A systematic review of the prevalence, risk factors, and protective factors of posttraumatic stress disorder among paramedics.

Paramedics are frequently exposed to trauma and may be at elevated risk of posttraumatic stress disorder (PTSD) and complex PTSD (CPTSD). This review aimed to map PTSD prevalence among paramedics, identify risk and protective factors, and scope existing literature on CPTSD in paramedics. Studies were identified through a systematic database search, appraised using the Appraisal Tool for Cross-Sectional Studies (AXIS) and the Newcastle-Ottawa Quality Assessment Scale (NOS; for cohort studies). Data were analyzed through narrative synthesis. A total of 43 studies involving 12,783 paramedics were included. PTSD prevalence ranged from 1.0% to 82.4% in the 29 studies that reported prevalence, with 15 studies reporting rates of 14.6%-40%. Consistent risk factors included low social support, poor sleep, workplace stress, anxiety, and depression. Protective factors included resilience, social support, and a sense of coherence. Most cross-sectional studies were rated as high quality. The limited longitudinal evidence suggests lower PTSD prevalence or symptom levels than cross-sectional findings. No studies examined CPTSD. Taken together, the findings indicate that PTSD is common among paramedics, although evidence on CPTSD is absent. Future research should prioritize longitudinal designs and examine CPTSD prevalence in paramedics.