Comparative Analysis of Mental Health Challenges and Shift Work Impact on Urban vs. Rural Emergency Responders
DOI:
https://doi.org/10.47672/ajhmn.2669Abstract
Purpose: This study examines the mental health challenges faced by emergency responders in urban and rural settings, analyzing the impact of shift work and organizational support on their psychological well-being. It aims to identify key differences in mental health outcomes between urban and rural responders and provide evidence-based recommendations for improving mental health support systems.
Materials and Methods: This study employs a comprehensive literature review and data analysis to compare mental health challenges across geographic locations. Statistical comparisons highlight differences in the prevalence of PTSD, depression, anxiety, burnout, and sleep disorders among urban and rural responders. Visual data representations, including tables and figures, illustrate key findings to enhance understanding.
Findings: The results indicate that urban emergency responders experience higher rates of PTSD (38%), depression (42%), anxiety (45%), burnout (50%), and sleep disorders (55%) compared to their rural counterparts. Shift work significantly exacerbates these mental health issues, with urban responders reporting higher levels of fatigue, stress, and overall psychological distress. Rural responders, while facing lower exposure to violent incidents, experience unique stressors such as professional isolation and limited access to mental health services.
Unique Contribution to Theory, Practice and Policy: This study contributes to existing literature by highlighting the geographic disparities in mental health outcomes among emergency responders and emphasizing the role of shift work and organizational support in shaping these outcomes. In practice, the findings underscore the need for tailored interventions, such as peer support programs and targeted mental health training, to address the specific needs of urban and rural responders.
Downloads
References
Brown, V., Bowie, M., Bales, D., Scheyett, A., Thomas, R., & Cook, G. (2023). Cooperative Extension offices as mental health hubs: A social ecological case study in rural Georgia, United States. SSM - Mental Health, 3, 100191–100191. https://doi.org/10.1016/j.ssmmh.2023.100191
Cramm, H., Richmond, R., Jamshidi, L., Edgelow, M., Groll, D., Ricciardelli, R., MacDermid, J. C., Keiley, M., & Carleton, R. N. (2021). Mental health of Canadian firefighters: The impact of sleep. International Journal of Environmental Research and Public Health, 18(24), 13256–13256. https://doi.org/10.3390/ijerph182413256
Derynda, B., Gupta, K., Bhattacharya, S., & Hollar, T. L. (2023). Combating poor mental health in emergency responders: Helping emergency responders overcome (HERO) Act. Osteopathic Family Physician, 15(2). https://doi.org/10.33181/13099
Edwards, A., Hung, R., Levin, J., Forthun, L. F., Sajatovic, M., & McVoy, M. (2023). Health disparities among rural individuals with mental health conditions: A systematic literature review. Rural Mental Health, 47(3), 163–178. https://doi.org/10.1037/rmh0000228
Fisher, M., & Lavender, C. D. (2023). Ensuring optimal mental health programs and policies for first responders: Opportunities and challenges in one U.S. state. Community Mental Health Journal, 59(7), 1341–1351. https://doi.org/10.1007/s10597-023-01121-1
Harris, R., Drummond, S., Meadley, B., Rajaratnam, S. M. W., Williams, B., Smith, K., Bowles, K., Nguyen, E., Dobbie, M. L., & Wolkow, A. (2023). Mental health risk factors for shift work disorder in paramedics: A longitudinal study. Sleep Health, 9(1), 49–55. https://doi.org/10.1016/j.sleh.2022.09.009
Hruska, B., & Barduhn, M. S. (2021). Dynamic psychosocial risk and protective factors associated with mental health in emergency medical service (EMS) personnel. Journal of Affective Disorders, 282, 9–17. https://doi.org/10.1016/j.jad.2020.12.130
Khan, W. A., Conduit, R., Kennedy, G., & Jackson, M. L. (2020). The relationship between shift work, sleep, and mental health among paramedics in Australia. Sleep Health, 6(3), 330–337. https://doi.org/10.1016/j.sleh.2019.12.002
Khan, W. A., Conduit, R., Kennedy, G., Alslamah, A. A., Alsuwayeh, M. A., & Jackson, M. L. (2020). Sleep and mental health among paramedics from Australia and Saudi Arabia: A comparison study. Clocks & Sleep, 2(2), 246–257. https://doi.org/10.3390/clockssleep2020019
Khan, W. A., Jackson, M. L., Kennedy, G., & Conduit, R. (2021). A field investigation of the relationship between rotating shifts, sleep, mental health, and physical activity of Australian paramedics. Scientific Reports, 11(1). https://doi.org/10.1038/s41598-020-79093-5
Kshtriya, S., Kobezak, H. M., Popok, P. J., Lawrence, J. A., & Lowe, S. R. (2020). Social support as a mediator of occupational stressors and mental health outcomes in first responders. Journal of Community Psychology, 48(7), 2252–2263. https://doi.org/10.1002/jcop.22403
Kyron, M. J., Rikkers, W., Bartlett, J. L., Renehan, E., Hafekost, K., Baigent, M., Cunneen, R., & Lawrence, D. (2021). Mental health and wellbeing of Australian police and emergency services employees. Archives of Environmental & Occupational Health, 77(4), 282–292. https://doi.org/10.1080/19338244.2021.1893631
Lawn, S., Roberts, L., Willis, E., Couzner, L., Mohammadi, L., & Goble, E. (2020). The effects of emergency medical service work on the psychological, physical, and social well-being of ambulance personnel: A systematic review of qualitative research. BMC Psychiatry, 20(1). https://doi.org/10.1186/s12888-020-02752-4
Roberts, R., Wong, A., Jenkins, S., Neher, A., Sutton, C., O’Meara, P., Frost, M., Bamberry, L., & Dwivedi, A. (2021). Mental health and well-being impacts of COVID‐19 on rural paramedics, police, community nurses, and child protection workers. The Australian Journal of Rural Health, 29(5), 753–767. https://doi.org/10.1111/ajr.12804
Summers-Gabr, N. M. (2020). Rural–urban mental health disparities in the United States during COVID-19. Psychological Trauma, 12(S1), S222–S224. https://doi.org/10.1037/tra0000871
Torquati, L., Mielke, G. I., Brown, W. J., Burton, N. W., & Kolbe-Alexander, T. (2019). Shift work and poor mental health: A meta-analysis of longitudinal studies. American Journal of Public Health, 109(11), e13–e20. https://doi.org/10.2105/ajph.2019.305278
Vujanovic, A. A., Lebeaut, A., & Leonard, S. (2021). Exploring the impact of the COVID-19 pandemic on the mental health of first responders. Cognitive Behaviour Therapy, 50(4), 320–335. https://doi.org/10.1080/16506073.2021.1874506
Wagner, S. L., White, N., Regehr, C., White, M., Alden, L. E., Buys, N., Carey, M. G., Corneil, W., Fyfe, T., & Matthews, L. R. (2020). Ambulance personnel: Systematic review of mental health symptoms. Traumatology, 26(4), 370–387. https://doi.org/10.1037/trm0000251
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2025 Hadeel Almasry

This work is licensed under a Creative Commons Attribution 4.0 International License.
Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution (CC-BY) 4.0 License that allows others to share the work with an acknowledgment of the work's authorship and initial publication in this journal.