Childhood care and abuse in firefighters assessed for mental ill-health following the Fort McMurray fire of May 2016.

Background: We aimed to determine the relationship between childhood abuse and mental ill-health in firefighters deployed to a devastating fire that engulfed Fort McMurray Methods: A stratified sample of 282 firefighters was selected from a cohort of 1234 for assessment by Structured Clinical Interview (SCID) for DSM-5 diagnostic criteria and the Childhood Experience of Care and Abuse questionnaire (CECA-Q). Diagnoses were grouped as post-traumatic stress disorder (PTSD), anxiety disorders, depressive disorders and substance use disorders. Scales extracted from the CECA-Q included parental loss, antipathy, neglect, physical punishment, sexual abuse and support from a same-age confidant. The relation to diagnostic group was examined by multivariable logistic regression Results: 192 SCID interviews and 188 CECA-Qs were completed: 124 met DSM-5 criteria for diagnoses including anxiety disorder (56), depressive disorder (54), PTSD (77) and substance use disorder (43). Childhood sexual abuse was reported by 24 firefighters all of whom met DSM-5 diagnostic criteria. Sexual abuse and a childhood confidant differentiated diagnoses in an initial multivariable model of those with psychiatric disorders. Compared to those without a psychiatric diagnosis, father's antipathy was related to anxiety and substance use, physical punishment to PTSD and substance use. A childhood same-age confidant protected against anxiety, depression and PTSD. Fire exposures related only to PTSD. Limitations: The comparison group without mental disorders was small. Childhood abuse information was collected retrospectively and may be biased by current state. Conclusions: Firefighters’ mental health is a function of both work-role traumas and childhood events. Occupational health provision must address this complexity.