Peritraumatic and trait dissociation differentiate police officers with resilient versus symptomatic trajectories of posttraumatic stress symptoms

Research has consistently demonstrated that stress reactions to potentially traumatic events do not represent a unified phenomenon. Instead, individuals tend to cluster into prototypical response patterns over time including chronic symptoms, recovery, and resilience. We examined heterogeneity in a posttraumatic stress disorder (PTSD) symptom course in a sample of 178 active-duty police officers following exposure to a life-threatening event using latent growth mixture modeling (LGMM). This analysis revealed 3 discrete PTSD symptom trajectories: resilient (88%), distressed-improving (10%), and distressed-worsening (2%). We further examined whether trait and peritraumatic dissociation distinguished these symptom trajectories. Findings indicate that trait and peritraumatic dissociation differentiated the resilient from the distressed-improving trajectory (trait, p < .05; peritraumatic, p < .001), but only peritraumatic dissociation differentiated the resilient from the distressed-worsening trajectory (p < .001). It is essential to explore heterogeneity in symptom course and its predictors among active-duty police officers, a repeatedly exposed group. These findings suggest that police officers may be a highly resilient group overall. Furthermore, though there is abundant evidence that dissociation has a positive linear relationship with PTSD symptoms, this study demonstrates that degree of dissociation can distinguish between resilient and symptomatic groups of individuals.     

Patterns of PTSD among police officers following shooting incidents: A two-dimensional model and treatment implications

Shooting incidents are a rare phenomenon in low violence police work. However, when an incident occurs, the psychological impact for the officers involved may take the form of severe PTSD symptomatology. Of 37 police officers who had been involved in serious shooting incidents between 1977 and 1984 we found that 17 (46%) fulfilled DSM-III criteria for PTSD, either at the time of the interview (n=7, 19%) or prior to it (n=10, 27%). Of the PTSD-negative group 17 still showed an impressive pattern of PTSD symptoms. Only three showed no symptoms of PTSD at all. Lauferet al. (1985) presented a two-dimensional model which seems to fit the PTSD-pattern in police officers reacting to trauma. From clinical experience, it is apparent that most police officers involved in these incidents seek refuge in denial (Lazarus, 1984). Focused psychotherapy in combination with working through of the incidents and sometimes psychopharmacological intervention appear to be of value in alleviating PTSD in police officers. Preliminary experience in psychotherapy with these police officers is presented in two case vignettes.     

Frequency and severity approaches to indexing exposure to trauma: the Critical Incident History Questionnaire for police officers

The Critical Incident History Questionnaire indexes cumulative exposure to traumatic incidents in police by examining incident frequency and rated severity. In over 700 officers, event severity was negatively correlated (r(s) = -.61) with frequency of exposure. Cumulative exposure indices that varied emphasis on frequency and severity-using both nomothetic and idiographic methods-all showed satisfactory psychometric properties and similar correlates. All indices were only modestly related to posttraumatic stress disorder (PTSD) symptoms. Ratings of incident severity were not influenced by whether officers had ever experienced the incident. Because no index summarizing cumulative exposure to trauma had superior validity, our findings suggest that precision is not increased if frequency is weighted by severity.     

Exposure to Violence During Ferguson Protests: Mental Health Effects for Law Enforcement and Community Members

There is little information available on the mental health effects of exposure to shared community violence such as the August 2014 violence that occurred in Ferguson, Missouri. This study sought to examine the relationship between proximity to community violence and mental health in both community members and police officers. We recruited 565 adults (community, n = 304, and police, n = 261) exposed to the violence in Ferguson to complete measures of proximity to violence, posttraumatic stress, depression, and anger. Using structural equation modeling, we assessed aspects of proximity to violence—connectedness, direct exposure, fear from exposure, media exposure, reactions to media, and life interruption—as correlates of posttraumatic stress disorder (PTSD) symptoms, depression, and anger. The final model yielded (n = 432), χ²(d = 12) = 7.4, p = .830; comparative fit index = 1.0, root mean square error of approximation = 0 [0, .04]. All aspects of proximity except direct exposure were associated with mental health outcomes. There was no moderation as a function of community versus police. Race moderated the relationship between life interruptions and negative outcomes; interruption was related to distress for White, but not Black community members. Based on group comparisons, community members reported more symptoms of PTSD and depression than law enforcement (η_p² = .06 and .02, respectively). Black community members reported more PTSD and depression than White community members (η_p² = .05 and .02, respectively). Overall, distress was high, and mental health interventions are likely indicated for some individuals exposed to the Ferguson events.     

Critical Incident History Questionnaire Replication: Frequency and Severity of Trauma Exposure Among Officers From Small and Midsize Police Agencies

Frequency and severity of trauma exposure are thought to influence posttraumatic reactions. Weiss et al.’s Critical Incident History Questionnaire (CIHQ; 2010) measures these variables among law enforcement officers; they reported findings using a sample of officers from large urban departments. We noted the need for replication studies utilizing samples from smaller and rural police agencies. The purpose of this study was to replicate the CIHQ findings from Weiss et al. using a sample (N = 193) of officers from small and midsize police departments and officers whose duties include policing rural and isolated jurisdictions. Frequency and severity findings were similar to those reported by Weiss et al. (2010). Regarding frequency, the present study found the critical incident exposure mean score was 188.5, compared to 168.5 from Weiss et al. (2010). Making a mistake that kills or injures a colleague had the highest mean nomothetic severity rating in both studies. Among the various variables examined in this study, PTSD symptoms demonstrated the strongest association with the exposure indices, based on Spearman rank correlations (r = .26–.46).     

Associations Among Hair Cortisol Concentrations,Posttraumatic Stress Disorder Status,and Amygdala Reactivity to Negative Affective Stimuli in Female Police Officers

Posttraumatic stress disorder (PTSD) is associated with altered hypothalamic‐pituitary‐adrenal (HPA) axis function. Measurement of hair cortisol concentrations (HCC) allows retrospective assessment of HPA axis regulation over prolonged periods of time. Currently, research investigating HCC in PTSD remains sparse. Previous cross‐sectional studies have included only civilian populations, although it is known that trauma type moderates associations between PTSD status and HPA axis function. We investigated differences in HCC between trauma‐exposed female police officers with current PTSD (n = 13) and without current and lifetime PTSD (n = 15). To investigate whether HCC was associated with neural correlates of PTSD, we additionally performed exploratory correlational analyses between HCC and amygdala reactivity to negative affective stimuli. We observed significantly lower HCC in participants with PTSD than in participants without PTSD, d = 0.89. Additionally, within participants with PTSD, we observed positive correlations between HCC and right amygdala reactivity to negative affective (vs. happy/neutral) faces, r = .806 (n = 11) and left amygdala reactivity to negative affective (vs. neutral) pictures, r = .663 (n = 10). Additionally, left amygdala reactivity to negative faces was positively correlated with HCC in trauma‐exposed controls, r = .582 (n = 13). This indicates that lower HCC is associated with diminished amygdala differentiation between negative affective and neutral stimuli. Thus, we observed lower HCC in trauma‐exposed noncivilian women with PTSD compared to those without PTSD, which likely reflects prolonged HPA axis dysregulation. Additionally, HCC was associated with hallmark neurobiological correlates of PTSD, providing additional insights into pathophysiological processes in PTSD.     

How sleep disturbance is associated with Chinese police officers' job satisfaction: A moderated mediation model

Tasked with a wide variety of duties, police officers often encounter stressful situations and suffer from sleep disturbance. Previous studies have found that police officers with sleep disturbance generally reported lower levels of job satisfaction; however, the psychological mechanisms by which sleep disturbance is associated with job satisfaction are still relatively underexplored. This study investigated how sleep disturbance was associated with job satisfaction via the mediation of job involvement and via the moderation of resilience among police officers. Data from a sample of 827 Chinese police officers (86.9% men) was analysed. Participants completed a written questionnaire assessing sleep disturbance, job satisfaction, job involvement, resilience, and demographic information. A moderated mediation model was conducted to examine the research questions. Sleep disturbance was negatively associated with job involvement, which, in turn, was positively associated with job satisfaction. Furthermore, both direct and indirect effects of sleep disturbance on job satisfaction were moderated by resilience. Specifically, the negative association between sleep disturbance and job satisfaction was significant only for those with low levels of resilience, but not for those with high levels of resilience. In addition, the positive association between job involvement and job satisfaction was stronger for those with higher resilience compared with those with lower resilience. The findings advance understanding of the psychological mechanisms underlying the association between sleep disturbance and job satisfaction among police officers.     

Stressful life events and posttraumatic growth among police officers: A cross‐sectional study

Police officers often continue to face numerous threats and stressors in the aftermath of a disaster. To date, posttraumatic growth (PTG) has been studied primarily in the context of significant trauma; thus, it is not known whether stressful life events are associated with PTG. This study investigated the development of PTG among 113 police officers working in the New Orleans area following Hurricane Katrina. Hierarchical regression was used to evaluate if gratitude, social support, and satisfaction with life moderated the relationship between stressful life events (as measured by the total life stress score) and PTG, after adjustment for age, sex, race, level of involvement in Hurricane Katrina, and alcohol intake. Results indicate that stressful life events are independently associated with PTG. Gratitude, satisfaction with life, and social support were seen to moderate this relationship; as stressful life events increased so too did PTG—particularly among officers with higher levels of gratitude (B = 0.002, p ≤ .05), satisfaction with life (B = 0.002, p ≤ .05), and social support (B = 0.001, p ≤ .05). These findings suggest that promoting satisfaction with life, interpersonal support, and gratitude may be beneficial to those who are regularly at risk of trauma exposure.     

Secondary traumatic stress and secondary posttraumatic growth in a sample of Dutch police family liaison officers

This study investigated secondary traumatic stress (STS) and secondary posttraumatic growth (SPG) in a sample of Dutch police family liaison officers (N = 224). Our study had two aims: (a) to identify potential risk and protective factors for STS and (b) to investigate the association between STS and SPG. None of the risk (caseload and a personal trauma history) and protective factors (age, work experience, and support by supervisors and coworkers) identified in previous research correlated with STS. However, a small positive association was found between STS and SPG. In the discussion section we warn against the use of interventions that aim to prevent STS until more is known about risk and protective factors for STS and provide directions for future research.     

Prospective Trajectories of Posttraumatic Stress in College Women Following a Campus Mass Shooting

In a sample with known levels of preshooting posttraumatic stress (PTS) symptoms, we examined the impact of a campus mass shooting on trajectories of PTS in the 31 months following the shooting using latent growth mixture modeling. Female students completed 7 waves of a longitudinal study (sample sizes ranged from 812 to 559). We identified 4 distinct trajectories (n = 660): (a) minimal impact‐resilience (60.9%), (b) high impact‐recovery (29.1%), (c) moderate impact‐moderate symptoms (8.2%), and (d) chronic dysfunction (1.8%). Individuals in each trajectory class remained at or returned to preshooting levels of PTS approximately 6 months postshooting. The minimal impact‐resilience class reported less prior trauma exposure (η² = .13), less shooting exposure (η² = .07), and greater emotion regulation skills than all other classes (η² > .30). The chronic dysfunction class endorsed higher rates of experiential avoidance prior to the shooting than the minimal‐impact resilient and high impact‐recovery classes (η² = .15), as well as greater shooting exposure than the high impact‐recovery class (η² = .07). Findings suggest that preshooting functioning and emotion regulation distinguish between those who experience prolonged distress following mass violence and those who gradually recover.     

Nocturnal Autonomic Balance and Sleep in PTSD and Resilience

Posttraumatic stress disorder (PTSD) has been associated with heightened nocturnal autonomic nervous system (ANS) arousal and sleep disturbances. It has been suggested that relationships between sleep and nocturnal ANS activity are influenced by insomnia; however, investigation of this relationship has been limited in PTSD. This study examined nocturnal ANS activity and its relationship to sleep in PTSD and resilience. Physically healthy young adult African Americans with current PTSD (n = 20) or who had never had PTSD despite exposure to a high‐impact traumatic event (resilient, n = 18) were monitored with ambulatory electrocardiograms and actigraphy for 24‐hr periods. Frequency‐domain heart‐rate variability measures, that is, low‐frequency to high‐frequency ratios (LF/HF), which index sympathetic nervous system activity, and normalized HF (nHF), which indexes parasympathetic nervous system activity were examined. Normalized HF during the time‐in‐bed period was lower for those with PTSD than those with resilience (p = .041). Total sleep time was strongly correlated with time‐in‐bed LF/HF (r = ?.72) and nHF (r = .75) in the resilient group, but these were not correlated in the PTSD group. The results suggest elevated nocturnal ANS arousal and dissociation between ANS activity and total sleep time in PTSD.     

The structure of peritraumatic dissociation: A cross validation in clinical and nonclinical samples

Empirical data have challenged the unidimensionality of the Peritraumatic Dissociative Experiences Questionnaire (PDEQ), a widely used measure for peritraumatic dissociation. The aim of this study was to assess the factor structure of the PDEQ in 3 trauma‐exposed samples: (a) trauma‐exposed police officers (N = 219); (b) trauma‐exposed civilians (N = 158); and (c) treatment‐seeking trauma‐exposed civilians (N = 185). Confirmatory factor analyses using measurement invariance testing supported a 2‐factor structure (CFIs .96–.98; RMSEAs .07–.09), but excluded 2 of the original items. Factor 1 was termed Altered Awareness; Factor 2 was termed Derealization. Altered Awareness reflected disturbances in information processing during the traumatic event, whereas Derealization reflected distortions in perception. Hierarchical linear regression analysis showed that Derealization predicted posttraumatic stress severity at 26.5 weeks follow‐up only in the sample of police officers (R² = .45). Future longitudinal research shortly following trauma is required to elucidate causality and underlying mechanisms of peritraumatic dissociation, which may contribute to the development of more accurate screening strategies, as well as more effective strategies for prevention and early intervention.     

Contribution of risk and resilience factors to anxiety trajectories during the early stages of the COVID-19 pandemic: A longitudinal study

The COVID-19 pandemic, and the response of governments to mitigate the pandemic's spread, resulted in exceptional circumstances that comprised a major global stressor, with broad implications for mental health. We aimed to delineate anxiety trajectories over three time-points in the first 6 months of the pandemic and identify baseline risk and resilience factors that predicted anxiety trajectories. Within weeks of the pandemic onset, we established a website ( covid19resilience.org ), and enrolled 1362 participants (n = 1064 from US; n = 222 from Israel) who provided longitudinal data between April–September 2020. We used latent growth mixture modelling to identify anxiety trajectories and ran multivariate regression models to compare characteristics between trajectory classes. A four-class model best fit the data, including a resilient trajectory (stable low anxiety) the most common (n = 961, 75.08%), and chronic anxiety (n = 149, 11.64%), recovery (n = 96, 7.50%) and delayed anxiety (n = 74, 5.78%) trajectories. Resilient participants were older, not living alone, with higher income, more education, and reported fewer COVID-19 worries and better sleep quality. Higher resilience factors' scores, specifically greater emotion regulation and lower conflict relationships, also uniquely distinguished the resilient trajectory. Results are consistent with the pre-pandemic resilience literature suggesting that most individuals show stable mental health in the face of stressful events. Findings can inform preventative interventions for improved mental health.     

Spirituality, Resilience, and Anger in Survivors of Violent Trauma: A Community Survey

This study evaluates the relationship between spirituality, resilience, anger and health status, and posttraumatic symptom severity in trauma survivors. A community sample (N = 1,200) completed an online survey that included measures of resilience, spirituality (general beliefs and reincarnation), anger, forgiveness, and hatred. In survivors of violent trauma (n = 648), these measures were evaluated with respect to their relationship to physical and mental health, trauma-related distress, and posttraumatic symptom severity. Using multivariate regression models, general spiritual beliefs and anger emerged in association with each outcome, whereas resilience was associated with health status and posttraumatic symptom severity only. Forgiveness, hatred, and beliefs in reincarnation were not associated with outcome. The importance of these findings to treating trauma survivors is discussed.     

Duty-related trauma exposure in 911 telecommunicators: considering the risk for posttraumatic stress

Peritraumatic distress may increase the risk for posttraumatic stress disorder (PTSD) in police officers. Much less is known about emotional reactions and PTSD symptomatology in 911 telecommunicators. The current study assessed duty-related exposure to potentially traumatic calls, peritraumatic distress, and PTSD symptomatology in a cross-sectional, convenience sample of 171 telecommunicators. Results showed that telecommunicators reported high levels of peritraumatic distress and a moderate, positive relationship was found between peritraumatic distress and PTSD symptom severity (r = .34). The results suggest that 911 telecommunicators are exposed to duty-related trauma that may lead to the development of PTSD, and that direct, physical exposure to trauma may not be necessary to increase risk for PTSD in this population.     

Chronic Trauma Effects on Personality Traits in Police Officers

The impact of cumulative occupational exposure to traumatic events (TEs), posttraumatic stress (PTS) symptoms, and work environment stress on personality traits over time was examined in 38 police officers from an urban agency. California Psychological Inventory (CPI) personality trait scores from prehire evaluations were compared with follow‐up CPI scores to test whether exposure to traumatic events was correlated with changes in traits from baseline to 5–10 years later. Measures of occupational TEs, PTS symptoms, and police work environment stress were administered. Mean trait scores declined on all CPI traits analyzed in the study. Trait change was evaluated using the Reliable Change Index; change in participants’ scores unlikely to occur by chance ranged from 11% to 63% in the traits examined. All participants reported substantial TE exposure. PTS symptoms were correlated with steeper decline in 4 of 5 traits, with effect sizes ranging from r =  ?.47 to r = ?.67. Scores on measures of job‐related TEs were negatively correlated with only one CPI trait (empathy) at T2 (r = ?.31), and were unrelated to slope of trait change. Work environment stress was significantly related to gender, with female officers reporting higher levels of operational (r = .45) and organizational (r = .54) stress.     

Psychological contributors to the frail phenotype: The association between resilience and frailty in patients with cirrhosis

We examined whether a key psychological trait—resilience, defined as one's ability to recover quickly from difficulties—contributes to the frail phenotype in patients with cirrhosis. Included were 300 adult patients with cirrhosis who underwent outpatient physical frailty testing using the Liver Frailty Index and resilience testing using the Connor-Davidson Resilience Scale (CD-RISC). The Liver Frailty Index was categorized as robust, prefrail-robust, prefrail-frail, and frail; CD-RISC was categorized using population norms as: least, less, more, and most resilient. Linear regression was used to assess factors associated with frailty (by the Liver Frailty Index per 0.1 unit change). Among the most resilient, only 10% were frail; among the least resilient, 29% were frail. In univariable analysis, resilience was strongly associated with the Liver Frailty Index (coef = −0.13 per point increase; 95% confidence interval [CI], −0.20 to −0.60; P < .001) and remained significantly associated with frailty in multivariable adjustment (coef = −0.13, 95% CI −0.19 to −0.07; P < .001). Low resilience is strongly associated with the frail phenotype in patients with cirrhosis. Given that resilience is modifiable, our data suggest that effective interventions to mitigate frailty should include strategies to build resilience in patients with low baseline resilience.     

Genetic and environmental contributions to regional cortical surface area in humans: a magnetic resonance imaging twin study

Cortical surface area measures appear to be functionally relevant and distinct in etiology, development, and behavioral correlates compared with other size characteristics, such as cortical thickness. Little is known about genetic and environmental influences on individual differences in regional surface area in humans. Using a large sample of adult twins, we determined relative contributions of genes and environment on variations in regional cortical surface area as measured by magnetic resonance imaging before and after adjustment for genetic and environmental influences shared with total cortical surface area. We found high heritability for total surface area and, before adjustment, moderate heritability for regional surface areas. Compared with other lobes, heritability was higher for frontal lobe and lower for medial temporal lobe. After adjustment for total surface area, regionally specific genetic influences were substantially reduced, although still significant in most regions. Unlike other lobes, left frontal heritability remained high after adjustment. Thus, global and regionally specific genetic factors both influence cortical surface areas. These findings are broadly consistent with results from animal studies regarding the evolution and development of cortical patterning and may guide future research into specific environmental and genetic determinants of variation among humans in the surface area of particular regions.     

Does workload cause work‐home interference or is it the other way around?

The present study was designed to investigate the causal relationships between work‐home interference (WHI) and one of its strongest correlates, quantitative workload. Two‐phase longitudinal data (with a 1‐year time lag) were gathered from 828 Dutch police officers. Drawing on the effort‐recovery model, and in line with the current WHI literature, we hypothesized that relatively high workload precedes increased levels of WHI 1 year later (‘normal’ causation). In addition, we tested the alternative hypothesis that relatively high levels of WHI predict increased workload 1 year later (‘reversed’ causation). Results of hierarchical regression analyses showed that workload and WHI have causal and reversed causal relationships across time, supporting both hypotheses (although effect sizes are limited). Accordingly, these findings suggest that workload is not merely an antecedent of WHI but is also a potential consequence. Copyright © 2007 John Wiley & Sons, Ltd.     

Simultane Versorgung drei Schussverletzter

The German combat support hospital in Kunduz, north Afghanistan is equipped to provide initial care of the wounded in an area of increasing conflict. We report of the simultaneous care of three Afghan national police officers involved in a small arms exchange of fire with a criminal background and suffering from life-threatening injuries which were treated by the German army. The article focuses on structured procedures during trauma support as well as the decision-making process during the examination procedure in a situation of limited capacity.