Profiles of suicidality risk: a cross-sectional study of insomnia, PTSD and psychological distress in firefighters

Purpose Firefighters face sleep disruption and repeated trauma exposure, contributing to insomnia, psychological distress and PTSD – often interrelated conditions. Around 70% of individuals with PTSD report co-occurring sleep issues. Alarmingly, Australian emergency service workers have higher rates of suicidal thoughts and plans than the general population. This study examined whether insomnia is associated with suicidality in firefighters, independent of PTSD symptoms and psychological distress. Design/methodology/approach A cross-sectional survey was completed by 578 Metropolitan Fire Service firefighters. Participants self-reported insomnia, PTSD symptom severity, psychological distress and suicidality. Logistic regression assessed whether insomnia was associated with suicidality after controlling for PTSD symptoms and psychological distress. Cluster analysis identified profiles of firefighters most at risk. Findings Nine percent of participants reported suicidality in the previous 12 months. Insomnia was initially associated with suicidality; each one-point increase on the insomnia index was linked to 1.42 times greater odds of suicidality. However, this association was no longer significant after accounting for PTSD symptoms and psychological distress. Firefighters with high levels of insomnia, PTSD symptoms and psychological distress had the greatest risk of suicidality. Practical implications Interventions targeting insomnia may be beneficial, but a more holistic mental health approach is likely to be more effective in reducing suicide risk. Originality/value Findings highlight that while insomnia is associated with suicidality in firefighters, this appears to be part of a broader pattern involving PTSD and psychological distress.