Public safety research from the Lilly lab

Papers on PTSD, depression, and overall mental health:

Lilly, M. M., Calhoun, B., Painter, I., et al. (2019). Destress 9-1-1: Efficacy of an online mindfulness-based intervention in reducing stress among 9-1-1 telecommunicators.  

ABSTRACT:  Objectives: Emergency medical dispatchers (EMDs) experience significant stress in the workplace. Yet, interventions aimed at reducing work-related stress are difficult to implement due to the logistic challenges associated with the relatively unique EMD work environment. This investigation tested the efficacy of a seven-week online mindfulness-based intervention (MBI) tailored to the EMD workforce. Methods: Active duty EMDs from the United States and Canada (N = 323) were randomly assigned to an intervention or waitlist control condition. Participants completed surveys of stress and mindfulness at baseline, post-intervention, and three-month follow-up. Repeated measures mixed effects models were used to assess changes in stress and mindfulness. Results: Differences between the intervention group and control group in pre-post changes in stress using the C-SOSI were statistically significant, with a difference of -10.0 (95% CI: -14.9, -5.2, p < 0.001) for change from baseline to post intervention, and a difference of -6.5 (95% CI: -11.9, -1.1, p = 0.02) for change from baseline to three-month follow-up. Change in mindfulness scores did not differ between groups. However, increases in mindfulness scores were correlated with greater reductions in stress for all participants, regardless of group (r = -0.53. p < 0.001). Conclusions: Development of tailored online MBIs for employees working in challenging work environments offer a promising direction for prevention and intervention. This study found that a short, weekly online MBI for EMDs resulted in reductions in reports of stress. Implications for online MBIs in other emergency responding populations and directions for future research are discussed.

Turner, K. D., Lilly, M. M., Gamez, A. M., & Kressler, K. (2019). Impact of work-related factors on stress and health among 911 calltakers and dispatchers in California.  

ABSTRACT: Empirical literature examining the health and wellness of emergency responders has continued to grow over the past decade. Yet, there is a relative absence of literature on 9-1-1 telecommunicators, who are often the “first, first responder” in an emergency. Examination of work-related factors that enhance risk for stress and adverse outcomes may improve current prevention and intervention efforts in this population. Civilian 9-1-1 call takers and dispatchers from the state of California (N = 833) participated in an online study to examine the impact of work-related factors (i.e., work-life balance, burnout, work conditions) on health-related outcomes (i.e., satisfaction with life, depression/anxiety, physical health). Further, the extent to which work-related factors had an indirect effect on health outcomes through perceived stress was tested using path analysis. Results indicated that burnout and work-life balance had significant direct effects on perceived stress and health-related outcomes. Further, perceived stress was a mechanism by which burnout and work-life balance had an impact on health-related outcomes. Work conditions (i.e., mandatory overtime, weekend shifts) exhibited a direct effect only on satisfaction with life. Implications for study findings on the 9-1-1 industry are discussed. 

Lilly & Allen (2015). Psychological inflexibility and psychopathology in 9-1-1 telecommunicators.  

ABSTRACT: Mental health in 9-1-1 telecommunicators has been understudied in comparison to other emergency responders. This study enrolled a sample of telecommunicators from across the United States (N = 808). The prevalence was 17.6-24.6% for current probable Posttraumatic Stress Disorder (PTSD) and 23.9% for probable major depression, as measured by self-report. Structural equation modeling revealed a significant direct effect of psychological inflexibility on psychopathology (path coefficient = .32) when considered among duty-related distress and dissociation, neuroticism, anger, and emotion dysregulation. The results provide further evidence of the adverse psychological effects of duty-related trauma exposure, including exposure that is vicarious in nature. The results indicate a need for prevention and intervention in this population, with psychological inflexibility as a potential target in these efforts.

Allen, Mercer, & Lilly (2015): Duty-related posttraumatic stress symptoms in 9-1-1 telecommunicators: The roles of childhood trauma exposure and emotion-focused coping. 

ABSTRACT: A history of childhood trauma exposure has been linked to the development of posttraumatic stress symptoms in adulthood following new exposure. Unhealthy coping behaviors that may develop or be utilized in response to early trauma could lend themselves to psychological issues in adulthood. Emotion-focused and problem-focused coping strategies in relation to stressful duty-related situations are examined as indirect pathways through which childhood trauma exposure may be associated with duty-related posttraumatic stress symptoms in 9-1-1 telecommunicators (N = 808). Multiple mediation models revealed that three of the four emotion-focused coping strategies, but not the problem-focused strategies, functioned as significant mediators in the association between childhood exposure and duty-related posttraumatic stress symptoms. Pairwise comparisons showed that self-controlling and escape avoidance strategies were the strongest pathways of the indirect childhood trauma exposure-posttraumatic stress symptoms association. Implications of results regarding coping in response to new traumatic events in adulthood and potential research and intervention directions are discussed. 

Lilly & Pierce (2013): PTSD and depressive symptoms in 911 telecommunicators: The role of peritraumatic distress and world assumptions in predicting risk. 

ABSTRACT: Continued exposure to trauma increases risk for both depression and PTSD. This may be particularly true for individuals with work-related exposure to trauma such as 911 telecommunicators, a group with significant exposure to work-related trauma that has received limited empirical attention. The present study examines current symptoms of PTSD and depression in telecommunicators and the extent to which peritraumatic distress and world assumptions interact to predict psychopathology. A sample of 171 911 telecommunicators from across the country completed a survey that assessed current symptoms of depression and PTSD, as well as exposure to different types of work-related events, peritraumatic distress, and world assumptions. Symptoms of PTSD and depression were significantly related to peritraumatic distress, self-worth, and benevolence of the world. Analyses revealed that the relationship between peritraumatic distress and both current depression and PTSD was significantly stronger for individuals who reported more negative assumptions about the benevolence of the world and self-worth. Further, positive assumptions regarding the controllability of the world were associated with PTSD, particularly in individuals who reported high peritraumatic distress. The results suggest that 911 telecommunicators experience significant work-related exposure to trauma, yet retain somewhat positive world assumptions. The important role of world assumptions in explaining the link between peritraumatic distress and posttrauma psychopathology in the form of current PTSD and depression is discussed.

Pierce & Lilly (2012): Duty‐related trauma exposure in 911 telecommunicators: Considering the risk for posttraumatic stress. 

ABSTRACT: Peritraumatic distress may increase the risk for posttraumatic stress disorder (PTSD) in police officers. Much less is known about emotional reactions and PTSD symptomatology in 911 telecommunicators. The current study assessed duty‐related exposure to potentially traumatic calls, peritraumatic distress, and PTSD symptomatology in a cross‐sectional, convenience sample of 171 telecommunicators. Results showed that telecommunicators reported high levels of peritraumatic distress and a moderate, positive relationship was found between peritraumatic distress and PTSD symptom severity (r = .34). The results suggest that 911 telecommunicators are exposed to duty‐related trauma that may lead to the development of PTSD, and that direct, physical exposure to trauma may not be necessary to increase risk for PTSD in this population.

Paper on physical health and obesity:

Lilly, London, & Mercer (2016). Predictors of obesity and physical health complaints among 9-1-1 telecommunicators. 

ABSTRACT: Objective: This study aims to: (1) examine rates of obesity and physical health complaints among 9-1-1 telecommunicators, and (2) document the role of emotion dysregulation, psychological inflexibility, duty-related distress and dissociation, and psychopathology in predicting obesity and physical health complaints in this population. Methods: The sample consisted of 9-1-1 telecommunicators from across the country (N = 758). Participants completed an online survey assessing their mental and physical health functioning. Results: A total of 82.5% of the sample reported a body mass index (BMI) that fell within the overweight or obese category, and an average of 17 physical health complaints within the last month. Peritraumatic reactions (distress and dissociation), emotion dysregulation, and psychological inflexibility had effects on physical health largely through psychopathology (alcohol abuse, PTSD, depression).

Paper on posttraumatic growth and coping:

London, Mercer, & Lilly (2017). Considering the impact of early trauma on coping and pathology to predict posttraumatic growth among 9-1-1 telecommunicators. ABSTRACT: Recent research has demonstrated that first responders may report posttraumatic growth (PTG), positive psychological changes that arise in the aftermath of a trauma. Less is known regarding the perception of PTG among 9-1-1 telecommunicators, a group of first responders exposed to a high degree of lifetime trauma, including duty-related trauma as well as early and non-duty-related trauma. Moreover, the impact of childhood trauma on the processes involved in the perception of growth is less clear. While some distress is needed to facilitate processes that lead to the perception of PTG, it has been suggested that positive associations between PTG and pathology reflect avoidant coping or represent an illusory component of PTG. Structural equation models were used to examine early trauma exposure, coping, and pathology in predicting PTG among 9-1-1 telecommunicators (N = 788). In separate models using active and avoidant forms of coping, childhood trauma exposure had an indirect effect on PTG through coping. In a model considering both forms of coping, childhood trauma had an indirect effect on PTG through psychopathology, but not through coping. The results show that early trauma exposure leads to the perception of growth through pathways indicative of both adaptive and maladaptive coping processes.

Recent papers with Dr. Hendrika Meischke’s team at University of Washington:


Kerr, D., Meischke, H., Lilly, M. M., Ornelas, I. J., & Calhoun, R. (2019). Engagement with an online mindfulness intervention for 9-1-1 telecommunicators: A mixed methods study. Advanced online publication, Journal of Medical Internet Research.

Meischke, H., Lilly, M. M., Beaton, R., et al. (2018). Protocol: A multi-level intervention program to reduce stress in 9-1-1 telecommunicators. BMC Public Health, 18(570), Advanced online publication. doi: 10.1186/s12889-018-5471-0

Baseman, J., Revere, D., Painter, I., Stangenes, S., Lilly, M., Beaton, R., et al. (2018). Impact of new technologies on stress, attrition and well-being in emergency call centers: The Next Generation 9-1-1 Study protocol. Forthcoming in BMC Public Health, 18(597), Advance online publication. doi: 10.1186/s12889-018-5510-x

Meischke, H., Painter, I., Lilly, M.M., Beaton, R., Revere, D., Calhoun, B., et al. (2015). An exploration of sources, symptoms and buffers of occupational stress in 9-1-1 emergency call centers. Annals of Emergency Dispatch & Response, 3, 28-35.