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Work stressors associated with mental health, well-being and intention to leave among ambulance staff in England: an explanatory mixed-methods study

Por: Anchors · Z. · Arnold · R. · Nicholson · H. · Voss · S. · Walsh · N. E. · Black · S. · Moore · L.
Background and aim(s)

Ambulance staff have the highest sickness absence, burnout and turnover intentions in the National Health Service, with work-related stress and anxiety identified as key drivers. Although multiple occupational stressors have been reported, it remains unclear which have the greatest impact. This study examined which work stressors are most strongly associated with mental health, well-being and intention to leave; whether these associations are explained by stress appraisals and mental rest; and which staff are most vulnerable to adverse outcomes.

Methods

A mixed-methods, explanatory, sequential design, stress audit was conducted in one ambulance service in England. An online survey with ambulance staff (n=420) assessed key stress elements (work stressors, stress appraisals, mental rest) and key outcomes (depression, well-being, intention to leave). Semistructured interviews with staff (n=8) explored the findings of the survey in more depth. Linear regression analyses examined relationships between predictors (eg, stressors) and outcomes (eg, well-being) and analysis of variances and t-tests explored differences between groups (eg, gender). A thematic analysis of qualitative data was conducted.

Results

Quantitative and qualitative findings suggest that stress related to manager support (ie, upper management prioritising efficiency over staff needs), workplace demands (ie, organisational demands creating extra burden), poor relationships (eg, with non-peer staff) and constant change had the most negative impact on staff. Low mental rest and threat appraisals (ie, feeling ‘overwhelmed’ by work demands) were strong predictors of all negative outcomes, alongside cumulative stress exposure and negative emotional responses. Longer tenure, supervisory roles, mixed urban–rural working and male gender were associated with greater risk of poorer outcomes.

Conclusions

This study offers a comprehensive and novel insight into the stress experiences of ambulance staff. Findings underscore the need for theoretically-informed, evidence-based interventions that integrate organisational reform and individual support strategies to mitigate sickness absence, safeguard well-being and prevent attrition.

Exploring the relationship between mental health and urban green space soundscapes: A scoping review

by Elham Ahmadi, Sophia Baierl, Stephan Voss, Ida Asenkerschbaumer, Ursula Berndt, Leonie Bernhard, Anita Hennig, Anna-Lena Würfele, Michaela Coenen

Urban soundscapes, particularly those experienced in green spaces, have been increasingly recognized as factors that influence human mental health. This scoping review explores the existing literature on soundscapes within urban green spaces and their associated mental health outcomes. It aims to classify the methodologies used in this domain, identify mental health outcomes related to urban green space soundscapes, and examine specific soundscape elements and their correlations with mental health. A systematic search of peer-reviewed studies was conducted. After screening titles, abstracts, and full texts, 22 studies met the inclusion criteria. Diverse methodological approaches were identified, with an emphasis on quantitative multi-method designs. Commonly studied mental health outcomes include stress reduction, mood enhancement, perceived restorativeness, and cognitive restoration. Standardized psychometric tools, such as the Perceived Stress Scale (PSS-14), Positive and Negative Affect Schedule (PANAS) and Perceived Restorativeness Soundscape Scale (PRSS) are frequently used as outcome measures. Natural soundscape elements such as birdsong, water sounds, and rustling leaves had a positive association with relaxation and perceived mental restoration throughout all studies, while mechanical sounds, such as traffic noise were linked to adverse mental health outcomes. These findings highlight that natural soundscapes in urban green spaces have a potential positive relationship with mental health by reducing stress and enhancing mood. However, the cross-sectional design and methodological heterogeneity of the included studies limit causal interpretation. Future research should explore multi-sensory experiences and examine soundscapes in diverse urban contexts to provide more robust insights into their relationship with mental health. The practical implications suggest that urban planners should prioritize integrating natural sound elements into urban areas to improve mental health. The study protocol of this scoping review had been registered at OSF (osf.io/4r7gd).

Feasibility of Lantern Using WhatsApp to Improve Antiretroviral Therapy Adherence

imageThis pilot study tested the feasibility of Lantern program, an adherence program to HIV medications using WhatsApp, a secure social media messaging application from Meta, for a smartphone-based platform to enhance medication-taking adherence of antiretroviral therapy among people living with HIV in Indonesia. Thirty participants were recruited for this 8-week study. We recruited persons if they had taken antiretroviral therapy for at least 3 months prior to the study, had a smartphone, Internet access, and could use Lantern with WhatsApp. Here, we report the results from the focus group discussions, with the participants evaluating the qualitative aspects of the experiences. The WhatsApp platform was found to be safe, practical, and relatively inexpensive and provided confidentiality for the participants. Three themes emerged from the focus groups: the study motivated participants to take their antiretroviral therapy medications on time, they still set medication reminder alarms, and being in the study made them feel supported. The Lantern program indicated good feasibility and acceptability for adherence to antiretroviral therapies among people living with HIV. Future research should examine on how community organizations and healthcare providers can take advantage of the WhatsApp program to improve adherence to antiretroviral therapies.
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