Impact of Shiftwork on Retinal Vasculature Diameters over a 5-Year Period: A Preliminary Investigation Using the BCOPS Study Data

Our aim was to investigate the impact of shiftwork on changes in central retinal arteriolar equivalent (CRAE), a measure of arteriolar width, and central retinal venular equivalent (CRVE), a measure of venular width, over five years. The participants were 117 officers (72.7% men) examined at the first (2011-2014) and second (2015-2019) follow-up examinations in the Buffalo Cardio-Metabolic Occupational Police Stress study. Shiftwork data were obtained from the City of Buffalo, NY payroll records. Retinal diameters were measured using a standardized protocol. ANCOVA was used to compare mean change in CRAE and CRVE between the two examinations across shiftwork categories. Among men only, those who worked ≥70% hours on day shifts had a larger decrease in mean CRAE (-7.13 µm ± 2.51) compared to those who worked <70% day (-0.08 ± 0.96; p = 0.011). Among patrol officers, those who worked ≥70% day had a larger decrease in CRAE compared to those who worked <70% day (p = 0.015). Also, officers who worked ≥70% day had an increase in mean CRVE (µm) (4.56 ± 2.56) compared to those who worked <70% (-2.32 ± 1.32; p = 0.027). Over the five-year period, we observed adverse changes in arteriolar and venular diameters among officers who worked ≥70% on day shifts. The results should be interpreted with caution due to the small sample sizes.

Mental Health Treatment Reported by US Workers before and during the COVID-19 Pandemic: United States (2019-2020)

The COVID-19 pandemic introduced a significant and unprecedented exacerbation of community mental health challenges. We compared the prevalence of mental health treatment (MHT) before and during the COVID-19 pandemic among US workers. Self-reported MHT data (N = 30,680) were obtained from the Sample Adult data of the National Health Interview Survey (2019 and 2020). MHT was defined as having taken prescription medications for mental health issues or receiving counseling from a mental health professional in the past 12 months. We calculated age-adjusted prevalence estimates and employed t-tests to compare MHT in 2019 and 2020 using SAS-callable SUDAAN 11.0. The prevalence of MHT significantly increased from 16.3% in 2019 to 17.6% in 2020 (difference = 1.3, p = 0.030). The prevalence of taking prescription medications for mental health issues significantly increased in 2020 compared to 2019 (12.5% to 13.6%, difference = 1.1, p = 0.037). The prevalence of receiving counseling significantly increased but only among those who worked 30-49 h/week, difference = 1.2, p = 0.022. US workers, especially those with typical work hours, appeared to experience higher mental distress during the first year of the pandemic compared to the year prior to the pandemic period. These findings highlight the need for targeted interventions to address mental health issues in these workers.

Association Between the Metabolic Syndrome and Retinal Microvascular Diameters Among Police Officers

OBJECTIVES

We examined the associations of the metabolic syndrome severity score (MSSS) and the metabolic syndrome (MetSyn) components with central retinal arteriolar equivalent (CRAE) and central retinal venular equivalent (CRVE).

METHODS

Participants in this cross-sectional study were 253 officers from the Buffalo Cardio-Metabolic Occupational Police Stress study (2011-2014). The MSSS is a z -score that represents the severity of MetSyn and was estimated using a sex/race-specific equation and the five MetSyn components. Associations of MSSS and the MetSyn with CRAE/CRVE were obtained using linear regression models or analysis of covariance.

RESULTS

For every 1-standard deviation of MSSS, CRAE decreased by 2.3 μm (SE = 1.2, P = 0.0262) and CRVE increased by 3.4 μm (SE = 1.6, P = 0.0308) after adjusting for confounders.

CONCLUSIONS

Officers with higher MSSS had narrower (ie, worse) arteriolar diameters and wider (ie, worse) venular diameters.

Proportionate mortality and national rate of death from COVID-19 among US law enforcement officers: 2020

Purpose –

The goal of the present study is to determine the proportionate mortality and national rate of duty-related deaths from COVID-19 among US law enforcement officers during the year 2020.

Design/methodology/approach –

Data for the current study were obtained from the National Law Enforcement Officer Memorial Fund (NLEOMF) database for the year 2020. The database contains deaths designated as caused by incidents that occurred while in the line of duty. The chi-square test and two-sample t-test were used to compare characteristics of officers who died of COVID-19 versus other causes of death. Both the proportionate mortality and rates of death were calculated. To compute the rate of death, the authors obtained data on the total number of law enforcement officers employed in the United States (and therefore at risk) for the year 2020 from Bureau of Labor Statistics.

Findings –

COVID-19 deaths (n = 182) accounted for 62% of all duty-related law enforcement officer deaths during 2020. The national rate of death due to COVID-19 (12.8/100,000 per year) for law enforcement officers was higher compared to all other causes of death combined (8.0/100,000 per year).

Research limitations/implications –

A limitation of the study is the uncertainty of a definitive assessment that the viral infection was acquired through work (versus at home or other non-work-related community settings). Although highly unlikely, deaths designated as duty related entail financial benefits for the survivors and may be a potential source of bias. Given the complexity of personal exposures, the percentage of COVID-19 deaths attributed to duty may represent an over or under estimation of the actual value. Therefore, the data should be interpreted cautiously.

Practical implications –

These findings provide police organizations with information needed to understand the risk of death among officers during the COVID-19 pandemic and to make informed decisions about future preparedness strategies.

Originality/value –

There are presently no published scientific studies that examine both the proportionate mortality and national rate of death from COVID-19 among law enforcement officers for the year 2020.

Longitudinal and cross-sectional associations between the dietary inflammatory index and objectively and subjectively measured sleep among police officers

Police officers experience exposures associated with increased inflammation, such as the stress associated with shiftwork and poor-quality diet, both of which have been shown to affect sleep duration and quality. This study examined the longitudinal and cross-sectional effects of the Energy-density Dietary Inflammatory Index (E-DII™) on objectively and subjectively measured sleep among police officers. Data were derived from the Buffalo Cardio-Metabolic Occupational Police Stress Cohort (n = 464 at baseline), with longitudinal data collected from 2004 to 2019. A food frequency questionnaire obtained estimated dietary intake from which E-DII scores were calculated. Dependent variables were objectively (Micro Motion Logger Sleep Watch™) and subjectively (Pittsburgh Sleep Quality Index) measured sleep quality and quantity. The analyses included a series of linear mixed-effects models used to examine cross-sectional and longitudinal associations between the E-DII and sleep quantity and quality. Cross-sectionally, more pro-inflammatory diets were associated with higher wake-after-sleep-onset but improved subjective sleep quality. In models accounting for both longitudinal and cross-sectional effects, for every 1-unit increase in the E-DII scores over time (representing a pro-inflammatory change), wake-after-sleep-onset increased by nearly 1.4 min (p = 0.07). This result was driven by officers who primarily worked day shifts (β = 3.33, p = 0.01). Conversely, for every 1-unit increase in E-DII score, the Pittsburgh Sleep Quality Index global score improved. More pro-inflammatory diets were associated with increased wake-after-sleep-onset, an objective measure of sleep quality. Intervention studies to reduce dietary inflammatory potential may provide greater magnitude of effect for changes in sleep quality.

Associations of adverse childhood experiences (ACEs) with sleep duration and quality: the BCOPS study

BACKGROUND

Adverse Childhood Experiences (ACEs) are associated with numerous adverse health outcomes in adulthood. Our objective was to investigate associations between ACEs and sleep measures among 206 police officers from the Buffalo Cardio-Metabolic Occupational Police Stress study.

METHODS

ACEs (independent variable) was assessed using the ACE questionnaire. Sleep measures were assessed using the Pittsburgh Sleep Quality Index and actigraphy. ANOVA/ANCOVA were used to investigate associations between ACEs and sleep measures.

RESULTS

The mean self-reported sleep duration was significantly lower among participants who reported ≥1 ACEs compared to those who reported no ACEs (6.0 ± 0.11 vs. 6.4 ± 0.14 h; multivariate-adjusted p = 0.035). Sleep efficiency was significantly lower among participants who reported ≥1 ACEs compared to those who reported none (mean = 88.7%, 95% CI = 87.7-89.6 vs. 90.2%, 89.2-91.2; unadjusted p = 0.031) but was slightly attenuated and lost statistical significance after multivariate-adjustment (88.8%, 87.8-89.7 vs. 90.1%, 88.9-91.1; p = 0.094). Compared to participants who reported no ACEs, those who reported ≥1 ACEs had a higher mean activity index score (36.9 ± 0.96 vs. 31.2 ± 1.25; multivariate-adjusted p = 0.001); a higher mean wake after sleep onset (WASO) (44.3 ± 2.24 vs. 35.3 ± 2.92 min; multivariate-adjusted p = 0.019); and a higher sleep fragmentation index (3.8 ± 1.65 vs. 3.3 ± 1.20 unadjusted p = 0.044 and 3.8 ± 0.13 vs. 3.3 ± 0.18; multivariate-adjusted p = 0.062). Among men (but not women) who reported ≥1 ACEs, self-reported sleep duration was significantly lower (5.9 ± 0.13 vs. 6.4 ± 0.15 h; multivariate-adjusted p = 0.025) and activity index was significantly higher (39.1 ± 1.3 vs. 33.2 ± 1.51; multivariate-adjusted p = 0.004) compared to those who reported no ACEs.

CONCLUSION

Exposure to ≥1 ACE was associated with worse sleep measures.

Adverse childhood experiences and police mental health

Purpose –

The purpose of this study is to examine cross-sectional associations between adverse childhood experiences (ACEs) and mental health among police officers.

Design/methodology/approach –

The sample was from the Buffalo Cardio-Metabolic Occupational Police Stress study data (132 male and 51 female officers). Standardized surveys were administered to participants. Regression coefficients were obtained from models adjusted for age, sex, race and alcohol intake. All statistical tests were performed using a statistical significance level at p < 0.05.

Findings –

Regression analyses showed significant positive associations between ACEs and mental health (Posttraumatic Stress Disorder [PTSD]: β = 1.70, p < 0.001 and depressive symptoms: β = 1.29, p < 0.001). Resiliency significantly modified the association between ACEs and PTSD. A positive and significant association was observed among officers with lower resiliency (β = 2.65, p < 0.001). The association between ACEs and PTSD was stronger among male officers compared to females (β = 2.66, p < 0.001 vs. β = 0.59, p ≤ 0.248, respectively).

Research limitations/implications –

Child abuse and development of PTSD or depression could not be traced through time as this was a cross-sectional study. Recall bias may affect results.

Practical implications –

PTSD and depression associated with ACEs can affect the interpretation of threat and can exacerbate emotional regulation in officers. An inquiry should be expanded regarding work assignments of victimized officers, such as child exploitation and pornography investigation.

Originality/value –

There are few studies on ACEs and the mental health of police officers. The present study is among the first to associate multiple police mental health issues with ACEs.

Dying for the job: police mortality, 1950-2018

Purpose –

This study is a mortality assessment on police officers (68-years, 1950-2018) and includes all causes of death.

Design/methodology/approach –

The authors investigated 1,853 police deaths (1950-2018) using sources of mortality that included the National Death Index, NY State, and available records from the Buffalo NY police department. Standardized Mortality Ratios were calculated. Death codes were obtained from 8th and 9th International Classification of Disease revisions in accordance with the year of death.

Findings –

Compared to the US general population, white male police officers from 1950-2018 had elevated mortality rates for some causes of death, including diseases of the circulatory system, malignant neoplasms, cirrhosis of the liver, and mental disorders. Black and female officers had lower mortality rates for all causes of death compared to the general population.

Research limitations/implications –

The findings of elevated risk for chronic disease among police need to be studied in relation to stress, lifestyle, and exposure to chemical and physical agents. There is a special need to further study officers from minority populations as larger samples become available.

Practical implications –

The results of this study will provide police and occupational health practitioners with objective evidence to determine the health impact of work on law enforcement officers.

Originality/value –

This study is longest running mortality assessment on police officers ever conducted (1950-2018) and includes white, black, and female officers.

Associations of burnout with awakening and diurnal cortisol among police officers

The aim of this cross-sectional study was to assess the associations of burnout with cortisol parameters in 197 police officers from the Buffalo Cardio-Metabolic Occupational Police Stress (BCOPS) study (2010–2014). The Maslach Burnout Inventory-General Survey assessed depersonalization, exhaustion, and professional efficacy. Officers provided salivary cortisol samples collected upon awakening, and 15, 30, and 45 ​min thereafter as well as three additional samples at lunchtime, dinnertime, and bedtime. Total area under the curve with respect to increase (AUCW_I for waking and AUCD_I for diurnal), total area under the curve with respect to ground (AUCW_G for waking and AUCD_G for diurnal), and diurnal slope were determined and used in this study. Unadjusted and adjusted (age, sex, and race/ethnicity) associations were examined using linear regression. The mean age of the officers was 48 years and 72% were males. The depersonalization component of burnout was negatively associated with AUCD_G (β ​= ​−108.4; p ​= ​0.036). Similarly, as exhaustion increased, AUCW_I (β ​= ​−9.58, p ​= ​0.038), AUCD_G (β ​= ​−114.7, p ​= ​0.029) and the diurnal slope (β ​= ​−0.000038; p ​= ​0.017) decreased. The Professional efficacy was not associated with any of the cortisol parameters. These results suggest that certain characteristics of burnout may be associated with diminished cortisol secretion in this group of urban police officers. Our findings add to previous studies examining associations of burnout with the cortisol awakening response. Future longitudinal studies are needed to evaluate the temporal relationship between burnout and these cortisol parameters.

•

Burnout component scores and cortisol parameter values did not differ significantly between male and female officers.

•

Adjusted models demonstrated significant negative associations between the burnout components and cortisol parameters.

•

As depersonalization increased, AUCD_G decreased.

•

As exhaustion increased, AUCW_I, AUCD_G, and the diurnal slope decreased.

•

Professional efficacy was not associated with either AUCW_I or AUCD_G.

Shift Work Adaptation Among Police Officers: The BCOPS Study

Few studies have examined shiftwork adaptation among police officers or potential differences in disease biomarkers among adapted and maladapted shiftworkers. This study characterized shiftwork adaptation among 430 police officers from the Buffalo Cardio-Metabolic Occupational Police Stress (BCOPS) study. Police officers working fixed night shifts with symptoms characteristic of adaptation and maladaptation were identified using latent class analysis (n = 242). Two approaches were applied, one with police-specific symptoms and another using more general symptoms as shiftwork adaptation indicators. Biomarkers of inflammation, heart rate variability, and cardiometabolic risk were then compared between shiftwork adaptation groups, and with officers working day shifts, after adjusting for confounding. When analyses included police-specific symptoms, maladapted shiftworkers (n = 73) had more self-reported stress, sleep disturbances, fatigue, and less social support than adapted shiftworkers (n = 169). Using more general symptoms, maladapted officers (n = 56) reported more stress and depression, and less social support than adapted officers (n = 186). In police-specific models, adjusted (least-squares) means (± standard error) of circulating interleukin-6 (IL-6) concentrations in maladapted officers (0.8 ± 0.1 ln[pg/ml]) were modestly elevated relative to adapted shiftworkers (0.7 ± 0.1 ln[pg/ml], p = .09) and relative to permanent day workers (0.5 ± 0.1 ln[pg/ml], p ≤ 0.01), and leptin levels in maladapted officers (9.6 ± 0.1 ln[pg/ml]) exceeded those in the adapted (9.4 ± 0.1 ln[pg/ml], p ≤ 0.01) and day shift groups (9.4 ± 0.1 ln[pg/ml], p = .03). In the general model, adjusted mean tumor necrosis factor-alpha (TNF-α) concentrations among maladapted officers (5.6 ± 0.23 pg/ml) exceeded the adapted (4.8 ± 0.2 pg/ml, p ≤ 0.01) and day workers (5.0 ± 0.2 pg/ml, p = .04), and insulin among maladapted officers was higher (2.4 ± 0.1 ln[uu/ml]) than the adapted group (1.8 ± 0.1 ln[uu/ml], p = .03). No differences were observed for the other biomarkers. The results suggest that maladaptation among police officers working fixed night shifts may lead to increases in leptin, insulin, IL-6, and TNF-α; however, the cross-sectional design and possible residual confounding preclude interpretation of cause and effect. Prospective studies are planned to further characterize the relationship between shiftwork maladaptation and biomarkers of chronic disease risk in this police officer cohort.

Shift work and overtime across a career in law enforcement: a 15-year study

PURPOSE –

To characterize changes in work hours across a career in law enforcement.

DESIGN/METHODOLOGY/APPROACH –

N = 113 police officers enrolled in the BCOPS cohort were studied. The police officers started their careers in law enforcement between 1994 and 2001 at a mid-sized, unionized police department in northwestern New York and continued to work at this police department for at least 15 years. Day-by-day work history records were obtained from the payroll department. Work hours, leave hours and other pay types were summarized for each calendar year across their first 15 years of employment. Linear mixed-effects models with a random intercept over subject were used to determine if there were significant changes in pay types over time.

FINDINGS –

A total of 1,617 individual-years of data were analyzed. As the police officers gained seniority at the department, they worked fewer hours and fewer night shifts. Total paid hours did not significantly change due to seniority-based increases in vacation time. Night shift work was increasingly in the form of overtime as officers gained seniority. Overtime was more prevalent at the beginning of a career and after a promotion from police officer to detective.

ORIGINALITY/VALUE –

Shiftwork and long work hours have negative effects on sleep and increase the likelihood of on-duty fatigue and performance impairment. The results suggest that there are different points within a career in law enforcement where issues surrounding shiftwork and long work hours may be more prevalent. This has important implications for predicting fatigue, developing effective countermeasures and measuring fatigue-related costs.

An analysis of shiftwork and self-reported depressive symptoms in a police cohort from Buffalo, New York

Shiftwork has been associated with elevated depressive symptoms; police officers frequently work shifts and may experience depressive symptoms. This study assessed the association between depressive symptoms and shiftwork in a police cohort from Buffalo, New York, USA using a repeated cross-sectional design with data collected in 2004-2009 (n = 428) and 2010-2014 (n = 261). Electronic payroll records were used to quantitatively classify officers on the day, evening, or night shift based on the shift they spent most of their working hours. Two self-reported depressive symptomology measures were used as outcomes - the Center for Epidemiological Studies - Depression (CES-D) scale and the Beck Depression Inventory (BDI). Repeated measures linear and logistic regression analyses were used to estimate least squares means or odds, respectively, of depressive symptom questionnaire scores by shiftwork category. Those working the evening/night shift had higher odds for depressive symptoms according to the BDI (based on a cut-point score of 14) than those working the day shift (OR = 4.60, 95% CI = 1.15-18.39). Similar results were observed for the evening shift group. No differences in mean CES-D or BDI scores were observed between groups for short-term shiftwork, long-term shiftwork, or shift changes. After stratifying by stress, as measured by the Perceived Stress Scale (PSS), total Impact of Events (IES), and the Spielberger Police Stress Survey (SPSS), mean values for depressive symptoms were higher in the high-stress categories regardless of shiftwork status. Further research should include biomarkers for depression, a longitudinal study design with a larger cohort, and joint effects of shiftwork and stress on depressive symptoms.

Actigraphy-Based Assessment of Sleep Parameters

Actigraphy, a method for inferring sleep/wake patterns based on movement data gathered using actigraphs, is increasingly used in population-based epidemiologic studies because of its ability to monitor activity in natural settings. Using special software, actigraphic data are analyzed to estimate a range of sleep parameters. To date, despite extensive application of actigraphs in sleep research, published literature specifically detailing the methodology for derivation of sleep parameters is lacking; such information is critical for the appropriate analysis and interpretation of actigraphy data. Reporting of sleep parameters has also been inconsistent across studies, likely reflecting the lack of consensus regarding the definition of sleep onset and offset. In addition, actigraphy data are generally underutilized, with only a fraction of the sleep parameters generated through actigraphy routinely used in current sleep research. The objectives of this paper are to review existing algorithms used to estimate sleep/wake cycles from movement data, demonstrate the rules/methods used for estimating sleep parameters, provide clear technical definitions of the parameters, and suggest potential new measures that reflect intraindividual variability. Utilizing original data collected using Motionlogger Sleep Watch (Ambulatory Monitoring Inc., Ardsley, NY), we detail the methodology and derivation of 29 nocturnal sleep parameters, including those both widely and rarely utilized in research. By improving understanding of the actigraphy process, the information provided in this paper may help: ensure appropriate use and interpretation of sleep parameters in future studies; enable the recalibration of sleep parameters to address specific goals; inform the development of new measures; and increase the breadth of sleep parameters used.

Law enforcement worker suicide: an updated national assessment

PURPOSE –

The purpose of this paper is to update the assessment of national data on law enforcement worker suicide based on the National Occupational Mortality Surveillance database (NOMS, Centers for Disease Control and Prevention).

DESIGN/METHODOLOGY/APPROACH –

Death certificate data for 4,441,814 decedents, age 18-90 who died in one of the 26 reporting states were the source of NOMS data. Utilizing proportionate mortality ratios (PMRs), the ratio of suicides in law enforcement occupations in those who are 18-90 years old with a designated usual occupation was calculated.

FINDINGS –

Findings indicate a significantly higher proportion of deaths from suicide for law enforcement officers (PMR = 154, 95% CI = 147-162), compared to all the US decedents in the study population who were employed during their lifetime. Law enforcement personnel are 54% more likely to die of suicide than all decedents with a usual occupation. PMRs were highest for African-Americans, Hispanic males and for females. PMRs were similar for detectives, corrections officers and all law enforcement jobs, when not stratified by race, ethnicity and sex.

RESEARCH LIMITATIONS/IMPLICATIONS –

Bias may arise because a PMR can be affected by disproportionate increased or decreased mortality from causes of death other than suicide.

PRACTICAL IMPLICATIONS –

A better understanding of the scope of law enforcement suicide can inform policy focused on the planning and initiation of prevention programs.

ORIGINALITY/VALUE –

The use of a national database to study law enforcement worker suicide adds to other information available on law enforcement worker suicide in specific geographic areas. The discussion on prevention in this paper presents ideas for policy.

Associations of Sleep Measures with Retinal Microvascular Diameters among Police Officers

PURPOSE

We examined cross-sectional associations of sleep measures with central retinal artery equivalent (CRAE) and central retinal vein equivalent (CRVE) and investigated whether sex and race/ethnicity modified these associations.

METHODS

Participants (N = 202; 78% white; 71% men) were enrolled in the Buffalo Cardio-metabolic Occupational Police Stress study (2011-2014). Wrist actigraphy was used to assess sleep measures including sleep duration, sleep efficiency, sleep onset latency, wake after sleep onset, number of awakenings, and longest wake episode. CRAE and CRVE were obtained from fundus photography of retina and were averaged from both eyes per officer.

RESULTS

We observed significant associations between sleep efficiency and CRVE (β = -2.81 µm; P= .046), and between longest wake episode and CRVE (β = 3.24 µm; P= .021). Adjustments for demographics, lifestyles, and physical and psychological factors attenuated these associations. Sex modified the independent associations of sleep onset latency and longest wake episode with CRVE. One standard deviation (SD) increase in sleep onset latency was associated with 4.81 µm larger CRVE (P= .028) (P-interaction = 0.098), and one SD increase in longest wake episode was associated with 4.62 µm larger CRVE (P= .032) (P-interaction = 0.115) among men. Race/ethnicity also modified the association between longest wake episode and CRVE (P-interaction = 0.088). A significant association was observed only among white officers (β = 4.96 µm; P= .025).

CONCLUSIONS

We found that poor sleep quality, measured by longest wake episode, was positively and independently associated with retinal venular diameter among white and male officers. Longitudinal studies are warranted to assess whether poor sleep quality is a risk factor for retinal diameter changes.

Temporal trends in prevalence of cardiovascular disease (CVD) and CVD risk factors among U.S. older workers: NHIS 2004-2018

PURPOSE

This study examined trends in the prevalence of cardiovascular disease (CVD) and CVD risk factors among U.S. older adults and workers. We also investigated correlations between the temporal prevalence of CVD and selected risk factors (hypertension, obesity, physical inactivity, smoking, and treated diabetes) among participants.

METHODS

Data were obtained from the National Health Interview Survey (2004-2018) for U.S. adults aged greater than or equal to 50 years (n = 207,539), of which 84,180 were employed. Temporal trends in prevalence were assessed by fitting weighted regression models to the age-standardized prevalence to the 2010 U.S.

POPULATION

The relationship between temporal prevalence of CVD with each risk factor was assessed using Spearman's correlation coefficient.

RESULTS

Among all older adults, the prevalence of CVD significantly declined (β = -0.16, P < .001) during 2004-2018; similar decline was observed among employed adults (β = -0.16, P = .001). Temporal prevalence in CVD was positively correlated to physical inactivity (r = 0.73, P = .002) and smoking (r = 0.81, P < .001), but not to any of the other risk factors.

CONCLUSIONS

Among employed adults aged greater than or equal to 50 years, the prevalence of CVD, physical inactivity, and smoking dramatically declined over the past 15 years. The temporal decline in prevalence of CVD was significantly associated with decline prevalence of physical inactivity and smoking.

Occupational injury and psychological distress among U.S. workers: The National Health Interview Survey, 2004-2016

INTRODUCTION

Injuries at work may negatively influence mental health due to lost or reduced working hours and financial burden of treatment. Our objective was to investigate, in U.S. workers (a) the prevalence of serious psychological distress (SPD) by injury status (occupational, non-occupational, and no injury) and injury characteristics, and (b) the association between injury status and SPD.

METHODS

Self-reported injuries within the previous three months were collected annually for 225,331 U.S. workers in the National Health Interview Survey (2004-2016). Psychological distress during the past 30 days was assessed using the Kessler 6 (K6) questions with Likert-type scale (0-4, total score range: 0-24). SPD was defined as K6 ≥ 13. Prevalence ratios (PR) from fitted logistic regression models were used to assess relationships between injury and SPD after controlling for covariates.

RESULTS

The prevalence of SPD was 4.74%, 3.58%, and 1.56% in workers reporting occupational injury (OI), non-occupational injury (NOI), and no injury, respectively. Workers with head and neck injury had the highest prevalence of SPD (Prevalence: OI = 7.71%, NOI = 6.17%), followed by workers with scrape/bruise/burn/bite (6.32% for those with OI). Workers reporting OI were two times more likely to have SPD compared to those without injury (PR = 2.19, 95%CI: 1.62-2.96). However, there was no significant difference in SPD between workers with OI and workers with NOI (PR = 0.98, 95%CI: 0.65-1.48).

CONCLUSION

The prevalence of SPD varied by injury status with the highest being among workers reporting OI. We found that the workers reporting OI were significantly more likely to have SPD than those without injury, but not more than those with NOI. Practical Applications: Mental health management programs by employers are necessary for workers who are injured in the workplace.

Fatigue and short-term unplanned absences among police officers

PURPOSE –

The purpose of this paper is to assess whether shift work, sleep loss and fatigue are related to short-term unplanned absences in policing.

DESIGN/METHODOLOGY/APPROACH –

N = 367 police officers from the Buffalo Police Department were studied. Day-by-day work and sick leave data were obtained from the payroll. Absenteeism was defined as taking a single sick day on a regularly scheduled workday. Biomathematical models of fatigue (BMMF) predicted officers' sleep-wake behaviors and on-duty fatigue and sleepiness. Prior sleep, fatigue and sleepiness were tested as predictors of absenteeism during the next shift.

FINDINGS –

A total of 513,666 shifts and 4,868 cases of absenteeism were studied. The odds of absenteeism increased as on-duty fatigue and sleepiness increased and prior sleep decreased. This was particularly evident for swing shift officers and night shift officers who were predicted by BMMF to obtain less sleep and have greater fatigue and sleepiness than day shift officers. The odds of absenteeism were higher for female officers than male officers; this finding was not due to a differential response to sleep loss, fatigue or sleepiness.

PRACTICAL IMPLICATIONS –

Absenteeism may represent a self-management strategy for fatigue or compensatory behavior to reduced sleep opportunity. Long and irregular work hours that reduce sleep opportunity may be administratively controllable culprits of absenteeism.

ORIGINALITY/VALUE –

Police fatigue has consequences for police officers, departments and communities. BMMF provide a potential tool for predicting and mitigating police fatigue. BMMF were used to investigate the effects of sleep and fatigue on absenteeism.

Hidden danger: A 22-years analysis of law enforcement deaths associated with duty-related illnesses (1997-2018)

Purpose –

Law enforcement is a dangerous profession not only due to assaults, accidents and homicides but also due to health risks. This study examined trends in the national frequency and rate of law enforcement jobrelated illness deaths in the United States over a 22-year period (1997-2018).

Design/methodology/approach –

Data were obtained from the National Law Enforcement Officers Memorial Fund (NLEOMF) on death frequencies related to health issues at work. Death rates were based on the total number of police officers in the United States [rate = (frequency/population at risk) × 100,000]. Trends were examined using standardized regression.

Findings –

A total of 646 deaths were attributed to job-related illness. There was a significant upward trend in overall job-related illness deaths (frequency analyses: β = 0.88, p < 0.0001; rate analyses: β = 0.82, p ≤ 0.0001) mainly driven by a significant increase in 911 cancer deaths (frequency analyses: β = 0.88, p < 0.0001; rate analyses: β = 0.88, p ≤ 0.0001). Nearly 82 percent of circulatory deaths were from a heart attack, with an average death age of 46.5 years.

Research limitations/implications –

Deaths were not included if they failed to meet medical requirements of the NLEOMF. The data are descriptive, do not estimate risk and should be interpreted cautiously.

Practical implications –

Police wellness programs may help to reduce the danger of deaths associated with job-related illness.

Originality/value –

This is among the first studies to examine frequency and rate of police health-related deaths due to job exposures.

Associations of objectively measured sleep characteristics and incident hypertension among police officers: The role of obesity

This study investigated the associations of baseline sleep onset latency, wake after sleep onset, longest wake episode, number of awakenings, sleep efficiency and sleep duration with incident hypertension during a 7-year follow-up (n = 161, 68% men) and the joint effect of insufficient sleep and obesity on incident hypertension. Sleep parameters were derived from 15-day actigraphy data. Relative risks and 95% confidence intervals were estimated using a robust Poisson regression model. Each 10-min increase in sleep onset latency was associated with an 89% higher risk of hypertension (95% confidence interval [CI] = 1.12-3.20). Each 10-min increase in longest wake episode was associated with a 23% higher risk of hypertension (95% CI = 1.01-1.50) and each 10% decrease in sleep efficiency was associated with a 50% higher risk of hypertension (95% CI = 1.02-2.22). These associations were independent of demographic and lifestyle characteristics, depressive symptoms, shift work, sleep duration and body mass index. Having <6 hr of sleep and a body mass index ≥30 kg/m² increased the risk of hypertension (relative risk = 2.81; 95% CI = 1.26-6.25) compared with having ≥6 hr of sleep and a body mass index <30 after controlling for confounders. Relative excess risk due to interaction was 3.49 (95% CI = -1.69-8.68) and ratio of relative risk was 3.21 (95% CI = 0.72-14.26). These results suggest that poor sleep quality is a risk factor for hypertension. Longitudinal studies with larger sample sizes are warranted to examine the joint effect of insufficient sleep and obesity on development of hypertension.

Police stress and depressive symptoms: role of coping and hardiness

PURPOSE –

Chronic exposure to occupational stress may lead to depressive symptoms in police officers. The association between police stress and depressive symptoms and the potential influences of coping and hardiness were evaluated. The paper aims to discuss this issue.

DESIGN/METHODOLOGY/APPROACH –

Stress level was assessed in the Buffalo Cardio-Metabolic Occupational Police Stress Study (2004-2009) with the Spielberger Police Stress Survey. The frequency and severity of events at work were used to calculate stress indices for the past year. The Center for Epidemiologic Studies Depression (CES-D) Scale was used to measure depressive symptoms during the past week. Linear regression was used to evaluate the association between the stress indices and depressive symptom scores. Models were adjusted for age, sex, race, smoking status and alcohol intake, and stratified by median values for coping (passive, active and support seeking) and hardiness (control, commitment and challenge) to assess effect modification.

FINDINGS –

Among the 388 officers (73.2 percent men), a significant positive association was observed between total stress and the CES-D score (β = 1.98 (SE = 0.36); p < 0.001). Lower CES-D scores were observed for officers who reported lower passive coping (β = 0.94 (SE = 0.45); p = 0.038) and higher active coping (β = 1.41 (SE = 0.44); p = 0.002), compared with their counterparts. Officers higher in hardiness had lower CES-D scores, particularly for commitment (β = 0.86 (SE = 0.35); p = 0.016) and control (β = 1.58 (SE = 0.34); p < 0.001).

ORIGINALITY/VALUE –

Results indicate that high active coping and hardiness modify the effect of work stress in law enforcement, acting to reduce depressive symptoms.

Associations between adiposity measures and 25-hydroxyvitamin D among police officers

OBJECTIVE

Studies show that serum levels of 25-hydroxyvitamin D (25(OH)D), a biomarker for vitamin D status, are lower in persons with higher adiposity levels and that police officers have been found to have a high prevalence of obesity. The purpose of this study was to examine relationships between several adiposity measures and 25(OH)D, and also compare those measures to determine the best one that predicts insufficiency of 25(OH)D (<20 ng/mL) among police officers in the Northeast area of the United States.

METHODS

Participants were 281 police officers (71.5% men) from the Buffalo Cardio-Metabolic Occupational Police Stress Study (2011-2016). Associations of body mass index (BMI), abdominal height (AbHt), waist circumference (WC), WC-to-height ratio (WCHtR), percent body fat (PBF), and fat mass index (FMI) with 25(OH)D were obtained using multiple regression models after adjustment for age, race/ethnicity, season, multivitamin supplement use, and high-density lipoprotein cholesterol. The area under the curve (AUC) was used to evaluate the predictive ability of each adiposity measure to identify insufficient 25(OH)D concentrations.

RESULTS

The prevalence of obesity (BMI ≥ 30) was 50.7% in men and 21.3% in women. Mean levels of 25(OH)D were 32.4 ng/mL in men and 34.4 ng/mL in women. After adjustment for covariates, PBF and FMI among men were inversely associated with 25(OH)D: PBF (β ± SE = -2.40 ± 1.01, P = .018); FMI (-2.21 ± 0.93, .018). Among women, no adiposity measure was associated with 25(OH)D. PBF was the best predictor of insufficient 25(OH)D concentrations regardless of gender (AUC = 0.878).

CONCLUSION

Adiposity measures were inversely associated with 25(OH)D, but differed between female and male officers.

Shiftwork and Biomarkers of Subclinical Cardiovascular Disease: The BCOPS Study

OBJECTIVE

To assess the association of shiftwork with biomarkers of subclinical cardiovascular disease and examine the moderating role of body mass index (BMI) in a police cohort.

METHODS

A cross-sectional analysis was conducted among officers who were categorized as working the day, evening, or night shift. Comparisons with inflammatory biomarkers were performed among shifts using analysis of variance/covariance and further stratified by BMI to assess potential effect modification.

RESULTS

Associations were observed between day and night shiftworkers for leukocytes, tumor necrosis factor alpha, and homocysteine. After BMI stratification, higher c-reactive protein (CRP) levels were observed among evening shiftworkers with a BMI more than or equal to 30 kg/m versus the day shift.

CONCLUSIONS

Future studies examining prospective changes in these markers will allow for more comprehensive evaluation of their association with shiftwork.

Depressive Symptoms Among Police Officers: Associations with Personality and Psychosocial Factors

Protective psychosocial factors may reduce the risk of stress-related illnesses in policing. We assessed the association between protective factors and depressive symptoms among 242 police officers. Participants were from the Buffalo Cardio-Metabolic Occupational Police Stress (BCOPS) Study (2004-2014). Coping, hardiness, personality traits, and social support were assessed at baseline. Depressive symptoms were measured at baseline and follow-up using the Center for Epidemiologic Studies-Depression (CES-D) scale. The relationship between protective factors and the rate of change in depressive symptoms was assessed using linear regression. Logistic regression evaluated associations between protective factors and new-onset depression. Of participants free of depression at baseline, 23 (10.7%) developed probable depression during the follow-up. Odds of new-onset depression increased with increasing neuroticism (adjusted odds ratio [ORADJ] = 1.22, 95% confidence interval [CI], 1.11-1.35) and passive coping (ORADJ = 2.07, 95% CI, 1.06-4.03). Increasing agreeableness (ORADJ = 0.87, 95% CI, 0.78-0.96) and conscientiousness (ORADJ = 0.90, 95% CI, 0.84-0.98) were associated with decreased odds of new-onset depression. New-onset depression was not significantly associated with other coping subscales, hardiness, or social support. There were no significant associations between protective factors and change in depressive symptom scores. This study suggests certain personality characteristics and passive coping may be associated with increased odds of new-onset depression in police officers.

Influence of Work Characteristics on the Association Between Police Stress and Sleep Quality

BACKGROUND

Police officers' stress perception, frequency of stressful events (stressors), and police work characteristics may contribute to poor sleep quality through different mechanisms.

METHODS

We investigated associations of stress severity (measured by stress rating score) and frequency of stressors with sleep quality and examined the influence of police work characteristics including workload, police rank, prior military experience, and shift work on the associations. Participants were 356 police officers (256 men and 100 women) enrolled in the Buffalo Cardio-Metabolic Occupational Police Stress Study from 2004 to 2009. A mean stress rating score and mean frequency of stressors occurring in the past month were computed for each participant from the Spielberger Police Stress Survey data. Sleep quality was assessed using the global score derived from the Pittsburgh Sleep Quality Index survey. Linear associations of the stress rating score and frequency of stressors with sleep quality (Pittsburgh Sleep Quality Index global score) were tested. Age, sex, race/ethnicity, and smoking status were selected as potential confounders.

RESULTS

The stress rating score was positively and independently associated with poor sleep quality (β = 0.17, p = 0.002). Only workload significantly modified this association (β = 0.23, p = 0.001 for high workload group; p-interaction = 0.109). The frequency of stressors was positively and independently associated with poor sleep quality (β = 0.13, p = 0.025). Only police rank significantly modified the association (β = 0.007, p = 0.004 for detectives/other executives; p-interaction = 0.076).

CONCLUSION

Both police officers' perception of stress severity and the frequency of stressors are associated with poor sleep quality. Stress coping or sleep promotion regimens may be more beneficial among police officers reporting high workloads.

Effort-Reward Imbalance and Overcommitment at Work: Associations With Police Burnout

The present study examined associations of effort-reward imbalance (ERI) and over-commitment at work with burnout among police officers using data from 200 (mean age = 46 years, 29% women) officers enrolled in the Buffalo Cardio-Metabolic Occupational Police Stress Study. ERI and overcommitment were assessed using Siegrist's "effort/reward" questionnaire. The Maslach Burnout Inventory-General Survey was used to assess burnout and its three subscales (exhaustion, cynicism, and professional efficacy). Analysis of covariance was used to examine mean values of burnout scores across quartiles of ERI and overcommitment. Linear regression was used to test for linear trend. ERI and overcommitment were positively and significantly associated with cynicism and exhaustion (trend p value < .001), while professional efficacy showed an inverse association with overcommitment (p = .026). Cynicism and exhaustion scores were significantly higher in officers who reported both overcommitment and ERI compared with their counterparts (p < .001). The results suggest that ERI and overcommitment at work are determinants of higher cynicism and exhaustion. The inverse association of overcommitment with professional efficacy (an indicator of engagement at work) suggests that extreme involvement in work may negatively affect efficacy. Overcommitment may be related to a need for approval and inability of officers to withdraw from work, even in an off-duty status. Police agencies should consider organizational remedies to maintain acceptable levels of commitment by officers. In addition, there is a need to monitor and improve effort-reward imbalance experienced by officers.

Exploration into best practices in peer support for bereaved survivors

This exploratory, qualitative study addresses the question: what are the important elements in effective peer support programs for bereaved survivors? Interviews with 10 highly experienced experts were analyzed to identify recurrent themes and elements. Findings indicate that effective peer support programs for the bereaved should be: easily accessible; confidential; provide a safe environment; use peer supporters with similar shared experiences to clients; select peer supporters carefully; partner with professional mental health providers; train peer supporters thoroughly; and provide care and monitoring for peer supporters. These results can help inform efforts to improve peer support programs for bereaved survivors.

Sleep quality and the cortisol awakening response (CAR) among law enforcement officers: The moderating role of leisure time physical activity

OBJECTIVE

The goal of this study was to investigate the role of leisure time physical activity (LTPA) on the association between sleep quality and the cortisol awakening response (CAR) in people with an occupation that exposes them to high levels of stress.

METHODS

Participants were 275 police officers (age = 42 years ± 8.3, 27% women) enrolled in the Buffalo Cardio-Metabolic Occupational Police Stress (BCOPS) study (conducted between 2004 and 2009). Officers provided four salivary cortisol samples (on awakening and 15, 30, and 45 min after awakening). Hours of leisure time physical activity were assessed using the Seven-Day Physical Activity Recall questionnaire. Sleep quality (good/poor) was evaluated using the Pittsburgh Sleep Quality Index (PSQI) scale. Analysis of covariance and repeated measures models were used to examine the association of sleep quality to the two aspects of CAR: cortisol levels (total area under the curve (AUCG), mean, and peak cortisol) and cortisol profiles (the overall pattern in cortisol level during the 45 min period following awakening, the increase in cortisol from baseline to average of post awakening values (mean increase), and area under the curve with respect to increase (AUCI)). Analyses were stratified by participant level of reported LTPA (sufficiently vs. insufficiently active, defined as ≥ 150 vs. < 150 min/week of moderate intensity activity, respectively). Since cortisol activity is known to be influenced by gender, we conducted additional analyses also stratified by gender.

RESULTS

Overall, results demonstrated that LTPA significantly moderated the association of sleep quality with CAR. Among participants who were sufficiently active, CAR did not differ by sleep quality. However, in those who were insufficiently active during their leisure time, poor sleep quality was associated with a significantly reduced level of total awakening cortisol secretion (AUCG (a.u.) = 777.4 ± 56 vs. 606.5 ± 45, p = 0.02; mean cortisol (nmol/l) = 16.7 ± 1.2 vs. 13.3 ± 0.9, p = 0.03; peak cortisol (nmol/l) = 24.0 ± 1.8 vs. 18.9 ± 1.5, p = 0.03 for good vs. poor sleep quality, respectively). The normal rise in cortisol after awakening was also significantly lower in inactive officers with poor sleep quality than in those with good sleep quality (mean increase (nmol/l) = 6.7 ± 1.5 vs. 2.3 ± 1.2, p = 0.03; AUCI (a.u.) = 249.3 ± 55 vs. 83.3 ± 44, p = 0.02 for those with good vs. poor sleep quality, respectively). While findings for male officers were consistent with the overall results, CAR did not differ by sleep quality in female officers regardless of LTPA level.

CONCLUSION

Findings of this study suggest that poor sleep quality is associated with diminished awakening cortisol levels and dysregulated cortisol patterns over time, but only among officers who were inactive or insufficiently active during their leisure time. In contrast, sleep quality was not associated with any measures of CAR in officers who reported sufficient activity, suggesting a potential protective effect of LTPA. In analyses stratified by gender, findings for male officers were similar to those in the pooled sample, although we found no evidence for a modifying effect of LTPA in women. Future longitudinal studies in a larger population are needed to confirm these findings and further elucidate the relationships between LTPA, sleep quality, and cortisol response.

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.

Examining the Brachial Artery Reactivity Curve Measured by B-Mode Ultrasound in the Buffalo Cardio-Metabolic Occupational Police Stress (BCOPS) Pilot Study

Brachial artery reactivity was assessed in the Buffalo Cardio-Metabolic Occupational Police Stress (BCOPS) Pilot Study using B-mode ultrasound. Carotid artery intima-media thickness (CIMT), a known subclinical predictor of cardiovascular disease, also was examined in relation to brachial artery reactivity. A continuous scan was performed on the artery for 8 min (1 min of baseline, 4 min of cuff inflation at 40 mmHg greater than systolic pressure, 3 min after cuff release).

The sample for analysis (n = 78; 43 men, 35 women) consisted of active-duty police officers from a larger sample in the BCOPS pilot study. Means and standard deviations (SDs) stratified by gender were calculated, along with Pearson's correlations between brachial variables, and with CIMT. Arterial diameters (baseline, pre-cuff release, peak) were significantly different ( p < 0.001) between men and women. Peak arterial dilation occurred at 50.77 ± 21.97 sec (49.67 ± 20.22 cardiac cycles) after cuff deflation in men, and 44.66 ± 24.07 sec (44.57 ± 20.36 cardiac cycles) after cuff deflation in women. Mean common carotid artery IMT and mean maximum IMT of all carotid sites were significantly correlated ( p < 0.01) in men (r = 0.691) and women (r = 0.450). Brachial reactivity measures were inversely correlated with CIMT in women, and in contrast, positively correlated in men.

Effort-reward imbalance in police work: associations with the cortisol awakening response

PURPOSE

We hypothesized that effort-reward imbalance (ERI) is associated with an atypical cortisol response. ERI has been associated with higher job stress. Stress triggers cortisol secretion via the hypothalamic-pituitary-adrenal (HPA) axis, and significant deviation from a typical cortisol pattern can indicate HPA axis dysfunction.

METHODS

176 police officers participated from the Buffalo Cardio-Metabolic Occupational Police Stress (BCOPS) Study. ERI was the exposure variable. Outcome variables were saliva-based peak and mean cortisol values, total area under the curve ground (AUCG) and baseline (AUCI); linear regression line fitted to log-transformed cortisol. Regression analyses were used to examine linear trend between ERI and cortisol parameters. Repeated measures analysis examined whether the pattern of cortisol over time differed between low ERI (< median) and high ERI (≥ median).

RESULTS

Mean age was 46 years (SD = 6.6). After adjustment for potential confounders, there was a significant inverse association between ERI and peak cortisol (β = - 0.20, p = 0.009), average cortisol (β = - 0.23, p = 0.003), and total area under the curve (β = - 0.21, p = 0.009). ERI was not significantly associated with AUCI (β = - 0.11, p = 0.214); slope of the regression line fitted to the cortisol profile (β = - 0.009, p = 0.908). Repeated measures analyses showed that the cortisol pattern did not vary significantly between high and low ERI using the median as a cut point (interaction p value = 0.790).

CONCLUSIONS

ERI was inversely associated with the magnitude of awakening cortisol over time, indicating HPA axis dysregulation and potential future health outcomes.

An Exploration of Shift Work, Fatigue, and Gender Among Police Officers: The BCOPS Study

The present study examined the association between shift work and fatigue among male ( n = 230) and female ( n = 78) police officers. A 15-year work history database was used to define dominant shifts as day, afternoon, or night. A 10-item questionnaire created from the Standard Shiftwork Index (SSI) assessed fatigue. Gender-stratified analyses of variance and covariance and Poisson regression were used to compare means and prevalence of individual items across shifts. No significant differences in total fatigue scores were observed across shifts. However, the prevalence of the fatigue item "feelings of tiredness" was 89% higher among male officers working the afternoon shift compared with officers working the day shift (prevalence ratio [PR] = 1.89, 95% confidence interval [CI] = [1.12, 3.23], p = .020), after adjustment for covariates. Women reported a lower prevalence of tiredness than men on the afternoon shift. Organizations with afternoon shift workers should consider reducing fatigue at work through education and other methods.

Stressful life events and posttraumatic growth among police officers: A cross-sectional study

Police officers often continue to face numerous threats and stressors in the aftermath of a disaster. To date, posttraumatic growth (PTG) has been studied primarily in the context of significant trauma; thus, it is not known whether stressful life events are associated with PTG. This study investigated the development of PTG among 113 police officers working in the New Orleans area following Hurricane Katrina. Hierarchical regression was used to evaluate if gratitude, social support, and satisfaction with life moderated the relationship between stressful life events (as measured by the total life stress score) and PTG, after adjustment for age, sex, race, level of involvement in Hurricane Katrina, and alcohol intake. Results indicate that stressful life events are independently associated with PTG. Gratitude, satisfaction with life, and social support were seen to moderate this relationship; as stressful life events increased so too did PTG-particularly among officers with higher levels of gratitude (B = 0.002, p ≤ .05), satisfaction with life (B = 0.002, p ≤ .05), and social support (B = 0.001, p ≤ .05). These findings suggest that promoting satisfaction with life, interpersonal support, and gratitude may be beneficial to those who are regularly at risk of trauma exposure.

The effect of social support, gratitude, resilience and satisfaction with life on depressive symptoms among police officers following Hurricane Katrina

BACKGROUND

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

AIM

This cross-sectional study examined the effect of social support, gratitude, resilience and satisfaction with life on symptoms of depression.

METHOD

A total of 86 male and 30 female police officers from Louisiana participated in this study. Ordinary least-square (OLS) regression mediation analysis was used to estimate direct and indirect effects between social support, gratitude, resilience, satisfaction with life and symptoms of depression. All models were adjusted for age, alcohol intake, military experience and an increase in the number of sick days since Hurricane Katrina.

RESULTS

Mean depressive symptom scores were 9.6 ± 9.1 for females and 10.9 ± 9.6 for males. Mediation analyses indicates that social support and gratitude are directly associated with fewer symptoms of depression. Social support also mediated the relationships between gratitude and depression, gratitude and satisfaction with life, and satisfaction with life and depression. Similarly, resilience mediated the relationship between social support and fewer symptoms of depression.

CONCLUSION

Social support, gratitude and resilience are associated with higher satisfaction with life and fewer symptoms of depression. Targeting and building these factors may improve an officer's ability to address symptoms of depression.

Social avoidance in policing: Associations with cardiovascular disease and the role of social support

PURPOSE

The purpose of this paper is to examine the association of social avoidance among police, cardiovascular disease (CVD) (metabolic syndrome (MetSyn)), and social support.

DESIGN/METHODOLOGY/APPROACH

Participants were officers from the Buffalo Cardio-Metabolic Occupational Police Stress study (n = 289). Social avoidance (defined as the tendency to avoid social contact) and other subscales from the Cook-Medley Hostility Scale were analyzed. The mean number of MetSyn components across tertiles of the Cook-Medley scales was computed using analysis of variance and analysis of covariance. Social support was measured with the Social Provisions Scale, categorized as high or low based on the median.

FINDINGS

The mean number of MetSyn components increased significantly across tertiles of social avoidance (1.51 ± 0.18, 1.52 ± 0.12, and 1.81 ± 0.12); the only Cook-Medley subscale that remained significantly associated with MetSyn following adjustment for age and gender. Participants high in social avoidance reported significantly lower social support (79.9 ± 8.5 vs 85.8 ± 8.6; p = 0.001).

RESEARCH LIMITATIONS/IMPLICATIONS

The study is cross-sectional and therefore precludes causality. The authors were unable to determine the direction of associations between social avoidance and MetSyn. The measure of social support was unidimensional, including only perceived support; additional types of social support measures would be helpful.

PRACTICAL IMPLICATIONS

This study suggests that occupational-based police social isolation is associated with health outcomes and lower support. Several suggestions are made which will help to improve communication between the police and public. Examples are the use of social media, training in communication techniques, and changing the police role to one of public guardians.

ORIGINALITY/VALUE

Social avoidance is the least studied the Cook-Medley subscale associated with CVD. It is important for the health of officers to maintain a social connection with others.

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.

Police work stressors and cardiac vagal control

OBJECTIVES

This study examines relationships between the frequency and intensity of police work stressors and cardiac vagal control, estimated using the high frequency component of heart rate variability (HRV).

METHODS

This is a cross-sectional study of 360 officers from the Buffalo New York Police Department. Police stress was measured using the Spielberger police stress survey, which includes exposure indices created as the product of the self-evaluation of how stressful certain events were and the self-reported frequency with which they occurred. Vagal control was estimated using the high frequency component of resting HRV calculated in units of milliseconds squared and reported in natural log scale. Associations between police work stressors and vagal control were examined using linear regression for significance testing and analysis of covariance for descriptive purposes, stratified by gender, and adjusted for age and race/ethnicity.

RESULTS

There were no significant associations between police work stressor exposure indices and vagal control among men. Among women, the inverse associations between the lack of support stressor exposure and vagal control were statistically significant in adjusted models for indices of exposure over the past year (lowest stressor quartile: M = 5.57, 95% CI 5.07 to 6.08, and highest stressor quartile: M = 5.02, 95% CI 4.54 to 5.51, test of association from continuous linear regression of vagal control on lack of support stressor β = -0.273, P = .04).

CONCLUSIONS

This study supports an inverse association between lack of organizational support and vagal control among female but not male police officers.

Peer Support Services for Bereaved Survivors: A Systematic Review

This systematic literature review assesses the evidence regarding benefits of peer support services for bereaved survivors of sudden or unexpected death. Reports were included that addressed peer support services for adults who experienced death of a family member, close friend, or coworker. Of the 32 studies meeting all inclusion criteria, most showed evidence that peer support was helpful to bereaved survivors, reducing grief symptoms and increasing well-being and personal growth. Studies also showed benefits to providers of peer support, including increased personal growth and positive meaning in life. Several studies addressed the growing trend of Internet-based peer support programs, finding that these are beneficial in part due to their easy accessibility. Peer support appears to be especially valuable for survivors of suicide loss, a result that may be related to stigma and lack of support from family and friends experienced by many suicide survivors. The reviewed studies provide consistent evidence that peer support is beneficial to bereaved survivors.

Association of shiftwork and immune cells among police officers from the Buffalo Cardio-Metabolic Occupational Police Stress study

Shift workers suffer from a constellation of symptoms associated with disruption of circadian rhythms including sleep abnormalities, and abnormal hormone secretion (e.g. melatonin, cortisol). Recent, but limited, evidence suggests that shift workers have elevated levels of circulating white blood cells (WBCs) compared to their day working counterparts. Interestingly, recent reviews highlight the strong linkage between the immune system and circadian rhythms which includes, but is not limited to, circulating cell populations and functions. The elevated levels of these WBCs may be associated with the increased chronic disease risk observed among this group. The purpose of this analysis was to examine the cross-sectional association between long- and short-term (3, 5, 7, and 14 days) shiftwork (SW) and counts of WBCs among officers in the Buffalo Cardio-Metabolic Occupational Police Stress (BCOPS) cohort. Data collection for this analysis took place among 464 police officers working in Buffalo, New York, USA between 2004 and 2009. Precise SW histories were obtained using electronic payroll records. Officers were assigned a shift type based on the shift (i.e. day, evening, night) that they spent a majority (i.e. ≥50%) of their time from 1994 to the data collection date for long-term SW. The same process was applied to SW over 3, 5, 7, and 14 days prior to data collection. A fasted blood sample collected in the morning of a non-work day was used for characterization of WBCs (total), neutrophils, monocytes, lymphocytes, eosinophils, and basophils. Potential confounding factors included demographic characteristics (e.g. age, sex, race), occupational characteristics (e.g. rank), health behaviors (e.g. smoking, alcohol consumption, diet), anthropometrics, and other biomarkers (e.g. lipids, hemoglobin A1C, leptin). Generalized linear models were used to estimate least square means of the immune cells according to SW categorization for long- and short-term SW histories. Compared to the day shift group, those working long-term night shifts had greater absolute numbers of total WBCs, neutrophils, lymphocytes, and monocytes (all p < 0.05). Those working mainly on the night shift over 7-days had elevated counts of WBCs, lymphocytes, and monocytes (p < 0.05) compared to those mainly working day shifts. Results based on 3-, 5-, and 14-day SW were similar to the 7-day results. This study corroborates other studies with similar findings. However, this analysis provided insights into the effect of both long- and short-term SW on the number of circulating WBCs. SW may lead to disruption of circadian-influenced components of the immune system, which in term, may result in various chronic diseases. These findings, plus previous findings, may provide evidence that SW may lead to immune system dysregulation. Future research is needed to understand whether increases in immune cells among shift workers may be associated with the increased disease risk among this group.

Police work stressors and cardiac vagal control

OBJECTIVES

This study examines relationships between the frequency and intensity of police work stressors and cardiac vagal control, estimated using the high frequency component of heart rate variability (HRV).

METHODS

This is a cross-sectional study of 360 officers from the Buffalo New York Police Department. Police stress was measured using the Spielberger police stress survey, which includes exposure indices created as the product of the self-evaluation of how stressful certain events were and the self-reported frequency with which they occurred. Vagal control was estimated using the high frequency component of resting HRV calculated in units of milliseconds squared and reported in natural log scale. Associations between police work stressors and vagal control were examined using linear regression for significance testing and analysis of covariance for descriptive purposes, stratified by gender, and adjusted for age and race/ethnicity.

RESULTS

There were no significant associations between police work stressor exposure indices and vagal control among men. Among women, the inverse associations between the lack of support stressor exposure and vagal control were statistically significant in adjusted models for indices of exposure over the past year (lowest stressor quartile: M = 5.57, 95% CI 5.07 to 6.08, and highest stressor quartile: M = 5.02, 95% CI 4.54 to 5.51, test of association from continuous linear regression of vagal control on lack of support stressor β = -0.273, P = .04).

CONCLUSIONS

This study supports an inverse association between lack of organizational support and vagal control among female but not male police officers.

Fatigue and on-duty injury among police officers: The BCOPS study

INTRODUCTION

Policing involves inherent physical and psychological dangers as well as occupational stressors that could lead to chronic fatigue. Although accounts of adverse events associated with police fatigue are not scarce, literature on the association between chronic fatigue and on-duty injury are limited.

METHODS

Participants were officers from the Buffalo Cardio-Metabolic Occupational Police Stress (BCOPS) Study. A 10-item questionnaire was administered to assess how tired or energetic the officers generally felt irrespective of sleep hours or workload. The questionnaire consisted of five positively worded and five negatively phrased items that measured feelings of vigor/energy and tiredness, respectively. Total as well as separate scores for positive and negative items were computed by summing scores of individual items. Payroll records documenting each officer's work history were used to assess occurrence of injury. Poisson regression was used to estimate prevalence ratios (PR) of injury.

RESULTS

Nearly 40% of officers reported feeling drained. Overall prevalence of on-duty injury during the past year was 23.9%. Injury prevalence showed a significant increasing trend across tertiles of total fatigue score: 19.6, 21.7, and 30.8% for lowest, middle and highest tertiles, respectively (trend p-value=0.037). After controlling for potential confounders, a 5-unit increase in total fatigue score was associated with a 12% increase in prevalence of injury which was marginally significant (p=0.075). A 5-unit increase in fatigue score of the positively worded items was associated with a 33% increase in prevalence of injury (PR=1.33, 95% CI: 1.04-1.70, p=0.022).

CONCLUSION

Officers who do not feel active, full of vigor, alert, or lively had a significantly higher prevalence of non-fatal work place injury compared to their counter parts. Practical applications: With additional prospective evidence, workplace interventions designed to enhance level of energy may reduce feelings of tiredness and hence may prevent workplace injury.

The impact of perceived intensity and frequency of police work occupational stressors on the cortisol awakening response (CAR): Findings from the BCOPS study

Police officers encounter unpredictable, evolving, and escalating stressful demands in their work. Utilizing the Spielberger Police Stress Survey (60-item instrument for assessing specific conditions or events considered to be stressors in police work), the present study examined the association of the top five highly rated and bottom five least rated work stressors among police officers with their awakening cortisol pattern. Participants were police officers enrolled in the Buffalo Cardio-Metabolic Occupational Police Stress (BCOPS) study (n=338). For each group, the total stress index (product of rating and frequency of the stressor) was calculated. Participants collected saliva by means of Salivettes at four time points: on awakening, 15, 30 and 45min after waking to examine the cortisol awakening response (CAR). Saliva samples were analyzed for free cortisol concentrations. A slope reflecting the awakening pattern of cortisol over time was estimated by fitting a linear regression model relating cortisol in log-scale to time of collection. The slope served as the outcome variable. Analysis of covariance, regression, and repeated measures models were used to determine if there was an association of the stress index with the waking cortisol pattern. There was a significant negative linear association between total stress index of the five highest stressful events and slope of the awakening cortisol regression line (trend p-value=0.0024). As the stress index increased, the pattern of the awakening cortisol regression line tended to flatten. Officers with a zero stress index showed a steep and steady increase in cortisol from baseline (which is often observed) while officers with a moderate or high stress index showed a dampened or flatter response over time. Conversely, the total stress index of the five least rated events was not significantly associated with the awakening cortisol pattern. The study suggests that police events or conditions considered highly stressful by the officers may be associated with disturbances of the typical awakening cortisol pattern. The results are consistent with previous research where chronic exposure to stressors is associated with a diminished awakening cortisol response pattern.

Highly Rated and most Frequent Stressors among Police Officers: Gender Differences

This descriptive study examined the top five most frequent and highly rated occupational stressors from the Spielberger Police Stress Survey among 365 police officers enrolled in the Buffalo Cardio-Metabolic Occupational Police Stress (BCOPS) Study (2004-2009). Prevalence, frequency, and rating of stressors were compared across gender. Poisson regression was used to estimate the prevalence and prevalence ratio (PR) of events. Analysis of variance was used to compare mean frequency of occurrence and mean stress ratings by gender. Many reported stressors dealt with violent situations. Responding to family disputes (83 %) was reported as the most frequent stressor and exposure to battered children (27 %) was the most highly rated stressor (mean rating: 67.6 ± 35.3). Killing someone in the line of duty (mean rating: 66.3 ± 43.0) and experiencing a fellow officer being killed (mean rating: 65.3 ± 40.6) were highly rated but infrequent (0.27 % and 3.6 %, respectively). Male officers tended to report more frequent stressors which took away from their time off duty such as court appearances (PR = 1.26, 1.04-1.52) and working second jobs (PR = 2.37, 1.57-3.57). In contrast, female officers reported experiencing a 37 % higher prevalence of lack of support from supervisor (PR = 0.63, 0.48-0.82) relative to male officers. Results of the present study are discussed within the context of specific police stressors and gender.