Prevalence of anxiety, depression, and post-traumatic stress disorder among paramedic students: a systematic review and meta-analysis.
Common mental disorder
Meta-analysis
Paramedic
Paramedicine
Paramedicine student
Prevalence
Journal
Social psychiatry and psychiatric epidemiology
ISSN: 1433-9285
Titre abrégé: Soc Psychiatry Psychiatr Epidemiol
Pays: Germany
ID NLM: 8804358
Informations de publication
Date de publication:
12 Sep 2024
12 Sep 2024
Historique:
received:
12
10
2023
accepted:
28
08
2024
medline:
12
9
2024
pubmed:
12
9
2024
entrez:
12
9
2024
Statut:
aheadofprint
Résumé
There are elevated mental health concerns in paramedic students, but estimates vary between studies and countries, and no review has established the overall prevalence. This systematic review addressed this by estimating the global prevalence of common mental health disorders, namely anxiety, depression, and post-traumatic stress disorder (PTSD), in paramedic students internationally. A systematic search of six databases, including MEDLINE, EMBASE, PsycINFO, CINAHL, Scopus, and medRxiv, was conducted to identify studies relating to mental health among paramedicine students. The search encompassed studies from inception until February 2023. To be considered for inclusion in the review, the studies had to report prevalence data on at least one symptom of anxiety, depression, or PTSD in paramedicine students, using quantitative validated scales. The quality of the studies was assessed using Joanna Briggs Institute (JBI) Checklist, which is a specific methodological tool for assessing prevalence studies. Subgroup analyses were not conducted due to insufficient data. 1638 articles were identified from the searches, and 193 full texts were screened, resulting in 13 papers for the systematic review and meta-analysis. The total number of participants was 1064 from 10 countries. The pooled prevalence of moderate PTSD was 17.9% (95% CI 14.8-21.6%), anxiety was 56.4% (95% CI 35,9-75%), and depression was at 34.7% (95% CI 23.4-48.1%). This systematic review and meta-analysis has found that paramedicine students globally exhibit a high prevalence of moderate PTSD, anxiety, and depression. The prevalence of these mental health conditions surpasses those among paramedic providers and the general population, as indicated by previous reviews. Further research is therefore warranted to determine appropriate support and interventions for this group.
Identifiants
pubmed: 39264380
doi: 10.1007/s00127-024-02755-6
pii: 10.1007/s00127-024-02755-6
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Informations de copyright
© 2024. The Author(s).
Références
Ahn E, Kang H (2018) Introduction to systematic review and meta-analysis. Korean J Anesthesiol 71(2):103–112. https://doi.org/10.4097/kjae.2018.71.2.103
doi: 10.4097/kjae.2018.71.2.103
pubmed: 29619782
pmcid: 5903119
Alhabeeb AA, Al-Duraihem RA, Alasmary S, Alkhamaali Z, Althumiri NA, BinDhim NF (2023) National screening for anxiety and depression in Saudi Arabia 2022. Front Public Health 11:1213851. https://doi.org/10.3389/fpubh.2023.1213851
doi: 10.3389/fpubh.2023.1213851
pubmed: 37441650
pmcid: 10333514
Almutairi I, Al-Rashdi M, Almutairi A (2020) Prevalence and predictors of depression, anxiety and stress symptoms in paramedics at Saudi Red Crescent Authority. Saudi J Med Med Sci 8(2):105. https://doi.org/10.4103/sjmms.sjmms_227_18
doi: 10.4103/sjmms.sjmms_227_18
pubmed: 32587491
pmcid: 7305676
Alshahrani K, Johnson J, O’Connor DB (2022) Coping strategies and social support are associated with post-traumatic stress disorder symptoms in Saudi paramedics. Int J Emerg Serv 11(2):361–373. https://doi.org/10.1108/IJES-08-2021-0056
doi: 10.1108/IJES-08-2021-0056
Alshahrani KM, Johnson J, Hill L, Alghunaim TA, Sattar R, O’Connor DB (2022) A qualitative, cross-cultural investigation into the impact of potentially traumatic work events on Saudi and UK ambulance personnel and how they cope. BMC Emerg Med 22(1):116. https://doi.org/10.1186/s12873-022-00666-w
doi: 10.1186/s12873-022-00666-w
pubmed: 35761202
pmcid: 9235175
Alzahrani A, Alzahrani A (2021) Abdulrahman Bayazeed Department of Family Medicine, King Abdulaziz Medical City Ministry of the National Guard-Health Affairs. Medicine https://doi.org/10.21203/rs.3.rs-956849/v1
Alzahrani A, Keyworth C, Wilson C, Johnson J (2023) Causes of stress and poor wellbeing among paramedic students in Saudi Arabia and the United Kingdom: a cross-cultural qualitative study. BMC Health Serv Res 23(1):444. https://doi.org/10.1186/s12913-023-09374-y
doi: 10.1186/s12913-023-09374-y
pubmed: 37147658
pmcid: 10163716
Bazrafshan M-R, Jokar M, Rahmati M, Ahmadi S, Kavi E, Sookhak F, Aliabadi SH (2019) The Relationship between Depression and Internet Addiction among Paramedical Students in Larestan, Iran. J Clin Diagnost Res. https://doi.org/10.7860/JCDR/2019/36363.12742
doi: 10.7860/JCDR/2019/36363.12742
Begg CB, Mazumdar M (1994) Operating characteristics of a rank correlation test for publication bias. Biometrics 50(4):1088. https://doi.org/10.2307/2533446
doi: 10.2307/2533446
pubmed: 7786990
Birtill M, King J, Jones D, Thyer L, Pap R, Simpson P (2021) The use of immersive simulation in paramedicine education: a scoping review. Interact Learn Environ https://doi.org/10.1080/10494820.2021.1889607
Biondi-Zoccai G, Lotrionte M, Landoni G, Modena MG (2011) The rough guide to systematic reviews andmeta-analyses. HSR Proceedings in Intensive Care & Cardiovascular Anesthesia 3(3):161–173
Bonde JPE (2008) Psychosocial factors at work and risk of depression: a systematic review of the epidemiological evidence. Occupational and Environmental Medicine 65(7):438. https://doi.org/10.1136/oem.2007.038430
doi: 10.1136/oem.2007.038430
pubmed: 18417557
Borenstein M, Hedges LV, Higgins JPT, Rothstein HR (2021) Introduction to Meta-Analysis ((Second ed.)). Wiley
Borenstein M, Hedges LV, Higgins JPT, Rothstein HR (2010) A basic introduction to fixed-effect and random-effects models for meta-analysis. Res Synthesis Methods 1(2):97–111. https://doi.org/10.1002/jrsm.12
doi: 10.1002/jrsm.12
Byrne A, Barber R, Lim CH (2021) Impact of the <scp>COVID</scp> -19 pandemic – a mental health service perspective. Prog Neurol Psychiatry 25(2):27. https://doi.org/10.1002/pnp.708
doi: 10.1002/pnp.708
Debray TPA, Moons KGM, Riley RD (2018) Detecting small-study effects and funnel plot asymmetry in meta-analysis of survival data: a comparison of new and existing tests. Res Synth Methods 9(1):41–50. https://doi.org/10.1002/jrsm.1266
doi: 10.1002/jrsm.1266
pubmed: 28975717
Egger M, Smith GD, Schneider M, Minder C (1997) Papers Bias in meta-analysis detected by a simple, graphical test. BMJ. https://doi.org/10.1136/bmj.315.7109.629
doi: 10.1136/bmj.315.7109.629
pubmed: 9432252
pmcid: 2127994
Fjeldheim CB, Nöthling J, Pretorius K, Basson M, Ganasen K, Heneke R, Cloete KJ, Seedat S (2014) Trauma exposure, posttraumatic stress disorder and the effect of explanatory variables in paramedic trainees. BMC Emerg Med 14(1):11. https://doi.org/10.1186/1471-227X-14-11
doi: 10.1186/1471-227X-14-11
pubmed: 24755358
pmcid: 4004503
Frajerman A, Chaumette B, Krebs M-O, Morvan Y (2022) Mental health in medical, dental and pharmacy students: a cross-sectional study. J Affect Disord Rep 10:100404. https://doi.org/10.1016/j.jadr.2022.100404
doi: 10.1016/j.jadr.2022.100404
pubmed: 35992770
pmcid: 9378210
Fullerton CS, Ursano RJ, Wang L (2004) Acute stress disorder, posttraumatic stress disorder, and depression in disaster or rescue workers. Am J Psych 161(8):1370–1376. https://doi.org/10.1176/appi.ajp.161.8.1370
doi: 10.1176/appi.ajp.161.8.1370
pubmed: 15285961
GBD Results Tool. In: Global Health Data Exchange [website]. Seattle: Institute for Health Metrics and Evaluation (2019) ( https://vizhub.healthdata.org/gbd-results?params=gbd-api-2019-permalink/716f37e05d94046d6a06c1194a8eb0c9 , accessed 29 April 2024).
Geissbühler M, Hincapié CA, Aghlmandi S et al (2021) Most published meta-regression analyses based on aggregate data suffer from methodological pitfalls: a meta-epidemiological study. BMC Med Res Methodol 21:123. https://doi.org/10.1186/s12874-021-01310-0
doi: 10.1186/s12874-021-01310-0
pubmed: 34130658
pmcid: 8207572
Gilroy R (2018). Mental health: caring for the paramedic workforce. J Paramed Pract 10(5):192–193. https://doi.org/10.12968/jpar.2018.10.5.192
Grevin F (1996) Posttraumatic Stress Disorder, Ego Defense Mechanisms, and Empathy among Urban Paramedics. Psychol Rep https://doi.org/10.2466/pr0.1996.79.2.483
Guadagni V, Cook E, Hart C, Burles F, Iaria G (2018) Poor sleep quality affects empathic responses in experienced paramedics. Sleep Biol Rhythms 16(3):365–368. https://doi.org/10.1007/s41105-018-0156-8
doi: 10.1007/s41105-018-0156-8
Hansen CD, Rasmussen K, Kyed M, Nielsen KJ, Andersen JH (2012) Physical and psychosocial work environment factors and their association with health outcomes in Danish ambulance personnel – a cross-sectional study. BMC Public Health 12(1):534. https://doi.org/10.1186/1471-2458-12-534
doi: 10.1186/1471-2458-12-534
pubmed: 22824415
pmcid: 3439275
Harvey SB, Modini M, Joyce S, Milligan-Saville JS, Tan L, Mykletun A, Bryant RA, Christensen H, Mitchell PB (2017) Can work make you mentally ill? a systematic meta-review of work-related risk factors for common mental health problems. Occupat Environ Med 74(4):301–310. https://doi.org/10.1136/oemed-2016-104015
doi: 10.1136/oemed-2016-104015
pubmed: 28108676
Hegg-Deloye S, Brassard P, Jauvin N, Prairie J, Larouche D, Poirier P, Tremblay A, Corbeil P (2014) Current state of knowledge of post-traumatic stress, sleeping problems, obesity and cardiovascular disease in paramedics. Emerg Med J 31(3):242–247. https://doi.org/10.1136/emermed-2012-201672
doi: 10.1136/emermed-2012-201672
pubmed: 23314206
Higgins JPT (2003) Measuring inconsistency in meta-analyses. BMJ 327(7414):557–560. https://doi.org/10.1136/bmj.327.7414.557
doi: 10.1136/bmj.327.7414.557
pubmed: 12958120
pmcid: 192859
Higgins JP (2008) Cochrane handbook for systematic reviews of interventions (version 5.0. 1)
Holmes L, Jones R, Brightwell R, Cohen L (2017) Student paramedic anticipation, confidence and fears: Do undergraduate courses prepare student paramedics for the mental health challenges of the profession? Australasian J Paramed https://doi.org/10.33151/ajp.14.4.545
Huang YQG (2022) Prevalence of Anxiety and Depression Among Pharmacy Students: A Systematic Review and Meta-Analysis
Ibrahim AK, Kelly SJ, Adams CE, Glazebrook C (2013) A systematic review of studies of depression prevalence in university students. J Psychiatr Res 47(3):391–400. https://doi.org/10.1016/j.jpsychires.2012.11.015
doi: 10.1016/j.jpsychires.2012.11.015
pubmed: 23260171
Institute of Medicine (US) Committee on Standards for Systematic Reviews of Comparative Effectiveness Research. In: Eden J, Levit L, Berg A, Morton S(Eds.). (2011). Finding What Works in Health Care: Standards for Systematic Reviews. National Academies Press (US)
Khan WAA, Conduit R, Kennedy GA, Jackson ML (2020) The relationship between shift-work, sleep, and mental health among paramedics in Australia. Sleep Health 6(3):330–337. https://doi.org/10.1016/j.sleh.2019.12.002
doi: 10.1016/j.sleh.2019.12.002
pubmed: 32223969
Kirby R, Shakespeare-Finch J, Palk G (2011) Adaptive and maladaptive coping strategies predict posttrauma outcomes in ambulance personnel. Traumatol 17(4):25–34. https://doi.org/10.1177/1534765610395623
doi: 10.1177/1534765610395623
Kola L, Kohrt BA, Hanlon C, Naslund JA, Sikander S, Balaji M, Patel V (2021) Correction to Lancet Psychiatry 2021; Published online Feb 24. https://doi.org/10.1016/S2215-0366(21)00025-0 . The Lancet Psychiatry 8(5):e13. https://doi.org/10.1016/S2215-0366(21)00090-0
Kondirolli F, Sunder N (2022) Mental health effects of education. Health Econ 31(S2):22–39. https://doi.org/10.1002/hec.4565
doi: 10.1002/hec.4565
pubmed: 35797349
pmcid: 9796491
Krifa I, van Zyl LE, Braham A, Ben Nasr S, Shankland R (2022) Mental health during COVID-19 Pandemic: the role of optimism and emotional regulation. Int J Environ Res Public Health 19(3):1413. https://doi.org/10.3390/ijerph19031413
doi: 10.3390/ijerph19031413
pubmed: 35162435
pmcid: 8835172
Lawn S, Roberts L, Willis E, Couzner L, Mohammadi L, Goble E (2020) The effects of emergency medical service work on the psychological, physical, and social well-being of ambulance personnel: a systematic review of qualitative research. BMC Psychiatry 20(1):348. https://doi.org/10.1186/s12888-020-02752-4
doi: 10.1186/s12888-020-02752-4
pubmed: 32620092
pmcid: 7332532
Lowery K, Stokes MA (2005) Role of peer support and emotional expression on posttraumatic stress disorder in student paramedics. J Traum Stress. https://doi.org/10.1002/jts.20016
doi: 10.1002/jts.20016
Lucchetta RC, Lemos IH, Gini ALR, de Cavicchioli SA, Forgerini M, Varallo FR, de Nadai MN, Fernandez-Llimos F, Mastroianni PC (2022) Deficiency and insufficiency of vitamin d in women of childbearing age: a systematic review and meta-analysis. Revista Brasileira de Ginecologia e Obstetrícia/RBGO Gynecology and Obstetrics 44(04):409–424. https://doi.org/10.1055/s-0042-1742409
doi: 10.1055/s-0042-1742409
pubmed: 35211934
Mackinnon K, Everett T, Holmes L, Smith E, Mills B (2020) Risk of psychological distress, pervasiveness of stigma and utilisation of support services: Exploring paramedic perceptions. Australasian J Paramed https://doi.org/10.33151/ajp.17.764
McKinnon A, Lorenz H, Salkovskis P, Wild J (2021) Abstract thinking as a risk factor for the development of posttraumatic stress disorder symptoms in student paramedics. J Trauma Stress. https://doi.org/10.1002/jts.22749
doi: 10.1002/jts.22749
pubmed: 34708439
Mehta D, Bruenig D, Pierce J, Sathyanarayanan A, Stringfellow R, Miller O, Mullens AB, Shakespeare-Finch J (2022) Recalibrating the epigenetic clock after exposure to trauma: The role of risk and protective psychosocial factors. J Psychiatr Res 149:374–381. https://doi.org/10.1016/j.jpsychires.2021.11.026
doi: 10.1016/j.jpsychires.2021.11.026
pubmed: 34823878
Miller O, Shakespeare-Finch J, Bruenig D, Mehta D (2020) DNA methylation of NR3C1 and FKBP5 is associated with posttraumatic stress disorder, posttraumatic growth, and resilience. Psychol Trauma Theory Res Pract Policy 12(7):750–755. https://doi.org/10.1037/tra0000574
doi: 10.1037/tra0000574
Munn Z, Moola S, Lisy K, Riitano D, Tufanaru C (2015) Methodological guidance for systematic reviews of observational epidemiological studies reporting prevalence and cumulative incidence data. Int J Evidence-Based Healthcare 13(3):147–153. https://doi.org/10.1097/XEB.0000000000000054
doi: 10.1097/XEB.0000000000000054
pubmed: 26317388
O’Hara R, Johnson M, Siriwardena AN, Weyman A, Turner J, Shaw D, Mortimer P, Newman C, Hirst E, Storey M, Mason S, Quinn T, Shewan J (2015) A qualitative study of systemic influences on paramedic decision making: care transitions and patient safety. J Health Services Res Policy 20(1_suppl): 45–53. https://doi.org/10.1177/1355819614558472
Pacheco JP, Giacomin HT, Tam WW, Ribeiro TB, Arab C, Bezerra IM, Pinasco GC (2017) Mental health problems among medical students in Brazil: a systematic review and meta-analysis. Rev Bras Psiquiatr 39(4):369–378. https://doi.org/10.1590/1516-4446-2017-2223
doi: 10.1590/1516-4446-2017-2223
pubmed: 28876408
pmcid: 7111407
Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, Shamseer L, Tetzlaff JM, Akl EA, Brennan SE, Chou R, Glanville J, Grimshaw JM, Hróbjartsson A, Lalu MM, Li T, Loder EW, Mayo-Wilson E, McDonald S, Moher D (2021) The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ. https://doi.org/10.1136/bmj.n71
doi: 10.1136/bmj.n71
pubmed: 33782057
pmcid: 8479591
Petrie K, Milligan-Saville J, Gayed A, Deady M, Phelps A, Dell L, Forbes D, Bryant RA, Calvo RA, Glozier N, Harvey SB (2018) Prevalence of PTSD and common mental disorders amongst ambulance personnel: a systematic review and meta-analysis. Soc Psychiatry Psychiatr Epidemiol 53(9):897–909. https://doi.org/10.1007/s00127-018-1539-5
doi: 10.1007/s00127-018-1539-5
pubmed: 29869691
Proctor EK, Landsverk J, Aarons G, Chambers D, Glisson C, Mittman B (2009) Implementation Research in Mental Health Services: an Emerging Science with Conceptual, Methodological, and Training challenges. Administration and Policy Mental Health Mental Health Servic Res 36(1):24–34. https://doi.org/10.1007/s10488-008-0197-4
doi: 10.1007/s10488-008-0197-4
Robinson E, Sutin AR, Daly M, Jones A (2022) A systematic review and meta-analysis of longitudinal cohort studies comparing mental health before versus during the COVID-19 pandemic in 2020. J Affect Disord 296:567–576. https://doi.org/10.1016/j.jad.2021.09.098
doi: 10.1016/j.jad.2021.09.098
pubmed: 34600966
Rotenstein LS, Ramos MA, Torre M, Segal JB, Peluso MJ, Guille C, Sen S, Mata DA (2016) Prevalence of depression, depressive symptoms, and suicidal ideation among medical students. JAMA 316(21):2214. https://doi.org/10.1001/jama.2016.17324
doi: 10.1001/jama.2016.17324
pubmed: 27923088
pmcid: 5613659
Rybojad B, Aftyka A, Baran M, Rzońca P (2016) Risk factors for posttraumatic stress disorder in polish paramedics: a pilot study. J Emerg Med 50(2):270–276. https://doi.org/10.1016/j.jemermed.2015.06.030
doi: 10.1016/j.jemermed.2015.06.030
pubmed: 26281820
Sarokhani D, Delpisheh A, Veisani Y, Sarokhani MT, Manesh RE, Sayehmiri K (2013) Prevalence of depression among University Students: a systematic review and meta-analysis study. Depress Res Treat 2013:1–7. https://doi.org/10.1155/2013/373857
doi: 10.1155/2013/373857
Stansfeld SA, Shipley MJ, Head J, Fuhrer R, Kivimaki M (2013) Work Characteristics and personal social support as determinants of subjective well-being. PLoS ONE 8(11):e81115. https://doi.org/10.1371/journal.pone.0081115
doi: 10.1371/journal.pone.0081115
pubmed: 24260545
pmcid: 3834222
Steeg S, John A, Gunnell DJ, Kapur N, Dekel D, Schmidt L, Webb RT (2022) The impact of the COVID-19 pandemic on presentations to health services following self-harm: systematic review. British J Psychiatry 221(4):603–612
doi: 10.1192/bjp.2022.79
Sun Y, Wu Y, Fan S, Dal Santo T, Li L, Jiang X, Thombs BD (2023) Comparison of mental health symptoms before and during the covid-19 pandemic: evidence from a systematic review and meta-analysis of 134 cohorts. BMJ. https://doi.org/10.1136/bmj-2022-074224
doi: 10.1136/bmj-2022-074224
pubmed: 37907210
pmcid: 10616786
Uzuntarla Y (2018) Learning Approach and Trait Anxiety on Paramedic and Nursing Students. Australasian J Paramed 15:1–6. https://doi.org/10.33151/ajp.15.4.569
World Health Organization (2023) Depression. Available at: https://www.who.int/news-room/fact-sheets/detail/depression (Accessed April 28, 2024)
World Health Organization (2020) World Mental Health Day: an opportunity to kick-start a massive scale-up in investment in mental health. https://www.who.int/news-room/detail/27-08-2020-world mental-health-day-an-opportunity-to-kick-start-a-massive-scale-up-in-investment-in-mental-health
Williams B, King C, Shannon B, Gosling C (2021) Impact of COVID-19 on paramedicine students: a mixed methods study. Int Emerg Nurs 56:100996. https://doi.org/10.1016/j.ienj.2021.100996
doi: 10.1016/j.ienj.2021.100996
Williams B, Beovich B, Olaussen A (2021) The definition of paramedicine: an international delphi study. J Multidiscip Healthc 14:3561–3570. https://doi.org/10.2147/JMDH.S347811
doi: 10.2147/JMDH.S347811
pubmed: 35002246
pmcid: 8722816
Wills HL, Asbury EA (2019) The incidence of anxiety among paramedic students. Australasian J Paramed 16:1–6. https://doi.org/10.33151/ajp.16.649
Wu T, Jia X, Shi H, Niu J, Yin X, Xie J, Wang X (2021) Prevalence of mental health problems during the COVID-19 pandemic: a systematic review and meta-analysis. J Affect Disord 281:91–98. https://doi.org/10.1016/j.jad.2020.11.117
doi: 10.1016/j.jad.2020.11.117
pubmed: 33310451