Are You Living With Clinical Depression?

Author: IAFF Staff

October 25, 2019

While a surge in training, education, and post-traumatic stress disorder (PTSD) awareness campaigns has helped change the conversation about mental health issues in the fire service, the risk of clinical depression among fire fighters is less understood. 

A study in the Journal of Occupational and Environmental Medicine found that 11% of fire fighters experience depression. Some data have shown that depression seems to rise over the course of a career in the fire service, with new recruits having lower levels of symptoms and experienced fire fighters having the highest level of symptoms.

In populations seeking behavioral health treatment, the rates of clinical depression are much higher. In a survey of 133 fire fighters admitted to the IAFF Center of Excellence during a six-month period, 73% of patients screened positive for major depressive disorder, based on a validated depression questionnaire commonly used by practitioners. 

Sadness Versus Depression 

It’s normal to feel sad from time to time based on reactions to life events, loss, change or sometimes for no reason at all. While people who feel sad might say they are depressed, clinical depression means something very different. Medical experts classify major depressive disorder (MDD) as a serious, debilitating mood disorder, characterized by recurring periods of prolonged sad or depressed mood, along with physical, cognitive and behavioral changes. 

Depressed woman firefighter sitting in a truck looking out of the window

Identifying Depression 

If you think you may be struggling with depression, the best way to get an accurate diagnosis is to be assessed by a licensed mental healthcare provider. The Patient Health Questionnaire for Depression (PHQ-2) is a simple, one-question screening tool that can quickly identify those who are at risk for clinical depression and need further evaluation. 

The question is:

Over the last two weeks, how often have you been bothered by the following problems?

  • Little interest or pleasure in doing things (not at all, several days, more than half of the days, nearly every day)
  • Feeling down, depressed or hopeless (not at all, several days, more than half of the days, nearly every day)

If your answer to both items was “more than half of the days” or “nearly every day” of the past two weeks, this is considered a positive screen. It is recommended that you be evaluated by a mental health provider to determine if you meet the criteria for major depressive disorder. 

Treatment Options 

Major depressive disorder is typically treated through psychotherapy, medication or a combination of both. Cognitive behavior therapy (CBT) is often recommended for treating depression. CBT is evidence-based, time-limited and designed to activate behavior while correcting unhelpful thought patterns that fuel emotions, actions, and physical symptoms that keep you feeling depressed. Depression treatment can occur in an individual or group setting. In some cases, severe major depression that has been resistant to medication is treated using alternative therapies, such as transcranial magnetic stimulation (TMS) or electroshock therapy (ECT).

A Plan for Treatment 

Whichever form of treatment you choose, it is critical you receive an individual treatment plan that identifies clear goals for treatment and how to achieve them. If you are coping with major depressive disorder, talking to a therapist about your problems may be supportive but is unlikely to result in symptom stabilization.

A treatment plan for depression is individualized based on a number of factors, including the severity of symptoms, the onset of the illness, past treatment history, any co-occurring mental health or substance abuse problems, access to treatment, insurance coverage and individual appropriateness for one type of therapy over another. 

The IAFF Center of Excellence is a residential treatment facility exclusively for IAFF members to seek treatment for a variety of behavioral health problems, including major depression, complicated grief, PTSD and substance use disorders. Call today for a free and confidential mental health screening. 

If you are currently having suicidal thoughts, please seek help immediately: 

  • Visit a licensed mental health professional or the emergency room 
  • Call the Suicide Prevention Lifeline at 1-800-273-TALK (8255)
  • Call the Firefighter & Family Crisis and Support Line: 1-844-525-FIRE (3473)

Lauren Kosc, M.A., LCPC is a behavioral health specialist, clinician and blog writer for the International Association of Fire Fighters. If you are an IAFF member in recovery and want to share your story, contact [email protected].


Carey, Mary; et al. “Sleep Problems, Depression, Substance Use, Social Bonding, and Quality of Life in Professional Firefighters.” Journal of Occupational and Environmental Medicine, August 2011. Accessed October 25, 2019. 

Patient Health Questionnaire for Depression (PHQ-9)

Medical Disclaimer: The IAFF Center of Excellence aims to improve the quality of life for people struggling with a substance use or mental health disorder with fact-based content about the nature of behavioral health conditions, treatment options and their related outcomes. We publish material that is researched, cited, edited and reviewed by licensed medical professionals. The information we provide is not intended to be a substitute for professional medical advice, diagnosis or treatment. It should not be used in place of the advice of your physician or other qualified healthcare provider.

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