighters

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Dr Kevin Teoh from the Department of Organizational Psychology shares the findings so far from the Firefighter Longitudinal Health Study.

Firefighters working on the Brumadinho Dam Disaster in 2019

Firefighters play a crucial role in the emergency response system, taking on a myriad of roles that range from the firefighting to responding to car crashes, delivering emergency care and raising safety awareness. They also perform rescue services and are involved in disaster relief.

The nature of this work is often physically, mentally and emotionally challenging, and firefighters can be exposed to traumatic situations such as the destruction of property, burn victims, serious injuries and death. All this can eventually take a toll on the mental health of this occupational group, and it is not surprising that firefighters report high levels of burnout, posttraumatic stress and common mental health disorders (Katsavouni et al., 2016; Lima & Assunção, 2011; Noor et al, 2019).

An international partnership

To better understand what, and how, different factors lead to the development of poor mental health in firefighters, in 2018 two psychologists from Brazil – Dr Eduardo de Paula Lima and Dr Alina Gomide Vasconcelos – visited the Birkbeck Centre for Sustainable Working Life for a six-month Fellowship. More specifically, they came from the Minas Gerais Fire Department, whose firefighters received international media coverage when the Brumadinho dam collapsed in 2019, leading to the loss of at least 256 lives.

The cornerstone of our international collaboration is the ongoing Firefighter Longitudinal Health Study (FLOHS), which aims to better understand the dynamic relationships among individual, operational (traumatic) and organisational risk factors in the development of post-traumatic symptoms and other mental health problems in firefighters. Recruits are assessed in their first week of training with follow up data collected every two years.

The role of working conditions

A simplistic take on the poor mental health of firefighters is that this is the product of the challenging work that they do. However, this ignores the fact that there is consistent research showing that psychosocial working conditions can have a beneficial and detrimental impact on our mental health (Harvey et al., 2017). Within the field of organizational psychology, psychosocial working conditions refer to how work is designed, organised and managed. Here in the Department of Organizational Psychology, we have studied this in a range of different occupations, including doctors (Teoh, Hassard, & Cox, 2018), teachers (Hassard, Teoh, & Cox, 2016) and performing artists (McDowall et al., 2019).

The current study

As psychologists, we were not only interested in whether exposure to traumatic events had a link to firefighters’ mental health, but whether psychosocial working conditions had a similar effect. In our first published study from the FLOHS project, we examined the data from 312 firefighters that were part of the first batch of participants. Three types of psychosocial working conditions were measured: how demanding the job is (i.e. job demands), how much influence one has on their work environment (i.e. job control) and how supported one is (i.e. social support). This was in addition to measuring firefighters’ exposure to traumatic events. The findings were quite clear:

  • 13% of firefighters reported a level of poor mental health that warrants psychological intervention.
  • Higher levels of exposure to trauma and higher levels of job demands were associated with poorer mental health.
  • Higher levels of job control and social support were associated with better mental health.
  • The strength of the relationship that job demands had on poor mental health reduced when firefighters reported high levels of either job control or social support.

What does this all mean? What if I’m not a firefighter?

The findings show that to support the mental health of firefighters, fire departments should focus on reducing the levels of job demands while increasing the levels of social support and job control. Given the inherently difficult nature of firefighting that will be very difficult to remove or reduce, the very least that firefighters deserve is to work in an organisation where the psychosocial working conditions are not another contributing factor to poor mental health.

This message has direct relevance to workers in other occupations within the emergency services, including healthcare workers, the police and the armed forces. In addition, more generally, our findings emphasise that supporting the mental health of workers requires improvements to their psychosocial working conditions and needs to focus on the organisation itself – not through individual interventions such as resilience or mindfulness training (Kinman & Teoh, 2018).

The citation for the study is: Teoh, K. R. H., Lima, E., Vasconcelos, A., Nascimento, E., & Cox, T. (2019). Trauma and work factors as predictors of firefighters’ psychiatric distress. Occupational Medicine. doi: 10.1093/occmed/kqz168

Further information:

References

Harvey, S. B., Modini, M., Joyce, S., S, M.-S. J., Tan, L., Mykletun, A., … Mitchell, P. B. (2017). Can work make you mentally ill? A systematic meta-review of work-related risk factors for common mental health problems. Occupational and Environmental Medicine, oemed-2016-104015. https://doi.org/10.1136/oemed-2016-104015

Hassard, J., Teoh, K. R.-H., & Cox, T. (2016). Organizational uncertainty and stress among teachers in Hong Kong: work characteristics and organizational justice. Health Promotion International, daw018. https://doi.org/10.1093/heapro/daw018

Katsavouni, F., Bebetsos, E., Malliou, P., & Beneka, A. (2016). The relationship between burnout, PTSD symptoms and injuries in firefighters. Occupational Medicine, 66(1), 32–37. https://doi.org/10.1093/occmed/kqv144

Kinman, G., & Teoh, K. R.-H. (2018). What could make a difference to the mental health of UK doctors? A review of the research evidence. London, UK, UK. Retrieved from https://www.som.org.uk/sites/som.org.uk/files/What_could_make_a_difference_to_the_mental_health_of_UK_doctors_LTF_SOM.pdf

Lima, E. de P., & Assunção, A. Á. (2011). Prevalência e fatores associados ao Transtorno de Estresse Pós-Traumático (TEPT) em profissionais de emergência: uma revisão sistemática da literatura. Revista Brasileira de Epidemiologia, 14(2), 217–230. https://doi.org/10.1590/S1415-790X2011000200004

McDowall, A., Gamblin, D., Teoh, K. R.-H., Raine, C., & Ehnold-Danailov, A. (2019). Balancing Act: The Impact of Caring Responsibilities on Career Progression in the Performing Arts. London. Retrieved from http://www.pipacampaign.com/wp-content/uploads/2019/04/BA-Final.pdf

Noor, N., Pao, C., Dragomir-Davis, M., Tran, J., & Arbona, C. (2019). PTSD symptoms and suicidal ideation in US female firefighters. Occupational Medicine. https://doi.org/10.1093/occmed/kqz057

Teoh, K. R.-H., Hassard, J., & Cox, T. (2018). Individual and organizational psychosocial predictors of hospital doctors’ work-related well-being. Health Care Management Review, 1. https://doi.org/10.1097/HMR.0000000000000207

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BEI Research Year in Review

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2019 was a busy year for the School of Business, Economics and Informatics. Here are some of our research highlights.

BEI Research Year in Review

Improving Diversity on Sport Boards

Improving diversity on sport boards

Dr Richard Tacon and Dr Geoff Walters from the Department of Management worked with Sport England to improve the diversity of board members in the sport and physical activity sector. The programme, unveiled in September, follows a series of studies demonstrating that sports governance lacks diversity, particularly with regards to ethnicity and disability.

Richard and Geoff have designed and implemented training materials as part of the initiative, which will identify and develop a pool of suitable candidates from under-represented groups. The intention is that sports organisations will then be able to turn to these people when recruiting for new board positions.

Diagnosing Gaming Disorder

Gaming

Researchers led by Bruno Schivinski, Lecturer in Marketing, developed the first psychological test to check for ‘gaming disorder’, a new type of mental illness now recognised by the World Health Organisation.

Now accessible online, the test provides participants with feedback on their video game habits in comparison with the rest of the population. Research is ongoing to understand the point at which gaming becomes a health problem and the factors which contribute to the development of gaming disorders to promote responsible gaming.

Sticking up for Parents in the Performing Arts

Paloma Faith is among those calling for better support for parents in the performing arts

Academics from the Department of Organizational Psychology developed a survey of workers and work-life balance in the performing arts in partnership with Parents and Carers in Performing Arts (PiPA).

Over 2500 UK workers from the performing arts, including 1000 parents and carers, took the survey. It found that 43% of performing artists who left their careers did so because they became parents. Carers pay a significant penalty in terms of well-being and remuneration in order to maintain a career in the performing arts and are far more likely to leave the industry than non-carers, leading to a drain in talent and reduced diversity in the arts. Professor Almuth McDowall, Head of Department, added her voice to the call for change alongside leading figures in the sector such as actor Cate Blanchett and singer Paloma Faith.

Understanding Text Data

Researchers from the Department of Computer Science and Information Systems developed a tool to simplify the process of understanding and using data from text. Called Samtla API, the new service can automatically annotate words and phrases from digital text documents with named entities and sentiments using machine learning and text mining technologies.

Spearheaded by Dr Mark Levene, Dr Martyn Harris, and Dr Andrius Mudinus, the initiative grew in response to the growing need for easily understandable annotations on the large volumes of text data, generated by media, businesses and individuals all over the world.

A Prizewinning Contribution

Dr Alexey Pokrovskiy was awarded the European Prize in Combinatorics

In August, Dr Alexey Pokrovskiy from the Department of Economics, Mathematics and Statistics was awarded the European Prize in Combinatorics. The prestigious award is made once every two years, recognising excellent contributions in Combinatorics, Discrete Mathematics and their Applications by young European researchers aged 35 or under.

Adapting to Climate Change

Strategic management experts from the Department of Management and the Cass Business School at City, University of London found that greater collaboration between the insurance industry and state policy makers could improve society’s ability to recover from disasters linked to climate change.

Using insurance is a step away from crisis towards risk management, strengthening socio-economic resilience under a changing climate. Birkbeck’s Dr Konstantinos Chalkias, the Cass Business School’s Professor Paula Jarzabkowski and their co-authors put forward seven recommendations to the Global Commission on Adaptation to maximise the benefits of insurance for climate adaptation.

Supporting Sustainable Return to Work following Mental Ill-health Absence

Dr Jo Yarker from the Department of Organizational Psychology and Professor Karina Nielsen from the University of Sheffield have been researching how to support employees who are returning to work following mental ill-health absence.

In the UK alone, stress, anxiety or depression accounts for 57% of all working days lost to ill-health in 2017-18. Yarker and Nielsen developed a toolkit for employees, colleagues, line managers and HR professionals to support individuals to return to and stay in work.

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Supporting sustainable return to work

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Dr Jo Yarker from the Department of Organizational Psychology shares her research into supporting employees who are returning to work following mental ill-health absence.

Around 15% of the working population suffer from common mental disorders (CMDs) such as depression, anxiety and adjustment disorder (OECD, 2014). For half of these, experience of mental ill-health will lead to a period of long-term sickness absence. In the UK alone, stress, anxiety or depression accounts for 57% of all working days lost to ill-health in 2017-2018 (HSE, 2018).

Sustainable return to work for workers with CMDs is therefore a major societal challenge in terms of scale and costs. A successful initial return to work is no guarantee for sustainable return to work, with research suggesting that approximately 19% of workers subsequently relapse and take further absence or exit the workforce (Koopmans, Bültmann, Roelen, Hoedeman, van der Klink, & Groothoff, 2011).

Relapse has significant consequences for sustaining work, with implications for employment prospects, productivity and wages (OECD, 2014). There is an urgent need to better understand how workers with CMDs can be better supported to return to, and stay in, productive work. Together with my colleague Professor Karina Nielsen from the University of Sheffield, I sought to find out how to support employees returning to work following mental ill-health absence.

Understanding the barriers to sustainable return to work

Our study was the first to our knowledge to follow workers post-return using a qualitative approach. We used the recently developed IGLOO framework in our research: examining the Individual, Group, Leader, Organisational and Overarching (IGLOO) contextual factors (Nielsen, Yarker, Munir & Bültmann, 2018) that influence workers with CMDs’ ability to remain in employment throughout working life.

We conducted interviews with 38 workers who had returned from long-term sick leave due to CMDs, the majority of whom we spoke to at multiple points following their return.  We’d originally planned to follow workers in the first months after return, however, after being contacted by workers who still experienced challenges long after return, we decided to include these too. We also spoke to twenty line managers with experience managing returning workers.

Our findings

Participants reported a number of resources, in and outside of work, that helped them stay and be productive at work.

Resources at work across the five IGLOO levels help employees stay and be productive at work:

  • Individual: Creating structure within their working day to help maintain focus and concentration.
  • Group: Gaining feedback on tasks from colleagues, help with challenging tasks and being treated as before, not as someone with a CMD.
  • Leader: Agreement of communication to colleagues, continued support and access to work adjustments, and signaling (and being) available but not intrusive.
  • Organisational: Flexible working practices and leave policies, accommodating absenteeism policies, work-focused counselling, and demonstrating care through support.
  • Overarching context: This level was not applicable as we only examined UK workplaces.

Resources at home across the five IGLOO levels help employees stay and be productive at work:

  • Individual: Prioritising self-care and the establishment of clear boundaries between work and leisure.
  • Group: Understanding and non-judgmental support from friends and family.
  • Links to services: Consistent point of contact and facilitation of links to external services and treatment.
  • Organisational: Access to work-focused counselling.
  • Overarching context: Those who were financially independent were able to make choices that better suited their needs; the majority reported the positive media attention around mental health enabled them to ask for help.

The main results of our study point to important avenues for future research and practice. Within the workplace, the findings highlight the need to:

  • Consider resources at all IGLOO levels and implement multi-level interventions.
  • Train returned workers in how to structure their day.
  • Train and support line managers, both in having difficult situations but also on how to support workers creating structure and support them manage their workload.
  • Develop more information about appropriate work adjustments that can be implemented and how these can be accessed.
  • Offer flexibility to the returning employee, in relation to work schedule, ad hoc flexibility when depleted to prevent further decline and aid recovery, and flexibility in tasks.
  • Adopt an individual approach as there is no off-shelf-style that works for all.
  • Adopt a long term approach, ensuring that employees are able to access adjustments in the months and years that follow.
  • Conduct further research to enable us to understand the contribution of these features and their synergistic effect on enabling returned employees to remain productive at work.

Outside the workplace, the findings highlight the need to:

  • Conduct further research to better model the impact of support received from friends and family, GP services and those within the voluntary sector.
  • Equip GP services with the skills and knowledge to support return to work.

We developed guidance for employees, colleagues, line managers and HR professionals to support returned workers to thrive at work. This and our full report can be found on the Affinity Health at Work website.

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Managing the ‘always on’ culture – a myth buster and agenda for better practice

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Professor Almuth McDowall (Department of Organizational Psychology) shares her research into worklife balance and calls on employers to take responsibility for their organisation’s culture.

Break, Business, Business People, Businesswoman, Cafe

There is much being written and said about the ‘always on culture’ and how we are increasingly glued to our digital devices – whether at work or at home. Some of my own research has also concerned itself with this topic. My colleague and friend Gail Kinman and I had the results from a practice survey published in 2018 as we wanted to know what organisations are doing about the changing world of work, and the use of information and computer technology.

Well, precious little is the answer. Over half of our respondents said that their organisations don’t have a relevant policy in place and don’t offer any guidance or training. Somewhat worryingly over 40% thought that it should be up to individuals to manage the issue, rather than their line managers or human resources.

Why would people choose to be ‘always on’ outside formal working hours?

Working unpaid during leisure time does not make logical sense! We gift the UK economy billions in unpaid overtime year on year, as research by the Trade Unions Congress has revealed. Our systematic review with colleagues Svenja Schlachter, Ilke Inceoglu and Mark Cropley pointed to a complex picture.

People have different motivations, influenced by issues such as what everyone else does (social norms), what the expectations in the job are, how committed people feel to their job, how they value ‘switching off’ and recovery and whether this is supported in their environment. One key issue which came out of this review is the ‘empowerment enslavement paradox’. Our digital devices are both an enabler, as they afford flexibility, but also ‘digital leash’ as it’s difficult to say ‘enough is enough’ and switch off. As we all know, screen-time can be very seductive.

Is there any evidence that being ‘always on’ is bad for our health?

A recent econometric analysis shows that ICT infrastructure has a positive impact on population health (the authors measured general health outcomes such as infant mortality etc.). Regarding the impact of social media use, there is evidence that high use is linked to poor sleep quality, anxiety depression and low self-esteem. Of course, such studies cannot tell us whether teenagers who are highly anxious to start off with are more likely to be prolific users.

There is far less robust evidence on the exact effects from the world of work – what happens to you if you are on your phone, tablet or laptop near 24/7? We lack good research to tell us what the exact effects are.

What we do know though is that we need recovery and respite, our systems are simply not programmed to be on continuous overdrive. We also know that leisure activities which are quite different from our work tasks are better for our recovery than doing more of the same. I take this to heart. For instance, I find that reading at night doesn’t help me switch off as academics read rather a lot at work, so I take ballet classes online (and am known to teach the odd one myself!), knit and crochet.

What can organisations do?

Employers have a duty of care and should ensure that people are not overworked and can switch off. Worklife balance research tells us that those who live ‘enriched’ lives have better mental and physical health, important for them, and important for their employer. We should actively support employees by ensuring that:

  • A worklife balance policy is in place as a point of reference; then check processes and structures against this policy
  • Employers review job design and ensure that digital tasks (checking and responding to emails, synchronising devices, remote calls and conferences) are actually captured in people’s workload and tasks – these often fall off the radar
  • There is consultation to ask employees what they need – mutually negotiated boundaries and solutions work much better. Think creatively about flexible solutions!
  • Everyone, including senior leaders and managers, role models good behaviours. People need time to switch off, so don’t expect your staff to be available outside normal working hours
  • Staff are offered training and development. Managing in an increasingly digital workspace requires up-to-date management and leadership skills
  • Employees look out for implicit expectations and ‘rumours’. “I check my emails on holiday because this is what is expected of me”. Really? Question such assumptions as they can often take on a life of their own

Finally, if in doubt, ask a psychologist. The Department of Organizational Psychology is keen to work with organisations to establish, consolidate and evaluate best practice.

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