Incidence, Prevalence, and Severity of Mental Health Issues Among Emergency Medical Service Clinicians: A Systematic Review and Meta-Analysis.
The Journal of emergency medicine · 2025-09-09 · Systematic review
Abstract
BACKGROUND: Emergency Medical Services (EMS) clinicians are the first line of care for the public in emergency medical situations. The prevalence and severity of mental health diagnoses among EMS clinicians are unclear. OBJECTIVES: To systematically review the incidence, prevalence, and severity of depression, anxiety, posttraumatic stress disorder (PTSD), suicidality, and substance use among EMS clinicians. METHODS: We searched Medline, Embase, CENTRAL, CINAHL, ClinicalTrials.gov, journals, and websites for studies published from January 1, 2001 through June 30, 2024. We conducted duplicate screening of abstracts followed by full-text articles. We included studies from high-income countries that enrolled at least 100 EMS clinicians. We assessed the risk of bias, conducted meta-analyses, and evaluated strength of evidence (SoE) using standard methods. RESULTS: We included 85 studies, of which 11 studies had high risk of bias, 66 moderate risk, and eight low risk. No study reported on incidence of any outcome. During routine practice, prevalence estimates were: suicidal ideation 33%, suicide plans 8.7-10.9%, and suicide attempts 2.8-5.6% (moderate SoE). During routine clinical practice and after critical incidents, depression, anxiety, and PTSD prevalence each varied considerably (low SoE). During routine practice, the mean severity of depressive symptoms was minimal-to-mild, anxiety was mild-to-moderate, PTSD was mild, and alcohol usage was of low risk (each moderate SoE). The Suicide Behaviors Questionnaire-Revised mean score was 4.92 (95% confidence interval 2.44-7.39; ≥ 7 indicates at risk of suicide; moderate SoE). After critical incidents, depressive symptoms were minimal-to-mild, and anxiety was mild-to-moderate (moderate SoE for each). CONCLUSIONS: More research is needed because of the marked heterogeneity of studies and lack of consistency in the epidemiologic methods used.