Co-occurrence of traumatic brain injury and post-traumatic stress disorder in a national sample of UK police officers: Impact on social well-being and employment outcomes

Abstract

Objective: To determine the lifetime prevalence of traumatic brain injury (TBI) in UK police officers and evaluate associations between mild TBI (mTBI), persistent post-concussion-like symptoms (PPCS), post-traumatic stress disorder (PTSD) and complex PTSD (C-PTSD). Setting: Online survey of serving police officers across England, Scotland and Wales. Participants: A total of 617 currently serving police officers were eligible for the study and the final sample consisted of 573 participants. Subgroup comparisons were made between individuals with no TBI history (n = 355), a single mTBI (n = 88) and multiple mTBIs (n = 130). Design: Cross-sectional survey assessing lifetime history of TBI, PPCS and PTSD symptoms. Main measures: Lifetime TBI prevalence was assessed with the Ohio State TBI-Identification Method. Post-concussion-like symptoms were evaluated with the Rivermead Post-Concussion Symptoms Questionnaire (RPQ) and PTSD/C-PTSD were measured using the International Trauma Questionnaire. Results: Lifetime prevalence of TBI was 38% (n = 234), with 23% reporting multiple TBIs. One-way ANOVAs demonstrated that individuals with multiple TBIs exhibited significantly greater cognitive (unadjusted R2 =.02, P =.001) and somatic symptoms (unadjusted R2 =.02, P <.001) and reported more severe total RPQ symptoms (unadjusted R2 =.02, P =.009) compared to those without mTBI history. Multiple TBI history was associated with increased severity across all PTSD/C-PTSD domains (P <.004), and a significantly higher C-PTSD prevalence (P =.001). These results remained significant in ANCOVAs, adjusting for demographic, occupational and trauma-exposure variables (P <.04). Conclusions: Comorbidity between TBI and C-PTSD is prevalent in this sample of police officers. Symptom endorsement is additive in those with mTBI history, this could lead to risk to employment, relationship breakdown, and further mental health problems. Routine occupational health checks should monitor both TBI and associated symptoms over time. If necessary, police officers with head or neck injuries should follow a graduated return-to-duty protocol, including a gradual increase in activity level and appropriate mental health intervention.