Associations Between Sleep Disturbances, Mental Health Outcomes and Burnout in Firefighters, and the Mediating Role of Sleep During Overnight Work: A Cross-sectional Study

Overview

Journal J Sleep Res

Specialty Psychiatry

Date 2019 May 28

PMID 31131535

Citations 21

Authors

Alexander P Wolkow

Laura K Barger

Conor S OBrien

Jason P Sullivan

Salim Qadri

Steven W Lockley

Charles A Czeisler

Shantha M W Rajaratnam

Affiliations

Soon will be listed here.

Abstract

This study investigated whether sleep disorder risk and mental health outcomes in firefighters were associated with burnout, particularly emotional exhaustion, and examined the mediating role of sleep at work in these relationships. A secondary aim was to investigate associations between habitual sleep characteristics and burnout. North American firefighters (n = 6,307) completed the Maslach Burnout Inventory (emotional exhaustion, depersonalisation, personal accomplishment), and were screened for sleep disorders and self-reported current mental health conditions and sleep characteristics. Multiple logistic regression analyses examined associations between sleep, mental health outcomes and burnout. Firefighters screening positive for a sleep disorder, particularly insomnia, had increased risk of emotional exhaustion (adjusted odds ratio 3.78, 95% confidence interval 2.97-4.79). Firefighters self-reporting a current mental health condition were at greater risk of emotional exhaustion (adjusted odds ratio 3.45, 95% confidence interval 2.79-4.27). Sleep during overnight work mediated the impact of having a sleep disorder and mental health condition on high burnout. Sleepiness and sleep deficit (difference between required and actual sleep), even in firefighters without sleep disorder risk, were associated with depersonalisation (adjusted odds ratio 1.65, 95% confidence interval 1.34-2.03 and adjusted odds ratio 1.29, 95% confidence interval 1.06-1.57, respectively) and low personal accomplishment (adjusted odds ratio 1.25, 95% confidence interval 1.07-1.47 and adjusted odds ratio 1.17, 95% confidence interval 1.01-1.35, respectively). Sleep and mental health problems were associated with increased risk of burnout in firefighters, and sleep during overnight work mediated these relationships. The results suggest the need to examine the effectiveness of occupational interventions that improve the opportunity for sleep, together with screening for and treating sleep disorders, to reduce burnout risk.

Citing Articles

Occupational Burnout and Insomnia in Relation to Psychological Resilience Among Greek Nurses in the Post-Pandemic Era.

Sikaras C, Pachi A, Alikanioti S, Ilias I, Sideri E, Tselebis A Behav Sci (Basel). 2025; 15(2).

PMID: 40001757 PMC: 11851848. DOI: 10.3390/bs15020126.

Elucidating the relationship between burnout and sleep disturbances among firefighters: a network analysis.

Liu B, Liu L, Ren L, Ma Z, Zou M, Li Y BMC Public Health. 2025; 25(1):240.

PMID: 39833771 PMC: 11748853. DOI: 10.1186/s12889-025-21357-8.

Exploring Health Promotion Behaviors, Occupational Burnout, and Sleep Disturbances in Traditional Industry Workers.

Yu Y, Chang Y, Chang S Healthcare (Basel). 2025; 13(1.

PMID: 39791658 PMC: 11720068. DOI: 10.3390/healthcare13010051.

Examination of Stress Among Recruit and Incumbent Women Firefighters.

Hollerbach B, Jitnarin N, Koeppel M, Valenti M, Beitel S, Goodrich J Saf Health Work. 2024; 15(4):452-457.

PMID: 39697309 PMC: 11650798. DOI: 10.1016/j.shaw.2024.10.003.

Understanding the effect of occupational stress on sleep quality in firefighters: the modulating role of depression and burnout.

Khoshakhlagh A, Al Sulaie S, Cousins R, Yazdanirad S, Laal F Int Arch Occup Environ Health. 2024; 97(9):1007-1016.

PMID: 39436431 PMC: 11561029. DOI: 10.1007/s00420-024-02104-9.

References

Katsavouni F, Bebetsos E, Malliou P, Beneka A . The relationship between burnout, PTSD symptoms and injuries in firefighters. Occup Med (Lond). 2015; 66(1):32-7. DOI: 10.1093/occmed/kqv144. View

Ahola K, Honkonen T, Isometsa E, Kalimo R, Nykyri E, Aromaa A . The relationship between job-related burnout and depressive disorders--results from the Finnish Health 2000 Study. J Affect Disord. 2005; 88(1):55-62. DOI: 10.1016/j.jad.2005.06.004. View

Allen R, Walters A, Montplaisir J, Hening W, Myers A, Bell T . Restless legs syndrome prevalence and impact: REST general population study. Arch Intern Med. 2005; 165(11):1286-92. DOI: 10.1001/archinte.165.11.1286. View

Gluschkoff K, Elovainio M, Kinnunen U, Mullola S, Hintsanen M, Keltikangas-Jarvinen L . Work stress, poor recovery and burnout in teachers. Occup Med (Lond). 2016; 66(7):564-70. DOI: 10.1093/occmed/kqw086. View

Ogden C, Carroll M, Curtin L, McDowell M, Tabak C, Flegal K . Prevalence of overweight and obesity in the United States, 1999-2004. JAMA. 2006; 295(13):1549-55. DOI: 10.1001/jama.295.13.1549. View

Toker S, Biron M . Job burnout and depression: unraveling their temporal relationship and considering the role of physical activity. J Appl Psychol. 2012; 97(3):699-710. DOI: 10.1037/a0026914. View

Jay S, Smith B, Windler S, Dorrian J, Ferguson S . Does Suspected Sleep Disordered Breathing Impact on the Sleep and Performance of Firefighting Volunteers during a Simulated Fire Ground Campaign?. Int J Environ Res Public Health. 2016; 13(2):173. PMC: 4772193. DOI: 10.3390/ijerph13020173. View

Hom M, Stanley I, Rogers M, Tzoneva M, Bernert R, Joiner T . The Association between Sleep Disturbances and Depression among Firefighters: Emotion Dysregulation as an Explanatory Factor. J Clin Sleep Med. 2015; 12(2):235-45. PMC: 4751428. DOI: 10.5664/jcsm.5492. View

Brody D, Pratt L, Hughes J . Prevalence of Depression Among Adults Aged 20 and Over: United States, 2013-2016. NCHS Data Brief. 2018; (303):1-8. View

10.

Sullivan J, OBrien C, Barger L, Rajaratnam S, Czeisler C, Lockley S . Randomized, Prospective Study of the Impact of a Sleep Health Program on Firefighter Injury and Disability. Sleep. 2017; 40(1). PMC: 6084754. DOI: 10.1093/sleep/zsw001. View

11.

Gumenyuk V, Roth T, Korzyukov O, Jefferson C, Kick A, Spear L . Shift work sleep disorder is associated with an attenuated brain response of sensory memory and an increased brain response to novelty: an ERP study. Sleep. 2010; 33(5):703-13. PMC: 2864886. DOI: 10.1093/sleep/33.5.703. View

12.

Yoo H, Franke W . Sleep habits, mental health, and the metabolic syndrome in law enforcement officers. J Occup Environ Med. 2012; 55(1):99-103. DOI: 10.1097/JOM.0b013e31826e294c. View

13.

Barger L, Lockley S, Rajaratnam S, Landrigan C . Neurobehavioral, health, and safety consequences associated with shift work in safety-sensitive professions. Curr Neurol Neurosci Rep. 2009; 9(2):155-64. DOI: 10.1007/s11910-009-0024-7. View

14.

Poston W, Haddock C, Jahnke S, Jitnarin N, Tuley B, Kales S . The prevalence of overweight, obesity, and substandard fitness in a population-based firefighter cohort. J Occup Environ Med. 2011; 53(3):266-73. PMC: 5826653. DOI: 10.1097/JOM.0b013e31820af362. View

15.

Soldatos C, Dikeos D, Paparrigopoulos T . The diagnostic validity of the Athens Insomnia Scale. J Psychosom Res. 2003; 55(3):263-7. DOI: 10.1016/s0022-3999(02)00604-9. View

16.

Netzer N, Stoohs R, Netzer C, Clark K, Strohl K . Using the Berlin Questionnaire to identify patients at risk for the sleep apnea syndrome. Ann Intern Med. 1999; 131(7):485-91. DOI: 10.7326/0003-4819-131-7-199910050-00002. View

17.

Fahrenkopf A, Sectish T, Barger L, Sharek P, Lewin D, Chiang V . Rates of medication errors among depressed and burnt out residents: prospective cohort study. BMJ. 2008; 336(7642):488-91. PMC: 2258399. DOI: 10.1136/bmj.39469.763218.BE. View

18.

Johns M . Sensitivity and specificity of the multiple sleep latency test (MSLT), the maintenance of wakefulness test and the epworth sleepiness scale: failure of the MSLT as a gold standard. J Sleep Res. 2000; 9(1):5-11. DOI: 10.1046/j.1365-2869.2000.00177.x. View

19.

Bianchi M, Cash S, Mietus J, Peng C, Thomas R . Obstructive sleep apnea alters sleep stage transition dynamics. PLoS One. 2010; 5(6):e11356. PMC: 2893208. DOI: 10.1371/journal.pone.0011356. View

20.

Motomura Y, Kitamura S, Nakazaki K, Oba K, Katsunuma R, Terasawa Y . Recovery from Unrecognized Sleep Loss Accumulated in Daily Life Improved Mood Regulation Prefrontal Suppression of Amygdala Activity. Front Neurol. 2017; 8:306. PMC: 5491935. DOI: 10.3389/fneur.2017.00306. View