Firefighters Remain More Likely To Die By Suicide Than On Duty

Firefighting is a brave and noble profession often associated with heroism. But firefighters and researchers are sounding the alarm on the mental and physical effects of the profession, warning that it comes with a severe cost – increased levels of occupational stress that can lead to depression, burnout, anxiety, post-traumatic stress disorder (PTSD), and suicidal ideation. The National Fallen Firefighters Foundation estimates that there are between 100 and 200 firefighter deaths by suicide each year, double the rate of the general population.

Firefighters, being first responders, stand on the frontline of disasters and emergencies. The stress they bear comes at a critical cost to their well-being. Repeated exposure to traumatic scenes including car accidents, homicides, suicides, infant drownings, and cardiac arrests – in addition to fires – can cause cumulative stress overload and distress as a result of the scenes they attend. In addition to traumatic events, firefighters may also suffer the effects of shift work (often 24 hours), long hours , physical and emotional exhaustion, stigma associated with seeking help, and a culture of toughness.

In 2021, a systematic literature review of 29 studies found that firefighters experienced a variety of psychosocial stressors in additional to physical stress, and that those stressors were associated with multiple health‐related outcomes. These were organized into six areas: “depression‐suicidality, non‐depressive mental health problems, burnout, alcohol use disorders, sleep quality, and physiological parameters, and somatic disorders.”

Additionally, a recent publication from the Ruderman Family Foundation follows up its initial 2018 report on mental health and suicide of first responders, finding that, “policemen and firefighters are more likely to die by suicide than in the line of duty.”

While the new report doesn’t include recent 2021 and 2022 statistics, it’s known that the added effects of the Covid-19 pandemic such as increased workload, stress and trauma from being a first responder, and exposure to the virus itself impacted both work and home life. In fact, a study on the stigma on first responders during Covid-19 showed a notable “increased sense of isolation, stigmatization, and lack of support.”

As Jay Ruderman, President of the Ruderman Family Foundation described the new data, “Our research underscores the ongoing mental health crisis facing first responders, which has become a perfect storm that combines the existing dangers of their work and the toll exerted by the pandemic.”

But, according to the Firefighter Behavioral Health Alliance (FBHA), moral injury is additionally to blame, although rarely discussed. Their most recent paper explores the implications of moral injury, or as they describe it, “Moral injury is the damage done to one’s conscience or moral compass when that person perpetrates, witnesses, or fails to prevent acts that transgress one’s own moral beliefs, values, or ethical codes of conduct.” Given the distressing events faced on a regular basis, it’s easy to see how one’s beliefs and emotions become wounded.

Another way to think of the mental toll is as cumulative exposures to traumatic stress, that when left unaddressed, can “snowball,” leading to burnout, PTSD, and moral injury.

Unfortunately, no government organization requires reporting of firefighter deaths or attempts. Nor is there mandatory research to find patterns, trends, or understand the multidimensional aspects that lead to loss of life. However, some cities and departments, like Detroit, do audits of their fire services.

In addition, work like that being conducted by the FBHA can support the development of strategies to help this essential workforce deal with the considerable mental health challenges that come with their work. Jeff Dill, Founder and CEO of FBHA says, “One of our goals is to ensure, through behavioral health workshops and providing resources, that our brothers and sisters have a great career, but a better retirement.”

With that in mind, to reduce the number of deaths by suicide in our firefighting population during service and in retirement we must promote a culture of self-care as well as provide access to mental health services, train firefighters on suicide prevention, and implement effective debriefing after traumatic events. The psychosocial stressors and moral injury related to their work calls for specific interventions and mental health support.

“It is incumbent upon us to redouble our efforts to end the silence and eradicate the stigma surrounding the mental health of first responders,” says Ruderman.

Although the conversations can be uncomfortable, by increasing awareness and drawing attention to the lives, experiences, and traumas experienced by first responders we can collectively ensure more resources and support are available.