Post Traumatic Stress Disorder (PTSD) is an anxiety disorder characterised by clinical features of re-experiencing the event/s, as well as avoidance and hyperarousal. 

In some occupations, PTSD can be considered a work related disorder, particularly where there is a high risk of experiencing a traumatic event, as with firefighters, police and ambulance personnel.

While Police experience more traumatic events than the general population, PTSD occurs approximately 7% of the Police population, with 34% showing sub threshold PTSD symptoms.

At the commencement of their careers in the force, police cadets are selected on the basis of their physical and psychological condition, however PTSD is the most commonly reported occupational disorder within this occupational group. It is also often cited as one of the most stressful occupations.

The Brief Eclectic Psychotherapy (BEP) treatment was developed in a Netherlands academic hospital for the treatment of PTSD, particularly police. More than 90% of policer personnel recovered after receiving the treatment. Attention was also paid to their reintegration into the workplace. 

While age and gender may help predict the risk of developing PTSD, the factors relating to work status were yet to be addressed. The objective of this study was to (i) describe a population of Dutch police officers with PTSD before and after an outpatient treatment program, comparing working personnel with personnel on sick leave, and (ii) to identify the factors related to return to work.

The retrospective study reviewed the records of 121 police officers (84 men and 37 women, mean age 38.4) with PTSD referred to one academic hospital in the Netherlands. Psychologists performed the individual treatment in the patients’ home regions over a 16 week period. The BEP treatment combines cognitive- behavioural and psychodynamic approaches in the one treatment.

The five essential elements in the treatment were:

• Psycho-education
• Imaginary guidance
• Writing assignments and mementoes
• Domain of meaning and integration
• Farewell ritual

Following treatment, an outtake was performed in the same hospital as the intake. 

At intake, 59 participants were on sick leave and 62 were working. Of those working, 16 were in their original job, 21 were in their original job with task adaptations, 14 were temporarily in another job within the police force. Documentation was incomplete for a further 11.  The average time was 86% of the hours they had originally been assigned.

At outtake, 90% were working. None of the independent variables at intake (cluster scores on PTSD, age, sex, psychological co-morbidity or years of experience) were significantly related to working status at outtake.

Those still on sick leave after outtake suffered from more complaints. One in four on sick leave, and one in twelve working, reported re-experiencing events. Police on sick leave at outtake may have received less benefit from the treatment. An explanation may be that the treatment was developed for decreasing complaints of PTSD and not specifically to realise return to work. 

The researchers recommended that the psychologists communicate with the occupational health professional about the possibilities of returning to work. The occupational health professional should have contact with the police organisation involved, and the organisation should try to create a safe place for return to work. The researchers recognised however that the creation of other functions may be challenging due to the nature of the job. 

The researchers suggested a future prospective study to investigate return to work after treatment of PTSD and which factors at intake were related to work status at outtake, along with consulting with stakeholders in return to work in the treatment.

The researchers recommended that, “specific attention be paid to successful return to work as part of the treatment program, therefore the occupational health professional and employer should be involved.

AUTHORS

Plat MC, Westerveld GJ, Hutter RC, Olff M, Frings-Dresen MH & Sluiter JK.

TITLE

Return to Work: Police personnel and PTSD

SOURCE

Work. 2013 Jan 1;46(1):107-11. doi: 10.3233/WOR-121578.

ABSTRACT

INTRODUCTION:

This study i) describes the number of police personnel with PTSD who are working and those who are on sick leave before and after an out-patient-clinic treatment program and ii) examines which factors are related to return to work.

METHOD:

In this retrospective study all police officers had an intake interview before and an outtake interview following a 16-week treatment for PTSD. Information about several personal characteristics, PTSD complaints, and work related factors were gathered. A t-test and chi-square test were used to evaluate differences between working police personnel and police personnel on sick leave at intake and outtake. Binary logistic regression was used to test whether the intake data were related to returning to work at outtake.

RESULTS:

At the start of the treatment half of the police personnel were on sick leave (n=59) and at outtake 48 participants who were not working at intake had returned to work. None of the variables at intake contributed significantly to return to work at outtake.

CONCLUSION:

The majority of police officers returned to work after the treatment program. We recommend that attention be paid to successful return to work as part of the treatment program, therefore the occupational health professional and employer should be involved.