Prospective Study of Traumatic Stress in Police Officers

描述（由申请人提供）：这是一个有竞争力的续期申请，授予R01 MH 056350 - 06，警察创伤后应激的前瞻性研究。这项研究的目的是促进对创伤后应激障碍的风险和恢复力因素的理解。我们招收了400名警察学院的新兵，在训练期间对他们进行了全面的生物和心理社会特征评估。在警察服务的前两年，重新评估了与职责相关的重大事件和日常工作环境的压力源，压力源和警察服务之外的支持，以及PTSD症状。我们要求五年的支持，以跟踪我们的队列通过第三年至第七年的警察服务，一个高风险的时间累积暴露和离开警察服务。更新的主要目的是前瞻性地确定以下预测因素是否可以解释警察服务前七年的PTSD症状：（1）在学院培训期间评估的心理社会特征，包括智商，特质分离，既往创伤，家族史，神经质，世界观和特质愤怒;（2）生物标志物，包括唤醒皮质醇，声音惊吓，内分泌和心理生理反应，以关键事件模拟和活动记录在学院培训期间评估;（3）评估警察服役期间对危及生命的重大事件的暴露和创伤周围反应;（4）评估警察服役期间的日常工作压力、警察服役外的负性生活事件和社会支持;（5）评估警察服役期间的遗传多态性。（六）在警察服务的第3年和第5年，工作时间更长，轮班工作，并确定这种关系是否可以用睡眠开始后醒来和睡眠持续时间来解释通过腕动记录仪测量;（7）确定在警察服务的前七年中抑郁症状的遗传和行为预测因素。我们有能力进行拟议的研究，这将是执法中创伤后压力风险和复原力因素的最大和最全面的前瞻性研究。我们已经招募并全面评估了400名学院新兵。我们成功地管理了纽约和弗朗西斯科的实验室。学院的新兵们慷慨地同意参加密集的测试，包括关键事件模拟和冲击增强惊吓测试。我们分别保留了近84%和82%的一年和两年摊款。我们在所有程序和时间点的缺失数据不到3%。第一年的重大事件暴露率很高，95.4%的人报告了重大事件，近一半涉及个人生命威胁。迄今取得的成果有力地支持了延长的目标。在警察局工作一年后，PTSD症状的最强预测因子是较低的智商。在学院训练期间评估的特质分离水平更高，在事件暴露时更大的个人生命威胁和创伤周围分离，以及在服务的第一年期间更大的日常工作环境压力和负性生活事件。从公共卫生的角度来看，长期以来人们一直关注警察工作的压力，2001年9月11日恐怖袭击和卡特里娜飓风的事件强调了回答与PTSD相关的风险和弹性因素相关的问题的必要性。我们的研究旨在确定关键事件压力和日常工作压力的弹性和脆弱性因素。我们研究的长期目标是为培训和压力管理提供最佳实践，以最大限度地提高警察的身心健康，预防职业残疾。据估计，执法机构筛选和培训警察学院新兵的费用为18 500美元，加上警察服务期间高级培训的额外费用，以及与全国922 000名州和地方警察的压力相关的医疗和精神疾病有关的大量人力和财政费用。从执法的角度来看，有一个迫切需要的研究，将准确地告知选择标准，分配到高风险的角色，包括反恐单位，炸弹小组，帮派特遣部队和特警队，并在执法生涯中最大限度地保留。从更广泛的公共卫生角度来看，前瞻性研究有望改善消防、紧急医疗、军事、救灾和其他从事危险工作的人员的选拔、培训和早期预防干预。更准确地了解风险因素也将导致在发生大规模自然和人为灾害时更有效地利用有限的心理健康资源。这一公共卫生的必要性通知这一建议的总体目标，这是通过以下我们的未来纵向队列的警察学院新兵额外五年的警察服务，以促进对创伤后应激反应的风险和复原力因素的理解。

DESCRIPTION (provided by applicant): This is a competitive renewal application for grant R01 MH 056350-06, Prospective Study of Posttraumatic Stress in Police Officers. The goal of this research is to advance understanding of risk and resilience factors for posttraumatic stress disorder. We have enrolled 400 police academy recruits assessed on a comprehensive set of biological and psychosocial characteristics during training. Recruits were reassessed during the first two years of police service on duty-related critical incident and routine work environment stressors, stressors and support outside of police service, and PTSD symptoms. We are requesting five years of support to follow our cohort through years three through seven of police service, a time of high risk for cumulative exposure and for leaving police service. The primary aims for the renewal are to determine prospectively if the following predictors explain PTSD symptoms across the first seven years of police service: (1) Psychosocial characteristics including IQ, trait dissociation, prior trauma, family history, neuroticism, worldview and trait anger assessed during academy training; (2) Biomarkers including awakening cortisol, acoustic startle, endocrine and psychophysiological responses to critical incident simulation and actigraphy assessed during academy training; (3) Exposure to life threatening critical incidents and peritraumatic responses assessed during police service; (4)Routine work stress, negative life events outside police service and social support assessed during police service; (5) Genetic polymorphisms; (6) Greater work hours and shift work during years 3 and 5 of police service and determine if this relationship is explained by wake after sleep onset and sleep duration as measured by actigraphy; and (7) Determine genetic and behavioral predictors of depression symptoms across the first seven years of police service. We are well positioned to conduct the proposed research which will be the largest and most comprehensive prospective study of risk and resilience factors for posttraumatic stress in law enforcement. We have recruited and comprehensively assessed 400 academy recruits. We have successfully managed laboratories in New York and San Francisco. The academy recruits have generously agreed to participate in intensive testing including critical incident simulation and shock enhanced startle testing. We have retained nearly 84% and 82% of those due for one year and two year assessments, respectively. We have less than 3% missing data across all procedures and time points. Rates of critical incident exposure are high in the first year with 95.4 % reporting critical incidents, nearly half involving personal life threat. Results to date strongly support the aims for the renewal. After one year of police service the strongest predictors of PTSD symptoms are lower I.Q. and higher levels of trait dissociation assessed during academy training, greater personal life threat and peritraumatic dissociation at the time of incident exposure, and greater routine work environment stress and negative life events during the first year of service. From a public health perspective there have been longstanding concerns about the stress of police work, with the events of the September 11, 2001 terrorist attacks and Hurricane Katrina underscoring the imperative to answer questions related to risk and resilience factors associated with PTSD. Our research aims to identify resilience and vulnerability factors for critical incident stress and routine work stress. The long term goal of our research is to inform best practices in training and stress management in order to maximize the emotional and physical health and prevent occupational disability in police officers. It is estimated that it costs $18,500 for law enforcement agencies to screen and train police academy recruits, plus additional costs of advanced training during police service, and substantial human and financial costs associated with stress-related medical and psychiatric illness in a national work force of 922,000 state and local police officers. From the perspective of law enforcement alone there is an urgent need for studies that will accurately inform selection criteria, assignment to high risk roles including counterterrorism units, bomb squads, gang task forces and swat teams, and maximize retention during a career in law enforcement. From a broader public health perspective, prospective studies carry the promise of improved selection, training and early preventative intervention for fire, emergency medical, military, disaster relief and other personnel exposed to hazardous duty. More accurate knowledge of risk factors will also lead to greater efficiency in use of limited mental health resources in times of large scale natural and man-made disasters. This public health imperative informs the overall goal of this proposal which is to advance the understanding of risk and resilience factors for posttraumatic stress by following our prospective longitudinal cohort of police academy recruits for an additional five years of police service.