How healthy are the police? A survey of life-style factors

Alcohol/substance use and occupational/post-traumatic stress in paramedics

Background:

Paramedics work in high-pressure environments and experience traumatic events, which contribute to high levels of occupational and post-traumatic stress. Such stress can result in alcohol and substance misuse in other health professionals, but this relationship has not been examined in paramedics. This review is the first exploration of the literature on this.

Methods:

A systematic literature review was conducted using PRISMA guidelines, with databases searched using terms relevant to paramedics and alcohol/substance use. Studies were analysed using descriptive statistics for quantitative data and thematic analysis for qualitative information.

Findings:

Eleven studies were identified. Nine studies examined alcohol use; seven examined substance use; five examined both. Alcohol and smoking may be linked to occupational stress.

Conclusions:

The nature and extent of alcohol and substance use in relation to occupational and post-traumatic stress among paramedics need further investigation to facilitate advice and support.

The Perfect Storm: Mapping the Life Course Trajectories of Serial Killers

Since the 1970s, scholars have produced a large body of research attempting to establish the mechanisms by which sexual serial killers come to arrive at a life of repeat fatal violence. From the standpoint of developmental psychology, however, the explanations offered are far too limited in scope. Human development is the product of complex reciprocal transactions that occur between an individual and their environment throughout their life span. This present study is meant to encourage a critical reconsideration of past knowledge (mainly static traits) in favor of the recognition of the complexity of human development. Using life span developmental psychology as a guiding framework, this study traces the developmental mechanisms that come together to shape the psychopathology that drives the motivations of sexual serial killers.

The SHIELD (Safety & Health Improvement: Enhancing Law Enforcement Departments) Study: Mixed Methods Longitudinal Findings

The SHIELD (Safety & Health Improvement: Enhancing Law Enforcement Departments) Study is a worksite wellness team-based intervention among police and sheriff departments assessing the program's effectiveness to reduce occupational risks and unhealthy lifestyle behaviors. The SHIELD program focused on improving diet, physical activity, body weight and sleep, and reducing the effects of unhealthy stress and behaviors, such as tobacco and substance abuse. The SHIELD team-based health promotion program was found to be feasible and effective at 6 months in improving diet, sleep, stress, and overall quality of life of law enforcement department personnel. Both intervention and control groups were followed for 24 months, and we report those durability findings, along with qualitative group interview results that provide insight into the changes of the long-term outcomes. Long-term effects were observed for consumption of fruits and vegetables, and there was some evidence for effects on tobacco and alcohol use. Assessment of dietary habits, physical activity behaviors, weight loss maintenance, and substance use is rare more than 1 year following an intervention, and in general, initial positive changes do not persist in prior research. The SHIELD program was feasible, effective, and durable for improving dietary changes.

Burnout Syndrome and alcohol consumption in prison employees

OBJECTIVE

The aims of this study were to estimate the association between an at-risk drinking pattern and sociodemographic variables, and to compare the mean scores of the factors associated with the Burnout Syndrome, according to the alcohol consumption pattern in staff members from two Brazilian prisons.

METHODS

A cross-sectional study was developed with 339 participants (response rate = 63.8%). The instruments used were a sociodemographic questionnaire, the Alcohol Use Disorders Identification Test (AUDIT), and the Maslach Burnout Inventory - General Survey (MBI-GS).

RESULTS

The participants' average age was 40.2 (SD = 8.8) years, and 81.0% were male. Among 78.5% of participants (95%CI 74.1 - 82.8) reported consuming alcoholic beverages. The prevalence of at-risk drinking behavior in the sample was 22.4% (95%CI 18.0 - 26.9), and of the Burnout Syndrome was 14.6% (95%CI 10.8 - 18.4). We observed a significant association between at-risk drinking behavior with gender, higher risk for men (OR = 7.32, p < 0.001), smoking, increased risk for smokers (OR = 2.77, p < 0.001), and religious practice, showing lower risks for religion practitioners (OR = 0.364, p < 0.001). We noticed significantly higher mean scores (p < 0.001) of emotional exhaustion and cynicism, and lower scores of professional achievement among individuals who reported consuming alcoholic beverages.

CONCLUSION

Men who smoke were more likely to develop an at-risk drinking pattern, while religion is presented as a protective factor. Individuals who consume alcohol were more affected by the different factors of the Burnout Syndrome.

Assessing the Role of Gambling on Problematic Alcohol Consumption by Police Officers

While a number of studies have attributed critical incident stressors to alcohol abuse among police officers, no study has examined the role gambling, if any, plays on problematic alcohol consumption. Therefore, data from the Police Stress and Domestic Violence in Police Families in Baltimore, Maryland, 1997-1999 are analyzed to test the influence of gambling on problematic alcohol consumption engaged by police officers. Results indicated that gambling is significant in predicting problematic alcohol consumption. Burnout, peer drinking, and self-control also predicted the dependent variable. The study's results, as well as the study's limitations and directions for future research, are also discussed.

Using Gottfredson and Hirschi’s A General Theory of Crime to Explain Problematic Alcohol Consumption by Police Officers: A Test of Self-Control as Self-Regulation

Problematic alcohol consumption by police officers is well documented in the literature. However, no study has utilized Gottfredson and Hirschi’s A General Theory of Crime to determine what role, if any, self-control (i.e., self-regulation) plays in predicting this behavior. Therefore, data from the Police Stress and Domestic Violence in Police Families in Baltimore, Maryland, 1997-1999 are analyzed to test the influence of work-related stress on officers’ self-control and problem drinking. Results indicated that self-control is significant in predicting problematic alcohol consumption by police officers. Two control variables (burnout and peer drinking) also predicted the dependent variable. The current study provides further evidence that self-control continues to be one of the most consistent factors most likely to lead to criminal behavior, including those committed by police officers.

Psychiatric Disability in Law Enforcement Officers

Law enforcement officers all across the world are exposed to violence, confrontation, and traumatic incidents. They regularly witness death and suffering and are at risk of personal injury. Psychiatric sequelae include an increased risk for trauma-related symptoms, depression, alcohol-use disorders, and stress-related medical conditions. Law enforcement officers have been applying for early disability retirement pensions at an increased rate for stress-related psychiatric and medical conditions. As a result, law enforcement agencies are prematurely losing valuable resources, officers with training and experience. Departments have become proactive in trying to address mental health issues to prevent psychiatric disability by implementing employee wellness plans and stress reduction interventions. Programs have been developed to mitigate the effects of stress on law enforcement personnel. Many law enforcement agencies have developed strategies to encourage early confidential referral for psychiatric treatment. They utilize peer support groups and employee assistance programs and develop alliances with mental health professionals. When these approaches fail, a fitness for duty process can be used to identify impairment in work functioning due to psychiatric factors with the prospect of later returning the officer to full duty. Copyright © 2017 John Wiley & Sons, Ltd.

Occupational Stress, Coping and Personality in the Police: An SEM Study

This article explores the relationships among exogenous factors, such as gender, age, rank/grade, tenure and personality, occupational stress, coping strategies, well-being, organisational commitment and job satisfaction. The sample used for this study comprised 1,535 police officers from a British police force, 20.78 per cent of whom were female. It was expected that personality, gender, age, rank and tenure were associated with ***work-related stress; coping; well-being, and work attitudes. More specifically, it was predicted: (1) that there was a correlation among personality, well-being and work attitudes; and (2) that coping strategies were directly associated with well-being and work attitudes. Using LISREL 8.54 these relationships were examined. The resulting model yielded meaningful and significant relationships and fitted the observed data: χ2 (114) = 291.88; p ≤ 0.01; RMSEA = 0.032; AGFI = 0.96; CFI = 0.99; n = 1510. Personality traits were found to be directly related to work-related stress, coping strategies, tension and burn out as well as negatively related to overall job satisfaction. Gender, age and rank did not show meaningful relationship with any of the endogenous variables. Occupational stressors were associated with low organisational commitment and poor overall job satisfaction. Also coping strategies were directly associated with organisational commitment and job satisfaction.

The Influence of Early Strain on Later Strain, Stress Responses, and Aggression by Police Officers

Research has established policing as one of the most stressful occupations and that work-induced strain can lead to various criminal and negative outcomes. This study extends existing literature in criminology and criminal justice by applying general strain theory to police stress. This study examines the influence of prior strain—namely, child abuse and interparental violence—on officer critical incident strain, psychological–physiological stress responses, and officer-on-officer aggression. Data analyzed the stress responses of 1,104 police officers from the Police Stress and Domestic Violence in Police Families in Baltimore, Maryland, and results show that prior strain events influence respondents in three key ways. First, those reporting exposure to childhood strain had higher work-related strain scores. Second, youthful strain events and work-related critical incident strain are associated with increased stress. Finally, child abuse exposure and critical incident strain increases the odds of officer-on-officer violence among participants. The sample offers several important implications for strain theory because it includes only adult respondents and offers some degree of control for serious adolescent delinquency.

Exploring stress levels, job satisfaction, and quality of life in a sample of police officers in Greece

Background

The ongoing economic crisis in Greece has affected both stress and quality of life (QoL) at all socioeconomic levels, including professionals in the police force. The aim of this study was to examine perceived stress, job satisfaction, QoL, and their relationships in a sample of police officers in Greece.

Methods

A cross-sectional study was conducted during the first trimester of 2011 in 23 police stations in the greater Athens area. A total of 201 police officers agreed to participate (response rate 44.6%). The General Health Questionnaire-28 (GHQ-28) was used to assess general health, and the World Health Organization Quality of Life-BREF Questionnaire and Perceived Stress Scale-14 (PSS-14) questionnaires were used to assess QoL and perceived stress, respectively.

Results

The PSS and GHQ subscales and total scores exhibited strong, positive, and significant correlations coefficients (r): 0.52 for somatic disturbances, 0.56 for stress and insomnia, 0.40 for social dysfunction, and 0.37 for depression, yielding an r equal to 0.57 for the total GHQ score. A higher level of perceived stress was related to a lower likelihood of being satisfied with their job; in this regard, male participants and higher ranked officers reported lower job satisfaction. The PSS and GHQ scores were inversely, consistently, and significantly related to almost all of the QoL aspects, explaining up to 34% of their variability. Parenthood had a positive effect on QoL related to physical health, and women reported lower QoL related to psychological health.

Conclusion

Higher levels of stress are related to an increased risk of reporting suboptimal job satisfaction and QoL. The magnitude of these associations varied depending on age, gender, and rank, highlighting the need for stress-management training.

The safety and health improvement: enhancing law enforcement departments study: feasibility and findings

This randomized prospective trial aimed to assess the feasibility and efficacy of a team-based worksite health and safety intervention for law enforcement personnel. Four-hundred and eight subjects were enrolled and half were randomized to meet for weekly, peer-led sessions delivered from a scripted team-based health and safety curriculum. Curriculum addressed: exercise, nutrition, stress, sleep, body weight, injury, and other unhealthy lifestyle behaviors such as smoking and heavy alcohol use. Health and safety questionnaires administered before and after the intervention found significant improvements for increased fruit and vegetable consumption, overall healthy eating, increased sleep quantity and sleep quality, and reduced personal stress.

The epidemiology of cancer among police officers

BACKGROUND

This review summarizes peer-reviewed studies examining cancer risks among police officers. It provides an overview of existing research limitations and uncertainties and the plausible etiologic risk factors associated with cancer in this understudied occupation.

METHODS

Previous cancer studies among police officers were obtained via a systematic review of the MEDLINE, CABDirect, and Web of Science bibliographic databases.

RESULTS

Quality observational studies of cancer among police officers are sparse and subject to limitations in exposure assessment and other methods. Results from three studies suggested possible increased mortality risks for all cancers, and cancers of the colon, kidney, digestive system, esophagus, male breast, and testis, as well as Hodgkin's disease. Few incidence studies have been performed, and results have been mixed, although some associations with police work have been observed for thyroid, skin, and male breast cancer.

CONCLUSIONS

Police are exposed to a mix of known or suspected agents or activities that increase cancer risk. Epidemiologic evidence to date is sparse and inconsistent. There is a critical need for more research to understand the biological and social processes underlying exposures and the suggested disproportionate risks and to identify effective prevention strategies.

Addictions and the criminal justice system, what happens on the other side? Post-traumatic stress symptoms and cortisol measures in a police cohort

The Buffalo Cardio-metabolic Occupational Police Stress study, an occupational cohort study of police officers, was conducted to evaluate physiologic and stress measures in a high-risk occupation where occupational exposure to difficult criminal situations can lead to physiologic and psychological health consequences among those who enforce the law. The chronic exposure to human tragedy may place police officers at special risk for mental health disorders and the potential for misuse of alcohol or drugs. While exact etiologies of post-traumatic stress were not determined by this study, overall post-traumatic stress (PTS) prevalence rates among the police officers was 35%, with 10% of individuals demonstrating severe PTS symptomatology. Waking cortisol measures tended to be higher among officers with more PTS symptomatology, with some gender related differences noted. Given the increase in incarcerations for addictions related offenses over the past 20 years and the chronic exposure to human suffering and tragedy, early recognition of PTS symptoms is essential in making the diagnosis of post-traumatic stress in high-risk occupational cohorts. Providing early entry into treatment and subsequently attempting to eliminate or minimize long-term consequences of post-traumatic stress can have a significant impact on the prevention of long term sequelae of chronic stress, such as the use or misuse of drugs or alcohol.

Fitness characteristics of a suburban special weapons and tactics team

Special Weapons and Tactics (SWAT) operators are specialized law enforcement officers who traditionally perform their duties with higher anticipated workloads because of additional body armor, weapons, and equipment used for enhanced operations and protection. This elevated workload increases the need for SWAT operators to improve or maintain their physical fitness to consistently perform routine operations. Typical tasks require trunk rotation, overhead upper extremity use, upper and lower body strength use, and long waiting periods followed by explosive movements while wearing additional equipment. Eleven male SWAT operators from 1 SWAT team performed flexibility, strength, power, and aerobic capacity tests and a variety of job-related tasks. Data were compared with age- and gender-based normative data. Fitness testing revealed that officers ranked high on tests of muscular strength (leg strength, 90th percentile; bench press, 85th percentile); however, body composition (55th percentile), core body strength, and flexibility ranked lower. Furthermore, aerobic capacity and muscular power had a wide range of scores and were also not ideal to support maximal performance during routine operations. These data can assist exercise specialists choose fitness programs specifically for job-related tasks of SWAT operators when creating fitness programs. Fitness programming for law enforcement should focus on improving aerobic fitness, flexibility, core strength, and muscular power while maintaining muscular strength to meet the needs of these specialized officers.

[Factors associated with the lifestyle of military police officers]

The scope of this investigation was to analyze the association between lifestyle and socio-demographic and occupational characteristics among military police officers (MPs). This involved a cross-sectional epidemiological study. The sample consisted of 288 MPs within the Police Force of Recife, Pernambuco. The data were collected by means of a semi-structured questionnaire. For the data analysis, IT tools were used (STATA-10.0 and SPSS- 15.0 for Windows) and descriptive statistics procedures, chi-square analysis and regression associations (p < 0.05). Among the lifestyle results, 12% said that they smoked, 10% were classified as cases of suspected excess consumption of alcoholic beverages, 73% were considered to be insufficiently active and 40% admitted they were involved in frequent or occasional conflicts. Age of 39 years or over (RP = 1.39), lower education level (RP = 1.68), the lowest economic level (RP = 1.49) and being in the profession for 18 years or more (RP = 1.49) were associated with lifestyles with greater risk to health (with two or more unhealthy factors). Therefore, promotion and prevention measures should be adopted in order to attempt to reduce the health vulnerabilities of these workers.

Patterns and predictors of alcohol use in male and female urban police officers

In a large sample of urban police officers, 18.1% of males and 15.9% of females reported experiencing adverse consequences from alcohol use and 7.8% of the sample met criteria for lifetime alcohol abuse or dependence. Female officers had patterns of alcohol use similar to male officers and substantially more than females in the general population. Critical incident exposure and posttraumatic stress disorder (PTSD) symptoms were not associated with level of alcohol use. Greater psychiatric symptoms were related to adverse consequences from alcohol use. There was a noteworthy gender by work stress interaction: greater routine work stress related to lower current alcohol use in female officers. 

Occupational risk factors in the emergency medical services

INTRODUCTION

During a medical emergency, the American public often relies on the expertise of emergency medical technicians (EMTs). These professionals face a number of occupational hazards, and the literature suggests that EMTs are at a greater risk of developing physical and mental stress-related disorders. The purpose of this paper is to systematically examine gaps in the extant literature and to present a theoretically driven conceptual model to serve as a basis for future intervention and research efforts.

METHODS

A systematic review of the literature was conducted utilizing relevant databases (e.g., PsychInfo, Medline). All empirical articles regarding emergency medical responders were reviewed, but given the limited research available, relevant theoretical and conceptual literature on the constructs of interest in other, related populations also were included. Based on this extensive review, a modification of the stress process model is suggested to explain the relationships among occupational stress exposure, post-traumatic stress disorder (PTSD), and high-risk alcohol and other drug use.

RESULTS

Exposure to traumatic events was reported to be between 80% and 100% among EMTs, and rates of PTSD are >20%. High-risk alcohol and drug use rates among other emergency response professionals were reported to be as high as 40%. The proposed model suggests direct linkages between occupationally related stress exposure, including chronic and critical incident stress, PTSD, and high-risk alcohol and other drug use. Social support and personal resources (e.g., coping, locus of control) are proposed to have mediating and moderating influences on the three main constructs, and cohesion is introduced as an important, idiosyncratic influence in this population. The moderating influences of gender, age, ethnicity, marital status, and socioeconomic status, level of training, and years of service are included in the proposed model.

CONCLUSIONS

High-risk alcohol and other drug use and post-traumatic symptomatology pose substantial risks for EMTs, and consequently, for the patients they serve. It is imperative that researchers develop and test a theoretically grounded model of risk and protective factors that will guide intervention development and future study. The model suggested in this paper, based on a comprehensive literature review and development of theory, represents a critical first step in the intervention research process.

Enhancing emotion-regulation skills in police officers: results of a pilot controlled study

Police officers are routinely exposed to situations that elicit intense negative emotions; thus, officers have a particularly strong need for effective methods of regulating such emotions. The main purpose of this study was to investigate whether a manualized emotion-regulation training (Integrative Training of Emotional Competencies; iTEC; Berking, 2010a) can improve the emotion-regulation skills of police officers. First, self-reports of 9 emotion-regulation skills were assessed in a sample of officers (N=31) and compared to those of a matched community-based control group. Then, the effects of the training on the emotion-regulation skills of officers were evaluated in a time-staggered design with a waitlist control condition. Results indicate that, compared to controls, officers have difficulties in accepting and tolerating negative emotions, supporting themselves in distressing situations, and confronting emotionally challenging situations. The training significantly enhanced successful skill application, especially some skills with which officers reported difficulty applying. These findings suggest that a focus on emotion-regulation skills may be an important component for programs aimed at preventing mental-health problems in police officers.

Parental exposure to mass violence and child mental health: the First Responder and WTC Evacuee Study

Children's reactions after being exposed to mass violence may be influenced by a spectrum of factors. Relatively unexplored is the extent to which family exposure to mass violence may affect child mental health, even when these children have not been directly exposed. In a representative sample of NYC public school children assessed 6 months after the September 11, 2001 attack on the World Trade Center (WTC), seemingly elevated rates of psychopathology were recorded among children of WTC evacuees. Children of NYC First Responders (police officers, EMTs, and fire fighters) displayed a complex pattern of response to the WTC attack. Overall, the findings from this previous study support putative transmission of trauma to children whose parents were exposed to the WTC attack. The "Children of First Responder and WTC Evacuee Study"-a two-site longitudinal study-is currently underway in the United States (New York City) and in Israel (Tel Aviv area) in an effort to understand the impact of different patterns of mass violence. The NYC sample permits us to examine the impact of a rare instance of mass violence (e.g., WTC attack), while the Israeli sample provides information about repeated and frequent exposure to mass violence brought about by acts of terrorism. In addition, children's exposure to mass violence is considered in the context of their exposure to other potentially traumatic events. This study aims to improve our general understanding of the impact of mass violence on children, especially the psychological effects on children whose parents' work experiences are by nature stressful. Knowledge generated by this study has implications for guiding efforts to meet the needs of children who have, directly or through a family member, been subjected to rare or infrequent mass violent event as well as to children whose exposure to mass violence is part of daily life.

Fatores de estresse ocupacional e coping entre policiais civis

Este estudo foi desenvolvido com os objetivos de identificar fatores de estresse ocupacional e de verificar as estratégias de enfrentamento utilizadas pelos policiais civis. Participaram voluntariamente 40 policiais civis de uma delegacia regional e utilizou-se um roteiro de entrevista semi-estruturado com quatro perguntas. Após análise de conteúdo foram obtidas 222 respostas sobre os estressores ocupacionais, que foram classificados em 18 categorias envolvendo as características do trabalho, relacionamento com colegas e superiores, imagem negativa da classe por parte da sociedade e da mídia e falta de apoio legal e governamental ao trabalho da polícia. Sobre a estratégia usada para lidarem com o estresse foram obtidas 86 respostas, e a maioria utiliza manejo dos sintomas. Sugere-se intervenção de profissionais, tanto na estrutura e no ambiente de trabalho quanto no treinamento dos policiais, com o objetivo de otimizar a maneira de enfrentar os fatores de estresse no trabalho.

Patterns of drinking in the UK Armed Forces

AIMS

To examine patterns of drinking in the UK Armed Forces, how they vary according to gender and other demographics, and to make comparisons with the general population.

DESIGN

Large cross-sectional postal questionnaire study (response rate 60%).

SETTING

United Kingdom.

PARTICIPANTS

A random representative sample of the regular UK Armed Forces who were in service in March 2003 (n = 8686; 7937 men, 749 women). Comparisons were made with the general population of Great Britain.

MEASUREMENTS

Alcohol consumption was assessed using the Alcohol Use Disorders Identification Test (AUDIT).

FINDINGS

Sixty-seven per cent of men and 49% of women in the UK Armed Forces had an AUDIT score of 8+ (defined as hazardous drinking), compared to 38% of men and 16% of women in the general population. In both sexes, for all ages, the military have a higher prevalence of hazardous drinking. Binge drinking was associated with being younger, being in the Army, being single, being a smoker and being white. Among military men, heavy drinking (AUDIT score 16+) was associated with holding a lower rank, being younger, being single, being in the Naval Service or Army, being deployed to Iraq, not having children, being a smoker, having a combat role and having a parent with a drink or drug problem.

CONCLUSIONS

Excessive alcohol consumption is more common in the UK Armed Forces than in the general population. There are certain socio-demographic characteristics associated with heavy drinking within the military; for example, young age, being single and being a smoker, which may allow the targeting of preventive interventions.

Trauma and Addiction: Implications for Helping Professionals

(1) Helping professionals and first responders often experience stressful and traumatic incidents on a daily basis, and sometimes several times per day. (2) Research in addictions suggests an important link between traumatic experiences and the potential for addiction. (3) The idea of self-medicating to cope with stress and trauma is common not only in patients but also in helping professionals and first responders. (4) Treatment of substance-related disorders, trauma disorders, and stress responses share an important common consideration--immediacy.

Alcohol and tobacco consumption among police officers

Police occupy an important position within the community as both enforcers of the law and as role models for appropriate behavior. Despite this interesting juxtaposition, research has shown that they may consume alcohol and tobacco at rates higher than the general population. A significant causal factor is occupational stress, and the fact that police are regularly exposed to stressors beyond the range of normal human experiences. Given this ongoing and unavoidable relationship, the recognition and control of stress is paramount within law enforcement. Because police stressors are usually multi-faceted, health promotion interventions should focus on stress-reduction at both the institutional and individual level. Examples of health promotion strategies may include reducing overtime, carefully organizing shift rosters, streamlining administrative processes and allowing rest breaks for those on the night-shift. Interventions which focus on the individual are also important, because excess alcohol and tobacco consumption levels often relate to individual stress-coping mechanisms. Programs to help recognize and prevent excess alcohol and tobacco consumption may be worthwhile, as too, counseling, interpersonal support and critical incident debriefing. Promoting non-drinking and non-smoking stress-reduction activities where police can socialize and de-brief with their colleagues may be beneficial. Encouraging social events at sports clubs and gymnasiums has also been suggested. In order to achieve these goals however, governments will need to place a greater emphasis on the occupational health of police officers and the law enforcement agencies in which they work.

Predictors of police suicide ideation

Further inquiry into processes that lead to suicide in the police occupation is necessary. Suicide ideation in police officers and possible correlates associated with such ideation is explored in this paper. The focus was on psychologically traumatic police work experiences, the development of posttraumatic stress (PTSD) in officers, and the inordinate use of alcohol associated with this condition. The impact of these occupationally based factors and their association with suicide ideation has not yet been fully explored. Results suggest that certain traumatic police work exposures increase the risk of high level PTSD symptoms, which subsequently increase the risk of high alcohol use and suicide ideation. The combined impact of PTSD and increased alcohol use led to a ten-fold increase risk for suicide ideation.

Sources and Assessment of Occupational Stress in the Police

The role of the police in Western society is undergoing a transformation that reflects the economic social and technological changes in the community and the assertion of individual rights within a democracy. The aim of this study is to evaluate level of stress among a group of French policemen and to examine the association between policing, potential stressors and stress levels. The sample is drawn from a large metropolitan police force (n=617). The population extends from the first line policeman to top senior management. Each policeman is matched for age (more or less five years) and sex, to a control. Policemen and controls complete a self administered questionnaire including demographic, occupational and health characteristics, and a stress level assessment with the help of a visual analogue scale. The average age of the two groups is 40 yr. Eighty-four percent are men. The total score for average sources is not statistically significantly different for policemen and controls. Comparison of a police group with a high stress level to a police population with a low and moderate stress level is made. The comparison is done first only with men, and second with the whole population. Policemen with a high stress level (same results only for men and the whole population) belong to the following groups: more than 15 yr service, sergeant, officer and administrative employee rank, divorced experience, age over 30, no leisure-time activities and no hobbies. Multivariate analysis shows that the two last parameters are bound to the stress level. For the whole population, age over 30 has to be added, and for the group of men, length of service over five years should be noted. Stress at work is an ill-health provoking factor. Police from minority groups such as ageing subjects or police officers have been reported to experience greater stress. This population is adversely affected by lack of available manpower and long working hours. In fact sources of stress in the police population are found both in the weariness of the job and private life planning.

Relationship between cardiovascular disease morbidity, risk factors, and stress in a law enforcement cohort

It is unclear to what extent law enforcement officers (LEOs) experience increased prevalence of cardiovascular disease (CVD; defined as coronary heart disease, myocardial infarction, angina, or stroke) and, if so, whether perceived stress affects this relationship. First, self-reported CVD risk factors among currently employed male LEOs from 9 states (n = 2818) were compared to CVD risk factors among similarly-aged males with similar incomes in the same states (n = 8046). Second, CVD prevalence was compared among LEOs (n = 1791) and similarly-aged males with similar incomes (n = 2575) from four of these states. Finally, among the LEOs only, the possible effect of perceived stress on the relationship between CVD prevalence and CVD risk factors was assessed. LEOs reported higher prevalence of hypertension, hypercholesterolemia, tobacco use, and elevated body mass index. CVD prevalence did not differ significantly between the LEO group and the general population (2.3% +/- 15% versus 3.1% +/- 17%; P = 0.095). In the LEO-only group, the best predictors of CVD were: time in the profession (OR = 1.07; 95% CI = 1.03-1.11), perceived stress (OR = 1.05; 95% CI = 1.00-1.10), and hypertension (OR = 0.33; 95% CI = 0.18-0.62). In the LEO-only group, perceived stress was associated with CVD (P = 0.008), and three CVD risk factors were significantly affected by perceived stress: cholesterol, hypertension, and physical activity. Perceived stress was affected by duration of time in the profession (P = 0.004), independent of an age effect (P = 0.353). Among susceptible officers, perceived stress may contribute to CVD directly and through potentiating several CVD risk factors.