The relationship between shift-work, sleep and mental health among Paramedics in Australia and Saudi Arabia

Paramedics often perform shift work duties in conflict with their natural sleep patterns, which can cause chronic circadian misalignment and numerous health problems including; insomnia, shift work disorder, depression, anxiety, and stress. Furthermore, little is known about the cross-cultural or universal applicability of findings from studies of western paramedics for paramedics in other world regions. This project aimed to investigate paramedics via surveys assessing the prevalence of sleep and mental health issues, the role of chronotype, and the relationship between these variables in Australian and Saudi paramedics. A field study investigated the acute effects of a rotating shift schedule on sleep, mood, stress, fatigue, sleepiness, energy expenditure, and physical activity of Australian paramedics. A total of 136 Australian paramedics (M age = 39.1, SD = 12.1 years) and 104 Saudi paramedics (M age = 32.5, SD = 6.1 years) responded to the two surveys. Generally, paramedics from both countries reported significant negative mental health outcomes with insomnia being a significant contributor to the burden of depression and anxiety among Australian paramedics. Significantly higher rates of depression, PTSD, insomnia, and fatigue, along with significantly poorer physical functioning were observed among Saudi paramedics when compared to paramedics from Australia that was explained by the higher working and driving durations of the Saudi paramedics. Also, Australian paramedics with evening chronotype reported poorer sleep and mood outcomes compared to morning types. A total of 15 paramedics participated in the field study (M age = 39.5; SD = 10.7 years). Paramedics who worked in rotational shifts showed sleep restriction during the night shift. Paramedics also reported significant levels of stress, fatigue, and sleepiness after the end of the night shift and during the entire day one of recovery. The relationship between sleep and mental health is complex and may be bi-directional. In paramedics, sleep issues potentially exacerbate the increased burden of mental health concerns, especially depression and anxiety. Addressing sleep issues and/or matching chronotype to shift preference may help to improve the mood, sleep and well-being. Finally, there is a need to investigate the cognitive abilities of the paramedics, especially paramedics working in rotating shift.