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| BRIEF RESEARCH ARTICLE |
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| Year : 2022 | Volume
: 6
| Issue : 4 | Page : 378-383 |
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Prevalence of substance use and assessment of sleep quality, stress, and anxiety in police personnel in the pandemic
Ashika B George, Jyoti V Shetty
Department of Psychiatry, Bharati Hospital and Research Centre, Pune, Maharashtra, India
| Date of Submission | 16-Oct-2021 |
| Date of Decision | 29-Jan-2022 |
| Date of Acceptance | 21-Feb-2022 |
| Date of Web Publication | 30-Jan-2023 |
Correspondence Address:
Dr. Ashika B George
Department of Psychiatry, Bharati Hospital and Research Centre, Pune, Maharashtra
India
 Source of Support: None, Conflict of Interest: None
DOI: 10.4103/aip.aip_127_21
Background: COVID-19 pandemic has thrown everyone into crisis mode. Lockdowns have affected police personnel, especially as they were working on the ground level. Our study aims to assess the prevalence of substance use and assess the stress, anxiety, and sleep quality among police personnel during the COVID-19 pandemic. Design: This design was a cross-sectional study, July–September 2020. Setting: This study was conducted at Bharati Vidyapeeth Police Station. Materials and Methods: One hundred police personnel were selected at random and interviewed. The Perceived Stress Scale and Symptoms of Stress Scale, the Coronavirus Anxiety Scale, Alcohol, Smoking, and Substance Involvement Screening, and the Pittsburgh Sleep Quality Index were used. Statistical Analysis: The collected data were coded and entered in Microsoft Excel sheet, were analyzed using inferential and descriptive analysis as mean, standard deviation, t-test, and Chi-square by Statistical Packages for the Social Sciences version 20.0 software. Results: The stress assessed using the SPSS and inferential and descriptive analysis came out to be as follows: 1% with high stress, 33% with moderate stress, and 66% experiencing low stress. The prevalence of CRA was found to be 8%. A total of 31% were found to have some sleep issues. A total of 44% of the police personnel were found to use some substance, with the prevalence of alcohol being 32% and nicotine being 22%. There was no significant association found between anxiety, stress, and sleep quality with substance use in the study. There was no significant relationship found between sociodemographic profile and scores on the scales used.
Keywords: Corona-related anxiety, COVID-19, Perceived Stress Scale, Pittsburgh Sleep Quality Index, police personnel
How to cite this article:
George AB, Shetty JV. Prevalence of substance use and assessment of sleep quality, stress, and anxiety in police personnel in the pandemic. Ann Indian Psychiatry 2022;6:378-83 |
How to cite this URL:
George AB, Shetty JV. Prevalence of substance use and assessment of sleep quality, stress, and anxiety in police personnel in the pandemic. Ann Indian Psychiatry [serial online] 2022 [cited 2023 Mar 26];6:378-83. Available from: https://www.anip.co.in/text.asp?2022/6/4/378/368778 |
| Introduction | |  |
Pandemics of various infectious diseases with millions dying have been recorded in the history for the past several centuries. COVID-19 is the latest pandemic.[1]
Various studies are being done all over the world on the impact of COVID-19 on various personnel. However, the police personnel, as first responders to most emergencies, not only face a higher risk of infection than the general public but also suffer from fatigue caused by working overtime and the pressures of responsibility. While the nationwide lockdown due to the coronavirus pandemic has taken a toll on most citizens' physical and mental health, the police personnel are no exception as they are badly equipped and overworked to the level of exhaustion. With the added protocols, when dealing with responding to a pandemic of this magnitude, we get a sense of how out of one's depth they must be, especially in terms of equipment and training.[2]
The sudden disruption of society resulting from the COVID-19 pandemic may impact the mental health of police personnel and lead to a wide variety of psychological problems. Unfortunately, little attention has been paid to the psychological responses of police personnel.[3] Apart from stress, anxiety, and issues with sleep, the evolution or worsening of substance use disorders while trying to self-medicate maybe present. Alcohol-dependent patients using alcohol to self-medicate insomnia is both understandable and maladaptive. On the one hand, if insomnia is a withdrawal symptom, either acute or protracted, then relief drinking is a likely strategy, especially given that alcohol has a reinforcing effect in individuals with insomnia.[4] It was also seen that high trait anxiety is of a significant predictive value for relapse to uncontrolled drinking in both males and females.[5] Police who use sleep-promoting and wake-promoting drugs, especially when working night shifts, are most vulnerable to adverse health, performance, and safety outcomes.[6] Apart from this, drug abuse is a multidimensional problem which involves not only the person but also has an influence on various social, cultural, biological, geographical, historical, and economic aspects of the society.[7] Sleep disorders often remain undiagnosed. Untreated sleep disorders among police personnel may adversely affect their health and safety and pose a risk to the public.[8]
With this study, we are trying to find out the prevalence of substance use, anxiety, and stress in police personnel and assess the sleep quality of police personnel who have been working on the field or on the administrative side during the COVID-19.
Aims
This study aims to the assessment of stress, anxiety, and sleep disturbance and the prevalence of substance use in police personnel during the COVID-19 crisis.
Objectives
- To screen police personnel for substance use using the Alcohol, Smoking, and Substance Involvement Screening Test (ASSIST) Scale
- To assess the incidence of sleep quality issues in police personnel who are posted during the COVID-19 crisis using the Pittsburgh Sleep Quality Index Scale
- To assess stress in police personnel using the Perceived Stress Scale (PSS) and Symptoms of Stress Scale
- To assess anxiety in police personnel using the Coronavirus Anxiety Scale (CAS)
- To correlate stress, substance use, sleep quality, and anxiety with sociodemographic data.
| Materials and Methods | | |
Study was conducted at the four chowkis affiliated with the Bharati Police Station, Katraj-Pune, 411043, close to our parent institute. There was a total of around 180 police personnel currently employed in the abovementioned police station. At random, 100 police personnel were interviewed over a duration of 3 months during the COVID-19 pandemic. Permission was taken from the head of the police station at the beginning of the study. The interviews were conducted over the phone after verbal consent was taken; and face to face when possible, after written consent was taken.
Ethical committee clearance was obtained from the Institutional Ethical Committee before starting the study. This was a cross-sectional study.
A specially designed pro forma was used to collect the sociodemographic and clinical data. They were age, sex, marital status, educational status, family structure, and medical and psychiatric comorbidities. Those with preexisting neuropsychiatric comorbidities were excluded from the study.
Stress, anxiety, substance use, and sleep quality were assessed using scales. The scales used were:
Perceived stress scale and symptoms of stress scale
The PSS-10 is a self-report instrument consisting of ten items purported to assess "how unpredictable, uncontrollable, and overloaded respondents find their lives." Each of the items on the PSS-10 is rated on a five-point Likert scale, ranging from 0 (never) to 4 (very often). The PSS-10 consisted of six positively (items 1, 2, 3, 6, 9, and 10: positive factor) and four negatively (items 4, 5, 7, and 8: negative factor) worded items. Negatively worded items were re-coded during analysis. Total scores range from 0 to 40, with higher scores indicating higher levels of perceived stress.[9],[10]
The coronavirus anxiety scale
This scale was designed with each item capturing a particular form of anxiety. Each item was rated on a five-point scale ranging from 0 (not at all) to 4 (nearly every day), to reflect the frequency of the symptoms. An optimized cut score of ≥9 has a 90% sensitivity and 85% specificity. This scaling format is based on the DSM-5's cross-cutting symptom measure, adult self-rated version (APA, 2013, pp. 734), to be consistent with the American Psychiatric Association's system of measuring psychiatric symptoms over time and response to treatment.[11]
Alcohol, smoking, and substance involvement screening test
It was developed for the World Health Organization (WHO) by an international group of substance abuse researchers to detect and manage substance use and related problems in primary and general medical care settings.
The pittsburgh sleep quality index
Pittsburgh Sleep Quality Index (PSQI) is an effective instrument used to measure the quality and patterns of sleep in adults. It differentiates "poor" from "good" sleep quality by measuring seven areas (components): Subjective sleep quality, sleep latency, sleep duration, habitual sleep efficiency, sleep disturbances, use of sleeping medications, and daytime dysfunction over the last month.
The collected data were coded and entered in Microsoft Excel sheet. It was analyzed using inferential and descriptive analysis such as mean, standard deviation (SD), t-test, and Chi-square by Statistical Packages for the Social Sciences version 20.0 software. Continuous and categorical variables were summarized as mean values ± variance (SD) and frequency (percentage), respectively. Significance was checked for using the t-tests and Chi-square tests.
| Results | | |
Our sample of 100 police personnel, ranging from 27 to 40 years of age, included a majority of married men with only one unmarried subject. It was seen that the fear of spreading the infection to the family was a common thread among all of them. Probably due to this, it was also seen that 47 of the subjects were currently living alone after sending their families back to their villages. [Table 1] shows the sociodemographic data of the police personnel.
A total of 57% of the police personnel were found to use no substance, with the prevalence of alcohol being 32%, nicotine being 8%, and 13% were using both substances. This is shown in [Table 2] and [Figure 1], [Figure 2], [Figure 3]. | Table 2: Police personnel for substance use using the Alcohol, Smoking, and Substance Involvement Screening Test Scale
Click here to view |
While assessing sleep quality, a total of 31% were found to have some sleep issues and 69% had no difficulty in sleep. This is shown in [Table 3] and [Figure 4].
The stress assessed using the PSS was came out to be as follows: 1% with high stress, 33% with moderate stress, and 66% experiencing only low stress. This is shown in [Table 4] and [Figure 5].
The prevalence of CRA (corona-related anxiety) in police personnel's was found to be 8%, according to the Corona-Related Anxiety Scale. This is shown in [Table 5] and [Figure 6]. | Table 5: Anxiety in police personnel using the Coronavirus Anxiety Scale
Click here to view |
[Table 6] shows that there is no correlation between the stress and sociodemographic variables.
[Table 7] shows that there is no correlation between the sleep quality and sociodemographic variables.
[Table 8] shows that there is no correlation between the anxiety and sociodemographic variables.
There was no significant association found between anxiety, stress, and sleep quality with substance use in the study. There was also no statistically significant relationship is found between sociodemographic profile and scores on CAS, PSQI, ASSIST, or PSS scales.
| Discussion | | |
In our study, we were able to find the prevalence of anxiety, stress, and substance use and assess the sleep quality among police personnel during the COVID pandemic. However, our study failed to find any statistically significant relationship between anxiety, stress, and substance use and sleep quality with any of the sociodemographic data. The concern about being infected from the community and workplace may also be a potential source of fear among police personnel. Furthermore, concerns about carrying the infection to the family members may also be a source of psychological distress.[12] This was a significant fear noted in our study as well which was noted in other studies as well; however, we noted that the high-stress incidence using PSS-10 scale was only 1% and moderate stress being 33% without really being able to take into consideration specific points like this; which further sheds light on the need for more personalized questionnaires. This in turn could give a clearer picture on areas to tackle effectively for maximum change.
Although our study also did not show any significant relationship between stress, anxiety, substance use, and sleep disturbance with each other, it was seen that 50% of police personnel who had CSA were found to have concurrent substance use and 14 out of the total 19 with sleep disturbance had substance use. This was seen in a study done in the UK.[5]
It was also seen that 4 police personnel out of the 100 interviewed in this study had quit alcohol during this pandemic. According to them, they stopped drinking for health reasons, rather than due to lack of availability and financial strains.
In our study, we were able to find the prevalence of anxiety, stress, and substance use which were similar to the Mekonnen Tsehay study where it was seen that the rate of depression was found to be 28.9%. Of these, 19.7% had mild, 7.3% had moderate, 1.6 had moderate–severe, and 0.3% had severe depression symptoms. The rate of general anxiety symptoms was found to be 30.2%. Of these, 22.1% of the police officers had mild, 2.6% had moderate, and 5.5% had severe anxiety. Moreover, 13.8% of police officers had subthreshold insomnia and 2.1% had clinical (moderate–severe) insomnia. Participants who are men, married, highly resilient and have high social support were associated with lower depression, anxiety, and insomnia scores than those of women being single or widowed/divorced, low resilient coping score, and low social support, respectively.[13]
Our study had only males, of whom all were married except for one. Due to the COVID pandemic, a common theme of sending nonessential workers in the family to the villages to stay in the family home was seen. This was done hoping that they would be less exposed to the infection and also due to arising financial issues. Less family support due to this compounded with the decreased social interactions brought by the lockdown may have added to the psychological stress of the police personnel.
Limitations
This was a cross-sectional study with small sample size, conducted about 5 months after the first reported COVID case in India. This could have been enough of a time period for most of these personnel to adapt to these new circumstances.
Police personnel may have been inhibited to talk about these issues considering the significant stigma around such topics.
Some interviews were conducted face to face whereas some were conducted over the phone as there was difficulty in catching hold of all the police personnel due to their busy schedules; and thus, there was more difficulty in building rapport in the interviews over the phone.
The Pittsburgh Sleep Quality Index Scale was especially hard to administer as there was a lot of police personnel with frequent shift changes.
| Conclusion | | |
Even though statically significant associations were not found in this study, it was observed that those who were found to have significant anxiety and poor sleep quality did have more substance use. This may be due to the vicious cycle of self-medication and then developing a substance use disorder. Four police personnel who were found to have quit their substance use during the pandemic for purely health reasons may be showing that people are becoming more concerned about their health.
Ethical statement
This study was approved by Institutional Ethics Committee with reference numbers BVDUMC/IEC/21 on June 24, 2020, and BVDUMC/IEC/39 on June 6, 2020.
Declaration of patient consent
Personnel consent statement was taken from each patient (written/ verbal) as per institutional ethics committee approval.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
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[Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6]
[Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6], [Table 7], [Table 8]
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