Summary of evidence for studies examining impact of prevention following exposure to work-related trauma for law enforcement personnel
| Article | Quality rating | Contribution | Population | Design | Sample size | Measures | Prevention type | Results PTSD | Results depression | Results anxiety |
|---|---|---|---|---|---|---|---|---|---|---|
| Carlier et al. (1998) | Medium | Definite | Dutch police officers who responded to same fatal plane crash | Post-test only study with control group | 105 (46 with CISD; 59 without CISD) | Structured interview for PTSD (SI-PTSD) | Critical Incident Stress Debriefing (CISD) | No difference between groups 8 months post disaster. No significant difference in PTSD diagnosis after 18 months, but significantly more hyperarousal symptoms in CISD group | ||
| Carlier et al. (2000) | Medium | Definite | Traumatized Dutch police officers | Non-randomized pre-test post-test study with 2 control groups | 243 (86 received CISD; 82 refused CISD = internal control group; 75 historical control who did not receive CISD) | Spielberger State-Trait Anxiety Inventory (STAI); Anxiety Disorders Schedule-Revised (ADIS-R); Self-Rating Scale for PTSD (SRS-PTSD); Impact of Events Scale (IES); Peritraumatic Dissociative Experiences Questionnaire (PDEQ-R) | Critical Incident Stress Debriefing (CISD) | No differences at pre-test, 24 h and 6 months, but 1 week intervention group displayed significantly more PTSD symptomatology | No differences on STAI 24 h post trauma | |
| Leonard and Alison (1999) | Medium | Moderate | Australian police officers | Case control design with matched sample | 60 (30 received CISD and 30 control) | Coping Scale; State-Trait Anger Expression Inventory | Critical Incident Stress Debriefing (CISD) | No significant difference on Coping Scale after CISD; Significantly lower state and trait anger after CISD | ||
| Stephens (1997) | Medium | Moderate | New Zealand police officers | Retrospective cohort study | 527 (121 debriefed and 404 non-debriefed) | Civilian Mississippi PTSD scale (M-PTSD); traumatic stress schedule; 2 social support scales; ease of talking about trauma at work scale; and attitudes of expressing emotion at work scale | CISD | No difference on M-PTSD scores within debriefed group for those with more traumatic events. Participants with higher PTSD scores significantly more likely to report less social support, less positive attitudes to expressing emotion, and less ease in talking about trauma at work | ||
| Young (2012) | Medium | Moderate | US police officers | Pre-test post-test study with control group | 37 (20 debriefed; 17 control group) | Impact of Event Scale – Revised (IES-R); Beck Depression Inventory (BDI) | Critical Incident Stress Management (adaptation of CISD for cumulative stress with social support) | No statistically different changes in post-traumatic stress | No statistically different changes in depression | |
| Bär et al. (2004) | Medium | Weak | German police officers | Post-test only study | 649 | ICD-10 | Secondary preventative intervention after traumatic event incl. defusing, structured discussions and debriefings | 2.9% developed PTSD and 14.5% had another stress reaction. Impact of prevention activity unclear | 9.4% had a different psychological illness | |
| Ruck et al. (2013) | Medium | Moderate | UK prison staff who experienced traumatic experiences | Pre-test post-test design with self-selected control group | 91 at time 2 (55 debriefed and 36 non-debriefed) | Impact of Events Scale Extended (IESE); Generalized Anxiety and Depression Scale (GAD) | 7 stage Mitchell debriefing process delivered by trained facilitators | Debriefed group had higher IESE scores prior to debrief and significantly lower scores at T2 | No differences on GAD | No differences on GAD |
| Watson and Andrews (2018) | Medium | Definite | UK police officers | Cross-sectional survey | N = 693 intervention group N = 166 control group | PCL-C, no cut-off or scoring method reported Stigma and Barriers to Care Questionnaire Military Stigma Scale | Trauma Risk Management (TRiM) program in the workplace | Compared to controls, the TRiM group scored significantly lower on the PCL-C Controlling for PTSD symptoms, the TRiM group also showed significantly lower public stigma and barriers to help-seeking | ||
| Ramey et al. (2016) | Medium | Moderate | US police officers | Experimental wait listed control design | 38 (Pilot A 20 immediate intervention and Pilot B 18 delayed intervention 3 months) | Anger and Resentment subscale of Personal and Organizational Quality Assessment-R; IES; Perceived Stress Scale | Resilience training | Younger officers had a significant benefit from the resilience training on several measures of psychological stress (e.g. critical incident stress). Older officers had a non-significant opposite effect. Overall: Significant benefit | Younger officers had a significant benefit from resilience training on several measures of psychological stress (e.g. emotional vitality). Older officers had a non-significant opposite effect. Overall: unclear effect | |
| Arble et al. (2017) | Low | Moderate | US police academy recruits from Detroit | Pre-training (recruits) post-training 12 months later) study without control group | 22 | Anonymous survey; 28-item Brief Coping Orientation to Problems Experienced; 10-item Sources of Support scale; 17-item PTSD Checklist; Hospital Anxiety and Depression Scale; Karolinska Institute Sleep Questionnaire; Alcohol Use Disorder Identification Test | Imagery-based program (incl Relaxation, imaginal traumatic incidents and group discussion) | PTSD symptoms did not increase 12 months post program, which is not typical of new police officers. Maintained pre-deployment sleep quality, which is also not usual | Reduced alcohol consumption (non- significant) | Overall anxiety significantly decreased 1 year after training |
| Becker et al. (2009) | Medium | Weak | US law enforcement officers (including students, cadets and officers) | Traumatic scenario followed by list of intervention options for participants to choose from | 379 (including 99 criminal justice students; 108 police cadets; 156 law enforcement officers) | Modified Credibility Scale (CS); Posttraumatic Stress Diagnostic Scale (PDS) | Cognitive Processing Therapy; Pharmacological; EMDR and psychodynamic treatment; Brief eclectic psychotherapies; + questions about CISD | Participants (with and without PTSD) preferred Cognitive Processing Therapy. Overall 2nd preference was exposure therapy, but not for those with PTSD who preferred psychodynamic treatment as 2nd choice | ||
| Bademci et al. (2016) | Medium | Moderate | Correctional officers in Turkey | Quasi-experimental pre-test post-test design no control group | 42 | Qualitative interviews; Minnesota Job Satisfaction Inventory (MJSI), Maslach Burnout Inventory (MBI), Positive and Negative Affect Scale (PANAS), Beck Anxiety Inventory (BAI), Beck Depression Inventory (BDI) | Psychosocial support group to help officers to deal with feelings of insecurity and helplessness | Burnout, negative feelings and depression scores significantly decreased Job satisfaction and positive feelings increased | Anxiety scores significantly decreased | |
| Ramey et al. (2017) | Medium | Moderate | Police academy recruits | Experimental with randomized group assignment; testing at baseline, post-intervention, and 2-month follow-up | N = 34 | Impact of Events Scale | Resilience training | No significant change in IES scores within- or between-groups |
| Article | Quality rating | Contribution | Population | Design | Sample size | Measures | Prevention type | Results PTSD | Results depression | Results anxiety |
|---|---|---|---|---|---|---|---|---|---|---|
| Medium | Definite | Dutch police officers who responded to same fatal plane crash | Post-test only study with control group | 105 (46 with CISD; 59 without CISD) | Structured interview for PTSD (SI-PTSD) | Critical Incident Stress Debriefing (CISD) | No difference between groups 8 months post disaster. No significant difference in PTSD diagnosis after 18 months, but significantly more hyperarousal symptoms in CISD group | |||
| Medium | Definite | Traumatized Dutch police officers | Non-randomized pre-test post-test study with 2 control groups | 243 (86 received CISD; 82 refused CISD = internal control group; 75 historical control who did not receive CISD) | Spielberger State-Trait Anxiety Inventory (STAI); Anxiety Disorders Schedule-Revised (ADIS-R); Self-Rating Scale for PTSD (SRS-PTSD); Impact of Events Scale (IES); Peritraumatic Dissociative Experiences Questionnaire (PDEQ-R) | Critical Incident Stress Debriefing (CISD) | No differences at pre-test, 24 h and 6 months, but 1 week intervention group displayed significantly more PTSD symptomatology | No differences on STAI 24 h post trauma | ||
| Medium | Moderate | Australian police officers | Case control design with matched sample | 60 (30 received CISD and 30 control) | Coping Scale; State-Trait Anger Expression Inventory | Critical Incident Stress Debriefing (CISD) | No significant difference on Coping Scale after CISD; Significantly lower state and trait anger after CISD | |||
| Medium | Moderate | New Zealand police officers | Retrospective cohort study | 527 (121 debriefed and 404 non-debriefed) | Civilian Mississippi PTSD scale (M-PTSD); traumatic stress schedule; 2 social support scales; ease of talking about trauma at work scale; and attitudes of expressing emotion at work scale | CISD | No difference on M-PTSD scores within debriefed group for those with more traumatic events. Participants with higher PTSD scores significantly more likely to report less social support, less positive attitudes to expressing emotion, and less ease in talking about trauma at work | |||
| Medium | Moderate | US police officers | Pre-test post-test study with control group | 37 (20 debriefed; 17 control group) | Impact of Event Scale – Revised (IES-R); Beck Depression Inventory (BDI) | Critical Incident Stress Management (adaptation of CISD for cumulative stress with social support) | No statistically different changes in post-traumatic stress | No statistically different changes in depression | ||
| Medium | Weak | German police officers | Post-test only study | 649 | ICD-10 | Secondary preventative intervention after traumatic event incl. defusing, structured discussions and debriefings | 2.9% developed PTSD and 14.5% had another stress reaction. Impact of prevention activity unclear | 9.4% had a different psychological illness | ||
| Medium | Moderate | UK prison staff who experienced traumatic experiences | Pre-test post-test design with self-selected control group | 91 at time 2 (55 debriefed and 36 non-debriefed) | Impact of Events Scale Extended (IESE); Generalized Anxiety and Depression Scale (GAD) | 7 stage Mitchell debriefing process delivered by trained facilitators | Debriefed group had higher IESE scores prior to debrief and significantly lower scores at T2 | No differences on GAD | No differences on GAD | |
| Medium | Definite | UK police officers | Cross-sectional survey | PCL-C, no cut-off or scoring method reported | Trauma Risk Management (TRiM) program in the workplace | Compared to controls, the TRiM group scored significantly lower on the PCL-C | ||||
| Medium | Moderate | US police officers | Experimental wait listed control design | 38 (Pilot A 20 immediate intervention and Pilot B 18 delayed intervention 3 months) | Anger and Resentment subscale of Personal and Organizational Quality Assessment-R; IES; Perceived Stress Scale | Resilience training | Younger officers had a significant benefit from the resilience training on several measures of psychological stress (e.g. critical incident stress). Older officers had a non-significant opposite effect. Overall: Significant benefit | Younger officers had a significant benefit from resilience training on several measures of psychological stress (e.g. emotional vitality). Older officers had a non-significant opposite effect. Overall: unclear effect | ||
| Low | Moderate | US police academy recruits from Detroit | Pre-training (recruits) post-training 12 months later) study without control group | 22 | Anonymous survey; 28-item Brief Coping Orientation to Problems Experienced; 10-item Sources of Support scale; 17-item PTSD Checklist; Hospital Anxiety and Depression Scale; Karolinska Institute Sleep Questionnaire; Alcohol Use Disorder Identification Test | Imagery-based program (incl Relaxation, imaginal traumatic incidents and group discussion) | PTSD symptoms did not increase 12 months post program, which is not typical of new police officers. Maintained pre-deployment sleep quality, which is also not usual | Reduced alcohol consumption (non- significant) | Overall anxiety significantly decreased 1 year after training | |
| Medium | Weak | US law enforcement officers (including students, cadets and officers) | Traumatic scenario followed by list of intervention options for participants to choose from | 379 (including 99 criminal justice students; 108 police cadets; 156 law enforcement officers) | Modified Credibility Scale (CS); Posttraumatic Stress Diagnostic Scale (PDS) | Cognitive Processing Therapy; Pharmacological; EMDR and psychodynamic treatment; Brief eclectic psychotherapies; + questions about CISD | Participants (with and without PTSD) preferred Cognitive Processing Therapy. Overall 2nd preference was exposure therapy, but not for those with PTSD who preferred psychodynamic treatment as 2nd choice | |||
| Medium | Moderate | Correctional officers in Turkey | Quasi-experimental pre-test post-test design no control group | 42 | Qualitative interviews; Minnesota Job Satisfaction Inventory (MJSI), Maslach Burnout Inventory (MBI), Positive and Negative Affect Scale (PANAS), Beck Anxiety Inventory (BAI), Beck Depression Inventory (BDI) | Psychosocial support group to help officers to deal with feelings of insecurity and helplessness | Burnout, negative feelings and depression scores significantly decreased | Anxiety scores significantly decreased | ||
| Medium | Moderate | Police academy recruits | Experimental with randomized group assignment; testing at baseline, post-intervention, and 2-month follow-up | Impact of Events Scale | Resilience training | No significant change in IES scores within- or between-groups |
Source(s): Authors’ own work