Quality, Not Quantity, Counts in Onset of Posttraumatic Stress


from Law Enforcement News

In a study whose findings are made all the more timely by the events of Sept. 11, researchers have found that it is the quality, not the frequency, of an officer”s response to critical incidents which provides the strongest indicator of whether symptoms of posttraumatic stress disorder will develop.

Researchers in San Francisco, beginning in 1997 with $1.8 million in funding from the National Institute of Mental Health, queried more than 700 sworn law-enforcement personnel from agencies in New York, Oakland, and San Jose. Suzanne Best, the study”s senior research psychologist, said that in addition to being asked about social support, use of alcohol, sleep and routine work stress, participants were asked to select the most personally distressing critical incident they had experienced during their careers.

"There were a lot of incidents involving children," Best told Law Enforcement News, "Children being abused, or coming upon a child who had died of SIDS, or children who were seriously injured in car accidents. The others tended to deal with a fellow officer being injured or killed. Some of them were related to personal life-threat."

Researchers found two elements that could explain why some officers get past terrible events and others suffer PTSD: how frightening the incident is on a personal level, and the extent to which the event provoked a dissociative reaction in which the officer felt a profound sense of unreality.

"Most of the officers have a high level of exposure to disturbing events," said the study”s principal investigator, Charles Marmar, associate chief of staff for mental health services at the San Francisco Veterans Affairs Medical Center and a professor of psychiatry at the University of California, San Francisco. "There may be what”s called a "ceiling effect" where you have a high level of exposure. It doesn”t explain why some are coping well and a minority are having more difficulty. What seems to be more important is the quality of their emotional reaction at the time of the event."

"A dissociative reaction could involve the feeling that what is happening is more like a dream, a movie or a play", Marmar told Law Enforcement News. "There could be tunnel vision, or the sense that time is moving very slowly. Sounds, he said could seem distant and muffled. Combined with the panic or distress the officer felt at the time of the incident, this is significant in predicting who is going to have continuing PTSD symptoms."

While the study found that just 7 percent of the 741 officers who participated in the research had full or partial posttraumatic stress disorder, nearly half said they had trouble sleeping at levels typical of patients found at insomnia clinics, Marmar noted.

"It”s very controversial, we don”t know what to make of the insomnia", he said. "It raises a concern- with the chronic stress of police service- whether over time there is a cumulative impact on sleep quality. We want to make sure there isn”t a relationship between that and any difficulties performing the complicated and challenging tasks that police officers have to perform, whether high-speed chases or making rapid appraisals under difficult circumstances."

Researchers were not able to determine whether there is a direct relationship between self-reported sleep disturbances and on-the-job performance, said Marmar, because of an agreement with the participating police agencies that a firewall safeguarding internal personnel records not be breached.

Surprisingly, the survey found insomnia to be more strongly associated with routine job stress than with PTSD. Long shifts, bias in the workplace, the unfavorable sentencing of defendants apprehended by participants and unreliable equipment were all factors that influenced sleep disturbances, said Marmar. Greater critical incident exposure, he said, was related to nightmares.

Among the study”s other findings were that in-service men and women appear to be identical with regard to traumatic exposure and symptoms of stress, he said. In the general population, women are twice as likely to suffer PTSD than are men. The answer could lie in selection or training, said Marmar, although he speculated that it is probably a combination of the two.

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