Objective

People with depression experience barriers to seeking professional help. Different diagnostic terminology can influence people's treatment/management preferences. The aim of this study was to investigate how alternative depression diagnostic labels and recommendations impact help-seeking intentions and psychosocial outcomes.

Methods

Participants (18–70 years) were recruited using an online panel (Australia) to complete a randomized controlled trial. They read a hypothetical scenario where they discussed experiencing depressive symptoms with their GP and were randomized to receive one of four diagnoses ("depression," "burnout," "functional impairment syndrome" [fictitious label], no label [control]), and one of two follow-up recommendations ("clinical psychologist," "mind coach"). Primary outcome: help-seeking intention (5-point scale, higher = greater intention)" secondary outcomes: intention to speak to boss, self-stigma, worry, perceived severity, illness perceptions, and personal stigma.

Results

A total of 676 participants completed the survey. There was no main effect of diagnostic label on help-seeking intention or stigma outcomes. Intention to speak to a boss was higher with the depression compared to burnout label (MD=0.40, 95% CI: 0.14–0.66) and perceived severity was higher with the depression label compared to control (MD=0.48, 95% CI: 0.22–0.74) and all other labels. Those who received the "clinical psychologist" recommendation reported higher help-seeking intention (MD=0.43, 95% CI: 0.25–0.60) and treatment control (MD=0.69, 95% CI: 0.29–1.10) compared to the "mind coach" recommendation.

Conclusion

Findings highlight the success of efforts to promote help-seeking from clinical psychologists for depression. If burnout is considered a separate diagnostic entity to depression, greater awareness around what such a diagnosis means may be needed. Future research should examine how different terminologies surrounding other mental health conditions impact help-seeking and stigma.

Emergency service workers are routinely exposed to potentially traumatic events involving sudden violent deaths, including suicide, in fulfilling their occupational roles. Yet, firefighters are a unique population of emergency service workers whose primary purpose is to protect life. How, then, do they experience the intentional act to end life when a person has died by suicide? The profound impact of exposure to suicide is well documented in the empirical literature, particularly in light of close relationships. However, exploration of the breadth and complexity of exposure in an occupational context is limited, particularly in those without an attachment relationship to the deceased, such as the experience of firefighters.

This doctoral study explores the experiences of firefighters exposed to suicide situated within the unique cultural and organisational context of firefighting, examining how firefighters live with and through the experience of exposure to suicide in their personal and professional lives. The study is grounded in narrative inquiry methodology, using a qualitative reflexive paradigm with an insider researcher perspective. In-depth semi-structured interviews elicited the stories of 20 firefighters based in Australia who had been exposed to suicide occupationally and personally. A reflexive thematic analysis was used to draw out meanings across and within the shared stories of firefighters.

The results of the analysis generated four themes collectively describing the lived experiences of firefighters exposed to suicide. The first two themes tell of the experience of exposure to suicide and how that exposure poses a threat to firefighters’ understanding of the world. This details the conflicts and discrepancies in the truth about the expectations and realities of the world firefighters exist within. The results show how exposure to suicide occurs in a liminal space triggered by not knowing why a person has died by suicide and the uncertainty this creates about the world around them, given the cultural nuances of control associated with firefighting as a profession. The final two themes reflect firefighters’ internal experience of exposure to suicide brought about by disruptions to temporality. ‘Fears for the future’ identifies how suicide is experienced as a threat to firefighters’ sense of safety, whilst ‘Reflections of the past’ captures how suicide is experienced as a retrospective reckoning, which is interpreted as a failure to protect life and an ultimate threat to a firefighter’s identity.

The study concludes that firefighters’ experiences of exposure to suicide can be understood as a violation of coherence that disrupts their familiar ways of understanding and being in the world. The results of the study situate a discussion about the philosophical and psychological theories that may better inform firefighter suicide exposure preparedness. Strategies are highlighted to better support those working within the field and enhance ways to offer postvention support to these first responders.

Audio files and interview transcripts with firefighters recorded between 2019-202 that form the raw dataset from which the analysis was conducted. Files which demonstrate the coding process are also included in the form of files drawn from NVIVO, excel spreadsheets and JPEG images of concept maps.