Faculty Bibliography

We studied the effects of increasing threat conditions on self-reported emotion, eyeblink electromyogram, and skin conductance responses to startling sounds in 55 police officers who endorsed a range of PTSD (posttraumatic stress disorder) symptoms. We found that contextual threat affected both physiologic and self-reported emotional responses. Greater PTSD symptom severity was related to greater physiologic responses under the low and medium but not under the high threat condition. The relationship between PTSD symptoms and physiologic responses was neither explained by self-reported emotional responses nor preexisting reported exaggerated startle symptoms. Our results emphasize the importance of contextual threat and suggest that laboratory measures of startle improve upon self-reported exaggerated startle alone in indexing PTSD symptom severity in urban police officers

BACKGROUND: This study examined the relationship of hypothalamic-pituitary-adrenal measures and hippocampal N-acetylaspartate (NAA) in posttraumatic stress disorder (PTSD) patients and control subjects. METHODS: Eleven patients with combat-related PTSD and 11 control subjects were evaluated with magnetic resonance spectroscopy as well as by morning salivary cortisol samples before and after administration of low-dose dexamethasone (.5 mg). RESULTS: Left hippocampal NAA was strongly associated with both pre-dexamethasone cortisol levels (n = 22, r =.53, p =.013) and post-dexamethasone cortisol levels (n = 22, r =.63, p =.002). After accounting for clinical symptom severity and hippocampal volume, cortisol levels accounted for 21.9% of the variance (F = 5.6, p =.004) in left hippocampal NAA and 12.6% of the variance (F = 3.2, p =.035) in right hippocampal NAA. CONCLUSIONS: This study shows a positive relationship between cortisol levels and hippocampal NAA in subjects without hypercortisolemia. Within the range of values seen in our subjects, cortisol may have a trophic effect on the hippocampus

The relationship between routine work stress and psychological distress was investigated among 733 police officers in three US cities, during 1998-1999. The Work Environment Inventory (WEI) was developed to assess exposure to routine work stressors, while excluding duty-related traumatic stressors (critical incidents). The WEI and its general properties are presented. The relationship between routine work stress exposure and psychological distress is then explored. Exposure to routine work stressors predicted general psychological distress (r = 0.46). as well as post-traumatic stress symptoms following officers' most traumatic career incident (rs = 0.26 to 0.39). Multivariate analyses found that these effects were independent of, and larger than, the effects of cumulative critical incident exposure. (Time since the most traumatic event, social support, and social desirability effects were also controlled statistically.) Routine occupational stress exposure appears to be a significant risk factor for psychological distress among police officers, and a surprisingly strong predictor of post-traumatic stress symptoms.

OBJECTIVE: Police officers face many stressors that may negatively impact sleep quality. This study compares subjective sleep quality in police officers with that in control subjects not involved in police or emergency services. We examined the effects of critical incident exposure (trauma exposure) and routine (nontraumatic) work environment stressors on sleep quality after controlling for the effects of work shift schedule. METHODS: Subjective sleep disturbances were measured by the Pittsburgh Sleep Quality Index in police officers (variable-shift workers, N = 551; stable day-shift workers, N = 182) and peer-nominated comparison subjects (variable-shift workers, N = 98; stable day-shift workers, N = 232). The main predictor variables were 1) duty-related critical incident exposure to on-line policing and 2) work environment stress related to routine administrative and organizational aspects of police work. RESULTS: Police officers on both variable and stable day shifts reported significantly worse sleep quality and less average sleep time than the two corresponding control groups. Within police officers, cumulative critical incident exposure was associated with nightmares but only weakly associated with poor global sleep quality. In contrast, the stress from officers' general work environment was strongly associated with poor global sleep quality. Sleep disturbances were strongly associated with posttraumatic stress symptoms and general psychopathology. CONCLUSIONS: A large percentage of police officers report disturbances in subjective sleep quality. Although the life-threatening aspects of police work are related to nightmares, the routine stressors of police service seem to most affect global sleep quality in these subjects. These findings may have implications for health and occupational performance

BACKGROUND: During future long-duration space missions, countermeasures need to be developed to deal with psychosocial issues that might impact negatively on crewmember performance and well-being. METHODS: In our recently completed NASA-funded study of 5 U.S. astronauts, 8 Russian cosmonauts, and 42 U.S. and 16 Russian mission control personnel who participated in the Shuttle/Mir program, we evaluated a number of important psychosocial issues such as group tension, cohesion, leadership role, and the displacement of negative emotions from crewmembers to people in mission control and from mission control personnel to management. RESULTS: Based on our findings, which are reviewed, a number of psychosocial countermeasures are suggested to help ameliorate the negative impact of potential psychosocial problems during future manned space missions. CONCLUSIONS: Crewmembers should be selected not only to rule out psychopathology but also to select-in for group compatibility and facility in a common language. Training should include briefings and team building related to a number of psychosocial issues and should involve both crewmembers and mission control personnel. During the mission, both experts on the ground and the crewmembers themselves should be alert to potential interpersonal problems, including the displacement of negative emotions from the crew to the ground. Supportive activities should consist of both individual and interpersonal strategies, including an awareness of changing leisure time needs. Finally, attention should be given to postmission readjustment and to supporting the families on Earth

Advances in psychopharmacology of PTSD are presented, focusing on antidepressants, adrenergic agents, antianxiety agents, and mood stabilizers. Treatment recommendations are related to recent advances in the understanding of the biology of PTSD. Pharmacotherapy of PTSD in children and adolescents is discussed, including recommended dose ranges. Recommendations are specified for pharmacotherapy of trauma survivors in the immediate aftermath of traumatic exposure, and for those with acute and chronic posttraumatic stress disorders

BACKGROUND: Anecdotal reports from space and results from simulation studies on Earth have suggested that space crewmembers may experience decrements in their mood and interpersonal environment during the 2nd half of the mission and that negative emotions may be displaced to outside monitoring personnel. METHODS: To evaluate these issues, we studied 5 American astronauts, 8 Russian cosmonauts, and 42 American and 16 Russian mission control personnel who participated in the Shuttle/Mir space program. Subjects completed questions from the Profile of Mood States, the Group Environment Scale (GES), and the Work Environment Scale (WES) on a weekly basis during the missions. Subscale scores from these measures were analyzed using a piecewise linear regression approach that analyzed normally distributed subscales using a mixed model and non-normally distributed subscales by dichotomizing the variables and using a generalized estimating equation. RESULTS: After protecting against possible Type I errors due to multiple significance tests, only weak support was found for the biphasic model: the only significant findings in favor of the hypothesized 2nd half decrements in the interpersonal environment were in crewmember GES Leader Support and astronaut WES Work Pressure. Strongly consistent confirmation was found on all six tested measures for the hypothesized displacement of tension and dysphoria from crewmembers to mission control personnel. The hypothesized displacement of tension and dysphoria from mission control personnel to management was found on five of the six tested measures. CONCLUSIONS: The absence of moderate to strong support for the biphasic model suggests that crewmember interpersonal functioning does not depend appreciably on 1st half/2nd half time effects. The consistent support found for the displacement of tension and dysphoria suggests that countermeasures need to be developed to deal with this phenomenon in both crewmembers and mission control personnel

OBJECTIVE: Previous studies of veterans have linked posttraumatic stress disorder (PTSD) after combat-related trauma to increased reports of health problems. It is unclear whether this association between PTSD and increased health problems generalizes to civilians who are exposed to a broader array of traumatic events. We also do not know whether trauma exposure is associated with increased health problems in individuals who do not develop PTSD. Using a non-treatment-seeking civilian sample, we examined whether lifetime PTSD or trauma exposure by itself was associated with current health problems. METHODS: Using a cross-sectional design and self-report measures, we evaluated urban Canadian bus drivers (n = 342) on trauma exposure, lifetime PTSD, and current health problems. Based on their responses, we divided our sample into individuals who had never experienced trauma (n = 91), trauma-exposed individuals who had never developed PTSD (n = 218), and persons who developed PTSD at some point after trauma (n = 33). We compared these groups on health problems, treatment service use, and health assessment measures. RESULTS: The PTSD group reported increased health complaints, more frequent use of health treatments, and poorer health self-ratings compared with the exposed non-PTSD and nonexposed groups. Trauma-exposed drivers without PTSD did not differ from unexposed drivers on any health measure. Controlling for sex and trauma frequency did not alter our findings. CONCLUSIONS: Trauma exposure that leads to PTSD is associated with increased health problems, while trauma exposure alone is not. Our results extend previous findings to a broader civilian context and clarify associations between trauma exposure and health

We studied 655 urban police officers (21% female, 48% white, 24% black, and 28% Hispanic) to assess ethnic and gender differences in duty-related symptoms of posttraumatic stress disorder (PTSD). We obtained self-report measures of: a) PTSD symptoms, b) peritraumatic dissociation, c) exposure to duty-related critical incidents, d) general psychiatric symptoms, e) response bias due to social desirability, and f) demographic variables. We found that self-identified Hispanic-American officers evidenced greater PTSD symptoms than both self-identified European-American and self-identified African-American officers. These effects were small in size but they persisted even after controlling for differences in other relevant variables. Contrary to expectation, we found no gender differences in PTSD symptoms. Our findings are of note because: a) they replicate a previous finding of greater PTSD among Hispanic-American military personnel and b) they fail to replicate the well-established finding of greater PTSD symptoms among civilian women