Suicide mortality in United States urban career firefighters and emergency medical service providers

AI Summary

FDNY firefighters exhibited lower suicide mortality than US adults (SMR 0.38, 95% CI 0.27 to 0.51) and NYC adults (SMR 0.57, 95% CI 0.41 to 0.77).
FDNY EMS personnel and non-FDNY urban responders had suicide rates not significantly different from demographically matched general population rates.
Posttraumatic stress disorder and depression symptoms strongly increased suicide risk; hazard ratios approximately 5.44 and 5.41 respectively.

Prev Med. 2026 May 20:108608. doi: 10.1016/j.ypmed.2026.108608. Online ahead of print.

ABSTRACT

OBJECTIVE: Evidence regarding whether first responders have elevated suicide rates is mixed. We investigated if career firefighters and emergency medical service providers (EMS) had increased suicide mortality compared with general populations.

METHODS: We included two occupational cohorts of responders employed by United States urban fire departments: 32,925 FDNY firefighters and EMS employed between 9/11/2001-12/31/2023, and 11,917 non-FDNY responders employed between 9/11/2001-12/31/2009. Follow-up started at the later of hire date or 9/11/2001 and ended at earliest of death date or 12/31/2023. We obtained death data from the National Death Index. Demographic-specific US and NYC suicide rates were used to calculate standardized mortality ratios (SMRs) and 95% CIs. Multivariable extended Cox models with time-dependent variables assessed associations between select characteristics and suicide in FDNY responders.

RESULTS: FDNY firefighters had lower suicide rates than US (SMR = 0.38, 95% CI = 0.27, 0.51) and NYC adults (SMR = 0.57, 95% CI = 0.41, 0.77). FDNY EMS suicide rates and non-FDNY responders’ rates were not significantly different from general population rates. Suicide risk factors included posttraumatic stress disorder (hazard ratio [HR] = 5.44, 95% CI = 2.60, 11.40) and depression symptoms (HR = 5.41, 95% CI = 2.72, 10.77).

CONCLUSIONS: Among nearly 45,000 career first responders, suicide rates were not elevated compared with general populations.

PMID:42167545 | DOI:10.1016/j.ypmed.2026.108608

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