How common are alcohol problems in the UK Police Service and what is the level of comorbidity with mental health problems?
Lead Research Organisation:
University of Liverpool
Department Name: Institute of Psychology Health & Society
Abstract
Background: There is a dearth of research on alcohol use and associated risk factors, in the UK Police Service. Australian data suggests that 35% of police met the criteria for increased risk and high-risk alcohol use (defined as AUDIT scores above 8 and 16, respectively). High-risk alcohol use is more common in the UK Armed Forces than the general population and we may expect a similar pattern in police, due to occupational similarities, such as frequent exposure to trauma, shift-work and the male-dominated culture.
Aims: This PhD research aims (i) to identify the prevalence of high-risk alcohol use (defined using the UK chief medical officer's guidelines) within a representative sample of the UK Police Service and the co-occurrence with mental health problems; (ii) to compare alcohol use in the UK Police Service to the UK Armed Forces; (iii) to examine whether mental health and occupational stress predict future use of alcohol and (iiii) to qualitatively explore social theories relating to the drivers of high-risk alcohol use in the UK Police Service and its social consequences.
Methods: To review the existing literature, a systematic review and meta-analysis will be conducted, to determine the prevalence of increased-risk and high-risk alcohol use across occupations with an increased risk of trauma exposure, i.e., first responders, health care workers, armed forces personnel, train drivers and journalists.
For the first aim, we will use The Airwave Health Monitoring Study which recruited police from all police forces in England, Scotland and Wales which used Airwave, a Terrestrial Trunked Radio (TETRA). Data was collected from 40,986 police personnel between 2004 and 2012. The study included the following measures: age, sex, marital status, ethnicity, educational attainment, years in the police service, salary, rank, children under 18 and smoking status. Assessment of mental health included self-reports of depression, anxiety and post-traumatic stress disorder (PTSD), in addition to occupational stress. Alcohol use was measured using a past weekly drinks diary, using the UK chief medical officer's guidelines to determine increased-risk and high-risk alcohol use. Prevalence estimates with 95% confidence intervals for high-risk alcohol use will be reported. The associations between demographic variables, mental health and occupational stress, with alcohol use as the outcome, will be determined through regression analyses.
For the second aim, we will combine the Airwave Health Monitoring Study and the King's Centre for Military Health Research cohort study. The datasets will be matched on year of data collection, age and educational attainment, using entropy balancing. We will use logistic regression analyses to determine differences in alcohol use.
For the third aim, we will use follow up data from the Airwave Health Monitoring Study from approximately 9000 police personnel. The follow up data was collected from 2015 onwards, using the same measures as the first wave. Structural equation modelling will be used to determine the associations between alcohol use at wave 2, with occupational stress and mental health at wave 1.
For the final aim, we will conduct semi-structured telephone interviews with police officers who meet the criteria for high-risk alcohol use, to explore the drivers and consequences of high-risk alcohol use. The qualitative data will be transcribed using NVivo and analysed with thematic analysis.
Implications: The present research project will provide much needed representative data on the prevalence of high-risk alcohol use in the UK Police Service, advancing academic research on mental health and risk-taking behaviours in an occupational groups commonly exposed to trauma, such as those identified in the systematic review. The findings of this research could be used to inform the development of tailored interventions for alcohol problems in UK police.
Aims: This PhD research aims (i) to identify the prevalence of high-risk alcohol use (defined using the UK chief medical officer's guidelines) within a representative sample of the UK Police Service and the co-occurrence with mental health problems; (ii) to compare alcohol use in the UK Police Service to the UK Armed Forces; (iii) to examine whether mental health and occupational stress predict future use of alcohol and (iiii) to qualitatively explore social theories relating to the drivers of high-risk alcohol use in the UK Police Service and its social consequences.
Methods: To review the existing literature, a systematic review and meta-analysis will be conducted, to determine the prevalence of increased-risk and high-risk alcohol use across occupations with an increased risk of trauma exposure, i.e., first responders, health care workers, armed forces personnel, train drivers and journalists.
For the first aim, we will use The Airwave Health Monitoring Study which recruited police from all police forces in England, Scotland and Wales which used Airwave, a Terrestrial Trunked Radio (TETRA). Data was collected from 40,986 police personnel between 2004 and 2012. The study included the following measures: age, sex, marital status, ethnicity, educational attainment, years in the police service, salary, rank, children under 18 and smoking status. Assessment of mental health included self-reports of depression, anxiety and post-traumatic stress disorder (PTSD), in addition to occupational stress. Alcohol use was measured using a past weekly drinks diary, using the UK chief medical officer's guidelines to determine increased-risk and high-risk alcohol use. Prevalence estimates with 95% confidence intervals for high-risk alcohol use will be reported. The associations between demographic variables, mental health and occupational stress, with alcohol use as the outcome, will be determined through regression analyses.
For the second aim, we will combine the Airwave Health Monitoring Study and the King's Centre for Military Health Research cohort study. The datasets will be matched on year of data collection, age and educational attainment, using entropy balancing. We will use logistic regression analyses to determine differences in alcohol use.
For the third aim, we will use follow up data from the Airwave Health Monitoring Study from approximately 9000 police personnel. The follow up data was collected from 2015 onwards, using the same measures as the first wave. Structural equation modelling will be used to determine the associations between alcohol use at wave 2, with occupational stress and mental health at wave 1.
For the final aim, we will conduct semi-structured telephone interviews with police officers who meet the criteria for high-risk alcohol use, to explore the drivers and consequences of high-risk alcohol use. The qualitative data will be transcribed using NVivo and analysed with thematic analysis.
Implications: The present research project will provide much needed representative data on the prevalence of high-risk alcohol use in the UK Police Service, advancing academic research on mental health and risk-taking behaviours in an occupational groups commonly exposed to trauma, such as those identified in the systematic review. The findings of this research could be used to inform the development of tailored interventions for alcohol problems in UK police.
Studentship Projects
| Project Reference | Relationship | Related To | Start | End | Student Name |
|---|---|---|---|---|---|
| ES/P000665/1 | 01/10/2017 | 30/09/2027 | |||
| 1949414 | Studentship | ES/P000665/1 | 01/10/2017 | 30/09/2021 | Patricia Irizar |
| Description | Policing can be a stressful occupation, characterised by operational stressors and organisational stressors, both of which have known associations with poor mental health. There is strong evidence indicating a relationship between poor mental health and alcohol problems, with emerging evidence also showing a link with abstinence from drinking. Due to the nature of their work, UK police employees may be using alcohol to cope with stress or trauma. I aimed to understand the level of alcohol problems in the UK Police Service and examine the relationship with poor mental health and job strain. I took a multi-method approach. First, a systematic review and meta-analysis was conducted, to collate the evidence on the prevalence of hazardous and harmful alcohol use in trauma-exposed occupations. Next, representative data from 40,000 UK serving police employees was analysed, to determine the prevalence of hazardous and harmful alcohol use (and abstinence), and their co-occurrence with poor mental health and job strain. Then, the level of harmful alcohol use and poor mental health was compared in police employees and military personnel, analysing men and women in separate studies. Given that harmful drinking often co-occurs with other harmful behaviours, this thesis examined the classes of health (risk) behaviours, and their associations with mental health and job strain. Finally, qualitative interviews were used to gain a deeper understanding of police employees experiences of hazardous/harmful drinking or abstinence. The quantitative and qualitative findings were integrated through triangulation. The meta-analysis identified gaps in the literature, with only two UK studies and no UK studies of police employees. Of the 40,000 UK police employees, 33% met criteria for hazardous drinking and 3% for harmful drinking. Those with poor mental health were more likely to drink harmfully and abstain (versus low-risk). High strain (versus low) was associated with reduced odds of hazardous drinking (though this was moderated by mental health). There were comparable levels of probable PTSD but higher levels of harmful drinking in military personnel compared to police employees (for both men and women). Police employees with poor mental health had double the odds of engaging in multiple health risk behaviours. The interviews developed an understanding of the motivations for drinking and abstaining, and the organisational culture of drinking. The evidence indicated a J-shaped relationship, whereby poor mental health was linked with both abstinence and harmful drinking, in the UK Police Service. Critically, those with poor mental health were also more likely to engage in multiple health risk behaviours and may be at risk of harm. The triangulated findings have important theoretical implications, contributing to the self-medication hypothesis and sick quitter hypothesis, and practical implications, highlighting the need for accessible support for alcohol problems within the Police Service. |
| Exploitation Route | For the UK Police Service: 1. Employees should be supported in seeking help to treat alcohol problems, which includes the provision of readily available support. 2. Managers must be provided with information on how to identify the signs of alcohol problems and be aware of how to signpost those needing support. For example, managers must know whether an individual needs signposting to internal occupational health services, external health care services, or specialised treatment services. 3. All employees should have access to alcohol awareness training. 4. Occupational health services within police forces should routinely screen for comorbid mental health and alcohol problems. If a police employee presents to occupational health services with one problem, they should be screened for the presence of the other problem, and then provided with appropriate pathways of support. 5. Police forces should provide resources to employees, which outline the harms of using alcohol to cope, as drinking to cope is associated with harmful drinking behaviours alcohol-related harms. These resources could also provide examples of healthier coping strategies, which could be used for individual coping or group coping Raising awareness on the risks associated with using alcohol to cope may increase help-seeking by removing the assumption that alcohol use is only problematic if extreme. For health care providers: 1. The present findings further support the need for integrated mental health and alcohol support within health care services, such as in primary care (e.g., GP services) or emergency services (e.g., when presenting in A&E with either a mental health or alcohol problem). 2. Police employees, and potentially other high-risk occupations (e.g., other first responders), may need more regular screening for both mental health and alcohol problems, either within health care or occupational health settings. For example, once a practitioner is aware that an individual works in a high-risk occupation, they could administer brief screening tests. 3. It is important to address co-occurring health risk behaviours, as this increases the risk of premature death. Within the general population, services have previously been set up to target individual behaviours, but a more holistic approach is needed, to develop interventions which address multiple health risk behaviours. For policy makers: 1. The detrimental impact of the 2010 budget cuts has led to increased demands, single crewing, cancelled annual leave, and regularly working overtime. There is a need for increased government funding for the UK Police Service, to reduce the demands placed on employees and to ensure they can work safely. With increased funding and additional officers, the UK Police Service must work towards the removal of single crewing, which is linked to physical harm and possible mental health harm, as there are no opportunities for peer risk assessments following a traumatic incident. 2. The government have proposed an additional £415 million to police funding, to recruit an additional 20,000 officers. However, there must be additional funding specifically for occupational health services within the UK Police Service, to ensure they can provide adequate support for employees. 3. Policy makers must ensure that all occupational settings incorporate clearer alcohol workplace policies, that clarify rules and expectations of employees with regards to alcohol consumption at work. Evidence suggests that these policies can contribute to reducing employee excessive consumption, yet up to 40% of workplaces do not have these policies in place. 4. Policy makers should consider encouraging widespread alcohol awareness training amongst first responders and health care workers (similar to existing mental health first aid training), including how to conduct risk assessments and provide brief alcohol interventions to individuals who come into contact with emergency services. |
| Sectors | Communities and Social Services/Policy,Healthcare,Other |
| Description | I have written an article for the Medical Council on Alcohol, regarding the relationship between trauma exposure and alcohol consumption, to be shared with medical students. I have also written a report for the N8 Policing Research Partnership (N8 PRP) regarding the relationship between alcohol consumption and mental health in police employees and why it is important to examine this link. These articles have been shared with lay people and employees within occupations which have an increased risk of comorbid mental health and alcohol problems. It is hoped that these articles will raise awareness of such issues and decrease the stigma surrounding alcohol problems, as this is the first step in increasing the availability of support. After publishing studies related to this award, I wrote lay summaries of the findings in the form of blogs and news articles, which were disseminated widely through social media, reaching representatives from the UK Police Federation. I have shared my findings with Oscar Kilo, the national police wellbeing charity, who have since created a Blue Light Wellbeing Framework, which includes recommendations on how to support police employees who have an alcohol problem. |
| First Year Of Impact | 2021 |
| Sector | Education,Healthcare,Other |
| Impact Types | Policy & public services |
| Description | A feasibility study of the Blue Light project in Liverpool: working with the Police Service and Homeless services to reduce alcohol harms |
| Amount | £22,146 (GBP) |
| Organisation | University of Liverpool |
| Sector | Academic/University |
| Country | United Kingdom |
| Start | 03/2022 |
| End | 09/2022 |
| Description | Comparison studies - King's College London |
| Organisation | King's College London |
| Country | United Kingdom |
| Sector | Academic/University |
| PI Contribution | I have worked alongside researchers at King's College London, through an honorary contract, to collaborate on two publications which have compared the level of harmful alcohol use and probable PTSD in military personnel and police employees. I have contributed by analysing the data and co-writing the manuscripts. |
| Collaborator Contribution | The researchers at King's College London have contributed by providing access to two datasets - the Airwave Health Monitoring Study and the Health and Wellbeing of the UK Armed Forces cohort study. The research team have also contributed by analysing the data and co-writing the manuscripts. |
| Impact | One manuscript has received a revise and resubmit decision and will hopefully soon be published in an academic journal. |
| Start Year | 2019 |
| Description | Article for Medical Council on Alcohol |
| Form Of Engagement Activity | A magazine, newsletter or online publication |
| Part Of Official Scheme? | No |
| Geographic Reach | National |
| Primary Audience | Professional Practitioners |
| Results and Impact | I wrote an article about the relationship between trauma exposure and alcohol consumption, and how certain occupations are at an increased risk of using alcohol to cope because of such high levels of trauma exposure. |
| Year(s) Of Engagement Activity | 2020 |
| URL | https://www.m-c-a.org.uk/education/Publications |
| Description | Blog for Alcohol Charity - 4-Alpha |
| Form Of Engagement Activity | Engagement focused website, blog or social media channel |
| Part Of Official Scheme? | No |
| Geographic Reach | Regional |
| Primary Audience | Other audiences |
| Results and Impact | I wrote a blog about my recent research on drinking motivations in UK military personnel for an alcohol support group for military personnel. This has led to further interest in my research, with the BBC news contacting our research team for more information. This research has also been written about in a magazine called Soldier. |
| Year(s) Of Engagement Activity | 2020 |
| URL | https://www.4-alpha.co.uk/blog/new-research-irizar |
| Description | Guest talk at Bath University |
| Form Of Engagement Activity | A talk or presentation |
| Part Of Official Scheme? | No |
| Geographic Reach | Regional |
| Primary Audience | Postgraduate students |
| Results and Impact | I gave a talk on the findings from some of the studies which have been conducted as a result of this award. |
| Year(s) Of Engagement Activity | 2021 |
| Description | N8 Policing Research Partnership |
| Form Of Engagement Activity | A magazine, newsletter or online publication |
| Part Of Official Scheme? | No |
| Geographic Reach | National |
| Primary Audience | Other audiences |
| Results and Impact | I wrote an article for the N8 Policing Research Partnership annual newsletter 2020, regarding the importance of understanding the relationship between mental health problems and alcohol consumption in UK police employees. |
| Year(s) Of Engagement Activity | 2020 |
| URL | https://n8prp.org.uk/wp-content/uploads/2020/08/12455_N8_Policing_Report_2020_WEB-1.pdf |
| Description | Poster Presentation - Emergency Responders Conference |
| Form Of Engagement Activity | A talk or presentation |
| Part Of Official Scheme? | No |
| Geographic Reach | Regional |
| Primary Audience | Policymakers/politicians |
| Results and Impact | I presented my meta-analysis at the Emergency Responders Conference in London, organised by King's College London. This led to much discussion and potential help with recruited participants for future research. |
| Year(s) Of Engagement Activity | 2020 |
| Description | Poster Presentation SSA conference |
| Form Of Engagement Activity | A talk or presentation |
| Part Of Official Scheme? | No |
| Geographic Reach | Regional |
| Primary Audience | Postgraduate students |
| Results and Impact | I presented the findings of my systematic review and meta-analysis at the Society for the Study of Addiction Conference in November. This led to questions and discussion, with some other academics emailing me about my research. |
| Year(s) Of Engagement Activity | 2019 |
| Description | University of Liverpool Addiction Research Blog |
| Form Of Engagement Activity | Engagement focused website, blog or social media channel |
| Part Of Official Scheme? | No |
| Geographic Reach | Regional |
| Primary Audience | Postgraduate students |
| Results and Impact | I am the editor of the University of Liverpool Addiction Research Blog. I frequently write blogs about my research or other topics relevant to addiction research. |
| Year(s) Of Engagement Activity | 2018,2019,2020 |
| URL | https://liverpooladdiction.wordpress.com/ |