Post-Traumatic stress disorder and post-traumatic growth in firefighters: examining the moderating effects of resilience on occupational safety behaviors

Abstract

Background Posttraumatic stress disorder (PTSD) and posttraumatic growth (PTG) represent divergent outcomes following trauma exposure in high-risk professions. This investigation examined the complex interplay between PTSD, PTG, and resilience in relation to occupational safety behaviors among Turkish firefighters. Methods A multi-site cross-sectional study was conducted across five metropolitan fire departments in Turkey (N = 122). Participants completed validated psychometric instruments including the PTSD Checklist for DSM-5 (PCL-5), Posttraumatic Growth Inventory-Expanded Form (PTGI-X), Brief Resilience Scale, alongside detailed evaluations of safety practices, perceptions, and behaviors that assessed protocol adherence, equipment maintenance, training attendance, and safety communication metrics. Hierarchical multiple regression and chi-square analyses examined the relationships between psychological factors and safety outcomes, with particular attention to moderating effects. Results Analyses revealed significant associations between psychological adaptation patterns and safety-critical behaviors. PTSD symptomatology demonstrated negative correlations with safety protocol adherence (r=-.24, p <.01) and safety awareness (r=-.21, p <.01). PTG manifested distinct cultural patterns, with Personal Strength emerging as the predominant domain (M = 3.10, SD = 1.08). A distinct disparity emerged between technical and psychological safety dimensions, with high adherence to equipment-related protocols (breathing apparatus maintenance: M = 4.00) contrasting markedly with poor implementation of psychological safety practices (comfort in communicating safety concerns: M = 1.66). Regression analyses indicated that psychological factors accounted for 28% of the variance in safety performance metrics, with resilience moderating the relationship between PTSD symptomatology and safety outcomes. Conclusions This investigation identifies critical relationships between psychological adaptation and occupational safety in firefighting, revealing how PTSD symptoms and PTG distinctly influence safety behaviors through culturally mediated patterns. The significant gap between adherence to technical safety protocols versus psychological safety practices underscores the need for integrated interventions that address both domains. These findings support developing comprehensive programs that enhance psychological resilience while maintaining technical safety standards in emergency services, suggesting a paradigm shift in occupational safety approaches for high-risk professions.