Ambulance workers have high accident and mortality rates but low anxiety and depression

A systematic review on ambulance personnel found that ambulance workers have a higher mortality rate, higher level of fatal accidents and higher rate of early retirement on medical grounds than the general working population. However, a survey among ambulance personnel indicates that they report lower levels of anxiety and depression symptoms, and tend to avoid seeking professional help.

Background

In the past few years, researchers have become increasingly aware that ambulance personnel may be at risk of developing work-related health problems. A research article entitled ‘Health status in the ambulance services: A systematic review (352Kb PDF)’ published by BioMed Central in 2006 revealed that ambulance personnel are reported to be affected by a wide range of health problems such as post-traumatic stress symptoms, as well as mental and somatic problems. Furthermore, this occupational group has higher rates of mortality, accidents and early retirement than the general working population. The most consistent finding of the review was the high levels of post-traumatic stress symptoms and psychological distress consistently reported by ambulance personnel.

Moreover, concerns have been expressed regarding the reluctance of ambulance personnel to seek professional help, especially when trying to deal with mental health problems. However, no study of ambulance personnel comparing the level of mental health problems and the corresponding level of help sought to that of the general working population was found in the literature review, which was based on 49 relevant studies.

More recently, a study on health problems and help-seeking (243Kb PDF) based on a comprehensive nationwide survey of Norwegian ambulance personnel was published by BioMed Central in 2008. The survey was conducted in 2005 as part of a doctoral thesis, and was administered by mail to all eligible ambulance personnel in Norway. In total, 1,286 persons returned questionnaires, representing a 41% response rate. In addition, reference data for Norway on self-reported depression and anxiety symptoms and professional help-seeking were obtained from the Nord-Trøndelag health study (348Kb PDF) (HUNT 2, 1995–1997), which involved a total of 31,987 employees, representing a 71% response rate.

Survey findings

Ambulance personnel report low levels of psychological distress

The prevalence of anxiety (11%) and depression (7.2%) symptoms among ambulance personnel was slightly lower than, but not significantly different to, that of the general working population. The 2008 survey is the first of its kind to compare the levels of anxiety and depression symptoms in a nationwide sample of ambulance workers with those of the general working population, adjusting for age and sex.

Men and women reporting depression and anxiety symptoms (%)

Note: Anxiety and depression symptoms were defined as a score of eight or more on the Hospital anxiety and depression scale.

Source: BioMed Central, 2008

Somatic health complaints

In all, 43.6% of ambulance personnel reported experiencing one or more substantial somatic complaint. Prevalence rates for each symptom were taken from a study of the general population in Norway. Compared with men in the general population, ambulance men report a higher rate of neck pain (14.7% versus 11.2%), upper back pain (9.4% versus 6%) and lower back pain (22.1% versus 14%). Ambulance women, on the other hand, report a lower incidence of all complaints compared with that of women in the general population. Compared with the responses of ambulance men, however, ambulance women report relatively high levels of neck pain (20.7% versus 14.7%) and shoulder complaints (18.2% versus 13.7%).

Ambulance men and women reporting various somatic health complaints (%)

Note: Substantial somatic complaints were considered to have some or severe intensity (a score ≥ 2 on a scale ranging from 0–3) on a 10-item version of the Subjective Health Complaint questionnaire.

Source: BioMed Central, 2008

Low level of seeking professional help

Ambulance personnel in general report a lower level of seeking professional help than the general working population. As few as 2.8% of ambulance workers reported visiting an occupational health practitioner in the last 12 months, compared with 24.4% of the general working population. Moreover, this gap was also significant when taking into account differences in age, sex and level of depression and anxiety symptoms in the two samples.

Help-seeking during last 12 months among ambulance personnel compared with general working population (%)

Source: BioMed Central, 2008

Commentary

Contrary to common belief, ambulance personnel reported significantly less anxiety and depression symptoms than the general working population in Norway. Seeking professional help was less frequently reported among ambulance personnel and this effect was independent of the level of anxiety and depression symptoms. The survey’s 41% response rate was rather low, therefore report bias may be a problem as, for example, anxiety and depression symptoms are socially undesirable topics, particularly in the male-dominated ambulance service.

References

Sterud, T., Ekeberg, O. and Hem, E., ‘Health status in the ambulance services: A systematic review’, BMC Health Services Research, Vol. 6, No. 1, 2006, p. 82.

Sterud, T., Hem, E., Ekeberg, O. and Lau, B., ‘Health problems and help-seeking in a nationwide sample of operational Norwegian ambulance personnel’, BMC Public Health, Vol. 8, No. 1, 2008, p. 3.

Tom Sterud, National Institute of Occupational Health