First Responder Wellness Research

**This article is more than 20 years old, yet its message remains incredibly relevant today.**

In 2004, Patrick Corrigan published one of the most influential papers on mental health stigma and help-seeking. While mental health awareness has grown significantly since then, many of the barriers he identified continue to affect people seeking care—especially first responders, military personnel, healthcare workers, and others working in high-stress professions.

Corrigan argued that stigma interferes with mental health care because people often avoid treatment to escape the negative labels, stereotypes, and discrimination associated with mental illness. He identified two major ways stigma causes harm:

🚫 It can diminish self-esteem and self-worth.

🚫 It can reduce social opportunities and create fear of judgment from others.

Perhaps the most important finding was that stigma doesn't just affect how society views mental health—it affects whether people seek help in the first place. Many individuals who could benefit from counseling, therapy, or other mental health services choose not to access them because they fear being perceived differently by coworkers, supervisors, family members, or their communities.

For first responders, this remains a critical issue.

Even today, many emergency responders report concerns about:

🚑 Being viewed as weak

🚑 Career consequences

🚑 Confidentiality

🚑 Being treated differently by peers

🚑 Letting others down

The conversation around first responder wellness has improved substantially over the past two decades, but stigma continues to be one of the most significant barriers to care.

The good news is that culture can change.

Every conversation about mental health, every leader who models vulnerability, every peer who checks in on a coworker, and every organization that normalizes help-seeking helps reduce stigma and increase access to support.

Sometimes the most impactful research isn't the newest research. Sometimes it's the research that continues to explain challenges we are still working to solve decades later.

💬 In your experience, what forms of stigma still exist in first responder culture today?

**Article Citation:**
Corrigan, P. W. (2004). *How stigma interferes with mental health care.* American Psychologist, 59(7), 614–625. https://doi.org/10.1037/0003-066X.59.7.614 PDF

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RURAL PARAMEDIC FRIENDS - I NEED YOUR HELP!!!!!

I'm doing a follow up study on a previously published paper on rural paramedic experiences in Louisiana (link -> https://pubmed.ncbi.nlm.nih.gov/41451684/ )

I am a paramedic and Ph.D. student at West Virginia University. in the Department of Industrial and Management Systems Engineering conducting a study, under the supervision of Dr. Avishek Choudhury, Assistant Professor at West Virginia University in the Department of Industrial and Management Systems Engineering, on the safety and mental health challenges faced by pre-hospital paramedics. I am reaching out because of your experience as a paramedic and would like to invite you to participate in a semi-structured qualitative interview.

The purpose of this study is to better understand the unique challenges paramedics encounter in their work and how these affect their well-being. The interview will take approximately 45 minutes and can be conducted at a time (via Zoom Meeting) that is convenient for you. Participation is entirely voluntary, and you may withdraw at any time without consequence.

The West Virginia University Institutional Review Board's review of this research project is on file with the WVU Office of Human Research Protections.

If you are interested in participating, you may schedule your interview date and time here https://calendly.com/cpm00041-mix/safety-mental-health-challenges-in-rural-paramedics
If you would like more information, please reply to this email or contact me at [email protected] or 337-418-0155.

I am aiming to recruit 24 paramedics who are NOT in Louisiana for this study, and I would greatly value your perspective.

Thank you for considering this opportunity, and I look forward to hearing from you!

**One of the most difficult conversations in first responder wellness is su***de. But it's a conversation we must continue to have.**

A study by Caulkins and Wolman examined suicidality among emergency responders and found concerning rates of suicidal thoughts, planning, access to means, and su***de attempts within first responder populations. Their findings add to a growing body of evidence suggesting that emergency responders face unique occupational risks related to su***de.

Some findings highlighted by the authors include:

🚑 Elevated rates of suicidal thoughts among emergency responders.

🚑 Significant numbers reporting su***de planning and access to means.

🚑 Personal su***de attempt rates that exceed what is typically observed in the general population.

🚑 Exposure to trauma, death, injury, suffering, and cumulative occupational stress may contribute to increased risk.

Perhaps one of the most important lessons from this research is that su***de risk is rarely caused by a single event. It often develops through the interaction of occupational stress, trauma exposure, burnout, mental health concerns, relationship difficulties, physical health challenges, and barriers to seeking help.

The good news is that su***de is preventable.

Research consistently points toward the importance of:

✅ Early identification of distress

✅ Peer support

✅ Access to evidence-based mental health care

✅ Supportive leadership

✅ Reducing stigma around help-seeking

✅ Building organizational cultures that prioritize wellness

As first responders, we train extensively to recognize emergencies in others. We must also learn to recognize warning signs in ourselves and those we serve beside every day.

Checking in with a coworker, asking a difficult question, or encouraging someone to seek support can make a difference.

**You do not have to carry the weight of this work alone.**

💬 What do you think organizations can do to better identify and support first responders who may be struggling?

**Article Citation:**
Caulkins, C. G., & Wolman, D. (2020). *Emergency Responder Suicidality: An Analysis by Field and Emergency Medical Services Credential.* Journal of Forensic Brain and Neurological Disorders, 2(1), 1–10.

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I am truly humbled by the support this page has received.

What started as a place to share research, information, and conversations about first responder wellness has grown into something much bigger than I ever imagined. Through this page, I have had the opportunity to connect with countless first responders, mental health professionals, researchers, peer supporters, organizational leaders, and advocates who share a common goal: improving the well-being of those who serve our communities.

Over the past several months, I have met with many individuals and organizations who want to collaborate and help build upon this work. Every conversation reinforces something I have believed for a long time: there are many people who care deeply about first responder mental health and are willing to work together to create meaningful change.

This past week marked a significant milestone for me personally. I had the opportunity to meet with a West Virginia State Delegate to discuss the work I have been doing and the vision for developing proactive approaches to first responder wellness. The meeting was originally scheduled for one hour but lasted nearly two. He was engaged, asked thoughtful questions, and expressed genuine interest in the information, research, and ideas being discussed.

It was only a first step, but it was an important one.

This week, I am continuing conversations through the university to build upon that momentum. I am also taking steps toward developing an advisory board that will help guide the creation of training curricula designed for different audiences and levels of implementation. My hope is to bring together professionals with diverse expertise and lived experiences to help ensure these efforts are practical, evidence-informed, and responsive to the needs of first responders and the organizations they serve.

There is still a great deal of work ahead, but it feels like the pieces are beginning to come together.

Thank you to everyone who has followed this page, shared content, participated in discussions, offered feedback, connected me with others, and supported these efforts. I am grateful for the encouragement and look forward to continuing this journey together.

The goal remains the same: to build proactive, sustainable approaches to supporting the mental health and well-being of first responders.

One conversation at a time. One partnership at a time. One step at a time.

**Can resilience skills training improve mental health among public safety personnel?**

A recent study by Carleton and colleagues examined changes in mental health symptoms among public safety personnel after participating in **Emotional Resilience Skills Training (ERST)**. The findings provide encouraging evidence that proactive mental health training may help reduce symptoms associated with several common mental health concerns experienced by those working in high-stress professions.

The researchers found that participants who completed the training reported improvements in symptoms associated with:

🧠 Anxiety

💙 Depression

⚠️ Posttraumatic stress

😴 Sleep-related difficulties

🔥 Occupational stress and emotional strain

The training focused on developing practical emotional resilience skills that participants could use both on and off the job. Rather than waiting until someone reaches a crisis point, the approach emphasizes building psychological skills before problems become overwhelming.

One of the most important takeaways from this study is that **mental health training does not have to be reactive.**

Just as public safety personnel regularly train for physical emergencies, tactical scenarios, and clinical skills, there may be value in routinely training psychological skills that help individuals manage stress, regulate emotions, and recover from difficult experiences.

This research aligns with a growing body of evidence suggesting that prevention and early intervention may play an important role in supporting the long-term well-being of public safety personnel.

As someone who researches preventive mental health infrastructure for first responders, I find studies like this particularly important because they shift the conversation from "How do we respond after someone is struggling?" to "How do we help people stay well in the first place?"

💬 What types of resilience or wellness training have you found most helpful throughout your career?

**Article Citation:**
Carleton, R. N., Sauer-Zavala, S., Teckchandani, T. A., Maguire, K. Q., Jamshidi, L., Shields, R. E., Afifi, T. O., Nisbet, J., Andrews, K. L., Stewart, S. H., Fletcher, A. J., Martin, R., MacPhee, R. S., MacDermid, J. C., Keane, T. M., Brunet, A., McCarron, M., Lix, L. M., Jones, N. A., & Asmundson, G. J. G. (2025). *Mental health disorder symptom changes among public safety personnel after emotional resilience skills training.* Comprehensive Psychiatry, 138, 152580. https://doi.org/10.1016/j.comppsych.2025.152580

**Peer support programs are everywhere in first responder organizations—but do they work?**

Peer support has become one of the most common approaches used to support first responder mental health. Yet a recent critical review suggests that while peer support programs are widely accepted and highly valued, there is still surprisingly little research evaluating their effectiveness.

Bowers, Beidel, and Steigerwald reviewed the existing literature on peer support programs for first responders and identified several important findings:

🤝 Peer support programs are widely implemented across fire, EMS, law enforcement, and other first responder organizations.

🤝 Many first responders report feeling more comfortable talking with peers who understand the realities of the job.

🤝 Peer supporters may help reduce barriers to seeking professional mental health care.

🤝 Programs vary significantly in training, structure, implementation, and evaluation.

🤝 There is currently limited high-quality research examining long-term outcomes and effectiveness.

One of the most important takeaways from this review is that **peer support should not be viewed as a replacement for professional mental health care.** Instead, peer support may serve as a critical bridge that helps first responders recognize concerns, access resources, and connect with additional support when needed.

The authors also highlight the need for stronger research to determine which peer support models are most effective, how programs should be implemented, and what outcomes organizations should measure.

As first responder wellness efforts continue to grow, it is encouraging to see peer support recognized as an important component of a larger mental health infrastructure. However, this review reminds us that good intentions alone are not enough—we also need evidence to guide best practices.

💬 Has your agency implemented a peer support program? What aspects have been most helpful, and what challenges have you observed?

**Article Citation:**
Bowers, C., Beidel, D. C., & Steigerwald, V. L. (2025). *Peer support programs for first responders: A critical review and research roadmap.* International Journal of Environmental Research and Public Health, 22(10), 1532. https://doi.org/10.3390/ijerph22101532

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**Why are first responders at increased risk for su***de?**

When we talk about su***de prevention in first responder populations, it's important to understand that risk is about more than stress, trauma, or mental health symptoms alone.

A study by Bond and Anestis examined the relationship between **suicidal ideation** and what researchers call the **capability for su***de** among first responders. The authors found that repeated exposure to painful and provocative experiences—something many first responders encounter throughout their careers—may contribute to an increased capability for engaging in suicidal behavior.

In simple terms, the job can change how individuals experience fear, pain, and exposure to difficult situations.

The study found that:

🚑 First responders often experience repeated exposure to death, injury, violence, and trauma.

🚑 These experiences may increase acquired capability for su***de by reducing fear of pain and death over time.

🚑 Suicidal thoughts and suicidal capability are not the same thing, but understanding both is important for prevention efforts.

🚑 Su***de prevention requires more than identifying distress—it also requires understanding occupational risk factors unique to first responder professions.

One of the most important takeaways from this research is that su***de is rarely caused by a single factor. It is often the result of a complex interaction between psychological distress, occupational experiences, social support, access to care, and individual circumstances.

This reinforces why proactive mental health support, peer support programs, leadership engagement, stigma reduction, and accessible counseling services are so important in emergency services.

We cannot eliminate trauma from first responder work, but we can build systems that help people process it before it becomes overwhelming.

💬 What do you think organizations can do to better support su***de prevention efforts among first responders?

**Article Citation:**
Bond, A. E., & Anestis, M. D. (2021). *Understanding capability and suicidal ideation among first responders.* Archives of Su***de Research, 27(2), 295–306. https://doi.org/10.1080/13811118.2021.1993397Download PDF

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📣 It's that time again! Let's build the resource list.

If you are a **therapist, coach, peer support specialist, chaplain, or wellness professional** who works with first responders, military personnel, veterans, or their families, drop your information in the comments below.

Please include:

📍 Location (City/State)

📞 Contact Information

🌐 Website (if applicable)

📧 Email Address

👥 Populations Served (EMS, Fire, Law Enforcement, Dispatch, Corrections, Military, Veterans, Healthcare, etc.)

💻 In-Person, Telehealth, or Both

🎓 Relevant Training or Certifications

This post is intended to help connect people with resources and professionals who understand the unique challenges associated with high-stress careers.

**Please keep comments limited to resource information so individuals can easily find services when needed.**

If you're looking for support, take a few minutes to browse the comments. There are many dedicated professionals and peers who are passionate about helping those who serve others.

Thank you to everyone who contributes and helps make this community a valuable resource for first responders and their families.

🚑🚒🚓🎧🔒

Send a message to learn more

**Stress in EMS is not just about the calls.**

When people think about stress in Emergency Medical Services, they often think about trauma exposure, critical incidents, and life-or-death situations. While those experiences certainly contribute, research suggests that many of the stressors affecting EMS professionals occur long before the tones drop.

A study by Bardhan and Byrd examined psychosocial work stress among EMS professionals and found evidence of significant work-related stress across all certification levels. The researchers identified high effort-reward imbalance and overcommitment as important indicators of occupational stress within EMS.

The study also highlighted several workplace factors that may contribute to stress, including:

🚑 Long work hours

🚑 Rotating shifts

🚑 High job demands

🚑 Organizational and leadership stressors

🚑 Repeated exposure to traumatic events

🚑 Hazardous work environments

Perhaps one of the most interesting findings was the relationship between occupational stress indicators and sleep-related concerns, particularly among rotating-shift employees. The researchers found significant associations between psychosocial work stress and sleep apnea measures, reinforcing the importance of sleep health in EMS wellness.

This is an important reminder that improving mental health in EMS requires more than individual resilience. It requires attention to organizational culture, scheduling practices, workload, leadership, recovery, and sleep.

The conversation about first responder wellness cannot focus only on what happens during critical incidents. We also need to examine the systems and workplace conditions that contribute to chronic stress over time.

💬 In your experience, what creates the most stress in EMS: the calls themselves, staffing shortages, leadership issues, shift schedules, paperwork, or something else?

**Article Citation:**
Bardhan, R., & Byrd, T. (2023). *Psychosocial Work Stress and Occupational Stressors in Emergency Medical Services.* Healthcare, 11(7), 976. https://doi.org/10.3390/healthcare11070976