Post-traumatic stress symptoms in an elite unit of Brazilian police officers: prevalence and impact on psychosocial functioning and on physical and mental health

Prevalence of post-traumatic stress disorder and associated factors among police officers in Central Gondar Zone, North West Ethiopia, 2023: institutional-based cross-sectional study

Background

Post-traumatic stress disorder (PTSD) is a psychiatric disorder that follows exposure to a traumatic or stressful life event. Police officers are exposed to a number of traumatic events that put them at risk of developing post-traumatic stress disorder. Previous studies have found the prevalence of post-traumatic stress disorder among police officers to be varied and inclusive. However, in Ethiopia, little is known about the prevalence of post-traumatic stress disorder and associated factors among police officers. Therefore, assessing the prevalence and associated factors of post-traumatic stress disorder among police officers might have a plausible role in future investigations.

Objective

The aim of this study was to assess the prevalence of post-traumatic stress disorder and associated factors among police officers in Central Gondar Zone, North West Ethiopia, 2023.

Methods

An institutional-based cross-sectional study was conducted in Central Gondar Zone by using self-administered and semi-structured questionnaires. A multi-stage cluster sampling technique was employed to select a sample of 634 participants. Post-traumatic stress disorder was assessed using the PTSD Checklist DSM-5. The collected data were coded and entered using Epi data Software version 4.6.02 and then exported to STATA version 14 for analysis. Bivariable and multivariable logistic regression analyses were done to identify factors associated with post-traumatic stress disorder. Statistically significant results were declared at a 95% confidence interval (CI) of a p-value less than 0.05.

Results

The prevalence of post-traumatic stress disorder was found to be 15.2%, with a 95% CI of 12.5% to 18.3%. In the multivariate analysis, female (AOR = 3.36, 95% CI 1.95-5.78), being directly exposed to traumatic events (AOR = 2.01, 95% CI 1.16-3.48), current alcohol use (AOR = 2.90, 95% CI 1.65-5.12), and having poor social support (AOR = 4.25, 95% CI 1.58-11.36) were factors significantly associated with post-traumatic stress disorder.

Conclusion

According to this study, police officers suffered from a significant burden of post-traumatic stress disorder. Female sex, police personnel directly exposed to traumatic events, current alcohol users, and those who had poor social support were found to be strongly associated with post-traumatic stress disorder. Therefore, early detection and intervention are crucial to mitigating the overall problem.

Outcomes of transdiagnostic internet-delivered cognitive behavioural therapy tailored to public safety personnel: A longitudinal observational study

First responders and other public safety personnel (PSP) experience high rates of mental health problems and face barriers to accessing mental healthcare. Internet-delivered cognitive behavioural therapy (ICBT) is an effective and accessible treatment for various mental health concerns. Canadian PSP report favorable attitudes toward ICBT, and preliminary outcomes demonstrate that they benefit from it. Expanding on this research, the current study consisted of a longitudinal observational study of 560 Canadian PSP who participated in ICBT. It was designed to assess the longer term effectiveness of ICBT and moderators of outcomes by gender, linguistic and occupational group, and years of occupational experience. We evaluated symptom change at 8, 26, and 52 weeks post-enrollment, and results among PSP who had elevated clinical scores, showed large reductions (Hedges' g) in symptoms of depression (g = 1.3), anxiety (g =1.48), posttraumatic stress (g =1.24), panic (g =1.19), and anger (g =1.07) and moderate reductions in symptoms of social anxiety (g =.48-.56). Moderator analyses revealed modest differences in pre-treatment symptoms among certain groups but no group differences in symptom change over time. Clients showed good completion of treatment materials and reported high treatment satisfaction. The results suggest further study of ICBT tailored to PSP is warranted, including evaluating ICBT tailored for PSP in other countries.

Traumatic stress, active engagement and resilience in first responders and civilians in the outbreak of war

Background: The outbreak of war in Israel on 7 October and the unique events of that day have presented unprecedented challenges to first responders (FRs), who are professionally trained to engage in providing assistance in such circumstances. Moreover, while research demonstrates the long-term psychological consequences of FRs, little is known regarding how FR's engagement in providing assistance relates to stress and resilience levels as events continue to unfold.Objective: The current study examined the relationship between traumatic stress symptoms (TSS) and resilience levels among FRs and controls during the first weeks of the Iron Swords war, while focusing on the moderating role of active engagement in providing assistance.Method: Data were collected during the first month of the Iron Swords war from 374 participants living in Southern Israel, of whom 77 (20.6%) were FRs. All participants filled out scales assessing TSS and resilience and provided relevant background information.Results: High TSS levels were associated with reduced resilience in FRs and non-FRs. Moreover, both the study group and active engagement were significant moderators for the TSS-resilience link, which was insignificant among FRs who provided assistance and for civilians who did not provide assistance. However, the TSS-resilience association remained significant for FRs who did not engage in providing assistance and for civilians who did.Conclusions: Our findings highlight the importance of examining the extent to which FRs act in line with their duties during times of adverse stress. Clinical interventions aimed towards FRs who did not engage in providing assistance are needed and should focus on the extent to which their moral values, beliefs and expectations are met, as these appear critical parameters in preserving resilience.

Examining how organizational leaders perceive internet-delivered cognitive behavioural therapy for public safety personnel using the RE-AIM implementation framework

Background

Within Canada, internet-delivered cognitive behavioural therapy (ICBT) has recently been tailored by PSPNET to meet the needs of public safety personnel (PSP) to help address high rates of mental health problems within this population. Perceptions and outcomes of ICBT among PSP are promising, but it remains unknown how PSPNET is perceived by PSP organizational leaders. It is important to assess this gap because these leaders have significant potential to influence the uptake of ICBT.

Methods

In the current study, PSP leaders (n = 10) were interviewed to examine their perceptions of PSPNET and opportunities to improve ICBT implementation. The RE-AIM evaluation framework was used to assess PSP leaders' perceptions of PSPNET in terms of reach, effectiveness, adoption, implementation, and maintenance.

Results

The results evidenced that leaders perceived PSPNET as effective in reaching and serving PSP and PSP organizations. PSP leaders reported perceiving ICBT as effectively implemented, especially for being freely offered to individual PSP and for improving PSP's access to experienced therapists specifically trained to work with PSP. Participants indicated organizations have promoted and will continue promoting PSPNET longer-term, facilitating adoption and maintenance. Factors perceived as facilitating successful service delivery included building relationships and trust with PSP organizations and general support for PSP leadership mental health initiatives. PSP leaders identified perceived areas for improving ICBT implementation (e.g., ensuring leaders have access to data on PSPNET uptake and outcomes, creating promotional videos, expanding availability of PSPNET to other provinces, offering additional options for receiving therapist support).

Implications

Overall, the study provides insights into PSP leaders' perceptions of the implementation of ICBT among PSP and ideas for optimizing implementation efforts.

Correlates and prevalence of post-traumatic stress disorders in the São Paulo metropolitan area, Brazil

BACKGROUND

Post-traumatic stress disorder (PTSD) is a debilitating condition, which generates an extensive burden. We aimed to investigate in a huge metropolitan area, the prevalence of traumatic experiences, the development of PTSD, and its predictors.

METHODS

Traumatic experiences and PTSD were assessed in 5037 adult individuals of the general population. Cross-tabulations method assessed the prevalence of traumatic events and PTSD. Logistic regression models investigated predictors of lifetime and 12-month odds of PTSD and the conditional probability of developing PTSD for specific traumas.

RESULTS

Lifetime and 12-month diagnoses of PTSD were found in 3.2% and 1.6% of the sample. 'Witnessing anyone being injured or killed, or unexpectedly seeing a dead body' (35,7%) and 'being mugged or threatened with a weapon' (34.0%) were the two most reported traumas. The commonest events before PTSD onset were 'sudden unexpected death of a loved one' (34.0%), 'interpersonal violence' (31.0%), and 'threats to the physical integrity of others' (25.0%). Experiences related to "interpersonal violence" presented the highest conditional probability for PTSD (range 2.2-21.2%). Being 'sexually assaulted or molested' (21.2% total; 22.3% women; 0.0% men) and being 'raped' (18.8% total; 18.4% women; 20.1% men) were the two experiences with the highest odds for PTSD. While being female was a predictor of less exposure to any event (OR = 0.69), females were more prone to develop lifetime PTSD after exposure to an event (OR = 2.38).

CONCLUSION

Traumatic events are frequent in the general population and a small group of traumatic events accounts for most cases of subsequent PTSD.

Prevalence and factors associated with post traumatic stress disorder among field police patrol officers serving in Kampala Metropolitan region

BACKGROUND

Occupation groups like police officers and fire fighters are exposed to a number of traumatic events which put them at a risk of developing post-traumatic stress disorder (PTSD). Previous studies have found the prevalence of PTSD in police officers to vary between 7 and 19%. However, most of these studies have been undertaken in western setting with little research having been undertaken in sub-Saharan Africa including Uganda.

OBJECTIVE

To determine the prevalence and factors associated with post-traumatic stress disorder among field police patrol officers serving in Kampala Metropolitan Police (KMP) North Region.

METHODS

This was a cross sectional study that was conducted on 392 field police patrol officers serving in KMP North Region. Diagnosis of PTSD was undertaken using the Clinician Administered PTSD Scale for DSM-5. In order to assess for psychiatric comorbidities, the study used the Mini International Neuropsychiatric Interview (M.I.N.I.) RESULTS: In this study, the prevalence of PTSD was 7.4%. An additional 62.5% had sub-threshold PTSD, which was defined as, the presence of at least one PTSD symptom but not meeting full criteria for PTSD diagnosis. The factors found to be significantly associated with PTSD were all related to the presence of psychiatric comorbidities, namely the presence of: a current major depressive episode (aOR = 4.7; 95% CI: 1.5- 14.8; p = .009); an alcohol use disorder (aOR = 5.1; 95% CI: 2.0-13.0; p = .001); and presence of dissociation symptoms (aOR = 6.7; 95% CI: 2.0-22.2; p = .002).

CONCLUSION

PTSD is one of the common psychiatric disorders experienced by serving police officers in Uganda. The tendency of PTSD in this group to co-occur with other psychiatric disorders means that any treatment program to address it should be part of a comprehensive multi-disorder mental health treatment programme in the police office.

A Qualitative Study: Emotional Damage to Police Victims in China

This article aims to analyze the emotional injury and behavioral consequences that police officers in China experience after they have been violently attacked (e.g., when police are victims of violent crimes). The analysis was based on self-narration from police officers who were victimized (from here "police victims"). First, the study explored the emotional trauma caused by violent and nonviolent attacks on police victims. Second, this study explored the impact of this violence on the police community. Finally, the study assessed the impact of violent attacks on police enforcement capabilities. Research shows that police in China have become victims of violent attacks that may have caused emotional damage. However, the extent and consequences of this emotional damage are not clear and deserve further discussion. Therefore, this research attempts to contribute to an in-depth discussion of this topic. The research used a focus group format to interview police victims (n = 40). The interviews included questions about emotional damage, occupational hazards, ensuing self-doubt, long-term behaviors, returning to work, and self-protection. The results show that police victims have suffered severe emotional damage, which may affect their ability to continue in law enforcement. It is particularly noteworthy that some police officers received unequal treatment, which led to the breakdown of family and social relationships. Chinese police victims face severe emotional damage. They have suffered great mental pressure and bad social evaluation. A reasonable recovery plan is required to help police victims return to normal life. The recovery plan should aim to improve the lives of police victims, especially by helping them relieve stress.

Profiling Police Forces against Stress: Risk and Protective Factors for Post-Traumatic Stress Disorder and Burnout in Police Officers

Police officers are frequently exposed to highly stressful situations at work and have an increased risk to develop symptoms of post-traumatic stress disorder (PTSD) and burnout (BO). It is currently not well understood which officers are most at risk to develop these disorders. The aim of this study was to determine which coping strategies and personality traits could act as protective or risk factors in relation to PTSD and BO. The second aim, in the interest of designating preventive and therapeutical measures, was to determine whether certain profiles of police officers could be identified as high risk for developing mental disorders. Herein, 1073 French-speaking police officers in Switzerland reported in an online survey about their PTSD and BO symptoms, anxiety, depression, suicide ideation, coping strategies, occupational stress, and personality factors. The cluster analysis highlighted three principal profiles of police officers: those who are not at risk of developing pathologies because they are not exposed or insensitive to these stressors, and those who are, among which personality and coping strategies oriented the risk of developing PTSD or BO. These same protective and risk factors were also corroborated in the linear and logistic regression analyses. These results may suggest that a crucial opportunity for mitigating mental health issues in the force could consist of screening recruits for risk-related personality traits and orienting them towards psychological training programs for the development of functional coping strategies.

Understanding and Addressing Occupational Stressors in Internet-Delivered Therapy for Public Safety Personnel: A Qualitative Analysis

Internet-delivered cognitive behavioral therapy (ICBT) is effective when tailored to meet the needs of public safety personnel (PSP). Nevertheless, there is limited research on the nature of the occupational stressors faced by PSP who seek ICBT and how PSP use ICBT to address occupational stressors. We provided tailored ICBT to PSP (N = 126; 54% women) and conducted a qualitative content analysis on clinicians’ eligibility screening notes, clients’ emails, and clients’ survey responses to understand the occupational stressors faced by PSP and their use of ICBT to address such stressors. Clients described several occupational stressors, including operational stressors (e.g., potentially psychologically traumatic events and sleep/shiftwork issues) and organizational stressors (e.g., issues with leadership, resources, and workload). More clients shared occupational concerns during the screening process (97%) than during treatment (58%). The most frequently cited occupational stressor was exposure to potentially psychologically traumatic events. Clients reported using course skills (e.g., controlled breathing and graduated exposure) to manage occupational stressors (e.g., responding to calls, workplace conflict, and work–family conflict). Thought challenging was the most frequently reported strategy used to manage occupational stressors. The current results provide insights into the occupational stressors PSP experience and endeavor to manage using ICBT, which can inform further efforts to tailor ICBT for PSP (e.g., adapting course materials and examples to take into account these operational and occupational stressors).

Mental health and help seeking among trauma-exposed emergency service staff: a qualitative evidence synthesis

OBJECTIVES

To identify factors and contexts that may contribute to mental health and recovery from psychological difficulties for emergency service workers (ESWs) exposed to occupational trauma, and barriers and facilitators to help-seeking behaviour among trauma-exposed ESWs.

BACKGROUND

ESWs are at greater risk of stressor-related psychopathology than the general population. Exposure to occupational stressors and trauma contribute to the observed rates of post-trauma psychopathology in this occupational group with implications for workforce sustainability. Types of organisational interventions offered to trauma-exposed ESWs are inconsistent across the UK, with uncertainty around how to engage staff.

DESIGN

Four databases (OVID MEDLINE, EMBASE, PsycINFO and SCOPUS) were systematically searched from 1 January 1980 to March 2020, with citation tracking and reference chaining. A modified Critical Appraisal Skills Programme tool and quality appraisal prompts were used to identify fatally flawed studies. Qualitative studies of trauma-exposure in front-line ESWs were included, and data were extracted using a customised extraction table. Included studies were analysed using thematic synthesis.

RESULTS

A qualitative evidence synthesis was conducted with 24 qualitative studies meeting inclusion criteria, as defined by the PerSPEcTiF framework. Fourteen descriptive themes emerged from this review, categorised into two overarching constructs: (1) factors contributing to mental health (such as the need for downtime, peer support and reassurance) and (2) factors influencing help-seeking behaviour (such as stigma, the content/form/mandatory nature of interventions, and mental health literacy issues including emotional awareness and education).

CONCLUSION

ESWs reported disconnect between the organisations' cultural positioning on trauma-related mental health, the reality of undertaking the role and the perceived applicability and usefulness of trauma interventions. Following traumatic exposure, ESWs identify benefitting from recovery time and informal support from trusted colleagues. A culture which encourages help seeking and open dialogue around mental health may reduce stigma and improve recovery from mental ill health associated with trauma exposure.

Acceptability of a real-time notification of stress and access to self-help therapies among law enforcement officers

BACKGROUND

Law enforcement officers (LEOs) are exposed to chronic stress throughout the course of their shift, which increases the risk of adverse events. Although there have been studies targeting LEO safety through enhanced training or expanded equipment provisions, there has been little attempt to leverage personal technology in the field to provide real-time notification of LEO stress. This study tests the acceptability of implementing of a brief, smart watch intervention to alleviate stress among LEOs.

METHODS

We assigned smart watches to 22 patrol LEOs across two police departments: one suburban department and one large, urban department. At baseline, we measured participants' resting heart rates (RHR), activated their watches, and educated them on brief wellness interventions in the field. LEOs were instructed to wear the watch during the entirety of their shift for 30 calendar days. When LEO's heart rate or stress continuum reached the predetermined threshold for more than 10 min, the watch notified LEOs, in real time, of two stress reduction interventions: [1] a 1-min, guided breathing exercise; and [2] A Calm app, which provided a mix of guided meditations and mindfulness exercises for LEOs needing a longer decompression period. After the study period, participants were invited for semi-structured interviews to elucidate intervention components. Qualitative data were analyzed using an immersion-crystallization approach.

RESULTS

LEOs reported three particularly useful intervention components: 1) a vibration notification when hearts rates remained high, although receipt of a notification was highly variable; 2) visualization of their heart rate and stress continuum in real time; and, 3) breathing exercises. The most frequently reported type of call for service when the watch vibrated was when a weapon was involved or when a LEO was in pursuit of a murder suspect/hostage. LEOs also recollected that their watch vibrated while reading dispatch notes or while on their way to work.

CONCLUSIONS

A smart watch can deliver access to brief wellness interventions in the field in a manner that is both feasible and acceptable to LEOs.

The nature of posttraumatic stress disorder in treatment-seeking first responders

BACKGROUND

Approximately 10% of first responders report posttraumatic stress disorder (PTSD). Although reports within first responders suggest that they have distinct symptom presentations, there is a need to understand how the clinical profiles of first responders may differ from others seeking treatment for PTSD.

OBJECTIVE

This study compared the PTSD symptom profiles of first responder and civilians seeking treatment for PTSD.

METHOD

Participants self-referred to the Traumatic Stress Clinic (University of New South Wales, Sydney) for enrolment in out-patient treatment trials for PTSD. Participants comprised people of mean age 41.72 years (SD = 10.71) who met DSM-IV criteria for PTSD. The sample was composed of 128 first responders and 182 civilians. Clinician-administered interviews of PTSD (Clinician-Administered PTSD Scale) and depression were conducted, as well as measures of self-report measures of depression, alcohol use, posttraumatic appraisals, and anger.

RESULTS

First responders reported greater rates of dysphoric cluster of symptoms, including diminished interest, emotional numbing, and social detachment, and less psychological reactivity and avoidance of situations, than civilians with PTSD. Beyond PTSD symptoms, first responders also reported more severe levels of depression and suppressed anger.

CONCLUSIONS

These findings indicate that treatment-seeking first responders present with a distinct clinical profile that is characterized by dysphoric symptoms. These symptoms can predict poor treatment response and require specific attention in treating PTSD in first responders.

Why Do Public Safety Personnel Seek Tailored Internet-Delivered Cognitive Behavioural Therapy? An Observational Study of Treatment-Seekers

First responders and other public safety personnel (PSP) experience elevated rates of mental disorders and face unique barriers to care. Internet-delivered cognitive behavioural therapy (ICBT) is an effective and accessible treatment that has demonstrated good treatment outcomes when tailored specifically for PSP. However, little is known about how PSP come to seek ICBT. A deeper understanding of why PSP seek ICBT can inform efforts to tailor and disseminate ICBT and other treatments to PSP. The present study was designed to (1) explore the demographic and clinical characteristics, motivations, and past treatments of PSP seeking ICBT, (2) learn how PSP first learned about ICBT, and (3) understand how PSP perceive ICBT. To address these objectives, we examined responses to online screening questionnaires among PSP (N = 259) who signed up for an ICBT program tailored for PSP. The results indicate that most of our sample experienced clinically significant symptoms of multiple mental disorders, had received prior mental disorder diagnoses and treatments, heard about ICBT from a work-related source, reported positive perceptions of ICBT, and sought ICBT to learn skills to manage their own symptoms of mental disorders. The insights gleaned through this study have important implications for ICBT researchers and others involved in the development, delivery, evaluation, and funding of mental healthcare services for PSP.

Initial Outcomes of Transdiagnostic Internet-Delivered Cognitive Behavioral Therapy Tailored to Public Safety Personnel: Longitudinal Observational Study

Background

Canadian public safety personnel (PSP) experience high rates of mental health disorders and face many barriers to treatment. Internet-delivered cognitive behavioral therapy (ICBT) overcomes many such barriers, and is effective for treating depression, anxiety, and posttraumatic stress disorder (PTSD) symptoms.

Objective

This study was designed to fill a gap in the literature regarding the use of ICBT tailored specifically for PSP. We examined the effectiveness of a tailored ICBT program for treating depression, anxiety, and PTSD symptoms among PSP in the province of Saskatchewan.

Methods

We employed a longitudinal single-group open-trial design (N=83) with outcome measures administered at screening and at 8 weeks posttreatment. Data were collected between December 5, 2019 and September 11, 2020. Primary outcomes included changes in depression, anxiety, and PTSD symptoms. Secondary outcomes included changes in functional impairment; symptoms of panic, social anxiety, and anger; as well as treatment satisfaction, working alliance, and program usage patterns.

Results

Clients reported large symptom reductions on measures of depression and anxiety, as well as moderate reductions on measures of PTSD and secondary symptoms, except for social anxiety. Most clients who reported symptoms above clinical cut-offs on measures of depression, anxiety, and PTSD during screening experienced clinically significant symptom reductions. Results suggested good engagement, treatment satisfaction, and working alliance.

Conclusions

Tailored, transdiagnostic ICBT demonstrated promising outcomes as a treatment for depression, anxiety, and PTSD among Saskatchewan PSP and warrants further investigation.

Trial Registration

Clinicaltrials.gov NCT04127032; https://www.clinicaltrials.gov/ct2/show/NCT04127032

Probable post-traumatic stress disorder and harmful alcohol use among male members of the British Police Forces and the British Armed Forces: a comparative study

Background: British Armed Forces' and Police Forces' personnel are trained to operate in potentially traumatic conditions. Consequently, they may experience post-traumatic stress disorder (PTSD), which is often comorbid with harmful alcohol use. Objective: We aimed to assess the proportions, and associations, of probable PTSD and harmful alcohol use among a covariate-balanced sample of male military personnel and police employees. Methods: Proportions of probable PTSD, harmful alcohol use, and daily binge drinking, were explored using data from the police Airwave Health Monitoring Study (2007-2015) (N = 23,826) and the military Health and Wellbeing Cohort Study (phase 2: 2007-2009, phase 3: 2014-2016) (N = 7,399). Entropy balancing weights were applied to the larger police sample to make them comparable to the military sample on a range of pre-specified variables (i.e. year of data collection, age and education attainment). Multinomial and logistic regression analyses determined sample differences in outcome variables, and associated factors (stratified by sample). Results: Proportions of probable PTSD were similar in military personnel and police employees (3.67% vs 3.95%), although the large sample size made these borderline significant (Adjusted Odds Ratio (AOR): 0.84; 95% Confidence Intervals (CI): 0.72 to 0.99). Clear differences were found in harmful alcohol use among military personnel, compared to police employees (9.59% vs 2.87%; AOR: 2.79; 95% CI: 2.42 to 3.21). Current smoking, which was more prevalent in military personnel, was associated with harmful drinking and binge drinking in both samples but was associated with PTSD in military personnel only. Conclusions: It is generally assumed that both groups have high rates of PTSD from traumatic exposures, however, low proportions of PTSD were observed in both samples, possibly reflecting protective effects of unit cohesion or resilience. The higher level of harmful drinking in military personnel may relate to more prominent drinking cultures or unique operational experiences.

Post-Traumatic Stress Disorder in the Military Police of Rio de Janeiro: Can a Risk Profile Be Identified?

Background: Significant exposure to critical incidents characteristic of military police work has a potentially traumatic effect and multiple consequences for the mental health of these professionals, such as Post Traumatic Stress Disorder (PTSD). This study aims to investigate the occurrence of PTSD in this occupational group and its correlations with socio-demographic and occupational variables. Methods: This is a cross-sectional study of Rio de Janeiro’s Military Police officers (n = 3.577). Data was collected from self-reported questionnaires applied in an institutional health program. Post-Traumatic Stress Disorder Checklist—Civilian version was used to assess PTSD. Results: Rates of 16.9% for full PTSD and 26.7% for partial PTSD were found. Based on logistic regression analysis, female officers and police officers in lower ranks of the military hierarchy and performing administrative duties were found to be at most risk of developing PTSD. Conclusions: These results suggest the need to further understand the predictive organizational and individual variables of PTSD correlated with the increased vulnerability of professionals in order to contribute to institutional policies for the prevention and rehabilitation of these cases.

Trauma-Related Sleep Problems and Associated Health Outcomes in Police Officers: A Path Analysis

Police officers are frequently exposed to two different types of potentially traumatic events: one dealing with physical threats to self and the other involving the witnessing of harm to others. These different types of traumatic experiences are thought to produce various posttraumatic reactions. Furthermore, sleep problems are also reported as a hallmark of posttraumatic stress disorder. There is evidence, however, that sleep problems may mediate the relationship between posttraumatic stress disorder symptoms and health outcomes, especially physical health and depression. Previous research has shown this to be the case among officers from large urban agencies. The purpose of the present study was to test a model involving a pathway from trauma type and posttraumatic stress disorder symptoms to physical health and depression that is mediated by sleep quality in officers (N = 193) using data from small- to mid-size police agencies. Results revealed that sleep problems served as a mediator between posttraumatic stress disorder hyperarousal and avoidance symptoms and health outcomes, that the trauma types are related to different posttraumatic stress disorder symptoms, and that complicated relationships exist between the study variables. In addition, the results indicated that approximately 25% of our sample displayed probable partial posttraumatic stress disorder or probable full posttraumatic stress disorder, causing substantial functional impairment. Suggestions for improving officer health and performance in the field are provided. Specifically, it appears that interventions designed to address posttraumatic stress disorder hyperarousal symptoms related to personal life threat and the posttraumatic stress disorder avoidance symptoms related to the witnessing of human suffering may maximize officer sleep quality and ultimately overall wellness. In particular, mindfulness-based interventions are well suited for addressing these symptom clusters.

Considering the Impact of Early Trauma on Coping and Pathology to Predict Posttraumatic Growth Among 9-1-1 Telecommunicators

Recent research has demonstrated that first responders may report posttraumatic growth (PTG), positive psychological changes that arise in the aftermath of a trauma. Less is known regarding the perception of PTG among 9-1-1 telecommunicators, a group of first responders exposed to a high degree of lifetime trauma, including duty-related trauma as well as early and non-duty-related trauma. Moreover, the impact of childhood trauma on the processes involved in the perception of growth is less clear. While some distress is needed to facilitate processes that lead to the perception of PTG, it has been suggested that positive associations between PTG and pathology reflect avoidant coping or represent an illusory component of PTG. Structural equation models were used to examine early trauma exposure, coping, and pathology in predicting PTG among 9-1-1 telecommunicators (N = 788). In separate models using active and avoidant forms of coping, childhood trauma exposure had an indirect effect on PTG through coping. In a model considering both forms of coping, childhood trauma had an indirect effect on PTG through psychopathology, but not through coping. The results show that early trauma exposure leads to the perception of growth through pathways indicative of both adaptive and maladaptive coping processes.

PTSD and post-traumatic stress spectrum in the Italian Navy Operational Divers Group and corps of Coast Guard Divers employed in search and rescue activities in the Mediterranean refugees emergences and Costa Concordia shipwreck

Rescue personnel is at high risk for Post-traumatic Stress Disorder (PTSD) because of the possible repetitive exposition to "cruel details of traumatic events" (DSM-5). Literature reported PTSD rates in combat exposed veterans, although the Italian Navy military personnel has been frequently involved in no-war activities in most recent years, such as Search and Rescue (SAR) activities of civilians involved in catastrophic events. The study aimed at exploring the prevalence of PTSD and its impact on social and work functioning among divers of the Italian Navy employed in the SAR activities for the Costa Concordia shipwreck (2012), the collapsed control tower of the Genoa harbour (2013), and the "Mare Nostrum" and "Triton" immigrant emergency Operations in the Mediterranean Sea. The 85 Italian Navy and Coast Guard Divers on duty for these activities were involved in the study and forty fulfilled the assessments, including the: Impact Event Scale (IES-r), Trauma and Loss Spectrum Self-Report (TALS-SR) and Work and Social Adjustment Scale (WSAS). In the three years before enrollment 77.5% of the sample (n = 31) performed at least one rescue operation, with full and partial DSM-5 PTSD rates being 7.5% and 22.5%, respectively. A correlation emerged between WSAS domains or total scores and TALS-SR score domains for PTSD. Rescue Navy personnel resulted to be at risk for post-traumatic stress symptoms, and these subthreshold PTSD manifestations appear to impact on functioning. Further studies are needed to better investigate PTSD risk and resilience factors in this particular group of workers.

Prevalence of Mental Illness and Mental Health Care Use Among Police Officers

IMPORTANCE

Limited literature has characterized patterns of mental illnesses and barriers in seeking mental health care among police officers.

OBJECTIVES

To assess the prevalence of mental illness (diagnosis) and symptoms of mental illness, evaluate the characteristics of officers interested in seeking mental health care, and characterize perceptions of mental health care use.

DESIGN, SETTING, AND PARTICIPANTS

This survey study was conducted among officers at a large police department in Dallas-Fort Worth, Texas. Focus group sessions were conducted from April 1, 2019, to November 30, 2019, and the survey was conducted from January 1 to February 27, 2020. A total of 446 sworn, employed patrol officers who were present during the recruitment briefing were eligible to participate in surveys and focus groups.

MAIN OUTCOMES AND MEASURES

Officers reported lifetime or current diagnosis of depression, anxiety, and posttraumatic stress disorder, as well as current mental health symptoms (using validated screeners of depression, anxiety, posttraumatic stress disorder, and suicidal ideation or self-harm) and mental health care use in the past 12 months. Focus group data were collected to contextualize mental health care use. Logistic regression analyses were used for quantitative data, and focus groups were iteratively coded by 4 coders using inductive and deductive thematic identification.

RESULTS

Of the 446 officers invited to participate, 434 (97%) completed the survey (mean [SD] age, 37 [10] years; 354 [82%] male; 217 White [50%]). Of these officers, 19 (17%) had sought mental health care services in the past 12 months. A total of 54 officers (12%) reported a lifetime mental health diagnosis, and 114 (26%) had positive screening results for current mental illness symptoms. Among officers with positive screening results, the odds of interest in using mental health services was significantly higher for officers with suicidal ideation or self-harm than for those who did not (adjusted odds ratio, 7.66; 95% CI, 1.70-34.48). Five focus groups were conducted with 18 officers and found 4 primary barriers in accessing mental health services: (1) inability to identify when they are experiencing a mental illness, (2) concerns about confidentiality, (3) belief that psychologists cannot relate to their occupation, and (4) stigma that officers who seek mental health services are not fit for duty.

CONCLUSIONS AND RELEVANCE

The study found that although few officers were seeking treatment, they were interested in seeking help, particularly those with suicidal ideation or self-harm. Additional interventions appear to be needed to systematically identify and refer officers to health care services while mitigating their concerns, such as fear of confidentiality breach.

Exploring Perceptions of Internet-Delivered Cognitive Behaviour Therapy among Public Safety Personnel: Informing Dissemination Efforts

Background Public safety personnel (PSP) experience high rates of mental health disorders but have limited access to treatment. To improve treatment access, there is a growing interest in offering internet-delivered cognitive behaviour therapy (ICBT) to PSP. As attitudes towards ICBT can both impact and inform ICBT implementation efforts, this study examines perceptions of ICBT among PSP who viewed a poster (a commonly used method of advertising ICBT) or a poster supplemented with a story of a PSP who benefitted from ICBT. Methods Participants (N = 132) from various PSP sectors were randomly assigned to view a poster or a poster and a story. Participants then completed an online survey assessing their perceptions of ICBT using both qualitative and quantitative questions. We used a mixed-methods approach to analyze the data. Results No differences in perceptions of ICBT were identified between the conditions. Ratings of credibility, treatment expectancy, anticipated treatment adherence, and acceptability suggested that PSP had positive perceptions of ICBT. Most participants (93%) reported that they would access ICBT if they needed help with mental health concerns. Participants ranked therapist-guided ICBT as their second most preferred treatment, with psychologists ranked first. Female participants found ICBT more credible than male participants. More experienced PSP reported lower acceptability and anticipated adherence to ICBT. Conclusions The findings suggest that many PSP are likely to be receptive to ICBT even when a simple poster is used as a method of informing PSP of this treatment option. Further attention to improving the perceptions of ICBT among certain groups may be warranted.

Systematic review of posttraumatic stress disorder in police officers following routine work-related critical incident exposure

BACKGROUND

The prevalence of PTSD in police officers has been the subject of a large and highly variable empirical literature. The present systematic review evaluates the extant literature on PTSD in police officers using an international dataset.

METHODS

We employed best-evidence narrative synthesis to evaluate whether PTSD prevalence in police is elevated in comparison to the general population of Canada (8%), which itself has a higher lifetime PTSD prevalence than many other regions and thus serves as a conservative standard of comparison.

RESULTS

PTSD prevalence in police varied considerably across studies from 0% - 44% (M = 14.87%, Median = 9.2%). Despite this variability, strong evidence exists to suggest PTSD prevalence is elevated in police officers. Examination of possible sources of variability in prevalence outcomes highlighted substantial variability in outcomes due to the selection of measurement tool for assessing PTSD (e.g., DSM vs. IES). Examination of commonly-assessed predictive factors for PTSD risk across the literature showed that individual-difference factors (e.g., age, years of service) bear weak-to-nonexistent relationships with PTSD risk, while incident-specific factors (e.g., severity of exposure) are more strongly and consistently associated with PTSD prevalence. Organizational factors (e.g., low support from supervisor) are at present understudied but important possible contributors to PTSD risk.

CONCLUSIONS

PTSD prevalence is elevated in police officers and appears most strongly related to workplace exposure. Measurement variability remains a critical source of inconsistencies across the literature with drastic implications for accurate detection of officers in need of mental health intervention.

Global prevalence and risk factors for mental health problems in police personnel: a systematic review and meta-analysis

Police face an increased risk of developing mental health problems, yet reliable estimates of their psychological difficulties remain unknown. This systematic review and meta-analysis estimate the pooled prevalence and risk factors for mental health problems among police personnel worldwide. Three independent reviewers searched 16 databases and screened 11 506 articles published between January 1980 and October 2019. Eligible studies involved at least 100 active police professionals and used validated instruments to ascertain specific mental health problems. Estimates were pooled using random-effects meta-analyses. In total, 60 cross-sectional and seven longitudinal studies, involving 272 463 police personnel from 24 countries met criteria for inclusion. The overall pooled point prevalence was 14.6% for depression (95% CI 10.9% to 18.6%), 14.2% for post-traumatic stress disorder (PTSD; 95% CI 10.3% to 18.7%), 9.6% for a generalised anxiety disorder (95% CI 6.7% to 12.9%), 8.5% for suicidal ideation (95% CI 6.1% to 11.2%), 5.0% for alcohol dependence (95% CI 3.5% to 6.7%) and 25.7% for hazardous drinking (95% CI 19.6% to 32.4%). The strongest risk factor for depression and suicidal ideation was higher occupational stress, and the strongest risk factors for PTSD were higher occupational stress and avoidant coping strategies. Higher levels of peer-support were associated with significantly lower PTSD symptoms. Our findings suggest that the prevalence of mental health problems among police exceeds twice that previously reported in mixed samples of first responders, and is associated with poor social support, occupational stress and maladaptive coping strategies. Without effective intervention, psychological difficulties will remain a substantial health concern among police.

Identifying the Key Risk Factors for Adverse Psychological Outcomes Among Police Officers: A Systematic Literature Review

It is well established that police work is highly stressful; however, a paucity of evidence limits our knowledge and understanding of the factors that may lead to, compromise, and/or compound psychological distress for this unique population. To address this lack, the current systematic review was conducted to reveal the individual, organizational, and operational risk factors that have been identified in the research literature to date and their associations with depression, anxiety, posttraumatic stress disorder (PTSD), and burnout. We performed searches on literature published between January 2008 and January 2018 and identified a total of 20 studies that met our inclusion criteria. The results indicated that individual factors, including high levels of neuroticism, low social support, and engaging in passive or avoidant coping strategies, were associated with adverse psychological outcomes. This review identified low social support from colleagues as the most common risk factor linked to adverse psychological outcomes. Other organizational risk factors associated with such outcomes included high work demands, low resources, and low reward. This article demonstrates that individual, organizational, and operational factors all impact the negative psychological outcomes of police officers to some degree. In particular, the current review suggests that certain negative psychological outcomes are likely a result of a combination of risk factors across the three domains of risk, highlighting the necessity to observe psychological risk of police in a more comprehensive way.

Basic Processes in Dynamic Decision Making: How Experimental Findings About Risk, Uncertainty, and Emotion Can Contribute to Police Decision Making

In this paper, we review basic findings from experimental studies in judgment and decision making that could contribute to designing policies and trainings to enhance police decision making. Traditional judgment and decision-making research has focused on simple choices between hypothetical gambles, which has been criticized for its lack of generalizability to real world contexts. Over the past 15 years, researchers have focused on understanding the dynamic processes in decision making. This recent focus has allowed for the possibility of more generalizable applications of basic decision science to social issues. We review recent work in three dynamic decision-making topics: dynamic accumulation of evidence in the decision to shoot or not shoot, how previous decisions influence current choices, and how the cognitive and neurological processing of fear influences decisions and decision errors. We conclude this review with a summary of how basic experimental research can apply in policing and training.

Conceptualization, Assessment, and Treatment of Traumatic Stress in First Responders: A Review of Critical Issues

First responders are regularly confronted with exposure to traumatic events, including potentially life-threatening situations as well as the grave injuries and deaths of colleagues and civilians. Evidence indicates that the prevalence of posttraumatic stress disorder (PTSD) is substantially higher among first responders than the general population. This article provides information about the outpatient trauma services at McLean Hospital's LEADER (Law Enforcement, Active Duty, Emergency Responder) program to assist clinicians who encounter these first responders in their practices or who are specifically interested in working with this patient population. We begin by synthesizing the literature on the prevalence of PTSD in first responders following work-related exposure to traumatic stress, and by addressing the occupation-specific risk factors and the third-variable risk factors that may contribute to potentiated risk. We then discuss assessment strategies and treatment options used in our program, which is tailored for individuals who are dealing with mental health issues stemming from occupation-specific traumatic-stress exposure. We also address the unique challenges of treating traumatized first responders with more complex issues such as traumatic stress exposure across the lifespan and safety issues, including acute suicidality. We conclude by discussing notable gaps in the literature, including the need to investigate why and how women present with different PTSD symptoms than men and how these differences need to be taken into account in determining appropriate treatment for women.

A systematic review on occupational hazards, injuries and diseases among police officers worldwide: Policy implications for the South African Police Service

Background

Occupational hazards, injuries and diseases are a major concern among police officers, including in Sub-Saharan Africa. However, there is limited locally relevant literature for guiding policy for the South African Police Service (SAPS). The purpose of this review was to describe the occupational hazards, injuries and diseases affecting police officers worldwide, in order to benchmark policy implications for the SAPS.

Methods

We conducted a systematic review of studies using Google Scholar, PubMed and Scopus.

Results

A total of 36 studies were included in this review. Six revealed that police officers’ exposure to accident hazards may lead to acute or chronic injuries such as sprains, fractures or even fatalities. These hazards may occur during driving, patrol or riot control. There were two studies, which confirmed physical hazards such as noise induced hearing loss (NIHL), due to exposure to high levels of noise. Three studies on chemical hazards revealed that exposure to high concentrations of carbon dioxide and general air pollution was associated with cancer, while physical exposure to other chemical substances was linked to dermatitis. Four studies on biological hazards demonstrated potential exposure to blood borne diseases from needle stick injuries (NSIs) or cuts from contaminated objects. One study on ergonomic hazards showed that musculoskeletal disorders can result from driving long distances and lifting heavy objects. There were 15 studies that indicated psychological hazards such as post-traumatic stress disorder (PTSD) as well as stress. Moreover, four studies were conducted on organizational hazards including burnout, negative workplace exposure and other factors.

Conclusions

This review outlined the global impact of occupational hazards, injuries and diseases in the police force. It served as a benchmark for understanding the policy implications for South Africa, where there is paucity of studies on occupational health and safety.

Predictors of Outcome and Residual Symptoms Following Trauma-Focused Psychotherapy in Police Officers With Posttraumatic Stress Disorder

Police officers exposed to potentially traumatic events (PTE) are at a heightened risk of developing posttraumatic stress disorder (PTSD). Little is known about trauma-focused psychotherapy outcomes in the police. In this naturalistic study, we evaluated whether PTE exposure and baseline clinical characteristics predicted PTSD symptom reduction during treatment and residual PTSD symptoms posttreatment. In consecutive referrals to a specialized mental health service for police officers (N = 665), PTSD was measured pre- and posttreatment using structured clinical interviews. Treatment consisted of brief eclectic psychotherapy for PTSD. We grouped PTE as follows: injury/maltreatment, loss (colleague or private), other job-related, other private traumatic events. Data were analyzed multivariably using structural equation modeling and logistic regression. Treatment effect size was large, d = 3.6, 95% CI [3.4, 3.8]. Police officers who reported more injury/maltreatment or private traumatic had more baseline PTSD symptoms as well as larger symptom reduction during treatment; police officers who reported more losses of loved ones showed smaller PTSD symptom reduction. Concentration problems persisted in 17.7% of police officers posttreatment, and these were predicted by baseline PTSD symptoms and loss of loved ones. Proportions of variance explained by the multivariable models ranged from 0.08 to 0.14. Our findings increase insight into the type of PTE and clinical characteristics of police officers with PTSD who benefit most from trauma-focused treatment. Because loss of loved ones can be presumed to have a profound impact on social and interpersonal functioning, a more specific treatment focus on grief processes may further enhance efficacy.

Associations Between Police Work Stressors and Posttraumatic Stress Disorder Symptoms: Examining the Moderating Effects of Coping

The role of coping in the association between stress and posttraumatic stress disorder (PTSD) is not clear. We investigated the effects of active and passive coping strategies on the associations between police stress (administrative and organization pressure, physical and psychological threats, and lack of support) and PTSD symptoms in 342 police officers. Linear regression model was used in the analyses. The association between physical and psychological stress and PTSD symptoms was stronger in officers who used lower active coping (B = 4.34, p <0.001) compared to those who utilized higher active coping (p -interaction = 0.027) (B =1.79, p ≤ 0.003). A similar result was found between lack of support and PTSD symptoms (p -interaction = 0.016) (lower active coping, B = 5.70, p < 0.001; higher active coping, B = 3.33, p <0.001), but was not significantly different comparing the two groups regarding the association between administrative and organizational pressure and PTSD symptoms (p -interaction = 0.376). Associations of total stress, administrative and organizational pressure, and physical and psychological stressors with PTSD symptoms were significantly stronger in officers who utilized higher passive coping (p -interaction = 0.011, 0.030, and 0.023, respectively). In conclusion, low active or high passive coping methods may exacerbate the effect of work stress on PTSD symptoms.

The Link between Posttraumatic Stress Disorder and Functionality among United States Military Service Members Psychiatrically Hospitalized Following a Suicide Crisis

Posttraumatic stress disorder (PTSD) is one of the most commonly diagnosed psychiatric disorders in the United States and has been linked to suicidal thoughts and behaviors, yet the role of a PTSD diagnosis on functional impairment among suicidal individuals remains unknown. This study examined the association between PTSD status and functional impairment among military psychiatric inpatients admitted for acute suicide risk (N = 166) with a lifetime history of at least one suicide attempt. Measures of functionality included: (1) alcohol use; (2) sleep quality; (3) social problem-solving; and (4) work and social adjustment. Thirty-eight percent of the sample met criteria for PTSD. Women were more likely than men to meet criteria for PTSD (p = 0.007), and participants who met PTSD criteria had significantly more psychiatric diagnoses (p < 0.001). Service members who met PTSD criteria reported more disturbed sleep (p = 0.003) and greater difficulties with work and social adjustment (p = 0.004) than those who did not meet PTSD criteria. However, functionality measures were not significantly associated with PTSD status after controlling for gender and psychiatric comorbidity. Gender and number of psychiatric comorbidities other than PTSD were significant predictors of PTSD in logistic regression models across four functionality measures. Future studies should assess the additive or mediating effect of psychiatric comorbidities in the association between impaired functioning and PTSD. Clinicians are encouraged to assess and address functionality during treatment with suicidal individuals, paying particular attention to individuals with multiple psychiatric diagnoses.

Incidence of suicide among military police officers in South Brazil: An 11-year retrospective cohort study

BACKGROUND

Suicide is known to be the leading cause of death among police officers (PO) worldwide. However, most studies were conducted in developed countries, with no data from Brazil. The present study aimed to evaluate the incidence and the sociodemographic profile of suicide among a military PO subpopulation in South Brazil.

METHODS

This retrospective cohort evaluated 31,110 military PO with available data on cause of death from 2006 to 2016. Participants were monitored for an average of 18.8 ± 9.6 years following the date of entry into the military police.

RESULTS

Mean age at the end of the follow up time was 41.4 ± 9.1 years, with 90.7% males. A total of 650 participants died (2.1%), with 43 suicides (6.6% of all deaths) - cumulative incidence of 138/100,000. Bivariate analysis revealed a significant association (p < 0.05) between suicide and age (HR = 0.70, 95%CI = 0.66-0.74), females (HR = 1.67, 95%CI = 1.08-2.60) and enlisted military rank (HR = 14.9, 95%CI = 2.05-108.5). Multivariate models showed an independent association between suicide and age (HR = 0.71, 95%CI = 0.67-0.74) and enlisted military rank (HR = 9.96, 95%CI = 1.30-76.3).

CONCLUSIONS

The incidence of suicide among military PO in South Brazil was high, compared to the national suicide rate. Younger age and lower military rank were independent predictors of suicide in this subpopulation.

Resilience mediates the relationship between social support and post-traumatic stress symptoms in police officers

OBJECTIVE

Police officers in the New Orleans geographic area faced a number of challenges following Hurricane Katrina in 2005.

DESIGN

This cross-sectional study examined gratitude, resilience, and satisfaction with life as mediators in the association between social support and post-traumatic stress disorder (PTSD) symptoms in 82 male and 31 female police officers. The Gratitude Questionnaire, Connor-Davidson Resilience Scale, Satisfaction with Life Scale, and the Interpersonal Support Evaluation List were used to measure gratitude, resilience, satisfaction with life, and social support, respectively. PTSD symptoms were measured using the PTSD Checklist-Civilian (PCL-C). Ordinary least square regression mediation analysis was used to estimate direct and indirect effects among gratitude, resilience, satisfaction with life, social support, and PTSD symptoms. All models were adjusted for age, alcohol, race, and previous military experience.

RESULTS

Mean PCL-C symptoms were 29.1 (standard deviation [SD] = 14.4) for females and 27.9 (SD = 12.1) for males. There was no direct relationship between social support and PTSD symptoms (c9 = -0.041; 95% confidence interval [CI] = -0.199, 0.117) independent of the indirect effect through resilience (effect = -0.038; 95%CI = -0.099, -0.002). Neither gratitude (effect = -0.066; 95% CI = -0.203, 0.090) nor satisfaction with life (effect = -0.036, 95% CI = -0.131, 0.046) contribute to the indirect effect.

CONCLUSIONS

These results indicate that resilience mediates the relationship between social support and symp-toms of PTSD. Targeting social support and resilience in officers may facilitate reduction of PTSD symptoms.

Alcohol use and suicidality in firefighters: Associations with depressive symptoms and posttraumatic stress

Both suicidality and alcohol use disorders are significant public health concerns among firefighters, and alcohol use is associated with increased suicide risk. In addition, firefighters endorse high rates of symptoms of depression and posttraumatic stress disorder (PTSD). Thus, the current investigation examined associations between alcohol dependence and suicide risk among a large sample of firefighters. Specifically, this study examined the indirect effects of alcohol dependence on suicidality outcomes via both depression and posttraumatic stress, using structural equation modeling. A total of 2883 male firefighters completed a self-report survey, containing measures of alcohol use, suicidality, PTSD, and depressive symptoms. Results indicated good model fit. The latent alcohol dependence variable was directly related to the latent suicide risk variable. However, when depression and posttraumatic stress latent variables were added into the model, alcohol dependence was no longer associated with suicide risk. Furthermore, alcohol dependence was indirectly related to suicide risk via latent depression and posttraumatic stress variables. Indirect effects were established after controlling for relevant covariates. Clinical implications are discussed.

Gender and Age Differences in Trauma and PTSD Among Dutch Treatment-Seeking Police Officers

Little is known about how age and gender are associated with posttraumatic stress disorder (PTSD) symptoms and traumatic experiences in treatment-seeking police offers. In this study, we examined 967 diagnostic files of police officers seeking treatment for PTSD. Six hundred twelve (63%) of the referred police officers were diagnosed with PTSD (n = 560) or partial PTSD (n = 52). Police officers reported on average 19.5 different types of traumatic events (range 1-43). Those who experienced a greater variety of traumatic events suffered from more PTSD symptoms. Also, women reported more often direct life-threatening or private events as their index trauma than men and suffered from more PTSD symptoms than their male colleagues. Results indicate that police officers experience a considerable number of different traumatic events, which is significantly associated with PTSD symptoms. The results highlight the importance of early detection of PTSD symptoms in the police force.

Association of peritraumatic dissociation with symptoms of depression and posttraumatic stress disorder

AIM

In this study, we evaluated whether peritraumatic dissociation (PD) was associated with symptoms of depression and posttraumatic stress disorder (PTSD), and whether this association was modified by trauma prior to police work.

METHOD

Symptoms of depression, PTSD, peritraumatic dissociative experience (PDE), and trauma prior to police work were measured using the Center for Epidemiologic Studies Depression scale, PTSD Checklist-Civilian, PDE questionnaire, and the Brief Trauma questionnaire, respectively, in 328 police officers. Separate regression models were used to assess if either symptoms of depression or PTSD were associated with PD stratified by prior trauma. Means were adjusted for race, number of drinks per week, and smoking.

RESULTS

PD was associated with symptoms of PTSD and depression (β = 0.65, p < .001 and β = 0.27, p < .001, respectively). PD was positively associated with symptoms of PTSD regardless of prior trauma (β = 0.61, p < .001(without prior trauma), 0.75, p < .001 (with prior trauma). In contrast to PTSD, depression symptoms were significantly associated with PD scores in individuals with prior trauma (β = 0.47, p < .001), but not in individuals without prior trauma (β = 0.13, p = .165).

LIMITATIONS

This is a cross-sectional study. Outcomes were obtained via self-report and were not clinically diagnosed. Aspects of both the trauma event as well as the symptoms and severity of PD may have introduced recall bias.

CONCLUSION

These results add to the literature indicating that PD plays a role in symptoms of PTSD and depression and how prior trauma may modify this relationship. (PsycINFO Database Record

Coping with Work-related Traumatic Situations among Crime Scene Technicians

Crime scene technicians collect evidence related to crime and are therefore exposed to many traumatic situations. The coping strategies they use are thus very important in the process of facing the psychological consequences of such work. The available literature shows that crime scene technicians are an understudied subgroup of police workers. Our study is therefore the first unfolding insights into technicians' coping strategies, post-traumatic symptomatology and somatic health, based on a sample of 64 male crime scene technicians (85% of all Slovene technicians). Crime scene technicians mainly use avoidance coping strategies. Approach strategies that are more effective in the long-term-i.e. lead to a larger buffering of the effects of traumatic stress-are more frequently used if technicians are familiar with the nature of the task, when they have time to prepare for it, and if they feel that past situations have been positively resolved. Behavioural avoidance strategies were found to be least effective when dealing with traumatic experiences and are also related to more frequent problems of physical health. Results indicate that appropriate trainings for future technicians would facilitate the use of more effective coping strategies and consequently lead to a more effective and satisfied worker. Copyright © 2014 John Wiley & Sons, Ltd.

Psychological interventions for post-traumatic stress disorder in people living with HIV in Resource poor settings: a systematic review

OBJECTIVE

Post-traumatic stress disorder is pervasive in low- and middle-income countries. There is evidence to suggest that post-traumatic stress disorder is more common among people living with HIV than non-infected matched controls. We carried out a systematic review of interventions for adult post-traumatic stress disorder from resource poor settings with a focus on people living with HIV.

METHODS

We included all studies that investigated interventions for adult post-traumatic stress disorder from resource poor settings with a focus on interventions that were either randomised controlled trials or observational cohort studies carried out from 1980 to May 2015.

RESULTS

Of the 25 articles that were identified for full review, two independent reviewers identified seven studies that met our study inclusion criteria. All randomised controlled trials (RCT) (n = 6) used cognitive behavioural therapy-based interventions and focused on people living with HIV in resource poor settings. There was only one study focusing on the use of lay counsellors to address post-traumatic stress disorder but core competencies were not described. There were no intervention studies from Africa, only an observational cohort study from Rwanda.

CONCLUSION

Rigorously evaluated interventions for adult post-traumatic stress disorder in people living with HIV are rare. Most were undertaken in resource poor settings located in high-income countries. There is a need for research on the development and implementation of appropriate interventions for post-traumatic stress disorder in people living with HIV in low- and middle-income countries.

Exposure to Violence During Ferguson Protests: Mental Health Effects for Law Enforcement and Community Members

There is little information available on the mental health effects of exposure to shared community violence such as the August 2014 violence that occurred in Ferguson, Missouri. This study sought to examine the relationship between proximity to community violence and mental health in both community members and police officers. We recruited 565 adults (community, n = 304, and police, n = 261) exposed to the violence in Ferguson to complete measures of proximity to violence, posttraumatic stress, depression, and anger. Using structural equation modeling, we assessed aspects of proximity to violence-connectedness, direct exposure, fear from exposure, media exposure, reactions to media, and life interruption-as correlates of posttraumatic stress disorder (PTSD) symptoms, depression, and anger. The final model yielded (n = 432), χ(2) (d = 12) = 7.4, p = .830; comparative fit index = 1.0, root mean square error of approximation = 0 [0, .04]. All aspects of proximity except direct exposure were associated with mental health outcomes. There was no moderation as a function of community versus police. Race moderated the relationship between life interruptions and negative outcomes; interruption was related to distress for White, but not Black community members. Based on group comparisons, community members reported more symptoms of PTSD and depression than law enforcement (ηp (2) = .06 and .02, respectively). Black community members reported more PTSD and depression than White community members (ηp (2) = .05 and .02, respectively). Overall, distress was high, and mental health interventions are likely indicated for some individuals exposed to the Ferguson events.

A systematic review of suicidal thoughts and behaviors among police officers, firefighters, EMTs, and paramedics

First responders-police officers, firefighters, emergency medical technicians (EMTs), and paramedics-experience significant job-related stressors and exposures that may confer increased risk for mental health morbidities (e.g., posttraumatic stress disorder [PTSD], suicidal thoughts and behaviors) and hastened mortality (e.g., death by suicide). Inherent in these occupations, however, are also factors (e.g., camaraderie, pre-enlistment screening) that may inoculate against the development or maintenance of psychiatric conditions. Several reviews of the literature have documented the prevalence and potency of PTSD among first responders; the value of these extant reviews is considerable. Nonetheless, the literature has not been systematically described with regard to suicidality. In this systematic review, we present 63 quantitative studies examining suicidal thoughts, behaviors, and/or fatalities among first responders; identify population-specific risk and protective factors; and pinpoint strengths and weaknesses of the existing literature. Findings reveal elevated risk for suicide among first responders; however, studies utilizing more rigorous methodologies (e.g., longitudinal designs, probability sampling strategies) are sorely needed. First responders have an armamentarium of resources to take care of others; it is the duty of researchers, clinicians, and the public to aid in taking care of their health as well, in part by reducing suicide risk.

Health in police officers: Role of risk factor clusters and police divisions

OBJECTIVE

Law enforcement is a stressful occupation associated with significant health problems. To date, most studies have focused on one specific factor or one domain of risk factors (e.g., organizational, personal). However, it is more likely that specific combinations of risk factors are differentially health relevant and further, depend on the area of police work.

METHODS

A self-selected group of officers from the criminal, community, and emergency division (N = 84) of a Swiss state police department answered questionnaires assessing personal and organizational risk factors as well as mental and physical health indicators.

RESULTS

In general, few differences were observed across divisions in terms of risk factors or health indicators. Cluster analysis of all risk factors established a high-risk and a low-risk cluster with significant links to all mental health outcomes. Risk cluster-by-division interactions revealed that, in the high-risk cluster, Emergency officers reported fewer physical symptoms, while community officers reported more posttraumatic stress symptoms. Criminal officers in the high-risk cluster tended to perceived more stress. Finally, perceived stress did not mediate the relationship between risk clusters and posttraumatic stress symptoms.

CONCLUSION

In summary, our results support the notion that police officers are a heterogeneous population in terms of processes linking risk factors and health indicators. This heterogeneity thereby appeared to be more dependent on personal factors and individuals' perception of their own work conditions than division-specific work environments. Our findings further suggest that stress-reduction interventions that do not target job-relevant sources of stress may only show limited effectiveness in reducing health risks associated with police work.

The impact of posttraumatic symptoms and comorbid mental disorders on the health-related quality of life in treatment-seeking PTSD patients

BACKGROUND

There is a dearth of literature dealing with the impact of the severity of posttraumatic symptoms and of comorbid mental disorders on the health-related quality of life (HRQOL) of victims of civilian violence with a primary diagnosis of PTSD.

OBJECTIVES

To investigate the influence of the severity of posttraumatic symptoms and of presence of comorbid mental disorders on the HRQOL of treatment-seeking outpatients with PTSD.

METHODS

A sample of 65 PTSD patients was recruited in a specialized outpatient clinic. The volunteers had the diagnoses of PTSD and of comorbid mental disorders established with the Structured Clinical Interview for DSM-IV Axis I Disorders (SCID-I). The severity of posttraumatic, depression and anxiety symptoms was measured with the PCL-C, BDI and BAI, respectively. HRQOL was assessed by means of the SF-36, a 36-item self-administered scale that measures eight domains of quality of life: vitality, physical functioning, bodily pain, general health perceptions, physical role functioning, emotional role functioning, social role functioning, and mental health. Multiple linear regression models were fitted to investigate the relationship between the severity of posttraumatic, mood, and anxiety symptoms; the presence of specific current comorbid disorders and of psychotic symptoms, and the number of current comorbid conditions for each of the eight domains of HRQOL, after adjusting for the effect of sociodemographic characteristics.

RESULTS

The severity of PTSD symptoms predicted worse HRQOL in all eight domains of SF-36, even after controlling for the severity of depression and anxiety symptoms, the presence of panic disorder, OCD, specific and social phobia, psychotic symptoms, and the number of comorbid disorders. The strongest negative association between PTSD symptoms severity and HRQOL was found in the Social Functioning domain. Although the inclusion of the depressive symptoms in the models led to a reduction of the magnitude of the negative association between the severity of PTSD symptoms and the HRQOL domain scores, the former still accounted for most of the explained variance of the latter.

CONCLUSIONS

We found that even in the presence of comorbid mental disorders, the severity of posttraumatic symptoms remained the strongest predictor for impaired HRQOL in PTSD outpatients. Our results suggest that improvement of HRQOL should be considered a therapeutic objective and an essential outcome measure in the treatment of PTSD.

Prevalence of oral mucosal lesions in a brazilian military police population

BACKGROUND

Data obtained from oral health surveys are very important for identifying disease-susceptible groups and for developing dental care and prevention programs. So, the purpose of the current article was to investigate the prevalence of oral mucosa lesions (OMLs) in a population of Brazilian police.

MATERIAL AND METHODS

Interviews and oral cavity examinations were performed on a sample of 395 police officers who were randomly selected by the calibrated researcher. The number of individuals was obtained by a sample calculation using the finite population correction. The diagnostic criteria were based on the WHO (1997) criteria and adapted to Brazilian surveys.

RESULTS

In total, 8.61% of the population presented some OML. Traumatic injuries and benign migratory glossitis (BMG) were the most prevalent lesions.

CONCLUSIONS

The prevalence of potentially malignant disorders was lower than among the Brazilian population.The most prevalent lesion among the police officers was related to trauma. Patients dissatisfied with oral health had a higher risk of presenting OMLs. Key words:Mouth disease, mouth mucosa, military personnel, public health, oral pathology, oral leukoplakia.

Correlates of hopelessness in the high suicide risk police occupation

Police officers are chronically exposed to work stress. We examined specific stressors that may be associated with hopelessness, a possible risk factor for suicide in this high suicide risk population. The study included 378 officers (276 men and 102 women) with complete data. Analysis of variance was used to estimate mean levels of hopelessness scores as associated with stress, adjusted for age, gender, and race/ ethnicity. Posttraumatic symptoms were tested as a modifier of the association between stress and hopelessness. Increasing stress of administrative practices and lack of support were significantly associated with increasing hopelessness among officers (p < .006 - hopelessness range: 1.64-2.65; and p < .001 - hopelessness range 1.60-2.80, respectively). Posttraumatic stress disorder (PTSD) symptoms significantly modified the association between lack of organizational support and hopelessness (p < .010) with significant association only among individuals with higher PTSD symptoms (p < .001). Results suggest that hopelessness is associated with specific stressors in police work, and this is modified by posttraumatic symptomatology.

Subthreshold posttraumatic stress disorder in the world health organization world mental health surveys

BACKGROUND

Although only a few people exposed to a traumatic event (TE) develop posttraumatic stress disorder (PTSD), symptoms that do not meet full PTSD criteria are common and often clinically significant. Individuals with these symptoms sometimes have been characterized as having subthreshold PTSD, but no consensus exists on the optimal definition of this term. Data from a large cross-national epidemiologic survey are used in this study to provide a principled basis for such a definition.

METHODS

The World Health Organization World Mental Health Surveys administered fully structured psychiatric diagnostic interviews to community samples in 13 countries containing assessments of PTSD associated with randomly selected TEs. Focusing on the 23,936 respondents reporting lifetime TE exposure, associations of approximated DSM-5 PTSD symptom profiles with six outcomes (distress-impairment, suicidality, comorbid fear-distress disorders, PTSD symptom duration) were examined to investigate implications of different subthreshold definitions.

RESULTS

Although consistently highest outcomes for distress-impairment, suicidality, comorbidity, and PTSD symptom duration were observed among the 3.0% of respondents with DSM-5 PTSD rather than other symptom profiles, the additional 3.6% of respondents meeting two or three of DSM-5 criteria B-E also had significantly elevated scores for most outcomes. The proportion of cases with threshold versus subthreshold PTSD varied depending on TE type, with threshold PTSD more common following interpersonal violence and subthreshold PTSD more common following events happening to loved ones.

CONCLUSIONS

Subthreshold DSM-5 PTSD is most usefully defined as meeting two or three of DSM-5 criteria B-E. Use of a consistent definition is critical to advance understanding of the prevalence, predictors, and clinical significance of subthreshold PTSD.

Peritraumatic tonic immobility is associated with PTSD symptom severity in Brazilian police officers: a prospective study

OBJECTIVE

Peritraumatic reactions feature prominently among the main predictors for development of posttraumatic stress disorder (PTSD). Peritraumatic tonic immobility (PTI), a less investigated but equally important type of peritraumatic response, has been recently attracting the attention of researchers and clinicians for its close association with traumatic reactions and PTSD. Our objective was to investigate the role of PTI, peritraumatic panic, and dissociation as predictors of PTSD symptoms in a cohort of police recruits (n=132).

METHODS

Participants were asked to complete the following questionnaires during academy training and after the first year of work: Posttraumatic Stress Disorder Checklist - Civilian Version (PCL-C), Physical Reactions Subscale (PRS), Peritraumatic Dissociative Experiences Questionnaire (PDEQ), Tonic Immobility Scale (TIS), and Critical Incident History Questionnaire.

RESULTS

Employing a zero-inflated negative binomial regression model, we found that each additional point in the TIS was associated with a 9% increment in PCL-C mean scores (RM = 1.09), whereas for PRS, the increment was 7% (RM = 1.07). As the severity of peritraumatic dissociation increased one point in the PDEQ, the chance of having at least one symptom in the PCL-C increased 22% (OR = 1.22).

CONCLUSIONS

Our findings highlight the need to expand investigation on the incidence and impact of PTI on the mental health of police officers.

Adjustment among children with relatives who participated in the manhunt following the Boston Marathon attack

BACKGROUND

Following the Boston Marathon attack, the extraordinary interagency manhunt and shelter-in-place made for a truly unprecedented experience for area families. Although research on Boston youth has found robust associations between manhunt-related experiences and post-attack functioning, such work does little to identify the specific needs of a particularly vulnerable population--i.e., children with a relative who participated in the manhunt. Understanding the adjustment of these youth is critical for informing clinical efforts.

METHODS

Survey of Boston-area parents/caretakers (N = 460) reporting on their child's attack/manhunt-related experiences, as well as psychosocial functioning in the first six post-attack months; analyses compared youth with and without a relative in law enforcement or the armed services who participated in the manhunt.

RESULTS

The proportion of youth with likely PTSD was 5.7 times higher among youth with relatives in the manhunt than among youth without. After accounting for child demographics, blast exposure, and children's own exposure to manhunt events (e.g., hearing/seeing gunfire/explosions, having officers enter/search home), having a relative in the manhunt significantly predicted child PTSD symptoms, emotional symptoms, and hyperactivity/inattention. Fear during the manhunt that a loved one could be hurt mediated relationships between having a relative in the manhunt and clinical outcomes; living within the zone of greatest manhunt activity did not moderate observed relationships.

CONCLUSIONS

Children with relatives called upon to participate in the unprecedented interagency manhunt following the Boston Marathon attack carried a particularly heavy mental health burden. Continued research is needed to clarify the clinical needs of youth with relatives in high-risk occupations.