The Connected We St@nd programme: A feasibility pilot study of an online self-management intervention for adults on in-centre haemodialysis and family caregivers.

OBJECTIVE: The 'Connected We St@nd' is an online self-management intervention programme for people receiving in-centre haemodialysis and family caregivers that combines an educational and psychosocial support component. This study aimed to evaluate its feasibility and acceptability before proceeding to a large-scale trial. DESIGN: This was a pre-post single-arm feasibility pilot study conducted with adults undergoing in-centre haemodialysis and family caregivers. METHODS: Feasibility was based on eligibility, consent, retention, completion and intervention adherence rates, while acceptability was assessed in post-intervention focus group interviews. RESULTS: Twenty-six people (16 adults on haemodialysis and 10 family caregivers) recruited through social networks completed the intervention. Consent, retention and completion rates were excellent (>90%) and eligibility (77.5%) and intervention adherence were satisfactory (69% for the psychosocial support sessions). Qualitative findings revealed that participants shared positive feelings regarding their participation in the programme. The valuable interactions with group peers and health psychologists during the support sessions, the perception of the adequacy and coherence of the programme's contents and materials and the participants' confidence in using the platform developed to deliver the intervention were some of the aspects highlighted as facilitators of intervention acceptability. Additionally, people on haemodialysis and caregivers reported that participation in the programme brought several educational and emotional benefits (e.g., additional disease-related knowledge, improved communication and coping skills, greater confidence in managing dialysis complications or caregiving demands) that helped increase their self-management skills and psychosocial adjustment to the demands of kidney failure and renal therapies. CONCLUSIONS: The results suggested that the 'Connected We St@nd' programme is likely to be feasible and acceptable for adults on haemodialysis and family caregivers, thus representing a promising resource for the future of interdisciplinary renal rehabilitation. Suggestions were made to fine-tune the intervention design to proceed with a large-scale trial.

Memory Impairments and Wellbeing in Breast Cancer Patients: A Systematic Review.

Breast cancer is one of the most diagnosed cancers among women. Its effects on the cognitive and wellbeing domains have been widely reported in the literature, although with inconsistent results. The central goal of this review was to identify, in women with breast cancer, the main memory impairments, as measured by objective and subjective tools and their relationship with wellbeing outcomes. The systematic literature search was conducted in the PubMed, Scopus, and ProQuest databases. The selected studies included 9 longitudinal and 10 cross-sectional studies. Although some studies included participants undergoing multimodal cancer therapies, most focused on chemotherapy's effects (57.89%; n = 11). The pattern of results was mixed. However, studies suggested more consistently working memory deficits in breast cancer patients undergoing chemotherapy. In addition, some associations have been identified between objective memory outcomes (verbal memory) and wellbeing indicators, particularly depression and anxiety. The inconsistencies in the results could be justified by the heterogeneity of the research designs, objective and subjective measures, and sample characteristics. This review confirms that more empirical evidence is needed to understand memory impairments in women with breast cancer. An effort to increase the homogeneity of study methods should be made in future studies.

Taking Care of an Adolescent and Young Adult Cancer Survivor: A Systematic Review of the Impact of Cancer on Family Caregivers.

Research usually investigates adolescents and young adults (AYA) with cancer in combination with younger and older cancer patients and survivors. However, AYAs with cancer are a unique group, and their caregivers' experience may also differ from other caregivers of cancer survivors. This systematic review aims to understand the impact of a cancer diagnosis on family caregivers, comparing the experience of caregivers of AYA childhood cancer survivors (AYA CCS) and caregivers of AYA with cancer. Relevant studies were identified through PubMed, Scopus, and Web of Science databases, and their quality was assessed using the Joanna Briggs Institute's critical appraisal checklists. Sixteen studies (17 reports) met the inclusion criteria. Findings were synthesized separately for caregivers of AYA CCS and caregivers of AYA with cancer. Results showed that caregivers in both groups experienced high distress after the diagnosis. Partners of AYAs with cancer experienced diminished quality of life (QoL) and over half reported moderate to high fear of cancer recurrence (FCR). Findings indicated that cancer negatively impacts family caregivers, regardless of the patient's age at diagnosis. However, findings are heterogeneous, and most do not focus on QoL or FCR. More research is needed on the impact of cancer among these family caregivers.

CanCOG®: Cultural Adaptation of the Evidence-Based UCLA Cognitive Rehabilitation Intervention Program for Cancer Survivors in Portugal.

Cognitive difficulties are highly prevalent and negatively impact cancer survivors' quality of life. The UCLA Cognitive Rehabilitation Intervention Program (in short, UCLA program) is an evidence-based intervention developed and tested in the US to address the cognitive complaints of cancer survivors. Since there are no cognitive rehabilitation programs available for Portuguese cancer-related settings, this study aimed to culturally adapt the UCLA program to Portugal. Nine steps were implemented for this cultural adaptation: needs assessment, initial contacts, translation, cultural adaptation, independent review by a panel of experts (n = 6), focus group discussions with cancer survivors (n = 11), systematization of inputs and improvement of the final materials, fidelity check, and preliminary acceptability assessment. The findings suggested that changes to the original materials were needed. A Portuguese name, "CanCOG®-Reabilitação Cognitiva no Cancro" (in English "CanCOG®-Cognitive Rehabilitation in Cancer"), and a logo were created to make it more memorable and appealing for the Portuguese population. The language was adjusted to ensure content accessibility and semantic and conceptual equivalence. Finally, references to several cultural aspects, such as habits, customs, and traditions, were adapted to fit the new cultural context. The UCLA program may be a promising tool to help alleviate the cognitive difficulties reported by cancer survivors in different cultural contexts. Future research is needed to confirm the feasibility, acceptability, and preliminary efficacy of its Portuguese version, "CanCOG®-Reabilitação Cognitiva no Cancro".

Illness perception and treatment adherence in haemodialysis: a systematic review.

Patients with kidney failure need lifelong renal replacement therapy to survive and, worldwide, in-centre haemodialysis is the most common modality. The efficacy of this treatment largely depends on the patients' adherence to several health behaviours. According to Leventhal's self-regulation model, patients' illness perceptions can be a key factor for treatment adherence. Therefore, it is of utmost importance to better understand this relationship to further fine-tune the effectiveness of renal rehabilitation programs. This study aimed to systematically review the literature on the association between illness perceptions and treatment adherence in adults undergoing in-centre haemodialysis. The search was performed on PubMed, Scopus, CINAHL, Web of Science (all databases included), and ProQuest (all databases included), from the 17th to the 21st of December 2020. The last update was performed on the 9th of June of 2022. Articles were critically appraised using the Joanna Briggs Institute (JBI) Critical Appraisal Checklists for Analytical Cross-Sectional Studies. Nine studies were included comprising a total of 1161 patients undergoing in-centre haemodialysis. Associations between illness perceptions and treatment adherence were found in six studies. Adherence to dietary restrictions was the type of adherence with more significant associations with illness perceptions, followed by fluid control and medication intake. Two studies combining several types of adherences into an overall score also showed significant associations with illness perceptions. No significant associations were found between illness perceptions and adherence to dialysis sessions. These findings suggest that illness perceptions in patients undergoing in-centre haemodialysis should continue to receive research attention. Future interventions should acknowledge the importance of modifying maladaptive illness perceptions to improve treatment adherence in kidney failure. The protocol for this systematic review was registered on PROSPERO (CRD42021231929).

Validation of the Portuguese Version of the Fear of Progression Questionnaire-Short Form (FoP-Q-SF) in Portuguese Cancer Survivors.

In 2020, around 60,000 people were diagnosed with cancer in Portugal, and many of them suffered some level of Fear of Progression (FoP) of the disease. Although this FoP is realistic, and is part of the normal and appropriate response to this type of disease, there is no instrument to assess and understand whether it is exaggerated in the face of the situation. The present study aimed to translate and validate the Fear of Progression Questionnaire-Short Form (FoP-Q-SF) for the Portuguese population. The sample consisted of 220 volunteers, aged 18 years or over and diagnosed with cancer for at least six months. Participants completed the FoP-Q-SF, the Hospital Anxiety and Depression Scale (HADS), the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core-30 (EORTC QLQ-C30) and the Post-Traumatic Stress Disorder Checklist-Civilian Version (PCL-C). The FoP-Q-SF demonstrated high internal reliability (α = 0.86) and the confirmatory factor analysis supported the one-dimensional structure of the FoP-Q-SF. Convergent validity was supported with significant positive correlations with psychological distress, especially anxiety (0.68). The FoP-Q-SF has been found to be a valid instrument to measure FoP in Portuguese cancer survivors.

Towards a Better Understanding of the Factors Associated with Distress in Elderly Cancer Patients: A Systematic Review.

This study presents a systematic review of the sociodemographic, clinical, and psychosocial factors associated with distress in elderly cancer patients. Relevant studies were identified using four electronic databases: PubMed, Scopus, Web of Science and ProQuest. Cross-sectional and longitudinal studies exploring factors associated with distress in people over 60 years of age were included and independently assessed using the Joanna Briggs Institute Critical Assessment Checklists. A total of 20 studies met the inclusion criteria. Research showed that being a woman, being single, divorced or widowed, having low income, having an advanced diagnosis, having functional limitations, having comorbidities, and having little social support were factors consistently associated with emotional distress. Data further showed that the impact of age, cancer type, and cancer treatment on symptoms of anxiety and/or depression in elderly patients is not yet well established. The findings of this review suggest that the emotional distress of elderly cancer patients depends on a myriad of factors that are not exclusive, but coexisting determinants of health. Future research is still needed to better understand risk factors for distress in this patient population, providing the resources for healthcare providers to better meet their needs.

Attentional Bias Toward Reproduction-Related Stimuli and Fertility Concerns Among Breast Cancer Survivors.

The current study examined whether an attentional bias exists for reproduction-related visual cues among breast cancer survivors and its relationship with fertility concerns and emotional distress. Breast cancer survivors (n = 38) aged 18-40 were compared to 37 healthy women recruited from the general population. Attentional bias was investigated using a visual dot-probe task and response times (RT) were measured. Participants also completed several questionnaires, including the Reproductive Concerns After Cancer Scale (RCACS) and the Hospital Anxiety and Depression Scale (HADS). Biased cognitive processing toward reproduction-related stimuli was observed for all young women. However, attentional bias was a significant predictor of concerns about partner disclosure of fertility status, with higher bias scores associated with higher levels of concern only for breast cancer survivors. The desire to have a (or another) biological child was also a significant predictor of higher concerns related with fertility potential for all young women. Higher vigilance regarding reproduction-related cues seems to lead to higher concerns among women with breast cancer history whose fertility is threatened. This result may have important research and clinical implications. Interventions focused on goal-oriented attention self-regulation and problem-solving can help to manage fertility concerns and distress in the course of the disease.

The role of fear in the relationship between vicarious violence at work and work ability in nurses: A cross-sectional study.

Fear is a powerful emotion that can influence future behavior. This study investigated how fear influences the relationship between vicarious violence at work and employees' work ability. This is a quantitative cross-sectional study. Self-report data were collected from 154 Portuguese nurses who completed an online survey. Statistical significance of the indirect effect was based on bias-corrected bootstrap confidence intervals. The results support the mediation model. Those who observe/hear of others being beaten or threatened experience strong affective reactions, such as fear, which in turn has a negative impact on the assessment of their work ability. We suggest that occupational safety and health programs designed to prevent violence at work take into account those who experience violence at work vicariously and include strategies and interventions focused on affective reactions to minimize the negative effects of vicarious violence at work, with benefits in employees' improved ability to work.

Women's Cognitive and Emotional Appraisal of Sex Pictures: The Predictive Role of Age, Exposure Time, and Sexual Beliefs.

This study researched how age predicts women's cognitive and emotional appraisal of sex pictures. One hundred and fifty five women were exposed to romantic, sexually moderate and sexually explicit pictures. Women reported on the emotional valence, subjective sexual arousal, and level of sexual content attributed to the pictures; women's sexual beliefs were further evaluated. Findings revealed that age predicted increased pleasantness to sexually moderate and explicit pictures, as well as higher subjective sexual arousal to all type of pictures. Some predictions were moderated by sexual beliefs and exposure time, pointing the role of contextual factors in women's appraisal of erotica.

Effectiveness of psychosocial interventions on the burden and quality of life of informal caregivers of hemodialysis patients: a systematic review.

PURPOSE: To systematically review the effectiveness of psychosocial interventions developed for informal caregivers of hemodialysis patients. METHODS: Relevant studies were identified through five electronic databases: PubMed, Scopus, Web of Science, ProQuest, and the CENTRAL. Randomized controlled trials (RCTs) and quasi-experimental studies describing interventions for informal caregivers of adult in-center hemodialysis patients (≥18 years old) were included and independently appraised by two reviewers using the Joanna Briggs Institute Statistics Assessment and Review Instruments critical appraisal checklists. RESULTS: Eleven articles evaluating eight intervention programs were included in this review, covering a total of 729 informal caregivers. Most studies implemented educational or psycho-educational interventions (n = 6). Psycho-educational interventions designed to promote caregivers' ability to care and to cope with the caregiving role had positive effects on burden and/or quality of life. Psychological interventions also had large effects on reducing the burden over time. CONCLUSIONS: There are still few interventions available to caregivers of hemodialysis patients. Psychosocial interventions showed great potential in improving the caregiver burden and quality of life. Further research with rigorous designs is needed to achieve stronger evidence on the extent of the current findings. TRIAL REGISTRATION NUMBER: CRD42021247916.Implications for rehabilitationPatients with end-stage renal disease (ESRD) undergoing in-center hemodialysis often require emotional and/or practical support from family members or friends.Research has consistently shown that informal caregivers of hemodialysis patients may experience significant burden and a negative impact on their quality of life as a result of their caregiving role during the disease trajectory.This review evidenced that intervention programs involving education and psychological strategies had large positive effects on reducing caregiver burden and improving quality of life.The findings provide valuable evidence to recommend the inclusion of psychosocial programs to family caregivers as part of comprehensive renal care.

A family-centred perspective on the arteriovenous fistula in end-stage renal disease: Findings from dyadic interviews.

INTRODUCTION: The preservation of a well-functioning arteriovenous fistula (AVF) is crucial for successful dialysis in patients with end-stage renal disease (ESRD); nonetheless, complications are frequent which leads to lower quality of life, hospitalisations and death. Self-care behaviours help to reduce the risk of complications and family caregivers can play an important role as partners for behaviour change. However, the patient and family caregiver's experiences with such an invasive intervention are largely unknown. AIMS: This study aimed to explore the experiences of patients with ESRD and their family caregivers with the AVF through joint interviews. METHODS: A qualitative exploratory study was conducted with a purposive sample. Semi-structured joint interviews were conducted with 14 dyads (28 participants) composed of patients on haemodialysis with AVF and their respective family caregivers. Interviews were audiotaped, transcribed verbatim and submitted to thematic analysis. FINDINGS: Four major themes were identified: (i) AVF negative impacts; (ii) (un)presence of self-care behaviours; (iii) AVF self-management facilitators and (iv) AVF self-management barriers. DISCUSSION: The findings suggested that more attention needs to be paid to patients' and their family caregivers' support needs (e.g. fears, concerns, knowledge, adherence barriers and facilitators) regarding AVF self-management. The dyads seem to be aware of how to take care of the AVF; however, self-care behaviours still need to be improved. CONCLUSION: Innovative interventions need to follow an interdisciplinary approach with an educational and support component. The integration of family caregivers should also be considered, since this study evidenced their lack of knowledge and skills, and willingness to participate in these initiatives.

Reproduction-related cognitive processing and distress among young adult women: the role of personal breast cancer history.

Breast cancer diagnosis can threaten fertility and biological motherhood in women of reproductive age due to the gonadotoxic effects of treatments. Much evidence documents these women fertility-related concerns and distress, but no study has attempted to understand how implicit cognitive processes can contribute to this maladjustment. In this research, we explored whether reproduction-related stimuli interfere with cognition among cancer survivors with infertility risk using an emotional Stroop task. Furthermore, we investigated the relationship between reproduction-related cognitive processing and psychological morbidity. Young cancer survivors aged 18-40 years who received anticancer treatments and an age-matched non-cancer control group without known fertility problems were compared. Color-naming times and error rates were assessed. Participants in both groups were slower naming the color of reproduction-related words in comparison to unrelated negative valence words. Although in the same direction, this difference did not reach statistical significance for positive and neutral unrelated word lists. Further analysis suggested that biased attention toward reproduction-related information was associated with higher depression levels in young women with personal breast cancer history, but not in healthy women. These findings suggest that biased processing of reproduction-related cues might be a vulnerability factor after a breast cancer diagnosis. Additionally, this study puts in evidence the potential usefulness of using experimental tasks to investigate attentional bias in a context where fertility is at risk.

Impact of Psychological Aggression at the Workplace on Employees' Health: A Systematic Review of Personal Outcomes and Prevention Strategies.

Psychological aggression perpetrated by customers, coworkers, and supervisors is a behavior frequently experienced in the workplace with negative consequences for an individual's health. The aim of this systematic review was to examine the personal outcomes of overt workplace psychological aggression and summarize empirical evidence on how to prevent and reduce its effects. A search on PubMed, Scopus, ProQuest, and Web of Science electronic databases was made. Data were obtained from 30 studies (26 cross-sectional, 3 longitudinal, 1 quasi-experimental) representing 20,683 employees. Longitudinal studies indicated that workplace psychological aggression is significantly associated with musculoskeletal injury and psychological strains (anxiety, depression, anger) over time. Research also suggests that psychological aggression at work predicts fear, emotional exhaustion, depersonalization, personal accomplishment, and physical symptoms, for example. Additionally, the information collected suggested that support from coworkers, supervisors, and management; informational support; political skills; job resources; and confidence to prevent and respond to aggression moderate significantly the impact of workplace psychological aggression on personal and organizational outcomes. Perceptions of a violence-prevention climate, aggression-preventive supervisor behavior, and aggression-preventive employee effort are also significantly associated with a reduction in psychological aggression at work and strains. In conclusion, this review allows us to understand the effects of the psychological aggression by identifying the preventive strategies that could be adopted by managers, supervisors, or leaders to deal with it and promote individual's health in the workplace.

Toward an Understanding of the Factors Associated With Reproductive Concerns in Younger Female Cancer Patients: Evidence From the Literature.

BACKGROUND: Cancer treatments may compromise fertility and family building in reproductive-age women. Previous research has shown that younger women with cancer experienced several reproductive health concerns. OBJECTIVE: The aim of this study was to conduct a focused review of existing research about the subjective perceptions of reproductive concerns among young women with cancer (aged 15-49 years) and identify their potential predictors and outcomes. METHODS: A systematic synthesis of mixed-methods research was conducted including peer-reviewed articles in English. Relevant studies were identified through the electronic databases Scopus, Web of Science, PubMed, ProQuest, and Psychology & Behavioral Sciences Collection (through EBSCOhost). RESULTS: A total of 22 reports met the eligibility criteria (8 qualitative and 14 quantitative). Research showed that younger women reported concerns related to their fertility status and/or own health after conception, their children's health, and their dyadic relationships. Redefinition of the motherhood role and the family future were also a source of concern. However, there is variance among women in concerns and experiences based on life stages and expectations. CONCLUSIONS: Reproductive concerns seem to be affected by personal circumstances and previous therapeutics. These concerns constitute a potential risk factor, simultaneously, for psychosocial maladjustment and adherence to endocrine therapy and fertility care. IMPLICATIONS FOR PRACTICE: This article proposes a conceptual framework to understand the dimensions and potential predictors and outcomes of perceived concerns among reproductive-age cancer patients. Our data allow us to look at these concerns from a multifactorial perspective, identifying areas to be addressed in providing clinical care, namely, by nurses accompanying patients over an extended period.

Portuguese Version of the 12-Item Violence Prevention Climate Scale: Test of Psychometric Properties.

BACKGROUND AND PURPOSE: A violence prevention climate is critical for nurses' well-being but also for nursing practice and the quality of care. This study examined the reliability and factor validity of the European Portuguese version of the 12-item Violence Prevention Climate Scale (VPCS). METHODS: Data came from a sample of 120 nurses providing care in Portugal. Confirmatory factor analysis was used to test the structural theory of the scale. RESULTS: First and second-order confirmatory factor analysis models showed identical goodness-of-fit suggesting the adequacy of the models to the sample data. Our results also provide evidence of composite reliability, and convergent and discriminant validity. CONCLUSIONS: Consistent with previous studies, data from this study showed that the Portuguese version of the 12-item VPCS is a reliable and valid scale to evaluate nurses' perceptions of a violence prevention climate.

Job Stress, Burnout and Coping in Police Officers: Relationships and Psychometric Properties of the Organizational Police Stress Questionnaire.

Policing is a stressful occupation, which impairs police officers' physical/mental health and elicits burnout, aggressive behaviors and suicide. Resilience and coping facilitate the management of job stress policing, which can be operational or organizational. All these constructs are associated, and they must be assessed by instruments sensitive to policing idiosyncrasies. This study aims to identify operational and organizational stress, burnout, resilient coping and coping strategies among police officers, as well to analyze the psychometric properties of a Portuguese version of the Organizational Police Stress Questionnaire. A cross-sectional study, with online questionnaires, collected data of 1131 police officers. With principal components and confirmatory factor analysis, PSQ-org revealed adequate psychometric properties, despite the exclusion of four items, and revealed a structure with two factors (poor management and lack of resources, and responsibilities and burden). Considering cut-off points, 88.4% police officers presented high operational stress, 87.2% high organizational stress, 10.9% critical values for burnout and 53.8% low resilient coping, preferring task-orientated than emotion and avoidance coping. Some differences were found according to gender, age and job experience. Job stress and burnout correlated negatively with resilient coping, enthusiasm towards job and task-orientated coping. Results reinforce the importance to invest on police officers' occupational health.

Fertility under uncertainty: exploring differences in fertility-related concerns and psychosocial aspects between breast cancer survivors and non-cancer infertile women.

BACKGROUND: The threat to fertility due to anticancer treatments can be distressing to women who wish to complete their family. The current study assessed the fertility-related concerns, psychological distress and health-related quality of life (HRQoL) of breast cancer survivors in comparison to non-cancer women with infertility history and to healthy controls from the general population. METHODS: We surveyed young adult women aged 18 to 40 who wished to have a (or another) biological child. Participants completed self-report measures assessing fertility concerns, anxiety, depression and physical, emotional, role and social functioning. Group differences were assessed using multivariate comparisons as well as univariate tests and discriminant analysis for individual measures. RESULTS: A total of 136 women were recruited, of whom 43 were breast cancer survivors, 56 non-cancer infertile women and 37 healthy controls. Considering the female cancer survivors as the focus of the analysis, data suggested that these women presented identical concerns to the non-cancer infertile group and higher than the healthy women with regard to fertility potential (p < 0.01). However, women diagnosed with cancer reported worse HRQoL than their counterparts, showing lower scores in physical functioning (p < 0.05) than infertile women and lower role (p < 0.05) and social HRQoL (p < 0.01) than the controls. Anxiety and depressive symptoms did not differ between the three groups. CONCLUSIONS: The results suggest that living with uncertainty about reproductive potential after cancer can be a disruptive experience. Breast cancer survivors and infertile women are at risk of future emotional maladjustments, given the reported level of fertility concern.

The European Portuguese version of the Reproductive Concerns After Cancer Scale (RCACS): A psychometric validation for young adult female cancer survivors.

PURPOSE: The purpose of this study was to evaluate the psychometric properties of the Portuguese version of the 18-item Reproductive Concerns After Cancer Scale (RCACS) among young adult female cancer survivors. METHODS: The psychometric validation was conducted based on a convenience sample of 192 cancer survivors aged between 18 and 40 years. An exploratory factor analysis (EFA) was used to test the factor structure of the Portuguese version of RCACS and reliabilities were examined. Convergent and discriminant validity was also used to assess the construct validity. The Hospital Anxiety and Depression Scale (HADS), the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core-30 (EORT QLQ-C30) and the need for parenthood and rejection of child-free lifestyle subscales of the Fertility Problem Inventory (FPI) were used as convergent measures. RESULTS: A five-factor model was obtained with acceptable fit indexes and internal consistencies (.72<α<.89): (1) fertility potential, (2) children's health risk and future life, (3) partner disclosure, (4) barriers to getting pregnant/having children and (5) acceptance. Overall, convergent and discriminant validities were confirmed. Levels of anxiety and depression symptoms as well as health-related quality of life (QoL) had weak-to-moderate associations with reproductive concerns. Women who had a child or did not want a biological child were less concerned. CONCLUSION: This scale proved to be a reliable and valid measure of reproductive concerns for the Portuguese population with potential relevance for application in clinical practice.

Burnout and Stress Measurement in Police Officers: Literature Review and a Study With the Operational Police Stress Questionnaire.

Research has demonstrated that policing is a stressful occupation and that this stress has a negative impact on police officers' mental and physical health, performance, and interactions with citizens. Mental health at the workplace has become a concern due to the costs of depression, anxiety, burnout, and even suicide, which is high among police officers. To ameliorate occupational health, it is therefore crucial to identify stress and burnout levels on a regular basis. However, the instruments frequently used to measure stress have not valorized the specificity of policing tasks. This study aims to: (i) conduct a literature review to identify questionnaires used to assess occupational stress and burnout among police officers; (ii) analyze the psychometric characteristics of a Portuguese version of Operational Police Stress Questionnaire (PSQ-Op); and, using the PSQ-Op and other questionnaires, (iii) to identify operational stress, burnout, and distress levels among Portuguese police officers. The literature review identified 108 studies which use a multiplicity of questionnaires to measure burnout or occupational stress among police officers, but few studies use specific police stress questionnaires. Sample sizes were mostly below 500 participants and studies were mainly developed in the last decade in the USA and Brazil, but also in another 24 countries, showing the extent of the interest in this topic. This study applied to 2057 police officers from the National Portuguese Police, a force policing urban centers, and used the PSQ-Op, as well the Spanish Burnout Inventory and the Kessler Psychological Distress Scale. The results show that the psychometric properties of the Portuguese version of PSQ-Op are adequate. Factorial analysis revealed two dimensions defined as social and work issues, which were associated with measures of distress and burnout. Fit indices suggested a second-order solution called operational police stress. Overall, and considering the scale range of each questionnaire, the results showed moderate values of operational stress, distress, and burnout. However, considering their cut-off points, 85% of the sample presented high operational stress levels, 11% critical values for burnout, and 28% high distress levels, with 55% of the sample at risk of a psychological disorder. These results reinforce the need to prevent stress and to invest in police officers' occupational health.