Mental health symptoms in Public Safety Personnel: Examining the effects of adverse childhood experiences and moral injury

Sophia L Roth; Krysta Andrews; Alina Protopopescu; Chantelle Lloyd; Charlene O'Connor; Bruno J Losier; Ruth A Lanius; Margaret C McKinnon

doi:10.1016/j.chiabu.2021.105394

Mental health symptoms in Public Safety Personnel: Examining the effects of adverse childhood experiences and moral injury

Child Abuse Negl. 2022 Jan:123:105394. doi: 10.1016/j.chiabu.2021.105394. Epub 2021 Nov 19.

Authors

Sophia L Roth¹, Krysta Andrews², Alina Protopopescu³, Chantelle Lloyd³, Charlene O'Connor⁴, Bruno J Losier⁵, Ruth A Lanius⁶, Margaret C McKinnon⁷

Affiliations

¹ Departments of Psychology, Neuroscience & Behaviour, McMaster University, Hamilton, ON, Canada; Homewood Research Institute, Guelph, ON, Canada. Electronic address: roths1@mcmaster.ca.
² Homewood Research Institute, Guelph, ON, Canada; Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada.
³ Departments of Psychology, Neuroscience & Behaviour, McMaster University, Hamilton, ON, Canada; Homewood Research Institute, Guelph, ON, Canada.
⁴ Homewood Research Institute, Guelph, ON, Canada; Program for Traumatic Stress Recovery, Homewood Health Centre, Guelph, ON, Canada.
⁵ Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada; Forensic Psychiatry Program, St. Joseph's Healthcare Hamilton, ON, Canada.
⁶ Departments of Psychiatry, Western University, London, ON, Canada; Departments of Neuroscience, Western University, London, ON, Canada; Imaging Division, Lawson Health Research Institute, London, ON, Canada.
⁷ Homewood Research Institute, Guelph, ON, Canada; Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada; Mood Disorders Program, St. Joseph's Healthcare Hamilton, Hamilton, ON, Canada. Electronic address: mckinno@mcmaster.ca.

PMID: 34808481
DOI: 10.1016/j.chiabu.2021.105394

Abstract

Background: Adverse Childhood Experiences (ACEs) increase risk for negative mental health outcomes in adulthood; however, the mechanisms through which ACEs exert their influence on adult mental health are poorly understood. This is particularly true for Public Safety Personnel (PSP; e.g., police, firefighters, paramedics, etc.), a group with unique vulnerability to negative psychiatric sequalae given their chronic exposure to potentially traumatic, work-related events.

Objectives: To examine the role of moral injury (MI) and emotion regulation in the relation between ACEs and adult mental health symptoms in adulthood.

Participants and setting: Participants (N = 294) included a community sample of Canadian and American PSP members aged 22 to 65.

Methods: The current study uses cross-sectional data collection via retrospective self-report questionnaires administered between November, 2018 and November, 2019 to assess level of ACEs (ACE-Q), emotion regulation difficulties (DERS) and symptoms of post-traumatic stress (PCL-5), dissociation (MDI), depression, stress, and anxiety (DASS-21). Additionally, participants completed the Moral Injury Assessment for Public Safety Personnel, the first measure of MI developed specifically for PSP.

Results: Path analysis revealed that ACEs significantly predicted adverse mental health symptoms in adulthood; this effect was mediated by symptoms of MI and moderated by difficulties with emotion regulation.

Conclusions: This study is the first to identify MI as a mechanism involved in the relation between ACEs and adult psychopathology and highlights the protective role of emotion regulation skills. These findings can inform the development of future research and clinical interventions in PSP populations.

Keywords: ACEs; Emotion regulation; Moral injury; PTSD; Public safety personnel; Trauma.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Adult
Adverse Childhood Experiences*
Aged
Canada
Cross-Sectional Studies
Humans
Mental Health
Middle Aged
Retrospective Studies
Stress Disorders, Post-Traumatic* / epidemiology
Stress Disorders, Post-Traumatic* / psychology
Young Adult

Grants and funding

CIHR/Canada