When we talk about suicide in the first responder community, it’s crucial to understand that suicide isn’t about wanting to die, it’s about wanting unbearable pain to end. Understanding this distinction matters deeply in how we help people who are struggling.
Research has identified three key factors that, when combined, create the highest risk for suicide. By understanding these components, first responders and their support systems can better recognize warning signs and intervene before it’s too late.
The Three-Factor Model of Suicide Risk
The Interpersonal Theory of Suicide identifies three critical components that contribute to suicide risk. While any one factor alone is concerning, it’s the combination of all three that creates the highest danger.
1. Thwarted Belongingness: “I Am Alone”
Thwarted belongingness is the feeling of being disconnected, of not being truly part of your family, friends, or crew. It fosters the thought, “No one will care if I die.”
In the first responder world, this might look like:
- A new firefighter who can’t quite fit in with their shift
- A medic who works so much overtime they’ve lost touch with friends
- Someone who feels like they can’t relate to their family anymore because of what they’ve seen
Research shows that of all the factors that can lead to suicide, social isolation is one of the strongest predictors. This affects everyone from young recruits to seasoned veterans.
Interestingly, suicide rates actually decrease during two types of events: times of celebration when people come together to share joy, and times of hardship when communities unite in facing challenges. This tells us something powerful about the protective nature of belonging.
Warning signs include:
- Increasing isolation from crew members
- Working excessive overtime to avoid going home
- Loss of interest in department social activities
- Expressing feelings of not fitting in anywhere
2. Perceived Burdensomeness: “I Am a Burden”
“They’ll be better off without me.” These six words should stop us in our tracks because they signal one of the most dangerous misconceptions someone can have.
Perceived burdensomeness is when someone believes their existence burdens their family, friends, or society. Pay attention to that word “perceived”, this is a perception, not reality.
In first responder culture, this might manifest as thoughts like:
- “My partner deserves someone more reliable”
- “My family shouldn’t have to deal with my moods”
- “The department would be better off without me”
- “My mistakes cost too much”
Research studying suicide notes found that expressions of feeling like a burden appeared more frequently in notes from those who died compared to those who survived attempts, and in notes from those who chose more violent means.
Warning signs include:
- Expressing guilt about missed family events due to work
- Believing others would be happier without them
- Excessive apologizing for normal behavior
- Feeling responsible for things beyond their control
3. Acquired Capability: Increased Tolerance for Pain and Death
Having thoughts about suicide and being capable of suicide are two very different things. Our bodies and minds naturally fight against self-harm, but this protective barrier can wear down over time.
This is particularly relevant for first responders because regular exposure to death and trauma can lead to:
- Desensitization to things that would shock others
- Higher tolerance for physical and emotional pain
- Pride in pushing through discomfort
- Decreased fear responses
Research shows capability for suicide can build through:
- Previous suicide attempts
- Exposure to others’ pain and death
- History of physical injuries or medical procedures
- Repeated exposure to intense or frightening situations
- Witnessing others’ trauma
Warning signs include:
- Talking about being “numb” to everything
- Increasing risk-taking behavior
- Expressing unusual comfort with death
- Demonstrating disconnection from normal fear responses
Why First Responders Are Particularly Vulnerable
First responders face unique risks because their profession naturally exposes them to all three components:
- Belongingness challenges: Shift work, rotating schedules, and the nature of emergency work can strain relationships with family and friends who “don’t understand.”
- Burden perceptions: The weight of responsibility, dealing with preventable tragedies, and feeling like mistakes have life-or-death consequences can fuel feelings of being a burden.
- Acquired capability: Regular exposure to death, trauma, and violence as part of the job can gradually wear down natural protective barriers.
Additionally, research suggests that up to one-third of all first responders may develop PTSD, and 37% of fire and EMS professionals have contemplated suicide, nearly ten times the rate of civilian American adults.
Intervention Strategies
Understanding these three factors gives us three places to intervene:
Combating Isolation (Thwarted Belongingness)
- Check on the quiet ones regularly
- Include everyone in station activities
- Make sure no one eats alone
- Reach out to those working excessive overtime
- Maintain connections outside the job
Challenging Burden Perceptions (Perceived Burdensomeness)
- Take expressions of feeling like a burden seriously
- Provide specific examples of their value and contributions
- Challenge negative self-perceptions with evidence
- Help them see their positive impact on others
Recognizing Dangerous Capability (Acquired Capability)
- Monitor for increasing risk-taking behaviors
- Watch for emotional numbness or disconnection
- Encourage healthy fear responses
- Promote seeking help before habituation becomes dangerous
Creating a Safety Net
The most important thing to remember is that pain can end without life ending. There are always other solutions, even when it doesn’t feel that way. When someone has all three risk factors present, immediate intervention is critical.
If you notice these warning signs in yourself or a colleague:
- Take it seriously, don’t dismiss concerns
- Reach out for professional help immediately
- Stay with the person if they’re in immediate danger
- Remove means of self-harm if possible
- Connect them with crisis resources
Remember: No one is a burden. Everyone’s life has value. And that thought that “they’ll be better off without me”? It’s never, ever true.
Disclaimer: The information presented in this article is for educational purposes only and should not be used to diagnose or prescribe treatment for any illness or disorder. This content is not intended to replace professional medical or mental health advice. If you or someone you know is experiencing thoughts of suicide or mental health concerns, please seek immediate help from qualified healthcare professionals.
If you are having suicidal thoughts or are in crisis, please reach out immediately:
- Suicide and Crisis Lifeline 988
- Fire/EMS Helpline 1-888-731-FIRE (3473)
- Copline 1-800-267-5463
- Veteran’s Crisis Line 1-800-273-8255 & press 1 or Text 838255
- Frontline Helpline 1-866-676-7500
- Emergency Responder Crisis Text Line: Text BADGE to 741741
- Safe Call Now: 1-206-459-3020