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  • 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
  • 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
      • 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
  • 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
  • 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
  • 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
    • 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?
  • 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 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
  • 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
  • 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
  • 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 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
  • 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_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
  • 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.
  • 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.