More than 600 members of the Northern Ireland Ambulance Service (NIAS) were forced to take time off work due to stress-related illness over the last three years.
Some 675 staff required sick leave for stress, anxiety or depression between 2016 and 2019, according to figures released by the NIAS in response to a freedom of information act request.
The highest number of absences (267) was recorded in 2018/19 because of stress, anxiety and depression.
This was a rise from the 215 recorded in 2017/18 and 193 the previous year.
Males accounted for the higher proportion of absenteeism, with 470 men taking sick leave for stress, anxiety or depression in the three years period compared to 205 females.
Of these 181 were paramedics who were recorded on the Health and Social Care Trust's Human Resources, Payroll, Travel and Subsistence system (HRPTS) as having been absent from work due to stress, anxiety or depression.
Meanwhile, six female officers staff members required sick leave for post-natal health concerns in the past three years.
Commenting to the figures, a spokesperson for NIAS said the service recognised that significant psychological and emotional stress is being experienced by staff in their frontline, control and support duties.
"We are committed to supporting all staff to the maximum extent," the spokesperson said.
"Some stresses are naturally associated with a first responder service like NIAS. However, these stresses can be intensified by factors such as assaults on staff, resource shortages, difficulties with shift patterns or meal breaks, the pressure of generational health crises like Covid-19, and also, personal issues.
"Recognising such factors, NIAS began a Wellbeing Partnership with trade unions in November 2017.
"This work has sought to normalise and address psychological and emotional health issues, and to encourage openness among all staff about these realities."
NIAS said that since then, a range of support measures has been developed, including: training and guidance around wellbeing and resilience; various health and wellbeing events and initiatives across the Trust; commencement of a Health and Wellbeing Project Manager in April 2019; establishment of a staff-led Peer Support project, to which two staff have been seconded since August 2019 and participation in the regional psychological support services framework launched by the Minister for Health in April 2020."
The NIAS spokesperson added: "In particular, Peer Support has provided a significant psychological first-aid and signposting service to staff following the most traumatic incidents of the past 18 months.
"This project has developed links with partners across the UK and Ireland, working closely with PSNI and HSC colleagues, as well as international experts.
"During the most serious weeks of Covid-19, over 500 Covid-related staff contacts were proactively initiated by Peer Support to help staff. A review of Occupational Health provision is currently ongoing. The need for additional resources and expert psychological support has already been identified.
"Recently, an increase in attacks against staff has caused even greater trauma and added stress to our teams.
"These attacks need to stop."
Last month the NIAS revealed that assaults on ambulance staff soared to 44 incidents in May after dropping significantly during the March and April lockdown.
Some of the incidents involved patients spitting at NIAS crews, urinating over equipment and telling staff that they had coronavirus and intended to pass it on to them.
As a result of the Covid-19 restrictions on movement, ambulance crews had been at a lesser risk of assault in public places -but since the easing of the regulations, physical and verbal attacks have surged.
A spokesman for the Unison union, which represents the overwhelming majority of Ambulance Service staff, added: "Unison has been working constructively with the NIAS in an innovative partnership project to protect and improve the health and wellbeing of all staff, given the particular levels of stress faced by these key workers."