Psychosocial work environment and health among ambulance clinicians in northern Sweden

Ambulance clinicians in emergency medical services (EMS) work under demanding conditions characterised by high workload, unpredictable environments, and exposure to potentially traumatic incidents. These stressors may negatively affect their health and well-being. Understanding how psychosocial work environment factors relate to health outcomes is therefore important for developing preventive strategies in prehospital emergency care. This study aimed to describe ambulance clinicians' self-rated psychosocial work environment and health in northern Sweden and to examine associations between psychosocial work environment factors and health outcomes.

An exploratory cross-sectional study was conducted using an anonymous web-based survey of all ambulance clinicians in one northern Swedish region (November 2024; 22 ambulances across eight service areas). Of 187 eligible participants, 134 responded (71.6%). Measures included the General Nordic Questionnaire for Psychological and Social Factors at Work subscales (role clarity, role conflict, job demands, job control, social support, organisational culture, leadership), job satisfaction, self-rated health (SRH), insomnia, exhaustion, anxiety, depression, post-traumatic stress symptoms, and cumulative exposure to traumatic incidents. Analyses included descriptive statistics, Spearman correlations, and group comparisons.

Most ambulance clinicians reported good SRH (83.6%). However, 19.4% screened positive for elevated anxiety, 12.7% for depressive symptoms, 8.2% for clinical insomnia, 6.7% for exhaustion, and 2.2% for probable post-traumatic stress disorder. Higher job demands and role conflict were consistently associated with greater symptom burden and lower SRH, whereas role clarity and job satisfaction showed protective associations. A more positively perceived organisational culture and stronger leadership were also associated with better health outcomes. Clinicians working at urban stations reported higher job demands and role conflict, poorer sleep, higher anxiety and posttraumatic stress, and lower SRH compared with those at rural stations.

Psychosocial work environment factors were closely associated with ambulance clinicians' health. High job demands and role conflict were consistently linked to poorer health outcomes, whereas role clarity, job satisfaction, supportive leadership, and a positive organisational culture were associated with more favourable health outcomes. These findings highlight organisational factors that may be relevant to consider in efforts to improve workforce health and sustainability in emergency medical services.