Rank and Refuge: How Culture Shapes First Responder Help-Seeking and Maladaptive Coping Through Threats to Social Standing
Year: 2026
Type: preprint
Study design: Observational Study
Abstract: Emergency first responders experience disproportionately high rates of mental illness due to occupational trauma exposure, yet by some estimates fewer than half seek professional treatment despite available evidence-based interventions. This treatment gap coincides with elevated engagement in maladaptive coping behaviors including substance use, risk-taking, and interpersonal violence. While prior research implicates occupational cultures that stigmatize help-seeking, adverse cultural influences may be limited to individuals eager to improve their social standing. We propose and test how standing motivations—motivations concerning belonging and position in social groups—interact with first responder culture to predict health behaviors. In a cross-sectional online survey of 412 U.S. first responders (65% female; 70% While, 20% Black) across seven disciplines, we tested this framework at two levels of analysis - individual and group. Results indicate that key cornerstones of first-responder culture, such as conformity and brotherhood, were not direct barriers to adaptive coping. Rather, their effects depended on social standing concerns: at the individual level, conformity became a risk factor for maladaptive coping when need to belong was high, while at the group level, the protective effects of brotherhood on adaptive coping were suppressed when feelings of group disempowerment were high. Hence, intervening on social standing may prove more effective than attempts to modify cultural barriers, particularly given the persistence of first responder occupational cultures.
Language: English
Subfield: Occupational Therapy
Field: Health Professions
Domain: Health Sciences
Open Access status: green
OpenAlex ID: W7142296576