title: Multi-level modeling of aspects associated with poor mental health in a sample of prehospital emergency professionals.
abstract: BACKGROUND
  The goal of this paper is to investigate the respective influence of work characteristics, the effort-reward ratio, and overcommitment on the poor mental health of out-of-hospital care providers.
  
  
  METHODS
  333 out-of-hospital care providers answered a questionnaire that included queries on mental health (GHQ-12), demographics, health-related information and work characteristics, questions from the Effort-Reward Imbalance Questionnaire, and items about overcommitment. A two-level multiple regression was performed between mental health (the dependent variable) and the effort-reward ratio, the overcommitment score, weekly number of interventions, percentage of non-prehospital transport of patients out of total missions, gender, and age. Participants were first-level units, and ambulance services were second-level units. We also shadowed ambulance personnel for a total of 416 hr.
  
  
  RESULTS
  With cutoff points of 2/3 and 3/4 positive answers on the GHQ-12, the percentages of potential cases with poor mental health were 20% and 15%, respectively. The effort-reward ratio was associated with poor mental health (P < 0.001), irrespective of age or gender. Overcommitment was associated with poor mental health; this association was stronger in women (β = 0.054) than in men (β = 0.020). The percentage of prehospital missions out of total missions was only associated with poor mental health at the individual level.
  
  
  CONCLUSIONS
  Emergency medical services should pay attention to the way employees perceive their efforts and the rewarding aspects of their work: an imbalance of those aspects is associated with poor mental health. Low perceived esteem appeared particularly associated with poor mental health. This suggests that supervisors of emergency medical services should enhance the value of their employees' work. Employees with overcommitment should also receive appropriate consideration. Preventive measures should target individual perceptions of effort and reward in order to improve mental health in prehospital care providers.
authors.affiliation: Institute for Work and Health, Lausanne University, Switzerland. marc.arial@hospvd.ch
authors.forename: Marc
authors.initials: M
authors.lastname: Arial
authors.forename: Pascal
authors.initials: P
authors.lastname: Wild
authors.forename: Damien
authors.initials: D
authors.lastname: Benoit
authors.forename: Dominique
authors.initials: D
authors.lastname: Chouaniere
authors.forename: Brigitta
authors.initials: B
authors.lastname: Danuser
mesh_terms: D000223:Adaptation, Psychological; D000328:Adult; D000488:Allied Health Personnel; D000552:Ambulances; D003430:Cross-Sectional Studies; D004632:Emergency Medical Services / Q000379:methods*; D005260:Female; D019538:Health Care Surveys; D006801:Humans; D016014:Linear Models; D008297:Male; D001523:Mental Disorders / Q000453:epidemiology / Q000523:psychology*; D008603:Mental Health; D008875:Middle Aged; D008960:Models, Psychological; D015233:Models, Statistical; D009784:Occupational Diseases / Q000453:epidemiology / Q000523:psychology*; D011594:Psychometrics; D013315:Stress, Psychological; D011795:Surveys and Questionnaires; D014481:United States / Q000453:epidemiology; D017132:Workplace / Q000523:psychology; D055815:Young Adult