Salivary Measures of Stress and Immunity in Police Officers Engaged in Simulated Critical Incident Scenarios

College of Nursing, University of South Florida, Tampa, FL 33612, USA.
Journal of occupational and environmental medicine / American College of Occupational and Environmental Medicine (Impact Factor: 1.63). 06/2010; 52(6):595-602. DOI: 10.1097/JOM.0b013e3181e129da
Source: PubMed


This research investigated the effects of a critical incident lethal force scenario on a panel of salivary biomarkers, measured at baseline and then at 10 and 30 minutes postscenario, in 141 law enforcement volunteer officers.
Officers were randomly assigned to two virtual reality scenarios. One scenario was brief and involved a police officer chasing a suspect on a motorcycle, confronting the suspect who draws a gun and shoots the police officer. The other scenario involved a lengthy chase by the police officer through a workplace of an armed perpetrator ultimately engaging in gunfire with the police officer. Saliva was analyzed for cortisol, secretory immunoglobulin A (sIgA), interleukin-6, and alpha-amylase concentrations.
The "workplace" scenario produced the largest responses in biomarkers, with significant rises in cortisol, interleukin-6, alpha-amylase, and secretory immunoglobulin A. These data suggest that virtual reality can produce stress and immune effects.
This research suggests that virtual reality scenarios produce physiologic stress responses, mimicking occupational stress.

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    • "Another study investigated law enforcement officers during two virtual reality scenarios of different intensity (short chase of a motorcyclist vs. lengthy chase of an armed suspect engaging in gunfire; Groer et al., 2010). Cardiovascular markers as well as salivary cortisol and alpha-amylase (sAA), a surrogate marker of autonomic activity (e.g., Granger et al., 2007; Nater and Rohleder, 2009), were markedly increased in the lengthy scenario while sAA was even increased during the short chase (Groer et al., 2010), confirming the stressfulness of these situations. However , some shortcomings of virtual reality scenarios have to be considered. "
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    ABSTRACT: Introduction: Police work is one of the most demanding professions with various sources of high occupational stress. Among the most demanding tasks are amok situations, such as school shootings. Hardly anything is known about endocrine and cardiovascular markers in safety professionals during emergency situations in real life and how this relates to stress perception and management. This study will therefore explore police officers' stress responses to a reality-based school shooting simulation assessing neuroendocrine, cardiovascular, and psychological stress markers. Methods: A convenience sample of 50 police officers (39.5 ± 8.7 yrs, 9 women) participating in a basic or refresher amok training session for the German uniformed and criminal police were recruited. Saliva samples were collected shortly before the simulation task (school shooting), immediately after, 20 and 45 min after finishing the task for the assessment of cortisol and alpha-amylase (sAA), as markers of the hypothalamic-pituitary-adrenal axis and the autonomic nervous system, respectively. Heart rate (variability) was assessed continuously. Officers rated their actual mood right before and 10 min after the simulation. Subjective experience of task stressfulness was assessed minutes after finishing the simulation. Results: Overall, the simulated school shooting did not result in changes of mood, tiredness, or calmness but higher restlessness was experienced during the basic training, which was also experienced as more controllable. Female officers reported to experience more strain and anxiety. Cortisol showed highest levels at the beginning of the training and steadily decreasing values thereafter. In contrast, sAA increased substantially right after the simulation with officers on the front position showing most pronounced changes. Cardiovascular reactivity was highest in officers acting on the side positions while advancing to find the suspect. Furthermore higher self-efficacy as well as, by trend, controllability and relevance of results correlated with cardiovascular measures. Discussion: Autonomic but not endocrine stress markers increased to a simulated school shooting, which were further related to the subjective experience of the simulation. Our results provide a more in-depth picture of stress responses in such situations, which will in the long run raise the possibility to refine training programs, design more effective stress-management strategies for these critical incidents, and improve performance but also coping with work-related stress.
    No preview · Article · Sep 2014 · Psychoneuroendocrinology
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    • "The techniques used to collect saliva varied among the reviewed studies , although the majority (eight) of the 13 studies used Salivettes (Campisi et al., 2012; Dugue et al., 1996; Filaire et al., 2010; Ilardo et al., 2001; Mastrolonardo et al., 2007; Minetto et al., 2005; Usui et al., 2012; Zefferino et al., 2006). Four studies used the passive drool method only (Groer et al., 2010; Izawa et al., 2013; Lester et al., 2010; Mahmood and Ibrahim, 2013), and one study used both Salivette and passive drool methods to collect saliva (Minetto et al., 2007). In comparison to passive drool, levels of salivary testosterone, DHEA, progesterone, and estradiol were found to be higher when collected using Salivettes, whereas salivary IgA levels were lower (Shirtcliff et al., 2001). "
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    ABSTRACT: There is burgeoning interest in the ability to detect inflammatory markers in response to stress within naturally occurring social contexts and/or across multiple time points per day within individuals. Salivary collection is a less invasive process than current methods of blood collection and enables intensive naturalistic methodologies, such as those involving extensive repeated measures per day over time. Yet the reliability and validity of saliva-based to blood-based inflammatory biomarkers in response to stress remains unclear. We review and synthesize the published studies that have examined salivary markers of inflammation following exposure to an acute laboratory stressor. Results from each study are reviewed by analyte (IL-1β, TNF-α, IL-6, IL-2, IL-4, IL-10, IL-12, CRP) and stress type (social-cognitive and exercise-physical), after which methodological issues and limitations are addressed. Although the literature is limited, several inflammatory markers (including IL-1β, TNF-α, and IL-6) have been reliably determined from saliva and have increased significantly in response to stress across multiple studies, with effect sizes ranging from very small to very large. Although CRP from saliva has been associated with CRP in circulating blood more consistently than other biomarkers have been associated with their counterparts in blood, evidence demonstrating it reliably responds to acute stress is absent. Although the current literature is presently too limited to allow broad assertion that inflammatory biomarkers determined from saliva are valuable for examining acute stress responses, this review suggests that specific targets may be valid and highlights specific areas of need for future research.
    Full-text · Article · Sep 2014 · Brain Behavior and Immunity
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    • "In a recent study, Ramey et al. (2012) examined the inflammatory cytokine response in law enforcement officers and found that the job demand (physical and psychological) assessed by the Job Content Questionnaire was positively associated with resting IL-1 beta and IL-6. This finding is further supported by Groer et al. (2010) who demonstrated a significant increase in salivary IL-6 in police officers following simulated workplace scenario (6 min of tracking a gunman through a building. It is important to note that ~23% of law enforcement officers who reported metabolic syndrome were physically inactive (Yoo et al., 2009). "
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    ABSTRACT: Psychological stress has been proposed as a major contributor to the progression of cardiovascular disease (CVD). Acute mental stress can activate the sympathetic-adrenal-medullary (SAM) axis, eliciting the release of catecholamines (NE and EPI) resulting in the elevation of heart rate (HR) and blood pressure (BP). Combined stress (psychological and physical) can exacerbate these cardiovascular responses, which may partially contribute to the elevated risk of CVD and increased proportionate mortality risks experienced by some occupations (e.g., firefighting and law enforcement). Studies have supported the benefits of physical activity on physiological and psychological health, including the cardiovascular response to acute stress. Aerobically trained individuals exhibit lower sympathetic nervous system (e.g., HR) reactivity and enhanced cardiovascular efficiency (e.g., lower vascular reactivity and decreased recovery time) in response to physical and/or psychological stress. In addition, resistance training has been demonstrated to attenuate cardiovascular responses and improve mental health. This review will examine stress-induced cardiovascular reactivity and plausible explanations for how exercise training and physical fitness (aerobic and resistance exercise) can attenuate cardiovascular responses to stress. This enhanced functionality may facilitate a reduction in the incidence of stroke and myocardial infarction. Finally, this review will also address the interaction of obesity and physical activity on cardiovascular reactivity and CVD.
    Full-text · Article · Nov 2013 · Frontiers in Physiology
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