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Violanti: Stress, A Police Health Problem

STRESS: A POLICE HEALTH PROBLEM
A Badge of Life Article
 
By John M. Violanti, Ph.D
StateUniversity of NY at Buffalo, NY
School of Public Health & Health Professions
Social & Preventive Medicine
 
 
How Does Stress Affect Health?
 
The term “stress” is often misunderstood and overused. However, among its numerous definitions, many describe stress as a process where life’s demands place an undue strain on a person, which results in psychological and biological changes that increase the risk for disease. Others see stress as a state of imbalance, where negative occurrences far outweigh the individual’s ability to cope with them.
 
Stress alters the functioning of the body’s hormone control centers and produces a chemical imbalancethat affects the nervous and endocrine systems. The primary hormone secreted during the stress situation is cortisol. Cortisol is known as the “stress hormone”. Cortisol has a normal pattern through the day, rising when a person awakens, levels out at midday and decreases as nighttime approaches. When persons such as police officers are under chronic and acute stress, cortisol becomes dysregulated. It may no longer rise in the morning and flatten out during the day, or it may not change at all.
 
Under conditions of chronic stress, dysregulated cortisol will lead to a compromised immune system and the body’s ability to fight off disease and infection. No bodily organ can avoid being affected in some way by dysregulation of cortisol secretion. The stress response is considered “adaptive” when it reacts to an acute situation and its duration is limited. It is considered “maladaptive” when the reaction is not brought under control by hormonal regulatory mechanisms. If a person cannot remove himself or herself from the stressful encounter, as is often the case with police work, the stress response may become chronic and unregulated.
 
 
                                     Table 1. SWORN POLICE OFICERS IN THE UNITED STATES
 
Type of agency                                                                      Number of agencies   Number of full-time

Total                                                                                                                                  836,787      
All State and local                                                                             17,876                      731,903      
Local police                                                                                       12,766                      446,974      
Sheriff                                                                                                  3,067                      175,018      
Primary State                                                                                           49                        58,190        
Special jurisdiction                                                                              1,481                        49,398        
Constable/Marshal                                                                                  513                          2,323          
Federal                                                                                                                               104,884      
Source: Bureau of Justice Statistics; www.ojp.usdoj.gov/bjs
 
As table one indicates, there are over 836,000 police officers in the United States. This is a large working population which is negatively affected by stress and traumatic events at work. Police work is at times routine, intermixed with episodes of intensive danger. Police officers are often placed in situations of severe emotional stress which include viewing dead bodies, seeing sexually exploited children or being involved in a shooting. They are required to work different shifts, which may affect their sleep and dietary habits.
 
Police mortality studies have demonstrated that officers are afflicted with stress-related disease at a higher rate than the general population.
 
•                     Rates for policemen, sheriffs and marshals are significantly elevated for arteriosclerotic heart disease, cancer, suicide, and homicide. 
 
•                     Increased rates were found for cancers of the colon and liver, diabetes mellitus, arteriosclerotic heart disease, pulmonary embolism and homicide among Washington state police officers. Mortality for arteriosclerotic heart disease was highest for younger officers.
 
•                     Police officers at the City of Buffalo, NY had increased rates for heart disease, digestive cancers and cancers of the lymphatic and hematopoietic tissues, brain cancer and esophageal cancer. Police had a three-fold rate of suicide compared to city of Buffalo, NY municipal workers. 
 
•                     Police in New Jersey had a significantly increased risk for arteriosclerotic heart disease, digestive and skin cancers, and skin diseases above that of the general population. Cirrhosis of the liver and digestive diseases also increased as duration of police service increased.
 
•                     Urban police officers in Rome, Italy had increased rates for colon cancer, bladder cancer, non-Hodgkin’s lymphoma and melanoma. Bladder cancer rates were significantly increased for patrol car drivers and kidney cancer rates were higher among motorcycle officers. Police officers under the age of 50 had increased rates for ischemic heart disease.
 
In many of the police mortality studies noted above, police officers either suffered from disease or died at a much earlier age than reference groups like municipal workers or the general U.S. population. Results from the State University of NY at Buffalo police mortality studyfound the average age of death for police officers was 66 years compared to the general population average of 75 years. This is unusual for a presumably healthy working population.
 
 
What can be done?
 
While there are many factors involved in police stress that have not been addressed here, there are solutions worthy of further discussion because they may lessen the impact of police stress on the wear and tear of bodily systems. Mental health intervention is one choice.  Police officers are exposed to stress in their work on a continuous basis. Expectations of traumatic work events are ever-present, and police training emphasizes how to deal with the worst cases. Although intervention protocols have improved and mental health professionals are routinely made available to help police officers deal with adversity in their work and personal lives, persuading officers to seek psychological help remains a challenge. Police officers generally think of themselves as problem solvers, not people who have problems. In addition, there is a pervading mistrust of the mental health profession among police officers.  
 
Police organizations should seriously consider providing resources that will assure confidentiality. In terms of the human dimension, taking care of small problems before they become large is a wise strategy for the police organization. In terms of budgetary considerations, it costs approximately $160,000 to train a new police officer in the U.S., and the organization loses the experience of the fallen officer. Prevention and early treatment are more cost effective than ignoring stress problems.
 
 
Future research in police stress and disease will help to better explain its adverse impact on police officers. It is hoped that such research will provide important information in clarifying this important problem. It is the least we can do for the men and women who so nobly serve and protect civilized society.


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