Prospective Study of Traumatic Stress in Police Officers

描述（由申请人提供）：这是一份竞争性续期申请，申请资助R01 MH 056350-06，警务人员创伤后应激的前瞻性研究。本研究的目的是促进对创伤后应激障碍的风险和恢复因素的理解。我们招收了400名警察学院新兵，在训练期间对他们进行了全面的生物和社会心理特征评估。在警察服务的头两年，对新招募人员进行了与任务有关的重大事件和日常工作环境压力源、警察服务之外的压力源和支持以及创伤后应激障碍症状的重新评估。我们要求五年的支持，跟随我们的队列完成第三至第七年的警察服务，这是一个累积暴露和离开警察服务的高风险时期。(1)警校训练期间评估的心理社会特征包括智商、特质解离、既往创伤、家族史、神经质、世界观和特质愤怒；(2)在学院训练中评估的生物标志物包括觉醒皮质醇、声惊吓、内分泌和心理生理对关键事件模拟和活动的反应；(3)在警察服务期间暴露于危及生命的重大事件和创伤周围反应评估；(4)日常工作压力、警外负面生活事件和警期社会支持评估；(5)遗传多态性；(6)在警察服务的第3年和第5年期间，更多的工作时间和轮班工作，并确定这种关系是否可以通过活动记录仪测量的睡眠时间和睡眠时间来解释；(7)确定警察服务前七年抑郁症状的遗传和行为预测因子。我们有条件进行这项拟议的研究，这将是执法中创伤后压力的风险和恢复力因素的最大和最全面的前瞻性研究。我们已经招募并综合评估了400名学院学员。我们成功地管理了纽约和旧金山的实验室。学院的新成员已经慷慨地同意参加密集的测试，包括关键事件模拟和电击强化惊吓测试。我们分别保留了近84%和82%的一年和两年的到期评估。在所有程序和时间点上，我们只有不到3%的数据丢失。关键事件曝光率在第一年很高，有95.4%的人报告了关键事件，近一半涉及个人生命威胁。迄今为止的结果有力地支持了更新的目标。在警察服务一年后，PTSD症状的最强预测因子是在学院培训期间评估的较低的智商和较高水平的特质解离，在事件暴露时更大的个人生活威胁和创伤周围解离，以及在服务的第一年更大的日常工作环境压力和负面生活事件。从公共卫生的角度来看，长期以来一直存在对警察工作压力的担忧，2001年9月11日的恐怖袭击事件和卡特里娜飓风强调了回答与创伤后应激障碍相关的风险和复原力因素相关问题的必要性。我们的研究目的是确定关键事件压力和日常工作压力的恢复力和脆弱性因素。我们研究的长期目标是告知培训和压力管理的最佳做法，以最大限度地提高警察的情绪和身体健康，防止职业残疾。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，加上在警察服务期间进行高级培训的额外费用，以及与922 000名州和地方警察的全国工作队伍中与压力有关的医疗和精神疾病有关的大量人力和财政费用。仅从执法的角度来看，迫切需要进行研究，以准确地为选择标准提供信息，为高风险角色（包括反恐部队、拆弹小组、帮派特遣部队和特警队）的分配提供信息，并最大限度地保留执法人员的职业生涯。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人员的选择、培训和早期预防干预。更准确地了解风险因素还将导致在发生大规模自然灾害和人为灾害时更有效地利用有限的精神卫生资源。这一公共卫生的必要性说明了本建议的总体目标，即通过跟踪我们对警察学院新兵进行额外五年警察服务的前瞻性纵向队列，提高对创伤后压力的风险和恢复力因素的理解。

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.