Forte Journal Of Neuroscience and Psychology Volume 1 Issue 3 2019 Review Article Citation: Anish S. Shah. “Posttraumatic Stress Disorder Among Law Enforcement Officers: A Review of Risk Factors and Current Trends in Treatment ”. Forte Journal Of Neuroscience and Psychology 1.3 (2019): 1-14 Page | 1 Posttraumatic Stress Disorder Among Law Enforcement Officers: A Review of Risk Factors and Current Trends in Treatment Anish S. Shah *1 1 MD, 480 B Tesconi Circle, Santa Rosa, California 95401 *Corresponding Author: Anish Shah, MD, 480 B Tesconi Circle, Santa Rosa, California 95401 E-mail: [email protected]Received: October 01, 2019; Accepted: October 15, 2019; Published: November 10, 2019 Active duty law enforcement officers are at risk of developing posttraumatic stress disorder (PTSD). Concerns about job status might impede the individual from seeking treatment. Relatively little is known about the emergence and subsequent effects of PTSD among active duty law enforcement officers. It is unclear whether traditional treatment for the disorder is appropriate in this unique population. The current literature on PTSD among law enforcement officers is reviewed using the Ovid Psych Info, Ovid Medline, and NCBI PubMed databases. Data suggest that law enforcement officers exhibiting poorer general adjustment, past history of adversity, personal psychiatric history, familial psychiatric history, and a tendency to engage in cognitive avoidance of distressing thoughts as well as memories about past stressful events are at a greater risk for suffering from PTSD. Further research is suggested to improve the understanding of PTSD and its treatment within law enforcement. Keywords: Occupational trauma exposure, chronic trauma exposure, posttraumatic stress disorder, law enforcement, treatment. Individuals employed in law enforcement are exposed to a significant degree of job-related stress and traumatic events. Law enforcement officers who experience severe events or who are exposed to a high number of traumatic situations are at greater risk for developing symptoms of traumatic stress, such as chronic sleep loss, intrusion and avoidance symptoms such as flashbacks, and depression (Arble, Lumley, Pole, Blessman, & Arnetz, 2016; Fleischmann, Strode, Broussard, & Compton, 2016; Green, 2001; Holowka & Marx, 2012; Kopel & Friedman, 1999; LeBlanc, Regehr, Jelley, & Barath, 2007; Maia, Marmar, Metzler, Nobrega, Berger, Mendlowicz et al., 2007; Neylan, Brunet, Pole, Best, Metzler, Yehuda et al., 2004; Regehr, Hill, Knott, & Sault, 2003; Rehehr, Johanis, Dimitropoulos, Bartram, & Hope, 2003). Symptoms of traumatic stress can have detrimental effects on the individual’s occupational and/or academic functioning Introduction Abstract
14
Embed
Posttraumatic Stress Disorder Among Law Enforcement ... · prevalent anxiety and anxiety-related disorders (Connor & Butterfield, 2003). Projected lifetime prevalence of PTSD using
This document is posted to help you gain knowledge. Please leave a comment to let me know what you think about it! Share it to your friends and learn new things together.
Transcript
Forte Journal Of Neuroscience and Psychology Volume 1 Issue 3 2019
Review Article
Citation: Anish S. Shah. “Posttraumatic Stress Disorder Among Law Enforcement Officers: A Review of Risk Factors and Current Trends in Treatment”. Forte Journal Of Neuroscience and Psychology 1.3 (2019): 1-14
Page | 1
Posttraumatic Stress Disorder Among Law Enforcement Officers: A
Review of Risk Factors and Current Trends in Treatment
Anish S. Shah *1
1 MD, 480 B Tesconi Circle, Santa Rosa, California 95401
*Corresponding Author: Anish Shah, MD, 480 B Tesconi Circle, Santa Rosa, California 95401
Forte Journal Of Neuroscience and Psychology Volume 1 Issue 3 2019
Review Article
Citation: Anish S. Shah. “Posttraumatic Stress Disorder Among Law Enforcement Officers: A Review of Risk Factors and Current Trends in Treatment”. Forte Journal Of Neuroscience and Psychology 1.3 (2019): 1-14
Page | 2
(Smith, Schnurr, & Rosenheck, 2005), their
interpersonal relationships (Bolton, Hill, O’Ryan,
Udwin et al., 2004), their marital relationship (Sayers,
Farrow, Ross, & Oslin, 2009), and even their overall
family functioning (Cohen, Zerach, & Solomon, 2011;
Sayers et al., 2009). Among law enforcement officers
untreated PTSD can have cumulative effects on
functioning and is a serious public health issue (Ellrich
& Baier, 2015; Violanti, 2014).
While both psychological and physiological responses
to intensely stressful and traumatic events have long
been recognized and studied, PTSD as a distinct
diagnostic category did not emerge until the 1980s,
when it first appeared in the third edition of the
Diagnostic and Statistical Manual of Mental Disorders
(DSM-III; American Psychiatric Association [APA],
1980). PTSD was not extensively studied prior to 1980,
and research on various treatment options and their
applicability to specific populations remains sparse.
There have also been changes to the diagnostic criteria
for PTSD in each subsequent manual (APA, 1980;
APA, 2013; APA, 2015).
Despite these subtle changes, a diagnosis of PTSD is
generally warranted when an individual exhibits
excessively recurrent distressing symptoms following
an episode of intense stress or trauma and causes the
individual some degree of impairment in their ability to
function on a day to day basis. Most recently, the DSM-
5 has adopted a four-cluster framework for categorizing
the individual symptoms of PTSD (APA, 2015). These
Relatively little is known about the emergence and
subsequent effects of PTSD among active duty law
enforcement officers (Arble et al., 2016). Much of the
existing data are based upon samples of military
veterans (Sayers et al., 2009). Current studies have
begun to emerge exploring PTSD within the law
enforcement population (Ellrich & Baier, 2015).
Findings from this literature might help explain why
many law enforcement officers suffer from unmanaged
symptoms of PTSD and inform treatment
recommendations for this specific population.
Forte Journal Of Neuroscience and Psychology Volume 1 Issue 3 2019
Review Article
Citation: Anish S. Shah. “Posttraumatic Stress Disorder Among Law Enforcement Officers: A Review of Risk Factors and Current Trends in Treatment”. Forte Journal Of Neuroscience and Psychology 1.3 (2019): 1-14
Page | 3
A literature search was conducted in the databases Ovid
Tak, 2008; Yuan, Wang, Inslicht, McCaslin, Metzler,
Henn-Haase et al., 2011).
According to surveys conducted by World
Mental Health (WMH), relatively low conditional
prevalence rates of PTSD were identified across other
countries. The conditional prevalence of PTSD in South
Africa was 3.5%, which is quite similar to the 3.3%
conditional prevalence of PTSD in Spain, and
somewhat higher than the rate of 2.5% in Italy (Atwoli
et al., 2013; Ellrich & Baier, 2015; Kawakami et al.,
METHODS
RESULTS
Forte Journal Of Neuroscience and Psychology Volume 1 Issue 3 2019
Review Article
Citation: Anish S. Shah. “Posttraumatic Stress Disorder Among Law Enforcement Officers: A Review of Risk Factors and Current Trends in Treatment”. Forte Journal Of Neuroscience and Psychology 1.3 (2019): 1-14
Page | 4
2014; Levy-Gigi, Richter-Levin, & Kéri, 2014). The
type of trauma also may play a role in the development
of PTSD symptoms, which is particularly relevant for
law enforcement officers. According to WMH surveys,
higher conditional prevalence rates of developing PTSD,
particularly in response to being exposed to sexual and
physical violence, were reported in Spain, Japan, and
Northern Ireland (Atwoli et al., 2013; Ellrich & Baier,
2015). In comparison to the general population, law
enforcement officers are much more likely to be
directly exposed to these types of trauma in the line of
duty, placing them at greater risk for developing
symptoms of PTSD.
Risk Factors:
A few studies exist which have examined the potential
risk factors for developing PTSD among law
enforcement officers, particularly those who are
involved in emergency service work. It seems that
officers who exhibit poorer general adjustment, past
history of adversity, personal psychiatric history,
familial psychiatric history, and a tendency to engage in
cognitive avoidance of distressing thoughts and
memories about past stressful events are at a much
greater risk for suffering from PTSD (Hetherington,
1993). Findings from a study conducted by Weiss and
colleagues (1995) suggested that officers in emergency
service who tended to dissociate were more at risk for
later developing symptoms of PTSD than their peers
who did not exhibit this same tendency toward
dissociation.
Other factors that place law enforcement
officers at increased risk for developing PTSD
symptoms following a traumatic event at work include
individual’s personality characteristics, including their
Forte Journal Of Neuroscience and Psychology Volume 1 Issue 3 2019
Review Article
Citation: Anish S. Shah. “Posttraumatic Stress Disorder Among Law Enforcement Officers: A Review of Risk Factors and Current Trends in Treatment”. Forte Journal Of Neuroscience and Psychology 1.3 (2019): 1-14
Page | 5
general temperament, likely contribute to developing
symptoms of PTSD, as well as their likelihood of
getting treatment when symptoms become a problem.
It should be noted that it is reasonable to
expect emotional responses to trauma. Almost all
individuals will exhibit some degree of symptoms
shortly after a traumatic event. These responses, which
typically resolve within several days, several weeks, or
even a few months, are considered normal and non-
pathological (Atwoli et al., 2013; Bisson, Tavakoly,
Witteveen, Ajdukovic et al., 2010). It is believed that
these symptoms are part of the cognitive and emotional
processing of the event that must be completed in order
to move toward acceptance, greater resilience, and
posttraumatic growth. Continued work in reducing risk
factors for law enforcement is crucial, as prevalence
rates have been estimated to be as much as 13% for
PTSD symptoms among suburban law enforcement
officers (Yehuda, McFarlane, & Shalev, 1998).
Therefore, a large portion of active duty law
enforcement officers face exposure to potentially
stressful and traumatizing events on a regular basis.
Previous work on PTSD demonstrates that a dose-
response relationship exists between exposure to a
traumatic event or stressor and the development of
negative mental health outcomes (Heavey, Homish,
Andrew, McCanlies, Mnatsakanova, Violanti et al.,
2015). This means that the more severe the trauma
event, the greater likelihood there is for developing
symptoms of the disorder (APA, 2015). Fullerton and
colleagues (2004) found that first responders to the
September 11th attacks exhibited higher rates of acute
stress disorder, posttraumatic stress disorder, and
depressive disorder, than a comparison group. This is
often exacerbated by being assigned to atypical work
activities during a disaster, in which they may not have
received adequate training for, as well as strenuous
work hours, sleep deprivation, separation from family
and support, and home destruction (Bernard et al.,
2006).
Comorbid Conditions:
The rate of comorbidity between PTSD and other
psychiatric conditions within the general population is
quite high. Lifetime estimates have suggested that
between 70 and 80% of individuals suffering from
PTSD also have a co-occurring psychiatric condition
(Brady, Killeen, Brewerton, & Lucerini, 2000). Some of
the most common co-occurring psychiatric conditions
include: Generalized Anxiety Disorder (GAD),
Obsessive-Compulsive Disorder (OCD), Alcohol and
Drug abuse, Depression, and even Schizophrenia. The
link between PTSD and substance abuse disorders is
quite strong. Individuals who are diagnosed with PTSD
are 4.5 times more likely to subsequently develop a
Hughes, & Nelson, 1995). There are several possible
explanations to account for the high comorbidity
between PTSD and substance abuse disorders. Some
have postulated that individuals with PTSD use and
abuse substances as a way to escape their intense
feelings of discomfort associated with difficult
memories or flashbacks of the trauma (Araújo et al.,
2013). This framework for understanding the
comorbidity is known as the self-medicating model.
Another model that has been widely accepted in terms
of understanding the link between PTSD and substance
abuse disorders is the high-risk model. This model
suggests that individuals who experience more frequent
traumatic situations inherently take more risks and are
therefore more likely to abuse substances (Atwoli et al.,
2015).
Findings from several studies have suggested
that the rates of comorbidity within populations of law
Forte Journal Of Neuroscience and Psychology Volume 1 Issue 3 2019
Review Article
Citation: Anish S. Shah. “Posttraumatic Stress Disorder Among Law Enforcement Officers: A Review of Risk Factors and Current Trends in Treatment”. Forte Journal Of Neuroscience and Psychology 1.3 (2019): 1-14
Page | 6
enforcement officers are similar to the comorbidity rates
observed within the general population (Breslau et al.,
1998; Kessler et al., 1995). More work is necessary in
this area to more carefully estimate the rates of
comorbidity among law enforcement officers, given the
differential prevalence rates of other conditions within
this unique population. Comorbidities that accompany
PTSD can lead to many distinct treatment challenges,
given the complex intertwining of the mental and
physical aspects of each of the conditions. This will be
described in more detail below.
Treatment:
As with many other mental health conditions presenting
to health care facilities, PTSD is under-recognized and
often left untreated. Undiagnosed and untreated PTSD
is of particular concern among individuals employed in
law enforcement, given the degree of debilitation
associated with the condition and the risk for chronic
exposure to traumatic events. Some have even
suggested that PTSD is among the most severe and
impairing of all psychiatric diagnoses (Bobo, Warner, &
Warner, 2007). The onset of symptoms for this
condition is often delayed weeks, months, or even years
following the significant traumatic event, which can
lead to longer delays in receiving adequate treatment,
while in most instances prevention and early
intervention are recommended (APA, 2015).
In guidelines published by the Department of
Veterans Affairs/Department of Defense (VA/DoD;
2010), it is recommended that reasonable efforts be
made to increase the psychological resilience of
workers who are employed in high-risk occupations
where the probability of trauma exposure is moderate or
high. While very little is known about the possibility of
adequately preparing an individual or community for
exposure to a traumatic event, several suggestions are
identified for pre-trauma preparation that take into
account theoretical models of the development of PTSD,
existing empirical work on risk factors for developing
explicit implementation of these recommendations is
not commonly practiced in most workplaces, with the
exception of some military training environments, and
there is little evidence on the use of these prevention
strategies within law enforcement.
Recommendations have also been made for
steps to take following exposure to trauma (Baldwin,
Anderson, Nutt, Allgulander, Bandelow, den Boer et al.,
2014; CADTH, 2015; VA/DoD, 2010). For known
cases of exposure to trauma, it is important to assess the
exposure in terms of type, frequency, nature, and
severity. Not all individuals who have been exposed to
trauma and may be at risk for developing PTSD self-
identify as suffering from symptoms of the disorder.
Therefore, these guidelines also include provisions for
screening individuals for potential symptoms, while
also remaining sensitive to concerns regarding social
Forte Journal Of Neuroscience and Psychology Volume 1 Issue 3 2019
Review Article
Citation: Anish S. Shah. “Posttraumatic Stress Disorder Among Law Enforcement Officers: A Review of Risk Factors and Current Trends in Treatment”. Forte Journal Of Neuroscience and Psychology 1.3 (2019): 1-14
Page | 7
stigma and adverse occupational effects from results of
the screen, both of which are particularly important for
individuals employed in law enforcement positions.
For individuals who have been identified as
meeting criteria for PTSD, recommendations include
both psychotherapy, specifically those that are
evidenced-based, and pharmacotherapy as potential
first-line treatments (Baldwin et al., 2014; CADTH,
2015; VA/DoD, 2010). In terms of psychotherapy
interventions that have received support for the
treatment of PTSD symptoms within the general public,
these methods include exposure-based therapy,
cognitive behavior therapy (CBT), eye movement
desensitization and reprocessing (EMDR), relaxation
techniques, imagery rehearsal therapy, brief
psychodynamic therapy, and hypnotic techniques. In
terms of pharmacotherapy, medications receiving the
strongest support include selective serotonin reuptake
inhibitors (SSRIs; fluoxetine, paroxetine, or sertraline),
or serotonin-norepinephrine reuptake inhibitors (SNRIs;
venlafaxine). Several other drugs have also been
suggested for the treatment of PTSD, including tricyclic
antidepressants and monoamine oxidase inhibitors.
While in most instances a combination of
psychotherapy and pharmacotherapy is recommended
as best practice, monotherapy with either psychotherapy
or pharmacotherapy is recommended as a first-line
treatment for PTSD (CADTH, 2015). Across all
guidelines, no specific provisions were identified for
working with individuals employed in law enforcement.
Moreover, there are relatively few studies available that
examine the effectiveness and applicability of these
interventions among populations of law enforcement
officers in particular and more work is necessary to
address this gap in the literature (Grauwiler, Barocas, &
Mills, 2008).
According to practice guidelines established by the
International Society for Traumatic Stress Studies,
PTSD is associated with significant impairments within
the workplace (Kessler et al., 1995). This is of
particular concern with regard to law enforcement,
given that they face emotionally taxing and traumatic
experiences regularly as part of their chosen career.
PTSD has been associated with approximately 3.6 lost
days of productivity at work every month across the
United States (Fox et al., 2012). This lost time emerges
primarily in the form of decreased productivity and
absenteeism. This highlights the need for appropriate
interventions to address the detrimental effects of PTSD
within the workplace in order to help the individual
effectively return to work (Evans, Pistrang, & Billings,
2013). Of note, the most important factor to consider
with regard to treatment for PTSD among law
enforcement officers is early intervention during the
acute phase immediately following a traumatic or
potentially traumatic event (Stergiopoulos et al., 2011;
VA/DoD, 2010). This is the period of time when the
individual begins to regain their emotional control over
the situation, restores interpersonal communications, re-
consolidates their identity, regains their sense of
empowerment through reengagement in work, and
begins to build their sense of hope and anticipation of
particular, was thought to be ideal in treating the
impairing symptoms of PTSD. CBT alone is regarded
as the ‘gold standard’ for treating many different
anxiety disorders and has been shown to be more
effective in reducing symptoms of PTSD than
Forte Journal Of Neuroscience and Psychology Volume 1 Issue 3 2019
Review Article
Citation: Anish S. Shah. “Posttraumatic Stress Disorder Among Law Enforcement Officers: A Review of Risk Factors and Current Trends in Treatment”. Forte Journal Of Neuroscience and Psychology 1.3 (2019): 1-14
Page | 8
medication (Bisson et al., 2010; Cusack et al., 2015;
Roberts, Kitchiner, Kenardy, & Bisson, 2009). This
treatment is regarded as well established, following
many empirical studies examining its effectiveness.
CBT is unique in that the emphasis is placed primarily
on the individual’s present situation and is more
problem-focused than most other treatments.
Individuals who participate in CBT learn skills in
identifying distorted patterns of thinking and how to
modify their beliefs. With the E/RP component,
individuals then begin to practice facing situations that
they previous avoided in a structured and graded way.
This treatment is based upon the idea that a person’s
thoughts and beliefs about a situation have a powerful
influence over the manner in which they feel and
behave in those types of situations. Individuals
gradually learn to face distressing thoughts and
memories of the traumatic event, which in turn reduces
the associated distress.
Another commonly recommended treatment
for managing symptoms of PTSD is Eye Movement
Desensitization and Reprocessing (EMDR) therapy.
This is an integrative approach which has received
some support for its effectiveness in treating symptoms
of PTSD. Hypnosis has also been used with some
success (Cusack et al., 2015). Medication may also be
prescribed for treating symptoms of PTSD. These
medications would be used to treat the impairing
symptoms of the condition, such as prolonged insomnia
and/or intense feelings of anxiety or panic. Though
currently available medications are not as effective as
participation in a course of CBT, some individuals may
prefer this treatment plan as taking medication is more
convenient than psychotherapy (Cusack et al., 2015).
Given the stigma that still exists in terms of mental
health, the law enforcement population, in particular,
may prefer medications given their discrete nature, as
they do not have to leave work in order to attend regular
weekly appointments.
According to clinical trials, selective serotonin
reuptake inhibitors (SSRIs) are considered the gold
standard for treating symptoms of PTSD (Brady et al.,
2000; Cusack et al., 2015; Marshall, Beebe, Oldham, &
Zaninelli, 2001). Both sertraline (brand name: Zoloft)
and paroxetine (brand name: Paxil) have received
approval from the Food and Drug Administration
(FDA) as a first-line treatment for PTSD (Brady et al.,
2000; Cusack et al., 2015; Friedman, Marmar, Baker,
Sikes, & Farfel, 2007; Marshall et al., 2001).SSRIs may
not be indicated for managing symptoms of PTSD and
alternative medications may be considered for
individuals exhibiting symptoms of comorbid
conditions such as bipolar disorder, as SSRIs have been
shown to induce manic episodes. Other medications can
be used off-label for treating PTSD and have received
some support from previous trials, though more work is
necessary to more fully explore their efficacy in treating
treatment owing to the stigma of mental health and fear
of repercussions at work. More work is necessary in
order to identify and reduce any potential barriers to
seeking treatment.
Forte Journal Of Neuroscience and Psychology Volume 1 Issue 3 2019
Review Article
Citation: Anish S. Shah. “Posttraumatic Stress Disorder Among Law Enforcement Officers: A Review of Risk Factors and Current Trends in Treatment”. Forte Journal Of Neuroscience and Psychology 1.3 (2019): 1-14
Page | 9
PTSD is a complex disorder for which symptoms
emerge six months or more following exposure to an
intense and emotionally taxing or traumatic situation
and law enforcement officers may be at greatest risk for
developing difficulties with regard to PTSD, given their
regular exposure to traumatic events (Robinson, Sigman,
& Wilson, 1997; Zelazny & Simms, 2015). Law
enforcement officers suffering from untreated or
unmanaged PTSD are at an increased risk for
impairments at work, loss of productivity, and even
developing other comorbidity psychiatric conditions,
such as depression or substance use disorder. It may be
difficult for law enforcement officers to consider
seeking treatment, owing to limited time-off and stigma
surrounding mental health. Therefore, this population
brings a collection of unique barriers to receiving the
help that they need. The most recommended treatment
approach for PTSD among law enforcement officers is
CBT, which targets the individual’s experiential
avoidance of the traumatic event. Other treatments for
PTSD include EMDR and hypnosis, though more work
is necessary in order to provide adequate empirical
support for these techniques in their effectiveness in
treating the symptoms of PTSD.
1. Adjeroh, L. C., McCanlies, E. C., Andrew, M.
E., Burchfield, C. M., & Violanti, J. M. (2014).
Stressful life events and posttraumatic growth
among police officers. Annals of
Epidemiology, 24(9), 701.
2. Alexander, D. A., & Wells, A. (1991).
Reactions of police officers to body handling
after a major disaster: A before and after
comparison. British Journal of Psychiatry,
159(4), 517-555. doi: 10.1192/bjp.159.4.547
3. American Psychiatric Association. (1980).
Diagnostic and statistical manual of mental
disorders (3rd ed.). Washington, DC: Author.
4. American Psychiatric Association. (2013).
Diagnostic and statistical manual of mental
disorders (4th ed.). Washington, DC: Author.
5. American Psychiatric Association. (2015).
Diagnostic and statistical manual of mental
disorders (5th ed.). Washington, DC: Author.
6. Araújo, A. X., Berger, W., Coutinho, E. S.,
Marques-Portella, C., Luz, M. P., Cabizuca,
M.,…Mendlowicz, M. V. (2013). Comorbid
depressive symptoms in treatment-seeking
PTSD outpatients affect multiple domains of
quality of life. Comprehensive Psychiatry,
55(1), 56-63. doi:
10.1016/j.comppsych.2013.09.004
7. Arble, E., Lumley, M. A., Pole, N., Blessman,
J., & Arnetz, B. B. (2016). Refinement and
Preliminary Testing of an Imagery-Based
Program to Improve Coping and Performance
and Prevent Trauma Among Urban Police
Officers. Journal of Police and Criminal
Psychology, 1-10. doi:10.1007/s11896-016-
9191-z
8. Atwoli, L., Stein, D. J., Koenen, K. C., &
McLaughlin, K. A. (2015). Epidemiology of
posttraumatic stress disorder: Prevalence,
correlates and consequences. Current Opinion
in Psychiatry, 28(4), 307-311. doi:
10.1097/YCO.0000000000000167
9. Atwoli, L., Stein, D. J., Williams, D. R.,
McLaughlin, K. A., Petukhova, M., Kessler, R.
CONCLUSIONS
REFERENCES
Forte Journal Of Neuroscience and Psychology Volume 1 Issue 3 2019
Review Article
Citation: Anish S. Shah. “Posttraumatic Stress Disorder Among Law Enforcement Officers: A Review of Risk Factors and Current Trends in Treatment”. Forte Journal Of Neuroscience and Psychology 1.3 (2019): 1-14
Page | 10
C., & Koenen, K. C. (2013). Trauma and
posttraumatic stress disorder in South Africa:
Analysis from the South African Stress and
Health Study. BMC Psychiatry, 13, 182. doi:
10.1186/1471-244X-13-182
10. Baldwin, D. S., Anderson, I. M., Nutt, D. J.,
Allgulander, C., Bandelow, B., den Boer, J. A.,
Christmas, D. M., Davies, S., Fineberg, N. et
al., (2014). Evidence-based pharmacological
treatment of anxiety disorders, post-traumatic
stress disorder and obsessive-compulsive
disorder: A revision of the 2005 guidelines
from the British Association for
Psychopharmacology. Journal of
Psychopharmacology, 28(5), 403-439. doi:
10.1177/0269881114525674
11. Bernard, B., Driscoll, R., Kitt, M., West, C.,
Tak, S. (2006). Health hazard evaluation of
police officers and firefighters after Hurricane
Katrina – New Orleans, Louisiana, October 17-
28 and November 30-December 5, 20005.
MMWR: Morbidity and Mortality Weekly
Report, 55(16), 456-458.
12. Bisson, J.I., Tavakoly, B., Witteveen, A. B.,
Ajdukovic, D. Jehel, L., Johansen, V. J.,…Olff,
M. (2010). TENTS guidelines: Development
of post-disaster psychosocial care guidelines
through a Delphi process. British Journal of
Psychiatry, 196(1), 69–74. doi:
10.1192/bjp.bp.109.066266
13. Bobo, W. V., Warner, C. H., & Warner, C. M.
(2007). The management of post traumatic
stress disorder (PTSD) in the primary care
setting. Southern Medical Journal, 100(8),
797–802.
14. Bolton, D., Hill, J., O’Ryan, D., Udwin, O.,
Boyle, S., & Yule, W. (2004). Long-term
effects of psychological trauma on
psychosocial functioning. Journal of Child
Psychology and Psychiatry, 45(5), 1007-1014.
doi: 10.1111/j.1469-7610.2004.t01-1-00292.x
15. Brady, K. T., Killeen, T. K., Brewerton, T., &
Lucerini, S. (2000). Comorbidity of psychiatric
disorders and posttraumatic stress disorder.
Journal of Clinical Psychiatry, 61(Suppl 7),
22-32.
16. Brady, K. T., Pearlstein, T., Asnis, G. M.,
Baker, D., Rothbaum, B., Sikes, C. R., &
Farfel, G. M. (2000). Efficacy and safety of
sertraline treatment of posttraumatic stress
disorder: A randomized controlled trial.
Journal of the American Medical Association,
283(14), 1837-1844.
doi:10.1001/jama.283.14.1837
17. Breslau, N., Kessler, R. C., Chilcoat, H. D.,
Schultz, L. R., Davis, G. C., & Andreski, P.
(1998). Trauma and posttraumatic stress
disorder in the community: The 1996 Detroit
Area Survey of Trauma. Archives of General
Psychiatry, 55(7), 626-632.
doi:10.1001/archpsyc.55.7.626
18. Breslau, N., Peterson, E. L., Poisson, L. M.
Schultz, L. R., & Lucia, V. C. (2004).
Estimating posttraumatic stress disorder in the
community: Lifetime perspective and the
impact of typical traumatic events.
Psychological Medicine, 34(5), 889–898.
19. Canadian Agency for Drugs and Technologies
in Health (2015). Treatment for post-traumatic
stress disorder, operational stress injury, or
critical incident stress: A review of guidelines
[Internet]. Ottawa (ON): CADTH Rapid
Response Reports. [Epub ahead of print]
20. Carlier, I. V., Lamberts, R. D., & Gersons, B.
P. (1997). Risk factors for posttraumatic stress
symptomatology in police officers: A
Forte Journal Of Neuroscience and Psychology Volume 1 Issue 3 2019
Review Article
Citation: Anish S. Shah. “Posttraumatic Stress Disorder Among Law Enforcement Officers: A Review of Risk Factors and Current Trends in Treatment”. Forte Journal Of Neuroscience and Psychology 1.3 (2019): 1-14
Page | 11
prospective analysis. Journal of Nervous and
Mental Disorder, 185(8), 498–506.
21. Carlier, I. V., Lamberts, R. D., & Gersons, B.
P. (2000). The dimensionality of trauma: A
multidimensional scaling comparison of police
officers with and without posttraumatic stress
disorder. Psychiatry Research, 97, 29-39. doi:
http://dx.doi.org/10.1016/S0165-
1781(00)00211-0
22. Cohen, E., Zerach, G., & Solomon, Z. (2011).
The implication of combat-induced stress
reaction, PTSD, and attachment in parenting
among war veterans. Journal of Family
Psychology, 25(5), 688-698. doi:
10.1037/a0024065
23. Connor, K. M., & Butterfield, M. I. (2003).
Posttraumatic stress disorder. Focus, 1(3), 247-
262. doi: http://dx.doi.org/10.1176/foc.1.3.247
24. Crews, D. J., & Landers, D. M. (1987). A
meta-analytic review of aerobic fitness and
reactivity to psychosocial stressors. Medicine
and Science in Sports and Exercise, 19(5
Suppl), 114–120.
25. Cusack, K., Jonas, D. E., Formeris, C. A.,
Wines, C., Sonis, J., Middleton, J.
C.,…Gaynes, B. N. (2015). Psychological
treatments for adults with posttraumatic stress
disorder: A systematic review and meta-
analysis. Clinical Psychology Review. doi:
10.1016/j.cpr.2015.10.003 [Epub ahead of
print]
26. Darius, S., Heine, J., & Böckelmann, I. (2014).
Prevalence of symptoms of posttraumatic
stress disease in police officers in relation to
job-specific requirements. Psychotherapy and
Psychosomatic Medical Psychology, 64(9-10),
393-396. doi: 10.1055/s-0034-1387729
27. Department of Veterans Affairs, Department of
Defense. (2010). VA/DoD Clinical Practical
Guideline. Management of post-traumatic
stress. [Internet]. Available from:
http://www.healthquality.va.gov/guidelines/M
H/ptsd/cpg_PTSD-full-201011612.PDF
28. Ellrich, K., & Baier, D. (2015). Post-traumatic
stress symptoms in police officers following
violent assaults: A study on general and police-
specific risk and protective factors. Journal of
Interpersonal Violence. doi:
10.1177/0886260515586358 [Epub ahead of
print]
29. Evans, R., Pistrang, N., & Billings, J. (2013).
Police officers’ experiences of supportive and
unsupportive social interactions following
traumatic incidents. European Journal of
Psychotraumatology, 4. doi: 10.3402/ejpt.v4i0
[Epub ahead of print]
30. Fleischmann, M. H., Strode, P., Broussard, B.,
& Compton, M. T. (2016). Law enforcement
officers’ perceptions of and responses to
traumatic events: A survey of officers
completing Crisis Intervention Team training.
Policing and Society, 1-8. doi:
10.1080/10439463.2016.1234469
31. Fox, J., Desai, M. M., Britten, K., Lucas, G.,
Forte Journal Of Neuroscience and Psychology Volume 1 Issue 3 2019
Review Article
Citation: Anish S. Shah. “Posttraumatic Stress Disorder Among Law Enforcement Officers: A Review of Risk Factors and Current Trends in Treatment”. Forte Journal Of Neuroscience and Psychology 1.3 (2019): 1-14
Page | 12
33. Friedman, M. J., Marmar, C. R., Baker, D. G.,
Sikes, C. R., & Farfel, G. M. (2007).
Randomized, double blind comparison of
sertraline and placebo for posttraumatic stress
disorder in Department of Veterans Affairs
setting. Journal of Clinical Psychiatry, 68(5),
711-720.
34. Grauwiler, P. Barocas, B., & Mills, L. G.
(2008). Police peer support programs: Current
knowledge and practice. International Journal
of Emergency Mental Health, 10(1), 27-38.
35. Green, C. (2001). Human remains and the
psychological impact on police officers:
Excerpts from psychiatric observations.
Australasian Journal of Disaster and Trauma
Studies, 2001-2.
36. Heavey, S. C., Homish, G. G., Andrew, M. E.,
McCanlies, E., Mnatsakanova, A., Violanti, J.
M., & Burchfiel, C. M. (2015). Law
enforcement officers’ involvement level in
Hurricane Katrina and alcohol use.
International Journal of Emergency Mental
Health, 17(1), 267-273.
37. Heir, T., Hussain, A., & Weisæth, L. (2008).
Managing the after-effects of disaster
trauma—the essentials of early intervention.
European Psychiatric Review, 1(1), 66–69.
38. Hetherington, A. (1993). Traumatic stress on
the roads. Journal of Social Behavior and
Personality, 8(5), 369-378.
39. Holowka, D. W., & Marx, B. P. (2012).
Assessing PTSD-related functional impairment
and quality of life. In G. J. Beck & D. M.
Sloan (Eds.), Oxford handbook of traumatic
stress disorders. New York (NY): Oxford
University Press.
40. Kawakami, N., Tsuchiya, M., Umeda, M.,
Koenen, K. C., & Kessler, R. C. (2014).
Trauma and posttraumatic stress disorder in
Japan: Results from the World Mental Health
Japan Survey. Journal of Psychiatric Research,
53, 157-165. doi:
10.1016/j.jpsychires.2014.01.015
41. Kessler, R. C., Sonnega, A., Bromet, E.,
Hughes, M. & Nelson, C. B. (1995).
Posttraumatic stress disorder in the National
Comorbidity Survey. Archives of General
Psychiatry, 52(12), 1048–1060.
42. Kopel H., & Friedman, M. (1999). Effects of
exposure to violence in South African police.
In J. Violanti & D. Paton (Eds.), Police
Trauma: The Aftermath of Civilian Combat
(pp 99-112). Springfield (IL): Charles Thomas.
43. LeBlanc, V. R., Regehr, C., Jelley, R. B., &
Barath, I. (2007). Does posttraumatic stress
disorder (PTSD) affect performance? Journal
of Nervous and Mental Disorder, 195, 701-704.
44. Levy-Gigi, E., Richter-Levin, G., & Kéri, S.
(2014). The hidden price of repeated traumatic
exposure: Different cognitive deficits in
different first-responders. Frontiers in
Behavioral Neuroscience, 8. doi:
10.3389/fnbeh.2014.00281 [Epub]
45. Maia, D. B., Marmar, C. R., Metzler, T.,
Nóbrega, A., Berger, W., Mendlowicz, M. V.,
Coutinho, E. S., & Figueira, I. (2007). Post-
traumatic stress symptoms in an elite unit of
Brazilian police officers: Prevalence and
impact on psychosocial functioning and on
physical and mental health. Journal of
Affective Disorders, 97(1-3), 241-245. doi:
http://dx.doi.org/10.1016/j.jad.2006.06.004
46. Marshall, R. D., Beebe, K. L., Oldham, M., &
Zaninelli, R. (2001). Efficacy and safety of
paroxetine treatment for chronic PTSD: A
fixed-dose, placebo-controlled study.
Forte Journal Of Neuroscience and Psychology Volume 1 Issue 3 2019
Review Article
Citation: Anish S. Shah. “Posttraumatic Stress Disorder Among Law Enforcement Officers: A Review of Risk Factors and Current Trends in Treatment”. Forte Journal Of Neuroscience and Psychology 1.3 (2019): 1-14
Page | 13
American Journal of Psychiatry, 158(12),
1982-1988. doi:
http://dx.doi.org/10.1176/appi.ajp.158.12.1982
47. McFarlane, A. C. (1988). The aethiology of
post-traumatic stress disorders following a
natural disaster. British Journal of Psychiatry,
152, 116-121.
48. Mumford, E. A., Taylor, B. G., & Kubu, B.
(2015). Law Enforcement Officer Safety and
Wellness. Police Quarterly, 18(2), 111-133.
49. Neylan, T. C., Brunet, A., Pole, N., Best, S. R.,
Metzler, T. J., Yehuda, R., & Marmar, C. R.
(2005). PTSD symptoms predict waking
salivary cortisol levels in police officers.
Psychoneuroendocrinology, 30(4), 373-381.
DOI:
http://dx.doi.org/10.1016/j.psyneuen.2004.10.0
05
50. Rabe-Hemp, C. (2008). Survival in an “all
boys club”: Policewomen and their fight for
acceptance. International Journal of Police
Strategies & Management, 31, 251-270.
51. Regehr, C., Hill, J., Knott, T., & Sault, B.
(2003). Social support, self-efficacy, and
trauma in new recruits and experienced
firefighters. Stress and Health, 19, 189-193.
52. Regehr, C., Johanis, D., Dimitropoulous, G.,
Bartram, C., & Hope, G. (2003). The police
officer and the public inquiry. Brief Treatment
and Crisis Intervention, 3, 383-396.
53. Resick, P. A., Friedman, M. J., & Keane, T. M.
(2007). Handbook of PTSD, Science and
Practice. New York: Guilford Press.
54. Roberts, N. P., Kitchiner, N. J., Kenardy, J., &
Bisson, J. I. (2009). Systematic review and
meta-analysis of multiple-session early
interventions following traumatic events.
American Journal of Psychiatry, 166(3), 293–
301. doi: 10.1176/appi.ajp.2008.08040590
55. Robinson, H. M., Sigman, M. R., & Wilson, J.
P. (1997). Duty-related stressor and PTSD
symptoms in suburban police officers.
Psychological Reports, 81(3 Pt 1), 835-845.
56. Sayers, S. L., Farrow, V. A., Ross, J., & Oslin,
D. W. (2009). Family problems among
recently returned military veterans referred for
a mental health evaluation. Journal of Clinical
Psychiatry, 70(2), 163-170. doi:
10.4088/JCP.07m03863
57. Smith, M. W., Schnurr, P. P., & Rosenheck, R.
A. (2005). Employment outcomes and PTSD
symptom severity. Mental Health Services
Research 7(2), 89-101. doi: 10.1007/s11020-
005-3780-2
58. Stergiopoulos, E., Cimo, A., Cheng, C.,
Bonato, S., & Dewa, C. S. (2011).
Interventions to improve work outcomes in
work-related PTSD: A systematic review.
BMC Public Health, 11, 838. doi:
10.1186/1471-2458-11-838
59. Turnbull, G. J. (1998). A review of post-
traumatic stress disorder. Part I: Historical
development and classification. Injury, 29, 87-
91. doi: http://dx.doi.org/10.1016/S0020-
1383(97)00131-9
60. van der Meer, C. A., Bakker, A., Smit, A. S.,
van Buschbach, S., den Dekker, M.,
Westerveld, G. J., ... & Olff, M. (2016).
Gender and Age Differences in Trauma and
PTSD Among Dutch Treatment-Seeking
Police Officers. The Journal of Nervous and
Mental Disease.
61. Violanti, J. M. (2014). Dying for the job:
Police work exposure and health. Charles C
Thomas Publisher.
Forte Journal Of Neuroscience and Psychology Volume 1 Issue 3 2019
Review Article
Citation: Anish S. Shah. “Posttraumatic Stress Disorder Among Law Enforcement Officers: A Review of Risk Factors and Current Trends in Treatment”. Forte Journal Of Neuroscience and Psychology 1.3 (2019): 1-14
Page | 14
62. Weiss, D. S., Marmar, C. R., Metzler, T. J., &
Ronfeldt, H. M. (1995). Predicting
symptomatic distress in emergency service
personnel. Journal of Consulting and Clinical
Psychology, 63(3), 361-368. doi:
http://dx.doi.org/10.1037/0022-006X.63.3.361
63. Wessely, S., & Dandeker, C. (2010). King’s
Centre for Military Health Research: A Fifteen
Year Report. What Has Been Achieved by
Fifteen Years of Research into the Health of
the UK Forces? London: King’s College.
64. West, C., Bernard, B., Mueller, C., Kitt, M.,
Driscoll, R., & Tak, S. (2008). Mental health
outcomes in police personnel after Hurricane
Katrina. Journal of Occupational and
Environmental Medicine, 50, 689-695. doi:
10.1097/JOM.0b013e3181638685
65. Yehuda, R., McFarlane, A., & Shalev, A.
(1998). Predicting the development of
posttraumatic stress disorder from the acute
response to a traumatic event. Biological
Psychiatry, 44(12), 1305-1313. doi:
http://dx.doi.org/10.1016/S0006-
3223(98)00276-5
66. Yoo, H., & Franke, W. D. (2010). Stress and
cardiovascular disease risk in female law
enforcement officers. International Archives of
Occupational and Environmental Health, 84(3),
279-286. doi: 10.1007/s00420-010-0548-9
67. Yuan, C., Wang, Z., Inslicht, S. S., McCaslin,