Work-related stress in personnel of law enforcement: umbrella review

Work-related stress in personnel of law enforcement: umbrella review

SONIA CHIARAVALLOTI1, SHIZUKA KIBI1, DAVID SHAHOLLI1, MARIA VITTORIA MANAI1, GIUSEPPE LA TORRE1

1Department of Public Health and Infectious Diseases, Sapienza University of Rome.

Summary. Aim. The aim of this umbrella review is to review existing studies within the literature on the subject in order to verify the real association between occupational factors, stress and law enforcement, also identifying the main associated factors. Methods. The databases used for this review were PubMed and Scopus. The following were used for the search string: “work related stress”, (“police” OR “public safety” OR “law enforcement”) AND review. Results. 16 papers were retrieved, 8 of which were considered in the final analysis. The results indicate that organizational, operational and professional factors are the most reported causes of work stress in law enforcement. The adoption of measures to improve the organizational structure is of utmost importance. The relationships between colleagues or with managers were also important, as a poor working environment has been found to greatly increase the risk of stress. Health also plays an important role, acting on the decrease of stress. Interventions of aid for the management of stress can be mindfulness, psychotherapy and yoga. Conclusions. Mental disorders remain prevalent among law enforcement personnel and may have negative effects on officers’ health and performance. Moreover, most research is based on observational studies, not necessarily indicating a causal relationship.

Key words. Law enforcement personnel, stress, umbrella review, wellbeing, workplace.

Stress correlato al lavoro nel personale delle forze dell’ordine: una umbrella review.

Riassunto. Scopo. L’obiettivo di questa umbrella review è quello di esaminare gli studi esistenti nella letteratura sull’argomento per verificare la reale associazione tra fattori occupazionali, stress e forze e dell’ordine, identificando anche i principali fattori associati. Metodi. I database utilizzati per questa revisione sono stati PubMed e Scopus. Per la stringa di ricerca sono stati utilizzati: “stress correlato al lavoro” (“polizia” O “sicurezza pubblica” O “forze dell’ordine”) E revisione. Risultati. Sono stati recuperati 16 articoli, di cui 8 sono stati presi in considerazione nell’analisi finale. I risultati indicano che i fattori organizzativi, operativi e professionali sono le cause più presunte di stress lavorativo nelle forze dell’ordine. L’adozione di misure volte a migliorare la struttura organizzativa è della massima importanza. Anche i rapporti tra colleghi o con i manager sono risultati importanti, poiché è stato riscontrato che un ambiente di lavoro inadeguato aumenta notevolmente il rischio di stress. Anche la salute gioca un ruolo importante, agendo sulla diminuzione dello stress. Gli interventi di aiuto per la gestione dello stress possono essere la consapevolezza, la psicoterapia, lo yoga. Conclusioni. I disturbi mentali rimangono prevalenti tra il personale delle forze dell’ordine e possono avere effetti negativi sulla salute e sulle prestazioni degli agenti. Inoltre, la maggior parte della ricerca si basa su studi osservazionali, che non indicano necessariamente una relazione causale.

Parole chiave. Benessere, luogo di lavoro, personale delle forze dell’ordine, stress, umbrella review.

Introduction

In the 2004 European Framework Agreement, Work-Related Stress (WRS) is defined as «a condition that may be accompanied by physical, psychological and/or social disorders or dysfunctions and is a consequence of the fact that some individuals do not feel able to correspond to the work demands or expectations placed on them».

In compliance with the contents of the European Agreement, the current Italian regulatory framework, as described by Legislative Decree 81/2008 and subsequent amendments and additions, obliges employers to assess and manage the risk of work-related stress on a par with other potential risks1.

Historically, the assessment of workers’ health and safety has focused mainly on physical conditions, largely neglecting the psychological aspect.

Modern healthcare has paid more attention to mental health in recent decades and only now understands that it has major repercussions on overall well-being.

Focusing on the object of the study, i.e. law enforcement officers, the work of the latter is recognized as highly stressful2.

The term stress is identified in the psychophysiological response to a quantity greater than the tolerated one of emotional, cognitive or social tasks perceived by the subject as excessive3.

This condition, if prolonged over time, can have significant consequences on the health of the individual, leading to the onset of physical and mental disorders.

As far as work stress is concerned, it is defined as a set of physical and emotional reactions that occur when the demands placed by the organization are not commensurate with the skills, resources or needs of workers4. In the model proposed by NIOSH4, work stress is the result of complex interactions between stressors, individual characteristics of the worker (internal variables) and both work and non-work social context (external variables).

These variables, which can intervene at different stages of the body’s reaction in response to a stressor or a reaction that can result in damage to the health of the worker, are attributed the inter-individual variability of the biological response to the same stressor.

Police work is highly stressful, with specific risks such as exposure to violence and the use of weapons. Stress can cause serious health problems, including post-traumatic stress disorder, depression and cardiovascular problems, and can also compromise performance and safety. Protecting the health of officers is complex, considering the different qualifications and operational scenarios. Organizational factors, such as lack of support and difficult relationships, contribute to work-related stress. In some professions, burnout syndrome can develop, requiring ongoing specialist attention.

This paper aims to research and review the studies already existing in the literature on the association between work-related stress and law enforcement workers.

Methods

The presented study is a review of reviews (umbrella review). The umbrella review is a research methodology that synthesizes the results obtained from a set of reviews and/or meta-analyses (only reviews were included in this study).

The review was conducted following the recommendations of the PRISMA (Preferred Reporting Items for Systematic Review and Meta-Analysis) Statement.

Inclusion criteria to determine which studies would be reviewed were developed using the PICO acronym (Participants, Intervention, Comparator, Outcome Measures).

The evaluation of the studies will be made according to the judgment of AMSTAR 2.

To answer the research question in as much detail as possible, it was necessary to define what the inclusion and exclusion criteria were.

Only revisions have been included.

Studies dealing with the topic of work-related stress in public safety workers in general (e.g., health workers, firefighters) were excluded.

Inclusion criteria were developed using the PICO methodology.

In table 1 the PICO used for the umbrella review is presented.

To evaluate this umbrella review, the AMSTAR 2 checklist was used.

The latter provides us with a 16-item checklist that evaluates different methodological aspects reported in a review.

For each criterion, on the basis of what has been reported, the evaluation “yes”, “no”, or “partial yes” is assigned.

An excel file was created for the extrapolation of the data where the data were organized on the basis of the details of the study, i.e. the author’s data, date and country of publication, titles, objectives, and description of the interventions.

All steps in the preparation of a systematic review are important, but in the evaluation of AMSTAR 2 there are seven critical points to judge the quality of a systematic review of the literature and they are based on seven items:

• protocol recorded before the start of the review;

• adequacy of literature search, exhaustive bibliographic research;

• motivation for excluding studies;

• the risk of bias from individual studies is included in the review;

• adequate analytical methods;

• consideration of the risk of bias in the interpretation of the results;

• evaluate the basic possibility of publication and likely impact. These criteria are referred to as critical points, while the remaining nine criteria are referred to as weaknesses.

The score is assigned based on the presence of critical points and/or weaknesses.

• high score: the review must not present any critical points, thus providing an accurate and complete summary of the results of the studies;

• moderate score: the review has more than one non-critical point, so it has more than one weakness but no critical point, thus providing an accurate summary of the results of the studies;

• low score: the review has only one critical defect with or without non-critical weaknesses thus providing an accurate and comprehensive summary of the studies;

• critical low score: more than one critical flaw with or without non-critical weaknesses means that the review should not be relied upon to provide an accurate summary.

Results

Sixteen systematic literature reviews were found based on the selection criteria based solely on reviews (figure 1). In table 2 the research strategy is reported.

The revisions found in Scopus were six, one of which was not relevant and the other five were duplicates already present in PubMed.

Ten studies were found in PubMed, one of which was not relevant because it focused on workers other than those sought by this umbrella review, and one did not meet the review criterion.

Eight literature reviews were included for the drafting of the aforementioned umbrella review.

The reviews were conducted in six different countries: in the United Kingdom three systematic reviews were conducted, in Australia one systematic review was conducted, one in Hong Kong, one in Italy, one in Canada and one in the United States. Table 3 summarizes the salient characteristics of each study5-12.

Eight reviews were analyzed in this study: for each one, the salient points relating to the results of the factors involved in the stress of law enforcement.

Below are the risk factors recognized in each study.

Organizational, operational and professional factors are the most blamed as causes of work stress in law enforcement.

In the organizational factors we find interactions with colleagues, with leadership, managers, available resources, night shifts, workload, poor sleep-wake rhythms, lack of staff.

All these factors, if insufficient, reduce satisfaction.

As far as operational factors are concerned, aspects such as pressure and responsibility, exposure to traumatic situations, interaction with the public, high expectations from the civil service, regulatory and political changes are covered.

In the professional factors, on the other hand, we find specific training, especially on delicate and dangerous work environments, environmental risks, and a balance between social and personal life.

One of the main sources of work stress is the organization.

Organizational factors, often cited in studies, include workload, relationships between levels of the organization, and perceived sense of control. Team and supervisor relationships influence anxiety and stress, and poor quality of these relationships hinders recovery and resilience.

The eight articles selected for review were evaluated according to the AMSTAR 2 method (table 4)5-12.

As can be seen from the table, the paper of Magnavita et al.5, the article of Golding et al.6, and the paper of Finney et al.7, report a high score, since they do not have critical points.

On the other hand, Brooks and Greenberg10, Cheung and Li11, and Violanti et al.12 show a critical low score, due to the presence of more than one critical point.

Lees et al.8 and Bevan et al.9 show a low score.

Discussion

The results of this umbrella review indicate that organizational, operational and professional factors are the most alleged causes of work stress in law enforcement.

Eight reviews underline that among organizational factors, those that require particular attention are the interactions with colleagues, leaders, managers, as well as some factors related to type of work, such as night shifts, workload, poor sleep-wake rhythms, and lack of staff.

Concerning the operational factors some issue is particularly relevant, such as pressure and responsibility, exposure to traumatic situations, interaction with the public, high expectations from the civil service.

Moreover, factor associated to the professional issues are the specific training, used for preparing workers to interact with dangerous work environments, environmental risks, as well as the work-life balance.

Organizational factors, often cited in studies, include workload, relationships between levels of the organization, and perceived sense of control. Team and supervisor relationships influence anxiety and stress, and poor quality of these relationships hinders recovery and resilience. Perceived control over work, as shown in the study by Golding et al.6, is often low among personnel exposed to high-responsibility calls. Similar patterns have been reported in police officers.

Excessive workload has been associated with higher levels of emotional exhaustion and depersonalization, as shown among American police officers13,14. Job control can predict or prevent burnout: higher control reduces stress and exhaustion, while low control is associated with high levels of burnout. Studies such as Moon and Maxwell15 confirm that perceived overload is related to stress.

Workload and job demand, rather than overtime alone, appear to be associated with job stress, particulary in contexts characterized by limited organizational support16.

Organizational involvement also has an impact: in some Asian contexts, higher involvement is associate with greater exhaustion, while in others, lower involvement predicts increased burnout17,18.

Relationships between colleagues and mutual trust are crucial: poor cooperation and a negative environment increase burnout and stress19.

Availability of resources and insufficient compensation contribute to stress, as shown in police officers20,21.

Training and qualifications have mixed effects: some studies show that higher-ranking officers experience more stress, others that lower-ranking officers are more likely to experience burnout22-24.

Role ambiguity, i.e., uncertainty about expectations and the means to meet them, is another source of stress, although the results on the effects are mixed: some studies find a significant association, others do not14,25.

Collaboration and role clarity are therefore important factors for the well-being of law enforcement workers.

Job satisfaction is also a factor that can impact stress, as such has been contemplated within some studies.

A study of American law enforcement officers found that lower job satisfaction was a significant but weak predictor of greater feelings of emotional exhaustion14.

Another study conducted in South Korea reveals that dissatisfaction with colleagues and supervisors predicted greater feelings of emotional exhaustion and depersonalization, but no depersonalization for males15.

Among police members working in Turkey, lower job satisfaction was a significant predictor of an increased risk of job-related burnout26.

In a study conducted in Sri Lanka, perceived dissatisfaction with staffing adequacy was a significant predictor of increased feeling of being hectic and exhausted27.

A study on Indian police burnout found that lower job satisfaction was a significant predictor of heightened feelings of emotional exhaustion and depersonalization, but higher job satisfaction predicted a reduced sense of personal accomplishment16.

In a study in India, lack of reward and absence of a sense of work-related values were weak significant predictors of greater feelings of emotional exhaustion and depersonalization17.

Organizational support is often perceived trough the level of recognition and pride shown by the administration toward correctional officers work28.

Two of the studies included in Finney review reported that organizational support was significantly negatively associated with prison job stress7.

In fact, among studies conducted in the United States, uncooperative supervisors have been identified as a source of workplace stress.

In the study by Lees anxiety is a common mental disorder, characterized by unpleasant feelings of apprehension and tension in law enforcement8.

One study29 found that problems with coworkers, life events, and mental health problems increased the risk of developing further problems, reducing resilience. Renden et al.30 linked anxiety to law enforcement management and the demand for more realistic training.

Tehrani31 found that anxiety reduced performance effectiveness.

Nieuwenhuys et al.32 showed that anxiety impaired shooting accuracy and caused officers to shoot earlier, resulting in less accurate responses.

Renden et al.33 found that anxiety reduced self-defense performance, impaired communication, and the proper application of force, which negatively impacted officers work outcomes and health.

Post-traumatic stress disorder (PTSD), common among officers exposed to critical incidents, is associated with physical and psychological health conditions34.

Other studies35,36 indicated that approximately 8% of police officers suffer from PTSD, with a higher prevalence among those who have experienced trauma on duty37.

Exposure to violence and traumatic incidents increases the risk of depression, anxiety, and a reduction in quality of life38,39. Protective factors such as social support and resilience are associated with reduced PTSD symptoms12.

The work environment and coping strategies, such as approach and avoidance, influence the mental health of officers, who often experience feelings of helplessness, fear, and horror during traumatic calls40,41.

High organizational stress, such as work-family conflict and insecurity, is associated with poor physical and mental health42.

With regard to sleep disorders, a study by Rajaratnam et al.43 examined the relationships between the risk of sleep disorders, health, safety, and performance. At a two-year follow-up, 40.4% of subjects screened positive for at least one sleep disorder, and 28.5% had excessive sleepiness. Waggoner et al.44 examined shift work fatigue and operational performance, finding worse driving and reduced sleep quality among police officers, with increased sleepiness and decreased attention. Organizational stressors can cause negative physiological and psychological responses, such as cardiovascular disease, with a 23% increased risk45,46.

A study of 386 American officers found a higher prevalence of metabolic syndrome with higher perceived stress, although not statistically significant47.

Another Polish study found an association between stress and metabolic syndrome48. A longitudinal study of Italian officers showed that high levels of stress increased the risk of developing metabolic syndrome, assessed by demand-control and effort-reward models5.

For hypertension, some cross-sectional and longitudinal studies found associations between perceived stress and blood pressure, such as in a Polish study and in American samples48-51.

However, other studies did not find significance, such as the Indian study by Ganesh et al.52 and the Italian one by Magnavita5. Relationships between stress and abdominal obesity or dyslipidemia have been observed in some studies, while others have not found significant association.

A Chinese study on 3300 agents has highlighted a correlation between psychological distress and dyslipidemia53. Regarding diabetes, studies on Italian and Chinese agents have shown an increase in the incidence of glucose tolerance in relation to stress, more evident in the larger Chinese sample53.

Finally, several studies have examined the link between stress and cardiovascular disease. In North America, Franke and Ramey found associations between self-reported stress and cardiovascular morbidity, influenced by age and duration of activity49,54. Subsequent studies have confirmed this correlation, also with inflammatory markers, although some have not found significant relationships.

Another important element is that of training: it has been seen that staff trained even before hiring show less stress.

Training interventions in particular environments and subject to a greater psychological load are especially important, as in one study it was reported that people felt inadequate to meet the demands in that particular context due to a lack of knowledge.

Scarcity of resources can exacerbate the perception of stress and anxiety among agents, so investing in adequate resources and continuous training to ensure that agents have the necessary tools to do their jobs effectively is a necessary measure.

Training must not only be on operational skills, but also on stress management and psychological well-being, which is essential to prepare agents to face daily challenges.

Training should include coping and conflict management techniques.

It is recommended to develop regular training programs that include stress management techniques, resilience and coping strategies for dealing with high-pressure situations.

In addition to the specific training provided to help law enforcement workers manage particularly delicate situations, it would be useful to think about offering these categories of workers’ interventions such as mindfulness, yoga, psychotherapy, resilience training, stress management courses, meditation, but also the promotion of physical exercise, which is known to be able to lower stress levels within the body.

These interventions not only act on mental well-being, reducing anxiety, post-traumatic stress syndrome, depression, but by lowering stress levels, they also reduce the likelihood of having a cardiovascular event or being subject to comorbidities such as hypertension.

Stress prevention should be a widespread and normalized culture in law enforcement organizations, since it still unfortunately encounters a lot of resistance.

Organizational policies must be oriented towards the well-being of employees, with the aim of creating a healthy work environment. Institutional-scale interventions can help reduce the stigma associated with mental health among officers.

Develop clear policies regarding mental health and well-being, including employee assistance programs (EAPs) and awareness campaigns to foster a supportive culture.

A change of course in the management policies of law enforcement workers is fundamental: the difficulty of understanding with those who are hierarchically superior has also been reported, as they carry out a different job from the police forces who are in contact with the territory, and often the difficulties they encounter are not fully understood.

In conclusion, addressing Work-Related Stress in law enforcement is essential not only for the well-being of officers, but also for the overall effectiveness of security operations.

Through the implementation of targeted organizational strategies, the promotion of positive relationships and the appropriate support, more sustainable and productive work environments can be created.

It is critical that organizations continue to monitor and adapt their policies and practices to respond to the evolving needs of staff, thereby safeguarding the mental and physical health of agents.

This study identifies the main sources of stress in law enforcement, such as poor planning, difficult relationships, and excessive workload, which affect the well-being of officers.

It is important to adopt flexible organizational models and support systems, as well as monitor workload and promote training in interpersonal relationships, to improve working conditions.

Conflict of interests: the authors have no conflict of interests to declare.

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