the impact of work-related exposure to suicide among first responders and mental health professionals


More research is urgently needed into the impact that attending suicide events is having on paramedics and other first responders, a researcher at the University of Otago, Wellington, says.

Ph.D. student Renan Lyra, a psychologist by training, says a significant proportion of police officers, firefighters and paramedics will attend at least one suicide event in their careers, but there has been little research into the impact this has on their personal and professional lives and on their own suicide risk.

Mr Lyra has reviewed 25 research papers on the impact attending a suicide event has on those on the front line in countries including the US, the UK, Australia and in Europe.

His review, which has just been published in the international journal PLOS ONE, is understood to be the first to specifically look at the impact of work-related exposure to suicide among first responders and mental health professionals.

He found almost all the research papers published over the last 10 years were focused on the impact the suicide of a patient had on the psychologists, psychiatrists, social workers and nurses who worked with them, rather than on first responders.

Mr Lyra says attending the scene of a suspected suicide is one of the most critical and traumatic situations first responders are likely to encounter in the course of their work.

“For first responders, the emotional impact includes the high emotional labour they need to expend to manage their feelings, something which has been found to be associated with increased thoughts of suicide among firefighters.

Research which detailed the impact of attending a suicide event on mental health professionals found they experienced sadness, shock, feelings of blame, hopelessness, guilt, self-doubt, grief and anger.

“Their professional reactions ranged from sadness at work and increased awareness of suicide risk to reduced professional confidence and fear of publicity and litigation. They were also more likely to refer patients on to psychiatrists.”

Only two of the 25 research papers Mr Lyra examined measured mental health outcomes in mental health professionals after a patient’s suicide, with burnout and PTSD reported as significant adverse outcomes.

Mr Lyra says exposure to suicide is a major risk factor for suicide, with mental health professionals and first responders themselves being at higher risk of suicide than the general population.

“One of the explanations for the higher rates of suicides among these professions is their higher levels of occupational-related psychological distress, and for first responders, work-related post traumatic stress disorder (PTSD). One of the contributors to this may be their higher exposure to suicide.”

Mr Lyra says suicide is a major global health and social issue, with an estimated 800,000 people dying by suicide each year.

“The social and psychological costs of suicide are high. For every suicide, it has been estimated that between six and 20 people, usually family members and friends of those who died, are adversely affected psychologically and emotionally. This group is likely to include those who encounter suicide while on duty.”

Mr Lyra is planning further research on the impact of suicide on first responders. If you are, or have been, a first responder and wish to enquire about participating in the research, email [email protected].

Suicide is a leading cause of death in the United States (US), claiming the lives of over 47,000 Americans in 2017. 1 Suicide is the 10th leading cause of death for all ages in the US and the second leading cause of death for people ages 15–34. In 2017, rates of suicide in the US were double the rates of homicide. 1

In an attempt to address this public health problem, the National Institutes of Health increased funding for suicide prevention from $39 million in 2008 to $103 million in 2017. 1 Despite these efforts, rates of suicide have increased 38% since 1999 from 10.48 per 100,000 to 14.48 per 100,000 in 2017. 1

In an attempt to address increasing suicide rates in the US, researchers have sought to identify leading risk factors of suicide as well as populations at greatest risk. 1–6 National surveys suggest that emergency medical services (EMS) workers, including firefighters and emergency medical technicians (EMT), are at higher risk of experiencing suicidal ideation and suicide attempts compared to the general public.7–10

These elevated levels of suicidal ideation and suicide attempts are hypothesized to be the result of the occupational hazards associated with the EMS profession, which include routine exposure to high levels of physical and psychological stress. 2,3,11

While several studies have quantified individual risk factors among EMS workers, there is scant published research on completed suicide in this population. We analyzed the National Occupational Mortality Surveillance (NOMS) database to examine the proportion of death by suicide among firefighters and EMTs compared to other US decedents with a recorded occupation.

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More information: Renan Lopes de Lyra et al. Occupational exposure to suicide: A review of research on the experiences of mental health professionals and first responders, PLOS ONE (2021). DOI: 10.1371/journal.pone.0251038


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