Silent Struggles: Traumatic Brain Injuries and Mental Health in Law Enforcement

Abstract

Objective: To determine the prevalence of head injuries (HIs), posttraumatic stress disorder (PTSD), and depressive symptoms in law enforcement officers (LEOs) and (2) the association between HIs and psychological health conditions. Setting: County-level survey administered via Research Electronic Data Capture. Participants: A total of 381 LEOs completed the survey (age = 43 ± 11 years; 40 [11%] females; time as LEO = 1-50 years, median = 15 years). Design: Cross-sectional study. Main Measures: We examined the prevalence of HIs (the Ohio State University Traumatic Brain Injury Identification Method), PTSD (PTSD Checklist—Civilian [PCL-C]), and depressive symptoms (Patient Health Questionnaire-9 [PHQ-9]). We used Mann-Whitney U and chi-square analyses to compare PTSD and depressive symptoms between those with and without a HI history. Results: There were 282 (74%) participants who reported a lifetime history of 1 or more HIs; 116 (30%) sustained 1 or more HIs on the job. PCL-C scores ranged 17 to 85 (median = 27); 33 (10%) participants met or exceeded the clinical cutoff score of 50 to indicate a positive PTSD screening. Participants with a HI history (median = 29) had higher PCL-C scores than those with no HI history (median = 24; P < .001), but the proportion of participants who met the clinical cutoff for PTSD was not different between those with (n = 28, 11%) and without (n = 5, 5%) a HI history (X2 = 2.52, P = .112, odds ratio = 2.18; 95% confidence interval, 0.82-5.83). PHQ-9 scores ranged 0 to 20 (median = 3); 124 (36%) participants reported mild or greater depressive symptoms. Participants with a HI history (median = 3) had higher depressive symptoms than those with no HI history (median = 2; P = .012). The proportion of participants with mild or greater depressive symptoms was higher among those with a HI history (n = 99, 39%) than without (n = 25, 27%; X2 = 4.34, odds ratio = 1.74; 95% confidence interval, 1.03-2.93). Conclusion: HIs are prevalent in LEOs, which may have consequences for their performance, well-being, and career longevity. PTSD and depressive symptoms are higher in those with a HI history, suggesting LEOs need better traumatic brain injuries and mental health resources.