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Journal of Occupational & Environmental Medicine:
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A Topography of Psychiatric Disorders Among Correction Officers

Tartaglini, Aldo J. PhD; Safran, David A. PhD

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From Daval Star, Inc. Research & Consulting, New York, NY.

Address correspondence to: Aldo J. Tartaglini, PhD, Daval Star, Inc. Research & Consulting, 333 E. 33rd. Street #1A, New York, NY 10016.

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This study assessed the nature, scope, and work-related impact of psychiatric disorders among correction officers. It also examined the effect of psychiatric diagnoses on occupational functioning. Medical charts of 1029 correction officers with complaints of psychological distress were reviewed for DSM-III-R diagnoses and duration of disability. Subjects evinced a wide range of psychiatric conditions, accounting for a substantial loss of full-duty workdays. The most frequently observed diagnoses were V Codes, mood and adjustment disorders. The most disabling conditions in terms of duration of disability were mood, anxiety, and personality disorders. V Codes accounted for the highest cumulative duration of disability among all officers. Results suggest that psychiatric disability among correction officers is most often a function of V-Code conditions, as opposed to major Axis I or II psychopathology.

The law enforcement professions have long been considered inordinately stressful.1-4 Police and correction officers appear to be at a higher risk for debilitating stress-related illness than the civilian population.5-8 Most of the occupational health literature in this area has focused on physical illness.

Studies that have focused on psychological disorders have documented high rates of substance abuse, marital discord, and suicide among law enforcement officers.4,9,10. To date, no systematic effort has been made to assess the overall topography of psychiatric disorders among law enforcement personnel and how these conditions affect occupational functioning.

The dearth of empirical information regarding psychiatric disorders among police and correction officers may reflect the traditional insularity of the law enforcement professions or other inherent barriers to data collection.11,12 It may also stem from the tendency for researchers in this field to emphasize imprecise and/or nonstandard characterizations of psychological complaints among officers, as opposed to discrete forms of psychopathology.11 Extensive use of global terms such as "stress" and "burnout" presents difficulties to researchers attempting to make a priori predictions regarding the nature, scope, and work-related impact of specific psychiatric disorders among officers. This trend is particularly prominent in the correctional literature.6 Correctional researchers are faced with additional obstacles, such as the overreliance of investigators on police populations and the tendency to generalize findings across diverse occupational groups. Finally, reports have rarely quantified the impact of psychiatric disorders on occupational functioning.

The importance of investigating psychiatric disorders among correction officers is underscored by the fact that the US correctional system is expanding rapidly13,14 and is likely to attract workers with little or no experience in the field.15,16 These officers may be at greater risk for debilitating mental health conditions when confronted with the exigencies of physically and psychologically challenging jail environments.

Prisons and jails are generally considered psychologically hazardous work environments.6 Studies in the neglected area of correction-officer occupational health may aid efforts to safeguard employee mental health, optimize job performance, and improve the efficiency of correctional facilities.6

This study assesses the nature, scope, and work-related impact of specific DSM-III-R disorders among 1029 correction officers in a large urban jail setting. The effect of DSM-III-R Axis I and Axis II conditions on occupational functioning, as reflected in job attendance and ability to maintain full-duty status, is examined.

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Data were obtained from the charts of 1029 correction officers who presented with a complaint of debilitating psychological distress at a departmental clinic over the two-year study period. This figure represented approximately 10% of the total number of officers employed by the department. The officers were required to undergo diagnostic assessment and monitoring by staff psychologists (who were not connected with the present investigation) until they were able to return to full duty.

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Clinic charts were reviewed for DSM-III-R diagnoses and duration of disability, operationalized as length of time on sick leave/modified duty. Data were number-coded to ensure confidentiality. Officers who returned to full duty and had no contact with the clinic for at least three months were considered inactive cases. Diagnoses were grouped into ten clusters for statistical analysis. Summary statistics for diagnosis were calculated for the entire sample. Rates of psychiatric disorders among subjects were compared with available rates from the general population. Inferential procedures were applied to inactive cases (n = 848) to assess the differential impact of psychiatric disorders on duration of disability.

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The distribution of diagnostic clusters among correction officers in the entire sample (n = 1029) is as follows: (1) mood disorders, 18.56%; (2) psychotic disorders, 0.58%; (3) adjustment disorders, 11.66%; (4) nonphobic anxiety disorders (Post-Traumatic Stress Disorder, Panic Disorder, and Generalized Anxiety Disorder), 7.9%; (5) alcohol abuse, 4.47%; (6) personality disorders, 3.50%; (7) phase of life/life circumstance/marital/family problems, 36.35%; (8) occupational problems, 3.79%; (9) uncomplicated bereavement, 4.47%; and (10) malingering/none, 8.65% (Fig. 1).

Fig. 1
Fig. 1
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These results are comparable to those obtained from inactive cases only (n = 848). They are also consistent with results obtained from the first and second years of the study period examined separately, suggesting that the overall configuration of psychiatric disorders in this population is stable over time.

Compared with a sample of non-institutionalized civilians studied by Kessler et al,17 correction officers have a higher rate of mood disorders (18.56% vs 11.3%), alcohol abuse (4.47% vs 2.5%), and nonphobic anxiety disorders (7.9% vs 5.4%). The rate of adjustment disorders in correction officers (11.66%) was also elevated, compared with that of psychiatric outpatients (10%).18

Correction officers had lower rates of personality disorders than did a weighted sample of community residents (3.5% vs 5.9%).19 Officers were also found to have a lower prevalence of psychotic disorders than noninstitutionalized adults (0.58% vs 0.8%). The rates of mood, adjustment, and alcohol abuse disorders were higher in correction officers than in the general population.20

Mean duration of disability ranged from 96.8 days for Cluster 10 (malingering/none) to 295.8 days for Clusters 4 (anxiety disorders) and 6 (personality disorders) (Table 1).

Table 1
Table 1
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Mean duration of disability was highest in Clusters 1 (mood disorder), 4 (anxiety disorder), 5 (alcohol abuse), and 6 (personality disorder), and lowest in Clusters 7 (phase of life/marital/family problem), 8 (occupational problem), 9 (uncomplicated bereavement), and 10 (malingering/none).

Mean duration of disability differed significantly across diagnoses (H = 112.49, P = 0.00, Kruskal-Wallis test). Mann-Whitney U tests identified 22 significant contrasts (Table 2).

Table 2
Table 2
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Duration of disability scores for the mood, anxiety, and personality disorders were significantly higher than those associated with the other diagnostic clusters.

Cumulative duration of disability associated with each diagnostic group ranged from 286 days for Cluster 2 (psychotic disorders) to 53,169 days for Cluster 7 (phase of life/marital/family problem) conditions.

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Subjects evinced a wide range of psychological conditions, which accounted for a substantial loss of full-duty workdays. The most frequently observed diagnostic clusters were phase of life/marital/family problem, followed by mood and adjustment disorders.

Results suggest that the prevalence of mood, adjustment, and alcohol abuse disorders in correction officers is higher than that observed in the general population. The rates of psychotic disorders and personality disorders among officers were notably lower than those seen in the general population.

Occupations that foster a sense of helplessness tend to have higher rates of mood disorders among employees.21 Corrections may well be one such occupation due to rotating shift work, mandatory overtime, the need to take orders in a rigid quasi-military environment, and other factors.10 That relatively high rates of mood disorders are likely to be found among correction officers is supported by the finding of a high rate of suicide among law enforcement personnel.22

The finding of a higher rate of alcohol abuse among correctional personnel is consistent with previous research.6 However, rates for other disorders require replication across diverse prison settings and populations before these disorders can be considered reliable correlates of correctional work.

Although the most disabling conditions in terms of mean duration of disability were mood, anxiety, and personality disorders, phase of life/marital/family problems accounted for the highest cumulative duration of disability among all officers. The results suggest that psychological disability among correction officers is most often a function of V Code conditions, as opposed to major Axis I or II psychopathology.

That common stressors such as marital and family problems should prove so deleterious to occupational functioning in these officers warrants further investigation. It may be the case that psychologically toxic phenomena in the correctional workplace play an iatrogenic role, reducing stress tolerance, potentiating normal life stressors, and inducing disability where it would not otherwise occur.

Correctional work is demonstrably stressful and dangerous.23 In addition to the rotating shift work, mandatory overtime, contradictory roles, quasi-military power structure, and constant threat of violence from inmates, officers must contend with other, more subtle factors that make working conditions difficult. In the workplace, officers typically experience long periods of relative quiescence, punctuated by extreme emergency situations requiring quick thinking and carefully choreographed responses. The unpredictability of inmate behavior necessitates a continual level of vigilance and response-readiness that officers may find aversive.

Another factor is continual immersion in the inmate milieu, which supports norms and values that are in competition with those of the institution. Officers must be conversant with inmate mores and priorities in order to function in the correctional environment without undue threat of assault, yet they must also be willing to enforce institutional rules as appropriate. Failure to successfully navigate the two competing value systems may result in conflict with inmates, prison authorities, or both.

Finally, the inherently stressful nature of front-line corrections is compounded by organizational factors such as haphazard selection practices, counterproductive management policies, poor communication among staff, lack of teamwork, and other manifestations of organizational dysfunction. These workplace phenomena can interact with and exacerbate latent psychological vulnerabilities among officers, making them less resilient to the effects of common life stressors.19

Although it is not possible to eliminate the influence of life stressors and debilitating psychological illness, correctional organizations can adopt proactive strategies to decrease the psychological toxicity of the workplace. For example, wellness clinics can offer outreach counseling for officers who have experienced recent personal losses or job-related trauma (eg, riots, inmate suicide, deadly use of force) to reduce the deleterious impact of such stressors. Officers in need of more extensive treatment can be referred to outside mental health providers.

The success of these strategies may depend on the degree to which officers feel comfortable accessing available mental health services. Specifically, the issue of stigma associated with mental health treatment must be addressed. Since officers often consider seeking and accepting psychiatric care a mark of weakness with possible career implications, mental health services must be well-insulated from the correctional work environment.

Another approach to improving the occupational health of correction officers involves interventions directed at the organization itself. Techniques such as Total Quality Management, Continuous Quality Improvement, and more specialized forms of "organizational therapeutics" can reduce organizational dysfunction, improve efficiency, and thereby promote the psychological health of the workforce.

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17. Kessler RC, McGonagle KA, Zhao S, et al. Lifetime and 12-month prevalence of DSM-III-R psychiatric disorders in the United States. Arch Gen Psychiatry. 1994;51:8-19.

18. Kaplan HI, Sadock BJ, Grebb, JA. Kaplan and Sadock's Synopsis of Psychiatry, 7th ed. Baltimore: Williams & Wilkins; 1994.

19. Samuels JF, Nestadt MB, Romanoski AJ, Folstein MF, McHugh PR. DSM-III personality disorders in the community. Am J Psychiatry. 1994;151:1055-1062.

20. Regier DA, Boyd JH, Burke JD, et al. One-month prevalence of mental disorders in the united states. Arch Gen Psychiatry. 1988;45:977-986.

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23. Van Fleet F. The Effective Correctional Officer. Fredericksburg, VA: American Correctional Association; 1992;37-4.

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Pot Goes to Pot

…. German police are testing a new way to measure a driver's level of intoxication from hashish or marijuana. Until now, blood and urine tests showed only whether any cannabis was present, not how much. And in a country where soft-drug use has been "officially tolerated" since 1994, German cops have had trouble deciding how high is too high. The new Cannabis Intoxication factor (CIF) test is showing them:anyone with a CIF of 10 is about as unfit to drive as someone with 0.11 blood alcohol level….

From Periscope. Newsweek, September 16, 1996, p 6.

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