capt arnold farley for lcdr christine west rn, msn, mph centers for disease control and prevention...
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CAPT Arnold Farley for
LCDR Christine West RN, MSN, MPHCenters for Disease Control and PreventionNational Institute for Occupational Safety and
HealthHazard Evaluations and Technical Assistance
Branch
Follow-up Mental Health Assessment in the New Orleans Police Force
USPHS Scientific and Training SymposiumSan Diego, California
May 26, 2010
Objectives
Compare and contrast the mental health symptom prevalence of NOPD personnel at 2 and 15 months after Hurricane Katrina
Describe personal and occupational factors that may have influenced mental health outcomes in police officers
Identify recommendations to NOPD personnel for coping with adverse mental health symptoms
What is NIOSH? National Institute for Occupational
Safety and Health
Part of the Centers for Disease Control and Prevention
Conduct occupational safety and health evaluations and make recommendations for workplaces
Background
2 NIOSH surveys
Requested by NOPD management
1. October 2005: 2 months after Hurricane Katrina
2. December 2006: 15 months after Hurricane Katrina
Follow-up visit Sept 2009
– Discuss findings, ongoing concerns and additional recommendations
1st Survey, 2005 912 NOPD personnel participated
– 60-70% participation* 80% Male /Average Age: 38 Years /Average Job
Tenure: 11 Years
19% symptoms consistent with PTSD
26% symptoms consistent with major depression
PTSD symptoms associated with involvement in crowd control, body recovery
Depressive symptoms associated with rare family contact, uninhabitable home, and isolation from regular NOPD assignment
Both PTSD and depressive symptoms associated with being assaulted and injury to family member
* Denominator estimated
2nd Survey, 2006
Compared results to 1st Survey
– Only included those who participated in 2005 survey
Determined prevalence of physical and mental health symptoms in 2006
Distributed anonymous, self-administered questionnaire to police at several locations
Distributed resource packet of medical and mental health referral information
What was in the Questionnaires?
Work history and locations
Family circumstances, level of damage to residence, use of sick leave, personal activities, and job satisfaction
Physical and mental health status
– Respiratory / skin rash / gastrointestinal symptoms
– Posttraumatic stress disorder and depressive symptoms
Past medical history
Use of counseling services and health care services
Work history and locations
Family circumstances, level of damage to residence, use of sick leave, personal activities, and job satisfaction
Physical and mental health status
– Respiratory / skin rash / gastrointestinal symptoms
– Posttraumatic stress disorder and depressive symptoms
Past medical history
Use of counseling services and health care services
What was in the Questionnaires?
Results of 2006 NIOSH Survey
808 NOPD personnel completed questionnaire– 68% response rate
72% Male Average age: 40 Years Average job tenure: 13 Years 85% commissioned police officers 61% field/patrol capacity
Symptoms 1st Survey 2nd Survey
PTSD symptoms 19 21
Depressive symptoms
26 23
Gastrointestinal symptoms
7 14
Comparison of Symptoms 1st to 2nd Survey
Use of Counseling Services
Service
1st Surve
y%
2nd Survey %
Individual counseling 14 13
Group meeting 12 14
Family counseling 2 6
Counseling referral forindividual and/or family
2 3
Satisfaction with Job Factors
Factors %
Satisfied
Communication with coworkers
86
Communication with supervisor
76
Quality of supervision 71
Ability to make independent decisions
67
Work schedules 63
Equipment 24
Group Characteristics from Findings
PTSD and depression changed little
Higher rates of PTSD and depression
Symptoms may persist in some personnel
Continue to experience stressors from routine duties and reminders of hurricane
Disruption of social support structure
Living in temporary homes
Gastrointestinal Symptoms
Increase in gastrointestinal symptoms from 2005 to 2006
– Did not evaluate exposures
– Stressful life events and anxiety may be related to physical symptoms
Counseling Services
Use of services did not increase
Lack of awareness
Personnel may be uncomfortable seeking care
Lack of availability of services in the city
Limitations Actual symptom prevalences may be
different from reported prevalences
– Self-reported symptoms
– Unable to survey personnel on sick leave (~5%)
Unable to conduct direct comparison of symptoms
May not be able to attribute symptoms to hurricane events
May be underestimation of mental health symptoms due to reluctance to report
Recommendations
Develop strategies to increase use and acceptance of seeking care and treatment
Develop and implement a comprehensive occupational safety and health program:
– Joint employee-management committee for safety and health
– Medical screening / pre and post event
– Employee assistance program
Develop strategies to increase social support
Follow-up visit to NOPD in September 2009
Presented summary of findings from 2nd survey report
Provided additional recommendations
Presented strategies for improved social support
Met with department representatives and officers to discuss ongoing health and safety needs of personnel
Distributed handouts to police district stations
Additional concerns raised Sep 2009
Personnel continue to recount stories about their experiences during Hurricane
Continue to live apart from families, and in some cases this has resulted in divorce and custody battles
Observed increased anger, irritability, excess alcohol consumption, and requests for time off
Continued reluctance to access services
Need for additional officers on force
– Lost 20% of police force since Hurricane
Handout on giving and receiving social support
Developed for NOPD
– Reluctance to seek care
– History of suicides in police force
– Reliance on coworkers for support
– Lack of mental health resources in NOLA
– Lack of awareness from management
L.A.S.E.R.: Look, Ask, Support, Evaluate, Receive
– Acronym to help personnel remember several important steps to looking out for each other and offering social support
– Adapted from Psychological First Aid : Field Operations Guide
Recent changes and developments
Louisiana Spirit Program
– City-wide hurricane recovery resources
Employee Assistance Program
– Working on funding mechanism in Department
Department Disaster and Preparedness Plan
– Includes policy for liberal use of furlough and sick leave, and completion of a personal emergency evacuation plans
– Guidance on accessing health care during the disaster, ensuring the safety of evacuation sites, and procuring food and water
Acknowledgements Co-authors:
– Charles Mueller– Bruce Bernard– Richard Driscoll
NOPD management and personnel– Major Juan Quinton– Dr. Armond Devizen
NIOSH field assistants and supervisors
The findings and conclusions are those of the author and do not necessarily represent the views of the National Institute
for Occupational Safety and Health
More Information Contact Information:
Project Officer: [email protected]
Behavioral Scientist at NIOSH: [email protected]
Health Hazard Evaluation Program:
www.cdc.gov/niosh/hhe
Link to Health Hazard Evaluation Report in October 2005 and December 2006: http://www.cdc.gov/niosh/hhe/reports/pdfs/2006-0027-3001.pdf
http://www.cdc.gov/niosh/hhe/reports/pdfs/2007-0067-3076.pdf
Science Blog on police and stress: http://www.cdc.gov/niosh/blog/nsb063008_policestress.html
References
Abramson D, Stehling-Ariza T, Garfield R, Redlener I [2008]. Prevalence and predictors of mental health distress post-Katrina: Findings from the Gulf Coast child and family health study. Disaster Med Public Health Prep 2(2):77–86
Carlier IV, Lamberts RD, Gersons BP [1997]. Risk factors for posttraumatic stress symptomology in police officers: a prospective analysis. J Nerv Mental Dis 185:(8)498–506.
DeSalvo KB, Hyre AD, Ompad DC, Menke A, Tynes L, Muntner P [2007]. Symptoms of posttraumatic stress disorder in a New Orleans workforce following Hurricane Katrina. J Urban Health 84(2):142–152.
Fullerton CS, Ursano RJ, Wang L [2004]. Acute stress disorder, posttraumatic stress disorder, and depression in disaster on rescue workers. Am J Psychiatry 161(8):1370–1376.
Galea S, Brewin CR, Gruber M, Jones RT, King DW, King LA, McNally RJ, Ursano RJ, Petukhova M, Kessler RC [2007]. Exposure to hurricane-related stressors and mental illness after Hurricane Katrina. Arch Gen Psychiatry 64(12):1427–1434.
References
Huag et al. [2002]. Are anxiety and depression related to gastrointestinal symptoms in the general population? Scandinavian Journal of Gastroenterology 37(3): 294-298.
Hodgins GA, Creamer M, Bell R [2001]. Risk factors for posttrauma reactions in police officers: a longitudinal study. J Nerv Ment Dis 189(8):541–547.
Kessler RC, Galea MF, Gruber MJ, Sampson NA, Ursano RJ, Wessely S [2008]. Trends in mental illness and suicidality after Hurricane Katrina. Mol Psych 13:1374–1384.
Kim SC, Plumb R, Gredig Q, Rankin L, Taylor B [2008]. Medium-term post-Katrina health sequelae among New Orleans residents: predictors of poor mental and physical health. J Clin Nurs 17(17):2335–2342
Leon KA; Hyre AD; Ompad D; DeSalvo; Muntner P [2007]. Perceived stress among a workforce 6 months following Hurricane Katrina. Soc Psychiatry Psychiatr Epidemiol 42(12):1005–1011.
Weathers FW, Litz BT, Herman DS, Huska JA, Keane TM [1993]. The PTSD Checklist: reliability, validity, and diagnostic utility. Paper presented at Annual Conference of the International Society for Traumatic Studies: October 25, 1993: San Antonio, Texas.
Weisler RH, Barbee JG, Townsend MH [2006]. Mental health and recovery in the Gulf Coast after Hurricanes Katrina and Rita. JAMA. 296(1):585–1588.