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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 <ul><li>Compare and contrast the mental health symptom prevalence of NOPD personnel at 2 and 15 months after Hurricane Katrina </li></ul><ul><li>Describe personal and occupational factors that may have influenced mental health outcomes in police officers </li></ul><ul><li>Identify recommendations to NOPD personnel for coping with adverse mental health symptoms </li></ul>
    • 3. What is NIOSH? <ul><li>National Institute for Occupational </li></ul><ul><li>Safety and Health </li></ul><ul><ul><li>Part of the Centers for Disease Control </li></ul></ul><ul><ul><li>and Prevention </li></ul></ul><ul><ul><li>Conduct occupational </li></ul></ul><ul><ul><li>safety and health evaluations and make recommendations for workplaces </li></ul></ul>
    • 4. Background <ul><li>2 NIOSH surveys </li></ul><ul><ul><li>Requested by NOPD management </li></ul></ul><ul><ul><li>October 2005: 2 months after Hurricane Katrina </li></ul></ul><ul><ul><li>December 2006: 15 months after Hurricane Katrina </li></ul></ul><ul><li>Follow-up visit Sept 2009 </li></ul><ul><ul><li>Discuss findings, ongoing concerns and additional recommendations </li></ul></ul>
    • 5. 1 st Survey, 2005 <ul><li>912 NOPD personnel participated </li></ul><ul><ul><li>60-70% participation* </li></ul></ul><ul><li>80% Male /Average Age: 38 Years /Average Job Tenure: 11 Years </li></ul><ul><li>19% symptoms consistent with PTSD </li></ul><ul><li>26% symptoms consistent with major depression </li></ul><ul><li>PTSD symptoms associated with involvement in crowd control, body recovery </li></ul><ul><li>Depressive symptoms associated with rare family contact, uninhabitable home, and isolation from regular NOPD assignment </li></ul><ul><li>Both PTSD and depressive symptoms associated with being assaulted and injury to family member </li></ul><ul><li>* Denominator estimated </li></ul>
    • 6. 2nd Survey, 2006 <ul><li>Compared results to 1 st Survey </li></ul><ul><ul><li>Only included those who participated in 2005 survey </li></ul></ul><ul><li>Determined prevalence of physical and mental health symptoms in 2006 </li></ul><ul><li>Distributed anonymous, self-administered questionnaire to police at several locations </li></ul><ul><li>Distributed resource packet of medical and mental health referral information </li></ul>
    • 7. What was in the Questionnaires? <ul><li>Work history and locations </li></ul><ul><li>Family circumstances, level of damage to residence, use of sick leave, personal activities, and job satisfaction </li></ul><ul><li>Physical and mental health status </li></ul><ul><ul><li>Respiratory / skin rash / gastrointestinal symptoms </li></ul></ul><ul><ul><li>Posttraumatic stress disorder and depressive symptoms </li></ul></ul><ul><li>Past medical history </li></ul><ul><li>Use of counseling services and health care services </li></ul>
    • 8. <ul><li>Work history and locations </li></ul><ul><li>Family circumstances, level of damage to residence, use of sick leave, personal activities, and job satisfaction </li></ul><ul><li>Physical and mental health status </li></ul><ul><ul><li>Respiratory / skin rash / gastrointestinal symptoms </li></ul></ul><ul><ul><li>Posttraumatic stress disorder and depressive symptoms </li></ul></ul><ul><li>Past medical history </li></ul><ul><li>Use of counseling services and health care services </li></ul>What was in the Questionnaires?
    • 9. Results of 2006 NIOSH Survey <ul><li>808 NOPD personnel completed questionnaire </li></ul><ul><ul><li>68% response rate </li></ul></ul><ul><li>72% Male </li></ul><ul><li>Average age: 40 Years </li></ul><ul><li>Average job tenure: 13 Years </li></ul><ul><li>85% commissioned police officers </li></ul><ul><li>61% field/patrol capacity </li></ul>
    • 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 <ul><li>PTSD and depression changed little </li></ul><ul><li>Higher rates of PTSD and depression </li></ul><ul><li>Symptoms may persist in some personnel </li></ul><ul><li>Continue to experience stressors from routine duties and reminders of hurricane </li></ul><ul><li>Disruption of social support structure </li></ul><ul><li>Living in temporary homes </li></ul>
    • 14. Gastrointestinal Symptoms <ul><li>Increase in gastrointestinal symptoms from 2005 to 2006 </li></ul><ul><ul><li>Did not evaluate exposures </li></ul></ul><ul><ul><li>Stressful life events and anxiety may be related to physical symptoms </li></ul></ul>
    • 15. Counseling Services <ul><li>Use of services did not increase </li></ul><ul><li>Lack of awareness </li></ul><ul><li>Personnel may be uncomfortable seeking care </li></ul><ul><li>Lack of availability of services in the city </li></ul>
    • 16. Limitations <ul><li>Actual symptom prevalences may be different from reported prevalences </li></ul><ul><ul><li>Self-reported symptoms </li></ul></ul><ul><ul><li>Unable to survey personnel on sick leave (~5%) </li></ul></ul><ul><li>Unable to conduct direct comparison of symptoms </li></ul><ul><li>May not be able to attribute symptoms to hurricane events </li></ul><ul><li>May be underestimation of mental health symptoms due to reluctance to report </li></ul>
    • 17. Recommendations <ul><li>Develop strategies to increase use and acceptance of seeking care and treatment </li></ul><ul><li>Develop and implement a comprehensive occupational safety and health program: </li></ul><ul><ul><li>Joint employee-management committee for safety and health </li></ul></ul><ul><ul><li>Medical screening / pre and post event </li></ul></ul><ul><ul><li>Employee assistance program </li></ul></ul><ul><li>Develop strategies to increase social support </li></ul>
    • 18. Follow-up visit to NOPD in September 2009 <ul><li>Presented summary of findings from 2 nd survey report </li></ul><ul><li>Provided additional recommendations </li></ul><ul><li>Presented strategies for improved social support </li></ul><ul><li>Met with department representatives and officers to discuss ongoing health and safety needs of personnel </li></ul><ul><li>Distributed handouts to police district stations </li></ul>
    • 19. Additional concerns raised Sep 2009 <ul><li>Personnel continue to recount stories about their experiences during Hurricane </li></ul><ul><li>Continue to live apart from families, and in some cases this has resulted in divorce and custody battles </li></ul><ul><li>Observed increased anger, irritability, excess alcohol consumption, and requests for time off </li></ul><ul><li>Continued reluctance to access services </li></ul><ul><li>Need for additional officers on force </li></ul><ul><ul><li>Lost 20% of police force since Hurricane </li></ul></ul>
    • 20. Handout on giving and receiving social support <ul><li>Developed for NOPD </li></ul><ul><ul><li>Reluctance to seek care </li></ul></ul><ul><ul><li>History of suicides in police force </li></ul></ul><ul><ul><li>Reliance on coworkers for support </li></ul></ul><ul><ul><li>Lack of mental health resources in NOLA </li></ul></ul><ul><ul><li>Lack of awareness from management </li></ul></ul><ul><li>L.A.S.E.R.: Look, Ask, Support, Evaluate, Receive </li></ul><ul><ul><li>Acronym to help personnel remember several important steps to looking out for each other and offering social support </li></ul></ul><ul><ul><li>Adapted from Psychological First Aid : Field Operations Guide </li></ul></ul>
    • 21. Recent changes and developments <ul><li>Louisiana Spirit Program </li></ul><ul><ul><li>City-wide hurricane recovery resources </li></ul></ul><ul><li>Employee Assistance Program </li></ul><ul><ul><li>Working on funding mechanism in Department </li></ul></ul><ul><li>Department Disaster and Preparedness Plan </li></ul><ul><ul><li>Includes policy for liberal use of furlough and sick leave, and completion of a personal emergency evacuation plans </li></ul></ul><ul><ul><li>Guidance on accessing health care during the disaster, ensuring the safety of evacuation sites, and procuring food and water </li></ul></ul>
    • 22. Acknowledgements <ul><li>Co-authors: </li></ul><ul><ul><li>Charles Mueller </li></ul></ul><ul><ul><li>Bruce Bernard </li></ul></ul><ul><ul><li>Richard Driscoll </li></ul></ul><ul><li>NOPD management and personnel </li></ul><ul><ul><li>Major Juan Quinton </li></ul></ul><ul><ul><li>Dr. Armond Devizen </li></ul></ul><ul><li>NIOSH field assistants and supervisors </li></ul>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 <ul><li>Contact Information: </li></ul><ul><li>Project Officer: [email_address] </li></ul><ul><li>Behavioral Scientist at NIOSH: [email_address] </li></ul><ul><li>Health Hazard Evaluation Program: </li></ul><ul><li>www.cdc.gov/niosh/hhe </li></ul><ul><li>Link to Health Hazard Evaluation Report in October 2005 and December 2006: </li></ul><ul><li>http://www.cdc.gov/niosh/hhe/reports/pdfs/2006-0027-3001.pdf </li></ul><ul><li>http://www.cdc.gov/niosh/hhe/reports/pdfs/2007-0067-3076.pdf </li></ul><ul><li>Science Blog on police and stress: </li></ul><ul><li>http://www.cdc.gov/niosh/blog/nsb063008_policestress.html </li></ul>
    • 24. References <ul><li>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 </li></ul><ul><li>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. </li></ul><ul><li>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.  </li></ul><ul><li>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.  </li></ul><ul><li>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. </li></ul>
    • 25. References <ul><li>Huag et al. [2002]. Are anxiety and depression related to gastrointestinal symptoms in the general population? Scandinavian Journal of Gastroenterology 37(3): 294-298. </li></ul><ul><li>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. </li></ul><ul><li>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. </li></ul><ul><li>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 </li></ul><ul><li>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. </li></ul><ul><li>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. </li></ul><ul><li>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. </li></ul>

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