Police Officer Suicide
Summary and Keywords
All too often we emphasize the dangers of police work, but seem to neglect the hidden psychological danger of this profession. Suicide is a consequence of that hidden danger. It is a clear indication of the intolerable strain placed on the police officer’s work and life roles. Policing is an occupation replete with stress and traumatic incidents. For example, witnessing death, encountering abused children, and experiencing violent street combat weigh heavily as precipitants to depression, alcohol use, and suicide among police. Ideas as far back as Freud’s aggression theory relate to the police because officers cannot legally express anger and aggression outwardly and turn it within. Following Freud, other studies examined the frustration of police work and how it was turned inward. Other theoretical ideas concerning police suicide that have emerged over the years are included in this article—police cultural socialization, strain theory, and interpersonal suicide theory.
Scientific research on police suicide has helped to focus on this topic. Much research is on suicide rates in an effort to determine the scope of this problem. Several recent studies are discussed in this article, including a national study. Such studies, however, are not without controversy and more work is necessary to clarify the validity of findings. There is lack of data available on police suicide, which adds to the problem of research. Many believe that causes of police suicide are really no different than those in other groups in society, such as relationship problems, financial difficulties, or significant loss. While scholars cannot yet be certain that police work is an etiological suicide risk factor, we can with some assurance state that it serves as a fertile arena for suicide precipitants. Culturally approved alcohol use and maladaptive coping, firearms availability, and exposure to psychologically adverse incidents all add to the suicide nexus.
Last, and most important, the issue of police suicide prevention is discussed. Likely the biggest challenge in prevention is convincing officers to go for help. The police and societal culture at large attach a stigma to suicide which is difficult to deal with. Additionally, the police culture does not allow for weakness of any kind, either physical or psychological. Several promising prevention approaches are discussed. Given the reluctance to report the deaths of police officers as suicides unfortunately leaves us in a position of “best guess” based on what evidence we can collect. Looking to the future, the development of a national database focused on police suicide would help to establish the actual scope of this tragic loss of life. Interventions need to more efficaciously target at-risk police officers. More research, using longitudinal study designs, is needed to inform interventions and, in particular, to determine how suicide prevention efforts can be modified to meet the unique needs of law enforcement officers.
I watched my husband deteriorate the last three to four weeks of his life, and I couldn’t stop it. He shot and killed himself the morning of March 8, 1995 . . . He was 45 years old. I wanted so desperately to have someone come over and try to talk with him, to help us, . . . there was nowhere to turn. I felt helpless and hopeless. Pacing . . . wringing hands . . . I can’t do it . . . I begged him—let’s just walk out the door and leave . . . but, he would not even consider it. Being an FBI Agent was who he was, how he defined himself.
— Police Suicide Survivor
One might expect that suicide rates among police officers would be lower than they are, given that police are an employed, healthy, and psychologically tested group. Certainly, rates should be lower than the general population, since suicide in the latter group includes the institutionalized, mentally ill, and unemployed. However, evidence suggests that there is an elevated rate of suicide among police officers, even when compared to the general population. In this article we will focus on several aspects of suicide among police to include a discussion of theory, research, etiology, and prevention.
Perhaps the first attempt at a major theory of police suicide found its roots in the ideas of Sigmund Freud. Freud’s idea of self-destruction led him to the concept of “death instinct,” a destructive drive in each person whose final goal is annihilation. This dangerous drive is dealt with by individuals in various ways. Freud theorized that death wishes against oneself were in part rendered harmless by being diverted to the external world in the form of aggression. That is, if one holds back aggression, it can lead to unhealthy consequences such as suicide (Litman, 1970). Based on this, Freud recommended that there would be less suicide if society permitted its members to freely express aggression. Freud’s ideas related easily to the police because they were strictly limited by the public and courts to express any type of aggressive activity. Police officers were expected to use as little force as possible and to always be pleasant regardless of what others did or said to them. Pent-up anger and aggression could not be freely expressed under any circumstances.
Henry and Short (1954) added a social dimension to Freud’s psychodynamic model of aggression and suicide. These authors viewed aggressive behavior as stemming more from societal frustration rather than internal drives. Henry and Short viewed suicide as aggression for which outward expression toward others is denied. The primary difference between Freud and Henry and Short is that the latter viewed society and not the individual as the precursor of aggressive suicide. However, similar to Freud, Henry and Short purported that frustration and the blockage of outward aggression may lead to suicide.
Freud’s concept of aggression and suicide was again applied to the police by Friedman (1968) in his analysis of 93 New York City police suicides. The cases studied by Friedman occurred during a tumultuous and corrupt period of time in the history of New York City (1934–1940). Friedman expected to find high rates of suicide among New York City officers due to the societal sanctioned use of power and aggression. He believed that such power led to a strong conflict in police officers.
Nelson and Smith (1970) approached police suicide from a social perspective, applying social determinants as precipitants of human behavior. The police officer who committed suicide was seen as lacking integration into society. Nelson and Smith hypothesized that officers are continuously disintegrated from society by the very nature of their jobs. The authors described police officers as not being particularly well liked for the work they do, and as being isolated from society. They were seen as experiencing much more exposure to misery and death than average citizens. This, coupled with strained family relationships and shift work, isolated them even further.
Heiman (1975) moved police suicide theory to a multidimensional orientation by calling for the inclusion of psychological and social factors: A common-sense approach would be to view police suicide from a psychological basis, emphasizing the unique and multi-determined aspects of suicide patterns, while at the same time being cognizant of the role of societal influences.
Loo (1986), in his study of Royal Canadian Mounted Police (RCMP), conceptualized police suicide as based on the person’s personality, coping skills, and logic more so than the effects of society. Loo stated that RCMP officers committed suicide as an escape function—most officers committed suicide in response to life situations which were intolerable.
Bonafacio (1991) proposed a more recent psychodynamic approach to police suicide. Bonafacio hypothesized that feelings of helplessness may be brought on by the officer’s exposure to crime, human misery, and death. These feelings may in turn exacerbate feelings of inadequacy that were already present in the officer’s personality, causing overwhelming feelings of self-loathing. Suicide may be the officer’s attempt to restore feelings of strength and adequacy. As officers are overcome by witnessing misery and human degradation about which they can do nothing, and when cynicism and alcohol are unable to manage these feelings of self-hatred or feeling impotent, then suicide may become the next option.
Recent Theoretical Perspectives
Violanti (1997), in an investigation of potential pathways to law enforcement suicide, explored socialization into the police role—a process which predisposes officers to a specific police behavioral role as the principal strategy for dealing with life stress. During the work experiential process, officers tend to assimilate a mode of dichotomized decision-making—the situation is either “right or wrong” and there is no discretionary middle ground (Blau, 1994). Such thinking may be the result of a quest for objectivity on the part of the officer, but eventually may spill over into personal and life problems. If this occurs, the officer may be said to employ a constrictive cognitive style in dealing with problems referring to the officer’s inability to cognitively process alternatives other than “right or wrong” or “black or white” (Shneidman, 1985). As Shneidman points out, such a cognitive style is dangerous when contemplating suicide, since one cannot adequately process alternatives to suicide. Socialization into a police cognitive role not only constricts thinking but also encourages officers to use this role in lieu of other life roles (Thoits, 1986). The officer may consistently approach stressful situations from a police role perspective rather than that of spouse, parent, friend, or significant other. Unfortunately, officers may lack important coping resources, such as mental flexibility and other life roles, and be more susceptible to despair, hopelessness, or depression (Turvey, 1996).
Agnew (2001) developed the idea of strain theory, suggesting that persons react negatively to situations that produce stressors and push them in different directions. General strain theory focuses on opposing forces in the integration of the individual and their environment that can lead to aversive behavior and strain. Zhang (2005) applied strain theory to suicide by proposing that suicide is a solution to psychological suffering brought about by situations that increase strain in individuals who feel alienated from their environment. In contrast, persons who are integrated into society may be at lower risk of suicide even when confronting strain (Zhang, 2005). Arter (2013) applied strain theory to police work, suggesting that the negative and stressful environment that police officers experience leaves them feeling cynical and isolated from society, which may exacerbate strain. In addition, a lower level of societal integration associated with police cultural values may tend to isolate officers from the support they need in psychological crisis situations, increasing the risk of suicide. Violanti et al. (2018) found that social avoidance of non-police persons by police may affect the level of needed support during psychological crises because it interferes with establishing a helping network. Bishopp and Boots (2014) examined gender differences associated with suicidal ideation among police officers and found that strain has a positive and direct effect on male but not female officer suicidal ideation.
Joiner (2005) proposed the interpersonal theory of suicide. According to this theory, suicidal behavior may emerge in response to repeated exposure to physically painful and/or fear-inducing experiences, opponent processes in life such as strain, and a feeling of thwarted belongingness. In essence, this theory may apply to police officers frequently exposed to traumatic experiences and those who experience a sense of isolation from society, resulting in a feeling that they do not belong (Van Orden et al., 2010). Consistent with interpersonal theory, Ribeiro et al. (2014) noted that the capability for suicide is characterized by a sense of fearlessness of death. Police officers frequently encounter death in their work and may become apathetic to it, making it easier for them to take their own life. According to Henry and Short (1954) social processes within the police culture suppress emotions and protect officers from anxiety about death. Violanti, Mnatsakanova, and Andrew (2013) examined implicit association testing (IAT) among police officers based on identification with death. Results suggested that officers had differing levels of identification: slight (18.5%), moderate (32.3%), and strong (29.2%).
Research on Police Suicide
Early research provided initial evidence on police suicide. Vena, Violanti, Marshall, and Feidler (1986) found male officers to have an age-adjusted mortality ratio for suicide of approximately three times that of male municipal workers in the same cohort. Lester (1992) found that 7 of 26 countries for the decade of 1980–1989 had police suicide rates above the general population. A mortality study of police officers in Rome, Italy, found the suicide ratio among male police officers to be 1.97 times as high as the general male Italian population (Forastiere et al., 1994). Violanti, Vena, and Marshall (1996) found that male police officers had a suicide rate of 8.3 times that of homicide and 3.1 times that of work accidents. Compared to male municipal workers, male police officers had a 53% increased rate of suicide over homicide, a threefold rate of suicide over accidents, and a 2.65-fold rate of suicide over homicide and accidents combined.
Berg, Hem, Lau, Loeb, and Ekeberg (2003), in a nationwide study on suicide ideation and attempts among 3,272 Norwegian police, found that 24% felt that life was not worth living, 6.4% seriously considered suicide, and 0.7% had attempted suicide. Serious suicide ideation was mainly attributed to personal and family problems. Violanti (2004) found that certain traumatic police work exposures increased the risk of having a high level of post-traumatic stress disorder (PTSD) symptoms, which subsequently increased the risk of alcohol use and suicide ideation. The combined impact of PTSD and increased alcohol use led to a tenfold increased risk of suicide ideation. Violanti, Charles et al. (2008) examined the association between depressive symptoms and suicide ideation in a sample of police officers. Prevalence of depression was higher among female than male officers (12.5% vs. 6.2%). For each standard deviation increase in depression symptoms, the prevalence ratio of suicide ideation increased 73% in female officers and 67% in male.
Studies on police suicide have been conducted via web surveillance methods (O’Hara & Violanti, 2009; O’Hara, Violanti, Levenson, & Clark, 2013). Approximately 55,000 suicide-specific web news articles were reviewed during these studies for information relating to police suicides in the United States. Suicide data collected were: (a) date of suicide, (b) location, (c) department, (d) age, (e) rank, (f) police service time, (g) means of suicide, (h) marital status, (j) probable causal factors, (k) military veteran status, and (l) statements by department and medical examiners. The study examined descriptive data across 2008, 2009, and 2012. Results indicated that male and female suicides appeared to occur at a similar rate across the three years, averaging 92% and 6% respectively. In 2012, suicides appeared to cluster in the 40–44 year age group more than in the previous three years. In 2012, a rather large increase in suicide was seen in officers with 15–19 years of service compared to 2009. Gunshot remained the most prevalent means of suicide across all three years (91.5%). In 2012, a category for possible reasons for suicide and military veteran status was added. Personal problems appeared to be the most prevalent personal reason (83%) with work-associated legal problems ranking second (13%). Approximately 11% of suicides were military veterans. California (n = 10) and New York (n = 12) had the highest police suicide rate. The 2012 data does show an estimated decrease in the number of police suicides since 2009 (17 fewer, 13.3%), which is encouraging news.
Additional findings from the web surveillance studies indicated that suicide among officers of lower rank (below sergeant) and the use of firearms continued to dominate. Many of the web reports contained general statements made by police departments concerning perceived reasons for the suicide. Suicide was commonly attributed to the personal and legal problems of the officer. Some departments blamed exposure to work trauma as a precipitant. Many stated that they noticed no signs of an impending suicide. The age of suicide clustered in the 40–44 year range, consistent with white male middle-aged persons in the general U.S. population (Centers for Disease Control and Prevention, 2013). This represented a demographic shift upwards from 2009, in which the age group 35–39 was most at risk, suggesting that the infusion of younger officers into law enforcement is resulting in an increased acceptance of emotional self-care and therapy. Youngest officers (20–24) had the lowest percentage of suicides; however, their numbers were very small.
Of interest in the web-based surveillance results were four murder–suicides involving police families. In our previous work, we posited that exposure of police officers to violence and aggression may increase the risk of homicide–suicide (Violanti, 2007). Several studies have suggested associations of suicide and aggression (Romanov et al., 1994). Farberow, Kang, and Bullman (1990) compared suicide completers with accident victims, and concluded that suicide completers were more likely to have histories of angry outbursts. Other associations noted in relation to suicide are hostility and irritability. Officers considering suicide may be more likely to have a history of violence and act violently in a greater variety of relationships, especially spousal (D’Angelo, 2000). Palermo (1994) suggested that homicide–suicide should be considered as an extension of aggression first turned inward in the form of suicide. The perpetrator is viewed as an aggressive individual who hides behind a facade of self-assertion, and is unable to withstand the reality of an unexpected rejection and possibly a drastic life change. He commits suicide after killing his extended self.
In a separate study on police murder–suicide Violanti (2007) found that police family homicide–suicides are increasing, as approximately twice as many cases were reported in 2006 as in the two previous years. The majority of homicide victims were women (N = 24; 83%), however, five of the victims were men killed by women police officers. The majority of incidents occurred in younger age groups (< 40 years of age). The primary weapon employed was the police service firearm (90%). Most incidents occurred on the local police departmental level (76%) as opposed to state- and federal-level departments. Similar to the majority of nationwide homicide–suicides, the homicide victim was primarily a spouse or female acquaintance. In three cases a child was also killed by the perpetrator (Violanti, 2007).
A National Police Suicide Study
Additional evidence for the increased risk of suicide among police was found in a recent national study of suicide (Violanti, Robinson, & Shen, 2013). The study evaluated the association between police suicide and that of the U.S. working population. The data were contributed by U.S. states to the National Occupational Mortality Surveillance (NOMS) System maintained by the National Institute of Occupational Safety and Health (National Occupational Mortality Surveillance (NOMS), 2012). Participating states were Colorado, Georgia, Idaho, Hawaii, Indiana, Kansas, Kentucky, Michigan, Nebraska, Nevada, New Hampshire, New Jersey, New Mexico, North Dakota, Ohio, Rhode Island, South Carolina, Texas, Utah, Vermont, Washington, West Virginia, and Wisconsin. Death certificate data for 1.46 million decedents, age 18–90, who died in one of the 23 states were the source of study data.
Results were expressed in terms of “proportionate mortality ratios” (PMRs). PMRs represent the proportion of deaths due to suicide among police, divided by the proportion of deaths due to suicide among the U.S. population as a whole. The result is converted to a percentage by multiplying the ratio by 100. A PMR over 100 is considered an increased risk for suicide. Police suicides for the years 1999, 2003–2004, and 2007 were examined. There were 264 suicide deaths, resulting in a significantly higher PMR for suicide than expected (PMR = 169), which represents a 69% higher risk for suicide among police compared to all decedents in the study population who were employed during their lifetime.
Interestingly, police detectives are at higher risk than officers. The PMR = 189 for detectives indicated an 82% higher risk than the U.S. population. Very little research currently exists concerning police detective suicide. Work exposure for detectives is somewhat unique from patrol officers, and one possible factor is the extraordinary types of stress that detectives face. An early study by Cooper and Grimaly (1983) found that the organization of the detective service and environmental influences were found to be major determinants of stress-related illnesses among detectives, with detective sergeants being particularly vulnerable to role-related stress. Sewell (1993) suggests that detective stress of investigating multiple murder cases falls into two broad categories: organizational and event. Sewell (1993) adds that a strong organizational commitment to reduce such stress is needed. In a related paper, Sewell (1994) comments that detectives must deal with additional stressors not experienced in patrol work. They need to deal with significant others involved with the crime being investigated and difficulties with the judicial and human service systems. Montheith (2006) in an investigation of PTSD among detectives, found a significant correlation between symptoms of PTSD and depression, a precursor for suicide. Van Patten (2001) found that investigators experienced significantly higher levels of stress compared to non-police persons. Exposure to traumatic stimuli at the crime scene involving the death of a child was the most significant predictor variable of stress for detectives. Miller (2008) comments that unique stressors are experienced by detectives who investigate brutal crimes, multiple murders, serial killings, and crimes against children. He adds that such crimes often exceed the coping abilities of even the most experienced investigator and that fatigue wears down normal psychological defenses, rendering the investigator more vulnerable to stress and failure.
Police Suicide Research Controversy
Police suicide evidence is not without controversy, mostly focusing on the accuracy and validity of police suicide rates. This is likely due to studies that are methodologically flawed, incomplete, or not generalizable to wide geographic areas. Kappeler, Blumberg, and Potter (1993, p. 125) argued that the connection between police stress and suicide is a myth which perpetuates public perception of “battered and blue crime-fighters.” Other researchers have attributed police suicide more to the fact that: (a) the police occupation is male dominated and statistically males commit suicide more often than females, and (b) officers have a readily available, lethal method with which to commit suicide (Alpert & Dunham, 1988).
Marzuk, Nock, Leon, Portera, and Tardiff (2002) conducted a study on New York City police officer suicide. Marzuk et al. concluded that the suicide rates for New York City police officers were below that of the adjusted New York population. Among the 668 deaths of police officers from 1977 to 1996, 80 were certified suicides (mean age = 33.5 years). Firearms were used in 93.8% of these suicides; other methods included hanging, carbon monoxide poisoning, and falling from a height. The overall suicide rate among police officers during the period was 14.9 per 100,000 person-years (95% CI = 11.9–18.6), compared with the demographically adjusted suicide rate for the New York City population (18.3 per 100,000 person-years, 95% CI = 18–18.6). The suicide rate for the upper end of the range, which included the 80 police officer suicides plus 22 additional deaths by methods usually seen in suicides, was 19 per 100,000 person-years (95% CI = 15.5–23.1). Marzuk et al. (2002) added that although the annual suicide rates varied and there were no evident trends, for 17 of the 20 years examined, the police officer suicide rate remained below that of the demographically adjusted rate of the New York City population.
Aamodt and Stalnaker (2001) suggested that, although the suicide rate of 18.1/100,000 for law enforcement personnel is higher than the 11.4/100,000 in the general population, it is not higher than would be expected for people of similar age, race, and gender. Thus, any difference between law enforcement rates and rates in the general population can be adequately explained by the race, gender, and age of people who enter the law enforcement field. This is an important point because it suggests that speculation about such factors as job stress and the availability of weapons are not factors that are exclusively associated with law enforcement suicide. The authors conclude that allocating mental health resources to law enforcement personnel at the expense of other professions does not appear justified. Furthermore, the reasons that officers commit suicide are similar to those of the general population, with the possible exception of legal problems.
Hem, Berg, and Ekeberg (2001) published a systematic critical review of suicide among police. They identified 41 original studies from North America, Europe, and Australia. The results indicated that some studies found elevated suicide rates among police officers; others showed an average or low rate of suicide. However, the rates varied widely and were inconsistent and inconclusive. Most studies were conducted in limited specific police populations, where local and regional variations in suicide can affect the rates of police suicide. Moreover, the reason for studying police suicide in a specific region may be due to a suicide cluster.
Loo (2003) conducted a meta-analysis of police suicide rates and ratios using 101 samples from the literature. Large effect sizes showed that suicide rates based on short time frames were significantly higher than for long time frames. There were regional differences such that rates in the Americas and Europe were higher than in the Caribbean and Asian regions. There were differences in rates between federal, regional, and municipal police forces. Loo concludes that researchers need to include the use of longer time frames when studying police suicide and include controls for year of suicide, gender, ethnic groups, and rates for population comparison groups.
Police Suicide Etiology
Prevention of suicide in this occupation warrants additional research that focuses on societal, psychosocial, and behavioral etiology.
Demographics of Police Suicide Etiology
Policing is a male-dominated occupation, and often research studies reflect this gender disparity. The female officer suicide rate was elevated among New York City officers from 1977 to 1996 (Marzuk et al., 2002). Similarly, a study of the National Occupational Mortality Surveillance (NOMS) dataset from 1984 to 1998 reported that female officers had nearly double (198%) the risk and African American female officers had a 344% increased risk of suicides compared to general U.S. population (Violanti et al., 2013). However, fewer than half (n = 23) of U.S. states participate in these measures, generating the possibility for selection bias. Nonetheless, suicides among female officers aged 26–30 were overrepresented in a German police department (Hartwig & Violanti, 1999). In contrast, a study of the Federal Austrian Police Force found a much lower rate of female officer suicides compared to Austrian women in the general population (Kapusta et al., 2010).
Women as a subgroup suffer more frequently from depression, a mental health correlate of suicide and suicidal ideation (Pratt & Brody, 2014). Studies of female law enforcement officers reflect this general demographic trend (Steyn, 2012). In a medium-sized northeast U.S. police department, the prevalence of depression was higher among female than male personnel (12.5% vs. 6.2%) (Violanti, Fekedulegn, et al., 2009). Moreover, for each standard deviation increase in depressive symptoms, the prevalence ratio of suicide ideation increased by 73% in female personnel, although this trend was also evident in male officers (67%) (Violanti et al., 2009). In another sample, intrusive memories and impairment explained 46% of the variance in suicidal ideation among female officers (Pienaar & Rothmann, 2005). It appears to be a consistent finding that psychosocial symptoms are predictive of suicidal ideation in female officers (Violanti et al., 2008). The often high, yet disparate female officer suicide rates, combined with findings on suicidal ideation in this population, warrants further investigation into suicide ideation, attempts, and completion rates (Violanti, 2010).
Non-white officers are another group for which there is limited information about suicide rates. White police officers comprise the majority of U.S., German, and Nordic police officers, but this is not the case internationally (Burke & Mikkelsen, 2007; Loo, 2001). Additionally, few studies have been completed within majority non-white countries. Moreover, the implications of “minority status” within a region, regardless of race/ethnicity, may confer additional risks or benefits regarding suicidality. As such, one study of proportionate mortality ratios (PMRs) among law enforcement officers in U.S. states found a significantly high suicide PMR for Hispanic male law enforcement officers compared to the Hispanic male working populations (PMR = 244). For the particular subset of Hispanic male detectives/criminal investigators/police officers, the PMR was even greater (PMR = 388) (Violanti, 2010).
A unique series of studies among South African police officers revealed notable findings. A stratified random sample of 1,781 officers in the South African Police Service revealed that officers of black and Indian races were associated with high suicidal ideation (Pienaar & Rothmann, 2005). A sample from the same study (n = 1,794) revealed that officers who experienced high suicidal ideation were less likely to use support coaching, turn to religion, express conscientiousness, or experience emotional stability (Pienaar, Rothmann, & Van deVijver, 2007).
Due to such small numbers, the rates of suicide among “double minorities” such as female Hispanic or African American officers are inconsistent. As stated, African American female officers were found to have a 344% increased risk of suicide compared to the general U.S. population (Violanti, 2010). This could potentially underestimate suicide rates among female African American officers because the suicide rate for this demographic is lower than the U.S. average.
Information about a wide range of non-white officers is absent from the literature. No data were found on Asian police officers, despite the fact that this highly ethnically diverse group is the fastest-growing racial demographic in the United States (Ortman & Guarneri, 2009). Furthermore, data about lesbian, gay, bisexual, and transgender (LGBT) and Native American/Alaskan/Pacific Islander officers warrants investigation, particularly since researchers have found high rates of depression and suicide among these groups (National Institute of Mental Health, 2015; Pratt & Brody, 2014).
Depression associated with work stress and suicide ideation may be a possible precipitant of increased police suicide risk. Violanti et al. (2008) examined the association between depressive symptoms and suicide ideation in a sample of police personnel. Prevalence of depression was higher among female than male personnel (12.5% vs. 6.2%). Another cross-sectional study by Violanti et al. (2009) assessed the association of shift work with suicide ideation among police personnel. Among policewomen with increased depressive symptoms, prevalence of suicide ideation increased by 116% for every 10-unit increase in percentage of hours worked on day shift. Among policemen with more symptoms of post-traumatic stress disorder (PTSD), prevalence of suicide ideation increased by 13% with every 10-unit increase in the percentage of hours worked on afternoon shift.
It is likely that law enforcement personnel experience chronic stress, which has been found to be associated with depression, a major risk factor for suicide (Beck, Steer, & Brown, 1996). Liu and Bai (2014) conducted a meta-analysis and concluded that hopelessness, depression, and family history of suicide were three factors which increased the risk for suicide. Krysinska and Lester (2014), in a meta-analysis of 50 articles, concluded that there is an association between PTSD and suicidality, with several mediating factors, such as concurrent depression and the pre-trauma conditions. In the Denhof and Spinaris (2016) study on depression and PTSD among U.S. corrections personnel, PTSD and stress contributed independently to suicidal behavior. Trauma stress may also contribute to the elevated suicide PMR among female personnel (Spinaris, Denhof, & Kellaway, 2012). Nemoroff et al. (2006), in a review of recent PTSD literature, concluded that PTSD is more frequent among women who tend to have different types of precipitating traumas and higher rates of comorbid panic disorder and agoraphobia than do men.
Alcohol, Suicide, and Law Enforcement
Alcoholism has been found to be the second most common diagnosis among all suicides in the general population (Connor & Duberstein, 2004; Silverman, Berman, Sanddal, O’Carroll, & Joiner, 2007). Schneider et al. (2010), in a community-based cohort study, found an approximate fourfold increased relative risk for completed suicide in subjects who smoked and had risky levels of alcohol consumption. The law enforcement culture, of which corrections is a part, reinforces the use of alcohol (Carlier, Lamberts, & Gersons, 1997, 2000; Violanti, 2004). Menard and Arter (2013) examined stress, PTSD, and alcohol use among an international sample of police personnel and concluded that traumatic incidents, coping, and stressors interacted significantly with drinking.
According to Substance Abuse and Mental Health Services Administration (SAMHSA) data (Larson, Eyerman, Foster, & Gfroerer, 2007), 8.3% of “protective service workers” in the United States reported heavy alcohol use in the past month, ranking this occupational group ninth of 21 occupations. A study by Davey, Obst, and Sheehan (2000) of a large sample of Australian police officers found that 30% of officers scored in the “at risk of harmful consumption” category on the World Health Organization’s Alcohol Use Disorders Identification Test (AUDIT), while 3% scored in the “alcohol dependent” category. Male officers, 18–35 years of age, those divorced or separated, constables, and operational personnel and officers who have served between 4 and 10 years were the groups most likely to fall in these risk categories.
The police network has the same risk factors for alcohol abuse as other “hard-drinking” occupations—stress, peer pressure, isolation, young males, and a culture that approves alcohol use. Officers tend to drink together and reinforce their own values. It is not uncommon, for example, for police officers to gather at a local bar after a work shift to have a “few drinks.” Additionally, the police network is reluctant to report a fellow officer for alcohol-related difficulties. Officers may go to great lengths to protect fellow officers in trouble (Kirschman, 1997).
Davey et al. (2000) correlated alcohol consumption with frequent social interaction among police officers. Obst, Davey, and Sheehan (2001) found police recruits risk of harm from alcohol increased as their training progressed, suggesting that the training process introduces recruits to a culture of alcohol consumption. Beehr, Johnson, and Nieva (1995) also attributed drinking to the influence of the police subculture.
Lindsay and Shelley (2009) examined reasons why police officers drink in a study of 1,328 full-time officers. Officers most at risk for drinking problems admitted that “fitting in” with the group was highest on their list of why they drank. Violanti (1993) found that high stress police academy training caused maladaptive coping strategies among recruits, the use of alcohol being a prominent strategy. Violanti (2004) found that the combined effect of alcohol use and PTSD led to tenfold risk of suicide ideation among police officers.
Hopelessness has been considered a risk factor related to suicidal behavior through a pattern of negative future attributions, inferred consequences of those events, and feelings that the situation cannot be changed (Connor, Duberstein, Conwell, Seidlitz, & Caine, 2001). According to Beck (1967), hopelessness refers to situations where individuals systematically misconstrue their life experiences in a negative way and anticipate dire outcomes for their problems. Ultimately, the person is drawn to the idea of suicide as a way out of insoluble problems (Beck, 1967). In a 10-year prospective follow-up study of patients hospitalized with suicidal ideation, Beck, Steer, Kovacs, and Garrision (1985) reported that hopelessness was predictive of suicide. Beck, Brown, Berchick, Stewart, and Steer (2006) and Wetzel, Margulies, Davis, and Karam (1980) found that hopelessness is more directly related to suicide than depression.
A sense of hopelessness may occur among officers given the negative aspect and perceived futility of their work and work-related stress. For example, officers may work years on one case only to have it dismissed in court on a legal technicality, or feel that their efforts against rising crime are futile (Marmar, McCaslin, Metzler, Best, & Weiss, 2006; Paton, Violanti, & Smith, 2002). Stress and hopelessness have been found to be related (Beck et al., 2006; Dixon, Heppner, Burnett, & Lips, 1993) and police work is an occupation replete with stress (Davey, Obst, & Sheehan, 2001; Pasillas, Follette, & Perumean-Chaney, 2013; Spielberger, Westberry, Grier, & Greenfield, 1981; Zhao, He, & Lovrich, 2002). Police officers commonly experience unexpected and uncontrollable stressful occurrences and such stress can increase the risk for hopelessness. Faced with responding to fatal accidents, crime, child abuse, homicide, suicide, and rape, police officers are exposed to potential factors that precipitate a detrimental psychological effect (Carlier et al., 1997). There is also frequent exposure to death and the threat of death (Sugimoto & Oltjenbruns, 2001).
To date, there are no prospective studies which find an association between police suicide and childhood abuse or neglect. However, in a recent personal communication with a police mental health professional (S. Samuels, personal communication, December 10, 2017) it was estimated that 25% of all police clients had a history of childhood abuse or neglect. Many of those police clients also expressed suicidal ideation. The history of childhood abuse prior to entering law enforcement is a promising area of future suicide research.
Previous research suggests an association between child abuse or neglect and suicidal behavior. Felitti et al. (1998) found a strong graded relationship between the amount of childhood abuse and several leading causes of death including suicide. Fuller-Thomson, Baker, and Brennenstuhl, (2012) reported that childhood physical abuse was significantly and independently associated with suicidal ideation. Dube et al. (2001) found a powerful graded relationship between adverse childhood experiences and the risk of attempts at suicide throughout life. This relationship was mediated by maladaptive behaviors such as alcoholism, depressed affect, and illegal drug use (Dube et al., 2001). Brezo et al. (2008) found prospective evidence that childhood abuse was related to suicidal ideation in adulthood. Enns et al. (2006), in a large community study mental health survey, found that childhood abuse and adversities are strongly associated with future suicidal behavior.
The Police Culture and Stigma
Likely the biggest problem in police suicide prevention is the hesitancy of officers to seek professional mental health help. The police culture does not allow for weakness in any form, including psychological difficulties. Officers are socialized into a state of invulnerability and feel that they must always be impervious to any problems such as depression. Additionally there is a strong stigma attached to mental health problems. Stigma is one of the most frequently identified barriers to mental health care and is prevalent among first responders such as the police. For example, Jayasinghe et al. (2005) found that slightly less than half of World Trade Center workers accepted referrals for mental health treatment after the 9/11 disaster. Officers may feel that if they admit mental health problems and go for help they will be less trusted by peers and supervisors to do their job and may lose opportunities for promotions. There is a need for more education for police concerning mental health and effective treatment.
One possible solution is a peer support program. This will allow distressed officers to initially talk with other officers first and then possibly seek professional help. An assumption underlying peer support is that police peers trained in basic listening techniques are more trusted by officers in distress (Landers & Zhou, 2011). Peer supporters draw on their shared experiences in order to provide empathic understanding, information, and advice. Davidson et al. (1999) reported that peer support reduced symptoms for participants and increased their social integration; an important factor in suicide prevention.
The Psychological Autopsy: Tracing the Retrospective Pathway to Suicide
The major objective of a psychological autopsy (PA) is to establish whether specific variables constitute risk factors for suicide among police officers. The PA is well established as the means for obtaining comprehensive retrospective information about victims of completed suicide (Beskow, Runeson, & Asgard, 1990; Robins, Murphy, Wilkinson, Gassner, & Kayes, 1959).
The PA has been found to be an important method for establishing and examining suicide risk factors among police. Regarding the method’s reliability and validity, Brent (1989) demonstrated that neither the presence or severity of the informants affective symptomatology nor the length of time between the date of death and date of interview influenced their report of suicide intent, number of psychiatric diagnoses, or diagnoses of affective, conduct, anxiety, or substance abuse disorders. Another study, Brent et al. (1988), showed that the psychiatric disorders reported in suicides also tended to aggregate in their families. This finding was interpreted as a strong argument that the diagnostic data obtained by the PA procedure are valid. Perhaps the best indicator of the reliability and validity of the method could be inferred from the consistency of findings across PA studies (Brent, Perper, Kolko, & Zelenak, 1988).
Thus far, our knowledge about police suicide has been derived primarily from retrospective mortality studies, and very little work has been done on suicide risk factors. Consequently, there exists a pressing need for a controlled, multidimensional PA study of police officers. The information gained from such a study will allow opportunities for the study of more effective and focused strategies for the prevention of police suicide. Psychological autopsies may be an important research tool in determining police suicide precedents. The issues of stress, post-traumatic stress disorder (PTSD), alcohol use, depression, and relationship problems must be further explored. This research design will allow us to examine risk factors reportedly associated with police suicide. Most previous studies on police suicide provide evidence of high risk, but fall short in explaining precipitant individual and social factors involved in police suicide. This lack of information impedes efforts at suicide prevention among the police, other similar occupations, and specific age groups. In future work, we must employ a valid design. The “PA” is well established as the means for obtaining comprehensive retrospective information about victims of completed suicide.
A more recent intervention which may be useful in police work is mindfulness. Mindfulness can be used by officers to manage stress and increase cognitive flexibility in dealing with trauma and crises (Kabat-Zinn, 2003), and it has been found to reduce mental difficulties often seen in suicidal persons. Chesin et al. (2016), in a review of mindfulness studies, reported that many studies show an improvement in suicidal persons with regard to attentional control, problem solving, and altered stress responses. In a longitudinal study on police officers, Williams, Ciarrochi, and Deane (2010) found that mindfulness predicted increased emotion identification skill and general mental health among officers. Christopher et al. (2016) applied a mindfulness-based intervention among police officers and found improvement in several areas, including reduced stress and increased resilience.
An Alternative Prevention Strategy: Suicide Implicit Association Testing (IAT)
Hesitancy of this high risk population to seek help makes it essential to detect suicide ideation on a different level than self-reports. We conducted a study to explore the potential for a new strategy, the suicide Implicit Association Test (IAT), to detect suicidal tendencies in police officers (Violanti et al., 2013). The test is taken on a computer where the officer quickly reacts to a series of pairing of words associated with life or death. The IAT measures subconscious levels of identification with life or death. An implicit below-conscious-level association with death may represent one of the final steps in the pathway to suicide that is activated when a police officer is deciding how to respond to extreme or chronic distress. Nock (2010) found implicit association of death/suicide with self was associated with an approximate sixfold increase in the odds of making a suicide attempt in the next six months, exceeding the predictive validity of known risk factors (e.g., depression). In the occupation of policing, where officers are hesitant to seek help due to cultural stigma among peers and job consequences, detecting suicide is difficult. In addition, officers may believe that reporting mental health problems or suicidal thoughts will affect their careers in areas of promotion and assignments (Violanti, 2007).
Results from the IAT suggested that officers had differing levels of identification with life: slight (18.5%), moderate (32.3%), and strong (29.2%). Fourteen percent were neutral in their identification with life, and 6% identified with death. Self-reported questionnaires on suicide ideation, depression, and PTSD did not significantly correlate with the IAT scores, which suggests that cognitions below the conscious level as detecting by the IAT may be of some value in detecting thoughts of suicide. More research is needed to help clarify the operational usefulness of IAT methods and their validity over time.
Law Enforcement Policy: The International Association of Chiefs of Police (IACP) Suicide Prevention Initiative
The police organization can help to reduce suicide by fostering resilience against the deleterious effects of stress among officers. Resilience is a concept that encapsulates the idea of overcoming and adapting to negative experiences (Southwick, Bonanno, Masten, Panter-Brick, & Yehuda, 2014). Self-esteem, coping skills, hardiness, and social support are positively associated with resilience. The salutogenic effects of resilience and organizational integration suggests that the organization, by its support, can reduce potential suicidal behavior. The police organization can increase social resilience among officers and change the pathway to maladaptive coping such as suicide. Coping style and social cohesion fostered by the organization acts to reduce stressors that individuals cannot reduce by themselves (Sledge, Boydstun, & Rahe, 1980).
To address the law enforcement suicide and police organizational issues, the IACP, with assistance from the U.S. Department of Justice’s Office of Community Oriented Policing Services, hosted “Breaking the Silence: A National Symposium on Law Enforcement Officer Suicide and Mental Health” (Steckler, 2013). Participants at the symposium worked together to develop a national strategy to address suicide prevention, built on the following four cornerstones: (a) culture change, (b) early warning and prevention protocols, (c) training, and, (d) event response protocols. Several areas of prevention-oriented action were suggested:
• Start at the top by recruiting leaders who care about the mental wellness of their officers, and who unequivocally endorse physical and mental wellness parity as critical to a resilient and healthy police force.
• Recruit and hire resilient officers who have demonstrated a commitment to public service and proven stress management skills.
• Establish and institutionalize effective early warning and intervention protocols to identify and treat at-risk officers, for example, by launching awareness campaigns on what to look for and who to call when officers may be in a mental health crisis or suffering from clinical anxiety or chronic depression.
• Audit your existing psychological services and determine whether they are effective in identifying early warning signs of mental wellness issues, including mental illness and suicidal behavior, and in treating at-risk officers.
• Invest in training agency-wide on mental health awareness and stress management.
• Begin mental wellness training at the academy, and continue the training throughout officer careers, with a particular emphasis on first-line supervisors.
• Include family training to reinforce and invest in those critical family connections.
• Establish clear post-event protocols to implement and follow when officers die by suicide.
These proactive goals will involve policy changes in police organizations and an acceptance that suicide is a tragic and real problem in this occupation. At present, this may not be the case in some organizations. Additional exploration and interventions will help researchers and practitioners to reduce the tragedy of suicide in this difficult occupation. The chief obstacles to effective stress management programs include recognition of the need for stress services, the lack of empirical evidence indicating their benefits or effectiveness (for personnel and the agency), and the lack of funding to support such programs (Brower, 2013).
Witnessing death, human misery, encountering abused children, and encountering violence at work weigh heavily as precipitants to depression, alcohol use, and suicide among police (Violanti & O’Hara, 2012). Such exposure in policing may have profound impacts on officers. It will likely take long-term prospective studies to make sense of suicide in this profession; an extremely difficult task when studying suicide. While we cannot yet be certain that police work in and by itself is a suicide risk factor, we can with some assurance state that it serves as a fertile arena for suicide precipitants, including relationship problems, culturally approved alcohol use and maladaptive coping, firearms availability, and exposure to psychologically adverse incidents. Contextually, police work is likely a probable part of the causal chain of suicide. We may be better informed for preventive actions if we know the inherent risk of police suicide in a quantitative, qualitative, and contextual sense.
Until we can obtain additional credible and accurate information on police suicide obtained and verified by police departments across the United States, we must continue to estimate the true scope of this problem. The stigma attached to suicide and the reluctance to report such police deaths unfortunately leaves us in a position of “best guess” based on what reliable and valid evidence we can collect. Looking to the future, the development of a national database developed by law enforcement agencies specifically focused on police suicide would help to establish the actual scope of this tragic loss of life.
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