Factors that contribute to mental distress and suicidal events for first responders in Nebraska: A qualitative study

Nationally, since 2018, over 1,400 first responders have died by suicide (Costa, 2025), with 153 deaths in 2024 and 71 deaths as of July 2025 (First Honor, Educate, Lead, and Prevention, 2025). Suicide disproportionately impacts first responders and emergency medical services workers compared to the general population (National Emergency Medical Services Management Association, 2016). Based on real-world experiences of first responders, this study aimed to identify the factors that cause mental health distress for first responders in Nebraska and explore their awareness of current strategies and mental health programs. A convenience sample of 15 first responders was recruited through email. In-depth qualitative semistructured interviews were conducted with active or retired Nebraska first responders to (a) identify the factors that influence their mental health and (b) examine the current formal policy(s), procedures, or regulations that address work-related mental illnesses. Data were analyzed using a thematic analysis. The interviews uncovered the following four themes that help explain higher first responder suicide rates: (a) horrific encounters tied to mental illness and suicide, (b) barriers to accessing mental health services, (c) low volunteerism tied to fatigue, and (d) recommendations for change. This study reveals that intricate mental health challenges are faced specifically by Nebraska first responders working in both urban and rural communities. These challenges are magnified because of severe workforce shortages and low volunteerism among workers. Though there were only 15 participants, the saturation and depth of information provided were adequate to suggest recommended changes for policy makers and organization leaders. (PsycInfo Database Record (c) 2026 APA, all rights reserved).