Role Identity, Dissonance, and Distress among Paramedics

Role identity theory describes the purpose and meaning in life that comes, in part, from occupying social roles. While robustly linked to health and well-being, this may become, however, when an individual is unable to fulfil the perceived requirements of an especially salient role in the way that they believe they should. Amid high rates of mental illness among public safety personnel, we interviewed a purposely selected sample of 21 paramedics from a single service in Ontario, Canada to explore incongruence between an espoused and able-to-enact paramedic role identity. Situated in an interpretivist epistemology, and using successive rounds of thematic analysis, we developed a framework for role identity dissonance wherein chronic, identity-relevant disruptive events cause emotional and psychological distress. While some participants were able to recalibrate their sense of self and understanding of the role, for others, this dissonance was irreconcilable, contributing to disability and lost time from work. In addition to contributing a novel perspective on paramedic mental health and well-being, our work also offers a modest contribution to the theory in using the paramedic context as an example to consider identity disruption through chronic workplace stress.

Isolation, self-blame and perceived invalidation in aid personnel: identifying humanitarian-specific distress using the PostAID/Q

Objective Humanitarian-specific psychological distress following deployment can elude detection using contemporary measures of trauma-related stress. This study assesses the unidimensional structure and convergent validity of the Post-deployment Altruistic Identity Disruption Questionnaire (PostAID/Q), an 18-item questionnaire underpinned by the construct Altruistic Identity/Disruption (AI/AID). Method Humanitarian aid personnel (N=108) completed an online web survey, inclusive of the Moral Injury Questionnaire (MIQ), Posttraumatic Distress Disorder Checklist (PCL-5), Psychological Well-Being Posttraumatic Changes Questionnaire (PWB-PTCQ) and Social Provisions Scale (SPS). Results A confirmatory factor analysis suggested a single factor structure providing further support for the conception of AI/AID as a unidimensional construct. Convergent validity was demonstrated through (1) utility for predicting a posttraumatic stress disorder (PTSD) diagnosis assessed by the PCL-5, and (2) moral injury assessed by the MIQ. The PostAID/Q was further moderately and negatively associated with the availability of social support (assessed by the SPS) and lower self-reports of psychological well-being post trauma (assessed by the PWB-PCTQ). Finally, the PostAID/Q demonstrated evidence of incremental validity in predicting humanitarian specific psychological distress over and above the PCL-5. Specifically, the PostAID/Q predicted increased moral injury on the MIQ, and decreased psychological well-being post trauma. Conclusions The PostAID/Q can assist in identifying humanitarian specific psychological responses post deployment guiding support for personnel, over and above more traditional measures of posttraumatic stress.

Older Canadians’ Identity and Well-Being in Retirement

Retirement can be a time of identity disruption for many older adults. Identity process theory (Whitbourne et al., 2002) states that age-related changes, such as retirement, can prompt an individual to incorporate new information about themselves into their personal identity using one of three identity process: assimilation, accommodation, and balance. Additionally, individual identity and the manner in which individuals retire—voluntary or involuntary—are associated with post-retirement well-being (Newton et al., 2018). The current study examined the relationship between identity processes, planned/unplanned retirement, and hedonic (life satisfaction) and eudaimonic (meaning in life) well-being in a sample of retired Canadians. Results indicated that identity accommodation and balance were associated with both types of post-retirement well-being, whereas unplanned retirement was consistently only related to life satisfaction. This study emphasizes the importance of including individual difference factors when examining older adults’ well-being and the utility of measuring well-being in multiple ways.

The Relations Between Identity Disturbances, Borderline Features, Internalizing Disorders, and Suicidality in Inpatient Adolescents

Previous studies have demonstrated positive associations between identity disturbances and suicidality in adolescents; however, mechanisms underlying these relationships are not well understood. The authors propose that borderline features and various internalizing disorders may mediate these relations. The aim of this study was to test a multiple mediation model of the associations between these constructs using structural equation modeling. Ninety-six inpatient adolescents aged 12–17 years completed the Assessment of Identity Development in Adolescents, the Childhood Interview for DSM-IV Borderline Personality Disorder, the Youth Self-Report, and the Columbia-Suicide Severity Rating Scale. Findings partly confirmed the theoretical model. Borderline features mediated the positive effect of identity disturbances on suicidal ideation severity. Mediations of withdrawn/depression and anxiety/depression on the effect of identity disruption on suicidal ideation intensity were demonstrated. Identity disruptions and borderline and depressive symptoms could be possible targets for interventions for youth experiencing suicidal ideation.

Two Cases of Persistent Complex Bereavement Disorder Diagnosed in the Acute Inpatient Unit

Pathological grief has been noted to have considerable adverse effects on affected individuals. In the DSM-5, the diagnosis of complicated grief is included under conditions for further study as Persistent Complex Bereavement Disorder (PCBD). PCBD can be easily missed because it is a relatively new and developing diagnosis. It can also be overlooked when it is comorbid with more common psychiatric disorders. We present 2 patients with PCBD diagnosed in the inpatient unit, while the patients were admitted for comorbid disorders. PCBD contributed immensely to both patients’ suffering and decline in functioning. This report highlights the presentation, diagnoses, and management of these patients. We theorize that paying attention to separation distress, reactive distress to loss, and identity disruption in individuals who have been bereaved for over 12 months will enhance treatment specificity and lead to better patient outcomes.

Differential Associations of Coping Strategies With Grief and Depression in Young Adults: The Role of Cause of Death and Relationship to the Deceased

Introduction: The impact of loss by death in young adults has been underinvestigated, although higher rates of traumatic deaths are reported at this developmental stage. This study examined the relative differential consequences of bereavement-related factors for Persistent Complex Bereavement Disorder (PCBD) and depression. In addition, coping strategies predicting the study outcomes were examined as a function of bereavement-related factors. Methods: The study included 580 bereaved young adults with up to 5-year post loss. They were administered a battery of valided tools measuring PCBD symptoms, normal acute grief reactions as measured by the Core Bereavement Items scale, depressive symptoms, coping strategies, and bereavement-related characteristics. Covariance and regression analyses were used. Results: We found that the dimensions of PCBD and depressive symptoms were differentially associated with the bereavement-related factors. More specifically, the death of an immediate family member was associated with higher levels of PCBD-separation distress, whereas the traumatic death of a friend and romantic partner was more associated with PCBD-social and identity disruption. Furthermore, the study revealed differential associations between PCBD severity, depressive symptoms, and coping strategies as functions of bereavement-related factors. Discussion: The study has provided better understanding of clinical manifestations of PCBD as a function of etiologic risk factors. The results clarifying risk and protective factors are especially useful for improving effective bereavement-health counseling interventions among bereaved young adults.