Research shows PTSD, anxiety may affect reproductive health of women firefighters

A new study led by University of Arizona Mel and Enid Zuckerman College of Public Health researchers in collaboration with fire service partners and other researchers around the country through the Fire Fighter Cancer Cohort Study showed that post-traumatic stress disorder and anxiety are associated with lower levels of anti-Müllerian hormone, a marker of ovarian reserve, among women firefighters.

The ovarian reserve is the number of healthy eggs in a woman’s ovaries that could potentially be fertilized. It is a measure of a woman’s fertility and ability to have children. 

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“These findings highlight the negative effect that mental health conditions can have on health – specifically, reproductive health,” said first author Michelle Valenti, MPH, a doctoral student in epidemiology at the Zuckerman College of Public Health and program coordinator of the Fire Fighter Cancer Cohort Study’s Women Firefighter Studies.

The paper “Evaluating the Effect of Depression, Anxiety, and Post-Traumatic Stress Disorder on Anti-Müllerian Hormone Levels Among Women Firefighters,” was published in the Journal of Women’s Health.

Firefighters are exposed to high stress and traumatic situations in addition to chemical exposures and have a higher prevalence of PTSD compared with the general population. Previous research showed that women firefighters have lower levels of anti-Müllerian hormone compared with women who are not firefighters; however, the reason why was unknown.

The research team, which included personnel at the Zuckerman College of Public Health’s Center for Firefighter Health Collaborative Research, led this analysis to determine whether anxiety, depression or PTSD were associated with anti-Müllerian hormone levels. They found that clinical diagnoses of PTSD and anxiety among women firefighters were associated with reductions in anti-Müllerian hormone levels of 66% and 33%, respectively.

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These findings highlight a potential mechanism through which adverse mental health conditions could lead to adverse reproductive outcomes. Further research is needed to identify potential areas for intervention.

“The work of this AMH study within the broader context of the FFCCS is imperative to taking care of all of our firefighters,” said Capt. Caitlin St. Clair of the Puget Sound Regional Fire Authority. “These findings provide scientific leverage to fire departments to implement programs to reduce stress and improve the lives of our firefighter women.”

The Women Firefighter Study, a subgroup of the Fire Fighter Cancer Cohort Study, aims to identify causes of stress, cancer and adverse reproductive health effects in women firefighters that would inform effective interventions to mitigate these conditions.

“This study demonstrates the power of the Fire Fighter Cancer Cohort Study’s Women Firefighter Study to evaluate exposures that lead to adverse gynecologic conditions,” Valenti said. “The Women Firefighter Study would not be possible without our amazing fire service partners who have championed women firefighter research.”

Co-authors from the Zuckerman College of Public Health include senior author Jeff Burgess, MD, MPH, a professor and director of the Center for Firefighter Health Collaborative Research at the U of A Mel and Enid Zuckerman College of Public Health and a member of the BIO5 Institute; Leslie Farland, ScD, an associate professor and member of the BIO5 Institute; Yiwen Liu, PhD, an assistant professor of epidemiology and biostatistics; Shawn Beitel, program administrator for firefighter research; research technician Jordan Baker; and graduate student Kaiwen Huang.

In addition to St. Claire, other fire service research liaisons who contributed to the study include Capt. John Gulotta of the Tucson Fire Department, Capt. Jamie Kolar and Derek Urwin, PhD, of the Los Angeles County Fire Department, and many other firefighters.

This research was funded by the Federal Emergency Management Agency under award nos. EMW-2015-FP-00213 and EMW-2019-FP-00526.