Head Injuries Among Law Enforcement Linked to Depression, PTSD

Jaclyn Caccese, PhD

Credit: The Ohio State University, School of Health and Rehabilitation Sciences

Law enforcement officers have a high prevalence of head injuries, which in turn increases their likelihood of developing PTSD and depressive symptoms, a new study found.¹ The research revealed approximately 30% of officers get a head injury on the job.

Officers risk head trauma while restraining non-compliant offenders, terminating traffic pursuits, and facing blast exposures such as firing high caliber weapons, explosive breaching, and using stun grenades. Job stress and poor sleep from shift work also worsen outcomes following a head injury. Despite nearly 1 in 3 police officers sustaining head injuries while working, this population is often overlooked for concussion monitoring

“This is an area where we have to improve awareness, just like we did in the sport concussion world,” said lead investigators Jaclyn Caccese, PhD, assistant professor at The Ohio State University Wexner Medical Center, in a press release.²

Many officers' head injuries go unreported, which may be due to the financial burden. Seeking care for just a mild concussion costs an average of $13,654, according to the OptumHealth Care Solutions Claims database.²

Investigators sought to determine the prevalence of head injuries, PTSD, and depressive symptoms among law enforcement officers and to assess the association between head injuries and psychological health conditions.

“The goal is really to improve officer safety and health in the long term,” Caccese said.² “…although treating these injuries is difficult in the moment, it leads to a longer career, better health outcomes and better quality of life.”

The team conducted a cross-sectional study with a county-level survey administered via REDCap.¹ A total of 381 officers (mean age: 43±11 years; 40% female) completed the survey. Most participants (74%) reported a lifetime history of ≥ 1 head injury, and 30% received ≥ 1 head injury on the job. Participants had been law enforcement officers for 1 – 50 years, with a median of 15 years.

Investigators examined the prevalence of head injuries using the Ohio State University TBI, PTSD with the PTSD Checklist-Civilian, and depression symptoms with the Patient Health Questionnaire- 9 (PHQ-9). They analyzed the data using Mann-Whitney U and chi-square to compare PTSD and depressive symptoms between officers with and without a head injury history.

PTSD Checklist-Civilian scores ranged from 17 – 85, with a median score of 27. Among the respondents, 10% met or exceeded the clinical cut-off score of 50, indicating a positive PTSD screening.

Participants with a head injury history (n = 29) had greater PTSD Checklist-Civilian scores than those without a head injury history (n = 24; P < .001). However, the proportion of participants meeting the clinical cutoff for PTSD was not significantly different between those with (11%) and without (5%) head injury history (odds ratio [OR], 2.181; 95% confidence interval [CI], 0.816 - 5.827); P = .112).

PHQ-9 scores ranged from 0 – 20 with a median score of 3. More than one-third (36%) of participants reported mild or greater depressive symptoms. Participants with a head injury history (n = 3) had greater depressive symptoms than those without a head injury history (n = 2) (P = .012). Moreover, participants with a head injury history (33%) have approximately 1.17 times greater odds of experiencing mild or severe depressive symptoms compared to those without a head injury history (27%) (OR, 1.1737; 95% CI, 1.030 – 2.932).

Caccesse noted it is challenging for officers to avoid head injuries since they must complete their tasks to ensure a safe environment.² Also, adrenaline can sometimes mask concussion symptoms. Caccesse compared what needs to be done to athletes who are removed from play and rehabilitated before returning.

“We’re trying to get that information translated to the occupational context,” Caccesse said.

Josh Walters, co-author and a deputy in the Franklin County, Ohio, Sheriff’s Office, leads a peer support team for deputies. Walters emphasized in the press release the importance of officers staying physically fit and proposed testing a return-to-duty protocol. This protocol would involve a gradual increase in activity and medical screening before officers return to full duty.

“Now we have some data that we can present to administrations, to unions, to leadership that says, ‘Here’s the problem. This is how we can fix it. Let’s start working that process,’” Walters said.

References

1. ^{Caccese, J, Smith, C, Edwards, N, et al. Silent Struggles: Traumatic Brain Injuries and Mental Health in Law Enforcement. Journal of Head and Trauma Rehabilitation. 2024.}
2. ^{In law enforcement, a link between head injuries and depression, PTSD. EurekAlert! August 5, 2024. https://www.eurekalert.org/news-releases/1053368. Accessed August 6, 2024.}