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Psychosocial interventions for prevention of psychological disorders in law enforcement officers

  1. Valentina Peñalba1,*,
  2. Hugh McGuire2,
  3. Jose R Leite3

Editorial Group: Cochrane Depression, Anxiety and Neurosis Group

Published Online: 21 JAN 2009

Assessed as up-to-date: 11 MAY 2008

DOI: 10.1002/14651858.CD005601.pub2

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How to Cite

Peñalba V, McGuire H, Leite JR. Psychosocial interventions for prevention of psychological disorders in law enforcement officers. Cochrane Database of Systematic Reviews 2008, Issue 3. Art. No.: CD005601. DOI: 10.1002/14651858.CD005601.pub2.

Author Information

  1. 1

    Universidade Federal de São Paulo, Psicobiologia, São Paulo, São Paulo, Brazil

  2. 2

    National Coordinating Centre for Women and Child Health, London, UK

  3. 3

    Escola Paulista de Medicina, Psicobiologia, São Paulo, São Paulo, Brazil

*Valentina Peñalba, Psicobiologia, Universidade Federal de São Paulo, Rua Napoleao de Barros 925 1st floor, São Paulo, São Paulo, Brazil. vpenalba@gmail.com . vpenalba@hotmail.com.

Publication History

  1. Publication Status: Edited (no change to conclusions)
  2. Published Online: 21 JAN 2009

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Characteristics of included studies [ordered by study ID]
Aremu 2006
MethodsRandomisation: method not specified
Allocation concealment: not stated
Assessors concealed: not stated
Attrition bias :not stated
ITT: not stated
Follow-up: not stated
Participants90 Police Officers (Assistant Superintendent of Police: 27; Superintendent of Police: 20; Deputy Superintendet of Police: 16; Chief Superintendent of Police:14; Assistant Commissioner of Police: 13)
Age: 27 to 47 (mean 37.8)
Diagnosis: none
Gender (M/F): not stated
Role of law enforcement: police officers
Years of employment in law enforcement officers: between 2 and 23 years of service
InterventionsInterventions - Primary prevention
Experimental Intervention: Social Skills Training (SST)
Session duration: 1 1/2 hours
Period of training: 8 weeks
Frequency of sessions: weekly
Number of sessions: 8
Experimental Intervention: Problem-Solving Skills Training: PST
Session duration: 1 1/2 hours
Period of training: 8 weeks
Frequency of sessions: weekly
Number of sessions: 8
Control Group: Assesment only
General counselling on community policing was given to the control group after the administration of the post -test
OutcomesPolice Interpersonal Self-Image Scale (PISS)
Notes
Risk of bias
ItemAuthors' judgementDescription
Allocation concealment?UnclearB - Unclear




Backman 1997
MethodsRandomisation: Randomisation stratified by gender
Allocation concealment: no. The person in charge of the treatment patients was the one in charge of allocation after the randomisation was done by the computer.
Assessors concealed: yes. People who assessed the blood sample and the questionnaire were not aware of the group states
Attrition bias: no. Equal numbers of dropouts in each group
ITT: no
Follow-up: 18 months
Participants75 male and female Swedish police trainees. Experimental group: 25 men and 12 women; Control group: 26 men and 12 women
Age: not specified
Diagnosis: none
Gender (M/F): 25/12 and 26/12
Role of law enforcement: police trainees
InterventionsIntervention - Primary prevention
Mental imaging training:
1) Theory: Trainees received instruction in stress theory
2) Physical and mental relaxation: Trainees practiced first physical relaxation and then mental relaxation at home using a cassette type
3) Learning activities: included problems management, triggers and self image, goal, environment, technique, concentration and practical training.
4) Trained at home: trainees were encouraged to train at home five times a week( 44% did so, 10% twice a week).
Session duration: 2 hours
Period of training: 10 weeks
Frequency: 1 day/week
Supervised training: monitored by facility staff.
Specially trained police officers from the Swedish National Counter Terrorist Squad carried out the mental training program.

Control Group:
Assesment only
OutcomesJenkins' Activity Survey (Typ-A)
Appels - Vital exhaustion
Cynicism - Cook, Medley
General Health Questionnaire - Goldberg, Banks
IPM - Coping
Bodily symptom scale
Karolinska Sleep Questionnaire
Burnout scale-Maslach
Prolactin (ug/L)
Cortisol (nmol/L)
Notes
Risk of bias
ItemAuthors' judgementDescription
Allocation concealment?NoC - Inadequate




Doctor 1994
MethodsRandomization: Quasi randomised. Sequentially numbered
Allocation concealment: yes
Assessors concealed: yes
Attrition bias: no. Equal numbers of drop-outs: 9 for 31 participants in the experimental group and 7 for 29 in the control group
ITT: no
Follow-up: no
Participants61 males and females. Experimental group: 31. Control group: 29
Age: 22 to 55
Diagnosis: none
Gender (M/F): 59/2
Role of law enforcement: Uniformed officers of constable and sergeant rank of two stations
InterventionsIntervention: Secondary prevention
Psychotherapy: counselling group sessions
Session duration: 1 hour
Period of training: 12 weeks
Frequency: 1 days/week
Adaptation strategy for psychotherapy: attendance was not obligatory but was encouraged by giving an equivalent amount of time off work in lieu
Counseling sessions: led by a registrar in psychiatry
Control group: No treatment. Assessment only
OutcomesGeneral Health Questionnaire
Sick leave records
Stress situation questionnaire (outcome measured before, but not after, the intervention)
Notes
Risk of bias
ItemAuthors' judgementDescription
Allocation concealment?YesA - Adequate




McNulty 1984
MethodsRandomisation: Controlled Clinical Trial. Method of allocation not specified. Quasi randomised Controlled trial
Allocation concealment: not stated
Assessors concealed: not stated
Attrition bias: not stated
ITT: not stated
Follow-up: no
Participants44 police recruits
Age: mean 22.2
Gender: not stated
Diagnosis: none
Role of law enforcement: police recruits
InterventionsIntervention: Secondary Prevention
Strees Management training. Physical and cognitive modes of handling stress with the specific request made that the recruits practice the technique between sessions
Period of Training: 10 weeks
Session duration: 90 minutes
Regime: Group
Frequency: weekly

Control Group:
Ocassional lectures on stress in formal setting at irregular periods
Session duration: not stated
Period of training: 5 months
Frequency: irregular
OutcomesHormone analysis: adrenaline and noradrenaline
Notes
Risk of bias
ItemAuthors' judgementDescription
Allocation concealment?UnclearB - Unclear




Norvell 1993
MethodsRandomisation: method not specified.
Allocation concealment: not specified
Assessors concealed: not specified
Attrition bias : yes, not met .19 people dropped out from the treatment and there was no report of dropouts in the control group
ITT: not stated
Follow-up: not stated
Participants48 participants. Experimental Group: 33 and Control Group: 15.
Age: mean 32.84 (SD 7.88) (experimental and control group combined). This is based on 43 participants only.
Gender (M/F): 45/0
Diagnosis: none
Role of law enforcement officers: state law enforcement officers
Years of employment in law enforcement: 8.56 6.63
InterventionsIntervention: Secondary Prevention
Intervention group
Exercise form: individualized instruction in proper exercise technique and training guide written for this experiment. Circuit weight training. Intensity: Training involved 12 circuit machines. The amount of resistance for all exercise was set such that the weight could be lifted a minimum of 8 but not more than 12 repetitions. Weight was adjusted throughout the program such that when 12 or more repetitions were performed, participants were instructed to increase the resistance by 5% at the next session.
Session duration: 20 minutes
Period of training: 16 weeks
Number of sessions: 48
Frequency: 3 days/week.
Supervised training: monitored by facility staff
Control group:
Waiting list
Exercise form: instructed to refrain from additional exercise programs in the interim
OutcomesHopkins Symptom Checklist (SCL-90) Global Severity Index.
Job Descriptive Index (JDI)
Cohen-Hoberman Inventory of Physical Symptoms (CHIPS)
Perceived Stress Scale
Notes
Risk of bias
ItemAuthors' judgementDescription
Allocation concealment?UnclearB - Unclear




O'Neill 1982
MethodsRandomisation: Randomisation stratified by gender
Allocation concealment: no. The person in charge of the treatment was the one in charge of allocation after the randomisation was done by the computer.
Assessors concealed: yes. People who assessed the blood sample and the questionnaire were not aware of the group states.
Attrition bias: no. Equal numbers of dropouts in each group.
ITT: no
Follow-up: 18 months
Participants86 Sheriff police officers. 86 in the Intervention group (because 39 declined the invitation and an additional of 28?).
Age: not stated
Gender (M/F): not stated
Diagnosis: none
Role of law enforcement officers: sheriff officers
Years of employment in law enforcement: not stated
InterventionsIntervention: Secondary Prevention
Experimental group:
1) Physical fitness modality:approach intervention: exercise and sport fitness
Regime: individual training
Period of intervention: not stated
Session duration:not stated
Frequency: 2 individual training
2) Psychological stress education approach in groups
Regime: group
Period of intervention: not stated
Session duration:1 1/2 hours
Frequency: weekly
3) Psychophysical modality :combination of Physical + Psychological approach (Two individual training + 1 1/2 weekly.)
Period of intervention: not stated
Session duration: not stated (physical approach) + 1 1/2 hour (psychological approach)
Frequency: weekly (psychological approach); not stated (physical approach)
Regime: Group and individually

4) Education: group only
Period of Intervention: not stated
Session duration: none
Regime: group
Frequency: not stated
OutcomesSCL 90
State-Trait Anxiety Index
Michigan Alcoholism Screning Test
Myers-Briggs Type Indicator
Police Job Strees Inventory
Notes
Risk of bias
ItemAuthors' judgementDescription
Allocation concealment?UnclearB - Unclear




Sarason 1979
MethodsRandomization: method not stated
Allocation concealment: not stated
Assessors concealed: not stated
Attrition bias: not stated
ITT: not stated
Follow up: not stated
Participants18 participants. Numbers in the experimental and control groups not specified.
Age: 22 to 34 years.
Gender (M/F): 10/8
Diagnosis: none
Role of law enforcement: Police Academy trainees
InterventionsIntervention: Primary prevention
Intervention group
Stress management program:
Regime: group
Development of awareness of their cognitive and physiological responses to anger-provoking and threatening situations and the way in which these responses can interfere with performance was accomplished through role playing, modelling and self-monitoring of responses during stressful situations.The idea was to develop a repertory of adaptive cognitive responses for use in preparing for an coping with stressors.Subjects also trained in progressive relaxation. Trainees observed models who displayed adaptive coping responses in the face of stress and practiced using coping skills themselves under conditions of stress.
Session duration: 2 hours
Period of training: 6 sessions
Control group:
Short course in abnormal psychology
Period of training: 6 sessions
Session duration: 2 hours
OutcomesState-Trait Anxiety Inventory
Test Anxiety Scale
Endler Hunt SR Inventory of Hostility
Notes
Risk of bias
ItemAuthors' judgementDescription
Allocation concealment?UnclearB - Unclear




Shipley 2002
MethodsRandomization: method not stated
Allocation concealment: not stated
Assessors concealed: not stated
Attrition bias: not stated
ITT: not stated
Follow up: none
Participants54 men and women. Experimental Group: 26 and Control Group: 28. Ontario Provincial.
Years of employment in law enforcement: 0
Age: not stated
Duration of illness: none
Gender (M/F): 20/6 and 20/8
Diagnosis: none
Role of law enforcement: police officers
InterventionsIntervention: Secondary Prevention
Visuo-Motor Behavoir Rehearsal
Session duration: 10 minutes of progressive relaxation portion + 20 minutes of an imagery/mental rehearsal portion administered by the senior author.
Period of training: once
Frequency: none.
The progressive relaxation portion of the exercise comprised a breathing exercise followed by systematic relaxation of major muscle groups, beginning with the head and face and concluding with the calves. The imagery/rehearsal portion was comprised of energizing cue words, positive self-statements, and imagery. They were instructed to have an open mind about the experience and to adopt a relaxed seating position.
Control group:
No treatment. Assessment only
OutcomesCSAI-2 State Anxiety Inventory-2
Subjetive evaluations
Performance evaluations
NotesNeed to contact the author for data for CSAI-2 before and after the intervention
Risk of bias
ItemAuthors' judgementDescription
Allocation concealment?UnclearB - Unclear




Short 1984
MethodsRandomisation: method not specified
Allocation concealment: not specified
Assessors concealed: not specified
Atrition bias: not specified
ITT: not specified
Follow-up: not specified
Participants45 participants from the large Metropolitan Police Department. Experimental Group: 22 and control group: 23
Age: 29 to 52 years (combining experimental and control group).
Gender (M/F): 22/0 23/0
Diagnosis: considered to be at least 20% over their optimum body weights.
Role of law enforcement officers: police officers
InterventionsIntervention: Secondary Prevention
Experimental Group: Conditioning Group
Theory exercise topics: instruction on topic regarding the principles of exercise; basic and advanced nutrition education; behavior modification techniques for altering dietary habits and the principles of cardiac conditioning, muscle development and endurance.
Session duration: 90 + 45 minutes
Period of training: 8 weeks
Frequency: 1 day/week
Number of sessions: 8

Exercise form: aerobic conditioning program. A supervised interval program of walk-jog activities of increasing duration and distance.
Session duration: 90 minutes
Period of training: 8 weeks
Frequency: 3 day/week
Regime: not stated

Control Group:Instruction group (instruction alone)
Exercise form: maintain activity habits similar to those before the study and refrain from any extra physical conditioning during the study.
Theory exercise topics: instruction on topic regarding the principles of exercise; basic and advanced nutrition education; behavior modification techniques for altering dietary habits and the principles of cardiac conditioning, muscle development and endurance.
Session duration: 90 minutes
Period of training: 8 weeks
Frequency: 1 day/week
OutcomesTennesse Self Concept Scale (TSCS)
Notes
Risk of bias
ItemAuthors' judgementDescription
Allocation concealment?UnclearB - Unclear




Wilson 2001
MethodsRandomisation: method not specified
Allocation concealment: not specified
Assessors concealed: met. An independent assessor who was blind to the treatment allocation administered all outcomes measures.
Attrition bias : no
ITT: no
Follow-up: 6 months after the last assessment.
Participants62 men and women from the Colorado Spring Police Department. Experimental group: 33 and control roup 29.
Age: 23 to 53 years (mean: 36.8 SD: 7.02)
Diagnosis: none
Gender (M/F): 50/12
Role of law enforcement officers: police officers
Exclusion criteria: not having a significant other who would participate, being in current therapy for the specific stressor, being unwilling to meet the time commitments for the study.
InterventionsIntervention: Secondary Prevention
Experimental intervention
Stress Management Program:EMDR
Session duration: 120 minutes
Period of training: 3 times
Frequency of sessions: not sated

Control Group
Job stress Program
Video course as a tool for reducing stress. Each topic is accompanied by workbook, which provides an overview for the 15 minutes video tape for that topic. The workbook includes stop and reflect questions that focus attention on the issues covered in the videotape, a summary of the skills and strategies discussed in the tape and a stop and reflect section to design a plan of action for dealing with stressors.
Session duration: 1 hour
Period of training: 6 sessions
OutcomesSubjective Units of Disturbance Scale (SUDS)
State-trait Anger Expression Inventory (STAXI)
Police Stress Inventory (PSI)
Job Stress Survey (JSS)
Coping Response Inventory (CRI)
Marital relationship Test (MAT)
Post-traumatic Stress Diagnostic Scale (PTSD)
Symptom Check List-90-Revsed (SCL-90-R)
Notes
Risk of bias
ItemAuthors' judgementDescription
Allocation concealment?UnclearB - Unclear


 
Characteristics of excluded studies [ordered by study ID]
StudyReason for exclusion
Arokoski 2002Non-randomised controlled trial.
Bar 2004Non-randomised controlled trial.
Carlier 1998Non-randomised controlled trial.
Carlier 2000Non-randomised controlled trial.
Danish 1970Non-randomised controlled trial.
Gersons 2000Outcomes not relevant to the current review. Not a prevention intervention.
Godschalx 1984Non-randomised controlled trial.
Harrel 1993Non-randomised controlled trial.
McMurray 1998Outcomes not relevant to the current review. Cluster randomised controlled trial.
Meadows 1985Outcomes not relevant to the current review. Non-randomised controlled trial.
Norris 1990Non-randomised controlled trial.
Pinfold 2003Non-randomised controlled trial.
Richmond 1999bNon-randomised controlled trial.
Schmit 1996Non-randomised controlled trial.
Tolin1999Non-randomised controlled trial.
Wallace 1977Non-randomised controlled trial.


 
Comparison 1. Primary Prevention - Intervention versus Control
Outcome or subgroup titleNo. of studiesNo. of participantsStatistical methodEffect size
 1 Depression1Mean Difference (IV, Fixed, 95% CI)Subtotals only
    1.1 Post-treatment
160Mean Difference (IV, Fixed, 95% CI)-2.14 [-4.00, -0.28]
    1.2 Follow-up - 18 months
160Mean Difference (IV, Fixed, 95% CI)-0.97 [-2.43, 0.49]
 2 General Health Questionnaire1Mean Difference (IV, Fixed, 95% CI)Subtotals only
    2.1 Post treatment
163Mean Difference (IV, Fixed, 95% CI)2.74 [0.78, 4.70]
    2.2 Follow-up - 18 months
163Mean Difference (IV, Fixed, 95% CI)1.30 [-0.61, 3.21]
 3 IBM-Coping1Mean Difference (IV, Fixed, 95% CI)Subtotals only
    3.1 Post-treatment
165Mean Difference (IV, Fixed, 95% CI)2.83 [1.51, 4.15]
    3.2 Follow-up- 18 months
165Mean Difference (IV, Fixed, 95% CI)2.24 [1.06, 3.42]
 4 Jenkin's Acivity Survey1Mean Difference (IV, Fixed, 95% CI)Subtotals only
    4.1 Post- treatment
163Mean Difference (IV, Fixed, 95% CI)-1.11 [-2.83, 0.61]
    4.2 Follow-up- 18 months
163Mean Difference (IV, Fixed, 95% CI)-2.77 [-4.66, -0.88]
 5 Karolinska Sleep Questionnaire - Impaired Awakening1Mean Difference (IV, Fixed, 95% CI)Subtotals only
    5.1 Post-treatment
166Mean Difference (IV, Fixed, 95% CI)-1.58 [-2.46, -0.70]
    5.2 Follow-up- 18 months
166Mean Difference (IV, Fixed, 95% CI)-1.06 [-1.84, -0.28]
 6 Karolinska Sleep Questionnaire - Sleep Quality1Mean Difference (IV, Fixed, 95% CI)Subtotals only
    6.1 Post-treatment
164Mean Difference (IV, Fixed, 95% CI)-1.97 [-3.55, -0.39]
    6.2 Follow-up- 18 months
164Mean Difference (IV, Fixed, 95% CI)-1.68 [-3.28, -0.08]
 7 Karolinska Sleep Questionnaire - Sleepiness1Mean Difference (IV, Fixed, 95% CI)Subtotals only
    7.1 Post-treatment
163Mean Difference (IV, Fixed, 95% CI)-1.82 [-3.05, -0.59]
    7.2 Follow-up- 18 months
163Mean Difference (IV, Fixed, 95% CI)-1.19 [-2.34, -0.04]
 8 Bodily Sympton Scale/Worry Depression1Mean Difference (IV, Fixed, 95% CI)Subtotals only
    8.1 Post-treatment
160Mean Difference (IV, Fixed, 95% CI)-2.14 [-4.00, -0.28]
    8.2 Follow-up 18 months
160Mean Difference (IV, Fixed, 95% CI)-0.97 [-2.43, 0.49]
 9 Burnout - Emotional1Mean Difference (IV, Fixed, 95% CI)Subtotals only
    9.1 Follow-up 18 months
167Mean Difference (IV, Fixed, 95% CI)0.02 [-1.78, 1.82]
 10 Burnout - Despersonalization1Mean Difference (IV, Fixed, 95% CI)Subtotals only
    10.1 Follow-up 18 months
167Mean Difference (IV, Fixed, 95% CI)-0.16 [1.00, 0.68]
 11 Burnout - Personal Accomplishment1Mean Difference (IV, Fixed, 95% CI)Subtotals only
    11.1 Follow-up 18 months
166Mean Difference (IV, Fixed, 95% CI)0.58 [-0.85, 2.01]
 12 Vital Exhaustion1Mean Difference (IV, Fixed, 95% CI)Subtotals only
    12.1 Post-Treatment
163Mean Difference (IV, Fixed, 95% CI)-2.49 [-5.57, 0.59]
    12.2 Follow-up 18 months
163Mean Difference (IV, Fixed, 95% CI)-3.94 [-6.95, -0.93]
 13 Cynicism1Mean Difference (IV, Fixed, 95% CI)Subtotals only
    13.1 Post-Treatment
164Mean Difference (IV, Fixed, 95% CI)-6.99 [-12.13, -1.85]
    13.2 Follow-up 18 months
164Mean Difference (IV, Fixed, 95% CI)-8.22 [-14.11, -2.33]
 14 Symptom Scale1Mean Difference (IV, Fixed, 95% CI)Subtotals only
    14.1 Post treatment
160Mean Difference (IV, Fixed, 95% CI)-2.14 [-4.00, -0.28]
    14.2 Follow-up 18 months
160Mean Difference (IV, Fixed, 95% CI)-0.97 [-2.43, 0.49]
 15 Dropouts175Risk Ratio (M-H, Fixed, 95% CI)2.05 [0.19, 21.70]
 
Comparison 2. Secondary Prevention - Intervention versus Control
Outcome or subgroup titleNo. of studiesNo. of participantsStatistical methodEffect size
 1 SCL-90 Hostility1Mean Difference (IV, Fixed, 95% CI)Subtotals only
    1.1 Post-Treatment
129Mean Difference (IV, Fixed, 95% CI)-3.84 [-8.48, 0.80]
 2 SCL-90 Depression1Mean Difference (IV, Fixed, 95% CI)Subtotals only
    2.1 Post-treatment
129Mean Difference (IV, Fixed, 95% CI)-7.32 [-11.79, -2.85]
 3 SCL-90 Somatization1Mean Difference (IV, Fixed, 95% CI)Subtotals only
    3.1 Post-Treatment
129Mean Difference (IV, Fixed, 95% CI)-1.84 [-5.68, 2.00]
 4 SCL-90 Anxiety1Mean Difference (IV, Fixed, 95% CI)Subtotals only
    4.1 Post-treatment
129Mean Difference (IV, Fixed, 95% CI)-6.80 [-9.22, -4.38]
 5 SCL-90 General1Mean Difference (IV, Fixed, 95% CI)Subtotals only
    5.1 Post-Treatment
129Mean Difference (IV, Fixed, 95% CI)-6.22 [-10.78, -1.66]
 6 Physical Symptoms Scale1Mean Difference (IV, Fixed, 95% CI)Subtotals only
    6.1 Post-Treatment
129Mean Difference (IV, Fixed, 95% CI)-5.23 [-8.02, -2.44]
 7 Job Descriptive Scale1Mean Difference (IV, Fixed, 95% CI)Subtotals only
    7.1 Post-Treatment
129Mean Difference (IV, Fixed, 95% CI)-8.82 [-21.73, 4.09]
 8 Perceived Stress Scale1Mean Difference (IV, Fixed, 95% CI)Subtotals only
    8.1 Post-Treatment
129Mean Difference (IV, Fixed, 95% CI)-3.17 [-6.94, 0.60]
 9 Dropouts2108Risk Ratio (M-H, Fixed, 95% CI)2.27 [1.01, 5.10]
 
Comparison 3. Secondary Prevention - Intervention versus Intervention
Outcome or subgroup titleNo. of studiesNo. of participantsStatistical methodEffect size
 1 Anger Trait1Mean Difference (IV, Fixed, 95% CI)Subtotals only
    1.1 Post-Treatment
162Mean Difference (IV, Fixed, 95% CI)-1.5 [-2.71, -0.29]
    1.2 Follow-up 6 months
162Mean Difference (IV, Fixed, 95% CI)-3.46 [-4.90, -2.02]
 2 Anger Stait1Mean Difference (IV, Fixed, 95% CI)Subtotals only
    2.1 Post-treatment
162Mean Difference (IV, Fixed, 95% CI)0.25 [-0.78, 1.28]
    2.2 Follow-up 6 months
162Mean Difference (IV, Fixed, 95% CI)-1.28 [-2.40, -0.16]
 3 Tenessee Self Concept Scale1Mean Difference (IV, Fixed, 95% CI)Subtotals only
    3.1 Post-Treatment
145Mean Difference (IV, Fixed, 95% CI)3.70 [-14.86, 22.26]
 4 Diagnosis of PTSD1Odds Ratio (M-H, Fixed, 95% CI)Subtotals only
    4.1 Post test
162Odds Ratio (M-H, Fixed, 95% CI)0.42 [0.04, 4.91]
    4.2 Follow-up 6 months
161Odds Ratio (M-H, Fixed, 95% CI)0.28 [0.03, 2.85]
 5 Job Stress Scale1Mean Difference (IV, Fixed, 95% CI)Subtotals only
    5.1 Post-Treatment
162Mean Difference (IV, Fixed, 95% CI)-0.66 [-3.43, 2.11]
 6 Marital Relationship1Mean Difference (IV, Fixed, 95% CI)Subtotals only
    6.1 Post-Treatment
162Mean Difference (IV, Fixed, 95% CI)-22.70 [-35.73, -9.67]
 7 Subjective Units of Disturbance Scale1Mean Difference (IV, Fixed, 95% CI)Subtotals only
    7.1 Post-Treatment
162Mean Difference (IV, Fixed, 95% CI)-2.28 [-2.57, -1.99]
 
Comparison 4. All Prevention versus Control - post-hoc selected outcomes
Outcome or subgroup titleNo. of studiesNo. of participantsStatistical methodEffect size
 1 Depression2Std. Mean Difference (IV, Random, 95% CI)Subtotals only
    1.1 Post-treatment
289Std. Mean Difference (IV, Random, 95% CI)-0.80 [-1.36, -0.24]
 
Table 1. Search strategies for electronic databases
CENTRALEmbaseMedlineLilacsPsycinfo
police*1 law enforcement.mp. [mp=title, abstract, subject headings, drug trade name, original title, device manufacturer, drug manufacturer name] (2855)
2 police$.mp. [mp=title, abstract, subject headings, drug trade name, original title, device manufacturer, drug manufacturer name] (5114)
3 law officer$.mp. [mp=title, abstract, subject headings, drug trade name, original title, device manufacturer, drug manufacturer name] (7)
4 1 or 2 or 3 (7479)
5 exp Mental Function/ (612989)
6 exp Mental Stress/ (8292)
7 exp "PSYCHOLOGICAL AND PSYCHOSOCIAL PHENOMENA"/ (591886)
8 exp Mental Disease/ (505071)
9 exp "PSYCHOLOGICAL AND PSYCHIATRIC PROCEDURES, TECHNIQUES AND CONCEPTS"/ (314390)
10 5 or 6 or 7 or 8 or 9 (1196912)
11 controlled study.de. (1929109)
12 clinical trial.de. (330242)
13 major clinical study.de. (959116)
14 randomized controlled trial.de. (93598)
15 double blind procedure.de. (55153)
16 clinical article.de. (940030)
17 random$.mp. [mp=title, abstract, subject headings, drug trade name, original title, device manufacturer, drug manufacturer name] (298276)
18 compar$.mp. [mp=title, abstract, subject headings, drug trade name, original title, device manufacturer, drug manufacturer name] (1527056)
19 control$.mp. [mp=title, abstract, subject headings, drug trade name, original title, device manufacturer, drug manufacturer name] (2530718)
20 follow up.mp. [mp=title, abstract, subject headings, drug trade name, original title, device manufacturer, drug manufacturer name] (328615)
21 ((singl$ or doubl$ or tripl$ or trebl$) adj (blind$ or mask$ or dummy)).mp. [mp=title, abstract, subject headings, drug trade name, original title, device manufacturer, drug manufacturer name] (74724)
22 placebo$.mp. [mp=title, abstract, subject headings, drug trade name, original title, device manufacturer, drug manufacturer name] (120622)
23 (clinic$ adj (trial$ or study or studies$)).mp. [mp=title, abstract, subject headings, drug trade name, original title, device manufacturer, drug manufacturer name] (123974)
24 11 or 12 or 13 or 14 or 15 or 16 or 17 or 18 or 19 or 20 or 21 or 22 or 23 (4402152)
25 human.de. (4854146)
26 nonhuman.de. (2535992)
27 25 and 26 (332713)
28 26 not 27 (2203279)
29 24 not 28 (3241082)
30 4 and 10 and 29 (1929)		1 law enforcement.mp. [mp=title, original title, abstract, name of substance word, subject heading word] (1889)
2 police$.mp. [mp=title, original title, abstract, name of substance word, subject heading word] (5073)
3 law officer$.mp. [mp=title, original title, abstract, name of substance word, subject heading word] (12)
4 1 or 2 or 3 (6661)
5 exp Mental Processes/ (380854)
6 exp Mental Disorders/ (554765)
7 exp PSYCHOLOGICAL TECHNIQUES/ (67607)
8 5 or 6 or 7 (909754)
9 randomized-controlled-trial.pt. (198152)
10 controlled clinical trial.pt. (67773)
11 randomized controlled trials.sh. (36154)
12 random allocation.sh. (52597)
13 double blind method.sh. (80589)
14 single blind method.sh. (8737)
15 clinical trial.pt. (400002)
16 exp Clinical trials/ (162754)
17 (clin$ adj25 trial$).ti,ab. (107224)
18 ((singl$ or doubl$ or tripl$ or trebl$) adj25 (blind$ or mask$ or dummy$)).mp. [mp=title, original title, abstract, name of substance word, subject heading word] (109275)
19 placebos.sh. (23474)
20 placebo$.ti,ab. (87368)
21 random$.ti,ab. (302881)
22 research design.sh. (39968)
23 comparative study.sh. (1174165)
24 exp evaluation studies/ (512022)
25 follow up studies.sh. (296255)
26 prospective studies.sh. (184088)
27 (control$ or prospectiv$ or volunteer$).ti,ab. (1506746)
28 9 or 10 or 11 or 12 or 13 or 14 or 15 or 16 or 17 or 18 or 19 or 20 or 21 or 22 or 23 or 24 or 25 or 26 or 27 (3249416)
29 (animals not humans).sh. (2847046)
30 28 not 29 (2516742)
31 4 and 8 and 30 (572)		(POLICE$) or (LAW ENFORCEMENT OFFICERS) or (LAW ENFORCEMENT OFFICERS/) or (LAW ENFORCEMENT OFFICERS/HI) or (LAW ENFORCEMENT OFFICERS/LJ) or (LAW ENFORCEMENT OFFICERS/SN) or (LAW ENFORCEMENT OFFICERS/ST) or (LAW ENFORCEMENT OFFICERS/TD) or (LAW ENFORCEMENT OFFICERS/UT) [Palavras] and (Exerci$) or (psyc$) or (awar$) or (intervent$) or (train$) or (fitn$) or (condit$) or (phys$) or (debr$) [Palavras] and ((Pt ENSAIO CONTROLADO ALEATORIO OR Pt ENSAIO CLINICO CONTROLADO OR Mh ENSAIOS CONTROLADOS ALEATORIOS OR Mh DISTRIBUICAO ALEATORIA OR Mh MÉTODO DUPLO-CEGO OR Mh MÉTODO SIMPLES-CEGO) AND NOT (Ct ANIMAIS AND NOT (Ct HUMANO AND Ct ANIMAIS)) OR (Pt ENSAIO CLÍNICO OR Ex E05.318.760.535$) OR (Tw clin$ AND (Tw trial$ OR Tw ensa$ OR Tw estud$ OR Tw experim$ OR Tw investiga$)) OR ((Tw singl$ OR Tw simple$ OR Tw doubl$ OR Tw doble$ OR Tw duplo$ OR Tw trebl$ OR Tw trip$) AND (Tw blind$ OR Tw cego$ OR Tw ciego$ OR Tw mask$ OR Tw ma! scar$)) OR Mh PLACEBOS OR Tw placebo$ OR (Tw random$ OR Tw randon$ OR Tw casual$ OR Tw acaso$ OR Tw azar OR Tw aleator$) OR (Mh PROJETOS DE PESQUISA) AND NOT (Ct ANIMAIS AND NOT (Ct HUMANO AND Ct ANIMAIS)) OR (Ct ESTUDO COMPARATIVO OR Ex E05.337$ OR Mh SEGUIMENTOS OR Mh ESTUDOS PROSPECTIVOS OR Tw control$ OR Tw prospectiv$ OR Tw volunt$ OR Tw volunteer$) AND NOT (Ct ANIMAIS AND NOT (Ct HUMANO AND Ct ANIMAIS))) AND NOT Mh ANIMAIS [Palavras]1 law enforcement.mp. [mp=title, abstract, subject headings, table of contents, key concepts] (2389)
2 police$.mp. [mp=title, abstract, subject headings, table of contents, key concepts] (7311)
3 law officer$.mp. [mp=title, abstract, subject headings, table of contents, key concepts] (10)
4 1 or 2 or 3 (8700)
5 exp Mental Disorders/ (235177)
6 exp Mental Health/ (14471)
7 5 or 6 (247415)
8 random$.mp. [mp=title, abstract, subject headings, table of contents, key concepts] (52019)
9 ((singl$ or doubl$ or trebl$ or tripl$) adj25 (blind$ or dummy or mask$)).mp. [mp=title, abstract, subject headings, table of contents, key concepts] (10763)
10 placebo$.mp. [mp=title, abstract, subject headings, table of contents, key concepts] (17094)
11 crossover.mp. [mp=title, abstract, subject headings, table of contents, key concepts] (2536)
12 assign$.mp. [mp=title, abstract, subject headings, table of contents, key concepts] (35953)
13 allocat$.mp. [mp=title, abstract, subject headings, table of contents, key concepts] (7927)
14 ((clin$ or control$ or compar$ or evaluat$ or prospectiv$) adj25 (trial$ or studi$ or study)).mp. [mp=title, abstract, subject headings, table of contents, key concepts] (187127)
15 exp placebo/ (1419)
16 exp treatment effectiveness evaluation/ (6693)
17 exp mental health program evaluation/ (1546)
18 exp experimental design/ (38566)
19 8 or 9 or 10 or 11 or 12 or 13 or 14 or 15 or 16 or 17 or 18 (290627)
20 animal.po. (169731)
21 (human or inpatient or outpatient).po. (1605807)
22 20 and 21 (5084)
23 20 not 22 (164647)
24 19 not 23 (271546)
25 4 and 7 and 24 (115)
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