Factors Associated with Suicide among Police Officers in Brazil: An Integrative Literature Review Study

Introduction

Police activity represents a stressful occupation with a significant negative impact on the mental and physical health of the professional and can generate high rates of depression, anxiety, exhaustion and lead to suicide [1]. Rescuers such as police, firefighters and paramedics have in their occupational routines occupational events capable of providing greater risks to mental health such as suicidal thoughts and behaviors. In contrast, factors such as companionship and pre-recruitment screening can serve as protective agents against the appearance of disorders or maintenance of psychiatric conditions in this population [2].

Among the feelings of risk, hopelessness represents a manifestation of psychological vulnerability that has an important relationship with the reduction of personal fulfillment of the police officer. This condition generates a negative potential for the mental health of police officers, which, in addition to depression and emotional exhaustion, is associated with a higher risk of suicide [3].

Thus, it is necessary to identify and understand the factors that are related to suicidal ideation among security professionals, due to their exposure to stressors that can intensify an important psychological imbalance [4]. Given the above, this integrative literature review aimed to identify the factors associated with suicide among police officers in Brazil.

Material and Methods

This is an integrative review conducted through the systematic search for scientific studies, critical evaluation and synthesis of available evidence on the investigated topic. The methodological tool adopted in the execution of the investigation was PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses). The study was conducted considering six methodological steps [5]: a) definition of the guiding question; b) systematic search of evidence; c) categorization of studies; d) evaluation of selected studies; e) interpretation of evidence; f) synthesis and presentation of the results.

The following guiding question was defined: “What are the factors associated with suicide among Brazilian police officers?”. Searches were performed in November 2023 in the scientific databases Virtual Health Library (VHL) (https:// pesquisa.bvsalud.org/portal/) and PubMed (https:// pubmed.ncbi.nlm.nih.gov/), from the search key: ((POLICE) AND (SUICIDE)) AND (BRAZIL). The descriptors used were extracted from the Mesh/National Library of Medicine platform.

Original articles published in the last 10 years that presented characteristics, profile and risk factors associated with suicide were included. Literature review studies, dissertations, theses, letters to the editor and articles in duplicate were excluded.

The search resulted in 67 studies published in the last 10 years, from the use of descriptors in both databases (35 in VHL and 32 in PUBMED). Then, the title, abstract and keywords were read to identify the objective of the studies and selection criteria; at this stage, 19 studies were selected. These were analyzed in full and 14 articles were excluded. Thus, five investigations made up the final sample of this review (Figure 1). A data collection form was used for critical analysis of the studies, consisting of the following information: title; authors; year; place of study execution; sample; objective; design and main results.

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Results

The studies were published between 2007 and 2022. The sample consisted of quantitative descriptive studies (n=3), retrospective cohort (n=1) and ecological time series (n=1). The surveys had samples mostly composed of military police men [6, 7, 8, 9]; only one study investigated federal highway police officers [10]. Table 1 shows the characteristics of the selected studies.

Discussion

The relationship between suicidal behavior and the police profession may be associated with problems that go beyond their occupational activities, such as financial limitations [7, 9], sex [6] and age [8, 10]. Posttraumatic stress disorder (PTSD) appears to be an important condition associated with suicide. In a sample of 157 police officers, 8.9% had full PTSD and 16% had partial PTSD, and the officers with full PTSD, compared to those without PTSD, were five times more likely to divorce and present, more often, suicidal ideation, a condition that can eventually lead to self-extermination [6].

The commitment of professional wage income by loans and debts was a factor that was related to the history of suicide and suicidal ideation [9]. The fear of not complying with financial obligations can cause a psychological imbalance and generate pathological conditions such as anxiety, stress and depression, factors associated with suicidal ideation [7].

Characteristics such as younger age, male sex and low career graduation were associated with suicide among police officers [8, 10]. This result may be associated with psychological overload in early career, a condition of greater difficulty to deal with stress. In contrast, married men with children also presented suicidal ideation, which may suggest an insufficient income for family support or compliance with financial obligations [9].

There was a shortage of studies conducted in Brazil and other police institutions such as Civil and Federal. This limits the comparability of the identified evidence. However, the results become relevant as police institutions identify, preventively; the factors associated with suicidal ideation and can create strategies that help professionals deal with the obstacles inherent in police practice.

Conclusion

The factors associated with suicide and suicidal ideation among police officers in Brazil were financial complications, psychopathological comorbidities, male sex, young age and incipient career graduation. New studies should be developed on the theme addressed, including also other police institutions, offering samples and more comprehensive epidemiological scenarios.