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The purpose of this paper is to provide a review of law enforcement suicide research from 1997 to 2016.

The PRISMA systematic review methodology was implemented. A SCOPUS search identified a total of 97 documents. After applying all exclusion criteria, the results included a list of 44 articles in the review.

Overall, studies investigating law enforcement suicide rates show conflicting results, with some studies showing lower suicide rates among law enforcement, some showing higher rates, and some showing no difference to comparison populations. Recurring research themes were lack of an appropriate comparison group, and small statistical power, particularly for minority and female officers. Stressors related to suicide among police included lack of organizational support, traumatic events, shift work, stigma associated with asking for help, or problems associated with fitting in with the police culture. Problems associated with domestic relationships and alcohol use were commonly mentioned as precursors to suicide or as correlates of suicidal ideation and were hypothesized to arise from stressful working conditions.

Some limitations in law enforcement suicide research include the lack of theory, under-reporting of suicides, and guarded survey responses from police officers. Future directions in police suicide research include investigating etiological factors such as past adverse life and family experiences, social-ecological variation in suicide, or differences in suicide rates within the law enforcement occupation.

Police work, given chronic and traumatic stress, lack of support, danger, and close public scrutiny is a fertile occupation for increased suicide risk. Awareness of the scope of the problem and associated risk factors can help to initiate prevention programs.

This paper provides a long-term review of literature regarding police suicidality, with suggestions for research and prevention.

The purpose of this paper is to provide a state-of-the-art review on the topic of police stressors and associated health outcomes. Recent empirical research is reviewed in the areas of workplace stress, shift work, traumatic stress, and health. The authors provide a comprehensive table outlining occupational exposures and related health effects in police officers.

A review of recent empirical research on police stress and untoward psychological and physiological health outcomes in police officers.

The results offer a conceptual idea of the empirical associations between stressful workplace exposures and their impact on the mental and physical well-being of officers.

A key limitation observed in prior research is the cross-sectional study design; however, this serves as a motivator for researchers to explore these associations utilizing a longitudinal study design that will help determine causality.

This review provides empirical evidence of both mental and physical outcomes associated with police stress and the processes involved in both. Research findings presented in this paper are based on sound psychological and medical evidence among police officers

This study examined the national prevalence of cluster suicides among law enforcement personnel at the county level, the influence on future suicides and risk factors associated with clusters.

Law enforcement suicide data were obtained from The National Violent Death Reporting System (NVDRS) and categorized into: (1) cluster and (2) non-cluster suicides. Chi-square was used to compare differences between the two groups. Logistic regression was used to predict the probability of suicide risk factors in the groups.

2,465 law enforcement suicides were listed in NVDRS between 2003–2018. 80 (9.4%) US counties had clusters, with 640 officers (25.7%) of officers as part of those clusters. Odds ratios for risk factors associated with the suicide cluster group were: mental health crisis (OR = 2.6, p = 0.026), age (OR = 1.01, p = 0.003), married (OR = 1.729, p=<0.001), military service (OR = 2.59, p=<0.001) and job problems (OR = 1.70, p = 0.05).

This study suggests that cluster suicides occur in law enforcement. The study is primarily descriptive and limited by the different numbers of contributing states in the NVDRS database through the years.

This study suggests that clusters occur in law enforcement and that they can impact future suicides. It is important for law enforcement organizations to recognize the potential for suicide clusters.

This study is among the first to empirically examine suicide clusters in law enforcement.

Balancing work and family in dual-earner households can be stressful. Research suggests that increased work-family conflict (WFC) significantly predicts poor psychological health and increased stress in police officers. The purpose of this paper is to assess whether child care stress was associated with anxiety symptoms and if stressful work events and shift work modified this relationship among 163 Buffalo, NY police officers.

Participants indicated child care stress by reporting how much stress they felt (0 – none to 10 – high) when making child care/daily living arrangements. Shiftwork was assessed from pay-roll data (1994 to date of exam) and by asking, “Do you work opposite shift from your spouse/partner to care for your children?” to assess partner’s shift. The Beck Anxiety Scale and Spielberger Police Stress Survey were used to assess anxiety and work stress, respectively. Effect modification was assessed by stratifying on police stress scores using their median values, and on partner’s shift. All models were adjusted for age, alcohol intake, sex and smoking status.

Results suggest that child care stress was positively associated with anxiety symptoms and that this relationship was moderated by high (>median) work stress factors and afternoon/midnight shift-work, but not having a partner who works opposite shift. These results indicate that child care stress is associated with anxiety symptoms and that this relationship may be modified by work factors.

A number of limitations should be considered while interpreting the results. This study is cross-sectional, which prevents causal inferences; therefore, the temporal pattern between exposure and outcome cannot be determined. The independent, dependent and moderating variables are all self-report measures, which may introduce recall bias. Lastly, generalizability is limited to police departments of similar size and geographic area.

Police experience high stress as part of their jobs, these results indicate that similar to other professions, WFC can also affect police officers, and is associated with higher levels of anxiety.

Few research studies have evaluated the affects of family issues in police. Specifically, the relationship between child care stress and anxiety, and how this relationship may be modified by high work stress.

The purpose of this paper is to update the assessment of national data on law enforcement worker suicide based on the National Occupational Mortality Surveillance database (NOMS, Centers for Disease Control and Prevention).

Death certificate data for 4,441,814 decedents, age 18–90 who died in one of the 26 reporting states were the source of NOMS data. Utilizing proportionate mortality ratios (PMRs), the ratio of suicides in law enforcement occupations in those who are 18–90 years old with a designated usual occupation was calculated.

Findings indicate a significantly higher proportion of deaths from suicide for law enforcement officers (PMR = 154, 95% CI = 147–162), compared to all the US decedents in the study population who were employed during their lifetime. Law enforcement personnel are 54% more likely to die of suicide than all decedents with a usual occupation. PMRs were highest for African-Americans, Hispanic males and for females. PMRs were similar for detectives, corrections officers and all law enforcement jobs, when not stratified by race, ethnicity and sex.

Bias may arise because a PMR can be affected by disproportionate increased or decreased mortality from causes of death other than suicide.

A better understanding of the scope of law enforcement suicide can inform policy focused on the planning and initiation of prevention programs.

The use of a national database to study law enforcement worker suicide adds to other information available on law enforcement worker suicide in specific geographic areas. The discussion on prevention in this paper presents ideas for policy.

Law enforcement is a dangerous profession not only due to assaults, accidents and homicides but also due to health risks. This study examined trends in the national frequency and rate of law enforcement job-related illness deaths in the United States over a 22-year period (1997–2018).

Data were obtained from the National Law Enforcement Officers Memorial Fund (NLEOMF) on death frequencies related to health issues at work. Death rates were based on the total number of police officers in the United States [rate = (frequency/population at risk) × 100,000]. Trends were examined using standardized regression.

A total of 646 deaths were attributed to job-related illness. There was a significant upward trend in overall job-related illness deaths (frequency analyses: β = 0.88, p < 0.0001; rate analyses: β = 0.82, p ≤ 0.0001) mainly driven by a significant increase in 911 cancer deaths (frequency analyses: β = 0.88, p < 0.0001; rate analyses: β = 0.88, p ≤ 0.0001). Nearly 82 percent of circulatory deaths were from a heart attack, with an average death age of 46.5 years.

Deaths were not included if they failed to meet medical requirements of the NLEOMF. The data are descriptive, do not estimate risk and should be interpreted cautiously.

Police wellness programs may help to reduce the danger of deaths associated with job-related illness.

This is among the first studies to examine frequency and rate of police health–related deaths due to job exposures.

The purpose of this paper is to assess whether shift work, sleep loss and fatigue are related to short-term unplanned absences in policing.

N = 367 police officers from the Buffalo Police Department were studied. Day-by-day work and sick leave data were obtained from the payroll. Absenteeism was defined as taking a single sick day on a regularly scheduled workday. Biomathematical models of fatigue (BMMF) predicted officers' sleep–wake behaviors and on-duty fatigue and sleepiness. Prior sleep, fatigue and sleepiness were tested as predictors of absenteeism during the next shift.

A total of 513,666 shifts and 4,868 cases of absenteeism were studied. The odds of absenteeism increased as on-duty fatigue and sleepiness increased and prior sleep decreased. This was particularly evident for swing shift officers and night shift officers who were predicted by BMMF to obtain less sleep and have greater fatigue and sleepiness than day shift officers. The odds of absenteeism were higher for female officers than male officers; this finding was not due to a differential response to sleep loss, fatigue or sleepiness.

Absenteeism may represent a self-management strategy for fatigue or compensatory behavior to reduced sleep opportunity. Long and irregular work hours that reduce sleep opportunity may be administratively controllable culprits of absenteeism.

Police fatigue has consequences for police officers, departments and communities. BMMF provide a potential tool for predicting and mitigating police fatigue. BMMF were used to investigate the effects of sleep and fatigue on absenteeism.

Chronic exposure to occupational stress may lead to depressive symptoms in police officers. The association between police stress and depressive symptoms and the potential influences of coping and hardiness were evaluated. The paper aims to discuss this issue.

Stress level was assessed in the Buffalo Cardio-Metabolic Occupational Police Stress Study (2004–2009) with the Spielberger Police Stress Survey. The frequency and severity of events at work were used to calculate stress indices for the past year. The Center for Epidemiologic Studies Depression (CES-D) Scale was used to measure depressive symptoms during the past week. Linear regression was used to evaluate the association between the stress indices and depressive symptom scores. Models were adjusted for age, sex, race, smoking status and alcohol intake, and stratified by median values for coping (passive, active and support seeking) and hardiness (control, commitment and challenge) to assess effect modification.

Among the 388 officers (73.2 percent men), a significant positive association was observed between total stress and the CES-D score (β=1.98 (SE=0.36); p<0.001). Lower CES-D scores were observed for officers who reported lower passive coping (β=0.94 (SE=0.45); p=0.038) and higher active coping (β=1.41 (SE=0.44); p=0.002), compared with their counterparts. Officers higher in hardiness had lower CES-D scores, particularly for commitment (β=0.86 (SE=0.35); p=0.016) and control (β=1.58 (SE=0.34); p<0.001).

Results indicate that high active coping and hardiness modify the effect of work stress in law enforcement, acting to reduce depressive symptoms.

This study is a mortality assessment on police officers (68-years, 1950–2018) and includes all causes of death.

The authors investigated 1,853 police deaths (1950–2018) using sources of mortality that included the National Death Index, NY State, and available records from the Buffalo NY police department. Standardized Mortality Ratios were calculated. Death codes were obtained from 8th and 9th International Classification of Disease revisions in accordance with the year of death.

Compared to the US general population, white male police officers from 1950–2018 had elevated mortality rates for some causes of death, including diseases of the circulatory system, malignant neoplasms, cirrhosis of the liver, and mental disorders. Black and female officers had lower mortality rates for all causes of death compared to the general population.

The findings of elevated risk for chronic disease among police need to be studied in relation to stress, lifestyle, and exposure to chemical and physical agents. There is a special need to further study officers from minority populations as larger samples become available.

The results of this study will provide police and occupational health practitioners with objective evidence to determine the health impact of work on law enforcement officers.

This study is longest running mortality assessment on police officers ever conducted (1950–2018) and includes white, black, and female officers.

The purpose of this study is to examine cross-sectional associations between adverse childhood experiences (ACEs) and mental health among police officers.

The sample was from the Buffalo Cardio-Metabolic Occupational Police Stress study data (132 male and 51 female officers). Standardized surveys were administered to participants. Regression coefficients were obtained from models adjusted for age, sex, race and alcohol intake. All statistical tests were performed using a statistical significance level at p < 0.05.

Regression analyses showed significant positive associations between ACEs and mental health (Posttraumatic Stress Disorder [PTSD]: β = 1.70, p < 0.001 and depressive symptoms: β = 1.29, p < 0.001). Resiliency significantly modified the association between ACEs and PTSD. A positive and significant association was observed among officers with lower resiliency (β = 2.65, p < 0.001). The association between ACEs and PTSD was stronger among male officers compared to females (β = 2.66, p < 0.001 vs. β = 0.59, p ≤ 0.248, respectively).

Child abuse and development of PTSD or depression could not be traced through time as this was a cross-sectional study. Recall bias may affect results.

PTSD and depression associated with ACEs can affect the interpretation of threat and can exacerbate emotional regulation in officers. An inquiry should be expanded regarding work assignments of victimized officers, such as child exploitation and pornography investigation.

There are few studies on ACEs and the mental health of police officers. The present study is among the first to associate multiple police mental health issues with ACEs.