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Cited by 68Suicide and Self-Harm StudiesStress and Burnout ResearchOccupational Health and Performance

Occupational stress and suicidality among firefighters: Examining the buffering role of distress tolerance

Open access
Stanley, Ian H., Boffa, Joseph W., Smith, Lia J., Tran, Jana K., Schmidt, N. Brad, Joiner, Thomas E., Vujanovic, Anka A.·2018·Psychiatry Research
DOI 10.1016/j.psychres.2018.05.058PMC PMC6397653
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Abstract

Past research indicates that firefighters are at increased risk for suicide. Firefighter-specific occupational stress may contribute to elevated suicidality. Among a large sample of firefighters, this study examined if occupational stress is associated with multiple indicators of suicide risk, and whether distress tolerance, the perceived and/or actual ability to endure negative emotional or physical states, attenuates these associations. A total of 831 firefighters participated (mean [SD] age = 38.37y[8.53y]; 94.5% male; 75.2% White). The Sources of Occupational Stress-14 (SOOS-14), Distress Tolerance Scale (DTS), and Suicidal Behaviors Questionnaire-Revised (SBQ-R) were utilized to examine firefighter-specific occupational stress, distress tolerance, and suicidality, respectively. Consistent with predictions, occupational stress interacted with distress tolerance, such that the effects of occupational stress on suicide risk, broadly, as well as lifetime suicide threats and current suicidal intent, specifically, were attenuated at high levels of distress tolerance. Distress tolerance may buffer the effects of occupational stress on suicidality among firefighters. Pending replication, findings suggest that distress tolerance may be a viable target for suicide prevention initiatives within the fire service.

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Crossref · 10.1016/j.psychres.2018.05.058

Cites

56 of 56 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Claims the paper makes

0 of 50 cited sources checked · 0 supported · 0 flagged

  • Findingown data

    In the current sample, 8.2% (n = 68) of participants exceeded the SBQ-R cutoff of 7 or greater, indicating clinically significant suicide risk.

    “In the current study, a total of 8.2% (n = 68) of participants exceeded previously established cutoff scores indicating clinically significant suicide risk (i.e., ≥ 7; Osman et al., 2001).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites Osman et al., 2001 source

      Not checked in the free run.

    • Rests on an assumption: The SBQ-R cutoff of 7 or greater identifies clinically significant suicide risk in firefighters.
  • Findingown data

    The interaction between occupational stress and distress tolerance was not statistically significant for lifetime suicidal ideation/attempts (SBQ-R Item 1).

    “The interaction between SOOS-14 occupational stress and DTS distress tolerance was not statistically significant for SBQ-R Item 1 (i.e., lifetime suicidal ideation/attempts; B = −0.003, SE = 0.002, p = 0.140)”
    Quote in the paperNot a substantial claim
  • Findingown data

    Among firefighters with higher distress tolerance, occupational stress did not significantly affect the reported likelihood of making a future suicide attempt.

    “we found that occupational stress did not significantly impact the reported likelihood of making a future suicide attempt for firefighters with higher levels of distress tolerance”
    Quote in the paperSubstantial claim
  • Findingreasoning

    Occupational stress was higher in the current study than in a previous firefighter sample.

    “higher in the current study than in a previous firefighter sample (VanderVeen et al., 2012)”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites VanderVeen et al., 2012 source

      Not checked in the free run.

  • Findingown data

    Greater occupational stress was associated with greater current suicidal intent among firefighters.

    “The results of the present study revealed that greater occupational stress was associated with higher global suicide risk and greater lifetime suicide threats and current suicidal intent among firefighters”
    Quote in the paperSubstantial claim
  • May combine two claims. 15
  • The quote only partly states this claim. 3
  • Classified as probably not a substantial claim. 25

  • May combine two claims. The quote only partly states this claim.

    Findingown data

    Occupational stress interacted with distress tolerance to predict lifetime suicide threats (SBQ-R Item 3), with higher distress tolerance attenuating the effect.

    “SBQ-R Item 3 (i.e., lifetime suicide threats; B = −0.002, SE = 0.001, p = 0.040)”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    The models explained a nontrivial proportion of variance in suicide-related outcomes, corresponding to medium-to-large effect sizes; the additional variance accounted for by interaction terms was statistically significant but relatively smaller.

    “our models explained a nontrivial proportion of variance in our suicide-related outcomes, corresponding to effect sizes in the medium-to-large range; however, the additional variance accounted for by our interaction terms, though statistically significant, was relatively smaller in magnitude.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    In the present sample of firefighters, greater occupational stress was associated with elevated global suicide risk, lifetime suicide threats, and current suicidal intent.

    “the present study found that greater occupational stress is associated with elevated levels of global suicide risk as well as lifetime suicide threats and current suicidal intent”
    • Also stated in: § Discussion · plain
      “While the present results extend this pattern to occupational stress and suicide risk as well as lifetime suicide threats and current suicidal intent among firefighters”
    Quote in the paperSubstantial claim

  • May combine two claims. The quote only partly states this claim.

    Findingown data

    Occupational stress interacted with distress tolerance to predict SBQ-R total score, with higher distress tolerance attenuating the effect.

    “the interaction between SOOS-14 occupational stress and DTS distress tolerance was statistically significant for the SBQ-R total score (B = −0.001, SE = 0.001, p = 0.043)”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    In the present sample, distress tolerance attenuated the association between occupational stress and global suicide risk, lifetime suicide threats, and current suicidal intent.

    “Our findings indicated that distress tolerance attenuates the effect of occupational stress on global suicide risk as well as lifetime suicide threats and current suicidal intent, specifically.”
    • Also stated in: § Conclusions · plain
      “these associations were attenuated at higher levels of self-reported distress tolerance”
    Quote in the paperSubstantial claim

  • May combine two claims. The quote only partly states this claim.

    Findingown data

    Occupational stress interacted with distress tolerance to predict current suicidal intent (SBQ-R Item 4), with higher distress tolerance attenuating the effect.

    “SBQ-R Item 4 (i.e., current suicidal intent; B = −0.007, SE = 0.002, p = 0.005).”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based).

    Study design and conductnone given

    The sociodemographic characteristics of the sample are generally consistent with those of the fire department as a whole.

    “importantly, the sociodemographic characteristics of our sample is generally consistent with the sociodemographic characteristics of the fire department as a whole.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductown data

    In the current study, the CES-D had good internal consistency (alpha = 0.82).

    “In the current study, the CES-D was analyzed as a continuous variable and internal consistency was good (α = 0.82).”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductown data

    In the current study, the SBQ-R had acceptable internal consistency (alpha = 0.77).

    “In the current study, the SBQ-R was analyzed as a continuous variable and internal consistency was acceptable (α = 0.77).”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductcitation

    The SBQ-R total score has good psychometric properties and has been identified as a gold standard assessment of suicidality.

    “The total SBQ-R demonstrates good psychometric properties (Osman et al., 2001) and has been identified as a gold standard assessment of suicidality (Batterham et al., 2015).”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites Osman et al., 2001 source

      Not checked in the free run.

    • cites Batterham et al., 2015 source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductown data

    In the current study, the Distress Tolerance Scale had excellent internal consistency (alpha = 0.93).

    “In the current study, the DTS was analyzed as a continuous variable and internal consistency was excellent (α = 0.93).”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductown data

    Missing data were minimal (less than 2% for included cases) and were handled using listwise deletion.

    “Missing data were minimal (< 2% for cases included as part of this ongoing study) and handled utilizing listwise deletion.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductcitation

    The CES-D has been validated in a sample of firefighters.

    “This instrument has been validated in a sample of firefighters (Chiu et al., 2010).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Chiu et al., 2010 source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Sawhney et al. found that work recovery strategies mitigate the effects of occupational stress on mental health symptoms.

    “the researchers found that engagement in “work recovery strategies” such as exercise, spending time with coworkers, and recreational activities (cf. distress tolerance activities) mitigates the effects of occupational stress on mental health symptoms.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Sawhney et al. (2017)

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductcitation

    The Distress Tolerance Scale has demonstrated good psychometric properties.

    “The DTS has demonstrated good psychometric properties (Simons & Gaher, 2005).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Simons & Gaher, 2005 source

      Not checked in the free run.

  • Classified as probably not a substantial claim. May combine two claims.

    Study design and conductcitation

    The analyses controlled for depression symptom severity and for age, race, and sex.

    “Analyses controlled for depression symptom severity, as measured by the CES-D (Radloff, 1977) as well as sociodemographic characteristics (i.e., age, race [White = 1, non-White = 0], and sex [Male = 1, nonMale = 0]) that have been shown to be associated with suicide risk among firefighters (Stanley et al., 2015).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites Stanley et al., 2015 source

      Not checked in the free run.

  • Classified as probably not a substantial claim.

    Premisecitation

    Anestis and Joiner (2012) suggest that the ability to endure distress might facilitate the transition from thinking about suicide to engaging in suicidal behavior.

    “Anestis and Joiner (2012) suggest that the ability to endure distress might facilitate the transition from thinking about suicide to engaging in suicidal behavior.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites Anestis and Joiner, 2012

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    There are some data suggesting that high distress tolerance, while protective against suicidal desire, may confer increased risk for suicidal behaviors.

    “there are some data to suggest that high levels of distress tolerance, while protective against suicidal desire, may actually confer increased risk for suicidal behaviors (Anestis et al., 2012; Vujanovic et al., 2017b)”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites Anestis et al., 2012

      Not checked in the free run.

    • cites Vujanovic et al., 2017b

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    PTSD symptom severity is associated with lifetime suicide ideation and prior suicide attempts in two large samples of firefighters.

    “PTSD symptom severity is associated with a lifetime history of suicide ideation and prior suicide attempts in two large samples of firefighters (Boffa et al., 2017; Martin et al., 2016).”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites Boffa et al., 2017 source

      Not checked in the free run.

    • cites Martin et al., 2016 source

      Not checked in the free run.

  • Classified as probably not a substantial claim.

    Premisecitation

    Individual stressors such as harassment, sleep disturbances, and social disconnectedness are associated with suicide-related symptoms among firefighter samples.

    “while past research has found that individual stressors such as harassment (Hom et al., 2017), sleep disturbances (Carey et al., 2011; Hom et al., 2016), and social disconnectedness (Chu et al., 2016) are associated with suicide-related symptoms among firefighter samples”
    Quote in the paperSubstantial claim0 of 3 sources checked
    • cites Hom et al., 2017 source

      Not checked in the free run.

    • cites Carey et al., 2011 source

      Not checked in the free run.

    • cites Chu et al., 2016 source

      Not checked in the free run.

  • May combine two claims.

    Interpretationreasoning

    The previous firefighter sample comprised firefighter cadets, so cumulative stress throughout career may not have been captured in that junior population compared to the present sample.

    “the previous sample comprised firefighter cadets. As such, the cumulative stress experienced by firefighters throughout their career may not have been captured in that relatively junior population, as compared to our sample”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites VanderVeen et al., 2012 source

      Not checked in the free run.

  • Classified as probably not a substantial claim.

    Study design and conductnone given

    The study relied exclusively on self-report methodologies.

    “we relied exclusively on self-report methodologies”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    For the adult general population, SBQ-R cutoff scores of 7 or greater identify at-risk individuals and specific risk behaviors.

    “Suggested cutoff scores to identify at-risk individuals and specific risk behaviors for the adult general population are ≥ 7 (Osman et al., 2001).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Osman et al., 2001 source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S2 (checkable), S3 (load-bearing). May combine two claims.

    Interpretationreasoning

    Firefighters may be selected for or self-select into emergency service careers.

    “it is possible that firefighters are, in part, selected for or self-select into emergency service careers such as the fire service”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductown data

    The study attempted to address the SBQ-R limitation by examining each SBQ-R item, including an item assessing suicidal intent, and observed a consistent pattern of findings.

    “We did, however, attempt to address this limitation by examining each SBQ-R individual item, including an item assessing suicidal intent, and observed a consistent pattern of findings.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Prior studies have reported an association between low distress tolerance and increased suicidal desire among acute-care psychiatric inpatients.

    “and acute-care psychiatric inpatients (Vujanovic et al., 2017a,b)”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Vujanovic et al., 2017a,b

      Not checked in the free run.

  • Classified as probably not a substantial claim. May combine two claims.

    Premisecitation

    The interpersonal theory of suicide theorizes that capability for suicide develops in part through exposure to painful and provocative experiences and is necessary but not sufficient for suicidal behaviors.

    “a construct that the interpersonal theory of suicide theorizes develops in part through exposure to painful and provocative experiences and is necessary but not sufficient for suicidal behaviors (Chu et al., 2017; Van Orden et al., 2010)”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites Chu et al., 2017 source

      Not checked in the free run.

    • cites Van Orden et al., 2010 source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Few psychological interventions have been tested among first responders.

    “Despite these modalities for improving distress tolerance, few psychological interventions have been tested among first responders (Haugen et al., 2012)”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Haugen et al., 2012 source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductcitation

    The SOOS-14 is a measure of occupational stress developed specifically for firefighter populations.

    “use of a measure of occupational stress developed specifically for firefighter populations (i.e., the Sources of Occupational Stress Scale—14 [SOOS-14]; Kimbrel et al., 2011).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Kimbrel et al., 2011 source

      Not checked in the free run.

  • Classified as probably not a substantial claim.

    Premisecitation

    Past research has linked high distress tolerance, as measured by a behavioral task, to increased capability for suicide.

    “past research has linked high distress tolerance, as measured by a behavioral task, to increased capability for suicide (Anestis and Joiner, 2012)”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites Anestis and Joiner, 2012

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Prior studies have reported an association between low distress tolerance and increased suicidal desire among undergraduates.

    “Prior studies have reported associations between low distress tolerance and increased suicidal desire among undergraduates (Anestis et al., 2011)”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Anestis et al., 2011 source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductcitation

    Psychiatric symptoms such as suicidal intent may have been underreported due to fears of job repercussions.

    “psychiatric symptoms (e.g., suicidal intent) may have been underreported due to fears of job repercussions (cf. Anestis & Green, 2015)”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Anestis & Green, 2015 source

      Not checked in the free run.

32 of 32

  • The paper relies on this without support.

    Occupational stress influences suicide risk rather than the reverse or a common cause.

    “the effects of occupational stress on suicide risk”
    “occupational stress exerted a strong influence on lifetime suicide threats and current suicidal intent”

  • The paper relies on this without support.

    The SBQ-R cutoff of 7 or greater identifies clinically significant suicide risk in firefighters.

    “previously established cutoff scores indicating clinically significant suicide risk (i.e., ≥ 7; Osman et al., 2001).”
2 of 2

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

  • Increased occupational stress in firefighters has been correlated to increased PTSD symptom severity, depression, and anxiety.

    “increased occupational stress in firefighters has been correlated to increased PTSD symptom severity, depression, and anxiety [54,55].”

    From The Cyclical Battle of Insomnia and Mental Health Impairment in Firefighters: A Narrative Review (2024) · cites this paper as [55]

    The Introduction (page not available) reports that occupational stress predicted later mental health symptoms, including depression and anxiety, in a firefighter study. It says traumatic exposures could contribute to PTSD, but does not report a correlation between occupational stress and PTSD symptom severity; the Discussion instead links PTSD symptom severity to suicidality. (LLM, conf=0.86)

    Experimental — accuracy not yet measured

  • Firefighters with higher distress tolerance attenuated the increased suicide risk from occupational stress.

    “the recent literature has found firefighters with higher distress tolerance attenuated this increased risk [55].”

    From The Cyclical Battle of Insomnia and Mental Health Impairment in Firefighters: A Narrative Review (2024) · cites this paper as [55]

Cites

1 retracted

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4 of the 60 references couldn’t be matched to a known paper.

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Related

Authors
Stanley, I. H., Boffa, J. W., Smith, L. J., Tran, J. K., Schmidt, N. B., Joiner, T. E., & Vujanovic, A. A.
Affiliations
  • Florida State University (US)
  • University of Houston (US)
Corresponding author
Vujanovic, Anka A.
ORCID
Venue
Psychiatry Research
Publisher
Elsevier BV
Published
2018-08
Volume
266
Pages
90-96
ISSN
0165-1781 (ISSN-L)
DOI
10.1016/j.psychres.2018.05.058
PMC
PMC6397653
OpenAlex
W2804734913
Cited by
67
References
60
Citations by year
2026: 4 · 2025: 10 · 2024: 9 · 2023: 7 · 2022: 6 · 2021: 16 · 2020: 7 · 2019: 7 · 2018: 1
FWCI
9.11
Type
journal article
Language
en
Open access
Licence
Locations
  • Psychiatry Research (acceptedVersion)
  • PubMed (publishedVersion)
  • Europe PMC (PubMed Central) (acceptedVersion)
  • PubMed Central (acceptedVersion)
Funders
  • National Institute of Mental Health (T32 MH93311)
  • Office of the Assistant Secretary of Defense for Health Affairs (W81XWH-16-2-0003)
Topics
  • Social Sciences › Psychology › Clinical Psychology › Suicide and Self-Harm Studies
  • Social Sciences › Psychology › Social Psychology › Stress and Burnout Research
  • Health Sciences › Health Professions › Occupational Therapy › Occupational Health and Performance
Keywords
firefighters, occupational stress, suicidality, distress tolerance, suicide risk, suicidal intent, suicide threats, stress buffering, suicide prevention, fire departments
MeSH terms
Occupational Stress, Adult, Female, Humans, Male, Middle Aged, Surveys and Questionnaires, Risk Factors, Suicide, Self-Injurious Behavior, Young Adult, Self Report, Suicidal Ideation, Firefighters

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