Mental Health and Well-Being Among Community Paramedics in Ontario, Canada

Objectives: Paramedics are at elevated risk for adverse mental health outcomes due to occupational exposures including trauma, workplace violence, and chronic operational stress. Community Paramedicine (CP) represents an evolving model of care in which paramedics provide scheduled, non-urgent clinical and psychosocial support, potentially altering exposure profiles and the associated mental health risks. Our objective was to estimate the prevalence of mental health concerns among community paramedics and compare their risk of adverse mental health outcomes with paramedics working in 9-1-1 emergency response roles. Methods: We conducted a cross-sectional survey of paramedics from two Ontario services during compulsory in-person continuing medical education sessions from September to December 2024. Participants completed validated self-report screening tools for posttraumatic stress disorder, major depressive disorder, generalized anxiety disorder, insomnia, alcohol use, and burnout. We used logistic regression models adjusted for demographic variables to assess the association between CP role and mental health outcomes. Results: A total of 995 paramedics participated (96% of eligible), including 63 (6%) assigned to CP roles. Overall, 12% screened positive for PTSD, 25% for major depressive disorder, 23% for generalized anxiety disorder, 30% for insomnia, and 36% for at least moderate burnout. CPs had significantly lower adjusted risk of major depressive disorder compared to paramedics in 9-1-1 response roles (adjusted odds ratio [aOR] 0.45, 95% confidence interval [CI] 0.20-0.98). For other outcomes, our point estimates favored lower risk among CPs but did not reach statistical significance, including a composite outcome of PTSD, major depressive disorder, or generalized anxiety disorder (aOR 0.81, 95% CI 0.46-1.45). Conclusions: Community paramedics demonstrated a lower adjusted risk of major depressive disorder and a consistent, though non-significant, pattern toward lower risk across multiple mental health outcomes compared to paramedics in 9-1-1 response roles. These findings suggest a potentially different occupational risk profile associated with CP practice environments. Further longitudinal and mixed-methods research is warranted.