Prevalence of PTSD and common mental disorders amongst ambulance personnel: a systematic review and meta-analysis
There is increasing concern regarding the mental health impact of first responder work, with some reports suggesting ambulance personnel may be at particularly high risk. Through this systematic review and meta-analysis we aimed to determine the prevalence of mental health conditions among ambulance personnel worldwide.
A systematic search and screening process was conducted to identify studies for inclusion in the review. To be eligible, studies had to report original quantitative data on the prevalence of at least one of the following mental health outcome(s) of interest (PTSD, depression, anxiety, general psychological distress) for ambulance personnel samples. Quality of the studies was assessed using a validated methodological rating tool. Random effects modelling was used to estimate pooled prevalence, as well as subgroup analyses and meta-regressions for five variables implicated in heterogeneity.
In total, 941 articles were identified across all sources, with 95 full-text articles screened to confirm eligibility. Of these, 27 studies were included in the systematic review, reporting on a total of 30,878 ambulance personnel. A total of 18 studies provided necessary quantitative information and were retained for entry in the meta-analysis. The results demonstrated estimated prevalence rates of 11% for PTSD, 15% for depression, 15% for anxiety, and 27% for general psychological distress amongst ambulance personnel, with date of data collection a significant influence upon observed heterogeneity.
Ambulance personnel worldwide have a prevalence of PTSD considerably higher than rates seen in the general population, although there is some evidence that rates of PTSD may have decreased over recent decades.
KeywordsAmbulance personnel Emergency services Paramedic Common mental disorder Meta-analysis Post-traumatic stress disorder Prevalence
The systematic review reported in this study was funded by Ambulance Victoria in collaboration with Phoenix Australia. SBH, JMS, AG and MD are supported by funding from NSW Health and the iCare Foundation. This project also benefited from funding from beyondblue and the Movember Foundation.
SBH and KP conceptualized the study, KP and JMS undertook search and screening processes, KP completed data extraction, KP and SBH carried out statistical analysis, and wrote subsequent versions of the manuscript. All other authors reviewed and approved the final submission.
Compliance with ethical standards
Conflict of interest
There are no conflicts of interest to report regarding this publication.
References marked with an asterisk are those studies included in the meta-analysis
- 9.Berger W, Coutinho ESF, Figueira I, Marques-Portella C, Luz MP, Neylan TC, Marmar CR, Mendlowicz MV (2012) Rescuers at risk: a systematic review and meta-regression analysis of the worldwide current prevalence and correlates of PTSD in rescue workers. Soc Psychiatry Psychiatr Epidemiol 47(6):1001–1011CrossRefPubMedGoogle Scholar
- 13.Health NIo (2014) Quality assessment tool for observational cohort and cross-sectional studies. National Heart, Lung, and Blood Institute. http://www.nhlbi.nih.gov/health-pro/guidelines/in-develop/cardiovascular-risk-reduction/tools/cohort. Accessed 5 Nov 2015
- 22.McGilloway S, Gallagher S (2009) Experience of critical incident stress among ambulance service staff and relationship to psychological symptoms. Emerg Ment Health 11(4):235–248*Google Scholar
- 37.World Health Organization (2017) Depression and other common mental disorders: global health estimates. World Health Organization, GenevaGoogle Scholar
- 45.Pietrzak RH, Goldstein RB, Southwick SM, Grant BF (2011) Prevalence and Axis I comorbidity of full and partial posttraumatic stress disorder in the United States: results from Wave 2 of the National Epidemiologic Survey on Alcohol and Related Conditions. J Anxiety Disord 25(3):456–465CrossRefPubMedGoogle Scholar