EMS Workers on the Frontline of the Opioid Epidemic: Effects of Sleep and Social Support on Depression

Background and Purpose: Health professionals responding to the opioid epidemic have faced a myriad of challenges. Social workers are concerned with both the impact of the opioid epidemic on individuals, and on the well-being of those responding to this crisis. Emergency Medical Services (EMS) professionals are the frontline responders meeting individuals at the point of overdose and coordinating with hospital social workers for intervention and referrals. Data have consistently demonstrated that EMS professionals are at increased risk of developing depression and that the toll of the opioid epidemic has implications for EMS workers’ physical and emotional well-being. There is limited research on the impact of the opioid epidemic on EMS professionals’ mental health and the role of sleep and social support in supporting their well-being. This study examines the critical role that sleep and social support play in the mental health of EMS workers responding to opioid overdose calls. In addition, we examine the attitudes of EMS workers towards individuals with substance use disorders and its relationship to their mental well-being.

Methods: This cross-sectional study surveyed EMS workers (N=608) across Pennsylvania on demographic variables, frequency of overdose calls, and attitudes towards opioid use and naloxone administration on depression. The Patient Health Questionnaire (PHQ-2) was used to identify probable depression in EMS workers. Hierarchical logistic regression models examined demographic variables, work-related variables including income, hours worked per week, and years on the job. Self-reported frequency of overdose calls and opinions regarding the opioid epidemic, such as “How often have you felt angry during overdose calls for taking you away from other emergency situations?” and “How often has the opioid epidemic reduced your desire to continue to work in EMS?” were also included. The final models incorporated self-reported quality of sleep measured by the Pittsburgh Sleep Quality Index (PSQI) and self-reported social support using the Medical Outcomes Study (MOS) social support survey.

Results: Of those who answered PHQ-2 screening questions (n=603), 12.6% screened positive for depression in the past two weeks. EMS participants who had responded to more than 30 overdose calls in the previous year compared to participants with no overdose calls were found to be 3.1 times more likely to screen positive for depression (p<0.05). Increases in negative attitudes related to the opioid epidemic and opioid use was associated with a 7% increase in the odds of screening positive for depression (p=0.01). Highlighting the importance of addressing lifestyle behaviors, in the final model, social support and sleep completely accounted for the relationship between number of overdose calls and depression.

Conclusions and Implications: This study adds to the literature on the impact of the opioid epidemic on mental health outcomes for EMS professionals providing frontline care. Social workers have opportunities to influence the impact of the opioid epidemic on EMS worker mental health. Trainings to highlight effectiveness of substance use treatment should be explored, along with ways to enhance social support and improve sleep for EMS workers to protect against the stress associated with responding to this public health crisis.