CAPT Arnold Farley for

LCDR Christine West RN, MSN, MPHCenters for Disease Control and PreventionNational Institute for Occupational Safety and

HealthHazard Evaluations and Technical Assistance

Branch

Follow-up Mental Health Assessment in the New Orleans Police Force

USPHS Scientific and Training SymposiumSan 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

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

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

Symptoms 1st Survey 2nd Survey

PTSD symptoms 19 21

Depressive symptoms

26 23

Gastrointestinal symptoms

7 14

Comparison of Symptoms 1st to 2nd Survey

Use of Counseling Services

Service

1st Surve

y%

2nd Survey %

Individual counseling 14 13

Group meeting 12 14

Family counseling 2 6

Counseling referral forindividual 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 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: cawest@cdc.gov

Behavioral Scientist at NIOSH: dwiegand@cdc.gov

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 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 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.