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The purpose of this paper is to provide a state-of-the-art review on the topic of police stressors and associated health outcomes. Recent empirical research is reviewed in the areas of workplace stress, shift work, traumatic stress, and health. The authors provide a comprehensive table outlining occupational exposures and related health effects in police officers.

A review of recent empirical research on police stress and untoward psychological and physiological health outcomes in police officers.

The results offer a conceptual idea of the empirical associations between stressful workplace exposures and their impact on the mental and physical well-being of officers.

A key limitation observed in prior research is the cross-sectional study design; however, this serves as a motivator for researchers to explore these associations utilizing a longitudinal study design that will help determine causality.

This review provides empirical evidence of both mental and physical outcomes associated with police stress and the processes involved in both. Research findings presented in this paper are based on sound psychological and medical evidence among police officers

Law enforcement is a dangerous profession not only due to assaults, accidents and homicides but also due to health risks. This study examined trends in the national frequency and rate of law enforcement job-related illness deaths in the United States over a 22-year period (1997–2018).

Data were obtained from the National Law Enforcement Officers Memorial Fund (NLEOMF) on death frequencies related to health issues at work. Death rates were based on the total number of police officers in the United States [rate = (frequency/population at risk) × 100,000]. Trends were examined using standardized regression.

A total of 646 deaths were attributed to job-related illness. There was a significant upward trend in overall job-related illness deaths (frequency analyses: β = 0.88, p < 0.0001; rate analyses: β = 0.82, p ≤ 0.0001) mainly driven by a significant increase in 911 cancer deaths (frequency analyses: β = 0.88, p < 0.0001; rate analyses: β = 0.88, p ≤ 0.0001). Nearly 82 percent of circulatory deaths were from a heart attack, with an average death age of 46.5 years.

Deaths were not included if they failed to meet medical requirements of the NLEOMF. The data are descriptive, do not estimate risk and should be interpreted cautiously.

Police wellness programs may help to reduce the danger of deaths associated with job-related illness.

This is among the first studies to examine frequency and rate of police health–related deaths due to job exposures.

This study is a mortality assessment on police officers (68-years, 1950–2018) and includes all causes of death.

The authors investigated 1,853 police deaths (1950–2018) using sources of mortality that included the National Death Index, NY State, and available records from the Buffalo NY police department. Standardized Mortality Ratios were calculated. Death codes were obtained from 8th and 9th International Classification of Disease revisions in accordance with the year of death.

Compared to the US general population, white male police officers from 1950–2018 had elevated mortality rates for some causes of death, including diseases of the circulatory system, malignant neoplasms, cirrhosis of the liver, and mental disorders. Black and female officers had lower mortality rates for all causes of death compared to the general population.

The findings of elevated risk for chronic disease among police need to be studied in relation to stress, lifestyle, and exposure to chemical and physical agents. There is a special need to further study officers from minority populations as larger samples become available.

The results of this study will provide police and occupational health practitioners with objective evidence to determine the health impact of work on law enforcement officers.

This study is longest running mortality assessment on police officers ever conducted (1950–2018) and includes white, black, and female officers.

Chronic exposure to occupational stress may lead to depressive symptoms in police officers. The association between police stress and depressive symptoms and the potential influences of coping and hardiness were evaluated. The paper aims to discuss this issue.

Stress level was assessed in the Buffalo Cardio-Metabolic Occupational Police Stress Study (2004–2009) with the Spielberger Police Stress Survey. The frequency and severity of events at work were used to calculate stress indices for the past year. The Center for Epidemiologic Studies Depression (CES-D) Scale was used to measure depressive symptoms during the past week. Linear regression was used to evaluate the association between the stress indices and depressive symptom scores. Models were adjusted for age, sex, race, smoking status and alcohol intake, and stratified by median values for coping (passive, active and support seeking) and hardiness (control, commitment and challenge) to assess effect modification.

Among the 388 officers (73.2 percent men), a significant positive association was observed between total stress and the CES-D score (β=1.98 (SE=0.36); p<0.001). Lower CES-D scores were observed for officers who reported lower passive coping (β=0.94 (SE=0.45); p=0.038) and higher active coping (β=1.41 (SE=0.44); p=0.002), compared with their counterparts. Officers higher in hardiness had lower CES-D scores, particularly for commitment (β=0.86 (SE=0.35); p=0.016) and control (β=1.58 (SE=0.34); p<0.001).

Results indicate that high active coping and hardiness modify the effect of work stress in law enforcement, acting to reduce depressive symptoms.

Policing requires atypical work hours. The present study examined associations between shiftwork and pregnancy loss among female police officers.

Participants were 91 female officers with a prior history of at least one pregnancy. Shiftwork information was assessed using daily electronic payroll work records. Any prior pregnancy loss (due to miscarriage) was self-reported. Logistic regression estimated odds ratios (OR) and 95% confidence intervals (CI) for main associations.

On average, the officers were 42 years old, had 14 years of service, and 56% reported a prior pregnancy loss. Officers who worked dominantly on the afternoon or night shift during their career had 96% greater odds of pregnancy loss compared to those on day shift (OR = 1.96, 95% CI:0.71–5.42), but the result was not statistically significant. A 25% increase in percent of hours worked on night shift was associated with 87% increased odds of pregnancy loss (OR = 1.87, 95% CI:1.01–3.47). Associations were adjusted for demographic and lifestyle factors. Objective assessment of shiftwork via electronic records strengthened the study. Limitations include small sample size, cross-sectional design and lack of details on pregnancy loss or the timing of pregnancy loss with regard to shiftwork.

The present study is preliminary and cross-sectional.

With considerable further inquiry and findings into this topic, results may have an impact on police policy affecting shift work and pregnant police officers.

Implication on the health and welfare of police officers.

To our knowledge, there are no empirical studies which associate shiftwork and pregnancy loss among police officers. This preliminary study suggested an association between shiftwork and increased odds of pregnancy loss and points out the need for further study.

The purpose of this paper is to provide a review of law enforcement suicide research from 1997 to 2016.

The PRISMA systematic review methodology was implemented. A SCOPUS search identified a total of 97 documents. After applying all exclusion criteria, the results included a list of 44 articles in the review.

Overall, studies investigating law enforcement suicide rates show conflicting results, with some studies showing lower suicide rates among law enforcement, some showing higher rates, and some showing no difference to comparison populations. Recurring research themes were lack of an appropriate comparison group, and small statistical power, particularly for minority and female officers. Stressors related to suicide among police included lack of organizational support, traumatic events, shift work, stigma associated with asking for help, or problems associated with fitting in with the police culture. Problems associated with domestic relationships and alcohol use were commonly mentioned as precursors to suicide or as correlates of suicidal ideation and were hypothesized to arise from stressful working conditions.

Some limitations in law enforcement suicide research include the lack of theory, under-reporting of suicides, and guarded survey responses from police officers. Future directions in police suicide research include investigating etiological factors such as past adverse life and family experiences, social-ecological variation in suicide, or differences in suicide rates within the law enforcement occupation.

Police work, given chronic and traumatic stress, lack of support, danger, and close public scrutiny is a fertile occupation for increased suicide risk. Awareness of the scope of the problem and associated risk factors can help to initiate prevention programs.

This paper provides a long-term review of literature regarding police suicidality, with suggestions for research and prevention.

Balancing work and family in dual-earner households can be stressful. Research suggests that increased work-family conflict (WFC) significantly predicts poor psychological health and increased stress in police officers. The purpose of this paper is to assess whether child care stress was associated with anxiety symptoms and if stressful work events and shift work modified this relationship among 163 Buffalo, NY police officers.

Participants indicated child care stress by reporting how much stress they felt (0 – none to 10 – high) when making child care/daily living arrangements. Shiftwork was assessed from pay-roll data (1994 to date of exam) and by asking, “Do you work opposite shift from your spouse/partner to care for your children?” to assess partner’s shift. The Beck Anxiety Scale and Spielberger Police Stress Survey were used to assess anxiety and work stress, respectively. Effect modification was assessed by stratifying on police stress scores using their median values, and on partner’s shift. All models were adjusted for age, alcohol intake, sex and smoking status.

Results suggest that child care stress was positively associated with anxiety symptoms and that this relationship was moderated by high (>median) work stress factors and afternoon/midnight shift-work, but not having a partner who works opposite shift. These results indicate that child care stress is associated with anxiety symptoms and that this relationship may be modified by work factors.

A number of limitations should be considered while interpreting the results. This study is cross-sectional, which prevents causal inferences; therefore, the temporal pattern between exposure and outcome cannot be determined. The independent, dependent and moderating variables are all self-report measures, which may introduce recall bias. Lastly, generalizability is limited to police departments of similar size and geographic area.

Police experience high stress as part of their jobs, these results indicate that similar to other professions, WFC can also affect police officers, and is associated with higher levels of anxiety.

Few research studies have evaluated the affects of family issues in police. Specifically, the relationship between child care stress and anxiety, and how this relationship may be modified by high work stress.

The purpose of this paper is to examine the association of social avoidance among police, cardiovascular disease (CVD) (metabolic syndrome (MetSyn)), and social support.

Participants were officers from the Buffalo Cardio-Metabolic Occupational Police Stress study (n=289). Social avoidance (defined as the tendency to avoid social contact) and other subscales from the Cook-Medley Hostility Scale were analyzed. The mean number of MetSyn components across tertiles of the Cook-Medley scales was computed using analysis of variance and analysis of covariance. Social support was measured with the Social Provisions Scale, categorized as high or low based on the median.

The mean number of MetSyn components increased significantly across tertiles of social avoidance (1.51±0.18, 1.52±0.12, and 1.81±0.12); the only Cook-Medley subscale that remained significantly associated with MetSyn following adjustment for age and gender. Participants high in social avoidance reported significantly lower social support (79.9±8.5 vs 85.8±8.6; p=0.001).

The study is cross-sectional and therefore precludes causality. The authors were unable to determine the direction of associations between social avoidance and MetSyn. The measure of social support was unidimensional, including only perceived support; additional types of social support measures would be helpful.

This study suggests that occupational-based police social isolation is associated with health outcomes and lower support. Several suggestions are made which will help to improve communication between the police and public. Examples are the use of social media, training in communication techniques, and changing the police role to one of public guardians.

Social avoidance is the least studied the Cook-Medley subscale associated with CVD. It is important for the health of officers to maintain a social connection with others.

The goal of the present study is to determine the proportionate mortality and national rate of duty-related deaths from COVID-19 among US law enforcement officers during the year 2020.

Data for the current study were obtained from the National Law Enforcement Officer Memorial Fund (NLEOMF) database for the year 2020. The database contains deaths designated as caused by incidents that occurred while in the line of duty. The chi-square test and two-sample t-test were used to compare characteristics of officers who died of COVID-19 versus other causes of death. Both the proportionate mortality and rates of death were calculated. To compute the rate of death, the authors obtained data on the total number of law enforcement officers employed in the United States (and therefore at risk) for the year 2020 from Bureau of Labor Statistics.

COVID-19 deaths (n = 182) accounted for 62% of all duty-related law enforcement officer deaths during 2020. The national rate of death due to COVID-19 (12.8/100,000 per year) for law enforcement officers was higher compared to all other causes of death combined (8.0/100,000 per year).

A limitation of the study is the uncertainty of a definitive assessment that the viral infection was acquired through work (versus at home or other non-work-related community settings). Although highly unlikely, deaths designated as duty related entail financial benefits for the survivors and may be a potential source of bias. Given the complexity of personal exposures, the percentage of COVID-19 deaths attributed to duty may represent an over or under estimation of the actual value. Therefore, the data should be interpreted cautiously.

These findings provide police organizations with information needed to understand the risk of death among officers during the COVID-19 pandemic and to make informed decisions about future preparedness strategies.

There are presently no published scientific studies that examine both the proportionate mortality and national rate of death from COVID-19 among law enforcement officers for the year 2020.

The purpose of this study is to examine cross-sectional associations between adverse childhood experiences (ACEs) and mental health among police officers.

The sample was from the Buffalo Cardio-Metabolic Occupational Police Stress study data (132 male and 51 female officers). Standardized surveys were administered to participants. Regression coefficients were obtained from models adjusted for age, sex, race and alcohol intake. All statistical tests were performed using a statistical significance level at p < 0.05.

Regression analyses showed significant positive associations between ACEs and mental health (Posttraumatic Stress Disorder [PTSD]: β = 1.70, p < 0.001 and depressive symptoms: β = 1.29, p < 0.001). Resiliency significantly modified the association between ACEs and PTSD. A positive and significant association was observed among officers with lower resiliency (β = 2.65, p < 0.001). The association between ACEs and PTSD was stronger among male officers compared to females (β = 2.66, p < 0.001 vs. β = 0.59, p ≤ 0.248, respectively).

Child abuse and development of PTSD or depression could not be traced through time as this was a cross-sectional study. Recall bias may affect results.

PTSD and depression associated with ACEs can affect the interpretation of threat and can exacerbate emotional regulation in officers. An inquiry should be expanded regarding work assignments of victimized officers, such as child exploitation and pornography investigation.

There are few studies on ACEs and the mental health of police officers. The present study is among the first to associate multiple police mental health issues with ACEs.