Journal of Preventive Medicine and Public Health

The Korean Society for Preventive Medicine (대한예방의학회)
권호 표지
DOI QR코드

DOI QR Code

Effect of Burnout on Post-traumatic Stress Disorder Symptoms Among Firefighters in Korea: Data From the Firefighter Research on Enhancement of Safety & Health (FRESH)

  • Kim, Woojin (Department of Preventive Medicine, Yonsei University College of Medicine) ;
  • Bae, Munjoo (Department of Occupational and Environmental Health, Yonsei University Graduate School of Public Health) ;
  • Chang, Sei-Jin (Department of Preventive Medicine and Institute of Occupational and Environmental Medicine, Yonsei University Wonju College of Medicine) ;
  • Yoon, Jin-Ha (Department of Preventive Medicine and Institute of Occupational Medicine, Yonsei University College of Medicine) ;
  • Jeong, Da Yee (Department of Dental Hygiene, Hanyang Women's University) ;
  • Hyun, Dae-Sung (Department of Preventive Medicine and Institute of Occupational and Environmental Medicine, Yonsei University Wonju College of Medicine) ;
  • Ryu, Hye-Yoon (Department of Preventive Medicine, Yonsei University Wonju College of Medicine) ;
  • Park, Ki-Soo (Department of Preventive Medicine and Institute of Health Science, Gyeongsang National University College of Medicine) ;
  • Kim, Mi-Ji (Department of Preventive Medicine and Institute of Health Science, Gyeongsang National University College of Medicine) ;
  • Kim, Changsoo (Department of Preventive Medicine, Yonsei University College of Medicine)
  • Received : 2019.05.17
  • Accepted : 2019.09.17
  • Published : 2019.11.29
Download PDF
⟨ Previous Next ⟩

Abstract

Objectives: It is well-known that post-traumatic stress disorder (PTSD) among firefighters contributes to their job-related stress. However, the relationship between burnout and PTSD in firefighters has rarely been studied. This study therefore explored the association between burnout and its related factors, such as trauma and violence, and PTSD symptoms among firefighters in Korea. Methods: A total of 535 firefighters participated in the Firefighter Research on Enhancement of Safety & Health study at 3 university hospitals from 2016 to 2017. The 535 participants received a baseline health examination, including questionnaires assessing their mental health. A Web-based survey was also conducted to collect data on job-related stress, history of exposure to violence, burnout, and trauma experience. The associations among burnout, its related factors, and PTSD symptoms were investigated using structural equation modeling. Results: Job demands (${\beta}=0.411$, p<0.001) and effort-reward balance (${\beta}=-0.290$, p<0.001) were significantly related to burnout. Burnout (${\beta}=0.237$, p<0.001) and violence (${\beta}=0.123$, p=0.014) were significantly related to PTSD risk. Trauma (${\beta}=0.131$, p=0.001) was significantly related to burnout; however, trauma was not directly associated with PTSD scores (${\beta}=0.085$, p=0.081). Conclusions: Our results show that burnout and psychological, sexual, and physical violence at the hands of clients directly affected participants' PTSD symptoms. Burnout mediated the relationship between trauma experience and PTSD.

Keywords

References

  1. Dirkzwager AJ, Yzermans CJ, Kessels FJ. Psychological, musculoskeletal, and respiratory problems and sickness absence before and after involvement in a disaster: a longitudinal study among rescue workers. Occup Environ Med 2004;61(10):870-872. https://doi.org/10.1136/oem.2003.012021
  2. Kang SK, Kim W. Work-related musculoskeletal disorders in firefighters. J Korean Med Assoc 2008;51(12):1111-1117 (Korean). https://doi.org/10.5124/jkma.2008.51.12.1111
  3. Paley MJ, Tepas DI. Fatigue and the shiftworker: firefighters working on a rotating shift schedule. Hum Factors 1994;36(2):269-284. https://doi.org/10.1177/001872089403600208
  4. Kales SN, Soteriades ES, Christophi CA, Christiani DC. Emergency duties and deaths from heart disease among firefighters in the United States. N Engl J Med 2007;356(12):1207-1215. https://doi.org/10.1056/NEJMoa060357
  5. Soteriades ES, Smith DL, Tsismenakis AJ, Baur DM, Kales SN. Cardiovascular disease in US firefighters: a systematic review. Cardiol Rev 2011;19(4):202-215. https://doi.org/10.1097/CRD.0b013e318215c105
  6. Rosenstock L, Demers P, Heyer NJ, Barnhart S. Respiratory mortality among firefighters. Br J Ind Med 1990;47(7):462-465.
  7. Nuwayhid IA, Stewart W, Johnson JV. Work activities and the onset of first-time low back pain among New York City fire fighters. Am J Epidemiol 1993;137(5):539-548. https://doi.org/10.1093/oxfordjournals.aje.a116707
  8. Maslach C, Jackson SE. Maslach burnout inventory. Palo Alto: Consulting Psychologists Press; 1986, p. 191-218.
  9. Maslach C, Leiter M. Burnout. In: Fink G, editor. Stress: concepts, cognition, emotion, and behavior. 1st ed. London: Academic Press; 2016, p. 351-357.
  10. Lee J, Lim N, Yang E, Lee SM. Antecedents and consequences of three dimensions of burnout in psychotherapists: a metaanalysis. Prof Psychol Res Pr 2011;42(3):252-258. https://doi.org/10.1037/a0023319
  11. Appels A, Schouten E. Burnout as a risk factor for coronary heart disease. Behav Med 1991;17(2):53-59. https://doi.org/10.1080/08964289.1991.9935158
  12. Borritz M, Rugulies R, Christensen KB, Villadsen E, Kristensen TS. Burnout as a predictor of self-reported sickness absence among human service workers: prospective findings from three year follow up of the PUMA study. Occup Environ Med 2006;63(2):98-106. https://doi.org/10.1136/oem.2004.019364
  13. Frajerman A, Morvan Y, Krebs MO, Gorwood P, Chaumette B. Burnout in medical students before residency: a systematic review and meta-analysis. Eur Psychiatry 2019;55:36-42. https://doi.org/10.1016/j.eurpsy.2018.08.006
  14. McManus IC, Winder BC, Gordon D. The causal links between stress and burnout in a longitudinal study of UK doctors. Lancet 2002;359(9323):2089-2090. https://doi.org/10.1016/S0140-6736(02)08915-8
  15. Capel SA. A longitudinal study of burnout in teachers. Br J Educ Psychol 1991;61(1):36-45. https://doi.org/10.1111/j.2044-8279.1991.tb00959.x
  16. van der Ploeg E, Kleber RJ. Acute and chronic job stressors among ambulance personnel: predictors of health symptoms. Occup Environ Med 2003;60 Suppl 1:i40-i46. https://doi.org/10.1136/oem.60.suppl_1.i40
  17. Regehr C, Hemsworth D, Leslie B, Howe P, Chau S. Predictors of post-traumatic distress in child welfare workers: a linear structural equation model. Child Youth Serv Rev 2004;26(4):331-346. https://doi.org/10.1016/j.childyouth.2004.02.003
  18. Canfield J. Secondary traumatization, burnout, and vicarious traumatization: a review of the literature as it relates to therapists who treat trauma. Smith Coll Stud Soc Work 2006; 75(2):81-101. https://doi.org/10.1300/J497v75n02_06
  19. LaFauci Schutt JM, Marotta SA. Personal and environmental predictors of posttraumatic stress in emergency management professionals. Psychol Trauma 2011;3(1):8-15. https://doi.org/10.1037/a0020588
  20. Brattberg G. PTSD and ADHD: underlying factors in many cases of burnout. Stress Health 2006;22(5):305-313. https://doi.org/10.1002/smi.1112
  21. Jo I, Lee S, Sung G, Kim M, Lee S, Park J, et al. Relationship between burnout and PTSD symptoms in firefighters: the moderating effects of a sense of calling to firefighting. Int Arch Occup Environ Health 2018;91(1):117-123. https://doi.org/10.1007/s00420-017-1263-6
  22. Chatzea VE, Sifaki-Pistolla D, Vlachaki SA, Melidoniotis E, Pistolla G. PTSD, burnout and well-being among rescue workers: seeking to understand the impact of the European refugee crisis on rescuers. Psychiatry Res 2018;262:446-451. https://doi.org/10.1016/j.psychres.2017.09.022
  23. Karasek R, Brisson C, Kawakami N, Houtman I, Bongers P, Amick B. The Job Content Questionnaire (JCQ): an instrument for internationally comparative assessments of psychosocial job characteristics. J Occup Health Psychol 1998;3(4):322-355. https://doi.org/10.1037/1076-8998.3.4.322
  24. Goldberg DP, Hillier VF. A scaled version of the General Health Questionnaire. Psychol Med 1979;9(1):139-145. https://doi.org/10.1017/S0033291700021644
  25. Blake DD, Weathers FW, Nagy LM, Kaloupek DG, Gusman FD, Charney DS, et al. The development of a clinician-administered PTSD scale. J Trauma Stress 1995;8(1):75-90. https://doi.org/10.1002/jts.2490080106
  26. Chang SJ, Koh SB, Kang D, Kim SA, Kang MG, Lee CG, et al. Developing an occupational stress scale for Korean employees. Korean J Occup Environ Med 2005;17(4):297-317 (Korean). https://doi.org/10.35371/kjoem.2005.17.4.297
  27. Chang SJ, Kang HT, Kim SK, Kim IA, Kim JI, Kim HR, et al. Development of Korean emotional labor scale and Korean work place violence scale. Incheon: Korea Occupational Safety and Health Agency; 2015, p. 70-75 (Korean).
  28. Kline RB. Principles and practice of structural equation modeling. 3rd ed. New York: Guilford Press; 2015, p. 60-63.
  29. Brunello N, Davidson JR, Deahl M, Kessler RC, Mendlewicz J, Racagni G, et al. Posttraumatic stress disorder: diagnosis and epidemiology, comorbidity and social consequences, biology and treatment. Neuropsychobiology 2001;43(3):150-162. https://doi.org/10.1159/000054884
  30. Sattler DN, Boyd B, Kirsch J. Trauma-exposed firefighters: relationships among posttraumatic growth, posttraumatic stress, resource availability, coping and critical incident stress debriefing experience. Stress Health 2014;30(5):356-365. https://doi.org/10.1002/smi.2608
  31. Lee JS, Ahn YS, Jeong KS, Chae JH, Choi KS. Resilience buffers the impact of traumatic events on the development of PTSD symptoms in firefighters. J Affect Disord 2014;162:128-133. https://doi.org/10.1016/j.jad.2014.02.031
  32. Ministry of the Interior and Safety. National fire service personnel psychological assessment report; 2014 [cited 2019 Nov 19], Available from: https://www.mois.go.kr/mpss/safe/open/notice/%3Bjsessionid=CMGbgjCfaoqub9Km76YGQ2n9.node11?boardId=bbs_0000000000000049&mode=view&cntId=62&category=&pageIdx=39 (Korean).
  33. Oh JH, Lim NY. Analysis of factors influencing secondary traumatic stress, burnout, and physical symptoms in firefighters. J Korean Acad Fundam Nurs 2006;13(1):96-106 (Korean).
  34. Smith TD, Hughes K, DeJoy DM, Dyal MA. Assessment of relationships between work stress, work-family conflict, burnout and firefighter safety behavior outcomes. Saf Sci 2018;103:287-292. https://doi.org/10.1016/j.ssci.2017.12.005
  35. Lourel M, Abdellaoui S, Chevaleyre S, Paltrier M, Gana K. Relationships between psychological job demands, job control and burnout among firefighters. N Am J Psychol 2008;10(3):489-496.
  36. Makara-Studzinska M, Golonka K, Izydorczyk B. Self-efficacy as a moderator between stress and professional burnout in firefighters. Int J Environ Res Public Health 2019;16(2):183. https://doi.org/10.3390/ijerph16020183
  37. Koch P, Stranzinger J, Nienhaus A, Kozak A. Musculoskeletal symptoms and risk of burnout in child care workers-a crosssectional study. PLoS One 2015;10(10):e0140980. https://doi.org/10.1371/journal.pone.0140980
  38. Santana A, De Marchi D, Junior LC, Girondoli YM, Chiappeta A. Burnout syndrome, working conditions, and health: a reality among public high school teachers in Brazil. Work 2012;41 Suppl 1:3709-3717. https://doi.org/10.3233/WOR-2012-0674-3709
  39. Maslach C, Schaufeli WB, Leiter MP. Job burnout. Annu Rev Psychol 2001;52(1):397-422. https://doi.org/10.1146/annurev.psych.52.1.397
  40. Katsavouni F, Bebetsos E, Malliou P, Beneka A. The relationship between burnout, PTSD symptoms and injuries in firefighters. Occup Med (Lond) 2016;66(1):32-37. https://doi.org/10.1093/occmed/kqv144

Cited by

  1. A Relational Model for Stress: A Systematic Review of the Risk and Protective Factors for Stress-Related Diseases in Firefighters vol.2, pp.1, 2019, https://doi.org/10.3390/psych2010008
  2. PTSD symptoms among health workers and public service providers during the COVID-19 outbreak vol.15, pp.10, 2019, https://doi.org/10.1371/journal.pone.0241032
  3. A Systematic Review and Meta-analysis on the Factors Related to Post-traumatic Growth of Fire Officials vol.45, pp.4, 2020, https://doi.org/10.21032/jhis.2020.45.4.373
  4. Doctors and Nurses: A Systematic Review of the Risk and Protective Factors in Workplace Violence and Burnout vol.18, pp.6, 2019, https://doi.org/10.3390/ijerph18063280
  5. Testosterone and occupational burnout in professional male firefighters vol.21, pp.1, 2021, https://doi.org/10.1186/s12889-021-10446-z