Risk of psychological distress, pervasiveness of stigma and utilisation of support services: Exploring paramedic perceptions

Kelly Mackinnon, Timothy Everett, Lisa Holmes, Erin Smith, Brennen Mills



Paramedics are exposed to significant and cumulative stressors that contribute to poor mental health. The provision of effective and engaging mental health support is essential in improving overall wellbeing. Many ambulance services have adapted their available support services to reflect this need. However, there remains limited research into the perceived efficacy of these services and barriers that limit uptake from paramedics.


Paramedics and ambulance volunteers from Australia and New Zealand were invited to complete an online survey consisting of a series of Likert-scale and open-ended response questions. The well-validated Kessler Psychological Distress Scale was also incorporated into the online survey.


A total of 184 participants completed the survey. A total of 50 (27%) participants reported high/very high levels of psychological distress. Participants exposed to at least one adverse event while working reported higher psychological distress scores than those that had not. Just over half (51%) of all participants disagreed/strongly disagreed there was no stigma associated with seeking mental health support from paramedic colleagues and 54% of participants disagreed/strongly disagreed there was no stigma from managerial staff.


These findings suggest paramedics are at a greater risk of psychological distress than the general population. This is particularly problematic given there is a clear perception of ongoing stigma among paramedics associated with the utilisation of mental health support services. Future research should explore methods for reducing stigma and encouraging help-seeking behaviours in this vulnerable population throughout all phases of an emergency service workers career.


paramedic; first responder; mental health; stigma; support

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Fong N, Taylor I, MacFarlane A. Review of St John Ambulance: health and wellbeing, and workplace culture. Available at: www.stjohnambulance.com.au/docs/default-source/corporatepublications/independent-oversight-panel-report-160908.pdf?sfvrsn=2 [Accessed 30 October 2019].

Smith E, Walker T, Burkle F. Lessons in post-disaster self-care from 9/11 paramedics and emergency medical technicians. Prehosp Disaster Med 2019;34:335-9.

Bužga M, Jirák Z, Bužgová R. State of physical health and fitness of paramedics in Czech Republic. Wulfenia 2015;22.

Tsismenakis A, Christophi C, Burress J, et al. The obesity epidemic and future emergency responders. Obesity 2009;17:1648-50.

Gamble R, Stevens A, McBrien H, et al. Physical fitness and occupational demands of the Belfast ambulance service. Br J Ind Med 1991;48:592.

Kent G, Mason P, Batt A. Eat, sleep and be healthy - a paramedic’s guide to healthier shift work. Faculty & Staff Publications - Public Safety. Available at: https://first.fanshawec.ca/fhcsps_publicsafety_facultystaffpublications/8 [Accessed 30 October 2019].

Sofianopoulos S, Williams B, Archer F. Paramedics and the effects of shift work on sleep: a literature review. Emerg Med J 2012;29:152.

LeBlanc V, Regehr C, Tavares W, et al. the impact of stress on paramedic performance during simulated critical events. Prehosp Disaster Med 2012;27:369-74.

Clompus S, Albarrin J. Exploring the nature of resilience in paramedic practice: a psycho-social study. Int Emerg Nurs 2016;28:1-7.

Courtney J, Francis A, Paxton S. Caring for the carers: fatigue, sleep, and mental health in Australian paramedic shift workers. Australian and New Zealand Journal of Organisational Psychology 2010;3:32-41.

Holmes L, Jones R, Brightwell R, Cohen L. Preparing student paramedics for the mental health challenges of the profession using the wisdom of the experienced. Australian Paramedic 2019;2:4-14.

Rickwood D, Deane F, Wilson C, Ciarrochi J. Young people’s help-seeking for mental health problems. Australian e-Journal for the Advancement of Mental Health 2005;4:4-27.

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.

Jones S. Describing the mental health profile of first responders: a systematic review. J Am Psychiatr Nurses Assoc 2017;23.

Marshall R, Milligan-Saville J, Mitchell P, Bryant R, Harvey S. A systematic review of the usefulness of pre-employment and pre-duty screening in predicting mental health outcomes amongst emergency workers. Psychiatry Res 2017;253:129-37.

Commonwealth of Australia. The people behind 000: mental health of our first responders. Available at: www.aph.gov.au/Parliamentary_Business/Committees/Senate/Education_and_Employment/Mentalhealth/Report [Accessed 30 October 2019].

Beyond Blue Ltd. Answering the call national survey. National mental health and wellbeing study of police and emergency services – final report. Available at: http://resources.beyondblue.org.au/prism/file?token=BL/1898 [Accessed 30 October 2019].

Turning Point. Beyond the emergency: a national study of ambulance responses to men’s mental health. Richmond, Victoria. Available at: www.beyondblue.org.au/docs/default-source/default-document-library/beyond-the-emergency-report.pdf [Accessed 30 October 2019].

Ambulance Victoria. Mental health and wellbeing strategy 2016-2019. Available at: www.ambulance.vic.gov.au/wp-content/uploads/2016/10/ambulance-victoria-mental-health-strategy-2016-19.pdf [Accessed 30 October 2019].

Sirens of Silence Charity Inc. Supporting our triple zero heroes. Available at: www.sirensofsilence.org.au/ [Accessed 30 October 2019].

Department of Health Queensland Ambulance Service. A multi-method evaluation and examination of QAS staff support services. Available at: www.aph.gov.au [Accessed 30 October 2019].

Varker T, Metcalf O, Forbes D, et al. Research into Australian emergency services personnel mental health and wellbeing: an evidence map. Aust N Z J Psychiatry 2018;52:129-48.

Cooper S, Porter J, Endacott R. Mixed methods research: a design for emergency care research? Emer Med J 2011;28:682-5.

Mewton L, Kessler R, Slade T, et al. The psychometric properties of the Kessler Psychological Distress Scale (K6) in a general population sample of adolescents. Psychol Assess 2016;28:1232-42.

Donker T, Comijs H, Cuijpers P, et al. The validity of the Dutch K10 and extended K10 screening scales for depressive and anxiety disorders. Psychiatry Res 2010;176:45-50.

Shakespeare-Finch J, Daley E. Workplace belongingness, distress, and resilience in emergency service workers. Psychol Trauma 2017;9:32-5.

Tuckey M, Scott J. Group critical incident stress debriefing with emergency services personnel: a randomized controlled trial. Anxiety Stress Coping 2014;27.

Kessler R, Barker P, Colpe L, et al. Screening for serious mental illness in the general population. Arch Gen Psychiatry 2003;60:184-9.

National Health Survey: first results, 2014-15. 4364.0.55.001. Australian Bureau of Statistics. Available at: www.ausstats.abs.gov.au/ausstats/subscriber.nsf/0/CDA852A349B4CEE6CA257F150009FC53/$File/national%20health%20survey%20first%20results,%202014-15.pdf [Accessed 30 October 2019].

Bennett P, Williams Y, Page N, Hood K, Woollard M. Levels of mental health problems among UK emergency ambulance workers. Emerg Med J 2004;21:235-6.

Skeffington P, Rees C, Mazzucchelli T. Trauma exposure and post-traumatic stress disorder within fire and emergency services in Western Australia. Aust J Psychol 2017;69:20-8.

Bennett P, Williams Y, Page N, et al. Associations between organizational and incident factors and emotional distress in emergency ambulance personnel. Br J Clin Psychol 2005;44:215-26.

Sterud T, Hem E. Lau B, Ekeberg Ø. 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 Toxicol 2011;6:10.

The Council of Ambulance Authorities Inc. Health and Wellbeing Strategy – a resilient workforce and healthy workplace. Available at: www.caa.net.au/images/documents/health-wellbeing/CAA-Mental-Health-and-Wellbeing-Strategy-v3-July17.pdf [Accessed 30 October 2019].

DOI: http://dx.doi.org/10.33151/ajp.17.764


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