Pre-trauma Sleep Difficulties and Fatigue Predict Trauma-Induced Changes in Mental Health Symptoms in Recruit Police Officers

Abstract Introduction Police are at risk of trauma and related mental health outcomes. Sleep disturbances and fatigue predict poor mental health in other populations, thus it is critical we determine whether they represent risk factors for mental health problems in first responders. We examined if pre-trauma sleep and fatigue experienced by police recruits predicted trauma-related mental health changes. Methods This study utilised data from the Police-in-Action Study, a longitudinal study which assessed police recruits (n=340) pre- (baseline) and post-15 months of emergency work (follow-up). Participants self-reported depression (Beck Depression Inventory; BDI), PTSD (PTSD Checklist for DSM-5; PCL-5), anxiety (State-Trait Anxiety Inventory) and stress (Perceived Stress Scale). Baseline sleep was measured using sleep items on the BDI and PCL-5, and the BDI fatigue item assessed baseline fatigue. Linear regressions examined whether baseline sleep and fatigue predicted the development of mental health symptoms (i.e., change in symptoms over time) while controlling for demographics, baseline mental health and trauma severity. Analyses were restricted to participants experiencing their core traumatic event between time-points (n=225), determined using the Clinician Administered PTSD Scale. Results Sleep difficulties in police at baseline predicted the development of depression (b=0.371 [0.109,0.633], p=0.006) and stress (b=2.430 [0.756,4.484], p=0.021) post-trauma. Baseline fatigue predicted post-trauma development of depression (b=0.272 [0.045,0.500], p=0.019) and anxiety (b=0.060 [0.007,0.113], p=0.028). Discussion Poor sleep and fatigue are pre-trauma risk factors for the development of mental health outcomes in new police. This suggests the need to investigate interventions targeting sleep and fatigue to reduce trauma-related mental health outcomes in police.