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

背景：在英国警察部门，缺乏关于酒精使用及其相关风险因素的研究。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(分别定义为审计分数高于8和16)。高风险酒精使用在英国武装部队中比普通人群更常见，我们可以预期警察中也会出现类似的模式，因为职业相似，如频繁暴露于创伤、轮班工作和男性主导的文化。目的：本博士研究旨在(I)在英国警察部门的代表性样本中确定高风险酒精使用(根据英国首席医疗官指南定义)的流行率以及与精神健康问题的共同发生；(Ii)将英国警察部门的酒精使用与英国武装部队进行比较；(Iii)研究心理健康和职业压力是否预示着未来的酒精使用，以及(Iii)定性地探索与英国警察部门高风险饮酒司机及其社会后果有关的社会理论。方法：为了回顾现有文献，将进行系统的综述和荟萃分析，以确定高风险和高风险饮酒在创伤暴露风险增加的职业中的流行率，即急救人员、卫生保健人员、武装部队人员、培训司机和记者。对于第一个目标，我们将使用空中电波健康监测研究，该研究从英格兰、苏格兰和威尔士使用空中电波(TETRA)的所有警察部队招募警察。数据是在2004年至2012年期间从40986名警察中收集的。这项研究包括以下衡量标准：年龄、性别、婚姻状况、种族、教育程度、警察服务年限、工资、军衔、18岁以下儿童和吸烟状况。精神健康评估除了职业紧张外，还包括抑郁、焦虑和创伤后应激障碍(PTSD)的自我报告。酒精使用量是通过过去一周的饮酒日记进行衡量的，使用英国首席医疗官的指南来确定高风险和高风险的酒精使用。将报告高风险酒精使用的95%可信区间的流行率估计。人口统计变量、心理健康和职业压力之间的关系将通过回归分析来确定。第二个目标是，我们将结合AirWave Health Monitor研究和King‘s Centre for Military Health Research队列研究。数据集将根据数据收集年份、年龄和教育程度进行匹配，使用熵平衡。我们将使用Logistic回归分析来确定酒精使用的差异。为了第三个目标，我们将使用来自大约9000名警察的气波健康监测研究的后续数据。后续数据是从2015年开始收集的，采用了与第一波相同的衡量标准。结构方程模型将被用来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。为了最终目的，我们将对符合高风险饮酒标准的警察进行半结构化电话采访，以探索高风险饮酒的驱动因素和后果。定性数据将使用NVivo转录并进行主题分析。影响：本研究项目将提供关于英国警察部门高风险酒精使用流行率的迫切需要的代表性数据，推进关于经常暴露于创伤的职业群体的心理健康和冒险行为的学术研究，例如在系统审查中确定的职业群体。这项研究的发现可以用来为英国警察制定针对酒精问题的量身定做的干预措施提供参考。

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.