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When firefighters think that the epidemic prevention regulations are inconsistent with the actual epidemic prevention, it will increase their work pressure on COVID-19. In this study, firefighters from all over Taiwan were used as the respondents, and a total of 453 respondents were obtained. This study uses confirmatory factor analysis and structural equation modeling to test the established hypotheses. The findings confirm that formalism, fear of self and family infection are positively influencing COVID-19 stress. COVID-19 stress positively affects PTSD and insomnia. COVID-19 stress negatively affects problem-focused strategies. Problem-focused strategies negatively affect post-traumatic stress disorder.<\/jats:p>","DOI":"10.3390\/ijerph20021097","type":"journal-article","created":{"date-parts":[[2023,1,9]],"date-time":"2023-01-09T01:36:17Z","timestamp":1673228177000},"page":"1097","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Causal Model Analysis of the Effect of Formalism, Fear of Infection, COVID-19 Stress on Firefighters\u2019 Post-Traumatic Stress Syndrome and Insomnia"],"prefix":"10.3390","volume":"20","author":[{"given":"Yun-Ming","family":"Tang","sequence":"first","affiliation":[{"name":"Asia Pacific Society of Fire Engineering, Kaohsiung City 825, Taiwan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8198-0669","authenticated-orcid":false,"given":"Tsung-Lin","family":"Wu","sequence":"additional","affiliation":[{"name":"Department of Leisure Management, I-Shou University, Kaohsiung City 84001, Taiwan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7902-8473","authenticated-orcid":false,"given":"Hsiang-Te","family":"Liu","sequence":"additional","affiliation":[{"name":"Department of Public Affairs and Administration, Ming Chuan University, Taoyuan City 333, Taiwan"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2023,1,8]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"881","DOI":"10.1136\/oemed-2019-105957","article-title":"Differential effect of Hurricane Sandy exposure on PTSD symptom severity: Comparison of community members and responders","volume":"76","author":"Gonzalez","year":"2019","journal-title":"Occup. 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