Symposia
Trauma and Stressor Related Disorders and Disasters
Min Eun Jeon, M.A.
Doctoral Student and Joiner Lab Supervisor
Florida State University
Tallahassee, Florida
Marielle Gomez, B.S.
Joiner Lab Manager
Florida State University
Tallahassee, Florida
Ian Stanley, PhD
Assistant Professor of Psychiatry & Staff Psychologist
Boston University School of Medicine & National Center for PTSD, VA Boston Healthcare System
Boston, Massachusetts
Melanie Hom, PhD
Post-doctoral Fellow
McLean Hospital/Harvard Medical
Belmont, MA
Thomas Joiner, Ph.D.
Robert O. Lawton Distinguished Professor of Psychology
Florida state University
Tallahassee, Florida
Background: Firefighters, who are frequently exposed to traumatic events, have high rates of suicidal thoughts & behaviors (STBs). Along with elevated symptoms of post-traumatic stress disorder (PTSD), exposure to trauma may be sufficiently painful to increase acquired capability through fearlessness about death (FAD)—a requisite for suicidal behaviors as per the interpersonal theory of suicide. A moderated network model was estimated in a sample of U.S. firefighters (n = 1091) to: 1) identify the relationships among PTSD symptoms, suicidal ideation (SI), planning (SP), & attempts (SA), and FAD; 2) test whether FAD mediated the relationship between PTSD symptoms and SI, SP, & SA; and 3) examine if any of these associations differed between firefighters who responded to suicide deaths (SDs) versus those who did not.
Methods: The PTSD Checklist for Diagnostic and Statistical Manual for Mental Disorders-5 (PCL-5) scores were summed by symptom Criterion B, C, D, & E. Those who had PTSD Checklist-Civilian (PCL-C) scores were converted to PCL-5 using the Moshier et al. (2020) empirical crosswalk. STBs were quantified using the Self-Injurious Thoughts and Behaviors Interview (SITBI), modified to ask the presence of any SI, SP, & SA since becoming a firefighter. Model estimation using cross-validation and the OR-rule was conducted using the R package mgm. Predictability was calculated to quantify the degree of a variable’s variance explained by other variables in the network. Network stability was tested using nonparametric bootstrapping for 1,000 samples.
Results: Variables in the network accounted for about 51% of STB variance. PTSD symptoms of negative alterations in cognitions & mood shared the most robust positive associations with all STBs. FAD partially mediated the relationship between PTSD Criterion D symptoms & SA, although the relevance of FAD was low. Firefighters who responded to SD featured a stronger positive correlation between FAD & Criterion D symptoms and SI & SP; a weaker positive relationship between SP & SA; and a negative relationship between SI & PTSD avoidance symptoms, whereas SI & PTSD avoidance symptoms had no relationship in those who did not respond to SD.
Discussion: FAD showed limited relevance in mediating PTSD symptoms and STBs. Firefighters who were first responders to SD had higher FAD scores and reported more STBs than those who never responded to SD. SP was also less correlated with SA, suggesting responding to SD may instill fear of dying by suicide, which may be distinct from fear of death.