The impact of rescue work on mental health and private life tasks: How to protect health and effectiveness in private life tasks in a high risk job

This thesis aims to assess the impact of rescue work on the mental health and the functioning levels in the private lives of rescue workers. We aspire to inspire further research and the development of preventive diagnostic tools, which could further strengthen the mental health of rescue workers and improve the effective functioning in their private lives. It presents the theoretical essence of the concept 'life task' and a discussion of four practical studies.
Research questions
1) How can we conceptualize the private life functioning of rescue workers, and develop an adequate measure?
2) How does the accumulation of critical incidents and other work characteristics (workload, social support) relate to mental health in rescue workers?
3) How does the accumulation of critical incidents and other work characteristics (workload, social support) relate to private life functioning in rescue workers?
4) By what process do the accumulations of critical incidents and other work characteristics influence private life functioning in rescue workers; more specifically, what is the role of mental health in this process?
5) Can preventive training improve the private life functioning of rescue workers and if so, which rescue workers benefit from such an intervention?

Research method
Cross-sectional.

Most important conclusions
'Life tasks' are defined as the experienced effectiveness in developing one's life and their maintenance as 'pillars of mental health' (Chapter 2). The concept consists of the following elements: social life; maintaining of mental health; household and finance; giving meaning; positivity. The experienced effectiveness of the life tasks concerns the care and the responsibility to maintain these tasks. If they are being well sustained, they will provide a resource of good mental health and well-being. This requires discipline and pro-active behavior. This thesis describes the development of a Life Task Test, which was found to be a reliable and a valid instrument that consists of the following scales: social life, mental health, household and finance, giving meaning, positivity.The first study (Chapter 3) examines the impact of accumulated critical incidents and the workload of 67 rescue workers (police officers and medical emergency drivers). Although health problems do not appear to be affected, the accumulation of critical incidents does lead to an increase in the experienced workload. Social support from managers and colleagues does not appear to have any moderating effect.The second study (Chapter 4) describes the development of a reliable and valid instrument that measures the experienced effectiveness in life tasks. Subjects of this study are police officers, who are absent from work due to their mental health adversities. The following are noteworthy conclusions: the experienced workload is related to an experienced diminished effectiveness in mental health status and positivity levels; the experienced lack of support from the managers and colleagues is related to an experienced diminished effectiveness in mental health, giving meaning and positivity; Ruminating about work is related to a diminished effectiveness in mental health, giving meaning and positivity. Police officers, who report experiencing more health complaints, feel less effective in positivity and in maintaining their mental health. Personal negativity and somatisation is related to an experienced diminished effectiveness in all life tasks. An exception is negativism. It is unrelated to an experienced diminished effectiveness in the social life.The third study (Chapter 5) examines the mediating effect of mental health on the effectiveness in life tasks. Predictors are critical incidents and workload. This study was performed among 166 police officers, who are absent from work due to mental health problems. Results confirm the process of erosion. Mental health is undermined by an accumulation of critical incidents and it leads to a deterioration in the functioning levels in the life tasks.The fourth study (Chapter 6) inspects the effect of a preventive training on the mental condition in a highly demanding professional environment, by means of self-management tools. The research group consisted of 67 rescue workers (police officers and ambulance personnel), who participated in two sessions. No significant improvement could be established. A possible explanation could be that this group consisted of more experienced rescue workers, who may be less susceptible to such training. Additionally, it is possible that a preventive training leads to an increased awareness of healthy stress signals, which could result in lower scores in the experienced levels of improvement. Differential analyses show that the higher the score on critical incidents is, the lower the score will be on giving meaning and positivity. Age was a negative predictor for the life task household and finance and positivity.

Most important recommendations
Practical recommendations stress the importance of incorporating preventive tools in the daily routines in the professional and the private life of the rescue workers (Chapter 7). These may comprise of recovery time, sources of energy, appreciation, acquiring more control and influence in work (e.g. work schedules), improving work organization, giving meaning and maintaining positivity (professionally and personally). In practical terms this implies the monitoring of accumulation and arrangement of recovery time (to be initiated by management and/or the rescue worker); setting limits to time served in the front line (3 to 5 years at most for the heaviest duties); limiting irregular work shifts (no more night shifts over the age of 55); discussing with colleagues what one did correctly and what went well. It is recommended that maintaining self-care and self-management are incorporated in the professional training courses, at a time when the professional and private environment is secure and safe. One of the great pitfalls of this type of profession is the fact that actions and behaviors are dictated by dangerous circumstances and then they are transferred to the private life.In treating psychological problems, it is recommended to integrate the reinforcement of life tasks in the course of treatment. Improving the effectiveness in life tasks contributes to recovery. Additionally, while evaluating a regular list of complaints, one should take the 'underscore' response into consideration, due to the tendency of a strong self-representation among this population. The Life Task Test can transcend this issue and provide more insight into the actual functioning levels of the rescue worker.Prior to trauma treatment, it is recommended to determine the level of erosion and functioning in life tasks by means of a diagnostic interview and the Life Task Test, since intensive trauma treatment may lead to even more serious disturbance of an already fragile balance.