What work-related exposures are associated with post-traumatic stress disorder? A systematic review with meta-analysis

Beneath the Surface: Mental Health in Commercial Fisheries

Commercial fishing is a dangerous occupation where injuries, stress, and traumatic events are common. This study determined probable Post-Traumatic Stress Disorder (PTSD) rates in a cohort of 142 commercial fishermen in the United States and assessed factors that influence PTSD outcomes and severity. Fishermen representing four fisheries were sampled: salmon gillnetters (Alaska), Dungeness crab (Oregon), scallopers and lobstermen (Massachusetts). Participants self-reported information on health, sleep, activity, and substance use through surveys, and responded to a brief PTSD screener (PC-PTSD-5) that assesses probable PTSD under the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). Positive PTSD screening rates in male fishermen were 12% (as compared to 10% for female fishermen), roughly three times the national average for US men (4%). Fishermen with self-reported depression, financial struggles, inability to control important things in their lives, difficulty going to (p = .0278) or staying (p = .038) asleep were significantly more likely to screen positive for PTSD. Factors influencing the severity of PTSD symptoms in those that have experienced a traumatic event included: financial insecurity, interpersonal concerns (family, crew), stress, and concern for safety on the vessel. Interestingly, sleep variables did not impact the severity of PTSD symptoms, only the outcome of probable PTSD. These results suggest the need to better understand the nature of traumatic events in fishing communities and to validate existing PTSD screening tools with fishermen to determine their accuracy in diagnosing PTSD in this population. Additionally, tailored behavioral health care for fishermen is essential to effective treatment and recovery from trauma.

Mental Health Support for First Responders Provided Outside of California's Workers' Compensation System

OBJECTIVE

Concern about psychiatric injuries for first responders has grown. We examine alternatives to workers' compensation (WC).

METHOD

We conducted 15 interviews across five California departments contracted with non-WC mental health (MH) providers. We performed content analysis.

RESULTS

MH support outside of WC most often was a dedicated contract with outside MH providers for assessment, diagnosis, and treatment. Departments had formal financing mechanisms with union and city support designating funding for MH care. Frustration and past WC experiences drove the desire for WC alternatives. First responders reported high levels of stigma associated with MH care. Compared to WC, these alternatives allowed more comprehensive services to injured workers along with ease of accessing care, expediting the healing process.

CONCLUSIONS

Contracting culturally competent MH providers outside of WC for first responders has potential and needs formal evaluation.

Risk factors for adverse health in military and law enforcement personnel; an umbrella review

BACKGROUND

A better understanding of adverse health and underlying risk factors in the context of military and law enforcement is essential to developing future preventative strategies. We conducted an umbrella review to provide an overview of the current literature regarding risk factors for adverse health in military and law enforcement populations.

METHODS

We systematically searched the literature for systematic reviews and meta-analyses regarding risk factors for adverse health in military or law enforcement populations. We critically appraised the studies that matched our inclusion criteria, extracted the adverse health outcomes and underlying risk factors, and narratively synthesised the findings.

RESULTS

This umbrella review included 34 systematic reviews that covered data from 43 countries. We identified twenty-six adverse health outcomes and 220 underlying risk factors. The adverse health outcomes covered in the included systematic reviews were one infectious disease (Heliobacter pylori infection); two endocrine, nutritional, or metabolic diseases (metabolic syndrome and obesity); seven mental, behavioural, or neurodevelopmental disorders (adjustment disorder, alcohol misuse, anxiety, depression, poor mental health, PTSD, and stress); two diseases of the nervous system (insomnia and sleep-disordered breathing); one disease of the ear or mastoid process (noise-induced hearing loss); eight diseases of the musculoskeletal system and connective tissue (cervical spine injuries, injuries, lower extremity injuries, musculoskeletal injuries, neck pain, rhabdomyolysis, and stress fractures); one symptom, signs and abnormal clinical and laboratory findings, not elsewhere classified (suicidal ideation); three injuries, poisonings, or other consequences of external causes (concussion, heat illness, and suicide); and one factor influencing health status and contact with health services (burnout). Of the 220 identified risk factors, 136 were modifiable, and the most frequently reported were female sex, older age, lower functional movement screen scores, maladaptive coping, lack of social support, and neuroticism.

CONCLUSION

This umbrella review identified twenty-six adverse health outcomes and their underlying risk factors in military and law enforcement populations. Hereby, this study provides potential starting points for preventing adverse health in these populations. It also identifies a broad lack of systematic reviews investigating mental, behavioural, or neurodevelopmental disorders in military populations and diseases of the musculoskeletal system and connective tissue in law enforcement populations.

PROSPERO REGISTRATION NUMBER

CRD42022378123.

Building psychological resilience in Armed Forces worldwide

Psychological resilience among troops can be enhanced through relatively simple interventions. Globally, various Armed Forces have successfully implemented modules for building psychological resilience. Programs from different countries are listed, evaluated and their underpinnings explored. Recommendations for a variety of feasible and culturally acceptable interventions targeted at individuals, families, units, community and organizations in the Indian context have been made; ranging from mindfulness training to embedded combat psychologists. Interventions are likely to succeed if integrated within existing basic training and unit/career programs.

Working Conditions and Mental Health in a Brazilian University

The highest prevalence of mental illnesses and mental suffering in contemporary society has raised awareness of the theme and their connection to work. In Brazil, university servants (professors and technical-administrative staff) are a focused occupational group. We developed this research with the objective of exploring the relationship between the perception of working conditions and the mental health of these servants. Structured questionnaires were applied to 285 servants, 33.5% being professors and 66.5% technical-administrative staff. Regarding working conditions, the questionnaires included items that measured 15 primary factors and questions about their contracts and legal conditions. To evaluate mental health, the participants answered a questionnaire about common psychic symptoms, negative and positive affects, self-esteem, and family-work conflict. We composed groups of participants according to their mental health indicator scores (cluster analysis), and after that, we compared the mean scores in working conditions for the groups. Then, we found that the mean scores of 13 from the 15 working condition factors were significantly different between the mental health groups. Our results showed the importance of improving working conditions in universities to prevent mental illnesses. Understanding the content of each working condition factor presents potency to contribute to defining the priorities among different aspects of working conditions.

A phenomenological exploration of work-related post-traumatic growth among high-functioning adults maltreated as children

Introduction

Childhood maltreatment is a highly prevalent traumatic experience, and its adverse psychological and behavioral consequences are well-documented. Notwithstanding these adverse outcomes, many individuals who suffered from traumatic experiences report post-traumatic growth, i.e., transformative positive changes resulting from their struggle to cope. Post-traumatic growth has been extensively explored among adult survivors of childhood maltreatment, with findings indicating both the previously recognized domains (personal strength, relating to others, appreciation of life, openness to new possibilities, and spiritual change) as well as abuse-specific domains of growth (e.g., increased ability to protect themselves from abuse). However, little attention has been given to vocational aspects of post-traumatic growth among survivors, despite the central role and importance of work in adulthood. Exploration of post-traumatic growth at work has focused on certain vocational traumatic experiences, such as those which occur in the military, or through secondary trauma. This exploratory qualitative study focuses on the question: What is the lived experience of work-related post-traumatic growth among high-functioning adult survivors of CM?

Method

Twenty in-depth interviews were held with high-functioning working adults who were maltreated as children. Phenomenological analysis was applied to the retrospective data reported in these interviews.

Result

Rich descriptions of work-related positive psychological changes were provided by all participants. Analysis revealed that survivors' post-traumatic growth corresponded with all five previously recognized domains of growth: changes in self, relating to others, openness to new possibilities, finding meaning to the abuse, and appreciation of life. It also revealed that work is perceived as a form of resistance (a subtheme of changes in self), and that finding meaning entails three emerging subthemes: being a survivor and a role model, giving others what was needed and never received, and making a better world.

Discussion

While the vocational lives of survivors of childhood maltreatment have rarely been examined through the lens of post-traumatic growth, our results show this lens to be highly valuable. Work-related post-traumatic growth has relevance not only regarding vocational traumas occurring in adulthood as has been previously studied, but also in the context of childhood traumas. Moreover, our research broadens the understanding of the possible domains of work-related growth.

Critical incident exposure among custody and noncustody correctional workers: Prevalence and impact of violent exposure to work-related trauma

BACKGROUND

Correctional workers are at high risk for exposure to trauma, both as direct violence and as threats to their safety and well-being. The distress associated with these critical incidents (CIs) affects mental and physical health. Current tools are limited for detecting CIs in this workforce and are therefore insufficient for addressing correctional worker trauma.

METHODS

Community prison employees (N = 105) self-reported CIs using the adapted Correctional Worker Critical Incident Survey (CWCIS). We examined: (1) prevalence of CIs and occurrences, (2) differences in exposures to CIs by custody and noncustody staff, and (3) differences in job satisfaction, posttraumatic stress (PTSD), lower back disease, and health behaviors, such as missed work and sleep.

RESULTS

CIs occurred among most staff (59%) and more often for custody staff as compared to noncustody staff. CIs most often experienced were coworker injury, exposure to disease, and badly beaten adults (frequency 10-50). For the 1-9 frequency category, the most described events were: seeing someone dying, life threatened, and coworker injury. PTSD was identified in 44% of staff, and those who experienced CIs reported lower job satisfaction, greater feelings of PTSD, and more work absences than those not experiencing CIs (p < 0.05).

CONCLUSIONS

CIs and PTSD are prevalent among custody and noncustody correctional workers; and job dissatisfaction, PTSD, and work absence are significantly worse for those who experienced CIs. The CWCIS detected CIs; future study is needed to inform trauma prevention, reduction, and rehabilitation interventions specific to correctional work.

Suffering in Silence: Violence Exposure and Post-Traumatic Stress Disorder Among Jail Correctional Officers

OBJECTIVE

Correctional officers are exposed to violence more often than many other public service workers, yet little is known about the traumatic nature of these risks. We examine violence exposure and post-traumatic stress disorder (PTSD) among a large, multi-facility sample of jail officers.

METHOD

One thousand three hundred and sixty five officers working in 20 jails were surveyed regarding background characteristics, exposure to violence at work, and post-traumatic stress symptoms measured by the PTSD Checklist for DSM-5 (PCL-5).

RESULTS

About one-third of the sample met the criteria for a "provisional PTSD Diagnosis" or "probable PTSD".' Victimization and exposure to violence, both in and outside of work, significantly contributed to PTSD symptoms.

CONCLUSIONS

Findings highlight the severity of, and link between, exposure to violence and PTSD among jail officers. Implications for diagnosing, treating, and preventing PTSD among jail officers are discussed.

Team Coping: Cross-Level Influence of Team Member Coping Activities on Individual Burnout

Coping with stress has been primarily investigated as an individual-level phenomenon. In work settings, however, an individual's exposure to demands is often shared with co-workers, and the process of dealing with these demands takes place in the interaction with them. Coping, therefore, may be conceptualized as a multilevel construct. This paper introduces the team coping concept and shows that including coping as a higher-level team property may help explain individual-level outcomes. Specifically, we investigated the effects of exposure to danger during deployment on burnout symptoms in military service members and examined to what extent this relationship was moderated by individual-level and team-level functional coping. We hypothesized that the relationship between individuals' exposure to danger and burnout is contingent on both. In line with our predictions, we found that service members who were highly exposed to danger, and did not engage in much functional coping, suffered most from burnout symptoms, but only when their teammates did not engage in much functional coping either. When their teammates did engage in much functional coping, the effect of exposure to danger on burnout was buffered. Hence, team members' coping efforts functioned as a resilience resource for these service members.