Cited by 338Posttraumatic Stress Disorder ResearchOccupational Health and PerformanceStress Responses and Cortisol

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Predicting Posttraumatic Stress Symptoms From Pretraumatic Risk Factors: A 2-Year Prospective Follow-Up Study in Firefighters

Heinrichs, Markus, Wagner, Dieter, Schoch, Walter, Soravia, Leila M., Hellhammer, Dirk H., Ehlert, Ulrike·2005·American Journal of Psychiatry

DOI 10.1176/appi.ajp.162.12.2276

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Abstract

OBJECTIVE: Most studies focusing on risk factors for posttraumatic stress disorder (PTSD) have used retrospective study designs. Only a small number of studies have prospectively examined risk factors in the immediate aftermath of trauma exposure in predicting PTSD symptoms. The purpose of this study was to identify predictive risk factors for posttraumatic stress symptoms and comorbid psychopathological symptoms present during the time before exposure to traumatic stress in a high-risk population. METHOD: Forty-three professional firefighters were assessed immediately after basic training (baseline) and at 6, 9, 12, and 24 months after entry into firefighter service. Subjects were screened for psychopathological symptoms, including symptoms of PTSD, depression, and anxiety. Subjects were also characterized with regard to personality traits such as self-efficacy, hostility, and alexithymia. Neuroendocrine activity was assessed by examination of awakening and diurnal salivary cortisol profiles and 24-hour urinary catecholamine excretion. Multiple linear regression analysis was used to analyze posttraumatic stress symptoms at 24-month follow-up as a function of pretraumatic characteristics. RESULTS: A high level of hostility and a low level of self-efficacy at baseline accounted for 42% of the variance in posttraumatic stress symptoms after 2 years. Subjects who had both risk factors at baseline showed a significant increase in measures of PTSD symptoms, depression, anxiety, general psychological morbidity, global symptom severity, and alexithymia during the 2-year period. Biological characteristics were not predictive of the development of psychopathological symptoms. CONCLUSIONS: These results suggest that specific personality traits may constitute markers of vulnerability to the development of psychopathological symptoms after trauma exposure. Early identification of preexisting risk factors is needed to provide effective prevention and intervention for individuals who are at risk of developing trauma-related disorders.

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Hair cortisol in relation to acute and post-traumatic stress symptoms in children and adolescents
Straub, J., Klaubert, L. M., Steudte‐Schmiedgen, S., Kirschbaum, C., & Goldbeck, L. (2017) · Anxiety Stress & Coping · doi:10.1080/10615806.2017.1355458 · Cited by 18
“Since the research suggests that peri-traumatic dissociation increases the risk of subsequent PTSD (Ozer, Best, Lipsey, & Weiss, 2003), it is conceivable that an insufficient functionality of the HPA axis may be associated with a higher susceptibility for developing PTSD.”
BackgroundResultInfluential
Relationship between the big five personality traits and PTSD among French police officers
Madamet, A., Potard, C., Huart, I., El‐Hage, W., & Courtois, R. (2017) · European Journal of Trauma & Dissociation · doi:10.1016/j.ejtd.2017.11.001 · Cited by 21
“…the role of Neuroticism (low Emotional stability) in perceived stress levels and stress reactivity (e.g. Garbarino, Chiorri, & Magnavita, 2014; Heinrichs et al., 2005; Jakšić, Brajković, Ivezić, 237 238 239 240 241 242 243 244 245 246 247 248 249 250 251 252 253 254 255 256 257 258 259 260…”
Evaluating web-based cognitive-affective remediation in recent trauma survivors: study rationale and protocol
Fine, N. B., Achituv, M., Etkin, A., Merin, O., & Shalev, A. Y. (2018) · European Journal of Psychotraumatology · doi:10.1080/20008198.2018.1442602 · Cited by 17
“roticism (Brewin, Andrews, & Valentine, 2000), low self-efficacy, and high hostility (Heinrichs et al., 2005), are robustly associated with the development”
Background
Neuroendocrine function and associated mental health outcomes following mild traumatic brain injury in OEF‐deployed service members
Ciarlone, S. L., Statz, J. K., Goodrich, J. A., Norris, J. N., Goforth, C. W., Ahlers, S. T., & Tschiffely, A. E. (2020) · Journal of Neuroscience Research · doi:10.1002/jnr.24604 · Cited by 16
“While a few prospective studies have assessed pre-trauma basal cortisol levels (Heinrichs et al., 2005; van Zuiden et al., 2011, 2012), these studies only measure a single neuroendocrine marker, cortisol, and therefore are unable to report on the neuroendocrine system overall.”
Background
THE PSYCHOLOGY OF LOCAL NEWS: COMPASSION FATIGUE AND POSTTRAUMATIC STRESS IN BROADCAST REPORTERS, PHOTOGRAPHERS, AND LIVE TRUCK ENGINEERS
Dworznik, G. (2008) · OhioLink ETD Center (Ohio Library and Information Network) · Cited by 16
Prevalence of Posttraumatic Stress Disorder among Firefighters in Iran: A Systematic Review and Meta-Analysis
Sahebi, A., Yousefi, K., Moayedi, S., Golitaleb, N., Vardanjani, A. E., & Golitaleb, M. (2020) · Iranian Journal of Psychiatry · doi:10.18502/ijps.v15i4.4301 · Cited by 16
“In another study by Heinrichs et al (6), the risk factors of PTSD was monitored in firefighters for 2 years.”
Background
Predicting Posttraumatic Stress and Depression Symptoms Among Frontline Firefighters in China
Shi, J., Chen, Y., Li, X. S., & An, Y. (2020) · The Journal of Nervous and Mental Disease · doi:10.1097/nmd.0000000000001250 · Cited by 18
“A substantial percentage of firefighters experienced adverse mental health outcomes such as posttraumatic stress disorder (PTSD) symptoms (Furr et al., 2010; Galea et al., 2005) and depression (Carey et al., 2011; Chen et al., 2007; Heinrichs et al., 2005).”
Background
The influence of between and within-person hope among emergency responders on daily affect in a stress and coping model
McLouth, L. E. S., & Smith, B. W. (2013) · Journal of Research in Personality · doi:10.1016/j.jrp.2013.06.008 · Cited by 16
The Psychological Costs of War: Military Combat and Mental HealthPreprint
Cesur, R., Sabia, J. J., & Tekin, E. (2011) · SSRN Electronic Journal · doi:10.2139/ssrn.1800257 · Cited by 16
Could alexithymia predict suicide attempts - a study of Croatian war veterans with post-traumatic stress disorder.
Kušević, Z., Ćusa, B. V., Babić, G., & Marčinko, D. (2015) · PubMed · Cited by 15
Stress coping styles in firemen exposed to severe stress
Witt, M. M., Stelcer, B., & Czarnecka-Iwańczuk, M. (2018) · Psychiatria Polska · doi:10.12740/pp/73837 · Cited by 15
Factors Influencing Post-Traumatic Stress Disorder in Critical Care Nurses based on Lazarus & Folkman's Stress, Appraisal-Coping Model
Kim, H. G., & Choi, J. Y. (2020) · Korean Journal of Adult Nursing · doi:10.7475/kjan.2020.32.1.88 · Cited by 15
Degree of exposure and peritraumatic dissociation as determinants of PTSD symptoms in the aftermath of the Ghislenghien gas explosion
Soir, E. D., Zech, E., Versporten, A., Oyen, H. J. V., Kleber, R. J., Mylle, J. J. C., & van der Hart, O. (2015) · Archives of Public Health · doi:10.1186/s13690-015-0069-9 · Cited by 15
“Studies indicated that the prevalence of PTSD during the first year after a disaster is 1 to 11% [1,5-7].”
BackgroundResult
Mental health implications of volunteer fire service membership
Wagner, S. L., & O’Neill, M. L. (2012) · Disaster Prevention and Management An International Journal · doi:10.1108/09653561211234499 · Cited by 15
Posttraumatic stress disorder in African Americans: A two year follow-up study
Benítez, C. I. P., Sibrava, N. J., Kohn‐Wood, L. P., Bjornsson, A. S., Zlotnick, C., Weisberg, R. B., & Keller, M. B. (2014) · Psychiatry Research · doi:10.1016/j.psychres.2014.07.020 · Cited by 22
“Most longitudinal studies with mostly White participants have used selfreport scales to assess the severity and persistence of PTSD symptoms (Dirkzwager et al., 2001; Koren et al., 2001; Heinrichs et al., 2005).”
Background
Difficulty describing feelings and post-traumatic symptoms after a collective trauma in survivors of L'Aquila earthquake
Giacinto, A. D., Lai, C., Cieri, F., Cinosi, E., Massaro, G., Angelini, V., Pasquini, A., Stuppia, L., & Giannantonio, M. D. (2015) · Journal of Mental Health · doi:10.3109/09638237.2015.1019055 · Cited by 14
“This has been particularly verified for veterans (Monson et al., 2004; O’Brien et al., 2008; Ouanes et al., 2014), first responders (Heinrichs et al., 2005), victims of abuse (Hund & Espelage, 2006), refugees (Söndergaard & Theorell, 2004).”
BackgroundResultInfluential
Longitudinal relationships between self‐efficacy, post‐traumatic distress and salivary cortisol among motor vehicle accident survivors
Cieślak, R., Benight, C. C., Łuszczyńska, A., & Laudenslager, M. L. (2011) · Stress and Health · doi:10.1002/smi.1379 · Cited by 16
“Longitudinal studies confirmed that self‐efficacy is predictive of the development and maintenance of post‐traumatic stress disorder (PTSD) symptoms (Benight, Cieslak, Molton, & Johnson, 2008; Heinrichs et al., 2005; for meta‐analysis, see Luszczynska, Benight, & Cieslak, 2009).”
Background
Personality and Mental Health: An Investigation of South African Police Trainees
du Preez, E., Cassimjee, N., Lauritz, L. E., Ghazinour, M., & Richter, J. (2011) · Psychological Reports · doi:10.2466/02.09.10.20.pr0.108.1.301-316 · Cited by 14
Work demand, stress and work-related musculoskeletal disorders among emergency workers
Kodom-Wiredu, J. K. (2019) · International Journal of Workplace Health Management · doi:10.1108/ijwhm-08-2018-0111 · Cited by 14
Early posttraumatic autonomic and endocrine markers to predict posttraumatic stress symptoms after a preventive intervention with oxytocin
Engel, S., van Zuiden, M., Frijling, J. L., Koch, S. B. J., Nawijn, L., Yildiz, R. L. W., Schumacher, S., Knaevelsrud, C., Bosch, J. A., Veltman, D. J., et al. (2020) · European Journal of Psychotraumatology · doi:10.1080/20008198.2020.1761622 · Cited by 14
“Concurring with our results, several prospective studies that assessed pretrauma morning cortisol and CAR did not find prognostic effects (Heinrichs et al., 2005; van Zuiden et al., 2011).”
Posttraumatic Stress Disorder Among Paramedics: Exploring a New Solution With Occupational Health Nurses Using the Ottawa Charter as a Framework
Drewitz-Chesney, C. (2012) · Workplace Health & Safety · doi:10.3928/21650799-20120516-51 · Cited by 14
“Paramedics Bennett et al. (2005) 22 612 Clohessy & Ehlers (1999) 21 56 Berger et al. (2007) 5.6a 234 Police West et al. (2008) 19 912 Maia et al. (2007) 9 152 Carlier, Lamberts, & Gersons (1997) 7 262 Firefighters Heinrichs et al. (2005) 16.3 43 Haslam & Mallon (2003) 6.5 31 Del Ben, Scotti, Chen, & Fortson (2006) 5 1…”
Influential
PTSD and anger: Evaluation of an indirect effect model in a civilian trauma sample
Ripley, A. J., Clapp, J. D., & Wilkowski, B. M. (2019) · Journal of Behavior Therapy and Experimental Psychiatry · doi:10.1016/j.jbtep.2019.02.004 · Cited by 13
Trauma and Posttraumatic Stress Disorder Among Homeless Young Adults: The Importance of Victimization Experiences in Childhood and Once Homeless
Kim, Y., Bender, K., Ferguson, K. M., Begun, S., & DiNitto, D. M. (2017) · Journal of Emotional and Behavioral Disorders · doi:10.1177/1063426617710239 · Cited by 17
“…of housed children, adolescents, and adults indicating that higher self-efficacy may help young adults feel a greater sense of control amid their adverse circumstances and thus decrease their likelihood of developing PTSD (e.g., Davis & Siegel, 2000; Heinrichs et al., 2005; Kennedy et al., 2007).”
BackgroundResult
Neuroendocrinology of Posttraumatic Stress Disorder
Bowers, M. E., & Yehuda, R. (2017) · Elsevier eBooks · doi:10.1016/b978-0-12-802175-0.00016-4 · Cited by 14
The USS Cole Bombing: Analysis of Pre-Existing Factors as Predictors for Development of Post-Traumatic Stress or Depressive Disorders
Nasky, K. M., Hines, N. N., & Simmer, E. (2009) · Military Medicine · doi:10.7205/milmed-d-04-3608 · Cited by 15
Hair cortisol predicts avoidance behavior and depressiveness after first-time and single-event trauma exposure in motor vehicle crash victims
Petrowski, K., Wichmann, S., Pyrc, J., Steudte‐Schmiedgen, S., & Kirschbaum, C. (2020) · Stress · doi:10.1080/10253890.2020.1714585 · Cited by 14
A Comparison of Firefighters and Police Officers: The Influence of Gender and Relationship Status
Shaffer, T. J. (2010) · Adultspan Journal · doi:10.1002/j.2161-0029.2010.tb00070.x · Cited by 16
Pilot Evaluation of K-12 School Security Professionals Online Training: Understanding Trauma and Social–Emotional Learning
Espelage, D. L., Valido, A., Sheikh, A. J. E., Robinson, L. E., Ingram, K. M., Torgal, C., Atria, C. G., Chalfant, P. K., Nicholson, A. M., Salama, C. D., et al. (2020) · School Mental Health · doi:10.1007/s12310-020-09399-2 · Cited by 14
A longitudinal study of the role of cortisol in posttraumatic stress disorder symptom clusters
Stoppelbein, L., & Greening, L. (2014) · Anxiety Stress & Coping · doi:10.1080/10615806.2014.923844 · Cited by 13
“In a study of firefighters who were followed for as long as 2 years, Heinrichs et al. (2005) did not find cortisol level prior to firefighting training to be predictive of PTSD 24 months later.”
Background
The physician's role in managing acute stress disorder.
Kavan, M., Elsasser, G. N., & Barone, E. J. (2012) · PubMed · Cited by 12
Evaluating Community Resilience and Associated Factors One Year after the Catastrophic Fort McMurray Flood
Obuobi-Donkor, G., Eboreime, E., Shalaby, R., Agyapong, B., Adu, M. K., Owusu, E., Mao, W., Oluwasina, F., Pazderka, H., & Agyapong, V. I. O. (2022) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph192316153 · Cited by 13
Perceived stress and secondary traumatization in social workers during coronavirus disease 2019: The moderating effect of psychological capital and social work supervision
Gur, A., Peled-Avram, M., Itzchak, G., Megira, S., Reich, A., & Farchi, M. U. (2023) · Journal of Social Work · doi:10.1177/14680173231197629 · Cited by 13
“Other studies support the concept that self-ef ﬁ cacy has a role in preventing the damage of secondary traumatization among rescue workers (Hantman & Farchi, 2015; Heinrichs et al., 2005; Prati et al., 2010).”
Result
Mental health risk for wildland firefighters: a review and future directions
Wagner, S. L., White, N. C., & Krutop, E. (2025) · International Journal of Wildland Fire · doi:10.1071/wf24159 · Cited by 11
Akute und posttraumatische Belastungsstörung
Kapfhammer, H. (2017) · Springer eBooks · doi:10.1007/978-3-662-49295-6_71 · Cited by 11
“Gesundheitspolitisch bedeutsam ist, dass nicht nur die Opfer ein erhöhtes PTBS-Risiko zeigen, sondern ganz offenkundig auch Hilfsmannschaften, Retter und Ärzte, Polizeibeamte oder Feuerwehrleute (Fullerton et al. 2004; Heinrichs et al. 2005; Pfefferbaum et al. 2006).”
Background
Alexithymia and Emotional Deficits Related to Posttraumatic Stress Disorder: An Investigation of Content and Process Disturbances
Ogłodek, E. A. (2022) · Case Reports in Psychiatry · doi:10.1155/2022/7760988 · Cited by 11
“Firefighters are exposed to various chemicals and physical hazards and can experience a significant number of accident and injuries during their duty and emergency services [1, 2].”
Background
Effects of Perception of Job Stress and Stress Coping Style on Mental Health of Firefighters
Lee, H. J., Kim, H. S., & Park, S. Y. (2011) · Journal of Korean Academy of Psychiatric and Mental Health Nursing · doi:10.12934/jkpmhn.2011.20.3.315 · Cited by 11
Posttraumatic Stress Disorder in Firefighters
Chung, Y.-K., Kim, S. Y., & Cho, S.-M. (2008) · Journal of Korean Medical Association · doi:10.5124/jkma.2008.51.12.1103 · Cited by 11
Examining the Relative Influences of the Risk Factors and Protective Factors That Affect Firefighter Resilience
Song, Y., Ha, J. H., & Jue, J. (2020) · SAGE Open · doi:10.1177/2158244020982610 · Cited by 12
“Based on previous research (Carpenter et al., 2015; Heinrichs et al., 2005; J. I. Kim & Byeon, 2013; Kwak & Byeon, 2013; H. K. Kwon et al., 2017; Meyer et al., 2012; Moon, 2017; E. H. Park & Jeon, 2010; Yoo, 2000), we considered three domains in our selection of risk and protective factors: the…”
Method
The impact of the traditional male role norms on the posttraumatic stress disorder among Polish male firefighters
Jakubowski, T. D., & Sitko-Dominik, M. M. (2021) · PLoS ONE · doi:10.1371/journal.pone.0259025 · Cited by 10
“Among risk factors against PTSD among firefighters, there are maladaptative coping styles [11–15], alienation, feelings of insecurity and lack of personal control [16], high neuroticism, and fear of dying on duty [17], anxiety sensitivity [18,19], negative emotionality [20], burnout [21,22], length of service and lowe…”
Background
Extended-release formulation of venlafaxine in the treatment of post-traumatic stress disorder
Pae, C., Lim, H. K., Ajwani, N., Lee, C., & Patkar, A. A. (2007) · Expert Review of Neurotherapeutics · doi:10.1586/14737175.7.6.603 · Cited by 10
The Relationship between Job Stress and Alcohol-use Disorders among Firemen
Jo, S. D., & Park, J. B. (2012) · Korean Society of Hazard Mitigation · doi:10.9798/kosham.2012.12.1.133 · Cited by 10

Authors: Heinrichs, M., Wagner, D., Schoch, W., Soravia, L. M., Hellhammer, D. H., & Ehlert, U.
Affiliations: University of Zurich (CH)
ORCID: Heinrichs, Markus
Soravia, Leila M.
Hellhammer, Dirk H.
Ehlert, Ulrike
Venue: American Journal of Psychiatry
Publisher: American Psychiatric Association Publishing
Published: 2005-12-01
Volume: 162
Issue: 12
Pages: 2276-2286
ISSN: 0002-953X (ISSN-L)
1535-7228
DOI: 10.1176/appi.ajp.162.12.2276
OpenAlex: W2153934273
Cited by: 337
References: 93
Citations by year: 2026: 8 · 2025: 8 · 2024: 8 · 2023: 10 · 2022: 15 · 2021: 8 · 2020: 21 · 2019: 17 · 2018: 17 · 2017: 26 · 2016: 18 · 2015: 23 · 2014: 22 · 2013: 14 · 2012: 31
FWCI: 14.65
Type: journal article
Language: en
Open access: closed
Locations: American Journal of Psychiatry (publishedVersion)
PubMed (publishedVersion)
Research Bank (Australian Catholic University) (submittedVersion)
Zurich Open Repository and Archive (University of Zurich) (submittedVersion)
Topics: Social Sciences › Psychology › Clinical Psychology › Posttraumatic Stress Disorder Research
Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Occupational Health and Performance
Life Sciences › Neuroscience › Behavioral Neuroscience › Stress Responses and Cortisol
Keywords: post-traumatic stress disorder, firefighters, hostility, self-efficacy, alexithymia, depression, anxiety, personality traits, trauma exposure, vulnerability indicators, salivary cortisol, urinary catecholamines, occupational stress
MeSH terms: Adult, Affective Symptoms, Mental Disorders, Circadian Rhythm, Cortisone, Fires, Follow-Up Studies, Health Status, Hostility, Humans, Life Change Events, Longitudinal Studies, Male, Occupational Diseases, Personality Assessment, Prospective Studies, Psychiatric Status Rating Scales, Surveys and Questionnaires, Risk Factors, Saliva, Stress Disorders, Post-Traumatic, Risk Assessment, Self Efficacy, Stress Disorders, Traumatic, Acute

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Predicting Posttraumatic Stress Symptoms From Pretraumatic Risk Factors: A 2-Year Prospective Follow-Up Study in Firefighters

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