New research from the University of the Western Cape (UWC) has shed critical light on a pressing issue within South Africa's emergency services: the strong connection between psychological distress and harmful alcohol use among police officers and paramedics. This cross-sectional study, published in the Turkish Journal on Addictions in May 2025, surveyed 429 experienced first responders in the Western Cape province—309 police officers and 120 paramedics—with an average age of 39 years and over 13 years of service. The findings reveal that 42.9% are at risk for harmful alcohol consumption, while 25.9% meet criteria for alcohol dependence, rates that surpass global meta-analyses for trauma-exposed professions at around 22%.

These statistics underscore a vicious cycle where daily exposure to trauma fuels emotional strain, prompting many to turn to alcohol as a short-term coping mechanism. However, this only exacerbates the underlying distress, leading to dependence and impaired performance on the job. As South Africa grapples with high crime rates and overburdened public services, safeguarding the mental well-being of these frontline workers is not just a health imperative but a national security priority.

Defining Psychological Distress in High-Stakes Professions

Psychological distress encompasses a range of mental health symptoms that impair daily functioning, including post-traumatic stress disorder (PTSD), depression, anxiety, burnout components like emotional exhaustion and depersonalization, chronic fatigue, and insomnia. In first responders—defined here as police officers from the South African Police Service (SAPS) and paramedics from provincial emergency medical services—these arise from repeated critical incidents such as violent crimes, mass casualties, and disasters.

The UWC study employed validated tools: the Alcohol Use Disorders Identification Test (AUDIT) for alcohol patterns (scoring 0-40, with ≥8 indicating hazardous/harmful use and higher thresholds for dependence); Patient Health Questionnaire-9 (PHQ-9) for depression; Generalized Anxiety Disorder-7 (GAD-7) for anxiety; PTSD Checklist for DSM-5 (PCL-5); Maslach Burnout Inventory (MBI) subscales; Life Events Checklist-5 (LEC-5) for trauma exposure; Chalder Fatigue Questionnaire (CFQ); and Insomnia Severity Index (ISI). Mean AUDIT scores stood at 9.5, signaling widespread risky patterns predominantly among urban-based males comprising 55% of the sample.

This distress manifests step-by-step: initial trauma exposure triggers acute stress responses, evolving into chronic symptoms if unaddressed. For instance, emotional exhaustion from prolonged shifts leads to depersonalization—treating victims impersonally as a detachment strategy—while insomnia disrupts recovery, heightening fatigue and vulnerability to anxiety spirals.

Core Predictors: From Anxiety to Insomnia Driving Alcohol Reliance

Linear regression analysis pinpointed anxiety (β=0.16), depersonalization (β=0.18), insomnia (β=0.13), and fatigue (β=-0.13, counterintuitively protective in this model perhaps due to reduced consumption capacity) as significant predictors of AUDIT scores, controlling for other factors. PTSD symptoms, surprisingly, did not predict alcohol use (β=0.11, p=0.10), suggesting subtler distress pathways dominate.

Pearson correlations showed medium strengths (r=0.20-0.35) between alcohol and depression, anxiety, exhaustion, depersonalization, and insomnia; smaller for PTSD (r=0.25) and trauma events (r=0.13). MANOVA confirmed at-risk groups (harmful use) and dependent groups exhibited elevated distress across metrics, with medium effect sizes (η_p²=0.06-0.09).

This table illustrates disparities, highlighting how distress clusters amplify alcohol's appeal as self-medication despite long-term harm.

South Africa's First Responders Under Siege: Suicide and Burnout Epidemic

Beyond UWC's data, national figures paint a dire picture. In the 2024/25 financial year, SAPS recorded 54 suicides—one weekly—down slightly from 62 prior year but totaling over 300 in recent periods. A 2025 survey pegged depression at 47.3%, generalized anxiety at 37.8%, and PTSD at 48.5% among police and paramedics, far exceeding general population rates.

Paramedics face similar burdens; a prior Western Cape study found 16% of trainees with PTSD, compounded by burnout in advanced roles. High crime—SA's murder rate tops global charts—means officers handle 20+ incidents daily, often gruesome, fostering hypervigilance and isolation.

Photo by micheile henderson on Unsplash

• Overcrowded stations and understaffing extend shifts to 12-16 hours.
• Resource shortages delay responses, amplifying guilt.
• Community distrust post-incidents like Marikana erodes morale.

UWC's Trailblazing Contributions from Psychology Experts

Led by Prof. Anita Padmanabhanunni, Dean of UWC's Faculty of Community and Health Sciences, and Prof. Tyrone B. Pretorius, former UWC Vice-Chancellor, this marks the first SA-specific probe into alcohol-distress links for these groups. UWC's Psychology Department has pioneered first responder research, including cynicism's wellbeing toll and GAD-7 validation locally. Padmanabhanunni notes, "Protecting first responders' mental health is essential for sustaining emergency services."

As a leading SA university, UWC trains psychologists equipped for trauma care, fostering community partnerships. Their work exemplifies higher education's role in evidence-based policy.

Barriers to Help: Stigma, Culture, and Systemic Gaps

Stigma labels vulnerability as weakness; masculinity norms demand stoicism, per Padmanabhanunni: "Emotional distress treated as weakness compels pushing through." Confidentiality fears and judgmental peers deter access. SAPS offers Employee Health and Wellness but uptake lags due to poor integration.

In rural areas, services are scarce; post-COVID, demand surged without capacity.

Pathways Forward: Integrated Interventions for Resilience

Authors urge organizational reforms: immediate critical incident stress management (CISM) post-trauma, involving group debriefs within 24-72 hours. Mindfulness-based stress reduction (MBSR) and cognitive behavioral therapy (CBT) target anxiety/insomnia; peer support networks normalize disclosure.

For alcohol, screening via AUDIT in wellness checks, coupled with motivational interviewing. SAPS pilots trauma risk management (TRiM); expand province-wide. Universities like UWC could develop tailored programs, training counselors for emergency contexts. Evidence shows early intervention halves PTSD incidence.Read the full UWC study here.

• Step 1: Routine mental health screenings at onboarding/promotions.
• Step 2: 24/7 confidential helplines with first-responder specialists.
• Step 3: Wellness days with yoga, counseling.
• Step 4: Leadership training on stigma reduction.

Higher Education's Pivotal Role in Mental Health Solutions

SA universities, especially UWC, Stellenbosch, and UCT, produce clinical psychologists specializing in trauma. Programs integrate first-responder simulations, boosting empathy and skills. Research grants fund longitudinal studies tracking interventions' efficacy. Collaborations with SAPS/EMS embed evidence-based protocols, positioning academia as crisis solvers.

Explore psychology lecturer jobs or research assistant roles to contribute.UWC Psychology Department.

Photo by Paolo Chiabrando on Unsplash

Looking Ahead: Sustaining SA's Frontline Guardians

The UWC study signals a turning point, urging policy shifts for proactive care. With suicides persisting and distress rife, integrated support could retain talent, enhance response quality, and save lives—both responders' and communities'. As SA advances, universities lead with research driving change.