Improving wellbeing in student paramedics: targeting risk factors and predictors of PTSD

Thesis

Student paramedics are at an increased risk of developing mental health problems compared to the general population due to the nature of their work. They are especially at high risk of developing posttraumatic stress disorder (PTSD), a severe stress reaction that can occur after exposure to traumatic events. To date, interventions aimed at reducing poor mental health or preventing the risk of PTSD in this population have not been very effective. Evidence-based interventions are urgently needed.

This thesis aims to address poor mental health in student paramedics. First, by evaluating a tool to improve wellbeing and reduce psychological distress (Study 1). Second, by targeting factors relevant to the development of PTSD with a specific focus on assessing and understanding rumination, a risk factor for PTSD, characterised by abstract thinking, and modifying responses to intrusive memories, a predictor of PTSD (Chapters 2, 3 and 4). No previous studies have looked at these factors in a population of student paramedics.

Study 1 showed that daily planning ahead can improve wellbeing in student paramedics significantly better than reading about mental health. Planning ahead also reduced psychological distress and increased the experience of mindfulness in student paramedics as did reading about how to cope with stress. Study 2 developed and validated a new measure of concrete and abstract thinking (CAT). The CAT fills a gap in the literature by providing a user-friendly, valid, reliable and population-specific measure of concrete and abstract thinking. A ‘Best Version CAT’ is recommended for further use. Abstract thinking measured by the CAT was associated with established measures of rumination, worry and PTSD. Study 3 builds on this by assessing abstract thinking (using the CAT) as a predictor of PTSD symptom severity, at 6-week and 6-month follow-up in a large sample of student paramedics. Findings revealed that abstract thinking predicts PTSD symptom severity over and above established measures of rumination at 6-weeks but not at 6-months. Finally, Study 4 aimed to reduce intrusive memories and maladaptive responses to intrusions after an analogue trauma film. The study failed to show superiority of a stimulus discrimination technique over a counting intrusions technique, both of which seemed to help student paramedics disengage from trauma memories.

The results of this thesis contribute to our understanding of factors that may influence the wellbeing and mental health of student paramedics. A better understanding of these factors may, in the future, help to inform targeted PTSD prevention for student paramedics and emergency workers more broadly.

Authors: Lorenz, HS

• Type of award: DPhil
• Level of award: Doctoral
• Awarding institution: University of Oxford
• Language: English
• Keywords: PTSD; Student Paramedics; Emergency workers; posttraumatic stress disorder