Sabra S. Inslicht

A prospective study of predictors of depression symptoms in police

Police work is one of the most stressful occupations. Previous research has indicated that work stress and trauma exposure may place individuals at heightened risk for the development of depression symptomatology. This prospective longitudinal study was designed to examine predictors of depression symptoms in police service. Participants comprised 119 healthy police recruits from an ongoing prospective study. They completed baseline measures of depression symptoms, childhood trauma exposure, neuroticism, and self-worth during academy training. Follow-up measures of depression symptoms, PTSD symptoms, critical incident exposure, negative life events, and routine work environment stress were assessed after 12 months of police service. Hierarchical linear regression analysis was conducted to examine predictors of current levels of depression symptoms, controlling for baseline depression symptoms and current PTSD symptoms. Greater childhood trauma exposure, lower self-worth during training, and greater perceived work stress in the first year of police service predicted greater depression symptoms at 12 months. Depression symptoms at 1 year of police service were partly independent from PTSD symptoms at 12 months. Greater childhood trauma exposure and lower self-worth during training may be important variables to screen as risk factors for duty-related depression. Strategies to reduce routine work environment stress have the potential to decrease duty-related depression in law enforcement.

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.

A prospective study of trait anger and PTSD symptoms in police

It is unknown whether anger is a risk factor for the development of posttraumatic stress disorder ( PTSD) symptoms, arises as a consequence of PTSD, or both. Two hypotheses were tested in 180 police recruits: Greater trait anger during training will predict greater PTSD symptoms at one year; greater PTSD symptoms at one year will predict greater state anger at one year. Both hypotheses were confirmed, suggesting that trait anger is a risk factor for PTSD symptoms, but that PTSD symptoms are also associated with an increase of state anger. Increased anger is important not only because of the impact it has on individual distress and physical health, but also because of its potential public health impact.

Increased cortisol in women with intimate partner violence-related posttraumatic stress disorder

Abstract:  Intimate partner violence (IPV) is a chronic and recurrent traumatic stressor associated with PTSD; however, its biological correlates are not well understood. This study examined diurnal salivary cortisol and platelet catecholamines in women with lifetime IPV‐related PTSD and in women exposed to IPV who did not develop PTSD. Cortisol was elevated in women with lifetime PTSD compared to controls. No differences were found for platelet catecholamines.

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.

Cortisol Awakening Response Prospectively Predicts Peritraumatic and Acute Stress Reactions in Police Officers

BACKGROUND The hypothalamic-pituitary-adrenal axis is a major stress response system hypothesized to be involved in the pathogenesis of posttraumatic stress disorder (PTSD). However, few studies have prospectively examined the relationships among pre-exposure hypothalamic-pituitary-adrenal activity, acute stress reactions and PTSD. METHODS Two hundred ninety-six police recruits were assessed during academy training before critical incident exposure and provided salivary cortisol at first awakening and after 30 minutes. A measure of cortisol awakening response (CAR) was computed as the change in cortisol level from the first to the second collection. At 12, 24, and 36 months following the start of active police service, officers were assessed for peritraumatic distress, peritraumatic dissociation, acute stress disorder (ASD) symptoms, and PTSD symptoms to their self-identified worst duty-related critical incident. Mixed models for repeated measures were used to analyze the effects of CAR on the outcome variables pooled across the three follow-up assessments. RESULTS After controlling for time of awakening, first awakening cortisol levels, and cumulative critical incident stress exposure, CAR during academy training was associated with greater peritraumatic dissociation, β = .14, z = 3.49, p < .0001, and greater ASD symptoms during police service assessed at 12, 24, and 36 months, β = .09, Z = 2.03, p < .05, but not with peritraumatic distress, β = .03, z = .81, p = .42, or PTSD symptoms, β = -.004, z = -.09, p = .93. CONCLUSIONS These findings suggest that greater cortisol response to awakening is a pre-exposure risk factor for peritraumatic dissociation and ASD symptoms during 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 officers 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.

Family psychiatric history, peritraumatic reactivity, and posttraumatic stress symptoms: A prospective study of police

BACKGROUND Family history of psychiatric and substance use disorders has been associated with posttraumatic stress disorder (PTSD) in cross-sectional studies. METHOD Using a prospective design, we examined the relationships of family history of psychiatric and substance use disorders to posttraumatic stress symptoms in 278 healthy police recruits. During academy training, recruits were interviewed on family and personal psychopathology, prior cumulative civilian trauma exposure, and completed self-report questionnaires on nonspecific symptoms of distress and alcohol use. Twelve months after commencement of active duty, participants completed questionnaires on critical incident exposure over the previous year, peritraumatic distress to the worst critical incident during this time, and posttraumatic stress symptoms. RESULTS A path model indicated: (1) family loading for mood and anxiety disorders had an indirect effect on posttraumatic stress symptoms at 12 months that was mediated through peritraumatic distress to the officers self-identified worst critical incident, (2) family loading for substance use disorders also predicted posttraumatic stress symptoms at 12 months and this relationship was mediated through peritraumatic distress. CONCLUSION These findings support a model in which family histories of psychopathology and substance abuse are pre-existing vulnerability factors for experiencing greater peritraumatic distress to critical incident exposure which, in turn, increases the risk for development of symptoms of posttraumatic stress disorder. Replication in other first responders, military and civilians will be important to determine generalizability of these findings.

Posttraumatic Stress Associated With Cancer History and BRCA1/2 Genetic Testing

Objective: A subset of women who are at elevated cancer risk due to family history exhibit evidence of cancer-specific distress. These stress responses may represent symptoms of posttraumatic stress disorder (PTSD). The present study assessed rates of PTSD related to personal or family cancer history and BRCA1/2 testing. Methods: Participants were 84 women enrolled in a larger project focused on genetic testing decisions. Semistructured diagnostic interviews were used to identify instances of threshold and subthreshold PTSD. Results: Results indicated that 16.7% of the women reported current threshold or subthreshold PTSD related to personal or family cancer history. An additional 26.2% reported past-only cancer-related threshold or subthreshold PTSD. Of the 65 women who received BRCA1/2 results and completed the test-related PTSD module, only 7.7% reported threshold or subthreshold PTSD related to the genetic testing process. However, when rates were examined based on carrier status, 25.0% of BRCA1/2 carriers reported test-related threshold or subthreshold PTSD compared with only 10.0% of variants and 2.3% of noncarriers. Conclusions: Results from this study suggest that both personal and family cancer diagnoses can be significant stressors for a subset of high-risk women. Rates of threshold and subthreshold PTSD related to genetic testing appear to be less common, although carriers may be at higher risk for significant posttraumatic symptoms. CI = confidence interval; DSM-IV = Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition; GAD = generalized anxiety disorder; MDD = major depressive disorder; PTSD = posttraumatic stress disorder; SCID = Structured Clinical Interview for the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition; SPSS = Statistical Package for the Social Sciences.

Pretraumatic prolonged elevation of salivary MHPG predicts peritraumatic distress and symptoms of post-traumatic stress disorder

Post-traumatic stress disorder (PTSD) is associated with elevated catecholamines and increased sympathetic arousal. However, it is unknown whether this condition is a pre-existing vulnerability factor for PTSD or an acquired result of either trauma exposure or the development of PTSD symptoms. We sought to examine if salivary 3-methoxy-4-hydroxy-phenylglycol (MHPG) in response to a laboratory stressor prior to critical incident exposure predicts the development of PTSD symptoms and if early childhood trauma influences this relationship. In a prospective cohort study, 349 urban police officers were assessed during academy training (baseline) and 243 were reassessed 12 months after the start of active duty (follow-up). At baseline, participants observed a video consisting of police critical incidents. Salivary MHPG was measured before and immediately after the challenge, and after 20min recovery. At follow-up, peritraumatic distress and PTSD symptoms were assessed in relationship to the worst critical incident during the past year. Participants with childhood trauma showed a trend towards higher MHPG increase to the challenge. Higher MHPG levels after 20min recovery were associated with both higher levels of peritraumatic distress and PTSD symptoms at follow-up. In a path analysis, elevated MHPG levels predicted higher peritraumatic distress which in turn predicted higher levels of PTSD symptoms while the direct effect of elevated MHPG levels on PTSD symptoms was no longer significant. Prolonged elevation of salivary MHPG in response to a laboratory stressor marks a predisposition to experience higher levels of peritraumatic distress and subsequently more PTSD symptoms following critical incident exposure.