Abstract
Wildfire seasons are becoming longer and more intense in British Columbia (BC), Canada and across the globe, equating to increased occupational demand for wildland firefighters and non-suppression staff. The limited research available indicates that wildland firefighters and fire dispatchers are at increased risk of post-traumatic stress disorder (PTSD), depression, anxiety, substance misuse, and suicide. The psychological consequences of these intense careers remain understudied and poorly understood, limiting the development of urgently needed supports for wildland fire service personnel. Using a cross-sectional survey, we assessed mental health outcomes in 254 wildland firefighters (68.5% men) and 97 non-suppression staff (28.9% men) employed by the BC Wildfire Service during the 2023 fire season. High rates of probable PTSD (24.5%), probable Major Depressive Disorder (MDD; 31.6%), probable Generalized Anxiety Disorder (GAD; 30.5%), and high suicide risk (34.2%) were identified in the overall sample. These data indicate that wildland firefighters in BC and their non-suppression colleagues face risk of adverse mental health outcomes at rates that exceed those found in the general population.
Keywords:
mental health; wildland firefighter; wildfire; PTSD; depression; anxiety; suicide risk; substance use; bush fire 1. Introduction
The 2023 fire season was the deadliest fire season on record in Canada, with eight wildland firefighter fatalities across British Columbia (BC), Alberta, and the Northwest Territories [1]. The devastating 2023 season highlights the severe risks inherent to the work of wildland firefighters and non-suppression staff, yet research on the psychological consequences of these risks is lacking [2]. Cross-occupational generalization of findings in other first responder populations may be limited due to the numerous unique features of wildland fire service work [2]. Further limits to generalizability arise from the literature’s focus on large-scale disasters, which comprise a minority of wildland fire events [3]. Research characterizing occupational mental health in the wildland fire service has been identified as a priority by wildland fire service personnel [4] and is urgently needed as fire seasons continue to accelerate in length and severity around the world. Research on wildland firefighters to date has focused on direct suppression firefighting personnel or a subset of non-suppression staff [5]. Non-suppression staff involved in wildland fire operations and wildland fire management through roles such as aviation, communications, dispatch, logistics, planning, prevention, management, and more, who comprise approximately 40% of the workforce, have been overlooked.
Limited data synthesized across several systematic reviews suggest that wildland firefighters and non-suppression staff are at high risk of adverse mental health outcomes, including post-traumatic stress disorder (PTSD), depression, anxiety, problematic substance use, and suicide risk [6,7,8,9]. Rates of PTSD, depression (including Major Depressive Disorder, MDD), Generalized Anxiety Disorder (GAD), substance use, and suicidal ideation in wildland firefighters may be 2–10 times higher compared to the general public [10]. Granberg and colleagues [11] reported probable prevalence rates of 22% for PTSD, 43.6% for depression, 48.9% for anxiety, 22.7% for substance use disorders and 16.5% for suicidal ideation in a sample of more than 700 wildland firefighters, while suicidal ideation has been estimated at rates as high as 36.7% in other wildland firefighter samples [12]. Similar prevalence rates have been estimated for wildland fire dispatchers [13]. Differences in organizational structure, crew configuration, firefighting tactics, and risk mitigation strategies limit the generalizability of findings across agencies.
Theobjectives of this research are as follows:
- Identify prevalence rates of probable PTSD, probable MDD, probable GAD, high stress, suicide risk, and moderate- to high-risk substance use in BC Wildfire Service (BCWS) wildland firefighters and non-suppression staff.
- Explore relationships among potential risk and protective factors of PTSD, probable MDD, probable GAD, high stress, suicide risk, and moderate- to high-risk substance use at individual (i.e., demographic), occupational, and organizational levels.
2. Materialsand Methods
2.1. Participants
All active BCWS employees (approx. N = 2260 as of August 2023) were invited to participate between June 15 and September 30, 2023 through internal all-staff emails, solicitation through various internal communication platforms, and a recruitment video presented at in-person training events. Participants completed a one-time online survey (SurveyMonkey Inc., San Mateo, CA, USA), were supported to participate during paid work time, and were given the opportunity to enter a separate draw for two $50 Save-On-Food gift cards.
InformedConsent
Due to the highly sensitive nature of the survey, all data was collected anonymously. Participants were informed that they could close the survey window at any time and incomplete data would not be included in analysis. The final survey item, which read “I have completed the survey with accurate information and do not need to return to any questions”, was used as a final consent check. Incomplete surveys, including those that did not check the final survey item and advance to the completed page, were excluded from analysis.
2.2. Survey
The complete survey is available as Supplementary Materials.
2.2.1. Demographics
Demographic questions included items capturing sex, gender, marital status, education level, student status, and ethnicity. Mental health-specific demographic questions included whether participants had ever been diagnosed with a mental illness, had been diagnosed with a mental illness within the past year, were currently taking prescribed medications for symptoms related to mental illness, and had ever experienced significant trauma before becoming an employee of BCWS. Demographic groups with fewer than five participants were collated into larger groups to retain anonymity.
Demographics specific to occupational role included base position type, number of active days on the fireline during the current season, number of seasons worked for BCWS, number of staff supervised, current job status, direct suppression status, and date difference (difference in days between the day the survey was taken and the day the survey opened).
Base position type was grouped into crew, zone, fire centre, and headquarters as the original variable groups had categories with fewer than five cases. Job status was grouped into regular (full-time or part-time) and auxiliary/other (auxiliary full-time or part-time and as-and-when staff hired short-term during periods of high activity).
2.2.2. Mental Health Scales
Mental health variables were measured using established self-report measurement tools. Formal diagnoses of PTSD, MDD, GAD, and suicide risk require comprehensive evaluation by a qualified professional. Given that this research aimed to provide a preliminary exploration of the mental health status of wildland firefighters and non-suppression wildfire staff, along with the logistical challenge of recruiting for lengthy, potentially emotionally distressing interviews during a busy fire season, the mental health measures were used to capture the relative level of psychological distress in the sample population and were used to infer probable rates of PTSD, MDD, GAD, suicide risk, and high stress within this population, in line with previous research in the field [10,11,12].
Symptom severity and probable prevalence of PTSD were assessed with the PTSD Checklist for DSM-5 (PCL-5) [14]. Internal consistency among items was excellent in the present sample (Cronbach’s α = 0.94). A total score was computed by summing scores across all items, and a cut-off score of 32 was used to categorize participants with symptom severity reflecting probable PTSD [15].
Depression, anxiety and stress were evaluated with the DASS-21 [16]. Question 5, “I find it difficult to work up the initiative to do things,” and question 6, “I tend to overreact to situations,” were unintentionally omitted from the online version of the questionnaire. Given that only one question was missing on the two distinct subscales, the measure remained valid. Total scores were calculated by averaging across the 6 remaining items for each scale, multiplying this value by 7 to produce a total sum, and finally multiplying this value by 2 in accordance with DASS-21 scoring instructions. Internal consistency was excellent in the present sample for the depression subscale, good for the stress subscale (Cronbach’s α = 0.90 and 0.86, respectively) and acceptable for the anxiety subscale (Cronbach’s α = 0.79). Cut-off scores for depression were normal (0–9), mild (10–13), moderate (14–20), severe (21–27), and extremely severe (28+). Anxiety cut-off scores were normal (0–7), mild (8–9), moderate (10–14), severe (15–19), and extremely severe (20+). Stress cut-off scores were normal (0–14), mild (15–18), moderate (19–25), severe (26–33), and extremely severe (34+).
The Suicide Behaviours Questionnaire Revised (SBQ-R) [17] was used to evaluate suicidal ideation and risk. Internal consistency in the present sample was good (Cronbach’s α = 0.84). Total scores were computed by summing the four items, with scores ≥ 7 representing high suicide risk.
Substance use was assessed with the Alcohol, Smoking, and Substance Involvement Screening Test (ASSIST) [18]. The ASSIST was scored according to instructions in the publicly available scoring manual, which differ slightly by substance. For each substance, the ASSIST includes a yes/no question about whether individuals have ever used a substance before, and subsequent items about use are asked only if participants respond “yes.” To produce risk scores for each substance, scores on these items are summed and categorized for each substance as low (0–10 for alcohol; 0–3 for all other substances), moderate (11–26 for alcohol; 4–26 for all other substances), and high (≥27 for all substances). Internal consistency for items on the alcohol, tobacco, and cannabis subscales ranged from acceptable to good (Cronbach’s α = 0.77–0.87). Due to large amounts of non-use reported on other substance-specific items, internal consistency was only evaluated for these three scales.
2.2.3. Organizational Risk
The 61-item GM@W survey [19] was used to quantify organizational psychosocial risk in wildland firefighters and support staff. Permission was obtained from the survey authors to use the survey outside the GM@W platform. Continuous scores are reported.
2.3. Analysis
Data were analyzed using R (version 4.5.2) [20]. Descriptive statistics were summarized using base functions and the arsenal package (version 3.6.3) [21]. Direct suppression status was coded from the number of fireline days, as all individuals engaged in direct suppression reported one or more fireline days. Those with zero fireline days were coded as “0” to indicate non-suppression. Those with 1 or more fireline days were coded with “1” to indicate direct suppression.
Because we were interested in characterizing probable diagnostic status in the sample, we did not conduct exclusion of participants as outliers based on total score. Responses on the PCL and DASS-21 were examined using person-fit statistics via the PerFit package [22], following the procedures of Messman and colleagues [23] for applying this approach to PCL-5 data. Person-fit statistics explore item-level response patterns across the sample to identify potentially anomalous responders (e.g., random responses) for further inspection.
Based on the person-fit analysis of PCL-5 and DASS-21 total scores, no participants appeared to be responding randomly, and therefore no participants were excluded. For both measures, 10 participants were identified as demonstrating potentially aberrant response patterns, with only one participant identified on both measures. Inspection of the item-level responses for these participants indicated that most participants identified as potentially aberrant responders responded 0 to most items and had low total scores. The remaining participants identified demonstrated response patterns where one or two symptoms were rated higher relative to other symptoms. We considered these to be valid response patterns for our mental health outcomes of interest.
3. Results
Five hundred and ninety-eight participants began the survey (estimated response rate 26.4%), with 351 participants completing all measures (completion rate 58.7%). Demographics and occupation status variables for the final sample are summarized in Table 1. Ninety-seven participants (27.6%) were non-suppression staff, and the remaining 254 (72.4%) were involved in active fire suppression.
Table 1.
Participant demographics and occupational variables.
A majority of participants (59.8%, N = 210) screened above cut-off thresholds for one or more negative mental health outcomes (PTSD, MDD, GAD, high stress, or suicidal ideation). Mental health outcomes are summarized in Table 2. Descriptive summaries split by positive screens for each mental health outcome are available in Supplementary Materials.
Table 2.
Mental health outcomes.
Approximately 25% (24.5%, N = 86) scored above the PCL-5 cut-off threshold with symptom levels indicative of probable PTSD. Thirty-one percent (31.6%, N = 87) scored at or above the moderate range for depressive symptoms indicating probable MDD, and thirty percent for probable GAD (30.5%, N = 107). Previous diagnosis of a mental disorder was significantly higher in non-suppression staff (see Table 1), and although probable prevalence of PTSD, suicidal ideation, and the rate of screening positive for any mental health outcome were elevated in non-suppression staff, these differences did not remain significant after correction for multiple comparisons.
Table 3 summarizes uncorrected bivariate associations between rates of positive screens for mental health outcomes with all other measured variables, with significant associations denoted in green (see Supplementary Materials for extended descriptives). Overall, demographic factors (including gender) were not commonly predictive of positive mental health screens. As expected, mental health outcomes were highly inter-related. Total scores on the DASS-21 anxiety subscale were also significantly higher in non-suppression staff compared to firefighters, although the prevalence of probable anxiety was not significantly different between groups.
Table 3.
Associations between positive screens for mental health outcomes and other variables.
4. Discussion
This study assessed the prevalence of probable PTSD, MDD, GAD, stress, suicide risk, and high-risk substance use in wildland firefighters and non-suppression support staff in BC, Canada during the 2023 fire season. High rates were identified across mental health outcomes, with high-risk substance use identified for caffeine, cannabis, tobacco, and alcohol. Prevalence for all outcomes was comparable to what has been observed in other wildland firefighter and non-suppression staff samples [11,12,13], indicating a need for enhanced focus on occupational mental health support.
The number of fireline days was not predictive of symptoms or positive screens (see correlation matrix in Supplementary Materials). This finding contradicts the previously identified dose–response relationship between trauma exposure and negative mental health outcomes observed in other firefighter populations [24] and may indicate fireline exposure does not necessarily equate to trauma exposure and cannot provide adequate context for inferring the presence or absence of potentially psychologically traumatic events.
Organizational level risk factors were more often predictive of symptoms or positive screens than individual or positional factors. The relationships identified indicate that BCWS would likely have the most impact on mental health outcomes by addressing bullying and harassment and job demands within the organization.
There were higher rates of screens for PTSD, suicide risk, and any positive screen in non-suppression staff, but these differences did not remain statistically significant after correcting for multiple comparisons. The trend towards higher screen rates of PTSD and suicide risk in non-suppression staff may be due to differences in direct exposure compared to vicarious trauma exposure, as seen in US Wildland Fire dispatchers [13]. Additionally, fire crew configurations may provide inherent group support, whereas post-shift or post-incident support for non-suppression staff may be more self-determined. More research is needed to better understand the potential differences in screening for PTSD and suicide risk in non-suppression staff.
Contrary to well-established patterns of higher screening rates of mental disorders in the general population [25,26], there was no significant effect of gender or any other demographic variable within the study sample for any mental health outcome (see Supplementary Materials). This contradicts previous work by Verble et al. [13] in wildfire dispatchers, where race, marital status, and gender were significant indicators of anxiety and depression. In the general Canadian population, women are more likely to screen positive for MDD, GAD [25] and PTSD [26], while men are more likely to screen for substance use disorders [25]. There were no identified gender differences relating to substance use within this sample. Reflecting the traditionally male-dominated occupation of wildland firefighting, previous research on mental health in wildland firefighters had a very small subset of female respondents, if any, whereas nearly half the current sample identified as women. Among firefighters specifically, 31.5% of the sample (n = 80) were women, suggesting that the lack of gender-based difference in prevalence is not due to issues related to statistical power. These results provide a starting point for novel research on gender-based experiences of potentially traumatic events, symptomatology, and mental health screening in direct suppression and non-suppression wildland fire staff.
The current research corroborated findings of high prevalence of PTSD, MDD, GAD, PTSD, suicide risk, and high-risk substance use in wildland firefighters previously identified in US samples [10,11,12]. Given the diversity of wildland fire organizational structures, crew configurations, and fire characteristics, it was crucial to establish an understanding of the current landscape of mental health outcomes in wildland firefighters in BC. This research also included all areas of non-suppression support staff, ranging from dispatchers and provincial call centre operators to provincial headquarters staff, many of whom had been excluded from previous literature. Due to substantial differences in firefighting practices and workforce organization across jurisdictions, the generalizability of our findings may be limited. Nevertheless, these findings contribute to the growing evidence base on wildland firefighter mental health and may serve as a foundation for future cross-jurisdictional comparisons.
Additional mental health education, training, and supports should be implemented across the organization, as previous work has shown reductions in anxiety and depression with pre-incident resilience training and post-incident peer support following a major wildfire event [27]. It should be noted that peer support was the only form of post-incident support recorded by Cherry and colleagues [27], and the efficacy of other forms of post-incident support, including psychological first aid and professional support services, has yet to be studied in the wildland fire context in BC. The psychological effects of significant wildfire events within prolonged, challenging fire seasons may persist years beyond the original stressor [27]. As such, long-term professional support options should be considered and studied.
5. Limitations
Incident-specific factors, such as severity, salience, and frequency of potentially traumatic events, were not assessed. The number of fireline days was used to indicate potential critical incident exposure. There may be aspects of the incidents or trauma exposures that were not adequately captured, especially for non-suppression staff. Further research is needed to explore the relationship between potentially traumatic events and mental health outcomes in both direct and non-suppression staff.
Further, the PCL-5 [14] instructs participants to consider the worst event they have experienced, or the only event in the case of having experienced only one critical event. That event may or may not have been associated with occupational exposure. Although participants were asked to describe the worst event, many described multiple events without details of the exposure context, thereby eliminating the opportunity for associative inferences. In-depth diagnostic interviews would be necessary in future research to identify direct associations between wildland fire occupational exposures and PTSD symptomatology in wildland firefighters and non-suppression staff.
Several self-report-related limitations and biases may impact these findings. Self-selection bias, wherein those experiencing high levels of psychological distress were potentially more likely to participate in the study, is plausible. Participant demand characteristics were also possible confounding factors. Participants may have underreported or overreported symptoms. Underreporting is a concern in first responder samples, especially related to disclosing trauma and mental health symptoms [28]. Given the sensitive nature of numerous questions, especially those relating to illegal drug use, underreporting is likely. Although the survey was anonymous, it is possible that crew members or other staff completed the survey in non-private settings (e.g., crew members using their crew leader’s computers or crew iPads at the fire base), skewing responses. This was mitigated by ensuring the survey was available in mobile format, so that staff could complete it on their personal phones. There is also the potential for recency bias given that the survey was administered throughout the fire season. If staff had just returned from a particularly challenging incident, or had an especially demanding day, their reports may have been altered. Given the length of the survey and the emotional demand associated with many of the questions, participant fatigue is a potential limitation, though this was mitigated by randomizing the question order within the DASS-21 and the SBQ-R. Randomization was not possible for the remaining survey tools.
Given the sensitivity of the topics within the survey and the risk of participant distress, responses from those who did not complete the survey were not analyzed. Future research in this area should provide participants with a choice to have partially completed surveys retained for analysis to allow for comparison between those who completed the survey and those who did not.
While these data provide a critical understanding of mental health in wildland firefighters and support staff, we cannot infer causation or directionality. High-quality longitudinal research is much needed within this essential population to gain a more comprehensive understanding of the specific causes of poor mental health outcomes within wildland firefighters and non-suppression support staff and the long-term consequences associated with this demanding profession.
6. Conclusions
Wildland firefighters and non-suppression support staff are at considerable risk of poor mental health outcomes including PTSD, MDD, GAD, high stress, suicide risk, and moderate-to-high risk substance use related to caffeine, alcohol, tobacco, and cannabis. This study provides a contextual perspective on mental health risk for wildland firefighters in BC, which was previously unknown because research findings have limited generalizability across organizations, provinces, and countries. It also provides the first fulsome investigation of mental health risk in non-suppression staff across the wildland fire organization, revealing that non-suppression staff are at elevated risk of PTSD, suicidal ideation, and any positive screen compared to direct suppression firefighters. Further research is urgently needed to better understand the cause and directionality of the identified psychological risks associated with wildland fire professions, as well as the efficacy of existing and novel mental health supports within this demanding occupational context.
Supplementary Materials
The following supporting information can be downloaded at https://www.mdpi.com/article/10.3390/fire9100455/s1.
Author Contributions
Conceptualization, A.L., C.P., and P.D.S.; methodology, A.L., C.P., and P.D.S.; formal analysis, A.L., and N.W.; investigation, A.L.; data curation, A.L.; writing—original draft preparation, A.L., and N.W.; writing—review and editing, C.P. and P.D.S.; supervision, C.P., and P.D.S.; All authors have read and agreed to the published version of the manuscript.
Funding
This research was funded by WorkSafe BC Research Training Award to A. Lane (2022-TG13).
Institutional Review Board Statement
The study was conducted in accordance with the Declaration of Helsinki, and approved by the Institutional Review Board of the University of Northern British Columbia (E2022.1215.070.00 approved 11 January 2023).
Informed Consent Statement
Informed consent was obtained from all subjects involved in the study.
Data Availability Statement
The datasets presented in this article are not readily available due to the nature of this research. Requests to access the dataset should be directed to the corresponding author and may be available pending research ethics board review.
Acknowledgments
We are deeply grateful to all the firefighters and support staff who work tirelessly across BC and around the globe. Our heartfelt thanks go to each participant who took the time and effort during an incredibly challenging fire season to participate in this research.
Conflicts of Interest
The authors declare no conflicts of interest. The funders had no role in the design of the study; in the collection, analysis, or interpretation of data; in the writing of the manuscript; or in the decision to publish the results.
Abbreviations
The following abbreviations are used in this manuscript:
| BC | British Columbia |
| PTSD | Post-traumatic Stress Disorder |
| MDD | Major Depressive Disorder |
| GAD | Generalized Anxiety Disorder |
| BCWS | BC Wildfire Service |
| PCL-5 | PTSD Checklist for DMS-5 |
| DSM-5 | Diagnostic and Statistical Manual of Mental Disorders, 5th Edition |
| DASS-21 | Depression, Anxiety, and Stress Scale-21 |
| SBQ-R | Suicidal Behaviours Questionnaire-Revised |
| GM@W | Guarding Minds at Work |
| ASSIST | Alcohol, Smoking and Substance Involvement Screening Test |
| SD | Standard Deviation |
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