Duty-related stressors and PTSD symptoms in suburban police officers

The prevalence of post-traumatic stress disorder among emergency medical services personnel in Saudi Red Crescent Authority, Riyadh, Saudi Arabia

Background

Determining the prevalence of PTSD and contributing variables among (EMS) specialists was the goal of the current investigation. Furthermore, limited evidence exists regarding the application of PCL-5 for EMT practitioners, and the incidence of PTSD among different age groups and genders in Saudi Arabia.

Methods

This cross-sectional descriptive study includes 211 prehospital care providers of the Saudi Red Crescent Authority stations in Riyadh. The randomization was done using Google Forms into subgroups according to participants' gender, years of experience, occupations, and average working hours. The presence and severity of PTSD symptoms were evaluated using the 20-item PTSD Checklist for DSM-5 (PCL-5) self-report questionnaire. Data were analyzed using Pearson Chi-Square, Mann-Whitney and Kruskal-Wallis tests. The reliability statistics were calculated using Cronbach's Alpha for the 20-survey questionnaire.

Results

The comparison of PCL-5 total scores indicated more PTSD symptomatology among females (1.61 + 0.799) as compared to male workers (1.13 + 0.642). The total score of PTSD demonstrated no statistically significant (P=0.79) differences between our age group classifications. In terms of the participants' city (Riyadh), the total PTSD score was less than the cutoff point which is 31. PTSD total score may not be affected by working experience as indicated by the non-significant difference in prevalence among EMT practitioners having <5 years, 5-10 years and above 10 years of working experience (P=0.215 with X2 = 3.076). PTSD incidence is affected by the type of occupation as statistically significant differences between groups (P=0.001) were recorded depending on the position and responsibilities of EMS practitioners. PTSD is also affected by average working hours per week, and there were statistically significant differences between groups (P=0.001).

Conclusion

The total score of PTSD in the case of emergency service practitioners was found to be 33.7% among all the research participants, which may be regarded as a high prevalence when compared to the general population. Our investigations would contribute to a better understanding of the underlying factors of mental stress in EMS specialists in Saudi Arabia and to the development of adequate mental health practices.

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

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

Posttraumatic stress disorder and complex posttraumatic stress disorder in UK police officers

BACKGROUND

We investigated work-related exposure to stressful and traumatic events in police officers, including repeated exposure to traumatic materials, and predicted that ICD-11 complex PTSD (CPTSD) would be more prevalent than posttraumatic stress disorder (PTSD). The effects of demographic variables on exposure and PTSD were examined, along with whether specific types of exposure were uniquely associated with PTSD or CPTSD.

METHODS

An online survey covering issues about trauma management, wellbeing and working conditions was disseminated via social media and official policing channels throughout the UK. In total, 10 401 serving police officers self-identified as having been exposed to traumatic events. Measurement of PTSD and CPTSD utilised the International Trauma Questionnaire.

RESULTS

The prevalence of PTSD was 8.0% and of CPTSD was 12.6%. All exposures were associated with PTSD and CPTSD in bivariate analyses. Logistic regression indicated that both disorders were more common in male officers, and were associated independently with frequent exposure to traumatic incidents and traumatic visual material, and with exposure to humiliating behaviours and sexual harassment, but not to verbal abuse, threats or physical violence. Compared to PTSD, CPTSD was associated with exposure to humiliating behaviours and sexual harassment, and also with lower rank and more years of service.

CONCLUSIONS

CPTSD was more common than PTSD in police officers, and the data supported a cumulative burden model of CPTSD. The inclusion in DSM-5 Criterion A of work-related exposure to traumatic materials was validated for the first time. Levels of PTSD and CPTSD mandate enhanced occupational mental health services.

Continuum of care for disasters and catastrophes

Disasters and their more extensive and more serious variant, catastrophes, are different than most human experiences. They are inherently quite complex. Extensive and diverse resources are required to assist disaster survivors as well as disaster response personnel, and hospital medical staffs. Except for warfare, there are few other human predicaments that require such a massive and highly coordinated response. Traditional psycho-therapeutic interventions have little chance of being helpful in the acute stages of a disaster. Research demonstrates that selected crisis intervention processes provided by crisis-trained psychological support personnel have been quite successful in assisting both the survivors and responders in coping with disasters and catastrophes. Assistance to military personnel, emergency operations personnel, and survivors must be carefully crafted to assure that the right type of help is provided at the right time by the most appropriate, well-trained, and experienced personnel. This paper employed a scoping review methodology synthesizing the lessons gleaned from wars and past disasters beginning in the late 1800's up to the present. It sets a course for the appropriate management of the psychological impacts of future disasters and catastrophes. Evidence suggests effective psychiatric and psychological services provided during and in the aftermath of a disaster must be simple, brief, immediate, practical, and innovative. Most importantly, disaster mental health support services must consist of an integrated and comprehensive continuum of mental health services spanning all levels of intensity of support and care.

Identifying predictors of return to work and the duration of time off work in first responders affected with musculoskeletal injuries or mental health issues

PURPOSE

To identify predictors of return to work, duration of time off work, and claim closure for first responders experiencing injuries or illnesses, and summarize the claim data.

METHODS

First responder claims collected between January 2012 and July 2017 were obtained from a disability management company. Known predictors of return to work were extracted from the data including age, sex, diagnosis, years of service, claim lag, medical report lag, and the return-to-work duties. Survival analyses were performed to identify predictors of return to work and claim closure using the Cox proportional regression analysis. Log-rank tests were performed to identify predictors that affected the rate of return to work and claim closure. Summary statistics were performed for the injury and return-to-work data.

RESULTS

60 of the 67 (89.6%) identified first responders returned to work within the data collection period. Musculoskeletal injuries predicted an increased likelihood of returning to work (hazard ratio = 2.0, 95%CI = 1.14-3.60) and a shorter duration of time off work (37 days on average) compared to mental health issues. Everyday of claim lag and medical report lag predicted a 2% decrease in likelihood of return to work. Returning to work was the only predictor of claim closure. 45 (67.2%) first responders returned to their pre-absence duties. 22 (32.8%) mental health claims and 45 (67.2%) injury claims were identified.

CONCLUSIONS

89.6% of first responders returned to work, although only 67.2% returned to their pre-absence duties. Predictors of return to work included injury type, as first responders with musculoskeletal injuries returned to work sooner, and claim and medical lag delayed the return to work.

Pandemic-related mental health risk among front line personnel

The mental health of frontline workers is critical to a community's ability to manage crises and disasters. This study assessed risks for mental health problems (traumatic stress, depression, anxiety, alcohol use, insomnia) in association with pandemic-related stressors in a sample of emergency and hospital personnel (N = 571). Respondents completed self-report surveys online from April 1st to May 7th, 2020 in the Rocky Mountain region of the United States. Results showed that roughly fifteen to thirty percent of respondents screened positive for each disorder. Odds of screening positive were similar between groups for probable acute traumatic stress, depressive disorder, anxiety disorder, and alcohol use disorder; emergency personnel reported significantly higher rates of insufficient sleep than healthcare workers. Logistic regressions showed that respondents who reported having an immunocompromised condition had higher odds of acute traumatic stress, anxiety, and depression. Having an immunocompromised household member was associated with higher odds of insufficient sleep and anxiety. Being in a direct care provision role was associated with higher odds of screening positive for risky alcohol use. Being in a management role over direct care providers was associated with higher odds of screening positive for anxiety, risky alcohol use, and insufficient sleep. There was an inverse relationship between number of positive COVID-19 cases and anxiety, such that as positive cases went up, anxiety decreased. Overall, the mental health risks that we observed early in the COVID-19 pandemic are elevated above previous viral outbreaks (SARS) and comparable to rates shown in disasters (9/11 attacks; Hurricane Katrina).

Highly public anti-Black violence is associated with poor mental health days for Black Americans

Highly public anti-Black violence in the United States may cause widely experienced distress for Black Americans. This study identifies 49 publicized incidents of racial violence and quantifies national interest based on Google searches; incidents include police killings of Black individuals, decisions not to indict or convict the officer involved, and hate crime murders. Weekly time series of population mental health are produced for 2012 through 2017 using two sources: 1) Google Trends as national search volume for psychological distress terms and 2) the Behavioral Risk Factor Surveillance System (BRFSS) as average poor mental health days in the past 30 d among Black respondents (mean weekly sample size of 696). Autoregressive moving average (ARMA) models accounted for autocorrelation, monthly unemployment, season and year effects, 52-wk lags, news-related searches for suicide (for Google Trends), and depression prevalence and percent female (for BRFSS). National search interest varied more than 100-fold between racial violence incidents. Black BRFSS respondents reported 0.26 more poor mental health days during weeks with two or more racial incidents relative to none, and 0.13 more days with each log₁₀ increase in national interest. Estimates were robust to sensitivity tests, including controlling for monthly number of Black homicide victims and weekly search interest in riots. As expected, racial incidents did not predict average poor mental health days among White BRFSS respondents. Results with national psychological distress from Google Trends were mixed but generally unsupportive of hypotheses. Reducing anti-Black violence may benefit Black Americans' mental health nationally.

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

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

Free Your Mind: Emotional Expressive Flexibility Moderates the Effect of Stress on Post-Traumatic Stress Disorder Symptoms

Servicemen are exposed to high levels of stress as part of their daily routine, however, studies which tested the relationship between stress and clinical symptoms reached inconsistent results. The present study examines the role of expressive flexibility, which was determined according to the ability to enhance or suppress either negative or positive emotional expression in conflictual situations, as a possible moderator between stress and Post-Traumatic Stress Disorder (PTSD) symptoms. A total of 82 active-duty firefighters (all men, age range = 25–66, M = 33.59, SD = 9.56, range of years in duty service = 2–41, M = 14.37, SD = 11.79), with different duty-related repeated traumatic exposure, participated in the study. We predicted and found that firefighters with low, but not high, expressive flexibility showed a significant positive correlation between duty-related traumatic exposure and PTSD symptomology (t(81) = 3.85, p < 0.001). Hence, the greater the exposure the higher level of symptoms they exhibited. In addition, we found a difference between the moderating roles of suppressing positive and negative emotional expression, as high but not low, ability to suppress the expression of negative emotions (t(81) = 1.76, p > 0.05), as low but not high, ability to suppress the expression of positive emotions (t(81) = 1.6, p > 0.05), served as a protective factor in buffering the deleterious effect of repeated traumatic exposure. The results provide a pivotal support for the growing body of evidence that a flexible emotional profile is an adaptive one, in dealing with negative life events. However, while there is a need to update behavior, the direction of the adaptive update may differ as a function of valance.

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

BACKGROUND

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

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.

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

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

Police killings and their spillover effects on the mental health of black Americans: a population-based, quasi-experimental study

BACKGROUND

Police kill more than 300 black Americans-at least a quarter of them unarmed-each year in the USA. These events might have spillover effects on the mental health of people not directly affected.

METHODS

In this population-based, quasi-experimental study, we combined novel data on police killings with individual-level data from the nationally representative 2013-15 US Behavioral Risk Factor Surveillance System (BRFSS) to estimate the causal impact of police killings of unarmed black Americans on self-reported mental health of other black American adults in the US general population. The primary exposure was the number of police killings of unarmed black Americans occurring in the 3 months prior to the BRFSS interview within the same state. The primary outcome was the number of days in the previous month in which the respondent's mental health was reported as "not good". We estimated difference-in-differences regression models-adjusting for state-month, month-year, and interview-day fixed effects, as well as age, sex, and educational attainment. We additionally assessed the timing of effects, the specificity of the effects to black Americans, and the robustness of our findings.

FINDINGS

38 993 (weighted sample share 49%) of 103 710 black American respondents were exposed to one or more police killings of unarmed black Americans in their state of residence in the 3 months prior to the survey. Each additional police killing of an unarmed black American was associated with 0·14 additional poor mental health days (95% CI 0·07-0·22; p=0·00047) among black American respondents. The largest effects on mental health occurred in the 1-2 months after exposure, with no significant effects estimated for respondents interviewed before police killings (falsification test). Mental health impacts were not observed among white respondents and resulted only from police killings of unarmed black Americans (not unarmed white Americans or armed black Americans).

INTERPRETATION

Police killings of unarmed black Americans have adverse effects on mental health among black American adults in the general population. Programmes should be implemented to decrease the frequency of police killings and to mitigate adverse mental health effects within communities when such killings do occur.

FUNDING

Robert Wood Johnson Foundation and National Institutes of Health.

On-Duty Nonfatal Injury that Lead to Work Absences Among Police Officers and Level of Perceived Stress

OBJECTIVE

We examined prevalence, frequency, duration, and recency of injury leave and the association of duty-related injury with perceived stress in U.S. police officers.

METHODS

This cross-sectional study contained 422 active duty police officers from a mid-sized urban police department. For each participating officer, work history records were used to assess on-duty injuries that lead to work absences. Linear regression analyses were used for analyses.

RESULTS

Most participants had experienced at least one injury (62%), and among those injured, 67% experienced more than one duty-related injury. The average number of injuries per officer was three (range 1 to 12). There was a significant linear trend in mean perceived stress across injury count even after adjusting for age, rank, and sex (P = 0.025).

CONCLUSION

Findings suggest that work-related injury is common and repeated work-related injuries are psychologically distressing in U.S. police officers.

Prison employment and post-traumatic stress disorder: Risk and protective factors

OBJECTIVES

To examine the prevalence of Post-Traumatic Stress Disorder (PTSD) in a sample of prison employees, investigate risk factors, and explore protective factors for PTSD.

METHODS

We surveyed 355 Washington State Department of Corrections employees. The survey included the PTSD checklist for the DSM-5 (PCL-5), the Critical Incident History Questionnaire, and the Work Environment Inventory.

RESULTS

We found 19% of the sample met the criteria for diagnosable PTSD. Several risk factors were associated with a higher PCL-5 score, including exposure to critical incidents, and having greater ambiguity in the job role. Being happy with job assignments and having positive relationships with supervisors and coworkers were associated with decreased PCL-5 score.

CONCLUSIONS

Prison employees have a PTSD rate equivalent to Iraq and Afghanistan war veterans and higher than police officers, suggesting the importance of developing programs for promoting resilience to stress, incorporating the knowledge gained on risk, and protective factors.

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

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

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

AIM

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

METHOD

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

RESULTS

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

LIMITATIONS

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

CONCLUSION

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

Assessing Psychological Distress in Zulu-Speakers: Preliminary Findings from an Adaptation of the SCL-90-R

The SCL-90-R, a 90-item multidimensional self-report symptom inventory, was translated into Zulu. A multistage translation procedure, involving back-translation, decentering, and the committee approach was employed. The translated instrument was pretested on a group of Zulu farm workers ( N = 12) and revisions made in order to improve its comprehensibility and acceptability to Zulu respondents. The concurrent validity of the Zulu SCL-90-R was investigated with samples of male psychiatric inpatients ( N = 23) and nonpatients ( N = 26). The Global Severity Index of the SCL-90-R demonstrated moderate diagnostic efficiency, with a sensitivity of .70 and a specificity of .77. These results suggest that the Zulu SCL-90-R may be a potentially useful psychometric instrument for the evaluation of psychological distress and screening for mental illness in Zulu-speakers.

Is My Stress Greater Than Yours? A Comparison of Policemen and Firemen

Previous research has suggested that police work is stressful both because of the nature of operational duties and because of the organisational climate in which police officers fulfil these duties. Few studies have compared, however, the views of police officers with those of other emergency personnel.

This paper compares large samples of policemen and firemen in relation to many aspects of their work, job satisfaction and several health indices.

The results confirm that police work and firefighting generate sources of stress for those involved in such work, but that policemen more commonly report health problems and identify such factors as shift work and long hours as being damaging to their personal life. Firemen, on the other hand, reported more job satisfaction than did the policemen.

Self-resilience as a protective factor against development of post-traumatic stress disorder symptoms in police officers

BACKGROUND

This study was conducted to check whether self-resilience, one of the characteristics known to affect the occurrence of post-traumatic stress disorder (PTSD) symptoms after experiencing traumatic events, could serve as a protective factor for police officers whose occupational factors are corrected.

METHODS

We conducted a cross-sectional study in which 112 male police officers in Gangwon Province participated. They visited the Wonju Severance Christian Hospital Occupational Environment Center for medical check-ups from June to December 2015. Their general characteristics were identified using structured questionnaires, and they were asked to fill in the Korean Occupational Stress Scale-Short Form (KOSS-SF). Further, the Center for Epidemiologic Studies-Depression Scale (CES-D), Connor-Davidson Resilience Scale-Korean (CD-RI-K), and Impact of Event Scale-Revised-Korean version (IES-R-K) were used to evaluate their job stress, depression, self-resilience, and PTSD symptoms. Logistic regression analysis was conducted to correct their personal, occupational, and psychological factors to analyze the relationship between self-resilience and PTSD symptoms.

RESULTS

Among 112 respondents who experienced a traumatic event, those with low self-resilience had significantly higher rate of PTSD symptoms than those with high self-resilience even after correcting for the covariate of general, occupational, and psychological characteristics (odds ratio [OR] 3.51; 95 % CI: 1.06-19.23).

CONCLUSIONS

Despite several limitations, these results suggest that a high degree of self-resilience may protect police officers from critical incident-related PTSD symptoms.

Correlates of hopelessness in the high suicide risk police occupation

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

Posttraumatic stress disorder: protective and risk factors in 18 survivors of a plane crash

The aim of this study is to identify protective and risk factors related to the development of posttraumatic stress disorder (PTSD) on a sample of survivors from a single plane crash. Eighteen survivors were examined 6 months following the event. The subjects all underwent psychiatric interviews, Clinician-Administered PTSD Scale structured interviews, personality and cognitive tests. Only 38.9% of them presented with all of the symptoms of PTSD; 22.2% showed no symptoms for PTSD; remaining survivors exhibited emotional/affective symptoms related to the event. In addition to the severity of the traumatic event itself, other risk factors identified were the loss of a relative, the manifestation of depressive symptoms, and the severity of physical injuries sustained. Low levels of hostility and high levels of self-efficacy represented protective factors against developing PTSD.

Prediction of PTSD in Police Officers after Six Months – a Prospective Study

The aim of this prospective study was to explore the predictors for the development of PTSD in police officers six months after encountering situations of a potentially traumatic nature. Fifty-nine police officers were studied immediately after the event (T1) and six months later (T2). At T2 PTSD was assessed using the Structured Clinical Interview for DSM-IV (SCID-I). PTSD was predicted by intrusions (Impact of Event Scale–Revised; IES-R), the impairment scale (is), global assessment of functioning scale (GAF), gender, age and sense of coherence scale (SOC). The diagnosis of an acute stress disorder (ASD) at T1 had a high specificity for identifying PTSD at T2. The strongest predictor for the development of PTSD was found to be the factor intrusions. Contrary to our expectations, age was not a significant predictive factor for PTSD. Thus, acute stress disorder (ASD) and a high degree of intrusions experienced immediately after a traumatic incident helped to identify early police officers at risk of developing chronic PTSD.

Predictors of PTSD symptoms in brazilian police officers: the synergy of negative affect and peritraumatic dissociation

BACKGROUND

Exposure to traumatic events is a necessary but not a sufficient condition for the development of posttraumatic stress disorder (PTSD). Pretrauma, peritrauma and posttrauma factors interact to impact on symptom severity. The aim of the present study is to determine risk factors for PTSD symptoms in Brazilian police officers.

METHOD

In a cross-sectional sample of active duty officers (n = 212), participants were asked to complete a socio-demographic questionnaire and self-report scales on affective traits, cumulative critical incident exposure, peritraumatic distress and dissociation, PTSD symptoms, and social support. Hierarchical linear regression analysis was conducted to examine predictors of PTSD symptoms.

RESULTS

Variables related to negative affect, job duration, frequency of critical incident exposure, peritraumatic dissociation, and lack of social support remained significant in the final model and explained 55% of the variance in PTSD symptoms. When interaction terms were evaluated, a synergistic effect between negative affect and peritraumatic dissociation was found.

CONCLUSIONS

The risk factors found in this study provide clues on how to elaborate primary prevention strategies regarding PTSD symptoms in police officers. Such initiatives may lessen the impact of repeated exposure to traumatic events on police officers over the course of their careers.

Posttraumatic Stress in Professional Firefighters in Japan: Rescue Efforts after the Great East Japan Earthquake (Higashi Nihon Dai-Shinsai)

Introduction

Firefighters are often exposed to stressful duty-related events and may experience extreme trauma. Such work-related stress can result in posttraumatic stress disorder (PTSD). It is therefore important to understand the traumatic stress experienced by firefighters in the course of their work and to promote appropriate intervention when necessary.

Methods

Data were collected from 118 workers (all males) in the Fire Department of Akita City, Japan who had participated in the Great East Japan Earthquake (Higashi Nihon Dai-Shinsai) rescue effort from March 11 through March 31, 2011. Study participants completed self-report surveys at three time intervals: shortly after return from the rescue effort, approximately two weeks after return from the rescue effort, and approximately one month after return from the rescue effort. The surveys included questions of demographics, physical complaints, medical history, and the Impact of Event Scale-Revised (IES-R) Japanese version, in which a cut-off point of 24/25 was set to screen for PTSD.

Results

A total of 117 participants undertook the initial survey with a range of 0-36 points obtained on the IES-R score. For the initial survey, two of 117 participants scored ≥25 points. For the intermediate survey phase, a range of 0-19 was obtained for 116 participants and for the final survey phase, a range of 0-11 points was obtained for 114 participants.

Conclusion

Contrary to expectations, the survey results showed no participant was judged to require prompt consultation for PTSD. The firefighters who participated in this study were in good mental health. However, more detailed study is required to ascertain whether these findings adequately and clearly reflect the mental health status of these participants.

FushimiM. Posttraumatic stress in professional firefighters in Japan: rescue efforts after the Great East Japan Earthquake (Higashi Nihon Dai-Shinsai). Prehosp Disaster Med.2012;27(5):1-3.

Treating posttraumatic stress disorder in first responders: a systematic review

First responders are generally considered to be at greater risk for full or partial posttraumatic stress disorder (PTSD) than most other occupations because their duties routinely entail confrontation with traumatic stressors. These critical incidents typically involve exposure to life threat, either directly or as a witness. There is a substantial literature that has examined the risk factors, symptom presentation, course, and comorbidities of PTSD in this population. However, to our knowledge, there are no systematic reviews of treatment studies for first responders. We conducted a systematic review of the PTSD treatment literature (English and non-English) in order to evaluate such treatment proposals based on what is known about treating PTSD in first responders. We especially sought to identify randomized controlled trials (RCTs) whose primary outcome was PTSD. Our search identified 845 peer-reviewed articles of which 0.002% (n=2) were bona fide RCTs of PTSD treatment in first responders. Both studies tested a psychosocial treatment. We did not locate a single psychopharmacologic RCT for PTSD in first responders. An additional 2 psychosocial studies and 13 case or observational studies comprised the remaining extant literature. Though both RCTs showed significant large treatment effects (d=1.37; h=0.92), the literature is startlingly sparse and is not sufficient for evidence-based recommendations for first responders.

The impact of killing and injuring others on mental health symptoms among police officers

This study examined the relationship between killing or seriously injuring someone in the line of duty and mental health symptoms in a sample of police officers (N = 400) who were first assessed during academy training and at five additional time points over three years. We found that nearly 10% of police officers reported having to kill or seriously injure someone in the line of duty in the first three years of police service. After controlling for demographics and exposure to life threat, killing or seriously injuring someone in the line of duty was significantly associated with PTSD symptoms (p < .01) and marginally associated with depression symptoms (p = .06). These results highlight the potential mental health impact of killing or seriously injuring someone in the line of duty. Greater attention to mental health services following these types of exposures can serve as a preventative measure for police officers who have been negatively impacted.

Protective factors for posttraumatic stress disorder symptoms in a prospective study of police officers

Although police officers are frequently exposed to potentially traumatic incidents, only a minority will develop chronic posttraumatic stress disorder (PTSD). Identifying and understanding protective factors could inform the development of preventive interventions; however, few studies have examined this. In the present prospective study, 233 police officers were assessed during academy training and again following 2 years of police service. Caucasian race, less previous trauma exposure, and less critical incident exposure during police service as well as greater sense of self-worth, beliefs of greater benevolence of the world, greater social support and better social adjustment, all assessed during academy training, were associated with lower PTSD symptoms after 2 years of service. Positive personality attributes assessed during training with the NEO Five-Factor Personality Inventory were not associated with lower PTSD symptoms. In a hierarchical linear regression model, only Caucasian race, lower critical incident exposure during police service, greater assumptions of benevolence of the world and better social adjustment during training remained predictive of lower PTSD symptoms after 2 years of police service. These results suggest that positive world assumptions and better social functioning during training may protect police officers from critical incident related PTSD.

Characteristics of police officer suicides in the Federal Austrian Police Corps

BACKGROUND

Suicide rates among police officers may be high because of strong occupational stressors.

AIMS

This study examined the suicide rate and suicide characteristics among police officers in the Federal Austrian Police Force.

METHODS

All suicides among policemen during the period 1996-2006 were analyzed retrospectively on the basis of personalized police record files from all Austrian police departments. Information on sex, age, marital status, children, region, method and place of suicide, suicide notes, position, and length of service was extracted from these files. The general Austrian population, adjusted for sex and age composition, served as the comparison group.

RESULTS

The suicide rate among male police officers was 30.2/100,000 (SD 11.0), which was comparable to the suicide rate in the adjusted general population (30.5/100,000; SD 2.9). The female police officer suicide rate was 1.8/100,000, while the corresponding suicide rate of the adjusted female general population was 12.5/100,000 (SD 1.7). Firearms were the most frequent suicide method (77.8%), and the incidence of suicide notes was 30.8%.

CONCLUSIONS

Suicide rates among police officers seem comparable to those of the age-adjusted general population. Given the healthy-worker effect, these results still suggest an increased risk of suicide among police officers. These findings should stimulate further research on stressors and risk factors for suicide among officers and should also encourage departments to increase awareness regarding suicidal signs among officers.

Occupational risk factors in the emergency medical services

INTRODUCTION

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

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

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

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

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

Routine work environment stress and PTSD symptoms in police officers

This study examined the relationship between routine work environment stress and posttraumatic stress disorder (PTSD) symptoms in a sample of police officers (N = 180) who were first assessed during academy training and reassessed 1-year later. In a model that included gender, ethnicity, traumatic exposure prior to entering the academy, current negative life events, and critical incident exposure over the last year, routine work environment stress was most strongly associated with PTSD symptoms. We also found that routine work environment stress mediated the relationship between critical incident exposure and PTSD symptoms and between current negative life events and PTSD symptoms. Ensuring that the work environment is functioning optimally protects against the effects of duty-related critical incidents and negative life events outside police service.

Trait dissociation predicts posttraumatic stress disorder symptoms in a prospective study of urban police officers

The current study prospectively examines the predictive relationship of trait dissociation, assessed during academy training, to PTSD symptoms assessed at 12 months of active police duty in relatively young and healthy police academy recruits (N = 180). The roles of pre-academy trauma exposure, exposure to life-threatening critical incidents during police duty, and peritraumatic dissociation at the time of the officer's worst critical incident were also examined. Utilizing path analytic techniques, greater trait dissociation, assessed during academy training, was predictive of both peritraumatic dissociation, and PTSD symptoms assessed at 12 months of police service. Moreover, after accounting for trait dissociation and peritraumatic dissociation, the relationship of previous trauma to later PTSD symptoms was no longer significant, demonstrating that the effect of previous trauma on later vulnerability to PTSD symptoms in this sample may be mediated by both trait and peritraumatic dissociation.

An Evaluation of a Police Debriefing Programme: Outcomes for Police Officers Five Years after a Police Shooting

To evaluate the effectiveness of a debriefing programme to reduce traumatic stress in a police organisation, officers involved in a shooting were surveyed by questionnaire, five years after the event. The results showed that 79 per cent of 57 officers had not received debriefing, despite its mandatory status. Those who had received debriefing had higher post-traumatic stress disorder (PTSD) scores; however, regression of PTSD and health scores, on stress perceptions, social support, other trauma, and debriefing, showed that debriefing had no significant effect. These results support those of other controlled studies suggesting that debriefing does not mitigate PTSD and may exacerbate symptoms. A number of limitations of the present study are discussed in terms of suggestions for urgent evaluation of such programs in organisational settings.

Attitudes of Medical Students, General Practitioners, Teachers, and Police Officers Toward Suicide in a Turkish Sample

Since attitudes predict future behavior and are important in suicide prevention, we aimed to determine the attitudes of professional groups with potential importance in suicide and suicide prevention. A total sample of 205 medical students, general practitioners, secondary school guidance teachers, and police officers from Ankara completed the Attitudes Toward Suicide Scale (ATSS). Principal components analysis revealed a nine factor model for the scale. Participants from different professions held different attitudes toward suicide. Medical students and general practitioners had the most permissive attitudes. General practitioners’ attitude scores about preparedness to prevent suicide were lower compared to other groups, which points out the importance of continuing medical education and implementation of suicide prevention programs in primary care.

The Law Enforcement Officer Stress Survey (LEOSS): evaluation of psychometric properties

This study establishes the reliability and validity of the Law Enforcement Officer Stress Survey (LEOSS), a short early-warning stress-screening measure for law enforcement officers. The initial phase of LEOSS development employed the behavioral-analytic model to construct a 25-item instrument specifically geared toward evaluation of stress in this population. The purpose of the present study was to examine psychometric properties of the LEOSS. Results indicate this instrument has good levels of internal consistency, test-retest reliability, and validity. Potential applications of the LEOSS in clinical and research contexts are discussed. The next phase of research on the LEOSS is discussed, and suggestions for directions that future research in this area might take are offered.

Previous trauma exposure and PTSD symptoms as predictors of subjective and biological response to stress

OBJECTIVE

The immediate and long-term effects of traumatic exposure and subsequent posttraumatic stress reactions in people in high-risk occupations are well-documented. What is less evident is the impact of this traumatic exposure and subsequent traumatic stress symptoms on workers' response to acute stress situations. This study aimed to examine the association between prior traumatic exposure related to policing, current posttraumatic stress symptoms and biological markers of stress, and subjective appraisal of stress before, during, and after exposure to acutely stressful stimuli.

METHOD

A stressful policing situation was created through the use of a video simulator room. Participants' responses to the simulated emergency were evaluated by monitoring heart rate, collecting salivatory samples for cortisol analysis, and repeated administration of a subjective measure of anxiety.

RESULTS

Biological indicators of stress, as measured by cortisol level and heart rate, were not associated with previous trauma exposure or trauma symptoms; however, biological response was associated with subjective anxiety. Vulnerability to psychological stress responses during an acute stress situation was also associated with lower levels of social support, previous traumatic exposures, and preexisting symptoms of traumatic stress. The importance of these factors became more pronounced as time progressed after the event.

CONCLUSION

Previous trauma exposure did not put individuals at increased risk of biological distress during an acute stress situation. However, previous trauma and reduced social supports were associated with continuing psychological distress, confirming previous research and raising concerns about the cumulative negative effects of traumatic exposure on psychological health in emergency responders.

Does posttraumatic stress disorder (PTSD) affect performance?

Research has increasingly identified alarming levels of traumatic stress symptoms in individuals working in emergency services and other high stress jobs. This study examined the effects of prior critical incident exposure and current posttraumatic symptoms on the performance of a nonpatient population, police recruits, during an acutely stressful event. A stressful policing situation was created through the use of a video simulator room that was responsive to actions of participants. The performance of participants to the simulated emergency was evaluated by 3 independent blinded raters. Prior exposure to critical incidents was measured using the Critical Incident History Questionnaire and current level of traumatic stress symptoms was measured using the Impact of Events Scale-Revised. Neither previous exposure to critical incidents nor trauma symptoms correlated with performance level. Recruits with high or severe levels of trauma symptoms did not demonstrate impairments in judgment, communication, or situation control compared with their colleagues with lesser or no trauma symptoms. On the basis of these findings, there is no reason to believe that police recruits with PTSD are prone to making errors of communication or judgment that would place them or others at increased risk.

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

BACKGROUND

Frequent exposure to traumatic situations put police officers under an increased risk for developing post-traumatic stress disorder (PTSD). The goals of this study were to determine the current prevalence of post-traumatic stress symptoms (PTSS) in Brazilian police officers and to compare groups with and without PTSS in terms of associated morbidity.

METHODS

Police officers from an elite unit (n=157) were asked to fill out a socio-demographic questionnaire, the 12-item General Health Questionnaire and the Post-Traumatic Stress Disorder Checklist-Civilian Version. The latter's scores were used to establish the diagnoses of "full PTSD" and of "partial PTSD".

RESULTS

Prevalence rates of "full PTSD" and "partial PTSD" were 8.9% and 16%, respectively. Compared with the "no PTSD" group, police officers with "full PTSD" were five times more likely to be divorced (21.6% vs. 4.3%, p=0.008), felt that their physical health was poorer (64.3% vs. 6%, p<0.001), had more medical consultations during the last 12 months [2.00 (+/-1.62) vs. 1.09 (+/-1.42), p=0.03] and reported more often lifetime suicidal ideation (35.7% vs. 5.2%, p=0.002).

LIMITATIONS

The sample was relatively small. A screening tool was employed instead of a semi-structured interview. The cross-sectional design is unsuitable for ascertaining cause-effect relations.

CONCLUSIONS

PTSD prevalence in our sample was comparable to those reported for North American and Dutch policemen. The presence of "full PTSD" was associated with evidences of considerable morbidity. These findings may contribute to the development of effective policies aimed at the prevention and treatment of PTSD in law enforcement agents.