Examining the between‐ and within‐person associations among perceived sleep quality and mental health symptoms in emergency medical service clinicians

Disturbed sleep is a known risk factor for heightened mental health symptoms, and this association may be particularly problematic among emergency medical service (EMS) clinicians. Yet, associations between daily sleep quality and daily mental health symptoms are understudied among this vulnerable group. We used ecological momentary assessments to examine between- and within-person associations between perceived sleep quality and mental health symptoms in 79 EMS clinicians employed at a large agency in central New York. Participants completed eight daily assessments (558 total) on perceived sleep quality and symptoms of posttraumatic stress disorder (PTSD) and depression. Multilevel regression models examined between- and within-person effects of sleep quality, controlling for covariates. Between-person effects in each model accounted for 17.0% and 31.0% of the total variance, respectively; within-person effects explained 1.0% per model. Poorer between-person perceived sleep quality was associated with higher PTSD and depressive symptom severity; perceived sleep quality 1.0 standard deviation (SD) below the sample mean was related to 58.8% and 16.3% increases in PTSD and depressive symptoms, respectively. There was also a within-person effect for depressive symptoms: On days when a participant's perceived sleep quality was 1.0 SD below their average, depressive symptom severity increased by 3.0%. Poorer subjective sleep may be an important risk factor for mental health symptoms at the between-person level. EMS policies supporting healthy sleep may benefit clinicians who routinely experience poor sleep. Day-to-day subjective sleep quality may increase the risk for depressive symptoms. Interventions to improve sleep and manage depressive symptom fluctuations when sleep is poor might be helpful.