2005 Predictors of post-traumatic stress symptoms among South African police personnel

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Predictors of post-traumatic stress symptoms among South African police personnel

Russell Jones Department of Psychology, Stellenbosch University, South Africa Ashraf KageeDepartment of Psychology, Stellenbosch University, Private Bag X1, Matieland, 7602, South Africae-mail: [email protected] The present study investigated the relationship between coping style, perceived social sup-port, length of service experience, age, and gender on symptoms of post-traumatic stress among members of the South African Police Service (SAPS) in the Western Cape. In Phase 1 of the study, 19 police officers participated in a series of qualitative interviews aimed at elicit-ing a list of duty-related stressors that formed the basis of a stressor questionnaire. In Phase 2 of the study 97 officers from12 police stations in the western metropolis of Cape Town completed a battery of questionnaires that assessed stressful experiences, symptoms of post-traumatic stress, coping, social and family support, and various demographic variables. The first multiple regression analysis showed that problem-focused coping, emotion-focused coping and perceived social support explained 42.6% of the variance in the severity of post-traumatic stress scores, although problem-focused coping was positively associated with symptom severity (ß = 0.68). In the second multiple regression analysis, coping was entered as a composite variable and, together with perceived social support, accounted for 29.3% of the variance in post-traumatic stress scores. These results imply a need to enhance specific coping skills among police officers in addressing duty-related traumatic stressors and to fortify social support structures both within the police service and in the private lives of officers. Keywords: coping, emotion-focused coping, perceived social support, police, post-trau-matic stress, post-traumatic stress disorder (PTSD), problem-focused coping

Police personnel in general and in South Africa in particular are exposed to a variety of duty-related stressors that differ significantly in quality and quantity from those experienced by the general population. Examples of such stressors include witnessing © Psychological Society of South Africa. All rights reserved. South African Journal of Psychology, 35(2) 2005, pp. 209–224.ISSN 0081-2463

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a fellow officer killed in the line of duty, killing someone in the line of duty, recovering bodies from a motor vehicle accident, witnessing domestic or community violence, and responding to cases involving child battery (Gulle, Tredoux & Foster, 1998). Police personnel may also be vulnerable to attack from the communities they serve. Between 1991 and 2001, 2 455 police personnel were reported killed, of which 918 were killed on duty and 1 537 were killed while off duty (Bruce, 2002). In the context of exposure to severe stressors of this nature, the likelihood that police personnel experience high levels of post-traumatic stress symptoms is high. The present study investigated the relationship between coping style, perceived social support, extent of service experi-ence, perceived stress, age, gender, and symptoms of post-traumatic stress.

THE PREVALENCE OF SYMPTOMS OF POST-TRAUMATIC STRESS AMONG POLICE OFFICERS For the purpose of the present study, we refer to the symptoms of post-traumatic stress disorder (PTSD) as delineated by the Diagnostic and Statistical Manual, fourth edi-tion, revised (DSM-IV-TR) (APA, 2000). The DSM-IV-TR specifies that following witnessing or being confronted with an event involving actual or threatened death or serious injury, a person may develop three classes of psychological symptoms. These classes of symptoms are (a) persistent re-experiencing of the traumatic event, (b) per-sistent avoidance of stimuli associated with the trauma, and (c) persistent symptoms of increased arousal. Re-experiencing symptoms include recurrent recollections or dreams of the traumatic event, acting or feeling as if the event were recurring, and intense distress or physiological reactivity in response to cues related to the event. Avoidant symptoms include efforts to avoid thoughts, feelings, activities, places or people associated with the traumatic event, an inability to recall an important aspect of the trauma, feelings of detachment or estrangement from others, and a sense of a foreshortened future. Symptoms of arousal include difficulty falling or staying asleep, irritability or outbursts of anger, difficulty concentrating, hypervigilance and exagger-ated startle response. At least one re-experiencing symptom, three avoidant symptoms, and two arousal symptoms need to be present for more than one month for a person to receive a diagnosis of PTSD (APA, 2000). When a victim of a traumatic event experi-ences symptoms that do not meet the criteria for a full diagnosis, reference is made to symptoms of post-traumatic stress rather than post-traumatic stress disorder.

Symptoms of PTSD have been noted among police personnel in various contexts (e.g. Carlier, Lamberts & Gersons, 1997; Robinson, Sigman & Wilson, 1997). How-ever, the fact that different methods are used in assessing the severity of trauma-related symptoms hinders appropriate comparisons between studies. For example, among Dutch police officers exposed to a traumatic stressor, the rate of PTSD, determined by semi-structured interviews administered by trained psychologists, was found to be 7% (Carlier et al., 1997). However, the prevalence of sub-threshold PTSD symp-toms in this sample was 34%. In a random sample of 105 suburban police officers

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in Ohio in the United States of America (USA), 13% had elevated symptoms of PTSD as measured by the Impact of Event Scale-Revised (Robinson et al., 1997). The discrepancy between the results obtained by Carlier et al. (1997) and Robinson et al. may be explained by the difference in assessment method (structured interview versus self-report checklist).

There have been few studies on PTSD among the police in South Africa. At the height of the anti-apartheid struggle in 1987, Burgers (1994) found that among riot police of all races in the Eastern and Western Cape, 36% reported symptoms of PTSD. In a study of PTSD and coping in the Brixton Flying Squad, Johannesburg, Kopel (1996) found that 31 of the 109 officers in the sample (28%) had elevated scores on both the Civilian Mississippi PTSD Scale and the PTSD Checklist (PCL-C), re-spectively. In a sample of 55 members of the Internal Stability Unit (ISU) operating in townships around Johannesburg, Pretoria, and Vereeniging, Kopel and Friedman (1997) found that 27 (49%) had scores on the IES that exceeded the cut-off score of 25 recommended by Horowitz, Wilner and Alvarez (1979). It is likely that sample selection played a role in this high prevalence rate, as the ISU’s were specifically used to quell community and political violence in tonwships.

In a sample of 66 SAPS members in Limpopo Province, Peltzer (2001) found that 9.1% scored in the clinical range on the Post-traumatic Symptom Scale (PTSS-10), indicating likelihood of caseness for PTSD. The difference in prevalence estimates between these data and that of Kopel (1996) and Kopel and Friedman (1997) may be due to the likelihood that the violence levels and therefore traumatic exposure of police in the Northern Province were lower than that in Gauteng, where data for the latter study were collected. However, despite the various ways in which post-traumatic stress symptoms were assessed, it is clear that stress and traumatisation are serious consequences of police work. Thus the coping mechanisms employed by police per-sonnel are an appropriate focus for the present study.

COPINGFolkman, Lazarus, Gruen and Delongis (1986, p. 527) refer to coping as ‘the person’s cognitive and behavioural efforts to manage (reduce, minimise, master, or tolerate) the internal and external demands of the person-environment transaction that is appraised as taxing or exceeding the person’s resources’. These authors differentiate between two kinds of coping, namely, problem-solving coping (comprising interpersonal efforts to solve problems and engage effectively with stressful situations) and emotion-focused coping (aimed at reducing stress and regulating emotions). In their conceptualisation of coping, Folkman et al. suggest that people may employ either or both of these methods of coping in managing stressful or traumatic events.

There appears to be mixed evidence concerning the effectiveness of the two coping styles in managing symptoms of traumatisation. Patterson (2003) found that police officers in a northeastern city in the US who scored high on emotion-focused coping


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on the Social Readjustment Scale (Holmes & Rahe, 1967) reported significantly fewer symptoms of stress and post-traumatic stress than those who reported using problem-focused coping. In contrast, Violanti (1992) found that problem-solving coping was significantly associated with a reduction in stress-related symptoms in a sample of 180 recruits in an American police academy. Blake, Cook and Keane (1992) used the Ways of Coping Checklist (Folkman & Lazarus, 1988a) to study coping styles and the treatment histories of a sample of World War II, Korean and Vietnam War vet-erans. These authors found that veterans who exhibited symptoms of PTSD showed significantly more use of emotion-focused coping, such as accepting responsibility and escape-avoidance than those who did not.

Jeavons, Horne, and Greenwood (2000) investigated coping styles and psychologi-cal trauma in a sample of road accident victims using the General Health Questionnaire (GHQ-28) (Goldberg & Hillier, 1979), the Impact of Events (IES) (Horowitz, Wilner, & Alvarez, 1979), the Post Traumatic Stress Disorder Interview (PTSD-I) (Watson, Brown, Kucala & Juba, 1993), and the Coping Inventory for Stressful Situations (CISS) (Endler & Parker, 1990). The instruments were administered three months and six months following the road accident. Jeavons et al. found no association between task-orientated coping (problem-focused coping) and symptoms of post-traumatic stress symptoms. Emotion-focused coping on the other hand was significantly re-lated to symptoms of trauma as measured by all three of the measures at both times of administration.

SOCIAL SUPPORTSocial support has been found to be a major factor in impeding the development of stress-related symptoms (e.g., Patterson, 2003). In a sample, of 527 New Zealand police personnel, Stephens and Long (1999) found a negative association between symptoms of post-traumatic stress and social support, with social support explaining 25% of the variance in post-traumatic stress scores. In the sample opportunities to talk about the traumatic event with friends and supervisors had the strongest negative association with symptoms of traumatisation. Thus, the support of both friends and superior of-ficers appear to be helpful in ameliorating the effects of traumatic events.

EXTENT OF EXPERIENCEAlthough Kopel (1996) found race and rank to have no effect on PTSD symptoms, Van Niekerk (1997) found that demographic variables such as age, length of service, and marital status were indeed associated with lower post-traumatic stress symptoms and better coping. Officers who reported elevated PTSD symptoms had a mean age of 31 years and a mean length of service of ten years. Moreover, 44% of these officers were married. In contrast, officers who reported fewer PTSD symptoms had a mean age of 35 years and an average length of service of 14 years. Of these officers, 55% were married. It therefore appears that the method of coping used by officers, the extent of


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perceived social support, the extent of service experience, and demographic variables such as age and marital status are likely protective factors against the development of post-traumatic stress symptoms among police personnel. The present study sought to investigate the extent to which these variables reliably account for PTSD symptom severity among a sample of police officers in the Cape Town metropole.

METHODPhase 1The purpose of Phase 1 of the study was to identify a list of stressors to which police personnel were likely to have been exposed. In the absence of a list based on the actual experiences of officers it would not have been possible to accurately identify the range of stressors facing police personnel in their daily duties.

ParticipantsParticipants in Phase 1 of the study were a convenience sample of 20 officers from four police stations in the Cape Town metropole (5 from each station). All participants had been in the police service for at least one month prior to the start of the study and were on active patrol at some point in their career.

ProcedureWe obtained ethical permission from Stellenbosch University and from each station commander to proceed with the study. Ethical considerations included the possibil-ity that the process of responding to the questionnaire could trigger psychological distress for some officers, and ensuring that a referral mechanism for those officers identified as distressed and in need of support was implemented. The officers of varying ranks that were available at the time of data collection were informed about the study, assured of confidentiality and anonymity, and were asked to participate in a qualitative interview concerning their duty-related experiences. During the course of the interview participants were asked to generate a list of as many of their most stressful duty-related situations in police work as they could. Each officer took ap-proximately ten minutes to complete the list. One officer misplaced his list and thus only 19 lists were used to compile the final stressor questionnaire.

Phase 2ParticipantsParticipants in Phase 2 of the study consisted of a convenience sample of 123 Western Cape police officers based at twelve police stations in the Cape Town metropole serving mainly historically disadvantaged residential areas. Inclusion and exclusion criteria were the same as in Phase 1 of the study. The ranks of the members of the sample included constables, sergeants, inspectors and captains.


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ProcedureThe participants were asked to complete a battery of questionnaires that assessed post-traumatic stress symptoms, coping style, extent of service experience, perceived social support and self-reported stress. The questionnaire battery was administered at each police station at an arranged time in order to ensure an optimal response rate. Some station commanders suggested that officers keep the questionnaires for at least one week to allow them to complete them in their own time. The average time officers took to complete the battery was thirty minutes.

MeasuresPTSD symptomsThe PTSD Symptom Scale: Self-Report Version (PSS-SR) (Foa, Riggs, Dancu, & Rothbaum, 1993) was used to assess the severity of PTSD symptoms. The PSS-SR is a seventeen-item self-report instrument corresponding to DSM-IV-TR PTSD criteria. The internal consistency as measured by Cronbach’s alpha for the total scale was re-ported to be 0.95 and the alpha coefficients for the Re-experiencing, Avoidance, and Arousal sub-scales were 0.78, 0.80, and 0.82, respectively. Test–retest reliability was 0.74 for the overall severity score, and 0.66, 0.56 and 0.71 for the re-experiencing, avoidance, and arousal sub-scales, respectively. The PSS-SR has been shown to be significantly correlated with the Rape Aftermath Symptom Test (r = 0.81, p < 0.01), the Impact of Event Scale Intrusion sub-scale (r = 0.81, p < 0.01), the Impact of Event Scale Avoidance sub-scale (r = 0.53, p < 0.01), the Beck Depression Inventory (r = 0.80, p < 0.01), and the State-Trait Anxiety Inventory (r = 0.56, p < 0.01). In the present study the internal consistency for this measure was 0.94.

Stressor questionnaireThe list of top duty-related stressors was used to ascertain an up-to-date list of the top stressors in police work.

Demographic questionnaireA demographic questionnaire assessed the rank, years in the police service, highest education level achieved, age, and gender of the participants.

Coping strategies The Ways of Coping Questionnaire (Folkman & Lazarus, 1988a) was used to assess the coping strategies of respondents. The questionnaire is a 66-item self-report Likert-type questionnaire that assesses coping responses on eight sub-scales. The eight sub-scales and their associated internal consistency as measured by Cronbach’s alphas ranged from 0.61 to 0.79. Edwards and O’Neill (1998) similarly found that the reliability estimates for the sub-scales ranged from 0.56 to 0.85, with an average of 0.73. In the present study, the internal consistency was 0.93 for the overall scale and 0.84 and 0.83 for the problem-focused and emotion-focused sub-scales, respectively.


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Social supportThe Multidimensional Scale of Perceived Social Support (MSPSS) (Zimet, Dahlem, Zimet, & Farley, 1988) was used to assess the officers’ perceived quality of social support. This instrument is a 12-item Likert-type self-report scale measuring sup-port from three sources, namely, family, friends, and a significant other. The scale has high internal reliability with a Cronbach’s coefficient alpha of 0.88 for the total scale and 0.91, 0.87 and 0.85 for the sub-scales of Significant Other, Family, and Friends, respectively. The test-retest reliability of the scale as a whole was 0.85. The test-retest reliabilities for Significant Other, Family, and Friends were 0.72, 0.85, and 0.82, respectively. Concurrent validity was measured through correlations with each sub-scale of the MSPSS with the Depression and Anxiety sub-scales of the Hopkins Symptom Checklist (HSCL) (Derogatis, Lipman, Rickels, Uhlenhuth, & Covi, 1974). The sub-scale Family was negatively correlated with symptoms of depression r = -0.24, p < 0.01 and anxiety r = -0.18, p < 0.01, while the sub-scales Friends and Sig-nificant Other were significantly correlated with symptoms of depression (r = -0.24, p < 0.01) only (Zimet et al. 1988). In the present study, the internal consistency for this measure was 0.091.

Based on our review of the literature, it does not appear that either the PTSD Symp-tom Scale or the Multidimensional Scale of Perceived Social Support has previously been used in South African samples. The Ways of Coping Questionnaire, however, has previously been used extensively in South Africa.

ANALYSISThe data were entered into SPSS student version 9.0. In order to assess collinearity, correlation coefficients between the variables were calculated. The variables, problem-focused coping, emotion-focused coping, perceived social support, extent of service experience, age, and gender were entered into a hierarchical regression model as predictors in order of importance according to prior literature, with severity of PTSD symptoms as the criterion variable. Two regression models were fitted, the first with Problem-focused and Emotion-focused coping entered as separate variables, and the second with the two entered as a composite variable called Overall coping.

RESULTSOf the total sample, 26 participants (21.1%) did not complete their questionnaires. Therefore, 97 questionnaires were included in the analysis. This number was sufficient to comply with the rule of thumb recommended by Field (2000) of a 15:1 subject to predictor ratio for adequate statistical power to support a reliable multiple regression analysis. Of the final sample size of 97, 26 (26.8%) were females. The mean age of the sample was 31.5 years. Data on race and ethnicity were not collected. Table 1 lists the mean scores and standard deviations of the sample on the measures that were used.


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Table 1. Descriptive statistics and Correlation Matrix for regression model 1 (N = 97)

Mean Std. Deviation

PTSD score

Problem-focused coping

Emotion-focused coping

Per-ceived social support score

Extent of service experien-ce score

Age of officer

Gender of officer

PTSD Score

15.1237 12.2468

Problem-focused coping score

33.9794 12.7066 0.4100.000**

Emotion-focused coping score

42.1134 12.2346 0.0700.497

0.750 0.000**

Per-ceived social support score

58.6804 58.6804 -0.453 0.000**

0.045 0.665

0.229 0.024*

Extent of service ex-perience score

33.2680 24.2665 0.129 0.208

-0.138 0.179

-0.323 0.001**

-0.201 0.048*

Age of officer

31.5567 6.1390 0.173 0.090

-0.017 0.868

-0.162 0.114

-0.156 0.126

0.870 0.000**

Gender of officer

0.007 0.0944

0.248 0.014*

0.197 0.053

0.191 0.062

-0.177 0.082

-0.086 0.404

Notes: * sig 0.05; ** sig 0.01

Stressful duty-related situationsThe following duty-related stressors were endorsed by the sample: investigating robberies (88.7%); investigating home burglaries (84.5%); responding to cases of domestic violence (84.5%); seeing a victim of violent assault (77.3%); investigating alcohol- and drug-related crimes (77.3%); investigating a shooting incident (76.3%); and experiencing the violent death of a colleague (49.5%). Non-traumatic stressors reported by the sample included experiencing a shortage of human resources (81.4%); lack of proper logistical equipment (81.4%); receiving a low salary (79.4%); and having to tolerate the laziness of other officers (76.3%).


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PTSD symptoms The sample reported a mean score of 15.12 on the PTSS (sd = 12.24), which, accord-ing to Foa et al. (1993), falls in the moderately severe range on this measure. Of the total sample, 19 (19.59%) participants scored in the moderate to severe range (21 to 35) and 9 (9.28%) participants scored in the severe range (36 and above). While these categories do not constitute diagnostic cut points for PTSD caseness, they reli-ably indicate the extent of post-traumatic symptoms experienced by the sample. If the severe symptom severity range is used as an indicator of the possible present or future development of PTSD caseness, then nearly 10% of the sample is at risk for this disorder.

Table 1 also shows the Pearson’s correlation matrix between the variables. The variables with significant relationships with PTSD symptom severity were perceived social support (r = -0.45, p < 0.01) and problem-focused coping (r = 0.41, p < 0.01). The other variables did not show significant correlations with PTSD symptom sever-ity. Age was significantly correlated with Extent of service experience (r = 0.87, p < 0.01), indicating collinearity between these variables (Field, 2000). As a consequence, Age was omitted from both regression models. Emotion-focused and problem-focused coping were also significantly correlated with each other (r = 0.75, p < 0.01). However, the magnitude of this correlation coefficient was sufficiently low to permit inclusion of both of these in the first regression model without concern about multicollinearity. Multicollinearity may become a problem in a regression model when the correlation between predictors exceeds 0.80 (Licht, 2000).

Regression Model 1Table 2 shows the model summary statistics, R2, Adjusted R2, R2 change, and F change for all stages of the regression model in the order of entry. The adjusted R2 for Step C of the model, in which only Problem-focused coping, Emotion-focused coping, and Perceived social support have been entered is 0.43, indicating that 43% of the vari-ance in PTSD scores are explained by a linear combination of these variables. The addition of the variables, Extent of service experience and Gender in the model did not result in any change in R2 or a statistically significant change in the F statistic. The beta values for the corresponding variables are as follows: 24.275 (PTSD) = 0.675 (Problem-focused coping) -0.353 (Emotion-focused coping) -0.300 (Perceived social support) + 1.471E-02 (Extent of service) -0.451(Gender).

From the beta values and significance values in Table 2, it is clear that the last two variables entered into the equation are not significant.

Regression Model 2A second regression model was fitted in which Emotion-focused and Problem-focused coping were added together to constitute an aggregate Coping variable. The second


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Table 2. Model Summary for regression model 1

Change Statistics

Block R2 Adjusted R2

R2

changeF change df Sig. F

change

A 0.168 0.159 0.168 19.206 1, 95 0.000

B 0.298 0.283 0.129 17.311 1, 94 0.000

C 0.444 0.426 0.146 24.456 1, 93 0.000

D 0.445 0.421 0.001 0.141 1, 92 0.708

E 0.445 0.414 0.000 0.039 1, 91 0.844

Notes:A. Predictors: (Constant), Problem-focused coping scoreB. Predictors: (Constant), Problem-focused coping score, Emotion-focused coping scoreC. Predictors: (Constant), Problem-focused coping score, Emotion-focused coping score,

Perceived social support scoreD. Predictors: (Constant), Problem-focused coping score, Emotion-focused coping score,

Perceived social support score, Extent of service experience scoreE. Predictors: (Constant), Problem-focused coping score, Emotion-focused coping score,

Perceived social support score, Extent of service experience score, Gender of Officer

model included the variables overall coping, perceived social support, education level attained, years in service, and rank. Table 3 shows the intercorrelations for the vari-ables in the model. Perceived social support (r = -0.453, p < 0.01) and overall coping (r = 0.260, p < 0.05) were correlated with PTSD symptom severity. Rank and years in service were significantly correlated with each other (r = 0.893, p < 0.01), indicating collinearity. Rank was thus excluded from further analyses, as officers with a higher rank are likely to be more occupied with increasing levels of administrative duties and may be less directly exposed to traumatic events than those of a lower rank.

Table 4 shows the model summary statistics, R2, adjusted R2, R2 change, and F change for all stages of the second regression model in the order of entry. The adjusted R2 for Step B of the model, in which overall coping and perceived social support have been entered, is 0.293, indicating that nearly 30% of the variance in PTSD scores are explained by a linear combination of these two variables. The addition of the variables education and years of service experience in the model did not result in any change in R2 or a statistically significant change in the F statistic. The beta values for the cor-responding variables are as follows: 19.897 (PTSD) = 0.189 (overall coping) + -0.361 (Perceived social support) + 3.368E-02 (education level) + 0.224 (years in service).

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Table 3. Pearson Correlation Correlation Matrix for regression model 2

PTSD symptom score

Overall coping score

Perceived social support score

Education level score

Years in service

Overall coping score

0.260 0.010**

Perceived social support score

-0.453 0.000**

0.1440.159

Education level score

-0.100 0.332

-0.361 0.000**

-0.011 0.0911

Years in service 0.157 0.124

-0.223 0.028*

-0.212 0.038*

0.1700.097

Rank 0.109 0.286

-0.283 0.005**

-0.182 0.075

0.2060.043*

0.8930.000**

Notes: * sig 0.05; ** sig 0.01

Table 4. Model Summary for regression model 2

Change Statistics

Block R2 Adjusted R2

R2

changeF change df Sig. F

change

A 0.068 0.058 0.068 6.883 1, 95 0.010

B 0.313 0.293 0.246 33.604 1, 94 0.000

C 0.313 0.291 0.000 0.032 1, 93 0.857

D 0.330 0.301 0.017 2.326 1, 92 0.131

Notes:A. Predictors: (Constant), Overall coping scoreB. Predictors: (Constant), Overall coping score, Perceived social supportC. Predictors: (Constant), Overall coping score, Perceived social support, Education level attainedD. Predictors: (Constant), Overall coping score, Perceived social support, Education level attained, years in service

The results of the two regression analyses suggest that the linear combination of Problem-focused coping, Emotion-focused coping, and perceived social support best predict PTSD symptom severity in this sample of police officers in the Western Cape. Other variables, while theoretically important, did not contribute significantly to ei-ther regression model. The inclusion of the three variables, problem-focused coping,


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emotion-focused coping, and perceived social support results in a significant regression model that accounts for 44.4% of the variance in PTSD symptom severity scores.

Upon examination of the beta coefficients, problem-focused coping was positively associated with symptoms of post-traumatic stress (beta = 0.68) while both emotion-focused coping and perceived social support were negatively associated with these symptoms (betas = -0.35 and -0.30, respectively). The strong positive association between Problem-focused coping and symptoms of post-traumatic stress was sur-prising and may hold clues for developing a deeper understanding of the relationship between coping and symptoms of traumatisation among police personnel in further investigation.

DISCUSSIONThe present study builds on research conducted by Gulle, Tredoux and Foster (1998) who documented the various stressful and traumatic situations that members of the SAPS face while on duty. It also extends previous findings on the sequelae that police personnel experience following duty-related traumatic experiences (e.g. Patterson, 2003; Stephens & Long, 1999; Violanti, 1992).

Nearly 10% of the sample reported severe symptoms of PTSD. This percentage falls midway between the 13% found by Robinson et al. (1997) in a sample of police officers in Ohio, US, and the 7% found by Carlier et al. in a sample of Dutch police officers. It is also twice as high as the 5% of Swedish police officers who experienced severe PTSD symptoms as reported by Renck, Weisaeth and Skarbo (2002). The percentage of the sample that reported severe PTSD symptoms is much lower than the 28.4% found by Kopel (1996) in the Brixton Flying Squad and the 49% found by Kopel and Friedman (1997) in a sample of officers in an Internal Stability Unit (ISU). The specifically violent nature of the Flying Squad and the ISU may explain these much higher levels of post-traumatic stress symptoms among these samples. The proportion of the sample in the present study that reported severe symptoms is also similar to the 9% found by Peltzer (2001). In summary, the findings of the pres-ent study related to the extent of symptom severity are comparable with other similar studies conducted both in South Africa and in other countries.

The results of the first regression analysis showed that the linear combination of problem- and emotion-focused coping and perceived social support accounted for nearly 43% of the variance in PTSD scores, indicating that these variables are significant predictors of symptoms of post-traumatic stress, with emotion-focused coping and social support constituting a potential psychoprophylactic role against the development of traumatisation. Surprisingly, gender and extent of service experience explained only 1% of the variance in PTSD symptom severity scores, indicating a minimal role for these variables in mediating against PTSD symptoms.

The finding of the present study that problem-focused coping was positively associated with PTSD symptom severity among the sample was unexpected, as police


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work is generally considered to be problem solving in nature. However, this finding is similar to that of Patterson (2003) who found that problem-focused coping did not have a beneficial effect on work events in a US sample of police officers. In contrast, our findings contradict those of Violanti (1992) who showed that problem-solving coping was significantly but moderately associated with a reduction in self-reported stress among a sample of US police academy recruits. One explanation of these results is that, while persons attending a police academy may experience general stress, this is typically of a non-traumatic nature. Police personnel, on the other hand, are far more likely to encounter traumatic events in their daily duties, which problem-focused coping appears to exacerbate. The association between problem-focused coping and elevated scores on the PTSS is clearly a matter that requires further investigation with different samples, alternative methodological designs, and different assessment instruments. It is necessary to establish whether this finding is idiosyncratic or whether it would be replicated in other samples. Many of the stressors faced by the police personnel cannot be easily solved, as they constitute the nature of police work. Thus, these stressors appear to be uncontrollable traumatic incidents. Problem-focused cop-ing may therefore create more stress than an emotion-focused coping, which regulates accompanying emotions.

In the second regression model, problem-focused and emotion-focused coping were entered as a single aggregate variable called overall coping. The linear combination of overall coping and perceived social support explained 29.3% of the variance in PTSD symptom severity scores. The addition of education and years of service as police personnel did not account for a significant proportion of the variance in PTSD severity scores and thus it appears that these variables did not play a role in mediating the severity of symptoms. It is clear that the first regression model, in which coping is considered separately, is superior to the second, in which coping is regarded as an aggregate variable in predicting severity of PTSD symptoms.

Implications of the studyThe findings of the study indicate that emotion-focused coping and perceived social support are important variables associated with a reduction in post-traumatic symptom severity. Despite expectations, the extent of service experience, gender, and education level had non-significant relationships with the symptom severity. Overall coping ac-counted for a smaller proportion of the variance in symptom severity as a composite variable, compared with problem-focused and emotion-focused coping entered as separate variables. These findings indicate possible strategies that may be considered, both in the training of police officers and in the post-trauma counselling they receive. A first consideration is that training and counselling strategies may include effective emotion-focused coping methods and maintaining and enhancing the utilisation of positive support networks. A second consideration is the use of a system of mentors or peer counsellors, in which senior officers are linked with junior officers with the


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aim of providing opportunities for them to discuss the psychological difficulties that persist following a traumatic event. If such efforts are initiated, mentors may require training in basic counselling skills and skills to refer cases for specialised psycho-logical services if these are needed. The introduction of a formal mentoring system in the police service may facilitate help seeking among officers and thus provide an appropriate method of ameliorating post-traumatic stress symptoms. A structured mentoring system may likely offset the stigma associated with seeking counselling, as a relationship that is already established with a mentor is more likely to be viewed as normative, compared to one that is initiated following a traumatic event. In an environment such as the police service the risk of appearing weak or vulnerable may be unacceptable to many officers and may thus dissuade them from seeking the help from which they may potentially benefit. In view of the data indicating possible iatro-genic effects of psychological interventions, such as critical incident stress debriefing implemented shortly after a traumatic event (see Kagee 2002), we caution against mandatory counselling following duty-related traumas.

Limitations of the studyThe main limitation of this research is its cross-sectional research design. Coping is a process that changes over time and it is likely that the coping methods employed by officers may also change over time and context. A longitudinal design may provide ad-ditional insight into the dynamic manner in which coping and social support moderate PTSD symptoms. The use of a self-report measure to assess coping is also inherently flawed. A self-report measure reduces the construct of coping, which is complex and multi-dimensional, to a simple score. Through such rudimentary quantification, the dynamic aspects of coping, such as its timing, appropriateness, and sequencing are lost (Coyne & Racioppo, 2000). Self-report measures typically do not incorporate the person as a whole and thus their beliefs and attitudes are lost (Lazarus, 1993).

Despite these limitations, the present study revealed the range of stressful and traumatic situations that officers face while on duty. It also permits comparisons with other work, both within South Africa and in other countries such as the US and the Netherlands. The finding that emotion-focused coping and perceived social support were negatively associated with symptom severity was expected and highlights the importance of strong support networks for officers both within the police force and in their private lives. The finding that problem-focused coping was positively associated with the severity of post-traumatic stress symptoms was not expected and could be attributed to possible sampling bias. However, the fact that the sample was drawn from several police stations around the Cape Town metropole suggests that sampling bias may not fully explain the relationship between problem-solving coping and symptom severity. This matter awaits further investigation. The police service is a vital com-ponent to the political, economic, and social development of South African society.


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As such, research efforts directed at understanding and improving the psychological well-being of police officers are of important social relevance.

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Russell Jones and Ashraf Kagee

2005 Predictors of post-traumatic stress symptoms among South African police personnel

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