In my 2019 review of the effectiveness of mental health prevention, early intervention, and suicide prevention programs used in veteran and first responder communities, I highlighted an important knowledge gap: an overly myopic focus on the role of traumatic events in the development of poor mental health in those groups. In other words, those in the veteran and first responder communities (and, by extension, the broader public safety community) are focused almost exclusively on the adverse effects of potential psychologically traumatising events, ignoring the effects of a wide variety of non-traumatic organisational factors. 

There have been decades of theory and research documenting the importance of non-traumatic occupational stress on the heath and well-being of employees. Some of this research is even longitudinal, allowing us to understand the direction of causation – and that research (including several meta-analyses) shows that non-traumatic work stress can actually cause poor mental health in employees.

Why Focus on Non-Traumatic Stressors?

Trauma exposure is an inherent part of the job for public safety personnel, and cannot be avoided among active duty personnel. In fact, recent Canadian research by Carleton et al. (2018) showed that most first responders and public safety personnel have experienced 11 of the 16 traumatic events listed in their research. When asked how many times they experienced each of those stressors, the most common response among the 4000+ respondents was 11+ times each. 

However, whereas traumatic stressors are relatively unavoidable, non-traumatic occupational stressors can be avoided if there are appropriate changes made to the way organisations are run. These types of stressors form the basis for many of the standards documents outlining the need for psychological safety in the workplace. Important occupational stressors include better management of employee workload, improvements in job control, healthier interpersonal aspects of the workplace (including reducing bad management, bullying, harassment, and more), and improving people’s time to effectively manage aspects of their physical health (e.g., exercise, sleep, diet), among others.

The Present Study

Because first responders and other public safety personnel have been so overly and narrowly focused on the adverse effects of traumatic events, very little research has examined the relative associations between traumatic and non-traumatic stress on their mental health.

However, a recent study by Carleton et al (2020) has addressed this important gap. In a sample of 4000+ public safety personnel (including fire, police, ambulance/paramedics, dispatchers, and corrections workers), respondents to a large scientifically-based survey completed several validated measures assessing workplace trauma exposure, non-traumatic operational and organisational workplace stressors common in the public safety work environment, and several aspects of poor mental health (i.e., PTSD, major depression, generalized anxiety, social anxiety, panic disorder, alcohol abuse, and any psychological disorder).

This study found the following:

• Trauma exposure was associated with falling above the clinical cut-off only for probable PTSD, major depression, generalized anxiety, and panic disorder, with adjusted odds ratios (which are measures of how strong the associations are) ranging from 1.08 – 1.16. These effect sizes are statistically significant but fairly small.
• Non-traumatic operational stressors were associated with falling above the clinical cut-off for all of the mental health measures - probable PTSD, major depression, social anxiety, generalized anxiety, panic disorder, alcohol abuse, and any psychological disorder - with adjusted odds ratios ranging from 1.39 (alcohol abuse) to 1.98 (social anxiety) to 2.28 (PTSD) and 2.29 (any psychological disorder). In other words, most of the associations between non-traumatic operational stressors and poor mental health were close to twice as strong as those for traumatic events.
• Non-traumatic organisational stressors were associated with falling above the clinical cut-off for all the mental health measures - probable PTSD, major depression, social anxiety, generalized anxiety, panic disorder, alcohol abuse, and any psychological disorder - with adjusted odds ratios ranging from 1.37 (alcohol abuse) to 1.75 (social anxiety) to 2.15 (PTSD) and 1.99 (any psychological disorder). In other words, most of the associations between non-traumatic operational stressors and poor mental health were much stronger than those for traumatic events.
• This pattern of non-traumatic stressors being much more strongly associated with poor mental health than traumatic exposures was still significant even when the shared variance among the three stress/trauma measures was statistically removed.

Given that, among these public safety personnel, non-traumatic stressors had a much stronger association with poor mental health, and that they were significantly associated with a wider range of poor mental health variables compared to trauma exposure, public safety managers and senior leaders are strongly encouraged to take these types of stressors more seriously and work to adjust their organisational structures to minimize the adverse impact on employees. The Carleton et al. report highlighted some of the most important stressors that managers may want to consider.

Take Away Message

Non-traumatic workplace stressors appear to be more important than trauma exposure for poor mental health among public safety personnel, even though the public safety community is overly focused on the role of trauma. 

Additional Information

This article was originally published on LinkedIn.

For more information about these findings, readers can download a copy of the full paper (it’s open source, so all interested people can read the full thing) here.

To read the Executive Summary of my 2019 review of the effectiveness of mental health prevention, early intervention, and suicide prevention programs used in veteran and first responder communities, as well as instructions for how to receive the full report, click here.

Dr. Donald McCreary is the owner of Donald McCreary Scientific Consulting (British Columbia, Canada), as well as an Adjunct Professor of Psychology at Brock University (St. Catharines, Canada). Don is a senior scientist, with over 30 years of doctoral experience conducting basic and applied research in a wide variety of settings (e.g., national defence and public safety contexts, local and provincial health authorities, not for profits, academia). His background is in social psychology, with a focus on the associations between occupational stress, health, well-being, and resilience. In 2004, Don was awarded Fellowship in the American Psychological Association for his significant career contributions to the psychological sciences. He is also a recipient of the Queen Elizabeth II Diamond Jubilee Medal, awarded by the Office of the Governor General of Canada, in recognition of his research and efforts promoting psychological well-being among members of the Canadian Armed Forces and public safety personnel.