Perceived Stress and Probable Alcohol Misuse in Firefighters: The Role of Posttraumatic Stress

Firefighters are at elevated risk for stress, posttraumatic stress disorder symptomatology, and alcohol use, the combination of which is highly complex and difficult to treat. The current study examined the indirect effects of perceived stress on probable alcohol misuse via posttraumatic stress severity using structural equation modeling. Participants included 2,790 male firefighters employed by a large fire department in a major U.S. metropolitan area. Results demonstrated that posttraumatic stress severity significantly mediated the association between perceived stress severity and probable alcohol misuse (beta = .19, 95% confidence interval [.15, .21], p < .001). This model suggested that 70% of the effect of perceived stress on probable alcohol misuse was accounted for indirectly via posttraumatic stress. Overall, perceived stress severity was associated with heightened posttraumatic stress severity, which in turn, was associated with greater levels of probable alcohol misuse. Furthermore, direct effects of perceived stress on probable alcohol misuse and posttraumatic stress on probable alcohol misuse were statistically significant. Results should be interpreted with respect to study limitations, including a cross-sectional design and reliance on self-report measures. Implications for clinical intervention efforts with firefighters are discussed.