Mental health screening amongst police officers: factors associated with under-reporting of symptoms.

BACKGROUND: Mental health screening in the workplace aims to identify employees who are becoming symptomatic, in order to provide timely support and evidence-based interventions to those affected. Given the stigma associated with mental illness, accurate disclosure of mental health symptoms cannot be assumed. The present study sought to investigate factors associated with the accurate reporting of mental health symptoms amongst police officers. METHODS: A total of 90 serving police officers completed identical mental health screening surveys, one administered by the employer and the other anonymously by an independent organisation. Responses were then linked to compare differences in the number and severity of mental health symptoms reported on each questionnaire. RESULTS: Comparisons of matched self-report scores indicated that employees under-reported symptoms of mental health disorders when completing screening administered by their employer, with only 76.3% of symptoms declared. Under-reporting occurred regardless of gender and symptom type. Less senior staff (p = 0.05) and those with the most severe post-traumatic stress disorder and common mental disorder symptoms (p = 0.008) were significantly more likely to under-report symptoms. CONCLUSIONS: Employer-administered mental health screening is not able to accurately capture all mental health symptoms amongst first responders. The fact that the severity of symptoms predicted the level of under-reporting means that simple changes to cut-off values cannot correct this problem.

Effectiveness of training workplace managers to understand and support the mental health needs of employees: a systematic review and meta-analysis.

Managers are in an influential position to make decisions that can impact on the mental health and well-being of their employees. As a result, there is an increasing trend for organisations to provide managers with training in how to reduce work-based mental health risk factors for their employees. A systematic search of the literature was conducted to identify workplace interventions for managers with an emphasis on the mental health of employees reporting directing to them. A meta-analysis was performed to calculate pooled effect sizes using the random effects model for both manager and employee outcomes. Ten controlled trials were identified as relevant for this review. Outcomes evaluating managers' mental health knowledge (standardised mean difference (SMD)=0.73; 95% CI 0.43 to 1.03; p<0.001), non-stigmatising attitudes towards mental health (SMD=0.36; 95% CI 0.18 to 0.53; p<0.001) and improving behaviour in supporting employees experiencing mental health problems (SMD=0.59; 95% CI 0.14 to 1.03; p=0.01) were found to have significant pooled effect sizes favouring the intervention. A significant pooled effect was not found for the small number of studies evaluating psychological symptoms in employees (p=0.28). Our meta-analysis indicates that training managers in workplace mental health can improve their knowledge, attitudes and self-reported behaviour in supporting employees experiencing mental health problems. At present, any findings regarding the impact of manager training on levels of psychological distress among employees remain preliminary as only a very limited amount of research evaluating employee outcomes is available. Our review suggests that in order to understand the effectiveness of manager training on employees, an increase in collection of employee level data is required.

Prevalence of PTSD and common mental disorders amongst ambulance personnel: a systematic review and meta-analysis.

PURPOSE: There is increasing concern regarding the mental health impact of first responder work, with some reports suggesting ambulance personnel may be at particularly high risk. Through this systematic review and meta-analysis we aimed to determine the prevalence of mental health conditions among ambulance personnel worldwide. METHODS: A systematic search and screening process was conducted to identify studies for inclusion in the review. To be eligible, studies had to report original quantitative data on the prevalence of at least one of the following mental health outcome(s) of interest (PTSD, depression, anxiety, general psychological distress) for ambulance personnel samples. Quality of the studies was assessed using a validated methodological rating tool. Random effects modelling was used to estimate pooled prevalence, as well as subgroup analyses and meta-regressions for five variables implicated in heterogeneity. RESULTS: In total, 941 articles were identified across all sources, with 95 full-text articles screened to confirm eligibility. Of these, 27 studies were included in the systematic review, reporting on a total of 30,878 ambulance personnel. A total of 18 studies provided necessary quantitative information and were retained for entry in the meta-analysis. The results demonstrated estimated prevalence rates of 11% for PTSD, 15% for depression, 15% for anxiety, and 27% for general psychological distress amongst ambulance personnel, with date of data collection a significant influence upon observed heterogeneity. CONCLUSION: Ambulance personnel worldwide have a prevalence of PTSD considerably higher than rates seen in the general population, although there is some evidence that rates of PTSD may have decreased over recent decades.

Can work make you mentally ill? A systematic meta-review of work-related risk factors for common mental health problems.

It has been suggested that certain types of work may increase the risk of common mental disorders, but the exact nature of the relationship has been contentious. The aim of this paper is to conduct the first comprehensive systematic meta-review of the evidence linking work to the development of common mental health problems, specifically depression, anxiety and/or work-related stress and to consider how the risk factors identified may relate to each other. MEDLINE, PsychInfo, Embase, the Cochrane Collaboration and grey literature databases were systematically searched for review articles that examined work-based risk factors for common mental health problems. All included reviews were subjected to a quality appraisal. 37 review studies were identified, of which 7 were at least moderate quality. 3 broad categories of work-related factors were identified to explain how work may contribute to the development of depression and/or anxiety: imbalanced job design, occupational uncertainty and lack of value and respect in the workplace. Within these broad categories, there was moderate level evidence from multiple prospective studies that high job demands, low job control, high effort-reward imbalance, low relational justice, low procedural justice, role stress, bullying and low social support in the workplace are associated with a greater risk of developing common mental health problems. While methodological limitations continue to preclude more definitive statements on causation between work and mental disorders, there is now a range of promising targets for individual and organisational-level interventions aimed at minimising mental health problems in the workplace.

The Amplification of Common Somatic Symptoms by Posttraumatic Stress Disorder in Firefighters.

Posttraumatic stress disorder (PTSD) in emergency service personnel and other trauma-exposed populations is known to be associated with a variety of physical health problems. However, little attention has been paid to the health of ageing emergency service personnel, who may be forced into early medical retirement because of a combination of these issues. Currently employed (N = 274) Australian firefighters completed a cross-sectional survey using validated, self-report measures of PTSD and somatic symptoms. Analyses examined the association between probable PTSD and a range of common somatic symptoms, and whether any association differed depending on the age of the firefighters. Firefighters with PTSD reported greater levels of neurological (p = .024), gastrointestinal (p = .015), and cardiorespiratory (p = .027) symptoms compared to those without PTSD. After adjusting for sex, age, and rank, linear regression analysis demonstrated that PTSD was significantly associated with increased total somatic symptom severity (p = .024), with PTSD accounting for 9.8% of the variance in levels of somatic symptoms. There was no interaction between age and the association between PTSD and somatic symptom severity. These results suggest that PTSD is associated with a significant increase in a wide range of somatic symptoms among firefighters, regardless of age. The implications for the identification and treatment of PTSD are discussed.

The mental health of fire-fighters: An examination of the impact of repeated trauma exposure.

OBJECTIVE: Emergency workers, such as fire-fighters, are routinely exposed to potentially traumatic events. While a number of studies have examined the occurrence of post-traumatic stress disorder, the role of multiple traumas on other mental health sequelae, such as depression and alcohol misuse, among emergency workers remains unclear. This study aimed to assess the prevalence of post-traumatic stress disorder, depression and alcohol misuse in a sample of current and retired fire-fighters and examine their relationship with cumulative trauma exposure. METHOD: A cross-sectional survey was completed by current (n = 488) and retired (n = 265) fire-fighters from Fire and Rescue New South Wales, Australia. Demographic and occupational information was collected, including the number of fatal incidents fire-fighters reported attending across years of service. Validated, self-report measures were used to determine probable caseness for post-traumatic stress disorder, depression and heavy drinking. RESULTS: Among current fire-fighters, rates of post-traumatic stress disorder and depression were 8% and 5%, respectively, while 4% reported consumption of more than 42 alcoholic drinks per week. Retired fire-fighters reported significantly greater levels of symptomatology, with the prevalence estimates of post-traumatic stress disorder at 18% (p = 0.001), depression at 18% (p < 0.001) and heavy drinking at 7%. There was a significant positive linear relationship between the number of fatal incidents attended and rates of post-traumatic stress disorder, depression and heavy drinking. CONCLUSION: Fire-fighters suffer from high rates of mental disorders, with rates of post-traumatic stress disorder, depression and heavy drinking continuing to rise in a linear manner with each additional trauma exposure. The level of psychiatric morbidity among retired fire-fighters appears to be particularly high. Our findings have important implications for the ongoing debates surrounding the detection of mental disorders in high-risk occupations and for policy considerations around the welfare of current and retired emergency workers.

Memory retrieval, extinction, and reinstatement of alcohol seeking.

In four experiments we studied the impact of retrieval-extinction training on the extinction and reinstatement of alcoholic beer seeking. Experiment 1 showed that preceding daily extinction sessions with a brief (10 min) extinction session (retrieval-extinction) attenuated the context-induced reinstatement of alcoholic beer seeking, thereby replicating and extending the findings of Xue et al. (2012). Experiment 2 then showed that the retrieval-extinction manipulation could attenuate the reinstatement produced by reversible inactivation of the nucleus accumbens shell prior to test. Experiment 3 showed that a modified extinction protocol that involved a reversed retrieval (i.e., extinction then retrieval) was also able to attenuate context-induced reinstatement. Finally, experiment 4 showed that the extinction-retrieval manipulation facilitated the reacquisition of alcoholic beer seeking as evidenced by increased breakpoints and responses during tests under a progressive ratio schedule. Taken together, these findings show that retrieval-extinction training protocols can alter the propensity to reinstate extinguished drug seeking but that these alterations are not always protective. These findings are inconsistent with accounts of the retrieval-extinction manipulation in terms of memory reconsolidation and deepened extinction. Instead, they are consistent with the notion that this manipulation increases the sensitivity of animals to the contingencies in effect during testing.

A comparison of face-to-face and online training in improving managers' confidence to support the mental health of workers.

BACKGROUND: In recognition of the important role managers play in the well-being of the staff they supervise, many workplaces are implementing specialised training for leaders to help them better understand and support the mental health needs of their staff. This training can be delivered through face-to-face or online training sessions. Evaluation of such programs have found positive results for each format when compared to a control group, but to date, face-to-face and online manager mental health training have not been compared with one another. AIMS: This study brings together results from two trials evaluating the same program content, each employing a different mode of content delivery. Both types of training aimed to change managers' confidence to better support the mental health needs of the staff they supervise. METHODS: Utilising data derived from two previously conducted trials, mean change in manager confidence from baseline at both post-intervention and follow-up were examined for each method of content delivery. An identical way of measuring confidence was used in each study. RESULTS: Managers' confidence improved from baseline with both methods of training. A greater change was observed with face-to-face training than for online, although both methods had sustained improvement over time. Analyses indicate that at follow-up, improvements in confidence were significant for both face-to-face (t 18  = 5.99; P < .001) and online training (t 39  = 3.85; P < .001). Analyses focused on managers who fully completed either type of training indicated very similar impacts for face-to-face and online training. CONCLUSIONS: Both face-to-face and online delivery of manager mental health training can significantly improve managers' confidence in supporting the mental health needs of their staff. This change is sustained over various follow-up periods. However, lower retention rates common in online training reduce the relative effect of this method of delivery.

The impact of trauma exposure on the development of PTSD and psychological distress in a volunteer fire service.

Emergency service workers (ESWs) are at increased risk of trauma-related mental disorders. However, volunteer ESWs, who comprise the majority of firefighters in Western countries, have limited access to the necessary support services for mental health problems. This study aimed to examine the impact of the level and types of trauma exposure on the development of mental disorders in a volunteer fire service. Members of an Australian volunteer fire service (N = 459) completed a cross-sectional survey. Information on the number and types of distressing critical incidents involved within the last year was collected. Validated, self-report measures were used to determine probable post-traumatic stress disorder (PTSD) and psychological distress caseness. The risk of probable PTSD was significantly higher for those with the most frequent involvement with distressing incidents and the highest levels of cumulative trauma exposure. Being trapped in a dangerous situation or being assaulted by other people, resulted in the greatest odds of developing a mental disorder. Volunteer fire service members with the highest levels of trauma exposure and involvement with particular types of critical incidents are at elevated risk of mental health problems. The implications for the provision of psychological support measures amongst volunteer emergency services are discussed.

The role of job strain in understanding midlife common mental disorder: a national birth cohort study.

BACKGROUND: Long-standing concerns exist about reverse causation and residual confounding in the prospective association between job strain and risk of future common mental disorders. We aimed to address these concerns through analysis of data collected in the UK National Child Development Study, a large British cohort study. METHODS: Data from the National Child Development Study (n=6870) were analysed by use of multivariate logistic regression to investigate the prospective association between job strain variables at age 45 years and risk of future common mental disorders at age 50 years, controlling for lifetime psychiatric history and a range of other possible confounding variables across the lifecourse. Population attributable fractions were calculated to estimate the public health effect of job strain on midlife mental health. FINDINGS: In the final model, adjusted for all measured confounders, high job demands (odds ratio 1·70, 95% CI 1·25-2·32; p=0·0008), low job control (1·89, 1·29-2·77; p=0·0010), and high job strain (2·22, 1·59-3·09; p<0·0001) remained significant independent predictors of future onset of common mental disorder. If causality is assumed, our findings suggest that 14% of new cases of common mental disorder could have been prevented through elimination of high job strain (population attributable fraction 0·14, 0·06-0·20). INTERPRETATION: High job strain appears to independently affect the risk of future common mental disorders in midlife. These findings suggest that modifiable work-related risk factors might be an important target in efforts to reduce the prevalence of common mental disorders. FUNDING: iCare Foundation and Mental Health Branch, NSW Health.

A systematic review of the usefulness of pre-employment and pre-duty screening in predicting mental health outcomes amongst emergency workers.

Despite a lack of proven efficacy, pre-employment or pre-duty screening, which alleges to test for vulnerability to PTSD and other mental health disorders, remains common amongst emergency services. This systematic review aimed to determine the usefulness of different factors in predicting mental disorder amongst emergency workers and to inform practice regarding screening procedures. Systematic searches were conducted in MEDLINE, PsycINFO and EMBASE to identify cohort studies linking pre-employment or pre-duty measures in first responders with later mental health outcomes. Possible predictors of poor mental health were grouped into six categories and their overall level of evidence was assessed. Twenty-one prospective cohort studies were identified. Dynamic measures including physiological responses to simulated trauma and maladaptive coping styles (e.g. negative self-appraisal) had stronger evidence as predictors of vulnerability in first responders than more traditional static factors (e.g. pre-existing psychopathology). Personality factors (e.g. trait anger) had moderate evidence for predictive power. Based on the evidence reviewed, however, we are unable to provide emergency services with specific information to enhance their current personnel selection. The results indicate that pre-duty screening protocols that include personality assessments and dynamic measures of physiological and psychological coping strategies may be able to identify some personnel at increased risk of mental health problems. However, further longitudinal research is required in order to provide meaningful guidance to employers on the overall utility of either pre-employment or pre-duty screening. In particular, research examining the sensitivity, specificity and positive predictive values of various screening measures is urgently needed.

Workplace mental health training for managers and its effect on sick leave in employees: a cluster randomised controlled trial.

BACKGROUND: Mental illness is one of the most rapidly increasing causes of long-term sickness absence, despite improved rates of detection and development of more effective interventions. However, mental health training for managers might help improve occupational outcomes for people with mental health problems. We aimed to investigate the effect of mental health training on managers' knowledge, attitudes, confidence, and behaviour towards employees with mental health problems, and its effect on employee sickness absence. METHODS: We did a cluster randomised controlled trial of manager mental health training within a large Australian fire and rescue service, with a 6-month follow-up. Managers (clusters) at the level of duty commander or equivalent were randomly assigned (1:1) using an online random sequence generator to either a 4-h face-to-face RESPECT mental health training programme or a deferred training control group. Researchers, managers, and employees were not masked to the outcome of randomisation. Firefighters and station officers supervised by each manager were included in the study via their anonymised sickness absence records. The primary outcome measure was change in sickness absence among those supervised by each of the managers. We analysed rates of work-related sick leave and standard sick leave seperately, with rate being defined as sickness absence hours divided by the sum of hours of sickness absence and hours of attendance. This trial was registered with the Australian New Zealand Clinical Trials Registry (ACTRN12613001156774). FINDINGS: 128 managers were recruited between Feb 18, 2014, and May 17, 2014. 46 (71%) of 65 managers allocated to the intervention group received the intervention, and 42 (67%) of 63 managers allocated to the control group were entered in the deferred training group. Managers and their employees were followed up and reassessed at 6 months after randomisation. 25 managers (1233 employees) in the intervention group and 19 managers (733 employees) in the control group provided data for the primary analysis. During the 6-month follow-up, the mean rate of work-related sick leave decreased by 0·28 percentage points (pp) from a pre-training mean of 1·56% (SE 0·23) in the intervention group and increased by 0·28 pp from 0·95% (0·20) in the control group (p=0·049), corresponding to a reduction of 6·45 h per employee per 6 months. The mean percentage of standard sick leave increased by 0·48 pp from 4·97% (0·22) in the intervention group and by 0·31 pp from 5·27% (0·21) in the control group (p=0·169). INTERPRETATION: A 4-h manager mental health training programme could lead to a significant reduction in work-related sickness absence, with an associated return on investment of £9.98 for each pound spent on such training. Further research is needed to confirm these findings and test their applicability in other work settings. FUNDING: NSW Health and Employers Mutual Ltd.