Psychological distress among emergency medical services personnel: implications for public health preparedness and system resilience

Abstract

Introduction: Emergency Medical Services (EMS) personnel are integral to disaster and emergency response systems. Recurrent exposure to high-acuity incidents, irregular shifts, and operational pressures may increase vulnerability to psychological distress, with potential implications for workforce sustainability and system resilience. This study assessed the severity distribution and predictors of stress, anxiety, and depression among EMS personnel in the Makkah region of Saudi Arabia. Methods: A cross-sectional survey was conducted between January and April 2024 among certified EMS professionals employed for > 1 year across the Saudi Red Crescent Authority, Ministry of Health, and Ministry of National Guard Health Affairs. Participants (n = 352) completed an electronic questionnaire including sociodemographic and lifestyle variables and the Depression, Anxiety, and Stress Scale-21 (DASS-21). Analyses included descriptive statistics, chi-square tests, Mann–Whitney U tests, and logistic and multivariate linear regression. Statistical significance was set at p < 0.05. Results: The proportions classified as extremely severe were 12.2% for stress, 23.0% for anxiety, and 17.6% for depression. In bivariate analyses, history of mental illness was associated with higher stress, anxiety, and depression scores; however, in logistic regression it remained significant only for depression. In multivariate linear models, use of medications for noncommunicable diseases (NCDs) was positively associated with stress, anxiety, and depression, whereas longer sleep duration was inversely associated with all outcomes. Years of professional experience significantly predicted stress levels. Conclusion: EMS personnel in the Makkah region demonstrated a substantial burden of clinically significant psychological distress, particularly for severe anxiety and depression. Sleep duration and NCD medication use emerged as consistent correlates across outcomes, indicating potential targets for occupational health strategies. Differences in estimates compared with other Saudi studies should be interpreted cautiously due to variation in populations, instruments, cut-offs, and study periods.