Being a first responder means putting yourself on the frontlines of your community and responding to often serious, tragic, and life-threatening events such as wildfires, mass shootings, and medical emergencies.
Although this is often part of a normal day on the job, over time and without support, it can take a psychological toll, leading to depression, anxiety, and post-traumatic stress disorder (PTSD). Treatment requires community, solution-based approaches, suicide prevention measures, and trauma-informed care tailored for the unique needs of frontline responders.
Why First Responders Face Higher Rates of Depression
According to SAMHSA, nearly 30% of first responders, including police officers, firefighters, emergency medical personnel (ambulance drivers, paramedics, emergency medical technicians), develop a behavioral health disorder such as depression, anxiety, post-traumatic stress disorder (PTSD), and substance abuse [1].
Paramedics report the highest rates of depression of about 37%, while police report 20%, and firefighters about 11%. Some of the reasons first responders face higher rates of depression include [1]:
- Daily, chronic stress and being put under high-pressure, life-threatening situations. First line responders see coworkers killed at higher rates than the general population, and are more exposed to traumatic situations such as death, murder, rape, and suicide.
- Disrupted sleep schedules. Many first responders rotate 24-hour shifts or have interrupted rest from emergency calls. They may sleep in community dorms and rarely get a good night’s rest. This affects circadian rhythms and serotonin production, increasing the risk of depression.
- Lack of a support system. One study found that among EMS providers, a lower social support network and worse sleep at baseline predicted increased depression and anxiety symptoms at a 3-month follow-up [2]. Many first responders struggle to connect with loved ones due to the intense nature of their job, which can make it challenging to speak about. Group therapy for first responders can be an effective space to feel heard, validated, and find a community of shared experiences.
- Guilt and shame eat away at many first responders due to moral injury. This is experienced when actions, inactions, or outcomes challenge the first responders’ deeply held values or beliefs. Examples include failing to save a life, witnessing death or destruction, or feeling powerless or unable to prevent harm [1].
- Other factors, such as genetics, family history, childhood trauma, or trauma unrelated to being a first responder, are still contributors.
Common Symptoms of Depression in First Responders
Depression in first responders can be sneaky, with many continuing to function normally and often struggling with high-functioning depression. They probably are not spending hours lying in bed or visibly showing they are sad. Symptoms often manifest physically, behaviorally, and emotionally, including:
- Extreme fatigue, even after a full night of rest
- Loss of enthusiasm, excitement, or pleasure
- Feelings of guilt and hopelessness
- Loss of appetite, or binge eating
- Irritability, anger, aggression
- Trouble concentrating, lapses in memory
- Frequent headaches, stomachaches, and muscle aches without a medical cause
Barriers to Seeking Help
The motivation to seek help among first responders is lower than in other professions, as there is not yet a culture of seeking help within this community, although that is changing. Many first responders, especially policemen or firemen, often feel shame and stigma around seeking help, viewing it as weak or a lack of strength. Other barriers include:
- Stigma: First responder communities, especially like the police force, have a culture of “toughness” that doesn’t address the trauma that many first responders see on a daily basis.
- Impact on Career: Some believe they may be skipped over for promotions if they speak out or are viewed differently by their force or fellow colleagues.
- Scheduling Difficulties: First responders often work irregular hours, long shifts, and inconsistent schedules. When they aren’t working, many are trying to catch up on sleep or spend as little time as they can with family. This highlights the need for more flexible treatment options such as outpatient/evening sessions, virtual therapy, and home-based support.
Advancing Public Safety: Mental Health Initiatives and Treatment Options for First Responders
The University of Colorado Center for Combat Medicine and Battlefield Research encourages solutions-focused research for first responders in order to build effective resources that support their mental health and public safety. Some examples of these initiatives include [3]:
Tailored Mental Health Treatment
“In our field, we often say, ‘if you know one EMS system, you know one EMS system.’ There’s a tendency to group together all of our first responders: EMS, police, and fire, but the reality is that it’s all different. Being a volunteer firefighter in a rural setting or a volunteer EMT is very different than being a full-time paid urban responder — which is very different from the first responders who battle wildfires— and so what we need in the research world is to collect the data and information while recognizing that one size is not going to fit all when it comes to finding solutions that work ” says Angela Wright, MD, associate professor of emergency medicine.
Some first responders may benefit from lower-level, outpatient Cognitive Behavioral Therapy to build coping skills to manage stress, while others may require a combination of trauma-informed therapy, such as Eye Movement Desensitization and Reprocessing (EMDR), and medication to manage intense symptoms of Post-Traumatic Stress Disorder (PTSD).
Suicide Prevention and Risk
Research has shown firefighters and EMS workers have increasingly high rates of suicidal ideation, often combined with sleep disorders and alcohol use. This reflects the need for increased suicide prevention efforts, including regular screening, reducing stigma, increasing access to crisis intervention, and encouraging the first responder community to use it.
The UC Health MEDIC program was launched to support these efforts, training thousands of emergency medical responders with up-to-date strategies to support their mental health and that of the community members they serve [4].
Effective Therapies for First-Line Responders
Most first-line responders can benefit from therapies that focus on challenging negative thoughts, beliefs, and processing exposure to trauma. Below are some of the most common:
- Trauma-Focused Cognitive Behavioral Therapy (TF-CBT)
- Dialectical Behavior Therapy (DBT)
- Accelerated Resolution Therapy (ART)
- Eye Movement Desensitization & Reprocessing (EMDR)
- Acceptance and Commitment Therapy (ACT)
- Ketamine Assisted Therapy (for treatment-resistant depression)
- TMS Therapy (for treatment-resistant depression)
- Peer Support Programs
Serving Those Who Serve: Mental Health Solutions Tailored for Utah First Responders
Harper Clinic provides holistic, integrative treatment to address the mental health of first responders. We blend cutting-edge, evidence-based neuroscience with holistic, whole-body approaches and tailored counseling for first responders to address the roots of depression, trauma, chronic stress, grief, and burnout.
Reach out to Harper Clinic by phone, text, or directly through our booking system to schedule your mental health consultation. Our providers can help you verify insurance benefits and set up a personalized support plan.
Sources
[1] SAMHSA. 2018. Disaster Technical Assistance Center Supplemental Research Bulletin First Responders: Behavioral Health Concerns, Emergency Response, and Trauma.
[2] Feldman, T. et al. 2021. Factors Predicting the Development of Psychopathology Among First Responders: A Prospective, Longitudinal Study. American Psychological Association.
[3] Mason, K. 2025. Elevating First Responder Mental Health Research and Its Effect on Communities. University of Colorado.
[4] Medical Education on the Delivery of Innovative Care (MEDIC) Program. UC Health.