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Gershon et al
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Methods
Sample
A convenience sample of sworn
police officers (ie, licensed to carry a
weapon and with arrest powers) employed by a large urban police department was surveyed. Police officers were recruited to voluntarily
complete a self-administered anonymous questionnaire during roll call,
which took place at each shift for the
13 departmental districts throughout
the city. From a total of 1106 responding officers, we selected data
from a subset of 105 officers aged 50
years and older. All procedures involving human subjects had prior
approval by the Johns Hopkins University School of Public Health Institutional Review Board.
Study Questionnaire
We designed a five-page, selfadministered survey to collect demographic and psychosocial data on
four major study constructs: (1)
stressors, (2) perceived stress, (3)
coping mechanisms, and (4) stressrelated health outcomes. To simplify
administration, the questionnaire was
aimed at a tenth-grade reading level
and took approximately 20 minutes
to complete. Copies of the study
questionnaire, coding information,
and scale psychometrics may be obtained from the senior author
(RRMG).
162
Measurement
Responses to most items used a
four-point Likert-type scale (eg,
from strongly agree to strongly
disagree).38 All new or revised
scales underwent psychometric evaluation, including Cronbachs alpha.39 The questionnaire included
items on the following:
demographic information: age,
gender, race/ethnicity, marital status, education, tenure, and history
of military service
stressors (ie, sources of stress at
work): 14 items, derived from
Beehr et als police stress questionnaire,40 grouped into four categories: (1) critical incidents (eg,
shooting someone, attending a police funeral, responding to a chemical spill); (2) poor cooperation
(eg, there is a good and effective
cooperation between units) [reverse scored]; (3) perceived inequality, (eg, promotions in the
department are tied to ability and
merit) [reverse scored]; and (4)
organizational structure (eg, the
administration supports officers
who are in trouble [reverse
scored]
perceived work stress: 11-items on
perceived (or felt) job stress (eg,
I feel negative, futile or depressed
about work, My interest in doing fun activities is lowered because of my work, I have difficulty concentrating on my job, I
feel tired at work even with adequate sleep,) from a well-characterized scale previously adapted
from the National Institutes for
Occupational Safety and Health
work stress scale41,42
coping strategies: 10 items total: 3
on problem-solving, 2 on emotionfocused, 1 on avoidance strategies,
and 4 items on negative behaviors
(eg, drinking alcohol), adapted
from scales developed by Beehr et
al and Billings and Moos40,43
stress-outcomes, categorized into
three health outcome subsets: (1)
psychological, including anxiety
(4 items), depression (9 items),
somatization (6 items), burnout (4
items), and posttraumatic stress
Gershon et al
TABLE 1
Demographics of Police Officers*
Characteristic
Mean age (yrs)
Gender
Male
Female
Race
White
Nonwhite
Education
High school
Some college
College/graduate school
Tenure on the police force (yrs)
Current rank
Officer
Supervisor
Marital status
Married
Unmarried
Military service
Yes
No
% or Range
53
50 67
103
2
98.1
1.9
92
13
87.6
12.4
16
12
37
28
15.2
49.5
35.3
2 44
46
59
43.8
56.2
82
23
78.1
21.9
67
38
63.8
36.2
* n 105.
Analyses
After data cleaning and editing
procedures, we conducted an array of
descriptive statistics (frequencies,
means, and standard deviations) for
all variables. Then, we factoranalyzed all new scales and determined their reliability using Pearsons coefficient correlation.47 This
was followed by chi-squared tests of
association between stressors and
perceived stress and between perceived stress and health outcomes.
Finally, we developed simple logistic
regression models to determine the
odds ratio (OR) and 95% confidence
intervals (95% CI) for the association between stressors and perceived
work stress and between perceived
work stress and adverse psychological physical and behavioral out-
Results
Descriptive Statistics
Response rate and demographic
characteristics. Of 1880 police officers potentially eligible to participate
in the larger survey, 1106 completed
the anonymous questionnaire, resulting in a 70% response rate. From the
1106 returned questionnaires, a total
of 105 usable questionnaires were
from officers aged 50 years or older.
This rate represents 9.4% of the total
sample, which correlates well with
the police departments statistics indicating that 10% to 12% of the
sworn police force falls in this age
range. The sample of older officers
had a mean age of 53.5 years and
was predominantly composed of
white men. In general, the demographic profile of the older subset of
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TABLE 2
Critical Incidents in Policing
% Reporting High
Emotional Affect
From Incident
Type of Incident
Attending a police funeral
Experiencing a needlestick or other exposure to
bloody and body fluids
Being the subject of an internal affairs investigation
Shooting someone
Personally knowing a victim
Making a violent arrest
Being involved in a hostage situation
Responding to a bloody crime scene
Responding to a call related to a chemical spill
77.5
60.0
50.0
47.5
41.8
23.8
17.7
13.9
12.7
Health Outcomes
Psychological symptoms. Of a
possible range of 1.00 to 3.00 (never,
sometimes, often), the mean scores
for the three stress-related psychological scales were as follows: anxiety 1.28 (range, 1.00 to 2.25),
somatization 1.43 (range, 1.00 to
2.33), and depression 1.51 (range,
1.00 to 2.56). The symptoms most
often reported by officers were low
energy (87%), feeling blue (79%),
headaches and pressure in the head
(58%), no interest in things (55%),
self-blame (53%), pains or pounding
in the chest (53%), loss of sexual
interest (48%), and stomach pains
(43%). Seven percent of the officers
reported that they sometimes thought
about ending their life. Symptoms of
PTSD were common; 27% of the
respondents reported that they had
intrusive or recurrent thoughts, memories, or dreams about distressing
work events; 26% avoided anything
related to the stressful event; and
26% felt detached from people and
activities that they believe were related to the stressful event. Symptoms of burnout were also frequent;
for instance, 40% stated that they felt
burned out from the job, 31% were
on automatic pilot most of the
time, 12% treat the public as if
they were impersonal objects, and
13% stated that they are at the end
of their rope.
Physical symptoms. The most
commonly reported physical symptoms included chronic low back pain
(45%), high blood pressure (42%),
foot problems (32%), heart disease
(16%), migraines (14%), and chronic
insomnia (13%).
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Univariate
Multivariate
Variable
OR
95% CI
OR
95% CI
Critical incidents
Poor cooperation
Maladaptive coping
3.84
2.23
4.95
1.71 8.65
1.01 4.96
2.1111.6
3.71
NS
5.35
1.2610.9
1.7516.35
Gershon et al
TABLE 3
Adjusted OR of Stress by Sources of Stress at Work*
Discussion
A key finding of this study is that
older officers with higher levels of
work stress are at significant risk of
serious physical, mental, and health
risk problems. Three of four officers
reporting stress also reported symptoms of depression, and nearly one of
every two stressed officers also had
symptoms of PTSD. Of special concern was the finding that all seven of
the officers (7%) reporting suicidal
thoughts also reported higher stress
levels. Officers with higher stress
were also more likely to report risky
health behaviors; 60% of those reporting high stress also reported
problem drinking patterns and nearly
one third reported inappropriately
aggressive behavior.
Our findings generally support
earlier stress research linking work
stress to health problems and health
risk behaviors.51 Our findings also
support and extend other police
stress research. For instance, in addition to several critical incidents commonly reported as stressful, we
found that needlestick injuries were
also highly stressful. Given that 50%
of the officers reported a history of
needlestick injury, this type of exposure may represent a law enforcement problem of some concern, especially because the negative impact
of needlesticks was second only to
attending a police funeral.
In contrast to other police stress
research, we did not obtain the same
level of association between police
stress and various organizational
stressors. For example, although
both organizational structure and inequitable treatment have previously
been identified as important sources
of police work stress, this was not the
case for this older cohort. It may be
that our respondents learned, over
time, to adapt to the management
structure so that it no longer bothered
them, or perhaps officers who were
especially distressed by these aspects
were no longer on the police force.
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TABLE 4
Adjusted OR of Stress-Related Health Outcomes by Perceived Sources of Stress at Work*
% Reporting
Outcome Variable
Psychological
Anxiety
Depression
Somatization
PTSD
Burnout
Physical
Chronic back pain
High blood pressure
Migraine
Foot problems
Heart disease
Behavior
Alcoholism
Smoking
Accidents
Aggression
Multivariate
Univariate
High
Stress
Low
Stress
OR
95% CI
OR
95% CI
57.8
75.6
71.1
53.0
73.0
16.7
25.0
30.0
28.0
32.0
6.84
9.27
5.74
2.89
5.93
12.81 6.65
3.1822.54
2.4713.33
1.29 6.47
2.5413.86
4.06
10.14
5.60
2.89
6.56
1.4911.04
3.8826.54
2.3513.35
1.28 6.51
2.5117.09
62.8
36.4
18.6
48.8
19.1
32.2
45.0
10.5
19.0
13.6
3.55
NS
NS
4.08
NS
1.57 8.06
4.04
NS
NS
4.09
NS
1.5010.84
60.0
40.0
9.0
27.0
32.0
22.0
3.0
8.0
3.24
NS
NS
4.00
1.457.22
2.76
NS
NS
5.13
1.017.55
1.699.81
1.3411.88
1.6310.23
1.5217.29
* OR, odds ratio; CI, confidence interval; PTSD, posttraumatic stress disorder; NS, not significant.
Adjusted for demographic and coping variables.
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Conclusions
These results highlight the importance of the development and implementation of interventions that either
moderate stressors or improve coping skills, or both, for aging, highrisk workers. Specific stress reduction interventions that address the
needs and concerns of the older work
population are needed. For instance,
aging workers may benefit not only
from job/task modifications that support their continued and safe employment but also from special programs that enhance their coping
capabilities by encouraging the substitution of negative health habits for
more effective and health-promoting
strategies. Support groups for older,
at-risk workers might be structured
to promote healthy preretirement,
and membership in these groups
Gershon et al
Acknowledgments
The original study Project SHIELDS
was funded by the National Institute of Justice. The authors appreciate the editorial assistance of Ms Jane Shipley and the review
comments of Dr Ray Sinclair. A special thank
you to Mr Gary McLhinney, President of the
Fraternal Order of Police, Baltimore Chapter;
Ms Dottie Woods; and Colonel Margaret
Patten for their helpful and generous support
for this project.
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