Date of Conferral

7-16-2025

Degree

Doctor of Healthcare Administration (D.H.A.)

School

Health Services

Advisor

Sue Subocz

Abstract

Firefighting exposes individuals to significant psychological dangers, leading to mental health issues like anxiety, depression, and posttraumatic stress disorder. This study investigated the underuse of mental health services among firefighters, focusing on the relationship between health insurance status and service utilization while considering age, gender, race, and ethnicity. Data from the National Health Interview Survey within the Integrated Public Use Microdata Series were analyzed using a quantitative approach. The study employed logistic regression to examine the likelihood of mental health service utilization based on health insurance status, adjusting for demographic factors. The sample included 1,526 firefighters, predominantly male (78.9%) and non-Hispanic White (68.9%). Age distribution was varied, with the largest group being adults aged 26–45 (48.2%). Most firefighters had private insurance (79.2%), while 11.4% had public insurance, and 9.2% were uninsured. Only 5.3% of firefighters reported using mental health services in the past year. Bivariate analysis revealed significant associations between mental health service utilization and age, race/ethnicity (χ² = 10.782, p = .029), and health insurance status (χ² = 21.718, p < .001), but not gender. Logistic regression showed that public insurance was a significant predictor of service utilization, with firefighters having public insurance being more likely to use mental health services compared to those without insurance (OR = 8.551, p < .001). These findings highlight the importance of health insurance in accessing mental health care for firefighters and the need for targeted interventions to address barriers to service utilization.

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