A prospective study of predictors of depression symptoms in police

Operational Police Stress Is Associated With Disordered Eating in Police Officers

OBJECTIVE

Police officers are under high operational stress and are at high risk for stress-related mental health disturbances. However, little research has investigated disordered eating in this population. In this study, we compared disordered eating symptoms between male and female police officers, examined the association between operational police stress and disordered eating symptoms, and explored body mass index (BMI) and sex as potential moderators of these associations.

METHOD

The participants consisted of 476 police officers from North Carolina, United States. Operational police stress was assessed using the Operational Police Stress Questionnaire, and disordered eating symptoms were assessed using the Eating Pathology Symptoms Inventory. Weight and height were measured by trained staff.

RESULTS

Compared with female officers (n = 149), male officers (n = 325) scored significantly higher on binge eating, excessive exercise, muscle building, and negative attitudes toward obesity, and lower on body dissatisfaction, cognitive restraint, restricting, and purging. After adjusting for BMI and sex, significant positive associations were found between operational police stress and all disordered eating symptom subscales, except for excessive exercise. No association was significantly moderated by BMI or sex.

DISCUSSION

Disordered eating is an understudied yet critical concern among stressed police officers, affecting both males and females. Targeted prevention and intervention strategies, such as regular screening during physical exams, could enable early detection of disordered eating symptoms in this high-stress occupation group.

A scientometric review of the association between childhood trauma and sleep

Sleep is a complex state which involves interactions between neurophysiological, psychological and neurochemical processes which in turn have an important impact on brain functioning, immune responses, mental health, and quality of life. The incidence of Adverse Childhood Experiences (ACEs) varies across different countries and have been linked with lifespan sleep disturbances with further effects on people's physical and mental health functioning. This review aims to explore the significance of ACE and its impact on sleep by identifying key documents, thematic trends, and knowledge gaps in the literature. A document co-citation analysis of 882 documents from Scopus was conducted to achieve this goal. Research trends focused on the long-term consequences of childhood adverse events with respect to sleep, with emphasis on the role of type, timing and accumulation of these experiences. A recent study has also taken advantage of machine learning and network analysis for discovering essential factors could offer useful information about adults with history of childhood adversity and sleep problems. The studies show unanimously that ACEs are associated with multiple sleep disturbances/disorders which can persist into adulthood, with consequences for suboptimal cognitive and behavioral functioning. Such neurobiological scars can be associated with an increased risk of mental disorders. Future studies are needed that focus on longitudinal analysis of the relationship between early adversity, sleep, and resilience characteristics in adult populations exploring the use of objective assessment measures as well as neurobiological markers.

Mental COP: Mental Health Cohort Of Police officers in Korea

PURPOSE

This cohort study addresses the need for comprehensive and longitudinal research on police officers' mental health, focusing on the relationship between occupational factors, individual characteristics and mental health status or suicidality. The Mental COP (Mental health Cohort Of Police officers in Korea) research provides important insights by tracking new police officers over time, contributing to evidence-based interventions and policies to improve their overall mental health and working conditions.

PARTICIPANTS

Mental Cop is a prospective open cohort study designed for new police officers for police recruitment, expected to graduate after 8 months of education at the Central Police Academy. To date, 6752 individuals have completed the baseline survey and are enrolled in the cohort.

FINDING TO DATE

The study data in Mental COP covered a wide range of issues for first responders, including personal factors, various mental health problems, occupational factors and measured biomarkers of allostatic load, including Heart Rate Variability. The main findings indicate a lower prevalence of mental health problems among those selected as new police officers compared with the general population with notable gender differences. Therefore, closer monitoring of women is required. Furthermore, the study revealed cohort-based differences in mental health, highlighting increased risk related to occupational factors (field training) and the management of vulnerable groups.

FUTURE PLANS

Another wave of Mental COP is scheduled for December 2023, with plans for future cohort expansion. Additionally, it will establish a more comprehensive and systematic scientific framework for future investigations by integrating broader medical examinations and National Health Insurance Service Data.

Psychosocial Work Conditions as Determinants of Well-Being in Jamaican Police Officers: The Mediating Role of Perceived Job Stress and Job Satisfaction

Policing is considered a high-stress occupation due to the demanding nature of the job. Addressing police stress requires a detailed understanding of how psychosocial risk factors influence various aspects of their well-being. Moreover, an analysis of the direct effects of work conditions and the mediating effects of cognitive appraisals is also warranted. Using the Demands-Resources-Individual Effects (DRIVE) model of work-related stress this study investigated the direct effects of work conditions on well-being and also examined the intermediate role of perceived job stress and job satisfaction in the relationship between work conditions and well-being. Five hundred and seventy-eight police officers from the Jamaica Constabulary Force (J.C.F.) completed the questionnaire. Data were analyzed using hierarchical regressions and the Hayes Process tool for mediation analysis. Both perceived job stress and satisfaction mediated the relationship between work conditions and general physical health. Perceived job stress was an indirect pathway through which work conditions influenced psychological distress, whereas job satisfaction was not a significant mediator. In contrast, job satisfaction mediated the relationship between work conditions and positive well-being, but perceived job stress did not. These findings provide significant evidence for periodically monitoring and auditing perceptions of stress and job satisfaction, as they are likely precursors to subsequent health problems.

A mixed-method exploration of mental toughness, perceived stress and quality of life in mental health workers

WHAT IS KNOWN ON THE SUBJECT?: Staff working with other people's mental health are in more danger of experiencing high stress at work. These members of staff are more likely to have mental health problems themselves. Previous research has suggested that training these members of staff to deal with their daily stress and become mentally tougher can protect them. WHAT THIS PAPER ADDS TO EXISTING KNOWLEDGE?: The findings showed that higher levels of perceived stress and reduced quality of life in mental health workers were related to lower levels of mental toughness. This research provides a detailed understanding of the current issues experienced in a range of different mental health settings, which may contribute to stress and quality of life. The research highlights the importance of protecting staff mental wellbeing, controlling and reducing levels of stress and suggests that one route to doing this is improving mental toughness. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: These findings suggest a need to increase the awareness of and further protect the mental health of staff working in the mentioned settings. Staff working in mental health settings should be provided with information about how to enhance mental toughness and how to reduce stress. This will lead to a better quality of life for mental health staff and in turn improve the quality of care provided. ABSTRACT: Introduction Clinicians working in mental health services are at increased risk of stress at work. Previous work suggests that mental toughness is a protective mechanism for stress in other professions. This has not yet been examined in mental health workers. Aim/Question To examine whether mental toughness predicts perceived stress and quality of life in mental health workers, to develop an understanding of the factors contributing to and techniques used to deal with stress in this population. Method Sixty-two workers completed measures of mental toughness, perceived stress, quality of life and answered questions regarding their personal experience of stress at work. Results Mental toughness was a predictor of stress (F(7, 54) = 10.58, p < .001) and quality of life (F(6, 55) = 7.58, p < .001, F(7, 54) = 7.15, p < .001 and F(7, 54) = 6.81, p < .001, for compassion satisfaction, burnout and secondary traumatic stress, respectively), with particular roles for the interpersonal confidence and control of life components. Qualitative analysis revealed sources of stress for health workers and a variety of stress management techniques to cope with workplace stress. The findings suggested that mental toughness develops in some but not all health workers due to the demands of their role. Discussion The findings provide an insight into stress, quality of life and protective factors for stress in mental health workers and suggest that future research should consider mental toughness training in mental health workers. Implications for Practice There is a need to increase the awareness of factors contributing to stress in mental health workers, such as a lack of resources and staff, and to promote organizational change to improve their professional quality of life. Future research should also explore the potential of mental toughness training in this population.

How sleep disturbance is associated with Chinese police officers' job satisfaction: A moderated mediation model

Tasked with a wide variety of duties, police officers often encounter stressful situations and suffer from sleep disturbance. Previous studies have found that police officers with sleep disturbance generally reported lower levels of job satisfaction; however, the psychological mechanisms by which sleep disturbance is associated with job satisfaction are still relatively underexplored. This study investigated how sleep disturbance was associated with job satisfaction via the mediation of job involvement and via the moderation of resilience among police officers. Data from a sample of 827 Chinese police officers (86.9% men) was analysed. Participants completed a written questionnaire assessing sleep disturbance, job satisfaction, job involvement, resilience, and demographic information. A moderated mediation model was conducted to examine the research questions. Sleep disturbance was negatively associated with job involvement, which, in turn, was positively associated with job satisfaction. Furthermore, both direct and indirect effects of sleep disturbance on job satisfaction were moderated by resilience. Specifically, the negative association between sleep disturbance and job satisfaction was significant only for those with low levels of resilience, but not for those with high levels of resilience. In addition, the positive association between job involvement and job satisfaction was stronger for those with higher resilience compared with those with lower resilience. The findings advance understanding of the psychological mechanisms underlying the association between sleep disturbance and job satisfaction among police officers.

Sleep and mental health in recruit paramedics: a 6-month longitudinal study

STUDY OBJECTIVES

To explore potential relationships and longitudinal changes in sleep and mental health in recruit paramedics over the first 6 months of work, and whether sleep disturbances pre-emergency work predict future mental health outcomes.

METHODS

Participants (N = 101, 52% female, Mage = 26 years) completed questionnaires prior to (baseline), and after 6 months of emergency work to assess for symptoms of insomnia, obstructive sleep apnea, post-traumatic stress disorder (PTSD), depression, anxiety, and trauma exposure. At each timepoint, participants also completed a sleep diary and wore an actigraph for 14 days to assess sleep patterns. Correlations between baseline sleep and mental health were conducted and changes in these variables across timepoints were examined using linear mixed models. Hierarchical regressions assessed whether sleep at baseline predicted mental health at follow-up.

RESULTS

Insomnia and depression symptoms, and total sleep time increased while sleep onset latency decreased across the first 6 months of emergency work. Participants experienced an average of 1 potentially traumatic event during the 6-month period. Baseline insomnia predicted increased depression symptoms at the 6-month follow-up, while baseline wake after sleep onset predicted follow-up PTSD symptoms.

CONCLUSION

Results highlight an increase in insomnia and depression across the initial months of emergency work, while sleep disturbances before emergency work were identified as potential risk factors for the development of depression and PTSD among paramedics in their early career. Screening and early interventions targeting poor sleep at the beginning of emergency employment may assist in reducing the risk of future mental health outcomes in this high-risk occupation.

Associations of experiential avoidance with burnout, wellbeing, and productivity loss among police officers: The mediating role of negative and positive affect

OBJECTIVES

The current study aims to investigate the indirect associations between experiential avoidance (EA) and burnout, wellbeing, and productivity loss (PL) via the mediating role of positive and negative emotions among police officers.

METHODS

Data were collected on 187 officers (84% male) aged 21-64 years between 2019 and 2020. Participants completed online self-report measures.

RESULTS

EA was indirectly associated with burnout via positive and negative affect. EA was indirectly associated with wellbeing through positive affect, positive affect and burnout, and negative affect and burnout. Finally, EA was indirectly associated with PL via positive affect and burnout, and negative affect and burnout.

CONCLUSION

Results provide support for the role of EA in officers' wellbeing and job performance via increasing negative affect and decreasing positive affect. This highlights the importance of interventions, such as acceptance and commitment therapy that target acceptance and psychological flexibility.

Mental health symptoms in Public Safety Personnel: Examining the effects of adverse childhood experiences and moral injury

BACKGROUND

Adverse Childhood Experiences (ACEs) increase risk for negative mental health outcomes in adulthood; however, the mechanisms through which ACEs exert their influence on adult mental health are poorly understood. This is particularly true for Public Safety Personnel (PSP; e.g., police, firefighters, paramedics, etc.), a group with unique vulnerability to negative psychiatric sequalae given their chronic exposure to potentially traumatic, work-related events.

OBJECTIVES

To examine the role of moral injury (MI) and emotion regulation in the relation between ACEs and adult mental health symptoms in adulthood.

PARTICIPANTS AND SETTING

Participants (N = 294) included a community sample of Canadian and American PSP members aged 22 to 65.

METHODS

The current study uses cross-sectional data collection via retrospective self-report questionnaires administered between November, 2018 and November, 2019 to assess level of ACEs (ACE-Q), emotion regulation difficulties (DERS) and symptoms of post-traumatic stress (PCL-5), dissociation (MDI), depression, stress, and anxiety (DASS-21). Additionally, participants completed the Moral Injury Assessment for Public Safety Personnel, the first measure of MI developed specifically for PSP.

RESULTS

Path analysis revealed that ACEs significantly predicted adverse mental health symptoms in adulthood; this effect was mediated by symptoms of MI and moderated by difficulties with emotion regulation.

CONCLUSIONS

This study is the first to identify MI as a mechanism involved in the relation between ACEs and adult psychopathology and highlights the protective role of emotion regulation skills. These findings can inform the development of future research and clinical interventions in PSP populations.

Development and validation of police mental health ability scale

OBJECTIVES

Police officers are generally under long-term occupational stress. Good mental health ability enables them to better deal with emergencies and enhance their combat effectiveness. We aimed to develop the Police Mental Health Ability Scale (PMHAS) to provide a reference for police selection and ability training.

METHODS

Through literature analysis, individual interviews, half-open and half-closed questionnaire surveys, and expert consultations, the components of police mental health ability (PMHA) were theoretically constructed. Then, we enrolled 824 in-service police officers who participated in the training in Chongqing City and Sichuan Province from November 2018 to January 2019 and recovered 767 valid questionnaires (recovery rate, 93.08%).

RESULTS

Exploratory factor analysis generated five factors for PMHAS, including cognitive intelligence, emotional catharsis, swift decisiveness, behavioral drive, and reward pursuit, accounting for 58.904% of the variance. Confirmatory factor analysis demonstrated that the model fit well (χ2/df = 1.117, RMSEA = 0.020, GFI = 0.948, CFI = 0.990, IFI = 0.990, TLI = 0.987). The correlation coefficients of factors (r = -0.023 ~ 0.580) were lower than that of each factor and total score (r = 0.477 ~ 0.819). The Cronbach's α coefficients of PMHAS and its factors were 0.606-0.863, and the test-retest reliabilities were 0.602-0.732.

CONCLUSION

These results suggest that PMHAS is reliable and valid enough for measuring PMHA, which shows that it is a potentially valuable tool for assessing the mental health ability of police officers.

Depression symptoms and risk of sick leave: a systematic review and meta-analysis

OBJECTIVES

Depression symptoms are one of the most common psychiatric disorders and affect all aspects of life. The impact of depression symptoms on sick leave in the working population is a major issue that requires a more comprehensive examination.

METHODS

This systematic review used the PRISMA method to identify eligible studies (n = 15). Subsequently, the association between depression symptoms and sick leave was examined and several important subgroup analyses were performed.

RESULTS

Depression symptoms were associated with sick leave, with an overall risk ratio (RR) of 1.52 [95% confidence interval (95% CI) 1.34-1.73]. In men, the result displayed RR 2.19 (95% CI 1.17-4.09) and in women, the result showed RR 1.54 (95% CI 1.35-1.76). Additional subgroup analyses that account for methodological differences across studies based on the method of assessing depression symptoms and sick leave showed that this association was consistent.

CONCLUSION

Depression symptoms are associated with sick leave. Given that sick leave can have an economic and social burden, more attention to depression symptoms is necessary.

The impact of a mindfulness-based intervention on the quality of life of Spanish national police officers

PURPOSE

Police officers belong to a profession with a high risk of stress, burnout and compassion fatigue. Incorporating mindfulness practices into the health and occupational-risk prevention programs run by the national police forces in Spain could provide a new approach to reducing stress and enhancing the psychological and emotional balance of these officers.

METHODS

A 7-week mindfulness-based intervention (MBI) was conducted in a group of 20 national police officers in Mallorca (Spain). Mindfulness, self-compassion, burnout, compassion fatigue, compassion satisfaction and perceived stress were measured and compared before and after the intervention.

RESULTS

We identified significant differences in mindfulness (F(5, 14) = 7.441, p = 0.001, η²  = 0.727), compassion satisfaction (F(1, 19) = 5.929, p = 0.025, η²  = 0.238) and perceived stress levels (t(18) = 2.863, p = 0.010, d = 0.611) after the intervention; non-significant improvements were observed for the remaining variables assessed.

CONCLUSIONS

MBIs could be an effective way of reducing stress levels among police officers in Spain.

Adapting meaning-centered psychotherapy for World Trade Center responders

OBJECTIVE

To date, nearly 10,000 World Trade Center (WTC) responders have been diagnosed with at least one type of WTC-related cancer, and over 70 types of cancer have been related to WTC occupational exposure. Due to the observed latency period for malignancies, the WTC Health Program anticipates increases in rates of new cancer diagnoses. Given the growing number of cancer diagnoses in this population, there is an urgent need to develop a novel intervention to address the psychosocial needs of WTC responders with cancer. Meaning-centered psychotherapy (MCP) is a structured psychotherapeutic intervention originally developed to help patients with advanced cancer find and sustain meaning in life despite illness-related limitations. Existential distress and loss of meaning are critical and understudied elements of psychological health that have been widely overlooked among WTC responders with cancer.

METHOD

We have adapted MCP for WTC responders (MCP-WTC) for the treatment of WTC responders who have been diagnosed with WTC-certified cancers. MCP-WTC aims to target the complex crisis in meaning faced by those responders who responded to the 9/11 attacks and subsequently were diagnosed with cancer as a result of their service.

RESULTS

We describe the adaptation of MCP-WTC and the application of this intervention to meet the unique needs of those exposed to the terrorist attacks of September 11, 2001 (9/11), participated in the rescue, recovery, and clean-up effort at Ground Zero, and were diagnosed with WTC-related cancer. We highlight the novel aspects of this intervention which have been designed to facilitate meaning-making in the context of the patient's response to 9/11 and subsequent diagnosis of cancer.

SIGNIFICANCE OF RESULTS

This work provides a rationale for MCP-WTC and the potential for this intervention to improve the quality of life of WTC responders and help these patients navigate life after 9/11 and cancer.

Suicidal Ideation and Mental Health: The Moderating Effect of Coping Strategies in the Police Force

The suicide rate in the police force (Fuerzas y Cuerpos de Seguridad-FFCCSS) is estimated to be greater than that of the general population. The objectives of this paper are to detect mental health problems, in particular depression and anxiety, and to analyze the moderating effect of coping strategies on the relation between mental health and suicide ideation in police officers. The Suicidal Behavior Questionnaire (SBQ-R), Beck’s Depression Inventory (BDI), the Anxiety Inventory (STAI), and the Brief Cope have all been used in the study. The sample consists of 98 Spanish police officers, of whom 91.8% were male. The results indicate that depression and anxiety can predict suicidal ideation. Nevertheless, it must be said that coping strategies do not have a moderating effect in the relation between mental health and suicidal ideation in this professional group.

Depression, suicidality and associated risk factors among police officers in urban Tanzania: a cross-sectional study

BACKGROUND

The WHO has classified depression as a disease of public concern. Police officers are a particular subpopulation group that is at an increased risk for mental health problems. This study examined the prevalence of depression, suicidality and associated risk factors among police officers in urban Tanzania.

AIMS

The aim of this study was to examine the prevalence of depression, suicidality and associated risk factors among police officers in Tanzania.

METHODS

A cross-sectional study was conducted between April 2019 and October 2020 among 550 participants in Dar es Salaam recruited using a multistage cluster sampling technique. The Patient Health Questionnaire-9 was used to screen for depression and suicidality. The Interpersonal Support Evaluation List-12 tool was used to measure perceived social support. Descriptive statistics were summarised using frequencies and percentages. Bivariate and multivariate analyses were used to establish associations between predictors of interest, depression and suicidality.

RESULTS

There were 497 participants in the study. Of these, 76.6% (376 of 491) were men, and the median (IQR) age was 37.0 (17) years. Around 19.8% (96 of 486) of the police officers screened positive for depression and 15.4% (75 of 413) for suicidality. A significant proportion was either moderately (29 of 96, 30.2%) or severely depressed (8 of 75, 10.7 %). Of those who experienced suicidal thoughts, 10.7% (8 of 75) reported having daily suicidal thoughts. Perceiving low social support was associated with an increased risk of reporting depression (adjusted OR (aOR): 28.04, 95% CI: 8.42 to 93.37, p<0.001) and suicidality (aOR: 10.85, 95% CI: 3.56 to 33.08, p<0.001) as compared with those with high perceived social support.

CONCLUSION

The magnitude of depression and suicidality among police officers in urban Tanzania is alarmingly high. The study findings indicate the need for routine screening for depression and suicidality among police officers and design appropriate mental health responsive services in this population.

Interpersonal Trauma in the Lives of Nurses and Perceptions of Nursing Work

The purpose of this study was to explore associations between trauma experiences among nurses and nursing perceptions of risk for involuntary job loss and standing in society. This observational study used 2001 data from the Nurses' Health Study II (N = 53,323 female nurses). The outcome variables were nurses' perceptions of their risk for involuntary job loss and their social standing in the United States and within their own community. The exposure variables were childhood and adulthood interpersonal trauma. Nurses reported high levels of emotional (60% childhood; 44% adulthood), physical (45% childhood, 23% adulthood), and sexual trauma (15% childhood, 11% adulthood). Emotional trauma was associated with perception of higher risk for involuntary job loss, but also higher perception of nurse societal standing. Nurses experience high rates of interpersonal trauma, which may influence how they perceive their profession.

Work Characteristics and Psychosomatic Health Complaints of Private Security Personnel

Abstract. The present study reports a broad perspective on work characteristics related to private security work and identified predictors of health impairments in a German-speaking sample ( N = 683). Occupational conditions, exposure to violence/aggression, and psychosocial work characteristics each significantly explained incremental variance in psychosomatic complaints. Detailed findings revealed that average weekly working hours (and unusual working hours) substantially exceeded those of other service sector occupations (or the general population) in Germany. Exposure to violence/aggression was also substantial in regard to the European average. Participants reported low social status, promotion opportunities, and pay while their work offered substantial learning demands. Possibilities to acquire relevant skills, supervisor feedback, job control, or participation opportunities seem to provide little support at work. Excessive working hours, worries about violence, social status, and lone work emerged among the strongest predictors of psychosomatic complaints. Additionally, unusual working hours and job stressors (physical workload, quality impairments) increased the prevalence of psychosomatic complaints.

To Be or Not to Be Flexible: Selective impairments as a means to differentiate between depression and PTSD symptoms

During the course of their lives, most individuals experience at least one potentially traumatic event. For some individuals this experience may result in them developing depression and/or post-traumatic stress disorder (PTSD) symptoms. The aim of the present study was to test the interactive effect of traumatic exposure and impaired cognitive flexibility on the tendency to develop either depression or PTSD symptoms. Eighty-two college students (M age = 25.32, SD age = 4.09) were assessed for exposure to traumatic events, depressive and PTSD symptoms. In addition, they completed a performance-based learning paradigm to evaluate the unique patterns of cognitive flexibility, defined as reduced and enhanced updating of prior knowledge in the face of new information. We predicted and found that for individuals with reduced updating, greater exposure to trauma was associated with elevated depressive symptoms. Contrary to our prediction, for individuals with enhanced updating, greater exposure was associated with elevated PTSD symptoms. While cognitive flexibility is traditionally associated with adaptive outcomes, our results illuminate the important role of a delicate updating balance to adaptively cope with aversive life events. The findings highlight the possible different roles of cognitive flexibility in the development of psychopathology and may serve as a first step toward developing tailored prevention and treatment methods.

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.

Mindfulness Training Improves Quality of Life and Reduces Depression and Anxiety Symptoms Among Police Officers: Results From the POLICE Study-A Multicenter Randomized Controlled Trial

Background: Police officers' high-stress levels and its deleterious consequences are raising awareness to an epidemic of mental health problems and quality of life (QoL) impairment. There is a growing evidence that mindfulness-based interventions are efficacious to promote mental health and well-being among high-stress occupations. Methods: The POLICE study is a multicenter randomized controlled trial (RCT) with three assessment points (baseline, post-intervention, and 6-month follow-up) where police officers were randomized to mindfulness-based health promotion (MBHP) (n = 88) or a waiting list (n = 82). This article focuses on QoL, depression and anxiety symptoms, and religiosity outcomes. Mechanisms of change and MBHP feasibility were evaluated. Results: Significant group × time interaction was found for QoL, depression and anxiety symptoms, and non-organizational religiosity. Between-group analysis showed that MBHP group exhibited greater improvements in QoL, and depression and anxiety symptoms at both post-intervention (QoL d = 0.69 to 1.01; depression d = 0.97; anxiety d = 0.73) and 6-month follow-up (QoL d = 0.41 to 0.74; depression d = 0.60; anxiety d = 0.51), in addition to increasing non-organizational religiosity at post-intervention (d = 0.31). Changes on self-compassion mediated the relationship between group and pre-to-post changes for all QoL domains and facets. Group effect on QoL overall health facet at post-intervention was moderated by mindfulness trait and spirituality changes. Conclusion: MBHP is feasible and efficacious to improve QoL, and depression and anxiety symptoms among Brazilian officers. Results were maintained after 6 months. MBHP increased non-organizational religiosity, although the effect was not sustained 6 months later. To our knowledge, this is the first mindfulness-based intervention RCT to empirically demonstrate these effects among police officers. Self-compassion, mindfulness trait, and spirituality mechanisms of change are examined. Clinical Trial Registration: www.ClinicalTrials.gov. identifier: NCT03114605.

Prospective risk and protective factors for psychopathology and wellbeing in civilian emergency services personnel: a systematic review

Emergency services personnel have an elevated risk of developing mental health conditions. Most research in this area is cross-sectional, which precludes inferences about temporal and potentially causal relationships between risk and protective factors and mental health outcomes. The current study systematically reviewed prospective studies of risk and protective factors for mental health outcomes in civilian emergency services personnel (firefighters, paramedics, police) assessed at pre-operational and operational stages. Out of 66 eligible prospective studies identified, several core groups of risk and protective factors emerged: (1) cognitive abilities; (2) coping tendencies; (3) personality factors; (4) peritraumatic reactions and post-trauma symptoms; (5) workplace factors; (6) interpersonal factors; (7) events away from work. Although there was insufficient evidence for many associations, social support was consistently found to protect against the development of mental health conditions, and peritraumatic dissociation, prior mental health issues, and prior trauma exposure were risk factors for future mental health conditions. Among operational studies, neuroticism was significantly associated with future PTSD symptoms, burnout, and general poor mental health, and avoidance and intrusion symptoms of PTSD were associated with future PTSD and depression symptoms. The current review results provide important targets for future research and interventions designed to improve the mental health of emergency services personnel.

Trauma and Coping Strategies in Police Officers: A Quantitative-Qualitative Pilot Study

Background. Because of their work, emergency workers, such as police officers (POs), are exposed to traumatic events on a daily basis. These experiences can have consequences in terms of physical and emotional stress. Primary attachment relationships affect the development of coping strategies for dealing with stressful events (primarily hyperactivating strategies in entangled adults and hypo-activating strategies in dismissing adults). In this study, we explored how POs describe the experience of traumatic accidents, the effects they reported and their coping strategies related to their attachment style. Methods. We used a quantitative-qualitative method. Thirty-nine POs were administered the Beck Depression Inventory, the Maslach Burnout Inventory and a semi-structured interview about traumatic events and reactions. Interviews were analyzed using Interpretative Phenomenological Analysis. Results. Traumatic events at work predominantly concerned aggressions, witnessing deaths, forced hospitalizations, and domestic violence involving children. POs with a responsible role were more likely than POs to use security-based strategies. Most POs narrated overactivation and deactivation strategies, which were associated with depressive symptoms, emotional exhaustion, and depersonalization. Conclusions. These results can be useful to improve trauma-informed interventions for POs based on their different attachment styles and coping strategies.

Burnout in Spanish Security Forces during the COVID-19 Pandemic

Since the beginning of the COVID-19 pandemic in Spain, members of the State Security Forces and the Armed Forces have been mobilized to guarantee the security and mobility of the population and to support health institutions by providing personnel for care, creating field hospitals, transferring the sick and the dead, etc. The objective of this study was to determine the levels of burnout in these professionals using the Maslach Burnout Inventory (MBI) scale, both in its different subscales and its total value. The study was developed using a quantitative methodology through a simple random sample (n = 2182). An ad hoc questionnaire was administered including variables related to: (a) socio-demographic issues, (b) subjective perceptions about their working conditions and the need for psychological and psychiatric treatment, and (c) the Death Anxiety Scale developed by Collett-Lester, and the MBI. The results show high levels of burnout (28.5%) in all its subscales: emotional exhaustion (53.8%), depersonalization (58.0%), and lack of personal development (46.3%). The logistic regression verifies a series of predictive variables that coincide in each of the subscales. These data indicate the need to implement prevention and treatment measures for workers so that their, stress, and anxiety to which they are subjected during their professional activity does not become a norm that can have negative repercussions for them, especially given the risk of new pandemic waves.

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

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

Computational causal discovery for post-traumatic stress in police officers

This article reports on a study aimed to elucidate the complex etiology of post-traumatic stress (PTS) in a longitudinal cohort of police officers, by applying rigorous computational causal discovery (CCD) methods with observational data. An existing observational data set was used, which comprised a sample of 207 police officers who were recruited upon entry to police academy training. Participants were evaluated on a comprehensive set of clinical, self-report, genetic, neuroendocrine and physiological measures at baseline during academy training and then were re-evaluated at 12 months after training was completed. A data-processing pipeline-the Protocol for Computational Causal Discovery in Psychiatry (PCCDP)-was applied to this data set to determine a causal model for PTS severity. A causal model of 146 variables and 345 bivariate relations was discovered. This model revealed 5 direct causes and 83 causal pathways (of four steps or less) to PTS at 12 months of police service. Direct causes included single-nucleotide polymorphisms (SNPs) for the Histidine Decarboxylase (HDC) and Mineralocorticoid Receptor (MR) genes, acoustic startle in the context of low perceived threat during training, peritraumatic distress to incident exposure during first year of service, and general symptom severity during training at 1 year of service. The application of CCD methods can determine variables and pathways related to the complex etiology of PTS in a cohort of police officers. This knowledge may inform new approaches to treatment and prevention of critical incident related PTS.

Men's Work-Related Stress and Mental Health: Illustrating the Workings of Masculine Role Norms

Although a strong relationship between employment and men’s mental health has been identified, theoretical linkages between masculinity, employment, and mental health are not well developed and mental health supports that account for gender and employment are correspondingly inadequate. The purpose of this study is to contribute to theoretical understandings of men’s employment-related mental health experience and raise possibilities for gender-responsive employer supports for men’s mental health. Specifically, this study is a secondary analysis of narrative accounts from 18 men employed in male-dominated occupations about their employment-related mental health. Results of this study present evidence of processes by which theoretical concepts of masculine role norms influence work-related stress and mental health including: (a) injunctive norms, which operate through an internal sense of the cultural “shoulds” and “should nots”; (b) descriptive norms, which are communicated through the behaviors that a man sees other men enacting in his immediate environment; and (c) cohesive norms, which exert influence through observations of how men who are leaders, behave. Men’s insights into the complexity of employment-related stress and mental health according to masculine role norms related to work demands and leadership modeling and messaging are discussed. This study concludes with potential ways forward for employer support for men’s mental health.

Salivary cortisol concentrations in police officers - a cross-sectional study in Beijing, China

Objective: We investigated the relationship between salivary cortisol level and the prevalence of depression 585 police officers working at the Police Departments of Beijing.

Method: Cross-sectional data were obtained from 585 Chinese police officers recruited from Beijing, China. Salivary cortisol was assayed using the chemiluminescence immunoassay. A multiple logistic regression analysis adjusted for potential confounders was used to assess independent associations between salivary cortisol level and depression.

Results: The median age of the included was 38 years (IQR, 29–45), 20.9% were female (n = 122). Finally, 15.6% (91/585; 95% CI: 12.6–18.5%) were considered to have depression. The median salivary cortisol level was significantly higher in police with depression than those police without depression [14.5(IQR, 11.9–15.9) nmol/l vs. 11.8(IQR, 9.4–14.2) nmol/l; P < 0.001]. The depression distribution across the salivary cortisol quartiles ranged between 5.4% (first quartile) and 26.9% (fourth quartile), P for trend <0.001. In multivariate models comparing the second (Q2), third and fourth quartiles against the first quartile of the salivary cortisol, cortisol in Q3 and Q4 were associated with depression, and increased prevalence of depression by 148% (OR: 2.48; 95% CI: 1.55–3.86) and 277% (3.77; 2.12–5.36). Based on ROC curves, the optimal cutoff value of salivary cortisol level to diagnose the depression was 13.8 nmol/l, which yielded the highest sensitivity and specificity [63.8% and 71.7%, respectively; area under the curve (AUC) = 0.695, 95% CI: 0.639–0.751; P < 0.0001].

Conclusions: The data showed that elevated levels of salivary cortisol were associated with increased prevalence of depression.

Early Life Stress and Pediatric Posttraumatic Stress Disorder

Traumatic stress exposure during critical periods of development may have essential and long-lasting effects on the physical and mental health of individuals. Two thirds of youth are exposed to potentially traumatic experiences by the age of 17, and approximately 5% of adolescents meet lifetime criteria for posttraumatic stress disorder (PTSD). The role of the stress system is the maintenance of homeostasis in the presence of real/perceived and acute/chronic stressors. Early-life stress (ELS) has an impact on neuronal brain networks involved in stress reactions, and could exert a programming effect on glucocorticoid signaling. Studies on pediatric PTSD reveal diverse neuroendocrine responses to adverse events and related long-term neuroendocrine and epigenetic alterations. Neuroendocrine, neuroimaging, and genetic studies in children with PTSD and ELS experiences are crucial in understanding risk and resilience factors, and also the natural history of PTSD.

Mindfulness-based resilience training for aggression, stress and health in law enforcement officers: study protocol for a multisite, randomized, single-blind clinical feasibility trial

BACKGROUND

Law enforcement officers (LEOs) are exposed to significant stressors, elevating their risk for aggression and excessive use of force, as well as mental health consequences, including post-traumatic stress disorder, burnout, alcohol misuse, depression, and suicide. Mindfulness training is a promising approach with high-stress populations that has been shown effective for increasing resilience and improving negative mental health outcomes common among LEOs.

METHOD

Implemented at two sites, the proposed study is designed to establish optimal protocols and procedures for a future full-scale, multisite trial assessing effects of mindfulness-based resilience training versus an attention control (stress management education) and a no-intervention control on physiological, behavioral, and psychological outcomes. To prepare for this future clinical trial, the current study is designed to: enhance efficiency of recruitment, engagement, and retention; optimize laboratory, assessment, and data management procedures; optimize intervention training and ensure fidelity to intervention protocols; and assess participant experience and optimize outcome measures across two sites. Herein, we describe the protocol and methodology of this multisite, randomized, single-blind clinical feasibility trial.

DISCUSSION

The long-term objective of this line of research is to develop an intervention that will reduce violence and increase resilience and mental health among LEOs, as well as yield significant benefits for the communities and residents they serve.

TRIAL REGISTRATION

ClinicalTrials.gov, NCT03784846. Registered on 24 December 2018.

Police Stress, Mental Health, and Resiliency during the COVID-19 Pandemic

The COVID-19 pandemic created social upheaval and altered norms for all members of society, but its effects on first responders have been particularly profound. Law enforcement officers have been expected to coordinate local shutdowns, encourage social distancing, and enforce stay-at-home mandates all while completing the responsibilities for which they are already understaffed and underfunded. The impact of the COVID-19 pandemic on officer stress, mental health, resiliency, and misconduct is explored drawing insight from reactions to the HIV epidemic over two decades earlier and the terrorist attacks of September 11, 2001. COVID-19 policing is hypothesized to serve as a significant stressor for officers and compound the general and organizational stress associated with the occupation. Avenues for providing officer support are discussed and recommendations for research into the phenomenon presented.

Childhood maltreatment compromises resilience against occupational trauma exposure: A retrospective study among emergency medical service personnel

BACKGROUND

Childhood maltreatment (CM) compromises resilience against stress and trauma throughout life. Therefore, it could present a major risk factor for the health of frequently trauma-exposed professionals such as emergency medical service (EMS) personnel.

OBJECTIVE

We investigated, whether EMS personnel's history of CM increased their risk for mental and physical stress symptoms after occupational trauma exposure.

PARTICIPANTS AND SETTING

Data from 103 German EMS personnel (age: Mdn±QD = 26.00 ± 8.50 years) were collected as part of a cross-sectional survey distributed among employees of the regional German Red Cross EMS division (response rate 46.6%). The sample corresponded well to the division's entire staff in terms of socio-anagraphic characteristics.

METHODS

CM and occupational trauma exposure as well as posttraumatic, depressive, and somatic symptoms were assessed with self-report questionnaires.

RESULTS

Moderation analyses indicated stronger positive associations between occupational trauma exposure and the severity of posttraumatic (β = .30, p < .001), depressive (β = .20, p = .026), and somatic symptoms (β = .18, p = .059) among EMS personnel who reported a higher exposure to CM.

CONCLUSIONS

Our study provides initial evidence that CM could increase the EMS personnel's vulnerability to the detrimental consequences of critical incidents on duty. Future research is needed (i) to replicate and generalize our observation on various trauma-exposed professions as well as (ii) to develop preventive measures for targeting the mediating and protective factors which influence the relationship between CM and the negative consequences of occupational trauma exposure.

Emergency personnel neuroticism, health and lifestyle: A UK Biobank study

Background

Emergency personnel face unpredictable and challenging incidents and their resilience and ability to cope influences their well-being. Personality traits, such as neuroticism, are postulated to be robust predictors of health and health behaviours. Despite evidence in the general population that neuroticism can positively impact health and health behaviours; to date neuroticism in emergency personnel has primarily been associated with adverse health outcomes.

Aims

To assess whether neuroticism has a negative or positive impact on subjective and objective health and health behaviours in emergency personnel.

Methods

This study used cross-sectional UK Biobank baseline data of emergency personnel (police, firemen and paramedics). Logistic regression models examined the strength of the associations of neuroticism tertiles with subjective (self-reported overall health and chronic conditions) and objective health (abdominal obesity) and self-reported smoking, sleeping, alcohol use and exercise levels.

Results

High neuroticism was positively associated with poorer subjective health outcomes in all emergency personnel (n = 2483). The association between neuroticism and chronic disease/s was significant for police in the second (odds ratio [OR] = 1.93, 95% confidence interval [CI] = 1.15–1.94) and third (OR = 1.62, 95% CI = 1.21–2.16) neuroticism tertiles. Neuroticism in firemen was associated with reduced abdominal obesity (OR = 0.49, 95% CI = 0.25–0.96) and increased exercise (OR = 2.14, 95% CI = 1.07–4.25).

Conclusions

We observed positive and negative associations between neuroticism and health outcomes and behaviours. While differences were observed across the emergency personnel groups, more research is needed to better understand how personality traits may impact health in workers with physically and mentally intense jobs.

Demographic and cognitive risk factors for police mental disorder symptoms

The current study was designed to assess whether cognitive risk factors (i.e. anxiety sensitivity (AS), intolerance of uncertainty (IU)) explained variance in mental disorder symptoms in Canadian police officers beyond variance explained by demographic variables (i.e. sex, marital status, education, years of service). Police participants (708 men; 271 women) completed measures assessing posttraumatic stress disorder, panic disorder, social anxiety disorder, major depressive disorder, generalized anxiety disorder, IU and AS. Multivariate analysis of variance demonstrated that only main effects of sex were significant for all symptom variables, except SAD. Hierarchical multiple regressions demonstrated that AS and IU accounted for greater variance than sex on all mental disorder symptom measures, which suggests that cognitive risk factors explain more variance in mental disorder symptoms than sex. Efforts to reduce AS and IU may be beneficial for improving police mental health.

Reliability and Validity of the Vicarious Trauma Organizational Readiness Guide (VT-ORG)

The Vicarious Trauma Organizational Readiness Guide (VT-ORG) is an assessment of an organization's readiness to address vicarious trauma (VT), which is exposure to the traumatic experiences of people served. This study reports on the psychometric properties of the VT-ORG. Employees of first responder agencies (e.g., law enforcement, fire, emergency services) and victim assistance agencies are at a high risk for vicarious traumatization, which can lead to PTSD, substance use, and suicidal ideation, among other negative impacts. Organizations that do not address VT may see such effects as employee turnover, reduced efficiency, and negative work environments. The VT-ORG is an assessment tool designed to help organizations complete the first step of organizational change-conducting a needs assessment. Study participants were 3,018 employees across 13 first responder and victim assistance agencies who completed the 67-item VT-ORG and additional measures for evaluation of its validity and reliability. The VT-ORG was found to have excellent internal consistency (Cronbach's α = .98). A structural equation model demonstrated that the subscales of the VT-ORG predicted criterion measures of turnover intention, compassion satisfaction, and organizational resilience, with an overall model fit of CFI = .99, RMSEA = .053. This study found the VT-ORG to be a reliable and valid assessment of organizational responses to vicarious trauma.

A systematic review of the current evidence regarding interventions for anxiety, PTSD, sleepiness and fatigue in the law enforcement workplace

Law enforcement is inherently stressful, and police officers are particularly vulnerable to mental and physical disorders. As such, researchers are currently assessing intervention strategies that may combat or manage these psychological, physical and mental issues. To review most recent information regarding anxiety, PTSD, and sleepiness and fatigue and identify the interventions and treatments proposed to overcome work related stressors and associated mental illnesses inflicting law enforcement officers. The EMBASE, OVID MEDLINE and PsycINFO databases were canvassed for articles investigating anxiety, post-traumatic stress disorder, sleepiness, and fatigue. Initial article selections were made based on title, whilst final inclusion was informed by a full critical appraisal with respect to the primary and secondary effects. The systematic search returned 363 records, of which 183 were unique. Following screening, 43 records were included in the final review. The included literature assessed the efficacy of several interventions, and provided a number of recommendations regarding interventions, and policy. Moreover, literature indicates that police officers benefit from interventions targeting work-related stress and potential psychological disorders, if these interventions are continuous. Furthermore, larger controlled studies are required to further elucidate the benefits of psychosocial intervention in law enforcement.

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.

Occupational status and hospitalisation for mental disorders: findings from Friuli Venezia Giulia region, Italy, 2008-2017

Purpose: To investigate to which extent occupational status, and job titles, were associated with types of hospitalisations and psychiatric diagnoses among inpatients of Friuli Venezia Giulia Region, Italy.Methods: Cross-sectional study based on 10 years register data (2008-2017) on 2929 subjects hospitalised in General Hospital Psychiatric Units. Odds ratios (OR) of hospitalisations and psychiatric diagnoses for occupational status and job titles were calculated by logistic regression analysis.Results: Employed were at lower risk of urgent and involuntary hospitalisation. The risk of urgent hospitalisation was higher for affective, organic or other disorders, while all psychiatric diagnoses were at lower risk of involuntary hospitalisation than psychosis. Using white collars as reference category, army showed a higher risk for urgent hospitalisation (OR = 2.3) and affective disorders (OR = 1.9). A higher risk for affective disorders was found in managers (OR = 2.0). Blue collars were at higher risk for alcohol and substance abuse (OR = 1.7).Conclusions: Employment was protective for urgent and involuntary hospitalisations and severe diagnoses. Hospitalisation for affective disorders was more likely in managers, army, and for substances abuse in blue collars. More research is needed to assess the association between specific occupational groups and involuntary hospitalisation.KeypointsEmployment was shown to be a protective factor for both urgent and involuntary hospitalisations and diagnosis of severe mental disorder.Managers, police and military forces were at higher risk of being hospitalised for affective disorders, while blue collars were at higher risk of hospitalisation for alcohol and substances abuse.Future research would benefit from a better analysis on the association between more specific occupational groups and hospitalisation for psychiatric disorders, with a particular focus on involuntary treatment.Further research is needed to compare the risk of hospitalisation for mental disorders in temporary or permanent position, according to recent international changes in labour market and its impact on mental health.

Differential effect of Hurricane Sandy exposure on PTSD symptom severity: comparison of community members and responders

OBJECTIVES

To evaluate whether the association between Hurricane Sandy exposures and post-traumatic stress disorder (PTSD) symptom severity was greater for exposed community members compared with responders.

METHODS

Data were analysed from three existing studies with similar methodologies (N=1648): two community studies, Leaders in Gathering Hope Together (n=531) and Project Restoration (n=763); and the Sandy/World Trade Center Responders Study (n=354). Sandy-related PTSD symptoms were measured using the PTSD checklist-specific traumatic event and dichotomised as elevated (>30) versus low/no (<30) PTSD symptoms. Sandy exposures were measured with a summed checklist. Multivariable logistic regression was performed to evaluate the differential effect of exposures on PTSD by responder status, adjusting for demographics and time elapsed since Sandy.

RESULTS

Responders were somewhat older (50.5 years (SD=8.3) vs 45.8 years (SD=20.0)), more likely to identify as white (92.4% vs 48.1%) and were male (90.7% vs 38.4%). Responders were less likely to have elevated PTSD symptoms than community members (8.6% vs 31.1%; adjusted OR=0.28, 95% CI 0.17 to 0.46). While exposure was significantly related to elevated PTSD status, the effects were similar for responders and community members.

CONCLUSIONS

Responders appear to be more resilient to PTSD symptoms post-Sandy than community members. Understanding the mechanisms that foster such resilience can inform interventions aimed at populations that are more vulnerable to experiencing PTSD after natural disasters.

Trauma, psychiatric disorders, and treatment history among pregnant African American women

OBJECTIVE

Pregnant African American women living in low-income urban communities have high rates of trauma exposure and elevated risk for the development of trauma-related disorders, including posttraumatic stress disorder (PTSD) and depression. Yet, engagement in behavioral health services is lower for African American women than Caucasian women. Limited attention has been given to identifying trauma exposure and PTSD, especially within at-risk communities. The present study examined rates of trauma exposure, PTSD, depression, and behavioral health treatment engagement in an obstetrics/gynecology (OB/GYN) clinic within an urban hospital.

METHOD

The study included 633 pregnant African American women screened within the OB/GYN clinic waiting room; 55 of the women also participated in a subsequent detailed clinical assessment based on eligibility for a separate study of intergenerational risk for trauma and PTSD in African American mother-child dyads.

RESULTS

Overall, 98% reported trauma exposure, approximately one third met criteria for probable current PTSD, and one third endorsed moderate-or-severe depression based on self-report measures. Similar levels were found based on clinical assessments in the subsample. While 18% endorsed depression treatment, only 6% received treatment for PTSD. In a subsample of women with whom chart reviews were conducted (n = 358), 15% endorsed a past psychiatric diagnosis but none shared their PTSD diagnosis with their OB/GYN provider.

CONCLUSION

Results of the current study highlight elevated levels of trauma exposure, PTSD, and depression in low-income, African American pregnant women served by this urban clinic, and demonstrate the need for better identification of trauma-related disorders and appropriate linkage to culturally responsive care especially for PTSD. (PsycINFO Database Record (c) 2020 APA, all rights reserved).

The Interrelations of Physical and Mental Health: Self-Rated Health, Depression, and PTSD Among Female IPV Survivors

Researchers have found that intimate partner violence (IPV) is associated with low self-rated health (SRH), which is correlated with increased medication usage, and has tremendous social consequences. IPV and low SRH are associated with posttraumatic stress disorder (PTSD) and depression, and the current study examined the interrelations between these variables among 505 Israeli women in shelters. To assess mediation, three regressions were designed. Traumatic events, Russian ethnicity, and chronic illness all contributed to low SRH. The direct effect of depression on SRH was insignificant when PTSD entered the regression. Our findings suggest that PTSD is a more fundamental factor than depression when predicting SRH among IPV survivors.

Posttraumatic Growth in Relation to the Frequency and Severity of Traumatic Experiences Among Police Officers in Small to Midsize Departments

The Critical Incident History Questionnaire (CIHQ) measures, through multiple measurement methods, the severity and frequency of traumatic events experienced by law enforcement officers. We, however, found no studies utilizing the CIHQ to examine posttraumatic growth (PTG) as measured by the Posttraumatic Growth Inventory. The purpose of this brief report was to assess the strength and direction of the relationships between PTG with trauma frequency, trauma severity, and health variables, including subjective traumatic stress, relationship stress, nontraumatic work stress, posttraumatic stress disorder (PTSD) symptoms, depression, and alcohol use among law enforcement officers (N = 193) from small and midsize agencies. In addition, we sought to explore differences between cognitive and behavioral PTG. Based on results from bivariate and multivariate analyses, we found that an idiosyncratic view of trauma severity shaped by personal experience demonstrated the strongest relationship with PTG among the frequency and severity variables and that increased PTG was not associated with reduced psychological distress. Alcohol use, a variable that is assessed primarily through behaviors compared with cognitions, was not significantly associated with PTG. Overall, the findings of this study demonstrate the importance for future research to consider both the frequency and severity of trauma exposure in the development of PTG and its impact on health outcomes.

Developmental Trajectories of Early Life Stress and Trauma: A Narrative Review on Neurobiological Aspects Beyond Stress System Dysregulation

Early life stressors display a high universal prevalence and constitute a major public health problem. Prolonged psychoneurobiological alterations as sequelae of early life stress (ELS) could represent a developmental risk factor and mediate risk for disease, leading to higher physical and mental morbidity rates in later life. ELS could exert a programming effect on sensitive neuronal brain networks related to the stress response during critical periods of development and thus lead to enduring hyper- or hypo-activation of the stress system and altered glucocorticoid signaling. In addition, alterations in emotional and autonomic reactivity, circadian rhythm disruption, functional and structural changes in the brain, as well as immune and metabolic dysregulation have been lately identified as important risk factors for a chronically impaired homeostatic balance after ELS. Furthermore, human genetic background and epigenetic modifications through stress-related gene expression could interact with these alterations and explain inter-individual variation in vulnerability or resilience to stress. This narrative review presents relevant evidence from mainly human research on the ten most acknowledged neurobiological allostatic pathways exerting enduring adverse effects of ELS even decades later (hypothalamic-pituitary-adrenal axis, autonomic nervous system, immune system and inflammation, oxidative stress, cardiovascular system, gut microbiome, sleep and circadian system, genetics, epigenetics, structural, and functional brain correlates). Although most findings back a causal relation between ELS and psychobiological maladjustment in later life, the precise developmental trajectories and their temporal coincidence has not been elucidated as yet. Future studies should prospectively investigate putative mediators and their temporal sequence, while considering the potentially delayed time-frame for their phenotypical expression. Better screening strategies for ELS are needed for a better individual prevention and treatment.

DISPOSITIONAL MINDFULNESS MODERATES THE RELATIONSHIP BETWEEN OCCUPATIONAL STRESSORS AND PERCEIVED STRESS AMONG LAW ENFORCEMENT PERSONNEL

Law enforcement personnel (LEPs) experience occupational stressors that can result in poor health outcomes and have a negative impact on the communities they serve. Dispositional mindfulness, or receptive awareness and attention to present moment experience, has been shown to negatively predict perceived stress and to moderate the relationship between stressors and negative stress-related outcomes. The current study is an investigation of the moderating role of specific facets of dispositional mindfulness (i.e., nonreactivity, nonjudging, and acting with awareness) in the relationship between occupational stressors and perceived stress in a sample of LEPs. As hypothesized, nonreactivity significantly moderated the relationship between operational stressors and perceived stress, such that LEPs low in nonreactivity exhibited a significant relationship between stressors and perceived stress, whereas those high in nonreactivity did not. Nonjudging also moderated the relationship between organizational stressors and perceived stress; however, unexpectedly, LEPs high in nonjudging evidenced a significant relationship between stressors and perceived stress, whereas those low in nonjudging did not. Potential implications of these findings for LEP stress reduction interventions are discussed.

A longitudinal assessment of the road to mental readiness training among municipal police

Police agencies increasingly implement training programs to protect mental health. The Road to Mental Readiness (R2MR) program was designed by the Canadian military to increase mental health resilience. A version of R2MR was adapted for municipal police by the Mental Health Commission of Canada (MHCC). The current research was designed to assess the R2MR program, as adapted and delivered by the MHCC, in a municipal police sample. Participants were 147 Canadian police agency employees (57% women) who received a single R2MR training session. Participants completed pre- and post-training self-report questionnaires, and follow-ups at 6 and 12 months. The questionnaires assessed mental health symptoms, work engagement, resiliency, mental health knowledge, and stigma. Multilevel modeling analyses assessed for within-participant changes over time. The results were consistent with other single session interventions; specifically, there were no significant changes in mental health symptoms, resilience, or work engagement (p > .05). There were small, but significant (p < .05), reductions in stigma at post-training that may facilitate help-seeking among police; relatedly, in open-ended response fields, participants commonly described the training as helpful for changing attitudes and improving communication. More engagement with the material may produce larger, sustained gains, but more published research is critically needed.

Mindfulness-based resilience training to reduce health risk, stress reactivity, and aggression among law enforcement officers: A feasibility and preliminary efficacy trial

The primary objective of this study was to assess feasibility and gather preliminary outcome data on Mindfulness-Based Resilience Training (MBRT) for law enforcement officers. Participants (n = 61) were randomized to either an 8-week MBRT course or a no intervention control group. Self-report and physiological data were collected at baseline, post-training, and three months following intervention completion. Attendance, adherence, post-training participant feedback, and interventionist fidelity to protocol all demonstrated feasibility of MBRT for law enforcement officers. Compared to no intervention controls, MBRT participants experienced greater reductions in salivary cortisol, self-reported aggression, organizational stress, burnout, sleep disturbance, and reported increases in psychological flexibility and non-reactivity at post-training; however, group differences were not maintained at three-month follow-up. This initial randomized trial suggests MBRT is a feasible intervention. Outcome data suggest MBRT targets key physiological, psychological, and health risk factors in law enforcement officers, consistent with the potential to improve officer health and public safety. However, follow-up training or "booster" sessions may be needed to maintain training gains. A fully powered longitudinal randomized trial is warranted.

Study protocol of a multicenter randomized controlled trial of mindfulness training to reduce burnout and promote quality of life in police officers: the POLICE study

BACKGROUND

Police officers experience a high degree of chronic stress. Policing ranks among the highest professions in terms of disease and accident rates. Mental health is particularly impacted, evidenced by elevated rates of burnout, anxiety and depression, and poorer quality of life than the general public. Mindfulness training has been shown to reduce stress, anxiety, burnout and promote quality of life in a variety of settings, although its efficacy in this context has yet to be systematically evaluated. Therefore, this trial will investigate the efficacy of a mindfulness-based intervention versus a waitlist control in improving quality of life and reducing negative mental health symptoms in police officers.

METHODS

This multicenter randomized controlled trial has three assessment points: baseline, post-intervention, and six-month follow-up. Active police officers (n = 160) will be randomized to Mindfulness-Based Health Promotion (MBHP) or waitlist control group at two Brazilian major cities: Porto Alegre and São Paulo. The primary outcomes are burnout symptoms and quality of life. Consistent with the MBHP conceptual model, assessed secondary outcomes include perceived stress, anxiety and depression symptoms, and the potential mechanisms of resilience, mindfulness, decentering, self-compassion, spirituality, and religiosity.

DISCUSSION

Findings from this study will inform and guide future research, practice, and policy regarding police offer health and quality of life in Brazil and globally.

TRIAL REGISTRATION

ClinicalTrials.gov NCT03114605 . Retrospectively registered on March 21, 2017.

Mental health stigma and barriers to mental health care for first responders: A systematic review and meta-analysis

OBJECTIVE

It is unclear how many first responders experience barriers to care and stigma regarding mental health care, and how this influences their help-seeking. A systematic review and meta-analysis was conducted on barriers to care and mental health stigma in first responders and their empirical relationship with psychosocial and psychiatric variables.

METHODS

The databases Medline, Embase PsycINFO, CINAHL, PILOTS, LILACS, Sociological Abstracts, SocINDEX, and Social Citation Index were searched to identify relevant studies. A quality assessment and meta-analysis was performed.

RESULTS

Fourteen articles met inclusion criteria, from which data from 12 samples were extracted for meta-analyses. All studies measured stigma regarding mental health care and 33.1% of first responders (95% CI 26.7-40.1; 12 individual samples) endorsed stigma items. The systematic review revealed that the most frequently endorsed items were fears regarding confidentiality and negative career impact. Five of 14 studies measured barriers to mental health care and 9.3% of first responders (95% CI 7.0-12.3; 4 individual samples) endorsed barriers to care items. The most frequently endorsed barriers were scheduling concerns and not knowing where to get help. Indications were found for more stigma and barriers in individuals with mental health problems.

CONCLUSIONS

Stigma and barriers to care are experienced by a significant proportion of firs responders, which can potentially lead to delayed presentation in mental health care and therefore, increased risk of chronicity of post-trauma psychopathology for these groups. The current systematic review draws attention to the paucity of research in this area, particularly in non-Western samples.