Associations of burnout with awakening and diurnal cortisol among police officers.

The aim of this cross-sectional study was to assess the associations of burnout with cortisol parameters in 197 police officers from the Buffalo Cardio-Metabolic Occupational Police Stress (BCOPS) study (2010-2014). The Maslach Burnout Inventory-General Survey assessed depersonalization, exhaustion, and professional efficacy. Officers provided salivary cortisol samples collected upon awakening, and 15, 30, and 45 min thereafter as well as three additional samples at lunchtime, dinnertime, and bedtime. Total area under the curve with respect to increase (AUCWI for waking and AUCDI for diurnal), total area under the curve with respect to ground (AUCWG for waking and AUCDG for diurnal), and diurnal slope were determined and used in this study. Unadjusted and adjusted (age, sex, and race/ethnicity) associations were examined using linear regression. The mean age of the officers was 48 years and 72% were males. The depersonalization component of burnout was negatively associated with AUCDG (ß = -108.4; p = 0.036). Similarly, as exhaustion increased, AUCWI (ß = -9.58, p = 0.038), AUCDG (ß = -114.7, p = 0.029) and the diurnal slope (ß = -0.000038; p = 0.017) decreased. The Professional efficacy was not associated with any of the cortisol parameters. These results suggest that certain characteristics of burnout may be associated with diminished cortisol secretion in this group of urban police officers. Our findings add to previous studies examining associations of burnout with the cortisol awakening response. Future longitudinal studies are needed to evaluate the temporal relationship between burnout and these cortisol parameters.

Dimensional analysis of actigraphic derived sleep data.

Nonlinear dimensional analyses can be a useful tool in understanding the underlying behavior of dynamical systems, including biological systems. Many biological functions can be modeled as chaotic processes, including sleep. Sleep data can be obtained from several methods, such as electroencephalograms, polysomnography, and actigraph. Actigraphy, because of its low level of invasiveness, is an increasingly popular method of obtaining sleep data. This study analyzed actigraphy data with nonlinear dimensional analyses to determine if such analytic methods would be useful in sleep studies. Participants wore actigraphs on their wrists, which recorded movement for several days. Several sleep quality variables, such as movement during sleep and total sleep time, were derived from these sleep data. These variables were used to determine whether the quality of sleep was good or poor. Lagged phase space plots were graphed and nonlinear parameters for the fractal dimension and the correlation dimension were computed for each participant. Descriptive and inferential statistics were performed to determine if the nonlinear parameters showed significant differences with respect to sleep quality.

Estimation of the maximum flow-mediated brachial artery response using local regression methods.

We consider methods for estimating the maximum from a sequence of measurements of flow-mediated diameter of the brachial artery. Flow-mediated vasodilation (FMD) is represented using the maximum change from a baseline diameter measurement after the release of a blood pressure cuff that has been inflated to reduce flow in the brachial artery. The influence of the measurement error on the maximum diameter from raw data can lead to overestimation of the average maximum change from the baseline for a sample of individuals. Nonparametric regression models provide a potential means for dealing with this problem. When using this approach, it is necessary to make a judicious choice of regression methods and smoothing parameters to avoid overestimation or underestimation of FMD. This study presents results from simulation studies using kernel-based local linear regression methods that characterize the relationship between the measurement error, smoothing and bias in estimates of FMD. Comparisons between fixed or constant smoothing and automated smoothing parameter selection using the generalized cross validation (GCV) statistic are made, and it is shown that GCV-optimized smoothing may over-smooth or under-smooth depending on the heart rate, measurement error and measurement frequency. We also present an example using measured data from the Buffalo Cardio-Metabolic Occupational Police Stress (BCOPS) pilot study. In this example, smoothing resulted in lower estimates of FMD and there was no clear evidence of an optimal smoothing level. The choice to use smoothing and the appropriate smoothing level to use may depend on the application.

A statistical test to determine the quality of accelerometer data.

Accelerometer data quality can be inadequate due to data corruption or to non-compliance of the subject with regard to study protocols. We propose a simple statistical test to determine if accelerometer data are of good quality and can be used for analysis or if the data are of poor quality and should be discarded. We tested several data evaluation methods using a group of 105 subjects who wore Motionlogger actigraphs (Ambulatory Monitoring, Inc.) over a 15 day period to assess sleep quality in a study of health outcomes associated with stress among police officers. Using leave-one-out cross-validation and calibration-testing methods of discrimination statistics, error rates for the methods ranged from 0.0167 to 0.4046. We found that the best method was to use the overall average distance between consecutive time points and the overall average mean amplitude of consecutive time points. These values gave us a classification error rate of 0.0167. The average distance between points is a measure of smoothness in the data, and the average mean amplitude between points gave an average reading. Both of these values were then normed to determine a final statistic, K, which was then compared to a cut-off value, K(C), to determine data quality.

Cellular phones and fatal traffic collisions.

A case-control study was conducted to determine statistical associations between traffic fatalities and the use or presence of a cellular phone, given involvement in a collision. The hypothesis of this study does not imply that cellular phones directly affect fatalities, but that phones increase the risk of certain accident characteristics in fatal collisions more than those same characteristics in non-fatal collisions. Analysis employed data from 223,137 traffic accidents occurring between 1992 and 1995. Information on collision characteristics and cellular phone involvement for each fatality was compared with the same information for each non-fatality (controls). Statistically adjusting for other collision variables (age, gender, alcohol use, speed, inattention and driving left of center), an approximate nine-fold increased risk was found for a fatality given the use of a cellular phone. An approximate two-fold increased risk for a fatality was found given the presence of a cellular phone in the vehicle. Combined effects of reported phone use, driving to the left of center and inattention increased the risk of a fatal collision more than phone use did by itself. This analysis implies a statistical, but not necessarily a causal, relationship. A multitude of factors are involved in any traffic collision, and the exact cause of an accident and its severity level is difficult to disentangle.

Mortality of a police cohort: 1950-1990.

This study presents findings from an updated retrospective cohort mortality study of male police officers from January 1, 1950 to December 31, 1990 (n = 2,593; 58,474 person-years; 98% follow-up). Significantly higher than expected mortality rates were found for all cause mortality (Standardized mortality ratio [SMR] = 110; 95% confidence interval [95% CI] = 1.04-1.17), all malignant neoplasms (SMR = 125; 95% CI = 1.10-1.41), cancer of the esophagus (SMR = 213; 95% CI = 1.01-3.91), cancer of the colon (SMR = 187; 95% CI = 1.29-2.59), cancer of the kidney (SMR = 2.08, 95% CI = 100-3.82), Hodgkin's disease (SMR = 313; 95% CI = 1.01-7.29), cirrhosis of the liver (SMR = 150; 95% CI = 1.00-2.16), and suicide (SMR = 153; 95% CI = 1.00-2.24). All accidents were significantly lower (SMR = 53; 95% CI = 0.34-0.79). Mortality by years of police service showed higher than expected rates for (1) all malignant neoplasms in the 1- to 9-years-of-service group; (2) all causes, bladder cancer, leukemia, and arteriosclerotic heart disease in the 10 to 19-year group; and (3) colon cancer and cirrhosis of the liver in the over 30 years of service group. Hypotheses for findings are discussed.

Cellular phones and traffic accidents.

Cellular phone use in motor vehicles is becoming an increasing world-wide phenomenon. Using data obtained from traffic accidents reported between 1992 and 1995 in the state of Oklahoma, USA, this study examined statistical rate-ratios of accident characteristics between drivers with or without cellular phones. Rates were calculated between cellular phone involvement and reported accident causes, types of collision, driver actions immediately prior to the accident, location of the accident, the extent of fatalities, and age and gender of drivers. Results indicated a significant increased rate among drivers with cellular phones for inattention, unsafe speed, driving on wrong side of road, striking a fixed object, overturning their vehicle, swerving prior to the accident, and running off the roadway. People with phones stood an increased risk of being killed in an accident over persons without phones. Males with phones had a significantly higher rate than females for many of accident characteristics mentioned above. Rate-ratios of some accident characteristics and fatalities increased as age increased, with the exception of drivers under age 20 yrs, who had the highest fatality rate. Limitations of the study and possible prevention alternatives are discussed.

Social network disturbances and psychological distress following earthquake evacuation.

The relationship between social network disturbances following earthquake evacuation and self-reported psychological distress (reduced version of the SCL-90-R) 3 to 4 years later was studied among 817 Italian male factory workers. Increased distress was reported by permanently relocated men, while those who were evacuated, but returned to their original homes, reported distress levels comparable to their nonevacuated co-workers. Additionally, among evacuated men, only those whose relocation placed them at an increased distance from family and/or friends reported distress levels higher than the nonevacuated. Change in visiting frequency with family and/or friends following evacuation was not related to distress. Although these data are correlational and cross-sectional, they are consistent with the hypothesis that disaster related distress is, in part, a function of resulting social network disruption.

Suicides, homicides, and accidental death: a comparative risk assessment of police officers and municipal workers.

Inherent dangers in police work, such as the possibility of homicide victimization or accidents, often overshadow the psychological consequences of this occupation. The present study employed data from a Buffalo, NY retrospective mortality municipal worker cohort to evaluate the risk of suicide, homicide, and accidents among police officers, and compared that risk to other municipal workers. Within the police occupation, officers had an 8.23-fold risk of suicide over homicide and a 3.1-fold risk of suicide over accidents. Compared to municipal workers, police officers had an RR = 1.53 (95% CI = 0.633-3.72) for suicide over homicide, a significant RR = 3.1 (95% CI = 1.94-4.97) for suicide over accidents, and a significant RR = 2.65 (95% CI = 1.76-4.00) for suicide over homicide and accidents combined. Possible reasons for suicide among police officers are discussed.

The impact of cohesive groups in the trauma recovery context: police spouse survivors and duty-related death.

This paper examines the impact of surviving spouse social interactions on psychological distress following the death of a police officer. It was hypothesized that satisfactory interactions within the police work group would lower distress, and unsatisfactory interactions outside the police environment (justice system, media, community persons) would increase distress. Results indicated that increased quality of interaction with police groups lowered psychological distress scores. Despite increased satisfaction with groups outside of policing, spouse's distress still increased, suggesting that satisfaction with and support by police groups appears to ameliorate distress more effectively than others. These findings suggest that police agencies and personnel may be helpful to surviving spouses after the death of an officer and should formulate policy to provide long term contact and assistance.

A comparative evaluation of police suicide rate validity.

The authors assessed sensitivity, specificity, and predictive value of official police suicide rates and compared them to municipal workers. Deaths officially classified as suicide, accidental, and undetermined were submitted to a panel of medical examiners for validation. Six cases originally in the accident and undetermined rubric were reclassified as suicide. Official police suicide rates had less sensitivity (83.3% compared to 92.3%) of actual suicides than municipal worker rates. Police suicide rates also showed a lower negative proportion than municipal worker rates (86.2% compared to 98.7%). A generalizable sensitivity proportion equation for assessing suicide rates in other police groups is presented.

Cellular phones and traffic accidents: an epidemiological approach.

Using epidemiological case-control design and logistic regression techniques, this study examined the association of cellular phone use in motor vehicles and traffic accident risk. The amount of time per month spent talking on a cellular phone and 18 other driver inattention factors were examined. Data were obtained from: (1) a case group of 100 randomly selected drivers involved in accidents within the past 2 years, and (2) a control group of 100 randomly selected licensed drivers not involved in accidents within the past 10 years. Groups were matched on geographic residence. Approximately 13% (N = 7) of the accident and 9% (N = 7) of the non-accident group reported use of cellular phones while driving. Data was obtained from Department of Motor Vehicles accident reports and survey information from study subjects. We hypothesized that increased use of cellular phones while driving was associated with increased odds of a traffic accident. Results indicated that talking more than 50 minutes per month on cellular phones in a vehicle was associated with a 5.59-fold increased risk in a traffic accident. The combined use of cellular phones and motor and cognitive activities while driving were also associated with increased traffic accident risk. Readers should be cautioned that this study: (1) consists of a small sample, (2) reveals statistical associations and not causal relationships, and (3) does not conclude that talking on cellular phones while driving is inherently dangerous.

Survivors' trauma and departmental response following deaths of police officers.

It was hypothesized that satisfaction with supportive reactions of the police department following the on-duty death of an officer helps to ameliorate traumatic stress in surviving spouses. This hypothesis is based on the premise that the police-work group is cohesive and provides a psychological safety net for the surviving spouse. A secondary analysis was conducted of data obtained from 162 surviving police spouses. Analysis indicated that spouses' reported satisfaction with the department was significantly associated with lower trauma stress scores. These findings suggest that police departments should formulate policy to provide assistance to spouses surviving duty-related police deaths.

Trends in police suicide.

Little empirical information is available concerning trends of suicide by police officers. Anecdotes and articles in the popular press imply that the rate is increasing but do not provide a scientific base. Data from an epidemiological mortality database are used to describe trends in police suicide in a medium-sized police department over a 40-yr. period.

Ranking police stressors.

Police stressors were measured using Spielberger's Police Stress Survey with a sample of 103 police officers. Rankings of police stressors are discussed.

Sources of police stressors, job attitudes, and psychological distress.

Sources of police stressors, job attitudes, and psychological distress were measured and analyzed from a sample of 103 police officers. Analysis indicated that police organizational stressors, mediated by job satisfaction and organizational goal orientation, increased psychological distress 6.3 times more than inherent police stressors. The indirect effect of organizational and inherent stressors appeared to nullify the distress-reducing potential of increased job satisfaction. Results are discussed in terms of these findings and the possible implications for further studies and intervention.

Coping strategies among police recruits in a high-stress training environment.

The use and impact of coping strategies were explored in a setting of environmental stress. The sample consisted of 180 police recruits subjected to training stress in a U.S. police academy. Measures of coping, personal distress, and life stressors were used. Recruits who scored high on personal distress tended to use more coping strategies than those who had lower distress scores. These findings suggest that the magnitude of personal distress may be an important factor in determining which array of coping techniques is used. In terms of effectiveness, the coping strategies of distancing and planful problem solving significantly reduced distress. Escape/avoidance and self-control coping did not appear to work in the police situation and significantly increased distress.

Mortality of a municipal worker cohort: III. Police officers.

Very little is known about the long-term health risks associated with the high stress police officer occupation. We report here on a retrospective cohort of 2,376 ever-employed white male police officers employed between January 1950 and October 1979. Vital status was obtained for 96%, the officers accumulating a total of 39,462 person-years. Six-hundred sixty-one deaths were observed. Total mortality from all causes was comparable to that of the overall U.S. white male population (standardized mortality ratio [SMR] = 106). Significantly increased mortality was seen for all malignant neoplasms combined (SMR = 127), cancer of the esophagus (SMR = 286), and cancer of the colon (SMR = 180). Significantly lower than expected mortality was seen for infectious diseases (SMR = 26), respiratory diseases (SMR = 64), and accidents (SMR = 60). Internal cohort comparisons revealed that policeman exhibited significantly higher mortality from suicide compared to all other municipal employees (rate ratio = 2.9). Analysis of mortality by length of service as a police officer showed that those employed 10-19 years were at significantly increased risk of digestive cancers and cancers of the colon and lymphatic and hematopoietic tissues and decreased risk for all diseases of the circulatory system. Policeman employed more than 40 years had significantly elevated SMRs for all causes, all malignant neoplasms combined, digestive cancers, cancers of the bladder and lymphatic and hematopoietic tissues, and arteriosclerotic heart disease. Risk of mortality from arteriosclerotic heart disease tended to increase with increasing years employed. These findings are discussed in light of the police stress literature. The hypotheses generated in this study must be tested through study of the role of important confounders including reactions to stress on the job.

Police occupational demands, psychological distress and the coping function of alcohol.

Alcohol use is an important problem among personnel in the high-stress police occupation. The impact of occupational demands, psychological distress, and coping on police alcohol consumption are explored. Results indicate that psychological distress, as an intervening factor between work demands and alcohol use itself, has an important positive effect on alcohol use.