First responders in COVID-19: The impact of compassion fatigue
Keywords:COVID-19, first responder, mental health
Scholarly literature has begun to report the psychosocial impact of coronavirus disease 2019 (COVID-19) on the general population and those who have fallen ill. Yet, few studies have explored the impact of COVID-19 on first responders and still fewer have focused on the impact of the pandemic on compassion fatigue among this highly exposed group. In this study, we hypothesize that COVID-19 experiences and disruption contribute to compassion fatigue and mental health problems. Seventy-four first responders completed an online survey via Qualtrics. The survey included items that assessed (1) mental health and pre-COVID-19 mental health or trauma exposure, (2) quality of life, (3) COVID-19 experiences and interdependence, (4) social and economic needs, (5) compassion fatigue, and (6) demographic and work characteristics. Multiple regressions using forward selection were conducted using SPSS version 27.0. Our findings support the concern that first responders are at greater risk for negative mental health sequelae, including compassion fatigue, in the context of COVID-19. Working a greater number of hours than usual, prior mental health concerns, identifying as female, concerns about community and personal health, and COVID-19 interdependence and disruptions were associated with higher levels of mental health problems and compassion fatigue. Importantly, decreases in perceived community closeness and quality of life were also associated with compassion fatigue and mental health problems among first responders. These findings highlight the need for services to address pre-existing and new mental health concerns and support compassion fatigue resilience among first responders in the context of COVID-19.
Centers for Disease Control and Prevention: Cases, data, and surveillance. Available at https://www.cdc.gov/coronavirus/2019-ncov/cases-updates/index.html. Accessed January 4, 2021.
Gould DW, Teich JL, Pemberton MR, et al.: Behavioral health in the Gulf Coast region following the Deepwater Horizon oil spill: Findings from two federal surveys. J Behav Health Serv Res. 2015; 42(1): 6-22.
Hansel T, Osofsky H, Speier A, et al.: Post disaster recovery and resilience: The mediating influences of mental health and environmental quality of life. Traumatology. 2019. Advance online publication. 2020; 26(3): 278-284. DOI:10.1037/trm0000213.
Osofsky HJ, Osofsky JD, Hansel TC: The Deepwater Horizon oil spill: Mental health effects on residents in heavily impacted areas. Disaster Med Public Health Prep. 2011; 5: 280-286.
Zvolensky MJ, Garey L, Rogers AH, et al.: Psychological, addictive, and health behavior implications of the COVID-19 pandemic. Behav Res Ther. 2020; 134. DOI:10.1016/h.brat.2020.103715.
Douglas PK, Douglas DB, Harrigan DC, et al.: Preparing for pandemic influenza and its aftermath: Mental health issues considered. Int J Emerg Ment Health. 2009; 11(3): 137.
Lau JT, Yang X, Pang E, et al.: SARS-related perceptions in Hong Kong. Emerg Infect Dis. 2005; 11(3): 417.
Luyt CE, Combes A, Becquemin MH, et al.: Long-term outcomes of pandemic 2009 influenza A(H1N1)-associated severe ARDS. Chest. 2012; 142(3): 583-592.
Wing Chit Mak I, Chu CM, Pan PC, et al.: Risk factors for chronic post-traumatic stress disorder (PTSD) in SARS survivors. Gen Hosp Psychiatry. 2012; 32: 590-598. DOI:10.1016/j.genhosppsych.2010.07.007.
Johnson SU, Ebrahimi OV, Hoffart A: PTSD symptoms among health workers and public service providers during the COVID-19 outbreak. PLoS One. 2020; 15(10): e0241032. DOI:10.1371/journal.pone.0241032.
Zolnikov TR, Furio F: Stigma on first responders during COVID-19. Stigma Health. 2020; 5(4): 375-379. DOI:10.1037/sah0000270.
Betancourt TS, Brennan RT, Vinck P, et al.: Associations between mental health and Ebola-related health behaviors: A regionally representative cross-sectional survey in post-conflict Sierra Leone. PLoS Med. 2016; 13(8): e1002073. DOI:10.1371/journal.pmed.1002073.
Reardon S: Ebola’s mental-health wounds linger in Africa: Health-care workers struggle to help people who have been traumatized by the epidemic. Nature. 2015; 519 (7541): 13-14. DOI:10.1038/519013a.
Jones S: Describing the mental health profile of first responders: A systematic review. J Am Psychiatr Nurses Assoc. 2017; 23(3): 200-214.
Kleim B, Westphal M: Mental health in first responders: A review and recommendation for prevention and intervention strategies. Traumatology. 2011; 17(4): 17-24.
Arbona C, Schwartz JP: Posttraumatic stress disorder symptom clusters, depression, alcohol abuse, and general stress among Hispanic male firefighters. Hisp J Behav Sci. 2016; 38(4). DOI:10.1177/0739986316661328.
Boss P: Ambiguous loss and unresolved grief. In Bryant CD, Peck DL (eds.): Encyclopedia of Death and the Human Experience. Sage Publishing Inc, 2009: 40-41.
Neria Y, DiGrande L, Adams BG: Posttraumatic stress disorder following the September 11, 2001, terrorist attacks: A review of the literature among highly exposed populations. Am Psychol. 2011; 66(6): 429-446. DOI:10.1037/a0024791.
Boscarino JA, Figley CR, Adams RE: Compassion fatigue following the September 11 terrorist attacks: A study of secondary trauma among New York City social workers. Int J Emerg Ment Health. 2004a; 6: 57-66.
Boscarino JA, Galea S, Adams RE, et al.: Mental health services and psychiatric medication use following the terrorist attacks in New York City. Psychiatr Serv. 2004b; 55: 274-283.
Stellman, JM, Smith, RP, Katz, CL, et al.: Enduring mental health morbidity and social function impairment in World Trade Center rescue, recovery, and cleanup workers: The psychological dimension of an environmental health disaster. Environ Health Perspect. 2008; 116: 1248-1253. DOI:10.1289/ehp.11164.
Perrin MA, DiGrande L, Wheeler K, et al.: Differences in PTSD prevalence and associated risk factors among World Trade Center disaster rescue and recovery workers. Am J Psychiatry. 2007; 164: 1385-1394. DOI:10.1176/appi.ajp.2007.06101645.
Berninger A, Webber MP, Cohen HW, et al.: Trends of elevated PTSD risk in firefighters exposed to the World Trade Center disaster: 2001-2005. Public Health Rep. 2010a; 125(4): 556-566.
Berninger A, Webber MP, Niles JK, et al.: Longitudinal study of probable post‐traumatic stress disorder in firefighters exposed to the World Trade Center disaster. Am J Ind Med. 2010b; 53(12): 1177-1185.
Osofsky H, Osofsky J, Arey J, et al.: Hurricane Katrina’s first responders: The struggle to protect and serve in the aftermath of the disaster. Disaster Med Public Health Prep. 2011; 5(S2): S214-S219. DOI:10.1001/dmp.2011.53.
Komarovskaya I, Brown AD, Galatzer-Levy IR, et al.: Early physical victimization is a risk factor for posttraumatic stress disorder symptoms among Mississippi police and firefighter first responders to Hurricane Katrina. Psychol Trauma. 2014; 6(1): 92-96. DOI:10.1037/a0031600.
Tak S, Driscoll R, Bernard B, et al.: Depressive symptoms among firefighters and related factors after the response to Hurricane Katrina. J Urban Health. 2007; 84(2): 153-161.
Wang H, Jin H, Nunnink SE, et al.: Identification of post-traumatic stress disorder and risk factors in military first responders 6 months after Wen Chuan earthquake in China. J Affect Disord. 2011; 130(1-2): 213-219.
Psarros C, Theleritis C, Kokras N, et al.: Personality characteristics and individual factors associated with PTSD in firefighters one month after extended wildfires. Nord J Psychiatry. 2018; 72(1): 17-23. DOI:10.1080/08039488.2017.1368703.
Benedek DM, Fullerton C, Ursano RJ: First responders: Mental health consequences of natural and human-made disasters for public health and public safety workers. Annu. Rev. Public Health. 2007; 28: 55-68.
Mak IWC, Chu CM, Pan PC, et al.: Long-term psychiatric morbidities among SARS survivors. Gen Hosp Psychiatry. 2009; 31(4): 318-326.
Pfefferbaum B, North CS: Mental health and the COVID -19 pandemic. N Engl J Med. 2020; 383: 510-512.
Lancee WJ, Maunder RG, Goldbloom DS: Prevalence of psychiatric disorders among Toronto hospital workers one to two years after the SARS outbreak. Psychiatr Serv. 2008; 59(1): 91-95.
Naushad VA, Bierens JJLM, Nishan KP, et al.: A systematic review of the impact of disaster on the mental health of medical responders. Prehosp Disaster Med. 2019; 34(6): 632-643. DOI:10.1017/S1049021X19004874.
Wilson LC: A systematic review of probable posttraumatic stress disorder in first responders following man-made mass violence. Psychiatry Res. 2015; 229(1-2): 21-26.
American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders. 5th ed. Washington, DC: American Psychiatric Association, 2013.
Zhai Y, Du X: Loss and grief amidst COVID-19: A path to adaptation and resilience. Brain Behav Immun. 2020; 87: 80-81.
Li X, Li S, Xiang M, et al.: The prevalence and risk factors of PTSD symptoms among medical assistance workers during the COVID-19 pandemic. J Psychosom Res. 2020; 139: 110270. DOI:10.1016/j.jpsychores,2020,110270.
Pappa S, Ntella V, Giannakas T, et al.: Prevalence of depression, anxiety and insomnia among healthcare workers during the COVID-19 pandemic: A systematic review and meta-analysis. Brain Behav Immun. 2020; 88: 901-907. DOI:10.1016/j.bbi.2020.05.026.
Vujanovic AA, Lebeaut A, Leanard S: Exploring the impact of the COVID-19 pandemic on the mental health of first responders. Cogn Behav Ther. 2021; 17: 1-16. DOI:10.1080/16506073.2021.1874506.
Greenberg N, Docherty M, Gnanapragasam S, et al.: Managing mental health challenges faced by healthcare workers during COVID-19 pandemic. BMJ. 2020; 368(1211): m1211. DOI:10.1136/bmj.m1211.
Walton M, Murray E, Christian MD: Mental healthcare for medical staff and affiliated healthcare workers during the COVID-19 pandemic. Eur Heart J Acute Cardiovasc Care. 2020; 9(3): 241-247.
Figley CR: Compassion fatigue as secondary traumatic stress disorder: An overview. In Figley CR (ed.): Compassion Fatigue: Coping with Secondary Traumatic Stress Disorder in Those Who Treat the Traumatized. New York: Brunner-Routledge, 1995: 1-20.
Figley CR: Compassion fatigue: Psychotherapists’ chronic lack of self care. J Clin Psychol. 2002a; 58: 1433-1441.
Figley CR: Treating Compassion Fatigue. New York: Brunner-Routledge, 2002b.
Adams RE, Boscarino JA, Figley CR: Compassion fatigue and psychological distress among social workers: A validation study. Am J Orthopsychiatry. 2010; 76(1): 103-108.
Adams RE, Figley CR, Boscarino JA: The compassion fatigue scale: Its use with social workers following urban disaster. Res Soc Work Pract. 2008; 18(3): 238-250. DOI:10.1177/10497315073101090.
Elliot DL, Kuehl KS: Effects of sleep deprivation on fire fighters and EMS responders. Final report. Report for the International Fire Chiefs Association. Available at https://www.iafc.org/docs/default-source/1safehealthshs/progssleep_sleepdeprivationreport.pdf?sfvrsn=f9e4da0d_2. Accessed May 19, 2021.
Henderson SN, Van Hasselt SN, LeDuc VB, et al.: Firefighter suicide: Understanding cultural challenges for mental health professionals. Prof Psychol Res Pr. 2016; 47(3): 224-230.
Cary MG, Al-Zaiti SS, Dean GE, et al.: Sleep problems, depression, substance use, social bonding, and quality of life in professional firefighters. J Occup Environ Med. 2012; 53(8): 928-933.
Crocker F, Joss N, Cooper C: Compassion fatigue among healthcare, emergency and community service workers: A systematic review. Int J Environ Res Public Health. 2016; 13(6): 618.
Thomas J: Association of personal distress with burnout, compassion fatigue, and compassion satisfaction among clinical social workers. J Soc Serv Res. 2013; 39: 365-379. DOI:10.1080/01488376.2013.771596.
Papazoglou K, Chopko B: The role of moral suffering (moral distress and moral injury) in police compassion fatigue and PTSD: An unexplored topic. Front Psychol. 2017; 8: 1999. DOI:10.3389/fpsyg.2017.01999.
Barr P: Compassion fatigue and compassion satisfaction in neonatal intensive care unit nurses: Relationships with work stress and perceived social support. Traumatology. 2017; 23(2): 214-222. DOI:10.1037/trm0000115.
Figley CR, Ludick M: Secondary traumatization and compassion fatigue. In Gold S (ed.): Handbook of Trauma Psychology. Volume 1. Washington, DC: APA Books, 2017: 573-593.
Ruiz-Fernandez MD, Ramos-Pichardo JD, Ibanez-Masero O, et al.: Compassion fatigue, burnout, compassion satisfaction and perceived stress in healthcare professionals during the COVID-19 health crisis in Spain. J Clin Nurs. 2020; 29: 4321-4330. DOI:10.1111/jocn.15469.
Amsalem D, Dixon LB, Neria Y: The coronavirus disease 2019 (COVID-19) outbreak and mental health: Current risks and recommended actions. JAMA Psychiatry. 2020; 78(1): 9-10.
Drew JM, Martin S: Mental health and well-being of police in a health pandemic: Critical issues for police leaders in a post-COVID-19 environment. J Community Saf Well Being. 2020; 5(2): 31-36.
Hansel TC, Saltzman LY, Bordnick PS: Behavioral health and response for COVID-19. Disaster Med Public Health Prep. 2020; 14(5): 670-676. DOI:10.1017/dmp.2020.180.
Spitzer RL, Kroenke K, Williams JBW, et al.: Brief measure for assessing generalized anxiety disorder. Arch Intern Medicine. 2006; 166: 1092-1097.
Shin C, Lee SH, Han KM, et al.: Comparison of the usefulness of the PHQ-8 and PHQ-9 for screening for major depressive disorder: Analysis of psychiatric outpatient data. Psychiatry Investig. 2019; 16(4): 300.
World Health Organization: The world health organization quality of life (WHOQOL)- BREF (No. WHO/HIS/HSI Rev. 2012.02). Available at https://www.who.int/tools/whoqol. Accessed May 19, 2021.
Sheehan DV, Harnett-Sheehan K, Raj BA: The measurement of disability. Int. Clin. Psychopharmacol.1996; 11: 89-95.
Gerpott FH, Balliet D, de Vries RE, et al.: How do people think about interdependence? A multidimensional model of subjective outcome interdependence. J Pers Soc Psychol. 2018; 115(4): 716-742. DOI:10.1037/pspp0000166.
Bickel G, Nord M, Price C, et al.: Guide to Measuring Household Food Security. Alexandria VA: US Department of Agriculture, Food and Nutrition Service, 2000.
Shaukat N, Ali DM, Razzak J: Physical and mental health impacts of COVID-19 on healthcare workers: A scoping review. Int J Emerg Med. 2020; 13(40). DOI:10.1186/s12245-020-00299-5.
Gentry E: Fighting compassion fatigue and burnout by building emotional resilience. Available at https://www.jons-online.com/issues/2018/december-2018-vol-9-no-12/2152-fightingcompassion-fatigue-and-burnout-by-building-emotional-resilience. Accessed on May 11, 2021.
Gentry J, Baranowsky AB: Compassion fatigue resiliency—A new attitude. Traumatology Institute, Updated 2019. Available at https://psychink.com/wp-content/uploads/2019/08/Compassion-Resiliency-A-New-Attitude-2019.pdf. Accessed on May 11, 2021.
Figley CR, Figley KR: Compassion Fatigue Resilience: The Oxford Handbook of Compassion Science. New York: Oxford University Press, 2017.
Gonzalez TC, Helm H, Edwards LI: An examination of resilience, compassion fatigue, burnout, and compassion satisfaction between men and women among trauma responders. N Am J Psychol. 2019; 21(1): 1-20.
Turgoose D, Maddox L: Predictors of compassion fatigue in mental health professionals: A narrative review. Traumatology. 2017; 23(2): 172-185. DOI:10.1037/trm0000116.
Badger K: Preventing compassion fatigue: Caring for ourselves while caring for others. Phoenix Society for Burn Survivors, 2019. Available at https://phoenix-society.org/resources/preventingcompassion-fatigue-caring-for-ourselves-while-caring-for-others. Accessed on May 11, 2021.
Potter P, Deshields Y, Berger JA, et al.: Evaluation of a compassion fatigue resiliency program for oncology nurses. Oncol Nurs Forum. 2013; 40(2):180-187.
Lanza A, Roysircar G, Rodgers S: First responder mental healthcare: Evidence-based prevention, postvention, and treatment. Prof Psychol Res Pr. 2018; 49(3): 193-204. DOI:10.1037/pro0000192.
Feuer BS: First responder peer support: An evidence-informed approach. J Police Crim Psych. 2021; 36: 365-371. DOI:10.1007/s11896-020-09420-z.
Haugen P T, McCrillis AM, Smid GE, et al.: Mental health stigma and barriers to mental healthcare for first responders: A systematic review and meta-analysis. J Psychiatr Res. 2017; 94: 218-229.
Del Boca FK, McRee B, Vendetti J, et al.: The SBIRT program matrix: A conceptual framework for program implementation and evaluation. Addiction. 2017; 112: 12-22.
Haugen PT, McCrillis AM, Smid GE, et al.: Mental health stigma and barriers to mental healthcare for first responders: A systematic review and meta-analysis. J Psychiatr Res. 2017; 94: 218-229.
Smith BG, Smith SB, Knighton D: Social media dialogues in a crisis: A mixed-methods approach to identifying publics on social media. Public Relat Rev. 2018; 44(4): 562-573.
Carleton RN, Afifi TO, Turner S, et al.: Mental health training, attitudes toward support, and screening positive for mental disorders. Cogn Behav Ther. 2020; 49(1): 55-73.
Szeto A, Dobson KS, Knaak S: The road to mental readiness for first responders: A meta-analysis of program outcomes. Can J Psychiatry. 2019; 64(1 suppl): 18S-29S.
Sutton SL: Beyond Crisis Response: Characterizing First Responder Interest in Mental Health Services. 2020. Doctoral Dissertation. 83. Shanafelt T, Ripp J, Trockel M: Understanding and addressing sources of anxiety among healthcare professionals during the COVID-19 pandemic. JAMA. 2020; 323(21): 2133-2134.
Walton M, Murray E, Christian MD: Mental healthcare for medical staff and affiliated healthcare workers during the COVID-19 pandemic. Eur Heart J Acute Cardiovasc Care. 2020; 9(3): 241-247. DOI:10.1177/2048872620922795.
Benedek DM, Fullerton C, Ursano RJ: First responders: Mental health consequences of natural and human made disasters for public health and public safety workers. Annu Rev Public Health. 2007; 28: 55-68. DOI:10.1146/annurev.publhealth.28.021406.144037.
Norris FH, Friedman MJ, Watson PJ: 60,000 disaster victims speak: Part II. Psychiatry. 2002; 65(3): 240-260.
Greenberg N, Wessely S, Wykes T: Potential mental health consequences for workers in the Ebola regions of West Africa—A lesson for all challenging environments. J Ment Health. 2015; 24: 1-3. DOI:10.3109/09638237.2014.1000676.
Kronenberg M, Osofsky HJ, Osofsky JD, et al.: First responder culture: Implications for mental health professionals providing services following a natural disaster. Psychiatric Annals. 2008; 38(2): 114-118.
Bonanno GA, Galea S, Bucciarelli A, et al.: What predicts psychological resilience after disaster? The role of demographics, resources, and life stress. J Consult Clin Psychol. 2007; 75(5): 671.
Choi KR, Heilemann MV, Fauer A, et al.: A second pandemic: Mental health spillover from the novel coronavirus (COVID-19). J Am Psychiatr Nurses Assoc. 2020; 26(4): 340-343.
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