Posttraumatic stress disorder (PTSD) and co-occurring psychological issues among Turkish metropolitan firefighters Running head: Psychological issues in firefighters with PTSD

Objectives. This study aimed to investigate the co-occurrence of childhood trauma, dissociation, suicidality, and depression with posttraumatic-stress disorder (PTSD) among professional firefighters working in metropolitan fire departments in Turkey. Methods. A cross-sectional study was conducted among 760 male firefighters aged 24-55 years with 2-35 years of work experience. Participants completed self-report questionnaires, including the PTSD Checklist for DSM-5 (PCL-5), Childhood Trauma Questionnaire-33 (CTQ-33), Dissociative Experiences Scale (DES), Suicidal Behaviors Questionnaire-4 (SBQ-4), and Patient Health Questionnaire-9 (PHQ-9). Results. Using a PCL-5 score ≥33 as the cutoff for probable PTSD, 28.5% of the participants met the criteria. Firefighters with PTSD showed significantly higher rates of childhood trauma (51.2% vs. 28.4%, p < 0.001), dissociation (52% vs. 10% above the clinical cut-off, p < 0.001), suicidal ideation (54.8% vs. 37.8%, p < 0.001), and depression (100% vs. 34.4% with at least mild symptoms, p < 0.001) than those without PTSD. PTSD severity positively correlated with childhood trauma (r = 0.42, p < 0.001), dissociation (r = 0.58, p < 0.001), suicidal ideation (r = 0.39, p < 0.001), and depression (r = 0.61, p < 0.001). Childhood trauma emerged as a significant predictor of PTSD status (odds ratio [OR] = 2.63, 95% CI: 1.89-3.67, p < 0.001). Conclusions. The findings highlight the significant co-occurrence of PTSD with childhood trauma, dissociation, suicidality, and depression among metropolitan firefighters. These results underscore the importance of comprehensive mental health screening and targeted interventions for firefighters, particularly in addressing the interplay between PTSD and other psychological issues.