Transcript Slide 1

Follow-up Mental Health Assessment in
the New Orleans Police Force
USPHS Scientific and Training Symposium
San Diego, California
May 26, 2010
CAPT Arnold Farley for
LCDR Christine West RN, MSN, MPH
Centers for Disease Control and Prevention
National Institute for Occupational Safety and Health
Hazard Evaluations and Technical Assistance Branch
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
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
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
Comparison of Symptoms 1st to 2nd Survey
Symptoms
1st Survey
2nd Survey
PTSD symptoms
19
21
Depressive
symptoms
26
23
Gastrointestinal
symptoms
7
14
Use of Counseling Services
1st Survey
%
2nd Survey
%
Individual counseling
14
13
Group meeting
12
14
Family counseling
2
6
Counseling referral for
individual and/or family
2
3
Service
Satisfaction with Job Factors
Factors
Communication with coworkers
% Satisfied
86
Communication with supervisor
Quality of supervision
Ability to make independent
decisions
Work schedules
Equipment
76
71
67
63
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/2006-00273001.pdf
http://www.cdc.gov/niosh/hhe/reports/pdfs/2007-00673076.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 hurricanerelated 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.