Work-Related Trauma, Alienation, and Posttraumatic and Depressive Symptoms in Medical Examiner Employees

Objective: First-responder employees, including firefighters, police, and medical examiners, are at risk for the development of depression and posttraumatic stress disorder (PTSD) as a result of exposure to workplace trauma. However, pathways linking workplace trauma exposure to mental health symptoms are not well understood. In the context of social-cognitive models of depression/PTSD, we examined the role of negative cognitions as mediators of the cross-sectional and longitudinal relationship of workplace trauma exposure to symptoms of depression/PTSD in medical examiner (ME) employees. Method: 259 ME personnel were recruited from 8 sites nationwide and completed an online questionnaire assessing potential trauma exposure (i.e., exposure to disturbing cases and contact with distressed families of the deceased), negative cognitions, and symptoms of depression and PTSD, and 151 completed similar assessments 3 months later. Results: Longitudinal analyses indicated that increases in negative cognitions, and, in particular, thoughts about alienation predicted increases in depressive symptoms from Time 1 to Time 2. In cross-sectional analyses, but not longitudinal analyses, negative cognitions mediated the relationship of case exposure to symptoms of both depression and PTSD. Negative cognition also mediated the relationship of contact with distressed families to depressive symptoms. The strongest effects were for negative cognitions about being alienated from others. Conclusion: The results of this study support social-cognitive models of the development of posttraumatic distress in the workplace and have implications for the development of interventions to prevent and treat mental health symptoms in first responders.