A survey of quality of life and depression for police officers in Kaohsiung,
Hsiu-Chao Chen1, Frank Huang-Chih Chou1,2, Ming-Chao Chen1, Shu-Fang Su3, Shing-Yaw Wang2,
Wen-Wei Feng4, Pei-Chun Chen1, Juin-Yang Lai1, Shin-Shin Chao1, Shiow-Lan Yang3, Tung-Chieh Tsai1,
Kuan-Yi Tsai1, Kung-Shih Lin1, Chun-Ying Lee1& Hung-Chi Wu1
1Department of Community Psychiatry, Kai-Suan Psychiatric Hospital, Kaohsiung, Taiwan (E-mail:
firstname.lastname@example.org);2Department of Nursing, I-Shou University;3Department of Nursing, Kai-Suan
Psychiatric Hospital, Kaohsiung, Taiwan;4Department of Dermatology, E-Da Hospital/I-Shou University,
Accepted in revised form 6 November 2005
Objective: The enormous job stress of police work may result in depression, which is highly correlated with
work disability and poor quality of life. We investigated the quality of life, the probability of depression,
and the related risk factors for police officers in Kaohsiung, Taiwan. Methods: We used the 12-item Short-
Form Health Survey (SF-12) and the Disaster-Related Psychological Screening Test (DRPST) to assess the
quality of life and prevalence of depression for 832 police officers in Kaohsiung. Results: The estimated rate
of probable major depression was 21.6% (180/832). Those with an educational level of university or above
and nondepressed police officers had higher scores in every subscale for quality of life. Police officers older
than 50 had higher scores in the mental aspects of quality of life. Family problems and job stress related to
achievement, peer pressure about performance, and heavy workloads were predictive factors for depres-
sion. Conclusion: Police officers might have a higher estimated rate of depression than previously thought,
and those with depression have a poorer quality of life.
Key words: 12-Item Short-Form Health Survey (SF-12), Depression, Disaster-Related Psychological
Screening Test (DRPST), Police officers, Quality of life
During the past two decades, concern about stress
as a problem in the workplace has grown consid-
erably [1, 2]. Certain aspects of work, such as high
demand/low control, shift work, and frequent
contact with the public, are considered highly
stressful, and jobs with these characteristics are
often referred to as ‘‘high-stress’’ . Violanti
stated that policing is one of the most stressful jobs
in U.S. society . Indeed, police work tends to be
regarded as stressful and dangerous because of
exposure to confrontation, violence, traumatic
incidents, and human misery, and even the possi-
bility of being seriously injured or killed. High
public demands on police officers and a mounting
focus on police efficiency and integrity also con-
tribute to the stress in this profession [3, 4]. The
changing nature of the work caused by efficiency
demands, heavy workloads, long working hours,
and job insecurity, among others, all lead to
increased job pressure in police forces.
Work stress may result in high rates of job
dissatisfaction, reduced productivity, absenteeism,
Quality of Life Research (2006) 15: 925–932
? Springer 2006
high turnover, early retirement, high accident
rates, poor public relations, and a high incidence
of lawsuits. Within the health domain, perceived
work stress was significantly associated with anx-
stress symptoms, symptoms of ‘‘burnout,’’ chronic
back pain, alcohol abuse, and inappropriately
aggressive behavior . Among the mental health
problems associated with stress, depression is one
major issue of public concern. Chronic psychoso-
cial stress has long been associated with the origin
and development of depression. The relationship
between stress and the neurobiologic changes seen
in depression has been well documented in recent
years. Many studies have shown that abnormali-
ties in the hypothalamic-pituitary-adrenal axis
found in the response to stress participate in the
development of depressive symptoms [5, 6]. Data
from the Canadian National Population Health
Survey revealed significant associations between
work stress and major depression in the Canadian
employed population . A review article on
depression and work productivity pointed out that
depression was associated with work impairment
and that the productivity gains after effective
treatment for depression could exceed direct
treatment costs .
Job stress seems to result in physical and mental
problems that are highly correlated with work
disability. Work disability is related to poor
quality of life and those with poorer quality of life
are less likely to return to work . Ravindran
et al.  also reported that major life stresses
contribute to depression, and depressive illness is
often accompanied by marked reductions in
quality of life. They noted that when the symptoms
of depression were alleviated, patients may still
suffer impairments of quality of life and might thus
render themselves more vulnerable to depression.
assessing the functional indices of illness such as
quality of life may be advantageous.
Many studies have addressed stress issues and
stress-related symptoms in police officers. How-
ever, a MEDLINE search (quality of life and
police or policemen as key words) revealed no
articles that focus on the examination of the health
related quality of life (HRQoL) of police officers.
Our present study used the 12-Item Short-Form
Health Survey (SF-12) to investigate the quality of
life in police officers from the Kaohsiung area of
southern Taiwan. We also used the Disaster-
Related Psychological Screening Test (DRPST)
 to evaluate the probability of depression and
to survey the stressors that are predictive of
depression in police officers.
In 2004, Kaohsiung had a population of 1.5 mil-
lion and about 4,300 policemen. Situated on the
southwest coast of Taiwan with a geographic area
of 153.6 km2, Kaohsiung is the largest commercial
harbor and the second-largest city in Taiwan.
Because police officers belong to a special popu-
lation, obtaining adequate information by random
sampling is difficult without intervention; thus, we
used purposeful instead of random sampling. Since
the police stations are widely distributed, we
selected only police officers who belonged to the
Kaohsiung city police department and police pre-
cincts. The special police that have to move fre-
quently were also excluded.
About 1,200 police officers in the Kaohsiung
area were invited to participate in a health pro-
motion activity that included mental health
screening and a series of speeches about mental
health. They were recruited for mental health
screening by voluntarily completing a self-admin-
istered questionnaire that focused predominantly
on quality of life, stress, and depression. Police
officers gave informed consent to participate in the
study after receiving information about the goal
and the method of the investigation, together with
approval from the local government authorities.
The questionnaire was mailed to the subjects with
assurance that only researchers conducting the
study would review their responses. A total of 912
police officers joined this program voluntarily;
however, only 832 completed the questionnaire
thoroughly. Fifty-six police officers refused to sign
informed consent and 24 others returned incom-
plete data. The response rate of effective ques-
tionnaires was 91.23% (832/912), and the response
rate of the entire sample invited to participate in
the study was 69.33% (832/1,200).
The DRPST developed by Chou et al.  is a
rapid screening scale for major depressive episode
(MDE) and posttraumatic stress disorder (PTSD).
It was designed initially for effective and rapid
screening of MDE and PTSD for disaster survi-
vors; screening for MDE is also suitable for the
general population based on DSM-IV criteria. The
first part of the DRPST is used to compile back-
education, marital status, and associated risk fac-
tors of mental illness. The second part investigates
the psychological symptoms of MDE and PTSD
based on DSM-IV criteria and validated by psy-
chiatrists . For MDE detection, a three-symp-
tom scale was selected according to DSM-IV
criteria of MDE. A score of 2 or higher on the
MDE scale was used to define positive cases of
MDE, giving a sensitivity of 92.1%, specificity of
98.3%, positive predictive value of 83.3%, and
negative predictive value of 99.3% compared to
the Mini-International Neuropsychiatric Interview
For the survey of police officers, the questions
about PTSD were omitted because it was not the
purpose of this study. We removed the questions
correlated to disasters such as physical injury or
economic loss suffered as a result of an earthquake
and modified the DRPST to collect demographic
and psychosocial data in three parts: (1) basic
demographic data including age, sex, marital sta-
tus, and education level; (2) history of physical and
mental disease and family history of psychiatric
illness; and (3) three dimensions of stress: eco-
nomic stress, family problems, and job stress. The
information on stress was collected by a checklist
with ‘‘yes’’ or ‘‘no’’ questions. The economic
stressors included loans for a house or car, insuf-
ficient family income, and debt. The family prob-
lems included separation or divorce, little time to
spend with family, disharmony of marriage, and
child-rearing problems. The job stressors included
performance that was based on the achievement of
the individual’s quota, the requests of command-
ing officers, peer pressure about performance,
heavy workload, and demands from the public.
The SF-12 is one of the most commonly used
HRQoL questionnaires. It has become widely used
in community-based health surveys and outcome
assessment of physical and mental illnesses be-
cause of its brevity and psychometric performance
[12–15]. The SF-12 incorporates two dimensions:
physical component summary (PCS) and mental
health-related functions along eight subscales:
physical functioning, role limitations caused by
physical problems, bodily pain, general health
(components of PCS), role limitations caused by
emotional problems, vitality, social functioning,
and mental health (components of MCS) [16, 17].
All scores were transformed to a 0–100 scale; 0
indicated the lowest well-being and 100 indicated
the highest. The PCS and the MCS were scored at
the same time with norm-based methods.
Analysis of variance was used to examine the score
differences of each SF-12 subscale for education,
age, marital status, sex, and the four groups
(depression with physical illness, depression with-
out physical illness, no depression with physical
illness, and no depression without physical illness)
with the least significant difference method used as
post hoc examination. Depression was defined
according to the DRPST. Because DRPST is a
screening tool, not a diagnostic tool, for the cases
of depression here we simply defined a statistically
significant probability of depression at the point of
this study, rather than as a diagnostic or an epi-
demiologic term. To determine which combination
of stressors best predicted which individuals were
cases of depression, a v2test was performed first to
determine which stressors were correlated to
depression. Then we used the logistic regression
model with conditional forward analysis to study
the significant stressors predictive of depression.
All data were analyzed with the SPSS 10.0 statis-
tical analysis software package.
The average age of the 832 police officers was
39.49±6.65 years. Most respondents (49.9%) had
finished their education to the junior college level.
Of the 832 officers, 93.3% were men and 82.8%
were married. The estimated rate of probable
major depression using a cutoff 2/3 of DRPST
(total scores: 0–3, those with scores of 2 or more
on the scale were cases of probable major depres-
sion) among the police was 21.6% (180/832).
Differences between the sexes were found in the
estimated rate of probable depression with 22.4%
(174/776) for men and 10.7% (6/56) for women.
The mean scores of PCS and MCS for all the
police officers were 50.55 and 41.02, respectively.
The men and women did not differ in the mean
scores for the quality of life, nor did marital status.
The officers’ past history and family history of
mental illness also did not affect the mean scores of
quality of life. However, educational level and age
affected the mean scores of quality of life. Those
with an educational level of university or above
had higher scores in every subscale. Younger po-
lice officers (634 yr) had higher scores in the sub-
scale of physical functioning and older police
officers (P50 yr) had higher scores in the subscales
of vitality, mental health, and MCS (Table 1).
Table 2 shows the effects of depression and
physical illness on the scores of the quality of life
subscales. Depressed police officers obviously had
lower scores than nondepressed police officers in
every subscale regardless of physical health. Those
with physical illness showed lower scores on the
subscales of physical illness, bodily pain, general
health, and PCS. In the group of nondepressed
police officers, those with physical illness also had
lower scores on the subscale of mental health.
According to the v2test, all divisions of the
three main stressors – economic stressors, family
problems, and job stressors – significantly corre-
lated with depression except for one family prob-
lem: separationor divorce.
regression model (Table 3), none of the economic
stressors was significantly predictive of depression;
however, three stressors of the four family prob-
lems were significantly predictive of depression.
Three of the five job stressors, ‘‘performance that
based on the achievement of the individual’s
quota,’’ ‘‘peer pressure about performance,’’ and
‘‘heavy workload’’ predicted depression.
This study used a quality of life survey of a large
sample of police officers in the Kaohsiung area to
depression. The results also provided a profile of
stressors correlated with depression for the police
officers. Collins and Gibbs  pointed out that the
proportion of police with measurable mental illness
has doubled over the past 10 years. Therefore,
Table 1. Analysis of variance of mean quality of life scores for education and age
£ 34 y/o
‡ 50 y/o
aUniversity or above > junior college, senior high school or below.
b£ 34 y/o, 35–49 y/o, P50 y/o.
cP50 y/o, 634 y/o, 35–49 y/o.
early recognition, diagnosis, and treatment of
policemen with mental illness are important to
decrease individual suffering as well as the eco-
nomic burden on the family and society.
The estimated rate of probable major depression
among the police officers was 21.6% (180/832).
The sampling of the police officers was purposeful;
they were recruited from those who voluntarily
participated ina health
Therefore, some of those who participated in our
survey might be those who cared about their
mental problems or those who had already suf-
fered from emotional illness. The rate of depres-
circumstances. However, if we assume that all
other police officers did not have major depression,
the estimated rate of major depression was around
4.0% (180/4,300). This is still higher than the
estimated rate of 0.97% for major depression re-
ported by the Taiwan Psychiatric Epidemiological
Project  and higher than that indicated in
another recent Taiwanese study (2.8%) .
Although DRPST is not a diagnostic tool, the
positive predictive value for a major depressive
episode was 83.3% . Those who were not con-
sistent with the diagnosis of major depressive dis-
order, with scores of 2 or more on the scale, were at
least noted to have depressive symptoms. These
might be individuals with dysthymia or subsyn-
dromal depression. Goldney et al. found that
although those with subsyndromal depression were
less disabled than those with specific depressive
Table 2. Analysis of variance of mean quality of life scores for the four groups (divided by depression and physical illness)
No depressionDepressionp value
1: a>b, c>d.
2: a, b>c, d.
4: a>b>c, d.
Table 3. Logistic regression model to predict depression in police
NumberOdds Ratio 95% Confidence Intervalp value
Little time to spend with families
Disharmony of marriage
Judgments from peers
syndromes, they also sought treatment and had the
same number of days of absenteeism as those with
depression other than major depression .
Therefore, those with subsyndromal depression
cannot be neglected.
The estimated rate of probable depression for
female police officers seemed lower than that for
male officers. Because most policewomen had of-
fice duties, the chances of facing dangerous or
stressful situations, as well as rotating shifts, which
include night duties and disruption of circadian
rhythms, were lower. Men are often the sole in-
come earners for their families, which increases
their perceived economic burden. According to the
results of our questionnaires, 69% (535/776) of
male officers considered that they had job stressors
and 52% (405/776) had economic stressors, but
only 41% (23/56) of female officers had job stres-
sors and 30% (17/56) had economic stressors.
Therefore, female police officers seemed to have
less stressful lives than their male counterparts.
However, because of the much higher percentage
of male police officers in this study, a similar study
with a larger female sample is necessary to fully
investigate these issues.
In the analysis of the quality of life subscales,
highly educated police officers had higher scores in
every subscale. Because most of the highly edu-
cated police officers did not serve as frontline
officers, they might have a better quality of life.
Physical strength declined with age, so the older
subjects had lower scores in physical functioning.
However, older age predicted higher scores in
vitality, mental health, and MCS. As we know,
police work includes moments of very high stress,
even terror, and police officers have to cope with
the high-tension state and emotional changes after
Experienced officers usually have developed better
stress management skills along with age and life
experience. If they cannot adapt to this kind of
occupational experience, they change jobs or post
away, otherwise, they might suffer from mental
illness under long-term stress and require early
retirement. In Taiwan, because police officers can
retire and receive generous retirement pay after
20 years, a 50-year-old police officer may retire.
Therefore, those who still work into their old age
might transfer to departments with easier duties
and lower tension such as office duty. Another
possible explanation for the phenomenon that
aging police officers exhibit better mental health is
that they achieve greater economic stability and
have fewer loans or debts to pay off.
Those with physical illness showed decreasing
scores in most of the subscales of the physical
dimension, which agrees with our general, intuitive
knowledge. In the group of nondepressed police-
men, those with physical illness also showed lower
scores on the subscale of mental health. Physical
illness seemed to affect the quality of life across
physical and mental dimensions with a predomi-
nant effect on the physical dimension . There-
fore, mental and physical function should be
emphasized simultaneously in any intervention for
those with physical illness.
As might be expected, depression was signifi-
cantlycorrelated with mental health. Cass et al. 
have demonstrated that the quality of life may be
used to evaluate mental health outcome for those
with recognized mental illness. Achat et al. 
postulate that depressive symptomatology is asso-
ciated with reduced levels of functioning across all
SF-36 domains, including the physical domain. It
has also been shown that the SF-36 physical
dimension scores are correlated with scores on
hospital anxiety and depression scales in the
. In our study, depression was significantly
correlated with the physical domain of SF-12 also,
regardless of physical illness. Many articles provide
evidence of the association between depression and
physical performance and suggest that recognition
and treatment of depression can be protective for
subsequent physical decline, and even lead to
improvement in physical functioning [25–27].
Lenert et al.  also found that remission of
depression produced changes in HRQoL, as
measured by the SF-12.
In the survey of overall quality of life for the
police officers, the PCS was very close to the norms
of general U.S. population (50.55 vs. 49.63);
however, the MCS was obviously lower than the
norms of general U.S. population (41.02 vs. 49.37)
. The MCS and all the mean scores of the
mental subscales were also obviously lower com-
pared with the previous community report in
Taiwan, even though the community was affected
by an earthquake . The high percentage of
depression may result in worse mental health in
the police officers. In the physical health domain,
because most of the police officers were young to
middle age and physically healthy, the PCS would
not be very different from the norms.
Although police work includes moments of very
high stress, even terror, police officers do not
experience these moments every day. Violanti and
Aron  demonstrated that police organizational
stressors increased psychological distress 6.3 times
more than inherent police stressors. We looked for
the stressors as the best predictors of depression.
Except for work stress, other dimensions of stres-
sors, including family problems and economic
stressors, were considered in this survey. In the
logistic regression model, none of the economic
stressors, three of the four family problems, and
three of the five job stressors predicted depression.
The income of the policemen is quite stable, and
Taiwanese culture is noted for its emphasis on the
family rather than the individual . Therefore,
one possible explanation is that only those with
economic stressors serious enough to affect the
whole family would become major problems for
the individual. Those with a stable job environ-
ment and family life receive pleasure and satis-
faction from their jobs and families, so they may
not feel depressed even under economic burden.
The strongest predictor of depression was family
problems, including little time to spend with fam-
ilies, disharmony of marriage, and child-rearing
problems. Family problems may result from the
uncertain work schedule, duties, and rotating
shifts. Police officers cannot work regular daytime
hours and thus lose opportunities to be with their
families at night or on weekends. Surprisingly,
divorce or separation was not a factor that pre-
dicted depression. However, in Chinese culture,
divorce or separation is discouraged, and couples –
especially those with children – are always
encouraged to stay together. Only those with very
serious and unresolved problems would divorce or
separate, and this might be the only way for them
to move to a less stressful life.
Job stress is often the focus of studies about
police mental health. We found the main predic-
tors of depression in the job stress aspect were
related to competition, honor, and workloads.
Most policemen value self-respect, which may re-
sult from the harsh training courses. They deny the
effects of occupational stress and trauma because
to admit to them might tarnish the ideal profes-
sional identity and lead to feelings of shame and
guilt. In addition, they are prohibited from pub-
licly expressing anger and hostility. These unusu-
ally stringent demands for self-control represent an
additional stressor . The interventions should
not only emphasize medical and welfare services
for police, but also training courses that teach
coping skills, such as specific techniques for man-
aging their anger and other negative emotions as
well as skills of stress management and relaxation.
The findings from our study could provide po-
lice departments with some information about the
main stressors, depression, and quality of life of
their officers. Modifying the workload and man-
agement climate, and developing techniques for
mitigating stressors in the department and between
individuals could improve the work environment.
Further psychiatric evaluation and treatment
should be provided to those who are at risk for
depression based on the results of the DRPST. If
the police department could offer mental health
services to officers at risk for depression, the
overall performance of the department might im-
This study has some limitations: First, because
the sampling of the policemen was purposeful and
only a screening questionnaire was applied in this
survey, the rate of depression might be overesti-
mated. Second, we surveyed only organizational
job stressors and did not emphasize work hazards.
Third, the positive predictive value of DRPST was
83.3%; therefore, around one-fifth of the cases of
probable major depressive disorder did not actu-
ally exhibit major depression. Fourth, the total
number of female police officers surveyed was
inadequate. These aspects should be considered in
The study was supported by grants from the
Bureau of Health, Kaohsiung City and from the
National Science Council, Republic of China
(No. NSC 94–2625-Z-280–001). The authors also
appreciated the help from the Kaohsiung City
Government Police Bureau.
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Address for correspondence: Dr. Frank Huang-Chih Chou,
Department of Community Psychiatry, Kai-Suan Psychiat-
ric Hospital, 130 Kai-Suan 2nd Rd., Kaohsiung, Taiwan
Telephone: +886-7-7513171, ext 2232; Fax: +886-7-5373299
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