The correlation between job stress,burnout,and cognitive performance in Iranian firefighters: A cross-sectional study

Abstract

BACKGROUND:

Appropriate cognitive performance is vital for a firefighter, but many occupational factors can negatively affect it.

OBJECTIVE:

This study assessed the correlation between job stress, burnout, and cognitive performance in firefighters.

METHODS:

This descriptive-correlational study was conducted in three fire stations in Iran in 2023 with 61 participants, including 34 firefighters in the exposed group and 27 office workers in the control group. After ensuring the confidentiality of the obtained information and completing the demographic information checklist, Job stress and burnout levels were measured using standardized questionnaires, and cognitive functions were assessed using two computerized tests: Stroop and continuous performance.

RESULTS:

The mean age and work experience of firefighters were 33.29±9.44 and 10.42±3.51 years, respectively. The firefighters’ job stress and burnout levels were, on average, 163.12±9.18 and 88.89±4.28, respectively, significantly higher than those of the control group (P < 0.05). The results of the Pearson correlation test revealed a strong correlation (r = 0.719) between job stress and burnout. Pearson correlation coefficient (r = –0.512–0.757), yielded from psychological tests, demonstrated that firefighters’ job stress and burnout had moderate to strong associations with certain indicators of Stroop and continuous performance tests.

CONCLUSION:

According to the obtained results, it is recommended to take fundamental measures to reduce occupational stress and burnout of firefighters as a factor affecting cognitive performance.

Keywords

Burnout cognitive function cognitive test firefighter job stress Stroop test

1 Introduction

According to their job characteristics, such as long-term shift work, irregular work schedules, complexity, and unpredictability of work conditions, firefighters can be affected by many psychological challenges, such as stress [1]. Job stress arises from the imbalance between individual abilities and job requirements, leading to negative impacts in areas such as absenteeism, job injuries, and work performance [2, 3]. Additionally, with pressures such as inadequate facilities and high mental and emotional tensions, burnout can also be common among firefighters [4].

Burnout is a psychological response to chronic work stress characterized by emotional exhaustion, lack of commitment, and a reduced sense of job-related efficacy [5]. This component causes negative consequences such as reduced work performance [6], increased emotional fatigue such as depression [7], increased sleep disorders and digestive disorders [8], reduced general health [2 , 9], and finally increased occupational accidents [10]. The studies by e.g. Cui et al. [11], Huang et al. [12], and Lv et al. [13] indicate the existence of burnout among firefighters.

On the other hand, firefighters need to process data quickly, make decisions, and respond appropriately to emergencies during their operational duties [9, 14]. For example, during a fire, they must make quick and accurate decisions to ensure the safety of people inside a building. Stress and burnout can complicate and hinder these decisions and responses [15 –17]. Also, empirical evidence about the relationship between stress as a factor in increasing job burnout and affecting cognitive performance has shown different results depending on stress levels, nature of work, individual variables, etc. [18]. Studies indicate that stress can impair cognitive function, particularly in the search for alternative solutions and making sound decisions [19]. Other studies have demonstrated that stress enhances the ability to respond to stressful situations [20]. So, examining the correlation between these components and their influence on each other is debatable.

Therefore, considering (1) the nature of the firefighting profession, (2) the necessity to understand and investigate the factors affecting the cognitive performance of firefighters, and (3) the lack of studies conducted in this field, the present study aims to investigate the correlation between job stress, job burnout, and cognitive performance of firefighters in Iran. This study aims to fill this important gap in the literature and better understand the impacts of these factors on each other. Figure 1 presents the research framework used in this article.

Fig. 1

Research paradigm of study.

2 Materials and methods

2.1 Study design

This descriptive correlational study was conducted with the participation of the Municipal Fire and Safety Organization operations staff at three fire stations.

2.2 Statistical population and sampling

The Census method was applied to calculate the sample size. For this purpose, after making the necessary arrangements with the fire station officials, a complete list of staff consisting of 76 people was provided to the examiners. After applying the inclusion criteria (no history of cardiac, hypoglycemic, antidepressant, or sedative drugs; absence of color blindness; normal hearing; no history of sleep disorders; absence of previous or current mental and neurological disorders; no experience of severe stress (death of a loved one, incurable disease, divorce); and at least six months of work experience), it was determined that 70 people were eligible.

In the next step, these staff (firefighters and administrative staff) were asked to participate in this study as volunteers by attending the fire stations, explaining the research objectives, and ensuring the confidentiality of the information received from the persons. Staff who did not want to participate in this research (n = 7) and those who did not complete tests thoroughly (n = 2) were excluded. In general, 34 male firefighters and 27 male administrative staff were tested as an exposed group and the control group, respectively. To carry out the present study in the form of a research project, the following tools were used:

2.3 Research tools

2.3.1 Demographic and occupational characteristics form

Important personal characteristics such as age, height, weight, BMI, and work experience at the current job were examined in this form. To maintain the confidentiality of the received information, each staff member was assigned a code to be used instead of their name. Also, after gathering information, no data on the test status is given to anyone, and the data is maintained with the examiners.

2.3.2 Philip L. Rice’s standardized job stress questionnaire

Rice’s 57-item job stress questionnaire collects information about job stress [21]. Hatami translated and standardized this questionnaire. The questionnaire consists of three subscales: (1) interactions at the workplace, (2) physical demand/condition, and (3) interest/interference [22]. The questionnaire begins with questions about interpersonal issues in the workplace and job satisfaction or dissatisfaction. Subsequently, the physical conditions that cause daily fatigue are addressed, followed by a section on job satisfaction. Hatami tested this questionnaire for 275 school teachers. The reliability calculated using Cronbach’s alpha was 89%. Its validity was 92% for the entire questionnaire and 89%, 88%, and 88% for the three subscales of interrelationships, physical demand, and interest in the job, respectively [23]. The test is graded on a five-point Likert scale (1 = Never, 2 = Rarely, 3 = Occasionally, 4 = Frequently, and 5 = Most of the time). An answer key is used for scoring, and the job stress score is calculated by adding the scores of each item. It is worth mentioning that this questionnaire has been used in other research on various occupations, such as emergency department workers, city bus drivers, and nurses, and it has been effective [24 –26].

2.3.3 Maslach Burnout Inventory (MBI)

Maslach has designed and validated the MBI [27]. This instrument provides a new estimate of the stress or burnout phenomena. MBI consists of 22 items that assess emotional exhaustion, depersonalization, and personal accomplishment in professional activity. This survey has been validated by Kouchi [28]. The test is scored on a 5-point Likert scale (1 = Very low, 2 = Low, 3 = Moderate, 4 = High, and 5 = Very high). In Kouchi’s study, the reliability of the questionnaire was determined to be 0.91 based on a pilot study involving 30 individuals. The measured values for emotional exhaustion, depersonalization, and lack of personal accomplishment were 0.81, 0.75, and 0.79, respectively. Maslach’s research confirmed the questionnaire’s validity using confirmatory and exploratory factor analysis. In Iran, Akbari et al. determined the questionnaire’s internal validity to be 0.79 using Cronbach’s alpha, which was significant at the 0.05 level [29]. The total score of the questionnaire between 1 and 22, 23 to 66, and above 66, respectively, indicates weak, moderate, and very high scores.

2.3.4 Computerized Stroop test

John Ridley Stroop initially developed the Stroop test to evaluate selective attention and cognitive flexibility [30]. Extensive research has utilized this test to determine an individual’s response inhibition, selective attention, cognitive variability, and cognitive flexibility. The test involves two phases. The first is to identify colors; however, this step does not affect the outcome because it is merely for practice and familiarization with the colors and the location of the keys on the keyboard. The actual implementation of the Stroop test constitutes the second phase. At this stage, the subject is presented with 48 congruent and 48 incongruent color words in red, blue, yellow, and green. Color and meaning coincide in the congruent words. Incongruent words are those whose hue does not correspond to their meaning. Regardless of the meaning of the words, the test-taker must specify, with maximum speed, only its apparent color based on the label on the keyboard. The duration of each stimulus’s presentation on display is two seconds, and the time between each stimulus’s presentations is 800 microseconds. Researchers believe that color-word assignment in the second phase of the experiment measures mental flexibility, interference, and response inhibition [31]. Ghadiri et al. reported a test-retest reliability coefficient of 0.55 for the number of errors in the first stage and 0.6 for the reaction time in the same stage. Moreover, in the second stage, the reliability coefficients for the number of errors and reaction time were 0.79 and 0.97, respectively [32]. According to the research conducted by Golden, the reliability and validity of this test are 0.81 (using the test-retest method) and 0.74 (using concurrent administration with physiological tests) [33].

2.3.5 Computerized Continuous Performance Test (CPT)

The primary purpose of the CPT is to assess sustained attention and impulse or impulsivity control [34]. This test requires the test-taker to focus for a specific period on a relatively simple set of visual or auditory stimuli (in this case, only visual stimuli are presented) and press a key when the target stimulus appears. There are 150 stimuli presented during this test. Each stimulus is presented for 200 milliseconds, with a one-second interval between them. This test examines the following variables: A) The omission error, which occurs when the test-taker fails to respond to the target stimulus, indicating that the test-taker has trouble responding. This type of error is interpreted as a problem with attention maintenance or inattention to stimuli; B) Commission error in which a test-taker responds to a non-target stimulus. This type of response indicates a deficiency in impulse inhibition and is interpreted as an impulsivity problem; C) Correct detection; and D) Reaction times. Hadidanfar [35], as cited by Karimi Aliabad et al. [36], reported that the test-retest reliability for the test’s various sections ranged between 0.59 and 0.93.

2.4 Statistical analysis

The collected data were analyzed using the IBM SPSS Statistics version 24. The Kolmogorov-Smirnov test was utilized to determine whether the data distribution was normal or abnormal. Mean±Standard Deviation (SD) was used to express descriptive statistics. The t-test was employed to express analytical statistics for normal data, while Pearson’s correlation coefficient was utilized to determine the relationship between the two variables. The correlation coefficient is between 1 and –1. The coefficient between 0 and 0.29 indicates a weak correlation. The coefficient between 0.30 and 0.69 indicates moderate correlation. The coefficient between 0.70 and 1 indicates a strong correlation. In this study, a significance level of 0.05 was considered.

3 Results

This study was conducted with 34 male firefighters from the Fire and Safety Services Organization (exposed group) and 27 men from the administrative unit of the Municipal Organization (control group). The mean and (SD) of age in the exposed and control groups were 33.29±(9.44) and 35.25±(8.39) years, respectively. Their years of work experience were 10.42±(3.51) and 11.72±(4.37). Age, height, weight, and work experience did not differ significantly between the two groups (P > 0.05). Table 1 lists some demographic and occupational characteristics of the participants.

Table 1
Demographic characteristics of the participants (n = 69)

Variables * Exposed group (n = 34) * Control group (n = 27) **P-value

Age (years) 33.29±(9.44) 35.25±(8.39) 0.23

Height (meters) 1.82±(0.62) 1.69±(0.73) 0.41

Weight (kg) 72.33±(10.23) 74.27±(10.29) 0.59

BMI (kg/m²) 24.68±(5.14) 25.44±(4.71) 0.12

Work experience 10.42±(3.51) 11.72±(4.37) 0.18

Variables	* Exposed group (n = 34)	* Control group (n = 27)	**P-value
Age (years)	33.29±(9.44)	35.25±(8.39)	0.23
Height (meters)	1.82±(0.62)	1.69±(0.73)	0.41
Weight (kg)	72.33±(10.23)	74.27±(10.29)	0.59
BMI (kg/m²)	24.68±(5.14)	25.44±(4.71)	0.12
Work experience	10.42±(3.51)	11.72±(4.37)	0.18

^*Mean±SD; ^**P < 0.05 is considered to be statistically significant; Student’s t-test.

3.1 Results of Rice’s job stress questionnaire

Table 2 displays Rice’s Job stress scores in the exposed and control groups. The questionnaire results indicated that firefighters in the subscales of workplace interrelationships had a normal level of job stress, with a mean and (SD) of 54.89±(6.45). The mean and (SD) for the physical demand and interest/involvement in the job subscales were 66.23±(5.32) and 26.14±(4.61), respectively. In addition, the overall stress score of these individuals was significantly higher (163.12±(9.18)) than that of the control group (97.22±(7.50)) (P < 0.05).

Table 2
Mean and (SD) of job stress scores in the studied groups (n = 69)

Variables Exposed group (n = 34) Control group (n = 27) *P-value

Interrelationships 54.89±(6.45) 44.27±(5.33) 0.02

Physical demand 66.23±(5.32) 39.14±(4.82) 0.04

Interest in the job 26.14±(4.61) 16.11±(3.62) 0.05

Overall stress score 163.12±(9.18) 97.22±(7.50) 0.01

Variables	Exposed group (n = 34)	Control group (n = 27)	*P-value
Interrelationships	54.89±(6.45)	44.27±(5.33)	0.02
Physical demand	66.23±(5.32)	39.14±(4.82)	0.04
Interest in the job	26.14±(4.61)	16.11±(3.62)	0.05
Overall stress score	163.12±(9.18)	97.22±(7.50)	0.01

^*P < 0.05 is considered to be statistically significant; Student’s t-test.

3.2 Results of MBI questionnaire

The results of this questionnaire revealed that the burnout score of firefighters was significantly higher than that of the control group (P = 0.03), with mean scores and (SD) of 88.89±(4.28) and 17.13±(3.44), respectively.

3.3 Results of computerized Stroop test

Table 3 presents the Stroop test indices for the exposed and control groups. The results of the study revealed that firefighters had significantly lower mean scores on all components of accuracy (number of correct answers) than the control group (P < 0.05). In contrast, the firefighters scored significantly higher on all speed components (mean reaction time of correct responses to the stimulus in milliseconds) than the control group (P < 0.05).

Table 3
Mean and (SD) of Stroop test scores in the study groups (n = 69)

Stroop test indicators Exposed group (n = 34) Control group (n = 27) *P-value

Congruent correct answers 38.4±(11.72) 47.5±(288.72) 0.01

Mean congruent reaction time (milliseconds) 1211.163±(25.25) 1124.119±(64.73) 0.04

Incongruent correct answers 32.7±(17.55) 42.7±(33.50) 0.02

Mean incongruent reaction time (milliseconds) 1470.149±(15.66) 1254.121±(52.12) 0.02

Stroop test indicators	Exposed group (n = 34)	Control group (n = 27)	*P-value
Congruent correct answers	38.4±(11.72)	47.5±(288.72)	0.01
Mean congruent reaction time (milliseconds)	1211.163±(25.25)	1124.119±(64.73)	0.04
Incongruent correct answers	32.7±(17.55)	42.7±(33.50)	0.02
Mean incongruent reaction time (milliseconds)	1470.149±(15.66)	1254.121±(52.12)	0.02

^*P < 0.05 is considered to be statistically significant; Student’s t-test.

3.4 Results of CPT

CPT indices in exposed and control groups are presented in Table 4. The results of the CPT revealed that the number of omission errors, commission errors, and reaction time of firefighters were significantly greater than those of the control group (P < 0.05). In contrast, the number of correct responses was significantly lower in the firefighter group than in the control group (P < 0.05).

Table 4
Mean and (SD) of scores of CPT indices in the studied groups (n = 69)

CPT indices Exposed group (n = 34) Control group (n = 27) *P-value

Omission error 2.0±(71.59) 0.0±(59.07) 0.01

Commission error 6.1±(24.12) 2.0±(31.11) 0.01

Correct responses 131.15±(11.19) 147.9±(32.15) 0.01

Reaction time (milliseconds) 492.12±(51.88) 424.63±(44.55) 0.02

CPT indices	Exposed group (n = 34)	Control group (n = 27)	*P-value
Omission error	2.0±(71.59)	0.0±(59.07)	0.01
Commission error	6.1±(24.12)	2.0±(31.11)	0.01
Correct responses	131.15±(11.19)	147.9±(32.15)	0.01
Reaction time (milliseconds)	492.12±(51.88)	424.63±(44.55)	0.02

^*P < 0.05 is considered to be statistically significant; Student’s t-test.

3.5 Relationships between the studied variables

Table 5 shows the results of the correlation matrix between the studied variables in the firefighters’ group. There was a strong and significant correlation between job stress and burnout among firefighters (r = 0.719) (Table 5).

Table 5
The matrix of correlations between research variables in the firefighters’ group (n = 69)

Variables A₁ A₂ A₃ A₄ A₅ A₆ A₇ A₈ A₉ A₁₀

A₁ 1

A₂ **0.719 1

A₃ 0.162 0.133 1

A₄ 0.142 0.138 –0.609 1

A₅ –.542 –.602 00.412 0.152 1

A₆ 0.761 0.731 0.172 –0.389 0.642 1

A₇ 0.757 0.715 0.116 0.124 0.178 0.192 1

A₈ 0.708 0.728 0.129 0.137 0.167 0.181 –0.629 1

A₉ –0.512 –0.582 0.149 0.172 0.186 0.173 –0.598 –0.436 1

A₁₀ 0.743 0.729 0.154 0.242 0.206 0.183 0.628 0.637 0.591 1

Variables	A₁	A₂	A₃	A₄	A₅	A₆	A₇	A₈	A₉	A₁₀
A₁	1
A₂	**0.719	1
A₃	0.162	0.133	1
A₄	0.142	0.138	–0.609	1
A₅	*–.542	*–.602	00.412	0.152	1
A₆	*0.761	*0.731	0.172	–0.389	0.642	1
A₇	*0.757	0.715	0.116	0.124	0.178	0.192	1
A₈	*0.708	0.728	0.129	0.137	0.167	0.181	–0.629	1
A₉	*–0.512	*–0.582	0.149	0.172	0.186	0.173	–0.598	–0.436	1
A₁₀	*0.743	*0.729	0.154	0.242	0.206	0.183	0.628	0.637	0.591	1

*P < 0.05; **P < 0.001. Abbreviations: A_1 : Job stress; A_2 : job Burnout; A_3 : correct responses in the congruent conditions; A_4 : mean reaction time in the congruent conditions (ms); A₅_: correct responses in incongruent conditions; A₆_: mean reaction time in incongruent conditions (ms); A₇_: omission errors; A₈_: response errors; A₉_: number of correct responses; A₁₀_: reaction times (ms).

In addition, the results demonstrated that the components of the Stroop test (correct congruent responses and mean incongruent reaction time) have a strong and statistically significant correlation with job stress (r = 0.742 and r = 0.761) and burnout (r = 0.761 and r = 0.731) (Table 4).

The results of the Pearson correlation test established that job stress score and burnout score had a strong and statistically significant direct correlation with CPT indices, including omission error (r_stress = 0.757) (r_burnout = 0.715), commission error (r_stress = 0.708) (r_burnout = 0.728), the number of correct responses (r_stress = –0.512) (r_burnout = 0.782), and reaction time (r_stress = 0.757) (r_burnout = 0.715) (Table 4).

4 Discussion

Firefighters are among the people exposed to various work risks, such as psychological risks in stressful work environments [37]. Based on this, it is necessary to pay a lot of attention to the psychological variables of firefighters as well as other job components and try to fix them if there are problems in these components. The review of the background of the current research shows that only limited studies have been conducted regarding psychological components among firefighters in some countries such as Iran. This is even though firefighters should be in good mental and physical condition due to the nature of their job. Therefore, this study was conducted to investigate the effect of occupational stress and burnout on the cognitive performance offirefighters.

The results of the present study revealed that firefighters have a higher level of job stress and burnout than the control group. This finding was consistent with the study of Smith et al. [38], which demonstrated that the correlation matrix between job stress and burnout in firefighters was strong and statistically significant. Another cross-sectional study in Poland, emphasizing the role of work experience and self-efficacy on job stress and burnout, showed that these two components were higher among firefighters than the control group [39]. However, stress and burnout among firefighters need to be better understood because these factors influence many work environments and vary according to job conditions.

The results of the Stroop test indicated that the firefighters possessed lower degrees of attention and selective response inhibition skills than the control group. This result is consistent with the results of other studies, for instance those by Robinson et al. [40], Hemmatjo et al. [41], and Zhang et al. [42], which were conducted with the participation of firefighters in the UK, Iran, and USA. In our study, the incongruent and congruent phases of the Stroop test were used to evaluate response inhibition and selective attention. In both congruent and incongruent modules, the exposed group responded with fewer correct responses over a longer time than the control group. Consistent with this finding, in Lee et al.’s study, South Korean firefighters with post-traumatic stress disorder (PTSD) (as the exposed group) had slower reaction times in the speed component [43]. This finding in our study suggests that the exposed group has weaker response inhibition and selective attention. People are expected to spend more time in the incongruent phase. The smaller the difference between the times spent in the two phases, the better, provided that the number of correct answers is high. The exposed group spent more time on the incongruent phase than the congruent one. This occurred while the number of correct answers also dropped. Although the exposed group responded slowly to the incongruent stage, the number of correct responses was lower because the exposed group exhibited less selective response inhibition and attention.

In the present study, the number of omission and commission errors was significantly higher in the exposed group than in the control group, indicating lower degrees of attention in the exposed group. Considering that stress produces steroids that are harmful to the receptors in different areas of the brain responsible for learning and memory [44], one of the main reasons for this can be increased stress. In this regard, the study by Kivimäki and Lusa, which was conducted with the participation of 18 firefighters in a simulated environment in Finland, revealed that as stress reactions increased during the simulation, controlled task-focused thinking decreased [45]. In addition, in this research, the firefighter’s reaction time, similar to the results of Hemmatjo et al. ‘s study [46], was significantly longer than that of the control group. This increase in reaction time was also observed in the exposed group during the Stroop test. In contrast, the number of correct responses in the exposed group was significantly lower than in the control group.

In previous studies, the negative effects of some parameters such as sleep disturbance, PTSD, heat stress, firefighter job activities, and personal protective equipment on some cognitive function parameters such as visual and auditory working memory and sustained attention have been investigated and proven [47 –52]. The present study also investigated and proven the effect of job stress and burnout on cognitive function. In line with these results, the data reveal that stress can affect some hormones, such as cortisol hormone, and cause impairments in cognitive function and active memory [53]. Also, stress can affect the hormone Glucocorticoids in some areas of the brain (such as the amygdala, hippocampus, and frontal lobes), destroying neurons in these areas, and then psychological syndromes such as burnout occur [54]. In addition, a study indicated that burnout significantly reduces gray matter in the anterior cingulate cortex and dorsolateral prefrontal cortex in the caudate and putamen volumes, affecting cognitive function [55]. Thus, while paying attention to other influential job components on firefighter’s cognitive functions, it is important to consider these two components. To prevent and reduce these components, necessary measures should be taken.

Among the limitations of the present study were the cross-sectional design, the participation of only male firefighters, and the use of a questionnaire to collect some data. In addition, conducting research during firefighter’s work shifts with a small number of participants, which limits the generalizability of this study, was another area for improvement.

5 Conclusion

Participating in emergency operations such as firefighting and rescue in changing environments requires firefighters to have suitable cognitive performance. Thus, considering the influence of cognitive function, in this research the correlation between job stress, job burnout and cognitive performance was investigated. This study showed that in addition to higher job stress and burnout in the exposure group, these two characteristics have significant correlation with each other and negatively affect the cognitive performance of firefighters (strong effect on Stroop test components and CPT indicators (such as omission error, commission error, number of correct answers, and reaction time)). Therefore, in order to improve the working condition of firefighters and prevent accidents, it is recommended to implement training programs and appropriate measures to reduce the impact of harmful factors on cognitive performance.

Ethical approval

This study resulted from research project no. IR. 1402-02-41-14821, which was approved by the Center for Behavioral Sciences in Health.

Informed consent

All subjects provided informed consent before participation.

Conflicts of interest

The authors declare no conflicts of interest.

Footnotes

Acknowledgments

The authors thank all participating firefighters and the safety and fire services.

Funding

No funding was received to conduct this study.

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