Religious Belief in a Sample of Trauma-Exposed Firefighters: Mitigating Occupational Stress and Enhancing Post-Traumatic Growth

Abstract

A religious lifestyle can be a powerful factor in predicting and promoting healthy functioning following trauma exposure. Previous research has demonstrated that higher levels of religiosity significantly predict posttraumatic growth following exposure to trauma. Firefighters are a population associated with routine exposure to potentially traumatic events, as well as high levels of occupational stress. While the relationship between religiosity and posttraumatic growth is well documented, the interaction of religious belief, occupational stress, and posttraumatic growth is less clear. The objective of this secondary analysis was to determine if religious belief moderates the relationship between occupational stress and posttraumatic growth in a sample of firefighters. The sample for this analysis was comprised of 109 firefighters who were assessed at various timepoints before fire service and throughout their first three years of fire service. A religious lifestyle did moderate the relationship between occupational stress and overall posttraumatic growth. However, a religious lifestyle and occupational stress were not significantly related. A religious lifestyle did moderate the relationship between occupational stress and the sub-domains of spiritual enhancement and appreciation of life.

Background

Firefighters encounter unique occupational stressors, placing them at high risk for exposure to traumatic events. Occupational stress levels are highest for firefighters among other emergency medical service (EMS) professions (Nazari & Hashemian, 2014). Significant occupational stressors may include financial strain, limited attention to job safety from managers, explosions at response sites, exposure to smoke and other toxins at fires, and shortage of technicians to develop and assess fire prevention safeguards (see Rajabi et al., 2020 for complete list). Consequently, with greater occupational stressors, firefighters are at increased risk for a variety of behavioral health concerns, including PTSD, depression, suicidality, anxiety, and alcohol use (Stanley et al., 2018; Sawhney et. al., 2017; Meyer et al., 2012). Because of the high-risk nature of this occupation, it is important to investigate factors that buffer the effects of occupational stressors in fire service. One such factor – post-traumatic growth – refers to positive psychological change and adaptive functioning following traumatic stress (Calhoun & Tedeschi, 2001). In prior research, firefighters who have experienced trauma reported both increased PTSD symptomology and post-traumatic growth (Shin et al., 2023). In turn, post-traumatic growth was associated with greater use of self-care to cope (Armstrong et al., 2014) and with increased organizational belongingness, which was linked with lower mental health symptoms in firefighters (Meyer et al., 2012).

A second factor associated with post-trauma functioning is religiosity. Engaging in religious behaviors (e.g. prayer) predicted post-traumatic growth in a diverse sample of trauma survivors (Harris et al., 2010). In a sample of military veterans with interpersonal trauma histories, greater religiosity prior to completing trauma-informed therapy predicted higher levels of post-traumatic growth post-treatment (Russano et al., 2017). Religiosity can even be considered a protective factor against workplace stressors. In helping professions, individuals who participate in public expressions of religion, like attending religious services or performing community service, tend to experience less psychological strain and burnout (Weiß, & Süß, 2019; Kutcher et al., 2010). Furthermore, greater levels of religiosity are associated with one’s ability to effectively cope with stress and are negatively associated with one’s experienced job strain. (Khan & Achour, 2010).

While the body of research on the relationship between religiosity and posttraumatic growth is growing, the relationship between religiosity, occupational stress, and post-traumatic growth has not been studied. Likewise, these factors have not yet been examined in a sample of firefighters. Therefore, the objective of this secondary analysis of a longitudinal study of fire service recruits was to determine if religiosity is associated with perceived occupational stress and with posttraumatic growth in a sample of early career firefighters. First, we hypothesized that greater religiosity would prospectively predict perceived occupational stress and posttraumatic growth. Second, we hypothesized that religiosity would moderate the relationship between occupational stress and post-traumatic growth such that individuals with higher levels of occupational stress who espouse religious belief would have greater levels of post-traumatic growth. This is the first study to prospectively examine the relationship between these factors.

Methods

This study is a single time point secondary data analysis of an NIH-funded longitudinal study called “Project Recruit” in which 322 firefighter recruits from seven U.S. cities participated. Doctoral-level clinical psychologists interviewed recruits at four different time points: prior to fire academy graduation (baseline) and following each of the first three years of fire service. This analysis includes the 109 firefighter recruits who completed self-report measures of occupational stress, religious lifestyle, and post-traumatic growth at the third annual follow up (as these measures were only added near the end of the study). Thus, the analyzed sample in the current study was N = 109. A G*power analysis suggested that, to detect a medium effect with power set at 0.8, a sample size of n = 55 would be required. This study was approved by the Institutional Review Boards of Baylor Scott & White Research Institute, Texas A&M University, the VA Boston Healthcare System, and the Boston University School of Medicine.

Measures

Sources of Occupational Stress Scale

The Sources of Occupational Stress Scale (SOOS-14) is a 14-item self-report measure of firefighters’ perceived sources of occupational stress on a 5-point Likert scale, ranging from 1 (“Not at all bothered”) to 5 (“Extremely bothered”; Kimbrel et al., 2011). Items are divided into 14 content domains (see Kimbrel et al., 2011 for complete list). The SOOS-14 has good internal consistency (α = .82) and moderate test-retest reliability (r = 0.51, p < 0.001) (Kimbrel et al., 2011; Kimbrel et al., 2015).

Lifestyle Questionnaire

The Lifestyle Questionnaire (LQ-R) is an unpublished 14-item self-report measure developed by Gulliver, Zimering, and Project Recruit’s research team of the frequency of engaging in religious behaviors, healthy diet, exercise, and humor. The LQ was based on the Health-Promoting Lifestyle Profile-II (HPLP-11; Walker & Hill-Polrecky, 1996), an index of health-promoting behaviors, including physical activity, spiritual growth, health responsibility, interpersonal relations, nutrition, and stress management. Each item assesses frequency with a 4-point Likert scale, ranging from 0 (“Never”) to 3 (“Routinely”). A single item with 3 sub-items addresses religious and spiritual practices: “I put my trust in God / higher power.” Sub-items include, “I ask God / higher power for help,” “I practice meditation or prayer,” “I take comfort in my faith or religious beliefs.” For the present analysis, only the item “I put my trust in God / higher power” was utilized, while the sub-items were not. This decision was made to assess general religious belief instead of discrete religious practices.

Post-traumatic Growth Inventory

The Post-traumatic Growth Inventory (PTGI) is a 21-item self-report measure of positive psychological outcomes following trauma exposure (Tedeschi & Calhoun, 1996). Items include: “I have a greater appreciation for the value of my own life,” and “I know that I can handle difficulties.” The PTGI is scored on a 6-point Likert scale, ranging from 0 (“I did not experience this change as a result of my crisis”) to 5 (“I experienced this change to a very great degree as a result of my crisis”). The PTGI is composed of 5 subscales, including new possibilities, relating to others, personal strength, appreciation, and spiritual enhancement. The PTGI has good internal consistency (α = 0.90) and adequate test-retest reliability (r = .71) (Tedeschi & Calhoun, 1996). Composite variables were created for each of the PTGI subscales by summing each item of each individual subscale, yielding 5 composite scores ranging from 0 to 35.

Data Analytic Plan

A regression analysis was conducted to test our hypothesis that religious belief moderated the relationship between occupational stress in the fire service and post-traumatic growth. All analyses were conducted using PROCESS for SPSS v4.2, with the SOOS-14 total score was entered as the independent variable and the PTGI total score was entered as the dependent variable. The religious belief item of the LQ-R was entered as the moderator variable. For individual subscales of the PTGI, each subscale not entered as the dependent variable were entered as covariates. A simple slopes analysis was utilized to probe the interaction at the levels of mean religious belief, low religious belief (−1 standard deviation), and high religious belief (+1 standard deviation). Correlations between occupational stress, religious belief, and post-traumatic growth were examined to assess for collinearity.

Results

Descriptive Statistics

Participants were predominantly white (78.9%) and male (89.9%). At the third annual follow-up, participants had a mean score of 2.76 on the religiosity item of the LQ-R, 15.97 on the PTGI, and 1.55 on the SOOS (see Table 1 for means and standard deviations).

Table 1.

Sample Descriptive Statistics

Variable	n (%) or M (SD)
Lifestyle Questionnaire (Religiosity)	2.76 (1.39)
Sources of Occupational Stress	1.55 (.51)
Post-Traumatic Growth Inventory	15.97 (18.92)
Age (Years)	27.76 (4.16)
Male	98 (89.9)
Highest Level of Education Completed
Some High School	0
High School Diploma / GED	6 (5.5)
Vocational Training / Trade School	1 (.9)
Associate’s degree	8 (7.3)
Some College	34 (31.2)
College Degree	44 (40.4)
Some Graduate School	10 (9.2)
Graduate Degree	6 (5.5)
Ethnicity
Hispanic or Latino	13 (11.9)
Not Hispanic or Latino	96 (88.1)
Race
American Indian / Alaskan Native	1 (.9)
Asian	0
Native Hawaiian or Other Pacific Islander	0
Black or African American	11 (10.1)
White	86 (78.9)
More than One Race	5 (4.6)
Other	2 (1.8)
Unknown or Not Reported	4 (3.7)
Marital Status
Never Married	62 (56.9)
Separated	4 (3.7)
Divorced	4 (3.7)
Married	39 (35.8)
Widowed	0
Veteran Status
Veteran	14 (12.8)
Not a Veteran	95 (87.2)

Main Results

Pearson’s correlations were utilized to assess the relationship between study variables. Occupational stress was significantly associated with overall post-traumatic growth (r = .44, p < .01), as well as all subscales of post-traumatic growth: relating to others (r = .44, p < .01), new possibilities (r = .44, p < .01), personal strength (r = .41, p < .01), spiritual enhancement (r = .41, p < .01), and appreciation of life (r = .27, p = .005). Neither occupational stress (r = 0.04, p = .67) nor post-traumatic growth (r = −.07, p = .34) were associated with religious belief. However, religious belief was associated with spiritual enhancement (r = −.17, p = .03). No correlations were greater than r = .7, so multicollinearity between predictors was not detected (Berry, 1985). See Table 2 for correlations.

Table 2.

Correlations Among Study Variables

Variable	Occupational Stress	Religious Belief
Post-Traumatic Growth	0.44**	0.07
Relating to Others	0.44	0.09
New Possibilities	0.44**	0.06
Personal Strength	0.41**	0.03
Spiritual Enhancement	0.41**	0.17*
Appreciation of Life	0.27**	0.001

Note:

^*p < .05,

^**p < .00

Taken together, religious belief and occupational stress predicted 24% of the variance overall in post-traumatic growth (F(3, 105) = 11.24, R² = .24, p < .001). There were not significant main effects of occupational stress (B = 3.16, p = .63) or religious belief (B = −5.37, p = .11), such that neither occupational stress nor religious belief were predictive of post-traumatic growth. However, religious belief did moderate the relationship between occupational stress and overall posttraumatic growth (B = 4.60, R² change = .04, p = .02; see Figure 1). Thus, individuals who reported higher levels of religious belief had greater post-traumatic growth in response to occupational stress.

Figure 1.

Impact of Occupational Stress on Post-Traumatic Growth as a Function of Religious Belief

A series of regression analyses was also conducted to determine if religiosity moderated the relationships between occupational stress and any of the five posttraumatic growth inventory subscales. Religious belief moderated the relationship between occupational stress and appreciation of life (F(7, 101) = 32.03, R² = .69, p < .001; see Figure 2) such that individuals who reported greater occupational stress had lower appreciation of life when they espoused religious belief (B = −.56, R² Change= .02, p = .02). As measured by the PTGI, lower appreciation of life may include a lack of change in priorities of what is important in life, less appreciation for the value of one’s own life, and less appreciation for each day. Based on simple slopes analysis, there was a significant negative effect of occupational stress on appreciation of life for individuals with moderate (B = −.98, p = .02) and high (B = −1.67, p = .002) religious belief, whereas the effect was not significant for individuals with low religious belief (B = −.20, p = .70).

Figure 2.

Impact of Occupational Stress on Appreciation of Life as a Function of Religious Belief

Additionally, religious belief also moderated the between occupational stress and spiritual enhancement (F(7, 101) = 57.63, R² = .80, p < .001; see Figure 3) such that individuals with greater religious belief had higher levels of spiritual enhancement in response to high levels of occupational stress (B = .27, R² Change= .01, p = .04). Simple slopes analysis demonstrated that the effect of occupational stress on spiritual enhancement was only significant for those with high religious belief (B = .69, p = .02) compared to those with low (B = −.03, p = .9) or moderate (B = .35, p = .13) religious belief.

Figure 3.

Impact of Occupational Stress on Spiritual Enhancement as a Function of Religious Belief

Religious belief did not moderate the relationship between occupational stress and personal strength (B = −.07, p = .75), occupational stress and the ability to perceive new possibilities (B = .44, p = .14), or occupational stress and the ability to relate to others (B = .07, p = .97). Therefore, post-traumatic growth was not impacted by religious belief in response to occupational stress. Please see Tables 3 and 4 for regression coefficients.

Table 3.

Results of Linear Regression Examining Predictors Religiosity and Occupational Stress on Post-Traumatic Growth

		Post-Traumatic Growth
	B	SE	p	R2
				.24
Religiosity	−5.37	3.32	.11
Occupational Stress	3.16	6.48	.63
Religiosity * Occupational Stress	4.60	2.01	.02

Note: B = unstandardized regression coefficient; SE = standard error of estimate; Bold text indicates a significant relationship where p < .05.

Table 4.

Results of Linear Regression Examining Predictors Religiosity and Occupational Stress on Post-Traumatic Growth Subscales

		Spiritual Enhancement				Appreciation of Life
	B	SE	p	R2	B	SE	p	R2
				.80				.69
Religiosity	−.25	.22	.25		.66	.40	.10
Occupational Stress	−.42	.41	.31		.58	.76	.45
Religiosity * Occupational Stress	.28	.13	.04		−.56	.25	.02

Note: B = unstandardized regression coefficient; SE = standard error of estimate; Bold text indicates a significant relationship where p < .05.

Discussion

To our knowledge, this is the first study to examine how level of religious belief affects the relationship between occupational stress and post-traumatic growth in firefighters. Our analyses demonstrated that occupational stress is not significantly predictive of post-traumatic growth. However, religious belief did impact the relationship between occupational stress and overall post-traumatic growth. Furthermore, individuals who reported higher levels of religious belief reported less appreciation of life (i.e., decreased change in priorities of what is important in life, less appreciation for the value of one’s own life, and less appreciation for each day of life) as a result of higher occupational stress. Religious belief also buffered the effects of occupational stress on spiritual enhancement such that individuals with stronger religious belief reported greater spiritual enhancement as a result of higher occupational stress. These findings are consistent with previous research demonstrating that religiosity may be an important factor in furthering post-traumatic growth in populations exposed to high levels of stressors (Gerber et al., 2011; Seidmahmoodi et al., 2011; Zeligman et al., 2020; Mesa, 2008). The present study expands on current research by highlighting that certain aspects of post-traumatic growth may be more significantly influenced by religious belief than others.

It is important to note that religious belief was not individually predictive of an individual’s degree of overall post-traumatic growth. Furthermore, neither occupational stress nor post-traumatic growth were significantly correlated with religious belief. There is a body of literature suggesting that more active religious coping may be more predictive of post-traumatic growth than simply putting one’s trust in a higher power. In a sample of Iranian college students, increased religious practice (including attending religious services, spending time in prayer or meditation, and experiencing the presence of the divine) was associated with increased post-traumatic growth scores (Amiri et al., 2021). Likewise, in a sample of childhood cancer survivors, moderate levels of religious service attendance were most highly associated with post-traumatic growth (Tobin et al., 2018). These findings suggest that post-traumatic growth is more highly associated with active religious practices as opposed to more private religious beliefs, as assessed in this study. However, it is important to assess private religiosity, as individuals may seek spiritual solace outside of organized religious practice.

Putting one’s trust in a higher power did significantly moderate the relationship between occupational stress specific post-traumatic growth subscales, including spiritual enhancement and appreciation of life. These associations may indicate that individuals appraise stressors differently in light of their religious convictions. For example, in a sample of Judeo-Christian clergy, both positive (viewing God as a source of solace) and negative (viewing stressors as a divine test) religious coping were associated with increased post-traumatic growth (Proffitt et al., 2007). Therefore, these findings suggest that more work should be done to assess how one’s appraisal of his or her own personal strength, ability to relate to other people, and spiritual enhancement may be predicted by one’s degree of religious conviction.

There are certain limitations to this study that should be noted. Foremost is that not all the religion items from the PTGI were used. Including all PTGI religion items may have provided more information about the religious experiences of participants that could not be captured by a single item. Additionally, participants in this study were volunteers, which may lead to a selection bias being reflected in results. Another limitation is that individuals with preexisting psychopathology were excluded, limiting the generalizability of the findings. Finally, a small sample size resulted from measures being added as the study progressed, so not all participants were given the measures included in this analysis. Future research should look deeper at expressions of religiosity in trauma-exposed populations and should examine related coping strategies to better understand how to maximize positive outcomes.

Impact Statement.

This study suggests that religious belief can play a meaningful role in enhancing post-traumatic growth in high-stress occupations. Specifically, religious belief may buffer occupational stress by bolstering spiritual enhancement but may limit appreciation of life. These findings have important implications for understanding how to foster more adaptive responding to high-stress occupations as well as inform interventions targeted for doing so.