Addressing PTSD and mental health challenges among America’s first responders

There are over 4 million first responders in the United States, a group that includes firefighters, law enforcement officers, emergency medical technicians, paramedics and 911 dispatchers. These are the people who arrive first on the scene of disasters, serving a critical role for society. And because of that, they often see things we can’t comprehend. As many as one in 10 first responders report experiences of post-traumatic stress disorder (PTSD). That’s nearly three times the rate reported in the general population in the United States.   

Dr. Anka Vujanovic, a professor and the director of clinical training in Texas A&M University’s Department of Psychological and Brain Sciences, has worked over the past decade to understand how PTSD manifests for these vital workers — and how to mitigate it — as part of her larger work on traumatic stress. She calls herself a “traumatologist”: a professional focused on the study and treatment of psychological trauma who focuses on traumatic stress, substance use, post-traumatic stress disorder and suicide risk.

But the mental health of first responders, she says, has long been overlooked by experts studying larger questions about occupational and traumatic stress.   

“First responders are, in many ways, the pillars of our communities. They show up on the worst days of our lives and run to burning buildings or chemical spills or motor vehicle accidents, while everyone else is running away,” she said. “Society has long equated first responders with courage and resilience — so much so that it averted the gaze of clinical scientists for a long time.”  

Fighting the stigma of care

Vujanovic’s interest in the mental health of first responders began more than a decade ago, when she received a call from a psychologist at the Houston Fire Department requesting to collaborate on a study of trauma among the agency’s first responders.   

“I remember sitting on that call and thinking, ‘Why are they calling me?’ And then I started looking at the literature, and it was shocking to see at that time how relatively little research on first responder mental health [there was] and how much there was to do,” she recalls.   

Vujanovic’s research often involves conducting surveys of hundreds of firefighters, emergency medical technicians and other first responders to understand their experiences with trauma, anxiety, depression, substance use and other events. Her work has also included clinical trials of attention training or resilience programming specifically tailored for first responder populations. The researchers contact first responders through professional organization email lists or by direct outreach with local fire and other emergency services. To encourage participation, they may offer raffle prizes or continuing education credits to survey respondents. And in addition to asking open-ended questions, the surveys may include scales that rank the severity of mental health symptoms or checklists inquiring about certain life events. Vujanovic has engaged first responders to inform study methods and design to ensure that they have a voice in how the research is carried out. 

Her work has shown that first responders reported increased alcohol use amid the COVID-19 pandemic and that firefighters experiencing PTSD and alcohol use disorder show higher alcohol use and suicide risk than firefighters experiencing PTSD alone. Overall, Vujanovic says, first responders also may have elevated rates of sleep problems, alcohol use and suicidal ideation and risk. Suicide rates among first responders may even be higher than line of duty deaths and comparable to rates documented among military service members and veterans.  

“The fact that they’re even in the range is alarming,” Vujanovic said. “And first responders struggle often in silence for fear of the mental health stigma.”  

That stigma can be so powerful that it supersedes other barriers to accessing care, like cost, the time it takes to seek treatment or the availability of treatment nearby.   

“First responders are repeatedly exposed to traumatic events as part of their job, but they often face barriers to seeking mental health care,” says Savannah Woller, a Ph.D. student in clinical psychology and the coordinator of the First Responder Consortium, who has worked in Vujanovic’s lab for the past three years, following her from the University of Houston to A&M. Woller has engaged with PTSD-focused research since her undergraduate years, and hopes to pursue a career in academia where she can continue researching trauma-related psychopathology and providing  evidence-based care.  

“Studying PTSD in this population is crucial not only to better understand their experiences but also to develop treatments that are tailored, accessible and truly effective for those on the front lines,” Woller said. “The ability to contribute to research that directly informs treatment continues to be incredibly meaningful to me.” 

Video: Mathew Baughman, Texas A&M College of Arts and Sciences

Understanding the scope and recurrence of these experiences among first responders allows for the creation of intervention strategies — like building awareness among primary care providers, who are more likely to see first responders in a clinical setting, due to the stigma of seeking mental health care. 

Traumatic stress has been a part of Vujanovic’s experience since childhood. Growing up in a family from a part of Europe affected by the atrocities of World War II and plagued by a decade-long civil war in the 1990s, Vujanovic learned about how trauma can  affect survivors from a young age.   

“The context in which I was born primed me to start thinking about those things, I think earlier than others might, because [trauma] recovery was just a topic of conversation,” she said. “I became very interested in how some people can be resilient in the aftermath of trauma, even though they might or might not feel stuck or struggle with traumatic stress or other symptoms after experiencing traumatic events. I was deeply inspired by my grandparents’ strength to overcome the horrors of war and to lead meaningful lives despite tremendous adversity — or perhaps, because of it. I knew I wanted to learn from and help those affected by trauma. Being able to dedicate my career to understanding and facilitating recovery for people affected by trauma is a privilege, and I am grateful to be able to do this work.”  

Vujanovic joined the College of Arts and Sciences in 2023 and Texas A&M now hosts a First Responder Consortium that partners with fire, police and other first responder departments across Texas and nationwide to research and improve the mental health of these workers.

Vujanovic’s research with first responders is applicable to nearly any high-stress job, she says, such as frontline medical workers and veterinarians. She says the traumatic stress research she’s done in this area has helped illuminate the importance of studying occupational stress more broadly, because it has the potential to impact so many professions. The College of Arts and Sciences, she says, has helped foster those connections. She has worked with the College of Nursing, for instance, contributing several chapters to a book in collaboration with Matthew Sorenson, the associate dean for Graduate Nursing Education, and Paul Thomas Clements, a clinical professor.   

In addition to understanding the occupational stress that first responders endure, Vujanovic says it’s important to determine how to mitigate it, so these essential workers can continue showing up for themselves and others. Over the next five years, Vujanovic and Texas A&M will work in collaboration with Stony Brook University to evaluate the efficacy of a group-based resilience training workshop on the mental health of firefighters. They will recruit 800 firefighters, with the goal of developing mental health programming for first responders.   

“We have so much more to learn about how to help our first responders to foster resilience and to access treatment without real or perceived repercussions, personally or professionally. That is where the impact is: This work can tangibly change policy, and can change lives by extension,” she said. “I am honored to work with trauma survivors, to be trusted with their stories. I am inspired by their strength. It’s really exciting work to do.”