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

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.