How common are alcohol problems in the UK Police Service and what is the level of comorbidity with mental health problems?

背景：在英国警察局，缺乏关于酒精使用和相关危险因素的研究。澳大利亚的数据显示，35%的警察符合增加风险和高风险饮酒的标准（定义为AUDIT分数分别高于8和16）。高风险酒精使用在英国武装部队中比一般人群更常见，我们可以预期警察中也有类似的模式，这是由于职业相似性，例如经常暴露于创伤，轮班工作和男性主导的文化。这项博士研究的目的是（i）确定高风险酒精使用的流行程度（使用英国首席医疗官的准则定义）在英国警察服务的代表性样本和精神健康问题的共同发生;（ii）比较酒精使用在英国警察服务的英国武装部队;（iii）研究心理健康和职业压力是否可以预测未来的酒精使用;（iii）定性探讨与英国警察局高风险酒精使用司机及其社会后果相关的社会理论。方法：为了回顾现有文献，将进行系统综述和荟萃分析，确定创伤暴露风险增加的职业中风险增加和高风险酒精使用的流行率，即，急救人员、卫生保健工作者、武装部队人员、火车司机和记者。对于第一个目标，我们将使用电波健康监测研究，该研究从英格兰，苏格兰和威尔士的所有警察部队招募警察，这些警察部队使用电波，地面集群无线电（TETRA）。数据收集自2004年至2012年的40，986名警务人员。这项研究包括以下措施：年龄，性别，婚姻状况，种族，教育程度，在警察服务的年数，工资，职级，18岁以下的儿童和吸烟状况。心理健康评估包括自我报告的抑郁，焦虑和创伤后应激障碍（PTSD），除了职业压力。酒精使用是通过过去每周的饮酒日记来衡量的，使用英国首席医疗官的指南来确定增加风险和高风险的酒精使用。将报告高危酒精使用的患病率估计值及95%置信区间。人口统计学变量之间的关联，心理健康和职业压力，与酒精使用的结果，将通过回归分析来确定。第二个目标，我们将结合联合收割机的电波健康监测研究和国王的军事健康研究中心的队列研究。这些数据集将使用熵平衡在数据收集年份、年龄和教育程度上进行匹配。我们将使用逻辑回归分析来确定酒精使用的差异。第三个目标，我们将使用来自空气波健康监测研究的随访数据，来自大约9000名警察。从2015年开始收集随访数据，使用与第一波相同的措施。结构方程模型将用于确定第二波饮酒与第一波职业压力和心理健康之间的关联。最后，我们将对符合高危酒精使用标准的警察进行半结构化电话访谈，以探讨高危酒精使用的司机和后果。定性数据将被转录使用NVivo和分析与thematic analysis.Implications：本研究项目将提供急需的代表性数据的患病率高风险的酒精使用在英国警察局，推进学术研究的心理健康和冒险行为的职业群体通常暴露于创伤，如那些确定的系统性审查。这项研究的结果可以用来通知量身定制的干预措施，在英国警察的酒精问题的发展。

Background: There is a dearth of research on alcohol use and associated risk factors, in the UK Police Service. Australian data suggests that 35% of police met the criteria for increased risk and high-risk alcohol use (defined as AUDIT scores above 8 and 16, respectively). High-risk alcohol use is more common in the UK Armed Forces than the general population and we may expect a similar pattern in police, due to occupational similarities, such as frequent exposure to trauma, shift-work and the male-dominated culture.Aims: This PhD research aims (i) to identify the prevalence of high-risk alcohol use (defined using the UK chief medical officer's guidelines) within a representative sample of the UK Police Service and the co-occurrence with mental health problems; (ii) to compare alcohol use in the UK Police Service to the UK Armed Forces; (iii) to examine whether mental health and occupational stress predict future use of alcohol and (iiii) to qualitatively explore social theories relating to the drivers of high-risk alcohol use in the UK Police Service and its social consequences.Methods: To review the existing literature, a systematic review and meta-analysis will be conducted, to determine the prevalence of increased-risk and high-risk alcohol use across occupations with an increased risk of trauma exposure, i.e., first responders, health care workers, armed forces personnel, train drivers and journalists. For the first aim, we will use The Airwave Health Monitoring Study which recruited police from all police forces in England, Scotland and Wales which used Airwave, a Terrestrial Trunked Radio (TETRA). Data was collected from 40,986 police personnel between 2004 and 2012. The study included the following measures: age, sex, marital status, ethnicity, educational attainment, years in the police service, salary, rank, children under 18 and smoking status. Assessment of mental health included self-reports of depression, anxiety and post-traumatic stress disorder (PTSD), in addition to occupational stress. Alcohol use was measured using a past weekly drinks diary, using the UK chief medical officer's guidelines to determine increased-risk and high-risk alcohol use. Prevalence estimates with 95% confidence intervals for high-risk alcohol use will be reported. The associations between demographic variables, mental health and occupational stress, with alcohol use as the outcome, will be determined through regression analyses.For the second aim, we will combine the Airwave Health Monitoring Study and the King's Centre for Military Health Research cohort study. The datasets will be matched on year of data collection, age and educational attainment, using entropy balancing. We will use logistic regression analyses to determine differences in alcohol use.For the third aim, we will use follow up data from the Airwave Health Monitoring Study from approximately 9000 police personnel. The follow up data was collected from 2015 onwards, using the same measures as the first wave. Structural equation modelling will be used to determine the associations between alcohol use at wave 2, with occupational stress and mental health at wave 1. For the final aim, we will conduct semi-structured telephone interviews with police officers who meet the criteria for high-risk alcohol use, to explore the drivers and consequences of high-risk alcohol use. The qualitative data will be transcribed using NVivo and analysed with thematic analysis.Implications: The present research project will provide much needed representative data on the prevalence of high-risk alcohol use in the UK Police Service, advancing academic research on mental health and risk-taking behaviours in an occupational groups commonly exposed to trauma, such as those identified in the systematic review. The findings of this research could be used to inform the development of tailored interventions for alcohol problems in UK police.