Mental Health Issues for First Responders: The Risk Factors

First responders include emergency and paramedical teams, search and rescue personnel, police, and firefighters. They are among the first at emergency and disaster scenes, and are subject to higher levels of physical and mental injuries. Their mental and behavioral health conditions may include:

  • depression

  • post-tramatic stress disorders (PTSD)

  • suicide/suicide ideation

  • substance abuse

Based on a comprehensive review of studies on mental health risk factors for first responders, a group of researchers identified a range of risk factors during a crisis:


Dealing with serious injury or dead bodies appears to be a risk factor for psychological distress and posttraumatic stress responses. Workers with such exposure experience stress, somatic complaints, fatigue symptoms, and are more likely to develop PTSD, depression, alcohol problems and anxiety.

The type of exposure could also make a difference, with exposure to burns and child victims increasing the likelihood of PTSD.

Duration on site and arrival time

Duration on site and number of hours spent in one shift appear to be risk factors for mental ill health. Working long hours on the disaster site and not taking a day off each week significantly increase the risk of mental distress, job dissatisfaction and subjective health complaints.

Earlier arrivals on the disaster site – i.e. being one of the first on the scene – are significantly associated with greater PTSD and depression. For example, arriving at the World Trade Center in the morning of 9/11 led to an increased risk for PTSD and depression that was significantly greater than even arriving in the afternoon of 9/11. Arrival in the afternoon was of a similar risk to arrival several days after the attack.

Emotional involvement

Researchers found that stress increases along with the stress of the survivors being dealt with, and workers with a high level of identification with survivors have greater intrusive, obsessive and compulsive thoughts. Identification with victims as a “friend” (i.e. envisaging the deceased as a friend; ‘this could have been my friend ’), as oneself, or as a family member are associated with PTSD.

Role-related stressors

Being involved in tasks outside of usual remit, such as providing supervision when not in a leadership role and police officers fighting fires, increases the risk of PTSD.

Certain tasks such as rejecting victims in need of help due to lack of resources or manpower, treating people who had been injured, cleaning up destroyed areas, handling residents’ complaints and being involved in crowd control are associated with PTSD and psychological distress.

Not being able to predict or control events, as well as feeling a lack of control over the nature and extent of victim injuries, are associated with post-traumatic stress in fire-fighters.

Perceptions of safety, threat and risk

Subjective perception of danger to oneself is the single best predictor of PTSD in utility workers. Researchers found that worries about personal safety are predictive of PTSD, while feeling not enough safety measures are in place and concern about equipment quality are associated with anxiety.

Harm to self or close others

Having a near-death experience, being seriously injured or having a “severe mental trauma” during the rescue predicts PTSD in rescue workers after an earthquake: those who experienced one of these have a rate of PTSD 25.6 times higher than those who have not.

Knowing someone injured or killed during the disaster is predictive of outcomes in many studies. One study found that loss of a co-worker led to a near 4-fold increase in elevated PTSD and more than a 2-fold increase in use of a counseling service.


Sources consulted:

First Responders: Behavioral Health Concerns, Emergency Response, and Trauma. 2018. Substance Abuse and Mental Health Services Administration (SAMHSA).

Samantha K. Brooks, Rebecca Dunn, Richard Amlôt, Neil Greenberg and G. James Rubin. 2016. “Social and occupational factors associated with psychological distress and disorder among disaster responders: a systematic review.” BMC Psychology, 4:18. DOI 10.1186/s40359-016-0120-9.


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