Psychosocial interventions for prevention of psychological disorders in law enforcement officers
Psychosocial interventions are widely used for the prevention of psychological disorders in law enforcement officers.
To assess the effectiveness and comparative effectiveness of psychosocial interventions for the prevention of psychological disorders in law enforcement officers.
CCDANCTR‐References was searched on 12/5/2008, electronic databases were searched, reference lists of review articles and included studies were checked, a specialist journal was handsearched, specialist books were checked and we contacted experts and trialists.
Randomised and quasi randomised controlled trials were eligible. The types of participants were people employed directly in law enforcement, including police officers and military police, regardless of gender, age and country of origin, and whether or not they had experienced some psychological trauma. All types of psychosocial intervention were eligible. The relevant outcome measures were psychological symptoms, adverse events and acceptability of interventions.
Data collection and analysis
Data was entered into Review Manager 4.2 for analysis, but this review was converted to RevMan 5.0 for publication. Quality assessments were performed. Two authors independently selected studies, extracted data and assessed the quality of studies. Summary effects were to be calculated using RevMan but no meta‐analyses were possible. For individual studies, dichotomous outcome data are presented using relative risk, and continuous outcome data are presented using the weighted mean difference. These results are given with their 95% confidence intervals (CI).
Ten studies were included in the review but only five reported data that could be used. Three of the ten studies were related to exercise‐based psychological interventions. Seven were related to psychological interventions. No meta‐analyses were possible due to diversity of participants, interventions and outcomes. Two studies compared a psychosocial intervention versus another intervention. Three studies compared a psychosocial intervention to a control group. Only one primary prevention trial reported data for the primary outcomes and, although this study found a significant difference in depression in favour of the intervention at endpoint, this difference was no longer evident at 18 months. No studies of primary prevention comparing different interventions and reporting primary outcomes of interest were identified.
The methodological quality of the included studies was summarised. No study met our full quality criteria and one was regarded as low‐quality. The remainder could not be rated because of incomplete data in the published reports and inadequate responses from the trialists.
There is evidence only from individual small and low quality trials with minimal data suggesting that police officers benefit from psychosocial interventions, in terms of physical symptoms and psychological symptoms such as anxiety, depression, sleep problems, cynicism, anger, PTSD, marital problems and distress. No data on adverse effects were available. Meta‐analyses of the available data were not possible. Further well‐designed trials of psychosocial interventions are required. Research is needed on organization‐based interventions to enhance psychological health among police officers.
Valentina Peñalba, Hugh McGuire, Jose R Leite
Plain language summary
Psychosocial interventions to prevent psychological problems in police officers
People working in law enforcement are subject to many things that can act as work stressors. These include aspects of their job that are linked to operational factors (job content) and aspects that are linked to organizational factors (job context). A wide variety of interventions are used to try to prevent psychological disorders in law enforcement officers. In view of the importance of the functions performed by law enforcement officers, and the fact that there is no definitive approach to deal with psychological problems they may develop, a systematic review of the evidence is needed to determine the effectiveness of psychosocial interventions in preventing these problems in this select population. We found ten randomised trials, but not of all these contributed useful data for this review and quantitative meta‐analyses were not possible. No data on adverse effects were available. The available evidence is, therefore, limited to the analysis of single, small and low quality trials. This suggests that police officers may benefit from psychosocial interventions in terms of psychological symptoms and physical symptoms. Further well‐designed trials of psychosocial interventions to enhance the psychological health of police officers are required. Trials of organisation‐based interventions are also needed.
Valentina Peñalba, Hugh McGuire, Jose R Leite
Implications for practice
There is insufficient evidence to show whether police officers benefit from psychosocial interventions including exercise‐based interventions. There is lack of evidence that psychosocial interventions can reduce stress‐related psychological symptoms.
Implications for research
Further high quality and appropriately large and statistically powered studies of psychosocial interventions in law enforcement officers are required. Specifically, randomised controlled trials with adequate methodological quality (minimising performance, attrition and detection biases). This review would be greatly improved if missing data from the included studies and additional data from new high quality studies were added. Future research is needed to assess organization‐based psychosocial interventions.