Tara A. Hartley

Area Under the Curve and Other Summary Indicators of Repeated Waking Cortisol Measurements

Objective: To derive the area under the curve and related summary measures of stress from saliva samples collected over time and to provide insight into the interpretation of the derived parameters. In research designed to assess the health consequences of stress these samples are often used as a physiologic indicator of the responsiveness of the hypothalamic-pituitary-adrenal (HPA) axis. To make these repeated measurements of salivary cortisol more useful in defining the relationships between stress and health there is a need to derive two forms of area under the curve that summarize the measurements: area under the curve with respect to ground (AUCG) and area under the curve with respect to increase (AUCI). The latter parameters, AUCI, however, is seldom used by research scientists. Methods: In this study, interpretation and generic definition of the area under the curve was provided through graphical analyses and examination of its association with other summary measures using data from the Buffalo Cardio-Metabolic Occupational Police Stress (BCOPS) Pilot Study. In generic form, AUCI is derived as the area under the curve above the baseline value minus the area above the curve below the baseline value. Results: The sign and magnitude of AUCI are related to the profile and the rate of change of the measurements over time. The parameter showed significant associations with other summary indicators that measure pattern or rate of change of the measurements over time. Conclusion: Principal components analyses revealed that summary parameters derived from repeated cortisol measurements can be grouped into two meaningful general categories: measures of the magnitude of response and measures of the pattern of response over time. AUCG = area under the curve with respect to ground; AUCI = area under the curve with respect to increase; AUCB = area under the curve with respect to baseline; HPA = hypothalamic-pituitary-adrenal; PCA = principal component analyses.

Association of a Dietary Inflammatory Index With Inflammatory Indices and Metabolic Syndrome Among Police Officers

Objectives:To determine whether the dietary inflammatory index (DII) is associated with inflammatory or metabolic biomarkers and metabolic syndrome (MetSyn) among police officers. Methods:Cross-sectional data from the Buffalo Cardio-Metabolic Occupational Police Stress study were derived from saliva and fasting blood samples, anthropometric measurements, long-term shiftwork histories, and demographic, stress/depression, and food frequency questionnaires (FFQs). Metabolic syndrome was defined using standard criteria. Results:Officers in DII quartiles 2 to 4 were more likely to exceed a threshold of 3.0 mg/L for C-reactive protein (odds ratio [OR] = 1.88; 95% confidence interval [95% CI] = 1.02 to 3.45; OR = 2.17; 95% CI = 1.19 to 3.95; OR = 1.57; 95% CI = 0.85 to 2.88, respectively) compared with quartile 1. The glucose intolerance component of MetSyn was more prevalent among officers in DII quartile 4 than among those in quartile 1 (OR = 2.03; 95% CI = 1.08 to 3.82). Conclusions:A pro-inflammatory diet was associated with elevated CRP and with the glucose intolerance component of MetSyn.

Atypical Work Hours and Metabolic Syndrome Among Police Officers

ABSTRACT This study examined whether atypical work hours are associated with metabolic syndrome among a random sample of 98 police officers. Shift work and overtime data from daily payroll records and reported sleep duration were obtained. Metabolic syndrome was defined as elevated waist circumference and triglycerides, low HDL cholesterol, hypertension, and glucose intolerance. Multivariate analysis of variance and analysis of covariance models were used for analyses. Officers working midnight shifts were on average younger and had a slightly higher mean number of metabolic syndrome components. Stratification on sleep duration and overtime revealed significant associations between midnight shifts and the mean number of metabolic syndrome components among officers with less sleep (p = .013) and more overtime (p = .007). Results suggest shorter sleep duration and more overtime combined with midnight shift work may be important contributors to the metabolic syndrome.

Shift-work and suicide ideation among police officers

BACKGROUND This cross-sectional study assessed the association of shift work with suicide ideation among police officers. METHODS Shift work was based on daily payroll records over 5 years (41 women, 70 men). Standardized psychological measures were employed. ANOVA and Poisson regression were used to evaluate associations. RESULTS Among policewomen with increased depressive symptoms, prevalence of suicide ideation increased by 116% for every 10-unit increase in percentage of hours worked on day shift (prevalence ratio (PR) = 2.16; 95% confidence interval (CI) = 1.22-3.71). Among policemen with higher (but not lower) posttraumatic stress disorder (PTSD) symptoms, prevalence of suicide ideation increased by 13% with every 10-unit increase in the percentage of hours worked on afternoon shift (PR = 1.13; 95% CI = 1.00-1.22). CONCLUSION Prevalence of suicide ideation significantly increased among policewomen with higher depressive symptoms and increasing day shift hours, and among policemen with higher PTSD symptoms with increasing afternoon shift hours.

Shift work and the incidence of injury among police officers

BACKGROUND Police officers may be injury prone due to fatigue, erratic work hours, and insufficient sleep. This study explored injury incidence among police officers across shifts. METHODS Day-to-day shift data from computerized payroll records (1994-2010) were available from a mid-sized urban police department (n = 430). Sleep duration, shift activity level, returning to work after days off, and injury incidence over time were also examined. RESULTS Age-adjusted incidence rate ratio (IRR) for injury on the midnight shift was 72% larger than the day shift (IRR = 1.72; 95% CI = 1.26-2.36) and 66% larger than the afternoon shift (IRR = 1.66; 95% CI = 1.23-2.25). Injury incidence for the first day back on the midnight shift was 69% larger than day shift (IRR = 1.69; 95% CI = 1.23-2.32) and 54% larger than the afternoon shift (IRR = 1.54; 95% CI = 1.36-1.76). High activity level combined with midnight shift work put officers at increased injury risk (IRR = 2.31; P = 0.0003). Probability of remaining free of injury was significantly higher for day shift than midnight shift (P < 0.0001). CONCLUSIONS Higher injury risk was associated with night shift work in police officers. Night shift combined with high work activity was strongly associated with injury risk. There was a significantly higher probability of not being injured on day compared to midnight or afternoon shifts.

Shift work and sleep: the Buffalo Police health study

Purpose – Working on the night shift is a potential source of occupational stress and has been associated with sleep disorders. The purpose of this paper is to investigate the association between shift work and sleep problems among police officers from Buffalo, New York.Design/methodology/approach – Randomly selected officers (n=111) responded to questions on sleep quality and quantity. Shift work data were obtained from daily payroll records from 1994 to the exam date (1999‐2000). Prevalence ratios (PR) were obtained using Poisson regression models that examined associations of shift work with sleep quality and quantity.Findings – Among police officers, night shift work was significantly and independently associated with snoring and decreased sleep duration.Originality/value – Although the sleep questions were similar to those used in validated sleep questionnaires, a major strength of this study was the availability of daily work history data on all officers for up to five years prior to the current exa...

Post‐traumatic stress symptoms and cortisol patterns among police officers

Purpose – The purpose of the present study is to examine associations between post‐traumatic stress disorder (PTSD) symptoms and salivary cortisol parameters.Design/methodology/approach – PTSD symptoms and cortisol responses were measured in a random sample of 100 police officers. The impact of event scale (IES) categorized into subclinical, mild, moderate and severe levels was employed to measure PTSD symptoms. Cortisol was analyzed from saliva samples over a period of three days and included an awakening response, high protein lunch challenge, whole day (diurnal), and a dexamethasone suppression test (DST).Findings – Officers in moderate and severe PTSD symptom categories had higher mean awakening cortisol values. A significant sample‐time by PTSD interaction (p=0.008) was found for awakening cortisol responses. Officers in the severe PTSD symptom category showed a blunted response to the cortisol protein meal challenge compared to those in lower PTSD categories. Diurnal cortisol levels suggested an inc...

Association between Depressive Symptoms and Metabolic Syndrome in Police Officers: Results from Two Cross-Sectional Studies

Policing is one of the most dangerous and stressful occupations and such stress can have deleterious effects on health. The purpose of this study was to examine the association between depressive symptoms and metabolic syndrome (MetSyn) in male and female police officers from two study populations, Buffalo, NY and Spokane, WA. Depressive symptoms were measured using the Center for Epidemiologic Studies-Depression (CES-D) scale. MetSyn was defined using the 2005 AHA/NHBLI guidelines. Analysis of covariance was used to describe differences in number of MetSyn components across depressive symptom categories. The number of MetSyn components increased significantly across categories of CES-D for Spokane men only (p-trend = 0.003). For each 5-unit increase in CES-D score, odds increased by 47.6% for having hypertriglyceridemia, by 51.8% for having hypertension, and by 56.7% for having glucose intolerance. Exploring this association is important since both are predictors of future chronic health problems and the results could be helpful in developing future gender-specific prevention and intervention efforts among police officers.

Addictions and the criminal justice system, what happens on the other side? Post-traumatic stress symptoms and cortisol measures in a police cohort.

&NA; The Buffalo Cardio‐metabolic Occupational Police Stress study, an occupational cohort study of police officers, was conducted to evaluate physiologic and stress measures in a high‐risk occupation where occupational exposure to difficult criminal situations can lead to physiologic and psychological health consequences among those who enforce the law. The chronic exposure to human tragedy may place police officers at special risk for mental health disorders and the potential for misuse of alcohol or drugs. While exact etiologies of post‐traumatic stress were not determined by this study, overall post‐traumatic stress (PTS) prevalence rates among the police officers was 35%, with 10% of individuals demonstrating severe PTS symptomatology. Waking cortisol measures tended to be higher among officers with more PTS symptomatology, with some gender related differences noted. Given the increase in incarcerations for addictions related offenses over the past 20 years and the chronic exposure to human suffering and tragedy, early recognition of PTS symptoms is essential in making the diagnosis of post‐traumatic stress in high‐risk occupational cohorts. Providing early entry into treatment and subsequently attempting to eliminate or minimize long‐term consequences of post‐traumatic stress can have a significant impact on the prevention of long term sequelae of chronic stress, such as the use or misuse of drugs or alcohol.

Gender and Age Differences in Posttraumatic Stress Disorder and Depression Among Buffalo Police Officers

Because of the stressful nature of police work, officers may be at increased risk for posttraumatic stress disorder (PTSD) and depression. The Impact of Event Scale (IES) and Center for Epidemiologic Studies–Depression (CES-D) survey were administered to 100 officers. Mean IES and CES-D scores and prevalence of PTSD and depression were compared across gender and age. Female officers had higher mean IES and CES-D scores than male officers. Mean CES-D scores tended to increase with age, whereas mean IES scores varied little across age. Prevalence of depression was greater among women (22.0%) than men (12.1%), yet differences were less evident for PTSD (36.6% women, 34.5% men). Depression and PTSD tended to increase with age and were not explained by gender, marital status, or education.