Mental and physical health impacts of policing in a remote location: A cross-sectional study from Andaman and Nicobar Islands, India

ABSTRACT

Background:

Policing involves a huge responsibility of protecting the citizens against crimes, and working in stressful conditions which affects health adversely. This cross-sectional study aimed to assess the health profile and stress of policemen in the Andaman and Nicobar Islands (ANI) of India.

Material and Methods:

A total of 2144 policemen working in ANI for at least 6 months were included in this cross-sectional study. The Police Stress Questionnaire (PSQ) was used to assess operational and organizational stress. SPSS version 24 was used for analysis. Chi-square, Fisher’s exact, and ANOVA tests were used to further analyse the data.

Results:

Among the participants, 17.8% had diabetes, 47.3% had hypertension, 61.2% were overweight/obese, 42.7% had hemoglobin levels <12.5 g/dL and 38.9% had a history of one or more substance use. Nearly two-thirds had moderate stress due to operational and organizational reasons, while one-third had high stress. A positive family history, higher rank of officers, and increased age were associated with these morbidities. Lower age, male sex, increased hours of duty, no monthly holidays, and lack of physical activity or meditation were significantly associated with increased stress. A longer duration of service and higher rank were associated with increased operational and organizational stress, respectively.

Conclusion:

Policemen working in ANI have more mental stress and lifestyle diseases than the general population and need focused remedial steps for better health outcomes.

Introduction

The highly stressful work environment of policemen negatively affects their mental and physical well-being over time. Their fitness is tested during recruitment, and they undergo physical training after selection; however, their health is ignored in subsequent years. They succumb to an unhealthy lifestyle due to multiple stressors, including irregular, unpredictable, and prolonged work schedules, unequal sharing of work, peer pressure, home sickness, dealing with dangerous circumstances and criminals, fear of disabling injuries, sudden transfers, and constant pressure to progress in their careers.[1] When unrecognized, these stressors affect their professional and personal lives, with the risk of physical morbidity.[2]

Occupational morbidity is an ever-growing but largely neglected concern among policemen.[3] Only half of the policemen seek treatment in response to health issues.[4] Studies have found a strong correlation between a greater number of service years and a higher risk of developing diabetes, hypertension, and obesity, with the majority having drug or alcohol addiction.[5,6,7]

ANIs, due to their remote location, face challenges in issues such as connectivity, airfares, tele-communication services, and healthy recreational options, and are perceived as tough locations for job postings. These challenges contribute to high occupational stress and unhealthy lifestyle. No prior study has investigated the health of policemen in ANI, and only a few studies have explored stress-related health issues among policemen in Southeast Asia. Therefore, this study, the first of its kind on the islands, was conducted to assess the health status of policemen and to evaluate the need for preventive measures, if any.

Aims and Objectives

1. To determine the sociodemographic and health profile of policemen working in the ANI.

2. To assess the prevalence of stress amongst the policemen working in ANI.

3. To find the association of physical health and stress with socio-demographic factors.

Methods and Methodology

The study commenced after obtaining approval from the Institutional Ethics Committee. This cross-sectional (analytical) study was conducted in Port Blair, ANI, India. All policemen aged 18 years and above working in ANI for 6 months or more were included. Any policeman who was pregnant, on sick/maternity leave, or unwilling to participate was excluded.

Sample size

We included all policemen, a total of 2144, in the South Andaman District of ANI, by universal sampling.

Study instruments

Structured schedules for demographic data and general physical examination findings were used. Self-administered questionnaires were used to measure stress – Organizational Police Stress Questionnaire (PSQ-Org) and Operational Police Stress Questionnaire (PSQ-Op) by McCreary D.R., Thompson, M.M.[8] along with translation in vernacular language.[9]

Outcome variables

Independent variables: Age, gender, religion, education, marital status, duration of service, hours of duty, class or rank, yoga, exercise, prayer.

Dependent variables: Presenting complaints, morbidities, substance use, Body Mass Index (BMI), prevalence of obesity, hemoglobin, stress (operational), stress (organizational).

Data collection

Health camps were conducted from 14.03.2022 to 26.03.2022. Eligible subjects reported an overnight fasting state, provided informed consent, and completed anonymous stress questionnaires with unique IDs. Another questionnaire was used to collect identification details, detailed history, and physical examination findings. Hemoglobin was measured using the copper sulfate method, and blood samples were drawn for other biochemical parameters, including fasting blood sugar. Treatment, referrals, and health education were provided as required.

Statistical analysis

MS Excel was used for data entry, and the analysis was performed using SPSS V.24 software. Qualitative data were expressed as frequencies and percentages, and quantitative data were expressed as means and standard deviations (SD). Chi-square and ANOVA tests were performed for further analysis, and a P value of < 0.05 was considered statistically significant.

Operational definitions

1. Diabetes mellitus: Those already diagnosed with diabetes or with a fasting blood sugar level of 126 mg/dL or more were considered diabetic.[10]

2. Hypertension: JNC 8 guidelines were used to classify blood pressure.[11] Additionally, a systolic BP ≥180 mmHg and/or diastolic BP ≥120 mmHg was considered a hypertensive emergency. Those with a known history and those found to be hypertensive on examination after three readings at a gap of 15 min were considered hypertensive.

3. Hemoglobin: Using the copper sulfate method, values were interpreted as deficient when <12.5 g/dL and adequate when ≥12.5 g/dL.[12]

4. Obesity: BMI was calculated using height (m) and weight (kg) and categorized based on the WHO classification.[13]

5. Stress levels: PSQs were used to measure both operational and organizational stress. We categorized the total PSQ Scores into three categories.[9]

Mean Total Score −1 SD: no to low-stress levels; Mean Total Score +1 SD: high-stress levels; scores between indicated moderate stress levels.

Results

A total of 2290 policemen participated in this study. After screening and cleaning the data, a complete case analysis was performed on 2144 participants. [Figure 1]

Figure 1.

Study Flow Diagram

The Mean age of the study sample was 41.04 (±8.27) years. Nearly 86% of them were males (n = 1842), 65% belonged to Hindu Religion (n = 1401), and 89% were married (n = 1906).

Physical complaints: Nearly 85% of the participants did not have any complaints. Among the remaining 15%, the most common complaints were lower back pain (28%), joint pain (20%), and gastritis (10.67%).

Morbidity: While 20.1% (n = 432) had a family history of conditions such as diabetes, hypertension, hypothyroidism, and cardiovascular disease, 22.9% (n = 491) reported having these conditions themselves, with hypertension being the most common 8.9% (n = 190), followed by diabetes 5.4% (n = 115). However, fasting blood sugar results showed that 17.8% had levels >126 g/dL, and blood pressure measurements revealed that 47.3% were hypertensive, with 8.4% (n = 40) in a state of hypertensive emergency.

Hemoglobin: Nearly 42.7% of the study subjects had a hemoglobin level of <12.5 gm/dL.

BMI: The mean BMI of the study population was 26.14 kg/m² (±3.61) which is overweight. ⁸ About 61.2% were overweight/obese with 47.7% (n = 1023) overweight and 13.5% (n = 289) obese. Of these, six had a BMI >40 kg/m². Approximately 37.5% (n = 804) had a normal BMI, and 1.3% (n = 28) were underweight.

Substance use: Almost 39% had a history of using one or more substances, including tobacco, alcohol, and paan. Of these, 19 have quit a few years ago.

Stress: As mentioned in Tables 1 and 2.

Table 1.

Association with operational stress

		Operational stress			Total	P, (Chi-square)
		No/Mild	Moderate	Severe
Total		413	1368	363	2144
Age (years)	<30	30	112	41	183	<0.001
	30–39	149	583	172	904
	40–49	145	454	115	714
	≥50	89	219	35	343
Gender	Female	69	170	63	302	0.013
	Male	344	1198	300	1842
Religion	Christian	43	171	44	258	0.475
	Hindu	276	891	234	1401
	Muslim	48	171	43	262
	Others	43	130	39	212
	Sikh	3	5	3	11
Education	Graduate and above	146	447	134	727	<0.001
	Higher secondary	155	524	151	830
	Secondary	112	397	78	587
Marital Status	Divorced	1	11	3	15	0.535
	Married	388	1264	328	1980
	Unmarried	24	92	32	148
	Widower	0	1	0	1
Duration Of Service (years)	<5	19	68	11	98	0.015
	5–15	107	395	133	635
	15–25	178	622	149	949
	25–35	89	242	60	391
	>35	20	41	10	71
Hours Of Duty/day	<8	60	92	12	164	<0.001
	8–12	297	973	234	1504
	12–16	52	207	80	339
	>16	4	96	37	137
Class/Rank	Gazetted Officers	3	6	2	11	0.948
	SI/ASI	42	148	37	227
	Lower Subordinates	368	1214	324	1906
Monthly Holidays (days)	None	268	1007	309	1584	<0.001
	1	107	292	39	438
	1–3	37	69	15	121
	>3	1	0	0	1
Yoga	No	194	751	241	1186	<0.001
	Yes	219	617	122	958
Exercise	No	102	347	144	593	<0.001
	Yes	311	1021	219	1551
Prayer	No	39	147	72	258	<0.001
	Yes	374	1221	291	1886

Pearson’s Chi-squared, adjusted according to Bonferroni. Fisher’s exact test

Table 2.

Association with organizational stress

		Organizational stress			Total	P, (Chi-square)
		No/Mild	Moderate	Severe
Total		422	1372	350	2144
Age (years)	<30	34	111	38	183	0.045
	30–39	160	595	149	904
	40–49	149	442	123	714
	≥50	79	224	40	343
Gender	Female	76	177	49	302	0.031
	Male	346	1195	301	1842
Religion	Christian	39	173	46	258	0.475
	Hindu	280	899	222	1401
	Muslim	51	164	47	262
	Others	48	131	33	212
	Sikh	4	5	2	11
Education	Graduate and above	150	441	136	727	<0.001
	Higher secondary	156	538	136	830
	Secondary	116	393	78	587
Marital status	Divorced	1	12	2	15	0.731
	Married	395	1265	320	1980
	Unmarried	26	94	28	148
	Widower	0	1	0	1
Duration of service (years)	<5	24	64	10	98	0.142
	5–15	118	402	115	635
	15–25	174	613	162	949
	25–35	91	244	56	391
	>35	15	49	7	71
Hours of duty/day	<8	49	103	12	164	<0.001
	8–12	308	974	222	1504
	12–16	59	211	69	339
	>16	6	84	47	137
Class/rank	Gazetted Officers	2	5	4	11	0.020
	SI/ASI	42	133	52	227
	Lower Subordinates	378	1234	294	1906
Monthly Holidays (days)	None	286	1022	276	1584	0.016
	1	101	278	59	438
	1–3	35	71	15	121
	>3	0	1	0	1
Yoga	No	213	755	218	1186	0.004
	Yes	209	617	132	958
Exercise	No	98	385	110	593	0.034
	Yes	324	987	240	1551
Prayer	No	39	147	72	258	0.007
	Yes	374	1221	291	1886

Pearson’s Chi-squared, adjusted according to Bonferroni. Fisher’s exact test

Significant associations between dependent and independent variables: The presence of a Morbidity was significantly associated with family history (P < 0.001). A history of substance abuse was significantly associated with marital status, with a higher prevalence in divorced or widowed individuals (P < 0.001). Haemoglobin levels decreased with increasing age (P = 0.007) and higher class or rank of participants (P = 0.015). No significant association was found between the presenting complaints and obesity with other sociodemographic factors.

There was a statistically significant difference between age groups for the total scores on the PSQ-Op, as per the one-way ANOVA (F (3,650) = 9.32, P < 0.001) and PSQ-Org (F (3,656) = 5.26, P < 0.001). A Tukey post hoc test revealed significant differences between each age group for scores on both PSQ-Op (P < 0.05) and PSQ-Org (P < 0.05). The ANOVA trend test showed a linear trend across age categories for both PSQ-Op (P < 0.001) and PSQ-Org (P < 0.001), with reduced stress in the higher age groups. [Tables 3 and 4]

Table 3.

ANOVA – TOTAL SCORE Psq-Op

	Sum of squares	df	Mean square	F	P
Age group	18165	3	6055	9.35	<0.001
Duration of service	10404	4	2601	3.99	0.003
Yoga	13781	1	13781	21.2	<0.001
Exercise	13677	1	13677	21.1	<0.001

Table 4.

ANOVA – TOTAL SCORE Psq-Org

	Sum of squares	df	Mean square	F	P
Age group	10486	3	3495	5.26	0.001
Duration of service	8916	4	2229	3.35	0.010
Yoga	8006	1	8006	12.0	<0.001
Exercise	6200	1	6200	9.30	0.002

Discussion

Policemen often face high physical stress in their jobs, aggravated by wearing heavy protection suits for several hours or strenuous fieldwork.[14] Though the majority of our participants did not have pain-related complaints, 15% had low back pain and joint pain. Participants in the constable rank and lower in our study reported increased pain after prolonged standing with heavy rifles.

The prevalence of diabetes in the participants was similar to that in the general population of ANI (17.9%) and higher than the national prevalence of 15.6%, while hypertension was much higher than that in the local general population (30.2%) and even higher than the national prevalence (24%).[15] A study conducted in Delhi reported the prevalence of diabetes and hypertension to be 14% and 12%, respectively, which is lower than that of the remotely posted participants in our study.[4] As very few patients are aware of their health status, there is a need for regular health screening for timely intervention.

The general population with ANI has a higher prevalence of overweight and obesity than the rest of India (22.9%), which is 45.3%.[15] Our study showed alarmingly higher rates in the policemen of the islands (61.2%). Studies have shown that those involved in higher levels of physical exercise are more fit, have a lower BMI, and experience fewer painful symptoms.[16] So regular physical activity needs to be a part of the service program to improve the overall health of policemen.[17]

The high prevalence of low hemoglobin calls for dietary counseling and policies ensuring balanced, nutritious food in police canteens. As hemoglobin levels were initially estimated using a crude method, those with levels <12.5 gm/dL were referred for further investigation to confirm and determine the cause of low hemoglobin. In our study, the use of one or more substances, such as alcohol and tobacco, was comparable with the national prevalence of substance use (38%), but lower than that of the general population in ANIs (58.7%).[15] This was lower than the findings of other studies in mainland cities, wherein as many as 72% and 80% of policemen were addicted to alcohol and/or cigarettes and other recreational drugs.[5,6] The easy access to subsidized alcohol may explain the high prevalence of ANI in the general population, and given the prevalence among policemen of other mainland cities, a larger proportion of our participants could have been addicted. However, the fear of being marked out or punitive action may have led to underreporting.

Occupational stress arises from demanding field duties and organizational issues, both of which contribute to a higher prevalence of mental health conditions, including anxiety, post-traumatic stress disorder, depression, substance use disorders, and suicidal tendencies, compared to the general public.[18] Our study emphasizes the significant impact of both occupational and organizational stressors on police well-being. These findings support the implementation of policies to monitor stress regularly to prevent physical and mental health issues. While our study found higher stress levels in younger subjects, similar to previous studies,[19,20] there are other studies where age was not found to be a predictor of stress.[21,22]

Periodic interventional programs such as yoga and mindfulness should be implemented to combat stress. Regular counseling sessions should be available to those in need. Organizational changes are needed to limit excessive administrative tasks, night shifts, and prolonged fieldwork to ensure a balanced distribution of duties.

Strengths and limitations

This is the first study of its kind to be conducted in a remotely located ANI and is one of the few that have been conducted on Policemen in the Southeast Asian region. To the best of our knowledge, our study had the largest sample size among the few previously conducted studies. Furthermore, this study covers both the physical and mental aspects of health. The scope and inference of this study are also wider, as it includes police personnel across all classes and ranks. Additionally, our findings did not simply rely on the self-reporting of the participants, but we also ascertained them through clinical assessment and laboratory tests. Therefore, we were able to identify new cases of diabetes and hypertension. The findings of this study were shared and discussed with the authorities in the Department of Andaman and Nicobar Police along with suggestions for possible remedial recommendations to be implemented at the administrative level. We also conducted health education sessions on lifestyle modifications and substance abuse after the completion of our study, which were well-received by the participants.

However, the study may have its limitation of being prone to social desirability bias with respect to a history of substance abuse and other lifestyle habits like yoga, exercise, and prayer. There is scope for further exploratory research on the subject to provide more detailed insights into the findings of this study.

Conclusion

Mental stress and lifestyle diseases such as hypertension, diabetes, and obesity are more common in policemen than in the general population. These health problems are more prevalent among those posted on remote islands, highlighting the need to focus on preventive health measures and administrative interventions.

Conflicts of interest

There are no conflicts of interest.

Funding Statement

Nil.