Factors Influencing Occupational Stress of State Security Forces During the COVID-19 Pandemic: A Scoping Review

Introduction

The pandemic situation caused by COVID-19 has posed significant and unprecedented challenges to police forces worldwide.¹ Police officers were responsible for enforcing the rules and other public health measures implemented during the lockdown aimed at curbing the spread of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2). The unpredictable nature of the situation and the uncertainty about the control and/or potential danger of the disease subjected police officers to considerable psychological pressure in addition to the health-related dangers.^1,2

Police officers faced a multitude of risk factors during the COVID-19 pandemic that could potentially impact their well-being. These included the constant possibility of infection, frequent changes in government guidelines and adjustments in police protocols, a highly stressful work environment, and working under exceptional conditions.³

An individual’s response to internal and external threats and challenges, which can cause major changes in their physical and mental state, is known as stress.⁴ Both the Transactional Model of Stress and Coping by Lazarus et al⁵ and the General Strain Theory by Agnew⁶ offer a valuable perspective for understanding the stress experienced by police officers during the pandemic. According to these theories, stress arises when individuals perceive a discrepancy between the demands of the environment and their coping resources in a particular situation. The individual assesses the level of stress resulting from environmental demands, known as stressors, and evaluates the own availability and effectiveness of coping resources to meet these demands. In the case of police officers, stressors such as the risk of infection and additional workload frequently exceeded their available resources, leading to a state of negative stress, accompanied by fatigue and impaired mood.^7,8

Some authors have classified possible stressors as either organisational (caused by the police administration and management) or inherent to the job (derived from the performance of their duties). In contrast, other authors have distinguished four groups according to the sources of risk, including management, task performance, community or context, and the judicial system.⁹

During the pandemic, police officers encountered new stressful situations in addition to the ones they have always encountered.¹⁰ Firstly, the outbreak of the novel coronavirus (SARS-CoV-2) has become a constant threat to one’s own health and, particularly, the health of family and friends. Furthermore, the introduction of new protocols and the implementation of new social norms caused many people to react against authority in times of pandemic.^3,11 At the same time, the initial phase of the pandemic was characterised by a shortage of personal protective equipment and a continuous adjustment of working hours due to contagions and rotations. Changes in the working team, a certain degree of social isolation, the need to quickly adapt to changing procedures, the limited availability of work permits, and the threat of being assaulted, among others, increased the workload and stress among the officers.^11–13 Possible manifestations of high levels of stress include headaches, frustration, digestive disorders, fatigue, difficulty in interpersonal relationships, or insomnia.^14,15 Other professionals, such as health professionals, were afraid to work and faced personal and family risks due to the possibility of contracting the virus. Despite this, just as with police officers, their commitment and dedication motivated them to offer the best care possible.¹⁶ Consequently, prolonged and intense stress resulting from a high-risk environment, high-intensity work demands, and a high workload can potentially lead to more serious mental health issues such as depression, substance abuse, and suicide.

It is necessary to evaluate the stress experienced by police officers during the COVID-19 pandemic, as this was a frontline group that faced the virus and suffered a significant rise in their workload, having to fulfil both their regular duties and new responsibilities related to enforcing public health measures. This situation, combined with uncertainty and prolonged exposure to high-risk environments, likely had a considerable impact on their mental health, manifesting in high levels of stress, anxiety, and exhaustion. Evaluating this issue is crucial not only to protect the well-being of officers but also to ensure an adequate response to future public health emergencies or similar crises. Thus, it is crucial to implement protection and prevention mechanisms aimed at these occupational groups.¹⁷

As a result, this review aimed to assess the factors influencing the occupational stress of state security forces during the COVID-19 pandemic.

Methods

Study Design

A scoping review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines for scoping reviews.¹⁸ We then followed the guidelines set out by Popay et al¹⁹ to carry out a narrative synthesis. This framework consists of four main principles: 1) Developing a theory of the stressors faced by state security forces during the COVID-19 pandemic; 2) Developing a preliminary synthesis of the findings across the included studies; 3) Exploring the relationships between the sets of data; and 4) Assessing the robustness of the synthesis.

Databases and Search Strategy

Using the Condition, Context, Population (CoCoPop) strategy²⁰ (Table 1), we conducted the search in the Pubmed, Scopus, and Web of Science electronic databases based on the keywords that the research question yielded.

Table 1 CoCoPop Format: Keywords

Based on these keywords, the Medical Subject Headings (MeSH) thesaurus was consulted, yielding the following descriptors: Police, Psychological Distress, Psychological Stress, and COVID-19. We used related terms to complete the search strategy based on the MeSH descriptors (Table 2), linking them with Boolean operators and/or to enhance the number of published studies related to the study’s subject.

Table 3 shows the search strategy used, carried out on 05 April 2024 in each of the databases mentioned above during the search process.

Table 2 Terms Used in the Search

Table 3 Search Strategy

Selection Criteria

The following criteria were used for the selection of the articles:

Inclusion Criteria

• Type: original articles, and meta-analyses.
• Population: state security forces.
• Idiomatic criteria: all languages.
• Studies where data collection took place from 1 January 2020 to 5 May 2023 (date on which the WHO decreed the end of the international emergency for COVID-19).
• Articles measuring any of the following values and/or effects: Stress levels and/or main stressors.

Exclusion Criteria

• Type: opinion articles, editorials, and letters to the editor/publisher.
• Studies of low scientific-technical quality after applying the quality assessment tool.
• Population: Non-military and not in off-duty situations.
• Articles that did not answer the research question and were not related to the objective of the review.

Data Collection and Extraction

Two researchers independently conducted searches, eliminated duplicate studies, and selected articles for inclusion after reading the abstract and title, according to the criteria set out above. To do this, descriptive summaries were drafted for each of the studies, including all relevant information from the data extraction sheet: details of the studies, context (date of data collection), study objective, study type, participants, methods, main findings, and quality, which would also help to explore preliminary relationships within and across studies. A thematic analysis approach was used to systematically identify the main, recurring and most important topics across multiple studies.

Subsequently, these same two authors reviewed the full text of the studies potentially eligible for inclusion in the review, and the decision to include or exclude studies in the review was made by consensus. The discrepancies were resolved by a third author.

Methodological Quality Assessment

The Joanna Briggs Institute (JBI) at the University of Adelaide tools were used.²¹ These tools make it possible to assess the methodological quality of a study and to determine the extent to which a study has excluded or minimised the possibility of bias in its design, conduct, and/or analysis. The versions for analytical cross-sectional studies (8 items), for qualitative research (10 items), and for Case-Control Studies (10 items) were used, setting the cut-off point at 6 to be accepted for inclusion in this review for the first, and 8 for the second and the third (Table S1–S3).

Results

The initial search strategy identified a total of 572 references, which were then screened according to the objective of this review. A total of 26 studies were finally selected (Figure 1). All these 26 studies have been compiled in Table 4.

Figure 1 Search flow diagram.

Table 4 Characteristics of the Studies Included in the Review

According to the setting, the 19% (n=5) of the studies were conducted in China^{22,26,27,33,45} and another 19% (n=5) in India;^{23,24,37,44,46} 8% (n=2) of the studies were conducted in Spain^9,34 and another 8% (n=2) in Taiwan;^38,42 the remaining countries in which studies were carried out were Mexico;³¹ Nepal;³⁰ Turkey;³² Norway;²⁸ Wales;²⁹ Greece;³⁵ Singapore;³⁶ Hong Kong;⁴⁷ Nigeria;⁴³ USA;⁴¹ Serbia;³⁹ and a multicentre study in Austria, Germany, Switzerland, the Netherlands, and Spain.²⁵

All but three of the selected studies were quantitative descriptive cross-sectional studies^23,41,43 and one was a case-control study.³⁵ Similarly, in all the studies, the sample consisted of police officers except for the study by Dey et al,²⁴ in which police officers were engaged in specific traffic activities. Also, in the study by Langvik et al,²⁸ there was a part of the sample of police officers who worked entirely/partly from home. In the study by Kukić et al,³⁹ the sample consisted of police officers in training.

Among the most frequently used instruments were the Perceived Stress Scale (PSS) in its various versions and the Depression, Anxiety and Stress Scales (DASS-21), which were applied in multiple contexts to assess the emotional and psychological impact on participants. Other validated scales such as the Maslach Burnout Inventory (MBI), including its human services survey version (MBI-HSS), the Insomnia Severity Index (ISI), the Kessler Psychological Distress Scale (K10 and K6), the Brief Resilience Scale (BRS), among others, were also used.

The prevalence of stress varied widely across the studies, ranging from 22% to 87.2%. Factors that increased stress levels included: lack of basic personal protective equipment,^9,34 having hardly any rest periods between tasks,²³ long working hours,^24,26,32,43 fear of infecting themselves or others,^{24,25,30,32–34,38,39,41–43} the pressure to maintain law and order,^{24,30,32,42,43} sex,^{25,26,30,39,46} marital status,^30,45 level of education,^33,45 work experience,^25,33 age,^{26,30,37,45,46} xenophobia,³⁰ emotion regulation and preparedness,^25,27 poor communication and/or training,^25,32 the presence of underlying chronic diseases,^26,33 recently having been infected or having had close contact with the disease,³³ lack of psychological support,²⁷ reduced interaction with co-workers,²⁸ perceived quality of life,³¹ sleep quality,^33,42,46 self-perceived health,³⁴ levels of engagement,^34,44 coping styles,³⁹ turnover intention,⁴⁰ work-family conflict,⁴⁰ policies,⁴² and physical activity.⁴³

Finally, in some studies, police officers felt that they did not need psychological support.^22,32

Discussion

The goal of this review was to evaluate the stressors that could affect stress levels in state security forces while performing their duties during the COVID-19 pandemic.

Firstly, it was found that the prevalence of stress varied widely in the reviewed studies, ranging from 22% to 87.2%. This could imply that while stress is a prevalent issue, its magnitude can significantly fluctuate based on the study’s context and the unique working conditions involved.⁴⁸

Various structural, organisational, situational, and personal elements have been identified as stressors. Lack of basic personal protective equipment^9,34 is a variable that can cause stress to officers, as same as to other professionals such as healthcare workers,⁴⁹ in many cases for fear of contracting the disease due to the absence of protective equipment.^{24,25,30,32–34,38,39,41–43}

Moreover, police officers’ duties include ensuring the safety and order of the population, and this can lead to exacerbated stress as they try to maintain law and order,²⁴ especially when part of the population may be against the movement restrictions imposed by some governments.⁵⁰ Long working hours^24,26,32,43 and the lack of adequate rest periods between tasks should be considered.²³ Police work is unpredictable, and during the pandemic, the number of working days or shifts may have been increased to cover for colleagues who have become infected.⁵¹ These findings highlight the importance of working conditions and the need to ensure that a safe and appropriate working environment is in place to reduce stress.

In terms of personal factors, there were some discrepancies between the studies. While for Q. Huang et al²⁶ and Grover et al³⁷ being over 45 years of age was a potential factor for stress, for Rajbhandari et al³⁰ the most predisposed group was the 18–27 age group, and for Ravikumar⁴⁴ occupational stress was not affected by age. Other studies in the general population suggest that older age may be associated with higher levels of stress, although further concomitant factors may play a role.⁵² In this sense, other variables such as being male and single were factors that might predispose to stress, yet no statistically significant differences were found.³⁷ Conversely, in the study by Ravikumar,⁴⁴ occupational stress did not vary by marital status or age. On the other hand, in the studies,^25,26,30,39 sex significantly predicted stress, with women being more likely to suffer stress than men, as in other exceptional situations.⁵³ Years of experience also play an important role in coping with new situations, and some studies have shown that fewer years of experience may increase the stress level related to job maintenance during COVID-19,^25,33 as in a sample of Swedish police officers before the pandemic⁵⁴ These factors suggest that stress is not only influenced by working conditions but also by individual and socio-demographic characteristics.

Other factors assessed in the studies relate to changes in working conditions brought about by the COVID-19 pandemic, such as the presence of chronic underlying diseases,^26,33 having less contact with co-workers,²⁸ a lower perceived quality of life,³¹ a decline in sleep quality,^33,42,46 reduced self-perceived health,³⁴ a work-family conflict and vice versa,⁴⁰ which, among others, are equally decisive. Such variety and multiplicity of factors underline the complexity of the stress phenomenon and the need to address it from a multifactorial perspective.¹⁷

Finally, it should be noted that some studies reported individuals believing that they did not need psychological support^22,32 and that for others, it was not even considered.²⁷ In contrast, in the study by Ndubueze,⁴³ psychological support did help. These differing approaches can be a major barrier to implementing effective interventions. It is, therefore, crucial to promote an organisational culture that is accepting and supportive of access to mental health resources and training in coping abilities.

This study is not without limitations. Firstly, the contexts and instruments used to collect the information varied. So, in many cases, knowledge of the setting was necessary to understand the results. In addition, each study was carried out at a different pandemic phase, and the events of counteracting the pandemic were not always comparable across studies. Furthermore, there have been several studies in which it was not possible to collect specific information from police forces. Lastly, the study did not include military personnel because their training and functions differ from those of the police.

Conclusion

This study aimed to evaluate the factors that could affect stress levels in state security forces while performing their duties during the COVID-19 pandemic. Our findings suggest that the demands imposed by COVID-19 on police officers, which go beyond the standard duty of maintaining law and order, had a considerable psychological impact on them.

It was found that the prevalence of stress varied between different studies, ranging from 22% to 87.2%. Therefore, this was prevalent issue which fluctuated between dates and context.

There was a wide variability of factors that may have had an influence on stress levels during the pandemic, including organisational factors (lack of basic personal protective equipment, lack of resting periods, long working hours or poor communication), pandemic situational factors (fear of contagion, pressure to maintain law and order, emotion coping, between others), and personal factors (mainly, sex, marital status, educational level, work experience, age, chronic illnesses, and family-work conflicts).

There is a vital need for police officers to receive psychological support, implementing strategies to reduce the effects of stress and offering customized psychological therapy and coping tools.