Factors associated with psychiatric morbidity, post-traumatic stress disorder and post-traumatic growth in paramedic first responders: the role of core beliefs


trauma effects
core beliefs

How to Cite

Surgenor LJ, Snell DL, Dorahy M. Factors associated with psychiatric morbidity, post-traumatic stress disorder and post-traumatic growth in paramedic first responders: the role of core beliefs. Australasian Journal of Paramedicine [Internet]. 2020Jan.14 [cited 2021Dec.8];17. Available from: https://ajp.paramedics.org/index.php/ajp/article/view/727



Paramedics are routinely exposed to traumatic events. This study describes the rates of post-traumatic stress disorder (PTSD), psychiatric morbidity and levels of post-traumatic growth (PTG) in New Zealand first responder paramedics, exploring a mix of demographic, professional, crewing status and exposure risk factors associated with these outcomes and their associations with core belief disruptions.


A cross-sectional study recruited paramedics (N=579) working in a first responder role. Univariate and multivariate logistic and linear regressions were conducted to identify predictors of PTSD, non-specific psychiatric morbidity and PTG in trauma-exposed participants.


Two-thirds (66.3%) reported significant psychiatric morbidity, with volunteer paramedics being significantly less at risk when compared with professional paramedics (OR=0.52; 95% CI: 0.31-0.87; p<0.01). Probable PTSD was reported by 14.6% of participants. Older age reduced the odds of this (OR=0.94; 95% CI: 0.92-0.98; p<0.01) while experiencing greater disruptions in core beliefs increased the odds (OR=2.75; 95% CI: 2.00-3.77; p<0.01). Being female (t=4.70; p<0.01) and experiencing greater core belief disruption (t=7.54; p<0.01) (adjusted R2=0.27) independently contributed to PTG.


Although PTSD rates were typical of first responders generally, psychiatric morbidity rates were high and may be more prevalent in professional staff. Contextual and methodological factors may have influenced these outcomes. Core belief disruptions predict both negative and positive emotional states, suggesting their important role in workplace interventions.




Bentley MA, Levine R. A national assessment of the health and safety of emergency medical services professionals. Prehosp Disaster Med 2016;31:S96-104. doi: 10.1017/S1049023X16001102.

Berger W, Coutinho ES, Figueira I, et al. 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 2012;47:1001-11. doi: 10.1007/s00127-011-0408-2.

Rybojad B, Aftyka A, Baran M, Rzońca P. Risk factors for posttraumatic stress disorder in Polish aramedics: a pilot study. J Emerg Med 2016;50:270-6. doi: 10.1016/j.jemermed.2015.06.030.

Berger W, Figueira I, Maurat AM, et al. Partial and full PTSD in Brazilian ambulance workers: prevalence and impact on health and on quality of life. J Trauma Stress 2007;20:637-42. doi: 0.1002/jts.20242.

McFarlane AC, Bookless C. The effect of PTSD on interpersonal relationships: issues for emergency service workers. Sex Relation Ther 2010;16:261-7. doi: 10.1080/14681990124457.

Pietrzak RH, Goldstein RB, Southwick SM, Grant BF. 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 2011;25:456-65. doi: 10.1016/j.janxdis.2010.11.010.

Luftman K, Aydelotte J, Rix K, et al. PTSD in those who care for the injured. Injury 2017;48:293-6. doi: 10.1016/j.injury.2016.11.001.

Fjeldheim CB, Nöthling J, Pretorius K, et al. Trauma exposure, posttraumatic stress disorder and the effect of explanatory variables in paramedic trainees. BMC Emerg Med 2014;14:11. doi: 10.1186/1471-227X-14-11.

Petrie K, Milligan-Saville J, Gayed A, et al. Prevalence of PTSD and common mental disorders amongst ambulance personnel: a systematic review and meta-analysis. Soc Psychiatry Psychiatr Epidemiol 2018;53:897-909. doi: 10.1007/s00127-018-1539-5.

Gouweloos-Trines J, Tyler MP, Giummarra MJ, et al. Perceived support at work after critical incidents and its relation to psychological distress: a survey among prehospital providers. Emerg Med J 2017;34:816-22. doi: 10.1136/emermed-2017-206584.

Goodwin L, Ben-Zion I, Fear NT, et al. Are reports of psychological stress higher in occupational studies? A systematic review across occupational and population based studies. PLoS One 2013;8:e78693. doi: 10.1371/journal.pone.0078693.

Boyle MJ, Williams B, Bibby C, et al. The first seven years of the metropolitan fire brigade emergency responder programme - an overview of incidents attended. Open Access Emerg Med 2010;2:77-82.

Haraldsdottir HA, Gudmundsdóttir D, Romano E, et al. Volunteers and professional rescue workers: traumatization and adaptation after an avalanche disaster. J Emerg Manag 2014;12:457-66. doi: 10.5055/jem.2014.0209.

Mather M. Extra funding for single-crew ambulances announced. Available at: www.stuff.co.nz/national/92544652/extra-funding-for-singlecrew-ambulances-set-to-be-announced [Accessed 14 May 2017].

Koenen KC, Ratanatharathorn A, Ng L, et al. Posttraumatic stress disorder in the world mental health surveys. Psychol Med 2017;47:2260-74. doi: 10.1017/S0033291717000708.

McLean CP, Asnaani A, Litz BT, Hofmann SG. Gender differences in anxiety disorders: prevalence, course of illness, comorbidity and burden of illness. J Psychiatr Res 2011;45:1027-35. doi: 10.1016/j.jpsychires.2011.03.006.

Donnelly EA, Bradford P, Davis M, Hedges C, Klingel M. Predictors of posttraumatic stress and preferred sources of social support among Canadian paramedics. CJEM 2016;18:205-12.doi: 10.1017/cem.2015.92.

Tolin DF, Foa EB. Sex differences in trauma and posttraumatic stress disorder: a quantitative review of 25 years of research. Psychol Bull 2006;132:959-92. doi: 10.1037/0033-2909.132.6.959.

Geronazzo-Alman L, Eisenberg R, Shen S, et al. Cumulative exposure to work-related traumatic events and current post-traumatic stress disorder in New York City's first responders. Compr Psychiatry 2017;74:134-43. doi: 10.1016/j.comppsych.2016.12.003.

Yehuda R, Hoge CW, McFarlane AC, et al. Post-traumatic stress disorder. Nat Rev Dis Primers 2015;1:15057. doi: 10.1038/nrdp.2015.57.

Corneil W, Beaton R, Murphy S, Johnson C, Pike K. Exposure to traumatic incidents and prevalence of posttraumatic stress symptomatology in urban firefighters in two countries. J Occup Health Psychol 1999;4:131-41.

Tedeschi RG, Calhoun LG. The Posttraumatic Growth Inventory: measuring the positive legacy of trauma. J Trauma Stress 1996;9:455-71.

Taku K, Cann A, Tedeschi RG, Calhoun LG. Core beliefs shaken by an earthquake correlate with posttraumatic growth. Psychol Trauma 2015;7:563-9. doi: 10.1037/tra0000054.

Liu AN, Wang LL, Li HP, Gong J, Liu XH. Correlation between posttraumatic growth and posttraumatic stress disorder symptoms based on Pearson correlation coefficient: a meta-analysis. J Nerv Ment Dis 2017;205:380-9. doi: 10.1097/Nmd.0000000000000605.

Zhou X, Wu X, Fu F, An Y. Core belief challenge and rumination as predictors of PTSD and PTG among adolescent survivors of the Wenchuan earthquake. Psychol Trauma 2015;7:391-7. doi: 10.1037/tra0000031.

Connerty TJ, Knott V. Promoting positive change in the face of adversity: experiences of cancer and post-traumatic growth. Eur J Cancer Care (Engl) 2013;22:334-44. doi: 10.1111/ecc.12036.

Lilly MM, Pierce H. PTSD and depressive symptoms in 911 telecommunicators: the role of peritraumatic distress and world assumptions in predicting risk. Psychol Trauma 2013;5:135-41. doi: 10.1037/a0026850.

Cann A, Calhoun LG, Tedeschi RG, et al. The Core Beliefs Inventory: a brief measure of disruption in the assumptive world. Anxiety Stress Coping 2010;23:19-34. doi: 10.1080/10615800802573013.

Galloucis M, Silverman MS, Francek HM. The impact of trauma exposure on the cognitive schemas of a sample of paramedics. Int J Emerg Ment Health 2000;2:5-18.

Jin YC, Xu JP, Liu DY. The relationship between post traumatic stress disorder and post traumatic growth: gender differences in PTG and PTSD subgroups. Soc Psychiatry Psychiatr Epidemiol 2014;49:1903-10. doi: 10.1007/s00127-014-0865-5.

Calhoun LG, Cann A, Tedeschi RG. The posttraumatic growth model: Sociocultural considerations, in posttraumatic growth and culturally competent practice: Lessons learned from around the globe. In: Weiss T & Berger R, editors. Posttraumatic growth and culturally competent practice: Lessons learned. Hoboken, NJ: Wiley. 2010, John Wiley & Sons Inc: Hoboken, NJ, US. p.1-14.

Aspinwall LG, Tedeschi RG. The value of positive psychology for health psychology: progress and pitfalls in examining the relation of positive phenomena to health. Ann Behav Med 2010;39:4-15. doi: 10.1007/s12160-009-9153-0.

SurveyMonkey Inc. San Mateo, California, USA. Available at: www.surveymonkey.com.

Surgenor LJ, Snell DL, Dorahy MJ. Posttraumatic stress symptoms in police staff 12-18 months after the Canterbury earthquakes. J Traum Stress 2015;28:162-6.

Schlenger WE, Caddell JM, Ebert L, et al. Psychological reactions to terrorist attacks: findings from the National Study of Americans' Reactions to September 11. JAMA 2002;288:581-8. doi: 10.1001/jama.288.5.581.

Weathers FW, Litz BT, Keane TM, Palmieri PA, Marx BP, Schnurr PP. Life Events Checklist for DSM-5 (LEC-5) 2013. Available at: www.ptsd.va.gov

May CL, Wisco BE. Defining trauma: how level of exposure and proximity affect risk for posttraumatic stress disorder. Psychol Trauma 2016;8:233-40. doi: 10.1037/tra0000077.

Blevins CA, Weathers FW, Davis MT, Witte TK, Domino JL. The Posttraumatic Stress Disorder Checklist for DSM-5 (PCL-5): development and initial psychometric evaluation. J Trauma Stress 2015;28:489-98. doi: 10.1002/jts.22059.

Bovin MJ, Marx BP, Weathers FW, et al. Psychometric properties of the PTSD Checklist for Diagnostic and Statistical Manual of Mental Disorders-Fifth Edition (PCL-5) in veterans. Psychol Assess 2016;28:1379-91. doi: 10.1037/pas0000254.

Wortmann JH, Jordan AH, Weathers FW, et al. Psychometric analysis of the PTSD Checklist-5 (PCL-5) among treatment-seeking military service members. ibid. 2016;28:1392-403. doi: 10.1037/pas0000260.

Kehl D, Knuth D, Hulse L, Schmidt S; BeSeCu-Group. Predictors of postevent distress and growth among firefighters after work-related emergencies: a cross-national study. Psychol Trauma 2015;7:203-11. doi: 10.1037/a0037954.

Goldberg D. Use of the general health questionnaire in clinical work. BMJ (Clin Res Ed) 1986;293:1188-9.

Hankins M. The factor structure of the twelve item General Health Questionnaire (GHQ-12): the result of negative phrasing? Clin Pract Epidemiol Ment Health 2008;4:10. doi: 10.1186/1745-0179-4-10.

Rey JJ, Abad FJ, Barrada JR, Garrido LE, Ponsoda V. The impact of ambiguous response categories on the factor structure of the GHQ-12. Psychol Assess 2014;26:1021-30. doi: 10.1037/a0036468.

Mattei A, Fiasca F, Mazzei M, Abbossida V, Bianchini V. Burnout among healthcare workers at L'Aquila: its prevalence and associated factors. Psychol Health Med 2017;22:1262-70. doi: 10.1080/13548506.2017.1327667.

Stanley IH, Hom MA, Spencer-Thomas S, Joiner TE. Examining anxiety sensitivity as a mediator of the association between PTSD symptoms and suicide risk among women firefighters. J Anxiety Disord 2017;50:94-102. doi: 10.1016/j.janxdis.2017.06.003.

Lancaster SL, Klein KR, Nadia C, Szabo L, Mogerman B. An integrated model of posttraumatic stress and growth. J Trauma Dissociation 2015;16:399-418. doi: 10.1080/15299732.2015.1009225.

Stutts LA, Stanaland AW. Posttraumatic growth in individuals with amputations. Disabil Health J 2016;9:167-71. doi: 10.1016/j.dhjo.2015.07.005.

Kilic C, Magruder KM, Koryurek MM. Does trauma type relate to posttraumatic growth after war? A pilot study of young Iraqi war survivors living in Turkey. Transcult Psychiatry 2016;53:110-23. doi: 10.1177/1363461515612963.

Jaffe AE, DiLillo D, Hoffman L, Haikalis M, Dykstra RE. Does it hurt to ask? A meta-analysis of participant reactions to trauma research. Clin Psychol Rev 2015;40:40-56. doi: 10.1016/j.cpr.2015.05.004.