Depression and anxiety in policework: a systematic review

• Pages: 417-434
• Published date: 25 September 2019
• DOI: https://doi.org/10.1108/PIJPSM-03-2019-0040
• Date: 25 September 2019
• Author: Shannon Wagner,Nicole White,Lynda R. Matthews,Christine Randall,Cheryl Regehr,Marc White,Lynn E. Alden,Nicholas Buys,Mary G. Carey,Wayne Corneil,Trina Fyfe,Elyssa Krutop,Alex Fraess-Phillips,Matthew H. Fleischmann
• Subject Matter: Public policy & environmental management,Policing,Criminal justice,Juvenile/youth crime,Police studies,Health & social care,Criminology & forensic psychology,Criminology & criminal justice

Depression and anxiety in

policework: a systematic review

Shannon Wagner and Nicole White

Department of Health Sciences,

University of Northern British Columbia, Prince George, Canada

Lynda R. Matthews

Faculty of Health Sciences, University of Sydney, Sydney, Australia

Christine Randall

School of Allied Health Sciences, Faculty of Health,

Griffith University, Gold Coast, Australia

Cheryl Regehr

Department of Social Work, University of Toronto, Toronto, Canada

Marc White

University of British Columbia, Vancouver, Canada

Lynn E. Alden

Department of Psychology, University of British Columbia, Vancouver, Canada

Nicholas Buys

Menzies Health Institute of Queensland, Faculty of Health,

Griffith University, Gold Coast, Australia

Mary G. Carey

School of Nursing, University of Rochester, Rochester, New York, USA

Wayne Corneil

Telfer School of Management, University of Ottawa, Ottawa, Canada

Trina Fyfe

Northern Medical Program,

University of Northern British Columbia, Prince George, Canada

Elyssa Krutop and Alex Fraess-Phillips

Department of Health Sciences,

University of Northern British Columbia, Prince George, Canada, and

Matthew H. Fleischmann

Department of Education & Counselling Psychology,

McGill University, Montreal, Canada

Abstract

Purpose –The purpose of this systematic review is to evaluate the extant literature on depression and

anxiety disorders in police using a multinational data set to determine whether the prevalence of these

trauma-related disorders (TRMDs) is elevated in comparison to the general population.

Design/methodology/approach –Systematic review was employed in combination with best-evidence

narrative synthesis to evaluate these hypotheses.

Findings –Despite widevariability in prevalenceoutcomes across the literature,strong evidence supportsthe

hypothesisthat the prevalenceof depression is elevatedin police, whereasmoderate evidence supportsthe same

hypothesis regarding anxiety. Preliminary evaluation of commonly examined predictive factors for each

disorder demonstrated weak and inconsistent associations between these TRMDs and sociodemographic

factors. No studies evaluated the relationship between incident-related factors (e.g. severity or frequency

Received 29 March 2019

Revised 25 July 2019

Accepted 15 August 2019

The current issue and full text archive of this journal is available on Emerald Insight at:

www.emeraldinsight.com/1363-951X.htm

Depression

and anxiety in

policework

Policing: An International Journal

Vol. 43 No. 3, 2020

pp. 417-434

© Emerald Publishing Limited

1363-951X

DOI 10.1108/PIJPSM-03-2019-0040

417

of exposure) and TRMDs, thus, at present, the literature on police is almost entirely unable to address the

questionof whether the prevalenceof these disorders in policeis influenced by exposureto work-related trauma.

Research limitations/implications –The findings highlight a critical need for future work to address

incident-related factors in predicting symptoms of depression and anxiety in police samples to determine whether

these disorders bear a unique relationship to work-related traumatic exposure. Such work will significantly benefit

the design and implementation of successful prevention and intervention strategies in the workplace.

Originality/value –The present review provides a comprehensive synthesis of a highly variable literature,

highlighting critical gaps in our current knowledge of TRMDs in police and suggesting numerous avenues for

future study.

Keywords Trauma, Anxiety disorders, Epidemiology, Major depressive disorder, Occupational exposure,

Police personnel

Paper type Literature review

Police officersroutinely face exposure to a wide variety of potentiallytraumatic situations, or

“critical incidents”(CIs) in the line of duty. Previous work suggests that a majority of police

officers experience CIs on-duty, with an incidence of exposure of up to 92 percent within the

first twoyears of service (Inslicht etal., 201 1; Maia et al.,2015; Martin et al., 2009). Further more,

CIs are often experienced at high frequency (e.g. Hartleyet al., 2013). Correspondingly,a large

body of literature concerns mental health in police officers, with particular focus on rates of

post-traumatic stress disorder (PTSD). The prevalence of PTSD in police samples varies

widely across the literature from 0 to upwards of 40 percent (e.g. (Carlier et al.,2000; Hodgins

et al., 2001; Lee,Kim, Won and Roh, 2016; Violanti and Gehrke,2004). Whereas few reviews to

date directly address the question of whether PTSD prevalence is elevated in police officers

relative to the general population,Berger et al. (2012) have suggested that prevalence may be

lower in police relative to other first responder groups.

To date, far fewer studies have examined prevalence of major depressive disorder( MDD)

and anxiety disorders (ADs) in police samples, and no reviews that we are aware of address

this issue or attempt to reconcile the high degree of variability in prev alence outcomes.

Obtaining a clear understanding of whether prevalence is elevated in police at the population

level is critical for informing organizational response to officers’mental health needs. MDD

and ADs are of particular interest in high-risk occupational settings, as these disorders

comprise the leading cause of sickness absence in the general population (World Health

Organization, 2019). Furthermore, both disorders can occur in the absence of traumatic

exposure,and also commonly arisefollowing exposure andare highly comorbid with PTSDin

the general population (APA, 2013). It is presently unknown whether occupational factors

related to policework, such as CI exposure, are uniquely associated with these disorders. The

present systematic review evaluates the extant literature on MDD and ADs associated with

routine policework (excluding disaster response) with the aim of determining whether the

prevalence of these disorders is elevated in police officers relative to the general population.

Depression in police officers

As mentioned,MDD has received far less focus inthe literature on police populations relative

to PTSD. Prevalence estimatesof MDD in police samples vary widely, and this inconsistency

is compoundedby the fact that MDD may be observed both in response to and in theabsence

of CI exposure. As such, the variability in rates of MDD may be due to numerous factors

related, potentially, to both CI exposure and to individual, regional or methodological

differencesacross samples that may or may not be systematicallyassociated with policework.

In any case, understanding MDD as a trauma-related disorder (TRMD) has wide-ranging

implicationsfor police officers’well-being.PTSD in police officershas been strongly associated

with higher scores on measures of depressive symptomology across a number of studies

(e.g. Lee, Choi,Kim, Nam, Kang, Koh and Oh, 2016;Marchand et al., 2015; Meffert et al., 2014),

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