{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,10]],"date-time":"2026-01-10T01:04:00Z","timestamp":1768007040319,"version":"3.49.0"},"reference-count":32,"publisher":"MDPI AG","issue":"9","license":[{"start":{"date-parts":[[2023,9,8]],"date-time":"2023-09-08T00:00:00Z","timestamp":1694131200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Societies"],"abstract":"<jats:p>Firefighters are considered a high-risk group for developing stress-related psychopathologies, such as post-traumatic stress disorder (PTSD), due to repeated exposure to potentially traumatic events (PTE). Studies have indicated that PTE is also associated with the development of Somatic Symptom Disorder (SSD). However, the occurrence of this condition among firefighters is an underexplored topic. This study aimed to assess the relationships between PTE and PTSD symptoms, and the relationship between PTE and SSD symptoms. Furthermore, we aimed to assess the role of SSD in the relationship between PTE and PTSD within Portuguese firefighters who battled the 2017 violent forest fires. To this end, a sample of 116 firefighters (75% male) completed self-report measures of posttraumatic symptoms, somatic symptoms, and other psychopathological symptoms. Contrary to several literature, in the present study, neither PTSD nor SSD symptoms seem to be correlated with any sociodemographic characteristics. However, the exposure to PTE is positively correlated with both PTSD and SSD symptoms. Furthermore, SSD seems to act as a mediator in the relationship between PTE and PTSD.<\/jats:p>","DOI":"10.3390\/soc13090206","type":"journal-article","created":{"date-parts":[[2023,9,8]],"date-time":"2023-09-08T07:52:11Z","timestamp":1694159531000},"page":"206","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":7,"title":["Posttraumatic Stress and Somatic Symptoms in Firefighters: A Mediation Analysis of the Impact of Potentially Traumatic Events"],"prefix":"10.3390","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6184-7211","authenticated-orcid":false,"given":"Joana Proen\u00e7a","family":"Becker","sequence":"first","affiliation":[{"name":"Faculty of Psychology and Educational Sciences, University of Coimbra, 3000-115 Coimbra, Portugal"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0369-2829","authenticated-orcid":false,"given":"Rui","family":"Paix\u00e3o","sequence":"additional","affiliation":[{"name":"Faculty of Psychology and Educational Sciences, University of Coimbra, 3000-115 Coimbra, Portugal"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2144-8299","authenticated-orcid":false,"given":"Patr\u00edcia","family":"Correia-Santos","sequence":"additional","affiliation":[{"name":"School of Psychology, University of Minho, 4710-057 Braga, Portugal"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7931-0172","authenticated-orcid":false,"given":"Manuel Jo\u00e3o","family":"Quartilho","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, University of Coimbra, 3000-548 Coimbra, Portugal"}]}],"member":"1968","published-online":{"date-parts":[[2023,9,8]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"74","DOI":"10.3390\/psych2010008","article-title":"A Relational Model for Stress: A Systematic Review of the Risk and Protective Factors for Stress-Related Diseases in Firefighters","volume":"2","author":"Becker","year":"2020","journal-title":"Psych"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"67","DOI":"10.1108\/IJES-10-2016-0020","article-title":"Firefighters and traumatic stress: A review","volume":"6","author":"Wagner","year":"2017","journal-title":"Int. J. Emerg. Serv."},{"key":"ref_3","doi-asserted-by":"crossref","unstructured":"Brooks, S.K., Dunn, R., Aml\u00f4t, R., Greenberg, N., and Rubin, J. (2016). Social and occupational factors associated with psychological distress and disorder among disaster responders: A systematic review. BMC Psychol., 4.","DOI":"10.1186\/s40359-016-0120-9"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"142","DOI":"10.1002\/jts.22166","article-title":"The Amplification of Common Somatic Symptoms by Posttraumatic Stress Disorder in Firefighters","volume":"30","author":"Paterson","year":"2017","journal-title":"J. Trauma. Stress"},{"key":"ref_5","doi-asserted-by":"crossref","unstructured":"Becker, J.P., Paix\u00e3o, R., and Quartilho, M.J. (2021). Psychopathology and Somatic Complaints: A Cross-Sectional Study with Portuguese Adults. Healthcare, 9.","DOI":"10.3390\/healthcare9040478"},{"key":"ref_6","doi-asserted-by":"crossref","unstructured":"Cooper, A., Abbass, A., Zed, J., Bedford, L., Sampalli, T., and Town, J. (2017). Implementing a Psychotherapy Service for Medically Unexplained Symptoms in a Primary Care Setting. J. Clin. Med., 6.","DOI":"10.3390\/jcm6120109"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"1329","DOI":"10.1056\/NEJM199910283411801","article-title":"An international study of the relation between somatic symptoms and depression","volume":"341","author":"Simon","year":"1999","journal-title":"N. Engl. J. Med."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"29","DOI":"10.1037\/sah0000172","article-title":"Dispositional self-forgiveness in firefighters predicts less help-seeking stigma and fewer mental health challenges","volume":"5","author":"Carpenter","year":"2020","journal-title":"Stigma Health"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"483","DOI":"10.1007\/s10608-018-9892-y","article-title":"Posttraumatic stress and suicidality among firefighters: The moderating role of distress tolerance","volume":"42","author":"Bartlett","year":"2018","journal-title":"Cogn. Ther. Res."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"277","DOI":"10.1016\/j.jpsychires.2016.10.014","article-title":"PTSD symptoms and suicidal thoughts and behaviors among firefighters","volume":"84","author":"Boffa","year":"2017","journal-title":"J. Psychiatr. Res."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"32","DOI":"10.1093\/occmed\/kqv144","article-title":"The relationship between burnout, PTSD symptoms and injuries in firefighters","volume":"66","author":"Katsavouni","year":"2016","journal-title":"Occup. Med."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"117","DOI":"10.1007\/s00420-017-1263-6","article-title":"Relationship between burnout and PTSD symptoms in firefighters: The moderating effects of a sense of calling to firefighting","volume":"91","author":"Jo","year":"2018","journal-title":"Int. Arch. Occup. Environ. Health"},{"key":"ref_13","unstructured":"Weathers, F.W., Litz, B.T., Keane, T., Palmieri, P.A., Marx, B.P., and Scnurr, P.P. (2022, March 04). The PTSD Checklist for DSM-5 (PCL-5), Available online: www.ptsd.va.gov."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"1267","DOI":"10.1002\/jclp.22930","article-title":"Portuguese version of the Posttraumatic Stress Disorder Checklist for DSM-5 (PCL-5): Comparison of latent models and other psychometric analyses","volume":"76","author":"Carvalho","year":"2020","journal-title":"J. Clin. Psychol."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"258","DOI":"10.1097\/00006842-200203000-00008","article-title":"The PHQ-15: Validity of a New Measure for Evaluating the Severity of Somatic Symptoms","volume":"64","author":"Kroenke","year":"2002","journal-title":"Psychosom. Med."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"352","DOI":"10.1016\/j.jpsychores.2014.11.006","article-title":"Assessing somatic symptom burden: A psychometric comparison of the Patient Health Questionnaire\u201415 (PHQ-15) and the Somatic Symptom Scale-8 (SSS-8)","volume":"78","author":"Gierk","year":"2015","journal-title":"J. Psychosom. Res."},{"key":"ref_17","first-page":"43","article-title":"Psychometric Properties and Factor Structure of the Portuguese Version of the Patient Health Questionnaire-15 (PHQ-15)","volume":"69","author":"Becker","year":"2023","journal-title":"Rev. Iberoam. Diagn. Ev."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"595","DOI":"10.1017\/S0033291700048017","article-title":"The Brief Symptom Inventory: An introduction report","volume":"13","author":"Derogatis","year":"1983","journal-title":"Psychol. Med."},{"key":"ref_19","first-page":"305","article-title":"Invent\u00e1rio de Sintomas Psicopatol\u00f3gicos (BSI): Uma revis\u00e3o cr\u00edtica dos estudos realizados em Portugal","volume":"Volume 3","author":"Machado","year":"2007","journal-title":"Avalia\u00e7\u00e3o Psicol\u00f3gica: Instrumentos Validados Para a Popula\u00e7\u00e3o Portuguesa"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"335","DOI":"10.1016\/0005-7967(94)00075-U","article-title":"The structure of negative emotional states: Comparison of the Depression Anxiety Stress Scales (DASS) with the Beck Depression and Anxiety Inventories","volume":"33","author":"Lovibond","year":"1995","journal-title":"Behav. Res. Ther."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"104","DOI":"10.1016\/j.jad.2013.10.031","article-title":"Adaptation and validation of the depression, anxiety and stress scale (DASS) to Brazilian Portuguese","volume":"155","author":"Vignola","year":"2014","journal-title":"J. Affect. Disord."},{"key":"ref_22","unstructured":"Hayes, A.F. (2017). Introduction to Mediation, Moderation, and Conditional Process Analysis. A Regression-Based Approach, Guilford Press. [2nd ed.]."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"453","DOI":"10.1177\/01454455211033515","article-title":"Behavioral and Occupational Health in Military Firefighters: An Understudied Population","volume":"46","author":"Moore","year":"2022","journal-title":"Behav. Modif."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"457","DOI":"10.5055\/jem.2014.0209","article-title":"Volunteers and professional rescue workers: Traumatization and adaptation after an avalanche disaster","volume":"12","author":"Romano","year":"2014","journal-title":"J. Emerg. Manag."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"236","DOI":"10.1016\/j.psychres.2016.11.037","article-title":"Differences in psychiatric symptoms and barriers to mental health care between volunteer and career firefighters","volume":"247","author":"Stanley","year":"2017","journal-title":"Psychiatry Res."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"100014","DOI":"10.1016\/j.sleepe.2021.100014","article-title":"The effects of sleep on firefighter occupational performance and health: A systematic review and call for action","volume":"1","author":"Frost","year":"2021","journal-title":"Sleep Epidemiol."},{"key":"ref_27","doi-asserted-by":"crossref","unstructured":"Becker, J.P., Paix\u00e3o, R., and Quartilho, M.J. (2022). Dynamic Psychotherapy as a PTSD Treatment for Firefighters: A Case Study. Healthcare, 3.","DOI":"10.3390\/healthcare10030530"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"434","DOI":"10.1002\/jts.22035","article-title":"The Strongest Correlates of PTSD for Firefighters: Number, Frequency, or Perceived Threat of Traumatic Events?","volume":"28","author":"Pinto","year":"2015","journal-title":"J. Trauma. Stress"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"321","DOI":"10.1007\/s11126-020-09797-4","article-title":"Psychiatric Co-Morbidities in Post-Traumatic Stress Disorder: Detailed Findings from the Adult Psychiatric Morbidity Survey in the English Population","volume":"92","author":"Qassem","year":"2021","journal-title":"Psychiatr. Q"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"388","DOI":"10.1016\/j.jpsychires.2021.09.030","article-title":"The ambivalence about accepting the prevalence somatic symptoms in PTSD: Is PTSD a somatic disorder?","volume":"143","author":"Graham","year":"2021","journal-title":"J. Psychiatr. Res."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"27","DOI":"10.1016\/j.jpsychores.2016.12.017","article-title":"Frequency of somatic symptoms in the general population: Normative values for the Patient Health Questionnaire-15 (PHQ-15)","volume":"96","author":"Hinz","year":"2017","journal-title":"J. Psychosom. Res."},{"key":"ref_32","first-page":"e9250","article-title":"Association of somatic symptom severity with sociodemographic parameters in patients with medically unexplained physical symptoms: A cross-sectional study from a tertiary care center in India","volume":"12","author":"Baitha","year":"2020","journal-title":"Cureus"}],"container-title":["Societies"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2075-4698\/13\/9\/206\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T20:47:10Z","timestamp":1760129230000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2075-4698\/13\/9\/206"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,9,8]]},"references-count":32,"journal-issue":{"issue":"9","published-online":{"date-parts":[[2023,9]]}},"alternative-id":["soc13090206"],"URL":"https:\/\/doi.org\/10.3390\/soc13090206","relation":{},"ISSN":["2075-4698"],"issn-type":[{"value":"2075-4698","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,9,8]]}}}