From Workplace Violence-Related Trauma to Quiet Quitting: Occupational Stress and Burnout as Serial Mediators Among Prehospital Emergency Healthcare Workers

Background Emergency medical personnel in prehospital settings face a heightened vulnerability to post-traumatic stress disorder (PTSD) and professional burnout. However, the specific psychological processes that connect these adverse states to forms of workplace withdrawal, such as quiet quitting, remain poorly understood. This study tested a serial mediation framework to ascertain whether the association between PTSD and quiet quitting was sequentially explained by the intervening roles of perceived occupational stress and workplace emotional burnout. Methods We conducted a survey among 305 prehospital emergency professionals in Turkey who reported experiencing workplace violence in the preceding six months. We collected data using an online questionnaire battery assessing PTSD (PTSD-SS), perceived occupational stress (POSS), workplace emotional burnout (WREBS), and quiet quitting (QQS). We analyzed the proposed serial mediation pathway using Hayes' PROCESS macro (Model 6) with 5,000 bootstrap resamples. Results A significant total effect of PTSD on quiet quitting was initially observed (β = 0.460, p < .001). However, this relationship lost its statistical significance after the introduction of the mediating variables (β = 0.105, p = .071), indicating full mediation. The total indirect effect, encompassing all mediator pathways, was significant (Effect = 0.279, 95% CI [0.199, 0.364]). Notably, the specific serial pathway—from PTSD through perceived occupational stress, emotional burnout, and finally to quiet quitting—was confirmed as significant and represented the most substantial indirect route (Effect = 0.155, 95% CI [0.091, 0.217]). Conclusion In this sample of prehospital emergency personnel, the link between PTSD and quiet quitting was not direct but was fully and sequentially mediated by perceived occupational stress and emotional burnout. These results suggest a cascade of negative psychological states in which trauma-related symptoms are associated with heightened job stress, which subsequently fosters emotional exhaustion and ultimately predicts a withdrawal of discretionary effort at work. This highlights the necessity for comprehensive organizational strategies that concurrently address trauma, manage ongoing work stressors, and actively prevent burnout to preserve the engagement and psychological health of this vital workforce in the long term. Clinical trial number: Not applicable.