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Examining the issues of stress and health in law enforcement

Police officers represent a relatively understudied occupational group, particularly with respect to identifying early signs of adverse health outcomes

By Penelope J. Baughman, PhD,
Tara A. Hartley, PhD, MPA, MPH,
Cecil M. Burchfiel, PhD, MPH,
John M. Violanti, PhD,
PoliceOne Special Contributors

The International Journal of Emergency Mental Health recently released a special issue highlighting research from the Buffalo Cardio-Metabolic Occupational Police Stress (BCOPS) study and from related studies of morbidity and mortality among police officers.

The BCOPS study is an investigation of the early or subclinical health consequences of stress in police officers and examines associations between a variety of officer exposures and outcomes including stress, shift work, traumatic incidents, lifestyle factors, stress biomarkers, body measures, and subclinical metabolic and cardiovascular disease.

Prior studies have found police officers to be at increased risk for cardiovascular events1 and suicide.2

Yet police officers represent a relatively understudied occupational group, particularly with respect to identifying early signs of adverse health outcomes. The introduction to the special issue emphasizes that although policing is a psychologically stressful work environment, filled with danger, high demands, ambiguity in work encounters, human misery, and exposure to death, its influences on the psychological well-being and physical health of officers needs further research.

The BCOPS study began in 2004, and is a collaboration between the National Institute for Occupational Safety and Health (NIOSH) and the University at Buffalo with tremendous support from the Buffalo, New York Police Department. A total of 464 police officers participated in the study which involved questionnaires measuring demographic, lifestyle, and psychological factors, DEXA measurements to record bone density and body composition, ultrasounds of the brachial and carotid arteries, 18 salivary cortisol samples throughout the day and in response to a series of challenges, and blood samples.

A unique feature of this study is the utilization of both objective sleep quality measures (obtained by an actigraph — an electronic device that measures the quantity and quality of sleep) and daily work history records which date back to 1960. These measures allowed researchers to assess the effects of shift work and extended work hours on officer stress and fatigue, and examine the effects of work-related stress and fatigue on cardiovascular and metabolic disease risk. Preliminary research findings were summarized in a 2008 blog.

A brief overview of the research featured in the special issue focusing on stress and health in law enforcement follows.

Health Disparities
Do health disparities exist for groups strongly influenced by the context of their occupation? Striking comparisons were found for BCOPS study officers. The prevalence of depressive symptoms in BCOPS study officers was nearly double (12.0 percent versus 6.8 percent) that of the general population.

More than 25 percent of BCOPS study officers had the metabolic syndrome, a group of factors believed to increase cardiovascular disease risk, compared to 18.7 percent of the U.S. employed population. Officers were nearly four times more likely to sleep less than six hours in a 24-hour period than the employed population (33.0 percent versus eight percent). (Hartley, et al.)

Stress and Sleep
Poor sleep quality increased as perceived stress levels increased in the BCOPS study officers. Compared to officers with the lowest perceived stress, female officers with the highest levels of perceived stress were nearly four times more likely and male officers were nearly six times more likely to have poor sleep quality. (Charles, et al.)

Stress and Metabolic Syndrome
Police stress, particularly administrative and organizational pressure and lack of support, was associated with metabolic syndrome among female, but not male BCOPS study officers. Of the five metabolic syndrome components (abdominal obesity, hypertension, reduced high density lipoprotein cholesterol [HDL-C], elevated triglycerides, and glucose intolerance), abdominal obesity and reduced HDL-C levels were consistently associated with police stress in women. (Hartley, et al.)

Obesity and Depression
Associations were studied between measures of obesity (body mass index [BMI], abdominal height, and waist circumference) and depressive symptoms in officers. In men, depression symptoms significantly increased with increasing levels of BMI and abdominal height. No significant associations were found in women. (Violanti, et al.)

Sleep Quality and Depression
Sleep quality was significantly and independently associated with depressive symptoms, with sleep quality decreasing with increasing depressive symptoms. (Slaven, et al.)

Suicide Risk
Previous research indicates that the majority of suicides in working officers occur near retirement eligibility. The notion that retired officers are more likely to commit suicide was examined using employment, retirement, and mortality records for a larger group of Buffalo police officers who worked for five years or more between 1950 and 2005. Suicide rates were 8.4 times higher in working officers as compared to separated/retired officers. (Violanti, et al.)

Cancer Risk
Records for the officers who worked between 1950 and 2005 were later matched with cancer registry records. Among white male officers, 18.2 percent developed cancer between 1976 and 2006. Their overall cancer risk was similar to that of the U.S. white male population, but an elevated risk of Hodgkin’s lymphoma was observed. The risk of brain cancer was slightly elevated and was significantly increased for officers with 30 or more years of police service. (Gu et al.)

The results presented in the special issue confirm and extend previous research on police officers. Information gained through the BCOPS study and other related investigations may be useful not only to aid further investigation of the health status of police officers, but may also be relevant for other high stress, first responder occupations. The BCOPS study offers useful information on associations between exposures and outcomes at a point in time.

Yet, in an ongoing follow-up study with this same group of police officers, we will confirm if these observed relationships are likely to be causal, that is do earlier exposures to stress and shift work lead to changes in health outcomes over time. 

Contact us or see our earlier blog posting for more information about the BCOPS study. Additional recommended publications are also available on shift work, sleep, stress, post-traumatic stress disorder, depressive symptoms, early evidence of cardiovascular disease, bone mineral density, lung function, and physical activity.

About the Authors
Penelope J. Baughman, PhD; Tara A. Hartley, PhD, MPA, MPH; Cecil M. Burchfiel, PhD, MPH; and John M. Violanti, PhD
Dr. Baughman is an Epidemic Intelligence Service Officer in the Biostatistics and Epidemiology Branch.
Dr. Hartley is an Epidemiologist in the Biostatistics and Epidemiology Branch.
Dr. Burchfiel is the Project Officer and the Chief of the Biostatistics and Epidemiology Branch. They are located at the NIOSH Health Effects Laboratory Division, Morgantown, WV.
Dr. Violanti is the Principal Investigator and a Research Professor in the Department of Social and Preventive Medicine, School of Public Health and Health Professions at the University at Buffalo, Buffalo, NY.

1 Zimmerman, F. H. [2012]. Cardiovascular disease and risk factors in law enforcement personnel: A comprehensive review. Cardiol Rev 20(4): 159-166.
2 Aamodt, M.G., N.A. Stalnaker. [2001]. Police officer suicide: Frequency and officer profiles. In Sheehan, D.C., J.I. Warren (Eds.) Suicide and law enforcement (pp. 383-398). Washington, DC: U.S. Government Printing Office.

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