Paramedics have a higher prevalence of probable post-traumatic stress disorder than the general population. However, some paramedics may experience significant distress and impairment on a daily or weekly basis while never meeting post-traumatic stress disorder diagnostic criteria, as post-traumatic stress reactions often resolve within days or weeks following potentially psychologically traumatic event exposure.
Objective
To evaluate post-traumatic stress symptom severity in a cohort of paramedics following exposure to a single potentially psychologically traumatic event (i.e., post-traumatic stress reaction strength) and following exposure to multiple events over time (i.e., post-traumatic stress overall), and examine how prior trauma history, frequency of event exposure, social support, and relationship satisfaction affect post-traumatic stress symptoms.
Methods
An observational repeated-measures study was used to evaluate post-traumatic stress symptoms among Australian paramedics. Participants completed an initial survey and six weekly repeated measures surveys. Data were analysed as a single group using descriptive and bivariate analysis.
Results
Thirty-one participants were included. A significant positive association was found between prior history and post-traumatic stress overall, but not post-traumatic stress reaction strength. Frequency of event exposure was significantly, independently associated with more post-traumatic stress overall and post-traumatic stress reaction strength. Neither social support nor relationship satisfaction were significantly associated with post-traumatic stress overall or post-traumatic stress reaction strength.
Conclusions
Prior trauma history and frequency of event exposure could increase paramedics’ risk of experiencing post-traumatic stress. However, findings are preliminary and hypothesis-generating and further investigation is required to inform prevention, screening, and treatment strategies for managing paramedics’ post-traumatic stress.
HoellAKourmpeliEDressingH. Work-related posttraumatic stress disorder in paramedics in comparison to data from the general population of working age. A systematic review and meta-analysis. Front Public Health2023; 11: 1–12.
2.
BarrettELGrummittLJonesS, et al.The prevalence of potentially traumatic events in childhood and associations with mental disorders, suicide and physical health in adulthood: an Australian nationally representative cross-sectional study. Aust N Z J Psychiatry2026; 60: 80–90.
3.
KyronMJReesCSLawrenceD, et al.Prospective risk and protective factors for psychopathology and wellbeing in civilian emergency services personnel: a systematic review. J Affect Disord2021; 281: 517–532.
4.
AlshahraniKMJohnsonJAlzahraniAA, et al.Exploring the relationships between encountering potentially traumatic work events, coping, and symptoms of posttraumatic stress disorder in Saudi paramedics: a daily diary study. Emergency Health Services Journal2025; 2: 13–22.
5.
Geronazzo-AlmanLEisenbergRShenS, et al.Cumulative exposure to work-related traumatic events and current post-traumatic stress disorder in New York city's first responders. Compr Psychiatry2017; 74: 134–143.
6.
DonnellyEABennettM. Development of a critical incident stress inventory for the emergency medical services. Traumatology2014; 20: 1–8.
7.
CarletonRNAfifiTOTaillieuT, et al.Assessing the relative impact of diverse stressors among public safety personnel. Int J Environ Res Public Health2020; 17: 1–25.
American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 5th Ed. Washington, DC: American Psychiatric Association, 2013.
10.
HarveySBMilligan-SavilleJSPatersonHM, et al.The mental health of fire-fighters: an examination of the impact of repeated trauma exposure. Aust N Z J Psychiatry2016; 50: 649–658.
11.
RicciardelliRCzarnuchSAfifiT, et al.Public safety personnel’s interpretations of potentially traumatic events. Occup Med2020; 70: 155–161.
12.
DavisKMacBethAWarwickR, et al.Posttraumatic stress symptom severity, prevalence and impact in ambulance clinicians: the hidden extent of distress in the emergency services. Traumatology2019; 25: 82.
13.
SkogstadMSkorstadMLieA, et al.Work-related post-traumatic stress disorder. Occup Med2013; 63: 175–182.
14.
WildJSmithKVThompsonE, et al.A prospective study of pre-trauma risk factors for post-traumatic stress disorder and depression. Psychol Med2016; 46: 2571–2582.
15.
KleinABSchnurrPPBovinMJ, et al.An empirical investigation of definitions of subthreshold posttraumatic stress disorder. J Trauma Stress2024; 37: 113–125.
16.
McLaughlinKAKoenenKCFriedmanMJ, et al.Subthreshold posttraumatic stress disorder in the world health organization world mental health surveys. Biol Psychiatry2015; 77: 375–384.
17.
DiGangiJAGomezDMendozaL, et al.Pretrauma risk factors for posttraumatic stress disorder: a systematic review of the literature. Clin Psychol Rev2013; 33: 728–744.
18.
OzerEJBestSRLipseyTL, et al.Predictors of posttraumatic stress disorder and symptoms in adults: a meta-analysis. Psychol Bull2003; 129: 52–73.
19.
Pihl-ThingvadJVangMLMøllerSR, et al.Critical incidents scale for ambulance work - Denmark (CISAW-D): the development of a screening tool for work exposure to critical events in operative ambulance personnel. Br Paramed J2022; 7: 26–33.
20.
BrooksDBrooksR. A systematic review: what factors predict post-traumatic stress symptoms in ambulance personnel?. Br Paramed J2021; 5: 18–24.
21.
WangYChungMCWangN, et al.Social support and posttraumatic stress disorder: a meta-analysis of longitudinal studies. Clin Psychol Rev2021; 85: 1–10.
22.
NtatamalaIAdamsS. The correlates of post-traumatic stress disorder in ambulance personnel and barriers faced in accessing care for work-related stress. Int J Environ Res Public Health2022; 19: 1–14.
23.
Díaz-TamayoAMEscobar-MorantesJRGarcía-PerdomoHA. Coping strategies for exposure to trauma situations in first responders: a systematic review. Prehosp Disaster Med2022; 37: 810–818.
24.
KvedaraiteMGelezelyteOKaratziasT, et al.Mediating role of avoidance of trauma disclosure and social disapproval in ICD-11 post-traumatic stress disorder and complex post-traumatic stress disorder: cross-sectional study in a Lithuanian clinical sample. BJPsych Open2021; 7: 1–7.
25.
HillMAPatersonJLRebarAL. Secondary traumatic stress in partners of paramedics: A scoping review. Australas Emerg Care2024; 27: 1–8.
26.
TaftCTWatkinsLEStaffordJ, et al.Posttraumatic stress disorder and intimate relationship problems: a meta-analysis. J Consult Clin Psychol2011; 79: 22–33.
27.
BromfenbrennnerU. Ecology of human development: Experiments by nature and design. Cambridge, MA: Harvard University Press, 1979.
28.
KelleyANCurtisMGWielingE. Expanding the traumatic stress framework to incorporate a socioecological family systems perspective. Fam Process2022; 61: 476–489.
29.
BakkerABDemeroutiE. The spillover-crossover model. In: Current issues in work and organizational psychology. London: Routledge, 2018, pp. 140–152.
30.
Nelson GoffBSSmithDB. Systemic traumatic stress: the couple adaptation to traumatic stress model. J Marital Fam Ther2005; 31: 145–157.
31.
AppelbaumMCooperHKlineRB, et al.Journal article reporting standards for quantitative research in psychology: the APA publications and communications board task force report. Am Psychol2018; 73: 3–25.
32.
EtikanIBalaK. Sampling and sampling methods. Biom Biostat Int J2017; 5: 215–217.
33.
LeavyP.Research design: quantitative, qualitative, mixed methods, arts-based, and community-based participatory research approaches. New York: The Guilford Press, 2017.
34.
QualtricsXM. Qualtrics. 2005.
35.
WillisEBeidelDBowersC, et al.Using a mobile application to address stress-related symptoms in emergency dispatchers. Ann Emerg Dispatch & Response2020; 8: 9–15.
ForkusSRRaudalesAMRafiuddinHS, et al.The posttraumatic stress disorder (PTSD) checklist for DSM–5: a systematic review of existing psychometric evidence. Clinical Psychology: Science and Practice2023; 30: 110–121.
38.
GrayMJLitzBTHsuJL, et al.Psychometric properties of the life events checklist. Assessment2004; 11: 330–341.
39.
WeisCNWebbEKStevensSK, et al.Scoring the life events checklist: comparison of three scoring methods. Psychol Trauma2022; 14: 714–720.
40.
SherbourneCDStewartAL. The MOS social support survey. Soc Sci Med1991; 32: 705–714.
WeissDSBrunetABestSR, et al.Frequency and severity approaches to indexing exposure to trauma: the critical incident history questionnaire for police officers. J Trauma Stress2010; 23: 734–743.
43.
WeissDSMarmarCR. Assessing psychological trauma and PTSD. In: WilsonJPKeaneTM (eds) Assessing psychological trauma and PTSD: a handbook for practitioners. New York: Guilford Press, 1997, pp.399–411.
44.
American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 4th ed. Washington, DC: American Psychiatric Association, 1994.
45.
ChangSKimW-HJungY-E, et al.Clinical utility of impact of event scale–revised for diagnostic and statistical manual of mental disorders-posttraumatic stress disorder. Psychiatry Investig2024; 21: 870–876.
46.
HendrickSS. A generic measure of relationship satisfaction. J Marriage Fam1988; 50: 93–98.
47.
VaughnMBaierMEM. Reliability and validity of the relationship assessment scale. Am J Fam Ther1999; 27: 137–147.
48.
R Core Team. R: A language and environment for statistical computing. R Foundation for Statistical Computing, 2019.
49.
BehrendtS.Add Standardized Regression Coefficients to Linear-Model-Objects. R package version 4.3.1. 2023.
50.
CreamerMBellRFaillaS. Psychometric properties of the impact of event scale—revised. Behav Res Ther2003; 41: 1489–1496.
51.
CohenSWillsTA. Stress, social support, and the buffering hypothesis. Psychol Bull1985; 98: 310–357.
52.
KautzMMCollinsASchechterCB, et al.Longitudinal trajectories of PTSD symptoms predict levels of posttraumatic growth in world trade center responders. Chronic Stress2022; 6: 1–11.
53.
BennettPWilliamsYPageN, et al.Associations between organizational and incident factors and emotional distress in emergency ambulance personnel. Br J Clin Psychol2005; 44: 215–226.
54.
SterudTHemELauB, et al.A comparison of general and ambulance specific stressors: predictors of job satisfaction and health problems in a nationwide one-year follow-up study of Norwegian ambulance personnel. J Occup Med Toxicol2011; 6: 1–9.
55.
FeldmanTRCarlsonCLRiceLK, et al.Factors predicting the development of psychopathology among first responders: a prospective, longitudinal study. Psychol Trauma2021; 13: 75–83.
56.
RetiTde TerteIStephensC. Perceived social support predicts psychological distress for ambulance personnel. Traumatology2022; 28: 267–278.
57.
ClearyECurranDKellyG, et al.The meta-analytic relationship between secondary traumatic stress and vicarious posttraumatic growth in adults. Traumatology2023; 29: 36–45.
58.
RusuPPNussbeckFWLeuchtmannL, et al.Stress, dyadic coping, and relationship satisfaction: a longitudinal study disentangling timely stable from yearly fluctuations. PloS One2020; 15: 1–23.
59.
SharpM-LSolomonNHarrisonV, et al.The mental health and wellbeing of spouses, partners and children of emergency responders: a systematic review. PLoS One2022; 17: 1–23.
60.
Plano-ClarkVLAndersonNWertzJA, et al.Conceptualizing longitudinal mixed methods designs: a methodological review of health sciences research. J Mix Methods Res2015; 9: 297–319.
61.
ChowdhuryRShahDPayalAR. Healthy worker effect phenomenon: revisited with emphasis on statistical methods–a review. Indian J Occup Environ Med2017; 21: 2–8.
62.
Bergen-CicoDLaneSThompsonM, et al.The impact of post-traumatic stress on first responders: analysis of cortisol, anxiety, depression, sleep impairment and pain. International Paramedic Practice2015; 5: 78–87.
63.
CrowtherMEFergusonSAAdamsRJ, et al.Sleep, dietary intake and physical activity changes with onset of shift work in intern paramedics. Paramedicine2024; 22: 127–139.
