Abstract
Purpose
Several studies suggest that work-related stress in police officers may be associated with an increased risk of cardiovascular diseases. A systematic review of studies is, however, still lacking.
Method
According to PRISMA statement, a systematic search of PubMed, ISI Web of Science, Cinahl and PsychInfo electronic databases was undertaken. Studies published in English between 1/1/2000 and 31/12/2016 were included. A studies quality assessment was performed using the Newcastle Ottawa scale (NOS).
Results
The preliminary search retrieved 752 records. After selection, 16 studies (total population 17,698) were retrieved. The average quality of studies was low. Exposure to stress in cross-sectional studies was inconstantly associated with hypertension, obesity, dyslipidaemia, and impaired glucose metabolism. In addition, there was a prevalence of positive studies showing an association between stress and cardiovascular disease morbidity. Studies of higher quality, such as longitudinal studies on large sample size, were more supportive of a significant positive association between stress and cardiovascular risk factors. Results were, however, often conflicting and inconsistent with regard to definitions and measurement of stress, features of individual study design, study conduct, and conclusions drawn.
Conclusions
A sound precautionary principle would be to adopt worksite health promotion programs designed to implement stress management strategies in this category of workers.
Similar content being viewed by others
References
Arial M, Gonik V, Wild P, Danuser B (2010) Association of work related chronic stressors and psychiatric symptoms in a Swiss sample of police officers; a cross sectional questionnaire study. Int Arch Occup Environ Health 83:323–331
Arnetz BB, Arble E, Backman L, Lynch A, Lublin A (2013) Assessment of a prevention program for work-related stress among urban police officers. Int Arch Occup Environ Health 86(1):79–88. https://doi.org/10.1007/s00420-012-0748-6
Babu GR, Jotheeswaran AT, Mahapatra T, Mahapatra S, Kumar A Sr, Detels R, Pearce N (2014) Is hypertension associated with job strain? A meta-analysis of observational studies. Occup Environ Med 71(3):220–227. https://doi.org/10.1136/oemed-2013-101396
Bellisarii FL, Gallina S, De Caterina R (2001) Tumor necrosis factor-alpha and cardiovascular diseases. Ital Heart J 2(6):408–417
Bergmann N, Gyntelberg F, Faber J (2014) The appraisal of chronic stress and the development of the metabolic syndrome: a systematic review of prospective cohort studies. Endocr Connect 3(2):R55–R80. https://doi.org/10.1530/EC-14-0031
Bowler RM, Kornblith ES, Li J, Adams SW, Gocheva VV, Schwarzer R, Cone JE. (2016) Police officers who responded to 9/11: Comorbidity of PTSD, depression, and anxiety 10–11 years later. Am J Ind Med. 59(6):425–436. https://doi.org/10.1002/ajim.22588
Chandola T, Britton A, Brunner E, Hemingway H, Malik M, Kumari M, Badrick E, Kivimaki M, Marmot M (2008) Work stress and coronary heart disease: what are the mechanisms? Eur Heart J 29(5):640–648. https://doi.org/10.1093/eurheartj/ehm584
Chen X, Leng L, Yu H, Yang XL, Dong GH, Yue S, Chen JS, Tang NJ (2015) Psychological distress and dyslipidemia in chinese police officers: a 4-year follow-up study in Tianjin, China. J Occup Environ Med 57(4):400–405. https://doi.org/10.1097/JOM.0000000000000372
Chiorri C, Garbarino S, Bracco F, Magnavita N (2015) Personality traits moderate the effect of workload sources on perceived workload in flying column police officers. Front Psychol 6:1835. https://doi.org/10.3389/fpsyg.2015.01835
Collins PA, Gibbs AC (2003) Stress in police officers: a study of the origins, prevalence and severity of stress-related symptoms within a county police force. Occup Med (Lond) 53(4):256–264
Cuffee Y, Ogedegbe C, Williams NJ, Ogedegbe G, Schoenthaler A (2014) Psychosocial risk factors for hypertension: an update of the literature. Curr Hypertens Rep 16(10):483. https://doi.org/10.1007/s11906-014-0483-3
Dragano N, Siegrist J, Nyberg ST, Lunau T, Fransson EI, Alfredsson L, Bjorner JB, Borritz M, Burr H, Erbel R, Fahlén G, Goldberg M, Hamer M, Heikkilä K, Jöckel KH, Knutsson A, Madsen IE, Nielsen ML, Nordin M, Oksanen T, Pejtersen JH, Pentti J, Rugulies R, Salo P, Schupp J, Singh-Manoux A, Steptoe A, Theorell T, Vahtera J, Westerholm PJ, Westerlund H, Virtanen M, Zins M, Batty GD, Kivimäki M (2017) IPD-Work consortium. Effort-reward imbalance at work and incident coronary heart disease: a multi-cohort study of 90,164 individuals. Epidemiology. https://doi.org/10.1097/EDE.0000000000000666
Fishta A, Backé EM (2015) Psychosocial stress at work and cardiovascular diseases: an overview of systematic reviews. Int Arch Occup Environ Health 88(8):997–1014. https://doi.org/10.1007/s00420-015-1019-0
Franke WD, Ramey SL, Shelley MC 2nd (2002) Relationship between cardiovascular disease morbidity, risk factors, and stress in a law enforcement cohort. J Occup Environ Med 44(12):1182–1189
Franke WD, Kohut ML, Russell DW, Yoo HL, Ekkekakis P, Ramey SP (2010) Is job-related stress the link between cardiovascular disease and the law enforcement profession? J Occup Environ Med 52(5):561–565. https://doi.org/10.1097/JOM.0b013e3181dd086b
Ganesh KS, Naresh AG, Bammigatti C (2014) Prevalence and risk factors of hypertension among male police personnel in Urban Puducherry, India. Kathmandu Univ Med J (KUMJ) 12(48):242–246
Garbarino S (2014) 24-hour work: the interaction of stress and changes in the sleep-wake cycle in the police force. G Ital Med Lav Ergon 36(4):392–396
Garbarino S, Magnavita N (2015) Work stress and metabolic syndrome in police officers. a prospective study. PLoS One 10(12):e0144318. https://doi.org/10.1371/journal.pone.0144318
Garbarino S, Magnavita N, Elovainio M, Heponiemi T, Ciprani F, Cuomo G, Bergamaschi A (2011) Police job strain during routine activities and a major event. Occup Med (Lond) 61(6):395–399
Garbarino S, Chiorri C, Magnavita N, Piattino S, Cuomo G (2012) Personality profiles of special force police officers. J Police Crim Psychol 27(2):99–110. https://doi.org/10.1007/s11896-011-9099-6
Garbarino S, Cuomo G, Chiorri C, Magnavita N (2013) Association of work-related stress with mental health problems in a special police force. BMJ Open. https://doi.org/10.1136/bmjopen-2013-002791
Garbarino S, Chiorri C, Magnavita N (2014) Personality traits of the Five-Factor Model are associated with work-related stress in special force police officers. Int Arch Occup Environ Health 87(3):295–306. https://doi.org/10.1007/s00420-013-0861-1
Gilbert-Ouimet M, Trudel X, Brisson C, Milot A, Vézina M (2014) Adverse effects of psychosocial work factors on blood pressure: systematic review of studies on demand-control-support and effort-reward imbalance models. Scand J Work Environ Health 40(2):109–132. https://doi.org/10.5271/sjweh.3390
Hartley TA, Burchfiel CM, Fekedulegn D, Andrew ME, Knox SS, Violanti JM (2011) Associations between police officer stress and the metabolic syndrome. Int J Emerg Ment Health 13(4):243–256
Janczura M, Bochenek G, Nowobilski R, Dropinski J, Kotula-Horowitz K, Laskowicz B, Stanisz A, Lelakowski J, Domagala T (2015) The relationship of metabolic syndrome with stress, coronary heart disease and pulmonary function–an occupational cohort-based study. PLoS One 10(8):e0133750. https://doi.org/10.1371/journal.pone.0133750
Juniper B, White N, Bellamy P (2010) A new approach to evaluating the well-being of police. Occup Med (Lond) 60(7):560–565. https://doi.org/10.1093/occmed/kqq130
Kamble SV, Phalke DB (2011) Study of occupational stress as a risk factor for various morbidities among policemen. J Indian Med Assoc 109(4):238–240
Kanda T, Takahashi T (2004) Interleukin-6 and cardiovascular diseases. Jpn Heart J 45(2):183–193
Karasek R (1979) Job control, job decision latitude and mental strain. Implications for job redesign. Adm Sci Q 24:285–306
Kivimäki M, Kawachi I (2015) Work stress as a risk factor for cardiovascular disease. Curr Cardiol Rep 17(9):630. https://doi.org/10.1007/s11886-015-0630-8
Kivimäki M, Virtanen M, Elovainio M, Kouvonen A, Vaananen A, Vahtera J (2006) Work stress in the etiology of coronary heart disease-a meta-analysis. Scand J Work Environ Health 32:431–442. https://doi.org/10.5271/sjweh.1049
Kivimäki M, Singh-Manoux A, Nyberg S, Jokela M, Virtanen M (2015) Job strain and risk of obesity: systematic review and meta-analysis of cohort studies. Int J Obes (Lond) 39(11):1597–1600. https://doi.org/10.1038/ijo.2015.103
Körlin J, Alexanderson K, Svedberg P (2009) Sickness absence among women and men in the police: a systematic literature review. Scand J Public Health 37(3):310–319
Landsbergis PA, Dobson M, Koutsouras G, Schnall P (2013) Job strain and ambulatory blood pressure: a meta-analysis and systematic review. Am J Public Health 103(3):e61–e71. https://doi.org/10.2105/AJPH.2012.301153
Leineweber C, Westerlund H, Hagberg J, Svedberg P, Luokkala M, Alexanderson K (2011) Sickness presenteeism among Swedish police officers. J Occup Rehabil 1:17–22. https://doi.org/10.1007/s10926-010-9249-1
Li J, Zhang M, Loerbroks A, Angerer P, Siegrist J (2015) Work stress and the risk of recurrent coronary heart disease events: a systematic review and meta-analysis. Int J Occup Med Environ Health 28(1):8–19. https://doi.org/10.2478/s13382-014-0303-7
Magnavita N, Garbarino S (2013a) Is absence related to work stress? A repeated cross-sectional study on a special police force. Am J Ind Med 56(7):765–775. https://doi.org/10.1002/ajim.22155
Magnavita N, Garbarino S (2013b) Social psychiatry in the waiting room. What a physician can learn about occupational stress from workers waiting to be examined. Psychiatry J 2013:701872. https://doi.org/10.1155/2013/701872
Maia DB, Marmar CR, Mendlowicz MV, Metzler T, Nóbrega A, Peres MC, Coutinho ES, Volchan E, Figueira I (2008) Abnormal serum lipid profile in Brazilian police officers with post-traumatic stress disorder. J Affect Disord 107(1–3):259 – 63
Moher D, Liberati A, Tetzlaff J, Altman DG (2009) PRISMA Group. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med 6(7):e1000097. https://doi.org/10.1371/journal.pmed.1000097
Patterson GT (2001) The relationship between demographic variables and exposure to traumatic incidents among police officers. Austr J Disaster Trauma Stud. http://www.massey.ac.nz/~trauma/issues/2001-2/patterson2.htm
Pira E, Garbarino S, Ciprani F, De Lorenzo G, Mennoia NV, Proto E, Roca A, Magnavita N (2016a) Linee-Guida SIMLII sulla sorveglianza sanitaria delle Forze dell’Ordine italiane: un vuoto da colmare. Mel Lav 107(2):153–158
Pira E, Garbarino S, Magnavita N, Ciprani F, De Lorenzo G, Garzaro G, Mennoia NV, Proto E, Roca A (2016b) Linee Guida per la Sorveglianza Sanitaria degli operatori dei Corpi di Polizia. Nuova Editrice Berti, Piacenza (ISBN 978–88-7643-706-5)
Ramakrishnan J, Majgi SM, Premarajan KC, Lakshminarayanan S, Thangaraj S, Chinnakali P (2013) High prevalence of cardiovascular risk factors among policemen in Puducherry, South India. J Cardiovasc Dis Res 4(2):112–115
Ramey SL (2003) Cardiovascular disease risk factors and the perception of general health among male law enforcement officers: encouraging behavioral change. AAOHN J 51(5):219 – 26
Ramey SL, Perkhounkova Y, Downing NR, Culp KR (2011) Relationship of cardiovascular disease to stress and vital exhaustion in an urban. Midwest Police Dep AAOHN J 59(5):221–227. https://doi.org/10.3928/08910162-20110418-02
Ramey SL, Downing NR, Franke WD, Perkhounkova Y, Alasagheirin MH (2012) Relationships among stress measures, risk factors, and inflammatory biomarkers in law enforcement officers. Biol Res Nurs 14(1):16–26. https://doi.org/10.1177/1099800410396356
Siegrist J (1996) Adverse health effects of high-effort/low-reward conditions. J Occup Health Psychol 1(1):27–41
Siegrist J (2001) Psychosocial factors influencing development and course of coronary heart disease. Herz. 26(5):316–325
Taloyan M, Kecklund G, Thörn L, Kjeldgård L, Westerlund H, Svedberg P, Alexanderson K. (2016) Sickness presence in the Swedish Police in 2007 and in 2010: Associations with demographic factors, job characteristics, and health. Work 54(2):379–387. https://doi.org/10.3233/WOR-162333
Ueyama T, Senba E, Kasamatsu K, Hano T, Yamamoto K, Nishio I, Tsuruo Y, Yoshida K (2003) Molecular mechanism of emotional stress-induced and catecholamine-induced heart attack. J Cardiovasc Pharmacol 41(Suppl 1):S115–S118
Van Tassell BW, Raleigh JM, Abbate A (2015) Targeting interleukin-1 in heart failure and inflammatory heart disease. Curr Heart Fail Rep 12(1):33–41. https://doi.org/10.1007/s11897-014-0231-7
Violanti JM, Aron F (1994) Ranking police stressors. Psychol Rep 75(2):824–826
Violanti JM, Fekedulegn D, Hartley TA, Andrew ME, Charles LE, Mnatsakanova A, Burchfiel CM (2006) Police trauma and cardiovascular disease: association between PTSD symptoms and metabolic syndrome. Int J Emerg Ment Health 8(4):227–237
Violanti JM, Fekedulegn D, Hartley TA, Charles LE, Andrew ME, Ma CC, Burchfiel CM (2016) Highly rated and most frequent stressors among police officers: gender differences. Am J Crim Justice 41(4):645–662. https://doi.org/10.1007/s12103-016-9342-x
Violanti JM, Fekedulegn D, Andrew ME, Hartley TA, Charles LE, Miller DB, Burchfiel CM (2017) The impact of perceived intensity and frequency of police work occupational stressors on the cortisol awakening response (CAR): findings from the BCOPS study. Psychoneuroendocrinology 75:124–131. https://doi.org/10.1016/j.psyneuen.2016.10.017
Virtanen M, Nyberg ST, Batty GD, Jokela M, Heikkilä K, Fransson EI, Alfredsson L, Bjorner JB, Borritz M, Burr H, Casini A, Clays E, De Bacquer D, Dragano N, Elovainio M, Erbel R, Ferrie JE, Hamer M, Jöckel KH, Kittel F, Knutsson A, Koskenvuo M, Koskinen A, Lunau T, Madsen IE, Nielsen ML, Nordin M, Oksanen T, Pahkin K, Pejtersen JH, Pentti J, Rugulies R, Salo P, Shipley MJ, Siegrist J, Steptoe A, Suominen SB, Theorell T, Toppinen-Tanner S, Väänänen A, Vahtera J, Westerholm PJ, Westerlund H, Slopen N, Kawachi I, Singh-Manoux A, Kivimäki M (2013) IPD-Work Consortium. Perceived job insecurity as a risk factor for incident coronary heart disease: systematic review and meta-analysis. BMJ 347:f4746. https://doi.org/10.1136/bmj.f4746
Walvekar SS, Ambekar JG, Devaranavadagi BB (2015) Study on serum cortisol and perceived stress scale in the police constables. J Clin Diagn Res 9(2):BC10–B4. https://doi.org/10.7860/JCDR/2015/12015.5576
West C, Bernard B, Mueller C, Kitt M, Driscoll R, Tak S (2008) Mental health outcomes in police personnel after Hurricane Katrina. J Occup Environ Med 50(6):689 – 95. https://doi.org/10.1097/JOM.0b013e3181638685
Wilson MD, Conroy LM, Dorevitch S (2014) Occupational stress and subclinical atherosclerosis: a systematic review. Int J Occup Environ Health 20(4):271 – 80. https://doi.org/10.1179/2049396714Y.0000000076
Wright BR, Barbosa-Leiker C, Hoekstra T (2011) Law enforcement officer versus non-law enforcement officer status as a longitudinal predictor of traditional and emerging cardiovascular risk factors. J Occup Environ Med 53(7):730–734. https://doi.org/10.1097/JOM.0b013e318220c2da
Yoo HL, Eisenmann JC, Franke WD (2009) Independent and combined influence of physical activity and perceived stress on the metabolic syndrome in male law enforcement officers. J Occup Environ Med 51(1):46–53. https://doi.org/10.1097/JOM.0b013e31817f9e43
Yu H, Liu JC, Fan YJ, Li C, Zhang LX, Chen X, Yue S, Lu WL, Yang XL, Tang NJ (2016) Association between occupational stressors and type 2 diabetes among Chinese police officers: a 4-year follow-up study in Tianjin, China. Int Arch Occup Environ Health 89(2):277–288. https://doi.org/10.1007/s00420-015-1071-9
Zimmerman FH (2012) Cardiovascular disease and risk factors in law enforcement personnel: a comprehensive review. Cardiol Rev 20(4):159–166. https://doi.org/10.1097/CRD.0b013e318248d631
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
The study was not funded. The authors declare that they have no conflict of interest.
Rights and permissions
About this article
Cite this article
Magnavita, N., Capitanelli, I., Garbarino, S. et al. Work-related stress as a cardiovascular risk factor in police officers: a systematic review of evidence. Int Arch Occup Environ Health 91, 377–389 (2018). https://doi.org/10.1007/s00420-018-1290-y
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00420-018-1290-y