Risk-Based Intensive Blood Pressure Lowering and Prevention of Heart Failure: A SPRINT Post Hoc Analysis.

[Figure: see text].

Changes in intimate partner violence during the early stages of the COVID-19 pandemic in the USA.

The objective of this study is to describe intimate partner violence (IPV) severity and types of victimization during the early states of the COVID19 pandemic. A survey was distributed through social media and email distribution lists. The survey was open for 14 days in April 2020 and 2441 participated. Information on IPV, COVID19-related IPV severity, sociodemographics, and COVID19-related behaviors (eg, job loss) were collected. Regression models were used to evaluate COVID19-related IPV severity across victimization types and sociodemographics. 18% screened positive for IPV. Among the respondents that screened positive, 54% stated the victimization remained the same since the COVID19 outbreak, while 17% stated it worsened and 30% stated it got better. The odds of worsening victimization during the pandemic was significantly higher among physical and sexual violence. While the majority of IPV participants reported victimization to remain the same, sexual and physical violence was exacerbated during the early stages of the pandemic. Addressing victimization during the pandemic (and beyond) must be multi-sectorial.

Prevalence of Mental Illness and Mental Health Care Use Among Police Officers.

Importance: Limited literature has characterized patterns of mental illnesses and barriers in seeking mental health care among police officers. Objectives: To assess the prevalence of mental illness (diagnosis) and symptoms of mental illness, evaluate the characteristics of officers interested in seeking mental health care, and characterize perceptions of mental health care use. Design, Setting, and Participants: This survey study was conducted among officers at a large police department in Dallas-Fort Worth, Texas. Focus group sessions were conducted from April 1, 2019, to November 30, 2019, and the survey was conducted from January 1 to February 27, 2020. A total of 446 sworn, employed patrol officers who were present during the recruitment briefing were eligible to participate in surveys and focus groups. Main Outcomes and Measures: Officers reported lifetime or current diagnosis of depression, anxiety, and posttraumatic stress disorder, as well as current mental health symptoms (using validated screeners of depression, anxiety, posttraumatic stress disorder, and suicidal ideation or self-harm) and mental health care use in the past 12 months. Focus group data were collected to contextualize mental health care use. Logistic regression analyses were used for quantitative data, and focus groups were iteratively coded by 4 coders using inductive and deductive thematic identification. Results: Of the 446 officers invited to participate, 434 (97%) completed the survey (mean [SD] age, 37 [10] years; 354 [82%] male; 217 White [50%]). Of these officers, 19 (17%) had sought mental health care services in the past 12 months. A total of 54 officers (12%) reported a lifetime mental health diagnosis, and 114 (26%) had positive screening results for current mental illness symptoms. Among officers with positive screening results, the odds of interest in using mental health services was significantly higher for officers with suicidal ideation or self-harm than for those who did not (adjusted odds ratio, 7.66; 95% CI, 1.70-34.48). Five focus groups were conducted with 18 officers and found 4 primary barriers in accessing mental health services: (1) inability to identify when they are experiencing a mental illness, (2) concerns about confidentiality, (3) belief that psychologists cannot relate to their occupation, and (4) stigma that officers who seek mental health services are not fit for duty. Conclusions and Relevance: The study found that although few officers were seeking treatment, they were interested in seeking help, particularly those with suicidal ideation or self-harm. Additional interventions appear to be needed to systematically identify and refer officers to health care services while mitigating their concerns, such as fear of confidentiality breach.

Cumulative, high-stress calls impacting adverse events among law enforcement and the public.

BACKGROUND: The unpredictable, and sometimes dangerous, nature of the occupation exposes officers to both acute and chronic stress over law enforcement officers' (LEO)  tenure. The purpose of this study is two-fold: 1) Describe multi-level characteristics that define high-stress calls for service for LEO; and 2) Characterize factors that impact cumulative stress over the course of a LEO's shift. METHODS: Qualitative data were collected from 28 LEOs at three law enforcement agencies in the Dallas-Fort Worth areas from April 2019 to February 2020. Focus group data were iteratively coded by four coders using inductive and deductive thematic identification. RESULTS: Five multi-level factors influenced officer stress: 1) officer characteristics (e.g. military experience; gender); 2) civilian behavior (e.g. resistance, displaying a weapon); 3) supervisor factors (micromanagement); 4) environmental factors (e.g. time of year); and, 5) situational factors (e.g. audience present; complexity of calls). Four themes that characterized cumulative stress: 1) cyclical risk; 2) accelerators; 3) decelerators; and 4) experience of an adverse event. CONCLUSIONS: LEOs become susceptible to adverse events (e.g. injury, excessive use of force) after repeated exposure to high-stress calls for service. Ongoing exposures to stress continue to occur throughout the shift. Our long-term goal is to interrupt this repetitive, cumulative process by restricting the number of consecutive high-risk, high-intensity calls an officer is permitted to respond to.