Law enforcement study finds link between head injuries and depression, PTSD

A new study sheds light for the first time on the high prevalence of head injuries and associated psychological distress in a population previously overlooked when it comes to concussion surveillance: police officers.

The survey of Ohio police officers found that 74% reported having one or more head injuries in their lifetime, and 30% had a head injury that occurred on the job. Many more of these injuries went unreported than were treated by a health care professional. And further analysis showed that post-traumatic stress disorder and depressive symptoms were higher among those who had one or more head injuries.

“This is an area where we need to raise awareness, just as we have done in the sports world with regard to concussions,” said lead author Jaclyn Caccese, Ph.D., assistant professor in the School of Health and Rehabilitation Sciences at The Ohio State University Wexner Medical Center.

“The goal is to improve the safety and health of officers in the long term,” said Caccese, also a researcher in Ohio State University’s Chronic Brain Injury Program.

“And I think there’s a lot of potential, especially when it comes to improving career longevity. While treating these injuries is difficult at the time, it leads to longer careers, better health outcomes and better quality of life, not only in their employment but also in their retirement. I think with that realization, they’re more likely to report injuries when they do get them.”

The study was published on August 5, 2024 in the Journal of Head Trauma Rehabilitation.

The medical and law enforcement researchers who co-authored the study published a separate report paperin the Journal of Athletic Trainingwhich advocates the implementation of a return-to-duty protocol for police officers following concussion, similar to practices already in place in sports and the military.

The researchers surveyed 381 law enforcement personnel in central Ohio about their history of head injuries in their lifetime, years of service in the military and civilian law enforcement, and rank and section assignment (such as patrol, corrections or administration). The participants also completed questionnaires to assess symptoms of PTSD and depression.

Of those respondents, 282 reported one or more previous head injuries, primarily from sports, followed by incidents such as falling or being hit by something or someone, being in a car accident, or being exposed to an explosion. More than 50% of participants reported head injuries that resulted in loss of consciousness or followed by numbness or confusion, or a gap in memory—all signs of a probable traumatic brain injury (TBI). A concussion is considered a mild TBI.

About 9% of total respondents tested positive for PTSD symptoms, and 36% reported mild or more severe depressive symptoms. Participants with a previous head injury reported higher symptoms for both conditions. Researchers estimate that fewer than one in four head injuries were diagnosed or treated by a health care provider.

Caccese said researchers are still learning more about the long-term effects of concussions, but current evidence shows that untreated head injuries can increase the risk of depression, anxiety, PTSD and problems with cognitive function and memory.

For law enforcement officers, concussions are common in the heat of the job. The stress of the role and poor sleep from shift work are also common in this population. The circumstances can contribute to poorer outcomes after a head injury.

“Sometimes law enforcement officers have to complete the task that they set out to do, or it’s not a safe environment to immediately remove yourself from your job. And I think sometimes adrenaline masks concussion symptoms,” Caccese said.

“In sports, we’ve been able to increase removal from play and improve rehabilitation and return to play after injury. Hopefully that will improve long-term health outcomes for athletes. We’re trying to translate that information into the professional context.”

Study co-author Josh Walters, a deputy sheriff in the Franklin County, Ohio, Sheriff’s Office, leads his office’s peer support team of deputy sheriffs who are certified to work with personnel dealing with a variety of issues. Collaborating to study head injuries and their association with PTSD and depressive symptoms grew out of the peer group’s long-standing collaboration with Ohio State researchers and clinicians to improve the health of deputy sheriffs through physical therapy, sleep studies and concussion-related training.

“Part of what we’re doing with Ohio State is looking at how we can extend the health of the deputy sheriff?” Walters said.

“Being physically fit is an important part of our job because not only do my colleagues depend on me, but the community depends on me. And if I can’t keep up physically, it could be a life-threatening situation for someone.”

The next step is to implement the team’s proposed return-to-service protocol. This protocol consists of discharge, a gradual increase in activity, and screening by a medical provider before full resumption of service. Its effectiveness and adaptability to different organizations will then be tested.

“Now we have some data that we can present to boards, unions and leaders who say, ‘Here’s the problem. Here’s how we can fix it. Let’s go through that process,’” Walters said.