Albert PR. Why is depression more prevalent in women?. J Psychiatry Neurosci. 2015; 40:(4)219-221

AlFaris E, Irfan F, Qureshi R Health professions' students have an alarming prevalence of depressive symptoms: exploration of the associated factors. BMC Med Educ. 2016; 16:(1)

Alharthy N, Alswaes S, Almaziad A, Alenazi N, Abdallah M, Alshehry M. Public perception of female paramedics at King Abdulaziz Medical City, Saudi Arabia. Int J Emerg Med. 2018; 11:(1)

Prevalence of anxiety among paramedic students in Saudi Arabia [preprint]. 2021. https// (accessed 13 November 2022)

Diagnostic and statistical manual of mental disorders, 5th edn. : DSM–5; 2013

Amstadter AB, Sheerin C, Lind M, Nugent NR. Genetic and biological underpinnings and consequences of trauma. In: Gold SN (ed). : American Psychological Association; 2017

Askim K, Knardahl S. The influence of affective state on subjective-report measurements: evidence from experimental manipulations of mood. Front Psychol. 2021; 12

Evaluation of the level of depression in students of school of paramedic sciences, Mazandaran University of Medical Sciences, in 2015. 2016. http//

Bayri Bingol F, Demirgoz Bal M, Aygun M, Bilgic E. Secondary traumatic stress among midwifery students. Perspect Psychiatr Care. 2020; 57:(3)1195-1201

Beaufort IN, De Weert-Van Oene GH, Buwalda VAJ, de Leeuw JRJ, Goudriaan AE. The Depression, Anxiety and Stress Scale (DASS-21) as a screener for depression in substance use disorder inpatients: a pilot study. Eur Addict Res. 2017; 23:(5)260-268

Bush DE, Ziegelstein RC, Tayback M Even minimal symptoms of depression increase mortality risk after acute myocardial infarction. Am J Cardiol. 2001; 88:(4)337-341

Buysse DJ, Reynolds CF, Monk TH, Berman SR, Kupfer DJ. The Pittsburgh Sleep Quality Index: a new instrument for psychiatric practice and research. Psychiatry Res. 1989; 28:(2)193-213

Cao X, Wang L, Wei S, Li J, Gong S. Prevalence and predictors for compassion fatigue and compassion satisfaction in nursing students during clinical placement. Nurse Educ Pract. 2021; 51

Carleton RN, Thibodeau MA, Teale MJ The Center for Epidemiologic Studies Depression Scale: a review with a theoretical and empirical examination of item content and factor structure. PLoS One. 2013; 8:(3)

Chaabane S, Chaabna K, Bhagat S Perceived stress, stressors, and coping strategies among nursing students in the Middle East and North Africa: an overview of systematic reviews. Syst Rev. 2021; 10:(1)

Chatterjee S, Saha I, Mukhopadhyay S, Misra R, Chakraborty A, Bhattacharya A. Depression among nursing students in an Indian government college. Br J Nurs. 2014; 23:(6)316-320

Chen CJ, Chen YC, Sung HC, Hsieh TC, Lee MS, Chang CY. The prevalence and related factors of depressive symptoms among junior college nursing students: a cross-sectional study. J Psychiatr Ment Health Nurs. 2015; 22:(8)590-598

Chung SK, Long CF. Research situation and trait anxiety scale amendment. Psychol Testing. 1984; 31:27-36

Chapter 8. Case-control and cross sectional studies. 2009. https// (accessed 13 November 2022)

De Moura Camargo R, de Oliveira Sousa C, de Oliveira MLC. Prevalence of cases of depression in nursing students in an institution of higher education in Brasilia. Nurs J Minas Gerais. 2014; 18:(2)

Deary IJ, Watson R, Hogston R A longitudinal cohort study of burnout and attrition in nursing students. J Adv Nurs. 2003; 43:(1)71-81

In: Dobson KS, and Dozois DJA (eds). Amsterdam: Elsevier; 2008

Elfrey MK, Ziegelstein RC. The ‘inactivity trap’. Gen Hosp Psychiatry. 2009; 31:(4)303-305

Eriksen MB, Frandsen TF. The impact of patient, intervention, comparison, outcome (PICO) as a search strategy tool on literature search quality: a systematic review. J Med Libr Assoc. 2018; 106:(4)420-431

Essau CA, Lewinsohn PM, Seeley JR, Sasagawa S. Gender differences in the developmental course of depression. J Affect Disord. 2010; 127:(1–3)185-190

Figley Institute. Basics of compassion fatigue. 2012. https// (accessed 13 November 2022)

First MB, Gaebel W, Maj M An organization- and category-level comparison of diagnostic requirements for mental disorders in ICD-11 and DSM-5. World Psychiatry. 2021; 20:(1)34-51

Fjeldheim CB, Nöthling J, Pretorius K Trauma exposure, posttraumatic stress disorder and the effect of explanatory variables in paramedic trainees. BMC Emerg Med. 2014; 14

Ghodasara SL, Davidson MA, Reich MS, Savoie CV, Rodgers SM. Assessing student mental health at the Vanderbilt University School of Medicine. Acad Med. 2011; 86:(1)116-121

Health and Care Professions Council. Age and gender breakdown of paramedics. 2017. https// (accessed 13 November 2022)

Huang CY, Hsu WY. A study of developing an adolescent depression inventory. J Educ Psychol. 2003; 26:167-190

Ibrahim AK, Kelly SJ, Adams CE, Glazebrook C. A systematic review of studies of depression prevalence in university students. J Psychiatr Res. 2013; 47:(3)391-400

Jackson-Koku G. Beck Depression Inventory. Occup Med (Lond). 2016; 66:(2)174-175

Johnson J, Simms-Ellis R, Janes G Can we prepare healthcare professionals and students for involvement in stressful healthcare events? A mixed-methods evaluation of a resilience training intervention. BMC Health Serv Res. 2020; 20:(1)

Joseph JK, Devu BK. Stress & coping strategies among nursing students of India: a systematic review. International Journal of Applied Research. 2021; 7:(2)425-432

Kerai SM, Khan UR, Islam M, Asad N, Razzak J, Pasha O. Post-traumatic stress disorder and its predictors in emergency medical service personnel: a cross-sectional study from Karachi, Pakistan. BMC Emerg Med. 2017; 17:(1)

Lowery K, Stokes MA. Role of peer support and emotional expression on posttraumatic stress disorder in student paramedics. J Trauma Stress. 2005; 18:(2)171-179

Mao A, Cheong PL, Van IK, Tam HL. ‘I am called girl, but that doesn't matter’—perspectives of male nurses regarding gender-related advantages and disadvantages in professional development. BMC Nurs. 2021; 20:(1)

McCarthy B, Trace A, O'Donovan M Nursing and midwifery students' stress and coping during their undergraduate education programmes: an integrative review. Nurse Educ Today. 2018; 61:197-209

Migliavaca CB, Stein C, Colpani V, Munn Z, Falavigna M Quality assessment of prevalence studies: a systematic review. J Clin Epidemiol. 2020; 127:59-68

Moher D, Liberati A, Tetzlaff J, Altman DG Preferred Reporting Items for Systematic Reviews and MetaAnalyses: The PRISMA Statement. PLoS Med. 2009; 6:(7)

Munn Z, Moola S, Lisy K, Riitano D, Tufanaru C. Methodological guidance for systematic reviews of observational epidemiological studies reporting prevalence and cumulative incidence data. Int J Evid Based Healthc. 2015; 13:(3)147-153

Ng LC, Stevenson A, Kalapurakkel SS National and regional prevalence of posttraumatic stress disorder in sub-Saharan Africa: a systematic review and meta-analysis. PLoS Med. 2020; 17:(5)

Ogińska-Bulik N, Gurowiec PJ, Michalska P, Kędra E. Prevalence and predictors of secondary traumatic stress symptoms in health care professionals working with trauma victims: a cross-sectional study. PLoS One. 2021; 16:(2)

Peter KA, Meier-Kaeppeli B, Pehlke-Milde J, Grylka-Baeschlin S. Work-related stress and intention to leave among midwives working in Swiss maternity hospitals—a cross-sectional study. BMC Health Serv Res. 2021; 21:(1)

Poreddi V, Ramachandra Konduru R, Math SB. Assessing the attitudes and perceptions towards nursing profession among nursing students. Nurs J India. 2012; 103:(1)6-8

Schardt C, Adams MB, Owens T, Keitz S, Fontelo P. Utilization of the PICO framework to improve searching PubMed for clinical questions. BMC Med Inform Decis Mak. 2007; 7

Shamliyan T, Kane RL, Dickinson S. A systematic review of tools used to assess the quality of observational studies that examine incidence or prevalence and risk factors for diseases. J Clin Epidemiol. 2010; 63:(10)1061-1070

Song JW, Chung KC. Observational studies: cohort and case-control studies. Plast Reconstr Surg. 2010; 126:(6)2234-2242

Song H, Fall K, Fang F, Erlendsdóttir H Stress related disorders and subsequent risk of life threatening infections: population based sibling controlled cohort study. BMJ. 2019; 367

Spitzer RL, Kroenke K, Williams JB, Löwe B. A brief measure for assessing generalized anxiety disorder: the GAD-7. Arch Intern Med. 2006; 166:(10)1092-1097

Tan JB, Yates S. Academic expectations as sources of stress in Asian students. Soc Psychol Educ. 2011; 14:(3)389-407

Tung YJ, Lo KKH, Ho RCM, Tam WSW. Prevalence of depression among nursing students: a systematic review and meta-analysis. Nurse Educ Today. 2018; 63:119-129

Wild J, El-Salahi S, Degli Esposti M. The effectiveness of interventions aimed at improving well-being and resilience to stress in first responders a systematic review. European Psychologist. 2020; 25:252-271

Williams B, Beovich B, Olaussen A. The definition of paramedicine: an international Delphi study. J Multidiscip Healthc. 2021; 14:3561-3570

World Health Organization. Depression. 2021. https// (accessed 13 November 2022)

World Health Organization. Nursing and midwifery. 2022. https// (accessed 13 November 2022)

Xu Y, Chi X, Chen S, Qi J, Zhang P, Yang Y. Prevalence and correlates of depression among college nursing students in China. Nurse Educ Today. 2014; 34:(6)e7-e12

Young CB, Fang DZ, Zisook S. Depression in Asian-American and Caucasian undergraduate students. J Affect Disord. 2010; 125:(1–3)379-382

Zeng Y, Wang G, Xie C, Hu X, Reinhardt JD. Prevalence and correlates of depression, anxiety and symptoms of stress in vocational college nursing students from Sichuan, China: a cross-sectional study. Psychol Health Med. 2019; 24:(7)798-811

Prevalence of stress disorders in frontline healthcare students

02 December 2022
Volume 14 · Issue 12


Emerging evidence indicates that some healthcare students are developing stress disorders, due to factors relating to their chosen field of study. If accurate, this could have a major impact not only on those students, but also on the professions into which they are entering. To understand the extent of the problem, a literature review was conducted to identify the overall prevalence of stress disorders in healthcare students who are exposed to occupational stress/trauma, and/or course-related stress. Two databases were searched to include studies reporting on the presence of primary or secondary stress disorders in healthcare students. Six studies were reviewed, which included primary outcomes of depression, anxiety and stress. The pooled prevalence of primary outcomes was 41.4%. Pooled prevalence of depression was 49.58%, anxiety 54.55% and stress 20.2%. High prevalence figures suggest the need for adequate provision of mental health resources.

Stress disorders are conditions preceded and/or triggered by trauma or other life stressors (Song et al, 2019). They can be categorised into primary, which result from direct experience, and secondary, which result from direct or indirect experience over time (Figley Institute, 2012). Each category includes a range of disorders, with primary conditions including acute stress, acute stress disorder and post-traumatic stress disorder (PTSD), and secondary conditions including secondary traumatic stress, vicarious trauma and compassion fatigue. Related disorders include anxiety, generalised anxiety disorder (GAD) and depression. Although there are different criteria for diagnoses (First et al, 2021), symptoms can overlap and causes may be similar.

There are many risk factors known to increase an individual's susceptibility to stress disorders, including genetic and biological factors (Amstadter et al, 2017), personal attributes and traits (Ogińska-Bulik et al, 2021) and specific life events, as recognised by the Diagnostic and Statistical Manual of Mental Disorders (DSM–5) (American Psychiatric Association, 2013).

Subscribe to get full access to the Journal of Paramedic Practice

Thank you for visiting the Journal of Paramedic Practice and reading our archive of expert clinical content. If you would like to read more from the only journal dedicated to those working in emergency care, you can start your subscription today for just £48.

What's included

  • CPD Focus

  • Develop your career

  • Stay informed