Mental Health of Paramedicine Students in the United Kingdom and the Kingdom of Saudi Arabia

Abstract

Research has shown higher mental health concerns among healthcare students, with paramedicine students experiencing particularly high levels of psychological distress due to exposure to traumatic incidents, high-pressure training environments, and demanding clinical placements. Unlike other healthcare professions, paramedicine students often encounter potentially traumatic events early in their training, yet they frequently suffer in silence without seeking appropriate support. There is limited research on paramedicine student’ mental health, especially from cross-cultural perspectives, and insufficient understanding of how to improve their wellbeing. This thesis aimed to deepen the understanding of mental health challenges faced by paramedicine students. This thesis presents five studies examining paramedicine students from the Kingdom of Saudi Arabia (KSA) and the United Kingdom (UK). The first study was a systematic review and meta-analysis investigating the global prevalence of anxiety, depression, and post-traumatic stress disorder (PTSD) among paramedicine students. Building on these findings, the next two studies used semi-structured interviews to explore the causes of stress and poor wellbeing among paramedicine students (Study 2) and to investigate their preferences, barriers, and facilitators for accessing mental health support (Study 3). To quantify mental health outcomes and their predictors in cross-cultural settings, the fourth study used a cross-sectional survey design investigating burnout and depression rates, along with their associations with clinical experiences and psychosocial factors. The fifth study employed longitudinal survey methods to monitor changes in mental health outcomes over six months, examining how clinical exposure and perceptions of demand, control, and support influence wellbeing trajectories. Key findings This thesis revealed alarmingly high rates of mental health disorders among paramedicine students globally. The systematic review and meta-analysis (Study 1) found pooled prevalence rates of 56.4% for moderate anxiety, 34.7% for depression, and 17,9% for PTSD - all significantly higher than those reported among qualified paramedics and the general population. Regarding factors contributing to poor mental health, the cross-cultural qualitative analysis (Study 2) identified four key themes: exposure to potentially traumatic events during clinical placements; relationship and communication challenges with faculty, peers, and training supervisors; problematic programme atmosphere, including inadequate preparation and support; and career-related concerns about job prospects and professional acceptance. These themes were consistent across both cultural contexts, although with some variation in emphasis. The investigation of support preferences and access barriers (Study 3) revealed that students preferred tailored, culturally sensitive interventions rather than generic student support services. Three main preferences emerged: specialised support addressing paramedicine-specific challenges; privacy protection to safeguard academic and career prospects; and opportunities for peer socialisation and communication. Major barriers included mental health stigma from multiple sources, university environment factors, personal beliefs about help-seeking, operational challenges in accessing services, and concerns regarding professional competency assessments. The cross-sectional survey (Study 4) found significant differences between countries, with students from KSA reporting higher levels of depression but lower burnout scores compared to UK students. Clinical experiences, perceived psychological demands, and lower social support emerged as key predictors of poor mental health outcomes across both cultures. The longitudinal study (Study 5) indicated that mental health outcomes remained relatively stable over six months, with baseline scores being the strongest predictors of follow-up wellbeing. Nevertheless, perceived control and social support showed protective effects against mental health deterioration, while high psychological demands predicted poorer outcomes over time. Implications and conclusions This thesis demonstrates that paramedicine students face significant mental health challenges that exceed those of other healthcare student populations and qualified practitioners. The findings highlight the urgent need for specialised, culturally sensitive mental health interventions integrated into paramedicine curricula. Without targeted support addressing the unique stressors of paramedicine training - including early trauma exposure, demanding clinical environments, and professional identity development - these mental health issues may persist into professional practice, potentially impacting both practitioner wellbeing and patient care quality. The thesis offers the first comprehensive cross-cultural evidence base for developing evidence-informed interventions to support the mental health and wellbeing of this vital healthcare workforce during their formative training years