Training Law Enforcement Officers for Safe and Healthy Critical Incidence Performance

Transcription

1 Training Law Enforcement Officers for Safe and Healthy Critical Incidence Performance Bengt B. Arnetz, MD, PhD. MPH, MScEpi Department of Family Medicine College of Human Medicine Michigan State University Michigan Occupational Health Conference September 24, 2016

2 Disclosure Nothing to disclose

3 Research Support R34 MH National Institute of Mentla Health/NIH Royal Foundation of Sweden ( Kungafonden)

4 Collaborators Eamonn Arble, PhD, EMU James Blessman, MD, WSU Mark Lumley, PhD, WSU Nnamdi Pole, PhD, Smith College Sarah Thomsen, PhD

5 Agenda Stress and Health Professional Behavior Contextual Challenges Novel Brain-based training Linking emotional control & performance Future Directions

6 Research Focus WHAT causes Stress HOW Stress Mechanisms Management Resilience Prevention Arnetz BB, Ekman R (eds) ISBN

7 Stressor Mental Health Psycho-Biological and Environmental Resources Risk Factors Risk Reactions Targets Outcome CI Stressor Genetic suscept. (epigenetics) Demographics (female, minority, age) Psychiatric hx (trauma sensitization) Intellect. funct. Coping Peri-traumatic emotional, cognitive & physiological arousal Fear (Sympathetic n.s. dying, loss of control, depersonalization) Fear condit. Memory cons. Hyperarousal Traumarelated symptoms Behavior Performance Maladaptive Behavior (alcohol, drugs, rigid avoidance, poor coping) Chronic, low-intensity, professionally-derived stressors New critical incident exposure

8 Contextual Stressors Facing first Responders

9 Imagery-Based Skills and Predictability Training Does imagery-based training among police: Decrease psycho-physiological responses to real-life critical incident exposure? Improve longer-term mental and physical health and job performance?

10 Scenario Short-terms effects 1 year post training Real-life enactment of prior bank robbery (analyzed) Police paired-up in a car Diverted to three prior incidents Arrived at bank, Told it was old Go to back: Meet an employee Parked car; after leaving car, robbers came out of building: 3 seconds, shots Chasing, if alive, hand-cuffing Closure/defusing

11 Scenario Effectiveness Effect size of scenario on heart rate: % of participants fired a shot (Military stat: approx.25% fires in combat) 44% experienced tunnel vision

12 Self-Rated Stress % of maximum F 1, time = 6.48, p =.02. F 1, time x group = 2.86, p =.10

13 Heart Rate Response Heart Rate. Mean-95% CI intervention Group Control F1 = 24.02; p<.01 Effect Size 1.4

14 Objective Performance t 1, group = 3.80, p =.02

15 Mean Antithrombin (AT kle/l) Antithrombin Scenario F 1, time = 6.75, p =.02. F 1, time x group = 4.84, p =.04

16 Stressor-Induced Cortisol Response F 1, time = 8.98, p =.009. F 1, time x group = 14.85, p =.002

17 Long-term Outcomes Entire group of 75 police officers assessed after 1 and 2 years, respectively, on the job for: mental and physical health biomarkers, and job performance

18 Exposure to Threat & Violence Mean +/- S.E.M Baseline Posttraining 2-Year Police Work Control Intervent F 2 time, , p =.0001

19 Wellbeing 2-Year Post-Training Mental Health Mental Wellbeing - GHQ Higher scores = greater wellbeing Time 1 Time 2 Time 3 Imagery Training Training as Usual F 2, time = 2.61, p =.07. F 2, time x group = 5.12, p =.007

20 Ratio: s-cortisol/s-dhea-s Mean +/- S.E.M Control Intervent 0.00 Baseline Posttraining 2-Year Police Work F 2, time, = 9.20, p =.0001

21 Health Effects from Imagery Training Imagery vs control group: Increased likelihood of improved mental health (OR: 3,5; 95% Confidence interval: ) More likely to improve mental health adjusting for occupational violence exposure (OR: 4.1; ) Greater likelihood of improvement in stress marker Prolactin (OR: 3.4; )

22 Predictors of Allostatic Load 2-Year Prospective Data Dependent: Allostatic Load# Independent RSQ/ß (S.E.) Change in RSQ F to enter Use alcohol to winddown.12 / 2.09 (.59) Threat & violence.19 /.11 (.05) exposure- prior 2 years # Sum Ln (s-cortisol; Fructoseamine; Cholesterol; Triglycerides; Apo B/A; Prolactin, Syst./Diastolic BP)

23 Changes in coping strategies and mental health from pre-training to 1-year follow-up Pre-Training M (SD) Follow-up M (SD) t p Effect Size Variables Coping strategies Positive reframing 3.38 (1.24) 4.14 (2.03) Humor 3.15 (0.91) 4.00 (1.90) Active coping 4.14 (1.96) 4.45 (1.87) Positive planning 3.64 (1.22) 4.14 (2.32) Self-blame 2.57 (0.75) 2.39 (0.51) Social support (4.24) (4.05) Mental health measures PTSD symptoms (5.22) (5.17) Anxiety 3.10 (1.92) 2.30 (1.78) Depression 0.82 (0.85) 1.41 (1.50) Sleep disruption 6.27 (2.68) 6.82 (2.79) Alcohol use 5.25 (2.96) 4.10 (1.49) N = 22. City of Detroit Police Department. Detroit Police Academy Source: E. Arble, M. Lumley, N. Pole, j. Blessman, B. Arnetz J of Police and Crinial Psychology, In Press, 2016

24 Stress to Health Pathways Source: E. Arble & B. Arnetz Stress 7 Health, 216, In Press

25 Law enforcement Resilience Arousal Resiliency Factors: Imagery Sleep Nutrition Leadership Time Real or re-lived trauma/stressor

26 Thank you!