Screening for PTSD in police officers: Preliminary psychometric properties of the adapted primary care PTSD screen for DSM-5 (PC-PTSD-5 [0-20]) screener.

OBJECTIVE: Police officers are at heightened risk for posttraumatic stress disorder (PTSD) due to frequent exposure to traumatic stressors. Early identification of PTSD symptoms is crucial for timely intervention. However, stigma and low utilization of mental health services create barriers to accessing care, which can be improved through the use of accessible, brief, and efficient screening instruments. The Primary Care PTSD for Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-5; PC-PTSD-5) scale is a brief, five-item self-report questionnaire demonstrating good reliability and validity in the identification of probable PTSD among veterans and civilians but has not yet been examined in first responder populations. METHOD: In this study, we assess the psychometric properties of an adapted version of the measure (PC-PTSD-5 [0-20]) in a sample of U.S. police officers (N = 394), focusing on reliability, structural validity, measurement invariance, and convergent and discriminant validity. RESULTS: Internal consistency of the PC-PTSD-5 [0-20] was good (α = .87), with uniform item-total correlations ranging from .78 to .83. Confirmatory factor analysis supported a single-factor structure (comparative fit index = 0.97, Tucker-Lewis index = 0.94, root-mean-square error of approximation = 0.12 (90% CI [.08, .16]), standardized root-mean-square residual = 0.03) that was invariant between male and female officers, χ²(9, N = 394) = 2.72, p = .974, and across years of service, χ²(9, N = 394) = 9.02, p = .436, providing evidence of construct validity. The measure also demonstrated convergent and discriminant validity, showing varying degrees of correlational strength with 20 operational stressors, the strongest of which were with traumatic stressors (r = .52, p < .001). CONCLUSIONS: These findings suggest the PC-PTSD-5 [0-20] may be a valuable tool for identifying PTSD symptoms in police officers, benefiting both clinical and research applications. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Clarifying relations of emotion regulation, emotional avoidance and anxiety symptoms in a community-based treatment-seeking sample.

OBJECTIVES: Anxiety is a global problem that is readily treatable with psychosocial interventions, though many individuals do not benefit following participation in extant treatment protocols. Accordingly, clarification of process-related variables that may be leveraged to enhance outcomes appears warranted. Emotion regulation (ER) is a robust correlate of anxiety symptoms and is often targeted in behavioural treatments applied to anxiety-related problems. Yet, some evidence suggests ER difficulties may be a proxy variable for emotional avoidance (EA). Clarifying the relative influence of ER and EA on anxiety symptom severity may improve specificity in targeting behavioural processes within psychosocial treatments designed to alleviate anxiety-related suffering. Accordingly, we examined relations of ER and EA to anxiety symptom severity after accounting for anxiety sensitivity and anxiolytic medication use in a community-based treatment-seeking sample. DESIGN: A four-step hierarchical linear regression analysis of cross-sectional data provided by a community-based treatment-seeking sample. METHODS: Totally, 120 participants (Mage = 39.18; Female = 58.3%) completed a questionnaire packet upon intake to an anxiety disorders clinic. RESULTS: EA and ER were strongly correlated, and each accounted for significant variance over and above model covariates. EA was a dominant risk factor for anxiety symptom severity, as ER was not a significant predictor (p = .073) following the inclusion of EA in the model (p = .006). CONCLUSIONS: EA appears to be a dominant risk factor, and ER a proxy risk factor, for anxiety symptom severity. EA may be an avenue for greater treatment specificity for those with anxiety symptoms.

Mapping PTSD, depression, and anxiety: A network analysis of co-occurring symptoms in treatment-seeking first responders.

First responders are at high risk for a range of co-occurring mental health conditions due to their repeated exposure to traumatic events. When first responders present for treatment, their complex presentation of symptoms including posttraumatic stress disorder (PTSD), depression, and generalized anxiety disorder (GAD) can prove challenging to differentiate for clinical purposes. Network analysis provides a means to identify the nuanced associations between the symptoms of these conditions and to identify groups of related symptoms. In this study, a treatment-seeking sample of first responders (N = 432) completed self-report measures of PTSD, depression, and GAD. Network analysis was used to identify symptom clusters within the sample. Our cross-sectional data yielded six empirically distinct communities: depression symptoms, GAD symptoms, and four communities comprising PTSD symptoms - intrusion and avoidance; irritability and aggression; negative affect; and arousal and sleep. Network associations underscore the heterogeneity of PTSD and also highlight overlapping and diverging symptoms of depression and GAD. These findings are discussed within the context of existing research on first responders, and recommendations for further study and treatment interventions are provided.

Indirect Associations Between Posttraumatic Stress Symptoms and Other Psychiatric Symptoms, Alcohol Use, and Well-being via Psychological Flexibility Among Police Officers.

Police officers experience a high number of potentially traumatic events (PTEs) often associated with elevated posttraumatic stress symptoms (PTSS). In addition, PTSS are related to co-occurring psychiatric symptoms (e.g., anxiety, depression), alcohol misuse, and low perceived well-being. Yet, behavioral processes that may account for the associations between PTSS and unfavorable outcomes remain unspecified. Psychological flexibility, or one's response to private experiences (e.g., PTE-related memories) with an open, aware, and active approach, may be one such process. The present study aimed to evaluate psychological flexibility as both a mediator and moderator of PTSS and commonly co-occurring psychiatric symptoms, alcohol use, and general well-being, using cross-sectional data provided by a sample of police officers (N = 459) recruited from three regionally distributed U.S. police agencies. Structural equation modeling indicated a well-fitting model wherein psychological flexibility indirectly accounted for associations among PTSS and endogenous outcomes, χ2 (107, N = 457) = 225.33, p < .001, CFI = .99, TLI = .98, RMSEA = .05, 90% CI [.04, .06], SRMR = .03. Psychological flexibility also moderated associations between PTSS and psychiatric symptoms, B = 1.58 (SE = 0.22), p < .001; and well-being, B = -3.84 (SE = 0.46), p < .001. Although additional research is needed, these preliminary results suggest psychological flexibility may be a behavioral process that accounts for negative outcomes associated with PTSS and a productive intervention target in the context of PTSS and generalized distress. Further research regarding the role of psychological flexibility in PTSS-related outcomes for police officers appears warranted.