Insomnia, Fatigue, and Comorbidity with Mental Disorder Symptoms Among Paramedics in Ontario, Canada

Objectives: Paramedics experience high rates of mental disorder symptoms and fatigue, with implications for provider well-being and patient safety. Less attention has been given to sleep quality, even though insomnia is a key contributor to fatigue and is frequently comorbid with other mental health concerns. Our objective was to estimate the prevalence of insomnia symptoms among paramedics in Ontario and examine its association with fatigue, career stage, and comorbidity with other mental disorder symptoms. Methods: We conducted a cross-sectional survey of paramedics from two Ontario paramedic services during compulsory continuing medical education sessions between September and December 2024. Insomnia symptoms were assessed using the Insomnia Severity Index. Fatigue was assessed using selected items from the Copenhagen Burnout Inventory. Mental disorder symptoms were assessed using the posttraumatic stress disorder checklist (PCL-5), patient health questionnaire (PHQ-9) for major depressive disorder, generalized anxiety disorder scale (GAD-7), and alcohol use disorder identification test (AUIDIT). We used multivariable logistic regression to assess demographic risk factors for insomnia and the independent association between insomnia and other mental disorder symptoms. Results: Of 1,019 eligible paramedics, 995 were included in the analysis, yielding a response rate of 96%. Overall, 303 participants (30%) screened positive for clinically significant insomnia, including 242 (24%) with moderate and 61 (6%) with severe symptoms. An additional 396 participants (40%) reported subclinical symptoms. Mid-career (adjusted odds ratio [aOR] 1.94, 95% Confidence Interval [CI] 1.17-3.21) and senior-career (aOR 2.53, 95% CI 1.35-4.75) were at greater risk for insomnia compared to recruits. Insomnia scores were moderately correlated with feeling tired, physically exhausted, and emotionally exhausted. Participants who screened positive for insomnia had increased adjusted odds of depression (aOR 9.08, 95% CI 6.45-12.78), suicidal ideation (aOR 1.99, 95% CI 1.27-3.13), posttraumatic stress disorder (aOR 5.78, 95% CI 4.16-8.01), and hazardous alcohol use (aOR 1.46, 95% CI 1.04-2.05). Conclusions: Insomnia symptoms were highly prevalent among paramedics and strongly associated with fatigue and mental disorder symptoms, particularly depression and suicidal ideation.