Determinants of mental health of police officers: A pathway model

doi:10.21203/rs.3.rs-3219368/v1

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Determinants of mental health of police officers: A pathway model

https://doi.org/10.21203/rs.3.rs-3219368/v1

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Background

The police work environment is associated with traumatic experiences and a high risk of stress for officers. Additionally, a hierarchical organizational environment and shift work can lead to exposure to high stress and may affect their mental health. Police officers’ mental health issues can affect their ability to safely perform their duties and lead to increased medical care-related expenses of public health and police organization; hence, factors that influence their mental health must be examined. The aim of this study was to investigate the mental health levels of police officers, identify factors related to their mental health, and analyze the paths among these factors.

Methods

A cross-sectional design was used, and 357 police officers from a metropolitan area in South Korea were included. The selected research variables were mental health, resilience, social support, mental health resource availability, health behavior, job stress, and trauma experience, using the PRECEDE (Predisposing, Reinforcing, and Enabling Constructs in Educational Diagnosis and Evaluation) model. Four hypotheses were investigated regarding direct and indirect relationships among the variable. Descriptive statistics, multivariate regression, and path analyses were performed using STATA 17.0.

Results

The participant groups’ mental health level ranked as “high risk”, with an average of 19.93 out of 54 using tool which was psychosocial well-being index short form. Path analysis showed that the hypothesis based on PRECEDE model could be fitted with the current data (RMSEA = .183, GFI = .571, SRMR = .080. CFI = .571 and TLI = .010). It was also confirmed that there were partial direct and indirect relationships between the variables. In a direct effect, higher health behavior (coefficient = .24, p < .001) and lower job stress (coefficient = − .28, p < .001) were positively associated with mental health. Additionally, higher mental health resource availability (coefficient = .10, p = .025) and lower traumatic experience (coefficient = − .10, p < .001) were indirectly positively associated with mental health.

Conclusions

The findings of this study can be applied to the development of a health policy model for supporting the mental health of police officers and the establishment of mental health intervention strategies for this population.

Police officers

mental health factors

path analysis

Police officers are routinely exposed to physically and psychologically threatening environments as the first responders to various crimes and incidents of conflict [1, 2]. They experience violence and verbal abuse while dealing with criminal suspects and arrestees, and are expected to deal efficiently with a variety of crime scene-related phenomena, including murder complications and dead bodies, rape and its aftermaths, and other forms of physical and mental assault [2, 3]. They also experience ongoing stress, posttraumatic stress, secondary trauma, depression, job burnout, and sleep disorders during their work [4, 5, 3]. Police officers experience high levels of stress due to shift work and rigid organizational power structures [6, 7]. Police organizations constitute hierarchical environments and conservative, masculine organizational characteristics that make it difficult to express mental distress [8].

In a cohort study in the United States, 242 police officers without depressive symptoms were followed for 10 years, and 10.7% of the study population developed depression by the end of the study [9]. In a study of Italian police, the suicide rate among Italian police officers was significantly higher than that of national residents under the age of 65 [10]. Of the 3,817 police officers who experienced a traumatic event, 41.1% were found to be at high risk for posttraumatic stress disorder [11]. These findings suggest that the negative impact of the job on mental health is high.

Police officers’ mental health can negatively impact public, organizational, national safety, and social costs. Mental health problems in police officers can lead to absenteeism and contribute to workload burdens for colleagues and organizational difficulties [12]. Furthermore, poor mental health among police officers who are required to carry guns on duty and deal with urgent incidents puts the public and police organizations at risk and can generate social controversy [6, 13, 14].

Therefore, mental health management of police officers is necessary for the safety and health of the public, and organizations. Therefore, developing preventive policies for the mental health care of police officers is crucial. To that end, it is necessary to diagnose and identify the factors affecting the mental health of police officers and explain the relationship between them.

A systematic review of mental health among police officers reported important factors were cynical personality, lack of social support, avoidant coping, job stress, and gender differences [3]. In addition, traumatic experiences and job stress were negative predictors of post-traumatic stress and job burnout [15]. Previous studies have analyzed individual factors that are difficult to change—such as personality type and gender—to provide a basis for developing interventions. In addition, there is a lack of an integrated explanation of the exact nature and extent of interaction between individual and organizational characteristics, work environment, and protective factors related to mental health among police officers.

To develop policies and interventions to improve the mental health of police officers, it is necessary to measure and identify their levels of mental health, reflect on their individual and organizational characteristics, and diagnose and examine the factors that affect mental health on the whole. The Predisposing, Reinforcing, and Enabling Constructs in Educational, Environmental Diagnosis, and Evaluation- Policy, Regulatory, and Organizational Constructs in Educational and Environmental Development (PRECEDE-PROCEED) model, proposed by Green et al. [16], the PRECEDE phase is the process of diagnosing health-related factors; in the PROCEED phase, factors are checked and intervention is conducted. PRECEDE-PROCEED is a health-planning model for systematically diagnosing and identifying factors affecting health using an educational and ecological approach, with an aim of improving health through targeted education and environmental interventions [17, 18]. This model is helpful in the integrated diagnosis of health-related factors using PRECEDE phase because it considers both the individual and the community. Therefore, through the diagnosis of mental health-related factors of police officers by considering individuals and organizations together, this model can explain the phenomenon and derive specific factors related to health behaviors and environments that can be intervened in, which can be helpful in planning for health improvement in practice.

This study aimed to identify factors affecting the mental health of police officers based on the PRECEDE model and to identify the relationships among all the factors.

The purpose of this study was to develop a hypothetical model to identify the factors affecting the mental health of police officers based on PRECEDE model [16] and to identify the relationships among each of the factors. In addition, direct and indirect pathways between the factors affecting police officers’ mental health were identified to confirm their relationships and influences on mental health.

Hypothetical model

In this study, a hypothetical model was constructed based on the PRECEDE model and a literature review on police officers’ mental health. The PRECEDE model is an ecological approach to worker healthcare and has been applied as a conceptual framework in workplace health promotion, occupational health and safety, and worker health policy research [16]. Based on the PRECEDE model, epidemiological, behavioral and environmental, and educational and ecological assessments were applied in this study.

Epidemiological assessment is used to diagnose social problems or identify factors that affect the quality of life; behavioral and environmental assessment is used to identify behavioral and environmental causes of health problems in individuals, organizations, and environments. Educational and ecological diagnoses involve the identification of factors that cause health problems in individual and organizational behavior, which can be divided into predisposing, reinforcing, and enabling factors that can collectively influence individual behavior. In the PRECEDE model, the educational and ecological factors affect behavioral and environmental ones; mental health, a health outcome, is affected by educational and ecological, as well as behavioral and environmental, factors [16, 18].

In this study, mental health—which is an important factor of wellness for police officers—was identified as a factor related to epidemiological assessment. Previous studies have identified resilience, social support, health behaviors, job stress, and traumatic experiences as mental health-related factors. Resilience is the ability to withstand hardships and adversity and grow through them, acting as a protective factor for individuals [19, 20]. In previous studies of police officers, resilience has been identified as a factor that can positively affect mental health [19, 21].

Additionally, social support, which also has a positive impact on an individual’s mental health and sense of well-being, is gained through reciprocal relationships [22, 23]. Social support has been shown to be a protective factor for police officers, with higher levels associated with lower levels of mental disorder symptoms [24]. Strategies to promote resource availability are important for health promotion because resource availability influences a population’s behavior and environment [18], and resource availability for sound mental health is related to help-seeking attitudes [25]. In a previous study, police officers with depressive symptoms had less trust in mental health services than those without such symptoms, leading to difficulties in accessing resources [26]. In an Australian police study, participants with mental health problems had a higher proportion of those who were less likely to seek professional help than those who were likely to seek it [27]. Among police officers, traumatic experiences and job stress have been identified as important factors negatively affecting mental health [28]. The relationship between job stress and traumatic experiences has been reported in previous studies with traumatic experiences as an antecedent factor [3, 29]. Health behaviors have been found to influence the mental health of workers and police officers [30]. Previous studies have shown that trauma experiences and health behaviors are related; a systematic review of trauma experience and health behaviors reported associations between the presence of posttraumatic stress symptoms, trauma experience, and exercise and between trauma experience and dietary behaviors [31, 32].

Based on previous studies, this study applied resilience, social support, and resource availability as educational–ecological diagnostics and constructed a hypothetical model in which the three factors affect health behaviors, occupational stress, and traumatic event experiences as behavioral–environmental diagnostics, thereby affecting mental health (Fig. 1).

Hypotheses

H 1. A direct relationship exists between health behaviors, job stress, traumatic experiences, and mental health.

H2. An indirect relationship exists between resilience, social support, resource availability, health behaviors, job stress, traumatic experiences, and mental health.

H3. Resource availability directly affects health behavior, job stress, and trauma experience.

H4. Resilience, social support, and resource availability directly affect health behavior.

Design

This study used a cross-sectional descriptive survey design to construct a model of the factors influencing the mental health of police officers based on the PRECEDE model (1980). The model was validated and shown to explain the relationships among each of the factors through data collection.

Participants

The target population of this study was police officers working in the metropolitan in South Korea. In path model analysis, the sample size should be from 10 to 20 times the number of free variables based on the maximum likelihood method [33]. The number of free variables in this study was 20, and when the free variables were multiplied by 17, a total sample size of 340 was calculated. The final sample size for this study was 500, reflecting a 45% nonresponse rate.

Police stations were selected for sampling potential participants. Non-probability quota sampling was done based on the number of police reports involving police stations, which is known as a key policing demand and burden indicator in the policing profession. The number of reports was collected by requesting access to the Korean National Police Agency. The data on the number of reported cases are not disclosed to the public, but data were requested and received for research purposes. Based on the total number of police reports (1,543,885) in 96 districts in the region in 2019. We divided the group of districts into 4 groups: upper, middle, lower, and lowest groups. Each group comprised 24 districts. The number of participants in each group was assigned taking into account the number of 112 reports, a number representing the workload of each group. The proportion of cases handled per district group was 38.9% (601,141) of the total number of cases in the upper group, 25.4% (391,450) of the total number of cases in the middle group, 20.3% (314,159) of the total number of cases in the lower group, and 15.4% (237,135). Therefore, from a target of 500 participants (100%), 195 (38.9%) in the upper group, 125 (25.4%) in the middle group, 102 (20.3%) in the lower group, and 78 (15.4%) in the lowest group were conveniently represented in the allocation table.

Measures

This study utilized measures of mental health, resilience, social support, resource availability, health behaviors, job stress, and traumatic event experiences.

Mental health

The Psychosocial Well-being Index Short Form (PWI-SF) [34] was used to measure mental health. The PWI-SF was developed based on Goldenberg’s General health questionnaire-60 (GHQ-60) and modified to fit the Korean context. The instrument consists of 18 questions on social performance and self-confidence, depression, general well-being and vitality, and sleeping disturbance and anxiety. Each question was answered on a 4-point Likert scale ranging from 0 (very much) to 3 (not at all), and the total score was calculated by summation, with a total score ranging from 0 to 54. Higher scores indicated poorer mental health. When developing the tool, cut-off points for mental health levels were proposed, with a score of 27 or higher categorized as “high risk,” 9 to 26 as “potentially stressed,” and 8 or lower as “healthy.” Cronbach’s α was.92 in this study.

Resilience

The Korean version of the self-resilience scale was used to measure resilience [35, 36]. The tool consists of 25 items in five domains: hardiness, persistence, optimism, support, and spirituality. Each item is scored on a 5-point Likert scale ranging from 0 (not at all) to 4 (very much). Total scores range from 0 to 100 points; higher scores indicate higher resilience. The Cronbach’s α was .93 in this study.

Social support

The Korean version of the support scale was used to measure social support [37, 38]. The tool consists of eight questions, including concerning support from supervisors and regarding support from coworkers. Each question was answered on a 5-point Likert scale ranging from 1 (not at all) to 5 (very much). The total score was calculated by averaging and ranged from 1 to 5. Higher scores indicated higher levels of social support. Cronbach’s α was .83 in this study.

Resource availability

To measure mental health resource availability, we used the tool of attitudes regarding the use of community mental health services [39]. This tool is a translation and revision of the help-seeking availability scale barriers [40] and the help-seeking attitudes scale [41, 42]. The instrument consists of 17 items in five domains: fear of mental health services, trust in mental health services, self-exposure, internal control, and barriers. Each question was answered on a 4-point Likert scale ranging from 1 (not at all) to 4 (very much). The total score ranged from 17 to 68. Cronbach’s α was.87 in this study.

Health behavior

To measure health behavior, we used the tool of Health Behavior Questionnaire [43]. This tool consists of a total of 16 questions on smoking, alcohol consumption, diet, exercise, sleep duration, weight control, and perceived health. For the 8 habits of smoking, drinking alcohol, diet, exercise, average sleep time, regular meals, snacking, and breakfast, 1 point was given for action, and 0 points were calculated for no action. Total scores were calculated from 0 to 8 points. Cronbach’s a of the Kuder-Richardson-20 (KR-20) in this study was .40.

Job Stress

To measure job stress, we used the Korean Local Police Job Stress Tool [44]. The tool consists of 17 questions in five domains: regarding organizational culture, field actions, complaint handling, training and supervision, and the working environment. Each question was answered on a 5-point Likert scale ranging from 1 (not at all) to 5 (very much). Scores were calculated by averaging and ranged from one to five. Higher scores indicated higher levels of job stress. Cronbach’s α was .87 in this study.

Traumatic experiences

To measure the traumatic experience, we used the Traumatic Event Experience Scale [45]. This tool was developed by Thomas-Riddle and translated and modified in Korea [46]. The instrument consists of 23 items in two domains: traumatic events and secondary traumatic events. The scale measures participants to check whether they have been exposed to each event and rate their traumatization on a scale from 0 to 10. The score was calculated by dividing the traumatization by the number of traumatic events based on the previous study [46]. In this study, traumatic event exposure was constructed, and the degree of traumatic event impact was modified on a 5-point Likert scale from 1 (not at all) to 5 (very much). The scores were calculated by dividing the sum of the traumatizing events by the total number of traumatic events. The resulting scores range from 0 to 5, with higher scores indicating more traumatic experiences. Cronbach’s α was.93 in this study.

Demographic characteristics

To identify demographic characteristics, the questionnaire was composed of questions on gender, age, marital status, domestic family status, education level, height/weight, fatigue, disease diagnosed by a doctor, and treatment. To identify working characteristics, station, rank, responsibility, work period, shift work period, and job satisfaction were surveyed.

Data collection and procedure

We obtained permission for data collection from the captain of each police station and obtained informed consent from all participants. We visited 15 police stations in the metropolitan area between July and August 2020. Data were collected using a self-administered questionnaire. After the participants completed the survey, they submitted it to the researcher and received a small gift. The study was approved by the Institutional Review Board and Ethics Committee of the Yonsei University Health System (approval number: Y-2020-0045). Each participant provided their written informed consent.

Data analysis

The data were analyzed using the STATA 17.0 program. Participants’ mental health, resilience, social support, resource availability related to mental health, health behavior, job stress, traumatic experiences, physical environment, demographics, and job characteristics were analyzed using descriptive statistics. The variables for each factor were analyzed using Pearson’s correlation coefficients. In the path analysis, to match the direction of the factors, mental health level was inversely converted and analyzed. Therefore, in the descriptive statistical analysis, a higher mental health score indicated poorer mental health, whereas, in the correlation and path analyses, a higher score indicated better mental health.

Path analysis was performed to examine the direct and indirect paths of mental health based on a hypothesized path model. To verify the fitness of the hypothesized model, standardized chi-square index (χ2 /df), goodness of fit index (GFI), standardized root mean residual (SRMR), root mean squared error of approximation (RMSEA), Turker-Lewis index (TLI), and comparative fit index (CFI) were used. χ2(CMIN) is the most basic measure of model fit, with a low value and p ≥ 0.90 suggesting acceptable fit. Model fit indices goodness of fit index (GFI), Tucker–Lewis index (TLI) with indices ≥ 0.95 indicating good fitting models, whereas indices ≥ 0.90 suggest acceptable fit. SRMR and RMSEA indices ≤ 0.08 indicate acceptable model fit [33]. The 95% confidence interval (CI) did not include 0, indicating a significant difference.

In this study, 357 police officers participated. The mean age of the participants was 37.6 years (SD = ± 10.5), and 88.8% (n = 317) of the participants were men. There were 105 police officers (29.4%) and 328 team members (91.9%). The total number of years of working experience was 10.86 years (SD = ± 10.37), and the number of years of shift work experience was 8.01 years (SD = ± 8.50) (Table 1).

Table 1

General characteristics of participants, n = 357
Characteristics		Categories	n(%)/ Mean\(\pm\)SD
Gender		Male	317 (88.8)
		Female	40 (11.2)
Age (year)			37.62\(\pm\)10.47
		20s	89 (24.9)
		30s	142 (39.8)
		40s	50 (14.0)
		≥ 50s	76 (21.3)
Marital status		Single	169 (47.3)
		Married	188 (52.7)
Rank		Police officer	97 (27.2)
		Senior police officer	105 (29.4)
		Assistant inspector	46 (12.9)
		Inspector	97 (27.2)
		Senior inspector	12 (3.4)
Working experience (year)			10.86\(\pm\)10.37
	≤ 5		174 (48.7)
	6–10		61(17.1)
	11–15		19 (5.3)
	16–20		22 (6.2)
	> 20		81 (22.7)
Shift working experience (years)			8.01\(\pm\)8.50

The mental health of the participants in this study averaged 19.93 ± 9.19 on a 54-point scale, with sub-scale averages of 9.68 ± 4.84 for social role performance and self-confidence, 1.52 ± 1.70 for depression, 7.38 ± 3.31 for general health and vitality, and 1.36 ± 1.32 for sleep disturbance and anxiety. When applied to the criteria of the tool, of the participants in this study, 225 (63.0%) were in the potentially stressed group, 92 (25.8%) were in the high-risk group, and 40 (11.2%) were in the healthy group.

Resilience, an antecedent factor, averaged 69.05 ± 14.71 on a 100-point scale, and its sub-factors were 24.95 ± 5.30 for hardiness, 22.05 ± 5.28 for persistence, 10.82 ± 2.53 for optimism, 5.46 ± 1.53 for support, and 5.77 + 1.49 for Spirituality. The reinforcing factor, social support, averaged 3.58 ± 0.48 on a 5-point scale, while the moderating factors were 3.92 ± 0.83 for supervisor support and 3.24 ± 0.44 for colleague support. The enabling factor, resource availability, had a mean of 48.03 ± 5.95 on a scale of 68, with sub-factors of 14.38 ± 1.74 for fear, 13.52 ± 2.57 for trust, 8.78 ± 1.45 for self-exposure, 5.24 ± 1.17 for internal control, and 6.11 ± 1.23 for barriers.

Behavioral factors included health behavior, with a mean of 3.30 ± 1.47 out of 8, and environmental factors included job stress, with a mean of 3.29 ± 0.64 out of 5. Traumatic experiences had a mean of 3.08 ± 0.79 on a 5-point scale, with traumatic event at 2.36 ± 1.25 and secondary trauma at 3.20 ± 0.91(Table 2).

Table 2

Descriptive Statistics of Observed Variable, n = 357
Variables	Category	Possible range	Mean\(\pm\)SD
Mental health	Total	0–54	19.93 (9.19)
	Social performance and self-confidence	0–24	9.68 (4.84)
	Depression	0–9	1.52 (1.70)
	General well-being and vitality	0–15	7.38 (3.31)
	Sleeping disturbance and anxiety	0–6	1.36 (1.32)
Resilience	Total	0-100	69.05 (14.71)
	Hardiness	0–36	24.95 (5.30)
	Persistence	0–32	22.05 (5.28)
	Optimism	0–16	10.82 (2.53)
	Support	0–8	5.46 (1.53)
	Spirituality	0–8	5.77 (1.49)
Social Support	Total	1–5	3.58 (0.48)
	Supervisor	1–5	3.92 (0.83)
	Colleague	1–5	3.24 (0.44)
Resource availability	Total	17–68	48.03 (5.95)
	Fear	5–20	14.38 (1.74)
	Trust	5–20	13.52 (2.57)
	Self-exposure	3–12	8.78 (1.45)
	Internal control	2–8	5.24 (1.17)
	Barrier	2–8	6.11 (1.23)
Health behavior	Total	0–8	3.30 (1.47)
Job stress	Total	1–5	3.29 (0.64)
	Working environment	1–5	2.25 (0.97)
	Training and inspection	1–5	3.11 (1.04)
	Field work	1–5	4.10 (0.77)
	Civil affairs	1–5	4.39 (0.73)
	Organizational environment	1–5	2.86 (0.97)
Traumatic experience	Total	0–5	3.07 (0.86)
	Traumatic event	0–5	2.36 (1.25)
	Secondary trauma experience	0–5	3.20 (0.91)

The results of the correlation analysis showed that mental health levels significantly increased as resilience, social support, resource availability, and health behaviors increased. However, as job stress and trauma experiences increased, mental health levels decreased significantly. The variance inflation factor (VIF) of all variables was less than 10, and the tolerance limit was less than 0.1. Therefore, there was no problem with multicollinearity.

Path analysis

A path analysis was conducted using the hypothesized model incorporating seven variables. The values of the model fit are shown in Table 3.

Table 3

Model fit of the hypothesized model, n = 357
Category	Index	Criteria for acceptance	Hypothesized model
Absolute fit measure	χ2 (df)	Lower	166.074 (13)
	P	≥ .05	< .001
	RMSEA	Good < .05 Moderate .05 to 1.0	.183
	GFI	≥ .900	.571
	SRMR	Good < .05 Moderate < .10	.080
Incremental fit measure	CFI	≥ .900	.571
	TLI	≥ .900	.010
Note: Age and gender were adjusted for mental health, and rank was adjusted for mental health, health behavior, job stress, and traumatic experience. RMSEA = root mean square error of approximation; GFI = goodness of fit index; SRMR = standardized root mean residual; CFI = comparative fit index; TLI = Turker-Lewis index; AIC = Akaike information criterion; BIC = Bayesian information criterion

The goodness-of-fit criteria were not met, except for SRMR. However, in this study, this hypothetical model was selected as the final model for analysis based on the theoretical model (Fig. 2).

Table 4 shows the standardized total, direct, and indirect effects of the variables in the model among police officers. Health behaviors (coefficient = .24, p < .001) and job stress (coefficient = − .28, p < .001) have a significant direct effect on mental health. Resource availability (coefficient = .10, p = .025) had a significant indirect effect on mental health through health behaviors, job stress, and traumatic experiences. Traumatic experiences (coefficient = − .10, p < .001) on mental health also had an indirect effect on job stress and traumatic experiences.

The factors that showed a statistically significant direct effect on health behaviors were resilience (coefficient = .15, p = .019) and the factor that showed an indirect effect was trauma experience (coefficient = .01, p < .001) by job stress. The factor that showed a direct effect on job stress was trauma experience (coefficient = .35, p < .001), and the factor that showed an indirect effect was resource availability (coefficient = − .05, p = .030). Resource availability (coefficient = − .13, p < .025) had a direct effect on trauma experience (Table 4).

Table 4

Standardized Direct, Indirect and Total Effects for the Hypothetical Model including Control Variables, (n = 357)
Endogenous variables	Exogenous variables	Direct effect	Indirect effect	Total effect
		Coefficient (p)
Mental health	←Resilience	-	.04 (.064)	.04 (.064)
	←Support	-	− .02 (.170)	− .02 (.170)
	←Resource availability	-	.10 (.025)	.10 (.025)
	←Health behavior	.24 (< .001)	-	.24 (< .001)
	←Job stress	− .28 (< .001)	− .01 (.800)	− .29 (< .001)
	←Traumatic experience	− .08 (.110)	− .10 (< .001)	− .18 (.001)
Health behavior	← Resilience	.15 (.019)	-	.15 (.019)
	← Support	− .08 (.158)	-	− .08 (.158)
	← Resource availability	.05 (.387)	.00 (.896)	.05 (.370)
	←Job stress	− .02 (.800)	-	− .02 (.800)
	←Traumatic experience	.01 (.911)	.01 (< .001)	.00 (.994)
Job stress	←Resource availability	− .07 (.143)	− .05 (.030)	-12 (.019)
	←Traumatic experience	.35 (< .001)	-	.35 (< .001)
Traumatic experience	←Resource availability	− .13 (.025)	-	− .13 (.025)
Note: Age and gender were adjusted for mental health, and rank was adjusted for mental health, health behavior, job stress, and traumatic experience.

This study was conducted to explore the state of mental health among Korean police officers. We used the PRECEDE model to investigate relationships between officers’ mental health and several variables, including resilience, social support, resource availability, health behavior, job stress, and traumatic experiences. We also assessed relationships between the individual variables.

The results showed that police officers’ job stress levels were “high risk”, with an average score of 19.93 out of 54 according to the tool of the mental health [34]. In a 2019 study of Dallas police officers, 26% of officers reported having mental health symptoms [47]. These results were similar to previous study that the mental health of police officers is at risk and vulnerable, and their environment can influence to mental health [48].

The relationship between health behaviors, job stress, traumatic experiences, and mental health (H1) is partially supported. Health behaviors and job stress were directly associated with mental health, while traumatic experiences were indirectly associated with mental health. This finding is similar to that of a previous study, which reported that regular exercise was negatively associated with depression and anxiety [30]. A previous study reported that alcohol use negatively affects the mental health of police officers [49]. In a meta-analysis of the mental health effects of exercise intervention programs for police officers, physical activity appeared to have a mediating effect on the relationship between stress and mental health. The active intervention group showed better mental health than the control group [50]. Job stress also had a direct negative effect on mental health, and the effect size of its influence was greater than that of the other factors, such as support [49, 51]. A previous study reported that higher job stress was associated with depression, and the effect size was .35, with a slightly stronger effect size [52]. Posttraumatic stress symptoms and depression can occur when organizational stress is added to their traumatic experience [53]. Therefore, in this study, it can be explained that job stress mediates and negatively affects the relationship between trauma and mental health. The results of this study show that health behaviors and job stress directly affect police officers' mental health. Health behavior, a factor that can be changed by individual and organizational efforts, should be considered when establishing mental health improvement strategies. Among the factors affecting mental health, resource availability had an indirect effect. Additionally, the availability of resources indirectly affected work stress and had a direct impact on trauma experiences.

The relationship between resource availability, job stress, and trauma experiences (H2) was partially supported. Resource availability indirectly affected job stress and directly affected trauma experiences. In other words, the more police officers express their mood and seek mental health-related help, the lower the level of job stress and trauma experience. Police officers with depression are observed to have less access to mental health services than participants without mental health symptoms [26, 54]. Therefore, it can be said that the availability of resources is an important factor in mitigating job stress and traumatic experience.

Resilience directly affects health behavior, thereby supporting H3. In a previous study, resilience moderated the relationship between stress and negative emotions [55]. As resilience increased, smoking and nicotine dependence decreased [55]. In a study on workers, the resilience of participants who exercised regularly was higher than that of those who did not [56].

In this study, trauma experience had an indirect effect on health behavior, and the effect size was positive (.01), showing a small effect. There was a difference from this previous study. In previous studies, as trauma experiences and job stress increased, negative health behaviors such as alcohol consumption, overeating, and smoking increased [57]. In a study of the United States police officers, those experiencing high job stress were 1.76 times more likely to engage in problematic drinking than those experiencing low job stress [58]. Houdmont et al. [60] reported that health behavior can be used as a coping mechanism for job stress, and Lee et al. [31] suggested that health behavior has a positive effect on reducing trauma experience. In the case of Korean police officers, it can be explained that the trauma experience was reduced through healthy behavior.

The results of this study indicate that trauma experience had a statistically significant negative effect on stress and consequently had a negative effect on mental health. The findings also show that job stress was found to be statistically significant as a mediating factor. A previous study reported that posttraumatic stress symptoms and depression can occur when tissue stress is added to the traumatic experience [52]. Therefore, in this study, it can be said that trauma experiences have a rather large effect on job stress and consequently, a negative effect on mental health.

Based on the results of this study, an intervention program that can improve health behaviors is needed to improve police officers’ mental health. Health behavior, a factor that can be changed by individual and organizational efforts, should be considered when establishing mental health improvement strategies. In addition, there should be an educational program that can increase help-seeking regarding resource availability. Therefore, to improve police officers’ mental health, it is necessary to improve mental health promotion policies, health checkups, and work environments, along with employee assistance programs.

This was a cross-sectional study; therefore, there are limitations in interpreting the causal relationships in relation to the results. In addition, the trauma experience measurement tool used in this study reflected only the number and impact of traumatic events; therefore, reflection on the extent of severity of traumatic events experienced by police officers may be somewhat limited. Thus, future research is necessary to determine the number of traumatic events experienced by police officers, the severity of specific traumatic events, and the extent of their mental health effects.

The strength of this study is that we comprehensively assessed the mental health of police officers, and the vulnerability of police officers’ mental health was verified using real data. In addition, the characteristics of police organizations were well reflected in the fact that the PRECEDE model was able to diagnose the factors affecting mental health, considering both personal and organizational aspects. Thus, this model can be usefully applied to develop an intervention.

Our findings provide the basis for identifying factors related to the mental health of police officers based on the PRECEDE model. It was found that resilience, social support, resource availability, health behavior, job stress, trauma experience, and physical environment are factors that influence the mental health of police officers; moreover, their mental health is vulnerable to these factors. The PRECEDE model explains that educational factors can promote health through the education of participants, and environmental factors can have a positive effect on health outcomes by improving the environment. Therefore, it is necessary to improve resilience, educate people who can seek mental health-related help, and improve their work environments to increase health behaviors and reduce job stress. Organizational support for trauma prevention and management is also required for more holistic outcomes. The findings of this study will be useful for developing interventions and policies to improve police officers’ mental health.

Abbreviations used in this article: PRECEDE: Predisposing, Reinforcing, and Enabling Constructs in Educational Diagnosis and Evaluation.

Ethics approval and consent to participate

This study was approved by the Institutional Review Board and Ethics Committee of Yonsei University Health System (approval number: Y-2020-0045) in accordance with the declaration of Helsinki. The research and questionnaire were approved by the Yonsei University Health System. All participants were informed about the study and its aim and purposes before the consent form.

Each participant in this study signed an informed consent to participate. Anonymity and confidentiality were ensured by not revealing the name or personality identification on the research and questionnaires. All information obtained from the research was kept in a locked storeroom in the researcher’s office. All questions and demographics were coded into a data system and stored on a secure computer. All records related to research are destroyed after being kept for 3 years.

Consent for publication

Not applicable.

Availability of data and materials

The relative secrecy of police officers’ mental health makes it difficult to reveal the data set for this study. However, researchers may make reasonable requests to the corresponding author.

Conflict of Interests

The authors declare that they have no competing interests.

Funding

This work was supported by the National Research Foundation of Korea (NRF) grant funded by the Korean government (MSIT) (2022R1G1A1009132).

Authors’ contributions

GW contributed to all research-related planning, research data collection, analysis, writing the manuscripts, and final checks.

Acknowledgments

I appreciate the contribution of all participants to the study and would like to thank Professor Mona Choi, Sun Ah Kim, Gwangsook Kim, Changgi Park, and Jaepoong Park.

Larsson G, Berglund AK, Ohlsson A. Daily hassles, their antecedents and outcomes among professional first responders: A systematic literature review. Scand J Psychol. 2016;57:359–67. https://doi.org/10.1111/sjop.12303.
Purba A, Demou E. The relationship between organisational stressors and mental well-being within police officers: A systematic review. BMC Public Health. 2019;19:1286. https://doi.org/10.1186/s12889-019-7609-0.
Sherwood L, Hegarty S, Vallieres F, Hyland P, Murphy J, Fitzgerald G, Reid T. Identifying the key risk factors for adverse psychological outcomes among police officers: A systematic literature review. J Trauma Stress. 2019. https://doi.org/10.1002/jts.22431.
Brady PQ. Crimes Against Caring: Exploring the risk of secondary traumatic stress, burnout, and compassion satisfaction among child exploitation investigators. J Police Crim Psychol. 2017;32(4):305–18. https://doi.org/10.1007/s11896-016-9223-8.
Ryu GW, Yang YS, Choi M. Evaluating real-time momentary stress and affect in police officers using a smartphone application. BMC Public Health. 2020;20(1):1154–4. https://doi.org/10.1186/s12889-020-09225-z.
Garbarino S, Guglielmi O, Puntoni M, Bragazzi NL, Magnavita N. Sleep quality among police officers: Implications and insights from a systematic review and meta-analysis of the literature. Int J Environ Res Public Health. 2019;16(5). https://doi.org/10.3390/ijerph16050885.
Seok JM, Cho JH, Jeon WJ, Ahn JO. Risk factors for fatigue and stress among Korean police officers. J Phys Ther Sci. 2015;27(5):1401–5. https://doi.org/10.1589/jpts.27.1401.
Workman-Stark AL. Understanding Police Culture. Springer; 2017.
Jenkins EN, Allison P, Innes K, Violanti JM, Andrew ME. Depressive symptoms among police officers: associations with personality and psychosocial factors. J Police Crim Psychol. 2019;34(1):66–77. https://doi.org/10.1007/s11896-018-9281-1.
Grassi C, Del Casale A, Cuce P, Kotzalidis GD, Pelliccione A, Marconi W, et al. Suicide among Italian police officers from 1995 to 2017. Riv Psichiatr. 2019;54(1):18–23. https://doi.org/10.1708/3104.30936.
Lee JH, Kim I, Won JU, Roh J. Post-traumatic stress disorder and occupational characteristics of police officers in Republic of Korea: A cross-sectional study. BMJ Open. 2016;6(3):e009937. https://doi.org/10.1136/bmjopen-2015-009937.
Fekedulegn D, Burchfiel CM, Hartley TA, Andrew ME, Charles LE, Tinney-Zara CA, Violanti JM. Shiftwork and sickness absence among police officers: the BCOPS study. Chronobiol Int. 2013;30(7):930–41. https://doi.org/10.3109/07420528.2013.790043.
Fekedulegn D, Burchfiel CM, Charles LE, Hartley TA, Andrew ME, Violanti JM. Shift Work and Sleep Quality Among Urban Police Officers: The BCOPS Study. J Occup Environ Med. 2016;58(3):e66–71. https://doi.org/10.1097/jom.0000000000000620.
Vila B. Impact of long work hours on police officers and the communities they serve. Am J Ind Med. 2006;49(11):972–80. https://doi.org/10.1002/ajim.20333.
Mona GG, Chimbari MJ, Hongoro C. A systematic review on occupational hazards, injuries and diseases among police officers worldwide: Policy implications for the South African Police Service. J Occup Med Toxicol. 2019;14:2. https://doi.org/10.1186/s12995-018-0221-x.
Green LW, Kueuter MW, Deeds SG, Patridge KB. Health education planing a dignosis approach. 1st ed. Mayfield publishing company; 1980.
Crosby R, Noar SM. What is a planning model? An introduction to PRECEDE-PROCEED. J Public Health Dent. 2011;71(Suppl 1):7–15. https://doi.org/10.1111/j.1752-7325.2011.00235.x.
Green LW, Kueuter MW. Health program planning: An educational and ecological approach. Mc-Graw-Hill; 2005.
Fletcher D, Sarka M. Psychological resilience: A review and critique of definitions, concepts, and theory. Eur Psychol. 2013;18(1):12–23. https://doi.org/10.1027/1016-9040/a000124.
McCanlies EC, Gu JK, Andrew ME, Burchfiel CM, Violanti JM. Resilience mediates the relationship between social support and post-traumatic stress symptoms in police officers. J Emerg Manag. 2017;15(2):107–16. https://doi.org/10.5055/jem.2017.0319.
Andrew ME, McCanlies EC, Burchfiel CM, Charles LE, Hartley TA, Fekedulegn D, Violanti JM. Hardiness and psychological distress in a cohort of police officers. Int J Emerg Ment Health. 2008;10(2):137–47. https://doi.org/10.1037/e517322011-502.
Cohen S, Wills TA. Stress, social support, and the buffering hypothesis. Psychol Bull. 1985;98(2):310–57. https://doi.org/10.1037/0033-2909.98.2.310.
Reblin M, Uchino BN. Social and emotional support and its implication for health. Curr Opin Psychiatry. 2008;21(2):201–5. https://doi.org/10.1097/YCO.0b013e3282f3ad89.
Angehrn A, Vig KD, Mason JE, Stelnicki AM, Shields RE, Asmundson GJG, Carleton RN. Sex differences in mental disorder symptoms among Canadian police officers: the mediating role of social support, stress, and sleep quality. Cogn Behav Ther. 2022;51(1):3–20. https://doi.org/10.1080/16506073.2021.1877338.
Bayer JK, Peay MY. Predicting Intentions to seek help from professional mental health services. Australian N Z J Psychiatry. 1997;31(4):504–13. https://doi.org/10.3109/00048679709065072.
Fox J, Desai MM, Britten K, Lucas G, Luneau R, Rosenthal MS. Mental-health conditions, barriers to care, and productivity loss among officers in an urban police department. Conn Med. 2012;6(9):525–31.
Reavley NJ, Milner AJ, Martin A, Too LS, Papas A, Witt K, Keegel T, LaMontagne AD. Depression literacy and help-seeking in Australian police. Aust N Z J Psychiatry. 2018;2:1063–74. https://doi.org/10.1177/0004867417753550.
Komarovskaya I, Maguen S, McCaslin SE, Metzler TJ, Madan A, Brown AD, et al. The impact of killing and injuring others on mental health symptoms among police officers. J Psychiatr Res. 2011;45(10):1332–6. https://doi.org/10.1016/j.jpsychires.2011.05.004.
Maguen S, Metzler TJ, McCaslin SE, Inslicht SS, Henn-Haase C, Neylan TC, Marmar CR. Routine work environment stress and PTSD symptoms in police officers. J Nerv Ment Dis. 2009;197(10):754–60. https://doi.org/10.1097/NMD.0b013e3181b975f8.
Wu X, Liu Q, Li Q, Tian Z, Tan H. Health-related quality of life and its determinants among criminal police officers. Int J Environ Res Public Health. 2019;16(8). https://doi.org/10.3390/ijerph16081398.
Lee SY, Park CL. Trauma exposure, posttraumatic stress, and preventive health behaviours: a systematic review. Health Psychol Rev. 2018;12(1):75–109. https://doi.org/10.1080/17437199.2017.1373030.
Schnurr PP, Green BL. Trauma and health: Physical health consequences of exposure to extreme stress. Amer Psycholog Assoc. 2004. https://doi.org/10.1037/10723-000.
Kline RB. Principles and Practice of Structual Equation Modeling. 4th ed. Guilford Press; 2016. pp. 327–48.
Chang SJ, Koh SB, Kang DM, Kim SA, Kang MG, Lee CG, et al. Developing an occupational stress scale for Korean employees. Ann Occup Environ Med. 2005;17(4):297–317. https://doi.org/10.35371/kjoem.2005.17.4.297.
Baek HS, Lee KU, Joo EJ, Lee MY, Choi KS. Reliability and validity of the Korean version of the Connor-Davidson resilience scale. Psychiatry Investig. 2010;7:109–15. https://doi.org/10.4306/pi.2010.7.2.109.
Connor KM, Davidson JR. Development of a new resilience scale: The Connor-Davidson Resilience Scale (CD-RISC). Depress Anxiety. 2003;18(2):76–82. https://doi.org/10.1002/da.10113.
House JS. Work Stress and Social Support. MA: Addison-Wesley Ivancevich; 1981.
Son KA, Ko JW. The relative effect of personal, structural, and situational attributes on organizational commitment for teachers in Korea. J Hum Resour Manag Res. 2007;5(4):73–94. http://www.riss.kr/link?id=A107885068.
Song YM. Attitude and related factors of psychiatric patients for using community mental health. Master’s thesis, Chung-Ang University; 2009.
Kuhl J, Jarkon-Horlick L, Morrissey RF. Barriers to Adolescents Seeking Help Scale (BASH) [Database record]. APA PsycTests;1997. https://doi.org/10.1037/t39995-000.
Fischer EH, Turner JI. Orientations to seeking professional help: Development and research utility of an attitude scale. J Consult Clin Psychol. 1970;35(1):79–90. https://doi.org/10.1037/h0029636.
Kim JM, Yoo SK. Psychological and cultural Antecedents to help-seeking. Korean J Couns Psychotherapy. 2002;14(4).
Cho EY. Application and testing the PRECEDE model for health promotion of air crew. Korean J Aerosp Environ Med. 2002;2(3):151–70.
Kim WH, Kang KW. The development of Korean Local Police officers’ Job stress measurement instrument and survey of their Job stress. Korean Assoc. Public Saf Criminal Just Rev. 2019;28(2). 10.21181/KJPC.2019.28.2.61.
Riddle RT. The Relation Between Life Stress, Work Stress, and Traumatic Stress and Burnout and Cynicism in Police Officers. United States International University. Dissertation for Ph.D.; 1999.
Lee OJ, Ji YH. The analysis of field police officers` post traumatic stress disorder(PTSD) symptoms for the application of police job stress reduction program. Korean Assocf Police Sci Rev. 2010;12(4).
Jetelina KK, Molsberry RJ, Gonzalez JR, Beauchamp AM, Hall T. Prevalence of mental illness and mental health care use among police officers. MA Netw Open. 2020;3:10e2019658. https://doi.org/10.1001/jamanetworkopen.2020.19658.
Marshall RE, Milligan-Saville J, Petrie K, Bryant RA, Mitchell PB, Harvey SB. Mental health screening amongst police officers: factors associated with under-reporting of symptoms. BMC Psychiatry. 2021;21(1):135. https://doi.org/10.1186/s12888-021-03125-1.
Ballenger JF, Best SR, Metzler TJ, Wasserman DA, Mohr DC, Liberman A, et al. Patterns and predictors of alcohol use in male and female urban police officers. Am J Addict. 2011;20(1):21–9. https://doi.org/10.1111/j.1521-0391.2010.00092.x.
Penalba V, McGuire H, Leite JR. Psychosocial interventions for prevention of psychological disorders in law enforcement officers. Cochrane Database Syst Rev. 2008;3:Cd005601. https://doi.org/10.1002/14651858.CD005601.pub2.
Garbarino S, Cuomo G, Chiorri C, Magnavita N. Association of work-related stress with mental health problems in a special police force unit. BMJ Open. 2013;3(7). https://doi.org/10.1136/bmjopen-2013-002791.
Lee SH, Kim DH. The relation of job stress and depression of police officers who worked in local patrol division: focusing on the moderating effects of resilience. Korean Assn Police Sci Rev. 2017;16(3):281–310. https://doi.org/10.38084/2017.16.3.12.
Velazquez E, Hernandez M. Effects of police officer exposure to traumatic experiences and recognizing the stigma associated with police officer mental health: A state-of-the-art review. Policing. 2019;42(4):711–24. https://doi.org/10.1108/PIJPSM-09-2018-0147.
Grupe DW. Mental health stigma and help-seeking intentions in police employees. J Community Saf Well Being. 2023;8(Suppl 1):32–s39. https://doi.org/10.35502/jcswb.290.
Wang Y, Chen X, Gong J, Yan Y. Relationships between stress, negative emotions, resilience, and smoking: Testing a moderated mediation model. Subst Use Misuse. 2016;51(4):427–38. https://doi.org/10.3109/10826084.2015.1110176.
Yoshikawa E, Nishi D, Matsuoka YJ. Association between regular physical exercise and depressive symptoms mediated through social support and resilience in Japanese company workers: a cross-sectional study. BMC Public Health. 2016;16:553. https://doi.org/10.1186/s12889-016-3251-2.
Maia DB, Marmar CR, Henn-Haase C, Nobrega A, Fiszman A, Marques-Portella C, Mendlowicz MV, Coutinho ES, Figueira I. (2011). Predictors of PTSD symptoms in brazilian police officers: the synergy of negative affect and peritraumatic dissociation. Braz J Psychiatry 2011; 33(4:362–366. https://doi.org/10.1590/s1516-44462011000400009.
Gershon RRM, Barocas B, Canton AN, Xianbin L, Vlahov D. Mental, physical, and behavioral outcomes associated with perceived work stress in police officers. Crim Justice Behav. 2008;36(3):275–89. https://doi.org/10.1177/0093854808330015.
Houdmont J, Stavroula L. Contemporary Occupational Health Psychology: Global Perspectives on Research and Practice. John Wiley & Sons; 2012. 10.1002/9780470661550.

No competing interests reported.

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Determinants of mental health of police officers: A pathway model

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