The Use of Abbreviated Screening Tools in Primary Care Settings As an Important and Proactive Resource to Identify at-Risk First Responders

Background/Purpose

First responders (FRs) are at higher risk for mental health issues than the general population (Stanley et al., 2016). Rates of PTSD for FRs are three to five times higher than the U.S. adult population (Lewis-Schroeder et al., 2018). A diagnosis of PTSD frequently co-occurs with other mental health conditions among FRs, and this leads to an increased suicide risk (Baker et al., 2023; Bowler et al., 2016; Jones et al., 2018). Mental health issues are often underreported in this population due to stigmas and fear of losing status or employment (Drew & Martin, 2021; Marshall et al., 2021).

Resilience can be protective against PTSD and has been shown to be inversely related to suicidality (Lee et al., 2016; Ponder et al., 2023a; 2023b). Resilience theory, therefore, refers to shifting the focus of treatment and intervention to the development and promotion of protective and adaptive factors, rather than the typical focus on problems, risk factors, and diagnoses. A primary care setting is an appropriate place to intentionally screen FRs for those in need of early treatment and intervention in order to refer them to resources that will build resilience and protective factors.

This current study will use abbreviated instruments with treatment-seeking FRs to ascertain whether abbreviated assessments will replicate the findings of earlier studies. If confirmed, the results will support the use of abbreviated screening tools in primary care settings as an important and proactive resource to identify at-risk FRs.

Methods
This cross-sectional study analyzed clinical intake data from 192 treatment-seeking FRs at a nonprofit outpatient mental health clinic between 2019 and 2021 using abbreviated screening tools. Resilience was measured using the Response to Stressful Experiences Scale–4. Measures used for mental health outcomes were the GAD-2 (anxiety), PHQ-2 (depression), PHQ-SI (suicidality), CAGE-AID (substance abuse), and PC-PTSD-5 (PTSD). Bivariate correlational analyses and logistic regression were conducted. For the non-parametric effect size, it was based on Chinn’s (2000) calculation, the OR π/sqrt(3) = 1.81. Then the OR divided by 1.81 was used to get the ln(odds).

Results
The sample was divided between LEOs (56%) and FFs/EMTs (44%). Both groups were primarily male (71%/74%), with a mean age of 38 and 35 years and an average of 12 and 11 years of service, respectively. Participants primarily identified as White (76%/87%).

In the LEO sample, suicidality was negatively correlated with resilience and positively correlated with PTSD and depression. In the FF/EMT sample, suicidality was positively correlated with generalized anxiety and depression. Additionally, this study found that for FFs/EMTs, depression increased the odds of suicide risk by 68%, while previous mental health treatment decreased the odds of suicide by 83%.

Conclusions/Implications
This study adds to the social work knowledge base by confirming the efficacy of abbreviated screening instruments for identifying mental health concerns in FRs. Early screening and identification of at-risk FRs in primary care settings can help mitigate help-seeking stigma and prevent suicide in this population.