The researchers also confirmed a finding from their earlier studies of combat veterans – that those who feel the event is unreal as it unfolds, as if they were in a dream, a movie or a play – have a higher risk of developing symptoms.
The study also found that although only seven percent of officers are currently reporting significant problems with PTSD symptoms, more than 45 percent of police officers reported sleep disturbances typical of patients in insomnia clinics, according to the study’s principal investigator Charles Marmar, MD, associate chief of staff for mental health at SFVAMC, and UCSF professor and vice chair of psychiatry.
The study of 741 police officers from New York, Oakland and San Jose is being published in several journal articles including a recent issue of the American Journal of Psychiatry, and was funded by a grant from the National Institute of Mental Health, managed by Northern California Institute for Research and Education (NCIRE).
“At the moment of confronting a personal life threat or witnessing gruesome injuries to others, police officers vary in their immediate emotional reactions. We found that police officers who reported greater grief, horror, and panic-like symptoms – extreme terror, feeling they might die, experiencing a loss of control over their emotions, and physical symptoms such as a pounding heart or shaking hands – were at much higher risk for PTSD symptoms later on,” Marmar said.
Surprisingly, a police officer’s emotional response at the time of a traumatic event was much more important in determining their risk than the total number of traumatic events they experienced, Marmar said.
“In other groups we have studied – Vietnam War veterans, emergency workers – the frequency and severity of exposure was an important risk factor for PTSD symptoms. For police officers, most of whom have high exposure, this was much less important,” he said.
“These results suggest that at the time of a very traumatic incident, police officers should be screened for their immediate emotional reactions. Those who report feeling intense fear, horror, or helplessness, or those who have a profound sense that the event was unreal, should be targeted for education, supportive counseling and, if symptoms persist, cognitive behavioral therapy and other treatments,” he said.
INSOMNIA
Nearly half of the officers in the study suffered from insomnia.
“These high rates of insomnia are particularly alarming, because sleep deprivation can drastically hinder mental and physical performance,” said co-investigator Thomas Neylan, MD, UCSF assistant professor of psychiatry, and medical director of the PTSD program at SFVAMC.
“A police officer simply must be well rested. If they are not, they won’t react as quickly, they can’t think as clearly, and they’re not as alert. This can be dangerous given the types of decisions officers make on a daily basis, such as evaluating threatening behavior in a suspect,” he said.
The findings on traumatic incidents and sleep disturbances among police officers will be published in the March/April 2002 issue of the journal, Psychosomatic Medicine.
Only a small minority of police officers in the study, seven percent, had full or partial PTSD, Marmar said. While this number may sound encouraging, the actual incidence could be much higher, because the study didn’t include officers who were unwilling to complete the survey, or those who had already left police work because of problems with post-traumatic stress.
The study consisted of questionnaires completed by 741 police officers, and 332 control subjects who had a similar background but were not police officers. Roughly two-thirds of the police surveyed were from the New York Police Department; the others were from police departments in Oakland and San Jose, California.
The project identified other risk factors for PTSD:
ROUTINE WORK STRESS
Routine on-the-job stress significantly increased officers’ risk for having PTSD symptoms. Surprisingly, overall routine work stress – including such items as public criticism, gender discrimination or lax judicial sentencing – affected PTSD risk more than the number or severity of traumatic events experienced.
“This suggests that improving the general work environment, for example by reducing discrimination and fostering good relations with the public, would reduce officers’ risk of post-traumatic stress symptoms,” Marmar said.
These same improvements might also help officers sleep better at night -- routine work stress was also the biggest risk factor for insomnia.
HISPANIC ETHNICITY
Hispanic police officers were somewhat more likely than other officers to suffer symptoms of PTSD. Earlier studies of Vietnam veterans by Marmar and his colleagues also have suggested that Hispanics have a higher PTSD risk.
The researchers offered no conclusive explanation for why Hispanics might be more at risk. They are collaborating with other research groups to explore the importance of reporting style, acculturation and other factors.
Other ethnic groups did not have significantly increased risk.
Daniel Weiss, PhD, UCSF professor of psychiatry and Jeffrey Fagan, PhD, professor of law at Columbia University served as co-principal investigators on the study. Other contributors include Suzanne Best, PhD, Thomas Metzler, MA, and Kumar Vendantham, MD, all at UCSF; Akiva Liberman PhD, National Institute of Justice; Alain Brunet, PhD, McGill University; and Nnamdi Pole, PhD, University of Michigan.
NCIRE is one of the fastest growing medical research groups in the nation. Founded in 1988, NCIRE now manages more than $30 million in funding from organizations such as the National Institutes of Health, Department of Veterans Affairs, the National Aeronautics and Space Administration, and the National Science Foundation. Based at the San Francisco VA Medical Center, NCIRE is the largest of the 80 congressionally authorized VA research corporations.
The San Francisco Veterans Affairs Medical Center has been a primary affiliate of University of California, San Francisco since 1974. The UCSF School of Medicine and the SFVAMC collaborate to provide education and training programs for medical students and residents at SFVAMC. SFVAMC maintains full responsibility for patient care and facility management of the medical center. Physicians at SFVAMC are employed by the Department of Veterans Affairs and also hold UCSF faculty appointments.
Journal
American Journal of Psychiatry