Occupational Medicine 2020;70:427–433
Advance Access publication on 24 July 2020 doi:10.1093/occmed/kqaa129

Mental health and social support among public
safety personnel
K. D. Vig1, , J. E. Mason1, R. N. Carleton1, G. J. G. Asmundson1, G. S. Anderson2 and D. Groll3,
Department of Psychology, University of Regina, 3737 Wascana Parkway, Regina, Saskatchewan S4S 0A2, Canada, 2Office of
Applied Research and Graduate Studies, Justice Institute of British Columbia, New Westminster, British Columbia V3L 5T4,
Canada, 3Department of Psychiatry, Queen’s University, Kingston, Ontario K7M 8A6, Canada.
1

Background Social support may be a protective factor for the mental health of public safety personnel (PSP),
who are frequently exposed to potentially psychologically traumatic events and report substantial
post-traumatic stress disorder (PTSD) and major depressive disorder (MDD) symptoms. Research
examining perceived social support and its association with PTSD and MDD in different PSP
categories (e.g. firefighters, paramedics) is limited.
Aims

To examine differences in perceived social support across PSP and determine whether perceived
social support is associated with differences in rates of MDD and PTSD.

Methods

We asked Canadian PSP, including correctional workers and officers, public safety communications officials, firefighters, paramedics, municipal and provincial police officers, and Royal Canadian
Mounted Police (RCMP) officers, to complete an online anonymous survey that assessed sociodemographic information (e.g. occupation, sex, marital status, service years), social supports and
symptoms of mental disorders, including PTSD and MDD. Analyses included ANOVA and logistic
regression models.

Results

Perceived social support differed by PSP occupation. RCMP officers reported lower social support
than all other PSP except paramedics. For most PSP categories, PSP who reported greater social
support were less likely to screen positive for PTSD (adjusted odds ratios [AORs]: 0.90–0.93).
Across all PSP categories, greater perceived social support was associated with a decreased likelihood of screening positive for MDD (AORs: 0.85–0.91).

Conclusions Perceived social support differs across some PSP categories and predicts PTSD and MDD diagnostic status. Studies involving diagnostic clinical interviews, longitudinal designs and social support
interventions are needed to replicate and extend our results.
Key words

Occupational health; post-traumatic stress disorder; public safety personnel; social support.

Introduction
Social support predicts positive mental health outcomes
[1]. Social support includes the resources provided to an individual by his or her social network. Social support comes
in different forms, including instrumental (e.g. providing
transportation or money), informational (e.g. giving advice or guidance) and emotional (e.g. expressing empathy
and reassurance) supports, all of which may come from
different sources, such as friends, family and co-workers
[2]. Meta-analytic results indicate that social support is
negatively associated with symptoms of various mental disorders, including depression [3] and post-traumatic stress

disorder (PTSD) [4]. Furthermore, researchers have demonstrated that perceived social support, or the subjective
feeling of being supported by others, is more closely associated with positive mental health outcomes than received
(i.e. actual) social support [3,5]. Increased social support
is associated with better mental health outcomes in both
cross-sectional and longitudinal research, implicating high
levels of social support as a potential protective factor
for mental health [1]. Research demonstrating that perceived social support is an important protective factor for
maintaining mental health highlights the potential role of
social support as a target for interventions designed to promote mental health in at-risk populations.

© The Author(s) 2020. Published by Oxford University Press on behalf of the Society of Occupational Medicine.
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Correspondence to: K. D. Vig, Anxiety and Illness Behaviours Laboratory, Department of Psychology, University of Regina, 3737
Wascana Parkway, Regina, Saskatchewan S4S 0A2, Canada. Tel: 306-337-2473; fax: 306-337-3275; e-mail: kelseydvig@uregina.ca

428 OCCUPATIONAL MEDICINE

Key learning points

PTSD and major depressive disorder (MDD) can
develop in response to trauma [6], and both are associated with persistent distress or impairment in daily functioning [7]. Researchers have proposed individual social
network support access as critical for promoting individual resilience in response to trauma [8]. Indeed, the
stress-buffering model proposes that the positive effects
of social support on overall health are only observed in
response to stress [9,10]. In the stress-buffering model,
social support buffers the potential detrimental effects of
stress on health by providing the individual with resources
to help cope with stress. The stress-buffering model appears particularly relevant for populations or occupations
exposed to more stress in their day-to-day lives than the
general population. For example, researchers looking
at military populations determined that increased postdeployment social support is inversely associated with
PTSD and depressive symptom severity [11], and a lack
of social support has been identified as a risk factor for
persistent PTSD [12].
Public safety personnel (PSP) include, among others,
public safety communications officials (PSCOs; e.g.
dispatchers, 911 operators), correctional workers, firefighters, paramedics and police officers, all of whom are
regularly exposed to potentially psychologically traumatic
stressors as a function of their work [13]. Individuals in
PSP occupations report high rates of symptoms of mental
disorders, particularly MDD and PTSD [14], and report
being most likely to turn to non-professionals when in
need of mental health support (e.g. spouse, friend) [15].
Researchers have found that greater levels of perceived
social support are associated with lower levels of depression and PTSD symptom severity in police officers [16]
and firefighters [17]. Similarly, meta-analytic evidence
indicates that both perceived and received social support
is significantly associated with positive mental health
outcomes in many PSP [1]. However, the meta-analysis
examined mental health generally (i.e. not specific

mental disorders) and only included a subset of PSP (i.e.
police officers, firefighters, paramedics, rescue workers).
We found no published studies comparing associations between mental health outcomes and social support across diverse PSP categories. Furthermore, many
studies have evaluated relationships between social support and mental disorder symptoms [11,17] but few
have assessed whether social support is related to mental
disorder diagnoses [12]. Our study was designed to determine whether perceived social support was associated
with differences in rates of MDD and PTSD in a diverse
sample of Canadian PSP. The goal of the study was to
provide a more nuanced perspective of the relationships
between perceived social support and common mental
disorder diagnoses for individuals from different PSP
occupational groups. We hypothesized that (i) different
PSP categories report different levels of perceived social
support; and (ii) increased perceived social support is associated with lower rates of positive screens for PTSD
and MDD for all PSP categories.

Methods
Participants completed an anonymous, voluntary, webbased survey between 1 September 2016 and 31 January
2017. We used a variety of recruitment strategies,
including e-mail invitations from advocacy organizations,
provincial and municipal public safety organizations and
the Public Safety Steering Committee of the Canadian
Institute for Public Safety Research and Treatment
(CIPSRT). More information about the sampling frame
is available elsewhere [13,14]. The study was approved by
the Institutional Research Ethics Board at the University
of Regina. The survey asked about participants’ sociodemographic variables, including which PSP category
they felt best described their current occupation.
The Life Events Checklist for DSM-5 (LEC-5) [18]
assesses lifetime history of potentially psychologically

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What is already known about this subject:
• Public safety personnel report high rates of mental disorders.
• Greater perceived social support is associated with reduced rates of many mental disorders, including major
depressive disorder and post-traumatic stress disorder.
What this study adds:
• This study was designed to evaluate associations between mental health and perceived social support among
public safety personnel from different occupational groups.
• Higher perceived social support is associated with a decreased likelihood of screening positive for major depressive disorder and post-traumatic stress disorder across nearly all public safety occupational groups.
What impact this may have on practice or policy:
• Targeted interventions designed to promote social support should be developed and evaluated as these may
help reduce the incidence of mental disorders among public safety personnel.

K. D. VIG ET AL.: MENTAL HEALTH AND SOCIAL SUPPORT AMONG PSP 429

depressive symptoms in the past 2 weeks on a Likert scale
from 0 (not at all) to 3 (nearly every day). The PHQ-9 has
strong test–retest reliability [23] and demonstrates good
sensitivity and specificity for detecting MDD. As per the
established recommendations [22], we considered participants to have screened positive for MDD if they endorsed either item 1 (decreased interest or pleasure) or
item 2 (depressed mood) and at least four other symptoms. We considered items 1–8 to be endorsed if participants rated them 2 or higher. We considered item 9,
which relates to suicidal thoughts and self-harm, to be
endorsed if participants rated it 1 or higher.
The 10-item Social Provisions Scale (SPS-10) [24]
is a shortened version of the original Social Provisions
Scale, a self-report measure of perceived social support. Respondents rate each item on a Likert scale from
1 (strongly disagree) to 4 (strongly agree) and items are
summed to provide a total score. The SPS-10 has demonstrated good reliability and validity [24].
We conducted a one-way ANOVA to compare perceived social support across each PSP category. We used
post hoc Bonferroni tests to clarify significant effects.
Next, we stratified data by PSP occupational group and
calculated two binomial logistic regression models for
each PSP group: one model included PTSD screens as
the dependent variable and a second model included
MDD screens as the dependent variable. Perceived social support was the independent variable in all models
and we adjusted all logistic regression models for sociodemographic covariates (i.e. sex, marital status, years of
education and total years of service). We conducted all
analyses using IBM SPSS Statistics Version 23.0 (SPSS,
Chicago, IL, 2015).

Results
In total, 8520 PSP began the survey and answered at least
the first question. We excluded 4282 (48%) participants
from all analyses if they did not complete the measures
described above. In line with prior research [13,14], we
grouped the remaining 4238 PSP into PSCO (n = 213),
correctional workers and officers (n = 592), firefighters
(n = 650), paramedics (n = 590), municipal and provincial police officers (n = 1086) and Royal Canadian
Mounted Police (RCMP) officers (the federal police
force in Canada; n = 1107). We excluded participants
who reported other PSP categories from our analyses
due to the limited number of cases in each category. The
sample was generally demographically representative of
the Canadian population [14].
Internal consistency for all measures was acceptable
(Cronbach’s alpha of 0.80 or greater). Visual inspection
of Q–Q plots and histograms of social support identified
deviation from normality for all PSP occupational groups.
However, univariate ANOVA is robust to deviations
from normality for large sample sizes [25]. Levene’s test

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traumatic events. The LEC-5 includes 16 events that can
lead to distress or PTSD (e.g. physical assaults, sudden
violent death) and allows participants to report other
very stressful experiences. We adapted the wording for
some items to avoid capturing events that are relatively
common for PSP and less likely to be traumatic (e.g. we
revised ‘a transportation accident’ to ‘a serious transportation accident’). Participants respond to each potentially psychologically traumatic event by choosing one of
the following: happened to me, witnessed it, learned about it,
part of my job, not sure or does not apply. The publishers of
the LEC-5 created the measure by modifying one item
on the original LEC and adding the response category
part of my job to reflect changes to the DSM-5 diagnostic criteria for PTSD. Psychometric properties for
the LEC-5 are not available. However, a psychometric
analysis of the original LEC demonstrated its utility as
a stand-alone assessment of traumatic exposure, stable
test–retest reliability and acceptable convergence of 0.55
with similar, more in-depth assessments of trauma exposure [19]. We only used the LEC-5 to determine
whether participants experienced at least one potentially
psychologically traumatic event [7]. We considered participants who reported having experienced at least one
event on the LEC-5 to have experienced a potentially
traumatic event. Detailed information about the nature
and frequency of potentially traumatic events reported
by the PSP in our sample is available elsewhere [13].
The PTSD Checklist for DSM-5 (PCL-5) [20] is a
self-report measure of past-month PTSD symptoms.
Using a Likert scale from 0 (not at all) to 4 (extremely),
participants rate 21 statements assessing how much
they were bothered by various symptoms of PTSD. The
PCL-5 has demonstrated good psychometric properties,
including strong convergent and divergent validity and
test–retest reliability [21].
The PCL-5 can be combined with the LEC-5 and
used as a screening tool for PTSD [19]. The PCL-5
alone is not sufficient as a screening tool because it does
not assess whether the individual experienced a traumatic event as per the DSM-5 definition of a traumatic
event (i.e. ‘… actual or threatened death, serious injury,
or sexual violence’; p. 271) [7]. A PTSD diagnosis requires exposure to a potentially psychologically traumatic event. Each rating of 2 or greater is considered
symptom endorsement. Participants are considered
to have screened positive for PTSD if they report exposure to at least one potentially psychologically traumatic event on the LEC-5, obtain a total score greater
than 32 on the PCL-5 and endorse at least one intrusion
symptom, one avoidance symptom, two negative alterations in cognition or mood and two hyperarousal symptoms on the PCL-5.
The 9-item Patient Health Questionnaire (PHQ-9)
[22] is a self-report measure of depressive symptoms.
Participants indicate how often they are bothered by

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Discussion
PSP differed in their levels of perceived social support
based on their occupational group, with RCMP reporting
particularly low levels of perceived social support. Higher
social support was associated with a decreased likelihood
of screening positive for MDD and PTSD across nearly
all PSP categories. For every one-point increase in perceived social support, correctional workers and officers,
firefighters, paramedics, municipal and provincial police officers and RCMP officers were 7–10% less likely
to screen positive for PTSD and 11–15% less likely to
screen positive for MDD. PSCOs who reported greater
perceived social support were also less likely to screen
positive for MDD, but not PTSD.
We designed our study to evaluate whether higher perceptions of social support were associated with a lower
likelihood of screening positive for PTSD and MDD in
a diverse sample of Canadian PSP. The study has many
strengths, such as the large and diverse PSP sample,
measurement tools with strong psychometric support
and robust analytic decisions. There are also several limitations that offer directions for future research. First,
participants were Canadian PSP who self-selected for
the study and a sizable portion of participants began the
survey but did not finish. Our results may not therefore
be representative of all PSP despite the demographic representativeness of the sample. Given the lack of data on
the total number of potential participants, assessment of
sample representativeness is necessarily limited. Second,
the positive screens for MDD and PTSD we assigned
are diagnostic approximations as we used self-reported
screening measures. Moreover, the self-report tools assessed only current and not lifetime symptoms of MDD
and PTSD. Third, we used a cross-sectional design, prohibiting discussions of temporal or causal relationships
between mental health and social support. Thus, our results cannot inform the debate over whether increased
perceived social support protects against PTSD and

Table 1. Mean (standard deviation) and frequencies (percentages) for socio-demographic variables and social support and mental
disorder measures
PSP category

PSCOs

Corrections

Firefighters

Paramedics

Police

RCMP

Age in years, M (SD)
Years of service, M (SD)
Female, n (%)
University degree, n (%)
Married, n (%)
Social support, M (SD)
Major depressive disorder, M (SD)
Post-traumatic stress disorder, M (SD)

41.16 (9.77)
13.88 (9.40)
166 (78%)
62 (29%)
139 (65%)
33.01 (5.32)
7.23 (5.42)
19.04 (17.30)

44.37 (9.03)
15.98 (8.77)
326 (55%)
302 (51%)
455 (77%)
32.55 (5.46)
7.70 (5.89)
25.43 (18.72)

45.83 (9.44)
20.35 (10.10)
45 (7%)
17 (28%)
561 (86%)
33.13 (5.38)
5.42 (5.49)
16.80 (16.14)

40.41 (10.47)
16.52 (9.89)
231 (39%)
125 (21%)
424 (72%)
32.26 (5.77)
7.38 (6.12)
22.65 (18.69)

43.29 (8.08)
18.37 (8.69)
295 (27%)
450 (41%)
870 (80%)
33.12 (5.53)
5.85 (5.71)
19.09 (18.66)

43.05 (8.95)
17.75 (9.40)
283 (26%)
423 (38%)
890 (80%)
31.60 (5.42)
7.53 (6.12)
25.14 (20.03)

Corrections = correctional workers and officers; Police = municipal and provincial police officers; Years of service = number of years working in their occupation;
Social support = Social Provisions Scale; Major depressive disorder = 9-item Patient Health Questionnaire; Post-traumatic stress disorder = PTSD Checklist for
DSM-5.

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indicated there was homogeneity of variances (P NS). All
continuous variables (i.e. perceived social support and
total years of service) met the assumption of linearity
with the logit transformation of the dependent variables
based on the results of the Box–Tidwell procedure with
a Bonferroni correction.
Descriptive statistics for socio-demographic variables,
perceived social support levels and self-reported mental
health disorder symptoms by PSP category are shown in
Table 1. Additional details about proportions of positive
screens for MDD and PTSD in each group are reported
in a previous study of this sample [14]. The one-way
ANOVA evaluating the effect of PSP category on perceived social support was significant, F(5, 4232) = 11.10,
P < 0.001, with a small effect size (ηp2 = 0.013). Results
from the Bonferroni post hoc t-tests comparing perceived
social support across each PSP category demonstrated
that RCMP officers reported significantly lower levels
of perceived social support compared to all other PSP
occupations (Ps < 0.01) except for paramedics (P NS).
Paramedics reported lower perceived social support than
municipal and provincial police officers (P NS), but
paramedics did not differ significantly from the other
PSP categories (Ps NS).
The logistic regression model results depicting the
associations between perceived social support and positive mental disorder screens across PSP categories are
shown in Tables 2 and 3. The comparisons are presented
as adjusted odds ratios (AORs), which measure the association between an exposure (social support) and an
outcome (PTSD and MDD) after controlling for the effects of related predictors (i.e. sex, marital status, years of
education, total years of service). For each PSP category
except PSCO (AOR = 1.00), higher perceived social support was associated with lower odds of screening positive
for PTSD (AORs ranged from 0.90 to 0.93). For all PSP
categories, increased perceived social support was associated with significantly decreased odds of screening positive for MDD (AORs ranged from 0.85 to 0.91).

K. D. VIG ET AL.: MENTAL HEALTH AND SOCIAL SUPPORT AMONG PSP 431

Table 2. Logistic regressions predicting the likelihood of screening positive for PTSD based on social support
PSP category

PSCOs
Corrections
Firefighters
Paramedics
Police
RCMP

B

−0.01
−0.10
−0.07
−0.10
−0.11
−0.10

SE

0.04
0.02
0.02
0.02
0.01
0.01

Wald

<0.01
31.04***
14.19***
29.44***
53.06***
57.09***

AOR

1.00
0.90
0.93
0.91
0.90
0.90

95% CI for AOR
Lower

Upper

0.93
0.87
0.89
0.87
0.88
0.88

1.07
0.94
0.96
0.94
0.93
0.93

Table 3. Logistic regressions predicting the likelihood of screening positive for MDD based on social support
PSP Category

PSCOs
Corrections
Firefighters
Paramedics
Police
RCMP

B

−0.10
−0.12
−0.13
−0.16
−0.15
−0.14

SE

0.05
0.03
0.03
0.03
0.02
0.02

Wald

4.56*
24.48***
26.86***
39.44***
56.84***
57.20***

AOR

0.91
0.89
0.88
0.85
0.86
0.87

95% CI for AOR
Lower

Upper

0.83
0.84
0.84
0.81
0.83
0.84

0.99
0.93
0.92
0.90
0.89
0.91

Corrections = correctional workers and officers; Police = municipal and provincial police officers. AOR adjusted for sex, marital status, education, and number of
years working in their occupation. df = 1.
*P < 0.05, ***P < 0.01.

MDD [26], or whether decreased perceived social support is a consequence of PTSD or MDD [27].
Our results provide important empirical evidence of
differences in perceived social support and of robust associations between social support and positive screens
for PTSD and MDD across a variety of Canadian PSP
occupational groups. Our results are consistent with past
research indicating an association between greater perceived social support and improved mental health outcomes [1]. Our results also extend previous evidence by
using a large, diverse PSP sample. We believe our study
is the first to directly compare social support across PSP
occupational groups and to subsequently demonstrate
that different PSP occupations are associated with different levels of social support. Specifically, paramedics
reported lower social support relative to municipal and
provincial police officers, and RCMP officers reported
lower social support relative to all other PSP categories
except paramedics. Differences in perceived social support may reflect unique challenges faced by RCMP
officers and paramedics, possibly associated with the organizational structure of the institutions. For example,
RCMP officers are more likely to be required to work
in remote or rural areas and answer calls alone, which

may result in fewer social connections and less access to
supports. Researchers have demonstrated that support
from co-workers in the first few days following a potentially psychologically traumatic event may be a protective
factor for the mental health of police officers [28]. In our
study, RCMP officers reported the lowest social support
of all PSP categories, which may increase their vulnerability to PTSD and MDD symptoms. Our results are
consistent with the high rates of PTSD (30%) and MDD
(32%) reported by RCMP officers in a prevalence survey
[14]. However, further research is needed to empirically
assess whether organizational differences that affect perceived social support mediate the relationship between
PSP category and mental disorder symptoms.
Unlike the other PSP categories, PSCOs who reported
higher levels of perceived social support were less likely to
screen positive for MDD, but not for PTSD. The result
may be explained by unique aspects of call centre work
environment that might mitigate some of the potential
benefits of increased social support for PTSD, but not for
MDD. PSCOs are responsible for answering emergency
calls, sending appropriate emergency services and assisting callers until these services arrive. PSCOs are regularly presented with many stressors in the course of their

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Corrections = correctional workers and officers; Police = municipal and provincial police officers. AOR adjusted for sex, marital status, education and number of years
working in their occupation. df = 1.
***P < 0.01.

432 OCCUPATIONAL MEDICINE

Funding
This work was supported in part by the Canadian Institutes
of Health Research (FRN:285489 and FRN:162545 to
R.N.C., FRN:130446 to G.J.G.A.) and the Ministry of
Public Safety and Emergency Preparedness through the
Policy Development Contribution Program.

Acknowledgements
Recruitment support graciously provided by many, including
but not limited to: Badge of Life Canada; Canadian Institute
for Military and Veteran Health Research; Canadian Institute
for Public Safety Research and Treatment Public Safety
Steering Committee; Canadian Ministry of Public Safety
and Emergency Preparedness; Tema Conter Trust; Wounded
Warriors Canada.

Competing interests
None declared.

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Longitudinal studies of PSP from diverse occupational
groups are needed to better understand our findings and
determine the temporal relationship between reduced social support and increased odds of screening positive for
PTSD and MDD. If increased social support mitigates
the onset of clinically significant symptoms of mental
disorders, efforts to bolster perceived social support
may also help bolster resilience among PSP. Bolstered
social support may involve development and evaluation
of formal peer-support programmes, therapeutic interventions to increase perceptions of actual support, or
facilitating linkages with family and friends. In the interim, further research using randomly selected stratified
samples with diagnostic clinical interviews would help
expand our understanding of the relationships between
perceived social support and PSP mental health.

K. D. VIG ET AL.: MENTAL HEALTH AND SOCIAL SUPPORT AMONG PSP 433

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