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  • 12/03/10 12:03 PM
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  • 12/03/10 12:03 PM Elaborate on symptoms
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  • Transcript

    • 1. 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 Follow-up Mental Health Assessment in the New Orleans Police Force USPHS Scientific and Training Symposium San Diego, California May 26, 2010
    • 2. 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
    • 3. 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
    • 4. Background
      • 2 NIOSH surveys
        • Requested by NOPD management
        • October 2005: 2 months after Hurricane Katrina
        • December 2006: 15 months after Hurricane Katrina
      • Follow-up visit Sept 2009
        • Discuss findings, ongoing concerns and additional recommendations
    • 5. 1 st 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
    • 6. 2nd Survey, 2006
      • Compared results to 1 st 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
    • 7. 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
    • 8.
      • 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?
    • 9. 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
    • 10. Comparison of Symptoms 1 st to 2 nd Survey Symptoms 1 st Survey 2 nd Survey PTSD symptoms 19 21 Depressive symptoms 26 23 Gastrointestinal symptoms 7 14
    • 11. Use of Counseling Services Service 1 st Survey % 2 nd Survey % Individual counseling 14 13 Group meeting 12 14 Family counseling 2 6 Counseling referral for individual and/or family 2 3
    • 12. Satisfaction with Job Factors Factors % Satisfied Communication with coworkers 86 Communication with supervisor 76 Quality of supervision 71 Ability to make independent decisions 67 Work schedules 63 Equipment 24
    • 13. 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
    • 14. 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
    • 15. 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
    • 16. 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
    • 17. 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
    • 18. Follow-up visit to NOPD in September 2009
      • Presented summary of findings from 2 nd 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
    • 19. 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
    • 20. 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
    • 21. 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
    • 22. 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
    • 23. More Information
      • Contact Information:
      • Project Officer: [email_address]
      • Behavioral Scientist at NIOSH: [email_address]
      • 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/2006-0027-3001.pdf
      • http://www.cdc.gov/niosh/hhe/reports/pdfs/2007-0067-3076.pdf
      • Science Blog on police and stress:
      • http://www.cdc.gov/niosh/blog/nsb063008_policestress.html
    • 24. 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 8 4 (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 hurricane-related stressors and mental illness after Hurricane Katrina. Arch Gen Psychiatry 64 (12):1427–1434.
    • 25. 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.

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