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Critical Incident Exposure and Sleep Quality in Police Officers

From the Department of Psychiatry (T.C.N., T.J.M., S.R.B., D.S.W., C.R., K.V., A.B., T.L.L.), University of California, San Francisco; and Columbia University School of Public Health (J.A.F., K.L.), New York, NY.

Address reprint requests to: Dr. Thomas C. Neylan, PTSD Program, Psychiatry Service 116P, VA Medical Center, 4150 Clement St., San Francisco, CA 94121. Email: neylan{at}itsa.ucsf.edu

OBJECTIVE: Police officers face many stressors that may negatively impact sleep quality. This study compares subjective sleep quality in police officers with that in control subjects not involved in police or emergency services. We examined the effects of critical incident exposure (trauma exposure) and routine (nontraumatic) work environment stressors on sleep quality after controlling for the effects of work shift schedule.

METHODS: Subjective sleep disturbances were measured by the Pittsburgh Sleep Quality Index in police officers (variable-shift workers, N = 551; stable day-shift workers, N = 182) and peer-nominated comparison subjects (variable-shift workers, N = 98; stable day-shift workers, N = 232). The main predictor variables were 1) duty-related critical incident exposure to on-line policing and 2) work environment stress related to routine administrative and organizational aspects of police work.

RESULTS: Police officers on both variable and stable day shifts reported significantly worse sleep quality and less average sleep time than the two corresponding control groups. Within police officers, cumulative critical incident exposure was associated with nightmares but only weakly associated with poor global sleep quality. In contrast, the stress from officers’ general work environment was strongly associated with poor global sleep quality. Sleep disturbances were strongly associated with posttraumatic stress symptoms and general psychopathology.

CONCLUSIONS: A large percentage of police officers report disturbances in subjective sleep quality. Although the life-threatening aspects of police work are related to nightmares, the routine stressors of police service seem to most affect global sleep quality in these subjects. These findings may have implications for health and occupational performance.

Key Words: stress • psychological • sleep disorders • stress disorders • posttraumatic

Abbreviations: CD = control subject, day shift;; CIHQ = Critical Incidents History Questionnaire;; CV = control subject, variable shift;; ES = effect size;; GSI = Global Severity Index;; MS-CV = Mississippi Scale for Civilian Posttraumatic Stress Disorder;; PD = police officer, day shift;; PSQI = Pittsburgh Sleep Quality Index;; PTSD = posttraumatic stress disorder;; PV = police officer, variable shift;; SCL-90-R = revised 90-item Symptom Checklist;; SF-12 = Medical Outcomes Study 12-item Short-Form Health Survey;; WEI = Work Environment Inventory.

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