Ambulance Personnel: Systematic Review of Mental Health Symptoms

Ambulance personnel, including paramedics, emergency medical technicians, and others, are exposed to potentially distressing situations frequently as a function of their duties. The present systematic review evaluated the prevalence of trauma-related mental disorders, including posttraumatic stress disorder (PTSD), depression, and anxiety in ambulance personnel with best-evidence narrative synthesis across an international dataset of 24 eligible studies to determine whether prevalence is elevated in this occupational group relative to the general population. In addition, we integrate and synthesize findings related to predictive factors for the prevalence of these disorders across the literature, broadly grouping predictive factors into three categories: individual-difference factors (e.g., sociodemographics), exposure-related factors (e.g., frequency), and organizational factors (e.g., support from supervisors). The relationship between exposure-related factors and depression/anxiety symptoms is of special interest because both disorders may occur outside the context of traumatic stress but are also highly comorbid with PTSD. We report strong evidence that prevalence rates of probable PTSD, depression, and anxiety disorder are elevated in ambulance personnel. The strongest predictive associations for PTSD symptoms concerned exposure-related and organizational factors, whereas individual-difference factors bore weak or inconsistent associations with symptoms. Importantly, there is a concerning lack of data regarding the impact of workplace traumatic exposure on depression and anxiety in ambulance personnel, and as such it is not possible at present to differentiate between manifestation of symptoms following exposure compared with ongoing symptoms unrelated to the workplace. Addressing this gap in the literature is of critical importance for guiding organizational response to these disorders in ambulance service.